Penny Glass - Academia.edu (original) (raw)
Papers by Penny Glass
Infant Behav Develop, 1986
Pediatrics, 1989
Extracorporeal membrane oxygenation is an important technology in the treatment of high-risk infa... more Extracorporeal membrane oxygenation is an important technology in the treatment of high-risk infants whose long-term outcome is being followed prospectively at our institution. The extracorporeal membrane oxygenation procedure allows temporary cardiopulmonary support for critically ill full-term neonates who are refractory to maximum ventilatory and medical management as a consequence of severe persistent pulmonary hypertension. The technique necessitates both the permanent ligation of the right common carotid artery and jugular vein and systemic heparinization. The survivors constitute a unique group of high-risk infants, from the standpoint of the hypoxic-ischemic insults preceding extracorporeal membrane oxygenation and the risks associated with the procedure. Our results indicate that most of our survivors are developing normally at 1 year. Major morbidity, in terms of either significant developmental delay (Bayley mental and motor indices less than 70) or significant neuromotor abnormality, occurred in only 10% of these infants. Poor outcome was associated with major intracranial hemorrhage and chronic lung disease. Ligation of the right carotid artery and jugular vein was not associated with a consistent lateralizing lesion. Long-term follow-up through school age is essential.
Journal of Pediatric Neurology, 2015
Birth defects original article series
Proceedings of the National Academy of Sciences of the United States of America, Jan 13, 2015
Developmental medicine and child neurology, Jan 10, 2014
To determine whether corpus callosum (CC) and corticospinal tract (CST) diffusion tensor imaging ... more To determine whether corpus callosum (CC) and corticospinal tract (CST) diffusion tensor imaging (DTI) measures relate to developmental outcome in encephalopathic newborn infants after therapeutic hypothermia. Encephalopathic newborn infants enrolled in a longitudinal study underwent DTI after hypothermia. Parametric maps were generated for fractional anisotropy, mean, radial, and axial diffusivity. CC and CST were segmented by DTI-based tractography. Multiple regression models were used to examine the association of DTI measures with Bayley-II Mental (MDI) and Psychomotor Developmental Index (PDI) at 15 months and 21 months of age. Fifty-two infants (males n=32, females n=20) underwent DTI at median age of 8 days. Two were excluded because of poor magnetic resonance imaging quality. Outcomes were assessed in 42/50 (84%) children at 15 months and 35/50 (70%) at 21 months. Lower CC and CST fractional anisotropy were associated with lower MDI and PDI respectively, even after controlli...
Objective: Amplitude integrated electroencephalography (aEEG) has been used in neonates in variou... more Objective: Amplitude integrated electroencephalography (aEEG) has been used in neonates in various clinical and research applications. We hypothesized that an abnormal aEEG score could be used as a predictor of short-term adverse outcome. Methods: Very low birth weight infants were enrolled in a prospective observational cohort study. Two channel 12-hour continuous aEEG recordings were performed within 48 h of life and at 1 week of age. Recordings were classified as abnormal if they correspond to a 2 point difference in score. Short-term adverse outcome was defined as either death or Bayley scales 270 at 4 months corrected age. Results: One hundred infants were enrolled. Their average gestational age was 27.9 1 2.6 weeks and average birth weight was 997 1 299 gram. Fifteen enrolled infants died, one was withdrawn, 29 lost to follow up, and 55 examined at 4 months. Those with adverse outcome had significantly increased percentages of abnormal EEG at 1 week of life (31% vs. 8%), severe intraventricular hemorrhage (IVH) (27% vs. 4.5%), intubation in the delivery room (45% vs. 16%), and increased average days of mechanical ventilation (16 days vs. 4 days). Combining abnormal aEEG at 1 week of life to severe IVH on early head ultrasound increased the sensitivity of ultrasound to detect short-term adverse outcome from 27% to 50%. Conclusion: aEEG is feasible in premature infants and when its data at 1 week of life are combined with early head ultrasound, sensitivity for detecting short-term adverse outcomes was increased.
Journal of Maternal-Fetal and Neonatal Medicine, 2014
Although the maturation of sleep wake cycling (SWC) in premature infants has been described, its ... more Although the maturation of sleep wake cycling (SWC) in premature infants has been described, its value in predicting neurodevelopmental outcome (NDO) is yet to be known. To examine the relationship between NDO and SWC evaluated by amplitude integrated electroencephalogram (aEEG) in very low birth weight (VLBW) infants. VLBW infants (<1500 grams and ≤34 weeks gestational age) were enrolled in a prospective study. Two channel 12-hour aEEG recordings were completed at 34 weeks postmenstrual age (PMA) and SWC scores were assigned. NDO was measured by the Bayley's Mental Developmental Index (MDI) and Psychomotor Developmental Index (PDI) at 9 and 18 months corrected age (CA). Eighty-four of the 103 enrolled infants had an aEEG completed at 34 weeks PMA. At 9 months CA, in linear regression models, MDI was significantly associated with severe intraventricular hemorrhage (IVH) and SWC score, while PDI was associated with GA and SWC score. At 18 months CA, these associations lost significance. At 34 weeks PMA, all VLBW premature infants demonstrate some degree of SWC on aEEG. Maturation of SWC at 34 weeks PMA is not associated with gestational age, however may relate to early NDO. Further studies are needed to evaluate this relationship.
Seminars in Perinatology, 2005
Intracranial injury continues to be a major complication associated with extracorporeal membrane ... more Intracranial injury continues to be a major complication associated with extracorporeal membrane oxygenation (ECMO)-treated neonates. The reported frequency of abnormal neuroimaging has ranged from 28% to 52%, depending on neuroimaging techniques and methods of classification. The purpose of this chapter is to describe types of imaging techniques commonly used to evaluate the ECMO neonate, to specify different types of injuries that have been reported, and to identify factors which increase the risk of injury. We will then describe the functional impact at age 5 years following neonatal brain injury among ECMO infants. Semin Perinatol 29:58-65
Science, 1980
Newborn infants, chronically exposed in utero to low doses of methadone with or without concomita... more Newborn infants, chronically exposed in utero to low doses of methadone with or without concomitant heroin, display more rapid eye movement sleep and less quiet sleep than control infants, while babies fetally exposed to both opiates and nonopiates have less organization of sleep states. Other perinatal factors, such as birth weight and gestational age, are related more to the amount of fetal drug exposure than to the type.
Infants & Young Children, 2002
... However, the extreme immaturity of the visual system at this age is signaled by the presence ... more ... However, the extreme immaturity of the visual system at this age is signaled by the presence of fused eyelids, cloudy optic media, and remnants of an embryonic tissue (tunica vasculosa lentis) in the eye ... Eye movement is usually conjugate during tracking, even if the ...
Infant Behavior and Development, 1986
Documenta Ophthalmologica, 1990
Retinopathy of prematurity (ROP) has increased in the United States in the past decade. Its resur... more Retinopathy of prematurity (ROP) has increased in the United States in the past decade. Its resurgence has been attributed to advances in medical care which have increased the survival of infants less than 1000 g. Retinal immaturity and exposure to supplementary oxygen are generally accepted as the principal factors associated with ROP, however precocious exposure of the immature retina to light may also contribute. The preterm infant is routinely exposed for the duration of hospital stay to bright continuous light at levels which produce retinal damage in animals. A recent study has provided evidence implicating light in ROP. Preterm infants for whom the light levels were reduced had a lower incidence of ROP, compared to a similar group of preterms exposed to standard levels of nursery light. Given the problems of a non-randomized design, the results must be considered preliminary; however the findings are substantiated by parallel results in both hospitals studied and by an effect of exposure to light within the treatment group. Speculations regarding the mechanisms of light as a contributor to ROP include: alterations of retinal metabolism, cellular damage by phototoxicity, and the generation of free radicals. Mechanisms of phototoxicity are compatible with theories of oxygen toxicity. Light may not be necessary for ROP to occur, but it may increase the risk.
Brain and Development, 2008
Objective: To review reported neurodevelopmental outcome data for patients with congenital heart ... more Objective: To review reported neurodevelopmental outcome data for patients with congenital heart disease, identify risk factors for adverse neurodevelopmental sequelae and summarize potential neuromonitoring strategies that have been described. Methods: A Medline search was performed utilizing combinations of the keywords congenital heart, cardiac, neurologic, neurodevelopment, neuromonitoring, quality of life, and outcome. All prospective and longitudinal follow-up studies of patients with congenital heart disease were included. Additionally, studies that examined neuroimaging, neuromonitoring, and clinical factors in relation to outcome were examined. Case reports and editorials were excluded. Additional references were retrieved from selected articles if the abstract described an evaluation of neurodevelopmental outcomes and/or predictors of outcome in patients with congenital heart disease. Results: Overall, patients with CHD have increased rates of neurodevelopmental impairments, although intelligence appears to be in the normal range. Preoperative risk stratification, intraoperative techniques, postoperative care, and neuromonitoring strategies may all contribute to ultimate long-term neurodevelopmental outcomes in patients with CHD postsurgical repair. Conclusions: As advances in the medical and surgical management improves survival in patients with CHD, increasing knowledge about neurodevelopmental outcomes and the factors that affect them will provide for strategies to optimize long-term outcome in this high-risk population.
Brain and Development, 2011
Over the decades, the evolution of neonatology has been a continuum. After intense focus on cardi... more Over the decades, the evolution of neonatology has been a continuum. After intense focus on cardiac and respiratory support, now more time, effort and research are concerned about brain development of the term and preterm infants. There is no single standardized neurodevelopmental assessment tool that can be advocated for infants in the neonatal intensive care unit. The tools that are currently available vary in their physiological bases, pre requisite training and expertise, time allotted to perform and score, and clinical utility and validity. In this communication, we describe the neurobehavioral and sensory capabilities of the neonate. We then compare the commonly used neurobehavioral examinations with an emphasis on premature infants. We envision this effort as an essential step before the development of a universal and comprehensive assessment tool.
Critical Care Medicine, Oct 1, 2003
Objective: The purpose of this study was to evaluate the long-term cardiopulmonary outcome at age... more Objective: The purpose of this study was to evaluate the long-term cardiopulmonary outcome at ages 10 -15 yrs following neonatal extracorporeal membrane oxygenation (ECMO). The specific aims of the study were to assess baseline aerobic capacity, cardiac function, and pulmonary function in neonatal ECMO survivors using graded exercise testing, echocardiography, and pulmonary function tests.
Journal of Neurology Neurosurgery and Psychiatry, 1977
Eleven patients with inoperable brain tumours were treated with high doses of corticosteroids (me... more Eleven patients with inoperable brain tumours were treated with high doses of corticosteroids (methylprednisolone 200-2000 mg/day) for up to 151 days (mean 55 days). Neurological improvement occurred in eight patients on high doses after deterioration on concentional doses (methylprednisolone 80-120 mg/day). In two patients steroids could be completely discontinued for several months. Serious adverse effects included sepsis in three patients
Infant Behav Develop, 1986
Pediatrics, 1989
Extracorporeal membrane oxygenation is an important technology in the treatment of high-risk infa... more Extracorporeal membrane oxygenation is an important technology in the treatment of high-risk infants whose long-term outcome is being followed prospectively at our institution. The extracorporeal membrane oxygenation procedure allows temporary cardiopulmonary support for critically ill full-term neonates who are refractory to maximum ventilatory and medical management as a consequence of severe persistent pulmonary hypertension. The technique necessitates both the permanent ligation of the right common carotid artery and jugular vein and systemic heparinization. The survivors constitute a unique group of high-risk infants, from the standpoint of the hypoxic-ischemic insults preceding extracorporeal membrane oxygenation and the risks associated with the procedure. Our results indicate that most of our survivors are developing normally at 1 year. Major morbidity, in terms of either significant developmental delay (Bayley mental and motor indices less than 70) or significant neuromotor abnormality, occurred in only 10% of these infants. Poor outcome was associated with major intracranial hemorrhage and chronic lung disease. Ligation of the right carotid artery and jugular vein was not associated with a consistent lateralizing lesion. Long-term follow-up through school age is essential.
Journal of Pediatric Neurology, 2015
Birth defects original article series
Proceedings of the National Academy of Sciences of the United States of America, Jan 13, 2015
Developmental medicine and child neurology, Jan 10, 2014
To determine whether corpus callosum (CC) and corticospinal tract (CST) diffusion tensor imaging ... more To determine whether corpus callosum (CC) and corticospinal tract (CST) diffusion tensor imaging (DTI) measures relate to developmental outcome in encephalopathic newborn infants after therapeutic hypothermia. Encephalopathic newborn infants enrolled in a longitudinal study underwent DTI after hypothermia. Parametric maps were generated for fractional anisotropy, mean, radial, and axial diffusivity. CC and CST were segmented by DTI-based tractography. Multiple regression models were used to examine the association of DTI measures with Bayley-II Mental (MDI) and Psychomotor Developmental Index (PDI) at 15 months and 21 months of age. Fifty-two infants (males n=32, females n=20) underwent DTI at median age of 8 days. Two were excluded because of poor magnetic resonance imaging quality. Outcomes were assessed in 42/50 (84%) children at 15 months and 35/50 (70%) at 21 months. Lower CC and CST fractional anisotropy were associated with lower MDI and PDI respectively, even after controlli...
Objective: Amplitude integrated electroencephalography (aEEG) has been used in neonates in variou... more Objective: Amplitude integrated electroencephalography (aEEG) has been used in neonates in various clinical and research applications. We hypothesized that an abnormal aEEG score could be used as a predictor of short-term adverse outcome. Methods: Very low birth weight infants were enrolled in a prospective observational cohort study. Two channel 12-hour continuous aEEG recordings were performed within 48 h of life and at 1 week of age. Recordings were classified as abnormal if they correspond to a 2 point difference in score. Short-term adverse outcome was defined as either death or Bayley scales 270 at 4 months corrected age. Results: One hundred infants were enrolled. Their average gestational age was 27.9 1 2.6 weeks and average birth weight was 997 1 299 gram. Fifteen enrolled infants died, one was withdrawn, 29 lost to follow up, and 55 examined at 4 months. Those with adverse outcome had significantly increased percentages of abnormal EEG at 1 week of life (31% vs. 8%), severe intraventricular hemorrhage (IVH) (27% vs. 4.5%), intubation in the delivery room (45% vs. 16%), and increased average days of mechanical ventilation (16 days vs. 4 days). Combining abnormal aEEG at 1 week of life to severe IVH on early head ultrasound increased the sensitivity of ultrasound to detect short-term adverse outcome from 27% to 50%. Conclusion: aEEG is feasible in premature infants and when its data at 1 week of life are combined with early head ultrasound, sensitivity for detecting short-term adverse outcomes was increased.
Journal of Maternal-Fetal and Neonatal Medicine, 2014
Although the maturation of sleep wake cycling (SWC) in premature infants has been described, its ... more Although the maturation of sleep wake cycling (SWC) in premature infants has been described, its value in predicting neurodevelopmental outcome (NDO) is yet to be known. To examine the relationship between NDO and SWC evaluated by amplitude integrated electroencephalogram (aEEG) in very low birth weight (VLBW) infants. VLBW infants (<1500 grams and ≤34 weeks gestational age) were enrolled in a prospective study. Two channel 12-hour aEEG recordings were completed at 34 weeks postmenstrual age (PMA) and SWC scores were assigned. NDO was measured by the Bayley's Mental Developmental Index (MDI) and Psychomotor Developmental Index (PDI) at 9 and 18 months corrected age (CA). Eighty-four of the 103 enrolled infants had an aEEG completed at 34 weeks PMA. At 9 months CA, in linear regression models, MDI was significantly associated with severe intraventricular hemorrhage (IVH) and SWC score, while PDI was associated with GA and SWC score. At 18 months CA, these associations lost significance. At 34 weeks PMA, all VLBW premature infants demonstrate some degree of SWC on aEEG. Maturation of SWC at 34 weeks PMA is not associated with gestational age, however may relate to early NDO. Further studies are needed to evaluate this relationship.
Seminars in Perinatology, 2005
Intracranial injury continues to be a major complication associated with extracorporeal membrane ... more Intracranial injury continues to be a major complication associated with extracorporeal membrane oxygenation (ECMO)-treated neonates. The reported frequency of abnormal neuroimaging has ranged from 28% to 52%, depending on neuroimaging techniques and methods of classification. The purpose of this chapter is to describe types of imaging techniques commonly used to evaluate the ECMO neonate, to specify different types of injuries that have been reported, and to identify factors which increase the risk of injury. We will then describe the functional impact at age 5 years following neonatal brain injury among ECMO infants. Semin Perinatol 29:58-65
Science, 1980
Newborn infants, chronically exposed in utero to low doses of methadone with or without concomita... more Newborn infants, chronically exposed in utero to low doses of methadone with or without concomitant heroin, display more rapid eye movement sleep and less quiet sleep than control infants, while babies fetally exposed to both opiates and nonopiates have less organization of sleep states. Other perinatal factors, such as birth weight and gestational age, are related more to the amount of fetal drug exposure than to the type.
Infants & Young Children, 2002
... However, the extreme immaturity of the visual system at this age is signaled by the presence ... more ... However, the extreme immaturity of the visual system at this age is signaled by the presence of fused eyelids, cloudy optic media, and remnants of an embryonic tissue (tunica vasculosa lentis) in the eye ... Eye movement is usually conjugate during tracking, even if the ...
Infant Behavior and Development, 1986
Documenta Ophthalmologica, 1990
Retinopathy of prematurity (ROP) has increased in the United States in the past decade. Its resur... more Retinopathy of prematurity (ROP) has increased in the United States in the past decade. Its resurgence has been attributed to advances in medical care which have increased the survival of infants less than 1000 g. Retinal immaturity and exposure to supplementary oxygen are generally accepted as the principal factors associated with ROP, however precocious exposure of the immature retina to light may also contribute. The preterm infant is routinely exposed for the duration of hospital stay to bright continuous light at levels which produce retinal damage in animals. A recent study has provided evidence implicating light in ROP. Preterm infants for whom the light levels were reduced had a lower incidence of ROP, compared to a similar group of preterms exposed to standard levels of nursery light. Given the problems of a non-randomized design, the results must be considered preliminary; however the findings are substantiated by parallel results in both hospitals studied and by an effect of exposure to light within the treatment group. Speculations regarding the mechanisms of light as a contributor to ROP include: alterations of retinal metabolism, cellular damage by phototoxicity, and the generation of free radicals. Mechanisms of phototoxicity are compatible with theories of oxygen toxicity. Light may not be necessary for ROP to occur, but it may increase the risk.
Brain and Development, 2008
Objective: To review reported neurodevelopmental outcome data for patients with congenital heart ... more Objective: To review reported neurodevelopmental outcome data for patients with congenital heart disease, identify risk factors for adverse neurodevelopmental sequelae and summarize potential neuromonitoring strategies that have been described. Methods: A Medline search was performed utilizing combinations of the keywords congenital heart, cardiac, neurologic, neurodevelopment, neuromonitoring, quality of life, and outcome. All prospective and longitudinal follow-up studies of patients with congenital heart disease were included. Additionally, studies that examined neuroimaging, neuromonitoring, and clinical factors in relation to outcome were examined. Case reports and editorials were excluded. Additional references were retrieved from selected articles if the abstract described an evaluation of neurodevelopmental outcomes and/or predictors of outcome in patients with congenital heart disease. Results: Overall, patients with CHD have increased rates of neurodevelopmental impairments, although intelligence appears to be in the normal range. Preoperative risk stratification, intraoperative techniques, postoperative care, and neuromonitoring strategies may all contribute to ultimate long-term neurodevelopmental outcomes in patients with CHD postsurgical repair. Conclusions: As advances in the medical and surgical management improves survival in patients with CHD, increasing knowledge about neurodevelopmental outcomes and the factors that affect them will provide for strategies to optimize long-term outcome in this high-risk population.
Brain and Development, 2011
Over the decades, the evolution of neonatology has been a continuum. After intense focus on cardi... more Over the decades, the evolution of neonatology has been a continuum. After intense focus on cardiac and respiratory support, now more time, effort and research are concerned about brain development of the term and preterm infants. There is no single standardized neurodevelopmental assessment tool that can be advocated for infants in the neonatal intensive care unit. The tools that are currently available vary in their physiological bases, pre requisite training and expertise, time allotted to perform and score, and clinical utility and validity. In this communication, we describe the neurobehavioral and sensory capabilities of the neonate. We then compare the commonly used neurobehavioral examinations with an emphasis on premature infants. We envision this effort as an essential step before the development of a universal and comprehensive assessment tool.
Critical Care Medicine, Oct 1, 2003
Objective: The purpose of this study was to evaluate the long-term cardiopulmonary outcome at age... more Objective: The purpose of this study was to evaluate the long-term cardiopulmonary outcome at ages 10 -15 yrs following neonatal extracorporeal membrane oxygenation (ECMO). The specific aims of the study were to assess baseline aerobic capacity, cardiac function, and pulmonary function in neonatal ECMO survivors using graded exercise testing, echocardiography, and pulmonary function tests.
Journal of Neurology Neurosurgery and Psychiatry, 1977
Eleven patients with inoperable brain tumours were treated with high doses of corticosteroids (me... more Eleven patients with inoperable brain tumours were treated with high doses of corticosteroids (methylprednisolone 200-2000 mg/day) for up to 151 days (mean 55 days). Neurological improvement occurred in eight patients on high doses after deterioration on concentional doses (methylprednisolone 80-120 mg/day). In two patients steroids could be completely discontinued for several months. Serious adverse effects included sepsis in three patients