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Biomedical subjects

R W Cooke

Publications and source records attributed to R W Cooke.

At least 73 records · Page 4Linked to original sources
PubMed1991

Factors associated with chronic lung disease in preterm infants.

Among 659 infants of 30 weeks' gestation or less born in a regional perinatal centre between 1983 and 1989, 195 were ventilated for four days or more and survived to 28 days, and 87 of these developed chronic lung disease. There was a sevenfold increase in the annual incidence of chronic lung disease over time. During the same period there were significant increases in the number of infants who survived, the incidence of septicaemia, and the use of parenteral lipid emulsions. Chronic lung disease was significantly associated with low birth weight, shorter gestation, duration of ventilation, vaginal delivery, sepsis, and the use of lipid. Respiratory and physiological measurements at 96 hours were significantly worse in infants who subsequently developed chronic lung disease. Initial logistic regression showed that gestation, arterial carbon dioxide tension (PaCO2), and ventilation rate at 96 hours; and birth in 1988 or 1989, were independently associated with chronic lung disease, but when septicaemia and use of lipid during the first 21 days were included, only gestational age (odds ratio 0.64, 95% confidence interval (CI), 0.49 to 0.81 for each week) and use of lipid (odds ratio 8.1, 95% CI, 2.32 to 28.0) remained significantly associated with chronic lung disease. The observed increase in incidence of chronic lung disease in this population was associated with earlier use of parenteral lipids in infants of very low gestation rather than with changes in population, survival, or ventilator treatment of respiratory distress syndrome.

Birth Weight↗
PubMed1990

Cerebral palsy in very low birthweight infants.

Eighty one very low birthweight survivors with cerebral palsy were matched with controls by sex, gestational age, and place of birth. Using discriminant analysis, the perinatal profiles for infants with cerebral palsy and their controls were shown to differ significantly. When infants with various types of cerebral palsy were analysed with their controls the discriminating variables differed. Diplegic infants could be differentiated from controls on antenatal variables alone, but significant discrimination of hemiplegic and quadriplegic infants required the addition of postnatal variables. Cranial ultrasound appearances differed appreciably between types of cerebral palsy. Future studies should differentiate between types of cerebral palsy and include ultrasound data. Cerebral palsy in very low birthweight infants is unlikely to prove a useful outcome indicator for neonatal intensive care.

Brain↗
PubMed1990

Five year outcome of preterm sextuplets related to size at birth.

Preterm sextuplets were studied to examine whether growth retardation affects long term outcome. All were growing normally at 5 years. Intelligence quotients (IQ) ranged from 105-116 and motor impairment scores from 1.0-7.0. No neurological or behavioural abnormalities were found. The largest sextuplet has maintained her position for growth and IQ. No relation between test scores and birth weight or perinatal variables was found in the remaining siblings.

Birth Weight↗
PubMed1990

Birthweight specific trends in cerebral palsy.

A register of infants with cerebral palsy born to mothers resident in the Mersey region from 1967-84 has been maintained using various sources of information. A total of 1056 patients are registered of whom 331 (31%) have hemiplegia or mixed hemiplegia, 236 (22%) have diplegias or mixed diplegia, and 369 (35%) have quadriplegia or mixed quadriplegia. The remainder have dyskinetic or dystonic forms except for seven, who are unclassified. There has been no significant change in the prevalence of cerebral palsy among infants of normal birth weight (greater than 2500 g). Among low birthweight infants (less than or equal to 2500 g) there has been a significant increase in prevalence of all the main clinical types. This increase started later among the very low birthweight infants (less than or equal to 1500 g) than among those weighing 1501-2500 g. These changes in prevalence could be the result of either improved survival of prenatally impaired infants because of improvements in medical care, or a reflection of failure to maintain optimal conditions at or around the time of birth.

Birth Weight↗
PubMed1989

Blood pressure and cerebral haemorrhage and ischaemia in very low birthweight infants.

Hourly blood pressures were recorded directly in 131 very low birth weight infants in intensive care during the first 4 days of life. Cranial ultrasound evidence of intraventricular haemorrhage correlated well with periods of hypotension, but not of hypertension. Ischaemic lesions did not correlate with periods of hypotension, but were associated with previous haemorrhage. The findings suggest that hypotension predisposes to primary intraventricular haemorrhage and that later parenchymal ischaemic lesions relate to local factors rather than hypotension.

Brain Ischemia↗
PubMed1989

Maturation of the cortical evoked response to posterior-nerve stimulation in the preterm neonate.

Short-latency somatosensory evoked potentials elicited by stimulation of the posterior tibial nerve at the ankle were studied in 75 preterm infants. Normative data for the latency of the first cortical component (P1) were obtained for infants from 27 weeks gestation to term, and showed a linear decrease with increasing gestational age. As the pathway of this response traverses areas of the brain likely to be affected by ischaemic and haemorrhagic lesions, abnormalities in the response might indicate later motor disorder.

Afferent Pathways↗
PubMed1989

Laterality and prematurity.

Lateral preferences were determined by postal questionnaire for 240 children, without major neurological impairment, who were born at less than 31 weeks' gestation to examine the association between neonatal brain injuries and later lateral preference. Left hand preference was reported in 64 (26.7%) children at a median age of 52 months (range: 24-104 months). Left foot preference was shown by 70 (29.2%) and left eye preference by 86 (35.8%). Significantly more preterm children were left handed compared with parents or siblings in whom expected frequencies of left handedness were found. All index children had serial neonatal cerebral ultrasound examinations, of which 95 were abnormal. Left preference occurred at similar frequencies in those with normal neonatal scans (26.9%), bilateral lesions (28.3%), left sided lesions (23.8%), and right lesions (23.8%). Lateral preference appears to be unaffected by the side or extent of neonatal brain injury in children without major impairments.

Brain↗
PubMed1989

Cranial ultrasound assessment of gestational age in low birthweight infants.

The anatomical features of the cerebral hemispheres of 97 infants were studied by ultrasonography. A scoring system was devised based on anatomical and ultrasound appearances and compared with gestational age calculated from the date of the mother's last period. There was a significant positive correlation between gestational age and ultrasound score. Cranial ultrasonography is an accurate and reproducible method of assessing gestational age in low birthweight infants.

Brain↗
PubMed1989

Electrolytes and glucose in cerebrospinal fluid of premature infants with intraventricular haemorrhage: role of potassium in cerebral infarction.

Potassium, sodium, and glucose concentrations in cerebrospinal fluid and plasma were determined in 73 infants whose gestational ages ranged from 25 to 40 weeks. Six of 29 (21%) neonates with intraventricular haemorrhages had raised potassium concentrations in the cerebrospinal fluid (3.7-30 mmol/l); five developed cerebral infarctions. There was a significant correlation between sodium and glucose concentrations in plasma and cerebrospinal fluid with prolonged hypoglycorrhachia accompanying posthaemorrhagic hydrocephalus. Raised concentrations of potassium in cerebrospinal fluid occur with intraventricular haemorrhage and may contribute to the development of cerebral infarction.

Blood Glucose↗
PubMed1989

Motor skills in extremely low birthweight children at the age of 6 years.

Fifty three children aged 6 years old who had weighed less than 1251 g at birth without cerebral palsy and receiving mainstream education, were entered into a controlled study of motor skills. The index and control children were matched by age, sex, and school. The index group were considered by their teachers to have similar academic performances to their index group were considered by their teachers to have similar academic performances to their controls, although two index cases were receiving remedial teaching. On the test of motor impairment extremely low birthweight children had significantly more motor difficulties than controls. In addition, the index group had more minor neurological signs, lower intelligence quotients, and more adverse behavioural traits. The higher motor impairment scores among index children were independent of differences in intelligence quotient between the two groups. There was no association between impairment score and the presence or degree of periventricular haemorrhage or periventricular leucomalacia on neonatal cerebral ultrasound. Children with Apgar scores at five minutes of less than 7 had significantly higher impairment scores compared with those whose scores were 7 or more. Three perinatal factors (Apgar score at five minutes, neonatal septicaemia, and abnormal movements) explained 32% of the variance in impairment score at the age of 6 years. In children who do not have cerebral palsy perinatal factors may still be important in the development of motor skills. The presence of subtle neuromotor impairments at 6 years of age has implications for schooling that need further evaluation.

Child↗
PubMed1988

Congenital defects and the care of low birthweight infants.

Proportions of infants of birthweight 501-2000 g born in 1979-1981 who had defects recognisable at birth were ascertained by examining hospital records and tracing survivors. Twenty-seven per cent of 230 stillbirths, 8.4% of 1411 livebirths, 4.5% of 1117 neonatal survivors and 3.6% of 1074 two-year survivors had a congenital defect, birth prevalence rising with lower birthweight only in stillbirths. Among livebirths, birth prevalence was increased in growth retarded infants, in singletons and in infants of mothers who had not had a previous reproductive loss. Twenty-four per cent and 57% of neonatal deaths in the 1001-1500 g and 1501-2000 g birthweight groups respectively were associated with a congenital defect. Major neurological impairments were directly attributable to congenital defects in 10% of 71 survivors; surgery and hospital admissions were far more frequent in infants with congenital defects than others. The 1501-2000 g group accounted for 77% of all survivors with a congenital defect. Further improvements in the prognosis of low birthweight infants will depend to a large extent on prenatal prevention of disease.

Chromosome Aberrations↗
PubMed1988

Cerebral palsy in low-birthweight infants. I. Spastic hemiplegia: associations with intrapartum stress.

Children with and without spastic hemiplegia were identified among a representative sample of 1048 low-birthweight survivors by clinical assessment after three years of age. The hypothesis that hemiplegia was predetermined at birth was tested by estimating the probability of hemiplegia for each infant by logistic regression analysis, using data from hospital records on conditions known at the time of birth. 16 of 42 children with cerebral palsy had spastic hemiplegia. Allowing for the lower birthweights of hemiplegic children, increased prevalence was associated with previous reproductive loss, breech vaginal delivery, later birth-order, prolonged second stage of delivery, emergency caesarean section, and low Apgar scores. These variables identified correctly most children as having a higher or lower estimated probability of hemiplegia. Hemiplegia was also associated with prolonged respiratory disease and intraventricular haemorrhage. In this population it is likely that intrapartum events were closely related to the pathogenesis of hemiplegia; their effects may have been mediated by postnatal events.

Cerebral Palsy↗
PubMed1988

Cerebral palsy in low-birthweight infants. II. Spastic diplegia: associations with fetal immaturity.

Twenty children with spastic diplegia were identified by clinical assessment among a representative cohort of 1048 survivors with a birthweight of 2000g or less. Data from hospital case-records were used to investigate which perinatal conditions might differentiate infants with diplegia from other low-birthweight survivors. Even allowing for a strong association with lower gestational age, diplegic children were more likely to have suffered respiratory disease, necrotising enterocolitis and fits in the neonatal period, than children without cerebral palsy. Among preterm infants, diplegia differed from hemiplegia mainly in a lack of significant association with recorded maternal characteristics and markers of intrapartum stress. Important determinants of diplegia were not identified, but the results suggest that infants born both immature and relatively immature for their gestational age have the highest risk of diplegia. Factors that influence the rate of fetal development may be implicated in the aetiology of diplegia in both preterm and fullterm infants.

Cerebral Palsy↗
PubMed1988

Maturation of the neonatal somatosensory evoked response in preterm infants.

A group of 102 neurologically normal neonates with gestations between 26 and 40 weeks, without abnormality on cranial ultrasound, underwent evoked response testing. Satisfactory results were obtained for 90 per cent of the infants. Normal ranges with 95 per cent tolerance limits for the short-latency N1 component of the response were obtained at postmenstrual ages between 29 weeks and term. Somatosensory evoked responses are a practical tool for evaluating sensorimotor pathways in the newborn infant's brain.

Afferent Pathways↗
PubMed1988

Short-latency cortical somatosensory evoked responses of preterm infants with ultrasound abnormality of the brain.

Somatosensory evoked response (SER) testing was carried out on 30 neonates with abnormality of the brain diagnosed by ultrasound, and the results were compared with previously defined normal ranges. The N1 peak latencies of the cortical SER were significantly different from normal, but peripheral nerve conduction velocities were not. Early neurological follow-up of these infants suggests that the cortical SER shows good correlation with neurological and developmental outcome, and may provide useful additional diagnostic information to cranial ultrasound for these high-risk infants.

Brain↗