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Biomedical subjects

A R Watson

Publications and source records attributed to A R Watson.

At least 37 records · Page 2Linked to original sources
PubMed1998

Antenatally detected urinary tract abnormalities: changing incidence and management.

UNLABELLED: To define the incidence of urinary tract abnormalities detected by antenatal ultrasound and assess changes in postnatal management we conducted a retrospective survey using data bases of the nephro-urology unit, obstetric ultrasound and perinatal pathology departments. The birth population (105,542) of the two Nottingham teaching hospitals between January 1984 and December 1993 was divided into two 5-year cohorts, 1984-1988 and 1989-1993. Detailed fetal scanning at 18-20 weeks gestation was introduced in 1989. During this 10-year period, 201 abnormalities of the urinary tract were noted with a 2:1 male to female ratio. The incidence of abnormalities in the first 5 years was 1 in 964 compared to 1 in 364 in the last 5 years. There was a significant increase in the number detected before 20 weeks gestation (12% in 1984-1988 compared to 62% in 1989-1993). Despite the increased incidence of abnormalities detected, the termination rate remained static between the two 5-year cohorts. Only 3 fetuses had intra-uterine intervention and 173 were live-born. Eight infants subsequently died in association with other major congenital abnormalities. The incidence of transient abnormalities (antenatal dilatation with no abnormality noted on postnatal ultrasound) increased from 6% in 1984-1988 to 18% in the 1989-1993 cohort. A more conservative approach to postnatal management is reflected by 71% of infants having operations between 1984 and 1988 compared to 35% in 1989-1993. CONCLUSION: The advent of detailed fetal scanning at 18-20 weeks gestation has significantly increased the detection rate of urinary tract abnormalities with no significant increase in pregnancy termination rates. The need for antenatal intervention is a rare event and most problems can be managed conservatively both pre- and postnatally.

Abortion, Induced↗
PubMed1998

Listeria monocytogenes meningitis in a penicillin-allergic paediatric renal transplant patient.

Currently in many centres the extended spectrum cephalosporins (e.g. cefotaxime and ceftriaxone) are being used empirically for patients with suspected bacterial meningitis. We present a case of meningitis in a penicillin allergic paediatric renal transplant patient from whose cerebrospinal fluid (CSF) Listeria monocytogenes was cultured, despite four days of cefotaxime therapy. The patient was successfully treated with meropenem but required neuro-endoscopic intervention for hydrocephalus.

Amoxicillin-Potassium Clavulanate Combination↗
PubMed1998

Distress and the micturating cystourethrogram: does preparation help?

This study evaluates the impact of therapeutic preparation methods on children undergoing MCUG. Parents of 35 children who had undergone MCUG were surveyed by questionnaire. The child's reaction to investigation was assessed using the Groningen Distress Rating Scale (rating 1 = calm > 5 = panic) and parental coping styles using the Utrecht Coping List. Families received one of two types of therapeutic preparation: storybooklet or storybooklet and play preparation. Reported distress levels were significantly lower with therapeutic preparation (mean score 2.5 +/- 1.02 SD) than without (mean score 3.3 +/- 1.22 SD). Previously, controls reported 46% of anxiety-linked behaviour changes post-MCUG, falling to 13% after therapeutic preparation. Parents who gave a candid explanation reported significantly lower child distress levels (mean 2.0 +/- 0.91 SD) than those parents who avoided upsetting details (mean 3.1 +/- 0.47 SD). We conclude that distress associated with the MCUG can be reduced by therapeutic preparation of the child and family prior to investigation.

Adaptation, Psychological↗
PubMed1998

Gastrostomy buttons for nutritional support on chronic dialysis.

RATIONALE: Nutritional support for children on chronic dialysis often involves the use of nasogastric tubes or gastrostomy feeding. We report our experience using gastrostomy buttons (GB) over a 6.6-year period to document their success/failure, the feeding regimens employed and the impact on growth. DESIGN: In 339 patient months of prospective observation, 22 children (14 male) commenced gastrostomy feeding at a median age of 2.3 years (range 0.2-10.3 years). Sixteen patients had an initial gastrostomy catheter inserted at the same time as a chronic dialysis catheter. Eighteen patients were established on continuous cycling peritoneal dialysis (CCPD) and four on haemodialysis (HD). RESULTS: The mean duration of combined gastrostomy feeding and chronic dialysis was 14.5 months (range 2.4 56 months). In 20 of the children followed for 6 months on combined GB feeding and dialysis, the mean protein and energy intakes were 2.5 g/kg bodyweight/day (range 1.7-3.4 g) and 108 kcal/kg bodyweight/day (range 72-129 kcal). The mean energy intake achieved was 116% (range 98-155%) of the estimated average requirement (EAR) for energy. The mean percentage of total energy and protein intakes delivered via the GB during the study period was 61% (33-95%) and 61% (23-98%) respectively. Mean height standard deviation score (SDS) was -2.22 prior to GB feeding and -2.06 at the end of the study period (P = 0.005) and mean weight SDS was -2.22 and -1.16 (P = 0.001) respectively. The mean life of the GB was 7.7 months (range 2.6 14 months) with most button changes due to leakage problems. Two episodes of peritonitis were attributable to the GB with one requiring peritoneal dialysis catheter removal due to candida infection. The GB was removed at a mean of 2.8 months (range 0.8-8.3 months) after renal transplantation in 13 children. CONCLUSION: The gastrostomy button provides a valuable and aesthetically appealing route for nutritional support with few complications.

Anthropometry↗
PubMed1998

Growth posttransplantation in children previously treated with chronic dialysis and gastrostomy feeding.

Nasogastric and gastrostomy feeding are beneficial in providing nutritional support to children on chronic dialysis, but concerns have been raised about transfer to exclusive oral nutrition postrenal transplantation (TX). The present study reports the growth data and feeding outcomes in 14 children (9 male) who received combined dialysis [continuous cycling peritoneal dialysis (CCPD): n = 12; hemodialysis (HD): n = 2] and gastrostomy button (GB) feeding for a mean duration of 15.6 months, and who were transplanted at a mean age of 5.4 years. In 12 patients GB feeding was discontinued shortly after TX, and in 2 it was maintained for 3 and 8 months, respectively. No infective episodes were attributable to the GB post-TX, and the buttons were usually removed within 3 months with the dialysis catheter. The mean height and weight standard deviation scores (SDS) were -2.44 and -2.29, respectively, prior to dialysis and GB feeding; -2.19 and -1.22, respectively, prior to TX; and had improved to -1.6 and -0.79, respectively, 12 months post-TX. The mean percentage weight-for-height at the time of TX was 105% (range: 86%-128%), and was unchanged 1 year post-TX. We conclude that GB feeding in this group of children resulted in few complications or feeding problems post-TX. The use of GB feeding without growth hormone maintained growth parameters in most children while on dialysis, and a significant improvement in growth occurred after the renal transplantation.

Anthropometry↗
PubMed1997

Stress and burden of care in families with children commencing renal replacement therapy.

A collaborative project was initiated in two pediatric centers to examine the long-term demands and outcomes in families with children commencing renal replacement therapy. Parents returned questionnaires on stress, anxiety, depression, information needs, and intrusion factors pre, at 3 months, 6 months, and annually. A burden of care assessment (BCA) for families was devised using a scoring system based on the domains of patient, sibling, parents, environment, demands of therapy, and dialysis/transplant factors. Team members also documented medical events and family contacts. In 2 years, 38 patients (26 male) were enrolled with an age range 0.2-18.5 years. Mean stress, anxiety, and depression scores were higher in mothers than fathers, and scores were higher in parents of patients > 10 years compared to the patient group < 10 years. In families with a high initial BCA score there was a positive correlation with maternal stress and anxiety scores. Patients from families with a low BCA score had better growth performance. Older children requiring renal replacement therapy may produce more stress and intrusion for parents than younger children. Burden of care assessments may be a useful means of predicting families who require greater support from the multidisciplinary team.

Adolescent↗
PubMed1996

Hyperlipidaemia, diet and simvastatin therapy in steroid-resistant nephrotic syndrome of childhood.

In children with steroid-resistant nephrotic syndrome (SRNS) hyperlipidaemia may in the long term be associated with progressive renal insufficiency and increased risk of coronary heart disease. We have assessed the efficacy and tolerability of diet prior to and in combination with a hydroxymethylglutaryl CoA reductase inhibitor, simvastatin, in seven children with SRNS with a mean age of 8 years (range 1.8-16.3 years). Dietary advice to maintain adequate energy and protein intakes with reduced saturated fat and cholesterol intake had little impact on lipid levels pre treatment (mean reduction in cholesterol 1 mmol/l, triglyceride 1.1 mmol/l) but was maintained throughout the study duration. The mean cholesterol and triglyceride concentrations pre treatment were 12.1 +/- 2 (SEM) mmol/l and 8 +/- 2.1 (SEM) mmol/l, respectively. On a median simvastatin dose of 10 mg/day (range 5-40 mg) there was a 41% reduction in cholesterol to 6.6 +/- 0.77 (SEM) mmol/l and a 44% reduction in triglyceride to 3.9 +/- 1.38 (SEM) mmol/l at 6 months which was sustained at 12 months in five patients. The drug was well tolerated with no clinical side effects being noted. Over 6 months the mean plasma albumin concentrations increased from 18.2 +/- 1.26 (SEM) g/l to 23 +/- 2.51 (SEM) g/l, accounted for by three patients (1 complete remission, 1 partial remission, 1 end-stage renal failure). Plasma creatinine concentrations remained stable in five patients with two having progressive chronic renal failure. Growth parameters for both weight and height were maintained. Simvastatin has a beneficial effect on abnormal lipid levels in SRNS but the effectiveness of long-term therapy needs to be evaluated.

Adolescent↗
PubMed1996

Distress and radiological investigations of the urinary tract in children.

UNLABELLED: The distress associated with radiological investigations may be related to the information and style of parental explanation given to the child and the parents own coping style. In a questionnaire survey we assessed distress in relation to investigations of the urinary tract using the Groningen Distress Rating Scale and the Utrecht Coping List. We found the micturating cystourethrogram (MCUG) to be significantly more distressing than radionuclide investigations. MCUG distress was adversely correlated with passive and palliative parental coping styles. Results suggested that cognitive coping styles modelled by the parents ameliorated distress on dimercaptosuccinic acid scintigraphy. CONCLUSION: The high level of MCUG associated distress and presence of traumatised children in the MCUG sample, along with the potential for parental contribution to distress reduction, suggests that both children and parents would benefit from more active preparation programmes prior to MCUG testing.

Adaptation, Psychological↗
PubMed1996

Home health and respite care.

Families with a child on chronic peritoneal dialysis have to assume a significant burden of care, which can result in stress and potential complications. Adequate preparation of the child and family with appropriate information in many forms is essential. We describe a home-visiting strategy using the named nurse, dietitian, and social worker, which also includes liaison with nurseries, schools, community nurses, and primary care physicians. Respite care is provided by an occasional evening baby-sitting service and increasing use of daytime support from a home care nurse. The holiday support strategy includes a holiday caravan for families in addition to an organized holiday for children alone. A parents' support group has provided valuable feedback on quality-of-care issues.

Caregivers↗
PubMed1996

Transitioning adolescents from pediatric to adult dialysis units.

Transferring adolescent patients from pediatric to adult renal units can be difficult for all concerned. There has been little agreement or discussion on the factors involved in the timing of the transition. Communication and choice are key words when dealing with young people. The process of transition can be improved by discussion between the patient and team members on the likely timing of transition and the choice of an adult unit offering the same treatment modalities, for example, automated peritoneal dialysis. Information about the adult unit should be obtained, and liaison visits by patient, family members, and possibly accompanying staff are considered helpful. Transition should be a positive event, and each adolescent will require an individualized plan devised in discussion with team members.

Adaptation, Psychological↗
PubMed1995

Strategies to support families of children with end-stage renal failure.

The burden of care for families looking after children with end-stage renal failure can be considerable, especially when it involves home peritoneal dialysis and supplementary feeding. Good communication with the family and between team members delivering the multidisciplinary care is essential. Stress may be partly reduced by meeting the information needs and supplementing the spoken word with booklets, videos, tape-recorded interviews and play preparation for children. Families greatly appreciate a continuum of care between the hospital and community which is enhanced by team members visiting the home, nursery/school and primary care physician to impart and update knowledge. Respite care is essential for home dialysis patients. It can be enhanced by an evening baby-sitting service and the involvement of a home care renal nurse, as well as a holiday support strategy. Participation of the families in a regular parents support group provides not only an opportunity to integrate families into the unit, but also allows direct feedback on issues affecting the quality of care.

Child↗
PubMed1995

Neonatal hypertension and cardiac failure.

Two newborn infants developed cardiac failure due to severe hypertension which was recognised as the heart failure was treated. Renal abnormalities were found in both infants who are normotensive off treatment at 18 months follow up. The finding of hypertension rather than hypotension in the presence of cardiac failure and the apparent absence of a cardiac abnormality should prompt a search for a renal or renovascular cause.

Female↗