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Query: UMLS:C0029713 (immaturity)
 4,335 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

The prenatal relationships between surfactant disaturated phosphatidylcholine (DSPC) and surfactant-associated proteins of preterm infants with respiratory distress syndrome (RDS) have not been well documented. In the present study we measured the concentration of DSPC, surfactant glycoproteins (GP), and surfactant proteolipids (PLP) in amniotic fluids obtained within 6 hours prior to delivery of 16 newborn infants with gestational ages between 27 and 32 weeks. In control infants of 27-32 weeks gestation without RDS, the values of DSPC, GP, and PLP per milliliter of amniotic fluid were 20 +/- 2.9 micrograms, 684 +/- 115.3 ng and 289 +/- 62.5 ng, respectively. These values were significantly higher, threefold for PLP, fourfold for DSPC, and fivefold for GP, than amniotic fluid levels in infants with RDS. The findings support the concept that immaturity of surfactant in RDS involves both phospholipids and surfactant-associated proteins. Measurements of surfactant lipid-protein complex appear to enhance the reliability for identifying prenatally, infants at risk of developing hyaline membrane disease. More extensive studies are warranted to assess the usefulness of these assays for clinical application.
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PMID:Prenatal relationship of surfactant lipid and protein constituents in infants with respiratory distress syndrome: a preliminary communication. 292 68

The evaluation and reimbursement of hospital use by means of diagnosis-related groups (DRGs) may have a major impact on the utilization of regional neonatal care. Medicare has already implemented the DRG system and other payors, including Medicaid, Blue Cross, and commercial insurance, are also considering adopting it. Under this approach, neonates are assigned to one of seven DRGs, each of which is reimbursed at a relatively fixed rate. An evaluation of hospital utilization by neonates focused on three of these DRGs in four regional neonatal systems located in Upstate New York. Calendar year 1983 data indicated that Level III, II, and I neonatal facilities generated substantially different mean stays for these DRGs in the four regions. The ranges of mean stays between Level III and Level I facilities were greatest for DRGs involving neonates who died or were transferred and those with extreme immaturity and/or respiratory distress syndrome. Federal length of stay and cost standards for these categories failed to address the different utilization experience of these levels of care. The analysis suggests that, as additional payors adopt DRGs, the standards relating to neonatal care must be modified.
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PMID:Impact of selected diagnosis-related groups on regional neonatal care. 308 62

Times of first stool passage were studied in 171 infants who weighed less than 1,500 g at birth. Delayed passage (greater than 48 hours) was noted in 20.4% of this group. Significant differences were noted between the delayed and nondelayed groups for gestational age, presence of severe respiratory distress syndrome, and the time of the first enteral feeding. In very low birth weight infants, delay in the passage of the first stool is a common occurrence. This delay is probably due to physiologic immaturity of the motor mechanisms of the gut, lack of triggering effect of enteral feeds on gut hormones, and the presence of severe respiratory distress syndrome, which may singly or in concert adversely affect gastrointestinal motility.
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PMID:Passage of the first stool in very low birth weight infants. 310 45

The purpose of the present study was to describe the relations among various perinatal, environmental, and demographic measures in a sample of low birth weight infants and to relate those measures to 1-year developmental status. Perinatal variables included birth weight, gestational age, Apgar scores, and summary measures of respiratory distress and morbidity. Home visits provided ratings of the infants' environment at 7 and 12 months corrected age. The Bayley Scales of Infant Development were given at the 12-month home visit. A principal components factor analysis revealed four factors. The first factor was labeled an immaturity-illness factor, since it was primarily composed of gestational age, birth weight, and the respiratory distress and morbidity summary scores. Ratings of the infant's home environment loaded on the second factor, the demographic variables on the third factor, and the 1- and 5-minute Apgar scores comprised the fourth factor. The four factor scores together with the number of delays on the Denver Developmental Screening Test, given at 7 months corrected age, were entered as independent variables in four multiple regression analyses with the corrected and uncorrected mental development index index (MDI) and psychomotor development index (PDI) Bayley scores as the dependent variables. These regression analyses indicated that 1-year developmental status is a reflection of the infant's immaturity and neonatal morbidity, the quality of his or her home environment, and freedom from sensorimotor delays.
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PMID:Predictors of one-year developmental status in low birth weight infants. 322 23

The outcomes of 77 fetal intraperitoneal transfusions in 35 pregnancies managed with direct ultrasound guidance and intensive perinatal management were reviewed. Patients were monitored with amniocentesis, and standard indications were used for timing of transfusions. The mean gestational age at first transfusion was 27.3 weeks (range 22-33). The overall mortality rate was 14% (five of 35). No immediate transfusion-related deaths occurred; all fetuses who were not hydropic at first transfusion survived (26 of 26). The mean gestational age at delivery was 33.6 weeks (range 25-36). One infant developed respiratory distress syndrome (RDS). Transfusion-related complications occurred in five cases (fetal colon infusions in two, fetal retroperitoneal infusion in two, and fetal abdominal wall hematoma in one). None of these infants required urgent delivery or suffered long-term sequelae. In nonhydropic fetuses, intraperitoneal transfusions under direct ultrasound guidance had a low incidence of morbidity and no mortality. These results should provide baseline data against which to compare new techniques, such as direct cord transfusion. With neonatal mortality rates of 10% and significant morbidity rates of 10-20% in infants delivered at 32 weeks who develop RDS, intraperitoneal transfusion should be considered in the 32- to 33-week fetus with marked pulmonary immaturity.
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PMID:Intraperitoneal fetal transfusion under direct ultrasound guidance. 327 12

The paper reviews the effects on lung maturation of glucocorticoids in animals and humans and presents relevant recent findings from the author's laboratory. It is now well established that antenatal glucocorticoid treatment reduces the incidence and severity of the respiratory distress syndrome (RDS) in prematurely born infants. The recommended doses of glucocorticoids produce fetal glucocorticoid activity levels similar to those of newborns with RDS or prolonged rupture of the membranes. Extensive follow-up studies have shown that adverse effects on child development are unlikely to occur. It is also evident that a significant number of fetuses do not respond to the treatment, which is of particular consequence in fetuses of less than 28 weeks gestation. These fetuses are less likely to respond to glucocorticoid therapy that fetuses between 28 and 32 weeks gestation and are at a higher risk of developing complications due to their immaturity. In fetal sheep, there is a similar decrease in the efficacy of glucocorticoids on lung maturation with decreasing gestational age. Simultaneous infusion of cortisol, triiodothyronine and prolactin but not of any of these hormones administered singly or in combination of two produced mature lungs in fetal sheep of 125 days gestation. Similar results were obtained with thyrotropin releasing hormone (TRH) and cortisol. It remains to be seen whether the combined administration of glucocorticoids and TRH accelerates lung maturation in human fetuses.
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PMID:New approaches to hormonal acceleration of fetal lung maturation. 332 38

This one-dimensional thin-layer chromatographic method is used for assay of phospholipids in the gastric aspirate of newborns. The solvent mixture (chloroform/hexane/methanol/glacial acetic acid/water, 12/7/4/3/0.3 by vol) completely resolves lecithin, sphingomyelin, phosphatidylinositol, phosphatidylserine, phosphatidylethanolamine, and phosphatidylglycerol. The method is simple, precise, inexpensive, and rapid (chromatographic development takes less than 25 min) and gives high chromatographic resolution. We used this method to determine the lecithin/sphingomyelin densitometric ratio (L/S ratio) and the phosphatidylglycerol percentage in 200 samples of gastric aspirate and found an L/S ratio of 2.5 to be a satisfactory cutoff value for distinguishing fetal lung maturity and immaturity. We confirmed that the presence of phosphatidylglycerol excluded the possibility of respiratory distress.
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PMID:Improved thin-layer chromatographic determination of phospholipids in gastric aspirate from newborns, for assessment of lung maturity. 335 10

Seven VLBW infants with pulmonary hypoplasia (P.H.) were studied retrospectively and their necropsied lungs were analyzed morphologically and histometrically in an attempt to establish the clinical and pathological criteria of P.H. Clinically they had various features as follows; 1) causes with oligohydramnios due to amniotic fluid leakage, 2) bell-shaped chest and/or small lung radiographically, 3) severe respiratory distress immediately after birth, 4) frequent complications with air leaks, lethal within several hours after birth. Pathologically they showed a series of changes; 1) remarkably decreased LW: BW ratios, less than 0.015, 2) decreased number of alveoli per alveolar duct, less than 3 or 4 alveoli/duct compared with 6.5 of normal controls at 28 weeks' gestation, 3) immature duct system and increased interstitium which suggested delay in growth and structural maturation of the lungs. It is suggested that the tendency to develop pulmonary air leaks is not only due to high pressure ventilation but also to histological immaturity of the lungs.
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PMID:Clinicopathological studies on pulmonary hypoplasia in very low birth weight infants. 363 Jun 94

Cord serum levels of thyroglobulin (Tg) and thyroid stimulating hormone (TSH) in 147 term and preterm infants were related to gestation age, birth weight, respiratory distress syndrome (RDS), and several perinatal factors by means of multiple linear regression analysis. None of the perinatal factors influenced Tg and TSH cord serum levels. However, in infants who developed RDS, Tg and TSH cord serum levels differed significantly from values in infants who did not develop this syndrome. In RDS infants, significantly higher Tg values were found. Tg cord serum levels increased with birth weight in the "average" RDS infant (i.e. infants with birth weights according to the 50th percentile of the growth chart for their gestation age), while these levels decreased in the "average" non-RDS infant. In RDS infants TSH cord serum levels increased with increasing birth weight, while these levels did not vary in non-RDS infants. Although Tg and TSH cord serum levels in RDS infants increased during gestation, no correlation between Tg and TSH cord serum levels could be demonstrated. There was no correlation between Tg and TSH cord serum levels in non-RDS infants. Since we found a clear correlation between Tg cord serum levels and gestation age, but no correlation between Tg and TSH cord serum levels, we suggest that other phenomena are responsible for the high Tg levels such as organ immaturity.
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PMID:Serum thyroglobulin levels in preterm infants with and without the respiratory distress syndrome. I. Cord blood study. 364 Mar 36

A case-control study was performed to identify risk factors for developing and dying from necrotizing enterocolitis (NEC). Eighty-six infants observed at The Johns Hopkins Hospital who had clinical and/or pathological evidence of this disease during the past 10 years were studied. Birth weight matched autopsied control infants without NEC were also studied for comparison with the autopsied infants who died with NEC. Patients with NEC had a mean birth weight of 1,620 +/- 198 g, and those who died from NEC had even lower birth weights (1,418 +/- 109 g). The development of NEC was correlated with significantly higher frequencies of oral feeding (p less than 0.005) and septicemia (p less than 0.001). Death with NEC was correlated with earlier onset and more extensive disease (both p less than 0.05), hypotension (p less than 0.001), septicemia (p less than 0.001), persistent respiratory distress (p less than 0.05), a patent ductus arteriosus (p less than 0.05), and lower 5-min Apgar scores (p less than 0.05). These findings suggest that NEC is caused by overwhelming hypotensive/ischemic injury to the intestines in association with enterosepticemia. Intestinal immaturity and oral feedings appear to be important predisposing factors in this condition.
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PMID:Risk factors for developing and dying from necrotizing enterocolitis. 372 56


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