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T Dolfin

Publications and source records attributed to T Dolfin.

35 records · Page 2Linked to original sources
PubMed1996

Transient gastric outlet obstruction and tetralogy of Fallot: a true association or a coincidental finding?

Infants suffering from congenital heart anomalies who are receiving intravenous prostaglandins may present with gastric outlet obstruction. We describe a newborn with tetralogy of Fallot who was not being treated with prostaglandins and presented with gastric outlet obstruction. The typical clinical and radiological signs of infantile hypertrophic pyloric stenosis resolved spontaneously within several days. We suggest that there may be an association between cyanotic heart disease and gastric outlet obstruction unrelated to the use of prostaglandins.

Abnormalities, Multiple↗
PubMed1996

Failure of early postnatal dexamethasone to prevent chronic lung disease in infants with respiratory distress syndrome.

OBJECTIVE: To study the effect of early postnatal dexamethasone (days 1-3) on the incidence and severity of chronic lung disease in preterm infants with respiratory distress syndrome. METHODS: A multicentre, randomised, placebo controlled, blinded study was carried out in 18 neonatal intensive care units in Israel. The primary outcome measure was survival to discharge without requirement for supplemental oxygen therapy beyond 28 days of life. The secondary outcome measures were requirement for mechanical ventilation at 3 and 7 days, duration of ventilation or oxygen therapy, need for subsequent steroids for established chronic lung disease and incidence of major morbidities. RESULTS: The study consisted of 248 infants (dexamethasone n = 132; placebo n = 116). No differences were found in the outcome variables except for a reduction in requirement for mechanical ventilation at age 3 days in treated infants (dexamethasone 44%, placebo 67%; P = 0.001). Gastrointestinal haemorrhage, hypertension, and hyperglycaemia were more common in treated infants, but no life threatening complications, such as gastrointestinal perforation, were encountered. CONCLUSIONS: These data do no support the routine use of early postnatal steroids, but may justify further study in a selected, high risk group of infants.

Birth Weight↗
PubMed1995

Survival rate and 2 year outcome in very low birthweight infants.

The purpose of this study was to determine the mortality rate of 282 infants with a birthweight (BW) of < 1,500 g during a 5 year period (1987-92), and to evaluate 2 year neurodevelopmental outcome in 114 infants (born 1987-90) and its correlation with intracranial pathologies diagnosed by ultrasonography. Overall survival rate was 76.6% (216/282). With the introduction of exogenous surfactant therapy in 1991 a significant increase in survival was noted in the 751-1,000 g BW infants (from 20/36 to 20/22, P < 0.002). Two year evaluation was performed in 114 of 119 infants (95.7%) who survived this age. Twenty-two children (22/114, 19.3%) were functionally disabled, of whom 15 (13%) had a major disability. Of these 15 infants, 5/28 weighed < 1,000 g and 10/86 weighed 1,001-1,500 g (P = 0.6). Severe intraventricular hemorrhage (IVH) and cystic periventricular leukomalacia (PVL) were significantly associated with adverse outcome at 2 year (5/11 and 10/10 respectively were handicapped, P < 0.001). We therefore conclude that every effort should be made to save the extremely premature infants (< 1,000 g BW). Since adverse outcome was significantly associated with severe brain pathologies (large IVH and cystic PVL) rather than with lower BW, brain ultrasonography as a diagnostic mode should be taken into clinical consideration.

Cerebral Hemorrhage↗
PubMed1994

Effect of surfactant replacement therapy on the outcome of premature infants with respiratory distress syndrome.

Lung surfactant replacement has been tested clinically in recent years. In this study the outcome of 31 premature infants with moderate to severe neonatal respiratory distress syndrome (RDS) treated with surfactant was compared to that of 74 prematures with RDS treated conventionally by positive pressure ventilation and supportive care. The groups were well matched for gestational age, birthweight, sex, and Apgar scores at 1 and 5 min. Surfactant treatment resulted in a significant decrease in mortality--from 36.6% in the untreated group to 12.9% in the surfactant-treated group (P < 0.04). This improvement in survival was seen also in prematures with a birthweight < 1,000 g; in the untreated group mortality was 57.6% compared to 23.5% in the treated group (P < 0.05). The incidence of pneumothorax was lower in the treated group--42% vs. 13% (P < 0.01). Surfactant treatment resulted in a trend of more survivors without bronchopulmonary dysplasia or intraventricular hemorrhage, even though surfactant therapy did not change the incidence of either.

Bronchopulmonary Dysplasia↗
PubMed1992

Polycythemia of the preterm and full-term newborn infant: relationship between hematocrit and gestational age, total blood solutes, reticulocyte count, and blood pH.

The umbilical venous hematocrit at birth (Hct 1) and the peripheral venous hematocrit at 2 h of life (Hct 2) were determined in 78 healthy full-term and 14 healthy preterm newborn infants. Hct 1 was 51.6 +/- 4.1% in full-term infants and 50.8 +/- 4% in preterm infants. Hct 2 was 60.9 +/- 2 and 58.6 +/- 6.1% in full-term and preterm infants, respectively. Significant differences between Hct 1 and Hct 2 were found in both groups of infants (p less than 0.01). The blood viscosity increased significantly in both groups from birth to 2 h of life. Neonatal polycythemia (Hct higher than 70% at 2 h of life) was detected in only 3 full-term infants (3.8%). They received partial exchange transfusion. There was a positive linear correlation of Hct 1 with Hct 2 in full-term newborns (r = 0.71, p less than 0.001) and preterm infants (r = 0.57, p less than 0.02). No infants with Hct 1 equal to or below 50% had Hct 2 higher than 65%. None with Hct 1 between 51 and 54% had Hct 2 higher than 70%. Neither Hct 1 nor Hct 2 correlated with birth weight, gestational age, total blood solutes, or reticulocyte counts at birth in either group. An inverse linear correlation was found between blood pH at birth and Hct 2 in preterm newborn infants (r = 0.66, p less than 0.02).

Birth Weight↗
PubMed1990

Intrapericardial extralobar pulmonary sequestration in a neonate.

A huge pericardial effusion was diagnosed during fetal ultrasound examination performed in the 42nd week of pregnancy on a healthy 25-year-old woman. Immediately after the birth, a two-dimensional echocardiogram confirmed this finding in the infant, and an intrapericardial kidney-shaped solid mass measuring 45 x 56 x 15 mm, completely surrounded by pericardial effusion, was visualized to the left part of the heart. The heart was normal. No signs of cardiac tamponade were seen. At the age of two days, the mass was surgically resected and the pericardial fluid evacuated. Microscopic examination revealed that the mass was formed totally of normal lung tissue surrounded by normal pleura. To the best of our knowledge, this is the first case of intrapericardial extralobar sequestration consisting of an accessory lung with completely normal lung tissue.

Adult↗
PubMed1985

Mode of delivery in the low birth weight fetus. Delivery by cesarean section independent of fetal lie versus vaginal delivery in vertex presentation. A study with long-term follow-up.

In a paired controlled multicenter study of patients in preterm labor of unknown etiology without additional maternal or fetal complications, 59 low birth weight infants in vertex presentation born vaginally were compared with 59 infants delivered by cesarean section. In the early postpartum period, hypothermia and acidosis occurred more often in the vaginal delivery group. The rate of respiratory disorders and need for assisted ventilation did not differ between the groups. Persistent ductus arteriosus occurred in 19% in the vaginal delivery group and in 7% in the abdominal delivery group. At follow-up until 18-24 months of age the rate of cerebral palsy did not differ between the groups, whereas the rate of psychomotor retardation was significantly higher in the vaginal delivery group (p less than 0.05). The difference in percentage of total outcome, i.e. sum of mortality and neurodevelopmental sequelae, being 20.3% in the vaginal delivery group versus 8.5% in the cesarean section group, fails to reach a statistical significance, but the results suggest that for the low birth weight infants, vaginal delivery may be more hazardous than abdominal delivery.

Adult↗
PubMed1984

Diagnosis and evolution of periventricular leukomalacia: a study with real-time ultrasound.

Periventricular leukomalacia is an ischemic lesion in periventricular white matter of premature infants. Hemorrhage into the ischemic area occurs in up to 25% of cases. We report two cases in which the diagnosis of periventricular leukomalacia was made during life with real-time ultrasound scanning. In one case, serial scans demonstrated the evolution of echodense regions, observed in the first 3 days of life, to cystic echolucent areas at 4 weeks. In the second case, periventricular echodense areas did not precede the occurrence of cystic echolucent lesions. This may reflect a more chronic ischemic cerebral insult (consistent with recurrent apnea and bradycardia) rather than a presumed acute episode of cerebral ischemia (with or without secondary hemorrhage) sustained by the first case. Real-time ultrasound scanning is a simple, non-invasive technique with which to document the evolution of periventricular leukomalacia, and thus to define the clinical neurological correlates in the neonatal period.

Brain Ischemia↗
PubMed1984

Perinatal factors that influence the incidence of subependymal and intraventricular hemorrhage in low birthweight infants.

A total of 95 preterm infants, delivered consecutively in a perinatal center, over a 9-month period, were studied serially with real-time ultrasound for detection of subependymal/intraventricular hemorrhage (SEH/IVH); all infants were less than or equal to 32-week gestation and/or less than or equal to 1500 gm birthweight. Detailed statistical analysis was carried out to determine the influence of perinatal factors on the occurrence of SEH/IVH. The incidence of SEH/IVH was 34%; severe hemorrhage (Grade III-IV) occurred in only 13%. Gestational age was an important factor associated with SEH/IVH. Thus, the incidence in infants less than or equal to 29-weeks gestation was 45%, whereas in infants greater than 29-weeks gestation age, it was 19% (p less than 0.01). The overall incidence of SEH/IVH in the group which was less than or equal to 29-weeks gestation and delivered by cesarean section was 53%, whereas in those infants delivered vaginally it was 47%. In infants whose gestational age was less than or equal to 29-weeks, the incidence of hemorrhage was 47% if delivered vaginally and presenting as a vertex and 31% if delivered by cesarean section. In infants greater than 29-weeks gestation, the incidence of SEH/IVH was 42% in those delivered by the vaginal vertex route, 5% if presentation was vertex and delivered by cesarean section (p less than 0.05). In infants greater than 29-weeks gestation, cesarean section in vertex presentation decreased the incidence of SEH/IVH when compared with vaginal vertex delivery.(ABSTRACT TRUNCATED AT 250 WORDS)

Cerebral Hemorrhage↗
PubMed1983

Effects of a face mask and pneumotachograph on breathing in sleeping infants.

The effect of facial attachments on breathing was measured by respiratory induction plethysmography (RIP) during quiet sleep in 32 studies in 18 infants. The addition of a face mask plus pneumotachograph led to an increase in tidal volume (VT) (22.0 +/- 13.5%, p less than 0.01) during 5-min sleep studies when compared to measurements using RIP alone. Applying only the mask rim also led to an increase in VT (14.6 +/- 3.1%, p less than 0.05). A significant increase in VT was noted in 3 of 6 infants studied when a lightweight cardboard ring was in place perinasally. Respiratory frequency fell significantly in the mask/pneumotachograph group (-5.9 +/- 10.0%, p less than 0.05) and with the mask rim (-7.4 +/- 8.8%, p less than 0.01), but there was individual infant variation. Minute ventilation rose significantly (19.1 +/- 16.9%, p less than 0.01) only with the addition of the mask and pneumotachograph. Instrument deadspace can account for some of the increase in VT noted, but in its absence, sensory stimulation of the trigeminal area can augment tidal breathing.

Humans↗
PubMed1983

Incidence, severity, and timing of subependymal and intraventricular hemorrhages in preterm infants born in a perinatal unit as detected by serial real-time ultrasound.

Real-time ultrasound scans were performed on 66 low-birth-weight infants within the first six hours of life (mean, two hours), and then at 12, 24, 48, and 72 hours, and thereafter at weekly intervals. All of the infants were born in a perinatal unit. The incidence of intraventricular hemorrhage and subependymal hemorrhage was 31%. Eight of 20 infants had small hemorrhages (Papile, grades I and II); seven infants sustained grade III hemorrhages, and five infants sustained grade IV hemorrhages. All hemorrhages occurred in the first 72 hours of life; 25% were diagnosed with the first scan (ie, within the first six hours of life). The infants especially at risk were those less than 29 weeks' gestation. Five infants developed progressive posthemorrhagic ventriculomegaly that subsided spontaneously by age 8 weeks. The mortality in the study group was only 4.5%.

Cerebral Hemorrhage↗
PubMed1982

Calibration of respiratory induction plethysmography (Respitrace) in infants.

To determine whether the recently increased sensitivity of the variable frequency oscillator and the use of separate rib cage and abdominal transducers made calibration of the Respitrace system easier, we performed 106 different calibration procedures against a pneumotachygraph in 36 normal infants, 41 using 2 separate periods of quiet sleep, 49 using quiet and REM sleep, and 16 using 2 separate periods of REM sleep. When the calibration was done using 2 separate periods of quiet sleep, or using periods of quiet and REM sleep, a change of at least 50% in the amplitudes of both the abdominal and rib cage signals between the 2 sleep periods, gave accurate calibration factors in 92%, compared with only 30% when the amplitude of either signal changed by less than 50%. Calculation of the calibration factors can be done either by the least squares method or by solving simultaneous equations with no significant difference between the results.

Humans↗
PubMedDate not supplied

Acinetobacter septicemia: a threat to neonates? Special aspects in a neonatal intensive care unit.

Acinetobacter is one of the organisms responsible for nosocomial infections in intensive care, neurosurgery, burn and hemodialysis units. There are only a few reports on Acinetobacter infections in neonatal intensive care units. Over a 31 month period, nine cases of Acinetobacter sepsis occurred in our unit, with four deaths. There was a cluster of four cases within 3 days. In this study the English literature on this pathogen is reviewed and it is suggested that Acinetobacter should be added to the list of organisms causing severe nosocomial infection in neonatal intensive care units.

Acinetobacter↗
PubMedDate not supplied

Some aspects of the humoral immunity and the phagocytic function in newborn infants.

Newborn infants, particularly those born prematurely, are prone to develop life-threatening pyogenic infections. Different studies have demonstrated impairment of various aspects of the humoral immunity and the phagocytic activity of neutrophils in newborns. We conducted a comprehensive study evaluating the complement function (CH50 and AP50) and the level of the vast majority of the complement components (Clq, Clr, Cls, C2-C9, FB and properdin) in preterm and full-term newborn infants as compared to adults. Furthermore, we investigated the effect of autologous and heterologous serum on the bactericidal activity of neutrophils, by crossing newborn serum with adult cells and vice versa. Results showed that preterm and full-term newborns have an impaired complement activity as compared to adults (CH50 P < 0.05, AP50 < 0.01) and significantly reduced complement components except for C7, which was found to be normal in full-term infants and in most appropriate-for-gestational age preterm newborns at 34-36 weeks. A statistically significant correlation was found between gestational age and the level of most of the complement components. CH50 and AP50 also showed a positive trend which, however, was not statistically significant. No correlation was found between birthweight and complement activity or complement component levels. The neutrophil bactericidal activity of full-term newborns was about one-third that of adults (P < 0.001). Adult serum improved the bactericidal activity of newborn neutrophils by 93%, indicating a considerable neonatal humoral defect. Conversely, neonatal serum blunted the adult bactericidal activity by 86%. Our results support the fact that both humoral and phagocytic functions in newborn infants are impaired, which may possibly account for their increased tendency to develop severe pyogenic infections.

Adult↗
PubMedDate not supplied

Urinary tract infection in premature infants: the role of imaging studies and prophylactic therapy.

BACKGROUND: The prevalence of urinary tract infection (UTI) in premature infants ranges from 4% to 25%. It is surprising, however, that scant information exists regarding management of UTI in premature infants, particularly the need for radiologic evaluation of the urinary tract and the use of preventive antibiotic therapy after the first episode of UTI occurs. The aim of this study was to answer these questions. PATIENTS AND METHODS: Twenty-seven (8%) premature infants (< 1750 gm birth weight) born during the period from 1990 through 1993 had UTI. Eleven of them were of extreme low birth weight (ELBW) (birth weight < 1000 gm). Ultrasound examination of the urinary tract was performed in all premature infants 7 days after a diagnosis of UTI was made and was repeated 1 month later, if disease was detected. Voiding cystography was performed in 21 premature infants (8 with ELBW) 6 to 8 weeks after a diagnosis of UTI was made. RESULTS: The mean birth weight of premature infants with UTI was 1112 +/- 294 gm. The prevalence of UTI was significantly higher (p < 0.01) in infants with ELBW (13%) compared with that in premature infants with birth weight >1000 gm (6%). The male/female ratio in all premature infants was 2.9:1 and was significantly higher in infants with ELBW (10:1; p < 0.01). Organisms involved were Klebsiella (59%), Candida albicans (15%), Escherichia coli (15%), and Enterobacter (11%). Only premature infants with ELBW had Candida UTI. Five premature infants (four with ELBW) had mild transient hydronephronis, and one had persistent hydronephrosis and hydroureter. Voiding cystography showed that three premature infants had vesicoureteral reflux and that one had a bladder diverticulum. All premature infants with pathologic voiding cystography had birth weight >1000 gm and had normal ultrasound examination. CONCLUSIONS: Premature infants with birth weight 1000 to 1750 gm should be given preventive antibiotic therapy at least until imaging evaluation (ultrasonography and voiding cystography) is complete. Premature infants with ELBW are more susceptible to fungal infection and do not seem to have underlying urinary tract abnormalities. Prophylactic therapy and voiding cystography may be unwarranted in this population subset.

Anti-Bacterial Agents↗