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Biomedical subjects

R G Faix

Publications and source records attributed to R G Faix.

At least 37 records · Page 2Linked to original sources
PubMed1990

Ultrasound attenuation coefficient in the fetal liver as a function of gestational age.

An apparent increase in the ultrasound attenuation coefficient per unit frequency, alpha f, of fetal liver as a function of gestational age has been observed. Measurements were made in utero with a 25 megasample/sec RF digitizer and a real time ultrasound system with a 5 MHz scan head. A precise measurement of alpha f was employed in which the intercept was tied to 0 at a frequency of 0. In 178 examinations of normal pregnancies, the linear regression of the alpha f increased 26% between 26 and 40 weeks gestation. This statistically significant increase (p less than 0.0001) is consistent with several observations, those of Parker et al. of increased attenuation in liver when glycogen is added, the increasing glycogen storage in the liver before birth, and our own pre- and postnatal measurements reported elsewhere. A noninvasive assay for glycogen content would have important applications in medicine and biomedical science. However, an increase in measurement accuracy and precise correlation with glycogen content will be required to make meaningful predictions in individual cases, as opposed to the present statistical trends.

Embryonic and Fetal Development↗
PubMed1990

Successful medical treatment of Candida parapsilosis endocarditis in a premature infant.

Endocarditis is an uncommon complication of disseminated candidiasis among premature infants, but has been recently reported to be almost uniformly fatal. The lone previously documented survivor required extensive surgical resection as well as prolonged systemic antifungal therapy. The present report details a premature infant who recovered from Candida endocarditis with medical therapy alone.

Amphotericin B↗
PubMed1989

The population pharmacokinetics of theophylline in neonates and young infants.

The population pharmacokinetics of theophylline were evaluated using 391 theophylline serum concentration measurements from 108 neonates and young infants (postnatal age 0-26 weeks), who received theophylline for the treatment of neonatal apnea. A one-compartment pharmacokinetic model with first-order elimination was used, with intravenous aminophylline and oral theophylline administration modeled as zero-order infusions. The effect of a variety of developmental and demographic factors on clearance (CL) and volume (V) were investigated. Hypothesis testing to evaluate potentially significant factors produced a final model in which clearance was based on weight (kg) raised to an exponential power and postnatal age (weeks), with CL (ml/hr) = 17.5 (weight)1.28 + 1.17 (postnatal age). Clearance was reduced by 12% for patients receiving parenteral nutrition. Volume of distribution in this population was adequately described using only weight, with V (L) = 0.858 L/kg. Bioavailability of orally administered drug was not significantly less than unity. Interindividual variability in clearance was modest, with a coefficient of variation for clearance of 16%. An estimate of interindividual variability in volume could not be obtained. As a measure of residual variability in theophylline serum concentrations, the coefficients of variation for theophylline serum concentrations of 5.0, 10.0, and 13.0 mg/L were found to be approximately, 25, 12, and 9%, respectively. The identification of influential patient factors and the quantification of their influence on theophylline disposition allow for a priori estimates of theophylline pharmacokinetic parameters in these patients.

Aging↗
PubMed1989

Neutropenia and intraventricular hemorrhage among very low birth weight (less than 1500 grams) premature infants.

To assess the previously reported association of intraventricular hemorrhage (IVH) with neutropenia, we prospectively followed during a 38-month study period infants with birth weight less than or equal to 1500 gm who survived greater than 72 hours and underwent serial cranial sonography and neutrophil counts for the first 14 days of life. Neutrophil counts were interpreted according to a widely employed reference range. Infants with conditions other than IVH reported to be associated with neutropenia (sepsis, maternal hypertension, 5-minute Apgar score less than or equal to 5) were excluded. Final study groups included 38 infants with IVH and 114 without IVH. No significant differences were found for birth weight, gestational age, respiratory distress syndrome, mechanical ventilation, prolonged rupture of membranes, patent ductus arteriosus, route of delivery, pneumothorax, or sex. The occurrence of neutropenia before 14 days of age was not significantly different between the groups (50% with IVH, 56% without IVH), nor were differences found at individual postnatal ages. Comparison of immature neutrophil count and immature/total neutrophil ratio also revealed no differences. The high incidence of neutropenia in our non-IVH group raises questions about application of these widely accepted reference ranges to very low birth weight infants.

Age Factors↗
PubMed1989

Adult respiratory distress syndrome in full-term newborns.

Since 1984, 11 newborns with severe respiratory distress have been treated whose clinical characteristics appear distinctive. Characteristics of these neonates were as follows: (1) they were full term by obstetric and neonatal criteria, (2) they had diffuse bilateral alveolar opacification on chest radiographs during the acute illness, (3) each had an acute perinatal triggering insult, (4) the neonates required continuous positive pressure ventilation for at least 48 hours with FiO2 greater than 0.50 for at least 12 hours, (5) they needed positive end-expiratory pressure of 6 cm of H2O or greater within three days of the triggering event, (6) there were no other known causes of these clinical conditions. Ten (91%) neonates had evidence of other organ dysfunction in addition to the lungs. Trials of hyperventilation in nine and tolazoline in five failed to improve oxygenation. Ten infants who underwent trials of increased positive end-expiratory pressure greater than or equal to 6 cm of H2O without other concurrent changes in ventilator settings responded with prompt increases in PaO2 (median increase 84 mm Hg, range 22 to 196 mm Hg). All 11 babies survived but required prolonged mechanical ventilation and supplemental oxygen. We suggest that adult respiratory distress syndrome can and does occur in newborns. A trial of positive end-expiratory pressure greater than or equal to 6 cm of H2O should be considered in full-term infants with severe respiratory distress in whom other causes can be excluded.

Acute Disease↗
PubMed1989

Polymicrobial sepsis among intensive care nursery infants.

To determine the incidence, characteristics, and course of polymicrobial sepsis among infants in intensive care nurseries, we reviewed all such episodes in our neonatal unit from September 1971 through June 1986. We identified 15 episodes (3.9% of all cases of culture-proven sepsis during the survey period) in which blood or cerebrospinal fluid (CSF) culture yielded multiple organisms felt to represent true pathogens. Mortality associated with late-onset polymicrobial sepsis (7 of 10; 70%) was significantly higher (P less than .001) than in late-onset monomicrobial sepsis (86 of 370; 23%). Six patients were 37 weeks' gestation or greater at birth, and five were younger than 4 days of age when the polymicrobial culture was obtained. Group D streptococci were recovered in eight cases (53%). Gastrointestinal foci appeared to be common among infants with late-onset polymicrobial infection (5 of 10), while prolonged rupture of membranes was frequently associated with early-onset infection (4 of 5). Though recovery of multiple organisms from blood or CSF may not always be significant, one should not immediately assume contamination. A report of more than one organism growing from a normally sterile body fluid in an intensive care nursery infant should be considered significant, and therapy should be adjusted to provide appropriate antimicrobial agents for all reported organisms if the infant has not substantially improved in the interval since the culture was actually obtained.

Anti-Bacterial Agents↗
PubMed1989

Mucocutaneous and invasive candidiasis among very low birth weight (less than 1,500 grams) infants in intensive care nurseries: a prospective study.

To determine whether mucocutaneous candidiasis presages the development of invasive candidiasis and to assess factors influencing the development of mucocutaneous candidiasis and invasive candidiasis among infants requiring neonatal intensive care, all infants admitted to our neonatal intensive care unit during a 47-month period were prospectively examined twice weekly for mucocutaneous candidiasis. Because 16 of 18 (89%) infants in whom invasive candidiasis (defined by positive cultures of blood, CSF, deep tissue or greater than or equal to 2 supra-pubic urine aspirates) developed had birth weights less than 1,500 g, further analysis was focused toward the very low birth weight group. Of 358 very low birth weight infants hospitalized for less than three days and serially studied until discharge from the neonatal intensive care unit, mucocutaneous candidiasis developed in 28 (7.8%), invasive candidiasis developed in 16 (4.5%), and in 323 there was no evidence of mucocutaneous candidiasis or invasive candidiasis. Although many risk factors were shown by univariate analysis to be significantly more common among those with invasive candidiasis and mucocutaneous candidiasis, adjustment for the covariant effects of duration of hospitalization and gestational age revealed that only prolonged duration of antibiotic therapy and duration of endotracheal intubation were significantly associated with invasive candidiasis. Invasive candidiasis developed later in nine of 28 (32%) infants with mucocutaneous candidiasis despite nystatin therapy of mucocutaneous candidiasis in all nine (median duration of therapy before invasive candidiasis, nine days). Very low birth weight infants in whom mucocutaneous candidiasis develops are at significantly greater risk of invasive candidiasis developing later than those in whom mucocutaneous candidiasis did not develop (9/28 v 7/330, P less than .001).

Anti-Bacterial Agents↗
PubMed1988

A randomized, controlled trial of parenteral clindamycin in neonatal necrotizing enterocolitis.

For an assessment of the efficacy of clindamycin in preventing bowel necrosis (intestinal gangrene or perforation), 42 premature infants with radiographically confirmed necrotizing enterocolitis (NEC) (pneumatosis, intraportal gas, or both) were randomly assigned to receive parenterally either ampicillin and gentamicin (control group, n = 22) or ampicillin, gentamicin, and clindamycin (n = 20), 20 mg/kg/d at 8-hour intervals for 10 to 14 days. Infants who had received antibiotics for greater than 24 hours before randomization and those developing intestinal gangrene or perforation less than 12 hours after randomization were excluded. Intestinal gangrene or perforation developed in four infants in the control group and six in the clindamycin group. Four in each group died of NEC. In the control group, one of 18 survivors developed a late stricture requiring surgical resection, whereas six of 15 survivors in the clindamycin group developed such strictures (P = 0.022). Routine inclusion of clindamycin in medical treatment of NEC does not reduce the frequency of intestinal gangrene or perforation and may be associated with an increase in late stricture formation.

Body Fluids↗
PubMed1988

Epidemiology of Clostridium difficile colonization in newborns: results using a bacteriophage and bacteriocin typing system.

We used a typing system based on bacteriophage and bacteriocin susceptibility to study the epidemiology of Clostridium difficile colonization of newborn infants. C. difficile was found in the stools of 30 (16.0%) of 187 infants who were screened. Increased length of stay in the nursery (P less than .001) and delivery by cesarian section (P less than .001) were associated with higher rates of colonization. The isolates initially detected from the environment and the infants were strain B1811-1700. Strain B1537/Cld7 became the predominant isolate obtained from the infants; positive cultures were also obtained from the environment and the hands of personnel who worked in the nursery and had strain B1537/Cld7. Our results suggest that the infants acquired C. difficile through transfer from the hands of hospital staff.

Bacterial Proteins↗
PubMed1987

Comparative efficacy of handwashing agents against cytomegalovirus.

Conscientious handwashing is often recommended as an important method for limiting transmission of cytomegalovirus (CMV) from infected individuals to health, education, and child care professionals. To assess the efficacy of handwashing, fingertips of radiation-sterilized latex gloves were inoculated with 0.2 mL of ten different CMV strains. Virus in each inoculum was quantitated by plaque assay. After five minutes, viral inocula were allowed to remain (control), or were washed away by dropwise application of 10 mL of distilled water (DI), 5 mL of 0.08% soap followed by 5 mL of DI, 5 mL of 0.01% chlorhexidine gluconate followed by 5 mL of DI, or 5 mL of 0.025% povidone-iodine solution followed by 5 mL of DI. Separate glove fingertips were sampled 5, 15, 30, 60, 120 and 240 minutes after washing and cultured in duplicate for CMV. Similar studies were performed using human cadaver skin. Ordinary soap was as effective at preventing CMV recovery as other more expensive agents. For inocula with less than 5 log10 pfu CMV/mL, washing with water alone was as effective as other agents. This was confirmed in similar studies with human hands using five CMV stains. Handwashing is probably an effective method for removing CMV from contaminated hands.

Cells, Cultured↗
PubMed1987

Medico-legal consultation: an expanded role of the tertiary neonatologist.

Between January 1982 and December 1984, the neonatologists at the University of Michigan Medical Center were asked to render 115 consultations regarding potential medical litigation. Requests for consultation were made by attorneys representing plaintiffs in 36 per cent of cases and defendants in 64 per cent (hospitals, 32 per cent, physicians, 30 per cent, private industry, 2 per cent). A review of these cases indicates frequently recurring themes, especially fetal distress, postdate pregnancies, and birth trauma among obstetrical cases, and neurologic injury, birth asphyxia, meconium aspiration, and hypoglycemia among neonatal cases. In many instances, incomplete documentation in the medical record and poor physician-patient communications were the issues leading to litigation. In 49 per cent of plaintiff cases reviewed, outcomes were felt not be related to the medical care rendered. Sixty-one per cent of defendant cases were felt to be strongly defensible; in 30 per cent of cases significant doubt as to defensibility existed. The physician practicing perinatal or neonatal medicine must be aware of the areas of vulnerability to malpractice litigation and the need for adequate documentation and patient communication. The daily activities of the tertiary neonatologist support his credentials as an expert medical witness in his specialty.

Academic Medical Centers↗
PubMed1987

Fetal skull fracture and brain injury after a maternal automobile accident. A case report.

A woman in labor and not wearing a seat belt sustained multiple fractures of the pelvis and femur while in an automobile accident. The fetus suffered fractures of the parietal and occipital bones. To minimize maternal pelvic and fetal injury, delivery by cesarean section was performed. The infant had generalized cerebral edema and intraventricular and subarachnoid hemorrhage, diagnosed shortly after birth. Motor abnormalities and residual injury to the periventricular white matter were evident at age 4 months. Use of seat belts may significantly diminish or prevent such injuries.

Accidents, Traffic↗
PubMed1986

Procedural hazards of neonatal ultrasonography.

Neonatal ultrasonography entails potential procedural hazards to the newborn infant. When performing ultrasound studies, the examiner may inadvertently move the endotracheal tube or may facilitate the spread of infection from one baby to another. The examiner should also be aware that the pressure of applying the transducer to the scalp is transmitted to the central nervous system and that the baby may become hypothermic during the procedure. Precautions include minimizing head and neck movement and application of pressure on the fontanel, using prewarmed coupling gel, which is removed after scanning, careful handwashing, and wiping the transducer with 70% isopropyl alcohol or 2% alkalinized glutaraldehyde between studies.

Body Temperature Regulation↗
PubMed1986

Intrapleural inoculation of candida in an infant with congenital cutaneous candidiasis.

Though several pathologic processes can produce large denuded skin lesions in very low birthweight infants, trauma is often diagnosed without further investigation. Failure to consider other causes may prevent institution of appropriate specific treatment and may contribute to the development of serious complications, as described in the present case report of a premature infant with congenital cutaneous candidiasis.

Adult↗