Mamta Fuloria

Gastroesophageal reflux in very low birth weight infants: association with chronic lung disease and outcomes through 1 year of age.

OBJECTIVE:To analyze the association between chronic lung disease (CLD) and clinically diagnosed gastroesophageal reflux (GER) in very low birth weight (VLBW) infants, and between GER and outcomes at 1 year adjusted age.METHODS:A total of 375 consecutively born VLBW infants with CLD and 345 gestational age-matched controls were studied. Records were reviewed to ascertain which infants were diagnosed with GER (based on clinical suspicion or confirmatory tests) and which infants had delayed growth or development at 1 year adjusted age.RESULTS:Infants with CLD were treated for GER more frequently than controls (CLD: 27% versus controls: 9%; p < 0.0001). Among infants with CLD, those with and without GER were comparable in terms of the days on supplemental oxygen [124 (64 to 93) vs 121 (47 to 394)] and the proportion with cystic changes on chest radiograph (44% vs 47%). Comparing outcomes at 1 year for infants with and without GER, no differences were found in the rates of Bayley Mental Developmental and Psychomotor Developmental Indices of <70, cerebral palsy, and measurements below the 10th percentile.CONCLUSION: Among VLBW infants, an association exists between CLD and GER, although this association might be due to greater diagnostic suspicion in infants with CLD. In VLBW infants, GER does not appear to increase the risk of delayed growth or development.

Resuscitation of the meconium-stained infant and prevention of meconium aspiration syndrome.

Resuscitation of the Meconium-Stained Infant and Prevention of Meconium Aspiration Syndrome

Antenatal betamethasone alters vascular reactivity in adult female ovine cerebral arteries.

Although the use of antenatal glucocorticoids has resulted in decreased neonatal morbidity/mortality, recent animal studies have raised concerns regarding adverse effects of these medications on postnatal cardiovascular function. We hypothesized that antenatal betamethasone (Beta) exposure alters cerebral vascular reactivity in adult female sheep. We observed that K+-induced constriction was comparable in middle cerebral artery (MCA) from Beta-exposed animals and age-matched controls. Pressure-induced constriction was significantly attenuated in MCA from Beta-exposed compared with control sheep. Inhibition of NOS significantly augmented pressure-induced constriction in MCA from both Beta-exposed and control sheep, whereas cyclooxygenase (COX) inhibition augmented pressure-induced constriction only in MCA from Beta-exposed sheep. Furthermore, NOS and COX inhibition significantly attenuated bradykinin (BK)-induced dilation in MCA from both Beta-exposed and control sheep. However, there seemed to be a greater contribution of both NOS and COX to BK-induced dilation in Beta-exposed compared with control MCA. Our findings demonstrate that fetal exposure to a clinically relevant course of Beta alters cerebral vascular tone and reactivity in adult female sheep.

Effect of meconium on the surface properties of perflubron

Objective Meconium passage with pulmonary aspiration in utero is associated with surfactant inactivation and is a major cause of neonatal morbidity and mortality. Ventilation with low surface tension perfluorocarbon in animal models of meconium aspiration has been shown to improve both oxygenation and lung compliance. Exogenously administered surfactant is inactivated by meconium. We wished to determine whether meconium would alter the surface properties of perfluorooctyl bromide (perflubron). Design Biophysical analysis using novel methods. Setting University research laboratory. Subjects Healthy newborns. Interventions First pass meconium was obtained from healthy newborns. Measurements and Main Results We evaluated the surface-active properties of perflubron after exposure to meconium-saline dilutions using the de Noüy ring distraction technique to measure interfacial tension and the sessile contact angle of meconium-saline suspensions. Both were assessed in the absence and presence of perflubron. Meconium-saline suspensions inhibited surfactant activity. In contrast, the surface properties of perflubron were unaffected by the presence of meconium-saline suspensions. Conclusions These data are consistent with reported observations of increased lung compliance in perfluorocarbon-treated animals with meconium aspiration. In addition to these clinical implications, the novel interfacial tension technique described here could prove useful for assessing the interfacial properties of other poorly miscible biological fluids.

The Effects of 11,12-Epoxyeicosatrienoic Acid (11,12-EET) on Isolated Blood Vessels from the Newborn Pulmonary Circulation † 1651

The Effects of 11,12-Epoxyeicosatrienoic Acid (11,12-EET) on Isolated Blood Vessels from the Newborn Pulmonary Circulation † 1651

Effects of Acidosis and CO 2 on Vascular Tone in Newborn Piglet Pulmonary Resistance Vessels (PRV)

Effects of Acidosis and CO 2 on Vascular Tone in Newborn Piglet Pulmonary Resistance Vessels (PRV)

Gastroesophageal Reflux Disease (GERD) and Outcome at One Year of Age in Very Low Birth-Weight (VLBW) Infants, with and without Chronic Lung Disease (CLD) 1254

Background: Little is known about the effect of GERD on the outcome of VLBW infants. GERD might affect feeding behavior and, therefore, weight gain. Infants with GERD often have been treated with medications which have central nervous system side effects. Further, a study by deRegneir et al(J Perinatology 1997) has shown that VLBW infants with CLD [who also may have GERD] are at increased risk for delayed growth and development.Objective: To estimate the strength of association between GERD and outcome during infancy in VLBW infants, with and without CLD.Methods: The study sample included 375 VLBW infants (birth weight< 1501 gm) with CLD (use of supplemental oxygen at 36 weeks post-menstrual age) and 345 VLBW infants without CLD. Consecutive infants with CLD were identified and then an infant without CLD was selected who was born closest in time to, and with gestational age within one week of, the CLD infant. All infants were born 1/1/84 to 5/31/95, were cared for in either of the two neonatal intensive care units (NICU) which serve a 17-county region, survived, and were followed through one year of age, adjusted for prematurity. Records were reviewed to ascertain each infants status with respect to GERD (treated with anti-reflux medications) and the following outcomes at one year adjusted age: presence of cerebral palsy, Bayley Scales Mental Developmental Index(MDI) and Psychomotor Developmental Index (PDI), weight, length, and head circumference percentiles from reference curves, and the number of re-hospitalizations after discharge from the NICU. Results: Among infants with CLD, GERD was not associated with cerebral palsy [odds ratio 1.0(0.5-1.9)], MDI < 68 [1.6 (0.9-3.0)], PDI < 68 [1.1 (0.6-1.9)], head circumference < 10th percentile [1.0 (0.6-1.7)], weight < 10th percentile [0.8 (0.5-1.4)], or length < 10th percentile [1.1 (0.7-1.8)]. However, infants with GERD were hospitalized more frequently (p = 0.004, chi square test for trend). Similarly, among infants without CLD, GERD was associated with an increased frequency of re-hospitalization (p = 0.01) but not with delayed growth or development. Conclusions: Among VLBW infants, GERD is associated with a greater likelihood of re-hospitalization during infancy, but not with delayed growth or development.

Association of Gastroesophageal Reflux Disease (GERD) and Chronic Lung Disease (CLD) in Very Low Birth Weight (VLBW) Infants 1255

Association of Gastroesophageal Reflux Disease (GERD) and Chronic Lung Disease (CLD) in Very Low Birth Weight (VLBW) Infants 1255

LOW-DOSE INSULIN INFUSIONS RESULT IN DELAYED INSULIN DELIVERY TO EXTREMELY LOW BIRTH WEIGHT (ELBW) INFANTS 1372

Glucose intolerance is a common occurrence in ELBW infants. Hyperglycemia in ELBW infants is treated with human insulin, diluted to a concentration of 0.2 U/ml to deliver infusion rates of 0.01-0.1 U/kg/hr in a minimal fluid volume. In 6 infants treated with low-dose insulin infusions, normalization of blood glucose (<130 mg/dl) did not occur until a median of 17 hours (range 14-25). We hypothesized that this delay was due to binding of insulin to the microbore tubing, rather than to insulin resistance. To test this hypothesis, we used a Microparticle Enzyme Immunoassay (Abbott Laboratories) to measure insulin concentration from stock solution (0.2 U/ml), and from the effluent collected at various time intervals during infusion @ 0.05 ml/hr through microbore tubing (tubing length 152 cm; residual volume 0.28 ml; medexinc). We found that at 1 hour, only 2.3% of the stock concentration was present in the effluent. The concentration delivered (expressed as% of stock concentration) increased as a function of time; 21.8 and 27.2% was delivered at 4 and 8 hours, respectively. It took an average of 18 hours to saturate insulin binding sites and achieve a steady state delivery rate equal to 100% of the stock concentration. This correlates well with the clinical lag time for blood glucose normalization observed in ELBW infants. Prior reports of insulin administration to ELBW infants recommend addition of albumin to IV solutions to reduce adsorption to plastic infusion materials, an approach which incurs added expense and exposure to a human blood product. As an alternative, we filled the tubing with 5 U/ml insulin × 5 minutes, followed by a 3 ml flush with saline, and then with stock insulin solution before resuming the insulin infusion of 0.2 U/ml @ 0.05 ml/hr. We recovered 20% of the stock concentration in the effluent collected at 1 hour and achieved steady state insulin delivery by 4 hours. We conclude that the delay in clinical response to insulin infusions in ELBW infants is due to binding of insulin to infusion tubing and that this problem can be minimized by flushing the tubing with a higher concentration (5 U/ml) of insulin prior to initiation of a low-dose insulin infusion rate.