Induction of mixed apneas by inhalation of 100% oxygen in preterm infants

1994 ◽  
Vol 77 (4) ◽  
pp. 1666-1670 ◽  
Author(s):  
R. Alvaro ◽  
J. Alvarez ◽  
K. Kwiatkowski ◽  
D. Cates ◽  
H. Rigatto
Keyword(s):  
Preterm Infants ◽  
Gestational Age ◽  
Flow Through ◽  
Group 2 ◽  
Central Apneas ◽  
Group 1

Administration of 100% O2 to preterm infants induces an apnea that is usually central. We hypothesized that this apnea may be “mixed” at times with an obstructive component appearing late during the respiratory pause. In addition, we reasoned that obstruction would depend on the duration of the apnea. Thus, we gave 100% O2 to 61 healthy preterm infants. Group 1 was > or = 1,500 g [birth wt 1.8 +/- 0.1 (SE) kg, gestational age 32 +/- 1 wk, postnatal age 19 +/- 2 days, n = 26] and group 2 was < 1,500 g [birth wt 1.2 +/- 0.1 kg, gestational age 29 +/- 1 wk, postnatal age 30 +/- 4 days, n = 35]. Ventilation was measured using a flow-through system. Respiratory efforts in the absence of flow were detected using chest and abdominal displacements or diaphragmatic electromyography. In group 1, 19% of the central apneas became obstructive at 17 +/- 3 s, whereas in group 2, 34% did so at 12 +/- 2 s. Mixed apneas were longer than those without obstruction (28 +/- 3 vs. 12 +/- 1 s; P = 0.0001). The incidence of mixed apneas was 0, 14, and 66% in group 1 and 0, 27, and 69% in group 2 in apneas of 3–10, 11–20, and > 20 s, respectively. These findings suggest that 1) a percentage of the central apneas induced by inhaling 100% O2 became obstructive, 2) the incidence of the obstructive component increased with the duration of apnea, and 3) smaller infants became obstructed sooner and had a higher incidence of obstruction than larger infants.(ABSTRACT TRUNCATED AT 250 WORDS)

Strength of the Breuer-Hering inflation reflex in term and preterm infants

1995 ◽  
Vol 79 (6) ◽  
pp. 1986-1990 ◽  
Author(s):  
J. P. De Winter ◽  
I. T. Merth ◽  
A. Berkenbosch ◽  
R. Brand ◽  
P. H. Quanjer
Keyword(s):  
Preterm Infants ◽  
Respiratory System ◽  
Gestational Age ◽  
Blood Gases ◽  
First Year ◽  
Static Compliance ◽  
Term Infants ◽  
Group 3 ◽  
Group 2 ◽  
Group 1

The effect of the presence of the respiratory distress syndrome (RDS) or related factors (static compliance of the respiratory system and transcutaneous blood gases) and gestational age on the strength of the Breuer-Hering inflation reflex (BHIR) was studied in three groups of infants. Twenty-six ventilated preterm infants with and without RDS were studied 6 h after birth (group 1). In 24 preterm infants, we followed the development of reflex strength during the first year of life (group 2). Twenty-one healthy nonintubated term infants were studied within the first week of life (group 3). The BHIR was initiated by end-inspiratory occlusions, and the strength was characterized by the ratio of expiratory time after and without preceding airway occlusion. The static compliance of the respiratory system in ventilated infants was assessed by the multiple-occlusion technique. In group 1, reflex strength declined with increasing gestational age; in the presence of RDS or low respiratory compliance, the decline was less. Transcutaneous blood gases did not affect reflex strength. At term age, reflex strength was similar in spontaneously breathing preterm (group 2) and term infants (group 3). The BHIR decreased in strength during the first year after preterm birth. We conclude that 1) the strength of the BHIR decreases with increasing gestational and postnatal ages and 2) RDS, due to changes in respiratory system mechanics, causes an increase in reflex strength.

scholarly journals Vermal Length and Transcerebellar Diameter in Gestational Age Estimation: A Guide to Forensic Expert

2019 ◽  
Vol 08 (03) ◽  
pp. 101-105
Author(s):  
Nadia Ahmad ◽  
S. L. Jethani ◽  
Deepa Singh ◽  
Ruchira Nautiyal
Keyword(s):  
Gestational Age ◽  
Age Determination ◽  
Linear Increase ◽  
Group 4 ◽  
Age Regression ◽  
Group 3 ◽  
Group 2 ◽  
Gestational Age Estimation ◽  
Formalin Fixed ◽  
Group 1

Abstract Background Transcerebellar diameter is one of the reliable, constant predicting parameters to assess the gestational age and fetal growth. Other than this, measurements of vermis, mostly the vermal length (height), have also been mentioned by authors to assess gestational age. Establishing a correlation between parameters and advancing gestation would be helpful in estimating the gestational age of fetus. Aims and Objectives To establish a correlation of vermal length and transcerebellar diameter with gestational age. Materials and Methods An observational and descriptive study conducted on 60 formalin-fixed human cerebellums. Fetuses with gross congenital/neurological abnormality were excluded. Fetuses were grouped into four groups—group 1 (13–17 weeks), group 2 (18–22 weeks), group 3 (23–27 weeks), and group 4 (28–32 weeks of gestation). Vermal length and transcerebellar diameter were measured with help of Vernier calipers. The data obtained were analyzed using statistical software SPSS version 20.0 and one-way analysis of variance. Observation A linear increase in vermal length parameters and transcerebellar diameter were seen with increasing gestational age. Regression analysis was done and regression equation was derived for each parameter. Conclusion Such correlations would help in fetal age determination in the field of forensic studies.

Evaluation of a Pediatric Multiple Vitamin Preparation for Total Parenteral Nutrition II. Blood Levels of Vitamins A, D, and E

PEDIATRICS ◽  
1986 ◽  
Vol 77 (4) ◽  
pp. 539-547
Author(s):  
H. L. Greene ◽  
M. E. Courtney Moore ◽  
B. Phillips ◽  
L. Franck ◽  
R. J. Shulman ◽  
...  
Keyword(s):  
Vitamin A ◽  
Parenteral Nutrition ◽  
Total Parenteral Nutrition ◽  
Preterm Infants ◽  
Reference Range ◽  
Infants And Children ◽  
Blood Levels ◽  
Vitamin D Levels ◽  
Group 2 ◽  
Group 1

This study represents the first attempt to evaluate the American Medical Association Nutrition Advisory Group (NAG) recommendations for intravenous vitamin A, D, and E dosages for infants and children. Patients studied included 18 preterm infants (group 1) and 26 term infants and children (group 2A) receiving total parenteral nutrition for 2 to 4 weeks and eight infants and children receiving total parenteral nutrition for 3 to 6 months (group 2B). Term gestation infants and children up to 11 years of age all received the same dosages (those that were recommended by the NAG for children weighing more than 10 kg). Preterm infants received 65% of these doses. In group 1, cord blood α-tocopherol levels were &lt;0.22 mg/dL in seven preterm infants (reference value = 0.29 ± 0.04), but mean levels increased to 1.65 ± 0.17 mg/dL after four days of treatment. Eight infants consistently received additional vitamin E orally (80 to 150 mg daily), and their levels increased to 2.18 ± 0.26 mg/dL by four days of study and to 3.49 ± 0.57 mg/dL after 3 weeks. Oral supplementation in the preterm infants appeared to be unnecessary because intravenous vitamins alone maintained levels above 1.1 mg/dL. In group 2, α-tocopherol levels were maintained within the reference range. Patients receiving lipid emulsions containing substantial quantities of α-tocopherol had significantly higher blood levels than patients receiving lipid emulsions containing little α-tocopherol (P &lt; .01). Mean 25-OH vitamin D levels were mintained above or within the reference range in groups 2A and 2B. Although only seven patients in group 1 had measurements performed after beginning total parenteral nutrition, their 25-OH vitamin D levels increased during total parenteral nutrition and were maintained within the reference range. Mean vitamin A levels in group 2 were maintained within the reference range of 23.5 ± 1.8 µg/dL, although three of eight patients in group 2A who had levels 2 SD less than the reference mean levels initially did not increase their levels during the 2-week period of treatment. Patients on home total parenteral nutrition (group 2B) showed a mean increase in retinol, from 29.2 ± 3.0 µg/dL to 37.4 ± 7.1 µg/dL. There was also good correlation between retinol-binding protein and retinol in all patients in group 2. Premature infant (group 1) levels were 13.9 ± 1.3 µg/dL initially (reference value = 15.7 µg/dL) and did not change after 28 days of treatment (13.5 ± 2.5 µg/dL). In addition, there was poor correlation with retinol-binding protein. The failure of retinol to increase with treatment may be secondary to losses of retinol in the delivery system. Further studies are needed to better define vitamin A and D needs during parenteral feeding of premature infants, although the dosage levels in term infants appear to maintain mean blood levels of all of the vitamins within the reference range.

scholarly journals Reduction of exposure to blood donors in preterm infants submitted to red blood cell transfusions using pediatric satellite packs

2013 ◽  
Vol 31 (3) ◽  
pp. 285-292 ◽  
Author(s):  
Cristina Lika Uezima ◽  
Ariane Moreira Barreto ◽  
Ruth Guinsburg ◽  
Akemi Kuroda Chiba ◽  
José Orlando Bordin ◽  
...  
Keyword(s):  
Birth Weight ◽  
Preterm Infants ◽  
Blood Donor ◽  
Blood Donors ◽  
Newborn Infants ◽  
Median Number ◽  
Erythrocyte Transfusion ◽  
Factors Associated ◽  
Group 2 ◽  
Group 1

OBJECTIVE: In preterm newborn infants transfused with erythrocytes stored up to 28 days, to compare the reduction of blood donor exposure in two groups of infants classified according to birth weight. METHODS: A prospective study was conducted with preterm infants with birth weight <1000g (Group 1) and 1000-1499g (Group 2), born between April, 2008 and December, 2009. Neonates submitted to exchange transfusions, emergency erythrocyte transfusion, or those who died in the first 24 hours of life were excluded. Transfusions were indicated according to the local guideline using pediatric transfusion satellite bags. Demographic and clinical data, besides number of transfusions and donors were assessed. . Logistic regression analysis was performed to determine factors associated with multiple transfusions. RESULTS: 30 and 48 neonates were included in Groups 1 and 2, respectively. The percentage of newborns with more than one erythrocyte transfusion (90 versus 11%), the median number of transfusions (3 versus 1) and the median of blood donors (2 versus 1) were higher in Group 1 (p<0.001), compared to Group 2. Among those with multiple transfusions, 14 (82%) and one (50%) presented 50% reduction in the number of blood donors, respectively in Groups 1 and 2. Factors associated with multiple transfusions were: birth weight <1000g (OR 11.91; 95%CI 2.14-66.27) and presence of arterial umbilical catheter (OR 8.59; 95%CI 1.94-38.13), adjusted for confounders. CONCLUSIONS: The efficacy of pediatrics satellites bags on blood donor reduction was higher in preterm infants with birth weight <1000g.

scholarly journals Availability of Donor Milk for Very Preterm Infants Decreased the Risk of Necrotizing Enterocolitis without Adversely Impacting Growth or Rates of Breastfeeding

Nutrients ◽  
2019 ◽  
Vol 11 (8) ◽  
pp. 1895 ◽  
Author(s):  
Débora Cañizo Vázquez ◽  
Sandra Salas García ◽  
Montserrat Izquierdo Renau ◽  
Isabel Iglesias-Platas
Keyword(s):  
Preterm Infants ◽  
Necrotizing Enterocolitis ◽  
Neonatal Intensive Care ◽  
Late Onset ◽  
Donor Milk ◽  
Very Preterm Infants ◽  
Very Preterm ◽  
Breastfeeding Rates ◽  
Group 2 ◽  
Group 1

Human milk contains non-nutritional factors that promote intestinal maturation and protect against infectious and inflammatory conditions. In the Neonatal Intensive Care Unit (NICU) setting, donor milk (DM) is recommended when availability of own mother’s milk (OMM) is not enough. Our aim was to compare the incidence of necrotizing enterocolitis (NEC) and late-onset sepsis (LOS) in very preterm infants (VPI) after the introduction of DM. Growth and breastfeeding rates were examined as secondary outcomes. Single center, observational and retrospective cohort study comparing 227 VPI admitted to our neonatal unit before (Group 1, n = 99) and after (Group 2, n = 128) DM introduction. Enteral nutrition was started earlier after DM availability (2.6 ± 1.1 vs. 2.1 ± 1 days, p = 0.001). Incidence of NEC decreased in group 2 (9.1% vs. 3.4%, p = 0.055), especially in those born between 28 and 32 weeks (5.4 vs. 0.0%, p = 0.044). Surgical NEC was also less frequent. Suffering NEC was 4 times more likely in group 1 (multivariate analysis). Availability of DM did not impact breastfeeding rates or preterm growth. Our findings support the protective role of DM against NEC, particularly in non-extreme VPI, a group less frequently included in clinical guidelines and research studies on the use of DM.

The effects of intrafetal ACTH administration on the outcome of pregnancy in the mare

1998 ◽  
Vol 10 (4) ◽  
pp. 359 ◽  
Author(s):  
J. C. Ousey ◽  
P. D. Rossdale ◽  
F. E. Dudan ◽  
A. L. Fowden
Keyword(s):  
Gestational Age ◽  
Plasma Cortisol ◽  
Maternal Plasma ◽  
Sterile Water ◽  
Adaptive Responses ◽  
Gestational Length ◽  
Adrenocortical Activity ◽  
Group 3 ◽  
Group 2 ◽  
Group 1

Enhanced adrenocortical activity in the fetus is related to the onset of parturition in many species. The aim of this study was to determine the effect of injection of fetal ACTH on gestational length and fetal viability in the horse. Pony mares (n=23) were studied from 300 days gestation. Seven control mares (Group 1) received three consecutive intrafetal injections of sterile water, while fetuses of a further 16 mares received Depot ACTH1–24. These mares were either allowed to foal spontaneously (Group 2, n=4) or delivery was induced within 3 days of the last fetal injection (Group 3, n=7); 5 mares aborted within 48 h of intrafetal ACTH injection. Maternal plasma progestagen concentrations increased significantly (P<0.05) in Groups 2 and 3 mares following intrafetal ACTH injection, compared with Group 1 mares. All Group 1 mares delivered live foals at a median gestational age of 327 days (interquartile range, 323–334), except one that aborted 16 days after the last fetal injection. Gestational length was significantly (P<0.05) shortened in Group 2 mares (median 314 [312–314]) days compared with controls. Group 1 and Group 2 foals showed normal postnatal adaptive responses and endocrine (plasma cortisol/progestagens) patterns. Group 3 mares delivered live foals at 306 (306–308) days gestation except one that aborted. Their foals were less mature compared with Groups 1 and 2 foals. Eight ACTH-injected fetuses were meconium-stained at delivery, including four that were aborted. Eight mares had thickened placentae, including three that aborted. The data show that both precocious maturation of the equine fetus and a significant reduction in gestational length compared with controls may be achieved in pony mares by intrafetal ACTH injections. This is probably mediated via adrenal regulation of fetal maturation and production of maternal progestagens.

scholarly journals Efficacy and safety of mifepristone-misoprostol combination with extraamniotic ethacridine lactate-misoprostol for termination of second trimester pregnancy

2018 ◽  
Vol 7 (10) ◽  
pp. 4229
Author(s):  
Hemavathi G. ◽  
Jagruthi C.
Keyword(s):  
Gestational Age ◽  
Second Trimester ◽  
Efficacy And Safety ◽  
Trimester Abortion ◽  
Medical College ◽  
Incomplete Abortion ◽  
Ethacridine Lactate ◽  
Second Trimester Pregnancy ◽  
Group 2 ◽  
Group 1

Background: Mid trimester termination of pregnancy is one of the most controversial areas of gynecological practice. It has moral, emotional, social and technical issues. This study was designed for comparison of efficacy and safety of Mifepristone-Misoprostol combination with exrtaamniotic Ethacridine Lactate-misoprostol for termination of second trimester pregnancy.Methods: The present was undertaken among the patients admitted to hospitals attached to J.J.M. Medical College; Bapuji hospital, Women and Children hospital and Chigateri general hospital Davangere during the study period   from November 2016 - October 2017.  Patients coming for second trimester abortion to above mentioned hospitals were assigned serial number from 1 to 80 and all patients with even number will be allocated to group 1 and all patients with odd number will be allocated in group 2, each group comprising 40 women each.Results: Majority of the cases in both the groups were between 21-25 yrs. Majority of the cases in both the groups were multigravidas. 11 cases from group 1 and 12 cases from group 2 were of gestational age between 14-16 wks. 29 cases from group 1 and 28 cases from group 2 were of gestational age between 18-20 wks. In the present study the mean induction abortion interval for group 1 was 19.56±1.82 hours and group 2 was 14.13±2.72 hours. This was statistically significant. Of the 40 cases in each group, 37 had complete abortion i.e. 92.5% 3 cases (7.5%) from both the groups had incomplete abortion. The side effects were relatively more in more in group 1 when compared to group 2.Conclusions: It was concluded that with this combination success rate was high (92.5 %), with Short induction abortion interval, less rate of incomplete abortion without any major complications.

scholarly journals Neonatal Problems and Infancy Growth of Term SGA Infants: Does “SGA” Definition Need to Be Re-evaluated?

2021 ◽  
Vol 9 ◽  
Author(s):  
Saygin Abali ◽  
Serdar Beken ◽  
Eda Albayrak ◽  
Aysegul Inamlik ◽  
Burcu Bulum ◽  
...  
Keyword(s):  
Gestational Age ◽  
Severe Hypoglycemia ◽  
Point Of View ◽  
Control Group ◽  
Term Infants ◽  
Group 3 ◽  
Group 2 ◽  
Definition Of ◽  
Neonatal Problems ◽  
Group 1

Introduction: The exact definition of small-for-gestational-age (SGA) infant is still controversial among clinicians. In this study, we aimed to understand which definition is better in terms of establishing both early postnatal problems and growth. In this way, we compared early neonatal problems and infancy growth of term infants with birth weight (BW) &lt; -2 SDS and with BW between 10th percentile (−1.28 SDS) and −2 SDS.Methods: A single center retrospective cohort study was conducted. Preterm infants, multiple gestations and newborns with any congenital anomalies were excluded from the study. Study group was defined as Group 1 (n = 37), infants BW &lt; −2.00 SDS; Group 2 (n = 129), between −1.28 and −2.00 SDS; and Group 3 (n = 137), randomly selected newborns with optimal-for-gestational-age (BW between −0.67 and +0.67 SDS) as a control group.Results: The incidence of severe hypoglycemia was highest in Group 1 (%10.8) and Group 2 and 3 had similar rates of severe hypoglycemia (0.8 and 0.7%, respectively). The incidence of polycythemia was 5.4% in Group 1 and was significantly higher than Group 3 (0.0%) while it was 2.3% in Group 2. Short stature (length &lt; −2 SDS) ratio at the age of 1 and 2 years were similar in each group. Overweight/obesity ratio at the age of 1 were 9.5, 20.8 and 16.7% in each group, respectively (p = 0.509).Conclusion: This study was planned as a pilot study to determine potential differences in the problems of hypoglycemia, polycythemia, and growth according to the differences in definition. Short term disturbances such as hypoglycemia and polycythemia are found to be higher in infants with a BW SDS below −2. From this point of view, of course, it will not be possible to change the routine applications immediately, however this study will be an initiative for discussions by making long-term studies.

Effects of inhaled oxygen (up to 40%) on periodic breathing and apnea in preterm infants

1992 ◽  
Vol 72 (1) ◽  
pp. 116-120 ◽  
Author(s):  
Z. Weintraub ◽  
R. Alvaro ◽  
K. Kwiatkowski ◽  
D. Cates ◽  
H. Rigatto
Keyword(s):  
Birth Weight ◽  
Tidal Volume ◽  
Preterm Infants ◽  
Gestational Age ◽  
Minute Ventilation ◽  
Periodic Breathing ◽  
Respiratory Pattern ◽  
Quiet Sleep ◽  
Flow Through ◽  
Transcutaneous Po2

To discover whether increases in inhaled O2 fraction (FIO2; up to 40%) decrease apnea via an increase in minute ventilation (VE) or a change in respiratory pattern, 15 preterm infants (birth weight 1,300 +/- 354 g, gestational age 29 +/- 2 wk, postnatal age 20 +/- 9 days) breathed 21, 25, 30, 35, and 40% O2 for 10 min in quiet sleep. A nosepiece and a flow-through system were used to measure ventilation. Alveolar PCO2, transcutaneous PO2, and sleep states were also assessed. All infants had periodic breathing with apneas greater than or equal to 3 s. With an increase in FIO2 breathing became more regular and apneas decreased (P less than 0.001). This regularization in breathing was not associated with significant changes in VE. However, the variability of VE, tidal volume, and expiratory and inspiratory times decreased significantly. The results indicate that the more regular breathing observed with small increases in FIO2 was not associated with significant changes in ventilation. The findings suggest that the increased oxygenation decreases apnea and periodicity in preterm infants, not via an increase in ventilation, but through a decrease in breath-to-breath variability of VE.

Outcomes among preterm infants with patent ductus arteriosus: Relationship with treatment, gestational age, hemodynamic status and timing of treatment

2021 ◽  
pp. 1-9
Author(s):  
S.M. Chikkabyrappa ◽  
N. Chaudhary ◽  
A. Agarwal ◽  
D. Rastogi ◽  
P. Filipov ◽  
...  
Keyword(s):  
Patent Ductus Arteriosus ◽  
Preterm Infants ◽  
Ductus Arteriosus ◽  
Retrospective Case ◽  
Chi Square ◽  
Hemodynamic Status ◽  
Group 3 ◽  
Group 2 ◽  
Patent Ductus ◽  
Group 1

BACKGROUND: There remains controversy regarding the outcomes resulting from treatment versus conservative management of patent ductus arteriosus (PDA) among preterm infants. The effects of extreme prematurity, hemodynamic status of the PDA, and age at treatment remain poorly defined. STUDY DESIGN: This retrospective case-control study including infants <  1250 gm who were categorized into 3 groups: Group 1: without PDA, Group 2: with untreated PDA, and Group 3: treated PDA. Diagnosis and treatment of PDA extracted from the medical records. Demographics, clinical characteristics, and outcomes compared using chi-square and analysis of variance. Logistic regression used to estimate adjusted odds ratios. RESULTS: The study included 734 infants, with 141(19%) in Group 1, 329 (45%) in 2, and 264 (36%) in 3. Group 3 had higher incidence of bronchopulmonary dysplasia (BPD) (aOR, 2.9; 95%CI 1.7–4.8). Infant treated for hemodynamically significant PDA (HSPDA) had higher incidence of BPD (aOR, 1.9; 95%CI 1.0–3.8) and retinopathy of prematurity (ROP) (aOR, 3.4; 95%CI 1.6–6.9). There were no differences in outcome associated with treatment among≤26 weeks gestation and the age when treated. CONCLUSION: Infants with PDA who were treated had higher incidence of BPD. Among those who were treated, those with HSPDA had a higher incidence of BPD and ROP.

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