Recombinant bovine interleukin-2 and dry cow therapy: efficacy to cure and prevent intramammary infections, safety, and effect on gestation.

Cows from eight commercial dairies were randomly assigned to intrammamary infusions of cephapirin or cephapirin plus interleukin-2 at the end of lactation. During the first phase of the trial, interleukin-2 was administered to 159 cows at a dose of 1 mg per gland by intracisternal infusion immediately after 300 mg of cephapirin were administered. One hundred sixty-one cows received infusions of a placebo (phosphate-buffered saline; PBS) immediately after cephapirin. In the second phase of the trial, 70 cows received 2 mg of interleukin-2 per gland, and 78 cows received the placebo. Cows were observed daily by the participating farmer for 72 h after infusion and also during routine feeding and care during the dry period and at calving. Potential side effects from udder infusions, particularly gross abnormalities of the udder and signs of systemic side effects were monitored. During the first phase, cure rates for intramammary infections caused by Staphylococcus aureus that were present at the end of lactation were 33.3% for quarters treated with cephapirin and 53.6% for quarters treated with cephapirin and interleukin-2. Cure rates did not differ between treatment groups for all other pathogens or during the second phase of the trial. The incidence of new intramammary infections during the dry period was not affected by intramammary infusion of interleukin-2. Eighteen of 229 (7.9%) cows treated with interleukin-2 aborted within 49 d of treatment compared with 4 of 239 (1.7%) cows treated with PBS. Eleven of the 18 (61.1%) abortions by cows treated with interleukin-2 occurred 3 to 7 d after infusion; none of the abortions by cows treated with PBS occurred until wk 7 after infusion.

Relative humidity under radiant warmers: influence of humidifier and ambient relative humidity.

The effects of humidifier air temperature and flow, and ambient relative humidity (RH(amb)) on RH and air temperature under a radiant warmer (RW) were determined in stable and unstable conditions, using an infant surrogate. Mean supplemented RH under the RW was 36.3% at 14% RH(amb) and 67.6% at 55% RH(amb). Humidifier temperature of 38 degrees C and air flow of 10 LPM produced highest RHs (74.5% and 43.1% in high and low RH(amb), respectively). RH(amb) was highest in summer and lowest in winter in this midwest U.S. hospital, and could be predicted by calendar date (r = 0.58). Humidification equipment capabilities and limitations must be known when using this method to limit evaporative water loss.

Comparison of Infasurf (calf lung surfactant extract) to Survanta (Beractant) in the treatment and prevention of respiratory distress syndrome.

OBJECTIVE: To compare the relative safety and efficacy of Infasurf (calf lung surfactant extract; ONY, Inc, Amherst, NY, IND #27169) versus Survanta (Beractant, Ross Laboratories, Columbus, OH) in reducing the acute severity of respiratory distress syndrome (RDS) when given at birth and to infants with established RDS. DESIGN: A prospective, randomized, double-blind, multicenter clinical trial. SETTING: Thirteen neonatal intensive care units participated in the treatment arm: seven of these concurrently participated in the prevention arm. PATIENTS: The treatment arm enrolled infants of

Thermal stability of premature infants during routine care under radiant warmers.

The body temperatures of infants weighing less than 1500 g under radiant warmers during routine care were documented in the first week of life. Ten infants (median gestational age 28 weeks, median birthweight 913 g) were studied. During 30 nursing interventions (mean 9.2 minutes) mean oesophageal and foot temperature changed 0 degrees C and -0.11 degrees C, respectively. A radiant warmer may limit heat loss during interventions because of easy access and rapid radiant warmer responsiveness.

Safety and efficacy of sufentanil therapy in the ventilated infant.

This pilot study examined the safety and efficacy of sufentanil in the ventilated neonate. Informed parental consent for study participation was obtained for eight infants who were admitted to the neonatal intensive care unit and required analgesic/sedative therapy as part of their medical management to support mechanical ventilation. An intravenous loading dose (0.2 microgram/kg) was administered over 20 minutes, followed by a continuous infusion (0.05 microgram/kg/hour). Whole blood samples were collected prior to onset of sufentanil therapy, immediately following the loading dose, and 24 hours after the start of the continuous sufentanil infusion for analysis of beta-endorphin and sufentanil serum content. Heart rate, respiratory rate, and blood pressure were recorded as a routine part of medical management. The ventilatory efficiency index (VEI) and ventilation index (VI) were calculated before and after sufentanil therapy. Four male and four female infants were admitted to this study; the mean gestational age was 37 weeks, and weight was 2,970 gm. Sufentanil therapy appeared to be well tolerated, as evidenced by a lack of nursing observations noting changes in heart rate or mean arterial pressure. VEI values increased in four subjects, and VI values decreased in six subjects. Overall, the mean increase in VEI was 19 percent; the decrease in VI was 27 percent. The beta-endorphin serum content decreased in all subjects, and nurses did not report any signs of patient discomfort. Serum sufentanil content was undetectable. Sufentanil appears to be a suitable agent to provide analgesia/sedation in the neonatal patient under the experimental conditions of this study.(ABSTRACT TRUNCATED AT 250 WORDS)

Coagulation studies in very low-birthweight infants.

Reference values for coagulation studies of premature infants (24 to 29 weeks' gestational age) are needed for the management of hemostatic disorders in the precariously ill infant. We collected data on the very low-birthweight infants admitted to our intensive care nursery who met criteria over a 4-year period to determine prothrombin time, activated partial thromboplastin time, and fibrinogen levels in this group. Fifty-two infants had a mean prothrombin time of 14.5 seconds, a mean activated partial thromboplastin time of 69.5 seconds, and a mean fibrinogen level of 1.35 g/L. Converting values to ratios of adult control values facilitated direct comparison of results to published reference ranges. Coagulation studies may vary over a broad range of prematurity, and normal ranges are needed for prospective, randomized protocols designed to prevent the complications of abnormal coagulation function.

The Peters'-Plus syndrome: description of 16 patients and review of the literature.

Peters'-Plus syndrome is characterized by Peters' anomaly, a typical face, cleft lip and palate, short limb dwarfism, and developmental retardation. We report the follow-up of six patients in the original report, 10 yet unreported patients, and review 26 patients that have been reported in the literature. The spectrum of the syndrome is broadened by data from affected sibs which indicate that a wider range of anterior chamber cleavage disorders may be present, a cleft lip or palate need not be present, and developmental retardation may be mild or even absent. An increased foetal loss in families with Peters'-Plus syndrome may indicate intrauterine death of some foetuses affected by the syndrome. The pattern of inheritance is autosomal recessive.

Terminal deletion of 7q presenting in utero with a truncus arteriosus and nonimmune hydrops.

Terminal deletion of 7q presents with variable anatomical and developmental findings. This case is the first reported in utero diagnosis based on cytogenetic findings and in utero demonstration of resolving congestive heart failure due to a truncus arteriosus.

Airway manifestations of chondrodysplasia punctata.

Chondrodysplasia punctata is a heterogeneous skeletal dysplasia characterized by small focal calcifications in articular and other cartilages in infancy, referred to as stippled epiphyses, with subsequent epiphysial dysplasia and associated anomalies of the face, eyes and skin. Nasal hypoplasia is commonly seen but secondary respiratory distress is infrequently described. We present two siblings with different degrees of involvement and a review of the different forms of this disorder. When an infant presents with a small nasal airway, the diagnosis of chondrodysplasia punctata should be considered and appropriate evaluations obtained.

Impact of a Resource-Based Relative Value Scale fee schedule on reimbursements to neonatologists.

We investigated the possible effect of the Resource-Based Relative Value Scale (RBRVS) fee schedule on reimbursements for neonatologists. This payment system may prove attractive to most third-party payers and is predicted to result in lower procedural reimbursement, which is a significant component of neonatal care. We studied the charges and reimbursements for the portion of our intensive care nursery patient population covered by Medicaid for a 1-year period. Total, procedural, and nonprocedural reimbursements under three current systems and the RBRVS were compared. The RBRVS system produced overall improved reimbursement compared with Medicaid, but decreased reimbursement compared with the other two systems. Nonprocedural services were relatively better reimbursed than procedural services. The impact of RBRVS will depend on the population mix of third-party payers, the proportion of nonprocedural charges in a particular neonatal intensive care unit, and the conversion factor used by the third-party payer.

Right-sided hydrothorax and central venous catheters in extremely low birthweight infants.

Central venous catheters (CVCs) have become more common in the care of very low birthweight newborns. Nutrition is enhanced, fluid delivery is more secure, and stress from the intervention of starting new IVs is reduced. Complications of these devices include infection, thrombus or embolus, damage to vessels and organs, and extravascular collections of fluid. Pleural fluid collections can occur due to superior vena caval obstruction with obstruction of lymphatic drainage, and erosion or perforation of the catheter through the vein into the pleural space. Three infants weighing less than 1000 gm had CVCs placed in an antecubital vein. Severe respiratory compromise developed in 1 at 5, 1 at 6, and 1 at 40 hours after line placement, and chest radiograph suggested fluid in the right pleural space. Milky fluid was found in two cases in which the infants received lipid emulsion and parenteral nutrition fluid (PNF). Bright yellow fluid, resembling PNF, was found in the third, not receiving lipids. None of the patients was enterally fed. The tips of the CVCs were adjusted to a more peripheral location and there was no recurrence of pleural fluid, nor were signs of superior vena cava syndrome seen. Etiologies for the unilateral hydrothorax include vein perforation and erosion, but another cause is discussed. A right pleural fluid collection in a patient with a CVC tip in the right subclavian vein is a serious problem, which may be solved with repositioning of the CVC instead of removal.

Hypomandibular faciocranial dysostosis: report of an affected sib and follow-up.

Hypomandibular faciocranial dysostosis is a condition heretofore described only in a single case. We report the birth of an affected sister along with follow-up information on the initial surviving patient. While a primary error in neural crest development was postulated in this syndrome, subsequently discovered anatomical abnormalities suggest a more complex pathogenesis.

Fever and petechiae in children.

A prospective study of patients with fever and petechiae was performed. Of 190 patients enrolled in the 1-year study, 13 (7%) had meningococcal disease. The most common bacterial association was Streptococcus pyogenes (19 patients). Viral infections were documented in 28 patients. Patients with invasive bacterial disease (group I) appeared more sick, were more likely to have signs of meningeal irritation, and were more likely to have petechiae on the lower extremities than those with less serious, nonbacteremic disease (group II). No patient in group I had petechiae only above the nipple line. Patients in group I had a significantly higher peripheral white blood cell count and absolute band form count. Although no laboratory test or physical finding was sufficiently sensitive to detect all patients with serious disease, the patient with abnormal cerebrospinal fluid, elevated white blood cell count, or elevated absolute band form count was at increased risk for invasive, bacterial disease. Conversely, the risk of serious disease was small if all of these values were in the normal range in the nonill-appearing child or if sore throat and clinical pharyngitis were present in the patient older than 3 years of age.

Local skin hyperthermia due to transcutaneous electrode heat.

The hypothesis that a transcutaneous monitor electrode can heat skin beyond the electrode edge was tested. This heating would cause a skin thermistor probe, if placed too close to the transcutaneous electrode, to transduce an artifactually high skin temperature. In a skin servo control system, this might result in a cooler environment than desired. Eight premature newborns in humidified incubators were tested once each between one and five days of age. Mean skin temperatures at 0.5 cm, 1.5 cm, and 2.5 cm from the electrode edge were significantly higher after electrode placement, although there were virtually no temperature changes in two of the subjects. Transcutaneous monitor electrodes can heat the surrounding skin. This may affect environment temperature in a skin servo control system if the skin probe is placed too close to the transcutaneous electrode.