Effects of amphetamine and phenylethylamine on catecholamine release in the glomerular layer of the rat olfactory bulb

The purpose of this study was to examine predictors of outcome in very low birth weight (< 1500 g) children. The very low birth weight sample consisted of 68 children weighing less than 750 g at birth and 65 children weighing 750 to 1499 g at birth who had been matched to the less than 750 g birth weight children in terms of hospital of birth, age, sex, and race. Mean ages for these two groups were 6.7 and 6.9 years, respectively. Outcomes were measured in terms of tests of cognitive function, neuropsychological abilities, and academic achievement and parent and teacher ratings of child behavior and school performance. A weighted sum of the number of major neonatal medical complications (Neonatal Risk Index) provided a composite measure of biological risk. Social risks were also assessed. Results indicated that the Neonatal Risk Index was the most consistent predictor of outcomes. Even after taking social risks into account, neonatal risk predicted overall cognitive ability and other achievement, neuropsychological, and behavior outcomes. Individual neonatal complications that predicted outcomes included severe cerebral ultrasonographic abnormality, chronic lung disease, necrotizing enterocolitis, and apnea of prematurity. Research and therapy to prevent or reduce neonatal complications and amelioration of social risks are of critical importance in improving outcomes of very low birth weight.     

Estimated gains in birth weight associated with reductions in smoking during pregnancy

OBJECTIVE: To compare the estimated effect on birth weight of reductions in maternal cigarette consumption and urinary cotinine during pregnancy. STUDY DESIGN: An observational study of 641 women with complete data on cigarette consumption, urinary cotinine and infant birth weight. Correlation and regression analyses were used to examine relationships between birth weight, cigarette consumption and urinary cotinine at first and last prenatal visits. RESULTS: Correlations of cigarette consumption and urinary cotinine with infant birth weight were -.23 and -.30 (first visit) and -.26 and -.31 (last visit); all P values were < .001. The regression equation relating urinary cotinine concentrations at first and last visits to infant birth weight explained a significantly larger proportion of the variability in birth weight than the equation relating cigarette consumption at these visits to infant birth weight, 11% vs. 7%, P = .04. Among continuing smokers, both equations predicted gains in birth weight in association with reductions in cigarette consumption, but quitting smoking before the first visit was associated with the most weight gain. As compared to the average infant birth weight of a woman who smoked 20 cigarettes per day throughout pregnancy, the estimated gain in birth weight would be 105 g if she cut down by 10 cigarettes per day after the first visit, 210 g if she quit after this visit and 310 g if she quit before the first visit. CONCLUSION: For women still smoking at their first prenatal visit, infant birth weight is already compromised, but subsequent reductions in cigarette consumption are associated with gains in birth weight. For women who cannot quit smoking, these reductions need to be substantial if increases in birth weight of > 100 g are to be achieved.     

Changes in the visual system in low birth weight children

PURPOSE: Evaluation of the visual system, especially refraction, in children with low birth weight under observation between 1990-1992. MATERIAL AND METHODS: 248 children with birth weight 600-2500 g and gestational age 26-37 weeks underwent ophthalmological examination including USG, ERG and VER. The children were first examined between 3-4 weeks of life, then at 8 and 12 weeks and 6, 12, 18 and 24 months. RESULTS: Refractive errors were found in 216 of patients, in 85.2% hypermetropia. ROP occurred in 7 children with birth weight below 1500 g and gestational age 27-32 weeks. Other ocular changes were observed in 19 (7.6%) of the examined children.     

A controlled trial of intravenous immune globulin to reduce nosocomial infections in very-low-birth-weight infants. National Institute of Child Health and Human Development Neonatal Research Network

BACKGROUND: Nosocomial infections are a major cause of morbidity and mortality in premature infants. As a rule, their low serum gamma globulin levels at birth subsequently decline to hypogammaglobulinemic values; hence, prophylactic administration of intravenous immune globulin may reduce the rate of hospital-acquired infections. METHODS: In this prospective, multicenter, two-phase controlled trial, 2416 infants were stratified according to birth weight (501 to 1000 g and 1001 to 1500 g) and randomly assigned to an intravenous immune globulin group (n = 1204) or a control group (n = 1212). Control infants were given placebo infusions during phase 1 of the study (n = 623) but were not given any infusions during phase 2 (n = 589). Infants weighing 501 to 1000 g at birth were given 900 mg of immune globulin per kilogram of body weight, and infants weighing 1001 to 1500 g at birth were given a dose of 700 mg per kilogram. The immune globulin infusions were repeated every 14 days until the infants weighed 1800 g, were transferred to another center, died, or were sent home from the hospital. RESULTS: Nosocomial infections of the blood, meninges, or urinary tract occurred in 439 of the 2416 infants (18.2 percent): 208 (17.3 percent) in the immune globulin group and 231 (19.1 percent) in the control group (relative risk, 0.91; 95 percent confidence interval, 0.77 to 1.08). Septicemia occurred in 15.5 percent of the immune globulin recipients and 17.2 percent of the controls. During phase 1 the rate of nosocomial infections was 13.4 percent in the immune globulin group and 17.8 percent in the control group; the respective rates during phase 2 were 21.0 percent and 20.4 percent. The predominant organisms included gram-positive cocci (53.0 percent), gram-negative bacilli (22.4 percent), and candida species (16.0 percent). Adverse reactions were rarely observed during the infusions. Immune globulin therapy had no effect on respiratory distress syndrome, bronchopulmonary dysplasia, intracranial hemorrhage, the duration of hospitalization, or mortality. The incidence of necrotizing enterocolitis was 12.0 percent in the immune globulin group and 9.5 percent in the control group. CONCLUSIONS: Prophylactic use of intravenous immune globulin failed to reduce the incidence of hospital-acquired infections in very-low-birth-weight infants.     

Identifying twin gestations at low risk for preterm birth with a transvaginal ultrasonographic cervical measurement at 24 to 26 weeks' gestation

OBJECTIVE: Because twins are a high-risk group for preterm birth, many clinicians routinely use prophylactic interventions such as home bed rest, hospital bed rest, oral tocolytics, or home uterine activity monitoring to prevent preterm delivery. We sought to identify twin gestations at low risk for spontaneous preterm birth with transvaginal ultrasonography of the cervix to avoid the unnecessary use of prophylactic interventions in these pregnancies. STUDY DESIGN: We measured cervical length at 24 to 26 weeks' gestation by transvaginal ultrasonography in women with twin gestations referred to our prematurity prevention clinic. Each delivery was classified as (1) spontaneous preterm birth < 34 weeks' gestation, (2) delivery at > or = 34 weeks' gestation with intervention, or (3) delivery at > or = 34 weeks' gestation without intervention. Intervention included strict bed rest at home or in the hospital, either parenteral or oral tocolysis, or both, or home uterine activity monitoring. Indicated preterm deliveries and patients with cerclage were excluded from this analysis. The ability of transvaginal cervical length to predict women who would deliver at > or = 34 weeks without intervention was evaluated. A cervical length of 35 mm was chosen by scatter diagram as the best cutoff to discriminate between the group delivered at term without intervention and the other two groups. RESULTS: Of 85 women with twin gestations who underwent ultrasonographic cervical length measurements at 24 to 26 weeks' gestation, 17 had spontaneous preterm birth at < 34 weeks, 23 were delivered at > or = 34 weeks but required intervention, and 45 were delivered at > or = 34 weeks without intervention. The mean cervical length for those delivered at > or = 34 weeks' gestation without intervention (36.4 +/- 5.8 mm) was significantly greater (p < 0.0001) than the mean for those delivered preterm (27.4 +/- 8.5) and those delivered at > or = 34 weeks' gestation who required intervention (27.7 +/- 10.5 mm). The sensitivity, specificity, and positive and negative predictive values of a cervical length > 35 mm for predicting delivery at > or = 34 weeks' gestation are 49%, 94%, 97%, and 31%, respectively. CONCLUSION: A transvaginal ultrasonographic measurement of the cervix of > 35 mm at 24 to 26 weeks in twin gestations can identify patients who are at low risk for delivery before 34 weeks' gestation.     

Accuracy of ultrasound estimation of fetal weight in multiple pregnancies

Our objective was to assess the accuracy of ultrasonographic estimation of fetal weight in twins and triplets as compared to singleton pregnancies. Retrospective analysis was undertaken of ultrasound data of all fetuses who underwent an examination within 1 week of delivery (singletons 1832, twins 518, triplets 51). At birth weights below 2500 g, there was a significant overestimation of fetal weight in twins as compared to singletons, but the accuracy of the estimate was the same, except in twins between 1500 and 2499 g, when the weight was based on abdominal circumference and femur length alone. At birth weights of more than 2500 g, no difference was detected between twins and singletons. At all birth weights below 2500 g, the accuracy of weight estimation in triplets was equal to that in singletons and there were no triplets above this weight. We conclude that ultrasonographic estimation of fetal weight is as accurate in twins and triplets as it is in singletons.     

Nonstructural protein-2 and the replication of canine parvovirus

STUDY OBJECTIVE: To conduct a population pharmacokinetic analysis of carbamazepine (CBZ). DESIGN: Retrospective chart review. SETTING: Ambulatory neurology clinics at three medical centers. PATIENTS: Patients diagnosed with epilepsy from 1991-1995. The index set included 829 adults receiving CBZ. A separate validation set consisted of 50 patients. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: Final regression equations were apparent oral clearance (Cl/F) (L/hr) = (0.0134 x TBW + 3.58), x 1.42 if receiving phenytoin only; x 1.17 if receiving phenobarbital or felbamate; x 1.62 if receiving phenytoin and phenobarbital or felbamate; x 0.749 if age > or = 70 years; apparent volume of distribution (Vd/F) (L) = 1.97 x total body weight; absorption rate constant [hr(-1)] = 0.441. Interindividual variability in Cl/F and Vd/F was 26% and 82%, respectively. Residual variability was 1.8 mg/L. Predictive performance analysis of the validation set provided a mean prediction error of 0.6 mg/L and median absolute error of 2.4 mg/L. CONCLUSIONS: These routinely collected data provided quantitative estimates of changes in CBZ Cl/F due to comedication and an age-related decrease in Cl/F The derived regression equations reasonably predicted concentrations in a separate validation set.     

Extremely low-birth-weight children and their peers. A comparison of school-age outcomes

OBJECTIVE: To document 7-year developmental and educational outcomes in a cohort of predominantly white, middle-class, extremely low-birth-weight (ELBW, < 1000 g) children to address the incidence of increased developmental disability and the need for special educational services. DESIGN: Observational study. PATIENTS: Fifty-four ELBW children and 58 comparison children, who were matched for race, gender, and socio-economic status (30 with low birth weights [1500-2500 g] and 28 with birth weights > 2500 g). The ELBW cohort was drawn from 104 presurfactant survivors born between 1984 and 1986 and cared for in a single hospital. SETTING: Suburban, university-based tertiary referral center. MAIN OUTCOME MEASURES: Teachers' reports of classroom placement and special education services and tests of cognitive, motor, language, and visual-motor integration abilities were studied. RESULTS: Twenty-seven (50%) of 54 ELBW children were in regular classrooms with no special services compared with 21 (70%) of 30 in the low-birth-weight group and 27 (93%) of 28 in the full-term group, indicating a significant trend toward increasing need for special services with decreasing birth weight across the 3 groups (P < .001). The ELBW group scored significantly lower than the comparison groups on all tests, although generally within the average range. Seventy-nine percent of ELBW children had average cognitive scores, but they averaged 14 to 17 points lower than the 2 comparison groups. Twenty percent of the ELBW children had significant disabilities including cerebral palsy, mental retardation, autism, and low intelligence with severe learning problems. CONCLUSIONS: Even with optimal socioeconomic environments, 20% of ELBW children are significantly disabled, and 1 of every 2 ELBW children requires special educational services. Objective testing pinpointed weakness on all measures compared with matched peer groups.     

Mothers' birth weight and survival of their offspring: population based study

OBJECTIVE: To test the hypothesis that a baby's survival is related to the mother's birth weight. DESIGN: Population based dataset for two generations. SETTING: Population registry in Norway. SUBJECTS: All birth records for women born in Norway since 1967 were linked to births during 1981-94, thereby forming 105104 mother-offspring units. MAIN OUTCOME MEASURES: Perinatal mortality specific for weight for offspring in groups of maternal birth weight (with 500 g categories in both). RESULTS: A mother's birth weight was strongly associated with the weight of her baby. Maternal birth weight was associated with perinatal survival of her baby only for mothers with birth weights under 2000 g. These mothers were more likely to lose a baby in the perinatal period (odds ratio 2.3, 95% confidence interval 1.4 to 3.7). Among mothers with a birth weight over 2000 g there was no overall association between mother's weight and infant survival. There was, however, a strong interaction between mother's birth weight, infant birth weight, and infant survival. Mortality among small babies was much higher for those whose mothers had been large at birth. For example, babies weighing 2500-2999 g had a threefold higher mortality if their mother's birth weight had been high (> or = 4000 g) than if the mother had been small (2500-2999 g). CONCLUSION: Mothers who weighed less than 2000 g at birth have a higher risk of losing their own babies. For mothers who weighed > or = 2000 g their birth weight provides a benchmark for judging the growth of their offspring. Babies who are small relative to their mother's birth weight are at increased risk of mortality.     

Catch-up growth during childhood among very low-birth-weight children

OBJECTIVES: To examine growth attainment and correlates of catch-up growth at 8 years of age in a cohort of very low-birth-weight (VLBW) children (< 1500 g), including appropriate and small-for-gestational-age children, and to compare their growth with normal-birth-weight (NBW) children. DESIGN: Eight-year longitudinal follow-up of a cohort of VLBW children. A geographically based, randomly selected sample of NBW children was recruited at 8 years of age. SETTING: Tertiary perinatal center. PARTICIPANTS: Two hundred forty-nine VLBW children born between January 1, 1977, and December 31, 1979 (78% of survivors), of whom 199 were born appropriate for gestational age and 50 were small for gestational age (< -2 SD). The NBW population included 363 children. MAIN OUTCOME MEASURES: For the VLBW population, rates of subnormal weight (below the third percentile) and height were obtained at birth, at 40 weeks (term), and at 8 and 20 months. For the VLBW and NBW populations, mean weight, height, and percentile distribution at 8 years were derived from the National Center for Health Statistics standards. RESULTS: Catch-up growth to above the third percentile occurred between 40 weeks and 8 months, 8 and 20 months, and up to 8 years of age among the VLBW children. At 40 weeks, 54% were subnormal in weight and 60% were subnormal in height; at 8 months, 33% and 22%, respectively, and at 8 years, 8% were subnormal in weight and height. Small-for-gestational-age children had lower rates of catch-up growth. Multivariate analyses disclosed maternal height, race, birth weight, and neurologic abnormality to predict percentile distribution of height; and maternal height, small for gestational age, and neurologic abnormality to predict subnormal height. CONCLUSIONS: Catch-up growth occurs during childhood among VLBW children. These results have implications when counseling parents about the potential growth attainment of their children.     

Insulin-like growth factor I in fetal serum obtained by cordocentesis is correlated with intrauterine growth retardation

We examined whether insulin-like growth factor-I (IGF-I) and one of its binding proteins (IGFBP-1) in fetal serum obtained by cordocentesis is correlated with intrauterine growth retardation (IUGR) and weight estimation by ultrasound. Cordocentesis sera from 27 fetuses suspected of having IUGR were analysed for IGF-I and IGFBP-1 by radioimmunoassay. The results showed that IGF-I concentrations were correlated significantly with birth weight (P < 0.001) and placenta weight (P < 0.05). Mean fetal concentrations of IGF-I were 38 +/- 18 microg/l. In patients (n = 11) with a weight deviation at delivery <-33%, IGF-I concentrations were 24.1 +/- 13.2 microg/l. IGFBP-1 was inversely correlated with birth weight (P < 0.006) and concentrations of IGF-I. Mean plasma concentrations of IGFBP-1 were 234.2 +/- 161.4 microg/l. Furthermore, IGF-I concentrations were correlated with the weight deviation estimated by ultrasonography at the time of cordocentesis (P < 0.007), as well as with the weight deviation at delivery (P < 0.0001). The actual weight deviation at delivery was correlated more strongly with fetal IGF-I concentrations than with the estimated weight deviation at cordocentesis. The lowest concentrations of IGF-I were found in patients with a weight deviation <-33%. Very low concentrations of IGF-I are thus associated with IUGR, indicating that IGF-I measured in fetal serum may increase the predictive value of ultrasonographic weight estimation.     

Weight-for-length reference data for preterm, low-birth-weight infants

OBJECTIVE: To provide weight-for-length reference data for preterm, very-low-birth-weight and low-birth-weight infants. DESIGN: Data from 867 infants (428 boys and 439 girls) in the Infant Health and Development Program, who each were preterm and who had a low birth weight, were used to develop weight-for-length reference data. The Infant Health and Development Program is a national, randomized, clinical trial that included various ethnic groups at 8 sites. At each site, sampling ensured that two thirds of the infants in the study weighed 2000 g or less and that one third of the infants weighed from 2001 to 2500 g at birth. Infants were examined at birth, at 40 weeks' postconception, and at 4, 8, 12, 18, 24, 30, and 36 months' gestation-adjusted age. Gestation-adjusted age was used instead of chronological age from birth to correct for the degree of prematurity. RESULTS: Weight-for-length percentiles are given for lengths at 3-cm intervals ranging from 48 to 100 cm. These percentiles are sex specific and are for a very-low-birth-weight group (< or = 1500 g) and a low-birth-weight group (1501-2500 g). CONCLUSIONS: These data should assist screening for deviations from normal growth and may aid in the early detection of failure to thrive and excessive weight gain in infancy.     

Transrectal ultrasonography and operative selection for early carcinoma of the rectum

BACKGROUND: Transrectal ultrasonography (TRUS) supplements clinical evaluation of early carcinoma of the rectum in selecting patients for local operative therapy, such as transanal excision (TAE). STUDY DESIGN: This study was done to evaluate the accuracy of ultrasonographic staging of tumor depth (T stage) in patients with suspected early carcinoma of the rectum, to compare ultrasonographic with clinical T-staging accuracies within this patient group, to determine if any specific tumor characteristics (configuration, size, location) predispose toward ultrasonographic T-staging inaccuracy, and to examine the role of TRUS in operative selection for patients with early carcinoma of the rectum. RESULTS: Between April 1990 and December 1992, 62 patients with primary carcinoma of the rectum underwent ultrasonographic staging (uT), whereby three uT4, 27 uT3, 24 uT2 and eight uT1 carcinomas were identified. Of the 32 patients with suspected intramural (uT1 or uT2) disease, 27 underwent prompt operative excision or resection at our institution, allowing comparative histopathologic staging. In this highly selected patient subset, uT1 staging was correct in all instances; uT2 staging was incorrect in 45 percent of instances, with 30 percent having unpredicted transmural penetration. Ultrasonographic and clinical staging accuracies were quantitatively similar, and no tumor characteristics were consistently associated with ultrasonographic imprecision. CONCLUSIONS: Among patients with clinically suspected early carcinoma of the rectum, the decision to perform TAE is supported by ultrasonographic T1 staging. By contrast, the decision to perform TAE cannot be based solely on ultrasonographic T2 staging, because of the possibility for transmural penetration of tumor.     

Helicobacter pylori infection in children

BACKGROUND: Although immigrants to the United States are usually ethnic minorities and socioeconomically disadvantaged, foreign-born women generally have lower rates of low birth weight infants than do US-born women. OBJECTIVE: To measure the relationship between maternal birthplace, ethnicity, and low birth weight infants. DESIGN: Retrospective cohort study of birth certificate data. SETTING: California, 1992. SUBJECTS: Singleton infants (n = 497 868) born to Asian, black, Latina, and white women. MAIN OUTCOME MEASURES: Very low birth weight (500-1499 g), moderately low birth weight (1500-2499 g), and normal birth weight (2500-4000 g, reference category). RESULTS: Foreign-born Latina women generally had less favorable maternal characteristics than US-born Latinas, yet foreign-born Latina women were less likely to have moderately low birth weight infants (odds ratio, 0.91; 95% confidence interval, 0.86-0.96) than US-born Latinas after adjusting for maternal age, education, marital status, parity, tobacco use, use of prenatal care, and gestational age. While foreign-born Asian women generally had a less favorable profile of maternal characteristics than US-born Asians, there was no statistically significant difference in the odds of very low birth weight or moderately low birth weight infants between foreign- and US-born Asian women. Foreign-born black women had more favorable maternal characteristics than US-born women, but there was no significant nativity difference in very low birth weight or moderately low birth weight between foreign- and US-born black women after adjusting for maternal and infant factors. CONCLUSIONS: The relationship between maternal birthplace and low birth weight varies by ethnicity. Further study is needed to understand the favorable pregnancy outcomes of foreign-born Latina women.     

Potential risk factors for vertical HIV-1 transmission in Catalonia, Spain: the protective role of cesarean section. The Working Group on HIV-1 Vertical Transmission in Catalonia

OBJECTIVE: To evaluate the roles of certain potential risk factors on the vertical transmission of HIV-1. DESIGN: Prospective registry of infants born to HIV-1-infected women in Catalonia (north-east Spain) from 1987 to 1992. METHODS: A total of 599 infants, born in Catalan hospitals to 520 women who were identified as being HIV-1-infected during gestation or at delivery, were included. Data on mode of delivery, birth weight, gestational age and breast-feeding as well as the mother's age, her route of HIV-1 infection, clinical stage and p24 antigenaemia, were recorded. HIV-1 infection status of 489 (82%) of the infants was determined according to the criteria of the US Centers for Disease Control and Prevention. Risk estimates and odds ratio (OR) were calculated and logistic regression was performed. RESULTS: The overall rate of vertical transmission was 18.6% (95% confidence interval, 15.2-22.0%). Multivariate analyses revealed that Cesarean section was associated with a lower rate of vertical transmission (OR = 0.3; P = 0.001), as was maternal HIV-1 infection via injecting drug use (OR = 0.44; P = 0.02). Breast-feeding (OR = 6.9; P = 0.001), very low birth weight (< 1500 g; OR = 6.3; P = 0.001) and p24 antigenaemia (OR = 4.6; P = 0.04) were all related to increased risk. The crude rate of HIV-1 transmission was 6% among Cesarean births compared with 21% for infants born via vaginal deliveries. The population-attributable risk for vaginal deliveries was 61.7%. CONCLUSIONS: The results show a protective effect of Cesarean section in the absence of zidovudine prophylaxis. However, current research should be directed towards the individual and combined effects that antiretroviral agents and Cesarean section may have on mother-to-child HIV-1 infection.     

A dose-response study of the effect of flutamide on benign prostatic hyperplasia: results of a multicenter study

OBJECTIVE: To compare morbidity and mortality rates of low birth weight (LBW) and appropriate birth weight infants born at term, focusing on diarrheal and respiratory infections. STUDY DESIGN: A cohort of 133 LBW infants (1500 to 2499 gm) and 260 appropriate birth weight infants (3000 to 3499 gm), individually matched by sex and season of birth, were followed for the first 6 months of life. None had congenital anomalies and all were from poor families living in the interior of Pernambuco, northeast Brazil. Data on infant deaths, hospitalizations, and morbidity were collected prospectively through daily home visits (except Sundays) from birth through week 8, then twice weekly for weeks 9 to 26. The effects of birth weight were assessed with a variety of multivariable techniques, controlling for confounders. RESULTS: Of the LBW infants, 56% were wasted (thin), 23% were stunted, and 17% were both wasted and stunted. The LBW infants (median 2380 gm) experienced a sevenfold higher mortality rate and fourfold higher rate of hospitalization than appropriate birth weight infants. Almost all deaths and hospitalizations were in the postneonatal period. The LBW infants also experienced 33% more days with diarrhea and 32% more days with vomiting (p = 0.003 in each case). The prevalences of cough and fever were not significantly different. CONCLUSIONS: Infant deaths, hospitalizations, and diarrheal morbidity are increased in term LBW infants who have only a modest weight deficit.     

Variation among neonatal intensive care units in narcotic administration

OBJECTIVES: To compare rates of narcotic administration for medically treated neonates in different neonatal intensive care units (NICUs) and to compare treated and untreated neonates to assess whether narcotics provided advantages or disadvantages for short-term outcomes, such as cardiovascular stability (ie, blood pressure and heart rate), hyperbilirubinemia, duration of respiratory support, growth, and the incidence of intraventricular hemorrhage. STUDY DESIGN: The medical charts of neonates weighing less than 1500 g, admitted to 6 NICUs (A-F), were abstracted. Neonates who had a chest tube or who had undergone surgery were excluded from the study, leaving the records of 1171 neonates. We modeled outcomes by linear or logistic regression, controlling for birth weight (<750, 750-999, and 1000-1499 g) and illness severity (low, 0-9; medium, 10-19; high, > or =20) using the Score for Neonatal Acute Physiology (SNAP), and adjusted for NICU. RESULTS: Narcotic use varied by birth weight (<750 g, 21%; 750-999 g, 13%; and 1000-1499 g, 8%), illness severity (low, 9%; medium, 19%; and high, 37%), day (1, 11%; 3, 6%; and 14, 2%), and NICU. We restricted analyses to the 1018 neonates who received mechanical ventilation on day 1. Logistic regression, adjusting for birth weight and SNAP, confirmed a 28.6-fold variation in narcotic administration (odds ratios, 4.1-28.6 vs NICU A). Several short-term outcomes also were associated with narcotic use, including more than 33 g of fluid retention on day 3 and a higher direct bilirubin level (6.8 micromol/L higher [0.4 mg/dL higher], P = .03). There were no differences in weight gain at 14 and 28 days or mechanical ventilatory support on days 14 and 28. Narcotic use was not associated with differences in worst blood pressure or heart rate or with increased length of hospital stay. CONCLUSIONS: Our study found a 28.6-fold variation among NICUs in narcotic administration in very low-birth-weight neonates. We were unable to detect any major advantages or disadvantages of narcotic use. We did not assess iatrogenic abstinence syndrome or long-term outcomes. These results indicate the need for randomized trials to rationalize these widely differing practices.     

Reactivity of monoclonal antibodies 17.13 and 63.12 with oral epithelial dysplasia and hyperkeratosis

OBJECTIVE: Patients in the neonatal intensive care unit require life support and monitoring equipment that must be securely attached to the skin; removal or replacement often causes skin trauma. In this study, we compared the effects of application and removal of three different adhesives on the skin barrier function of premature neonates. The effects were measured by transepidermal water loss (TEWL), colorimetric measurements, and visual inspection. DESIGN: Thirty neonates, between 26 and 40 weeks of gestational age and with birth weights ranging from 690 to 3000 gm, were enrolled in the study during the first week of life. Pieces of plastic tape (1 cm2), pectin barrier, and hydrophilic gel were applied to previously undisturbed sites on the back. A fourth site was used as a control. We measured TEWL, colorimetric readings, and visual inspection scores of skin irritation and stripping at each of the four sites serially: before adhesive application, 30 minutes after adhesive removal, and 24 hours later. RESULTS: Thirty minutes after adhesive removal, TEWL, colorimetric measurements, and visual inspection scores were all significantly higher at the sites of plastic tape and pectin barrier removal than at the control and gel adhesive sites (p < 0.01), demonstrating greater disruption of skin barrier function with removal of the plastic tape and pectin barrier. When the neonates were divided into three groups on the basis of birth weight (< 1000 gm [n = 10], 1000 to 1500 gm [n = 11], and > 1500 gm [n = 9], the same pattern of greater disruption in skin barrier function, as measured by TEWL, was observed in each birth weight group. Twenty-four hours after adhesive removal, TEWL of the plastic tape and pectin barrier sites were not significantly different from the control site, indicating recovery of skin barrier function. CONCLUSIONS: This study demonstrates that a single application and removal of two commonly used adhesives, plastic tape and pectin barrier, disrupts skin barrier function in neonates of varying gestational ages.     

Reference and Crop Evapotranspiration in South Central Nebraska. II: Measurement and Estimation of Actual Evapotranspiration for Corn

In planning, designing, and managing of surface and groundwater supply, it is essential to accurately quantify actual evapotranspiration (ETc) from various vegetation surfaces within the water supply areas to allow water management agencies to manipulate the land use pattern alternatives and scenarios to achieve a desired balance between water supply and demand. However, significant differences among water regulatory agencies and water users exist in terms of methods used to quantify ETc. It is essential to know the potential differences associated with using various empirical equations in quantifying ETc as compared with the measurements of this critical variable. We quantified and analyzed the differences associated with using 15 grass (ETo) and alfalfa-reference (ETr) combination, temperature and radiation-based reference ET (ETref) equations in quantifying grass-reference actual ET (ETco) and alfalfa-reference actual ET (ETcr) as compared with the Bowen ratio energy balance system (BREBS)-measured ETc (ETc-BREBS) for field corn (Zea mays L.). We analyzed the performance of the equations for their full season, irrigation season, peak ET month, and seasonal cumulative ETc estimates on a daily time step for 2005 and 2006. The step-wise Kc values instead of smoothed curves were used in the ETc calculations. The seasonal ETc-BREBS was measured as 572 and 561?mm in 2005 and 2006, respectively. The root-means-quare difference (RMSD) was higher for the full season than the irrigation season and peak ET month estimates for all equations. The standardized ASCE Penman-Monteith (PM) ETco had a RMSD of 1.37?mm?d?1 for the full growing season, 1.05?mm?d?1 for the irrigation season, and 0.76?mm?d?1 for the peak month ET. The ASCE-PM, 1963 and 1948 Penman ETc estimates were closest to the ETc-BREBS. The FAO-24 radiation and the HPRCC Penman ETc estimates also agreed well with the ETc-BREBS. Most combination equations performed best during the peak ET month except the temperature and radiation-based equations. There was an excellent correlation between the ASCE-PM ETco and ETcr with a high r2 of 0.99 and a low RMSD of 0.34?mm?d?1. The difference between the ETcr and ETco was found to be larger at the high ETc range (i.e., >8?mm), but overall, the ETcr and ETco values were within 3%. Significant differences were found between the cumulative ETco-METHOD and ETcr-METHOD versus ETc-BREBS. Most combination equations, including the standardized ASCE-PM ETco and ETcr underestimated ETc-BREBS during the early periods of the growing season where the soil evaporation was the dominant energy flux of the energy balance and in the late season near and after physiological maturity when the transpiration rates were less than the midseason. The underestimations early in the season can be attributed to the lack of ability of the physical structure of the ETref×crop coefficient approach to “fully” account for the soil surface conditions when complete canopy cover is not present. The results of this study can be used as a reference tool by the water resources regulatory agencies and water users and can provide practical information on which method to select based on the data availability for reliable estimates of daily ETc for corn.     

Composition of peripheral blood progenitor cell components collected from healthy donors

OBJECTIVES: The purpose of this study was to test the hypothesis that low circulating thyroxine concentrations characteristic of very low birth weight (VLBW) neonates (< 1500 g) are the result of decreased protein binding of thyroid hormones and to elucidate the mechanism(s) responsible and possible significance thereof. DESIGN: Cross-sectional comparison of thyroid related measurements in cord blood specimens from VLBW infants and from full term infants. Longitudinal comparison in cord and 2- and 4-week blood specimens from VLBW infants. PATIENTS: Cord blood specimens were analysed from 47 VLBW and 45 full term infants weighing > or = 2500 g. Repeat analyses in venous bloods from 32 of the VLBW infants were analysed at 2 weeks of age and again at 4 weeks in 23. The first cohort of patients was studied in 1994 and comprised 28 VLBW and 24 full term infants (Cohort A). The studies were repeated in 1995-96 in 19 VLBW infants and 21 full term infants (Cohort B). MEASUREMENTS: T4, free T4 (FT4), T3, thyroxine binding globulin (TBG), and TSH were measured in cord blood and 2- and 4-week venous specimens from VLBW infants and in cord blood specimens of full term infants. Molar ratios of T4/TBG were calculated. RESULTS: (1) Cord blood TBG, T4 and T3 concentrations of VLBW infants were each 60% of those of term infants. TBG concentrations were 397 +/- 111 vs 680 +/- 172 nmol/l (P < 0.0005). T4 concentrations were 76 +/- 22 vs 139 +/- 26 nmol/l (P < 0.0005). FT4 concentrations were in the normal adult range in both neonatal groups. T4/TBG ratios did not differ between the neonatal groups but were significantly less than that of adults (P < 0.001). (2) TSH concentrations in VLBW infants at 2 and 4 weeks were less than 50% of cord blood values. At 2 weeks, TBG concentrations of VLBW infants were unchanged from cord blood concentrations but mean T4 concentration fell by 18% and T4/TBG ratios by 21% (P < 0.005). Mean FT4 rose by 78% (P < 0.02). The changes in mean T4 and FT4 were due largely to FT4 concentrations of 37-113 pmol/l and T4 concentrations of 13-48 nmol/l in 5 infants. These infants also had lower T4/TBG ratios and were smaller and more ill than the remainder of the cohort. The changes disappeared by 4 weeks in 3 of the 4 infants tested. CONCLUSIONS: Cord T4/TBG ratios are the same in very low birth weight and term infants and are significantly lower than in adult blood. These are more than compensated for in term infants by a 236% increase in thyroxine binding globulin concentrations. The lower thyroxine binding globulin concentrations in very low birth weight infants explain their much lower T4 concentrations. Cord FT4 concentrations of full term and very low birth weight infants are in the normal adult range. T4 concentrations are further depressed and free T4 concentrations elevated in the most ill very low birth weight infants at 2 weeks of age in a manner analogous to that of the 'sick euthyroid syndrome'.