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Biomedical subjects

N Rutter

Publications and source records attributed to N Rutter.

At least 73 records · Page 4Linked to original sources
PubMed1987

Percutaneous drug absorption in the newborn: hazards and uses.

The newborn infant's skin is not a complete barrier to the absorption of externally applied agents, particularly if it is damaged, diseased, or immature. Immaturity is the most important factor that determines percutaneous absorption. Very immature infants in the early neonatal period have a poorly developed epidermis, which is readily permeable to drugs. The main consequences of percutaneous absorption are hazardous. Topically applied agents are absorbed, causing toxic systemic effects that may result in illness and even death without the cause being recognized. No drug or antiseptic agent should be applied to the premature infant's skin without consideration of the effects that might result from percutaneous absorption. On a more optimistic note, the relatively permeable skin could be an advantage to the preterm infant by providing an alternative method of drug administration. The drug theophylline for example can be absorbed and produce therapeutic blood levels for up to 3 days after a single topical application. There is a need for the development of transdermal drug delivery systems for the newborn infant similar to those currently used for therapy in adults.

Administration, Cutaneous↗
PubMed1986

Effect of night and day on preterm infants in a newborn nursery: randomised trial.

The effect of alternating night and day on sleep, feeding, and weight gain in 41 healthy preterm infants was examined in a randomised controlled trial. Twenty infants from a night and day nursery, where the intensity of light and noise was reduced between 7 pm and 7 am, spent longer sleeping and less time feeding and gained more weight than 21 infants from a control nursery, where the intensity of light and noise was not reduced. Differences were significant and became apparent only after discharge home; they were still present three months after the expected date of delivery, when infants from the night and day nursery were an average of 0.5 kg heavier (p less than 0.02). These findings suggest that physical environment has an effect (either direct or indirect) on the subsequent behaviour of preterm infants and that exposure to night and day is beneficial.

Body Weight↗
PubMed1986

Echo planar imaging of normal and abnormal connections of the heart and great arteries.

Echo planar imaging (EPI) is that form of magnetic resonance imaging which provides very short image acquisition times. EPI also provides very rapid sequential imaging. The EPI method is ideal for imaging the heart and thoracic content because images are devoid of cardio-respiratory motion artefact. Previously an analysis of transectional images has been presented. This paper is concerned with the study of the heart by the use of EPI constructions in the sagittal and coronal planes. Defining connections between ventricle and great artery is of cardinal importance in paediatric cardiology. EPI constructions in the normal heart, transposition, truncus arteriosus and right heart hypoplasia are presented and discussed.

Heart Defects, Congenital↗
PubMed1986

Transectional echo planar imaging of the heart in cyanotic congenital heart disease.

Echo planar imaging is that form of magnetic resonance imaging which gives very short image acquisition times. The method has been used to produce images of the infant heart which are free of cardiorespiratory motion artefact, despite tachypnoea and tachycardia. EPI transections of the normal heart are compared with transections in truncus arteriosus, tetralogy of Fallot, right heart hypoplasia and transposition of the great arteries. The diagnosis of the cause of cyanosis in these infants was established by the noninvasive EPI method and validation of the findings may be found in transectional postmortem analyses reported in the literature.

Heart Defects, Congenital↗
PubMed1986

Urinary excretion of epidermal growth factor in the newborn.

Urinary epidermal growth factor (EGF) excretion was studied serially in 36 newborn infants, from 26 to 40 weeks gestation, from birth to three months of age. All infants excreted EGF from birth. Excretion was significantly higher in term infants than in preterm infants at birth; in term infants excretion rose steadily in early infancy and there was a similar but delayed rise in EGF excretion by preterm infants. Urinary EGF excretion appears to be related to age from conception and birth does not influence it. There was no correlation between urinary EGF excretion and the rapid maturation of the lungs and skin which occurs in preterm infants in the early neonatal period.

Aging↗
PubMed1986

Percutaneous respiration in the newborn infant.

Percutaneous respiration was studied in 27 newborn infants (birth weight 0.96 to 4.43 kg, gestation 27 to 40 weeks) using a closed skin cell attached to the upper abdomen into which saturated air at 37 degrees C was introduced. Gas exchange across the skin was found to be strongly related to gestational age. Term infants had lower rates of gas exchange than found across adult skin (mean O2 absorption 32.0 vs 62.0 ml/m2/hr, mean CO2 excretion 40.5 vs 86.5 ml/m2/hr). In the first few days of life infants of less than 31 weeks gestation had rates of gas exchange five to six times higher (mean O2 absorption 178.4 ml/m2/hr, mean CO2 excretion 214.8 ml/m2/hr) than those in term infants, but these fell rapidly toward term levels by 2 weeks of age. Gas exchange correlated well with skin water loss, suggesting that the epidermal barrier limits both processes. There was a linear increase in skin O2 absorption as the O2 concentration in the skin cell increased. We estimate that if in the early neonatal period an infant of less than 31 weeks gestation were nursed naked in 40% oxygen, about 13% of total resting oxygen requirements could be obtained through the skin. Under certain limited circumstances, percutaneous oxygen delivery might be clinically useful.

Diffusion↗
PubMed1986

The effect of maternal labetalol on the newborn infant.

The possibility that placentally-transferred labetalol might cause sympathetic blockade in the newborn infant was examined by measuring systolic blood pressure, heart and respiratory rates, palmar sweating, blood glucose and the metabolic and vasomotor responses to cold stress. Measurements were made serially over the first 72 h of life in 22 term infants, 11 born to mothers treated with labetalol and 11 carefully matched controls. Infants of mothers treated with labetalol showed a mild transient hypotension which had disappeared within 24 h [mean systolic blood pressure at 2 h, 58.8 (SEM 2.4) mmHg compared with 63.3 (SEM 3.0) mmHg for controls, P less than 0.05]. There were no other significant differences between the two groups. It is concluded that labetalol does not cause clinically important sympathetic blockade in the mature newborn infant.

Blood Pressure↗
PubMed1986

Periventricular leucomalacia and intraventricular haemorrhage in the preterm neonate.

Two hundred very low birthweight infants were prospectively scanned to ascertain the incidence of periventricular leucomalacia (PVL) and haemorrhage. Before collection of data, clear definitions of ultrasound abnormalities believed to represent PVL and intraventricular haemorrhage were described. These referred to small and moderate intraventricular haemorrhage, paenchymal haemorrhage, and PVL, including prolonged flare (echoes in the periventricular region lasting for two weeks or more and not becoming cystic). Sixty nine infants (34%) had no abnormality on ultrasound scans. Intraventricular haemorrhage occurred in 107 babies (37 grade I and 62 grade II), and only eight infants were thought to have true parenchymal haemorrhage. Ultrasound appearances of PVL were seen in 27 infants, 19 of whom developed cysts and eight died in the precystic stage. Prolonged flare occurred in another 25 babies. Unilateral parenchymal haemorrhage occurred in four infants who subsequently developed cystic PVL in the contralateral hemisphere. Twenty one infants developed ventricular dilatation, 12 of whom had associated parenchymal lesions. Haemorrhage, PVL, and flare occurred commonly in infants of 30 weeks' gestation and below and became markedly less common in more mature infants. We believe prolonged flare represents a form of PVL, and in this study a total of 52 (26%) infants had an ultrasound appearance of periventricular leucomalacia, an incidence considerably higher than previously reported.

Age Factors↗
PubMed1986

Serum albumin concentrations and oedema in the newborn.

Serum albumin concentration was measured in 195 infants of 25 to 42 weeks' gestation during the neonatal period. Concentrations were significantly lower in preterm infants, rising from a mean of 19 g/l at 26 weeks to 31 g/l at term. There was a 15% increase in albumin concentrations in the first three weeks of life. Oedema in the early and late neonatal period was common in preterm infants but correlated poorly with hypoalbuminaemia. Measurement of serum albumin concentrations in preterm infants either routinely or because of oedema is not clinically useful.

Connective Tissue Diseases↗
PubMed1986

Reduction of skin damage from transcutaneous oxygen electrodes using a spray on dressing.

A spray on, copolymer acrylic dressing (Op-Site) was used to limit the skin damage caused by a transcutaneous oxygen electrode and its adhesive ring. Two identical electrodes were applied to the abdominal skin of 10 preterm infants, one on untreated skin, the other after application of Op-Site. It was found that Op-Site prevented the epidermal damage (as measured by transepidermal water loss) that occurs when the adhesive ring is removed from untreated skin. It did not interfere with transcutaneous oxygen measurements; absolute values and response times were unchanged. Op-Site is therefore useful in preventing the skin trauma that occurs when transcutaneous oxygen monitoring is being performed in preterm infants below 30 weeks' gestation in the first week of life. Care must be taken, however, to prevent a build up of Op-Site--it should be applied as a single layer, allowed to dry, and removed after use.

Electrodes↗
PubMed1986

Development of the epidermis in the newborn.

Histological development of the epidermis was studied on skin samples from 169 infants (gestation 24-40 weeks, age up to 1 year). Gestation markedly influenced epidermal development. Before 30 weeks, the epidermis is thin, has few cell layers and a poorly formed stratum corneum, but by 34 weeks it has largely matured. Postnatal influence on epidermal development is marked in the preterm infant, so that histologically the epidermis of the most immature infant resembles that of a term infant by 2 weeks of age. These changes in histology exactly parallel the development of the barrier properties of newborn skin.

Epidermis↗
PubMed1985

Percutaneous administration of theophylline in the preterm infant.

The preterm infant's skin is a poor barrier to the absorption of chemical agents. The possibility of turning this to the infant's advantage was explored by using the percutaneous route to administer theophylline. A standard dose of theophylline gel, equivalent to 17 mg anhydrous theophylline, was applied to an area of skin 2 cm in diameter over the upper abdomen under an occlusive dressing, and serial theophylline levels were measured; 25 studies were performed in 20 infants of less than or equal to 30 weeks gestation. Therapeutic theophylline levels (greater than 4 mg/L) were achieved in 11 of 13 infants who had not previously received the drug, and were maintained for up to 72 hours. In 12 studies in infants who were previously receiving aminophylline intravenously, theophylline levels were maintained for up to 70 hours. There was a significant decline in the amount of theophylline absorbed in the first 24 hours after application as the infant's postnatal age increased, but satisfactory blood levels were achieved in infants up to 20 days of age. The percutaneous route is a feasible method of administering theophylline in preterm infants.

Absorption↗
PubMed1985

Cardiac arrhythmias misdiagnosed as epilepsy.

A mother and three children presenting with syncope induced by exercise and emotion were diagnosed as epileptic. They, and three symptom free children, showed frequent ventricular and supraventricular tachyarrhythmias on ambulatory electrocardiographic monitoring. Three died before the correct diagnosis of disordered sympathetic innervation of the heart was made, but episodes of syncope and cardiac arrhythmias in the survivors have been successfully treated by propranolol.

Arrhythmias, Cardiac↗
PubMed1985

Humidification of incubators.

The effect of increasing the humidity in incubators was examined in 62 infants of less than 30 weeks' gestation. Thirty three infants nursed in high humidity for two weeks were compared retrospectively with 29 infants from an earlier study who were nursed under plastic bubble blankets or with topical paraffin but without raised humidity. Humidification reduced skin water loss and improved maintenance of body temperature from birth, but did not delay the normal postnatal maturation of the skin. Infants nursed without humidity frequently became hypothermic in spite of a high incubator air temperature. These advantages must be weighed against the finding that overheating was more common and Pseudomonas was more commonly isolated from the infants. It is recommended that incubator humidity is raised for babies under 30 weeks' gestation in the first days of life but meticulous attention should be paid to fluid balance, avoiding overheating, and cleansing of the humidifier reservoir.

Body Temperature↗
PubMed1985

The evaporimeter and emotional sweating in the neonate.

Emotional sweating from the palm of the hand occurs from birth in the term infant and can be conveniently measured with a skin evaporimeter. Such measurements provide objective information about an infant's state of arousal that might be useful to neonatologists and psychologists who are interested in studying stress and its modification in the newborn.

Electronics, Medical↗
PubMed1983

Barrier properties of the newborn infant's skin.

The barrier properties of the skin were examined in 223 studies in 70 newborn infants of 25 to 41 weeks' gestation, aged from 1 hour to 26 days. Percutaneous drug absorption was studied by observing the blanching response to solutions of 1% and 10% phenylephrine applied to a small area of abdominal skin. Skin water loss was measured at the same site using an evaporimeter. Infants of 37 weeks' gestation or more showed little or no drug absorption and had low skin water losses, indicating that their skin is an effective barrier. By contrast, infants of 32 weeks' gestation or less showed marked drug absorption and high skin water losses in the early neonatal period, indicating that their skin is defective as a barrier. Both drug absorption and water loss in these infants fell steadily; by about 2 weeks of age the skin of the most immature infants functioned like that of mature infants. The varying barrier properties can be explained by the poor development of the stratum corneum in the more premature infants at birth and its rapid maturation after birth. The trauma caused to the skin by use of adhesive tape and the fixation of transcutaneous oxygen electrodes resulted in increased drug absorption and water loss from the damaged area.

Absorption↗