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Biomedical subjects

A Whitelaw

Publications and source records attributed to A Whitelaw.

At least 73 records · Page 4Linked to original sources
PubMed1991

Fibrinolysis in cerebrospinal fluid after intraventricular haemorrhage.

Concentrations of cross linked fibrin degradation products were measured in the cerebrospinal fluid from five 'normal' preterm infants (median 102 ng/ml), four preterm infants with intraventricular haemorrhage (median 315 ng/ml), and five infants with progressive post-haemorrhagic ventricular dilatation (median 1000 ng/ml). Serial samples of cerebrospinal fluid from one infant showed a peak concentration two weeks after the haemorrhage.

Cerebral Hemorrhage↗
PubMed1990

C-reactive protein and bacterial infection in preterm infants.

Serum C-reactive protein (CRP) concentration was measured by a new solid phase ligand-binding radiometric monoclonal antibody immunoassay in a prospective study of 193 consecutively born preterm infants. In 104 with no clinical or laboratory evidence of infection the median CRP in cord serum was 0.125 mg/l (range 0.011-6.0 mg/l), at 24 h it was 1 mg/l (0.016-7.0) and at 48 h 2 mg/l (0.400-8.0). The present highly sensitive assay has enabled these normal ranges to be defined for the first time, at levels below the threshold of non-labelled immunoassays and of all commercially available CRP assays. The values in cord serum were significantly lower than in normal healthy adults (median 0.8 mg/l, range 0.07-29 mg/l, n = 468). Arterial catheterisation and endotracheal intubation, in the absence of infection, did not appear to elevate CRP, nor did cerebral germinal layer or intraventricular haemorrhage. Among nine infants with confirmed septicaemia eight had a serum CRP level raised at least once during the first 48 h and serum CRP in the other one increased 250-fold in 24 h before treatment was started. Using this assay, serum CRP is a useful and rapidly available adjunct to clinical assessment in diagnosis and exclusion of bacterial infection in the early neonatal period, has encouraged us to withhold or discontinue antibiotics and also has a role in monitoring response to treatment.

Antibodies, Monoclonal↗
PubMed1990

Effect of acetazolamide on cerebral blood flow velocity and CO2 elimination in normotensive and hypotensive newborn piglets.

The objectives of this study were to measure the effect of acetazolamide on cerebral circulation, pulmonary elimination of CO2, and cerebrovascular response to hypotension in newborn piglets. Eighteen anaesthetized newborn piglets were studied. A fontanelle was surgically created and the cerebral blood flow velocity (CBFV) in an intracranial artery measured by a computerized Doppler system. In 8 piglets, 30 ml/kg of blood was removed to produce hypotension before the administration of acetazolamide. Acetazolamide (50 mg/kg i.v.) given to normotensive piglets consistently produced a large increase in CBFV (median 45% by 5 min) with no change in mean arterial blood pressure or heart rate. The rise in CBFV was negatively correlated with the starting partial pressure of CO2 in arterial blood. Within 1 min of administration of acetazolamide, the end-expiratory CO2 pressure started to fall (mean fall 1.4 kPa), and the partial pressure of CO2 in the arterial blood started to rise (mean rise 2.0 kPa), despite the controlled ventilation being unchanged. Acetazolamide had no effect on CBFV in the hypotensive piglet. It seems likely that acetazolamide produces cerebral vasodilatation by inhibiting the elimination of CO2. In hypotension, there is maximal cerebral vasodilatation, and acetazolamide cannot increase CBFV further. The interference of acetazolamide with CO2 elimination could seriously limit its use in the treatment of hydrocephalus in preterm infants.

Acetazolamide↗
PubMed1989

Oxygenation, heart rate and temperature in very low birthweight infants during skin-to-skin contact with their mothers.

Fourteen very low birthweight infants were studied positioned either prone horizontal or skin-to-skin at 60 degree tilt between the mother's breasts. Heart rate, skin temperature and oxygenation by transcutaneous PO2 and pulse oximetry were measured. Nine of the infants had normal lungs when studied. These infants showed no change in tcPO2 or oxygen saturation but heart rate increased significantly by a mean of 6.5 beats per min during skin-to-skin contact. Five infants with chronic lung disease, including two on nasal catheter oxygen, showed a significant 1.0 kPa rise in tcPO2 during skin-to-skin contact. Back skin temperature was well maintained during skin-to-skin contact with the room temperature at 26 to 29 degrees C. None of the infants had a significant apnoea or bradycardia during the study. Stable very low birthweight infants can enjoy such close contact with their mothers and the tilted position may improve pulmonary function in some cases.

Blood Gas Monitoring, Transcutaneous↗
PubMed1988

Perinatal risk factors for the development of extensive cystic leukomalacia.

Seventeen infants with extensive cystic leukomalacia without associated intraventricular hemorrhages were compared with 34 infants with normal cranial ultrasound findings and 34 infants with large intraventricular hemorrhages to establish whether different risk factors could be elicited for these lesions. Adverse obstetric factors that were associated with extensive leukomalacia were the place of birth (outborn [ie, not born at our hospital but transferred here after delivery]) and the need for emergency cesarean section. Neonatal risk factors, with the exception of gestational age, were equally distributed between the infants with the two types of lesions. The results of this study suggest that extensive cystic leukomalacia and large hemorrhages have similar predisposing factors, but the type of lesion that develops depends on the maturity of the infant.

Birth Weight↗
PubMed1988

Skin to skin contact for very low birthweight infants and their mothers.

Separation between mothers and very low birthweight infants is often prolonged with subsequent psychological distress, behaviour problems, and lactation failure. Babies as small as 700 g, who no longer require oxygen, can be safely and enjoyably held naked, except for a nappy, between the mother's breasts for up to four hours a day. We have carried out a randomised trial among babies less than 1500 g. Seventy one infants were randomised. In 35, the mother was helped to hold her baby in skin to skin contact and encouraged to do so whenever she visited the baby. In 36, the mother was encouraged to handle her baby but without skin to skin contact. Mothers using skin to skin contact lactated for four weeks longer on average than the control group. At 6 months of age the infants who had skin to skin contact cried significantly less than the control group. Skin to skin contact can safely and enjoyably be offered to very low birthweight infants especially in developing countries where the mother's lactation is vital.

Child Behavior↗
PubMed1988

Effect of tilting on oxygenation in newborn infants.

Transcutaneous (tc) PO2 in newborn infants increased on head up tilting (median increase 0.5 kPa at term, 1.0 kPa preterm). Head down tilting was associated with an equivalent fall in tcPO2. There was no change in tcPCO2. Tilting of infants mechanically ventilated for respiratory distress syndrome or surgery produced no consistent change in PO2.

Blood Gas Monitoring, Transcutaneous↗
PubMed1986

Death as an option in neonatal intensive care.

Many paediatricians believe that there are circumstances in which infants should be allowed to die without having their lives prolonged by intensive care or surgery. During a four-year period, in a regional neonatal intensive-care unit, 75 infants were so seriously ill that withdrawal of treatment was discussed. 26 infants had severe acquired neurological damage, 26 had been born after extremely short gestation (25 weeks or less), and 23 had severe congenital abnormalities. The decision to withdraw treatment from a particular infant had to be unanimous among all the medical and nursing staff caring for that child and was based on a virtual certainty, not just of handicap, but of total incapacity--eg, microcephaly, spastic quadriplegia, and blindness. Of the 75 infants, the decision of the medical team was to withdraw treatment from 51. The parents of 47 infants accepted the decision and all these infants died. The parents of 4 infants chose continued intensive care, and 2 infants survived with disabilities. In the other 24 cases, the medical decision was to continue treatment. Of these, 17 survived and 7 died. When a thorough medical assessment had led to unanimous agreement among staff and parents that treatment should be withdrawn, its continuation on purely legal grounds is not justifiable.

Congenital Abnormalities↗
PubMed1985

Predictive value of cranial ultrasound in the newborn baby: a reappraisal.

During a 36-month period 435 babies of 34 weeks' gestation or less were regularly scanned with ultrasound. A large periventricular/intraventricular haemorrhage developed in 40 babies, and extensive cystic leucomalacia developed in 10. The neurodevelopmental outcome and the frequency of handicap in these 2 groups were compared. 9 of the 18 survivors with a large haemorrhage were found to be completely normal and only 2 showed a major handicap. However, severe cerebral palsy with mental retardation developed in all the survivors with extensive cystic leucomalacia, and 4 of the 7 babies were also cortically blind. These findings suggest that the size of the haemorrhage is not a good predictor of outcome, but that severe cystic leucomalacia is associated with a very poor prognosis.

Brain↗
PubMed1985

Myth of the marsupial mother: home care of very low birth weight babies in Bogota, Colombia.

Because of the shortage of equipment and staff and the frequency of cross-infection in hospital, paediatricians at San Juan de Dios Hospital, Bogota, have been sending home babies weighing as little as 700 g, cared for between the mother's breasts in a vertical position and fed only on mother's milk ("kangaroo babies"). Infants as immature as 32 weeks gestation were successfully cared for at home in this way. Mother's milk was supplemented with guava juice and later with soup, but mean time to regain birth weight was 36 days. The previously publicised high survival figures for this home-care programme were found to be misleading because they omitted babies who had died in the first few days after birth. Although this approach is valuable in developing countries, home care of very low birth weight babies would not improve survival in industrialised nations. Nevertheless, care of such tiny infants in special care baby units in developed countries could benefit from similar emphasis on education and motivation of mothers and early skin-to-skin contact.

Body Weight↗
PubMed1985

Dizygotic twins with 3-hydroxy-3-methylglutaric aciduria; unusual presentation, family studies and dietary management.

A 4-month-old infant with hypotonia and macrocephaly was diagnosed as having 3-hydroxy-3-methylglutaric aciduria, using gas chromatography and mass spectrometry and confirmatory enzyme studies. The same diagnosis was made on his asymptomatic non-identical twin. Examination of the pedigree is consistent with an autosomal recessive mode of inheritance. Dietary treatment improved the symptoms of the propositus, but did not prevent episodes similar to Reye's syndrome in both twins. One such episode closely followed immunisation and our experience suggests that children with this disorder should be observed carefully following immunisation. These episodes were accompanied by an overflow of a wide range of abnormal metabolites. Examination of the urine for organic acids should be considered in infants with unexplained hypotonia and macrocephaly, especially if accompanied by abnormal biochemical indices.

Acidosis↗