Mark Mammel - Academia.edu (original) (raw)

Papers by Mark Mammel

Research paper thumbnail of Muscle strength as an index of response to therapy in childhood dermatomyositis

Archives of Physical Medicine and Rehabilitation

ABSTRACT

Research paper thumbnail of Using conventional ventilators at unconventional rates

Research paper thumbnail of The St. Paul Infant Apnea Program. An approach to the evaluation and treatment of infantile apnea

Research paper thumbnail of Short-term dexamethasone therapy for bronchopulmonary dysplasia: Acute effects and 1-year follow-up

Developmental pharmacology and therapeutics

Eight ventilator-dependent infants with bronchopulmonary dysplasia (BPD) were treated with dexame... more Eight ventilator-dependent infants with bronchopulmonary dysplasia (BPD) were treated with dexamethasone (0.5 mg/kg/day). Therapy was initiated at 19.3 +/- 3.9 days of age, continued at the initial dose for 7 days, then tapered over 2 weeks. The clinical course of these infants with BPD was compared to that of 8 similar ventilator-dependent infants with uncomplicated hyaline membrane disease (HMD). At study entry, the BPD patients had significantly higher ventilator rates, peak inspiratory pressures, mean airway pressures, alveolar-arterial oxygen gradients and fraction of inspired oxygen (FiO2) values. After 7 days of dexamethasone therapy, ventilator rates, peak inspiratory pressures, mean airway pressures, FiO2 values and alveolar-arterial oxygen gradients improved significantly. At this time, ventilator rates, peak inspiratory pressures and FiO2 values were similar to those of patients with uncomplicated HMD. BPD patients were extubated after 6.5 +/- 2.4 days of therapy. The incidences of septicemia, rickets and retinopathy of prematurity were similar in the BPD and uncomplicated HMD patients. Most dexamethasone-treated patients developed arterial hypertension during the first 48 h of therapy. Blood pressures returned to normal within 7 days of stopping therapy. All BPD patients had cosyntropin responses tested 5.5 +/- 2.6 weeks after stopping therapy. Six were normal. Two had inadequate responses. At 1 year adjusted age, the dexamethasone-treated BPD infants and HMD infants had similar radiographic bone ages, similar growth patterns and similar scores on the Bayley infant development scale. Dexamethasone was useful in the treatment of early BPD. Used as short-term therapy, the drug had minimal complications and no long-term sequelae.

Research paper thumbnail of Necrotizing tracheobronchitis: a newly recognized cause of acute obstruction in mechanically ventilated neonates

The Laryngoscope

Necrotizing tracheobronchitis (NTB) is an acute inflammatory lesion of the lower airway which can... more Necrotizing tracheobronchitis (NTB) is an acute inflammatory lesion of the lower airway which can result in total airway obstruction. While potentially treatable, this lesion has been described predominantly in autopsy or animal studies. We observed clinical symptoms which reflect development of this lesion. Symptoms of acute airway obstruction (hypercarbia, respiratory acidosis, decreased chest wall movement) occurred in eight neonates undergoing treatment with high-frequency jet ventilation; five patients treated with HFJV were studied without signs of obstruction. Emergency bronchoscopy using a rigid bronchoscope was performed in the intensive care unit. The diagnosis of NTB was made by the observation of hyperemia, intraluminal debris, or the appearance of eschar formation. Necrotic debris was removed using forceps and/or suction as necessary. All patients survived treatment. Seven were long-term survivors, all with bronchopulmonary dysplasia. In patients who died, autopsy evaluation of the airway revealed a characteristic picture consisting of necrosis, neutrophil infiltration, epithelial erosion, and intraluminal obstruction.

Research paper thumbnail of Delivery in a tertiary care perinatal center reduces neonatal intensive care costs

Research paper thumbnail of Necrotizing tracheobronchitis: a newly recognized cause of acute obstruction in mechanically ventilated neonates

The Laryngoscope, 1987

Necrotizing tracheobronchitis (NTB) is an acute inflammatory lesion of the lower airway which can... more Necrotizing tracheobronchitis (NTB) is an acute inflammatory lesion of the lower airway which can result in total airway obstruction. While potentially treatable, this lesion has been described predominantly in autopsy or animal studies. We observed clinical symptoms which reflect development of this lesion. Symptoms of acute airway obstruction (hypercarbia, respiratory acidosis, decreased chest wall movement) occurred in eight neonates undergoing treatment with high-frequency jet ventilation; five patients treated with HFJV were studied without signs of obstruction. Emergency bronchoscopy using a rigid bronchoscope was performed in the intensive care unit. The diagnosis of NTB was made by the observation of hyperemia, intraluminal debris, or the appearance of eschar formation. Necrotic debris was removed using forceps and/or suction as necessary. All patients survived treatment. Seven were long-term survivors, all with bronchopulmonary dysplasia. In patients who died, autopsy evalu...

Research paper thumbnail of Motavizumab for Prophylaxis of Respiratory Syncytial Virus in High-Risk Children: A Noninferiority Trial

PEDIATRICS, 2009

WHAT'S KNOWN ON THIS SUBJECT: Monthly prophylaxis with palivizumab has been shown to reduce RSV h... more WHAT'S KNOWN ON THIS SUBJECT: Monthly prophylaxis with palivizumab has been shown to reduce RSV hospitalizations by ϳ50% overall compared with placebo in children at high risk for severe RSV disease. Motavizumab, a monoclonal antibody developed from palivizumab, has enhanced preclinical activity against RSV.

Research paper thumbnail of Muscle proteolysis and weight loss in a neonatal rat model of sepsis syndrome

Inflammation, 2002

Our hypothesis is that nitrogen loss in septic neonates is caused by increased muscle proteolysis... more Our hypothesis is that nitrogen loss in septic neonates is caused by increased muscle proteolysis. Sprague-Dawley rat pups (P7) were injected intraperitoneally with NaCl or 4 mg/kg/BW lipopolysaccharide (LPS) and then sacrificed at 2, 4, 24, and 48 hr. Sepsis syndrome was confirmed by elevated serum tumor necrosis factor (24.6 ng/mL +/- 18.4 [LPS] and < 1.0 ng/mL [controls]; p < .05). Proteolysis in gastrocnemius/soleus muscle was analyzed by quantitation of tissue tyrosine loss. The neonatal rats injected with LPS had significant media tyrosine release at 24 hr compared to the controls (0.39 +/- 0.14 versus 0.25 +/- 0.11 micromol tyrosine/g muscle; p < .05). At 48 hr, LPS-induced muscle tyrosine release ceased (0.24 +/- 0.04 [control] versus 0.23 +/- 0.03 micromol tyrosine/g muscle [LPS]). After 48 hr, gastrocnemius/soleus weight was less in the LPS-injected rats (50.5 +/- 4.8 to 31.2 +/- 4.0 g; p < .0001). Similar changes were not seen in the extensor digitorum longus,...

Research paper thumbnail of Suspected betamethasone-induced leukemoid reaction in a premature infant

Pharmacotherapy

The use of antenatal corticosteroids in threatened pregnancies of less than 34 weeks' duratio... more The use of antenatal corticosteroids in threatened pregnancies of less than 34 weeks' duration is a valuable tool for assisting fetal lung maturation. Although this practice has existed for over 20 years, little is known about a rare extreme elevation of the newborn's white blood cell count, called a leukemoid reaction. A case of leukemoid reaction is discussed to assist the clinician with the current thought processes and diagnostic differential behind this benign condition.

Research paper thumbnail of Nasal Cannula Therapy

Manual of Neonatal Respiratory Care, 2012

Research paper thumbnail of Prophylaxis of Early Adrenal Insufficiency to Prevent Bronchopulmonary Dysplasia: A Multicenter Trial

PEDIATRICS, 2004

Background. Infants developing bronchopulmonary dysplasia (BPD) show decreased cortisol response ... more Background. Infants developing bronchopulmonary dysplasia (BPD) show decreased cortisol response to adrenocorticotropic hormone. A pilot study of low-dose hydrocortisone therapy for prophylaxis of early adrenal insufficiency showed improved survival without BPD at 36 weeks' postmenstrual age, particularly in infants exposed to histologic chorioamnionitis.

Research paper thumbnail of Tracheostomy for Infants Requiring Prolonged Mechanical Ventilation: 10 Years' Experience

Research paper thumbnail of Growth and Neurodevelopmental Outcomes After Early Low-Dose Hydrocortisone Treatment in Extremely Low Birth Weight Infants

PEDIATRICS, 2007

BACKGROUND. Low cortisol concentrations in premature infants have been correlated with increased ... more BACKGROUND. Low cortisol concentrations in premature infants have been correlated with increased severity of illness, hypotension, mortality, and development of bronchopulmonary dysplasia. A total of 360 mechanically ventilated infants with a birth weight of 500 to 999 g were enrolled in a randomized, multicenter trial of prophylaxis of early adrenal insufficiency to prevent bronchopulmonary dysplasia. Mortality and bronchopulmonary dysplasia were decreased in the hydrocortisonetreated patients exposed to chorioamnionitis. We now report outcomes at 18 to 22 months' corrected age.

Research paper thumbnail of Positive End-Expiratory Pressure during Partial Liquid Ventilation: Impact on Lung Volume Recruitment and Gas Exchange

Research paper thumbnail of The Effects of Multiple Doses of Recombinant Human CuZn Superoxide Dismutase (rhSOD) in Premature Infants with Respiratory Distress Syndrome (RDS)

Pediatric Research, 1999

Jonathan M Davis 1, Warren N Rosenfeld 1, Susan E Richter 1, Richard Parad 1, Ira H Gewolb 1, Rob... more Jonathan M Davis 1, Warren N Rosenfeld 1, Susan E Richter 1, Richard Parad 1, Ira H Gewolb 1, Robert Couser 1, Anita Price 1, John P Kinsella 1, Steven M Donn 1, Dale Gertsmann 1, Rangasamy Ramanathan 1, Tonse Raju 1, Mark Hudak 1, Stephen ...

Research paper thumbnail of 1792 Tracheal Inflammation and High-Frequency Ventilation

Pediatric Research, 1985

Energy requirements in CF patients have been estimated t o a l low f o r malabsorption. Energy ne... more Energy requirements in CF patients have been estimated t o a l low f o r malabsorption. Energy needs may a l s o be increased due t o the extra work of breathing a s lung disease worsens. In order t o f i n d o u t which f a c t o r s r e l a t e t o energy needs, we conducted s i xteen, 75 min. calorimetry studies on 15 patients (Mean age(y)=16 .4+4.9(SD),range,9-26y). Standard open c i r c u i t i n d i r e c t techniques were used. Subjects were fasted x lbhr., and were a f e b r i l e . Ten subjects were recovering from chest infection within the preceeding two weeks. Lung disease ranged from mild t o severe (XFEV, =40?16%predicted). Twelve subjects were underweight (X weight a s a percentage of idea1=84?10). Factors studied in r e l a t i o n t o energy expenditure were f a t f r e e mass, % f a t , W 0 a 7 5 Wt.%ideal, pulm. flow r a t e s , a r t e r i a l i z e d blood gases, ?Pseudemonas cepacia i n sputum, and infection within the preceeding two weeks. Actual energy expenditure ranged from 92-149% o f predicted values a s determined from the Harris-Benedict equation. The variables most closely linked t o energy expenditure were, in order of s i g n i f icance, PaCO (r2=0.60), infection(r2=0.36), FVC(r2=0.27), FEVl(r2

Research paper thumbnail of Dexamethasone Reduces Ventilator Dependence in Bronchopulmonary Dysplasia

Pediatric Research, 1984

O n t a r i o , Canada. Recent r e p o r t s have shown r e s i d u a l b r o n c h i a l h y p e... more O n t a r i o , Canada. Recent r e p o r t s have shown r e s i d u a l b r o n c h i a l h y p e r r e a c t i v i t y i n long term s u r v i v o r s o f bronchopulmonary d y s p l a s i a and Wilson M i k i t y syndromes. Our aim was t o e x t e n d t h e s e s t u d i e s t o s u r v i v o r s of uncomplicated RDS. The s t u d y group c o n s i s t e d o f 7 males and 7 females born between 1974 and 1976. Measurements o f s t a t i c and dynamic lung volumes were made and a m e t h a c h o l i n e c h a l l e n g e (MCH) was performed on each c h i l d . E x p i r a t o r y f l o w r a t e s f o r t h e

Research paper thumbnail of 1745 the Hypercarbic Ventilatory Response Test: Near-Miss Sids Siblings of Sids, and Subsequent Apnea

Pediatric Research, 1985

So. F l o r i d a , Oept. o f P e d a t r i c s , Tampa, FL Plasma zinc l e v e l s have been v a... more So. F l o r i d a , Oept. o f P e d a t r i c s , Tampa, FL Plasma zinc l e v e l s have been v a r i a b l y reported a s low o r normal i n p a t i e n t s with c y s t i c f i b r o s i s (CF). Zinc i s a co-factor f o r more than 60 enzymes including t h e A6 d e s a t u r a s e enzyme, and may be required f o r t h e mobilization and t r a n s p o r t of vitamin A,

Research paper thumbnail of Improved gas exchange and survival after KL-4 surfactant in newborn pigs with severe acute lung injury

Pediatric Pulmonology, 2010

To determine the effectiveness of artificial surfactant therapy using KL-4 surfactant in newborn ... more To determine the effectiveness of artificial surfactant therapy using KL-4 surfactant in newborn pigs with hydrochloric acid (HCl)-induced acute lung injury (ALI). After induction of ALI via intratracheal HCl instillation, pigs were randomized to receive 5.8 ml/kg KL-4 surfactant or no surfactant prior to extubation to bubble CPAP. Clinical laboratory. Spontaneously breathing newborn pigs (&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt;1 week of age). Treatment with KL-4 surfactant on bubble CPAP with PEEP of 6 cmH(2)O for 3.5 hr after extubation compared with controls. Physiologic parameters and arterial blood gases were measured every 15 min. At the conclusion of the study, the lungs were excised for the analysis of histopathology and morphometric data. Pigs treated with KL-4 surfactant had arterial blood gases with less acidosis (P &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt; 0.001), higher P(a)O(2) levels (P &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt; 0.001), and lower P(a)CO(2) levels (P &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt; 0.001). Pigs treated with KL-4 surfactant had improved survival compared with controls (6/12 KL-4, 2/12 control, P &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt; 0.05). Postmortem morphometric data demonstrated that pigs treated with KL-4 surfactant had larger (P &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt; 0.05) exchange units in the caudal-dorsal lung as compared to relatively atelectatic region in the control animals. In newborn pigs with severe HCl-induced ALI, treatment with KL-4 surfactant resulted in improved respiratory parameters, less dependent atelectasis, and improved short-term survival.

Research paper thumbnail of Muscle strength as an index of response to therapy in childhood dermatomyositis

Archives of Physical Medicine and Rehabilitation

ABSTRACT

Research paper thumbnail of Using conventional ventilators at unconventional rates

Research paper thumbnail of The St. Paul Infant Apnea Program. An approach to the evaluation and treatment of infantile apnea

Research paper thumbnail of Short-term dexamethasone therapy for bronchopulmonary dysplasia: Acute effects and 1-year follow-up

Developmental pharmacology and therapeutics

Eight ventilator-dependent infants with bronchopulmonary dysplasia (BPD) were treated with dexame... more Eight ventilator-dependent infants with bronchopulmonary dysplasia (BPD) were treated with dexamethasone (0.5 mg/kg/day). Therapy was initiated at 19.3 +/- 3.9 days of age, continued at the initial dose for 7 days, then tapered over 2 weeks. The clinical course of these infants with BPD was compared to that of 8 similar ventilator-dependent infants with uncomplicated hyaline membrane disease (HMD). At study entry, the BPD patients had significantly higher ventilator rates, peak inspiratory pressures, mean airway pressures, alveolar-arterial oxygen gradients and fraction of inspired oxygen (FiO2) values. After 7 days of dexamethasone therapy, ventilator rates, peak inspiratory pressures, mean airway pressures, FiO2 values and alveolar-arterial oxygen gradients improved significantly. At this time, ventilator rates, peak inspiratory pressures and FiO2 values were similar to those of patients with uncomplicated HMD. BPD patients were extubated after 6.5 +/- 2.4 days of therapy. The incidences of septicemia, rickets and retinopathy of prematurity were similar in the BPD and uncomplicated HMD patients. Most dexamethasone-treated patients developed arterial hypertension during the first 48 h of therapy. Blood pressures returned to normal within 7 days of stopping therapy. All BPD patients had cosyntropin responses tested 5.5 +/- 2.6 weeks after stopping therapy. Six were normal. Two had inadequate responses. At 1 year adjusted age, the dexamethasone-treated BPD infants and HMD infants had similar radiographic bone ages, similar growth patterns and similar scores on the Bayley infant development scale. Dexamethasone was useful in the treatment of early BPD. Used as short-term therapy, the drug had minimal complications and no long-term sequelae.

Research paper thumbnail of Necrotizing tracheobronchitis: a newly recognized cause of acute obstruction in mechanically ventilated neonates

The Laryngoscope

Necrotizing tracheobronchitis (NTB) is an acute inflammatory lesion of the lower airway which can... more Necrotizing tracheobronchitis (NTB) is an acute inflammatory lesion of the lower airway which can result in total airway obstruction. While potentially treatable, this lesion has been described predominantly in autopsy or animal studies. We observed clinical symptoms which reflect development of this lesion. Symptoms of acute airway obstruction (hypercarbia, respiratory acidosis, decreased chest wall movement) occurred in eight neonates undergoing treatment with high-frequency jet ventilation; five patients treated with HFJV were studied without signs of obstruction. Emergency bronchoscopy using a rigid bronchoscope was performed in the intensive care unit. The diagnosis of NTB was made by the observation of hyperemia, intraluminal debris, or the appearance of eschar formation. Necrotic debris was removed using forceps and/or suction as necessary. All patients survived treatment. Seven were long-term survivors, all with bronchopulmonary dysplasia. In patients who died, autopsy evaluation of the airway revealed a characteristic picture consisting of necrosis, neutrophil infiltration, epithelial erosion, and intraluminal obstruction.

Research paper thumbnail of Delivery in a tertiary care perinatal center reduces neonatal intensive care costs

Research paper thumbnail of Necrotizing tracheobronchitis: a newly recognized cause of acute obstruction in mechanically ventilated neonates

The Laryngoscope, 1987

Necrotizing tracheobronchitis (NTB) is an acute inflammatory lesion of the lower airway which can... more Necrotizing tracheobronchitis (NTB) is an acute inflammatory lesion of the lower airway which can result in total airway obstruction. While potentially treatable, this lesion has been described predominantly in autopsy or animal studies. We observed clinical symptoms which reflect development of this lesion. Symptoms of acute airway obstruction (hypercarbia, respiratory acidosis, decreased chest wall movement) occurred in eight neonates undergoing treatment with high-frequency jet ventilation; five patients treated with HFJV were studied without signs of obstruction. Emergency bronchoscopy using a rigid bronchoscope was performed in the intensive care unit. The diagnosis of NTB was made by the observation of hyperemia, intraluminal debris, or the appearance of eschar formation. Necrotic debris was removed using forceps and/or suction as necessary. All patients survived treatment. Seven were long-term survivors, all with bronchopulmonary dysplasia. In patients who died, autopsy evalu...

Research paper thumbnail of Motavizumab for Prophylaxis of Respiratory Syncytial Virus in High-Risk Children: A Noninferiority Trial

PEDIATRICS, 2009

WHAT'S KNOWN ON THIS SUBJECT: Monthly prophylaxis with palivizumab has been shown to reduce RSV h... more WHAT'S KNOWN ON THIS SUBJECT: Monthly prophylaxis with palivizumab has been shown to reduce RSV hospitalizations by ϳ50% overall compared with placebo in children at high risk for severe RSV disease. Motavizumab, a monoclonal antibody developed from palivizumab, has enhanced preclinical activity against RSV.

Research paper thumbnail of Muscle proteolysis and weight loss in a neonatal rat model of sepsis syndrome

Inflammation, 2002

Our hypothesis is that nitrogen loss in septic neonates is caused by increased muscle proteolysis... more Our hypothesis is that nitrogen loss in septic neonates is caused by increased muscle proteolysis. Sprague-Dawley rat pups (P7) were injected intraperitoneally with NaCl or 4 mg/kg/BW lipopolysaccharide (LPS) and then sacrificed at 2, 4, 24, and 48 hr. Sepsis syndrome was confirmed by elevated serum tumor necrosis factor (24.6 ng/mL +/- 18.4 [LPS] and < 1.0 ng/mL [controls]; p < .05). Proteolysis in gastrocnemius/soleus muscle was analyzed by quantitation of tissue tyrosine loss. The neonatal rats injected with LPS had significant media tyrosine release at 24 hr compared to the controls (0.39 +/- 0.14 versus 0.25 +/- 0.11 micromol tyrosine/g muscle; p < .05). At 48 hr, LPS-induced muscle tyrosine release ceased (0.24 +/- 0.04 [control] versus 0.23 +/- 0.03 micromol tyrosine/g muscle [LPS]). After 48 hr, gastrocnemius/soleus weight was less in the LPS-injected rats (50.5 +/- 4.8 to 31.2 +/- 4.0 g; p < .0001). Similar changes were not seen in the extensor digitorum longus,...

Research paper thumbnail of Suspected betamethasone-induced leukemoid reaction in a premature infant

Pharmacotherapy

The use of antenatal corticosteroids in threatened pregnancies of less than 34 weeks' duratio... more The use of antenatal corticosteroids in threatened pregnancies of less than 34 weeks' duration is a valuable tool for assisting fetal lung maturation. Although this practice has existed for over 20 years, little is known about a rare extreme elevation of the newborn's white blood cell count, called a leukemoid reaction. A case of leukemoid reaction is discussed to assist the clinician with the current thought processes and diagnostic differential behind this benign condition.

Research paper thumbnail of Nasal Cannula Therapy

Manual of Neonatal Respiratory Care, 2012

Research paper thumbnail of Prophylaxis of Early Adrenal Insufficiency to Prevent Bronchopulmonary Dysplasia: A Multicenter Trial

PEDIATRICS, 2004

Background. Infants developing bronchopulmonary dysplasia (BPD) show decreased cortisol response ... more Background. Infants developing bronchopulmonary dysplasia (BPD) show decreased cortisol response to adrenocorticotropic hormone. A pilot study of low-dose hydrocortisone therapy for prophylaxis of early adrenal insufficiency showed improved survival without BPD at 36 weeks' postmenstrual age, particularly in infants exposed to histologic chorioamnionitis.

Research paper thumbnail of Tracheostomy for Infants Requiring Prolonged Mechanical Ventilation: 10 Years' Experience

Research paper thumbnail of Growth and Neurodevelopmental Outcomes After Early Low-Dose Hydrocortisone Treatment in Extremely Low Birth Weight Infants

PEDIATRICS, 2007

BACKGROUND. Low cortisol concentrations in premature infants have been correlated with increased ... more BACKGROUND. Low cortisol concentrations in premature infants have been correlated with increased severity of illness, hypotension, mortality, and development of bronchopulmonary dysplasia. A total of 360 mechanically ventilated infants with a birth weight of 500 to 999 g were enrolled in a randomized, multicenter trial of prophylaxis of early adrenal insufficiency to prevent bronchopulmonary dysplasia. Mortality and bronchopulmonary dysplasia were decreased in the hydrocortisonetreated patients exposed to chorioamnionitis. We now report outcomes at 18 to 22 months' corrected age.

Research paper thumbnail of Positive End-Expiratory Pressure during Partial Liquid Ventilation: Impact on Lung Volume Recruitment and Gas Exchange

Research paper thumbnail of The Effects of Multiple Doses of Recombinant Human CuZn Superoxide Dismutase (rhSOD) in Premature Infants with Respiratory Distress Syndrome (RDS)

Pediatric Research, 1999

Jonathan M Davis 1, Warren N Rosenfeld 1, Susan E Richter 1, Richard Parad 1, Ira H Gewolb 1, Rob... more Jonathan M Davis 1, Warren N Rosenfeld 1, Susan E Richter 1, Richard Parad 1, Ira H Gewolb 1, Robert Couser 1, Anita Price 1, John P Kinsella 1, Steven M Donn 1, Dale Gertsmann 1, Rangasamy Ramanathan 1, Tonse Raju 1, Mark Hudak 1, Stephen ...

Research paper thumbnail of 1792 Tracheal Inflammation and High-Frequency Ventilation

Pediatric Research, 1985

Energy requirements in CF patients have been estimated t o a l low f o r malabsorption. Energy ne... more Energy requirements in CF patients have been estimated t o a l low f o r malabsorption. Energy needs may a l s o be increased due t o the extra work of breathing a s lung disease worsens. In order t o f i n d o u t which f a c t o r s r e l a t e t o energy needs, we conducted s i xteen, 75 min. calorimetry studies on 15 patients (Mean age(y)=16 .4+4.9(SD),range,9-26y). Standard open c i r c u i t i n d i r e c t techniques were used. Subjects were fasted x lbhr., and were a f e b r i l e . Ten subjects were recovering from chest infection within the preceeding two weeks. Lung disease ranged from mild t o severe (XFEV, =40?16%predicted). Twelve subjects were underweight (X weight a s a percentage of idea1=84?10). Factors studied in r e l a t i o n t o energy expenditure were f a t f r e e mass, % f a t , W 0 a 7 5 Wt.%ideal, pulm. flow r a t e s , a r t e r i a l i z e d blood gases, ?Pseudemonas cepacia i n sputum, and infection within the preceeding two weeks. Actual energy expenditure ranged from 92-149% o f predicted values a s determined from the Harris-Benedict equation. The variables most closely linked t o energy expenditure were, in order of s i g n i f icance, PaCO (r2=0.60), infection(r2=0.36), FVC(r2=0.27), FEVl(r2

Research paper thumbnail of Dexamethasone Reduces Ventilator Dependence in Bronchopulmonary Dysplasia

Pediatric Research, 1984

O n t a r i o , Canada. Recent r e p o r t s have shown r e s i d u a l b r o n c h i a l h y p e... more O n t a r i o , Canada. Recent r e p o r t s have shown r e s i d u a l b r o n c h i a l h y p e r r e a c t i v i t y i n long term s u r v i v o r s o f bronchopulmonary d y s p l a s i a and Wilson M i k i t y syndromes. Our aim was t o e x t e n d t h e s e s t u d i e s t o s u r v i v o r s of uncomplicated RDS. The s t u d y group c o n s i s t e d o f 7 males and 7 females born between 1974 and 1976. Measurements o f s t a t i c and dynamic lung volumes were made and a m e t h a c h o l i n e c h a l l e n g e (MCH) was performed on each c h i l d . E x p i r a t o r y f l o w r a t e s f o r t h e

Research paper thumbnail of 1745 the Hypercarbic Ventilatory Response Test: Near-Miss Sids Siblings of Sids, and Subsequent Apnea

Pediatric Research, 1985

So. F l o r i d a , Oept. o f P e d a t r i c s , Tampa, FL Plasma zinc l e v e l s have been v a... more So. F l o r i d a , Oept. o f P e d a t r i c s , Tampa, FL Plasma zinc l e v e l s have been v a r i a b l y reported a s low o r normal i n p a t i e n t s with c y s t i c f i b r o s i s (CF). Zinc i s a co-factor f o r more than 60 enzymes including t h e A6 d e s a t u r a s e enzyme, and may be required f o r t h e mobilization and t r a n s p o r t of vitamin A,

Research paper thumbnail of Improved gas exchange and survival after KL-4 surfactant in newborn pigs with severe acute lung injury

Pediatric Pulmonology, 2010

To determine the effectiveness of artificial surfactant therapy using KL-4 surfactant in newborn ... more To determine the effectiveness of artificial surfactant therapy using KL-4 surfactant in newborn pigs with hydrochloric acid (HCl)-induced acute lung injury (ALI). After induction of ALI via intratracheal HCl instillation, pigs were randomized to receive 5.8 ml/kg KL-4 surfactant or no surfactant prior to extubation to bubble CPAP. Clinical laboratory. Spontaneously breathing newborn pigs (&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt;1 week of age). Treatment with KL-4 surfactant on bubble CPAP with PEEP of 6 cmH(2)O for 3.5 hr after extubation compared with controls. Physiologic parameters and arterial blood gases were measured every 15 min. At the conclusion of the study, the lungs were excised for the analysis of histopathology and morphometric data. Pigs treated with KL-4 surfactant had arterial blood gases with less acidosis (P &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt; 0.001), higher P(a)O(2) levels (P &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt; 0.001), and lower P(a)CO(2) levels (P &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt; 0.001). Pigs treated with KL-4 surfactant had improved survival compared with controls (6/12 KL-4, 2/12 control, P &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt; 0.05). Postmortem morphometric data demonstrated that pigs treated with KL-4 surfactant had larger (P &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt; 0.05) exchange units in the caudal-dorsal lung as compared to relatively atelectatic region in the control animals. In newborn pigs with severe HCl-induced ALI, treatment with KL-4 surfactant resulted in improved respiratory parameters, less dependent atelectasis, and improved short-term survival.