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Query: UMLS:C0020672 (hypothermia)
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Twenty prematures children with hyaline membrane disease treated by artificial ventilation under continuous alveolar distension pressure, died after intra-ventricular hemorrhage (group I). These cases have been compared to 20 surviving children, with respiratory diseases of similar severity, and supposed to be uninjured with regard to such cerebral lesions (group II). During the first two days of life, the frequency of important hypothermia, hemodynamic instability with tendency to collapse, metabolic or mixed recurring acidosis were significantly more frequent in group I than in group II. These abnormalities probably promote bleeding; their practical consequences are discussed. On the other hand, perinatal suffering and distrubances in blood coagulation do not take a determinant part. The further aggravation of the neurological status, after an lay phase, unexplained and important hematocrit drop, presence of blood at lumber puncture and, overall, at the electro-encephalogram rolandic sharp spikeswaves constitute the major arguments for the diagnosis of hemorrhage.
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PMID:[Intraventricular hemorrhages in hyaline membrane disease]. 90 32

To focus attention on the problem of infant mortality in Lebanon, data were compiled on infant mortality from 1978 to 1986 at the American University of Beirut Medical Center. Causes of death are analyzed for 602 males and 398 females. 54.9% deaths occurred at 1 month of age and 77.4% died within the 1st year. Autopsies were performed on .7%. 37.7% of all neonatal deaths were due to neonatal diseases such as hyaline membrane disease, asphyxia neonatorum, immaturity, necrotizing enterocolitis, hemorrhage, hemolysis, meconium aspiration, and kernicterus. Better prenatal care would reduce this group, or the administration of corticosteroids to the mother 24-48 hours prior to delivery, as well as rapid resuscitation at birth and prevention of the 5 curses: hypoxemia, hypoglycemia, hypothermia, hypotension, and acidosis. Although unavailable in Lebanon, administration of surfactants through an endotracheal tube would also help. Infections constitute 25.1% of deaths; many are preventable through adequate public health measures and strict personal hygiene, i.e., diseases such as sepsis, pneumonia, meningitis, gastroenteritis, hepatitis, encephalitis, and 1-2 cases of the following: diphtheria, measles, peritonitis, tetanus, tuberculosis, cytomegalis inclusion, herpes, parathyphoid, pertussis, poliomyelitis, and shigellosis. Congenital diseases were 21.6%. In utero diagnosis could prevent some diseases and in utero treatment is possible for hydrocephalus and hydronephrosis. Screening programs postnatally could lead to treatment. 5.9% were malignancies such as leukemia, lymphoma, brain tumors, histocytosis, Wilm's tumor, Ewing sarcoma, and Hodgkin's disease. Early diagnosis is critical if mortality is to be reduced in this group, but medical advances are still needed. 2.9% are miscellaneous diseases such as poisoning, rheumatic diseases, marasmus, Reye's syndrome, nephrosis, rickets, and epilepsy. Most of these diseases are preventable, except for rheumatic inflammation of the heart. Recommended necessary steps to reduce infant mortality are: prenatal care, diagnosis and screening, intrauterine surgery; resuscitation and intensive care centers with modern equipment and trained personnel; national vaccination and screening programs; adequate public health measures and hygiene; parental education; and well-equipped hospitals to serve all regardless of income level.
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PMID:Pediatric mortality: an avoidable tragedy. 251 28

Over a period of one year, 16,365 consecutively live born neonates were prospectively studied for evidence of birth asphyxia using the requirement of greater than one minute of positive pressure ventilation for identifying infants suffering from birth asphyxia. Asphyxia occurred in 2.8% of all neonates. Multivariate analysis of high risk factors associated with increased risk of asphyxia showed that low birth weight was the most significant predictor of asphyxia: asphyxia occurred in 68% of infants of less than 1,000 g birth weight and decreased to 1.2% in infants of 3-4 kg birth weight. Perinatal risk factors associated with a higher incidence of asphyxia include: postmaturity, birth weight (less than or equal to 2.5 kg) and with the presence of maternal and/or obstetric complications. The impact of asphyxia on neonatal mortality was most pronounced in more mature infants and the mortality was increased 3 fold in infants of less than 34 week gestation and greater than 27 fold for infants greater than 38 week gestation. Of the asphyxiated neonates, intrauterine growth retardation, fetal macrosomia, hypothermia, hyaline membrane disease, seizures, hypoglycemia and hyponatremia were significantly associated with an increased risk of death.
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PMID:Perinatal risk factors in birth asphyxia: relationship of obstetric and neonatal complications to neonatal mortality in 16,365 consecutive live births. 262 78

Perinatal factors associated with death or disability at 2 years were identified in an inborn cohort of 196 live births with a birth weight of 500-999 g. Antepartum haemorrhage, multiple pregnancy, breech presentation, perinatal asphyxia, hypothermia on admission, hyaline membrane disease, persistent pulmonary hypertension, severe respiratory failure, and intraventricular haemorrhage were associated with increased mortality. Factors associated with increased survival included maternal hypertension, caesarean birth, increasing maturity or size at birth, female sex, and fetal growth retardation. Stepwise multiple discriminant function analysis showed that six factors correctly classified the outcome in 83% of infants: intraventricular haemorrhage was the most important factor followed by the presence of acidosis and hypoxia in the early neonatal period, birth weight, pre-eclamptic toxaemia, and caesarean birth. This study also showed that intraventricular haemorrhage, seizures, antepartum haemorrhage and delay in regaining birth weight were associated with increased disability among survivors.
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PMID:Perinatal factors and adverse outcome in extremely low birthweight infants. 372 24

When sick newborn babies are transferred to Hammersmith Hospital they are collected from the referring hospital or from home by a paediatric resident doctor and a nurse. They prepare the baby for the journey by giving any urgent treatment required, for procedures are difficult to carry out in a moving ambulance. Babies who are likely to become apnoeic are intubated before transport so that ventilation can be started immediately if required. The baby travels in a portable incubator, and special attention is paid to prevention of hypothermia, adequate oxygenation, and respiration. Altogether 122 babies were transferred in 1969, the main reasons being prematurity, hyaline membrane disease, and apnoeic attacks. Five improved during the journey, 102 did not change significantly and 15 became worse. There was no evidence that travel per se harmed any of the babies, though in a few cases deterioration might have been prevented had observation and treatment been easier in the ambulance. Fifty-eight (47%) of the babies eventually died, but the group was a highly selected one with a high proportion of small, immature, and ill babies. We conclude that for very ill newborn babies the advantages of transfer to an intensive care unit probably outweigh the disadvantages of transport, provided that the precautions described here are taken.
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PMID:Transport of sick newborn babies. 545 57

Besides oxygen administration and immaturity of the premature retinal vessels, there are other risk factors for retrolental fibroplasia: (1) respiratory distress syndrome; (2) multiple episodes of bradycardia apnoea; (3) exchange transfusions; (4) hyaline membrane disease; (5) anemia of prematurity; (6) hyperbilirubinemia; (7) avitaminosis E; (8) cardiovascular defects; (9) infectious diseases; (10) multiple births; (11) hypocalcemia; (12) hypothermia; (13) hemorrhagic tendency; (14) delayed coaptation of the retina, and (15) spastic diplegia.
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PMID:Risk factors for retrolental fibroplasia. 668 25

Fifty infants who weighed 1250 g or less at birth were studied with serial real time cerebral ultrasound to evaluate the temporal relation of various perinatal factors to the onset and progression of periventricular haemorrhage (PVH). The significant antecedents of PVH were severe bruising at birth, low birthweight, short gestation, ratio of arterial oxygen pressure (PaO2) to fractional inspired oxygen (FiO2), and haematocrit on admission, hyaline membrane disease, assisted ventilation, pneumothorax, administration of tubocurarine, hypercapnia, hypoxaemia, and hypotension. Case control studies, in which infants with PVH at 26 weeks' and 28 weeks' gestation were compared with matched infants without PVH, confirmed that the antecedents identified were independent of gestational influences. A multivariate discriminant analysis for the antecedents of PVH showed that hyaline membrane disease, hypercapnia, and short gestation correctly classified presence or absence of PVH in 78% of the study group. A similar analysis comparing infants with germinal layer haemorrhage or intraventricular haemorrhage with those who developed intracerebral extension of haemorrhage showed that three factors found on admission (hypothermia, a low PaO2:FiO2 ratio, and severe bruising) combined to classify correctly 90% of the haemorrhages. Our data suggest that prevention of perinatal trauma and asphyxia as well as respiratory illness, especially hyaline membrane disease, and stabilisation of blood gas tensions, blood pressure, and haematocrit within the physiological range, are likely to be the most effective ways of preventing PVH in extremely preterm infants.
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PMID:Antecedents of periventricular haemorrhage in infants weighing 1250 g or less at birth. 669 88

The requirement of greater than one minute of positive pressure ventilation was prospectively used to identify infants suffering from asphyxia at birth in 38,405 consecutive deliveries. Multivariate analysis of high-risk factors associated with increased risk of asphyxia showed the prematurity was the most significant predictor of asphyxia. Asphyxia occurred in 62.3% of infants less than 27 weeks' gestation and decreased to 0.4% in infants greater than 38 weeks' gestation. Presence of asphyxia was associated with significant increase in neonatal mortality of infants greater than 36 weeks' gestation. Of the asphyxiated neonates, growth retardation, hypothermia, hyaline membrane disease, and seizures were significantly associated with an increased risk of death.
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PMID:Neonatal asphyxia. I. Relationship of obstetric and neonatal complications to neonatal mortality in 38,405 consecutive deliveries. 736 99

In a study population of 151 newborn infants less than 35 weeks gestation, who required intensive care for more than 24 hours, clinical and biochemical factors associated with the presence of intraventricular hemorrhage (IVH) were prospectively evaluated. The diagnosis of IVH was confirmed by computed tomography, ventricular tap, or autopsy. Alveolar rupture was highly correlated with the presence of IVH. Other factors associated with IVH were: hypoxemia, hypercarbia, mechanical ventilation, peak inflation presser > 25 cm H2O, inspiratory to expiratory ratio > 1:1, patent ductus arteriosus, bicarbonate administration after the first day of life, volume expansion in the first day of life, hypotension, stages III and IV hyaline membrane disease, and intrauterine growth retardation. Early bicarbonate administration (first day), sodium administration > 8 mEq/kg/day, acidosis and birth weight less than or equal to 1,200 gm were associated with IVH only in the infants who died with IVH. Factors not associated with IVH were Apgar less than or equal to 5 at one and five minutes, birth weight, gestational age, male sex, osmolality greater than or equal to 300, serum sodium greater than or equal to 150, hypothermia, continuous distending pressure > 6 cm H2O, positive end-expiratory pressure > 5 cm H2O, outborn birth, obstetric trauma, or coagulopathy. Certain therapeutic interventions may lead to an increase incidence of intracerebral hemorrhage in the high-risk preterm infant.
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PMID:Intraventricular hemorrhage: a prospective evaluation of etiopathogenesis. 740 91

A total of 2063 live births were studied during one year period from July 1994 to June 1995. Neonatal mortality rate (NMR) was 35.4 per thousand live births. The case fatality rate among low birth weight and preterms was 10.1% and 18.1% respectively. Though, low birth weight babies accounted for 27.8% of the live births but contributed for 79.5% of neonatal deaths [p < 0.001]. Similarly, preterm babies accounted for 13.2% of the live births but contributed for 69.9% of neonatal deaths [p < 0.001]. The causes of neonatal deaths found were birth asphyxia (31.1%), infections (23.3%), immaturity (17.8%), hypothermia (9.6%), hyaline membrane disease (2.7%) and cogenital malformation (1.4%). There is need to identify strategies to reduce the incidence of prematurity and low birth weight babies. Comprehensive antenatal coverage and adequate care followed by optimal management of newborns at birth is likely to reduce NMR and improve quality of life among survivors.
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PMID:Neonatal mortality rate: relationship to birth weight and gestational age. 1077 94


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