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Biomedical subjects

W Rosenfeld

Publications and source records attributed to W Rosenfeld.

At least 19 recordsLinked to original sources
PubMed1996

Parents' evaluations of wheezing in their children with asthma.

OBJECTIVE: Wheezing is a widely used physical sign of asthma that physicians assess in evaluation of their asthmatic patients. It may be possible to teach the parents to recognize it and to assess its severity so as to help them make better informed judgment in monitoring their children with asthma. STUDY DESIGN: Parents were taught to recognize wheezing by placing their ear over the chest and in front of the open mouth of their child. One session lasting a few minutes was sufficient for teaching. Subsequently, the parent and a physician evaluated the child independently for the presence and the severity of wheezing categorized as easily, barely, and none detected, and results were compared. Severity of wheezing was also compared with peak expiratory flow rate (PEFR) whenever possible. RESULTS: Six hundred thirty-six observations were made in 89 parent-child pairs. Wheezing was detected by the physician in 64% of examinations and by the parents in 56% (p < 0.001 by chi 2). When the physician heard the wheezing easily on 240 occasions, the parents also heard it in 99%. When the physician heard the wheezing barely on 170 occasions, the parents heard it only on 68% of the time. Mean PEFR was 55% predicted when the parents heard the wheezing easily, 75% when heard barely, and 93% when not heard (the difference is significant, p < 0.001 by analysis of variance). CONCLUSIONS: Parents can be taught to detect wheezing in their child with considerable accuracy when it is easily detectable to a physician. Such skills should be helpful to the parents in monitoring their child with asthma and in deciding when to increase medications and when to seek emergency care.

Adolescent↗
PubMed1992

Oxygen affects human endothelial cell proliferation by inactivation of fibroblast growth factors.

The fibroblast growth factors (FGF), including endothelial cell growth factor (ECGF)/acidic FGF and basic FGF, are important modulators of endothelial cell replication in vitro and in vivo. Premature infants and adults with lung injuries are often treated with high levels of inspired O2, which can be necessary for survival but potentially injurious to developing lungs and in tissue repair following injury. Human umbilical artery and vein endothelial cells were grown in ECGF- or FGF-supplemented Medium 199 and exposed to ambient levels of O2 from 10 to 95%. Endothelial cell growth, measured by [3H]thymidine incorporation, was inhibited by increasing levels of O2 and ceased above 50% O2. Vein endothelial cells could recover from up to 24 h of hyperoxic exposure when given fresh medium, but not after 48 h. Artery-derived cells were more sensitive to O2 than were vein-derived cells. Complete medium without endothelial cells, preincubated 24 h in 95% O2, lost its ability to support cell growth under normoxic conditions. Exposing individual medium components to high O2 demonstrated that purified natural ECGF and recombinant acidic or basic FGF were all inactivated by O2. Human recombinant superoxide dismutase prevented FGF inactivation. O2 inactivation of essential growth factors could thus have major consequences for lung development or repair of injured capillaries in infants or adults inspiring high levels of O2.

Cell Division↗
PubMed1991

Impact of pediatricians' attire on children and parents.

To evaluate perceptions of a pediatrician's attire, 50 children and parents in an outpatient facility were shown five photographs of a female or a male physician dressed differently (formal to informal). A list of positive and negative attributes was presented to the parents and children who were to match each picture to the attributes. Parents had a strong positive preference for the formally dressed female (short white coat and skirt), and the formally dressed male (short white coat and tie). More than 50% of the parents least preferred the most informal attire. Children had no clear preferences for males and preferred the female in the blouse and skirt. Children assigned negative attributes to informal attire but not to the same degree as did their parents. This study demonstrates that parents have stronger preferences than do their children. Although children had no strong positive preferences, they may feel negatively about informal attire.

Adolescent↗
PubMed1990

Clavicular fractures in neonates.

We evaluated the wide variation in the reported incidence of fractured clavicles (0.2% to 3.5%) in newborns by screening 626 consecutive infants delivered vaginally for fractures. One of us (P.R.J.) evaluated all infants, twice during the initial hospital stay and 2 weeks later. Eighteen fractured clavicles were identified for a frequency of 2.9% (18/626). One fracture was discovered on the first hospital examination, 10 on discharge, and 7 at follow-up. Only 2 patients had symptoms usually associated with fractured clavicles. The most reliable clinical sign for in-hospital diagnosis was difficulty in feeling the margins of the affected clavicle when compared with the normal clavicle. The mean birth weight of the infants was 3604 g (range, 3000 to 4930 g), and no obstetric complications occurred. The reported frequency of fractures diagnosed clinically during hospitalization significantly underestimates their occurrence. Most newborn infants with fractures have no symptoms and minimal physical findings during the first days of life, making repeated examination necessary.

Clavicle↗
PubMed1990

A new device for phototherapy treatment of jaundiced infants.

A new device for phototherapy consisting of a fiberoptic panel attached to an illuminator was compared with traditional phototherapy (4 special blue and 4 daylight bulbs). The panel surrounds the trunk eliminating eye patching and allowing more time for maternal-infant interaction. Forty-six jaundiced term neonates were studied. Two groups, nonhemolytic (n = 26) and hemolytic (ABO) (n = 20) jaundice, received fiberoptic or traditional phototherapy. In both groups, fiberoptic and control patients had similar weights, gestational ages, bilirubin levels and ages at entry. Post-therapy weights and duration of therapy were also similar. In the nonhemolytic fiberoptic group, there was a trend toward greater decreases in mean bilirubin levels at 12, 24, 36, and 60 hours with significant reduction at 48 hours of therapy (-2.8 vs -.5 mg/dL; P = .04). In the hemolytic group, bilirubin fell continuously in the fiberoptic group and after 36 hours in the traditional group. At 36 hours there was a trend toward a greater decrease in mean bilirubin for the fiberoptic group (-1.8 vs + 1.9 mg/dL; P = .08). There were no complications of therapy. The fiberoptic panel proved effective and safe; eliminated the need for eye patches; and permitted greater time for maternal-infant bonding.

Anemia, Hemolytic↗
PubMed1990

Improvement of neutrophil migration by systemic vitamin C in neonates.

The effect of oral vitamin C on chemotactic and random migration of neutrophils in 20 neonates (10 normal and 10 with suspected sepsis) was evaluated. Chemotaxis and random migration were studied between 24 and 48 hours of life, before and 24 hours after the administration of 400 mg (divided in four doses) of vitamin C. Chemotactic migration improved by 65% and random migration by 57% following vitamin C administration. The significant improvement in chemotaxis (P less than .01) and random migration may justify the inclusion of vitamin C as an adjunct to the therapy of neonatal sepsis.

Ascorbic Acid↗
PubMed1989

Ischemic injury to newborn rabbit ileum: protective role of human superoxide dismutase.

The effectiveness of human superoxide dismutase (hSOD) in the prevention of reperfusion injury was evaluated in a rabbit ileal loop model. Weanling white New Zealand rabbits, 6 weeks of age and weighing 500 to 1,000 g, were used. Intraluminal administration of SOD (5 mg/kg) was studied in 12 animals with each animal serving as its own control. In an additional 12 animals, parenteral SOD in a dose of 5 mg/kg in seven animals and 10 mg/kg in five animals was evaluated, while five additional control animals received parenteral saline. The effect of reperfusion injury was evaluated in each bowel loop by interruption of blood supply for five minutes, followed by reperfusion. Blood was drawn at 0, 16, 20, 24 hours in the parenteral group for measurement of hSOD levels by radioimmunoassay. The loops were studied pathologically for extent of mucosal damage. In the intraluminal group, nine of 12 loops without SOD v three of 12 loops with SOD showed necrosis when rendered ischemic (P = .0196). In the parenteral group 22 of 24 loops were normal when pretreated with SOD and subjected to ischemia v five of ten when no SOD was given (P = .0139). In the parenteral group, mean baseline level of hSOD was 0.42 +/- 0.26 micrograms/mL. Levels peaked at 16 hours (3.64 +/- 1.75 micrograms/mL) and progressively decreased at 20 hours (2.85 +/- 1.34 micrograms/mL) and 24 hours (1.82 +/- 1.15 micrograms/mL). This preliminary animal study suggests that hSOD may be an effective method for the prevention of postischemic bowel injury, adding to the literature on the protective effects of SOD in various models of intestinal ischemia.

Animals↗
PubMed1989

Phenytoin and phenobarbital concentrations in serum: a comparison of Ames Seralyzer with GLC, TDX, and EMIT.

A recently developed system for measuring antiepileptic drug concentrations was evaluated for phenytoin and phenobarbital. The apoenzyme reactive immunoassay system was compared with gas-liquid chromatography, EMIT, and TDX systems. Comparisons were performed with control specimens and with sera obtained from patients at three facilities. Precision for all methods was similar, with within-run and between-run coefficients of variation generally 5%. The accuracy of all methods was acceptable, but bias was present in some. However, measurements obtained by a nontechnical person (physician) in a clinical setting were sometimes inaccurate.

Chromatography, Gas↗
PubMed1986

Endogenous antioxidant defenses in neonates.

Deficiencies of antioxidant defenses have been postulated as possible mechanisms in the development of bronchopulmonary dysplasia (BPD). Neonates, especially prematures with respiratory distress syndrome (RDS), are exposed to high oxygen tensions for prolonged periods. To evaluate the neonates' ability to respond to an oxygen challenge with increased superoxide dismutase (SOD), 9 prematures were studied immediately at birth and on days 1, 3, 5, and 7. An increase in plasma levels was noted during the first week of life in the patients who were exposed to oxygen. The mean endogenous SOD level at birth was 1.28 microgram/ml. On day 1, plasma SOD rose to 1.53 microgram/ml and to 2.25 micrograms/ml on day 3 (P = .003). This trend continued into the fifth and seventh days. Whether this increase in SOD has clinical significance in the prevention of BPD requires further investigation.

Antioxidants↗
PubMed1986

Oxidant-mediated lung disease in newborn infants.

High concentrations of oxygen are administered with increased airway pressure to most preterm neonates with respiratory distress syndrome (RDS). Among 20% to 30% of survivors a form of chronic lung disease, bronchopulmonary dysplasia (BPD), develops. Its pathogenesis may include tissue damage caused by the superoxide anion (O2-) and other free oxygen radicals. Animal experiments and other data suggested a rationale for superoxide dismutase (SOD) administration in an effort to prevent or ameliorate BPD. Our preliminary studies in 19 prematures with RDS demonstrated its safety in human newborns and permitted measurement of its plasma levels. No adverse clinical findings occurred, and laboratory parameters were unchanged. Subcutaneous administration (0.25 mg/kg) of bovine SOD led to detectable levels at 1 1/2 h (mean 0.22 microgram/ml), with a slight rise to a higher peak at 2 1/2-4 h and a plateau over the remainder of the 12-h interval. Following doses 2-5, peak levels of 0.64 microgram/ml occurred at 4-8 h. With this background, a prospective double-blind controlled study of 45 neonates (mean gestational age, 29 weeks; birth weight, 1,100 g) showed a statistically significant reduction in prevalence of clinical and X-ray signs of BPD with fewer days of continuous positive airway pressure required. The safety and pharmacokinetics of bovine SOD were confirmed.

Antioxidants↗
PubMed1986

Serial trypsin inhibitory capacity and ceruloplasmin levels in prematures at risk for bronchopulmonary dysplasia.

Oxidant injury and release of proteolytic enzymes in prematures with respiratory distress syndrome (RDS), who are treated with ventilators and oxygen, have been postulated as possible causes of bronchopulmonary dysplasia (BPD). The premature may be at particular risk due to low levels of antiproteases, such as alpha-1-proteinase inhibitor (alpha 1PI), and antioxidants, such as ceruloplasmin (CER). Both alpha 1PI and CER deficiencies have been correlated with the severity of RDS. We studied serial alpha 1PI activity as measured by trypsin inhibitory capacity (TIC) and CER in the serum 27 prematures who required ventilator therapy for RDS. Serum TIC values for day 1 were significantly lower (0.34 vs. 0.92 mg inhibited/ml of sample) in the 13 patients who developed BPD compared to the 14 who did not. No significant differences were seen on succeeding days. No significant differences in CER were seen, although both groups had levels 33-50% of adult normals (11.3 vs 9.3 mg/dl). Other significant variables included birthweight (p less than 0.005), severity of RDS (p less than 0.03), and gestational age (p less than 0.03). One way analysis of variances demonstrated day 1 TIC to be the most significant variable (p less than 0.0001), followed by weight (p less than 0.007), severity RDS (p less than 0.04), and gestational age (p less than 0.03). CER levels were not a significant variable. A formula utilizing unstandardized canonical discriminant function including day 1 TIC, birthweight, severity of RDS, and gestational age was 100% sensitive and 85% specific in the prediction of BPD for the original study group. In an additional 25 consecutive admissions with severe RDS of whom 18 survived, the formula was 100% sensitive (6/6) and 75% specific (9/12).(ABSTRACT TRUNCATED AT 250 WORDS)

Birth Weight↗
PubMed1986

Phototherapy effect on the incidence of patent ductus arteriosus in premature infants: prevention with chest shielding.

Patent ductus arteriosus is common among premature neonates, especially those with birth weights less than 1,500 g. In vitro, room light inhibits the contraction of immature piglet's ductal rings. Because phototherapy is used frequently from the first days of life to treat jaundice in preterm neonates, we compared the occurrence of patent ductus arteriosus among premature infants exposed to this intense light source with those whose chests were shielded. Seventy-four babies with respiratory distress syndrome were randomly assigned to either a treatment group (chest shielded with aluminum foil while on phototherapy, 36 babies) or control group (no shield, 38 babies). All were on radiant warmers, received mechanical ventilation for respiratory distress syndrome, and phototherapy (Air Shields model PTU 78-1) from day 1 of life. Irradiance was maintained at greater than 4.0 microW/cm2/nm in all cases. Although both groups had similar birth weights, gestational ages, severity of respiratory distress syndrome, intravenous fluid intake, and duration of phototherapy, the incidence of patent ductus arteriosus was significantly less in the shield group (shield 11/36 v No shield 23/38; P = .009). Patent ductus arteriosus murmurs developed in shielded patients at a later date, they required less vigorous treatment (ie, indomethacin), and they had shorter hospitalizations (74 v 85 days; P less than .05). The significant reduction of patent ductus arteriosus with shielding suggests that phototherapy may play a role in the occurrence of patent ductus arteriosus in premature infants. Shielding may be a practical method to decrease this common complication should this initial observation be confirmed.

Ductus Arteriosus, Patent↗
PubMed1985

Pharmacokinetic evaluation of cefoperazone in infants.

The pharmacokinetics of cefoperazone were evaluated in 25 infants (mean age, 26 days) after intramuscular and intravenous routes of administration. The levels in blood that were achieved were severalfold higher than those required to inhibit common pathogens. The mean half-life of 240 min was one-half of that observed in 1- to 2-day-old infants but about twice that seen in adults. Further evaluation is needed to study the efficacy of the drug in infants and children.

Cefoperazone↗