Oxygen as a cause of blindness in premature infants: “Autopsy” of a decade of errors in clinical epidemiologic research

Jacobson, Robert M.; Feinstein, Alvan R.

doi:10.1016/0895-4356(92)90168-m

Cited by 36 publications

(12 citation statements)

References 94 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…A standard curve is run simultaneously and expressed lipid peroxidation as nM malondealdehyde/gm protein. Protein was measured by the method ofLowry (28).…”

Section: Antioxidant Reserve Capacitymentioning

confidence: 99%

Role of controlled cardiac reoxygenation in reducing nitric oxide production and cardiac oxidant damage in cyanotic infantile hearts.

Morita

Ihnken²,

Buckberg³

et al. 1994

J. Clin. Invest.

View full text Add to dashboard Cite

IntroductionCardiopulmonary bypass (CPB) is used increasingly to correct cyanotic heart defects during early infancy, but myocardial dysfunction is often seen after surgical repair. This study evaluates whether starting CPB at a conventional, hyperoxic P02 causes an "unintentional" reoxygenation (ReO2) injury. We subjected Repair ofheart defects causing cyanosis is performed on cardiopulmonary bypass (CPB)I in early infancy with increasing frequency. Postoperative cardiac dysfunction is the major cause of morbidity and mortality despite successful surgical correction and is more common in infants than in adult cardiac patients (29). The conventional method ofstarting CPB in hypoxemic infants is to raise P02 to > 400 mmHg by mixing their blood with fluid in the extracorporeal circuit pre-circulated at hyperoxic levels. We have speculated that such abrupt reoxygenation causes an "unintended reoxygenation injury" (2) and adds to subsequent intraoperative oxidative stress due to surgical ischemia that provides a bloodless field, and limits the effectiveness of a cardioplegic strategy shown previously to reduce reperfusion damage (3, 4). Our hypothesis is based on experimental evidence that cyanosis reduces endogenous myocardial antioxidants and reoxygenation enhances free radical generation (5). In support of this hypothesis, clinical reports show myocardial lipid peroxidation in pre-ischemic biopsies from cyanotic children (6), cardioplegic protection is less adequate in cyanotic versus normoxic patients despite shorter ischemic intervals (7) and myocardial dysfunction in cyanotic infants placed on extracorporeal membrane oxygenation (ECMO) despite absence of surgical ischemia (8,9). Studies indicate reactive oxygen species mediate reperfusion/reoxygenation injury (10) via the classic Haber-Weiss (Fenton) pathway ( 1). An alternate mechanism of oxidant injury was proposed recently by Beckman et al.(4), whereby superoxide anion (O -) and nitric oxide (NO) interact to form cytotoxic 02 species ( 12). We showed recently cyanotic infantile hearts reoxygenated on CPB have a burst ofNO which was associated with oxidant damage and myocardial dysfunction which could be ameliorated by either adding a NO synthase (NOS) inhibitor or antioxidants to the priming solution ofthe CPB circuit (2). Unfortunately, NOS inhibition with a L-arginine analog produced severe systemic vasoconstriction and resulted in pancreatic damage despite its cardioprotective effect and the antioxidants added to the CPB prime are not available clinically.Alternative strategies do, however, exist during conventional cardiac operations that can reduce NO and 0-production. For example, generation of 0-and NO is P02 dependent (13,14), and controlling the rate of reintroduction of molecular oxygen when CPB is started and cardioplegic solution is administered may avoid the burst of NO and 0-that follows

show abstract

“…A standard curve is run simultaneously and expressed lipid peroxidation as nM malondealdehyde/gm protein. Protein was measured by the method ofLowry (28).…”

Section: Antioxidant Reserve Capacitymentioning

confidence: 99%

Role of controlled cardiac reoxygenation in reducing nitric oxide production and cardiac oxidant damage in cyanotic infantile hearts.

Morita

Ihnken²,

Buckberg³

et al. 1994

J. Clin. Invest.

View full text Add to dashboard Cite

show abstract

“…This decreased pulmonary function subsequently causes irreversible brain damage in patients [6]. In premature neonates, 100% oxygen can cause retrolental fibroplasia, the formation of fibrous tissue behind the lens, causing blindness [7].…”

Section: Introductionmentioning

confidence: 99%

Moderate Hyperoxia (40%) Increases Antioxidant Levels in Mouse Tissue

Lee

Smith²,

Quach³

et al. 2005

Journal of Surgical Research

View full text Add to dashboard Cite

“…4 The disease developed as scarred membranes behind the lens of the eyes and produced permanent blindness in about 10,000 children. The disease was caused by the prophylactic administration of high doses of oxygen given in the hope of preventing the respiratory distress syndrome that sometimes occurred in premature babies.…”

Section: Problems Associated With Expanded "Prevention"mentioning

confidence: 99%

Does “Health Promotion” Really Promote Health?

Feinstein

2005

American J Econ Sociol

View full text Add to dashboard Cite

In his comment on Victor Fuch's essay, the late Alvan Feinstein raised the question of whether government-sponsored programs of "health promotion" are always good for well-being.Like many other discussions of the government's role in "health promotion," Victor Fuchs' excellent paper 1 makes the assumption that "promotion" is a well-established entity, so that the main job now is to disseminate it to everyone, at reasonable cost. Since the history of medicine and public health contains many splendid triumphs that followed a long array of errors and blunders, it is always important, in any era of medicine, to consider the possibility that the establishment beliefs are not always correct. 2 The idea of "promotion" is itself relataively new. Health and health care have always involved various forms of personal or societal interventions, but the idea of "promotion" usually refers to many new types of prevention, administered to apparently healthy people, that will help retain health and thwart illness. Until about 1920,

show abstract

Oxygen as a cause of blindness in premature infants: “Autopsy” of a decade of errors in clinical epidemiologic research

Cited by 36 publications

References 94 publications

Role of controlled cardiac reoxygenation in reducing nitric oxide production and cardiac oxidant damage in cyanotic infantile hearts.

Role of controlled cardiac reoxygenation in reducing nitric oxide production and cardiac oxidant damage in cyanotic infantile hearts.

Moderate Hyperoxia (40%) Increases Antioxidant Levels in Mouse Tissue

Does “Health Promotion” Really Promote Health?

Contact Info

Product

Resources

About