Mary P. Bedard's research while affiliated with Children's Hospital of Michigan and other places

Publications (32)

Article
To identify infants at risk of death and abnormal neurodevelopmental outcome following extracorporeal membrane oxygenation (ECMO) in the neonatal period. The medical records of 82 neonates treated with ECMO were reviewed to evaluate risk of death. All survivors were followed by neurologic examinations and tested using the Bayley Scales of Infant De...
Article
The incidence and site of electroencephalogram (EEG) abnormalities and the efficacy of post-ECMO EEG as a predictor of neurodevelopmental outcome was evaluated in survivors of neonatal extracorporeal membrane oxygenation (ECMO). All survivors of neonatal ECMO with an EEG performed prior to their discharge were included if they had at least 12 month...
Article
To evaluate the effect of antenatal phenobarbital (PB) therapy on neurodevelopmental outcome at 36 months. Prospective, randomized, controlled trial. Single-institution study. SUBJECT AND INTERVENTIONS: Children born to women who participated in the study evaluating the effect of antenatal phenobarbital (PB) on neonatal intracranial hemorrhage were...
Article
To evaluate the effect of antenatal phenobarbital (PB) therapy on neonatal intracranial hemorrhage (ICH) in preterm infants. Prospective, randomized, controlled trial. Single institution study. Women in preterm labor ( < 35 weeks' gestation) were assigned to control and treatment groups. The treatment group received 10 mg/kg (maximum, 1000 mg) PB i...
Article
The objective of the investigation was to determine what effect intracranial pathology has on alterations of superior sagittal sinus blood flow, and to determine the role of color flow Doppler imaging of the superior sagittal sinus in the diagnosis of intracranial pathology in the neonate and infant. One hundred examinations were performed prospect...
Article
To determine the incidence and site of single photon emission computed tomography scan (SPECT) abnormalities in survivors of neonatal extracorporeal membrane oxygenation and to evaluate the efficacy of SPECT scan as a predictor of neurodevelopmental outcome in these infants. Tertiary care neonatal intensive care unit in Detroit, MI. Survivors of ne...
Article
Seven term neonates with encephalopathy resulting from asphyxia and/or intracranial hemorrhage underwent invasive monitoring of intracranial pressure through the epidural or intracerebral space. The average age (in hours) at insertion of the monitor was 27 h in the 3 neonates with asphyxia and 70 h in the 4 neonates with hemorrhage. Intracranial hy...
Article
Twenty-eight term neonates with severe perinatal asphyxia were referred to a tertiary neonatal intensive care unit (NICU). The morbidity of asphyxia included involvement of the pulmonary (n = 24 infants), central nervous system (n = 22), renal (n = 15), cardiac (n = 14), metabolic (n = 13) and hematologic (n = 10) systems. The majority of neonates...
Article
The neurodevelopmental sequelae in 33 low birth weight neonates with moderate or severe hemorrhage and ventriculomegaly (VM group) and in 39 neonates with mild hemorrhage only (non-VM group) were evaluated prospectively. Both groups were comparable in birth weight, gestational age, and socioeconomic status. Ventriculoperitoneal shunts were inserted...
Article
Full-text available
Extracorporeal membrane oxygenation (ECMO) has been performed on 45 neonates at the Children's Hospital of Michigan in a 39-month period. Ultrasound evaluation of these patients prior to and during ECMO therapy has demonstrated abnormalities in the central nervous system including intracranial hemorrhage (21), extra-axial fluid collections (5), and...
Article
Forty-six pregnant women less than 35 weeks of gestation were enrolled in a prospective randomized controlled study evaluating the effects of antenatal phenobarbital on neonatal intracerebral hemorrhage. The women were randomly assigned to control (n = 22) or treatment (n = 24) groups; the treatment group received 500 mg of phenobarbital intravenou...
Article
Length of stay data collected for high-risk newborn infants admitted to a tertiary care children's hospital neonatal unit over a 6-year period were compared with mean and outlier lengths of stay published in the Federal Register as part of a proposed system for prospective payment of hospital cost by diagnosis-related groupings (DRGs). We found tha...
Article
We read with interest the article by Alpan and associates (Pediatrics 1984;74:375-378) concerning heparinization of alimentation solutions administered through peripheral veins. The authors conclude that heparinization of these solutions should be considered because they observed a significant reduction in the incidence of phlebitis and a prolongat...
Article
A prospective study of 14 outborn infants <800g at birth and transferred <24 hrs of age to a tertiary neonatal intensive care unit was conducted to determine neurologic and developmental outcome. Mean birthweight was 750g ± 69g and mean gestational age was 28 ± 2 wks. 8/14 were small for gestational age and 6 were male. 5/14 infants required ventil...
Article
To help establish criteria for initiating ECMO in our institution, the records of 79 patients with PFC requiring ventilation before ECHO was available were reviewed for the following criteria: 1) AaDO2 over time, and 2) Neonatal Pulmonary Insufficiency Index (NPII), which relates pH and FiO2 over time (both were evaluated for the first 60 hrs of li...
Article
A prospective randomized controlled study was performed evaluating the effects of antenatal phenobarbital (PB) on neonatal intraventricular hemorrhage (IVH). Forty-six pregnant women in labor <35 wks gestation were assigned to control (n=22) or treatment groups (n=24); the treatment group received 500 mg PB by slow intravenous infusion prior to del...
Article
Length of stay data for 3124 high-risk newborns admitted to a Children's Hospital NICU over 6 yrs were compared to Federal DRG-related mean and outlier lengths of stay. Federal figures markedly underestimated lengths of stay for these infants. The Federal mean (17.9 d) for infants <1000 g at birth (DRG-386) differs markedly from the 66.5 days we fo...
Article
In Reply.— We thank Boynton and Merritt for pointing out the error in the figure in our paper.1 The abscissa should be labeled "Total number of united pairs" as they have indicated. When using sequential analysis, a plan is constructed that takes into account the probability of erroneously rejecting the null hypothesis ( ), the probability of erron...
Article
Forty-two premature infants less than 24 hours of age, with normal admission echoencephalograms, were randomly assigned to control or phenobarbital treatment groups. Infants in the treated group received two loading doses of 10 mg/kg of phenobarbital 12 hours apart, followed by a maintenance dose of 2.5 mg/kg every 12 hours for 6 days. Serial echoe...
Article
Seven neonates (four preterm and three term) with severe hypoxic-ischemic parenchymal brain changes are presented to illustrate the kinds of parenchymal lesions demonstrable on ultrasound, to show the similarity of parenchymal lesions in preterm and term infants, and to correlate the severe neurologic deficits with the parenchymal changes. The lesi...
Article
Eighteen mothers in premature labor <35 week gestation were enrolled in a study to evaluate the effect of antenatal phenobarbital(PB) in preventing neonatal intraventricular hemorrhage.Mothers were randomly assigned to treatment or control groups; the treatment group received 500 mg PB administered intravenously.Maternal and cord blood PB levels we...
Article
The long-term outcome of infants subjected to perinatal asphyxia can be improved if they are recognized as high risk before birth and managed so as to reduce the period of hypoxemia to a minimum. Prompt and effective resuscitation of asphyxiated infants at the time of birth can contribute much to improving the long-term outcome of these infants.
Article
Cardiac output and regional blood flow distribution were measured in 14 newborn dogs before and 90 min following 0.3 mg/kg of indomethacin and in 4 control animals who received buffer alone using the Radioactive Microsphere Reference Organ Technique. Indomethacin produced no significant change in cardiac output or blood flow to the gastrointestinal...
Article
Sixty-two neonates diagnosed to have periventricular-intraventricular hemorrhage were classified by sonographic findings as follows: mild, confined to the subependymal region or accompanied by a small amount of blood in the normal-sized lateral ventricle (10); moderate, intermediate amount of blood in the enlarged lateral ventricle (26); and severe...
Article
Real time (RT) ultrasonic sector scanning of the head was performed through the anterior fontanelle in 130 neonates for the following indications: birth weight <1500 g (60),suspected hypoxic ischemic injury secondary to perinatal asphyxia (16),or severe respiratory disease (12), neural tube defects (16),multiple congenital anomalies (12),abnormal h...
Article
The cardiovascular effects of indomethacin were studied acutely in 9 newborn dogs (2-32 days) using the radioactive microsphere reference organ technique. Indomethacin, 0.3 mg/kg intravenously, produced a 22% drop in cardiac output (CO) from 224±31* to 175±26 ml/kg/min (p<.05). Renal blood flow fell slightly from 1.6±.2* to 1.3±.2 ml/gm/min (p<.05)...

Citations

... However, although blood supply to the heart is prioritized during an hypoxic event, studies reported deficits in the cardiac function after asphyxia at birth [72]. Sehgal et al. [65], indicate that when redistribution of cardiac output fails to maintain myocardial oxygenation, depletion of cardiac glycogen, anaerobic respiration, and metabolic acidosis occur, and without intervention, continuous circulatory deterioration will occur, eventually leading to myocardial dysfunction, circulatory shock, right and left ventricular insufficiency, tricuspid regurgitation, hypotension, and eventual cardiac arrest. ...
... 1 Infants with intraventricular hemorrhage (IVH) followed by posthemorrhagic ventricular dilation (PHVD) are at the highest risk. [2][3][4][5] PHVD can compromise the developing white matter tracts around the ventricles, leading to the white matter injury (WMI) associated with CP. 6,7 In recent decades, bedside cranial ultrasound (CUS) has allowed clinicians to identify IVH and monitor progression of PHVD. 8 The increase in size of the lateral ventricles on a twodimensional plane, as a marker of PHVD, correlates with adverse long-term outcome. ...
... Benign extra-axial fluid enlargement (viz. idiopathic external hydrocephalus without evidence of ventricular enlargement or hydrocephalus) has been extensively reported in the literature (46)(47)(48)(49)(50) since the early 1980s and has been associated with both prematurity (47,49) and previous ECMO exposure (51)(52)(53). ...
... After infectious pneumonia, the inflammatory and airway secretions may form a bronchial valve, which allows the air to enter but not to come out, subsequently forming a cyst [12]. The most common infectious agents associated with pneumatocele formation are bacteria (Streptococcus pneumoniae [17], Staphylococcus aureus [18]), but they can also present in fungal infections (Pneumocystis jiroveccii [19]), mycobacteria, and some adenoviruses. ...
... Since 1950s, phenobarbital-induced Adverse Drug Reactions (ADRs) such as, exfoliative dermatitis, Agranulocytosis, megaloblastic anemia, 'shoulder-hand' syndrome, osteomalacia, and Stevens-Johnson syndrome have been reported both in human and animal [6][7][8][9][10][11][12][13]. Vitamin K deficiency-associated bleeding disorder in neonates as a result of using phenobarbital during maternal age for epilepsy management has been reported in multiple studies [14][15][16][17]. In the natural blood coagulation process, Vitamin K plays a vital role in the activation of clotting cascades and an essential element of the body's hemostasis function [18,19]. ...
... In the preceding section, we looked at the data set produced by the linkage procedure from the standpoint of its internal mechanics; i.e., we verified in which steps observations were linked and how frequently identical identifying information occurred. Even though all birth weights were observed to occur within all DRGs, an aspect of DRGs' definition and coding that has been frequently criticized by a number of authors (1,(21)(22)(23)(24)(25)(26)(27)(28), we found the majority of low birth weight births in the first four DRGs: DRG 385 (died/transferred), DRG 386 (extreme immaturity/RDS), DRG 387 (prematurity w/major problems), and DRG 388 Note. Linkage of vital statistics linked birth/infant death file and infant hospital discharge file. ...
... More sophisticated ventilation modalities nowadays, including non-invasive ventilation makes muscle paralysis obsolete (McPherson and Inder, 2017). Phenobarbital sedation did not decrease PIVH incidence (Donn et al., 1981;Bedard et al., 1984). Vitamin E, a potent anti-oxidative agent, reduced the incidence of PIVH but routine use was not encouraged because of serious side effects (Brion et al., 2003). ...
... PDA ligation produces permanent ductus closure, improves pulmonary mechanics, and decreases the need for prolonged ventilator support. Recent studies, however, suggest that in addition to the known surgical complications that may accompany the procedure such as pneumothorax, recurrent nerve palsy, 30 and IVH, 31 the ligation itself may directly contribute to some of the neonatal morbidities. Previous studies have shown that early surgical ligation decreases alveolar water clearance, impedes lung growth, and increases the expression of genes involved with pulmonary inflammation. ...
... Our results in the neonatal piglet are consistent with those of others in perinatal animals which suggest a role for prostanoids in perinatal cerebral hemodynamics. For example, Bedard et al. (1983) reported that, although cerebral blood flow was not altered significantly by indomethacin in pentabarbitol-anesthetized puppies 3-27 days of age, indomethacin appeared (not significant with small sample size) to reduce cerebral blood flow in puppies less than 3 days old. In addition, Ment et al. (1983 Ment et al. ( , 1984) found, using carbon-14 autoradiography, that indomethacin and ethamsylate decreased cerebral blood flow of newborn puppies. ...