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Biomedical subjects

R G Harper

Publications and source records attributed to R G Harper.

At least 73 records · Page 4Linked to original sources
PubMed1985

Upper- vs lower-limb systolic blood pressure in full-term normal newborns.

The difference between upper- vs lower-limb systolic blood pressure (BP) was investigated in 100 normal full-term newborns younger than 24 hours of age by the oscillometric method. The mean systolic BP of both upper limbs was 72.3 +/- 7.6 mm Hg (mean +/- SD). The mean +/- SD systolic BP of both lower limbs was 71.3 +/- 8.2 mm Hg. Systolic BP in the upper limb was greater than that in the lower limb in 66% of newborns by as much as 20 mm Hg (mean +/- SD, 3.5 +/- 3.1). Systolic upper-limb BP was lower than systolic lower-limb BP in 28% of newborns by as much as 21 mm Hg (mean +/- SD, 5.1 +/- 5.1). Systolic BP did not correlate with birth weight. Follow-up evaluation of BP in 25 of the infants up to 3 years of age revealed higher systolic BP in the lower extremities in 24 of the 25 infants. We conclude that (1) it is normal to have a higher systolic BP in either the upper limb or the lower limb in newborns younger than 24 hours of age, and (2) there is no correlation of systolic BP with birth weight in full-term normal neonates younger than 24 hours of age.

Arm↗
PubMed1985

A complete computerized program for nutritional management in the neonatal intensive care nursery.

A computerized program in BASIC, which integrates the infant's fluid and nutritional requirements per gestational age and weight with the infant's postpartum age, was developed using the Apple II Plus microcomputer, dual floppy disks, and an Epson printer. Daily requirements of fluids, proteins, fat, CHO, vitamins, minerals, and trace elements are computed. For reference, the program displays the composition and indications for intravenous and hyperalimentation solutions, mature human milk, and 14 commercial formulas. Safety limits to prevent overload or deficient formulations are strategically displayed, warning the physician about possible complications and gradually orienting him toward achieving adequate nutritional balance in the patient. The nutritional intake, weight, and other important clinical variables are stored and retrieved for future evaluation. The flexibility of the program allows for modifications in intravenous and oral composition according to clinical requirements. The program improves the efficiency of the arduous daily formulation of nutritional needs, reduces the possibility of human error, facilitates the calculation process, diminishes time spent on the calculations, and increases the ease of nutritional data retrieval and the development of output programs.

Birth Weight↗
PubMed1982

Separation of omphalopagus twins.

The study and successful separation of a pair of omphalopagus twins weighing 1690 g at birth is presented. The test of greatest usefulness was an oral glucose tolerance test that demonstrated an absence of parasitism. Subsequently, it was found that the twins had a joined liver but separate GI and GU tracts. The time for separation was determined by observing the twins' toleration of compression of the bridge. Initially, obliteration of the tunnel-like connection would cause considerable respiratory distress. However, in the month before surgery, the tunnel could be compressed to the point of obliteration without causing tachypnea or other signs of respiratory distress. The change in toleration of compression was related to unequal growth of the twins and their connecting bridge. Though the weight of the twins quintupled in their first 6 mo, the circumference of the bridge remained the same. The surgery was carried out on a single table without frames. The twins were draped using self-adhering plastic. Intravenous fluoroscein was used to demarcate the large liver juncture, thus expediting the separation.

Abdominal Muscles↗
PubMed1982

The scope of nursing practice in level III neonatal intensive care units.

A structured, timed, telephone survey to determine the scope of nursing practice in level III neonatal intensive care units revealed that the staff/head nurse and neonatal nurse clinician/specialist now are responsible for a wide variety of sophisticated skills and procedures, which were heretofore usually performed by a physician. This study has broad implications for educational as well as service activities and indicates a need to change physician and nurse expectations and education accordingly.

Adult↗
PubMed1981

Fetal movement, biochemical and biophysical parameters, and the outcome of pregnancy.

Fetal movements, fetal heart rate patterns, and serum estriol levels were prospectively monitored in 91 high-risk and normal pregnant women. In four women, there was cessation of fetal movements. In three of these cases, there were pathologic changes in fetal heart rate patterns, with one neonatal death. Of the 87 women who did not demonstrate cessation of fetal movements, one had changes in fetal heart rate patterns. The difference between the two groups was statistically significant (Z test: p less than 0.001). No correlation was found between fetal movements and serum estriol levels in this study. Daily recording of fetal movements can be used as an effective screening test, with high sensitivity and specificity for the fetus in utero. Cessation of fetal movement places the fetus in a high-risk category and should alert the physician to the need for non-stress tests.

Estriol↗
PubMed1981

Observations on maternal preference for rooming-in facilities.

To determine the length of time mothers prefer their infants with them, 1,000 mothers at North Shore University Hospital (NSUH) and 435 mothers at Kings County Hospital (KCH) were asked postpartum whether they would prefer their infants with them every four hours for 1/2 hour for feeding or rooming-in with their infants during the daytime only or 24 hours a day. Approximately one third of the mothers at NSUH preferred rooming-in whereas approximately three quarters of the mothers at KCH preferred rooming-in. Significantly more mothers at KCH preferred 24-hour rooming-in than at NSUH. Factors such as primiparity, attendance at Lamaze classes, and breast-feeding were significantly associated with the mother's preference to room-in at NSUH, but there was no such association at KCH. This study suggests that: (1) the desire to room-in is not universal; (2) each institution must individualize rooming-in facilities according to the needs of the population; (3) although the demand for rooming-in varies, more mothers prefer rooming-in than there are accommodations presently available; and (4) factors that may be associated with rooming-in are not the same in all populations. It appears that it is as inappropriate to impose rooming-in as it is to deprive mothers of rooming-in.

Black or African American↗
PubMed1980

Xiphopagus conjoined twins: a 300-year review of the obstetric, morphopathologic, neonatal, and surgical parameters.

Obstetric, morphopathologic, neonatal, and surgical features of 36 reported cases of xiphopagus conjoined twins were correlated and reveal: (1) a 6% incidence of prenatal diagnosis; (2) a 36% rate of dystocia; (3) a 19% incidence of stillbirths; (4) variation in the extent of fusion; (5) a high rate of occurrence of concurrent congenital malformations, not limited to a conjoined area, especially of the heart (25%) and gastrointestinal tract (33%); (6) the importance of diagnostic tests to elucidate conjoined or abnormal structures because of the high rate of concurrent malformations; (7) opisthotonos as the body alignment position of choice; (8) a 69% female sex bias; (9) surgical separation usually in the first year of life; and (10) a 53% survival rate. This paper correlates the world literature for xiphopagus conjoined twins for the past 300 years.

Abnormalities, Multiple↗
PubMed1980

Sequential scintiangiography of the hepato-splenic system of xiphopagus conjoined twins.

Scintiangiography of xiphopagus conjoined twins following sequential i.v. injection of Tc-99m sulfur colloid revealed the size, configuration, and anatomic point of fusion of the twins' common liver prior to surgery. Cross circulation was determined to be non-significant by this approach. The technique is presented, compared to other methods, and the benefit of sequential hepatic scintiangiography for xiphopagus conjoined twins is reviewed.

Cross Circulation↗
PubMed1980

The relationship between maternal hypertensive disease of pregnancy and the incidence of idiopathic respiratory distress syndrome.

The relationship between maternal hypertensive disease of pregnancy (HDOP) and idiopathic respiratory distress syndrome (IRDS) was analyzed in 2,105 premature infants weighing between 1,000 and 2,199 gm and born between January 1968 and December 1975 at the Kings County Hospital Center and State University Hospital. HDOP was diagnosed in 250 mothers of 2,105 infants studied. The incidence of IRDS (15.2%) in the HDOP group was significantly lower than the 29.9% in the non-HDOP group (P less than .001). In infants whose gestational age was 32 weeks or less, the incidence of IRDS was 26.1% in the HDOP group and 40.8% in the non-HDOP group (P less than .01). In infants whose gestational age was 33 weeks or more, the incidence (9.3%) in the HDOP group was significantly lower than the 18.4% in the non-HDOP group (P less than .005). The low incidence of IRDS in the HDOP group remained even after eliminating infants with known predisposing and protecting factors from the development of IRDS. The incidence of IRDS was inversely related to the severity of maternal toxemia. The total mortality and mortality with IRDS were not significantly different in both HDOP and non-HDOP groups. When the infants did not develop IRDS, the mortality rate in the HDOP group was significantly higher than that in the non-HDOP group especially in the lower gestational age group. These data suggest that chronic stress accelerates fetal lung maturation and severe chronic stress is even more effective in accelerating fetal lung maturation. When maternal toxemia was severe enough to accelerate the fetal lung maturation, the mortality rate of the infants without IRDS increased.

Female↗
PubMed1979

The response to an oral glucose load during convalescence from hypoxia in newborn infants.

The ability to tolerate an oral glucose load during convalescence from hypoxia was studied in four term and 11 premature appropriate-for-gestational-age infants by sequential measurements of the changes occurring in blood pH, bicarbonate, plasma lactic acid, and plasma glucose following an oral glucose load. All infants developed metabolic acidosis and lactic acidemia after the oral glucose load. The maximum fall in blood bicarbonate occurred at 30 minutes, and the maximum rise in plasma lactic acid concentration was attained at 60 minutes. The metabolic changes were found to be more severe in infants given the oral glucose load early in their convalescence and in those infants less than 10 days of age. The absorption of glucose was also decreased in these infants, as shown by a reduced rise in blood sugar. These observations indicate that newborn infants, term or premature, tolerate glucose loads poorly during convalescence from hypoxia.

Acidosis↗
PubMed1977

Maternal ingested methadone, body fluid methadone, and the neonatal withdrawal syndrome.

The relationship between the quantity of methadone ingested by the pregnant mother, the quantity of methadone in maternal and neonatal body fluids, and the subsequent neonatal withdrawal course was studied. The severity of the neonatal withdrawal syndrome was found to be related to the total dose of methadone ingested by the mother during the last 12 weeks of pregnancy (p less than 0.02), the maternal dose of methadone at delivery (p less than 0.01), and the intrapartum serum methadone levels (p less than 0.01). The cord blood levels of methadone were consistently lower than the maternal serum levels. Amniotic fluid methadone levels were not constantly related to maternal or neonatal serum methadone levels. Concentrations of methadone 10 to 60 times greater than that of cord blood were found in neonatal urine.

Amniotic Fluid↗
PubMed1977

The high-risk perinatal registry. A systematic approach for reducing perinatal mortality.

A systematic and comprehensive review of all 320 perinatal deaths occurring in Nassau County in 1973 reveals that one-quarter of these deaths might have been prevented if modalities of care that were known and available at that time had been utilized appropriately. Preventability--the presence or absence of avoidable factors which might have materially lessened the risk of death --was determined for each perinatal death. Preventable deaths were disproportionately higher among postmature (P less than .01) and large-for-gestational-age (P less than .05) perinatal deaths, neonatal deaths after the first day of life (P less than .05), intrapartum fetal deaths (P less than .01), and perinatal deaths secondary to anoxia and idiopathic respiratory distress syndrome (P less than .01). The study concludes that rigorous application of currently available medical knowledge, the establishment of local perinatal mortality review committees, and vigorous outreach to practitioners are urgently needed to bridge the time gap between the development of new modalities of care and their application.

Adult↗