Biomedical subjects

J Astbury

Publications and source records attributed to J Astbury.

At least 37 records · Page 2Linked to original sources

PubMed1987

Outcome in infants of birth weight 500 to 999 g: a continuing regional study of 5-year-old survivors.

During 1979 and 1980, 351 infants of birth weight 500 to 999 g were born in the State of Victoria: 89 (25.4%) survived to the age of 2 years corrected for prematurity, and 83 were fully assessed by a multidisciplinary team; partial data were obtained on the remainder. At the age of 5 years, corrected for prematurity, 85/89 (96%) were evaluated by a multidisciplinary team, although not all children could be fully evaluated by the psychologists. Reports were available for another three children; one child was untraced. Of the survivors able to be classified at 5 years, 59/82 (72%) had no functional handicap. Functional handicaps was severe in 16 (19%), moderate in four (5%), and mild in three (4%). Functional handicaps were present in 50% (8/16) of outborn survivors compared with the 23% (15/66) for the inborn survivors (P = 0.02). Cerebral palsy was diagnosed in eight children at 5 years and in 12 children at 2 years. The diagnosis was stable for the children not ambulant at 2 years; five of seven 2-year-old children with mild cerebral palsy had "outgrown" the diagnosis by 5 years, but ataxic cerebral palsy was not identified in one child until 5 years. Six children were blind; four had severe sensorineural or mixed deafness, one more than at 2 years. Of 82 children assessed according to identical criteria for functional handicap at both 2 and 5 years, 52 (63%) remained in the same category at 5 years, three (4%) were judged to be more severely handicapped, and 27 (33%) were less severely handicapped. The 2-year evaluation of extremely low birth weight children often proved to be unduly pessimistic, for many showed improvement or recovery from functional handicaps and impairments by 5 years of age.

Australia↗

PubMed1987

Relationship between two-year behaviour and neurodevelopmental outcome at five years of very low-birthweight survivors.

A prospective five-year follow-up of survivors of very low birthweight (less than or equal to 1500 g) born in 1979 was carried out at the Queen Victoria Medical Centre, Melbourne, between 1980 and 1985. Of the 57 children reported here, 23 had been identified during psychological testing at two years as having an attention deficit disorder (ADD). Although the number with ADD at five years had decreased to 18, the two-year diagnosis was retained to test its predictive value for outcome at school-age. Children with ADD at two years differed significantly from their peers at five years in verbal, performance and full-scale IQ and had significantly more minor physical disabilities. They also had poorer visual acuity, more tremor, poorer balance, and more deviations with arms extended in pronation. The ADD children had more minor, though chronic, physical illnesses such as tonsillitis and serous otitis media. Their mothers expressed greater concern than the other mothers about hearing and behaviour. The ADD children were rated as significantly more aggressive, difficult to manage and less able to cope with frustration. As a predictor of five-year IQ, behaviour at two years was more powerful than social class. ADD discriminated a subgroup of very low-birthweight children whose lower IQ and multiple physical, neurological and behavioural difficulties place them at very high risk of learning disabilities.

Attention Deficit Disorder with Hyperactivity↗

PubMed1986

Prognosis for infants born at 23 to 28 weeks' gestation.

The survival and neurodevelopmental outcome of 356 extremely preterm infants born at 23 to 28 weeks' gestation were reported by week of gestation. Their corrected 1 year survival improved from 7% at 23 weeks to 75% at 28 weeks. The overall incidence of impairment was 19% and of major disability 12%. Boys had a significantly lower normal survival than girls. Multiple births had a significantly lower survival and higher incidence of impairment than singleton births. Predictions of outcome were made before delivery, after resuscitation, and at 1 week to aid the development of guidelines on when perinatal intensive care is justified, whether obstetric intervention for fetal reasons is warranted, and what initial and ongoing prognoses to give to parents. Intensive care for progressively smaller and more immature infants, many of whom were previously considered non-viable, needs to be carefully monitored by every perinatal centre.

Developmental Disabilities↗

PubMed1986

Neurodevelopmental outcome of periventricular haemorrhage and leukomalacia in infants 1250 g or less at birth.

The brains of 50 consecutively admitted infants weighing 1250 g or less at birth were serially examined beyond the neonatal period for periventricular haemorrhage and for periventricular leukomalacia with real-time ultrasound. There was significant correlation between the presence or absence and the severity of haemorrhage with survival. A prospective neurodevelopmental assessment was completed at 2 years of age, corrected for prematurity, on all survivors. None of the 20 survivors with normal scans or germinal layer haemorrhages had evidence of major disability and all four survivors with intracerebral haemorrhage or periventricular leukomalacia had major disability. The mental performance on the Bayley scales of infant development was also significantly worse in the latter group. Six of the eight survivors with intraventricular haemorrhage had no major disability, including three who had post-haemorrhagic hydrocephalus. Our results showed that cerebral ultrasound detection of brain pathology is a good predictor of neurodevelopmental outcome in such extremely low birthweight infants. However, as the maximum extent of periventricular haemorrhage may develop beyond one week of age and cystic periventricular leukomalacia commonly develops after the neonatal period, serial scanning is mandatory to ensure diagnostic accuracy for both periventricular haemorrhage and leukomalacia.

Blindness↗

PubMed1986

Sequelae of growth failure in appropriate for gestational age, very low-birthweight infants.

The pattern of growth of 235 very low-birthweight children, whose weights were appropriate for gestational age, was characterised by a significant decline in weight, length and head circumference from birth to discharge from hospital, followed by partial recovery in all three measures of growth by two years corrected age. 29 per cent of the children were below the 10th percentile for weight at two years, and this group had a significantly higher incidence of major disabilities, poorer muscular development, more hypotonia and lowered performance on the psychomotor index of the Bayley Scales of Infant Development than their heavier peers. These children's mothers more often perceived them as actively disliking close physical contact, and they were reported by their mothers to have had more infections, minor surgery and chronic otitis media. Taken together, the suboptimal weight-gain, delayed gross motor development and increased maternal perceptions of 'sickliness' and lack of 'cuddliness' in these children are reminiscent of non-organic failure to thrive.

Body Height↗

PubMed1986

Outcome of extremely-low-birthweight infants.

The overall 1-year survival rate of 261 infants born at 500 g-999g over a 7-year period was 46%. The survival rate of the 220 inborn infants, corrected for birth defects, would have increased from 47% to 57% if delivery room deaths were excluded and to 62% if postneonatal deaths had also been ignored. Survival improved progressively with increasing 100g weight groups. The disability rate in the 108 survivors who were at least 2 years old corrected for prematurity was 28% with little variation between the 100g weight groups. There were no significant trends in annual perinatal mortality, 1-year survival and disability rate in survivors over the study period for the inborn population. The male infants had significantly lower normal-survival rate than the female infants. Small-for-gestational-age infants, comprising 11% of the inborn group, had significantly better survival but a higher disability rate. Multiple births had significantly lower survival and normal-survival rates than had singleton births. Infants whose mothers were transferred for delivery at the perinatal centre before onset of labour had a significantly better survival rate than those whose mothers had 'booked' and those who were transferred in labour.

Body Weight↗

PubMed1986

Subsequent pregnancy following the birth of an extremely low birth-weight infant.

Of 103 mothers who delivered an extremely low birth-weight (ELBW, less than 1,000g) infant, 29% were primiparous; 51% of those who were multiparous had at least one previous miscarriage or perinatal death. The 41 (40%) mothers who decided against subsequent pregnancy were significantly older than the remaining mothers. Mothers were also significantly more likely to decide against subsequent pregnancy if their ELBW infant had survived. The outcome of subsequent pregnancies within 3 years of the ELBW birth was ascertained; 28% ended in miscarriage, 3% in stillbirth, 1% in neonatal death, 21% in a surviving preterm infant and 51% in a survivor born at term. Mothers diagnosed to have cervical incompetence had a significantly higher risk of a subsequent preterm birth. During the study period, 87% of mothers who became pregnant subsequent to their ELBW infant gave birth to at least one surviving child. Of the subsequent livebirths, 36% were less than 2,500g, 11% were less than 1,500g and 5% were less than 1,000g. Significantly more mothers whose ELBW infant had died conceived again within 1 year compared to those whose ELBW infant had survived. The necessary time for recovery from bereavement may be cut short by the subsequent pregnancy. The psychological problems as a result of unresolved mourning which mothers experience and their effects on subsequent children need to be further studied.

Abortion, Spontaneous↗

PubMed1986

Postnatal growth in infants born before 30 weeks' gestation.

The postnatal weight pattern up to 14 weeks after birth was determined in 184 singleton survivors born at 23 to 29 weeks' gestation in whom routine parenteral nutrition was used before milk feeding was established. A mean postnatal weight loss of 14% of birth weight occurred at a mean of 6 days. The more immature infants had significantly higher postnatal weight loss and longer time to regain birth weight despite a higher volume intake in the first week. From the fourth postnatal week all gestational subgroups had a mean weight gain at above intrauterine growth rate. As a result of the initial period of weight loss, however, the mean body weight remained below the 10th percentile of the intrauterine growth curve. The early growth rate in infants small for gestational age was higher than those who were appropriate weight for gestation, although the mean body weight of the former group remained significantly lower at 2 years.

Aging↗

PubMed1986

Perinatal factors and adverse outcome in extremely low birthweight infants.

Perinatal factors associated with death or disability at 2 years were identified in an inborn cohort of 196 live births with a birth weight of 500-999 g. Antepartum haemorrhage, multiple pregnancy, breech presentation, perinatal asphyxia, hypothermia on admission, hyaline membrane disease, persistent pulmonary hypertension, severe respiratory failure, and intraventricular haemorrhage were associated with increased mortality. Factors associated with increased survival included maternal hypertension, caesarean birth, increasing maturity or size at birth, female sex, and fetal growth retardation. Stepwise multiple discriminant function analysis showed that six factors correctly classified the outcome in 83% of infants: intraventricular haemorrhage was the most important factor followed by the presence of acidosis and hypoxia in the early neonatal period, birth weight, pre-eclamptic toxaemia, and caesarean birth. This study also showed that intraventricular haemorrhage, seizures, antepartum haemorrhage and delay in regaining birth weight were associated with increased disability among survivors.

Cerebral Hemorrhage↗

PubMed1985

Neonatal and neurodevelopmental significance of behaviour in very low birthweight children.

73 (34%) of 213 inborn, long term survivors with a birthweight less than 1500 g showed characteristics of Attention Deficit Disorder (ADD) during psychological testing at 2 years of age corrected for prematurity. Agreement on the diagnosis of ADD made by the paediatrician and psychologist in separate examinations was statistically significant. Children with ADD differed from those with normal behaviour on a large number of neonatal variables which were reduced to the following five on stepwise discriminant function analysis: necrotizing enterocolitis, bronchopulmonary dysplasia, major apnoeas requiring bag and mask resuscitation, duration of feeding on intravenous fat and weight percentile at discharge. These neonatal variables correctly classified 69% of children into their actual behaviour group at 2 years. On psychological testing, children with ADD had a significantly lower mental score on the Bayley Scales of Infant Development and were found on their paediatric/neurological examination at 2 years to have a significantly smaller head circumference, more tone disorders, poorer visual tracking and visual motor co-ordination, poorer gross and fine motor co-ordination and significantly more minor physical and neurological disabilities than normally behaved children. The behaviour of very low birthweight infants during formal psychological testing at 2 years is a potent indicator of past neonatal experience and current neurodevelopmental status.

Attention↗

PubMed1985

Effect of neonatal periventricular haemorrhage on neurodevelopmental outcome.

All 56 infants born between 23 and 28 weeks' gestation admitted to this hospital in 1981 were examined for periventricular haemorrhage with cerebral ultrasonography. Haemorrhage was diagnosed in 34 (61%)-12 (22%) had germinal layer haemorrhage, 18 (32%) had intraventricular haemorrhage, and four (7%) had intracerebral haemorrhage. The two year outcome of survivors with and without periventricular haemorrhage was compared to determine the effect on neurodevelopment. Only three (16%) of 19 infants with normal scans or germinal layer haemorrhages had evidence of major disability but nine (75%) of 12 infants with intraventricular or intracerebral haemorrhage had major disability. The mental and psychomotor performance on the Bayley scales of infant development was also significantly worse in the latter group. All three survivors with intracerebral haemorrhage had major disability. The continuation of life support treatment for extremely preterm infants who are at very high risk of severe handicap is a matter of increasing concern in neonatal intensive care. Our results show that if extensive periventricular haemorrhage, in particular intracerebral haemorrhage, occurs in this gestational group, extreme pessimism is warranted.

Birth Weight↗

PubMed1985

Viability of infants born at 24 to 26 weeks gestation.

81 inborn infants of 24-26 weeks gestation were studied. Overall survival rate excluding 2 lethal malformations was 44%: it was 36% at 24 wk, 32% at 25 wk and 57% at 26 wk. 68% of the multiparous mothers had a previous reproductive loss and 30% had a previous preterm birth. Antepartum haemorrhage and chorioamnionitis were the 2 most common obstetric associations. Perinatal asphyxia and severe respiratory disorders were significantly associated with increased mortality. Management of respiratory failure and provision of adequate nutrition were the 2 main therapeutic challenges. 30% of the deaths occurred in the delivery room and 68% by 24 hours. Periventricular haemorrhage was the most common necropsy finding. The mean gestation at discharge for the 35 survivors was 40 wk. On assessment at 2 years of age, corrected for prematurity, 10 (28%) had cerebral palsy, 3(9%) had developmental delay, 2 (6%) were blind, and 1 (3%) had sensorineural deafness. There were 4 children who had more than 1 disability; 9 of the 12 children with disability were considered to have a significant functional handicap. The proportions of survivors without significant functional handicap, born at 24-25 wk compared with those at 26 wk, were not statistically different (67% versus 80%). Common medical conditions in the first 2 years included respiratory illness, otitis media and gastroenteritis. 13 (37%) children required rehospitalisation for an average of 3 times; total days in hospital averaged 15 d. The most common reason for admission was respiratory illness. At 2 years, 24% were below the 10th centile for weight as were 26% for height; head circumferences were normal.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗

PubMed1984

Outcome in infants with birth weight 500 to 999 gm: a regional study of 1979 and 1980 births.

During 1979 and 1980, 351 infants weighing 500 to 999 gm were born in the State of Victoria, Australia; 89 (25.4%) survived to 2 years of age. Survival was better for tertiary center births (29%) than for those born elsewhere (17%). Multidisciplinary teams reviewed 83 of the survivors at 2 years of age postterm; some data were available for the other six children. Overall, 22.5% of infants had severe functional handicap, 29.2% had either moderate or mild handicap, and 48.3% had no handicap. Severe functional handicap was present in 50% of outborn infants; this was significantly more common than in those born in tertiary centers (15.5%), and the Bayley Mental Developmental Index was also significantly lower in outborn infants. The prevalence of cerebral palsy (13.5%), bilateral blindness (3.4%), and severe sensorineural deafness (3.4%) did not differ significantly in the inborn and outborn infants. Singleton inborn infants of appropriate weight for gestational age had significantly less severe functional handicap (9.1%), compared with 37.5% for the group of infants who were either small for gestational age or one of multiple births. Six of the 18 outborn infants could have been transferred in utero, and improvements in immediate neonatal care were possible in seven other infants.

Age Factors↗

PubMed1984

Necrotizing enterocolitis in very low birthweight infants: a four-year experience.

Fifty (13%) of 375 infants who weighed 1500 g or less at birth had necrotizing enterocolitis (NEC). Haematological changes suggestive of sepsis occurred in 83% and positive bacteriological cultures were found in 38%, the most common organism isolated being Clostridium perfringens. Complications included intestinal perforation in six patients and recurrence of NEC in five, of whom one subsequently developed an intestinal stricture. Five of the eight nursery deaths were secondary to peritonitis and overwhelming sepsis from NEC. In spite of the discontinuation of milk feeds for prolonged periods, satisfactory caloric intake and weight gain were achieved with parenteral nutrition in the survivors. Of the 41 long-term survivors, six (15%) were found to have a disability at 2 years of age, corrected for prematurity, compared with 48 (20%) of 241 very low birthweight survivors from the same study period who did not have NEC. None had evidence of gastrointestinal dysfunction. Six (15%) children remained below the 10th percentile for both weight and height. This study showed that early diagnosis and therapy for NEC in very low birthweight infants were associated with a favourable short- and long-term outcome.

Bacterial Infections↗

PubMed1984

Outcome of very low birthweight infants who required prolonged hospitalization.

Over a 4 year study period, 294 infants with a birthweight less than or equal to 1500 g survived their initial hospitalization; 103 (35%) were discharged after a gestational age of 40 weeks. The postdischarge infant mortality was significantly higher in those with prolonged initial hospitalization compared with the remaining survivors (6% vs 1%). During the first 2 years, significant infections were found in 66% and rehospitalization in 54% of the children who had prolonged initial hospitalization. At 2 years, 34% were below the 10th centile for weight as were 39% for height; head circumferences were normal. Major disability (27% vs 15%) and developmental delay (13% vs 4%) were significantly more common in survivors with prolonged initial hospitalization compared with the remaining survivors. The study demonstrated the continuing toll of perinatal morbidity among very low birthweight infants who required prolonged hospitalization and emphasized the need for comprehensive medical and social support, not only during their initial hospitalization, but also after discharge.

Australia↗

PubMed1984

Effect of mode of delivery on outcome of very-low-birthweight infants.

The hospital survival rate was 47% in 111 inborn infants who weighed 501-1000 g and 90% in 211 who weighed 1001-1500 g. The survival rate after caesarean birth was significantly higher than that after vaginal delivery in the 1001-1500 g group but not in the 501-1000 g group. At 2 years of age, 73% of survivors born at 501-1000 g and 85% of those born at 1001-1500 g had no neurological or developmental disability; no significant difference was found between caesarean and vaginal births. The mode of delivery did not significantly affect survival or late outcome of the 192 singleton infants with cephalic presentation. Although the survival rate was not significantly different between infants with breech and cephalic presentations, the former had a significantly higher disability rate. Within the group of 72 singleton infants with breech presentation, the survival rate after caesarean birth was significantly higher than after vaginal delivery in the 1001-1500 g group but not in the 501-1000 g group. No significant difference in late outcome was found between caesarean and vaginal births in this subgroup.

Breech Presentation↗

PubMed1984

Survival and 2-year outcome of extremely preterm infants.

The survival of 163 infants born within the hospital at 24-28 weeks gestation during a 4 1/2-year period and the morbidity in survivors at 2 years of age were reported. Hospital survival rates from 24-28 weeks at each week of gestation, excluding six infants with birth defects, were 36%, 32%, 57%, 70% and 74% respectively. The late outcome of children born at 24-26 weeks was compared with those born at 27-28 weeks. Of the 81 infants in the former group 46 (57%) died, nine (11%) survived with significant functional handicap and 26 (32%) were developing within the normal range. Of the 82 infants in the latter group, 28 (34%) died, eight (10%) survived with significant functional handicap and 46 (56%) were developing within the normal range. Although the mortality rate was significantly higher in the 24-26-weeks group, the physical disability and functional handicap rates in survivors were not statistically different between the two groups. Neither was developmental progress, as determined by psychological assessment, different.

Child Development↗

PubMed1984

Outcome of extremely low birth-weight infants in relation to the hospital of birth.

There were 351 liveborn infants of birth-weight 500-999 g born in the State of Victoria in the years 1979 and 1980; 89/351 (25.4%) survived to the age of 2 years: 42 (47.2%) survivors were of gestational ages of 24 to 26 weeks and 47 (52.8%) were born at 27 to 32 weeks' gestation. Survival of these extremely low birth-weight infants was significantly better (71/245, 29%) for births in tertiary centres compared with those born elsewhere (18/106, 17%). Of the 351 livebirths, 69.8% occurred in 1 of the 3 tertiary centres. All 89 survivors were traced; 84 (94.4%) were assessed at the age of at least 2 years by a multidisciplinary team. Three children had been fully assessed at 1 year of age and paediatric reports were available for 2 children. The quality of survival of children born in tertiary centres was significantly better than those transferred to a tertiary centre after birth; the prevalence of serious functional handicap was 72.2% (13/18) for outborn children compared with 22.5% (16/71) for those born in tertiary centres. The prevalence of serious functional handicap in the inborn survivors was lowest (9/55, 16.4%) in singleton births who had been of appropriate birth-weight for gestation. A review of the 18 surviving outborn infants' records indicated that 6 (33.3%) could have been transferred to a tertiary centre in utero and for the 12 infants where birth in a tertiary centre was not feasible, improvements in the early neonatal care were possible in another 7 infants.

Australia↗