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 52,417 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Optimum perinatal outcome is only achieved by the prevention of premature birth. When preterm delivery is unavoidable, antenatal pharmacologic therapy will result in a reduction in the leading causes of neonatal morbidity and mortality, mainly respiratory distress syndrome (RDS), BPD, intraventricular haemorrhage (IVH) and sepsis. These treatments combined with meticulous intrapartum management will result in significant improvements in the neonatal and long-term outcome in the premature baby.
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PMID:Preparing the fetus for preterm birth. 825 19

We hypothesized that gender and intrauterine growth retardation (IUGR) have greater effects than birth order on mortality and morbidity rates of very low birth weight (< 1501 gm) twins. Neonatal data were collected on 44 pairs of twins born alive between January 1984 and December 1987. Birth weight was 1018 +/- 289 gm and gestational age was 28.1 +/- 2.5 weeks. The male/female ratio was 46:42; 24 infants had IUGR, and 64 were appropriate in size for gestational age. Of the 88 infants, 61 (69%) survived. Birth order had no effect on outcome. Female twin pairs had a longer gestation than either male twin pairs or twins with discordant sex (29.2 +/- 2.5 weeks vs 27.4 +/- 2.0 weeks and 27 +/- 3 weeks, respectively; p < 0.002). They also had a lower mortality rate (14% vs 47% and 25%; p < 0.001) and a lower incidence of bronchopulmonary dysplasia (22% vs 57% and 50%; p < 0.02). Infants with IUGR had an increased mortality rate (50% vs 23%; p < 0.02) and an increased sepsis rate (61% vs 25%; p < 0.02) compared with infants with appropriate size for gestational age who were matched for gestational age. Multiple logistic regression analysis to assess the independent effects of gestational age, gender, and IUGR on mortality rate, bronchopulmonary dysplasia, and intraventricular hemorrhage revealed that gestational age was the most significant contributor to all three outcome variables; IUGR contributed to an increased mortality rate, and male gender contributed to the occurrence of bronchopulmonary dysplasia.
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PMID:Effects of birth order, gender, and intrauterine growth retardation on the outcome of very low birth weight in twins. 832 Jun 7

The patterns and nature of a four-month epidemic of severe respiratory syncytial virus (RSV)-associated disease were analyzed using presenting, demographic, clinical, and therapeutic data. Of 218 infants with RSV infection admitted to Rainbow Babies and Childrens Hospital, 49 (22.4%), most born prematurely, entered the pediatric intensive care unit (PICU). Fluorescent antibody and/or enzyme-linked immunosorbent assay documented RSV infection. PICU patients underwent airway stabilization; 53.5% were intubated and evaluated for sepsis. Patients with positive bacterial cultures received antibiotics; 18% were given ribavirin. Patterns of infection included hypothermia, septic shock appearance, apnea, pneumonia, and wheezing due to bronchiolitis. The average age difference between patients with hypothermia (23.3 days) and those with pneumonia (11.2 months) was statistically significant. There were no significant differences in average age, gestational age at birth, number intubated, worst pH and PCO2, duration of intensive care, or treatment modalities between infants with bronchopulmonary dysplasia who received ribavirin and those who did not.
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PMID:Atypical extrapulmonary presentations of severe respiratory syncytial virus infection requiring intensive care. 840 43

From September 1989 through July 1991, before commercial availability, Survanta (beractant intratracheal suspension), a modified bovine-derived surfactant used for prevention and treatment of neonatal respiratory distress syndrome, was made available to 231 neonatal intensive care units in the United States and Canada under a Treatment Investigational New Drug protocol. Results of this open clinical experience are reported. Investigators could give one dose of Survanta soon after birth to neonates weighing 600 to 1250 g (prevention strategy). Neonates weighing 600 to 1750 g who were not treated at birth could begin Survanta therapy if respiratory distress syndrome developed within 8 hours of birth (rescue strategy). All neonates could receive up to three more doses over the first 48 hours of life at minimum intervals of 6 hours if they met retreatment criteria. Qualifications for enrollment closely matched those used in previous randomized controlled clinical trials. This report includes results from 8168 neonates who completed the study. Treatment Investigational New Drug rates for intracranial hemorrhage, patent ductus arteriosus, pulmonary hemorrhage, pulmonary air leaks, bronchopulmonary dysplasia, death or bronchopulmonary dysplasia, pulmonary interstitial emphysema, pretreatment sepsis, and posttreatment sepsis were less than for treated neonates in the controlled trials and survival was equivalent across studies. Problems with treatment administration were reported with 30.4% of doses, while adverse events were reported in 0.5% of neonates. The results of the Treatment Investigational New Drug protocol revealed no new safety concerns associated with the widespread use of Survanta and confirmed the safety profile established in earlier controlled trials.
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PMID:Treatment Investigational New Drug experience with Survanta (beractant). 844 57

The neurodevelopmental outcome of 78 infants with bronchopulmonary dysplasia (BPD) was compared with that of 78 control infants matched for birthweight. To determine the effect of the severity of BPD, 62 infants requiring oxygen at 36 weeks' postmenstrual age (sBPD) were compared with their matched controls. Infants were followed up to 2 years of age, corrected for prematurity, and were classified for neurological impairment, developmental delay, and neurodevelopmental disability. Seventy six (98%) BPD infants and 71 (91%) controls had follow up data available to two years. Neurological impairment, developmental delay, and neurodevelopmental disability occurred more frequently in infants with BPD than in controls but this was not significant. For infants with sBPD, the increased incidence of neurological impairment and definite developmental delay was not significant when compared with the controls, though neurodevelopmental disability occurred more frequently (odds ratio (OR) 3.6: 95% confidence intervals (CI) 1.1-11.8). Predictors of disability in infants with sBPD included periventricular haemorrhage (OR 19.4: 95% CI 4.3-86.6), ventricular dilatation (OR 12.8: 95% CI 2.9-57.3), and sepsis (OR 5.0: 95% CI 1.3-19.4). Adjusting for the presence of these factors, the association between BPD and disability was no longer apparent (OR 0.9: 95% CI 0.2-3.6). The findings suggest that BPD is not independently associated with adverse neurodevelopmental outcome.
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PMID:Neurodevelopmental outcome of preterm infants with bronchopulmonary dysplasia. 853 67

The efficacy of the prophylactic use of intravenous immunoglobulin (Ig) was evaluated in a double-blind placebo-controlled trial of 21 pairs of ventilated neonates weighing more than 1,500 g. Each infant received 0.4 g/kg/day of intravenous Ig or a similar volume of placebo daily for 5 days. Criteria used to assess the efficacy of intravenous Ig were the number of infections, the duration of ventilation therapy and time to clinical recovery. There were no significant differences in the treated and placebo groups with regard to the frequency of positive blood cultures (28.6% and 14.3%), endotracheal cultures (57.1% and 66.7%) and abnormal white cell counts (52.4% and 57.1%). On entry to the study there was no significant difference in IgG levels between the treated (974.5 mg/dl; SD 575.3) and placebo groups (818 mg/dl; SD 516.9). However, on day 6 the treated group had a mean level of 1,400.3 mg/dl (SD 426.7) versus 710.9 mg/dl (SD 377.4) in the placebo group (P < 0.05). Clinical improvement occurred within 3 days in both groups. Ventilatory support was required for 11.8 days (SD 8.3) in the treated and 11.8 days (SD 7.3) in the placebo group. Both groups required 3-4 antibiotic treatments over a period of 14-15 days. Two patients died in the treated and 4 in the placebo group, with 1 infant in each group developing bronchopulmonary dysplasia. The patients who recovered did so within 14 days. Analyses of subgroups of patients with different diagnoses revealed no differences except a trend suggesting fewer infections in term babies treated with intravenous Ig. The organisms cultured in the intravenous Ig groups were Pseudomonas, Klebsiella, Escherichia coli and Staphylococcus and in the placebo group Pseudomonas, Klebsiella and Enterobacter. The above has shown that, except for a trend in the older neonates, intravenous Ig is not of prophylactic benefit in ventilated neonates. Newer adjuncts in immunotherapy such as hyperimmune gammaglobulin or monoclonal antibodies may prove of greater value in the treatment of neonatal sepsis.
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PMID:Intravenous immunoglobulin prophylaxis in neonates on artificial ventilation. 871 53

Nitric oxide production appears to be decreased in infants with persistent pulmonary hypertension (PPHN). Inhaled nitric oxide may improve oxygenation by two mechanisms: increased pulmonary blood flow and improved ventilation-perfusion matching. Nitric oxide inhalation has been tested in newborns with PPHN, congenital heart diseases, and bronchopulmonary dysplasia. We present a review of the articles concerning inhaled nitric oxide for infants with PPHN. Overall, 59% of the neonates had an initial improvement in oxygenation in response to nitric oxide inhalation. A sustained response was observed in 60% of the infants. Patients with extrapulmonary shunting, clear chest radiographs, and adequate lung volume seem to have a better response, whereas patients with congenital diaphragmatic hernia, severe sepsis, and alveolar capillary dysplasia are more likely to fail. To define the benefit-risk ratio, six prospective randomized trials are currently in progress.
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PMID:The role of nitric oxide in the treatment of neonatal pulmonary hypertension. 872 5

Preterm infants often have abnormally low serum vitamin A concentrations. Persistence of vitamin A deficiency for a prolonged postnatal period may contribute to the development of bronchopulmonary dysplasia. We retrospectively analyzed data from 22 infants with birthweight < or = 1250 g who had hyaline membrane disease requiring mechanical ventilation with oxygen and in whom serum vitamin A concentrations had been measured at the onset of enteral feeding and every 2 weeks thereafter. Thirteen infants (low serum vitamin A group) had one or more serum vitamin A concentrations < or = 11 mcg/dL at > 10 days of age. In 9 infants (higher serum vitamin A group) all serum vitamin A concentrations were > 11 mcg/dL at > 10 days of age. Mean birthweight, mean gestational age, sex, race, incidence of antenatal maternal glucocorticoid treatment and ventilatory support on the first day of life were similar for the two groups. Severe bronchopulmonary dysplasia was as defined as characteristic radiographic changes and either discharge from the hospital with supplemental oxygen or death from respiratory failure at > 28 days of age following mechanical ventilation with oxygen since birth. The incidence of severe bronchopulmonary dysplasia was significantly higher in the low serum vitamin A group (11/13, 3 deaths vs. 1/9, no deaths; p=0.001). The incidence of pulmonary air leak, the number of ventilator days, the number of days of postnatal glucocorticoid treatment for chronic lung disease, the number of episodes of suspected sepsis and the number of days of antibiotic treatment also were higher in the low serum vitamin A group. Low serum vitamin A group infants were older at the onset of enteral feeding (21 days vs. 8 days; p = 0.001) and during feeding their average daily enteral intake of vitamin A was lower (713 IU vs. 1255 IU; p = 0.001) when compared with infants in the higher serum vitamin A group. Our retrospective analysis of data from these infants confirms earlier reports from other workers that persistent marked vitamin A deficiency in very low birthweight infants is associated with a high incidence of severe bronchopulmonary dysplasia, delayed onset of enteral feeding and low enteral intake of vitamin A.
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PMID:Vitamin A deficiency and severe bronchopulmonary dysplasia in very low birthweight infants. 896 Jun 6

The objective of this study was assess whether residual amniotic fluid volume (AFV) following premature rupture of the membranes (PROM) is associated with fetal presentation, or the prevalence of either clinical or histologic infection in patients delivering below 32 weeks' gestation. From an established database of 465 deliveries below 32 weeks' gestation, patients with singleton, nonanomalous fetuses with AFV assessment within 24 hours of delivery were studied (n = 146). Fetal presentation was confirmed by ultrasound identifying 46 breech and 100 vertex-presenting fetuses. Premature rupture of the membranes was diagnosed by sterile speculum examination. Clinical chorioamnionitis was diagnosed by previously published criteria. Histopathology examination of the extraplacental amnion and the umbilical cord were performed by a single pathologist blinded to clinical data. Outcome variables evaluated: rupture-to-delivery interval, gestational age at delivery, neonatal morbidity parameters (1- and 5-min Apgar scores < 5 and 7, respectively; incidence of respiratory distress syndrome; bronchopulmonary dysplasia; retinopathy of prematurity; neonatal sepsis; intraventricular hemorrhage; days of ventilation; and hospitalization), and placental histologic parameters of maternal and/or fetal acute inflammation. Statistical analysis included contingency tables and analysis of variance with p < .05 considered significant, after corrections for multiple comparisons when appropriate. Residual AF volume following PROM was significantly lower in breech compared with vertex presentation (AFV = 0 in 20 vs. 34; AFV = 1 in 19 vs. 27; AFV = 2 in 7 vs. 39, respectively, p = .014). No significant difference was noted in the rupture-to-delivery interval, gestational age at delivery, neonatal morbidity parameters, or histologic evidence of maternal and/or fetal acute inflammation (50% vs. 42%, p > .2) between gestations with breech or vertex presentations. The incidence of clinical chorioamnionitis was significantly lower in breech compared with vertex presentation (40% vs. 60%, p < .05). We conclude that following PROM below 32 weeks' gestation, in breech-presenting fetuses, the residual AFV and incidence of clinical chorioamnionitis are significantly decreased compared with vertex-presenting fetuses.
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PMID:Residual amniotic fluid volume in preterm rupture of membranes: association with fetal presentation and incidence of clinical and histologic evidence of infection. 925 12

The primary objective of this study was to evaluate the safety and benefit of early enteral feeding in very-low-birth-weight (VLBW) infants without parenteral nutrition. Weight gain, feeding intolerance, nosocomial infection rate and a postnatal growth curve were recorded for 61 VLBW premature infants who were admitted to the Neonatal Intensive Care Unit of Mackay Memorial Hospital from September 1, 1995 to February 28, 1997. Nine infants were unable to complete the study and three were excluded because of severe bronchopulmonary dysplasia; therefore only 49 infants could be evaluated. They were divided into two groups based on birth weight: 1001 gm to 1250 gm (Group A, mean birth weight 1153 +/- 64 gm, mean gestational age 29.0 +/- 2.2 weeks), and less than or equal to 1000 gm (Group B, mean birth weight 911 +/- 82 gm, mean gestational age 27.1 +/- 1.5 weeks). They received breast milk or premature formula by intermittent nasogastric or continuous nasogastric feeding. Growth was followed over the first 30 postnatal days. Group A reached 100 kcal/kg/day of enteral feeding at a mean age of 17 days as compared with a mean age of 20 days for group B. Infants regained their birth weight at 20 and 25 days in Groups A and B, respectively. By the 30th postnatal day, weight gain exceeded birth weight by 218.2 +/- 143.1 gm and 95.3 +/- 81.5 gm in groups A and B respectively. No definite episodes of necrotizing enterocolitis (NEC) developed. Two cases of Escherichia coli sepsis and one of Klebsiella sepsis occurred. The conclusion was that early enteral feeding in very-low-birth-weight infants does not increase the risk of NEC. It was also demonstrated that enteral feeding alone can produce biphasic postnatal growth curves in very-low-birth-weight infants. Although early enteral feeding was well tolerated in the study infants, the occurrence of feeding intolerance in some (36%) would suggest that additional parenteral nutrition may benefit some infants until full enteral feeding can be achieved.
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PMID:Clinical experience with early enteral feeding in very-low-birth-weight infants. 929 29


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