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Biomedical subjects

N Rutter

Publications and source records attributed to N Rutter.

At least 91 records · Page 5Linked to original sources
PubMed1983

Pneumothorax in the neonatal period.

The incidence of pneumothorax in the neonatal period is reviewed. Most infants who developed a pneumothorax were undergoing intermittent positive pressure ventilation. The most common underlying pathology associated with pneumothorax was idiopathic respiratory distress syndrome. This was the only condition in which a pneumothorax occurred in spontaneously breathing patients. The development of a pneumothorax was not significantly related to gestational age, birth weight, high ventilator inflation pressure, maximum fractional inspired oxygen concentration or the method of delivery. Evidence is presented to suggest that the development of a pneumothorax is not primarily a complication of ventilation but is due to the more severe pulmonary pathology of infants who require ventilatory assistance. Whatever the mechanism, prompt diagnosis and treatment mean that this common complication does not necessarily increase mortality.

Birth Weight↗
PubMed1983

Making heel pricks less painful.

A mechanical lancet, the Autolet, was compared with a manual heel prick in 36 newborn infants undergoing routine blood sampling for the Guthrie test and hypothyroid screening. Each method was equally effective in obtaining satisfactory blood samples but the Autolet was considerably less painful.

Blood Specimen Collection↗
PubMed1983

Responses of the newborn infant to overheating.

The responses of newborn babies to overheating were investigated by exposing them to progressively higher incubator air temperatures until either sweating occurred or the rectal temperature reached 37.9 degrees C. 112 studies were performed on 83 healthy term and preterm infants. Activity, posture, heart rate, respiratory rate, skin colour and abdominal skin and hand temperature were monitored. Most babies regardless of gestational age became less active, and they frequently fell asleep at the warmest setting. The majority of infants altered their posture from predominantly flexion to extension. There were no significant changes in heart rate or respiratory rate. The skin of almost all the babies became redder, and the difference between central and peripheral skin temperatures decreased with warming. The pattern of these changes varied with maturity suggesting the development of vasomotor control. It is a surprising finding that even the most immature babies appear to make appropriate responses to heat stress. These responses may aid in the recognition of a baby who is too warm.

Body Temperature↗
PubMed1982

The heat balance of small babies nursed in incubators and under radiant warmers.

The heat balance of 12 healthy preterm babies (mean birth weight 1.58 kg, gestation 32 weeks, age 7 days) was studied first in an incubator and then under a radiant warmer during normal nursing. Heat production and heat loss by radiation, convection and evaporation were measured in presumed thermoneutral conditions. Although rectal and mean skin temperatures were normal and the same in both environments, there were important differences. Radiation was the major source of heat loss in the incubator and convective losses were low. Under the radiant warmer convection was the major source of heat loss and heat was gained by radiation. A small rise in metabolic heat production occurred under the radiant warmer. Respiratory water loss was low in both environments. Skin water loss was significantly higher under the radiant warmer. The most immature baby (gestation 28 weeks) could not be kept warm in the incubator despite high air temperature, because the evaporative heat loss from her skin was very high. Her body temperatures were normal under the radiant warmer. It is concluded that both devices provide acceptable thermal environments for most preterm babies but that incubators without humidification may be inadequate for immature babies with a high skin water loss.

Body Temperature↗
PubMed1982

Sweating in preterm babies.

The development of thermal sweating was investigated in 117 studies on 85 term and preterm infants. The babies were nursed naked in an incubator and exposed to progressively higher air temperatures until sweating occurred or until the rectal temperature reached 37.9 degrees C. Most babies of 36 weeks' gestation or more were able to sweat from the first day. Babies of less than 36 weeks' gestation did not sweat initially. However, postnatal existence hastened the development of sweating so that by 13 days all babies studied were able to sweat. Sweating occurred first and was most marked on the forehead. The intensity and extent of the sweat response depended on gestational age. With postnatal age the extent of the response rapidly increased but the intensity only rose slowly. The air temperature required to induce sweating was higher in the more immature babies but fell with postnatal ge. Although even the most immature infant soon develops the ability to sweat in response to heat stress, the efficiency of sweating as a thermoregulatory process is poor.

Gestational Age↗
PubMed1982

Percutaneous alcohol absorption and skin necrosis in a preterm infant.

A 27-week gestation infant developed severe haemorrhagic skin necrosis on the back and buttocks after umbilical arterial catheterisation. Before catheterisation the skin was cleaned with methylated spirits. A blood alcohol level taken 18 hours after catheterisation showed a blood ethanol level of 259 mg/100 ml and a blood methanol level of 26 mg/100 ml. We conclude that the methylated spirits caused this extensive skin damage and that percutaneous absorption via the readily permeable skin of this immature baby resulted in the dangerously high alcohol levels.

Catheterization↗
PubMed1982

Development of emotional sweating in the newborn infant.

Sweating from the palm and sole occurs independently of ambient temperature but is influenced by emotional factors. It thus provides a useful objective measure of emotional state. The development of this emotional sweating in the newborn was investigated by measuring palmar water loss and relating it to the infant's state of arousal. Although 433 individual measurements were made on 124 babies of gestational age 25 to 41 weeks and postnatal age 15 hours to 9 weeks. Palmar water loss was also recorded continuously in 22 infants undergoing heel prick for routine blood sampling. In babies of 37 weeks' gestation or more, there was a clear relationship between palmar water loss and arousal from the day of birth, and by the third week levels on vigorous crying were comparable with those of an anxious adult. Less mature babies did not show emotional sweating at birth; it was first seen at the equivalent of 36 to 37 weeks' gestation regardless of maturity. Continuous recordings confirmed the cross-sectional data and illustrated the abrupt nature of the response. Emotional sweating could be a useful tool for the assessment of emotional state of the newborn.

Emotions↗
PubMed1981

Reduction of skin water loss in the newborn. I. Effect of applying topical agents.

The waterproofing effect of a number of creams, oils, and greases was examined by measuring water loss from adult skin before and after topical application. Creams had a high water content and were ineffective, oils produced a modest fall in water loss, but paraffin in grease form had a pronounced, sustained waterproofing effect. A paraffin mixture (80% soft, 20% hard paraffin (BP) was then applied to the skin of 3 preterm babies nursed naked in incubators. Overall skin water loss fell by 40 to 60% after application and was still lower than pretreatment levels 6 hours later. The topical application of paraffin offers a new approach to reduction of the high evaporative water and heat losses of preterm babies.

Administration, Topical↗
PubMed1981

Reduction of skin water loss in the newborn. II. Clinical trial of two methods in very low birthweight babies.

Two methods of reducing evaporative water and heat loss in the newborn, the thermal blanket and topical paraffin, were compared in a clinical trial. Forty-four babies weighing less than 1.5 kg, nursed in incubators since birth, were either covered with a plastic bubble blanket or had a paraffin mixture applied to their skin at 6- and 8-hour intervals for the first 2 weeks of life. There was no significant difference between the two groups in terms of mortality, morbidity, weight gain or loss, and temperature control. Two babies in the blanket group were removed from the study because of persistently low body temperatures. Five babies in the paraffin group had minor skin rashes and a further 2 had more extensive rashes which led to their removal from the study. Both methods resulted in good temperature control in babies after the first day of life. In the first 24 hours however, neither method of treatment could prevent subnormal body temperatures in the babies weighing less than 1.0 kg, even though the incubator air temperature was on average more than 1 degree C above the rectal temperature. Other methods are necessary to achieve normal body temperatures in these vulnerable babies.

Bedding and Linens↗
PubMed1979

Water loss from the skin of term and preterm babies.

Water loss from the skin of term and preterm babies, nursed naked in incubators under neutral thermal conditions, was measured by a method based on estimating the water vapour pressure gradient close to the skin surface. 199 sets of measurements were made on 78 babies whose gestational ages ranged from 26 to 41 weeks, during the first 4 weeks of life. Babies of 34 to 41 weeks' gestation had high water losses in the first 4 hours after birth, which then fell to low levels averaging 6 g/m2 per hour. Babies of 30 to 33 weeks' gestation had high water losses in the first week which then fell to levels similar to those of mature babies. Babies less than 30 weeks' gestation had strikingly high losses, averaging 32 g/m2 per hour in the first 4 days of life. At 2 weeks, levels were still higher than those of mature babies. Light-for-dates babies had skin water losses appropriate for their gestations. The high water losses in extremely preterm babies are probably transepidermal and the result of a thin, poorly keratinised stratum corneum. Water loss from the palms and soles was high in term babies and although low in preterm babies it rose steadily in the first 4 weeks of life. This is thought to represent the onset of emotional sweating. In terms of actual heat and water lost, skin water loss is relatively unimportant in term babies nursed naked under neutral thermal conditions. However, in babies less than 30 weeks' gestation, weighing less than 1 kg, skin water loss makes a major contribution to overall water balance. Furthermore, evaporative heat loss from the skin may exceed resting heat production. It is suggested that reduction of skin water loss in these babies may increase their chances of survival and their rates of growth.

Body Water↗
PubMed1979

Response of term babies to a warm environment.

The response of healthy term babies to warm environments was assessed by placing them naked in incubators and increasing the air temperature in steps until either sweating occurred or the rectal temperature reached 37.9 degrees C. The rate of evaporation of water from the skin was measured by a method based on the estimation of vapour pressure gradient. When a 50% increase in the rate occurred at a given site, sweating was judged to have begun. 39 studies were made on 30 babies, aged from 4 hours to 11 days. As babies approached the point of sweating, spontaneous activity usually ceased, the skin reddened, and a sunbathing posture was adopted. Sweating was found on 35 occasions. It was most pronounced and often was found initially on the forehead but it was also detected on the trunk and limbs. No thermal sweating was noted on the palms or soles. Sweating generally began when the incubator air temperature exceeded 34 degrees C and the rectal temperature exceeded 37.1 degrees C, but there was wide individual variation. Older and more mature babies tended to sweat at lower air temperatures.

Age Factors↗
PubMed1978

Febrile convulsions--what do parents do?

To find out about the medical and parental management of children having their first febrile convulsion a hospital-based questionnaire study was carried out in which parents were asked what they did at the time. Fifty-four out of 89 parents brought their child directly to hospital while the remainder attempted to contact their general practitioner, usually successfully, and were then referred to hospital. Whichever course of action the parents chose the outcome was satisfactory. Eighty-seven per cent of convulsions lasted for less than 15 minutes and in only two instances did they last longer than 30 minutes. One child who had convulsions for an hour was given intramuscular phenobarbitone at home without success, and the fit was finally terminated with intravenous diazepam. Parental management of the fit was often widly inappropriate. Only a few parents laid the child on his side and waited for the fit to stop. The parents were bewildered and frightened--30% thought their child was dying or dead. Education of patents of young children is needed. Simply written instructions on how to reduce the temperature of a febrile child and manage a convulsion might help.

Attitude↗
PubMed1978

A postgraduate course in community paediatrics.

Community paediatrics is assuming increasing importance but is rarely taught as an entity. We have recently organized a course in community paediatrics for general practitioners, doctors working in the area child health services and hospital paediatricians. Features of this day release course are self-instruction at home with specially prepared material, discussion between doctors from different disciplines, discussion with non-medical professionals and the undertaking and presentation of a project. The course is flexible, and once set up can be run without extensive facilities and resources.

Child Health Services↗
PubMed1978

Hyponatraemia in children with febrile convulsions.

In a study of 23 children admitted to hospital with a febrile convulsion, mild hyponatraemia was found on 8 occasions. In 6 of these cases there was evidence of inappropriate secretion of antidiuretic hormone. The hyponatraemia is unlikely to be the cause of the convulsion, but probably predisposes the child to a subsequent convulsion during the same febrile illness.

Child, Preschool↗