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Biomedical subjects

P Sasidharan

Publications and source records attributed to P Sasidharan.

At least 19 recordsLinked to original sources
PubMed2001

Myocardial performance and baroreceptor reflexes in preterm neonates: an echocardiographic evaluation using the tilt-table test.

The hemodynamic consequence of head-up position in preterm infants is not known, so we used the tilt-table test to assess changes in myocardial performance and baroreceptor reflexes. Twenty-five preterm infants with gestational age (GA) (mean +/- SD) 31 +/- 2.9 weeks (range 25-35.5 weeks), birth weight of 1612 +/- 642 g (range 520-3260 g) were studied in supine, 30 degrees, and 60 degrees head-up positions. GA had a significant effect on heart rate (HR) (p = 0.007), systolic blood pressure (SBP) (p = 0.03), left ventricular (LV) cavity dimensions (p = 0.001), cardiac output (CO) (p = 0.001), LV ejection time (LVETc) (p = 0.05), and end systolic wall stress (ESWS) (p = 0.003). An inverse relationship was seen between velocity of circumferential fiber shortening (VcFs) and ESWS (slope b = -0.019 +/- 0.008, p = 0.003). Results of tilt tests showed that at supine, 30 degrees, and 60 degrees, respectively, HR was 162 +/- 10.5, 162 +/- 9, and 164 +/-12 (p = NS); SBP (mmHg) was 73 +/- 11, 72.5 +/- 9.5, and 78 +/- 10 (p = NS); CO (L/kg/min) was 0.4 +/- 0.16, 0.4 +/- 0.15, and 0.43 +/- 0.16 (p = NS); ESWS (g/cm2) was 38.7 +/- 8.3, 40.9 +/- 9.9, and 43.4 +/- 10.7 (p = NS); and VcFs (circ/sec) was 1.35 +/- 0.3, 1.28 +/- 0.4, and 1.26 +/- 0.2 (p = NS). LV filling pattern as seen by early/late atrial Doppler flow velocity ratio did not change with tilt (p = NS). Myocardial performance improved with increasing GA. No significant differences in myocardial performance were found between baseline and head-up tilt positions.

Analysis of Variance↗
PubMed2001

Bladder retention of urine as a result of continuous intravenous infusion of fentanyl: 2 case reports.

Sedation has been commonly used in the neonate to decrease the stress and pain from the noxious stimuli and invasive procedures in the neonatal intensive care unit, as well as to facilitate synchrony between ventilator and spontaneous breaths. Fentanyl, an opioid analgesic, is frequently used in the neonatal intensive care unit setting for these very purposes. Various reported side effects of fentanyl administration include chest wall rigidity, hypotension, respiratory depression, and bradycardia. Here, 2 cases of urinary bladder retention leading to renal pelvocalyceal dilatation mimicking hydronephrosis as a result of continuous infusion of fentanyl are reported.

Analgesics, Opioid↗
PubMed1999

Early detection of bacteremia in the neonatal intensive care unit using the new BACTEC system.

OBJECTIVE: With the newer techniques of culture analysis such as the BACTEC 9240 fluorometric detection system, detecting bacteremia in the neonate may be possible in a significantly shorter time. We hypothesized that neonatal bacteremia can be detected in less than 48 hours by this method. STUDY DESIGN: Our study included a retrospective review of 613 blood cultures obtained during the period August 1, 1995 to March 18, 1996 taken from 325 infants who had cultures drawn with a sepsis work-up and/or repeat cultures who had initial positive cultures in our Neonatal Intensive Care Unit. Results of blood cultures were studied in conjunction with the variables of body weight, gestational age, organism grown, complete blood count (CBC), and timing of positive cultures. Statistical analyses were performed using Fisher's and two-tailed Student's t tests. RESULTS: The results showed that of 325 infant blood cultures 49 (15%) were positive. Of these, 64% were coagulase-negative staphylococci, 14% viridans streptococci, 8% Escherichia coli, 4% Enterococcus sp., 4% Pseudomonas sp., 2% Enterobacter sp., 2% Klebsiella sp., and 2% Candida albicans. Of the positive blood cultures taken from infants not on antibiotics at the time of culture, 54% were detected positive at 18 hours, 71% at 24 hours, and 100% by 30 hours. Detection time by organism type was as follows: coagulase-negative staphylococci, 21.7 hours; viridans streptococci, 15.6 hours; E. coli, 7.5 hours; Enterococcus sp., 12 hours; Enterobacter sp., 5 hours; Klebsiella sp., 10 hours; and Pseudomonas sp., 12 hours. CONCLUSION: Our results indicate that the BACTEC 9240 fluorometric detection system helps in early identification of neonatal bacteremia (in 24 to 30 hours), with Gram-negative organisms being detected earlier than Gram-positive organisms (p < 0.05) and having significantly higher immature neutrophils in a CBC (I:T ratio of > or = 0.2 (p < 0.001). Early detection of neonatal bacteremia using this method will allow earlier diagnosis and appropriate treatment of the potentially bacteremic and bacteremic infant.

Bacteremia↗
PubMed1998

Approaching the management of the neonatal intensive care unit graduate through history and physical assessment.

NICU graduates, often ex-premature infants, offer unusual challenges to the primary care provider. History and physical assessment require an organized approach with meticulous attention to detail. These infants are at high risk for multiple problems including growth delays, nutrition and feeding problems, pulmonary sequelae, neurological sequelae and developmental delays, vision and hearing disturbances, as well as abnormalities in parent-infant bonding. This article emphasizes particular aspects of the history and physical examination that signify pathophysiology and sequelae common to the NICU graduate.

Bronchopulmonary Dysplasia↗
PubMed1998

Hospital readmission and morbidity following early newborn discharge.

To examine causes of newborn hospital readmission and morbidity related to early nursery discharge, we reviewed the charts of 664 newborns readmitted from home under the age of 15 days, between 1993 and 1995. Early discharge (ED) was defined as nursery length of stay of < or = 2 days. Morbidity related to ED: onset of symptoms within 1 day of ED; and in diseases with insidious onset: serum bilirubin level > 20 mg/dL (340 mumol/L), or dehydration following poor breastfeeding since birth. Seventeen percent of all readmitted infants had ED-related morbidity; 9% had major morbidity. Onset of symptoms prior to the age of 3 days occurred in 43% of ductal-dependent cardiac lesions, intestinal obstruction, seizures, and major infections. Morbidity was less pronounced in infants who were followed up within 2 days following ED. Specific findings related to subsequent morbidity were identified in the perinatal history of infants who were readmitted with major infections and with hyperbilirubinemia. Our findings suggest that: (1) close to half of the cases with acute-onset major morbidity can be identified within 3 days of birth, and (2) attention to the perinatal history and timely follow-up will contribute to a reduction in both morbidity and complications.

Hospitals, Pediatric↗
PubMed1998

Neonatal cord blood leptin: its relationship to birth weight, body mass index, maternal diabetes, and steroids.

Leptin is a 16-kD protein encoded by the ob/ob (obesity) gene. In rodents it plays a role in obesity, diabetes, fertility, and neuroendocrine function. In humans serum concentrations of leptin correlate with total body fat in both adults and children. We measured cord blood leptin in 186 neonates that included 82 appropriate for gestational age (AGA), 47 large for gestational age (LGA), 20 infants of diabetic mothers, 52 preterm infants, and 15 intrauterine growth-retarded (IUGR) infants. There were 16 pairs of twins. The mothers of 17 preterm infants were treated with steroids before delivery. Leptin (mean +/- SD) concentration in term, AGA infants (39.4 +/- 1.1 wk) with birth weight (BW) of 3.2 +/- 0.3 kg, body mass index (BMI) of 12.6 +/- 1.1 was 4.01 +/- 3.5 ng/mL. BW correlated with cord leptin (p = 0.002) in a multivariate analysis controlling for potential confounders. Both LGA infants and infants of diabetic mothers had higher cord leptin concentration 7.3 +/- 3.8 and 6.1 +/- 4.8 ng/mL, respectively, compared with AGA infants (p < 0.05). Preterm infants had a mean leptin level of 1.8 +/- 0.97 ng/mL and a 3-fold elevation was seen if mothers received steroids antenatally (p = 0.006). IUGR infants had increased leptin (6.5 +/- 3.9 ng/mL, p = 0.03). Concerning the twin pairs, the smaller had a higher leptin level compared with larger twin (4.1 +/- 9.51 versus 2.8 +/- 5.14, p = NS). Neonatal cord leptin concentrations correlate well with BW and BMI. No gender differences were found in cord blood leptin. Maternal obesity had no effect on cord leptin, whereas exogenous maternal steroids increased neonatal leptin concentrations.

Adult↗
PubMed1998

Role of corticosteroids in neonatal blood pressure homeostasis.

Corticosteroids are commonly administered during the perinatal period because of their diverse actions on various organ systems, both at the cellular and molecular level, and because of their effect on maturational physiology. In particular, in situations of refractory cardiovascular collapse, corticosteroids are used by many clinicians as a last-chance therapeutic modality. This article reviews the mechanism of neonatal blood pressure homeostasis with particular emphasis on the postnatal adaptation of the neonate's cardiovascular system and adrenal function to extrauterine life. Evidence also is provided about the existence of a hypocortisolism state in the sick or stressed very low birth weight infant.

Adaptation, Physiological↗
PubMed1995

Identification of sepsis in neonates following maternal antibiotic therapy.

To examine the value of current diagnostic tests identifying neonatal sepsis related to intrapartum treatment with antibiotics, we reviewed the charts of 219 mother-infant pairs, of which 139 mothers received intrapartum antibiotics (group 1) and 80 mothers did not (group 2). When compared with group 2 infants, group 1 infants had fewer positive blood cultures (4.3% vs 20%, P < 0.003), blood cultures positive for group B streptococci (GBS) (P < 0.001), and positive urine GBS latex agglutination (LA) tests (P < 0.001). Although the sensitivity of the white blood cell count (WBC) was 81%, the specificity was < 60% in both groups. The specificity of the urine GBS LA test was 92%. These results suggest (1) the WBC will neither confirm nor rule out neonatal septicemia; (2) blood cultures are indicated in suspected neonatal sepsis even if there was maternal intrapartum treatment with antibiotics; and (3) a urine GBS LA test is a useful adjunct in the diagnosis of neonatal GBS septicemia.

Ampicillin↗
PubMed1994

The effect of inhaled nitric oxide on the pulmonary circulation of the neonatal pig.

To study the pulmonary vasodilator selectivity of low levels of inhaled nitric oxide (NO) in a model of neonatal pulmonary hypertension, we sequentially exposed anesthetized, spontaneously breathing neonatal pigs to each of four different inspired gas mixtures: room air, room air with 25 parts per million NO, hypoxia (14% O2 in N2), and hypoxia with 25 parts per million NO. The room air, room air with NO, hypoxia, and hypoxia with NO exposures were of 15-min duration. The following measurements were made: mean systemic arterial, mean pulmonary arterial, and wedge pressures; thermodilution cardiac output; esophageal pressure; tracheal flow; and arterial PO2, PCO2, pH, hemoglobin, and methemoglobin. Inhalation of NO decreased pulmonary arterial pressure in both room air and hypoxia conditions (mean pulmonary arterial pressure 16 +/- 1 torr room air, 13 +/- 1 torr room air with NO, p < 0.005; and mean pulmonary arterial pressure 21 +/- 2 torr hypoxia, 14 +/- 1 torr hypoxia with NO, p < 0.005). NO had no significant effect on systemic arterial pressure, cardiac output, dynamic lung compliance, pulmonary resistance, or the measured blood variables during either control or hypoxic conditions. The results indicate that inhaled NO was a selective pulmonary vasodilator that could effectively reverse acute hypoxic pulmonary vasoconstriction. The normoxic vasodilation produced by NO inhalation also indicates the existence of basal vasomotor tone in the anesthetized, spontaneously breathing neonatal pig. The short-term exposures used produced no detectable manifestations of toxic side effects.

Administration, Inhalation↗
PubMed1992

Transfusion-induced changes in the breathing pattern of healthy preterm anemic infants.

In order to evaluate the effects of transfusion on breathing pattern in growing, otherwise healthy, anemic preterm infants, we studied 14 infants whose mean +/- SD birthweight was 1,212 +/- 294 grams, gestational age 29.28 +/- 2.23 weeks and hematocrit 25.86 +/- 2.24%. At a mean postnatal age of 41.35 +/- 19.45 days 12 hour nocturnal (transthoracic impedance) pneumocardiograms were obtained 24 hours prior to and after transfusion with 10 mL/kg of packed red blood cells. Posttransfusion pneumocardiograms revealed significant reduction of periodic breathing, of apnea episodes with 11-15 second duration, of apnea density, and of heart rate. These findings indicate that transfusion with packed red blood cells significantly alters certain cardiorespiratory variables in anemic preterm infants.

Anemia↗
PubMed1992

Effect of positioning on the breathing pattern of preterm infants.

Respiration, as judged by gas exchange and pulmonary function, is improved in preterm infants kept in the prone rather than the supine position. The influence of position on the breathing pattern as documented by the pneumogram was studied in 14 stable preterm infants with recent clinical apnoea. Ten of the infants had oximetry and nasal flow studies simultaneously with the impedance pneumogram. Each infant had consecutive nocturnal pneumograms, one in the prone, one in the supine position. The infants were kept for more than six hours in the assigned position. A significant increase in apnoea density and in periodic breathing was found in the supine v the prone position (mean (SE) 4.5 (0.7)% v 2.5 (0.5)%, and 13.6 (3.2)% v 7.7 (2.2)%, respectively). There was no positional difference in the incidence of bradycardia and prolonged apnoea. The examination of obstructive apnoea, mixed apnoea, and cyanotic spells did not reveal a consistent disparity between the two positions. These findings indicate an increase in central apnoea in preterm infants kept predominantly in the supine position. Possible relations of positional changes to lung mechanics are discussed. When evaluating pneumograms, attention must be given to the position in which they were performed.

Apnea↗
PubMed1992

Breathing pattern abnormalities in full term asphyxiated newborn infants.

Perinatal asphyxia is a cause of significant morbidity among full term infants, but breathing abnormalities after an asphyxic insult have not been studied. This report details breathing patterns of 16 full term asphyxiated infants, during the first week of life who were studied by transthoracic impedance pneumocardiograms. Pneumocardiograms were abnormal in 69% of infants in the asphyxiated group and 13% of infants in the control group. Significant differences were noted in the incidence of prolonged apnoea, the percentage of periodic breathing, and in apnoea density. These results indicate that there are significant abnormalities in the breathing pattern of full term infants, during their first week, after perinatal asphyxia. Similar abnormalities have been described in infants who had experienced 'near miss' sudden infant death syndrome.

Apnea↗
PubMed1992

Nonimmune hydrops fetalis: case reports and brief review.

We report two cases of nonimmune hydrops fetalis diagnosed prenatally. One fetus died in utero, and the second fetus survived and the infant was discharged from the intensive care nursery at 4 weeks of age. A brief review of the literature and the difficulties in arriving at a diagnosis and the management are described, along with certain prognostic factors determining the outcome.

Adult↗
PubMed1991

Early onset neonatal sepsis with Campylobacter jejuni: a case report.

Perinatal infections with bacteria belonging to the genus campylobacter are being increasingly recognized. We present a case of early onset neonatal sepsis with Campylobacter jejuni (previously C. Fetus ss. jejuni or Vibrio jejuni). The infant was born prematurely at 31 weeks of gestation and presented with respiratory distress and frequent apnoea from birth. The chest X-ray film demonstrated reticulogranular pattern consistent with hyaline membrane disease. The infant was successfully treated with ampicillin and gentamicin. C. jejuni infection should be considered in the differential diagnosis of early onset sepsis in the neonate and can mimic the radiological picture of hyaline membrane disease.

Campylobacter Infections↗
PubMed1991

Fetal abdominoscrotal hydrocele.

A case of abdominoscrotal hydrocele detected initially as an intraabdominal cyst on antenatal ultrasonography is described. Abdominoscrotal hydrocele should be included in the differential diagnosis of antenatally recognized intraabdominal cysts and abdominal masses in the newborn.

Adult↗
PubMed1990

Is fetal insulin secretion affected by fetal hypoxia?

Fifty-five pregnant Rhesus isoimmunized women were subjected to fetal blood sampling or fetal blood transfusion on 135 occasions. Glucose and C-peptide concentrations were measured in fetal blood, in addition to the routine investigations for complete blood count, blood gases and lactate concentration, in order to investigate whether fetal insulin secretion was affected by hypoxia from fetal anemia. We found a strong relation between the concentration of C-peptide and gestational age at sampling (r = 0.53, P less than or equal to 0.000001). Multiple regression analysis also demonstrated that glucose (P less than or equal to 0.0051) and lactate (P less than or equal to 0.0003) also affected the concentration of C-peptide. We were unable to find any relation between C-peptide concentrations and blood gas variables. We conclude that fetal insulin secretion, measured as C-peptide concentration in fetal blood, is not affected by hypoxia from anemia as long as hemoglobin concentration remains within the range 2.1-14.8 g/dl).

Age Factors↗