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Biomedical subjects

J H Drew

Publications and source records attributed to J H Drew.

At least 37 records · Page 2Linked to original sources
PubMed1987

Necrotizing enterocolitis: a 15-year experience.

Eighty-seven infants (0.13% of livebirths) developed necrotizing enterocolitis (NEC) during a 15-year period at the Mercy Maternity Hospital, Melbourne. The disease was associated with 23 deaths, representing a mortality rate of 26.4% and comprising 2.6% of all neonatal deaths. The incidence of NEC increased from 0.07% of all livebirths for the years 1971-1974 to 0.25% for the 19-month period from January, 1984 to July, 1985. The mean age at onset was 9.9 days with an inverse relationship between birth-weight and age of onset of the disease. The mothers of the infants who developed NEC belonged to a significantly higher risk obstetric population; gestational diabetes was identified in 3 of 28 mothers (10.6%) having glucose tolerance tested, and 1 other patients was a known diabetic. Subnormal oestriol excretion was detected in 15 of 45 patients tested, treble the overall hospital incidence. Of the 87 infants, 26 (29.9%) were VLBW (birth-weight less than 1,500 g), 5 were term (5.7%) and 9 (10.3%) were small for gestational age. The mean gestational age was 34.7 weeks and mean birth-weight was 1,988 g. Sixty-seven (77%) infants received medical treatment alone and 20 (23%) also received surgical treatment. Sequelae which developed in survivors were colonic strictures (4), fistulas (2) and the short-gut syndrome (1).

Apgar Score↗
PubMed1987

Cephalhaematoma: a 10-year review.

The incidence of cephalhaematoma at the Mercy Maternity Hospital over a 10-year period was 2.5%; of the 1,030 infants 68.4% were born to primiparas, 65.6% were males, the majority (91.1%) were between 37 and 42 weeks' gestation and 3,000 and 4,000 g birth-weight (71.6%). Forceps delivery and vacuum extraction were associated with increased incidences of cephalhaematoma (5.1% and 22.9% respectively), and the incidence was slightly increased (3.8%) when a scalp electrode had been applied. Hyperbilirubinaemia was more prevalent (12.9%) in infants with a cephalhaematoma as was exchange transfusion (0.8%) and the need for phototherapy (4.9%).

Birth Injuries↗
PubMed1985

Nonstressed antepartum cardiotocography in patients undergoing elective cesarean section--fetal outcome.

In a prospective study of 409 patients monitored with nonstressed antepartum cardiotocography and delivered by elective cesarean section, cardiotocography was requested for 170 because of clinical indications. This group had higher incidences of abnormal cardiotocography (p less than 0.001), fetal growth retardation (p less than 0.001) and neonatal deaths (p less than 0.025) than had the group without such requests, suggesting that clinicians effectively selected the high-risk pregnancy for testing of fetal well-being. Cardiotocographic evidence of critical reserve was found in 17 of 170 patients (10%) tested for a clinical indication and in none of the 239 patients in the control group. Patients with abnormal cardiotocography results had significantly higher incidences of cord arterial blood pH less than 7.26 (p less than 0.05) and Apgar scores of less than 6 at 1 minute (p less than 0.001), showing that an abnormal cardiotocogram is indicative of a fetus at risk of having hypoxia.

Apgar Score↗
PubMed1984

Serratia: a problem in a neonatal nursery.

We have noted an increased incidence of Serratia species isolates in our Special Care Nursery recently and have reviewed our experience over the 7 year period from 1976 to 1982. Fifty newborn infants had strains of Serratia isolated, 30 of which were found in 1982. Two strains of Serratia species were isolated: Serratia marcescens in 46 newborn infants and Serratia liquefaciens in six, with both types being found in two infants. All isolates were sensitive initially to gentamicin, kanamycin sulphate, chloramphenicol and co-trimoxazole. However, resistance was documented subsequently to each of these antibiotics. Only 64% of isolates only were sensitive initially to ampicillin; 27% subsequently developed resistance. Recent isolates were sensitive to cefotaxime sodium. Twenty-nine infants (58%) were colonized, and 16 (32%) had minor infections such as conjunctivitis. However in five infants (10%) life threatening illness occurred. Of the five infants with serious infection two had meningitis and three were septicaemic; one infant died. In both infants with meningitis difficulty was experienced in eradicating the organism and porencephaly developed in both.

Drug Resistance, Microbial↗
PubMed1984

Air leak in neonatal respiratory distress syndrome.

A review of 9401 consecutive live births at the Mercy Maternity Hospital, Melbourne, was performed to determine the incidence of air leak in those with respiratory distress syndrome. Respiratory distress was detected in 552 (5.9%) infants and hyaline membrane disease was the most common cause occurring in 238 (2.5%) infants. Air leak developed in 22% of infants with respiratory distress, 8% had pulmonary interstitial emphysema alone, 14% had pneumomediastinum or pneumothorax and 7% had emphysema with pneumomediastinum or pneumothorax. Mortality increased from 12% in infants without air leak to 31% (p less than 0.001) in infants with air leak. Ninety-five per cent of air leak developed in infants with hyaline membrane, and these were smaller, less mature and sicker than those without air leak. Eighty-seven per cent of air leak developed in infants treated with assisted ventilation and was commoner with mechanical ventilators with a more rapid rise in inspiratory pressure.

Humans↗
PubMed1983

Provision of perinatal services and survival of extremely low birthweight infants in Victoria.

The transfer of at-risk mothers to one of the three Level III maternity hospitals in Victoria has been promoted since 1975; since 1978, the Newborn Emergency Transport Service has been available throughout the State for the transport of infants to the four Level III neonatal units. By means of data from multiple sources, we ascertained the one-year survival of infants with birthweights of between 500 g and 999 g born in Victoria between 1978 and 1981. Of 711 live-born infants, 227 (31.9%) survived 28 days and 210 (29.5%) lived to at least one year of age; of 490 infants born in the Level III maternity units, 156 (31.8%) lived. There were 54 (24.4%) survivors among the 221 infants born elsewhere; all these survivors were included in the group of 105 babies who had been transferred after birth to Level III neonatal units. Although only 25.5% of all births for the State occurred in the Level III maternity hospitals, 69% of all infants who weighed between 500 g and 999 g at birth were delivered in these hospitals. The transfer of the mother or the new born baby to a Level III unit was possible in an additional 48 cases. Although survival rates from Level III hospitals may possibly improve in the future, the shortage of ventilator beds remains a practical obstacle.

Australia↗
PubMed1983

Quality of survival of infants with critical fetal reserve detected by antenatal cardiotocography.

During the 8-year period 1973 to 1980, antenatal cardiotocographic monitoring was performed on 3,006 high-risk pregnancies selected from a total obstetric population of 37,856 patients. A critical fetal reserve was detected in 72 patients (2.3%) whose pregnancies resulted in 20 perinatal deaths and 52 infants who survived the neonatal period; 45 of these infants have been assessed at ages ranging from 2 months to 8 years, 9 months. Growth was below the tenth percentile in 25.0% for weight, 23.3% for length, and 22.5% for head circumference at the review examination. Neurological abnormalities were detected in 12 infants but the abnormality was major in only four, including one who has familial interstitial polyneuropathy. The quality of survival of infants delivered of pregnancies complicated by critical fetal reserve is satisfactory; 93.2% had no neurological impairment likely to interfere with quality of life and indeed 13.5% had superior intelligence. Cardiotocographic evidence of critical fetal reserve does not signify that the fetus is doomed; delivery by cesarean section is indicated if the fetus is viable and has no ultrasonic evidence of untreatable major malformation.

Adult↗
PubMed1983

Jaundice: a 10 year review of 41,000 live born infants.

A review is presented of jaundiced newborn infants during the 10-year period to 1980. Included are those whose serum bilirubin level was 154 mumol/l or more. Of 41,057 live births, 4,406 (10.7%) infants had hyperbilirubinaemia. The most common (19.9;%) aetiological factor was prematurity, followed by ABO erythroblastosis 7.1%; sepsis 3.4%; Rhesus erythroblastosis 2.7%; bruising 2.2%; multifactorial 1.0% and glucose-6-phosphate dehydrogenase deficiency 0.5%. Treatment was not undertaken in 2,855 (64.7%) infants, but 1,419 (32.2%) received phototherapy alone, 122 (2.7%) infants received both exchange transfusion and phototherapy and 10 (0.2%) infants received exchange transfusion alone. Of the infants requiring exchange transfusion 50.0% had Rhesus erythroblastosis, 28.0% ABO erythroblastosis, 10.6% jaundice of prematurity and the remainder were due to a variety of causes. Sixty-three (1.4%) infants died, with two deaths being related to the hyperbilirubinaemia, as their death was due to necrotizing enterocolitis following exchange transfusion. Phototherapy proved safe with no deaths directly attributable to its use.

ABO Blood-Group System↗
PubMed1983

Non-immune hydrops fetalis: changing contribution to perinatal mortality.

During the decade to 1979, 203 hydropic infants died in the State of Victoria, Australia. Non-immune hydrops fetalis (NIHF) became more common than immune hydrops fetalis as a cause of fetal hydrops, and its contribution to the total perinatal mortality increased from 0.1% to 3%. The perinatal mortality rate of infants with NIHF was virtually 100%. The most consistent finding at post-mortem was pulmonary hypoplasia which was probably due to compression from serous cavity effusions. Survival may be improved by early diagnosis and termination of the pregnancy in selected patients with viable infants before the development of gross serous cavity effusions. The most constant clinical sign associated with hydrops fetalis was polyhydramnios which is an indication for ultrasonography and cardiotocography to detect cases of NIHF and to select the optimum time for delivery.

Australia↗
PubMed1983

Prospective follow-up of growth retarded infants and of those from pregnancies complicated by low oestriol excretion--7 years.

Growth and neurological outcome to 7 years of age were determined in 273 growth retarded infants, 341 infants from pregnancies complicated by subnormal urinary oestriol excretion and 72 control infants. By 1 year of age 80.6% of growth retarded infants were above the 10th percentile for weight. Growth continued so that after 2 years of age only 10.6% were beneath the 10th percentile. A neurological abnormality was detected in 9.5% of growth retarded infants and 8.3% of control infants (P = NS). Only 6 (2.2%) of the growth retarded infants were severely handicapped. A neurological abnormality was detected in 16.4% of infants from pregnancies with low oestriol excretion and although this incidence was higher than that of the control infants (8.3%), the difference failed to achieve statistical significance. The neurological abnormality was severe in only 7 infants (2.1%). The intelligence quotient (IQ) was the same in infants from pregnancies complicated by chronically low oestriol excretion whether hypertonic dextrose (mean IQ 103) had been administered to the mother or not (mean IQ 105). It is concluded that the pregnancy complicated by low oestriol excretion and/or fetal growth retardation should be treated with optimism.

Child↗
PubMed1983

Intrauterine growth retardation.

Fetal growth retardation ranks third after prematurity and malformations as a cause of perinatal deaths. Antenatal fetal monitoring (biochemical testing of fetoplacental function plus cardiotocography) has emerged as the most important means of reduction in the number of stillbirths and improvement in the quality of survival of infants who are born alive. Clinical acumen combined with biochemical and/or ultrasonographic testing will identify no more than 70% of growth retarded fetuses. However, not all small for dates fetuses are at risk, and many doomed to die in utero are not by definition, growth retarded. It should be the obstetrician's aim to identify the fetus at risk of death from hypoxia whether growth retarded or not. Biochemical and ultrasonographic methods of testing are not truly comparable, since some aim to identify the growth retarded fetus, irrespective of his state of health, whereas others aim to detect fetoplacental dysfunction, irrespective of whether or not the fetus is growth retarded. With present methods of antenatal diagnosis and treatment and timing of delivery determined by nonstressed cardiotocography, the physical and intellectual prognosis of growth retarded infants is most satisfactory; follow-up studies have shown that only about 2% of these infants are severely handicapped.

Delivery, Obstetric↗
PubMed1982

Nonimmunologic hydrops fetalis: a review of 61 cases.

Sixty-one cases of nonimmunologic hydrops fetalis were studied. The incidence of nonimmunologic hydrops fetalis, 1 in 3748 births, was unchanged in 2 decades. The mortality from nonimmunologic hydrops fetalis remained high (98%). Polyhydramnios (75%), anemia (45%), and preeclampsia (29%) were the commonest prenatal maternal complications, whereas postpartum hemorrhage or difficulty with placental delivery, or both, occurred in 64%. Ultrasound examination always was successful in detecting the hydropic state. Many presumed etiologic factors were noted, although in 38% no possible cause was found. A major congenital anomaly was present in 41%. The obstetric and neonatal care of nonimmunologic hydrops fetalis must be improved. If nonimmunologic hydrops fetalis is diagnosed during the investigation of polyhydramnios, consideration should be given to early delivery in the interest of the fetus.

Edema↗
PubMed1981

Bilirubin binding capacity and free bilirubin concentration: fluorescence quenching compared with peroxidase oxidation and sephadex column elution techniques.

Fluorescence quenching was compared with the techniques of peroxidase oxidation and Sephadex column elution for determining free bilirubin concentrations and the capacity of albumin to bind bilirubin and assessed as to its suitability for use as a routine method in a clinical laboratory. The poor reproducibility of the fluorescence quenching method made it unacceptable and peroxidase oxidation was found to be the most satisfactory technique. The Sephadex column elution technique did not measure free bilirubin concentration but gave a good estimate of binding capacity. This method is, however, limited by the sample size required for performing the determinations.

Bilirubin↗