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Biomedical subjects

B Paes

Publications and source records attributed to B Paes.

50 records · Page 3Linked to original sources
PubMed1989

Medical staffing in Ontario neonatal intensive care units.

Advances in technology have improved the survival rates of infants of low birth weight. Increasing service commitments together with cutbacks in Canadian training positions have caused concerns about medical staffing in neonatal intensive care units (NICUs) in Ontario. To determine whether an imbalance exists between the supply of medical personnel and the demand for health care services, in July 1985 we surveyed the medical directors, head nurses and staff physicians of nine tertiary level NICUs and the directors of five postgraduate pediatric residency programs. On the basis of current guidelines recommending an ideal neonatologist:patient ratio of 1:6 (assuming an adequate number of support personnel) most of the NICUs were understaffed. Concern about the heavy work pattern and resulting lifestyle implications has made Canadian graduates reluctant to enter this subspecialty. We propose strategies to correct staffing shortages in the context of rapidly increasing workloads resulting from a continuing cutback of pediatric residency positions and restrictions on immigration of foreign trainees.

Health Services Needs and Demand↗
PubMed1989

Modified bleeding time in the infant.

The present authors developed a modified template bleeding time for use in the newborn infant. The sensitivity of the bleeding time to the presence of antibiotics, indomethacin, generalized illness, and thrombocytopenia was tested in 242 infants. Both indomethacin and thrombocytopenia similarly prolonged the BT, and the latter could be corrected by raising the platelet count.

Anti-Bacterial Agents↗
PubMed1988

Fetal renal failure associated with intrauterine growth retardation.

Four preterm infants with severe intrauterine growth retardation had renal failure from birth. The amount of asphyxia associated with the birth process did not fully explain the renal failure. Before delivery all for fetuses had severe oligohydramnios and an empty urinary bladder. These observations strengthen the view that severe intrauterine growth retardation may be accompanied by oligohydramnios caused by fetal renal failure.

Acute Kidney Injury↗
PubMed1988

Pulmonary interstitial emphysema: selective bronchial occlusion with a Swan-Ganz catheter.

A 26 week preterm infant ventilated for hyaline membrane disease developed severe pulmonary interstitial emphysema with extensive right sided bullous formation, mediastinal shift, and subsequent left sided atelectasis. A paediatric Swan-Ganz catheter was used for selective bronchial occlusion with dramatic improvement in the infant's clinical condition and radiographic findings.

Catheterization, Swan-Ganz↗
PubMed1988

Development of the human coagulation system in the healthy premature infant.

This study was designed to determine the postnatal development of the human coagulation system in the healthy premature infant. Consecutive mothers of healthy premature infants born at either St Joseph's Hospital or McMaster University Medical Centre in Hamilton were asked for consent. One hundred thirty-seven premature infants (30 to 36 weeks of gestational age) entered the study. The premature infants did not have any major health problems and did not require ventilation or supplemental oxygen. Demographic information and a 20-mL blood sample were obtained in the postnatal period on days 1, 5, 30, 90, and 180. Between 40 and 96 premature infants were studied on each day for each of the following tests: prothrombin time, activated partial thromboplastin time, thrombin clotting time, plasminogen; 13 factor assays [fibrinogen, II, V, VII, VIII, IX, X, XI, XII, XIII, high-mol-wt kininogen (HMWK), prekallikrein (PK), von Willebrand factor (vWF)] and eight inhibitors [antithrombin III (AT-III), heparin cofactor II, alpha 2-antiplasmin, alpha 2-macroglobulin, alpha 1-antitrypsin, C1 esterase inhibitor, protein C (PC), and protein S (PS)]. A combination of biologic and immunologic assays were used. Between 30 to 36 weeks there was a minimal effect of gestational age for levels of AT-III, PC, and factors II and X only; therefore, the entire data set was used to generate reference ranges for these components of the coagulation system for premature infants. Next, the results for the premature infants were compared with those of a previously published study in 118 fullterm infants and with those for adults. An effect of gestational age was shown for plasminogen, fibrinogen, factors II, V, VIII, IX, XI, XII, HMWK, and all eight inhibitors. In general, the postnatal maturation towards adult levels was accelerated in premature infants as compared with the fullterm infants. By 6 months of age, most components of the coagulation system in premature infants had achieved near adult values.

Age Factors↗
PubMed1987

An audit of the effect of two cord-care regimens on bacterial colonization in newborn infants.

Proper care of the umbilical cord of newborn infants may prevent later infections. When St Joseph's Hospital in Hamilton, Ontario, started using alcohol instead of triple dye for umbilical cord care, there was a dramatic increase in the incidence of bacterial colonization in newborns in the nursery and, later, in the number of cases of staphylococcus-related skin infections in infants born at the hospital. Follow-up on 1,545 infants revealed that triple dye was significantly more effective than alcohol in reducing the growth of gram-positive organisms, especially Staphylococcus aureus and group B streptococcus, and several gram-negative organisms. Because hospital medical staff had carefully collected data on bacterial colonization, they were quickly aware of the problem and could justify resuming the use of triple dye.

Anti-Bacterial Agents↗
PubMed1987

Oral vitamin E supplementation for the prevention of anemia in premature infants: a controlled trial.

Serum vitamin E levels are reduced in newborn infants. It has been reported that this deficiency is responsible, in part, for the development of anemia in premature infants during the first 6 weeks of life. The efficacy of vitamin E supplementation for the prevention of anemia in premature infants has been studied in a randomized, controlled, and blinded trial. Premature infants whose birth weights were less than 1,500 g were given, by gavage, 25 IU of dl-alpha-tocopherol or a similar volume of the drug vehicle. Treatment was continued for the first 6 weeks of life. A total of 178 infants were studied. Vitamin E levels were significantly higher in a supplemented group by day 3 and for the remainder of the 6-week period. At 6 weeks of age, there was no significant difference between the supplemented and unsupplemented groups in hemoglobin concentration, reticulocyte and platelet counts, or erythrocyte morphology. It is concluded that there is no evidence to support a policy of administering vitamin E to premature infants to prevent the anemia of prematurity.

Anemia, Neonatal↗
PubMed1987

Development of the human coagulation system in the full-term infant.

The investigation of many hemostatic defects in the newborn is limited by the lack of normal reference values. This study was designed to determine the postnatal development of the human coagulation system in the healthy full-term infant. Consecutive mothers of healthy full-term infants born at St Joseph's Hospital in the city of Hamilton were approached for consent. One hundred eighteen full-term infants (37 to 42 weeks' gestational age) were entered into the study. Demographic information and a 2-mL blood sample were obtained in the postnatal period on days 1, 5, 30, 90, and 180. Between 40 and 79 full-term infants were studied on each day for each of the coagulation tests. Plasma was fractionated and stored at -70 degrees C for batch assaying of the following tests: prothrombin time, activated partial thromboplastin time, thrombin clotting time, and factor assays (biologic): fibrinogen, II, V, VII, VIII, IX, X, XI, XII, and high-molecular weight kininogen. Factor XIII subunits A and S, von Willebrand factor, and the inhibitors antithrombin III, alpha 2-antiplasmin, alpha 2-macroglobulin, alpha 1-antitrypsin, C1 esterase inhibitor, protein C, and protein S were measured immunologically. Plasminogen, prekallikrein, and heparin cofactor II were measured by using chromogenic substrates. The large number of infants studied at each time point allowed us to determine the following: the range of normal for each test at five time points in the postnatal period; that coagulation tests vary with the postnatal age of the infant; that different coagulation factors show different postnatal patterns of maturation; and that near-adult values are achieved for most components by 6 months of life. In summary, this large cohort of infants studied consecutively in the postnatal period allowed us to determine the normal development of the human coagulation system in the full-term infant.

Aging↗
PubMed1983

Infantile centronuclear myopathy. Evidence suggesting incomplete innervation.

A male case of centronuclear myopathy is reported, with severe weakness at birth and death at 7 weeks. In all the muscles studied the fibres, despite their immature appearances, showed normal histochemical differentiation into type I and type II moieties. In contrast to the extrafusal fibres, the intrafusal fibres seemed to be normal in their development. Although the small centrally-nucleated muscle fibres were equipped with motor end-plates, the EMG revealed profuse fibrillation activity. The conflicting findings are postulated to arise from the presence of inexcitable neuromuscular junctions which nevertheless permitted a neurotrophic influence to be exerted on the muscle fibres.

Biopsy↗
PubMedDate not supplied

Gastrointestinal function and growth in premature infants: is non-nutritive sucking vital?

OBJECTIVE: To determine the importance of non-nutritive sucking (NNS) in the development of gastrointestinal function and growth in premature infants. DATA SOURCES: A systematic computerized search of MEDLINE, the Cumulative Index of Nursing in Allied Health Literature, Health, Best Evidence, and the Cochrane Library was performed. STUDY SELECTION: The search yielded eight randomized controlled studies relative to the outcomes of interest: sucking response, gastric emptying, weight gain, and time to discharge from hospital. DATA EXTRACTION: Relevant articles were selected using published criteria for detecting clinically sound studies and evidence-based information. DATA SYNTHESIS: NNS reduces length of hospitalization; however, its effect on the other variables was inconclusive. CONCLUSION: There is a lack of agreement concerning the outcomes of interest, apart from the positive contribution of early hospital discharge. The studies were methodologically flawed, which compromised validity and estimation of the treatment effect. NNS cannot be currently recommended as a beneficial intervention.

Child Development↗