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Biomedical subjects

W P Fetter

Publications and source records attributed to W P Fetter.

At least 19 recordsLinked to original sources
PubMed2001

[Enterobacter cloacae epidemic on a neonatal intensive care unit due to the use of contaminated thermometers].

From December 1999 to March 2000 a nosocomial outbreak of multiresistant Enterobacter cloacae occurred in the neonatal intensive care unit (NICU) at the VU Medical Center, Amsterdam, the Netherlands. Twenty-six patients were infected or colonized with this strain resistant to third generation cephalosporins and with decreased sensitivity for aminoglycosides. Three neonates experienced sepsis with E. cloacae with serious clinical symptoms and two of them died. Comparison of the Enterobacter isolates by amplified-fragment length polymorphism indicated that this outbreak was caused by the spread of a single strain. Infection control precautions were initiated in order to stop further spread; barrier precautions, enforcement of hand disinfection and cohorting of colonized patients. A multidisciplinary crisis team coordinated these infection control precautions and informed all persons involved. Analysis of antibiotic usage in 1999 showed an increase in the use of third generation cephalosporins from November onwards. Due to the resistance pattern of the epidemic strain the use of third generation cephalosporins was discontinued in February 2000. At the end of February the NICU was temporarily closed. The epidemic strain of E. cloacae was isolated from one digital rectal thermometer. Patient use of thermometers and disposable coverings for rectal thermometers were introduced to eliminate this possible means of spread. No spread of multiresistant E. cloacae was found following the introduction of these interventions. Once all the neonates had been transferred, the NICU was disinfected and reopened in March.

Cephalosporin Resistance↗
PubMed2001

Neonatal respiratory morbidity following elective caesarean section in term infants. A 5-year retrospective study and a review of the literature.

Respiratory morbidity is an important complication of elective caesarean section. The presence of labour preceding caesarean section reduces the risk of neonatal respiratory morbidity. Recently, it has been shown that the incidence of respiratory morbidity is lower in infants with a gestational age of at least 39(+0) weeks at elective caesarean section compared to infants with a gestational age less than 39(+0) weeks.This article describes the results of a 5-year retrospective study on the incidence of respiratory distress in term neonates delivered by elective caesarean section in relation to gestational age and provides a literature review on neonatal respiratory morbidity following elective caesarean section.

Cesarean Section↗
PubMed1998

[Prone position favors motor development of infants].

OBJECTIVE: To determine the motor development in infants sleeping in the supine position compared to infants sleeping in the prone position, and to compare the levels of motor development of infants playing only in the supine position and of infants playing in the prone position as well. DESIGN: Prospective blinded comparing study. SETTING: Department of Physical Therapy, Maasziekenhuis, Boxmeer, the Netherlands. METHODS: Various measuring instruments were used in the home environment to determine the levels of motor development at the age of 5 months of 21 healthy infants born at term selected from a group of 160 infants attending the infant welfare clinic. RESULTS: Infants sleeping in the prone position (n = 8) showed a higher motor development than infants sleeping in the supine position (n = 13). Infants playing in the prone and supine position (n = 5) had a higher motor development than infants who played exclusively in the supine position (n = 15). CONCLUSION: Sleeping and playing in the prone position was accompanied by a higher motor development in healthy mature-born infants at the age of 5 months.

Child Development↗
PubMed1998

Thyroid hormone concentrations in preterm infants born to pre-eclamptic women with placental insufficiency.

The aim of this study was to compare thyroid function in preterm infants born to women with placental insufficiency (n = 15) and those born to women without placental insufficiency (n = 13). Gestational ages ranged between 28 and 33 weeks. Concentrations of free thyroxine (FT4), thyrotropin (TSH), triiodothyronine (T3) and reverse T3 (rT3) were measured by radioimmmunoassays in cord blood and on d 1, 3, 5, 7, 14 and 21. Infants born to the women with placental insufficiency had significantly lower mean FT4 (p = 0.001), TSH (p = 0.002) and rT3 values (p = 0.025) in cord blood, and higher rT3 values on d 5 (p = 0.019) and d 7 (p = 0.025). The following conclusions were reached: (i) preterm infants born to pre-eclamptic women with placental insufficiency have intact hypothalamic-pituitary-thyroid axes; (ii) compared to preterm infants born to healthy women, preterm infants born to pre-eclamptic women with placental insufficiency have lower FT4 and TSH concentrations before birth and (iii) elevated rT3 concentrations after birth, suggesting a temporarily impaired hepatic type 1 deiodination process.

Birth Weight↗
PubMed1997

[Hyperbilirubinemia in healthy full-term neonates: guidelines for diagnosis and treatment. Ad-hoc Commission Hyperbilirubinemia and Phototherapy of the Section Neonatology of the Netherlands Society for Pediatrics].

In healthy full-term neonates without haemolytic disease, hyperbilirubinaemia is not associated with neurological, auditory or cognitive disorders later in life. Therefore, the new threshold levels of hyperbilirubinaemia at which further diagnosis and treatment are indicated, are higher than the former ones.

Bilirubin↗
PubMed1997

[Hyperbilirubinemia in full-term neonates: sequelae for long-term development better than expected. Ad-hoc Commission Hyperbilirubinemia and Phototherapy of the Section Neonatology of the Netherlands Society for Pediatrics].

OBJECTIVE: Critical evaluation of guidelines for treatment of hyperbilirubinaemia in healthy full-term newborns, based on literature data concerning effects of hyperbilirubinaemia on later development. DESIGN: Structured literature survey. SETTING: Groningen, the Netherlands. METHODS: By electronic and hand searching of literature according to published guidelines data were collected on the relation between the peak total serum bilirubin concentration (TSB) in the first week of life and later development. RESULTS: One large study, the Collaborative Perinatal Project (CPP), showed statistically significant negative associations of TSB in the first week of life with Bayley development score at age 8 months, intelligence quotient (IQ) at age 4 years, and unspecified neurological abnormalities at age 7-8 years. In other studies, with considerable less power than the CPP, no such findings were made. In the original analyses of the CPP no correction was made for confounders and effect modifiers; after correction for such variables, a relation between TSB in the first week of life and later development was no longer found. At the age of 6 years, no statistically significant differences in IQ, hearing, and neurological abnormalities were found between children who, as newborns, had or had not been treated with phototherapy because of hyperbilirubinaemia. CONCLUSION: Treatment for jaundice in healthy full-term newborns is only indicated at considerably higher serum bilirubin levels than those recommended previously.

Bilirubin↗
PubMed1997

Ten-year neonatal hepatitis B vaccination program, The Netherlands, 1982-1992: protective efficacy and long-term immunogenicity.

From 1982 to 1989, 705 infants born to HBsAg-positive mothers entered the Dutch neonatal hepatitis B vaccination program and received passive-active hepatitis B immunization in three randomized controlled trials testing variations in time of starting active vaccination, dose and type of vaccine, and number of hepatitis B immunoglobulin (HBIg) injections. A meta-analysis of individual patient data of the three randomized trials was performed to determine which independent host and vaccination related factors influence protective efficacy and long-term immunogenicity, and to assess whether hepatitis B vaccination concomitant with standard DKTP vaccination provides optimal protection. Statistical methodology included multivariate logistic regression analysis. Eight infants (1.1%), all born to HBeAg-positive mothers, became HBsAg carriers within the first year of life. The protective efficacy rate (PER) of passive-active immunization at 12 months follow-up was 92% for the total group of children from 114 HBeAg-positive mothers with no significant differences between children starting active immunization at birth or at 3 months of age, between infants starting at 3 months of age receiving one or two doses of HBIg or between those receiving plasma derived or recombinant vaccine. The only factor that affected the PER significantly was the level of maternal HBV DNA; PER was 100% if maternal HBV DNA was < 150 pg ml-1 and 68% for HBV DNA levels > 150 pg ml-1. After 5 years of follow-up, the group that started active immunization at birth had significantly more infants with loss of seroprotection (anti-HBs levels < 10 IU l-1, 15%) than the corresponding group starting at 3 months of age (anti-HBs < 10 IU l-2, 2%). One of 35 children with loss of seroprotection at 2 years became a HBsAg carrier in the fifth year of follow-up. This meta-analysis shows that the protective efficacy of passive-active hepatitis B vaccination is mainly influenced by material HBV DNA levels, and independent of the time of starting active vaccination at birth or at 3 months of age; long-term immunity was enhanced by starting active vaccination concomitant with DKTP vaccination. These findings allow incorporation of hepatitis B vaccine into the standard infant immunization programs for countries with a passive-active immunization strategy for the control of hepatitis B. Additional measures are needed to protect neonates of highly viremic women.

DNA, Viral↗
PubMed1995

[How sick is the neonatal intensive care patient? Limited prognostic significance of the Neonatal Therapeutic Intervention Scoring System for mortality and for psychomotor development in the first year of life].

OBJECTIVE: To study the Neonatal therapeutic intervention scoring system (NTISS-score) as a prognostic indicator for mortality and psychomotor development in newborns admitted to an intensive care unit. DESIGN: Retrospective. SETTING: Neonatal intensive care unit, Sophia Hospital, Zwolle, the Netherlands. METHOD: The medical files of all neonates (n = 152) admitted for intensive care in 1991 were studied. The NTISS scores at admission were compared of infants with birthweights < 1500 g and > or = 1500 g and in these groups of infants who died and infants who survived and of infants with normal and with abnormal psychomotor development in the first year of life regardless of their birthweight (data of 110 children were available from outpatient clinic control or reports from paediatricians). RESULTS: 22 infants died. There was no significant correlation between NTISS score and birthweight or gestational age (r = -0.07 and -0.03 respectively). In the group of very low birthweight infants, the NTISS score was significantly higher of the infants who died (25.9; SD: 4.3) than of those who survived (15.9; 5.0). The NTISS score did not differ between infants with normal and with abnormal psychomotor development. CONCLUSION: The NTISS score at admission only correlates with mortality in infants with birthweights < 1500 g. There is no correlation with mortality in infants with birthweights > or = 1500 g, with gestational age or with psychomotor development in the first year of life.

Child Development↗
PubMed1995

Strabismus in very low birth weight and/or very preterm children: discrepancy between age of onset and start of treatment.

Very low birth weight (VLBW; less than 1500 g) and/or very preterm children are at risk for strabismus. However, the age of onset of strabismus is still unknown. The present study reports on the frequency of strabismus in 450 5-year-old children born with a birth weight of less than 1500 g and/or with a gestational age below 32 weeks. The age at which strabismus was initially diagnosed was determined retrospectively. At 5 years of age 65 of the at-risk children (14.4%) presented with strabismus. Fifteen of them (3%) had at that age not been referred to or treated by an ophthalmologist. At 3 years of age only 28 strabismic children were being treated; 7 at-risk children (2%) had been treated for strabismus before the end of the 1st year. These results were compared to those from a second study in which eye alignment was longitudinally examined in 194 VLBW children from 6 weeks until 12 months of (corrected) age and additionally in 65 of these children at the age of 2.5 years. At a first glance, the frequency of strabismus in the longitudinal study seemed rather stable during the first 2.5 years of life, with values varying between 14% and 18%. However, only a small percentage of misalignments which were noted at 6 weeks of age persisted until 2.5 years. On the other hand, if children had a misalignment at 9 months, strabismus was still present when they were reexamined at 1 and at 2.5 years of age.(ABSTRACT TRUNCATED AT 250 WORDS)

Age of Onset↗
PubMed1995

Neonatal transport by helicopter in The Netherlands: a 7-year overview.

In the Netherlands, neonatal intensive care is provided in 10 neonatal intensive care centres. Although antenatal transport is preferred, each year more than 1000 newborns are transported to the centres, in the majority of cases by ambulance. Transport by helicopter became available in 1987. From June 1987 till December 1993, 583 infants were transported by helicopter (median gestational age 32 weeks, range 24-43). Forty-four per cent had a gestational age of less than 32 weeks. Four hundred and forty-six infants were mechanically ventilated. No baby died in transfer. After admission, 101 infants died (18.4%). There were no accidents during transport Ten per cent of the requested flights was cancelled because of weather conditions. The mean transport time of the babies was 36 min (range 10-145), and the mean transport time of the transport teams was 128 min (range 20-345). The transports carried out from 1987 to 1989 were recalculated with regard to duration and cost, assuming they were carried out by ambulance instead of by helicopter: for the babies, the mean transport time by helicopter was 75% less than the calculated mean transport time by ambulance. However, the financial costs per transport were on average Dutch florins (DFL) 3000 higher by helicopter than by ambulance. In the Netherlands, the use of a helicopter for neonatal transport reduces the transport time, but doubles the costs.

Air Ambulances↗
PubMed1995

Surfactant replacement therapy in neonates with respiratory failure due to bacterial sepsis.

We describe four newborns (gestational ages 29-37 weeks; birthweights 1380-3040 grams) who were mechanically ventilated for respiratory insufficiency because of bacterial sepsis. A beneficial effect of bovine surfactant (Alvofact, dosages 50 or 100 mg/kg) was found, as shown by decreases in mean airway pressures and oxygen demands. No side effects were seen after instillation.

Bacterial Infections↗
PubMed1994

Minor neurological dysfunction and quality of movement in relation to neonatal cerebral damage and subsequent development.

Minor neurological dysfunction (MND) and quality of movement were studied in relation to neonatal cerebral damage and developmental assessments at 3 1/2 years of age in 66 very low-birthweight children without obvious disability. MND was found in 19 children and was significantly related to the quality of movement. The results demonstrate that MND is associated with neonatal cerebral damage at preschool-age, but that the assessment of quality of movement is associated with more complex sensory motor tasks and simultaneous processing. At preschool-age, quality of movement might therefore be a better marker of later learning problems than traditional signs of minor neurological dysfunction.

Brain Diseases↗
PubMed1994

Diagnostic value of plasma levels of tumor necrosis factor alpha (TNF alpha) and interleukin-6 (IL-6) in newborns with sepsis.

The aim of this study was to examine if TNF alpha and IL-6 plasma levels could be of value in diagnosing neonatal sepsis. Tumor necrosis factor alpha (TNF alpha) and interleukin-6 (IL-6) plasma levels were determined in 15 newborn infants with confirmed sepsis (group I), 18 with suspected sepsis (group II) and 22 control infants (group III). In 33 newborns, initially suspected of having sepsis (groups I and II), a positive test result for plasma concentration of TNF alpha (> 70 pg/ml) had a sensitivity of 73% and a specificity of 94%. A positive test result for IL-6 (> 500 pg/ml) had a sensitivity of 80% and a specificity of 78%. When plasma levels of TNF alpha and IL-6 were combined for the diagnosis of neonatal sepsis, a positive test result for both tests had a sensitivity of 60% and a specificity of 100%. When both tests are positive the diagnosis of neonatal sepsis is almost certain (likelihood ratio = infinity). The combination of TNF alpha and IL-6 determinations appears to be a good predictor of neonatal sepsis.

Biomarkers↗
PubMed1994

Absence of hepatitis B virus (HBV) DNA in children born after exposure of their mothers to HBV during in vitro fertilization.

During in vitro fertilization, 22 human embryos were exposed to hepatitis B virus (HBV) in contaminated human serum present in the culture medium. All mothers experienced hepatitis B during the first trimester of pregnancy, and two had hepatitis B surface antigen and HBV DNA, as determined by PCR, at the time of delivery. No HBV DNA was found in serum or lymphocytes from the exposed 22 infants. HBV DNA was also absent from one infant at autopsy.

Culture Media↗