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Biomedical subjects

M E Peters

Publications and source records attributed to M E Peters.

At least 19 recordsLinked to original sources
PubMed1998

Evaluation of criteria for chronic lung disease in surviving very low birth weight infants. Newborn Lung Project.

Criteria in common use for the diagnosis of chronic lung disease of prematurity or bronchopulmonary dysplasia in the neonatal period have not been sufficiently compared and validated against indicators of later respiratory complications. In this study of all 680 infants < or = 1500 gm birth weight admitted to six perinatal centers August 1, 1988, to July 31, 1990, 524 were alive and had no major congenital anomalies at 5 years old. Of 419 who had given permission to release their names and addresses, 272 were located and participated in a follow-up study. The following diagnostic criteria for bronchopulmonary dysplasia and chronic lung disease of prematurity were used during the initial hospitalization: (1) use of supplemental oxygen on day 30 of life, (2) a comprehensive bronchopulmonary dysplasia severity score applied at 25 to 35 days of life developed by a clinician panel to adjust for practice variation in ventilatory support and blood gases, (3) use of supplemental oxygen on day 30 of life with radiographic evidence consistent with bronchopulmonary dysplasia between days 25 and 35 of life, (4) radiographic evidence consistent with bronchopulmonary dysplasia alone, and (5) use of supplemental oxygen at 36 weeks' postconceptional age. These criteria were assessed against use of bronchodilators or steroids during the first 2 years of life, diagnosis of asthma, and hospitalizations for respiratory causes up to age 5. Although all criteria were significantly associated with all the outcomes, radiographic evidence was most predictive. These results indicate that, during a period when 21% of neonates were exposed to antenatal steroids, 24% received surfactant and 9% received postnatal corticosteroids, radiographic evidence was more predictive of long-term respiratory outcome than other commonly used criteria.

Bronchopulmonary Dysplasia↗
PubMed1996

The relation of maternal complications to outcomes in very low birthweight infants in an era of changing neonatal care.

We examine the relation of key neonatal outcomes to pregnancy complications and to the use of antenatal steroids and investigate whether there is evidence of recent change in this relation. Complete information on pregnancy and neonatal course was available for 749 out of 949 singleton births without major congenital anomalies below 1501 g admitted to seven regional neonatal intensive care units between August 1, 1988 and June 30, 1991. Mortality was highest in infants born after labor with spontaneous rupture of fetal membranes of less than 24 hours duration (odds ratio [OR] = 1.6, 95% confidence interval [1.0, 2.6]). Spontaneous rupture of membranes of over 24 hours duration was associated with decreased risk of respiratory distress syndrome (OR = 0.42, [0.28, 0.64]) and decreased risk of patent ductus arteriosus (OR = 43, [0.28, 0.66]). Pregnancy induced hypertension was associated with increased risk of respiratory distress syndrome in those born at less than 20 weeks' gestation (OR = 6.0, [2.0, 17]). Labor with or without rupture of membranes of short duration was associated with increased risk of intraventricular hemorrhage (OR = 1.9, [1.2, 2.5]). These associations were not different in early versus late time periods of the study. Antenatal steroids were associated with dramatically reduced risk of mortality (OR = 0.20, [0.09, 0.50] ), respiratory distress syndrome (OR = 0.52, [0.32, 0.85]), and intraventricular hemorrhage (OR = 0.37, [0.21-0.65]).

Adrenal Cortex Hormones↗
PubMed1994

A population study. Mortality and morbidity after availability of surfactant therapy. Newborn Lung Project.

OBJECTIVE: To assess the impact of recent changes in neonatal intensive care on the mortality and morbidity of very-low-birth-weight neonates (< 1501 g). DESIGN: Prospective cohort study. SETTING: Six neonatal intensive care units in Wisconsin and Iowa. PARTICIPANTS: All very-low-birth-weight neonates who were admitted to the neonatal intensive care units the year before the availability of exogenous surfactant (n = 333), during the investigational new drug protocol for synthetic surfactant (Exosurf) (n = 347), and after the release of synthetic surfactant (n = 356) (designated as periods 1, 2, and 3, respectively). INTERVENTIONS: None. MAIN RESULTS: The percentage of neonates receiving exogenous surfactant in the three periods was 3%, 37%, and 56%, and the percentage receiving antenatal steroids was 12%, 17%, and 27% (P = .0001 for increase in both modalities). The percentage of neonates dying in the three periods was 23%, 14%, and 19% (P = .05 for downward trend). The percentage of neonates with intraventricular hemorrhage decreased in the subgroup weighing between 700 and 1350 g (35%, 28%, and 24%) (P = .04) and increased in the subgroup weighing below 700 g (8%, 41%, and 45%) (P = .03). The percentage of neonates with bronchopulmonary dysplasia increased from 21% to 36% between periods 1 and 2 (P = .003) and decreased to 27% (P = .04) in period 3. Antenatal steroid use was strongly associated with the decrease in intraventricular hemorrhage (odds ratio, 0.35) and mortality risk (odds ratio, 0.20). CONCLUSIONS: Several developments in care have contributed to changes in mortality risk, incidence of intraventricular hemorrhage, and the severity of respiratory disease in very-low-birth-weight infants.

Hospital Mortality↗
PubMed1994

A new radiographic scoring system for bronchopulmonary dysplasia. Newborn Lung Project.

OBJECTIVES: To develop a simple, clinically meaningful radiographic score for bronchopulmonary dysplasia (BPD). To investigate its reliability, validity, and usefulness and to compare it to the Edwards score. WORKING HYPOTHESIS: Our radiographic scoring of BPD is reliable, correlates with respiratory support, and provides a necessary standardization in comparing severity of respiratory disease between hospitals. STUDY DESIGN: Prospective cohort study. PATIENT SELECTION: The study included all neonates (n = 366) with birth weight below 1501 g admitted to 7 neonatal intensive care units, who had chest radiographs taken at age 25-35 days. METHODOLOGY: A simple radiographic scoring system was developed. Scores ranging from 0 to 6 were assigned based on standard radiographs and descriptors of degree of abnormality. All radiographs taken between days 25 and 35 of age (n = 1087) were graded by a radiologist and a neonatologist. Radiographs from a stratified random sample of 37 neonates (10%) were also scored by the method of Edwards (n = 128 radiographs). A respiratory support index was constructed for days 25-35 and correlated with the radiographic score. RESULTS: Between-reader correlation was r = 0.87 for our score and r = 0.88 for the Edwards score. The two scores correlated with each other at r = 0.94. The respiratory support index correlated with our radiographic score at r = 0.75 overall, and r = 0.56 to 0.88 within hospitals. Higher postnatal corticosteroid use was found at the hospitals with the lower correlations. CONCLUSIONS: Our radiographic scoring is reliable, valid, and gives results similar to the Edwards score. Radiographs play a standardizing role in assessing severity of BPD between hospitals.

Age Factors↗
PubMed1993

Wisconsin cystic fibrosis chest radiograph scoring system.

A new clinical scoring system for patients with cystic fibrosis is needed because of recent advances in diagnosis and treatment which have changed the course of this disease. Chest radiograph scoring is the best objective measure of pulmonary disease for longitudinal studies beginning with infants; however, based on pilot studies, previous scoring systems are not sensitive enough in discriminating between degrees of mild lung disease. Therefore, a new radiographic scoring system was developed with the goal of achieving both sensitivity and reproducibility. This objective was pursued by applying multiattribute utility theory, using a panel of interpreters with expertise in cystic fibrosis radiology, and employing mathematical modeling techniques to weight the various components. The system was developed and validated in three phases including comparison to the Brasfield method of quantitative radiology. The data demonstrate that the new system can be applied reliably and conveniently to generate reproducible scores of pulmonary disease severity. Evaluation of the scores by four independent raters using chest radiographs from 61 patients at an average age of 8.37 years revealed good agreement with a .714 Kendall coefficient of concordance. Assessment of serial changes over time was performed using a group of 176 chest radiographs from 25 patients ranging from 4 weeks to 6 years old; this showed that the Wisconsin system generates score differences that are greater in magnitude with disease progression compared with the Brasfield method. Therefore, the new method is more sensitive to progression of mild disease and should be superior to prior radiographic scoring systems for evaluating therapies designed to modify the early course of disease. The Wisconsin system is designed to be useful in longitudinal clinical studies involving young children with cystic fibrosis and is capable to detecting progression from normality to mild lung disease.

Adolescent↗
PubMed1991

Multivariate assessment of traditional risk factors for chronic lung disease in very low birth weight neonates. The Newborn Lung Project.

All neonates (n = 581) with birth weights less than 1501 gm admitted to seven neonatal intensive care units in Wisconsin and Iowa were candidates for a study aimed at the multivariate assessment of risk factors for chronic lung disease while controlling for baseline severity of respiratory disease. Data from 361 neonates were analyzed for all risk factors except fluids; only neonates weighing less than 1200 gm were included (n = 220). Information on traditional risk factors for chronic lung disease was abstracted. A total of 110 (30%) of the analyzed neonates were oxygen dependent on day 30 of life. The following baseline factors were associated with increased risk of oxygen dependence in a joint multivariate model: lower birth weight (odds ratio 1.4/100 gm), higher baseline severity score (odds ratio 2.7/doubling at 32 weeks gestational age), lower gestational age (odds ratio 2.4/week at severity 0), Apgar score at 1 minute (odds ratio 1.6/2 points), male gender (odds ratio 1.9), and nonblack race (odds ratio 2.2). After adjustment for all baseline factors, patent ductus arteriosus, ventilator pressure at 96 hours, oxygen at 96 hours, and fluid intake were associated with oxygen dependence. Neonates with a low baseline severity score who remained oxygen dependent had a higher intake of fluid relative to output, whereas neonates with a higher baseline severity score had higher fluid intake and output. Lack of weight loss was associated with increased severity but not with oxygen dependence. The results of this study generally confirm the significance of previously reported risk factors for chronic lung disease in a multivariate setting but show that risk factors may not have the same impact in neonates with different baseline severity.

Chronic Disease↗
PubMed1991

The taste of desserts' packages.

This article reports an experiment on expressing the behavioural meaning of designed objects. Can a designer express the taste of a desert in the form of its packaging and can consumers match these forms when tasting the desserts? Analysis of responses of 12 adults indicates positive answers to these questions.

Adult↗
PubMed1990

Development and validation of an index for scoring baseline respiratory disease in the very low birth weight neonate. Severity Index Development and Validation Panels and Newborn Lung Project.

An accurate description of the population at risk for neonatal chronic lung disease is clearly of prime importance for comparative studies and the planning of interventions. Attempts to explain variations in chronic lung disease rates in such studies have been compromised by lack of a way of estimating the severity of the initial pulmonary disease as a risk factor. Therefore, a severity index was developed for use in very low birth weight (less than 1501 g) neonates. Special emphasis was placed on applicability of the index in the multicenter observational setting. Development followed a clinician panel approach, with the resulting index designed to capture clinical judgment of severity. The index was validated prospectively on neonates in a neonatal intensive care unit, and retrospectively using charts from nine hospitals nationwide. Correlations of the index with clinical judgment in the two samples were .95 and .93, respectively. In an additional validation the index combined with birth weight correctly predicted oxygen dependence status at 30 days in 36 of 42 neonates consecutively admitted to five neonatal intensive care units (P = .002). Birth weight and the severity index contributed about equally to the prediction, and therefore they seem to represent partly independent components of baseline propensity for prolonged oxygen dependence.

Apgar Score↗
PubMed1989

Lymphangioendothelioma of the liver in a neonate.

The case report describes the clinical features, imaging findings, and pathology of a lymphangioendothelioma that almost entirely replaced the liver parenchyma in a neonate. No other organs were involved.

Female↗
PubMed1988

Tracheomalacia and bronchomalacia associated with Larsen syndrome.

Bronchomalacia has not previously been described in association with Larsen syndrome. In this article, three children with Larsen syndrome are reported. All three patients have tracheomalacia, and one of them has diffuse bronchomalacia diagnosed at flexible fiberoptic bronchoscopy. The patients' symptoms of airway obstruction include stridor, cyanosis, apnea, and recurrent pneumonias. Recognition of these abnormalities may allow the institution of supportive therapy.

Abnormalities, Multiple↗
PubMed1988

Mammographic evaluation of the postsurgical and irradiated breast.

Mammography is important in women who elect lumpectomy and radiation therapy for breast carcinoma: to record the preoperative state, to assess the completeness of resection, and to detect recurrences and second primaries. Mammography of these patients, however, is difficult since surgery and irradiation may cause changes simulating carcinoma. This article describes the findings in the postsurgical and irradiated breast and the difficulty of differentiating the changes from recurrent carcinoma. It also illustrates the findings in recurrences and second primaries.

Breast↗
PubMed1986

Radiographic determination of bone maturation as an aid in predicting chronologic age in the owl monkey (Aotus trivirgatus).

The skeletal development of laboratory-bred owl monkeys (Aotus trivirgatus) ranging from 37 days to 58 months of age was examined radiographically. Femoral length, time of epiphyseal ossification, and fusion of various ossification centers were studied. Chronologic age can be predicted by femoral length determination up to 18 months. Initial ossification of calcaneal, tibial tuberosity, iliac crest, and ischial apophyses occurs between 5.5 and 14 months. Fusion of various secondary ossification centers allows age determination from 7.5 months to 58 months.

Age Determination by Skeleton↗
PubMed1985

Narrow trachea in mucopolysaccharidoses.

Nine of 56 patients with mucopolysaccharidoses (MPS) showed small tracheal diameters on their frontal chest radiographs. Autopsy of an MPS I-H (Hurler disease) patient demonstrated that the small calibre was secondary to deposition of glycosaminoglycan (mucopolysaccharide). Autopsies of two patients with other storage diseases, one with geleophysic dysplasia and one with mucolipidosis II, also exhibited compromise of their airways because of storage material accumulation.

Adolescent↗
PubMed1985

Radiographic workup. An integral part of the curriculum.

Description of a Senior Radiology Elective, designed to teach medical students the proper sequencing of radiologic studies, is presented. We believe that in using this teaching model students will learn sequencing concepts that result in better patient care while containing costs.

Abdominal Neoplasms↗