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At least 379 records · Page 21Linked to original sources

PubMed2005

Lack of effect of L-carnitine supplementation on weight gain in very preterm infants.

OBJECTIVE: Carnitine transfer across the placenta occurs predominantly during the third trimester. Unless L-carnitine is provided, very preterm infants develop carnitine deficiency. Although breast milk and infant formulas contain L-carnitine, parenteral nutrition solutions do not routinely provide L-carnitine. We hypothesized that prolonged L-carnitine supplementation in very preterm infants would improve weight gain and shorten length of stay in the hospital. STUDY DESIGN: The study was a double-blind parallel placebo-controlled randomized clinical trial. Eligible patients were <29 weeks of gestation, <72 hours of age, and did not have a potentially life-threatening congenital malformation or hereditary metabolic disorder. Patients were stratified by gestational age (23 to 25(6/7) and 26 to 28(6/7) weeks), and randomized to receive, either L-carnitine at a dose of 50 mumol/kg/day, or placebo. Carnitine was provided intravenously until the infants tolerated 16 ml/day of feeds. The sample size was calculated to have 80% power to detect a 10% increase in weight gain from birth until 36 weeks of postmenstrual age or discharge from the hospital. Secondary outcome variables included food efficiency (defined as weight gain divided by caloric intake), weight gain at 4 weeks of age, time to regain birth weight and length of stay. RESULTS: Among the 63 infants enrolled in the trial, 32 were randomized to L-carnitine and 31 to placebo. L-Carnitine supplementation did not significantly affect average daily weight gain from birth until 36 weeks or hospital discharge, or any of the secondary outcome variables. CONCLUSION: Prolonged supplementation of L-carnitine did not improve long-term weight gain in very preterm infants.

Carnitine↗

PubMed2005

Neurobehavioral assessment predicts differential outcome between VLBW and ELBW preterm infants.

OBJECTIVE: To evaluate the impact of birth weight on development of very low birth weight (VLBW) infants using the Neurobehavioral Assessment of the Preterm Infant (NAPI) before hospital discharge, and to show the relation to follow-up outcomes at 12, 18 and 30 months of age. STUDY DESIGN: In total, 113 preterm infants were assessed with the NAPI at 36 weeks postmenstrual age. Later, neurodevelopment was examined using the Bayley Infant Neurodevelopmental Screener (BINS) at 12 months and the Bayley Scales of Infant Development, at 18 and 30 months. The cohort was divided into two groups, based on birth weight, extremely low birth weight (ELBW) (<1000 g) and VLBW (1000 to 1500 g). RESULTS: ELBW infants showed significantly lower NAPI scores compared with VLBW infants at 36 weeks. The predischarge NAPI scores correlated with the 12, 18 and 30 months scores when the ELBW infants continue to have lower performance than the VLBW infants. In all, 14 infants developed cerebral palsy. These infants had significantly lower NAPI, BINS and Bayley scores compared with all other preterm infants. CONCLUSION: NAPI before discharge provides clinically meaningful information related to later neurodevelopmental outcome.

Birth Weight↗

PubMed2006

Equations to support predictive automated postnatal growth curves for premature infants.

Growth charts are used in pediatric medicine to plot anthropomorphic measurements over time, serving as a screen for diseases related to a patient's nutritional and general health status. Whereas reference data for term infants are available from the Center for Disease Control, reference data for premature infants in a neonatal intensive care unit have not been established. Predictive curves for preterm patients, which are based on a patient's postmenstrual age and anthropomorphic measurements at birth, cannot be easily implemented with traditional paper-based methods. Preterm growth charts can be generated in an electronic health record system, but doing so requires mathematical equations or computer-readable tables. This report examines published perinatal growth curves and presents equations for predicted postnatal weight, head circumference and length in preterm infants.

Anthropometry↗

PubMed2006

Site-specific characteristics of infants developing bronchopulmonary dysplasia.

HYPOTHESIS: Site-specific variables that contribute to the pathogenesis of bronchopulmonary dysplasia (BPD) can be identified. OBJECTIVES: To evaluate the demographic, nutrition and growth characteristics of infants at risk for developing BPD at two neonatal intensive care units (NICUs: sites A and O). STUDY DESIGN: Records of 306 infants of < or = [corrected] 30 weeks gestational age (GA) who survived to at least 36 weeks postmenstrual age were retrospectively reviewed. Data were obtained for maternal and neonatal demographics, weights, total fluids, calories, carbohydrate, protein and fat intake at birth, 7, 14, 21 and 28 days of life. RESULTS: BPD rates were not different at the two sites. No statistical differences were noted in the incidence of maternal chorioamnionitis, pregnancy-induced hypertension or use of antenatal steroids among infants who developed BPD (n = 169) and those who did not (n = 137). White race, birth weight, respiratory distress syndrome requiring surfactant, sepsis and patent ductus arteriosus were significantly associated (all P < or =0.03) with BPD. After controlling for significant confounding variables, infants who developed BPD had significantly (P < 0.001) less weight gain, received less calories and fat in the first postnatal month. In the 26 to 28 weeks GA group, the odds of getting BPD were 5.4 (95%CI: 1.4 to 21.3) times greater for site A than site O (P = 0.017). CONCLUSION: Our analysis suggests that while some decrease in BPD can be achieved by focusing on ventilation/oxygen use, this approach is unlikely to impact on the youngest infants.

Black or African American↗

PubMed2001

Growth restriction in dexamethasone-treated preterm infants may be mediated by reduced IGF-I and IGFBP-3 plasma concentrations.

OBJECTIVE: Preterm infants receiving dexamethasone for respiratory morbidity frequently suffer restricted growth. The aim of this study was to investigate the interactions between dexamethasone treatment regimen and circulating IGFBP-3 and IGF-I levels, and the associations between these variables and linear growth rate in preterm babies receiving dexamethasone for chronic lung disease of prematurity. DESIGN: A randomised, unblinded, clinical trial of two different courses of dexamethasone: a 42-day tapering course (the long course) and a repeatable 3 day pulse course. PATIENTS: Forty preterm infants (19 in the pulse group, 21 in the long group) with a birthweight < or = 1250 g who were ventilated at 7 days of age. MEASUREMENTS: Lower leg length was measured thrice weekly by knemometry, and IGFBP-3 and IGF-I levels were measured prior to commencing treatment, at 14 and 42 days of treatment and at 36 weeks postmenstrual age (PMA). Interactions between variables were analysed by stepwise regression analysis and analysis of covariance (ANCOVA). Associations between variables were assessed by correlation coefficients. RESULTS: In an ANCOVA, mean daily dose of dexamethasone/kg (MDDD) and treatment group both significantly influenced IGFBP-3 levels (P = 0.0009 and P = 0.017, respectively), and tended to influence IGF-I levels similarly (P = 0.098 and P = 0.07). MDDD also significantly influenced mean daily increase in lower leg length (MDILL; P < 0.01). IGFBP-3 and IGF-I levels were significantly related to MDILL (ANCOVA: P < 0.01). The correlation coefficients for IGFBP-3 and IGF-I levels and MDILL were 0.2 and 0.3 (both P < 0.0001), respectively. IGFBP-3 and IGF-I levels were highly correlated (r(2) = 0.52, P < 0.0001) and both increased significantly with increasing PMA (P < 0.0001). IGF-I levels were higher in females (P = 0.036). CONCLUSION: This study provides evidence that the growth-restricting effects of dexamethasone may be mediated, at least in part, via suppression of the IGF axis. Both dexamethasone dose and treatment regimen influence circulating IGF-I and IGFBP-3 levels, and both are important in inducing growth restriction.

Analysis of Variance↗

PubMed2003

Serum KL-6 level in newborns with meconium aspiration syndrome.

BACKGROUND: It has been reported that serum KL-6 increases in babies with progressing chronic lung disease (CLD). However, there have been few reports assessing KL-6 in meconium aspiration syndrome (MAS). KL-6 was measured in neonates with respiratory diseases including MAS. METHODS: Thirty-eight neonates with respiratory disease were enrolled in the study. These patients were classified into three groups, 14 patients with respiratory distress syndrome (RDS), 14 with MAS, and 10 with transient tachypnea of the newborn (TTN). The control group consisted of 12 healthy neonates. KL-6 levels were measured 1 day (median) after the birth. In the RDS group, measurement was repeated just prior to 36 weeks' postmenstrual age. RESULTS: The levels of KL-6 were 116 +/- 40 U/mL in the RDS, 281 +/- 138 U/mL in the MAS, and 106 +/- 41 U/mL in the TTN groups. KL-6 levels were significantly higher in the MAS group than in the control group (134 +/- 71 U/mL; P < 0.01). In addition, the levels were significantly higher in those with severe MAS than those with mild MAS (P < 0.05). In patients with RDS, KL-6 increased in patients who developed CLD (P < 0.05), while KL-6 levels did not change in those who did not develop CLD. CONCLUSION: These data confirm the high level of KL-6 in CLD, and suggest that KL-6 is increased in MAS.

Antigens↗

PubMed1992

Changes in tubal blood flow in evaluating ectopic pregnancy.

Ectopic pregnancy is not recognized in 5523% of all cases using state-of-the-art diagnostic procedures. In this study, blood flow in tubal arteries was measured using a transvaginal duplex Doppler ultrasonography system. A 3.5 MHz Doppler transducer coupled to a 5 MHz imaging transvaginal sector probe was used to depict flow characteristics in the tubal branch of the uterine artery. This was performed in 102 patients. There was a significant increase in the blood flow on the tubal gestation side (p < 0.0001; z = -4.08). This between-side difference was determined using qualitative frequency shift analysis. The mean reduction in the resistance index on the side with the ectopic pregnancy as compared to the contralateral side was 15.6%. These changes appear to be due to trophoblast invasion. Between-side differences showed no dependence on gestational age (between gestational weeks 4 and 12 postmenstruation). We compared these data with those from three control groups ('early viable intrauterine pregnancy', 'early intrauterine pregnancy failure', 'non-gravid state'). In all these control groups, the impedance to flow, expressed as 'resistance index', showed no significant between-side difference. All control groups had significantly higher mean resistance index values than the ectopic pregnancy side, but did not differ from the contralateral side of the ectopic pregnancy group. The advantages of this new method in diagnosing ectopic pregnancy are early detection, non-invasivity, and immediate results.

Journal Article↗

PubMed1993

Vaginal ultrasonography in patients with postmenopausal bleeding.

Our objective was to define a subset of women with postmenopausal bleeding in whom the accepted practice of endometrial sampling could be safely omitted. Vaginal endosonographic measurements were compared to the histological findings of curettings following diagnostic dilatation and curettage in 129 women with post-menopausal bleeding who were not receiving hormonal therapy. Atrophy was diagnosed in 49%, slight proliferation in 10%, endometrial polyps in 11%, hypoplasia in 12%, and adenocarcinoma in 12%. Endometrial atrophy was associated with a mean sonographic thickness of 2.6 mm of the double layer (range 0-6.5 mm). Of the women with a final histological diagnosis of atrophy, 92% had an endometrial thickness of 3 mm or less. Furthermore, all women with a sonographic endometrial thickness of 3 mm or less had atrophic endometrium (p < 0.0001). An endometrial thickness of 3 mm or less would have reduced the number of dilation and curettage procedures by 45% and no cases of endometrial pathologies would have been missed. In women presenting with postmenstrual bleeding, meticulous scanning of the endometrium can select a group where endometrial sampling can be omitted from the protocol.

Journal Article↗

PubMed1996

The onset of inter-human contacts: longitudinal ultrasound observations in early twin pregnancies.

Twin pregnancies provide us with the opportunity to observe first reactions towards touch in utero, and this study illustrates the onset and development of these contacts. Forty women with twin pregnancies volunteered to take part in this study, 25 of whom (five monochorionic, 20 dichorionic pairs) fulfilled the inclusion criteria. Between 8 and 12 weeks' gestation, ultrasound examinations were performed transvaginally, and from 13 weeks onwards transabdominally, at weekly intervals. Ultrasound findings were recorded on videotapes and were analyzed retrospectively. The first contacts producing reactions in the co-twin were defined as primary contacts, which could be slow or fast arm/leg/head/body contacts. Primary contacts followed an action-reaction model, and usually lasted < 3 s. These contacts were initially slow and then became fast. The first reactions of the co-twin towards touch were observed at 65 postmenstrual days. Contacts of longer duration between both bodies including extremities, or contacts initiated by sucking movements towards the co-twin were defined as complex contacts and were observed from 85 and 92 post-menstrual days, respectively. Nearly all contacts occurred significantly earlier in monochorionic compared to dichorionic twins. Female/female pairs seemed to develop complex body contacts earlier than male/male pairs, but for the onset of other contacts we have not yet found significant differences between gender combinations.

Age of Onset↗

PubMed2006

Place of birth and variations in management of late preterm ("near-term") infants.

BACKGROUND: The purpose of this study is to characterize variations in management late preterm infants because such variations in such a large group of neonates would have economic and health implications. METHODS: Comparison of the use of illustrative management approaches and gestational age at discharge among infants born at 33 to 34 6/7 weeks and discharged alive from 10 Massachusetts and California NICUs. RESULTS: Generally similar in birth weight and admission severity, significant differences were seen in illustrative interventions, such as the use of mechanical ventilation (range in use across hospitals from 9% to 43%) and nutritional practices (use of hyperalimentation ranged from 5% to 66%). Variations in average daily weight gain were seen with some infants averaging net losses. Postmenstrual age at discharge varied by a week between the hospital with the earliest discharge and that with the latest. CONCLUSIONS: Care for these infants would be improved by further examination of their needs and the establishment of practice guidelines to reduce unneeded variation.

California↗

PubMed2006

Definitions and diagnostic criteria for bronchopulmonary dysplasia.

The changes in clinical presentation of bronchopulmonary dysplasia (BPD) in recent years have made many of the original definitions of BPD obsolete. The use of supplemental oxygen as a criterion for BPD diagnosis has many limitations. Supplemental oxygen is necessary to treat these infants, but at the same time it plays an important role in the pathogenesis of BPD. Because there are no accepted standards for supplemental oxygen administration, there are wide variations for its indications among different centers and this has a marked effect on the reported incidence of BPD. For this reason, it is essential to standardize the indications for supplemental oxygen when duration of oxygen therapy is used as the main criteria to diagnose BPD. Using supplemental oxygen need at specific time points does not necessarily reflect chronic lung damage and should be avoided as a single diagnostic criterion for BPD. A prolonged duration of supplemental oxygen is necessary to demonstrate the presence of chronic lung damage. The criteria based on supplemental oxygen at 36 weeks postmenstrual age has gained wide acceptance, but it is a less stringent criterion for the more mature infants. The longer the gestation, the shorter the time on oxygen that is required to meet this BPD criterion. None of the proposed criteria based on duration of oxygen therapy have shown a strong predictive value for long-term outcome. In view of all these shortcomings, it is essential to develop more objective physiologic tools to define the degree of lung damage and improve the prediction for long-term outcome in these infants.

Bronchopulmonary Dysplasia↗

PubMed2006

Pulmonary outcomes in bronchopulmonary dysplasia.

The incidence of bronchopulmonary dysplasia (BPD), defined as oxygen need at 36 weeks of postmenstrual age, is about 30% for infants with birth weights <1000 g. BPD is associated with persistent structural changes in the lung that result in significant effects on lung mechanics, gas exchange, and pulmonary vasculature. Up to 50% of infants with BPD require readmission to the hospital for lower respiratory tract illness in the first year of life. Long-term measurements of lung function in BPD include normalization of pulmonary mechanics and some lung volumes over time as somatic and lung growth occur, whereas abnormality of small airway function persists. The majority of data reveals no long-term decrease in exercise capacity. Mild to moderate radiological abnormalities persist. BPD is a result of dynamic processes involving inflammation, injury, repair, and maturation. Infants with BPD have significant pulmonary sequelae during childhood and adolescence, and continued surveillance of young adults with BPD is critical.

Bronchiolitis↗

PubMed2001

Determination of nutritional requirements in preterm infants, with special reference to 'catch-up' growth.

The usual recommendation for feeding preterm infants is to provide sufficient nutrients to support rates of growth and nutrient accretion equal to intrauterine rates. However, most preterm infants don't tolerate feedings immediately and, therefore, incur significant deficits prior to achieving sufficient intake to support growth. Furthermore, unless they receive nutrient intakes in excess of those usually recommended, they will be smaller than a fetus of the same postmenstrual age at discharge and remain smaller for some time thereafter. The consequences of these early deficits are not known with certainty but there is some evidence that they should be repleted as soon as possible. This requires a redefinition of requirements to include those for both normal growth and catch-up growth. Strategies for doing so include: more aggressive early parenteral nutrition to reduce the magnitude of early losses; greater enteral intakes of protein, and, perhaps, other nutrients once enteral feedings are tolerated; and more attention to nutrition post-discharge. Of these, the latter is somewhat problematic. This is because there seems to be a finite period - perhaps as brief as a few weeks - during which response to increased nutrient intake occurs. Firm data are limited, but those available suggest that current nutritional management of preterm infants can be improved. Whether this will have long-term benefits remains to be determined.

Body Height↗

PubMed1977

Perinatal hypoxia and bioelectric brain maturation of the newborn infant.

Bioelectric brain maturation of twenty infants who had suffered acute perinatal hypoxia (patients) was compared with that of twenty healthy newborns (controls). None of the patients had suffered any other pre- or perinatal complications that could have influenced the bioelectric brain maturation. All infants (postmenstrual age: 40--42 weeks) were subjected to a polygraphic recording. The patients were examined after the acute phase of their disease; all were in good clinical condition at the time of recording. Statistic evaluation revealed significantly retarded bioelectric brain maturation in the patient group. Furthermore, a more immature EEG pattern was found to correspond to greater extent of oxygen deprivation. The study shows: determination of bioelectric brain maturation can be used to obtain information about suffered hypoxia and extent of oxygen deprivation.

Electroencephalography↗

PubMed1976

[A new immunochemical tube test for pregnancy using the latex-agglutination inhibition reaction. II. Clinical results (author's transl)].

In a multi-centre study 1117 morning urine samples were tested using the new immunochemical pregnancy tube test (Roche), based on the principle of indirect latex-agglutination inhibition. The test proved to be both qualitatively and semi-guantitatively suitable for demonstration of HCG in urine. There was only one false-negative result among 320 pregnancy tests (after 50th postmenstrual day). In 94 early pregnancies (test done before the 50th day) there were only two false-negative results. No false-positive result were seen. In the prognosis of threatened abortion, diagnosis of incomplete abortion, hydatid cyst, or chorionepithelioma the semiquantitative performance of the test was clinically useful and especially suitable because the result of the agglutination-inhibition reaction is unequivocal.

Abortion, Incomplete↗

PubMed2000

High-frequency ventilation in neonates.

High-frequency ventilation (HFV) has been advocated to reduce lung injury and chronic lung disease (CLD) in preterm infants. Several randomized controlled trials have compared HFV with conventional mechanical ventilation (CMV) in preterm and term infants. This review first discusses animal data pertinent to optimizing the application of HFV in preterm infants. Second, a meta-analysis of all randomized controlled trials using HFV as an early intervention is presented. Finally, rescue use of HFV in preterm and term infants with respiratory failure or air leak syndromes is summarized. Eleven trials of early intervention with HFV are included in the meta analysis. Overall, chronic lung disease at 36 weeks postmenstrual age was reduced in patients treated with HFV, but mortality was not changed. The decrease in CLD, however, is confounded, as it is only based on small trials, whereas no pulmonary benefit was found in the three largest trials. Furthermore, HFV appears to increase the incidence of severe intracranial hemorrhages and periventricular leukomalacia. Therefore, routine elective use of HFV cannot be recommended at the present time. Limited data on rescue use of HFV suggest some benefits over continued CMV.

Bronchopulmonary Dysplasia↗

PubMed2001

Brain development (sulci and gyri) as assessed by early postnatal MR imaging in preterm and term newborn infants.

OBJECTIVE: To investigate fetal brain development in vivo using early postnatal cranial MRI in term and preterm newborn infants. STUDY DESIGN: 51 infants, 1.5-T whole-body system, extremity coil, spin-echo images obtained in all three planes (T1- and T2-weighted). Independent review by two neuroradiologists (blinded for gestational age and medical history) regarding the development of 12 sulci and 10 gyri using a modified scoring system. Gestational age was obtained either by ultrasound or from the first day of the last menstrual period. EXCLUSION CRITERIA: head circumference <10th or >90th percentile, cerebral malformation, chromosomal/metabolic disorder. RESULTS AND CONCLUSION: Age at study ranged from 23 5/7-43 0/7 postmenstrual weeks. Brain maturation starts in the central area and proceeds towards the parieto-occipital cortex. The frontal cortex develops last. Transition to degrees 1, degrees 2 and, degrees 3 starts at week 25, 32 and 35 in the central cortex and is completed at week 34, 36 and 39, respectively. Our data compare favourably with the two previously published reports about brain maturation. Early MR imaging seems therefore to be suited to study maturation of the fetal brain. This may be of pathophysiological relevance in neonatal intensive care and neurological follow-up studies.

Birth Weight↗

PubMed2003

Risk factors predicting vasopressor use after patent ductus arteriosus ligation.

Ligation of the patent ductus arteriosus (PDA) is sometimes complicated by postoperative hypotension requiring vasopressor(s). It is unclear which infants are at risk for this complication. We conducted a retrospective and prospective cohort study to identify risk factors predicting vasopressor use after PDA ligation. Our patients were infants < 37 weeks of gestation who underwent PDA ligation. The primary outcome was the use of vasopressor(s) within 72 hours after PDA ligation, defined as beginning vasopressor(s) or increasing the dose of vasopressor(s). Thirty-two of 100 (32%) study infants required vasopressor(s) after PDA ligation. Infants who had lower birth weights, lower gestational ages, higher ventilator support, or whose mothers had received antenatal steroids had a higher risk of vasopressor use. Infants who required vasopressor(s) were at increased risk of dying before 36 weeks postmenstrual age. Lower birth weight, lower gestational age, and higher respiratory support define a high-risk subgroup of patients in whom the prophylactic administration of vasopressor(s) could be studied.

Cohort Studies↗