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Biomedical subjects

P MacMahon

Publications and source records attributed to P MacMahon.

18 recordsLinked to original sources
PubMed2002

Outcome of acute intussusception in a regional paediatric centre.

It has been suggested recently that acute intussusception should only be managed in a specialised paediatric centre. The aim of this study is to assess the incidence and outcome of acute intussusception in a comprehensive paediatric unit in Waterford Regional Hospital. It is a retrospective medical records study over a ten year period from June 1990 to June 2000. Our results showed that we had 24 cases giving an incidence of 2.4 cases per year. Contrast enema was performed in 23(95%) cases, successfully reduced in 14(61%) cases, unsuccessfully reduced in 7(30%). Surgical intervention was necessary in 7(30%) cases. Three (12.5%) cases were transferred to a specialised paediatric surgical centre. There were no perforation or death. We conclude from this study that management of acute intussusception can be successfully undertaken in a regional paediatric centre. It requires adequate throughput of cases and close co-operation between paediatrician, radiologist, anaesthetist, surgeons and of course a dedicated paediatric nursing staff.

Child, Preschool↗
PubMed2002

Deliberate self poisonings in children and adolescents--a frightening scourge.

Paediatricians may be called on to see a suicidal child or adolescent in the emergency department as a psychiatric consultation is not always immediately available. The paediatrician will then play a pivotal role in the evaluation and disposition of the patient.(1) American reports have shown that 8% of high school students have made a suicidal attempt and that 2% had made an attempt that required medical attention.(2) Suicidal attempts account for 12% of all emergency department visits for the adolescent age group.(3) In the U.K. overdoses account for 4.7% of all general hospital admission in those aged 12-20 years. (4) In Republic of Ireland the most recent national vital statistics data revealed that over a period of one year July'97 - July '98, more than 650 children and adolescents were admitted to hospital with the deliberate self poisoning. The female to male ratio was 3:1.(7)

Adolescent↗
PubMed2000

Prophylaxis in RSV infection (Palivizumab)--is it worthwhile?

Respiratory syncytial virus (RSV) is a recognised cause of lower respiratory tract infection in infants and young children. It causes severe respiratory disease in preterm infants with or without chronic lung disease. This study, conducted at Waterford Regional Hospital, evaluates the incidence of RSV infection in hospitalised children, its seasonal variation, and effectiveness of its prevention. Thirty eight percent of admitted children with bronchiolitis were RSV positive in the year 1999 November to March is the peak season for this infection. A highly selected group of 7 preterm children with or without chronic lung disease received Palivizumab prophylaxis. Not one of them acquired RSV infection. The high cost of Palivizumab was the main factor for its restricted use. Palivizumab was found to be effective in preventing RSV infection in our study. Since we had a small number of patients, further studies are needed for its economic and judicious use. Respiratory syncytial virus (RSV) is virulent easily transmissible and the most common cause of lower respiratory tract disease in children of less than 2 years of age. Up to 98% of children attending day care will be infected in single RSV season. Between 0.5% and 3.2% of children with RSV infection require Hospitalisation. Approximately 90,000 hospital admissions and 4500 deaths per year were reported in United States. In Ireland 2807 patients were admitted with Bronchiolitis in 1998. Major risk factors for hospitalisation due to RSV are Prematurity, chronic lung disease, congenital heart disease, compromised immunity and age younger then 6 weeks in otherwise healthy children. No effective treatment of RSV positive bronchiolitis beside supportive care in the form of adequate nutrition and oxygen therapy is available. Antiviral therapies such as Ribavirin has not been proved to be effective in RSV infection. Bronchodilators show variable results. Corticosteroids were not found effective. There is no effective vaccine available as yet. There is no proven method for active immunity. Various immunoglobulins are available for acquiring passive immunity against RSV infection. PREVENT study group in Jan. 1997 showed intravenous immunoglobulin (RSV- IGIV) use in reducing 41% to 63% hospitalisation in RSV patients. But RSV-IGIV was not licensed outside the United States because of risk of transmission of blood borne products, difficulty in administration ie. intravenous access, large fluid volume (15 ml/kg), high protein load (750 mg/kg), shortage of supply and need to postpone live vaccine (eg. MMR, varicella). monoclonal antibody Palivizumab was developed for prophylaxis against RSV infection. Clinical safety and efficacy of Palivizumab were demonstrated in IMpact trial published in Sept. 1998. Reduction in hospitalisation up to 55% was noted in this study. It was a pivotal randomised, double blind, placebo controlled phase 3 study conducted in 139 centres throughout Canada, United States and United Kingdom. We looked at our experience in patients admitted with bronchiolitis in Waterford Regional Hospital. We described the outcome of carefully selected Seven children of high risk group for Palivizumab prophylaxis. Its clinical Implications and cost effectiveness was evaluated in this study.

Antibodies, Monoclonal↗
PubMed1990

Routine lumbar punctures in the newborn--are they justified?

The records of 62,107 neonates cared for at three neonatal referral units between 1979 and 1985 were analysed with regard to the number of lumbar punctures (LP) performed and the results obtained. The mean perinatal mortality rate was 9.3/1000 live births and the neonatal mortality rate was 5.9/1000. The units were comparible in this respect. Two hundred and sixty three (0.4%) babies weighed less than 1.0 kg at birth and 510 (0.8%) babies weighed 1.0-1.5 kg. A total of 1554 LPs were performed on 1084 babies, 1.7% of the whole population. Seventeen babies were diagnosed as having meningitis following CSF examination; 5 weighed less than 1.5 kg (VLBW) (incidence of meningitis 6.5/1000 births) and 12 weighed more than 1.5 kg (incidence 0.2/1000 live births). An LP was performed on 44% of VLBW babies and 1.2% of babies weighing more than 1.5 kg. In both groups approximately 1.5% of CSF samples were positive. Eight of the 17 positive results were obtained during the first 3 postnatal days. Only one VLBW baby had meningitis on the 1st day of life (1.3/1000). In view of the low incidence of meningitis and the risk factors associated with an LP it is questionable whether this procedure should be a routine investigation in the VLBW newborn.

Humans↗
PubMed1990

Calcium and phosphorus solubility in neonatal intravenous feeding solutions.

The limited solubility of calcium and phosphorus in standard parenteral nutrition formulations has restricted the ability to provide sufficient minerals to preterm infants to prevent substrate deficient metabolic bone disease. We determined the solubility limits of calcium and phosphorus in a total of 160 formulations under carefully controlled conditions. By increasing the concentrations of dextrose, amino acids, and by using Addiphos instead of 8.7% dipotassium hydrogen phosphate as the phosphorus source, higher concentrations of both calcium and phosphorus were held in solution. This should permit the delivery of increased concentrations of these minerals at rates which approximate fetal accretion.

Amino Acids↗
PubMed1990

Acid-base state of the preterm infant and the formulation of intravenous feeding solutions.

An acidic intravenous source of phosphorus (Addiphos) was compared with dipotassium hydrogen phosphate in 25 preterm infants to study acid-base state. Eight infants were given either Addiphos or dipotassium hydrogen phosphate alternately for 48 hour periods and similar amounts of calcium and phosphorus were delivered. There were no significant differences in calcium and phosphorus intake, calcium and phosphate plasma concentrations, or acid-base state between study periods on the two solutions. Seventeen infants were given the two solutions alternately for 72 hour periods; Addiphos was used to increase the amounts of calcium and phosphorus being delivered. Calcium and phosphorus intake was decreased on dipotassium hydrogen phosphate, but Addiphos significantly increased calcium and phosphorus intake and plasma calcium and phosphate concentrations. It also lowered the pH of the urine and raised the titratable acidity. Acid-base state, however, was not significantly different. It is therefore possible to increase intake of calcium and phosphorus in preterm infants without causing a significant metabolic acidosis.

Acid-Base Equilibrium↗
PubMed1990

A further family with congenital renal proximal tubular dysgenesis.

A new syndrome of oligohydramnios, Potter's syndrome, and anuric renal failure leading to stillbirth or neonatal death from respiratory failure has recently been described. Histologically, there is renal tubular dysgenesis, especially of the proximal tubules, and apparent glomerular crowding. To date, five families have been reported, in four of which there have been affected sibs and in two parental consanguinity. The disorder is, therefore, thought to be inherited in an autosomal recessive manner.

Adult↗
PubMed1989

Early parenteral feeding of amino acids.

Serial 24 hour balance studies of nitrogen and energy were carried out over 10 days in two groups of ventilator dependent preterm infants, of comparable weight and gestational age. In one group (n = 10) a parenteral amino acid source (Vamin 9) was started within 24 hours of birth, and in the other group (n = 11) it was not started until 72 hours. The feeding protocol was otherwise identical. The nitrogen intake (286 compared with 21 mg/kg/day), energy intake (188 compared with 151 kJ), and nitrogen retention (120 compared with -133 mg/kg/day), were all significantly higher during the first three days of life in the group in which the amino acid solution was started early. There were no differences by 7-10 days. The early introduction of amino acids improves the early nutritional state of sick preterm infants.

Amino Acids↗
PubMed1989

Association of mineral composition of neonatal intravenous feeding solutions and metabolic bone disease of prematurity.

To assess the effects of increasing the mineral content of parenteral nutrition solutions on the biochemical and radiological indicators of metabolic bone disease of prematurity 27 neonates who required parenteral nutrition were sequentially allocated to receive either a standard solution (group 1) or one with an increased mineral content (group 2). The 13 patients in group 1 received 0.68 mmol/kg/day of calcium and 0.61 mmol/kg/day of phosphorus, and the 14 in group 2 received 1.25 and 1.20 mmol/kg/day, respectively. The two groups did not differ significantly in the severity of their illness measured by birth weight, gestational age, duration of parenteral nutrition or ventilation, or the amount of supplementary oxygen required. In patients in group 2 the median plasma phosphate concentration was higher, the plasma alkaline phosphatase activity was lower, and there was less radiological evidence of rickets. There were no complications caused by excess calcium and phosphorus, and the rate of growth was similar in both groups. We conclude that an increased mineral content in parenteral nutrition solutions reduces the severity of metabolic bone disease in sick infants who require this form of nutrition.

Alkaline Phosphatase↗
PubMed1986

Low inspired oxygen concentrations in very-low-birthweight infants needing ventilatory support: an approach to the prevention of retrolental fibroplasia.

The level of arterial oxygen tension [Pa,o2] at which retrolental fibroplasia (RLF) may develop in very-low-birthweight infants is not known, but may be less than 100 mmHg (13.3 kPa). We report an infant of 27 weeks gestation who developed RLF despite continuous monitoring of Pa,o2 from 2 h to 4 weeks of age, with no recorded values above 95 mmHg (12.7 kPa). We therefore decided to maintain the Pa,o2 below 80 mmHg (10.7 kPa) in very-low-birthweight infants, using when necessary a low oxygen gas mixture (fractional inspired oxygen concentration 0.16-0.20). We report the use of this approach in four infants, all of whom survived without evidence of RLF. The need for further clinical studies of such an approach is discussed.

Female↗
PubMed1984

Prescribing and formulating neonatal intravenous feeding solutions by microcomputer.

This paper describes a computer programme for a low cost microcomputer designed to assist in the task of administering total parenteral nutrition to neonates: no knowledge of computers is necessary to operate the system. The programme displays recommended values for each of the total parenteral nutrition constituents that must be prescribed, based on detailed analysis of all the pertinent variables. The recommended values may be rejected but they do provide a useful prompt, especially for the more junior doctors. The programme includes a number of safeguards that protect against entering potentially dangerous values. As soon as the operator has completed the procedure of entering total parenteral nutrition requirements the calculations necessary to formulate a solution containing these are automatically performed. The print out contains this data plus instructions on the infusion rate and an analysis of the formulation's calorific content. This system makes it easier to vary the quantity of individual total parenteral nutrition constituents and time has been saved which was previously wasted performing laborious calculations. One of the most important contributions has been the virtual elimination of errors in the complex task of prescribing and formulating total parenteral nutrition for sick neonates.

Computers↗
PubMed1983

Pulmonary artery growth during treatment with oral prostaglandin E2 in ductus dependent cyanotic congenital heart disease.

Growth of the pulmonary arteries was assessed in 11 patients with cyanotic congenital heart disease treated with oral prostaglandin E2. Each patient was dependent on patency of the ductus arteriosus for maintenance of the pulmonary circulation. Measurements were made initially from angiographic data obtained in the neonatal period. Subsequent assessments were made at the time of surgery after an interval of 2-8 months, during which time all the infants had gained weight normally. Comparisons were made with data obtained from 13 normal necropsy specimens. In only 4 of the 11 patients had the pulmonary arteries grown appreciably during the treatment period. In 2 patients no growth occurred, while in 5 patients the pulmonary arteries had actually become smaller. It had been hoped that the pulmonary arteries would grow in all 11 patients during this period, facilitating later surgical intervention. In patients with ductus-dependent cyanotic congenital heart disease, the prolonged use of oral prostaglandin E2 should be restricted to patients in whom the pulmonary arteries are too small to allow a palliative operation to be performed initially.

Body Weight↗
PubMed1983

Hyponatraemia caused by repeated cerebrospinal fluid drainage in post haemorrhagic hydrocephalus.

Three hyponatraemic infants had post-haemorrhagic hydrocephalus which was treated by repeated drainage of cerebrospinal fluid. Each required oral sodium supplements. The concentration of sodium in the cerebrospinal fluid was such that as much as 3 mmol of sodium could have been removed with each ventricular tap. Serum sodium concentrations should be monitored closely in any infant requiring regular drainage of cerebrospinal fluid.

Cerebral Hemorrhage↗