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Biomedical subjects

M L Chiswick

Publications and source records attributed to M L Chiswick.

70 records · Page 4Linked to original sources
PubMed1979

Kielland's forceps: role of antenatal factors in prediction of use.

The association between certain antenatal factors and the use of Kielland's forceps was analysed retrospectively in liveborn singleton births that occurred at this hospital between January and December 1976. Factors significantly associated with the use of Kielland's forceps were primiparity, short maternal stature, induction of labour, late engagement of the fetal head, low ratio of maternal height to fetal occipitofrontal head circumference, slow dilatation of the cervix in labour, and the use of epidural analgesia in labour. The findings support a contribution of cephalopelvic disproportion in the genesis of malposition, and when associated with slow dilatation of the cervix delivery should be expedited. Long-term follow-up studies are needed, however, before the role of caesarean section in reducing morbidity associated with malposition can be properly assessed.

Anesthesia, Epidural↗
PubMed1979

Kielland's forceps: association with neonatal morbidity and mortality.

The incidence of certain neonatal complications associated with the use of Kielland's forceps was analyzed retrospectively in liveborn singleton babies delivered at this hospital between January and December 1976. The neonatal mortality rate attributable to use of the forceps was 34.9 per 1000. The incidences of delayed onset of respiration (17.4%), birth trauma (15.1%), and abnormal neurological behaviour--namely, apathy or irritability or both--(23.3%) significantly exceeded those in a matched group of babies born spontaneously. Fetal asphyxia played a major part in the aetiology of neonatal complications. Babies on whom Kielland's forceps were used, however, had a significantly greater incidence of abnormal neurological behaviour even in the absence of fetal asphyxia (14.3%), and in all of these babies the abnormal behaviour was transient and did not necessitate admission to the special-care baby unit. Neither maternal height nor the infant's birth weight or occipitofrontal head circumference influenced the occurrence of neonatal complications. The results also suggest that neither the speed of cervical dilatation nor the timing of engagement of the fetal head is of help in predicting the occurrence of neonatal complications after the use of Kielland's forceps.

Anesthesia, Obstetrical↗
PubMed1979

Foot length--a new and potentially useful measurement in the neonate.

The foot length, occipito-frontal head circumference (OFC), crown-rump, and crown-heel length (CHL) of 123 neonates of gestational ages 26-42 weeks, were measured between 12 hours and 5 days. A gauge, designed and constructed at St Mary's Hospital, Manchester, was used to measure foot length. In term babies (37-42 weeks) who were of weights appropriate for gestational age (AGA) the scatter about the mean of foot length measurements was small (coefficient of variation = 4.5%) compared with birthweight (coefficient of variation = 12.0%). The wide range of foot length measurements in babies of different gestational ages prevented maturity being accurately estimated. The mean birthweight of term light-for-dates (LFD) babies was 30.9% lower than term AGA babies, whereas the mean foot length, OFC, and body length of LFD babies was reduced by only 4.2-8.8%. There was a positive linear correlation between foot length and other indices of body size in LFD and AGA babies of all gestational ages. However, in premature babies (less than 37 weeks) the correlation between foot length and birthweight (r = 0.95) and foot length and CHL (r = 0.96) was pronounced. The 95% confidence limits of the regression lines were +/- 327 g and +/- 2.3 cm respectively. Birthweight and CHL of premature babies can therefore be estimated from a measurement of foot length that is performed simply and rapidly. Measurements of foot length are valuable in premature babies who are too ill at birth for conventional anthropometric measurements to be made, and in whom such measurements cannot be carried out subsequently because of the encumbrance of the incubator and intensive care apparatus. Drug dosages and intravenous fluid requirements based on body weight or surface area can be indirectly calculated from a measurement of foot length.

Anthropometry↗
PubMed1977

Computerized transverse axial tomography in the newborn.

7 babies, aged 6 days--8 wk, who presented with abnormal neurological signs during the first days of life were investigated by computerized transverse axial tomography. 3 babies had suffered perinatal asphyxia. Only 1 baby required a general anaesthetic to facilitate the investigation. Structural intracranial lesions were seen in 6 babies and comprised hydranencephaly, cerebral agenesis with grossly dilated lateral ventricles, unilateral cerebral oedema, subarachnoid cyst of localized cerebral atrophy.

Brain↗
PubMed1977

Exchange transfusion and serum vitamin E (tocopherol) concentration in the newborn.

17 babies suffering from haemolytic disease or "hyperbilirubinaemia of prematurity" underwent exchange transfusion in the first 4 days of life. In 14 babies, including all those who had abnormally low pre-exchange serum vitamin E levels (<0.5 mg/100 ml), the vitamin E concentration rose as a result of exchange transfusion. In 3 babies the serum vitamin E concentration fell as result of exchange transfusion, but in no case was the post-exchange level below 0.5 mg/100 ml. The normal range of plasma vitamin E in stored ACD blood was 0.44--1.24 mg/100 ml. It was concluded that although vitamin E deficiency might be a factor in the aetiology of the anaemia of prematurity, prior subjection to exchange transfusion is unlikely to make a significant contribution to the vitamin E deficiency.

Erythroblastosis, Fetal↗
PubMed1976

Crying vital capacity. Measurement of neonatal lung function.

Serial measurements of crying vital capacity (CVC), expressed as ml/cm chest circumference, were made by reverse plethysmography during the first 2 weeks of life. Clinically normal babies born at term by elective caesarean section had a smaller mean CVC in the first 2 weeks of life compared with clinically normal term babies born vaginally. In contrast, no significant difference was shown between the mean CVC in term babies born vaginally and those born by urgent caesarean section. Clinically normal term babies born by caesarean section (elective and urgent) had a smaller mean percentage rise of CVC in the first 24 hours of life and a significant delayed rise of CVC from 24-48 hours compared with those born vaginally. Clinically normal preterm babies born vaginally had a smaller mean CVC in the first 2 weeks of life compared with term babies born vaginally, and were characterized by a significant rise of CVC from 5-10 days. Babies with hyaline membrane disease (HMD) had a smaller CVC in the first 2 weeks of life compared with clinically normal preterm babies. Babies of various gestational ages with transient tachypnoea (TT) had a smaller mean CVC in the first 2 weeks of life compared with clinically normal term babies, but a similar mean CVC in the first 72 hours of life compared with clinically normal preterm babies. At each postnatal age the mean CVC of babies with HMD was less than the corresponding mean in babies with TT. All babies with TT had a rise in CVC from 24-48 hours, whereas CVC fell in all babies with HMD except one during this period. CVC is a simple, safe, rapid, and noninvasive test of neonatal lung function, and is a valuable aid to other methods of assessing pulmonary function in the neonate with respiratory distress.

Age Factors↗
PubMed1976

Prolonged rupture of membranes, pre-eclamptic toxaemia, and respiratory distress syndrome.

A retrospective analysis was made of the incidence and severity of the idiopathic respiratory distress syndrome (RDS) in babies of less than 35 weeks' gestation born at this hospital from January 1967-December 1974. There was a lower incidence of RDS in babies born after pregnancies complicated only by prolonged rupture of membranes (PRM) (19%) and in babies born vaginally after pregnancies complicated only by pre-eclamptic toxaemia (PET) (18%) compared with the incidence of RDS after uncomplicated pregnancies (35%). Babies born vaginally who developed RDS after pregnancies complicated by PRM or PET had less severe disease compared with those who developed RDS after uncomplicated pregnancies. Mortality in babies who developed severe RDS was not influenced by the occurrence of PRM or PET. The biological implication of the study is that certain complications of pregnancy may accelerate pulmonary surfactant production in preterm babies.

Cesarean Section↗
PubMed1971

Association of oedema and hypomagnesaemia with hypocalcaemic tetany of the newborn.

The cases of 18 babies with hypocalcaemic tetany of the newborn are described. Studies were made before and 24 and 48 hours after therapy with calcium supplements. Twelve of the babies were non-oedematous and showed a positive correlation between serum calcium and magnesium levels. They showed a rise in serum magnesium levels during therapy with calcium. The other six had bilateral pitting oedema of the feet and greater weight gains in the first two weeks of life. They had abnormally low serum magnesium levels which did not correlate with the calcium levels. Furthermore, the serum magnesium levels, unlike those in the non-oedematous group, did not increase when calcium supplements were given. It is suggested that oedema in babies with hypocalcaemic tetany may be more common than is generally recognized, and that a contributory factor in the production of the hypomagnesaemia may be secondary aldosteronism.

Age Factors↗