Biomedical subjects

J Grigg

Publications and source records attributed to J Grigg.

45 records · Page 3Linked to original sources

PubMed1993

Association between pulmonary and gastric inflammatory cells on the first day of life in preterm infants.

It has been shown that inflammatory cells in the newborn lung are fetal in origin, whereas those in the amniotic fluid are maternal. In order to explore the relationship between fetal amnionitis and neonatal pneumonitis, we collected paired samples of gastric aspirate within 2 hours of birth, and bronchoalveolar lavage fluid within 24 hours of birth from intubated preterm infants. Leukocyte counts in bronchoalveolar lavage fluid correlated with the duration of membrane rupture (r = 0.68, P = 0.0001). There was a high degree of correlation between leukocyte counts in the two fluids (r = 0.86, P = 0.0001). The factors responsible for this association are unknown.

Bronchoalveolar Lavage Fluid↗

PubMed1993

Bilateral fiberoptic bronchoalveolar lavage in acute unilateral lobar pneumonia.

Bilateral cultures of bronchoalveolar lavage fluid were obtained from eight children with unilateral lobar pneumonia. In four patients bacterial pathogens were not isolated from lavage of the radiologically normal side but were subsequently cultured from the consolidated segment. This pattern helped to exclude contamination by oropharyngeal flora of bronchoalveolar lavage fluid. Bilateral bronchoalveolar lavage may help in the interpretation of lower respiratory tract cultures obtained by fiberoptic bronchoscopy.

Bronchoalveolar Lavage Fluid↗

PubMed1993

Inflammatory cells in the lungs of premature infants on the first day of life: perinatal risk factors and origin of cells.

Neither the origin of leucocytes in the premature newborn airway nor their relationship to perinatal factors has been adequately determined. In order to sample airway cells, modified bronchoalveolar lavage was performed on 74 intubated infants of < 32 weeks' gestation and < 24 hours of age. Cells were counted, stained and, in a small separate group of six infants, four boys and two girls, probed for the Y chromosome with suitable control samples. Perinatal risk factors for increased airway cellularity were analysed by multiple regression. Premature rupture of membranes of more than 24 hours' duration was independently associated with increased numbers of airway leucocytes (n = 74). More than 90% of airway leucocytes from four boys with pulmonary inflammation were positive for the Y chromosome indicating that the cells were of fetal rather than maternal origin.

Bronchoalveolar Lavage Fluid↗

PubMed1993

Pulmonary inflammatory cells in ventilated preterm infants: effect of surfactant treatment.

The aim of this study was to determine the effect of surfactant treatment on the number and distribution of inflammatory cells in bronchoalveolar lavage fluid (BALF) from mechanically ventilated preterm infants over the first week of life in relation to the subsequent development of chronic lung disease (CLD). The study included 25 babies who received surfactant on clinical grounds and 29 babies of similar severity who did not. BALF was collected on days 1, 3, 5, and 7 after birth. Cell counts were performed and differentials were calculated on 300 cells. CLD was equally common in both treatment groups. Of the 54 infants, 29 (53%) who developed CLD had a higher incidence of patent ductus arteriosus and air leak and needed a higher concentration of inspired oxygen on the fifth and seventh days of life. Babies who developed CLD had more polymorphonuclear leucocytes and fewer macrophages on days 5 and 7 than those who recovered. Surfactant treatment was associated with a higher total white cell count on day 3. Between days 3 and 7, macrophage numbers were higher in surfactant treated babies, whatever the pulmonary outcome. This data suggests that CLD was associated with persistence of high numbers of polymorphonuclear leucocytes in BALF at the end of the first week. Surfactant treatment caused a persistent increase in macrophage numbers. The association between persistent neutrophilia and CLD was unaffected by surfactant treatment.

Bronchoalveolar Lavage Fluid↗

PubMed1993

Bronchoalveolar lavage fluid glutathione in intubated premature infants.

Lower concentrations of uncorrected glutathione in the bronchoalveolar lavage fluid were found on the first day of life in seven infants who subsequently developed chronic lung disease when compared with 27 infants who did not require supplemental oxygen at 36 weeks' postconceptional age. The concentration of glutathione on the first day was independent of gestational age. These preliminary results suggest that glutathione accumulates in the lung epithelial lining fluid of preterm infants and that a relative deficiency may predispose to lung injury.

Bronchoalveolar Lavage Fluid↗

PubMed1992

Delivery of micronized budesonide suspension by metered dose inhaler and jet nebulizer into a neonatal ventilator circuit.

We compared the delivery of a micronized suspension of budesonide by a metered dose inhaler (MDI) with two different spacers (Aerochamber and Aerovent) and by two jet nebulizers (MAD2 and Ultravent) to a ventilated neonatal test-lung using a standard neonatal ventilator circuit. The combination of MDI and Aerochamber was significantly better at delivering budesonide to a filter in front of the test lung (14.2% of aerosolized dose) than were either the MDI and Aerovent (3.6%) or the Ultravent or MAD2 jet nebulizers (0.02% and 0.68% of initial reservoir dose). Of the droplets emerging from the MDI, Aerochamber, and ET tube, 18% of the initial dose was in droplets less than 4.7 microns. Assuming that the test-lung model accurately reflects in vivo deposition, the combination of MDI and Aerochamber appears to be an extremely effective way of delivering budesonide aerosol to ventilated newborn infants.

Aerosols↗

PubMed1992

Atypical mycobacterium keratitis.

We present two cases of Mycobacterium chelonae keratitis, both of which followed minor corneal trauma. One case initially showed improvement with medical therapy alone but eventually required penetrating keratoplasty. The second case required surgical intervention to provide tectonic support, but the infection resolved with antibiotic therapy.

Adult↗

PubMed1992

Delivery of therapeutic aerosols to intubated babies.

Delivery of drug aerosols to the lungs of ventilated neonates by metered dose inhaler and spacer (Aerochamber) and ultrasonic nebuliser (Pentasonic) was assessed using sodium cromoglycate. The mean proportion of a known intratracheal dose of sodium cromoglycate excreted in the urine of four intubated infants was 37.5%. After assuming that 38% of the sodium cromoglycate aerosol reaching the neonatal lung will be excreted in the urine, three puffs (15 mg) delivered by metered dose inhaler and spacer resulted in a pulmonary dose of 258 micrograms (1.7%, n = 7). A dose of 20 mg (4 ml) sodium cromoglycate ultrasonically nebulised over five minutes into the inspiratory limb of a standard ventilator circuit produced a pulmonary dose of 257 micrograms (1.3%, n = 7). Of two in vitro lung models assessed, a combination of filter and neonatal test lung was superior to a multistage impactor in estimating the in vivo pulmonary sodium cromoglycate dose delivered by metered dose inhaler and spacer (243 micrograms v 1740 micrograms).

Aerosols↗

PubMed1992

Fractional processing of sequential bronchoalveolar lavage fluid from intubated babies.

Two groups of intubated newborn babies were studied to determine the clinical effects of interrupted bronchoalveolar lavage (BAL) by suction catheter (S-BAL) and the similarities to adult fibreoptic BAL of fractional processing of sequential lavage fluid (BALF). Both groups were lavaged by two aliquots of 1 ml.kg-1, instilled via a blindly placed suction catheter, wedged on two separate insertions through the right main bronchus. In 14 infants, (sequential lavage group), BALF aliquots were analysed separately. There were no differences in the volumes recovered or total cell counts between the first and second BALF aliquots. Where cell morphology was visible (n = 11), the percentage of macrophages, but not the absolute number, increased in the second BALF aliquot (p less than 0.01). BALF urea and epithelial lining fluid volume estimated by urea dilution were similar between the two aliquots (n = 8). In a separate group (blood gas group), vital signs were recorded in 10 infants undergoing S-BAL. At 1 min after lavage there was a rise in mean arterial blood pressure (39 vs 49.5 mmHg, p less than 0.05) and a fall in transcutaneous oxygenation (10.6 vs 7.5 kPa, p less than 0.05). Recovery was present at 3 min post-S-BAL, but mean blood pressure remained elevated (39 vs 45 mmHg, p less than 0.05) and transcutaneous oxygen continued to be lower when compared to baseline values (10.6 vs 9.2 kPa, p less than 0.05). S-BAL of intubated infants appears to sample both the proximal and distal airways and results in changes in vital signs similar to routine non-selective endotracheal suctioning.

Blood Gas Analysis↗