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Biomedical subjects

M D Mullett

Publications and source records attributed to M D Mullett.

At least 19 recordsLinked to original sources
PubMed1997

The plantar response in normal newborn infants.

The neonatal plantar response has been reported as extensor in 90% of newborns and flexor in 93% of newborns, leading to uncertainty about its reliability and significance. To determine the normal neonatal plantar response we examined 349 healthy newborn infants, > 32 weeks gestation within 24 hours of birth. A supramaximal noxious stimulus was applied in a standardized manner to the lateral plantar surface of each foot. The plantar response was extensor in 90%, equivocal in 7%, and flexor in 3%. With proper physiologic technique, the normal neonatal plantar response is extensor.

Foot↗
PubMed1995

Longitudinal head growth in developmentally normal preterm infants.

OBJECTIVE: To determine growth in head circumference from birth to 18 months of age in normal infants with low birth weight. METHODS: Healthy, appropriate-for-gestational-age, singleton, white infants weighing less than or equal to 2500 g at birth and with normal development at 18 months of age were included in this study. Serial measurements of head circumference (corrected for gestational age) from 450 eligible infants were compared with reference data for head circumference. RESULTS: Longitudinal measurements of head circumference for infants weighing more than 1000 g at birth were similar to reference data for term infants. Head measurements for infants weighing less than or equal to 1000 g at birth were notably smaller than the measurements in the reference data. A cubic spline curve drawn through the head circumference measurements between birth and age 18 months (corrected for gestational age) for infants weighing less than or equal to 1000 g at birth was significantly (P < .001) below the curve for infants weighing more than 1000 g at birth. At age 18 months, the mean difference in head circumference between the group weighing less than or equal to 1000 g at birth and the weights in the reference data was 1.6 cm (P < .01). (Data were analyzed with Wilcoxon's signed rank test.) CONCLUSIONS: These data show that head circumference grids are appropriate for observing head growth in infants with a birth weight more than 1000 g. However, head circumference growth for normal infants with birth weight less than or equal to 1000 g does not "catch up" with that of larger premature infants or term infants.

Birth Weight↗
PubMed1990

Contribution of low-molecular-weight compounds to the fecal excretion of carbohydrate energy in premature infants.

It was hypothesized that low-molecular-weight products of carbohydrate fermentation would contribute only a small percentage to the total fecal excretion of nonfat, nonnitrogenous energy (carbohydrate energy) in premature infants. Infants born at 28-32 weeks' gestation who were 2-4 weeks of age were randomized to receive a formula with lactose as the sole carbohydrate (n = 7) or the same formula with 50% of the carbohydrate as glucose polymer (n = 8). The percent contribution (X +/- SD) to total carbohydrate energy of sugars (glucose, galactose, lactose, glucose polymer), short-chain fatty acids (acetate, propionate, butyrate, isobutyrate, valerate, and isovalerate), and D- and L-lactate was 9.4% +/- 2.9% for the 15 subjects and was not significantly different between groups. The percent contribution of all four sugars was 5.8% +/- 1.7% and did not differ between the two groups. Doubling the lactose intake resulted in significant increases in fecal excretion (kilocalories per kilogram per day) of acetate (77% increase; P = 0.03), total short-chain fatty acids (54%; P = 0.04), and galactose (188%; P = 0.03). These data suggest that as much as 90% of fecal carbohydrate energy may be in the form of large-molecular-weight compounds, presumably bacterial in origin.

Dietary Carbohydrates↗
PubMed1989

Daily sequential changes in plasma atrial natriuretic factor concentrations in mechanically ventilated low-birth-weight infants. Effect of surfactant replacement.

Plasma atrial natriuretic factor (ANF) concentrations are elevated in mechanically ventilated infants. To test the hypothesis that changes in pulmonary compliance affect ANF concentration, we measured plasma ANF concentrations sequentially in low-birth-weight, ventilated infants who either received surfactant replacement or placebo on day 1. ANF concentrations were elevated as compared to adult controls on day 1 and increased significantly on days 2 and 3 before declining. Day 5 concentrations were not different from day 1. Several infants had ANF concentrations greater than 1,280 pg/ml on days 2-4. There were no significant differences in ANF concentrations between surfactant-treated and non-treated infants on any day. ANF concentrations increased in parallel with changes in salt and water balance, but no significant relationships were apparent between absolute ANF concentrations and parameters of salt and water balance. The results suggest that ANF secretion is elevated in infants with pulmonary disease. While the temporal relationship between the initial rise in ANF concentration and increase in salt and water excretion suggest that ANF is involved in this diuresis, the role it may play is unclear from the present data.

Atrial Natriuretic Factor↗
PubMed1988

Physical characteristics of infant endotracheal tubes.

A change in the incidence of post-intubation complications in infants was the stimulus for the evaluation of the deformability of two brands of endotracheal tubes. The stiffness of each tube was evaluated at room and body conditions in the longitudinal axis of the tubes as well as a cross sectional plan. Shiley brand endotracheal tubes sizes 2.5 to 4.0 were less deformable than Portex brand of the same sizes.

Humans↗
PubMed1987

Dietary carbohydrate assimilation in the premature infant: evidence for a nutritionally significant bacterial ecosystem in the colon.

Carbohydrate energy absorption and breath hydrogen concentration were measured in 12 premature infants 28-32 wk gestational age and 2-4 wk postnatal age. Each of two groups of six infants were randomly assigned to receive one of two formulas that differed only in carbohydrate source: 100% lactose (LAC) or 50% lactose: 50% glucose polymer (LAC + GP). In 11 infants the peak breath hydrogen concentration suggested extensive colonic fermentation (range 44-239 ppm/5% CO2 or 44-239 microL/L per 50 mL/L CO2). An approximate 100% increase in lactose intake in the LAC group was associated with a similar increase in breath hydrogen concentration at 30, 60, and 120 min. None of the infants exhibited diarrhea or vomiting or developed delayed gastric emptying. Carbohydrate energy absorption (mean +/- SD) was, respectively, 86 +/- 5% and 91 +/- 3% in the LAC and the LAC + GP groups (p greater than 0.05). Thus, colonic bacterial fermentation may be critical to energy balance and to the prevention of osmotic diarrhea in premature infants fed lactose.

Bacteria↗
PubMed1986

Gastroesophageal reflux and the premature infant.

Gastroesophageal reflux (GER) is a well-recognized problem in infants and children. Only scant mention of the premature infant with GER can be found in the literature. Of 760 preterm infants admitted to the NICU between 1980 and 1984, 22 had documented GER. These infants all underwent medical management including upright positioning, small frequent feeds, and often, nasojejunal feedings. Seventeen babies did not respond to medical management and underwent surgical therapy to control the reflux. Of the 17 babies requiring fundoplication, 15 had been initially intubated for treatment of respiratory distress syndrome. Eight of these 15 were extubated in less than 25 days and were improving until they exhibited sudden episodes of deteriorating pulmonary status requiring reintubation. The other seven intubated patients developed striking bronchopulmonary dysplasia (BPD) in the first month and required prolonged ventilatory support. Pulmonary deterioration, failure to grow, and refusal to eat became the herald of GER in these infants. Fundoplication dramatically improved the pulmonary status in all but one infant. Three late deaths can be attributed to cor pulmonale and pulmonary failure. BPD was striking predisposing factor for severe GER in these premature infants. In the total premature population without BDP only 8 of 684 (1.2%) had GER with five responding to medical management and three others undergoing fundoplication for apnea-bradycardia spells. Fourteen of the 76 infants with BPD (18.4%) had significant GER and all required surgical management for control of symptoms. Premature infants who develop deteriorating pulmonary function, poor growth, and/or refusal to eat should be evaluated for GER.

Bronchopulmonary Dysplasia↗
PubMed1986

Parental recall of infant medical complications and its relationship to delivery method and education level.

Since relatively little is known as to why parents find it difficult to recognize when their high-risk infant ceases to be ill, this investigation examined parental reports of infant complications and the relationship these reports had with parental education level and method of delivery. Using a questionnaire format, 60 parents reported complications their infants experienced during NICU (neonatal intensive care unit) hospitalization. Maternal and paternal reports were comparable, although both significantly differed from actual diagnoses; parents underreported their infant's complications. Reported complications were not related to parental education level but were associated with method of delivery. Parents of Caesarean-section (C-section) infants identified a significantly smaller percentage of complications than did parents of vaginally delivered babies. It is suggested that (1) medical caregivers have the potential for helping parents more fully comprehend infant complications, (2) supplemental communication methods may be necessary for the task in (1), and (3) information communicated to parents may need to incorporate the current findings about parental education level and delivery method.

Attitude↗
PubMed1985

Patterns of pediatric gastroesophageal reflux.

Gastroesophageal reflux (GER) in the pediatric patient is a frequently recognized problem. Unlike the adult, in whom symptoms relating to esophagitis predominate, the infant and child may present with a variety of respiratory problems, vomiting and/or growth failure. GER is often seen in association with other conditions and must be considered in the evaluation of any pediatric patient with chronic recurring respiratory problems, vomiting or failure to thrive (FTT). Thirty-eight pediatric patients have been surgically managed at West Virginia University from 1977-1983 for GER. The patients fall into several different patterns of presentation and associated problems. Nine premature infants all with bronchopulmonary dysplasia (BPD) have undergone fundoplication for FTT, worsening BPD, and pneumonia. Seven infants and two older children had GER associated with previous esophageal atresia repairs. Esophagitis, vomiting and growth failure were the predominant complaints in this group, though all nine patients had recurring respiratory symptoms as well. Syndromes involving mental retardation and neurologic dysfunction affected another group of five patients, all of whom presented with the complications of long-term esophagitis. The remaining 15 children were otherwise healthy infants who had predominantly respiratory symptoms due to GER. The benefits of fundoplication in these severely affected infants and children far outweigh the relatively few complications. In the carefully selected patient, surgical management of GER is dramatically successful.

Adolescent↗
PubMed1982

Patent ductus arteriosus in premature infants: a review of current management.

Problems related to the ductus arteriosus confront the pediatrician more than any other isolated cardiac defect. Due to increased awareness of the problems of prematurity, the reported frequency of patent ductus arteriosus increased threefold between 1970 and 1975. Aggressive therapy directed toward closure of the ductus is indicated within the first week of life in the very immature infant. Pharmacologic closure of the PDA with indomethacin is effective about half the time.

Ductus Arteriosus, Patent↗
PubMed1982

Indomethacin for closure of patent ductus arteriosus in prematures.

A controlled, double blind trial of indomethacin versus placebo was conducted in prematures of birth weight less than 1750 g, with a murmur of patent ductus arteriosus (PDA). The dose of indomethacin was 0.2 mg/kg for 2 doses, orally, 24 hours apart. Forty-seven patients entered the trial. Twenty-four received indomethacin and 12 of these met the criteria for response; 23 received the placebo and two met the criteria for response (p less than 0.01). Subsequent surgical ligation for symptomatic PDA was required in 13 of 23 in the placebo group and 4 of 24 in the indomethacin group (p less than 0.01). When administered early, indomethacin is moderately effective in closing PDA in premature infants.

Clinical Trials as Topic↗