Blood glucose measurement in neonatal intensive care.
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Biomedical subjects
Publications and source records attributed to G J Reynolds.
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An evaluation of the use of a glucose reflectance meter for the cotside measurement of plasma rather than whole blood glucose was undertaken. Three hundred and twelve samples were obtained for examination. There is a closer correlation between plasma glucose than whole blood glucose to laboratory values. Confidence and prediction intervals show that even separating plasma from whole blood at the cotside does not improve the reliability of glucose reflectance meters when predicting blood glucose values in the context of managing high risk newborn infants. The cotside measurement of blood glucose using glucose reflectance meters should be abandoned and improved methods for quickly obtaining accurate laboratory data should be instituted.
An evaluation of the use of cotside blood glucose measurement by BM Reflolux was undertaken as part of a unit audit programme. During the study period, 383 paired samples were obtained for both cotside and laboratory analysis. There were 328 results from the cotside which were less than 4 mmol/L. Cotside measurements consistently underestimated laboratory measurements but the differences were not related to age, gestation, weight or haematocrit. The difference between cotside measurements and laboratory results was greater at lower blood glucose values. Confidence and prediction intervals of blood glucose values from cotside measurement suggest that this technique is not reliable for the diagnosis of hypoglycaemia in the newborn. Indiscriminate and uncontrolled use of cotside glucose monitoring should not be relied upon for clinical management.
A lambda gt 11 cDNA library, constructed from poly(A)+ mRNA isolated from Avena fatua aleurone layers incubated with 1 microM gibberellin A1 (GA1) for 4 days, was screened with an anti-idiotypic antiserum raised against the GA-specific monoclonal antibody MAC 182. One positive clone was isolated, sequenced and shown to encode a tetraubiquitin based on the deduced amino acid sequence. This polyubiquitin cDNA exhibited a high degree of homology to a cloned wheat hexaubiquitin in its 3'-non-coding region. Analysis of total RNA isolated from A. fatua aleurone layers, treated without or with a range of concentrations of GA1 from 10(-11) to 10(-6) M, by northern blotting using the cDNA probe revealed 8 different ubiquitin-containing transcript classes all of which are constitutively expressed in aleurone and are regulated by GA1.
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A quality assurance scheme for immunocytochemistry was started in 1984. There are currently 140 participating laboratories, most of which have shown considerable improvement in their results since joining the scheme. In our experience the supplier of the primary antibody does not affect the quality of the results; the sensitivity of the method used and the experience of the staff carrying out the technique are the most important factors. Participation in a scheme such as this enables laboratories to have their results compared with others and to share problems.
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An Australia-wide survey of the use of postoperative analgesia in neonates has been conducted. A high overall use of analgesia has been recorded with 75% of respondents prescribing an opioid. The frequency of use of local or regional analgesia was disappointingly low at 8% overall. The general attitude is that analgesia is desirable but a fear of respiratory depression inhibits its use, particularly in non-ventilated neonates and after more minor surgery. It is suggested that a wider use of regional anaesthesia techniques may reduce this problem.
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An Ohmeda Biox 3700 oximeter was evaluated during treatment of 12 patients with respiratory distress. The infants were of 27-33 weeks' gestation and between 2 days and 5 months postnatal age. Blood gases were taken from indwelling arterial catheters and were measured on an ABL 30 blood gas analyser. The study tested the accuracy of the oximeter in detecting hypoxia (PaO2 less than 55 mmHg) and hyperoxia (PaO2 greater than 80 mmHg). Results are based on 175 paired observations. Guidelines are suggested for the use of the pulse oximeter under three conditions. In a newborn infant with acute respiratory distress without direct arterial access, the limits should be set at 85% (lower) and 90% (upper). In an older infant with chronic respiratory distress, the upper limit of use should be 95%. In order to avoid oxygen tensions less than 55 mmHg which would increase the risk of pulmonary vasoconstriction, however, the lower limit should be 87%. Infants with indwelling arterial lines during their first few weeks of treatment should have oxygen tension measurements and simultaneous oxygen saturation readings plotted on a graph at the bedside. The graph should be updated every 48 h to take into account changed levels of 2,3-diphosphoglycerate, haemoglobin F, and carboxyhaemoglobin and the recommended limits should be changed accordingly.
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Samples of precolostrum (colostrum gravidarum), colostrum and mature milk obtained from five women during their antenatal and postnatal periods were measured for IgA, IgG, IgM, alpha-1-antitrypsin, lactoferrin, lysozyme, B1A globulin (C3) and B1E globulin (C4) by single radial immunodiffusion. Protein concentrations in precolostrum were equal to or greater than those found in colostrum obtained during the first 12-48 hours following delivery. Secretion of precolostrum is common, occurs early in the antenatal period and may often be of considerable volume. The anti-microbial proteins contained within this milk can be preserved intact by freezing. This represents an untapped pool of bacteriostatic proteins with specific activity against neonatal pathogens. We suggest that a potential protective effect against serious infection may be obtained by administering precolostrum to "at risk" infants during the first few days of life.
A simplified system of human milk banking, from milk supplied from home or hospital, has been evaluated for use in a neonatal intensive care unit. Twenty milk samples were obtained at a single expression using a standard hand pump and divided into three parts. Analyses were performed on the raw milk and on samples stored at -20 degrees C for 1 week and 1 month. No pathogens were isolated from any samples and the counts of Staphylococcus albus in the raw milk remained unchanged after storage. 19% of the cells in the original milk survived freezing and remained viable. There was a loss of bacteriostatic activity after storage for one month but significantly less than that caused by pasteurization. No change in levels of IgA, IgM, IgF, lactoferrin, lysozyme, C3 and C4 was apparent and concentrations of amino acids and fatty acids also remained unchanged after storage. We conclude that milk can be safely and conveniently stored by this method without loss or damage to the components of raw breast milk important for preterm and sick infants.
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