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Biomedical subjects

P R Dear

Publications and source records attributed to P R Dear.

At least 37 records · Page 2Linked to original sources
PubMed1990

How do parents of babies interpret qualitative expressions of probability?

One hundred mothers and 50 medical students and doctors were interviewed to examine their understanding of eight common probability expressions as they are used in statements of the kind that doctors regularly make to mothers of babies. Respondents were asked to translate each term into a number on a scale from 0 to 10. There was a wide range of interpretation of the expressions, and significant differences were found between the mothers and medical group for seven of the expressions. Most mothers expressed a preference for receiving information in numerical terms. We advise that verbal probability expressions should be restricted, and more information presented in numerical terms.

Communication↗
PubMed1989

An outbreak of acinetobacter septicaemia in a neonatal intensive care unit.

We describe an outbreak of Gram-negative septicaemia due to a rare, non-fermenting, aerobic organism, Acinetobacter calcoaceticus var. lwoffi. The outbreak occurred on a neonatal unit and was confined to babies who were receiving parenteral nutrition. Seven babies developed septicaemia within 24 hours. The source of the outbreak was never firmly established, but contamination of the parenteral nutrition fluid was considered most likely. All 7 babies recovered uneventfully after a week's course of intravenous ceftazidime. Thrombocytopenia was an unexpected feature of this infection.

Acinetobacter Infections↗
PubMed1989

Adrenal response in very low birthweight babies after dexamethasone treatment for bronchopulmonary dysplasia.

The tetracosactrin stimulation test was used to assess the adrenal responsiveness of 22 very low birthweight babies who had received a three week course of dexamethasone for the treatment of bronchopulmonary dysplasia. Five babies were studied in detail with blood samples taken for cortisol concentrations at 30 minute intervals for four hours. The tests were performed before, during, and after treatment with dexamethasone. A distinctive pattern of cortisol response to tetracosactrin was found among these babies, which was quite unlike that found in older children and adults. Using our pretreatment results as control data we conclude that there is undoubtedly evidence of modest suppression of the adrenal axis during dexamethasone treatment, although there is considerable recovery one month after stopping steroids. Basal cortisol concentrations, however, remained low in some cases, which may indicate the need for temporary corticosteroid replacement during severe illness.

Adrenal Glands↗
PubMed1989

Phycomycotic abscesses in a preterm infant.

We report a case of neonatal infection with rhizopus, one of the Mucoraceae family. Human infection is rare but the mortality is high without prompt, correct treatment. The infant had a simultaneous candida septicaemia secondary to colonisation of a central venous line. Serial C reactive protein estimations are valuable in monitoring treatment.

Abscess↗
PubMed1989

Plasma amino acid concentrations in parenterally fed preterm infants.

One hundred and nine sick preterm infants were studied, and the data obtained show that hyperphenylalaninaemia is an extremely rare occurrence as long as an adequate source of energy is provided. High concentrations of the other aromatic amino acid (tyrosine) on the other hand, were often encountered and seem to be due to immaturity of an isolated hepatic enzyme as there was no correlation between phenylalanine and tyrosine concentrations. Possible adverse consequences of hypertyrosinaemia are discussed in relation to toxicity and the assessment of hepatic function. We provide reference centiles for plasma amino acid concentrations in this population.

Amino Acids↗
PubMed1988

Oral vancomycin in prevention of necrotising enterocolitis.

Eighty four very low birthweight babies (considered high risk for developing necrotising enterocolitis) were given vancomycin orally for 48 hours before introduction of oral feeds; one developed necrotising enterocolitis. One hundred and twenty very low birthweight babies (not considered such high risk) were fed without first receiving vancomycin; 17 developed necrotising enterocolitis. Although this was not a randomised control trial, results indicate a role for vancomycin in prophylaxis of necrotising enterocolitis.

Administration, Oral↗
PubMed1988

Comparison of capillary and arterial blood gas measurements in neonates.

One hundred and fifty eight paired arterial and capillary blood samples were obtained from 41 sick preterm infants in their first week of life and the pH, and PCO2, and PO2 concentrations were measured. Half of the capillary samples were obtained from unwarmed heels and half from heels warmed to 40 degrees C. A potentially significant discrepancy (arbitrarily defined as 0.05 units for pH. 1 kPa for PCO2, and 3 kPa for PO2) was found in 19 (24%) of cases for pH, in 9 (11%) for PCO2 and in 21 (26%) for PO2. Warming the heel produced no significant improvement in results. We conclude that capillary blood provides satisfactory measurements of pH and PCO2 for all but the most critical purposes, but that the usefulness of capillary PO2 estimations is limited to the exclusion of hypoxia.

Arteries↗
PubMed1988

Determination of plasma bicarbonate of neonates in intensive care.

Most modern blood-gas analyzers are programmed to use the Henderson-Hasselbalch equation to calculate a value for plasma bicarbonate. It has been suggested, however, that among acutely ill patients, including newborns, these calculated values may be at variance with measured total CO2. To assess the clinical significance of such errors, we compared calculated bicarbonate with measured total CO2 in 79 blood samples from 40 babies in intensive care. The calculated bicarbonate values consistently exceeded the measured values by about 1.5 mmol/L. Of the errors, 94% were within the range -10% to +20%. When the systematic bias was removed, calculated and measured bicarbonate values agreed within +/- 3.30 mmol/L in 95% of cases. Because calculated values can be obtained much more quickly and frequently than laboratory measurements, we believe that these limits are clinically acceptable.

Bicarbonates↗
PubMed1987

Establishment of an intermediate care ward for babies and mothers.

This paper describes one year's experience with the running of a special postnatal ward area, established so that babies who needed more treatment and monitoring than is generally undertaken on postnatal wards but who did not need the facilities of the neonatal unit could be kept by their mother's bedside. This 'intermediate care ward' admitted 297 babies with their mothers during its first year of operation. We estimate that the opening of the ward led to a 20% reduction in admissions to the neonatal unit, without disadvantage to any baby. The indications for admission are outlined and the reactions of patients and staff to the innovation discussed.

Birth Weight↗
PubMed1987

The intersex baby.

About one in 2000 newborn babies has an ambiguity of the external genitalia. The extent of the ambiguity gives no clue to the underlying aetiology. In this article the intersex disorders are discussed, with particular emphasis on the chromosomal and endocrine investigations.

Adrenal Hyperplasia, Congenital↗
PubMed1986

Fatty acid composition of plasma and erythrocyte phospholipids in preterm infants.

Erythrocyte and plasma phospholipid fatty acids were determined in preterm babies at 0, 6 and 10 weeks. There were highly significant changes in fatty acid composition between birth and 6 weeks in both plasma and erythrocyte phospholipids, the changes being more numerous and quantitatively greater in phosphatidyl choline. There was little further change by 10 weeks. Linoleic acid increased by approximately 100% at 6 weeks in plasma phosphatidyl ethanolamine and 200% in phosphatidyl choline. In erythrocyte phosphatidyl ethanolamine, linoleic acid increased by approximately 150% at 6 weeks and in phosphatidyl choline increased 170%. Arachidonic acid decreased by 54%. The essential fatty acid status of the preterm babies studied using contemporary feeding regimes was satisfactory and by 6 weeks phospholipid fatty acid profiles were comparable with published data for normal healthy breast-fed infants.

Erythrocytes↗
PubMed1986

The early anaemia of the premature infant: is there a place for vitamin E supplementation?

1. The efficacy of oral vitamin E supplementation in preventing the early anaemia of the premature infant was assessed in a 10-week double-blind trial. Forty-two babies received either a placebo or 5 or 15 mg supplementary vitamin E/d with oral feeding. No infant received less than the recommended vitamin E:polyunsaturated fatty acid (E:PUFA) value of 0.6. No iron supplement was given. 2. Weekly full blood counts were taken, and plasma vitamin E assay and in vitro haemolysis tests performed on blood sampled on day 1, and also at 6 and 10 weeks of age. All blood withdrawn and transfused and all feeds were documented. 3. Thirty-six (86%) of the babies had a plasma vitamin E level at birth below the accepted adult norm, i.e. less than 5200 micrograms/l. At 6 weeks of age thirty-three (79%) and at 10 weeks thirty-five (83%) of the babies had levels within the normal adult range. No baby showed either clinical or haematological evidence of a vitamin E deficiency state during the trial. 4. It is concluded that in the absence of Fe supplementation and observing the minimum recommended E:PUFA value, contemporary feeding practices allow for the absorption of sufficient vitamin E by the premature baby to prevent the development of an early haemolytic anaemia. 5. No significant relation was found between plasma vitamin E levels and the degree of peroxide haemolysis.

Anemia↗
PubMed1986

Dicarboxylic aciduria and medium chain triglyceride supplemented milk.

Pronounced dicarboxylic aciduria was observed in preterm infants fed a medium chain triglyceride supplemented milk formula. As many special formulas contain a medium chain triglyceride oil attention needs to be drawn to its metabolic effects, regarding the diagnosis of inborn errors of metabolism and that dicarboxylic acids might be harmful.

Animals↗