John W. Scanlon

Effect of Surfactant on Morbidity, Mortality, and Resource Use in Newborn Infants Weighing 500 to 1500 g

BACKGROUND The administration of surfactant decreased mortality, morbidity, and costs of care for very-low-birth-weight infants in clinical trials. The extent to which these benefits can be achieved in the usual clinical settings is not known. METHODS We analyzed clinical and financial data obtained from 1985 to 1990 at 14 perinatal centers in the United States on 5629 neonates weighing 500 to 1500 g. The infants were divided into groups according to whether they were born before or after surfactant was introduced into clinical practice. Regression models controlling for race, sex, and birth weight were used to assess mortality, morbidity, and use of resources. Mortality rates specific for these variables were projected to the nation as a whole with reference to the 1985 U.S. birth cohort. RESULTS The odds of death in the hospital for very-low-birth-weight infants were reduced by 30 percent after surfactant was introduced. Among infants with bronchopulmonary dysplasia, mortality declined 40 percent. Projections of mortality nationwide declined 5 percent. Eighty percent of the decline in the U.S. infant mortality rate between 1989 and 1990 could be attributed solely to the use of surfactant. Among the survivors, the overall odds of morbidity did not change, whether or not we adjusted for changes in race, sex, and birth weight. The odds of respiratory distress syndrome and pulmonary interstitial emphysema among the survivors declined by 20 percent and 40 percent, respectively, with surfactant. Inflation-adjusted charges per survivor declined by 10 percent, or

Effects of intrapartum maternal glucose infusion on the normal fetus and newborn.

5,800, whereas the cost of care for each infant who died declined by 31 percent, or

The early detection of neonatal sepsis by examination of liquid obtained from the external ear canal

4,400. CONCLUSIONS The introduction of surfactant has led to decreased mortality and morbidity in very-low-birth-weight infants and to decreased use of resources both for infants who survive and for those who die.

Concentrations of the free amino acids in human amniotic fluid during normal and abnormal pregnancies.

The effect of maternal intravenous glucose infusion on the newborns glucose, insulin, and neurobehavioral performance was studied prospectively in 56 normal mother-newborn pairs. Maternal blood glucose levels at the time of delivery, umbilical venous blood glucose and insulin levels, and neonatal b

Effects of Oral Antibiotics on Stool Flora and Overall Sensitivity Patterns in an Intensive Care Nursery

Microscopic examination of Gram-stained material swabbed from a newborn infants external ear canal was a reliable, rapid method for assisting in the diagnosis of intrauterine bacterial sepsis. Culture of this material frequently grew the causative organism in proved sepsis. This technique should be added to the pediatricians work-up for suspected neonatal sepsis.

A Prospective Study of the Oxytocin Challenge Test and Newborn Neurobehavioral Outcome

Abstract The majority of the free amino acids of amniotic fluid decrease in concentration with the progression of pregnancy. Some exceptions include cysteic acid, which increases in concentration with pregnancy; taurine, methionine sulfoxide, and cystathionine, which peak around 33 to 37 weeks; ethanolamine, which is lowest at 33 to 37 weeks; and 3-methylhistidine, which is present in specimens only from 15 to 20 weeks of gestation. Published reports are summarized and salient differences are noted.

Amnionic fluid d(−)-β-hydroxybutyrate and the dysmature newborn infant

Summary: The effects of orally administered gentamicin and colistin on stool bacterial flora and overall antibiotic sensitivity patterns were evaluated in 100 newborns at risk for neonatal necrotizing enterocolitis. Gentamicin (2.5 mg/kg q6h) and colistin (1 mg/kg q6h) were administered to randomly selected groups of 50 newborns for 3 wk after birth during an 11-month study period. Stools were collected on days 1, 11, and 21 and cultures were grown under aerobic conditions on three different media. Staph. epidermidis was the most common predominant organism in both antibiotic groups, whereas E. coli and Klebsiella were the most common Gram-negative bacteria isolated. Seventeen % of these Gram-negative species were resistant to colistin and 9% to gentamicin, with a gradual increase occurring during the 3-wk period. On the basis of 980 positive cultures from all sites in babies in the nursery during the 11-month study, E. coli sensitivity to kanamycin and gentamicin ranged between 92% and 100% except for one month midway through the study when sensitivity to kanamycin was at 80% and then returned to the 92–100% range. Klebsiella sensitivity to both aminoglycosides remained greater than 95% throughout. The incidence of neonatal sepsis remained consistent at seven to nine per 1000 live births during the study. One baby of 50 in the gentamicin group developed necrotizing enterocolitis at 5 wk of age; 0/50 in the colistin group had necrotizing enterocolitis (not significant).Speculation: The results suggest that the use of oral antibiotics in a limited segment of the newborn nursery population may not have significantly adverse effects on the overall incidence of bacterial resistance to antibiotics and incidence of sepsis.

Cerebrospinal Fluid Concentration of Biogenic Amine Metabolites in Idiopathic Apnea of Prematurity

In a prospective study, infants of high-risk mothers delivered over a 1-year period were evaluated by clinical, biochemical, and behavioral methods. Of 67 newborns whose mothers had oxytocin challenge tests (OCTs), 54 were delivered after negative tests, and 13 after positive tests. Infants with positive OCTs had poor state organization and reflexive performance when compared with negative-OCT babies. These infants also showed evidence of intrauterine malnutrition, but did not have any greater asphyxiation than the negative OCT group. These results are consistent with the hypothesis that a positive OCT implies pathological placental respiratory insufficiency, which may be superimposed, in many instances, on impairment in utero of the placentas nutritional function. The clinical manifestation of such dysfunction is the alteration in subtle neonatal neurobehavior.

The use of fluorescein powder for evaluating contamination in a newborn nursery

Abstract Amnionic fluid d (−)-β-hydroxybutyrate (βOH) concentration was determined in 53 women whose pregnancies terminated in the delivery of a normal infant and 22 women whose pregnancies terminated in the delivery of a dysmature infant. The mean concentration of the normal pregnancy was 0.114 mM. as opposed to 0.211 mM. in the dysmature pregnancy. The average amnionic fluid β-hydroxybutyrate concentration tended to rise throughout gestation in all pregnancies. Amnionic fluid βOH concentration was predictive of pregnancy that would terminate in a dysmature infant if it was greater than 0.5 mM. Correction of the βOH concentrations to a constant solute density did not allow observed differences to be explained on the basis of dilution. There is a slight increase in amnionic βOH concentration in the last month of normal pregnancies.

Erythrocyte levels of 2,3-diphosphoglycerate in the syndrome of fetal malnutrition

The concentration of homovanillic acid and 3-methoxy-4-hydroxyphenylglycol (MHPG), the major metabolites of dopamine and norepinephrine, respectively, were studied in the cerebrospinal fluid (CSF) of 34 newborn infants. No significant difference was found in the levels of MHPG and homovanillic acid between preterm and term infants. Apneic preterm infants had significantly higher levels of MHPG than nonapneic prematures. Theophylline did not change the levels of these metabolites in CSF. There was a progressive rise of MHPG levels in CSF in preterm infants as their postnatal age increased. We suggest that idiopathic apnea of prematurity is not associated with depletion of catecholamine stores in the central nervous system. Theophylline does not seem to relieve apnea by stimulation of the central adrenergic system.