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Biomedical subjects

M Hack

Publications and source records attributed to M Hack.

At least 37 records · Page 2Linked to original sources
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↗
PubMed1988

How small is too small? Considerations in evaluating the outcome of the tiny infant.

An aggressive approach to the obstetric and neonatal care of the pregnant mother and her infant in the late second trimester has led to an increase in survival. Surviving infants have a high rate of neonatal morbidity, including bronchopulmonary dysplasia and intraventricular hemorrhage. No long-term follow-up reveals handicap rates of 22 to 35 per cent, with multiple sensory and neurodevelopmental handicaps. With current methods of care, the biologic threshold of extrauterine survival is 23 to 24 weeks' gestation, or a birth weight of 500 to 600 gm. There is no simple arithmetical answer to the question of "how small is too small?" It should be apparent from the information presented in this article that the state of the art is constantly in flux. New developments have, to date, continued to decrease the threshold of viability. Application of the full weight of the available technology results in only a few infants of less than 23 to 24 weeks' gestation or with birth weights of less than 500 to 600 gm surviving. The future continues to lie in the development of the methodology to prolong the sojourn in utero, rather than in dramatic biophysical, biochemical, and technologic advances.

Birth Weight↗
PubMed1987

Experience of families with very low birthweight children with neurologic sequelae.

To describe the quality of life for surviving very low birthweight (VLBW, less than 1.5 kg) children and their families, the authors interviewed the parents of 22 neurologically abnormal VLBW children, 3 to 7 years after their birth and compared them to the parents of 15 neurologically normal VLBW children. The infants were born between 1976 and 1979, (mean birthweight, 1.2 kg; mean gestational age, 30 weeks). They included three with spastic quadriplegia, 14 with spastic diplegia, and five with hydrocephalus. Eight children were not walking. Seven families rated their child's neurologic problem as severe, while 15 rated the problem as mild. Neurologically abnormal children tended to display more screaming and crying than the normal children. Cost of ongoing medical care was a problem for families of nine neurologically abnormal as compared with two families of normal children. The abnormal children required a total of 61 postneonatal rehospitalizations versus 11 in the normal group. Families of neurologically abnormal children reported on significant major changes in their personal lives for the care of their child. Both groups of parents reported heightened appreciation of their child. Plans for future children were affected in both. Parents identified an urgent need for better medical information, education of pediatricians regarding preterm development and neurologic sequelae, and better contact and support among parents themselves.

Child, Preschool↗
PubMed1986

Assessment of vibration induced white finger: reliability and validity of two tests.

The reliability and validity of two tests (cold water and reactive hyperaemia) designed to confirm a patient's history of vibration induced white finger were studied. The cold water test is a measure of digital rewarming after hand immersion in cold water. Reactive hyperaemia consists of measuring digital rewarming after cold water immersion plus temporary ischaemia imposed on the hand. For ten weeks, ten healthy male volunteers were submitted once a week to both tests to study their reliability. The results showed a strong inter and intraindividual scattering. The mean value for the whole group, however, did not differ significantly from one week to the next. Fifty two subjects exposed to hand/arm vibration were submitted to both tests to estimate their validity. They were classified, according to their medical history, into three groups: A = no symptoms, B = tingling or numbess, or both, C = Raynaud's phenomenon. Both tests agreed with the clinical staging. For reactive hyperaemia, however, the differences between the groups were statistically significant only when the test was performed at 10 degrees C. These tests are more useful to study a group than an individual case. Time has no significant effect on the mean result of a group.

Adult↗
PubMed1986

Alternative treatments for withdrawing the long-term benzodiazepine user: a pilot study.

Anxiolytic therapy with benzodiazepines and their potential for dependence are reviewed. Relaxation training and biofeedback have been used for chemically dependent anxious patients. These techniques have been recommended for benzodiazepine-dependent patients, but not investigated. Previous withdrawal studies offer only limited follow-up data. Stress management treatment was based on a successful case study. Recruitment difficulties were encountered. However, seven patients were randomly assigned to stress management or brief psycho-therapy. All showed improvement, but three of four patients available for 1 year follow-up had returned to pretreatment dependence. These withdrawal difficulties suggest the need for more effective treatments and more adequate follow-up studies.

Adult↗
PubMed1986

Very low birth weight infants: effects of brain growth during infancy on intelligence quotient at 3 years of age.

To evaluate the role of postnatal growth on IQ at 3 years of age, 139 appropriate for gestational age, very low birth weight infants (less than 1.5 kg) born in 1977 and 1978 were studied at 40 weeks (term), and at 8, 20, and 33 months (corrected) of age. Weight, height, and head circumference were measured at each age, neurologic status was measured at 20 months, and Stanford Binet IQ at 33 months. Multiple regression analysis revealed that head circumference at 8 months of age is the best growth predictor of IQ at 3 years of age. Path analysis was performed to measure the effects of biologic and social factors measured earlier in life on IQ at 3 years. These factors explained 43% of the variance in IQ at 3 years of age. Head circumference at 8 months had a direct effect on IQ at 3 years, controlling for all other variables in the model. Neonatal risk had an indirect effect via head circumference. Neurologic impairment had direct and indirect (via head circumference) effects; race and socioeconomic status had direct effects on IQ but no effects on growth at 8 months of age. Thus, brain growth at 8 months significantly influenced 3 year IQ at 3 years of age among very low birth weight infants, even when medical and sociodemographic variables were controlled.

Body Height↗
PubMed1985

Development of sucking rhythm in preterm infants.

We studied the ontogeny and temporal organization of non-nutritive sucking during active sleep in 6 healthy preterm infants (mean birthweight 1.1 kg (range 0.8-1.3 kg) gestational age 28.6 weeks (range 26-30 w] from 30 to 35 weeks of post-menstrual (PM) age. Recognizable rhythmical sucking bursts were recorded at 28 weeks in one infant and by 31-33 weeks in the others. Results were analyzed for the periods 30-31, 32-33 and 34-35 PM weeks. The number of bursts/min increased with age, while the duration of each burst was stable (mean 4.1 s). The pause between bursts decreased. Sucking pace within bursts increased with age which resulted in an increase in the overall rate of sucking. The coefficient of variation (CV) for intersuck time within bursts and for interburst time was computed to examine the stability of the sucking rhythm. For intersuck time the CV was relatively low and constant across ages. However, for interburst time CV was relatively large across ages. Thus, there appears to be a stability of the intraburst sucking rhythm from 30 weeks of gestation, whereas the interburst rhythm is less regular. This documentation of temporal organization in sucking from 30 weeks is one of the earliest indications of an intrinsic rhythm in human behavior.

Aging↗
PubMed1985

Preschool performance of children with normal intelligence who were very low-birth-weight infants.

Children who were very low-birth-weight infants (less than 1,500 g), beneficiaries of modern neonatal intensive care, are now of school age. To evaluate their school performance 80 children born in 1976 who had very low-birth-weight (mean birth weight 1.2 kg, mean gestational age 30 weeks) were examined at age 5 years. Sixty-five children were neurologically intact and had normal IQ (greater than or equal to 85) on the Stanford-Binet; five children were neurologically abnormal and ten had IQ below 85. Of the 65 children with normal intelligence and no neurologic impairments, 46 were single births and enrolled in preschool. These 46 children were matched by race, sex, and family background with classmate control children who had been born at full term. Outcome measurements included the Slosson Intelligence Test, the Woodcock-Johnson Psycho-Educational Battery (including subscales of Picture Vocabulary, Spatial Relations, Memory for Sentences, Visual Auditory Learning, Quantitative Concepts, and Blending) and the Beery Developmental Test of Visual-Motor Integration. No significant differences in IQ were found between children who were very low-birth-weight infants and control children; however, children who were very low-birth-weight infants performed significantly less well on the Spatial Relations subtest of the Woodcock-Johnson and on the Visual-Motor Integration test. Similar results were found for nine sets of twins and their control children. Recognition of these perceptual and visual-motor problems may permit appropriate early remedial intervention and prevent the compounding of these difficulties.

Child Development↗
PubMed1984

Catch-up growth in very-low-birth-weight infants. Clinical correlates.

Clinical correlates of catch-up growth were documented in 182 very-low-birth-weight (VLBW) infants (less than 1.5 kg) followed up prospectively until a corrected age of 33 months. At birth, 147 infants had weights appropriate for gestational age (AGA), and 35 were small for gestational age (SGA). The infants in each group were categorized as small if body weight was 2 SDs below the mean for age or appropriate if body weight was within 2 SDs of the mean at birth and at corrected ages of 40 weeks and 8, 21, and 33 months. Of the 147 AGA infants, 67 (46%) weighed less than 2 SDs of the mean for age at a corrected age of 40 weeks, 40 (27%) at 8 months, 28 (19%) at 21 months, and 25 (17%) at 33 months. Of the 35 SGA infants, 32 (91%) had subnormal weight at 40 weeks, 17 (49%) at 8 months and 21 months, and 16 (46%) at 33 months. Significant correlates of poor catch-up growth in the AGA group were birth weight, gestational age, severity of neonatal complications, poor neonatal head growth, and chronic physical and neurologic sequelae. In the infants in the SGA group, the correlates of poor catch-up growth were birth weight, multiple birth, and social class.

Adult↗
PubMed1984

Distribution of enamel defects and the association with respiratory distress in very low birthweight infants.

Although dental defects have long been observed among surviving pre-term infants, only few systematic studies address this problem. In a clinic limited to recall of infants of very low birthweight (less than 1.5 kg), enamel hypoplasia of primary incisors was found in 14/67 (21%) children, and enamel opacities were found in an additional 31% of the children. In contrast, enamel hypoplasia and opacities were found in 4% and 22%, respectively, of a control group of 46 normal birthweight children. The difference was significant (p less than 0.05) for the hypoplasia but not for the opacities. Primary incisor enamel hypoplasia was more commonly noted in maxillary central incisors than in lateral incisors (X2 = 28.0, p less than 0.01). Furthermore, hypoplasia was more common in maxillary incisors than in mandibular incisors (X2 = 48.4, p less than 0.01). In infants with dental defects, there was no significant correlation with pregnancy risk factors, gestational age, birthweight, septicemia, first-week caloric intake, serum bilirubin, or calcium. Infants with enamel hypoplasia were more likely, however, to have severe respiratory distress syndrome (X2 = 7.2, p less than 0.01), than infants with unaltered enamel. Central incisor edge involvement may indicate post-natal processes and/or a systemic disturbance extending back to the middle trimester of pregnancy.

Child, Preschool↗
PubMed1984

Transcutaneous oxygen tension during nonnutritive sucking in preterm infants.

The effects of nonnutritive sucking on transcutaneous oxygen tension, heart rate, and respiratory rate were studied sequentially in 14 sleeping preterm infants breathing room air. Transcutaneous oxygen tension increased during nonnutritive sucking in infants between 32 and 35 weeks postconceptional age, but not in those between 36 and 39 weeks. This response was not associated with a change in respiratory rate or sleep state, although heart rate tended to increase. These data offer further support for the beneficial effects of nonnutritive sucking in preterm infants.

Female↗