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Query: UMLS:C0728731 (prematurity)
 7,134 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Former preterm infants younger than 44 weeks postconceptual age are at increased risk for developing postoperative apnea and PB. When surgery cannot be deferred until the infant is developmentally more mature, several measures should be taken to minimize the risk of ventilatory dysfunction. First, outpatient surgery is not advisable for infants younger than 44 weeks postconceptual age. All infants should be admitted to the hospital and monitored for apnea and bradycardia for at least 12 to 18 hours after surgery. Second, we recommend the use of intravenous caffeine base 10 mg/kg in all infants at risk for postoperative apnea following general anesthesia. Preliminary studies of a small number of patients indicate that spinal anesthesia without sedation is associated with less apnea than is general anesthesia or spinal anesthesia with ketamine sedation. This option warrants further consideration. Infants with anemia of prematurity, generally a benign condition, are at increased risk for postoperative apnea. It is therefore preferable to delay elective surgery and supplement the feeds with iron until the Hct is above 30%. When surgery cannot be deferred, anemic infants must be observed and monitored carefully in the postoperative period.
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PMID:Anesthesia and apnea. Perioperative considerations in the former preterm infant. 829 2

At present, nearly all infants with birth weights of < 1 kg receive blood transfusions for treatment of clinical signs of tissue hypoxia resulting from anemia of prematurity. In contrast to the successful use of recombinant human erythropoietin (rhEp) in adults, treatment of anemic neonates with rhEp to stimulate red cell production and reduce the need for transfusions that pose serious infectious and immunologic risk has not been effective. The present study investigates the pharmacodynamics (PD) of endogenous erythropoietin (Ep) in sheep fetuses to determine possible causes for the poor rhEp response in early development. The dynamic relationship between plasma Ep and plasma iron resulting from spontaneous hypoxemic episodes is investigated by PD system analysis. The erythropoietic effect of Ep is measured in terms of the mobilization of plasma iron needed in the production on new erythrocytes. A hysteresis minimization approach is employed to determine the intrinsic PD dose-response relationship (transduction) of Ep. The dose-response relationship shows a well-defined threshold level that has to be exceeded before Ep begins to show a significant effect on plasma iron. It is postulated that the threshold mechanism may serve a useful purpose during early development by reducing the risk of the fetus developing a pathological degree of polycythemia and hyperviscosity in the relatively hypoxemic fetal environment. At the same time, the threshold serves the purpose of providing a needed response to more severe pathologic hypoxemic episodes. The occurrence of anemia during subsequent postnatal life when PaO2 levels increase markedly may be the inevitable, but unfortunate corollary of a continuation of this mechanism.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:A system approach to pharmacodynamics. Plasma iron mobilization by endogenous erythropoietin in the sheep fetus; evidence of threshold response in spontaneous hypoxemia. 837 18

In this study, the aim was to assess perinatal and neonatal mortality and morbidity in randomly selected villages of Oriya, Nagola, Rampur, and Chandokha in Aligarh District of Uttar Pradesh State, India. The population of 7541 received poor health services. A visit to all households within an 8 km distance netted 212 pregnant women between May 1987 and April 1988. Women were followed for a year; assessment included a routine clinical history and a general physical and obstetrical examination. Visits to the home included routine blood and urine tests. Cooperative mothers received a tetanus vaccine; calcium, iron, and folic acid tablets were distributed monthly during prenatal checkups. Daily visits were made during the postpartum period (6 weeks). Women were interviewed and information collected on their attitude, knowledge, and practice of existing health services and infant health. The results showed that transportation was an impediment to use of primary health services. Travel distance by foot to a bus stop was about 1-2 km. Considerable time was spent waiting for buses. 93% of the 212 illiterate and unaware of health care facilities. None of the women had used prenatal care in their prior pregnancies. There were 204 live births, of which 72.05% had complications within 6 weeks of the delivery. The conditions were conjunctivitis neonatorum (42.9%), "loose motions" (18.4%), and scabies/pyoderma (12.9%). 57% of the complications were due to poor hygiene or ignorance of the untrained Dai or female attendant. 10.9% of the cases were unavoidable. There were 17 perinatal deaths of which 5 were stillbirths (after 28 weeks gestation) and 12 were deaths at 1 week of age. 11 deaths were males (91.7/1000 total births) and 6 were females (67.4/1000 total births). The total rate was 81.3/1000 total births. There were 3 breech birth deaths, 2 from congenital defects, 2 from prematurity, a cord prolapse, a jaundice case, and fetal distress. 2 died of asphyxia neonatorum of unknown causes. The neonatal death rate was 63.7/1000 live births which is typical for rural areas in India. A community approach to health care, improvements in women's education, and grass roots level health personnel are recommended.
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PMID:High perinatal and neonatal mortality in rural India. 847 93

Seventy premature infants (birthweight 1.75 kg or less, gestational age 33 weeks or less) with hemoglobin less than 10 g/dL and hematocrit less than 30% were studied and randomly divided into three groups. All of them received oral elemental iron 3 mg/kg/day and vitamin E 5 mg/kg/day during the study period. Recombinant human erythropoietin (rHuEPO) 150 U/kg was administered intravenously twice a week for 4 weeks in group A (26 infants). Infants in group A received a total of 4 erythrocyte transfusions because of frequent apnea. Infants in group B (25 infants) received erythrocyte transfusion when their hemoglobin levels was less than 10 g/dL with signs and symptoms (including tachycardia, tachypnea, poor feeding, apnea, poor weight gain) attributed to anemia or who had a hemoglobin less than 8 g/dL even if asymptomatic. Infants in group B received a total of 36 erythrocyte transfusions. Infants in group C (19 infants) were assigned to a non-rHuEPO and nontransfusion group. Three of the 19 premature infants in group C received erythrocyte transfusions later because of frequent and prolonged apneic episodes and were excluded from this study. Our data revealed that reticulocyte and serum erythropoietin values were higher (p < 0.01) in rHuEPO-treated group than transfusion group and hemoglobin and hematocrit values were lower in group C than the other two groups during the rHuEPO treatment period. No significant difference (p > 0.05) was found in neutrophil and platelet counts among these three groups. Serum ferritin values were found lower in the rHuEPO-treated group than the other two groups. Lower weight gain was found in infants in group C. We conclude that rHuEPO administration can reduce the need for blood transfusion. Poor weight gain can be found in infants with anemia of prematurity who do not receive rHuEPO or blood transfusion therapy.
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PMID:Recombinant human erythropoietin in the treatment of anemia of prematurity. 854 Sep 30

The receptivity of 212 pregnant women in rural Uttar Pradesh, India, to prenatal services provided at their homes was assessed during a May 1987 to April 1988 longitudinal study. The women, from four randomly selected villages, were assessed every month until completion of the neonatal period. Receptivity to doorstep prenatal services was calculated by developing a weighted score based on time when prenatal services began, frequency of visits accepted, number of doses of tetanus toxoid immunization accepted, and place of and person attending the delivery. Of the 212 women, 17% had poor, 75.9% had moderate, and 7.1% had high receptivity to the prenatal services. The pregnancies resulted in 5 stillbirths and 12 neonatal deaths before one week, for a perinatal mortality rate of 81.3/1000. 3 of the 8 infants who were in breech presentation died, 2 infants died from congenital defects, 2 from prematurity, 1 from cord prolapse, 1 from jaundice, 1 from fetal distress, and 2 from unknown causes. Another neonate died of meningitis. The perinatal mortality rates were 90.9, 86.9, and 0/1000 births in women with poor, moderate, and high receptivity scores, respectively. The inverse relationship between maternal care receptivity and the mortality rates was statistically significant. The poor receptivity to home-based prenatal care results from ignorance, illiteracy, and poverty and from a deeply rooted confidence in traditional birth attendants. This study also revealed that anemia persisted in 62.2% of these women even after iron and folic acid supplementation. This study highlights the importance of providing health education to pregnant women to increase their receptivity to maternal care services.
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PMID:Maternal care receptivity and its relation to perinatal and neonatal mortality. A rural study. 863 4

The effect of recombinant human (r-Hu) erythropoietin (Epo) (300 IU/Kg per week for 4 weeks) was studied in healthy preterm infants (n = 14) fed human milk with additional milk protein and high doses of iron. The controls (n = 15) were in themselves a study group and were used to follow the natural course of anaemia of prematurity on such nutrition. Serum immunoreactive Epo (SiEpo) increased significantly 24 h after r-HuEpo injections (range 36 to > 128 mU/ml) and remained at these levels throughout the treatment period. r-HuEpo in such moderate doses kept haemoglobin above 11 g/dl. Bodyweight gain, protein and iron parameters indicated adequacy of dietary protein and iron. In controls, siEpo increased during the first weeks after nutritional supplementation, with a concommitant rise in reticulocyte count. At age 3 weeks, despite low siEpo levels, reticulocyte counts indicated active erythropoiesis. Following further moderate increases in siEpo, the reticulocyte count increased to high levels (7%). The reticulocyte response suggests that erythropoiesis in preterm infants is less dependent upon Epo levels than in adults.
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PMID:Erythropoietin (Epo), protein and iron supplementation and the prevention of anaemia of prematurity: effects on serum immunoreactive Epo, growth and protein and iron metabolism. 874 Mar 12

Erythropoietin (rHuEPO) therapy has been shown to be beneficial in preventing and treating anaemia of prematurity and to decrease the need for blood transfusions. There is, however, only scanty data on the effect of rHuEPO therapy on iron metabolism. We studied 29 preterm infants (age 34 +/- 14 days) who were randomly assigned to receive either rHuEPO 900 U kg-1 week-1 with 6 mg kg-1 day-1 of iron for 4 weeks (n = 15) or no therapy. The following parameters were evaluated and compared between and within groups at the beginning, during and at the end of the study: Haematocrit (SI), reticulocytes (10(9) micrograms l-1), serum ferritin (microgram 1-1) and iron (mumol l-1). The results were as follows. At the baseline, erythropoietin levels were similar in both groups: 7.2 +/- 5.6 versus 6.2 +/- 3.2 mU ml-1 (NS). In the treated infants the haematocrit remained stable during the study and was significantly higher than in the control group by the end of the study: 0.34 +/- 0.03 versus 0.28 +/- 0.05 (p = 0.001). rHuEPO therapy increased the reticulocyte count from 130 +/- 70 to 430 +/- 200 (p = 0.0002). However, rHuEPO therapy depleted both serum ferritin and iron levels from 321 +/- 191 to 76 +/- 58 micrograms l-1 (p = 0.04) and from 18 +/- 5 to 13 +/- 4 mumol l-1 (p = 0.03), respectively. We conclude that rHuEPO therapy prevented anaemia and its sequelae; however, serum ferritin and iron levels were depleted. We suggest that the effect of rHuEPO may be further increased by higher iron supplementation.
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PMID:Decreased ferritin levels, despite iron supplementation, during erythropoietin therapy in anaemia of prematurity. 874 Mar 13

1. Non-protein-bound iron has been implicated in the aetiology of chronic lung disease of prematurity. 2. The modification of a method for the measurement of non-transferrin-bound iron in small volumes of plasma and bronchoalveolar lavage fluid from preterm babies is described. 3. The assay runs with a good degree of precision and a lower limit of detection of 0.02 mumol/l. 4. Non-transferrin-bound iron was detected in 50% of plasma samples and 11% of bronchoalveolar lavage fluid samples collected over the first week of life from babies born prematurely.
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PMID:Chromatographic method for the determination of non-transferrin-bound iron suitable for use on the plasma and bronchoalveolar lavage fluid of preterm babies. 894 3

Erythropoietin, the primary stimulator of erythropoiesis, represents an important potential therapy for the anemia of prematurity. Enhancement of the therapeutic benefit of recombinant human erythropoietin (rhEp) in very-low-birth-weight infants will require a better understanding of rhEp's pharmacodynamic effects including its interaction with iron in stimulating erythropoiesis. The purpose of this study was to determine the effects of chronic rhEp administration on plasma iron levels and hematopoiesis using a twin lamb model. Nine pairs of twin lambs in which one twin was randomized to receive rhEp, and the other saline, were studied during a 1-week baseline and a subsequent 4- to 5-week treatment period. The effects of therapy on plasma iron levels and erythropoiesis were measured by integrating the areas under the concentration-time curves (AUC) of the study variables. During the rhEp treatment period, significantly greater negative daily AUCs were observed in the rhEp-treated lambs for plasma iron concentration (p = 0.0008), while significantly greater positive daily AUCs were observed for hemoglobin concentration (p = 0.04) and reticulocyte count (p = 0.02). In the rhEp-treated group, pretreatment iron concentrations were directly associated with the magnitude of the iron response during treatment such that the greater the pretreatment iron, the greater the daily AUC below the plasma iron concentration-time plot (r = -0.66, p = 0.05). For the placebo-treated group, this association tended toward, but did not achieve, statistical significance (r = -0.52, p = n.s.). These observations suggest that treatment of rapidly growing newborn lambs with rhEp results in increased iron utilization due to increased erythropoiesis and depends on iron status at the initiation of rhEp treatment. Use of the term neonatal lamb model offers advantages over studies in human infants for more detailed or invasive examinations of the interaction of iron and rhEp treatment.
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PMID:Effect of chronic erythropoietin administration on plasma iron in newborn lambs. 896 12

Recombinant human erythropoietin is used in clinical practice mainly for treatment of anemia of renal failure. In the past years, however, its use has been approved for other indications, including prevention of anemia in surgical patients or in patients undergoing platinum-based chemotherapy, treatment of anemia of prematurity, of anemia induced by zidovudine therapy in HIV-infected patients, and of anemia induced by chemotherapy of nonmyeloid malignancies. Erythropoietin should routinely be given subcutaneously to maximize its effects. Most patients undergoing rHuEpo treatment develop functional iron deficiency, a situation in which iron supply to the erythroid marrow is inadequate for the erythrocyte precursor demand. Iron supplementation should, therefore, be given to all individuals receiving rHuEpo except for those patients with increased serum iron and transferrin saturation. Outside the setting of uremia, only a portion of patients can clearly benefit from erythropoietin therapy; therefore, the use of rHuEpo should be individualized in nonrenal applications.
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PMID:How and when to use erythropoietin. 957 Jul 2


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