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Biomedical subjects

M L Chiswick

Publications and source records attributed to M L Chiswick.

At least 55 records · Page 3Linked to original sources
PubMed1984

Maternal diabetes and neonatal respiratory distress. I. Maturation of fetal surfactant.

The phospholipid composition of amniotic fluid samples from 30 normal patients and 44 diabetic patients over the last 10 weeks of pregnancy was studied. Higher levels of phosphatidylcholine (PC) and phosphatidylinositol (PI) were found in diabetic pregnancies where there was excellent glucose control. These differences were statistically significant at 34-36 weeks. Phosphatidylglycerol (PG) appeared significantly earlier in the well controlled diabetic pregnancies, but even in the poorly controlled diabetics the levels of PC, PI and PG were comparable to those in normal pregnancies. There was no evidence of delayed appearance of fetal surfactant phospholipids in either the well or poorly controlled diabetic pregnancies. The absolute lecithin (PC)/sphingomyelin (SM) ratio in diabetic pregnancies was generally greater for any given gestational age than those in normal pregnancies. Whilst in most cases this was due to a higher PC concentration, in a few poorly controlled diabetics it was the result of a lower concentration of SM.

Amniotic Fluid↗
PubMed1984

Maternal diabetes and neonatal respiratory distress. II. Prediction of fetal lung maturity.

Fifty babies were born at less than or equal to 37 weeks to mothers with diabetes. Delivery was undertaken in all patients with the reassurance that the L/S ratio was greater than or equal to 2.0 within the preceding 72 h. Five babies (10%) developed respiratory distress syndrome (RDS). Prediction of fetal lung maturity was improved dramatically by measuring amniotic fluid concentrations of phosphatidylcholine (PC), phosphatidylinositol (PI) and phosphatidylglycerol (PG). Fourteen babies were predicted as having 'no surfactant' (PC less than 20 mg/l, PI less than 2 mg/l and PG less than 2 mg/l), five developed RDS. None of the remaining 36 babies developed the illness: they were predicted as having either 'early surfactant' (PC greater than or equal to 20 mg/l, PI greater than or equal to 2 mg/l but PG less than 2 mg/l) or 'late surfactant' (PC greater than or equal to 20 mg/l, PI greater than or equal to 2 mg/l and PG greater than or equal to 2 mg/l). Measurement of PC levels alone was the most was the most accurate method of predicting RDS. There was a significant association between low surfactant phospholipid concentrations and the development of transient tachypnoea of the newborn.

Amniotic Fluid↗
PubMed1983

Protective effect of vitamin E (DL-alpha-tocopherol) against intraventricular haemorrhage in premature babies.

Forty four babies, of less than 32 weeks' gestation, were either randomly given 25 mg/kg vitamin E (DL-alpha-tocopherol acetate) intramuscularly after birth (day 0) and on days 1, 2, and 3 or served as controls. Frequent real time ultrasound examinations of the brain were made in each baby during the first week and less frequently thereafter. In babies under 32 weeks' gestation the incidence of intraventricular haemorrhage was lower in supplemented babies (18.8%) compared with the controls (56.3%). On days 0, 1, 2, and 3 median plasma vitamin E concentrations in babies without haemorrhage and in those with subependymal haemorrhage only were similar. Babies with intraventricular haemorrhage had lower median concentrations on day 1 (p less than 0.002) and day 2 (p less than 0.05) compared with those with subependymal haemorrhage and lower concentrations on day 0 (p less than 0.02) and day 1 (p less than 0.05) compared with those without haemorrhage. These findings suggest that in premature babies vitamin E, an antioxidant, protects endothelial cell membranes from oxidative damage and disruption and limits the magnitude of haemorrhage and its spread from the subependyma into the ventricles.

Cerebral Hemorrhage↗
PubMed1983

Protective effect of vitamin E on intraventricular haemorrhage in the newborn.

Forty-four consecutively born babies of birth weights under 1751 g were randomly selected to receive a daily intramuscular injection of vitamin E (all-rac-alpha-tocopheryl acetate) from the day of birth (Day 0) until Day 3, or were allocated to a non-supplemented control group. Frequent ultrasound examinations of the brain were made during the first week of life and babies were classified as having 'no haemorrhage', 'subependymal haemorrhage (SEH) only' or 'intraventricular haemorrhage' (IVH). The incidence of SEH or IVH was similar in supplemented (42.9%) and control babies (43.5%). SEH or IVH was observed only in babies of less than 32 weeks gestation; when only babies under 32 weeks were considered, IVH was less common in those supplemented (18.8%) than in the controls (56.3%). Babies with IVH had lower median plasma vitamin E concentrations when compared with babies without any haemorrhage and compared with those with only SEH. Three supplemented babies suffered IVH and they were the three with the lowest plasma vitamin E concentrations among the babies supplemented with vitamin E from Day 0 to Day 3. We speculate that vitamin E protects endothelial cell membranes of capillaries in the subependymal layer of the brain against oxidative damage and disruption and thereby limits the magnitude of haemorrhage in the subependymal layer, and reduces the risk of extension into the ventricles.

Cerebral Hemorrhage↗
PubMed1982

Outcome for newborn babies declined admission to a regional neonatal intensive care unit.

Between July 1979 and June 1980 the regional neonatal intensive care unit (NICU) at St Mary's Hospital, Manchester, received 170 requests from maternity units for the transfer of ill newborn babies. Most of the babies were suffering from respiratory failure. The initial request was declined in 65 babies because of overcrowding or lack of facilities at the NICU (n = 59), or because transfer was not justified on medical grounds (n = 6). Forty-two of the 65 babies were compelled to remain in the maternity unit because they could not be accommodated at hospitals with facilities for ventilating newborn babies. The neonatal survival rate of babies with respiratory failure who were transferred to the NICU was 66% whereas the survival rate of similar babies who were declined transfer was 30%. Our findings support the efficacy of intensive care for ill babies with respiratory failure and suggest that such facilities need to be more widely developed.

England↗
PubMed1981

Dietary vitamin E and polyunsaturated fatty acid (PUFA) in newborn babies with physiological jaundice.

We studied 69 term babies aged 2-8 days who had physiological jaundice and who were fed formula A (Ostermilk Complete; vitamin E, 0.46 mg per 100 ml; polyunsaturated fatty acid (PUFA), approximately 0.08 g per 100 ml), or formula B (Cow and Gate Premium; vitamin E, 1.0 mg per 100 ml; PUFA, approximately 0.55 g per 100 ml) or breast milk. Babies fed formula B, with the greatest vitamin E and PUFA content, had a significantly higher mean plasma vitamin E level compared with those fed formula A, even as early as the second and third day. Breast fed babies, 2-3 days old, had a lower mean plasma vitamin E level compared with formula B fed babies, thereafter vitamin E levels in breast fed babies rose. The RBCs of babies fed formula B and breast milk were significantly less susceptible to hydrogen peroxide (H2O2) haemolysis compared with the RBCs of those fed formula A. Reduced susceptibility to H2O2 haemolysis in formula B fed babies was observed in those as young as 2-3 days. Susceptibility to H2O2 haemolysis did not correlate with haemoglobin concentration, plasma bilirubin nor with the reticulocyte count in babies on different feeds. We conclude that in term newborn babies the vitamin E and PUFA contents of the milk feeds influence plasma vitamin E levels and susceptibility of RBCs to H2O2 haemolysis, but do not have an important bearing on the occurrence of physiological jaundice.

Erythroblastosis, Fetal↗
PubMed1979

Regional organisation of neonatal intensive care in the North-west.

From January 1976 to July 1978, 234 ill neonates were transported to the regional neonatal intensive care unit (ICU) of St Mary's Hospital, Manchester, from 26 maternity hospitals three to 120 miles (4.8-193.1 km) away. Ninety per cent were transferred from 15 hospitals within a 30-mile (48.3 km) radius of the ICU. Most referring hospitals had more than 2000 births a year and offered good nursing supervision of high-risk neonates in conventional special care baby units (SCBUs). In 200 of the 234 babies respiratory symptoms precipitated referral, hyaline membrane disease being the most common final diagnosis. Altogether 143 babies received definitive mechanical ventilation, and most of them were ventilated in the ambulance en route to the ICU. The neonatal survival rates for all babies and for those who received mechanical ventilation were 61% and 45% respectively. Lethal inoperable malformations and tentorial tears accounted for 23 of the 92 deaths.A crisis-orientated referral service directed towards the treatment of babies with impending or actual respiratory failure needs close collaboration between the regional ICU and referring SCBUs, with parallel development of their facilities and skills. A complementary but distinct pattern of referral is necessary to cater for those high-risk but not critically ill babies who are born in hospitals that lack staff and facilities to provide the vigilant and anticipatory care that is so necessary.

Critical Care↗