The role of patent ductus arteriosus ligation in bronchopulmonary dysplasia: reexamining a randomized controlled trial.

Objective: To reexamine data from a randomized controlled trial of prophylactic ductus ligation to determine whether ligation contributes directly to the development of bronchopulmonary dysplasia (BPD) in extremely low birth weight infants.

Study Design: The control group underwent ligation only if they had development of a symptomatic patent ductus arteriosus (PDA). The Prophylactic Ligation group underwent ligation within 24 hours of birth regardless of the presence or absence of symptoms of a PDA.

Association of patent ductus arteriosus and phototherapy in infants weighing less than 1000 grams.

To determine the relationship of phototherapy and patent ductus arteriosus, we analyzed prospectively collected data on 295 infants with birth weight of 501 to 999 gm admitted from 1984 through 1988. Seventy-four percent were evaluated by an imaging study to aid in the detection of a silent patent ductus arteriosus. Overall incidence of patent ductus arteriosus in the study population was 63%.

Black-white differences in newborn anthropometric measurements.

The mean birth weight of black infants is consistently less than that of white infants. In 1518 low-income multiparous women, the mean difference in singleton births was 171 g, of which 38 g was partitioned to preterm births and another 35 g reflected lower gestational ages in term births. A series of regression analyses were used to determine the effect of black race on various newborn measurements in 1205 term newborns, adjusting for other known risk factors.

28-day survival rates of 6676 neonates with birth weights of 1250 grams or less.

Survival rates specific for birth weight, gestational age, sex, and race are described for 6676 inborn neonates who weighed less than 1251 g at birth and were born during 1986 through 1987. Overall 28-day survival increased with gestational age and birth weight, from 36.5% at 24 weeks' gestation to 89.

Control of infection due to Klebsiella pneumoniae in an intensive care nursery.

Because of an increased incidence of necrotizing enterocolitis (NEC) temporally related to Klebsiella pneumoniae colonization noted in several infants, a study was undertaken to identify the source and to eradicate the infection. Twenty infants in the neonatal intensive care unit (NICU) and 51 in the well-baby nursery were prospectively studied. Cultures were done on all infants.

Hyperoxia potentiates Ureaplasma urealyticum pneumonia in newborn mice.

The effect of continuous exposure to 80% oxygen on newborn mice with Ureaplasma urealyticum pneumonia was determined. Mice were inoculated intranasally with either U. urealyticum or sterile broth and then housed in either 80% oxygen or room air (21% oxygen).

Effects of position changes on transcutaneous carbon dioxide tension in neonates with respiratory distress.

Routine neonatal care includes frequent position changes. Recent research has concluded that positions other than supine may result in beneficial physiologic responses. Specifically, several studies suggest that neonates may ventilate more effectively in a prone rather than in a supine position.

Intraventricular haemorrhage and the renin-angiotensin-aldosterone system in very low birthweight infants.

Blood volume, plasma renin activity (PRA) and urine aldosterone excretion (UAE) were measured in ten very low birthweight infants who had a Grade 3 or 4 intraventricular haemorrhage (IVH) during the first 2 days after birth. Mean (range) birthweight was 950 (630-1500) g and gestational age was 27 (23-31) weeks. Nine infants were receiving assisted ventilation and one was breathing spontaneously.

A randomized, controlled trial of very early prophylactic ligation of the ductus arteriosus in babies who weighed 1000 g or less at birth.

We speculated that prophylactic ligation of the ductus arteriosus would reduce mortality and morbidity in very-low-birth-weight infants. To test this hypothesis, we randomly assigned 84 babies who weighed 1000 g or less at birth and required supplemental oxygen either to receive standard treatment (n = 44) or to undergo prophylactic surgical ligation of the ductus arteriosus on the day of birth (n = 40). The ductus was ligated in babies in the control group only if the shunt was hemodynamically important.

Variability in 28-day outcomes for very low birth weight infants: an analysis of 11 neonatal intensive care units.

A retrospective study of all infants weighing 701 to 1,500 g born at 11 neonatal intensive care centers during 1983 and 1984 was performed to determine whether two specific 28-day outcomes, survival and survival without the need for supplemental oxygen, varied among the centers. Survival without the need for supplemental oxygen was chosen as a reflection of infants surviving without chronic lung disease. There were 1,776 live-born infants delivered during the 2-year study period.

Capillary and venous bilirubin values. Are they really different?

We measured total serum bilirubin values in paired capillary and venous samples from 79 untreated jaundiced newborn infants (group 1) and in 29 infants who were receiving phototherapy (group 2). While bilirubin values from the two sites correlated significantly for both groups, capillary samples underestimated venous bilirubin values when the latter exceeded 170 mumol/L (10 mg/dL) (mean and 95% confidence limits: group 1, -15.1 mumol/L [-0.

Low colloid osmotic pressure in very low birthweight infants receiving assisted ventilation.

Plasma colloid osmotic pressure (COP) was measured in three groups of very low birthweight infants. Babies in Group 1 (n = 8) were breathing spontaneously and had no respiratory disease. Those in Group 2 (n = 9) received assisted ventilation for hyaline membrane disease (HMD), and those in Group 3 (n = 7) received assisted ventilation for other reasons (five apnoea, two pneumonia).

The effect of assisted ventilation on creatinine clearance and hormonal control of electrolyte balance in very low birth weight infants.

Because renal function and electrolyte balance are commonly altered in premature infants, particularly those requiring ventilatory support, we studied the influence of assisted ventilation on renal electrolyte and water excretion in infants with birth weights less than 1501 g during the 2 days after birth. Twenty-two infants receiving assisted ventilation, either as intermittent mandatory ventilation or nasal continuous positive airway pressure, were compared with 21 spontaneously ventilating infants of similar birthweight and gestational age. Mean (and SEM) creatinine clearance was lower (p less than 0.

Effect of application pressure and gestational age on transfontanel pressure in healthy neonates.

We developed and evaluated a transducer holder and calibrated, spring-loaded applicator for the Ladd intracranial pressure monitor. The transducer holder/applicator combination allows reproducibility of application pressure and assures coplanarity of the transducer and the skin of the anterior fontanel. Measured transfontanel pressure (TFP) increased with increasing application pressure.

Diuresis and natriuresis following acute pneumothorax in very low birthweight infants.

Seven tension pneumothoraces developed in six very low birthweight infants receiving assisted ventilation for hyaline membrane disease. Mean values for blood pressure and creatinine clearance (Ccr) tended to increase following pneumothorax decompression, although neither increase was statistically significant. Urine volume, osmolar clearance and urine sodium excretion all increased significantly in the 8 h following diagnosis and decompression of pneumothoraces.

Neonatal mortality in infants born weighing 501 to 1000 grams. The influence of changes in birth weight distribution and birth weight-specific mortality rates on neonatal survival.

We analyzed changes over time in neonatal mortality rates for infants born weighing 501 to 1000 gm. The decline in total mortality in this weight group due to improved small-group, birth weight-specific mortality was contrasted to the increase in mortality caused by changes in the birth weight distribution resulting from the care of smaller infants. Had the birth weight distribution remained unchanged, the total improvement in neonatal mortality for the entire 501 to 1000 gm group would have been substantially greater.

Neonatal transcutaneous bilirubinometry.

The authors present data supporting the conclusion that the transcutaneous bilirubin index may be a valuable tool to help distinguish term babies with a total serum bilirubin value less than 13 mg/dl from those with higher levels and that it serves as a valuable screening device to decrease the number of unnecessary total serum bilirubin tests. Also examined are clinical guidelines and limitations of the device.

Hemodynamic effects of nifedipine in normoxic and hypoxic newborn lambs.

We studied the effects of nifedipine, a calcium-channel blocker, in two acutely instrumented groups of newborn lambs during normoxic and hypoxic conditions. Nifedipine at 10 or more micrograms/kg reduced systemic, but not pulmonary artery pressure and resistance in normoxic lambs. When acute hypoxia was produced in these animals, 50 or more micrograms/kg reduced, but did not prevent, the expected rise in pulmonary pressure and resistance.