Biomedical subjects
Publications and source records attributed to H L Halliday.
A neonate with an aneurysm of the vein of Galen was treated by embolisation using Giant-urco coils. Doppler ultrasound examination showed that blood flow in the internal carotid artery decreased while that in the pericallosal artery increased after occlusion, suggesting a 'steal phenomenon' with blood directed preferentially towards the aneurysm.
Plasma amino acids were measured in 8 babies with left-sided congenital heart disease, 3 interrupted aortic arch (IAA) and 5 hypoplastic left heart syndrome (HLH), at 1-6 days of age. There was an increase in total amino acid levels when compared with 40 control infants of similar gestational age and birth weight. Both branched-chain and aromatic amino acids were raised although there were differences between the babies with IAA and HLH. Babies with HLH had higher total amino acid levels than babies with IAA, the difference being due to raised branched-chain amino acids. Apart from the anatomical differences babies with HLH had metabolic acidosis at the time of sampling whereas babies with IAA had normal pH. It is possible that the increase in amino acid levels in babies with obstructed left-sided congenital heart disease is due to hepatic congestion and hypoperfusion, although altered acid base states may also be important.
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Two year follow-up of 80 surviving preterm babies from a controlled trial of surfactant replacement is reported. There were no statistically significant differences in rates of hospital admission, respiratory infections or antibiotic treatment. Wheezing, skin rashes and food intolerance were reported by parents with similar frequency in each group. Weight, length and occipito-frontal circumference were similar at all ages up to and including 2 years. Median developmental quotient (Griffiths scales) was 100 in the treated group and 95 in the control group (P = 0.053). Rates of cerebral palsy were similar in each group although milder forms predominated in the treated group. It is concluded that artificial surfactant (dipalmitoylphosphatidylcholine and high-density lipoprotein) replacement at birth is not associated with adverse long term effects on preterm babies.
A baby boy with transient neonatal diabetes mellitus presenting with hyperglycaemia, glycosuria, and dehydration without ketonuria on the second day of life is reported. C-peptide levels were measured to aid in the assessment of insulin treatment. Very low levels were found for the first 5 months of life (less than 0.06 nmol/l). Thereafter insulin treatment was discontinued and the baby thrived showing normal growth and development at age 2 1/2 years.
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Glutathione peroxidase activity was estimated in the cord blood of 47 newborn infants. In 23 cases corresponding maternal glutathione peroxidase activities were measured at time of delivery and compared with 23 non-pregnant women of the same age. Mean cord blood activity was 23.6 +/- 4.8 IU/g Hb at 37 degrees C. Maternal smoking and male fetal sex were associated with significantly lower fetal glutathione peroxidase activity. Maternal levels (33.0 +/- 5.0 IU/g Hb) were significantly higher than those in cord blood (p less than 0.001) but were the same as those for non-pregnant women. Maternal to cord blood level ratio was 1.5:1.
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In a prospective randomized trial, 36 women received cimetidine and 32 magnesium trisilicate mixture BP as antacid therapy every 2 h in labour. The women belonged to a high-risk category and the infants born were less than 36 weeks gestation, or less than 2000 g birthweight or otherwise in jeopardy because of severe maternal pre-eclampsia or diabetes. Measurements of a wide range of haematological and biochemical variables revealed no differences between the two groups of babies. The frequency of complications found in the infants was similar, although infants born to the women who received magnesium trisilicate required oxygen therapy for a longer period. Cimetidine did not appear to affect the development of gastric acidity, or to increase bacterial colonization of the gastrointestinal tract in the infant.
Introduction of pasteurised cows' milk to the diet of preterm infants before 36 weeks' postnatal age caused iron deficiency without anaemia. Cows' milk before 24 weeks was associated with iron deficiency and anaemia. The cause was either inadequate absorption or increased loss rather than reduced intake of iron.
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In a randomised, controlled trial of the effectiveness of artificial surfactant therapy 100 babies of less than 34 weeks' gestation were intubated at birth and received manual ventilation. The 49 babies in the treated group also received 30 mg dipalmitoylphosphatidylcholine and 3 mg high-density lipoprotein in a 5 ml suspension. There were no significant differences in mortality or in the incidence or severity of respiratory distress syndrome between the surfactant-treated and control groups as a whole or between subgroups divided on the basis of sex or pulmonary maturity (as assessed by the lecithin-sphingomyelin ratio). However, there appeared to be a trend towards improved survival in treated babies of 27-29 weeks' gestation.
The iron status of 49 preterm infants (mean gestational age 33.1 weeks) was assessed serially during the 1st year of life. Haemoglobin concentration, serum ferritin, serum transferrin, serum iron, and transferrin saturation were measured on nine occasions in each infant. In 16 infants of gestational age 28-32 weeks the haemoglobin concentration was significantly lower at 3, 6, and 9 weeks when compared to 33 infants of gestational age 33-36 weeks. For all other measures of iron status there were no significant differences between these gestational age groups. For the entire group of 49 infants the mean haemoglobin concentration reached a nadir of 11.2 g/dl at 9 weeks. Mean serum iron and transferrin saturation reached peaks of 24 mumol/l and 65%, respectively, at 3 weeks. The mean serum ferritin remained over 100 micrograms/l until after 18 weeks. 13 infants (26%) had iron deficiency defined as either serum ferritin less than 10 micrograms/1 (n = 10) or transferrin saturation less than 10% (n = 5) or both (n = 3).
Serial determinations were carried out on 27 male and 21 female preterm infants (gestational age 28-36 weeks) throughout the first year of life. Serum copper at birth was 0.33 +/- 0.20 micrograms/ml (n equal 8); at 9 weeks, 0.77 +/- 0.19 micrograms/ml (n = 22); at 24 weeks, 1.00 +/- 0.27 micrograms/ml (n = 31), and at 52 weeks 1.21 +/- 0.27 micrograms/ml (n = 40). Serum zinc at birth was 1.03 +/- 0.16 micrograms/ml (n = 9); at 9 weeks, 0.71 +/- 0.11 micrograms/ml (n = 17); at 24 weeks, 1.02 +/- 0.20 micrograms/ml (n = 20), and at 52 weeks, 1.19 +/- 0.34 micrograms/ml (n = 33). The results of this study compare well with values previously reported for infants studied at selected age points.
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The outcome of pregnancy is reported for 23 women who had been drinking alcohol heavily and who were delivered in Belfast maternity hospitals during the last 4 years. Twenty-one (91%) of the babies were small-for-gestational age and many had head circumference measurements less than 5th centile. Ten babies (44%) had abnormal facies consistent with the 'fetal alcohol syndrome' and 10 babies had congenital malformations of the heart, palate, genitalia and kidneys. Perinatal problems which included breech presentation, birth asphyxia, hypoglycaemia, polycythaemia, hypocalcaemia and withdrawal symptoms were frequently present. Most of the babies have shown delayed postnatal growth and six of the ten who are aged over 1 year have delayed development.
A 23-year-old white primigravid woman with Eisenmenger syndrome and hypoxemia was delivered of a male infant at 34 weeks' gestation after spontaneous onset of labor. The infant was small for gestational age, weighing 1670 g. He subsequently developed respiratory distress and was found to have a high hematocrit with clinical and echocardiographic evidence of persistent fetal circulation. After partial exchange transfusion with plasma, the hematocrit, pulmonary vascular resistance, and arterial oxygen tension became normal. The authors suggest that chronic maternal hypoxemia during pregnancy may cause polycythemia and increased pulmonary vascular resistance in the newborn, leading to persistent fetal circulation.
The new perinatal death certificate proposed by the World Health Organisation was examined in relation to existing measures for recording perinatal death statistics and also with regard to new information gathered. Present procedures appear to underestimate the number of perinatal deaths by roughly 10%, though late registrations may lower this figure slightly. The use of a minimum birth weight as the criterion for inclusion in perinatal statistics removed much of the uncertainty associated with definitions of live birth and stillbirth. The new certificate led to duplication of some information already recorded through birth notification yet failed to provide information on some other factors generally considered relevant to perinatal mortality. The format proposed for recording cause of death provided a more logical presentation of events. Standardizing birth information recorded on all infants, modifying death certificates, and developing efficient record-linkage schemes would be more valuable than introducing the WHO certificate. Useful interpretation of the meaning of the characteristics of infants dying in the perinatal period awaits these timely changes.