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Biomedical subjects

S Shankaran

Publications and source records attributed to S Shankaran.

77 records · Page 5Linked to original sources
PubMedDate not supplied

Identifying at risk infants following neonatal extracorporeal membrane oxygenation.

OBJECTIVE: To identify infants at risk of death and abnormal neurodevelopmental outcome following extracorporeal membrane oxygenation (ECMO) in the neonatal period. METHODS: The medical records of 82 neonates treated with ECMO were reviewed to evaluate risk of death. All survivors were followed by neurologic examinations and tested using the Bayley Scales of Infant Development or McCarthy Scale of Children's Abilities, and risk for abnormal neurodevelopmental outcome was assessed. RESULTS: The overall survival was 91% (75 of 82). The mean gestational age and birth weight of nonsurvivors were lower than those of survivors (37 +/- 1 weeks vs 40 +/- 0 weeks; 2734 +/- 230 vs 3325 +/- 69 gm, p < 0.05). Infants who were lost to follow-up (16%) did not differ from those with follow-up in demographic variables or clinical indicators of illness severity. Thirty-five of 63 infants (56%) with follow-up had normal neurodevelopmental outcome. Risk of abnormal outcome was higher in infants requiring assisted ventilation for > or = 15 days (relative risk [RR] 5.5; 95% confidence interval [CI] 2.0 to 14.8), supplemental oxygenation for > or = 22 days (RR 3.1; 95% CI 1.3 to 7.6), and black race (RR 8.9; 95% CI 1.3 to 62.9). None of the neuroimaging studies accurately predicted the neurodevelopmental outcome of these infants. CONCLUSION: We conclude that ECMO in critically ill infants is associated with good survival. The need for prolonged respiratory support may help in identifying infants at risk for abnormal neurodevelopmental outcome.

Cause of Death↗
PubMedDate not supplied

Early-onset neonatal group B streptococcal sepsis: intrapartum antibiotic prophylaxis in the clinical setting.

OBJECTIVE: To evaluate how guidelines for the use of intrapartum antibiotics for the prevention of early-onset Group B streptococcal infection are utilized in a clinical setting. STUDY DESIGN: Review of maternal/infant records for the year 1993 in a perinatal center. RESULTS: Intrapartum antibiotics were administered to 77.8% of 443 Group B streptococcus (GBS)-colonized women. There were 452 infants born to these mothers, of which four developed GBS infection. During the same period, an additional 11 infants with GBS infection were born to women with "negative" or "unknown" GBS status (the women did not receive intrapartum antibiotics). Infants of GBS-colonized women who had not receive antibiotics were more likely to develop infection than GBS negative or unknown status, odds ratio 9.0, 95% confidence interval (2.8-29.1). CONCLUSION: This study supports the use of intrapartum antibiotics as an important means of preventing early-onset neonatal GBS infection but demonstrates problems that may be encountered in the clinical application of guidelines for intrapartum antibiotic prophylaxis.

Adult↗
PubMedDate not supplied

Subcapsular hemorrhage of the liver in the very low birthweight neonate.

Between 1974 and 1989, 15 neonates were found, at autopsy, to have subcapsular hematoma of the liver in a retrospective clinicopathologic study of 644 neonates. The majority (75%) of the neonates were less than 28 weeks gestation, male gender, and were delivered by the vaginal route following a complicated pregnancy and labor including malpresentation. The clinical course included resuscitation at birth, ventilatory support and hypovolemic shock with death occurring within 24 hours in 11 neonates. Other clinical events included air leak (n = 4 infants) and infection (n = 4). Intracranial hemorrhage was suspected in all but was found at autopsy in 8 neonates. The subcapsular hematoma was intact in 7 and ruptured in 8 neonates. Hence, subcapsular hemorrhage of the liver should be considered in the differential diagnosis of hypovolemic shock in very low birthweight infants.

Autopsy↗
PubMedDate not supplied

Recombinant human erythropoietin therapy for treatment of anemia of prematurity in very low birth weight infants: a randomized, double-blind, placebo-controlled trial.

OBJECTIVE: To evaluate the efficacy and safety of recombinant human erythropoietin (rHuEPO) in very low birth weight infants with anemia of prematurity. STUDY DESIGN: Thirty infants were randomly assigned to receive either rHuEPO (300 U/kg per dose) or placebo twice a week. Hematologic parameters, transfusion requirements, caloric intake, and growth were monitored. RESULTS: The number and volume of erythrocyte transfusions were significantly lower in infants treated with rHuEPO. Serum ferritin levels, similar in both groups at study entry, fell and were significantly lower in rHuEPO-group infants at the completion of the study. An inverse correlation was observed between reticulocyte count and absolute neutrophil count both at entry and at completion of the study. CONCLUSION: Twice-a-week administration of rHuEPO significantly reduces the need for erythrocyte transfusion in very low birth weight infants in stable condition. A significant decrease in serum ferritin levels in infants receiving rHuEPO suggests the need to determine the optimal dose of iron supplementation in these infants.

Anemia, Neonatal↗