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K J Kimble

Publications and source records attributed to K J Kimble.

7 recordsLinked to original sources
PubMed1983

Predicting survival among ventilator-dependent very low birth weight infants.

Ventilator-bound very low birth weight (VLBW) infants represent an increasing proportion of our nursery population. We reviewed the hospital course of 38 VLBW infants who required more than 1 month of intermittent mandatory ventilation (IMV) between 1976 and 1978. Twenty-eight infants survived; 10 died. There were no significant differences between survivors and nonsurvivors in estimated gestational age (EGA), Apgar scores, first pH, first mean arterial pressure (MAP), h of IMV required, or birth weight; nor did the incidence of patent ductus arteriosus (PDA), respiratory distress syndrome (RDS), or transport differ. Pneumothorax was significantly more common among those infants who died. When ventilator settings were reviewed, significant differences were found consistently between the 2 groups of 3, 5, and 7 days of age, but not at 1, 14, 21, or 28 days of age. A predictive model for estimating the probability of survival of such infants was developed based upon these data, employing birth weight, mean airway pressure (MAWP) at 7 days of age, and occurrence of pneumothorax, and was applied prospectively to a group of 29 such infants born in 1979 and 1980. Prediction of outcome was significantly more accurate than chance alone. We conclude that prolonged ventilator dependence is largely confined to VLBW infants; that it is the rule among infants less than 750 g; and that accurate, objective assessment of an individual infant's prognosis may lead to improved care.

Birth Weight↗
PubMed1982

Favorable results of neonatal intensive care for very low-birth-weight infants.

From 1961 to 1976, 229 infants with birth weights ranging from 751 to 1,000 gm were admitted to the Stanford University Hospital Intensive Care Nursery. The overall neonatal mortality for these infants was 63% (144/229), and there were ten late deaths. Before 1967, no infant in this group who required mechanical ventilation survived; thereafter, 30% (34/114) of the ventilated patients survived. Of the 75 long-term survivors 60 participated in a high-risk infant follow-up program; these included 23 infants who had received mechanical ventilation. The mean birth weight of these infants was 928 +/- 67 (SD) gm. Seventeen children (28%) had significant morbidity: seven (12%) with severe handicaps and ten (17%) with moderate handicaps. During this same period, seven infants weighing less than 750 gm at birth were also observed. The three infants who had not required ventilatory support thrived; the other four infants had required respirators and were significantly handicapped. More recently, neonatal mortality for infants with birth weights from 751 to 1,000 gm has improved: for 1977 to 1980, it was 28% (33/118). Furthermore, neonatal mortality for ventilated infants in this weight group was 27% (26/95). These data indicate an improved prognosis for very low-birth-weight infants, even with ventilatory support.

California↗
PubMedDate not supplied

Transcutaneous PO2 monitoring in infants with cyanotic congenital heart disease treated with prostaglandin E1.

Transcutaneous PO2 (tcPO2) has been shown to closely approximate arterial PO2 (PaO2) in infants with normal oxygenation (PaO2 60-100 mm Hg). During hypoxemia (PaO2 less than 60 mm Hg), or administration of vasoactive drugs, such as tolazoline, correlation is frequently so poor that tcPO2 monitoring is of little value. We examined the relationship of tcPO2 to PaO2 among 6 infants with cyanotic congenital heart disease who were receiving prostaglandin E1 (PGE1). Close, linear correlation was found, even during hypoxemia. We conclude that tcPO2 monitoring has potential clinical value in such patients.

Arteries↗