PubMed Health⌕ Search

Biomedical subjects

L Sacre

Publications and source records attributed to L Sacre.

At least 19 recordsLinked to original sources
PubMed1993

Diagnosis and management of catheter-related infected intracardiac thrombosis in premature infants.

Infected right atrial thrombosis is an uncommon but severe complication of the use of central indwelling catheters in children. Massive thrombi around a right atrial catheter were seen in two critically ill premature infants after 3 weeks of parenteral nutrition. A catheter-related sepsis had previously occurred and had been treated by antibiotics. Subsequently, protracted thrombocytopenia, fluctuating hepatomegaly, and increasing respiratory distress were found in both cases. A right atrial mass was detected by 2 dimensional echocardiography. Cardiotomies for removal of the infected thrombus were performed with success in both cases. In one infant, weighing only 900 gm, surgical removal was accomplished with the aid of inflow stasis. Premature infants with catheter-related sepsis appear at greater risk for intracardiac thrombosis and should undergo echocardiography as part of their evaluation. Infected atrial thrombi can be safely removed by cardiotomy even in the very small premature infant.

Candidiasis↗
PubMed1992

Esophagitis of likely traumatic origin in newborns.

We describe 17 full-term newborns presenting with vague symptoms related to the upper gastrointestinal tract (anorexia, poor feeding, retching, regurgitation, and incessant crying) during their stay in the maternity unit. After an esophagogastroduodenoscopy performed between days 2 and 5 of life, the babies could clearly be divided into two groups. Twelve babies (group 1) had an extremely severe esophagitis (circular ulcerations), without gastroduodenitis. In the remaining five babies (group 2), the upper gastrointestinal tract was unaffected. Allergic, infectious, metabolic, and toxic etiologies were excluded. Esophageal pH monitoring data were within normal ranges in all. All babies of group 1 were treated as follows: prone anti-Trendelenburg position, cisapride, and cimetidine syrup. Symptoms and lesions disappeared within 48-72 h. Reendoscopy after 72 h showed an almost normal esophagus with greatly improved histology. These observations highlight four points of interest: (a) the existence of an extremely severe ulcerative esophagitis in apparently healthy newborns, (b) the very rapid clinical and histological recovery, (c) the difficulties in predicting esophagitis on clinical grounds, and (d) the mysterious origin despite thorough assessment. The distribution of the lesions (more severe in the upper esophagus), the early onset (almost at birth), the very rapid healing, and the absence of gastric and duodenal lesions are in favor of a possible "traumatic" origin (pharyngeal, esophageal, and gastric suction at birth). Finally, because the condition described is transient, questions arise regarding the necessity of treatment, and we currently do not recommend overtreating newborns presenting with similar symptoms and/or endoscopic findings.

Duodenum↗
PubMed1992

Effect of a whey hydrolysate prophylaxis of atopic disease.

The incidence of atopic manifestations was analyzed in infants "at risk" because of histories of atopy in first degree relatives. The incidence of atopic manifestations was significantly reduced (P = .0011) during the first 6 months of life when only the whey hydrolysate was administered (2/32 infants, 6.3%) compared with the incidence when an adapted formula was given (14/35 infants, 40%). This beneficial effect continued during the 6 to 12-month period, after diversification of the diet at 6 months. At the age of 1 year, 7/32 (21.8%) of the infants in the whey hydrolysate group had presented with manifestations of probable atopic disease compared with 17/35 (48.6%) infants in the adapted formula group (P = .021). The incidence of cow milk protein sensitivity was evaluated at 5/32 (15.6%) in the hydrolysate group and 15/35 (42.8%) in the adapted formula group (P = .014). Other foods such as egg and fish may be responsible for manifestations in three infants in hydrolysate group and in five infants of the adapted group (9.4% and 14.3%, respectively NS). These preliminary data show that the administration of a whey hydrolysate during the first 6 months of life to babies "at risk" decreased the incidence of atopic disease up to the age of 12 months. The incidence of cow milk protein sensitivity appeared to be decreased, whereas the incidence of sensitivities to other food proteins was comparable in both groups.

Food Hypersensitivity↗
PubMed1991

Cisapride decreases prolonged episodes of reflux in infants.

Twenty-nine infants (2-4 months old), with pathological gastroesophageal reflux assessed by 24-h esophageal pH monitoring, were studied. Cisapride or placebo was randomly added to positional treatment, prone-antiTrendelenburg position, which was applied to all infants. The pH monitoring was repeated after 13-16 days of treatment and revealed a significant improvement in both groups for most parameters. But the number of reflux episodes lasting longer than 5 min and the total number of reflux episodes had not decreased significantly in the placebo group. Only in the number of reflux episodes lasting longer than 5 min was improvement during treatment significantly greater in the cisapride group. This suggests cisapride both prevented reflux and improved esophageal clearance. These results suggest that in addition to other therapeutic measurements, such as positional treatment (which was previously demonstrated to be effective in this age group), cisapride might be of benefit in the treatment of gastroesophageal reflux disease.

Cisapride↗
PubMed1991

Gastroesophageal reflux, as measured by 24-hour pH monitoring, in 509 healthy infants screened for risk of sudden infant death syndrome.

Continuous long-term esophageal pH monitoring has become the preferred test to quantify acid gastroesophageal reflux. Because reflux to a limited extent is physiologic, the determination of optimal thresholds to separate normal from abnormal reflux is mandatory. Esophageal pH was measured during 24 hours in 509 healthy thriving infants, aged 3 days to 1 year, using a glass microelectrode with an external reference electrode connected to a portable recorder. Percentiles of the four parameters studied (reflux index or percent of the investigation time with a pH less than 4, number of episodes with a pH less than 4 during 24 hours, number of episodes lasting greater than 5 minutes, the duration of the longest episode (in minutes) are presented. A percentile curve of the reflux index regarding the age distribution shows that the normal range for the reflux index during the first 12 months of life is about 10% (95 percentile), decreasing from 13% at birth to 8% at 12 months. Application of an age-related percentile curve offers a close-to-reality possibility of data interpretation and illustrates that there is inevitably an overlap of data between normal and abnormal populations, because reflux is a phenomenon occurring to some extent in every human being.

Data Interpretation, Statistical↗
PubMed1989

Fatty acid patterns in parenterally fed premature and term infants: changes induced by intralipid and sunflower seed oil.

In order to prevent the development of essential fatty acid deficiency, 19 premature babies and term infants needing parenteral nutrition were studied during 14 days. Intralipid 20% was administered to ten and sunflower seed oil was rubbed six times daily on the skin of nine infants. Fatty acid pattern of plasma lipids were determined at birth and days 7 and 14. Levels of C16:0, C18:1, C18:2, and C20:4 did not change in the Intralipid group. In the sunflower seed oil group a decrease in C18:2 developed, which could be corrected by administering Intralipid (Intralipid was administered to four patients who had previously received sunflower seed oil during 14 days). Although Intralipid administration is often controversial or contraindicated in premature infants (hypoxia, septicemia, acidemia), it appears necessary to prevent plasmatic deficiency in C18:2. The latter cannot be prevented by topical application of sunflower seed oil, not even in very low birthweight infants.

Administration, Cutaneous↗
PubMed1989

Gastroesophageal reflux incidence and respiratory dysfunction during sleep in infants: treatment with cisapride.

We studied the effects of positional treatment and cisapride (a new prokinetic agent) on the incidence and duration of gastroesophageal reflux in 22 infants (4-26 weeks old) in asleep, awake, fasted, and postcibal periods. In addition to gastroesophageal reflux (assessed by 24-h continuous esophageal pH monitoring), all infants presented with a disrupted irregular sleep pattern ("respiratory dysfunction") (assessed by a simultaneously performed cardiopneumogram). Reflux was particularly prominent during the sleep and fasted periods. Investigations (cardiopneumogram and esophageal pH monitoring) in the study population were repeated under treatment conditions (cisapride) after 13-16 days. All pH monitoring data with regard to the total investigation time decreased significantly (p less than 0.001). The treatment-related differences were largest in the asleep and fasted periods, but treatment data were not completely within normal ranges (established in age-matched asymptomatic infants), as they were for the awake periods. Associated symptoms of gastroesophageal reflux (belching, cough, nocturnal wheezing, irritability, and restlessness at night) were evaluated before and during treatment by history. A combination of positional treatment and cisapride seemed effective (objectivated by pH monitoring data and clinical improvement); cisapride did not cause adverse reactions. The disrupted sleep pattern improved significantly or disappeared (p less than 0.001) in all infants. These data suggest that in a number of young infants, gastroesophageal reflux may be associated with a disturbed, irregular sleep of poor quality, which is characterized by a typical breathing pattern (multiple, irregularly repeated, short apneas).

Cisapride↗
PubMed1989

Cervical esophageal perforation diagnosed by endoscopy in a premature infant: review of recent literature.

A case of cervical esophageal perforation in a premature infant by an orogastric polyvinyl chloride (PVC) tube is reported. Perforation appeared as an esophageal atresia, suspected because of the inability to aspirate gastric secretions. Initially, atresia was confirmed by an esophagogram, but endoscopy revealed a "double esophagus" with a normally located and developed esophagus and a blind mediastinal fistula starting at the opposite side of the glottis. The "double esophagus" was confirmed by an esophagogram, followed by a contrast study in the pharynx. Esophageal perforation in the neonate is an iatrogenic disease that may mimic esophageal atresia. We recommend endoscopy instead of contrast studies for suspected esophageal atresia.

Diagnosis, Differential↗
PubMed1989

PH monitoring in children.

Long-term oesophageal pH monitoring has become the preferred technique for detection and quantification of gastro-oesophageal reflux (GOR). The most obvious advantages of pH monitoring are the duration of the investigation, the possibility of being able to relate "events" (emesis, heartburn, apnoea) to pH changes (and to study "occult GOR"), the physiological conditions in which the data are recorded (sleep, work), and the possibility of repeating the investigation in treatment conditions. However, it has been reported that the accuracy of pH monitoring is no higher than 90%, because the intermittent presence of acid in the oesophagus is only one of the various abnormalities in the syndrome of GOR. A tremendous number of technique- (pH monitoring system, type of electrode, location of the electrode) and patient-related factors influence pH data. Age, position (both for adults and for infants), duration of the investigation (day/night), feeding and drugs are patient-related factors. Finally, the question arises (which is still unanswered) whether the indication for pH monitoring should be considered in the interpretation of the data: are the same criteria valid for GOR in children presenting with emesis and oesophagitis as for children with GOR resulting in chronic respiratory disease or "near-miss sudden infant death syndrome".

Child↗
PubMed1988

Preliminary data on a field study with a new hypo-allergic formula.

The incidence of atopic manifestations due to cow's milk proteins was analysed in five groups of 15 newborns considered to be at risk for atopy because of a positive family history. All infants were studied over a 4-month period. The infants received either an adapted formula (AdFo), breast milk or a new hypo-allergic formula (HAF). Atopic manifestations appeared in 1 out of 15 breast-fed infants compared with 18 out of 45 infants fed with an AdFo. None of the infants receiving the HAF (exclusively from birth for 2-4 months) developed symptoms of atopy. Symptoms in each infant receiving an AdFo (n = 18) disappeared with the HAF. Although the results of this study are promising, data on a larger population and double-blind investigations are needed before firm conclusions can be drawn.

Animals↗
PubMed1988

Effects of formula feeding on gastric acidity time and oesophageal pH monitoring data.

Gastro-oesophageal reflux (GOR) occurs mainly during postcibal (PC) periods. The duration of PC gastric acidity and the incidence of GOR were analysed in 11 asymptomatic premature infants. GOR was studied during PC periods of 120 min and also during the following 120 min defined as fasting (FT) periods. These infants were subjected to simultaneous continuous gastric and oesophageal pH monitoring using a double-blind crossover technique. Two formulae with different fat contents (2.6 vs 3.6 g/100 ml) and different carbohydrate concentrations (8.1 vs 7.3 g/100 ml; malto-dextrin 2.8 vs 1.9 g/100 ml) were given. Gastric acidity (pH less than 4) in the PC periods lasted significantly (P less than 0.001) longer (68 min +/- 10) with the low fat/high malto-dextrin formula versus 43 min +/- 11 with the high fat/low malto-dextrin formula. Oesophageal pH monitoring data were within normal limits for the total investigation time in all infants. During PC periods acid GOR was detected more frequently in the group with a low fat formula. More PC GOR was recorded when the gastric acidity time was longer.

Dietary Carbohydrates↗
PubMed1987

The use of cimetidine in newborns.

Cimetidine, a specific H2 antagonist and a potent inhibitor of gastric secretion, was administered in newborns who failed to tolerate oral feeding and presented with abnormal gastric residues accompanied by microscopic or macroscopic high gastrointestinal bleeding. This group of 18 infants was compared to a control group of 15 in similar clinical conditions. After 4 days of treatment with cimetidine (24 mg/kg/day), adapted oral alimentation generally was well tolerated with normal gastric residues. No side effects of the therapy were observed.

Bottle Feeding↗
PubMed1986

Influences of neonatal serum IgE concentration, family history and diet on the incidence of cow's milk allergy.

Serum IgE concentration was measured on the 5th day of life in 943 infants. All infants were included in a 3 month follow-up study. The frequency of cow's milk allergy was studied according to either family history, IgE level, or both. Feeding (mother's milk or formula feeding) was taken into account. Manifestations suggestive of food allergy were hardly observed in breast-fed babies. In the formula-fed group a positive family history correlated with a 40% incidence of allergic manifestations, compared to a 13% incidence (P less than 0.001) in the group with negative family history. A high IgE level (IgE greater than 1.3 U/ml) indicated a 43% risk of developing allergic manifestations in formula-fed babies as compared to 15% (P less than 0.001) in the group with normal results of a screening test. Frequency of allergic manifestations in a subgroup with a negative family history and a high IgE level (38%) was equal to the frequency in the subgroup with a positive family history and negative screening test results (IgE less than 1.3 U/ml)(36%). The incidence in the subgroup with both positive screening test results and a positive family history was 49%. None of these differences were significant. The frequency in the subgroup with both parameters negative was 8% (P less than 0.001 to 3 other subgroups). Our results indicate that the family history seems to correlate as well with the incidence of allergic manifestations as the neonatal serum IgE concentration.(ABSTRACT TRUNCATED AT 250 WORDS)

Animals↗
PubMed1986

Neonatal diagnosis of the immotile cilia syndrome.

The immotile cilia syndrome is an inherited disorder characterized by inappropriate motility of the cilia. The clinical symptoms include recurrent sinopulmonary infections and reduced fertility. In about half of the cases, situs inversus is encountered. The case presented is of a two-day-old boy in whom diagnosis was based on ultrastructural abnormalities. Early diagnosis permitted immediate symptomatic treatment and an absence of infections during a 37-month period of observation. Nasal biopsies performed in six newborns with various degrees of respiratory distress secondary to classic neonatal respiratory problems and in a healthy one-day-old newborn demonstrated the presence of normal ciliary structures at birth. In cases without situs inversus, diagnosis of the immotile cilia syndrome may be difficult. The importance of early diagnosis and management is stressed; the ultrastructural abnormalities are present at birth in newborns with the immotile cilia syndrome.

Biopsy↗
PubMed1986

Influence of xanthines on gastroesophageal reflux in infants at risk for sudden infant death syndrome.

Theophylline and caffeine are two drugs frequently administered to infants at risk for sudden infant death syndrome, because of their stimulatory effects on the respiratory system. These drugs are known to increase gastric acid secretion and to decrease lower esophageal sphincter pressure that, in turn, possibly increases gastroesophageal reflux (GER). Thirty babies were tested for GER before and during caffeine treatment. Eighteen were studied under the same conditions while undergoing theophylline treatment. All results of pH monitoring before treatment were within normal ranges. Episodes of GER increased significantly (P less than .001) in about 50% of the group treated with caffeine and in 66% of the group treated with theophylline. These results were independent of plasma xanthine concentrations (within or below therapeutic ranges) and of the efficacy of the drug. In addition, an increase was noted for the number of episodes of GER in 24 hours (from 5.3 to 17.1 in the caffeine group and from 5.3 to 24.3 in the theophylline group) and for the time pH was less than 4 (from 0.87% to 6% in the caffeine group and up to 13% in the theophylline group). Because GER is another known risk factor for sudden infant death syndrome, the administration of xanthine derivatives in babies at risk for sudden infant death syndrome should be carefully considered in each case.

Administration, Oral↗
PubMed1985

Neonatal hepatitis with obstructive jaundice in an SZ heterozygous alpha 1-antitrypsin-deficient boy and destructive lung disease in his SZ mother. A review of the literature.

SZ-Alpha 1-antitrypsin deficiency, leading to severe transient neonatal cholestasis with mild hepatitis is rare. In our patient, intrahepatic bile duct hypoplasia was suspected. Since cholecystography and hepatic scintigraphy failed to reveal intrahepatic bile ducts, a diagnostic surgical liver biopsy was performed. Typical intrahepatocytic PAS-positive granules and a low serum alpha 1-antitrypsin concentration allowed a correct diagnosis of the SZ phenotype. The administration of an elementary diet quickly improved the clinical condition of our patient. Follow-up studies of this case and others will allow a better establishment of prognostic criteria and help in genetic counselling.

Adult↗