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Biomedical subjects

J Astbury

Publications and source records attributed to J Astbury.

51 records · Page 3Linked to original sources
PubMed1984

Perinatal risk factors for necrotizing enterocolitis.

The perinatal histories of 50 very low birthweight infants weighing 1500 g, or less, with necrotizing enterocolitis were compared with those of the remaining 325 very low birthweight infants who were admitted to this hospital during a four year study period. Many factors previously reported to be associated with necrotizing enterocolitis were found with equal frequency in both groups of babies. The only adverse factor which was more frequently present in patients with necrotizing enterocolitis was hypothermia on admission to hospital. Those infants who developed severe necrotizing enterocolitis also had a higher incidence of polycythaemia. A further controlled study which examined feeding practices showed that the timing, type, and volume of milk feeding were not different in infants with necrotizing enterocolitis and matched controls. Prematurity is clearly the greatest risk factor which predisposes to the development of necrotizing enterocolitis and most of the factors previously implicated in the aetiology may simply represent the descriptive characteristics of a population of sick, very low birthweight infants.

Animals↗
PubMed1983

Collaborative study of very-low-birth-weight infants. Correlation of handicap with risk factors.

Two large maternity services studied consecutive inborn infants (birth weight range, 500 to 1,500 g) born between 1977 and 1978. The multidisciplinary team members used identical assessment methods and documentation. Of 259 long-term survivors, 252 (97.3%) were seen at 2 years of age. Survival rates for hospitals 1 and 2 were 68.5% and 69.0%, respectively. Cerebral palsy rates for hospitals 1 and 2 were 11.8% and 11.2%, respectively. Major handicaps (cerebral palsy, mental developmental index [MDI] on the Bayley scales less than 69, epilepsy, deafness, or blindness) occurred in 30 (18.6%) and 17 (17.3%) of hospitals 1 and 2 survivors, respectively. Both cerebral palsy and developmental delay (MDI below 75 without severe or moderate cerebral palsy) were significantly correlated with a number of perinatal variables, but none were common to the two hospitals. Of the 30 children with cerebral palsy, 15 (50%) were not ventilated, and 28 (93%) had a five-minute Apgar score greater than 4; there was no indication that selective treatment to prevent cerebral palsy was possible.

Blindness↗
PubMed1983

Bronchopulmonary dysplasia in very low birthweight infants.

Twenty-four (6%) of 375 infants with birthweights less than or equal to 1500g developed bronchopulmonary dysplasia (BPD); 16 (15%) of 107 in those less than or equal to 100g and 8 (3%) of 268 in those greater than 1000g. The incidence was 10% in those who required assisted ventilation. Perinatal asphyxia, significant respiratory distress, pulmonary interstitial emphysema and patent ductus arteriosus were statistically more common in BPD infants compared with the remaining 351 very low birthweight infants. Hyaline membrane disease was the primary respiratory disease in 54% of BPD infants. The mean durations of oxygen and ventilatory therapy were 68 days and 37 days respectively. Twenty-nine percent did not require more than 60% oxygen for over 24 hours. Only 38% required a peak airway pressure of over 30 cmH2O. Early postnatal growth was satisfactory on parenteral nutrition support. No perinatal factor was found to be predictive of death from BPD. The prolonged duration of hospital treatment has obvious implications to the psychosocial and economic costs of BPD.

Bronchopulmonary Dysplasia↗
PubMed1983

Determinants of developmental performance of very low-birthweight survivors at one and two years of age.

The developmental outcome of 61 very low-birthweight infants was studied prospectively by means of the Bayley Scales of Infant Development at one and two years of age, corrected for prematurity. Preliminary analysis revealed that the mean scores for mental and psychomotor development were within the normal limits at both testing occasions. However, further analysis showed that there was a significant decrease in mental development scores from one to two years of age, due primarily to an increase in the numbers of low-scoring children with 'hyperactive' behaviour at two years. Separate subgroups of children with suboptimal mental and psychomotor development scores were characterised at both testing occasions by the presence of 'hyperactive' behaviour and disability, usually of a minor degree. The presence of hyperactivity, disability and lowered mental performance may help in the early identification of children at increased developmental risk.

Child Development↗
PubMed1983

Growth and development of very low birthweight infants recovering from bronchopulmonary dysplasia.

Twenty four infants with birthweights less than or equal to 1500 g had bronchopulmonary dysplasia (BPD). Four died in the neonatal period and four in the postneonatal period-one had been discharged and was aged one year. Sixteen (67%) survived long term and were followed up until they were two years old. Common medical conditions included respiratory illnesses in 14 (88%) children and otitis media in 8 (50%). Eleven (69%) required hospital admission for an average of 5 times; total days in hospital averaged 27 days. The most common reasons for admission were bronchiolitis and bronchopneumonia. At two years 37% were below the 10th centile for weight, as were 25% for height: head circumferences were normal. Two children had cerebral palsy, two had developmental delay, two had multiple disabilities, and one had sensorineural deafness. Of the 24 BPD infants, 8 (33%) died, 7 (29%) survived with a disability (severe in one), and 9 (38%) had a normal neurodevelopmental outcome. From the available perinatal data it was not possible to predict late disabilities in BPD survivors.

Blindness↗
PubMed1982

Infants born before 29 weeks gestation: survival and morbidity at 2 years of age.

In a collaborative study involving two hospitals with large maternity services, 166 liveborn infants of gestational age from 24 to 28 weeks were born in the calendar years 1977 and 1978. Of these infants, 75 (45.2%) died either in hospital or after discharge home. At the age of 2 years, 16 (9.6%) of the cohort had a major handicap [cerebral palsy, Mental Developmental Index (MDI) under 69, deafness or blindness]. An additional 20 children (12.0%) had significant developmental delay (MDI 69 to 84, -2 to -1 SD below mean) and 53 (31.9%) were considered to be free of these handicaps. Psychological assessments were not performed on two survivors (1.2%) but reliable reports indicated that they were free of major handicaps. Long-term survival increased in a stepwise fashion from 9.1% at 24 weeks to 68.5% at 28 weeks gestation, and there was a trend for major handicap and significant developmental delay to decrease in incidence with increasing maturity. Of the 58 children who had presented by the vertex 42 (72.4%) were free of significant handicap; however, of the 31 children in whom there had been either a breech presentation or a transverse lie, only 11 (35.5%) were free of significant handicap (chi 2 = 9.69, P less than 0.01). The mode of delivery (vaginal or caesarean section) did not significantly affect the handicap rate in the survivors.

Australia↗
PubMed1982

Early development of infants 1000 g or less at birth.

In a 4-year period the neonatal survival rate for 26 infants weighing 501-750 g was 42% and for 81 infants weighing 751-1000 g it was 61%. All 59 surviving infants have been assessed at follow-up; 39 were at least 2 years old (corrected for prematurity) and data from the remaining 20 were derived from assessment at 1 year corrected age. Five children had cerebral palsy, 4 had multiple handicaps, 4 each had a sensory handicap, 2 had developmental delay, and 1 had a dilated right ventricle without clinical hydrocephalus. Twelve of the 16 children with defined handicaps were considered to have significant functional handicaps. Therefore, of the 107 infants in this series, 48 (45%) died, 12 (11%) survived with significant functional handicaps, and 47 (44%) were considered to be developing within the normal range. No significant differences in the incidence of handicap were observed between inborn and outborn children, boys or girls, those who were small or appropriate for gestation, those who weighed less than or equal to 750 g or greater than 750 g at birth, and those who required or did not require prolonged oxygen or ventilation.

Child Development↗
PubMed1982

Determinants of stress for staff in a neonatal intensive care unit.

Components of stress for 22 paediatric consultants and 29 nursing sisters working in neonatal intensive care units were studied. Ten situations were rated for their intensity of stress and their frequency of occurrence. For intensity of stress, significantly more paediatric consultants rated the competing demands of personal life versus work as highly stressful, than did nursing sisters. For frequency of stress, significantly more paediatric consultants rated 4 situations as frequently occurring than did nursing sisters (priorities of care, understaffing/overwork, personal life versus work, condition of outborn infants). However, significantly more nursing sisters found problems in working with their peers a frequently occurring stress than paediatric consultants. Total scores calculated for intensity and frequency of stress showed that although the overall intensity of stress experienced was similar, paediatric consultants had a significantly higher mean score for frequency of stress than nursing sisters in the neonatal intensive care unit.

Australia↗
PubMed1982

Changing outcome over 13 years of very low birthweight infants.

The survival prospects for infants of birthweight less than or equal to 1500 g born in recent years have improved. Evidence for a corresponding decrease in long-term morbidity of survivors is conflicting but recent reports from some centers indicate that high morbidity rates are occurring. Until additional satisfactory reports are available on the outcome of very low birthweight (VLBW) infants born after 1975, preferably from a community or region, uncertainty will continue. The outcome of three cohorts of VLBW infants, born in the Royal Women's Hospital, Melbourne between 1966 and 1978 is reported; more than 90% of each cohort were fully assessed, aged 2-8 years. There were 169 long-term survivors from the first cohort (1966-1970 births) and 72 from the second cohort (1973-74 births); survival rates were 37.1% and 37.3% respectively; however, for the 1977-78 births, there were 161 survivors, a significant increase to 68.3%. In the first cohort, 32.7% had one or more visual defects and 3.9% were blind but visual morbidity decreased progressively in cohorts 2 and 3; 3% of the second cohort and 1.2% of the third cohort were blind. There was a trend for a decrease in severe sensorineural deafness. Cerebral palsy increased progressively, respectively 2.6%, 4.5% and 11.9% in the first, second and third cohorts. There was a significant increase in the mean Mental Developmental Index of the Bayley Scales at the age of 2 years from 75.38 for the 64 children born in 1966-70 compared with 90.96 for 150 children in the 1977-78 cohort. Although there had been an increase in upper social class families in the more recent cohort, improvement in test scores was still highly significant when higher social classes (1-3 Congalton Scale) were excluded. However, there was no significant improvement in the 6 year psychological test scores of the first and second cohorts. There was a steady increase in occurrence of cerebral palsy. Significance associations in the 1977-78 cohort were found with only 2 perinatal variables (use of theophylline and necrotizing entercolitis). Furthermore, 17 (89.5%) of children had a five-minute Apgar score greater than 5 and 14 (73.7%) did not require ventilatory support: Prevention of cerebral palsy by selective treatment in the delivery room or nursery was not feasible for prediction of this condition was not possible from perinatal risk factors.

Australia↗
PubMed1981

Parents' reactions to unrestricted parental contact with infants in the intensive care nursery.

In order to determine parental attitudes and reactions to a policy in which the quality and quantity of parental contact with their preterm or critically-ill infants in the intensive care nursery were determined by the parents, 20 parental pairs were studied regarding their pattern of involvement with their infants, the emotional stress which they experienced, and their responses to the nursery environment during the first fortnight after their infants' birth. This study demonstrated that early and extended parent-infant contact was possible for infants admitted to the intensive care nursery. Both parents chose to maintain a high level of involvement with their infants despite the associated anxiety and anticipatory grief experienced during this period. All felt more reassured with repeated visits, and most believed their infants also felt more loved and secure with the increased contact. The majority would have been opposed to restricted visiting hours and restricted contact with their infants. An open visiting policy and an organized parental-care programme is an important component of neonatal intensive care, since every preterm or critically-ill infant has a family whose psychosocial needs must be recognized and supported.

Attitude↗
PubMed1979

Amniocentesis in the early second trimester of pregnancy and maternal anxiety.

Anxiety state and trait were measured before and after amniocentesis early in the second trimester of pregnancy, in a group of 28 women who were at risk of bearing an abnormal foetus. A significant decrease in maternal anxiety occurred in the majority of women after receiving the results of the amniocentesis. It is concluded that amniocentesis for intrauterine diagnosis of foetal abnormalities makes a significant contribution to the psychological wellbeing of those pregnant women who are at greater risk of having an abnormal baby.

Adult↗