Children born extremely preterm are at risk for cognitive difficulties and disability. The relati... more Children born extremely preterm are at risk for cognitive difficulties and disability. The relative prognostic value of neonatal brain MRI and cranial ultrasound (CUS) for school-age outcomes remains unclear. Our objectives were to relate near-term conventional brain MRI and early and late CUS to cognitive impairment and disability at 6 to 7 years among children born extremely preterm and assess prognostic value. A prospective study of adverse early and late CUS and near-term conventional MRI findings to predict outcomes at 6 to 7 years including a full-scale IQ (FSIQ) <70 and disability (FSIQ <70, moderate-to-severe cerebral palsy, or severe vision or hearing impairment) in a subgroup of Surfactant Positive Airway Pressure and Pulse Oximetry Randomized Trial enrollees. Stepwise logistic regression evaluated associations of neuroimaging with outcomes, adjusting for perinatal-neonatal factors. A total of 386 children had follow-up. In unadjusted analyses, severity of white matt...
Children born extremely preterm are at risk for cognitive difficulties and disability. The relati... more Children born extremely preterm are at risk for cognitive difficulties and disability. The relative prognostic value of neonatal brain MRI and cranial ultrasound (CUS) for school-age outcomes remains unclear. Our objectives were to relate near-term conventional brain MRI and early and late CUS to cognitive impairment and disability at 6 to 7 years among children born extremely preterm and assess prognostic value. A prospective study of adverse early and late CUS and near-term conventional MRI findings to predict outcomes at 6 to 7 years including a full-scale IQ (FSIQ) <70 and disability (FSIQ <70, moderate-to-severe cerebral palsy, or severe vision or hearing impairment) in a subgroup of Surfactant Positive Airway Pressure and Pulse Oximetry Randomized Trial enrollees. Stepwise logistic regression evaluated associations of neuroimaging with outcomes, adjusting for perinatal-neonatal factors. A total of 386 children had follow-up. In unadjusted analyses, severity of white matt...
A prospective study had demonstrated the clinical usefulness of water-delay ultrasound as a means... more A prospective study had demonstrated the clinical usefulness of water-delay ultrasound as a means of routinely imaging the intracranial contents in infants younger than one year of age. Correlation between ultrasound and CT images was excellent, showing both normal and pathological anatomy. This technique is most helpful in the detection of hydrocephalus and other &quot;fluid lesions&quot; (subdural hygroma or hematoma, Dandy-Walker cyst, porencephalic cyst) and in evaluation of response to therapy. Because small amounts of intraventricular and subependymal hemorrhage cannot be detected by ultrasound, CT remains the procedure of choice when these conditions are suspected. The water-delay method is accurate and inexpensive, rarely requires patient sedation, and avoids exposure to ionizing radiations.
Maternal weight and height before pregnancy and weight gain during pregnancy were recorded for ea... more Maternal weight and height before pregnancy and weight gain during pregnancy were recorded for each of 109 mothers who were delivered of normal infants after gestations of 37 to 43 weeks. Infant parameters obtained included gestational age, birth weight, bilateral mid-arm circumference, and eight skin fold thickness measurements. The eight skin fold thicknesses were summed (SSFT) for each infant. Infants with SSFTs greater than 40 mm (N = 8) for the group were classified as &amp;amp;quot;fatter&amp;amp;quot; infants. All of the fatter infants were large for gestational age (LGA), but accounted for only one third of the LGA infants in the study. Birth weight, length, and cross-sectional mid-arm fat area were significantly increased in the fatter LGA group when compared to other LGA infants. Cross-sectional mid-arm muscle area was not significantly different for the fatter LGA infants compared to the other LGA group. Mothers were defined as obese or nonobese according to pregnant weight for height. Obese mothers had infants with significantly increased SSFTs when compared with infants of nonobese mothers. Mulitple regression analysis showed that both prepregnant weight for height and weight gain during pregnancy were associated with increased subcutaneous fat in the neonate. Weight gain during pregnancy was associated with increased neonatal fatness and length, while prepregnant weight for height was associated with neonatal fatness independent of neonatal length.
We reviewed 22 patients with congenital diaphragmatic hernias in whom operative repair was undert... more We reviewed 22 patients with congenital diaphragmatic hernias in whom operative repair was undertaken within 24 hours of age, in the period between 1970 and 1981. An improvement in survival rates since 1977 was observed. Preoperative pH, PO2, and alveolar-arterial O2 gradients (P[A-a]O2) were found to have predictive value. Patients with P(A-a)O2 greater than 500 torr both before and immediately after surgery did not survive. After an initial improvement in oxygenation some infants experienced a period of deterioration beginning at approximately 12 to 24 hours, peaking at 36 hours and improvement by 72 hours after surgery. Special attention should be directed toward maintaining aggressive cardiopulmonary support during this critical period. Reducing support prematurely may accentuate right-to-left shunting via fetal channels.
1. J Perinatol. 1990 Dec;10(4):416-9. Impact of surfactant treatment on cost of neonatal intensiv... more 1. J Perinatol. 1990 Dec;10(4):416-9. Impact of surfactant treatment on cost of neonatal intensive care: a cost-benefit analysis. Merritt TA, Hallman M, Vaucher Y, McFeeley E, Tubman TR. University of California, San Diego. PMID: 2126034 [PubMed - indexed for MEDLINE]. ...
Children born extremely preterm are at risk for cognitive difficulties and disability. The relati... more Children born extremely preterm are at risk for cognitive difficulties and disability. The relative prognostic value of neonatal brain MRI and cranial ultrasound (CUS) for school-age outcomes remains unclear. Our objectives were to relate near-term conventional brain MRI and early and late CUS to cognitive impairment and disability at 6 to 7 years among children born extremely preterm and assess prognostic value. A prospective study of adverse early and late CUS and near-term conventional MRI findings to predict outcomes at 6 to 7 years including a full-scale IQ (FSIQ) <70 and disability (FSIQ <70, moderate-to-severe cerebral palsy, or severe vision or hearing impairment) in a subgroup of Surfactant Positive Airway Pressure and Pulse Oximetry Randomized Trial enrollees. Stepwise logistic regression evaluated associations of neuroimaging with outcomes, adjusting for perinatal-neonatal factors. A total of 386 children had follow-up. In unadjusted analyses, severity of white matt...
Children born extremely preterm are at risk for cognitive difficulties and disability. The relati... more Children born extremely preterm are at risk for cognitive difficulties and disability. The relative prognostic value of neonatal brain MRI and cranial ultrasound (CUS) for school-age outcomes remains unclear. Our objectives were to relate near-term conventional brain MRI and early and late CUS to cognitive impairment and disability at 6 to 7 years among children born extremely preterm and assess prognostic value. A prospective study of adverse early and late CUS and near-term conventional MRI findings to predict outcomes at 6 to 7 years including a full-scale IQ (FSIQ) <70 and disability (FSIQ <70, moderate-to-severe cerebral palsy, or severe vision or hearing impairment) in a subgroup of Surfactant Positive Airway Pressure and Pulse Oximetry Randomized Trial enrollees. Stepwise logistic regression evaluated associations of neuroimaging with outcomes, adjusting for perinatal-neonatal factors. A total of 386 children had follow-up. In unadjusted analyses, severity of white matt...
A prospective study had demonstrated the clinical usefulness of water-delay ultrasound as a means... more A prospective study had demonstrated the clinical usefulness of water-delay ultrasound as a means of routinely imaging the intracranial contents in infants younger than one year of age. Correlation between ultrasound and CT images was excellent, showing both normal and pathological anatomy. This technique is most helpful in the detection of hydrocephalus and other &quot;fluid lesions&quot; (subdural hygroma or hematoma, Dandy-Walker cyst, porencephalic cyst) and in evaluation of response to therapy. Because small amounts of intraventricular and subependymal hemorrhage cannot be detected by ultrasound, CT remains the procedure of choice when these conditions are suspected. The water-delay method is accurate and inexpensive, rarely requires patient sedation, and avoids exposure to ionizing radiations.
Maternal weight and height before pregnancy and weight gain during pregnancy were recorded for ea... more Maternal weight and height before pregnancy and weight gain during pregnancy were recorded for each of 109 mothers who were delivered of normal infants after gestations of 37 to 43 weeks. Infant parameters obtained included gestational age, birth weight, bilateral mid-arm circumference, and eight skin fold thickness measurements. The eight skin fold thicknesses were summed (SSFT) for each infant. Infants with SSFTs greater than 40 mm (N = 8) for the group were classified as &amp;amp;quot;fatter&amp;amp;quot; infants. All of the fatter infants were large for gestational age (LGA), but accounted for only one third of the LGA infants in the study. Birth weight, length, and cross-sectional mid-arm fat area were significantly increased in the fatter LGA group when compared to other LGA infants. Cross-sectional mid-arm muscle area was not significantly different for the fatter LGA infants compared to the other LGA group. Mothers were defined as obese or nonobese according to pregnant weight for height. Obese mothers had infants with significantly increased SSFTs when compared with infants of nonobese mothers. Mulitple regression analysis showed that both prepregnant weight for height and weight gain during pregnancy were associated with increased subcutaneous fat in the neonate. Weight gain during pregnancy was associated with increased neonatal fatness and length, while prepregnant weight for height was associated with neonatal fatness independent of neonatal length.
We reviewed 22 patients with congenital diaphragmatic hernias in whom operative repair was undert... more We reviewed 22 patients with congenital diaphragmatic hernias in whom operative repair was undertaken within 24 hours of age, in the period between 1970 and 1981. An improvement in survival rates since 1977 was observed. Preoperative pH, PO2, and alveolar-arterial O2 gradients (P[A-a]O2) were found to have predictive value. Patients with P(A-a)O2 greater than 500 torr both before and immediately after surgery did not survive. After an initial improvement in oxygenation some infants experienced a period of deterioration beginning at approximately 12 to 24 hours, peaking at 36 hours and improvement by 72 hours after surgery. Special attention should be directed toward maintaining aggressive cardiopulmonary support during this critical period. Reducing support prematurely may accentuate right-to-left shunting via fetal channels.
1. J Perinatol. 1990 Dec;10(4):416-9. Impact of surfactant treatment on cost of neonatal intensiv... more 1. J Perinatol. 1990 Dec;10(4):416-9. Impact of surfactant treatment on cost of neonatal intensive care: a cost-benefit analysis. Merritt TA, Hallman M, Vaucher Y, McFeeley E, Tubman TR. University of California, San Diego. PMID: 2126034 [PubMed - indexed for MEDLINE]. ...
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