Marc G Weiss

Meningitis in premature infants with respiratory distress: Role of admission lumbar puncture

tress may be the only sign of sepsis, we would prefer to see more data on the yield of CSF examination in infants with respiratory distress before CSF examination is completely discarded, although a selective or delayed approach may be appropriate. Infants with bacteremia who are symptom free may have a sufficient concentration of organisms in the blood to seed the meninges.! ~ Lumbar puncture for sepsis workup of newborn infants currently has a yield of less than 3%. 1, z Therefore it seems appropriate to exclude a group of infants in whom the probability of meningitis is extremely small. In this review we found no cases of meningitis in 284 infants who were symptom free at the time lumbar puncture was performed. Although 284 is not a large number for statistical purposes, it represents only those infants who were examined. The denominator is larger if one includes all symptom-free infants with risk factors who did not undergo lumbar punctures and presumably did not have meningitis. The probability of meningitis in this group is less than 4:1000 and likely to be zero. We conclude that CSF examination is not indicated in the diagnostic evaluation of symptom-free infants born to mothers with chorioamnionitis or other risk factors for neonatal infection.

Plasma beta-endorphin concentrations and analgesia-muscle relaxation in the newborn infant supported by mechanical ventilation

We evaluated the effects of pancuronium and opiates on plasma beta-endorphin concentrations in 25 infants supported by mechanical ventilation. Infants receiving opiate were randomly assigned to receive either fentanyl or morphine. There was no change in beta-endorphin concentrations after administration of pancuronium, whereas both fentanyl and morphine reduced beta-endorphin concentrations by approximately 60%.

NEONATAL VIABILITY IN THE 1990'S: HELD HOSTAGE BY TECHNOLOGY. • 234

The survival of extremely low birth weight newborns (ELBW) [≤ 1000 grams] has dramatically and significantly improved since 1990. This has been attributed to Surfactant, maternal steroids and new forms of neonatal ventilation. Over a 10 year period at our institution, we evaluated neonatal survival (alive at Day 28 of life) based on birthweight (BW) and gestational age (GA). Small for GA newborns, as well as those who expired in the delivery room (DR) and beyond 28 days of life, were excluded. Newborns < 500 grams at birth with a GA ≤ 23 weeks are not routinely resuscitated.Table

Spontaneous Intestinal Perforation is not Associated with the Recent Administration of Antenatal Betamethasone

Intestinal disease in premature infants, especially spontaneous intestinal perforation and necrotizing enterocolitis, contributes significant morbidity and mortality in very low birth weight infants and has a large impact in neonatal care and patient quality of life. In very low birth weight infants, factors influencing a systemic inflammatory response and/ or submucosal thinning, including postnatal glucocorticoids and exposure to indomethacin or ibuprofen, exacerbate the development of intestinal perforation in an already at risk population. In this retrospective analysis we evaluated whether antenatal steroids, a glucocorticoid for fetal lung maturity often given to mothers in close proximity to delivery, may be related to the development of perforation when given close to delivery and without adequate time for recovery of the intestinal mucosa. In our data set, it did not appear to be significantly related. Our results also did not show a categorical association between antenatal steroids and spontaneous intestinal perforation. We did however show a significant relationship between smaller, more depressed infants developing spontaneous intestinal perforation, as well as an association with concomitant sepsis

Outcome of Infants with a Diagnosis of Hydrops Fetalis in the 1990's 1187

The diagnosis of Hydrops fetalis still carries a grave prognosis. The reported mortality is 50% - 100%. In the advent of more aggressive therapy, improvement in outcome is undetermined.

Parent Satisfaction with a Home Care Program Encouraging Early Discharge from the NICU 1120

The NICU environment is very stressful and costly. To address specifically these problems, we have instituted since September 1995 an aggressive program of early discharge from our NICU. Nurses from the neonatal intensive care unit visit the babies after discharge for a variable period of time. We have previously reported on the shortened length of stay and the decreased readmission rate with the program. To address the issue of patient satisfaction, a survey was mailed to all the families whose infants were sent home under the integrated neonatal home care program. A follow-up contact was made either by phone or during a visit to the neonatal clinic.

Contribution of Gastro-Esophagela Reflux to Apnea in Infants † 1774

Gastro-esophageal reflux (GER) is purported to be a cause of apnea and bradycardia (A/B) in infants. The degree to which GER contributes to A/B has not been well established. We therefore reviewed one years experience with 5 channel polysomnograms (PSGs) to evaluate the role of GER in A/B of infancy.

IMPACT OF MEDICAL VERSUS SURGICAL MANAGEMENT OF A HEMODYNAMICALLY SIGNIFICANT PATENT DUCTUS ARTERIOSUS (HSPDA) IN LOW BIRTH WEIGHT NEWBORNS. 1375

IMPACT OF MEDICAL VERSUS SURGICAL MANAGEMENT OF A HEMODYNAMICALLY SIGNIFICANT PATENT DUCTUS ARTERIOSUS (HSPDA) IN LOW BIRTH WEIGHT NEWBORNS. 1375

DIFFERENTIAL EFFECTS OF SURFACTANT THERAPY ON SURVIVAL IN THE EXTREMELY LOW BIRTH WEIGHT INFANT: A WHITE MALE ADVANTAGE? 1656

Comparisons between 1 year survival rates among extremely low birth weight infants (ELBW, <1000 g) at a large tertiary perinatal center, in 1984(n=81) and 1994 (n=100), showed a global improvement for females, 46% vs. 68%(p <.05) and males, 39% vs. 68% (p <.01). Race comparisons revealed significant improvement for white ELBW infants, 50% vs. 78% (p <.01) but not for non-whites (42% vs. 52%). Race and gender comparisons revealed a significant improvement for white males, 41% vs. 80% (p <.01) but improvements were not significant for white females, nor non-white females or males. For the subgroup of smallest infants (<751 g) significant improvement occurred for females overall, 31% vs.61% (p <.01), white infants, 19% vs. 67% (p <.01), and white males, 11% vs. 67%, (p <.05) but was not significantly improved for males overall, non-white males or females or white females. The major change in care was uniform use of surfactant therapy in all ELBW infants in 1994 and no surfactant use in 1984. Race and gender comparisons among 1994 infants only revealed a significant survival difference between males based on race. 80% of white males <1000 g vs.41% of non-white males survived (p <.01) while 67% of white males<751 g survived vs.11% of non-white males, (p <.05). Other 1994 race and gender comparisons revealed no significant differences. CONCLUSION: While survival rates of ELBW infants generally improved over a 10 year period with the routine use of surfactant therapy, it appears preferentially beneficial to white male infants whose survival rates at our institution have gone from lowest to highest in these weight groups.