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Biomedical subjects

L W Doyle

Publications and source records attributed to L W Doyle.

At least 109 records · Page 6Linked to original sources
PubMed1989

Health literature for parents of children with cerebral palsy.

This study examined the use of and need for written educational material by the parents of 41 children with cerebral palsy, aged between five and 63 months. After their initial counselling, the majority felt that they needed written information. The parents of 31 children attempted to find suitable books or pamphlets, but in 13 cases they failed to do so or found the material unsatisfactory. A significant association was found between reading material which the parents found satisfactory and their knowledge about the basic features of cerebral palsy.

Books↗
PubMed1988

Increased mortality of preterm infants transferred between tertiary perinatal centres.

Over 18 months almost one quarter of infants born before 30 weeks' gestation in a tertiary perinatal centre who required intensive care had to be transferred to other tertiary centres because intensive care facilities were fully occupied. When infants with lethal congenital malformations were excluded half of the 34 infants who were transferred died; this was twice the mortality (24%) in the 111 infants remaining. The difference between the groups was significant (relative odds = 3.1) and remained so after adjustment for any discrepancies in gestational age (relative odds = 4.0). After adjustment for potential confounding variables by logistic function regression the risk of dying for those transferred remained significantly higher than that for infants who remained (relative odds = 4.6, 95% confidence interval 1.8 to 12.1). As the requirement for neonatal intensive care is episodic and unpredictable more flexibility has to be built into the perinatal health care system to enable preterm infants delivered in tertiary perinatal centres to be cared for where they are born.

Australia↗
PubMed1988

Muscular strength at 5 years of children with a birthweight under 1500 g.

The hand-grip strength was measured as part of the 5-year neurodevelopmental assessment of 24 very low birthweight (VLBW) and 18 normal birthweight (NBW) children. Hand-grip strength was significantly lower in the VLBW children for left and right hands tested individually and for both hands used concurrently. Increasing hand-grip strength was significantly related to 5-year weight percentiles and to being in the NBW group. More of the VLBW children weighed less than the 10th percentile. After adjusting for the 5-year weight percentile, the hand-grip strength of VLBW children was still significantly lower than that for NBW children. This is another aspect of development in which VLBW children are disadvantaged.

Body Weight↗
PubMed1988

Mode of delivery of preterm twins.

At one high-risk perinatal centre over a 9-year period, 83.1% (103/124) sets of liveborn twins with gestational ages less than 33 weeks were delivered vaginally. Mortality in vaginal births was 26.7% (55/206), almost double that of Caesarean births of 14.3% (6/42), a non-significant difference. When gestational age discrepancies were corrected, however, the trend favouring survival of Caesarean births disappeared. Furthermore, there were no significant associations between mode of delivery and the condition of the infants at birth, or the presence of respiratory distress in the nursery. Because Caesarean section carries substantial risks for the mother our practice of predominantly vaginal deliveries for preterm twins should continue.

Asphyxia Neonatorum↗
PubMed1987

Extremely-low-birthweight infants: neurological, psychological, growth and health status beyond five years of age.

Of 60 consecutive survivors of birth weight 500-999 g, who were born in one tertiary perinatal centre from 1977 to 1980, 59 infants were assessed by a multidisciplinary team at two years of age (corrected for prematurity) and 58 children were evaluated when aged at least five years. At the latter examination, 9% of the 58 children who were assessed were severely disabled; 17% had a mild or moderate disability; and 74% had no important disability. For the 53 children who were tested, the means for the three scales of the Wechsler Preschool and Primary Scales of Intelligence were just above the test mean. The psychologist noted behavioural problems during her assessment in 50% of children, and 29% of mothers reported behavioural problems which could interfere with schooling. At the age of five years and over, five (9%) children had cerebral palsy and one child was deaf. Twenty-two (38%) children had a visual impairment, although only one child was blind; the detection of retinopathy of prematurity in the nursery was an important risk factor. Health problems with readmissions to hospital and suboptimal growth were present in many children at two years of age and frequently these problems persisted to five years of age. Although only four (7%) children were too disabled to attend a normal school, apprehension exists that many of the other children may later encounter educational difficulties. At the two-years' assessment, ascertainment of cerebral palsy had not been complete or entirely accurate and the Mental Developmental Index of the Bayley Scale tended to underestimate the later psychological performance.

Cerebral Palsy↗
PubMed1987

Care of very low birthweight infants with limited neonatal intensive care resources.

The advanced technology that is available to treat the tiniest infants has raised the legal and moral dilemma of where and how to distribute limited intensive care resources. In one neonatal intensive care unit it was determined that approximately 80% of its resources over a two-year period were utilized by very low birthweight infants, in spite of the fact that these infants comprised less than 50% of the total admissions to the unit. It was not possible to offer all very low birthweight infants full intensive care; to make this possible, it was calculated that resources would have to increase by 26%. In the present economic climate, and with limited numbers of nurses who are skilled in neonatal intensive care, the prospects for extra resources are poor. What action can or should be taken, legally and morally, when no facilities exist to treat a live-born infant who may possibly benefit from intensive care?

Australia↗
PubMed1987

Cerebral palsy in very low birthweight infants surviving to 2 years with modern perinatal intensive care.

The rate of cerebral palsy and factors associated with its occurrence were determined in surviving 2-year-old very low birthweight (VLBW) infants born during an era of modern perinatal intensive care. Of the survivors, 12.5% (52/416) of those traced had spastic cerebral palsy. Motor handicaps were mild in 42%, moderate in 25%, and severe in 33% of children with cerebral palsy. The prevalence of cerebral palsy was similar in all birthweight groups up to the upper limit of 1500 gm, and was considerably higher than in survivors born in the same hospital a decade earlier. Although several perinatal variables were associated with the occurrence of cerebral palsy, either singly or in combination, little statistical or clinical confidence would be placed in these associations. Moreover, although 77% of children with cerebral palsy had one or more commonly recognized perinatal risk factors, almost identical rates of risk factors were present in normal children. The advent of cranial ultrasonography during the time of the study was associated with an increase in mortality but no effect on the prevalence of cerebral palsy. Cerebroventricular hemorrhage correlated poorly with the presence of cerebral palsy. The prevalence of cerebral palsy in surviving VLBW infants is unacceptably high; however, no obvious preventable factors in its etiology could be identified.

Australia↗
PubMed1987

Escalating consumption of nursery resources by extremely immature infants.

Over a 9-year period at one tertiary perinatal centre there were 59,650 livebirths; although only 1,123 (1.9%) were born at or before 30 weeks' gestation, this small minority of infants consumed 71.7% of total patient-days in the neonatal intensive care unit (NICU) and an inordinate 87.9% of total patient-days of assisted ventilation. Infants born at 24 weeks required 39 times the patient-days of assisted ventilation and 19 times the patient-days in the NICU per survivor compared with those born at 30 weeks' gestation. In infants born before 28 weeks, for each week of decrease in gestation, survivors averaged an extra 13.0 days of assisted ventilation, stayed in the NICU 13.8 days more, and in hospital 14.9 days longer. Any therapy before 28 weeks which can keep infants safely in the uterus could save approximately 2 weeks of nursery resources for each extra intrauterine week and would be beneficial economically, even if it meant hospitalization of the mother over that time.

Female↗
PubMed1986

Effects of antenatal steroid therapy on mortality and morbidity in very low birth weight infants.

A cohort of 678 consecutive very low birth weight infants, liveborn in one tertiary institution during a 63-month period, was studied to investigate whether antenatal steroid therapy had any beneficial or harmful effects on mortality or morbidity over the first 2 years of life. Comparing the 244 babies who received treatment with the 434 controls, 195 (79.9%) and 265 (61.1%), respectively, were discharged home (P less than 0.001). Mortality in the treated group remained substantially lower and was almost halved after adjustment for birth weight, extreme immaturity, lethal malformations, and confounding obstetric variables (P = 0.001). Fatal cases of respiratory distress syndrome were less common in the treated group (P = 0.044). Of in-hospital survivors, those in the treated group required less positive pressure respiratory support (P = 0.003) and fewer days in oxygen (P = 0.018), and the incidences of bronchopulmonary dysplasia (P = 0.003) and patent ductus arteriosus (P = 0.002) were lower. Two-year survivors who had received treatment were heavier (P = 0.016) and had larger head circumferences (P = 0.029). These beneficial associations in the treated group were not at the expense of increased rates of infection or adverse neurologic outcome. We did not detect any adverse effects of antenatal steroid therapy on any relevant aspect of mortality or morbidity in infancy under circumstances in which the chances of finding substantial differences were high.

Betamethasone↗
PubMed1986

Fetal intravascular transfusion for severe erythroblastosis: effects on haematology and survival.

Since February 1984, 8 fetuses (including a set of hydropic twins) with severe erythroblasts in the second trimester have received intravascular transfusions guided by ultrasound. These transfusions were associated with a decreasing fetal reticulocytosis, a decreasing proportion of circulating fetal haemoglobin and a decreasing mean fetal red corpuscular volume. All infants were born alive at an average of 5.5 weeks after the first transfusion; 3 infants died, including the hydropic twins and another with lethal congenital anomalies. All 5 survivors required simple transfusions for up to 54 days after birth because of prolonged bone marrow suppression. In severe erythroblastosis in the second trimester, direct intravascular transfusion using ultrasound guidance promises to improve fetal outcome.

Blood Transfusion, Intrauterine↗
PubMed1985

Outcome for the very low birth-weight (500-1,499g) singleton breech: benefit of caesarean section.

Between January 1, 1977 and March 31, 1982, 84 of 131 (64.1%) consecutive liveborn very low birth-weight (VLBW) singletons delivered after breech presentation were discharged home alive. Of babies delivered by Caesarean section 40 of 47 (85.1%) survived, versus 44 of 84 (52.4%) delivered vaginally (X2 = 12.6, p less than 0.0005). When differences in birthweight and antenatal steroid therapy were adjusted by multiple regression analysis, after excluding a lethally malformed baby who was diagnosed antenatally and babies who were not treated aggressively because they were thought to be too immature (n = 19), those delivered by Caesarean section were still more likely to survive (p = 0.038). In survivors completely assessed at 2 years of corrected age, there was a statistically significant association between Caesarean section and reduced handicap (p = 0.019). For the VLBW singleton breech, there is good evidence that delivery by Caesarean section is beneficial.

Apgar Score↗
PubMed1985

Cesarean section or vaginal delivery at 24 to 28 weeks' gestation: comparison of survival and neonatal and two-year morbidity.

A large cohort of consecutive live births with gestational ages assessed antenatally from 24 to 28 weeks from one tertiary center was studied to determine the association between mode of delivery and in-hospital mortality and morbidity and morbidity at two years of age. Between 1 January 1977 and 31 March 1982, 52.8% (172 of 326) of such infants survived their primary hospitalization. Obstetric factors independently associated with improved survival were increasing gestational age (P less than .0001), the absence of maternal hypertension (P = .007), singleton pregnancy (P = .007), and antenatal steroid therapy (P = .018). Although 62.7% (32 of 51) of infants delivered by cesarean section survived compared with 50.9% (140 of 275) of infants delivered vaginally, the increased survival was not statistically significant (X 2 = 1.97). Moreover, the trend favoring cesarean section disappeared after adjustment for confounding obstetric factors. In univariate analyses cesarean births more frequently required ventilatory support and there was a trend toward a lower incidence of cerebroventricular hemorrhage; again, however, when adjusted for extraneous factors these associations disappeared. Of the 172 in-hospital survivors, five died at home unexpectedly; 162 of the remaining 167 were traced; 18 (11.1%) had cerebral palsy and two (1.2%) were deaf. Of the 111 children who were fully assessed, 13.5% had major handicaps, 23.4% were suspect, and 63.1% were free of handicap at two years' corrected age. There was no association between mode of delivery and frequency of handicap. Little evidence was found from mortality or morbidity data to support routine delivery of infants of borderline viability by cesarean section.

Birth Weight↗
PubMed1983

Regional cerebral glucose metabolism of newborn infants measured by positron emission tomography.

The new diagnostic technique, positron emission tomography with 18F-2-fluoro-2-deoxy-D-glucose (18FDG), was used to measure regional cerebral glucose metabolism in five newborn infants with demonstrated structural abnormalities of the brain. 18FDG was synthesized, diluted in normal saline and injected intravenously. After one hour, tomographic slices of the brain were obtained, the level of the slices being defined relative to the cerebral ventricles. Glucose metabolism of grey- and white-matter structures in the brain could be differentiated clearly. Decreased glucose metabolism was identified in regions of the brain shown by computerized axial tomography to be structurally abnormal. Positron emission tomography is a promising new diagnostic tool for the study of newborn infants with suspected abnormalities of brain function.

Brain↗
PubMed1982

A randomised trial of oral gammaglobulin in low-birth-weight infants infected with rotavirus.

Oral human gammaglobulin or placebo was given with each feed during the first week of life to 75 low-birth-weight babies. All were in a nursery where rotavirus was known to be endemic, 25 of the babies excreted rotavirus during the first 2 weeks of life. This group was regarded as the "challenge" group. Gammaglobulin administration was associated with delayed excretion of rotavirus and with milder symptoms of infection. Rotavirus-associated diarrhoea necessitating low-lactose feeds developed in 6 of 11 babies given placebo and 1 of 14 babies given gammaglobulin. Oral human gammaglobulin seems to protect low-birth-weight infants from diarrhoea caused by rotavirus.

Administration, Oral↗
PubMed1982

Insensible water loss in newborn infants.

In this review we have described, in some detail, the physical processes involved in water loss from both the skin and lungs. Although at first glance these physical processes may seem complex and confusing, once the basic concepts are grasped, the effect of the many variables in both the babies and their environment on IWL can be seen more clearly. Measurement of IWL, or its components, TEWL and RWL, is difficult in newborn infants. Some of the difficulties arise because of the nature of the subject being studied, and because of inaccuracy in the measuring apparatus. The difficulties in the subjects include lack of cooperation, and the presence of severe illness, both of which may limit the representativeness of any sample of babies that is eventually studied successfully. The size of the subjects studied means that small amounts of water are given off in any fixed period of time. Consequently, the accuracy of the measuring instruments has to be high. As we have discussed, each of the methods used to estimate IWL, TEWL, or RWL has limitations and potential inaccuracies. Despite the difficulties in obtaining estimates of IWL in newborn infants, there have been many studies over the years that have provided clinically useful data. More recently, improved survival of VLBW infants has lead to an awareness that IWL is substantially increased in these tiny babies. The best way to manage the problems of water and heat balance associated with increased IWL in VLBW infants remains to be determined.

Adult↗