Biomedical subjects
Publications and source records attributed to M Watkinson.
Ventriculomegaly is an excess of fluid in the lateral ventricles within the developing cerebrum. It is usually diagnosed at a routine fetal anomaly scan at 18-22 weeks gestation. Management of the condition and counselling of parents are difficult, as the cause, absolute risk, and degree of resulting handicap cannot be determined with confidence.
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Hypertension is rare in the newborn infant. It has a cumbersome definition and diagnosis, and screening is not justified using present definitions and technology. Thresholds for starting antihypertensive treatment in the first month of life are not clear, and the treatment is difficult, with idiosyncratic responses to drugs in neonates with varying renal and hepatic function.
Four infants developed invasive Pseudomonas aeruginosa ophthalmic infections between 5 and 90 days of age. Three died from septicaemia, and the fourth required enucleation of one eye. Absent red reflexes or other eye signs in a septicaemic infant merit urgent ophthalmological assessment for endophthalmitis, in particular, Pseudomonas.
AIM: To examine the relation of overventilation and other clinical events to the development of pneumothoraces in ventilated neonates. METHODS: A case-control study. RESULTS: Fifty three (8.7%) of 606 ventilated neonates developed a pneumothorax. Eighteen (34%) cases and 23 (43%) controls were unintentionally overventilated (PaCO(2) < 4 kPa) at some time before the pneumothorax developed in the cases (odds ratio (OR) = 0.78, 95% confidence interval (CI) 0.48 to 1.27). In the three hours before the diagnosis of pneumothorax, more cases than controls were reintubated (21/53 v 4/53; OR = 5.25, 95% CI 1.9 to 14.3), and also in seven cases (one control) the mean airway pressure was increased, whereas in nine controls (no cases) it was reduced (chi(2) = 12.0, df = 2, p = 0.001). Seven of 18 neonates diagnosed by transillumination had undergone no clinical procedures before diagnosis compared with five of 35 diagnosed radiologically (OR = 2.7, 95% CI 1.0 to 7.4). CONCLUSIONS: Unintentional overventilation was not associated with pneumothoraces. In the hours before diagnosis, there was increased clinical intervention, including reintubation; this was less so in those diagnosed by transillumination. The study did not elucidate whether such interventions caused the pneumothorax or were secondary to a failure to diagnose it.
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Explore the source record for details and available documents.
Explore the source record for details and available documents.
Explore the source record for details and available documents.
OBJECTIVE: To examine problems encountered in classifying perinatal death using the systems proposed by Hey et al. (1986) and Cole et al. (1986). SUBJECTS: 451 deaths from a regional perinatal mortality survey of which 293 had a post mortem examination. METHODS: Documents from each death were reviewed by four assessors, one from each discipline, selected randomly from a pool of obstetricians, paediatricians, general practitioners and midwives. Each assessor classified the cause of death blind to the others. The degree of agreement between assessors was calculated for the full and shortened obstetric and fetal-neonatal classifications using the kappa statistic for inter-rater agreement. RESULTS: The kappa statistic, which is a measure of the proportion of agreement above chance, gave a value of 0.55 for the full obstetric classification and 0.58 for the full fetal and neonatal classification when all four assessors made an assignment. An assignment was omitted in 6.2%, but the kappa value of zero for these omissions suggested that this was a nonsystematic result due to random protocol violations. The grouped (shortened) classifications generated a higher kappa value of 0.62 for the nine point obstetric system and 0.67 for the six point fetal and neonatal (New Wigglesworth) system. Post mortem had little effect on agreement. The best agreement levels observed were for congenital anomaly. CONCLUSION: This survey highlighted the complexity of the 22 and 24 point classifications, the uneven distribution of deaths within their categories, and the variable levels of agreement between professionals classifying deaths, thus questioning the validity of individual maternity units of health districts generating local data in this degree of detail for comparative purposes in regional and national statistics. Grouping the original categories led to greater agreement particularly for the New Wigglesworth classification. The role of post mortems in clarifying the cause of fetal and neonatal death needs further investigation.
Two different neonatal umbilical cord treatment regimens were studied prospectively. Although a greater proportion of cords had separated by the seventh day in those babies not treated with topical antiseptics (47% vs. 26%), there was a significant excess (53% vs. 30%) of umbilical colonization by Staphylococcus aureus compared to those neonates whose cords were treated with alcohol wipes and hexachlorophane powder. The main purpose of treating cords is to prevent significant S. aureus colonization, and therefore current proposals to stop antiseptic treatment of umbilical cords should be disregarded.
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OBJECTIVE: To establish the prevalence of babies born before arrival at two local hospitals. To identify women at risk of giving birth before arrival, and the morbidity and mortality associated with such births. DESIGN: A case control study. Each baby born before arrival and its mother were compared with the next born in the hospital (random control), and one matched for gestation and birthweight, together with their mothers. SETTING: Two maternity units serving East Birmingham and Solihull. SUBJECTS: All babies (and their mothers) born before arrival at these hospitals from January 1983 to December 1987. MAIN OUTCOME MEASURES: Perinatal mortality rates, patterns of perinatal morbidity, demographic, social and obstetric features of the mothers. RESULTS: 137 (0.44%) of 31,140 consecutive births were before arrival at hospital (BBA group). The perinatal mortality rate in the BBA group was 58.4/1000 (8 deaths) compared with 10.1/1000 for all inborn babies (relative risk 5.8, 95% confidence interval 2.9-11.4). In the BBA group the mean birthweight of 3008 g was 212 g (95% CI 50-374 g) less than that in the random control group; the mean gestation of 266 days was 10 days less (95% CI 5.9-14.1 days) than in the random control group. Hypothermia was the commonest morbidity. Women delivered before arrival tended to be either multigravid inner city Asians living a long way from the hospital or unmarried unbooked younger white Europeans. CONCLUSIONS: The high perinatal mortality was related to immaturity and low birthweight, rather than to birth before arrival itself. Although groups of mothers at risk of delivery before arrival can be identified more information is needed to establish whether additional antenatal care would be beneficial for these women and their babies.
Branhamella catarrhalis is a common nasopharyngeal commensal organism but is also a recognised pathogen. Lower respiratory tract infections caused by this organism have been reported in adults but not, to our knowledge, in otherwise healthy infants. Two infants, born prematurely, suffered near fatal pneumonia. Branhamella catarrhalis was the only microbial pathogen isolated in each case. We suggest that initial antibiotic therapy for severe pneumonia in young infants should be tailored to cover B. catarrhalis infection.
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Data from 634 newborn babies with birthweights less than or equal to 2000 g admitted to the South West Thames Regional Neonatal Unit in St George's Hospital since its opening in 1980 were analysed. Only 271 (43%) of the pregnancies were booked there; 200 (32%) of the babies were transferred in utero and 162 (26%) after delivery. Weight-specific neonatal survival rates, calculated after exclusion of lethal abnormalities showed that between 1001 and 1500 g, 79 (96%) of the 82 babies transferred in utero survived in 1981-1984, compared with only 57 (79%) of the 72 postnatal transfers (P less than 0.02). Under 1000 g, no such differences were found, possibly because paediatricians transferred only the fitter babies in this weight range. The birth of very-low-birthweight babies of short gestation in units unable to provide immediate resuscitation, adequate stabilization and full neonatal intensive care is a major risk factor for increased neonatal mortality. These findings support the role of regional perinatal centres as service units for antenatal transfer and neonatal intensive care, and as teaching centres.
Placental biopsies were taken immediately post partum from 65 Gambian mothers who had not received anti-malaria chemoprophylaxis during pregnancy whilst living in an area hyperendemic for Plasmodium falciparum malaria. The biopsies were examined without knowledge of the mothers' health or the outcome of pregnancies. Histologically, they were divided into two groups: those with macrophages containing malarial pigment in the inter-villous spaces, and those without such pathology. Babies with pigmented placentae had a mean (SD) weight for gestational age of 83.3 (10.6)%, which was significantly lower (p less than 0.01) than that of 91.2 (7.7)% in the non-pigmented group. The plasma oestradiol concentrations in the mothers who later delivered pigmented placentae were significantly lower from 32 weeks of gestation onwards, and did not continue to rise in the last trimester as they did in the non-pigmented group. The last trimester appears to be the critical time for protection of the foeto-placental unit against malaria. Anti-malaria chemoprophylaxis should be given to all pregnant women.