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At least 19 recordsLinked to original sources

PubMed1992

Primary care physicians' knowledge about diphtheria-tetanus-pertussis immunizations in preterm infants.

Preterm infants often receive their diphtheria-tetanus-pertussis (DTP) immunizations on a delayed schedule or in reduced dosage. Since primary care physicians (PCPs) immunize many preterm infants, the purpose of this study was to describe PCPs' knowledge about the use of DTP immunizations in preterm infants. Among the 479 PCPs who completed the questionnaire, 84% of pediatricians and 60% of family physicians correctly identified chronologic age as a criterion for initiating DTP immunizations in preterm infants. However, nearly 45% of PCPs linked this with other criteria such as a minimum weight requirement. Family physicians' answers differed from the recommendations more often than pediatricians' answers. The answers of pediatricians and family physicians who completed residency greater than 20 years ago differed from the recommendations more often than those who completed training less than or equal to 20 years ago. The answers of PCPs with fewer than five preterm infants in their practices differed from the recommendations more frequently than the answers of those with five or more preterm infants in their practices. Educational interventions are needed to bring PCPs' knowledge and practices into compliance with the American Academy of Pediatrics recommendations concerning DTP immunizations for preterm infants.

Age Factors↗

PubMed2024

Clinical sequelae of gut microbiome development and disruption in hospitalized preterm infants.

Aberrant preterm infant gut microbiota assembly predisposes to early-life disorders and persistent health problems. Here, we characterize gut microbiome dynamics over the first 3 months of life in 236 preterm infants hospitalized in three neonatal intensive care units using shotgun metagenomics of 2,512 stools and metatranscriptomics of 1,381 stools. Strain tracking, taxonomic and functional profiling, and comprehensive clinical metadata identify Enterobacteriaceae, enterococci, and staphylococci as primarily exploiting available niches to populate the gut microbiome. Clostridioides difficile lineages persist between individuals in single centers, and Staphylococcus epidermidis lineages persist within and, unexpectedly, between centers. Collectively, antibiotic and non-antibiotic medications influence gut microbiome composition to greater extents than maternal or baseline variables. Finally, we identify a persistent low-diversity gut microbiome in neonates who develop necrotizing enterocolitis after day of life 40. Overall, we comprehensively describe gut microbiome dynamics in response to medical interventions in preterm, hospitalized neonates.

Humans↗

PubMedDate not supplied

Cardiovascular effects of carbon dioxide in ventilated preterm infants.

Sick preterm infants may, under certain conditions, demonstrate blood pressure passive cerebral blood flow in response to changes in arterial carbon dioxide tension. Blood pressure in turn depends on cardiac output and peripheral resistance. A Doppler technique for assessing cardiac output compared favourably in terms of reproducibility to a thermodilution technique in a group of infants undergoing cardiac catheterization for congenital heart disease. Doppler was subsequently used to monitor changes in cardiac output following an increase in arterial carbon dioxide tension of 1 kPa in 25 ventilated preterm infants. Blood pressure increased significantly (p = 0.006). However, heart rate did not change significantly (p = 0.16) and, in addition, both stroke and minute volume decreased (p = 0.023, p = 0.02, respectively). This suggests that accompanying changes in components of peripheral resistance exert important effects on blood pressure in the preterm neonate in response to changes in arterial carbon dioxide tension.

Blood Pressure↗

PubMed1992

Impairment of the activity of the hepatic microsomal glucose-6-phosphatase system in three preterm infants.

Three preterm infants born at 26-30 weeks' gestation who died between 103 and 266 days after birth were found to have elevated hepatic glycogen levels. Kinetic analysis of the hepatic microsomal glucose-6-phosphatase system demonstrated that one infant had abnormally low levels of activity of the glucose-6-phosphatase enzyme (partial type 1a glycogen storage disease) and two had deficiencies of T2, a microsomal phosphate/pyrophosphate transport protein (type 1c glycogen storage disease). In all three cases glycogen storage disease was not suspected prior to death even though both hypo- and hyperglycaemic episodes were recorded in the first 15 days after birth indicating that they had somewhat disordered blood glucose regulation. In the infant with low glucose-6-phosphatase enzyme activity, abnormal development of the glucose-6-phosphatase enzyme cannot be ruled out. This is the first description of abnormalities in the glucose-6-phosphatase system in preterm infants.

Biopsy↗

PubMed1979

Acute triclofos poisoning in a preterm infant.

A preterm infant with accidental triclofos sodium poisoning is described. He developed deep coma, severe hypothermia, mild by hypotension and lack of the primitive and deep tendon reflexes. During recovery, the primitive reflexes were the last to appear. The natural course of triclofos poisoning, and its influence on the immature central nervous system of the preterm infant are discussed.

Central Nervous System↗

PubMed1990

Spontaneous resolution of bone mineral depletion in preterm infants.

Fifteen preterm infants and 17 born at full term whose gestational ages ranged from 25 to 34 weeks and 38 to 42 weeks, respectively, were examined initially at postconceptional ages ranging from 38 to 44 weeks and subsequently at 46 to 71 weeks. Each examination included measurement of bone mineral content of the mid-forearm by single photon absorptiometry. For the preterm group, the mean (SD) value of bone mineral content at the first examination was 109.0 (27.6) mg/cm and was significantly lower than the corresponding value of 194.4 (19.6) mg/cm for the whole full term group. The mean subsequent rate of mineral accretion in the preterm group was 8.70 (4.60) mg/cm/week, the mean individual duration of observation being 9.7 weeks. Rate of mineral accretion for the full term group was independent of the duration of observation and averaged 1.60 (2.20) mg/cm/week. The difference between mean values of rate of mineral accretion in the preterm and full term groups was highly significant. Our results show that there is a phase of rapid mineral accretion starting at 40 weeks' postconception in preterm infants that substantially reduces the perinatal mineralisation deficit.

Absorptiometry, Photon↗

PubMed1991

Selenium status of preterm infants fed human milk, preterm formula, or selenium-supplemented preterm formula.

The selenium status of 46 orally fed vitamin E-sufficient preterm infants (birth weight less than 1700 gm) was studied longitudinally for 3 weeks to determine the efficacy of selenium supplementation. Infants were fed either human milk (n = 21; 24 ng selenium/ml), preterm formula (n = 13; 7.8 ng selenium/ml), or preterm formula supplemented with sodium selenite (n = 12; 34.8 ng selenium/ml). Plasma and erythrocyte selenium and glutathione peroxidase activity and urinary and dietary selenium content were evaluated on study day 1 (day enteral feeds reached 100 kcal/kg/day) and weekly for 3 weeks. Throughout the study, selenium intakes of infants fed preterm formula plus sodium selenite were greater than those of infants fed human milk, which were greater than those of infants fed preterm formula (p less than 0.001). After 3 weeks no differences were observed among groups for plasma or erythrocyte selenium or glutathione peroxidase. Plasma selenium and glutathione peroxidase values within all groups were low compared with those reported for term infants fed human milk. Whereas urinary selenium levels of infants fed preterm formula plus sodium selenite were greater than those of infants fed preterm formula at weeks 1 and 2 (p less than 0.01), infants fed human milk and preterm formula had lower levels at week 3 than on study day 1 (p less than 0.05). We conclude that blood selenium measurements typically used to monitor selenium status do not reflect dietary selenium intakes of orally fed preterm infants.

Enteral Nutrition↗

PubMedDate not supplied

The role of the nursing staff in promoting the development of preterm infants through their contribution to mother-infant interaction.

Preterm birth constitutes a potential risk factor for infant development. There is evidence that parental sensitivity and responsivity can compensate for biological risk. Since the birth of a preterm infant often constitutes a crisis for parents, they may be impaired in their ability to relate appropriately to their infants. The nursing staff can play a vital role in enhancing the interaction between parents (in particular mothers) and their preterm infants, thereby indirectly promoting optimal infant development. This paper describes the psychological tasks faced by mothers of preterm infants, parents' experiences of preterm birth and suggestions as to what the nursing staff can do to facilitate healthy relationships between parents and their preterm infants, thereby preventing possible pathological development.

Adaptation, Psychological↗

PubMed1991

Ipratropium bromide for symptomatic preterm infants.

Twelve preterm infants, median gestational age 31.5 weeks, were entered into a randomised, placebo-controlled trial of bronchodilator therapy. Their postnatal age was a median of 17.5 months and all suffered from recurrent respiratory symptoms. The infants received either inhaled placebo or 40 micrograms of ipratropium bromide (active therapy) three times a day utilising a coffee cup as a spacer device. Each therapy was administered for 2 weeks. The symptom score during the active period was reduced by 59% compared to the placebo period (P less than 0.01) and this was associated with 38% improvement in lung function in the active period compared to a 20% change in functional residual capacity over the placebo period (P less than 0.01). We conclude inhaled ipratropium bromide appears to be an effective treatment for symptomatic infants at follow up.

Birth Weight↗

PubMed1978

Physiologic changes induced by theophylline in the treatment of apnea in preterm infants.

Ten preterm infants (birth weight 0.970 to 2.495 kg) with apnea due to periodic breathing (apneic interval = 5 to 10 seconds) or with "serious apnea" (greater than or equal to 20 seconds) were studied before and after the administration of theophylline. We determined the incidence of apnea, respiratory minute volume, alveolar gases, arterial gases and pH, "specific" compliance, functional residual capacity, and work of breathing. Theophylline decreased the incidence of apnea (P less than .05), increased respiratory minute volume (P less than 0.001), decreased (PACO2 (and PaCO2 P less than 0.001), increased the slope of the CO2 response curve (P less than 0.02) with a significant shift to the left (P less than 0.02). These findings suggest that the decreased incidence of apnea after theophylline is associated with an increase in alveolar ventilation and increased sensitivity to CO2 with a pronounced shift of the CO2 response curve to the left. These data are consistent with the idea that apnea is a reflection of a depressed respiratory system.

Apnea↗

PubMed1991

Metabolism and disposition of indomethacin in preterm infants.

38 preterm infants with symptomatic patent ductus arteriosus received indomethacin intravenously. Plasma samples were collected at 2, 4, 6 or 8 and 12 h after each of 3 doses. Indomethacin, demethylindomethacin and p-chlorobenzoic acid were determined in plasma and urine along with acid-labile metabolites using HPLC. Fifty-eight percent of the infants demethylated indomethacin; half of the unchanged and demethylated drug was found as conjugates in urine; 14% deacylated the drug. Shorter elimination half-life, smaller area under the plasma concentration-time curves and increased plasma clearance were associated with demethylation. Postnatal age greater than 2 weeks correlated with both demethylation and failure of indomethacin to effect ductal closure.

Birth Weight↗

PubMed1992

Cranial sonography in preterm infants.

Fifty preterm newborn infants with gestational age of 28-36 weeks were subjected to real time cranial sonography to (a) evaluate the ventricular system and brain parenchyma, (b) determine the incidence of intracranial abnormalities, and (c) to establish the utility and advantages of routine cranial sonography in preterm infants. The lateral ventricular width varied from 6-12 mm (8.67 +/- 1.85 mm) while hemispheric width ranged between 3.68 to 3.95 cm with a mean of 3.84 +/- 0.25 cm. The lateral ventricular ratio ranged from 20.9 to 26.4% and it showed progressive decrease with increasing gestational age. Cavum septum pellucidum was found in 68% of the preterms. Incidental intracranial pathologies were detected in 12% of the preterms screened.

Anthropometry↗

PubMed1992

Bioelectric brain maturation in fullterm infants and in healthy and pathological preterm infants at term post-menstrual age.

At the same post-menstrual age (39-41 weeks), EEG maturation assessed according to the Nolte and Haas method (Nolte, R. and Haas, H.G. (1978) Dev. Med. Child Neurol., 20, 167-182) was studied in 16 fullterm infants (FT), 17 healthy preterm infants (HP) and 18 pathological preterm infants (PP) affected by brain lesions (haemorrhage and/or leucomalacia). There were no significant differences in respect to EEG maturational codes, EEG types or bioelectrical age between the FT and HP groups. The preterm infants affected by brain lesions presented higher percentages of younger EEG codes (i.e. 36 weeks) in State 1 and a higher number of fluctuations between one maturation code and another in both State 1 and State 2, with respect to the HP group. Also, although the PP infants with young EEG codes did not present serious background EEG abnormalities, they did reveal minor EEG abnormalities, such as excessive asynchrony of the 'tracé alternant', lack of frontal sharp transients and monomorphic TA 'bouffees' with little activity at 2-6 c/s. However, no relationship between young EEG codes and onset-offset or duration of the states was found: young codes were often randomly distributed in successive State 1-State 2 epochs, regardless of groupings. Bioelectric age appropriate to the post-menstrual age precedes a normal development or only minor handicap at 24 months, while EEG immaturity of more than 2 weeks corresponds to later major handicaps. The prognostic value of EEG immaturity of between 1.1 and 2 weeks is uncertain.

Brain↗

PubMed1988

Intervention with disadvantaged parents of sick preterm infants.

Infants born preterm are, as a group, at increased risk for a wide variety of later developmental problems (Kopp and Parmelee 1979), although many preterm infants do well (Hack et al. 1983; Saigal et al. 1984). The perinatal vulnerability, however, is amplified in disadvantaged families (Sameroff and Chandler 1975), increasing the likelihood of later emotional and cognitive difficulties (Werner and Smith 1977). A preventive intervention project was designed, therefore, that would provide and then evaluate the effectiveness of supportive home visitor services to parents of infants who were at double jeopardy, both biologically and socially--that is, sick preterm infants being reared by low-income parents. E. Baxter, K. Weiler and I hypothesized that if intervention could increase mothers' involvement and level of responsive interactions with their children, that increased maternal commitment and responsiveness to the infant would act as a protective factor ameliorating or preventing later problems in the child (Beckwith and Cohen 1984; Werner and Smith 1982).

Adult↗

PubMed1979

Acquired cytomegalovirus infection in preterm infants.

Small sick preterm infants requiring care in a neonatal intensive care unit for more than 28 days were cultured for cytomegalovirus in urine and/or nasopharynx during two periods lasting a total of 13 months. Sixteen of 51 such infants began excreting the virus at 28 to 148 days of age (mean, 55 days). In 14 of the 16, a recognizable, self-limited symptom complex developed that consisted of respiratory deterioration, hepatosplenomegaly, a remarkable gray pallor, and both an atypical and absolute lymphocytosis. All of the infants with the clinical symptom complex had underlying chronic lung disease and all had received multiple blood transfusions during their hospitalization. Acquired cytomegalovirus may be relatively common in sick preterm infants and should be distinguished from other causes of rapid deterioration.

Cytomegalovirus Infections↗

PubMedDate not supplied

Neonatal jaundice among Nigerian preterm infants.

Jaundice among Nigerian preterm infants under special care was studied to determine the incidence of clinical jaundice, the predisposing factors and outcome among those with significant hyperbilirubinaemia (SBR greater than or equal to 10mg/dl). The incidence of jaundice among 292 preterm infants over an 18-month period was 71.2%. The male: female ratio was 1:1.04. Of the 74 infants with serum bilirubin 10mg/dl or more, prematurity alone was the identified cause in 44 (59.5%), Glucose-6-phosphate dehydrogenase (G-6-PD) deficiency and septicaemia were the only additional factors in 13 (17.6%) and 7 (9.5%) respectively, while multiple aetiological factors (prematurity, septicaemia and G-6-PD deficiency) were identified in six (8.1%) of the babies. Septicaemia was associated with higher mean bilirubin levels and the highest mortality. The two kernicteric infants in the study had septicaemia. Thus, the single most important cause of jaundice was prematurity. G-6-PD deficiency alone did not appear to increase the incidence and severity of hyperbilirubinaemia in this study. Septicaemia should be suspected and promptly treated in order to reduce mortality and risk of kernicterus among preterm infants with hyperbilirubinaemia.

Female↗

PubMed1991

Physiological effects of kangaroo care in very small preterm infants.

Kangaroo care for preterm infants has great benefits for the parents and for the parent-infant bonding process. A clinical observational study was conducted in which several physiological variables were collected, including among others transcutaneous oxygen pressure, heart rate, respiratory rate, occurrence of apneic attacks, breathing pattern (studied with power spectrum analysis), behavioral states and rectal temperature, during kangaroo care in small preterm infants. Kangaroo-care did not significantly affect any of these physiological variables comparing the period of 1 h before, 1 h during and 1 h after kangaroo care. We conclude that kangaroo care is a safe method, even for very small nonstabilized preterm infants.

Blood Gas Monitoring, Transcutaneous↗

PubMed1990

Behavioral and psychophysiologic assessment of the preterm infant.

Cardiorespiratory activity was recorded during attentional responsivity on the Brazelton scale in term and preterm infants. Preterm infants showed less heart rate deceleration, less heart rate variance and less power in the ECG spectrum at frequencies associated with respiratory sinus arrhythmia and oscillations in blood pressure: A lower threshold for attentional stimulation in the preterm infant may trigger a CNS mechanism that protects the infant from stimulus overload. Study of the coordination between behavioral and physiological reactivity provides an understanding of the role of the CNS in mediating information processing.

Child Behavior↗