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Biomedical subjects

M Hack

Publications and source records attributed to M Hack.

At least 19 recordsLinked to original sources
PubMed1992

Inguinal hernias in very low birth weight infants: incidence and timing of repair.

Although the increased occurrence of inguinal hernias (IH) in premature children is well known, its incidence in the very low birth weight (VLBW, < 1,500 g) subpopulation has not been previously established. Additionally, because of associated problems, these children present the surgeon with a dilemma in regards to the most appropriate time for repair. We sought to determine the incidence of IH, rate of incarceration, perioperative problems, and to possibly define the ideal time for correction. Between 1977 and 1987, 1,933 children under 1,500 g birth weight were admitted to our neonatal intensive care unit. Of these, 1,391 lived for at least 28 days and were followed until 20 months corrected age. IH was diagnosed in 222 of 1,391 (16%) of those who survived 28 days or more. IH occurred in 174 of 670 (26%) of the boys and 48 of 721 (7%) of the girls. The incidence by side was right 19.8%, left 14.9%, bilateral 61.7%, and was unclear 3.6%. Of the 222 infants with IH, 192 were operated at our institution at a mean postnatal age of 28 weeks (range, 5 to 110 weeks). Of these, 35 were operated prior to neonatal discharge. One or more incarcerations occurred in 35 VLBW operated at this hospital. In only one infant, an emergency operation was needed because of irreducibility. There was no operative mortality and minimal morbidity. Five recurrences occurred during the 20 months' follow-up. This series establishes the incidence of IH in VLBW (during the first 20 months). The wide range in age at operation suggests that no single criterion can be established for ideal timing of repair.(ABSTRACT TRUNCATED AT 250 WORDS)

Emergencies↗
PubMed1992

Neonatal auditory brainstem response failure of very low birth weight infants: 8-year outcome.

Fifty-six very low birth weight infants (less than 1.5 kg) were followed until 8 y of age to see if predischarge auditory brainstem response (ABR) results were predictive of neurobehavioral development. The results suggest that early ABR may predict subsequent performance on measures of intelligence quotient, language, and reading. Unilateral ABR abnormalities did not appear predictive, but bilateral abnormalities did. Analysis of a variety of neonatal risk factors in conjunction with early ABR and hearing loss with respect to educational outcome was also undertaken.

Age Factors↗
PubMed1992

The high-risk infant environment. Part 2. The role of caregiving and the social environment.

Neonatal intensive care units are essential for the successful care of very immature and sick infants. The technology of NICUs has contributed significantly to the reduction of neonatal mortality and improvement of neonatal outcome. While the outcome for high-risk neonates has vastly improved over the past three decades, a number of infants sustain injuries and complications that result in long-term disabilities. It is now clear that some of the long-term problems of high-risk infants are a result of the environment and care practices and are not attributable to the original disease or condition that necessitated intensive care. There is accumulating evidence that environmental factors and care practices can interact with disease processes in ways that can increase morbidity, and possibly mortality. In addition to developmental and behavioral problems, there is growing evidence of effects on visual function and perhaps other sensory systems. Many of the environmental and care factors may cause delay in recovery and increase NICU time or unnecessary discomfort, yet not produce long-term disabilities or problems, as currently assessed. Many of the potential behavioral and developmental problems, as well as many of the potential problems with visual, auditory, and other modes of sensory discrimination, are not included in the usual follow-up assessments. The absence of data or the limitations of existing studies are not a cause for comfort or the assumption that the environment and care practices are safe or not harmful.(ABSTRACT TRUNCATED AT 250 WORDS)

Environment↗
PubMed1992

The effect of very low birth weight and social risk on neurocognitive abilities at school age.

We tested the hypothesis that very low birth weight (VLBW < 1.5 kg) children would have significantly poorer neurocognitive abilities at school age than would normal birth weight full-term age mates, that differences would persist after control for neurologic impairment and social risk, and that VLBW would interact with social risk. Two hundred forty-nine VLBW children and a randomly selected sample of 363 normal birth weight age mates born 1977 through 1979 were tested at 8 years. A neurologic examination and tests of intelligence, language, speech, reading, mathematics, spelling, visual and fine motor abilities, and behavior were performed. Twenty-four (10%) VLBW had a major neurologic abnormality compared with none of the controls. VLBW had significantly poorer scores on all tests, with the exception of speech and the total behavior score. These differences persisted among VLBW children without major neurologic abnormality, with the exception of social competence, reading, and spelling. Even normal IQ, neurologically normal VLBW had significantly poorer scores than did controls in expressive language, memory, visuomotor, and fine motor function, and measures of hyperactivity. When social risk was controlled in multiple regression analyses, VLBW still had an adverse effect on all outcome measures with the exception of speech. Social risk was, however, the major determinant of outcome. We found an interaction between VLBW and social risk only in verbal IQ and in the opposite direction than hypothesized.

Brain Damage, Chronic↗
PubMed1991

Effect of very low birth weight and subnormal head size on cognitive abilities at school age.

BACKGROUND: We tested the hypothesis that very-low-birth-weight (less than 1.5 kg) infants with perinatal growth failure whose head size is not normal by eight months of age (corrected for prematurity) have significantly poorer growth and neurocognitive abilities at school age than very-low-birth-weight children with a normal head size at eight months. We also hypothesized that these differences would persist even after control for major neurologic impairment and perinatal and sociodemographic risk factors. METHODS: We have followed a cohort of very-low-birth-weight children since their birth during the period 1977 to 1979. At eight to nine years of age 249 children were evaluated with a neurologic examination and tests of intelligence; receptive and expressive language skills; speech, reading, mathematics, and spelling aptitude; visual and fine motor abilities; and behavior. Ages were corrected for premature birth. RESULTS: Among these 249 very-low-birth-weight children, head size was subnormal (less than the mean -2 SD for age) at birth in 30 (12 percent), at term in 57 (23 percent), and at eight months in 33 (13 percent). As compared with the 216 children with normal head sizes, the 33 children with subnormal head sizes at the age of eight months had significantly lower mean birth weights (1.1 vs. 1.2 kg) and higher neonatal risk scores (71 vs. 53) and at the age of eight years had a higher incidence of neurologic impairment (21 percent vs. 8 percent) and lower IQ scores (mean verbal, 84 vs. 98). Even among the children without neurologic abnormalities, a subnormal head size at eight months of age was predictive of poorer verbal and performance IQ scores at eight years of age; lower scores for receptive language, speech, reading, mathematics, and spelling; and a higher incidence of hyperactivity. In multiple regression analyses to control for socioeconomic and neonatal risk factors, intrauterine growth failure, birth weight, and neurologic impairment, a subnormal head size at eight months of age had an independently adverse effect on IQ and on scores for receptive language, speech, reading, and spelling. CONCLUSIONS: In very-low-birth-weight infants, perinatal growth failure, as evidenced by a subnormal head circumference at eight months of age, is associated with poor cognitive function, academic achievement, and behavior at eight years of age.

Cephalometry↗
PubMed1991

Very-low-birthweight children and speech and language development.

Very low birthweight (VLBW) is often considered to be a risk factor for speech and language disorders, yet data are equivocal. The present study compared speech and language comprehension and production between 249 very-low-birthweight (VLBW: less than 1.5 kg) and 363 normal-birthweight 8-year-olds, randomly sampled in a geographic area. Mean performance for the entire group of VLBW children and for the group when 24 VLBW children with major neurologic abnormalities were excluded, was significantly lower than for controls on the majority of speech and language measures. Further analyses addressed the clinical significance of these statistically significant differences. Test scores were converted to standard scores and grouped according to standard deviation intervals, thus portraying each child's performance in terms of the magnitude of discrepancy from each test's mean. When the 24 children with major neurological abnormalities were excluded, no significant differences between the VLBW and control children were observed. Using discrepancy between WISC-R performance IQ and language to define specific language impairment (SLI), a higher percentage of control than VLBW children were identified as having SLI. Neonatal risk factors did not differentiate between VLBW children with or without SLI. A higher proportion of VLBW than control children did present subnormal language associated with IQ less than 85, hearing deficits, and/or major neurological impairments. Thus, SLI is not more common among VLBW than control children. Language deficits accompanied by more general developmental problems, however, are more frequent.

Chi-Square Distribution↗
PubMed1991

Very low birth weight outcomes of the National Institute of Child Health and Human Development Neonatal Network.

This report describes the neonatal outcomes of 1765 very low birth weight (less than 1500 g) infants delivered from November 1987 through October 1988 at the seven participating centers of the National Institute of Child Health and Human Development Neonatal Intensive Care Network. Survival was 34% at less than 751 g birth weight (range between centers 20% to 55%), 66% at 751 through 1000 g (range 42% to 75%), 87% at 1001 through 1250 g (range 84% to 91%), and 93% at 1251 through 1500 g (range 89% to 98%). By obstetric measures of gestation, survival was 23% at 23 weeks (range 0% to 33%), 34% at 24 weeks (range 10% to 57%), and 54% at 25 weeks (range 30% to 72%). Neonatal morbidity included respiratory distress (67%), symptomatic patent ductus arteriosus (25%), necrotizing enterocolitis (6%), septicemia (17%), meningitis (2%), urinary tract infection (4%), and intraventricular hemorrhage (45%, 18% grade III and IV). Morbidity increased with decreasing birth weight. Oxygen was administered for greater than or equal to 28 days to 79% of less than 751-g birth weight infants (range between centers 67% to 100%), 45% of 751- through 1000-g infants (range 20% to 68%), and 13% of 1001- through 1500-g infants (range 5% to 23%). Ventilator support for greater than or equal to 28 days was given to 68% of infants at less than 751 g, 29% at 751 through 1000 g, and 4% at greater than 1000 g. Hospital stay was 59 days for survivors vs 15 days for infants who died. Sixty-nine percent of survivors had subnormal (less than 10th percentile) weight at discharge. The data demonstrate important intercenter variation of current neonatal outcomes, as well as differences in philosophy of care and definition and prevalence of morbidity.

Gestational Age↗
PubMed1990

Leiomyosarcoma arising in a lipoleiomyoma.

A leiomyosarcoma arising in a uterine lipoleiomyoma is described in a 70-year-old woman. The tumor measured 11 cm and was located in the corpus uteri. It was composed of a mixture of firm, pale tan, whorled tissue and soft, white or hemorrhagic areas. Histologically, the firm tissue was a mixture of bland smooth muscle, fat and fibrous tissue, whereas the soft areas showed a malignant spindle cell tumor with smooth muscle differentiation. Pure sarcoma similar to the malignant portion of the lipoleiomyoma had metastasized to the vaginal wall.

Aged↗
PubMed1990

Increased risk of cerebral palsy among very low-birthweight infants with chronic lung disease.

To determine the risk of cerebral palsy and other forms of neurosensory impairment in very low-birthweight infants (less than 1500g) with severe lung disease, as compared with those with lesser degrees of lung disease, and to examine perinatal and demographic correlates of chronic lung disease, the authors prospectively followed 249 survivors born between 1983 and 1984. 52 (21 per cent) developed chronic lung disease (CLD), defined as oxygen dependence greater than or equal to 28 days. 15 per cent of children with CLD developed cerebral palsy, compared with 3 per cent who required oxygen for between three and 27 days and 4 per cent of those requiring oxygen for two days or less. The overall neurological impairment rate, including cerebral palsy, abnormalities of muscle tone, hydrocephalus requiring a shunt, and severe visual or hearing impairment, was 29 per cent for infants with CLD. This compares with rates of 9 per cent for those requiring oxygen for between three and 27 days and 6 per cent for those on oxygen for two or less days. Infants with CLD had a significantly lower mean birthweight and gestational age; 43 per cent had grade III or IV intraventricular hemorrhages; and they also required longer periods in hospital.

Brain Diseases↗
PubMed1989

Outcomes of extremely-low-birth-weight infants between 1982 and 1988.

Infants with birth weights under 750 g are disproportionately represented in perinatal mortality and morbidity rates. We reviewed the outcomes of 98 infants delivered at our perinatal center between July 1982 and June 1985 (period 1) whose lengths of gestation were 20 or more weeks and whose birth weights were under 750 g, and compared them with the outcomes of 129 such infants born between July 1985 and June 1988 (period 2). The frequency of cesarean section increased from 12 to 19 percent between the two periods. During the entire six-year period, 12 percent of the infants with birth weights under 500 g were intubated, as compared with 28 percent of those between 500 and 599 g, 60 percent of those between 600 and 699 g, and 90 percent of those between 700 and 749 g. The frequency of endotracheal intubation increased between the two periods only for infants with birth weights above 500 g (P less than 0.02). Despite more aggressive treatment, survival did not change, although the mean time to death among infants transferred to the neonatal intensive care unit increased from 73 to 880 hours. Among all live-born infants with birth weights under 750 g, the rate of survival was 20 percent during period 1 and 18 percent during period 2, but 48 and 43 percent of those transferred to the neonatal intensive care unit survived in the two periods reviewed. Neonatal morbidity also did not change. Among survivors at a corrected age of 20 months, 4 of 18 born during period 1 and 7 of 14 born during period 2 had moderate-to-severe neurodevelopmental impairment. When all live-born infants of less than 28 weeks' gestation were considered, only 8 percent of those born at 23 weeks survived, as compared with 16 percent of those born at 24 weeks, and 53, 63, and 72 percent of those born at 25, 26, 27 weeks, respectively. Thus, despite a tendency to perform more cesarean sections and active resuscitations, no improvement in the survival of babies with lengths of gestation below 25 weeks or birth weights under 750 g was observed. The probability of survival is very poor if the length of gestation is less than 24 weeks or the birth weight less than 600 g.

Birth Weight↗
PubMed1989

Differential effects of intrauterine and postnatal brain growth failure in infants of very low birth weight.

We investigated the contribution of brain growth failure to outcome in infants of very low birth weight (VLBW; less than 1.5 kg) who were appropriate for gestational age (AGA; n = 379) or small for gestational age (SGA; n = 102). Growth was assessed at birth, term, and 8 and 20 months' corrected age and results of a Bayley Mental Developmental Index (MDI) and neurologic examination were evaluated at 20 months of age. Both groups had similar 20-month MDI scores (93 vs 90) and similar rates of neurologic impairment (14% vs 10%). More SGA infants (25%) than AGA infants (14%) had a subnormal head circumference at 8 months' corrected age, indicating failure to catch up in head growth. Subnormal head size at 8 months predicted the 20-month MDI score for both groups. However, multivariate analysis indicated that, whereas subnormal 8-month head size was directly associated with the MDI score in AGA children, in SGA children 8-month head size was not significantly related to the MDI score when neonatal illness, neurologic impairment, socioeconomic status, and race were controlled for. We conclude that in AGA VLBW infants, subnormal head size at 8 months results from major neonatal illness and has adverse later effects. In SGA infants, subnormal head size at 8 months has many causes, including growth retardation in utero, which may not have an adverse effect on outcome; if subnormal head size is superimposed with neonatal illness, a poorer outcome is likely.

Brain↗
PubMed1989

Severity of necrotizing enterocolitis: influence on outcome at 2 years of age.

The long-term outcome of very low birth weight (VLBW) infants with necrotizing enterocolitis has been reported to be similar to that of other VLBW infants. To examine the influence of disease severity on outcome, the growth and neurodevelopment of survivors of necrotizing enterocolitis were evaluated when the babies were 20 months' corrected age. Between 1975 and 1983, 1506 VLBW infants were admitted to the hospital, and necrotizing enterocolitis developed in 84 (5.6%). Forty infants (48%) survived to be 20 months' corrected age, and complete follow-up data were available for 36. Survivors were classified by modified Bell's criteria into four groups by increasing severity of disease; 13 had mild necrotizing enterocolitis (stage IIA, IIB), and 23 had severe necrotizing enterocolitis (stage IIIA, IIIB). The 36 survivors were compared with 766 surviving VLBW infants without necrotizing enterocolitis. There were no perinatal or socioeconomic differences between groups. Compared with infants with stage II necrotizing enterocolitis at 20 months, infants with stage III necrotizing enterocolitis had a higher rate of subnormal body weight (39% vs 15%) and subnormal head circumference (30% vs 0%). Thirty-three percent of necrotizing enterocolitis survivors had significant neurodevelopmental impairment; the majority of impaired infants (10 of 12) were survivors of stage III necrotizing enterocolitis. These findings highlight the importance of continued evaluations for medical and neurodevelopmental sequelae.

Child Development↗
PubMed1989

Children who were very low birth weight: development and academic achievement at nine years of age.

Children born at very low birth weights (VLBW) (less than or equal to 1500 g) who were beneficiaries of modern neonatal intensive care are reaching middle childhood, and their school achievement can be evaluated. We compared 65 9-year-old children born in 1976, who were very low birth weight and who were free of neurological impairment, with 65 children of normal birth weight who had been matched for race, sex, age, and social class on measures of IQ, cognitive, visuo-motor, and fine motor abilities, and academic achievement. VLBW children scored significantly lower than controls on the WISC-R, Bender-Gestalt, Purdue Pegboard, subtests from the Woodcock Johnson Cognitive Abilities Battery, and reading and mathematics (math) achievement. Exploratory analysis of a subset of 43 VLBW and matched controls with IQ scores greater than or equal to 85 yielded a similar trend, except that, on achievement tests, differences were significant only in math. Further analyses revealed that the differential in math achievement between VLBW and control children is not fully attributable to differences in IQ.

Achievement↗