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Biomedical subjects

E Hey

Publications and source records attributed to E Hey.

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

A comparison of two methods of follow-up in a trial of prophylactic volume expansion in preterm babies.

The outcome at age 2 years of preterm babies recruited into a three-arm randomised controlled trial of prophylactic volume expansion was ascertained in two ways: from a neurodevelopmental assessment performed by a paediatrician and from responses on a brief questionnaire completed by the child's personal health visitor. Of 776 babies recruited into the trial, 604 survived to the age of 2 years and the findings of a paediatric assessment were available for all survivors. Questionnaires were sent to the health visitors of 601 of the survivors; 513 (85.4%) were returned. There was sufficient information on the returned questionnaires to categorise 449 of the children as normal, impaired, moderately disabled or severely disabled. We were unable to detect a response bias by severity of disability. Agreement on individual questions ranged between 86.3% and 98.4%. There was some mismatch in the reporting of vision (weighted kappa = 0.71) and hearing (weighted kappa = 0.73), with differences in perception of level of severity of sensory loss. Health visitors tended to underestimate the child's functional level compared with the paediatrician. However, of 56 children classified as severely disabled by the paediatrician, 48 were classified similarly and eight as moderately disabled on the basis of the questionnaire. The end point of the trial was death or severe disability at 2 years of age. There was close similarity in the trial results whether based on the paediatric assessment or on the questionnaire. Further refinement of the questionnaire is needed, but this methodology may be useful in ascertaining the frequency of severe disability in large cohorts of babies.

Chi-Square Distribution↗
PubMed1998

Outcome of very preterm birth: children reviewed with ease at 2 years differ from those followed up with difficulty.

AIM: To determine whether those most easily reviewed in a population prevalence study differ from those followed up only with difficulty. METHODS: All babies born before 32 weeks of gestation in the North of England in 1983, 1990, and 1991 were traced, and all the survivors assessed at two years by one of two independent clinicians. RESULTS: 818 of the 1138 live born babies survived to discharge. There was some non-significant, excess disability in the 5% of long term survivors who were difficult to trace because of social mobility, but eight times as much severe disability in the 1% (9/796) in care and in the 5% (38/796) whose parents initially failed to keep a series of home or hospital appointments for interview, and five times as much emergent disability in the 2.7% (22/818) who died after discharge but before their second birthday. Had the babies who were seen without difficulty been considered representative of all the babies surviving to discharge, the reported disability rate would have been two thirds what it really was (6.9% instead of 11.0%). CONCLUSIONS: Population prevalence studies that ignore those who seem reluctant to cooperate risk serious ascertainment bias.

Appointments and Schedules↗
PubMed1997

Changing prognosis for babies of less than 28 weeks' gestation in the north of England between 1983 and 1994. Northern Neonatal Network.

OBJECTIVE: To investigate the changing prognosis for babies of less than 28 weeks' gestation. DESIGN: A prospective, collaborative, population based survey. SETTING: The former Northern Regional Health Authority. SUBJECTS: All the births between 1983 and 1994 at 22 to 27 completed weeks' gestation to women normally resident in the region. MAIN OUTCOME MEASURES: Miscarriage, stillbirth, death in the first year of life, and disability in survivors. RESULTS: There were 479070 registered births in the study period. No baby of 22 weeks' gestation survived; only eight (4%) of the 197 babies of 23 weeks who were alive at the onset of labour survived for a year-a proportion that did not change during the study period. Survival among other babies of less than 28 weeks improved progressively between 1983-6 and 1991-4, but administration of artificial surfactant to babies requiring ventilation from mid-1990 was associated with further improvement in survival only in those over 25 weeks' gestation. Babies of 24 weeks required three times as much high dependency care per survivor as babies of 27 weeks (76 v 26 days). The rate of severe disability in the one year survivors of less than 26 weeks' gestation (30/123; 24%) was similar to that seen in the sampled survivors of 26 and 27 weeks (29/108; 27%); the proportion disabled did not change significantly during the study period. All the children born in 1983, 1987, and 1991 were later reassessed in greater detail: 10% (13/136) seemed destined for a continuing life of total dependency. CONCLUSIONS: Gestation, if accurately assessed, can give a woman facing very preterm delivery a clear indication of the prognosis for her baby and help her judge the appropriateness of accepting obstetric intervention and sustained perinatal support.

Abortion, Spontaneous↗
PubMed1997

Gestational assessment assessed.

AIMS: To review the accuracy with which obstetric information on gestation is recorded in the neonatal records; and the reliability of the methods used for assessing gestational age after birth. METHODS: Service information on all babies born in 1989, and research information on all babies of < 32 weeks gestation born in the Northern Region in 1990-91, were reviewed to determine the accuracy with which antenatally collected information had been recorded in the neonatal records after birth. A prospective study was also mounted to assess how reliably paediatric staff could assess the gestational age of babies born to mothers with certain obstetric dates under service conditions. Paediatric residents looked at 347 babies of > 32 weeks gestation, and senior staff looked at 105 babies of < 30 weeks gestation. RESULTS: The best techniques for estimating gestation immediately after birth were only half as accurate (95% CI +/- 17 days) as estimates based on antenatal ultrasound at 15-19 weeks gestation. Assessments that relied on the tone, posture, and appearance of the baby at birth in those of < 32 weeks gestation were less reliable than assessments based on a retrospective review of when various reflex responses first appeared. They also tended to overestimate true gestation. Antenatal information of high quality was ignored, and arithmetic and transcription errors were introduced during the transfer of antenatal information into over 10% of postnatal records. CONCLUSIONS: Current ultrasound techniques for "dating" pregnancy antenatally are better than any of the methods of postnatal assessment. Given the reliability of the antenatal information now available, it is regrettable that so many inaccuracies have been allowed to creep into the routine computation and recording of gestation at birth.

England↗
PubMed1996

Prospective regional study of planned home births. Home Birth Study Steering Group.

OBJECTIVE: To collect data from a cohort of women requesting a home birth and examine the experience and outcome of pregnancy, the indications for hospital transfer, and the attitudes of mothers, midwives, and general practitioners. DESIGN: Follow up study with anonymised postal questionnaires. SETTING: Northern Regional Health Authority area. SUBJECTS: The 256 women resident in the Northern region who expected to deliver in 1993 and whose request for a home birth became known to one of the local supervisors of midwives. Limited cross validating information was also collected retrospectively on all other women delivering a baby outside hospital in 1993. MAIN OUTCOME MEASURES: Rate of and reason for transferred care; maternal, midwifery, and general practitioner views; perinatal outcome. RESULTS: Five women miscarried, leaving 251 in the study. Of these, 142 (57%) delivered at home. There were 17 (7%) caesarean sections but no perinatal deaths. General practitioners had reservations about half of the booking requests. Two thirds of the women thought they had not been offered any option about place of birth, 74 (29%) were referred to hospital for delivery before the onset of labour, and 35 (14%) were referred to hospital during labour. Intrapartum transfers were uneventful, and half the mothers commented spontaneously that they valued having spent even part of their labour at home. CONCLUSIONS: Home birth is valued for its family setting. General practitioners' support is sought and influential but uncommon, possibly because of a lack of understanding of the responsibilities of the midwife and general practitioner.

Attitude of Health Personnel↗
PubMed1995

Antenatal diagnosis of congenital heart disease and Down's syndrome: the potential effect on the practice of paediatric cardiology.

OBJECTIVE: To predict the effect of antenatal ultrasound screening for congenital heart disease and maternal serum screening of Down's syndrome on the practice of paediatric cardiology and paediatric cardiac surgery. DESIGN: A retrospective and prospective ascertainment of all congenital heart disease diagnosed in infancy in 1985-1991. SETTING: One English health region. PATIENTS: All congenital heart disease diagnosed in infancy by echocardiography, cardiac catheterisation, surgery, or necropsy was classified as "complex", "significant", or "minor" and as "detectable" or "not detectable" on a routine antenatal ultrasound scan. RESULTS: 1347 infants had congenital heart disease which was "complex" in 13%, "significant" in 55%, and "minor" in 32%. 15% of cases were "detectable" on routine antenatal ultrasound. Assuming 20% detection and termination of 67% of affected pregnancies, liveborn congenital heart disease would be reduced by 2%, infant mortality from congenital heart disease by 5%, and paediatric cardiac surgical activity by 3%. Maternal screening for Down's syndrome, assuming 75% uptake, 60% detection, and termination of all affected pregnancies, would reduce liveborn cases of Down's syndrome by 45%, liveborn cases of congenital heart disease by 3.5%, and cardiac surgery by 2.6%. CONCLUSIONS: Screening for congenital heart disease using the four chamber view in routine obstetric examinations and maternal serum screening for Down's syndrome is likely to have only a small effect on the requirements for paediatric cardiology services and paediatric cardiac surgery.

Cardiac Surgical Procedures↗
PubMed1994

Death in infancy from unrecognised congenital heart disease.

This study was undertaken to identify all congenital heart disease in infancy, including deaths before diagnosis, to provide a truer picture of the spectrum of congenital heart disease and to assess the 'treatability' of those dying before diagnosis. All births, infant deaths, and surviving babies with congenital heart disease in one health region in 1985-90 were identified and were classified as 'complex', 'significant', or 'minor'. Of the 1074 infants diagnosed in infancy, 185 died and 56 of these (30%) died undiagnosed. Severe non-cardiac malformations were present in 29 of the 56 while 27 were otherwise normal. Cardiovascular abnormalities in the latter group were complex in 13/27 and significant in 14/27. Identification of undiagnosed cardiovascular anomalies will improve epidemiological evaluation of congenital heart disease and, more importantly, earlier recognition of treatable abnormalities may reduce mortality.

Abnormalities, Multiple↗
PubMed1994

Presentation of obstructive left heart malformations in infancy.

This study documents the presentation of acutely life threatening congenital heart disease in infancy in order to assess the performance of screening examinations soon after birth and at 6 weeks of age. All cases of obstructive left heart malformations presenting in infancy in one health region from 1987-91 were analysed retrospectively. Altogether, 120 infants presented with either hypoplastic left heart syndrome, interruption of the aortic arch, coarctation of the aorta, or aortic valve stenosis. Twelve became symptomatic or died within 24 hours. Thirty four had an abnormal neonatal examination, eight of whom were referred. Six more became symptomatic before discharge. Ninety four babies went home, 51 developed heart failure before 6 weeks, and another seven died without diagnosis. Twenty five of 36 (69%) reaching 6 weeks without diagnosis had a second examination which was abnormal in 17. Two babies died undiagnosed after 6 weeks and the other 18 presented at up to 11 months of age. The neonatal and 6 week examinations perform poorly as screening tests for congenital heart disease. A normal neonatal examination does not exclude life threatening congenital heart disease.

Aorta, Thoracic↗
PubMed1993

The loss of a baby at birth: the role of the bereavement officer.

OBJECTIVE: To illustrate and emphasise the role of the Bereavement Officer in the management of perinatal death, as recommended and envisaged by a report of the Royal College of Obstetricians and Gynaecologists in 1985. DESIGN: A description of the training and responsibilities of the officer and an account of her involvement with all perinatal deaths within a given period. SETTING: Perinatal deaths in the 12 months, 1 October 1989 to 30 September 1990 from a regional neonatal intensive care unit within a maternity hospital. SUBJECTS: A total of 59 registerable deaths, three late terminations (severe fetal abnormality) and 12 late mid-trimester miscarriages were dealt with by the Bereavement Officer in this 12 month period. RESULTS: The introduction of this service to our unit has led to an improvement in our management of both perinatal and fetal deaths. CONCLUSION: The service has justified fully the recommendations made by the Royal College of Obstetricians and Gynaecologists. Reducing parents' distress will facilitate their grieving and any subsequent bereavement counselling.

Bereavement↗
PubMed1991

Sensitivity and specificity of daily tracheal aspirate cultures in predicting organisms causing bacteremia in ventilated neonates.

The sensitivity of daily tracheal aspirates in predicting neonatal bacteremia was ascertained from 48 of 354 ventilated neonates who became septic during a 4-year period. Fourteen babies (designated Group A) had a positive blood culture on the first day of life; 28 infants (Group B) and 6 infants (Group C) had bacteremia beyond the first day. Group C infants became septic as a result of intraabdominal pathology. Pathogens isolated from blood were correlated with those from preceding daily tracheal aspirates. The overall sensitivity of tracheal cultures in predicting results of blood cultures was 81% (Group A, 71%; Group B, 93%; Group C, 50%). The specificity of daily tracheal aspirates was ascertained from 28 of 50 ventilated infants who were nonseptic and had negative blood cultures during a 6-month period. Only 18 had consistently sterile tracheal aspirates (specificity, 64%). The mean number of days of intubation was 6.6 for the 10 false positive and 3.6 for the 18 true negative. Because of low positive predictive value (0.26) the role of daily tracheal aspirate culture is limited to providing early information regarding potential pathogens when sepsis occurs rather than to identify babies who are going to become septic.

Escherichia coli↗
PubMed1990

Born too small--is outcome still affected?

A cohort of boys weighing below the 2nd centile at birth between 1973 and 1974 were assessed at 10 to 11 years of age. Control children from the same population were matched for social class and age. Two boys in the light-for-dates group were profoundly disabled and were excluded from assessment. After these exclusions, there were no differences in intelligence or school achievement between the two groups, although tests of temperament and behaviour suggested some correlation between features of the 'attention deficit disorder' and the extent to which birthweight deviated from normal. Matching for social class is likely to have eliminated the confusing environmental and family influences associated with the poor outcome reported in a previous study of light-for-dates boys. In addition, improved perinatal care is likely to have contributed to the protection from long-term sequelae of the light-for-dates infants in the present study.

Birth Weight↗
PubMed1989

Pregnancy outcome at 24-31 weeks' gestation: mortality.

A study of all the mothers in the Northern region in 1983 whose pregnancies ended at between 24 and 31 weeks' gestation was undertaken. These pregnancies accounted for 1.3% of all the births and 44% of all the fetal and neonatal deaths in pregnancies that lasted more than 23 weeks. Most of the 389 singleton deliveries without malformations between 24 and 31 weeks were caused by spontaneous premature labour (n = 119, 31%), placental abruption (n = 79, 20%), pre-eclampsia (n = 56, 14%), and premature rupture of membranes (n = 48, 12%). The percentages of babies alive at the onset of delivery who survived the neonatal period were 66, 84, 78, and 73, respectively and the percentages of neonatal survivors with severe disabilities were 19, 13, 3, and 6, respectively. A further 65 (17%) of these babies died before the onset of labour for no obvious reason. The mode of delivery did not correlate with the outcome once the period of gestation at delivery was taken into account. The results highlight the inadequacy of the perinatal mortality index currently used in the United Kingdom, which identified 10.7 deaths/1000 registered births in 1983; 20% of the babies delivered at 24-31 weeks were excluded by this index because the birth went unregistered, as were 21% of all the babies born alive who died before discharge. An index that accounted for all babies weighing 500 g or more at birth irrespective of the period of gestation, and all neonatal (0-27 days) deaths, would be more appropriate and would bring reporting more into line with recommended international practice.

Congenital Abnormalities↗
PubMed1989

Pregnancy outcome at 24-31 weeks' gestation: neonatal survivors.

All surviving babies of less than 32 weeks' gestation born to mothers resident in the Northern region in 1983 were assessed. No baby was lost to follow up, and 230 long term survivors were assessed when 2 years old, by a single observer. Among 248 neonatal survivors, severe disability was present in 10 of the 37 at 24-27 weeks' gestation (27%) and in 18 of the 211 at 28-31 weeks' gestation (9%). On average the surviving babies required 27 days and seven days of intensive care nursing respectively. Babies who were ventilated for more than two weeks and babies who had neonatal fits had a poor prognosis. Because of postneonatal deaths only 20 of the 230 long term survivors of less than 32 weeks' gestation were severely disabled (9%). Comparable data were obtained for all babies weighing 1500 g or less at birth, irrespective of their gestational age. Severe disability was seen in eight of the 49 neonatal survivors (16%) who had weighed 500-999 g at birth, and in 17 of the 171 survivors (10%) who had weighed 1000-1499 g. The 10 neonatal survivors who had weighed exactly 1500 g at birth were all well. Only 18 of the 212 long term survivors (8%) who had weighed 1500 g or less at birth were severely disabled. Because the period of gestation is the only variable known to the obstetrician before delivery, and disability correlates better with gestation than birth weight, future studies should concentrate on relating morbidity, mortality, and the cost of neonatal care to gestation rather than weight at birth.

Developmental Disabilities↗
PubMed1986

Comparisons of data from regional perinatal mortality surveys.

The standard format in which NHS regions are invited to submit data from their perinatal mortality surveys for comparative analysis in the British Journal of Obstetrics and Gynaecology is described. Some examples of the way these data can and will be used to compare regional differences in mortality patterns are given and possible future developments are discussed. Although the term perinatal mortality is used in the title, it is hoped that surveys will cover stillbirths and neonatal deaths and also, where possible, late fetal deaths of less than 28 weeks gestation.

Birth Weight↗