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Biomedical subjects

P Kero

Publications and source records attributed to P Kero.

At least 19 recordsLinked to original sources
PubMed1995

Cerebral circulation assessed by transcephalic electrical impedance during the first day of life--a potential predictor of outcome?

Pulsatile changes in intracranial blood volume (transcephalic electrical impedance, delta Z), arterial blood pressure (aBP) and respiration were studied during the first day after birth in 42 neonates with a birth weight of 1040-3850 g and gestational age of 26-36 weeks. The neurological outcome was assessed at 1 year of age to study the predictive ability of delta Z. delta Z, ECG, respirogram and direct aBP were recorded at 8-h intervals. Outcome was adverse in seven infants of whom two died from severe peri-intraventricular haemorrhage. PCO2 was higher (6.2 kPa) in the infants with adverse outcome than in those infants with favourable outcome (5.0 kPa) (P = 0.004). Blood glucose (4.5 vs. 3.3 mmol/l, P = 0.030) and first day administration of fluid (80 vs. 63 ml/kg/day, P = 0.003) behaved, respectively. Of the infants receiving dopamine therapy, 60% had adverse outcome while only 11% of those not receiving dopamine had adverse outcome (P = 0.016). Of the infants with high diastolic blood pressure levels, 32% had adverse outcome, while none with low diastolic blood pressure levels had adverse outcome (P = 0.031). Spectral analysis was used to examine signal variabilities in the frequency domain. During the first 24 h of life, the variabilities of aBP and respiration were equal in all the infants. The high-frequency delta Z signal variability (1.50-4.00 Hz, heart rate level) was found to be lower in the infants with adverse outcome (330 units) than in the infants with favourable outcome (1280 units, P = 0.017). The low delta Z variability allowed us to assume that there is a decrease of pulsatile cerebral blood flow (CBF) in the infants with adverse outcome. We speculate that this may result from the 'no reflow phenomenon', increased tissue pressure due to ischaemia and/or PIVH, the 'brain sparing effect' or constriction of main cerebral arteries due to increased pressure support or metabolic factors (PCO2, glucose). We believe that transcephalic impedance provides a potential cot-side method for monitoring cerebral circulation in the neonatal period with an ability to predict outcome.

Blood Glucose↗
PubMed1995

Hemodynamic control of atrial natriuretic peptide plasma levels in neonatal respiratory distress syndrome.

To evaluate the contribution of the pulmonary and ductal hemodynamics on the cardiac atrial natriuretic peptide (ANP) synthesis and release in neonatal respiratory distress syndrome, serial blood samples for plasma C-terminal end, and the more stable N-terminal end (NT-proANP) of the propeptide were obtained. Simultaneous evaluation of the systolic pulmonary artery pressure (PAP) and magnitude of ductal shunting by the Doppler method were made of 37 distressed infants during the first 4 days of life. Both plasma ANP and NT-proANP rose after birth, peaked at 48 hours of age, and correlated significantly (r = 0.66; p < 0.001; n = 78) with each other. The initially high systolic PAP and, since the systemic arterial pressure (SAP) did not change, the PAP/SAP ratio declined slowly during the study period, as did the magnitude of ductal left-to-right shunting after an initial increase during the first hours after birth. Plasma NT-proANP had a positive correlation to the magnitude of ductal left-to-right shunting both during the first 2 and 4 days of life, but did not correlate with PAP, SAP, or PAP/SAP ratio during the same time periods. Eight infants with delayed closure of the ductus maintained elevated plasma NT-proANP values after the second day of life.(ABSTRACT TRUNCATED AT 250 WORDS)

Atrial Natriuretic Factor↗
PubMed1992

Synthetic surfactant replacement therapy decreases estimated pulmonary artery pressure in respiratory distress syndrome.

OBJECTIVE: To evaluate the effects of surfactant replacement therapy on the pulmonary artery pressure in infants with respiratory distress syndrome. DESIGN: Nonrandomized, "before-after" trial. SETTING: Neonatal intensive care unit at a referral center. PARTICIPANTS: Ten preterm infants with respiratory distress syndrome. INTERVENTIONS: Administration of two or four doses of an exogenous synthetic surfactant at 12-hour intervals. MEASUREMENTS AND RESULTS: Systolic pulmonary artery pressure was estimated by measuring tricuspid regurgitant flow velocity with the Doppler method before and, on average, 45 minutes after administration of synthetic surfactant. Measurable recordings were technically obtainable on 18 of 23 occasions. Surfactant instillation decreased pulmonary artery pressure significantly on 17 of 18 occasions, but did not change the systemic blood pressure. Twelve hours after surfactant treatment, pulmonary artery pressure measured on nine occasions returned to the pretreatment level. No change in the velocity or magnitude of the ductal left-to-right shunting due to exogenous surfactant was found. CONCLUSIONS: Synthetic surfactant replacement therapy in infants with respiratory distress syndrome induces a significant, but transient decrease in systolic pulmonary artery pressure with no effect on the ductal shunt.

Blood Pressure↗
PubMed1992

A new low-frequency platelet alloantigen, Vaa, on glycoprotein IIbIIIa associated with neonatal alloimmune thrombocytopenia.

We describe platelet alloimmunization which caused severe thrombocytopenia in a neonate and could only be detected by testing the father's platelets. The platelet-specific antibodies were identified by a monoclonal antibody-immobilized platelet protein assay (MAIPA) using monoclonal antibodies against glycoprotein (GP) IIbIIIa complex (AP2 and 2G12). The previously described alloantigen systems on the GPIIbIIIa complex (HPA 1, HPA 3 or HPA 4) were not responsible for the reaction. In addition the newly described private platelet antigen Sra was not identical to the antigen. The antigen is therefore different from all known platelet alloantigens and was designated Vaa. The antigen was present on the platelets of the affected child. Family studies showed that the platelet antigen was transmitted as an autosomal dominant trait in three generations. No Va (a+) individuals were found in a population study of 250 blood donors, which indicates that the antigen is of low frequency in the Finnish population. The Va antigen was not detectable by immunoblot analysis, which suggests that the epitope may not be a linear peptide structure. The antigen was also destroyed by solubilization of platelets. Thrombin activation of platelets, known to increase the expression of GPIIbIIIa on platelets, did not increase the number of binding sites for anti-Vaa antibodies to the extent observed with anti-HPA 1a binding.

Adult↗
PubMed1992

Atrial natriuretic peptide in the preterm infant. Lack of correlation with natriuresis and diuresis.

We assessed the relation of atrial natriuretic peptide (ANP) to renal function on postnatal day 2 and day 5 in preterm infants. Plasma ANP concentration was measured by radioimmunoassay in two groups of preterm infants: group 1, gestational age less than 30 weeks, n = 10; and group 2, gestational age 30-34 weeks, n = 11. The identity of the immunoreactivity as ANP-28 was confirmed by HPLC. Plasma ANP was significantly higher in group 1 than in group 2 on day 2 and day 5 (p < 0.01) and ANP concentration decreased by day 5 in both groups (group 1, p < 0.01; group 2, p < 0.02). The results showed no correlation between plasma ANP concentration and urinary sodium excretion or creatinine clearance, which may be due to a blunted renal response to ANP, but other factors may be involved also. We conclude that preterm infants are able to release large amounts of ANP, but a high plasma ANP concentration does not correlate directly with renal regulation of sodium and water balance.

Atrial Natriuretic Factor↗
PubMed1992

Tracheostomy in pediatric patients.

From 1978 to 1987, tracheostomy was performed on 33 children, 13 boys and 20 girls, with a male to female ratio of 0.65:1. The mean age at the time of tracheostomy was 726 days, 76% of the children being under the age of two years. The incidence of pediatric tracheostomy per hospital admissions was 0.05%. Subglottic stenosis (13 children) and respiratory distress syndrome with prolonged endotracheal ventilation (11 children) were the most common indications for tracheostomy. The mean duration of prolonged endotracheal intubation before tracheostomy was 64 days, and that of tracheostomy treatment 117 days. During the tracheostomy period, five children died, but only one death was related to tracheostomy. The total rate of complications was 30%. We emphasize the importance of strict indications for pediatric tracheostomy.

Adolescent↗
PubMed1992

Mode of delivery, plasma catecholamines and Doppler-derived cardiac output in healthy term newborn infants.

Umbilical cord arterial and venous concentrations of epinephrine, norepinephrine and the catecholamine metabolites 3,4-dihydroxyphenylglycol and 3,4-dihydroxyphenylacetic acid were determined in 41 healthy newborn infants delivered vaginally, vaginally with epidural analgesia, by cesarean section under general anesthesia or by cesarean section under epidural anesthesia. Doppler-derived cardiac output and arterial blood pressure were repeatedly measured during the first 48 h of life. There were fairly small differences in umbilical arterial and venous plasma concentrations of epinephrine and norepinephrine between the groups, with the highest levels of norepinephrine in infants delivered vaginally without analgesia (about 10 times as high as in the cesarean, general anesthetized group). No significant differences were found in the metabolite concentrations. Doppler-derived cardiac output and heart rate decreased in all groups during the study period and, in spite of increased catecholamine levels in the vaginally delivered infants, the differences between the groups were marginal. Healthy term infants with no signs of asphyxia were well prepared for a normal hemodynamic adaptation irrespective of mode of delivery or mode of obstetric anesthesia/analgesia.

Analgesia, Epidural↗
PubMed1992

Sympathoadrenal activity in preterm infants during the first five days of life.

We measured plasma concentrations of epinephrine (E), norepinephrine (NE), 3,4-dihydroxyphenylacetic acid (DOPAC), and 3,4-dihydroxyphenylglycol (DHPG) as well as urinary concentrations of metanephrine (M), normetanephrine (NM) and 3-methoxy-4-hydroxymandelic acid (MOMA) on day 2 and day 5 in preterm infants; gestational age less than 30 weeks (G less than 30; n = 16) and gestational age 30-34 weeks (G 30-34; n = 19). Concentrations of E (0.00-2.28 nmol/l) and NE (0.6-9.1 nmol/l) in plasma were much lower than those previously reported during preterm and term delivery. The E:NE ratio decreased from 1:10 on day 2 to 1:30 on day 5, and the M:NM ratio decreased from 1:4 on day 2 to 1:8 on day 5, indicating relatively higher catecholamine secretion from the adrenals than from the sympathetic nerve terminals in preterm infants during postnatal adaptation. Plasma concentrations of DOPAC and DHPG were significantly higher in G less than 30 than in G 30-34 (DOPAC, p = 0.0494; DHPG, p = 0.0092), probably relating to a low urinary excretion rate of catecholamine metabolites in infants in G less than 30. Plasma and urinary concentrations of catecholamines and their metabolites varied considerably, and no significant correlations to postnatal events could be demonstrated.

3,4-Dihydroxyphenylacetic Acid↗
PubMed1992

Renal function in preterm infants during the first five days of life: influence of maturation and early colloid treatment.

We measured the influence of maturation and early freshly frozen plasma infusion (FFP) on renal function (day 2 and day 5) in preterm infants in intensive care; they were divided into two groups, those with gestational ages less than 30 weeks (G less than 30) and those with gestational ages of 30-34 weeks (G 30-34). A total of 35 infants was studied. The infants were randomly assigned to one of two treatment groups, one receiving FFP, the other not, yielding four study groups; G less than 30 and no FFP (8 infants), G less than 30 and FFP (8 infants), G 30-34 and no FFP (9 infants) and G 30-34 and FFP (10 infants). The infants in the two FFP groups received FFP 10 ml/kg on days 1-3. FFP did not significantly influence creatinine clearance (CCr) or the urinary sodium excretion rate either in G less than 30 or G 30-34. CCr was significantly lower (p less than 0.001) and fractional urinary sodium excretion significantly higher (p less than 0.002) in infants of G less than 30 than in infants of G 30-34. Infants of G less than 30 had significantly higher plasma potassium concentrations (p less than 0.01) than infants of G 30-34. Despite the low CCr and the high urinary sodium excretion rate, infants of G less than 30 had stable fluid and electrolyte balance.

Aging↗
PubMed1991

Extracellular volume in preterm infants: influence of gestational age and colloids.

We assessed the effect of fresh frozen plasma (FFP) on extracellular volume (ECV) during the first few days of life in two groups of preterm infants, group 1 (gestational age less than 30 weeks) and group 2 (gestational age 30-34 weeks). The infants were randomly assigned to one of two treatment groups, one receiving FFP, the other not; group 1 infants receiving no treatment (n = 8) and group 1 infants receiving FFP (n = 11), and group 2 infants receiving no treatment (n = 9) and group 2 receiving FFP (n = 10). FFP was given at a dose of 10 ml/kg daily during a two-hour period for the first three days of life. ECV was measured on day 1 before FFP was given and on day 4 by the distribution of bromide. There was a significant correlation between birth weight and initial ECV (r = 0.85, P less than 0.001). In group 1 ECV was significantly higher than in group 2 (P less than 0.02). In group 1 receiving no treatment mean weight loss and mean decrease in ECV were equal (84 g/kg and 78 ml/kg, respectively), but no correlation between the two parameters could be found (r = 0.68, P = 0.06). In the other study groups, mean weight loss was higher than mean decrease in ECV, with no correlation between weight loss and change in ECV.(ABSTRACT TRUNCATED AT 250 WORDS)

Analysis of Variance↗
PubMed1991

Prevalence of headache at preschool age in an unselected child population.

In a representative study of 5356 five-year-old children, 4405 (82.2%) could be traced for follow-up. Headache occurred in 861 (19.5%) of them; highly frequently in 0.2%, fairly frequently in 0.5%, less frequently in 4.3% and infrequently in 14.5%. Type of dwelling was the only predictor of housing standard, the risk of headache being about 1.5-fold in children living in other than one-family houses. Low economic status of the family, nursery day care and an increasing number of leisure activities were additional risk factors. Compared with infrequent or no headache, those with highly frequent or fairly frequent headache were at a 1.4-fold risk of temper tantrums. The risk of stomach ache was 8.9-fold in children with infrequent headache and 13.7-fold in those with fairly frequent or frequent headache compared with children with no headache.

Child, Preschool↗
PubMed1991

Grading of left-to-right shunting ductus arteriosus in neonates with bedside pulsed Doppler ultrasound.

A nonimaging pulsed Doppler technique was used to grade the magnitude of flow in left-to-right shunting ductus arteriosus. The results were compared with those obtained with a color Doppler flow mapping technique. The correlation between the grading results by these two methods was 0.91 (p less than 0.01). To determine hemodynamic influence of left-to-right shunting ductal flow, simultaneous measurements of Doppler-derived cardiac output were done. Results showed significantly higher cardiac output in infants with grade III shunting than in infants with grade 0 and grade I shunting. The nonimaging pulsed Doppler ultrasound technique used in the present study proved to be a clinically useful and accurate grading system of left-to-right shunting at the ductal level. The simple grading system with nonimaging Doppler is a valuable adjunct to the color Doppler flow mapping technique. It allows a regular evaluation of ductal flow as well as cardiac output.

Cardiac Output↗
PubMed1990

Doppler ultrasound and clinical evaluation in detection and grading of patient ductus arteriosus in neonates.

The hemodynamics and patency of ductus arteriosus (PDA) in 51 infants were examined clinically and by echocardiography during the first or second day of life. Gestational ages ranged from 27 to 41 wk (34.0 +/- 3.6); birth weights ranged from 1070 to 4320 g (2256 +/- 923). Ductal flow was apparent by Doppler echocardiography in 24 of 51 infants but clinical examination disclosed only nine of these. Ultrasound is superior to clinical examination in diagnosing both symptomatic and asymptomatic PDA. Doppler ultrasound has the additional advantage of evaluating the size and relative importance of the ductal flow.

Birth Weight↗
PubMed1990

SCSB method compared to EEG-based polygraphy in sleep state scoring of newborn infants.

Knowledge of the sleep state is important in physiological studies since many physiological variables show different properties in different sleep states. The recently developed static charge sensitive bed (SCSB) method allows long-term recordings of body movements, respiration and ballistocardiogram without electrodes attached to the subject. The recordings are easy to carry out and they do not disturb the subject in any way. The recorded variables are basic characteristics of different sleep states. SCSB-recordings and electroencephalography (EEG) based polygraphy as well as blind sleep state scoring were carried out in 8 newborn infants. The positive correlation between SCSB-scoring and EEG-based polygraphy scored by two clinical neurophysiologists was 68.1 and 64.1%. Only in 2% of all epochs was active sleep scored as quiet sleep or vice versa. The results indicate the usefulness of the SCSB method in sleep state scoring of newborn infants.

Ballistocardiography↗
PubMed1990

Subglottic stenosis in neonates and children. Clinical findings and therapy.

From 1978 through 1987, acquired subglottic stenosis was confirmed endoscopically in 31 children. The mean gestational age of the children was 32 weeks and mean birthweight 2,180 g. Of the children 84% were below 12 months of age at the time of diagnosis. Respiratory distress syndrome was confirmed in 17 children. Before diagnosis, 97% of the children had been treated by endotracheal intubation for ventilatory support, the mean duration of intubation being 37 days. In 10 children, subglottic stenosis was mild and mature and these children were followed up only. Endolaryngeal prosthesis was employed in 2 children and laryngotomy with autogenous bone graft in 5 children. Mean follow-up time was 5 years 4 months. At follow-up, 18 of the children showed good or excellent results.

Child↗
PubMed1990

Pathological heart rate responses associated with body movements in neurologically damaged infants during sleep.

Simultaneous electrocardiogram (ECG) and static charge sensitive bed (SCSB) method recordings were carried out in fifteen healthy and twenty-one neurologically damaged infants during sleep at the age of one week, one month and three months. The SCSB method allows continuous long-term recording of body movements without electrodes connected to the subject. The heart rate response to body movements was studied. Healthy newborns had clear heart rate (HR) acceleration response to body movements. A rapid HR deceleration response occurred at the end of body movements. In the neurologically damaged infants the HR response to body movements was significantly hyperactive or delayed. The abnormal heart rate acceleration-deceleration response to body movements in damaged infants can best be explained by disturbed function of the autonomic nervous system.

Autonomic Nervous System↗
PubMed1989

How accurate is chest radiography in the diagnosis of tracheobronchial foreign bodies in children?

The radiographic and endoscopic findings of 83 consecutive patients with suspected foreign body (FB) inhalation into the tracheobronchial tree were compared and the accuracy of chest radiography was estimated. Typical radiologic signs of FB aspiration, such as localized air trapping, atelectasis and infection occurred on radiographs of patients with and without FB. Twenty-four percent of patients with endoscopically verified FB had no abnormalities on chest radiography. In an analysis of radiographs of 83 consecutive patients, in which the prevalence of FB aspiration was 41%, the diagnostic accuracy was 67%, sensitivity 68% and specificity 67%. Plain film radiology alone is not a sufficiently sensitive nor specific method for the diagnosis of FB aspiration.

Bronchi↗