Benzyl Alcohol: Toxic Agent in Neonatal Units

PEDIATRICS ◽  
1983 ◽  
Vol 72 (3) ◽  
pp. 356-358 ◽  
Author(s):  
◽  
Keyword(s):  
Benzyl Alcohol ◽  
Multiple Dose ◽  
Antimicrobial Agents ◽  
Very Low Birth Weight ◽  
Newborn Infants ◽  
Isotonic Saline ◽  
The United States ◽  
Low Birth Weight Infants ◽  
Toxic Agent ◽  
Arterial Blood

As advances have been made in the care of very low-birth-weight infants, some techniques or practices have caused unexpected complications. One such practice is umbilical vessel catheterization to monitor an infant's arterial blood pressure, infuse fluids and medications, and obtain blood specimens for laboratory examinations. The catheters frequently are flushed with sterile isotonic saline or a 5% solution of dextrose in water, with the flush solution frequently being obtained from a multiple-dose vial. The United States Pharmacopeia requires all medications or solutions marketed in a multiple-dose vial to contain an antimicrobial preservative. Benzyl alcohol, an aromatic alcohol, is used for this purpose in a wide variety of medications and fluids for parenteral therapy, usually in a concentration of 0.9%. Two groups of investigators, Gershanik et al1 (New Orleans) and Brown et al2 (Portland), independently concluded that an intravascular infusion of flush solutions containing 0.9% benzyl alcohol caused severe metabolic acidosis, encephalopathy, respiratory depression with gasping, and perhaps other abnormalities leading to the death of a total of 16 infants. Blood and urine from several affected infants had high levels of both benzoic and hippuric acids, known metabolites of benzyl alcohol. Both groups stated that no additional cases occurred after solutions with benzyl alcohol preservative were banned in their nurseries. Subsequently, in May 1982, the Food and Drug Administration3 with the concurrence of the American Academy of Pediatrics and the Centers for Disease Control,4 urged pediatricians and other personnel in hospitals not to use fluids preserved with benzyl alcohol (or other antimicrobial agents) as intravascular flush solutions for newborn infants and not to use diluents with this preservative to reconstitute or dilute medications for infants.

POVERTY AND VERY LOW BIRTH WEIGHT INFANTS IN DC

PEDIATRICS ◽  
1989 ◽  
Vol 83 (5) ◽  
pp. A77-A77
Author(s):  
Student
Keyword(s):  
Infant Mortality ◽  
Teenage Pregnancy ◽  
Maternal Nutrition ◽  
Very Low Birth Weight ◽  
Common Factor ◽  
District Of Columbia ◽  
The United States ◽  
Low Birth Weight Infants ◽  
Premature Babies ◽  
Increased Risk

The single largest contributor to infant mortality in the District of Columbia, and elsewhere in the United States, is immaturity. In the district the dead newborns are not simply those born a little too early; they are extraordinarily premature, babies weighing less than 2 pounds 4 ounces at birth. The cause of their premature birth is not known. It is not just teenage pregnancy, poor maternal nutrition, infectious disease, cigarette smoking, drug abuse or alcohol—although each of these is statistically associated with an increased risk for early delivery. The major common factor repeatedly identified is poverty. It is apparent that the overriding influences on infant mortality are social and cultural, not medical.

Prospective Evaluation of Percutaneous Central Venous Silastic Catheters in Newborn Infants With Birth Weights of 510 o 3,920 Grams

PEDIATRICS ◽  
1986 ◽  
Vol 78 (2) ◽  
pp. 245-250 ◽  
Author(s):  
Manuel Durand ◽  
Rangasamy Ramanathan ◽  
Bruce Martinelli ◽  
Milagros Tolentino
Keyword(s):  
Parenteral Nutrition ◽  
Total Parenteral Nutrition ◽  
Very Low Birth Weight ◽  
Newborn Infants ◽  
Central Venous Catheters ◽  
Central Venous ◽  
Low Birth Weight Infants ◽  
A Prospective Study ◽  
First Time ◽  
Percutaneous Central Venous Catheters

With improved neonatal survival, especially of very low birth weight infants, our efforts should be directed toward reduction of morbidity. Sick preterm infants require total parenteral nutrition for prolonged periods of time due to extreme prematurity and feeding intolerance. However, the use of surgically placed Broviac catheters has been associated with a high complication rate. A prospective study of 53 percutaneous central venous Silastic catheterizations for administration of total parenteral nutrition was performed in 45 newborn infants. At the time of catheter insertion, 37 babies weighed less than 1,500 g and 19 weighed less than 1,000 g. Percutaneous central venous catheters were placed successfully the first time in 50 of 55 attempts. In three babies, insertion was successful on second attempt. The catheters remained in place for 25.4 ± 16.7 days ([mean ± SD] range two to 80 days). In babies weighing less than 1,000 g, the catheters remained in place for a longer period of time (34.0 ± 18.0; range 12 to 80 days). Sixty-six percent of the catheters were removed electively. There were four cases of bacteremia (7.5%), and the overall incidence of mechanical complications was 26.4%. We conclude that percutaneous central venous catheters can be used safely and effectively in newborn infants for prolonged administration of total parenteral nutrition, especially in neonates weighing less than 1,000 g.

Low Birth Weight, Vital Records, and Infant Mortality

PEDIATRICS ◽  
1986 ◽  
Vol 78 (6) ◽  
pp. 1143-1145
Author(s):  
MYRON E. WEGMAN
Keyword(s):  
Birth Weight ◽  
Infant Mortality ◽  
Low Birth Weight ◽  
Very Low Birth Weight ◽  
The United States ◽  
Low Birth Weight Infants ◽  
Neonatal Deaths ◽  
Live Births ◽  
Order Of Magnitude ◽  
Almost All

About one tenth of all infant deaths occur in babies weighing less than 500 g at birth, almost all of whom die very shortly thereafter. In 1983, when the United States reported 3,638,933 live births, 4,368 of them were less than 500 g; that year there were 26,507 neonatal deaths. This means that slightly more than 0.1% of all live births contributed to 17% of neonatal mortality. Given this order of magnitude, any change in the numbers relating to these tiny babies can have a disproportionate influence on reported infant mortality and on interstate comparisons. Two questions promptly arise. How accurate and meaningful are the data regarding babies born weighing less than 500 g? What can be done to decrease the deaths in this category? Wilson et al1 call attention to how the number of very low birth weight infants reported by a state may be affected by the state's definition of a live birth.

Early Vital Sign Differences in Very Low Birth Weight Infants with Severe Intraventricular Hemorrhage

2021 ◽  
Author(s):  
Santina A. Zanelli ◽  
Maryam Abubakar ◽  
Robert Andris ◽  
Kavita Patwardhan ◽  
Karen D. Fairchild ◽  
...  
Keyword(s):  
Birth Weight ◽  
Low Birth Weight ◽  
Vital Sign ◽  
Intraventricular Hemorrhage ◽  
Neonatal Intensive Care ◽  
Very Low Birth Weight ◽  
Cranial Ultrasound ◽  
Low Birth Weight Infants ◽  
Vlbw Infants ◽  
Arterial Blood

Objective Severe intraventricular hemorrhage (sIVH, grades 3 and 4) is a serious complication for very low birth weight (VLBW) infants and is often clinically silent requiring screening cranial ultrasound (cUS) for detection. Abnormal vital sign (VS) patterns might serve as biomarkers to identify risk or occurrence of sIVH. Study Design This retrospective study was conducted in VLBW infants admitted to two level-IV neonatal intensive care units (NICUs) between January 2009 and December 2018. Inclusion criteria were: birth weight <1.5 kg and gestational age (GA) <32 weeks, at least 12 hours of systemic oxygen saturation from pulse oximetry (SpO2) data over the first 24 hours and cUS imaging. Infants were categorized as early sIVH (sIVH identified in the first 48 hours), late sIVH (sIVH identified after 48 hours and normal imaging in the first 48 hours), and no IVH. Infants with grades 1 and 2 or unknown timing IVH were excluded. Mean heart rate (HR), SpO2, mean arterial blood pressure (MABP), number of episodes of bradycardia (HR < 100 bpm), and desaturation (SpO2 < 80%) were compared. Results A total of 639 infants (mean: 27 weeks' gestation) were included (567 no IVH, 34 early sIVH, and 37 late sIVH). In the first 48 hours, those with sIVH had significantly higher HR compared with those with no IVH. Infants with sIVH also had lower mean SpO2 and MABP and more desaturations <80%. No significant differences in VS patterns were identified in early versus late sIVH. Logistic regression identified higher HR and greater number of desaturations <80% as independently associated with sIVH. Conclusion VLBW infants who develop sIVH demonstrate VS differences with significantly lower SpO2 and higher mean HR over the first 48 hours after birth compared with VLBW infants with no IVH. Abnormalities in early VS patterns may be a useful biomarker for sIVH. Whether VS abnormalities predict or simply reflect sIVH remains to be determined. Key Points

Will Neonatology Vanish in 1995?

PEDIATRICS ◽  
1986 ◽  
Vol 77 (5) ◽  
pp. 792-793
Author(s):  
EMILE PAPIERNIK
Keyword(s):  
United States ◽  
Birth Weight ◽  
Low Birth Weight ◽  
Prevention Program ◽  
Very Low Birth Weight ◽  
The United States ◽  
Low Birth Weight Infants

In Reply.— The interest of neonatologists in preventing preterm deliveries is remarkable in the United States. In France, where a policy of prevention was developed nationally in 1971, the first impulse also came from the neonatologists and specifically Alex Minkowski, who challenged the obstetricians to propose a real prevention program. The results of this program have now been published.1 incidence of very low birth weight infants in France in 1972 was 0.8 and in 1981 0.4.2

scholarly journals MACRONUTRIENTS OF MOTHERS’ MILK OF VERY LOW BIRTH WEIGHT INFANTS: ANALYSIS ACCORDING TO GESTATIONAL AGE AND MATERNAL VARIABLES

2021 ◽  
Vol 39 ◽  
Author(s):  
Maria Elisabeth Lopes Moreira ◽  
Sabrina Lopes Lucena ◽  
Patrícia Sffeir Coelho de Magalhães ◽  
Adriana Duarte Rocha ◽  
Ana Carolina Carioca Costa ◽  
...  
Keyword(s):  
Human Milk ◽  
Gestational Age ◽  
Neonatal Intensive Care ◽  
Very Low Birth Weight ◽  
Newborn Infants ◽  
Infrared Analysis ◽  
Low Birth Weight Infants ◽  
Significant Difference ◽  
Maternal Hypertension ◽  
First Moment

ABSTRACT Objective: To analyze the composition of macronutrients present in the milk of mothers of preterm newborn infants (PTNB) - protein, fat, carbohydrate, and calories - by gestational age (GA), chronological age (CA) and maternal variables. Methods: Longitudinal study that analyzed 215 milk samples from the 51 mothers of PTNB admitted in three Neonatal Intensive Care Units of Rio de Janeiro from May/2013-January/2014. Milk collection was performed by pickup pump, on a fixed day of each week until discharge. The spectrophotometric technique with Infrared Analysis (MilkoScan Minor 104) was used for the quantitative analysis. A sample of 7 mL of human milk was taken from the total volume of milk extracted by the mother. The data was grouped by GA (25-27, 28-31, 32-36, 37-40 weeks) and by CA (zero to 4, 5-8, 9-12, 13-16 weeks). Results: Protein, carbohydrate, fat and calories did not show any pattern of change, with no difference among groups of GA. When the macronutrients were analyzed by groups of CA, protein decreased, with significant difference between the first two groups of CA. Carbohydrates, fat and calories presented increasing values in all groups, without significant differences. Weight gain during pregnancy, maternal hypertension and maternal age were associated with changes in fat and calories in the first moment of the analysis of milk. Conclusions: There was a significant decrease in the levels of protein during the first eight weeks after birth. CA may be an important factor in the composition of human milk.

Impact of Improved Survival of Very Low Birth Weight Infants on Recent Secular Trends in the Prevalence of Cerebral Palsy

PEDIATRICS ◽  
1993 ◽  
Vol 91 (6) ◽  
pp. 1094-1100
Author(s):  
Vidya Bhushan ◽  
Nigel Paneth ◽  
John L. Kiely
Keyword(s):  
United States ◽  
Cerebral Palsy ◽  
Birth Weight ◽  
Low Birth Weight ◽  
Very Low Birth Weight ◽  
The United States ◽  
Epidemiologic Studies ◽  
Secular Trends ◽  
Industrialized Countries ◽  
Low Birth Weight Infants

Objective. To review recent secular trends in the prevalence of cerebral palsy in industrialized countries that have population-based cerebral palsy registries and to estimate such time-trends for the United States, where until recently such registries were absent. Data sources. Recent epidemiologic studies of cerebral palsy published in peer-reviewed journals in English, and US vital data bearing on the principal demographic determinants of cerebral palsy—birth rates, the birth weight distributions, birth weight-specific mortality risk, and cerebral palsy risk among survivors. Results. Most epidemiologic studies from industrialized countries show a rise in the childhood prevalence of cerebral palsy in recent decades, largely because of the increasing contribution of children of low and very low birth weight to its prevalence. The only demographic determinant of cerebral palsy prevalence that is changing rapidly in the United States is survival of low birth weight and very low birth weight infants. Based on the magnitude of change in the survival of low and very low birth weight infants, it is estimated that childhood prevalence of cerebral palsy rose about 20% between 1960 and 1986 in the United States. Conclusion. An apparently unavoidable side effect of the increasing success of newborn intensive care is a moderate rise in the childhood prevalence of cerebral palsy.

Benzyl Alcohol Toxicity: Impact on Mortality and Intraventricular Hemorrhage Among Very Low Birth Weight Infants

PEDIATRICS ◽  
1986 ◽  
Vol 77 (4) ◽  
pp. 500-506 ◽  
Author(s):  
Janet L. Hiller ◽  
Gerda I. Benda ◽  
Mohammadtaglii Rahatzad ◽  
James R. Allen ◽  
David H. Culver ◽  
...  
Keyword(s):  
Birth Weight ◽  
Low Birth Weight ◽  
Benzyl Alcohol ◽  
Medical Records ◽  
Intraventricular Hemorrhage ◽  
Neonatal Intensive Care ◽  
Very Low Birth Weight ◽  
Low Birth Weight Infants ◽  
Prenatal Factors ◽  
Improvement In Survival

Benzyl alcohol preservative in intravascular flush solutions has been reported to cause neurologic deterioration and death in very low birth weight infants. Following the widespread discontinuation of the use of such solutions in newborns, scattered reports of decreased mortality and decreased incidence of intraventricular hemorrhage among small premature infants appeared in the pediatric literature. To better assess the true impact of benzyl alcohol toxicity in this group of infants, we undertook a detailed review of the medical records of all babies &lt;1,250 g birth weight admitted to our neonatal intensive care unit for 13 months before and 13 months after the use of solutions containing benzyl alcohol was stopped. Significant decreases were found in both mortality rate (from 80.7% to 45.7%) and incidence of grade III/IV intraventricular hemorrhage (from 46% to 19%) among infants &lt;1,000 g birth weight who did not receive the preservative compared with those who did. No significant changes were found in several other prenatal factors that could have contributed to this improvement in survival. We conclude that benzyl alcohol toxicity contributed significantly to both mortality and the occurrence of major intraventricular hemorrhage among infants weighing &lt;1,000 g at birth and that solutions containing benzyl alcohol should never again be used in the care of such infants.

Feeding the Very Low-Birth-Weight Infant

1993 ◽  
Vol 14 (4) ◽  
pp. 123-132
Author(s):  
Rene Romero ◽  
Ronald E. Kleinman
Keyword(s):  
Birth Weight ◽  
Low Birth Weight ◽  
Very Low Birth Weight ◽  
The United States ◽  
Full Term ◽  
Nutrition Support ◽  
Low Birth Weight Infants ◽  
Term Infants ◽  
Stage Of Development ◽  
Organ Systems

Unfortunately, premature birth occurs commonly in the United States. Improving the survival of very low-birth-weight (VLBW) infants depends in large part upon understanding the physiologic capabilities of their immature organ systems and providing appropriate support as they mature. Advances in the nutritional support of these infants have contributed to the better outcomes we have come to expect today, even for the smallest infants. In this review, we will discuss the limitations of gastrointestinal function and the unique nutritional requirements of very low-birth-weight infants and describe the current methods of enteral and parenteral nutrition support used to meet these requirements. Developmental Physiology By 24 to 26 weeks of gestation, the fetal gastrointestinal tract is morphologically similar to that of the full-term infant; however, functional development is far from complete. Maturation of gastrointestinal motility, digestion, and absorption continues through much of the first year of life, even in full-term infants, as a result of an interplay between the preprogrammed "biological clock" and environmental influences. The decision to feed the VLBW infant must take into account the developmental limitations as well as the potential for enhancing intestinal maturation at each stage of development (Table 1). Fetal swallowing is evident at the beginning of the second trimester.

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