PubMed Health⌕ Search

Biomedical subjects

M Levene

Publications and source records attributed to M Levene.

12 recordsLinked to original sources
PubMed1992

Enterobacteriaceae and neonatal necrotising enterocolitis.

A comparative study of bowel colonisation and incidence of necrotising enterocolitis in neonates admitted to an intensive care unit is reported. Neonates of less than 33 weeks gestational age requiring mechanical ventilation for respiratory distress syndrome were randomised during the first week of life to receive either vancomycin and aztreonam or vancomycin and gentamicin for episodes of suspected sepsis after the first week of life. A higher proportion of neonates who received vancomycin and gentamicin had faecal colonisation with enterobacteriaceae at the end of the second, third, and fourth weeks of life. Treatment with vancomycin and aztreonam was associated with a rapid quantitative reduction in faecal colonisation with enterobacteriaceae, whereas there was no quantitative reduction in colonisation with enterobacteriaceae associated with treatment with vancomycin and gentamicin. There were no differences between the two groups in faecal colonisation with anaerobes, Enterococcus sp, Staphylococcus sp, or yeasts. Six (14.6%) of 41 who received vancomycin and gentamicin compared with 0 of 40 who received vancomycin and aztreonam subsequently developed necrotising enterocolitis.

Aztreonam↗
PubMed1992

Impaired motor function (clumsiness) in 5 year old children: correlation with neonatal ultrasound scans.

All 155 surviving children from a cohort of 200 very low birthweight infants originally studied in 1984-5 were traced. These infants had careful sequential ultrasound examinations in the neonatal period. The children were examined again at entry into school at 5 years of age. The test of motor impairment (TOMI) and the vocabulary subscale of the Wechsler preschool and primary scale of intelligence (WPPSI) were administered to 152 of the index cohort and 144 control children of the same age in the same class at school. Twelve of the cohort had cerebral palsy, but eight of these were in mainstream schools. The index group scored significantly higher on both the TOMI and the WPPSI subscale compared with the controls. The index cases were subdivided on the basis of their neonatal ultrasound scans into four groups: group 1, consistently normal; group 2, 'prolonged flare'; group 3, germinal matrix haemorrhage-intraventricular haemorrhage (GMH-IVH), without parenchymal haemorrhage, but no evidence of prolonged flare; and group 4, both GMH-IVH and prolonged flare. The group of index children with consistently normal ultrasound scans had a higher TOMI and lower WPPSI compared with their controls. There was a statistically significant increase in the TOMI subscore 1 (manual dexterity) in group 4 infants compared with group 1, but not differences between the other groups. Regression analysis suggests that neither prolonged flare nor GMH-IVH has an important individual contribution to the variation, but the low birth weight does have a significant relationship with motor impairment. It appears that relatively minor ultrasound appearances such as prolonged flare and GMH-IVH are associated with motor impairment (clumsiness) at 5 years, but this has a small effect compared with low birth weight.

Cerebral Palsy↗
PubMed1992

Role of excitatory amino acid antagonists in the management of birth asphyxia.

Birth asphyxia is an important cause of permanent neuro-developmental disability. Asphyxia sets in course a progression of intracellular events which culminates in neuronal death, and this process may take up to 48 h to complete. Entry of calcium into the neurone appears to be the key to the cell death, and it is known that during asphyxia, excessive glutamate is released which stimulates the voltage-dependent N-methyl-D-aspartate (NMDA) receptor to open with an accumulation of excess intracellular calcium. MK-801 is a very effective NMDA receptor antagonist, and it has been shown that this drug prevents or significantly reduces the extent of cortical neurone infarction following experimental asphyxia in 7-day-old rat pups. Unfortunately, MK-801 is toxic to the pup, but newer NMDA receptor antagonists may offer the opportunity for neuroprotection in the human infant who has suffered severe birth asphyxia.

Amino Acids↗
PubMed1990

Cerebral blood flow velocity recordings and the prediction of intracranial haemorrhage and ischaemia.

Doppler ultrasound was used to study prospectively cerebral and cardiovascular hemodynamics in a cohort of 120 preterm infants to see whether it was possible to predict infants at increased risk of developing cerebral pathology. The infants were divided into four outcome groups: Group I (n = 65, median gestation = 30 weeks) did not develop periventricular haemorrhage (PVH) nor periventricular leukomalacia (PVL) Group II (n = 43, median gestation = 28 weeks) developed PVH as the first or only cerebral lesion Group III (n = 7, median gestation = 29 weeks) developed PVL as the first or only cerebral lesion Group IV (n = 5, median gestation = 28 weeks) developed PVH and PVL simultaneously. Cerebral blood flow velocity (CBFV) and aorta blood flow velocity (ABFV) recordings made before the onset of PVH or PVL were compared between the four groups on each postnatal day but it was not possible to demonstrate a statistically significant difference between these variables in the four outcome groups. We conclude, therefore, that it is not possible to identify the infants who will go on to develop haemorrhage or ischaemic lesions on the basis of Doppler cerebral haemodynamic studies.

Aorta↗
PubMed1987

A double blind comparison of a new paediatric amino acid solution in neonatal total parenteral nutrition.

All infants requiring parenteral nutrition over a continuous 13-month period were allocated to receive either Vamin or a new paediatric amino acid solution, Paedmin, as their protein source in a double blind prospective study. Those of 32 weeks gestation and less gained weight more rapidly when fed Paedmin than Vamin (P less than 0.004), but there were significant changes in liver function after 14 days nutrition. Babies of 33 weeks gestation and greater gained weight more rapidly when fed Vamin than Paedmin (P less than 0.003) but without liver function changes. There were no differences in the rate of head growth. Amino acid analysis of serum and urine showed a greater urinary loss of amino acids for a given serum concentration in babies of 32 weeks and less for both nutrition groups. The apparent benefit of Paedmin in the immature group of infants must be further evaluated and weighed against changes in liver function.

Amino Acids↗
PubMed1986

Intralipid microemboli.

A baby girl died after receiving intravenous Intralipid. At necropsy a pulmonary Intralipid microembolus, unrelated to the cause of death, was found. Serum taken immediately before infusion agglutinated Intralipid. C reactive protein concentration was raised. This supports the theory that C reactive protein may agglutinate Intralipid in vivo, causing embolisation.

C-Reactive Protein↗
PubMed1976

The use of dextrostix and dextrostix reflectance meters in the diagnosis of neonatal hypoglycemia.

Dextrostix is now widely used as a method of screening for hypoglycemia of the newborn. There has always been some anxiety about its accuracy for estimating very low blood sugars; this is important, since symptomatic hypoglycemia of the newborn does not usually occur until the blood glucose falls below 20 mg/dl. In 1970 a reflectance meter was introduced which would measure the colour of the strip electronically. The aim of this study was to assess the accuracy of the meter and its reliability in estimating hypoglycemia. The study was continued to investigate a new model of the reflectance meter which superseded the original one. In the pilot study using the original model, blood samples were taken from 46 babies. Readings of the Dextrostix were made by two independent observers and compared with a reading taken on the reflectance meter. These estimations were later compared with blood glucose measured by the glucose oxidase method. the meter showed a marked tendency to overestimate the blood glucose: 44 out of 46 samples were overestimated (Fig. 1, 2). In the second series 180 cord blood samples were collected. Because the intention was to study very low levels of blood glucose, the samples were allowed to stand at room temperature for several hours to allow glycolysis to occur. Again, readings were taken by two independent observers and compared with the readings taken on the new Dextrostix-Eyetone meter. The blood glucose was measured on each of the samples. There was a strong correlation (r = 0.8877, p less than 0.00005) between the blood glucose values and the readings taken from the meter, with no tendency towards overestimation (Fig. 3). A similar correlation (r = 0.8533, p less than 0.00005) was seen for the observers' readings and the chemical method, although there was a tendency to underestimate blood glucose (Fig. 4). When the meter gave an estimate of more than 20 ml/dl, in no case was the actual blood glucose in the profoundly hypoglycemic group of less than 10 mg/dl. When estimated by eye there was one case in which the blood glucose was only 7 mg/dl but the observer had estimated the result of 30 mg/dl. In order to avoid any possibility that a blood glucose was less than 20 mg/dl, it is necessary to take action on any estimate below 40 mg/dl on a Dextrostix. Despite this, Dextrostix remains a very useful method of screening for neonatal hypoglycemia, whether assessed by eye or with the new Dextrostix-Eyetone meter. the meter does give better results than estimating Dextrostix by eye, but the difference was never statistically significant.

Color↗