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Biomedical subjects

R W Cooke

Publications and source records attributed to R W Cooke.

At least 109 records · Page 6Linked to original sources
PubMed1986

Infection and colonisation of neonates by Hansenula anomala.

Over a 13-month period 52 neonates (10% of those admitted to the Mersey Regional Neonatal Intensive Care Unit) were found to be colonised with the ascosporagenous yeast Hansenula anomala. 8 babies became infected, all but 1 of whom were heavily colonised before infection. 7 of the 8 infected babies were of very low birth-weight (less than 1500 g). All 8 had multiple problems associated with low birth-weight and prematurity and were kept in the intensive care unit. 5 babies had fungaemia, 2 had fungaemia and ventriculitis, and 1 had ventriculitis only. In each case H anomala was the sole pathogen isolated. Anti-Hansenula antibodies developed in 5 babies within 3 months of infection. Infected babies were successfully treated with a combination of 5-flucytosine and amphotericin B. Despite extensive searches the babies appeared to be the only reservoir of the yeast.

Amphotericin B↗
PubMed1986

Levels of 6-ketoprostaglandin F1 alpha in neonatal cerebrospinal fluid.

6-Ketoprostaglandin F1 alpha determinations were made by radioimmunoassay on samples of cerebrospinal fluid from 41 neonates. Levels were below the smallest quantity detectable (50 pg/ml) in 29 and greater than 200 pg/ml in only 3 babies. These results suggest that 6-ketoprostaglandin F1 alpha is not a major prostaglandin in the cerebrospinal fluid of human infants.

6-Ketoprostaglandin F1 alpha↗
PubMed1986

Reduction of immunoreactive prostacyclin metabolite after paralysis in ventilated preterm infants.

Levels of the stable metabolite of prostacyclin, 6-keto-prostaglandin F1 alpha (6-keto-PGF1 alpha) were measured by radioimmunoassay during the first 48 hours of life in a group of 20 infants ventilated for the respiratory distress syndrome in whom a simultaneous record of respiratory activity was made. 6-Keto-PGF1 alpha was significantly lower when the infants were paralysed (P = 0.0004) than when they were breathing spontaneously. Elimination of the capacity for spontaneous respiration may reduce barotrauma and hence the stimulus for prostacyclin release from the lung.

6-Ketoprostaglandin F1 alpha↗
PubMed1986

Ethamsylate reduces immunoreactive prostacyclin metabolite in low birthweight infants with respiratory distress syndrome.

Measurement of 6 ketoprostaglandin F1 alpha was made by radioimmunoassay during the first 3 days of life in 33 infants with respiratory distress syndrome who were subjects in a double blind controlled trial of ethamsylate for the prevention of intraventricular haemorrhage. Levels of 6-ketoprostaglandin F1 alpha were significantly lower on the first and second days of life in babies receiving ethamsylate. There was a reduction in the incidence of intraventricular haemorrhage in the treated group. High levels of prostacyclin metabolite are found in babies who develop haemorrhage, and reduction of prostacyclin synthetase activity may be the mode of action of this drug in vivo.

6-Ketoprostaglandin F1 alpha↗
PubMed1986

Why do so many small infants develop an inguinal hernia?

Prevalence and incidence of inguinal hernia in a representative sample of low birthweight survivors were determined by tracing children at 3 years of age. Prevalence was examined in relation to perinatal factors recorded in hospital case notes, using a logistic regression model to allow for confounding variables. Of the 1074 two year survivors, 995 (93%) were assessed. Seventeen per cent of 497 boys and 2% of 498 girls had a hernia by 3 years of age, a total cumulative prevalence of 9.2%: it was significantly increased by lower birth weight, male sex, neonatal intravenous feeding, and lack of respiratory disease. Neonatal illnesses were otherwise not associated with herniation, and most infants were well when they presented. Peak incidence was at the expected full term of gestation. Bilateral hernias were increasingly more common than unilateral hernias at lower gestational ages. It is proposed that causes of increased abdominal pressure in healthy neonates are important causes of herniation during a critical period of inguinal development.

Birth Weight↗
PubMed1986

Early administration of indomethacin to preterm infants.

Indomethacin (0.2 mg/kg) or saline was given intravenously during the first 24 hours to 50 preterm infants in a double blind controlled trial. Eight of the control group later required treatment with indomethacin for clinical signs of left to right shunt, but only one in the treatment group (p = 0.03). Treatment with indomethacin prolonged bleeding time, raised serum creatinine concentrations, and was associated with gastrointestinal haemorrhage in seven infants. Five of these had a serum indomethacin concentration greater than 1.0 microgram/ml. There was a significant reduction of the stable metabolite of prostacyclin, 6-ketoprostaglandin F1 alpha, commencing six hours after treatment and lasting for four days. There was no significant difference in the incidence of intraventricular haemorrhage, days of treatment with oxygen or ventilation, or mortality between the two groups.

6-Ketoprostaglandin F1 alpha↗
PubMed1985

Adriamycin and cisplatin for hepatoblastoma.

Four consecutive infants and children with hepatoblastomas were treated with a combination of Adriamycin (doxorubicin) and cisplatin. Three patients had unresectable tumors and in each there was a dramatic decrease in tumor size and serum alpha-fetoprotein (AFP) levels. The tumors of two of these patients, including one with pulmonary metastases which cleared, were rendered resectable. The third patient's tumor remained unresectable but his AFP level returned to normal following radiotherapy. All three patients are disease-free, and both without metastases are off therapy from 9 to 24 months. A fourth child received the combination as adjuvant therapy following resection of an embryonal hepatoblastoma and he remains disease-free 7 months after its discontinuation. Therapy was tolerable in all patients and its principal toxicities were myelosuppression and magnesium wasting. Adriamycin and cisplatin in combination were very effective in these patients and deserve further trials, especially in unresectable and metastatic hepatoblastomas.

Antineoplastic Combined Chemotherapy Protocols↗
PubMed1985

Serious infection in a neonatal intensive care unit: a two-year survey.

Over a two-year period 160 episodes of serious infection occurred in 139 infants admitted to a regional neonatal intensive-care unit. Eighty-seven (26%) of very low birth weight (VLBW) neonates and 52 (8%) of infants of birth weight greater than 1500 g were infected. The majority (84%) had bacteraemia alone. Though the clinical features of infection were not distinctive, in 94% of episodes the peripheral white blood cell or band counts were abnormal. Thirty-three (21%) of the infections occurred in infants under 48 h old and 15 of these followed prolonged rupture of membranes (greater than 48 h). All of the infections due to group B streptococci (5), Streptococcus viridans (2) and Haemophilus influenzae (3) occurred in this group. Coagulase-negative staphylococci (CONS) accounted for 49% of the infections and there was a marked increase in incidence of such infections during the survey. Infections with CONS were not necessarily associated with parenteral nutrition, the presence of intra-arterial catheters or mechanical ventilation but the rise in incidence was coincident with change in skin disinfectant usage and the general use of a third-generation cephalosporin to which the CONS were resistant. Although VLBW infants with meningitis were more likely to die than those of higher birthweight, the risk for those with bacteriaemia was the same in both groups. Infants with CONS sepsis were less likely to die than those with infections due to Gram-negative bacteria and the time from onset of infection to death was significantly longer for the former.

Bacterial Infections↗
PubMed1985

Micromethod for bleeding time in the newborn.

A new method of measuring bleeding time using an Autolet device is described. Normal ranges of bleeding time and volume of blood used in the test have been defined in a population including preterm babies. Abnormal values have been shown in newborns with a variety of problems, and an abnormality of bleeding time has been found to precede intraventricular haemorrhage.

Bleeding Time↗
PubMed1984

Klebsiella infection in a neonatal intensive care unit: role of bacteriological surveillance.

An outbreak of 12 cases of infection occurred over a 9-month period in a Regional Referral Neonatal Intensive Care Unit. The pathogen was a gentamicin- and multiply-resistant Klebsiella oxytoca (K55), of high virulence. Seven of 10 neonates with septicaemia died, the majority within 24 h of the onset of infection. Screening for the resistant klebsiella revealed that 64 (39 per cent) of 164 neonates became carriers and remained so throughout their stay. Hand carriage appeared to be a mode of cross-contamination and infection. Cohorting colonized neonates together with rigorous cross-infection control measures eliminated this organism from the unit after 29 weeks. There is evidence to suggest that in one case the infecting organism was acquired from a contaminated blood gas analyser. It is necessary to use incompatibility grouping and restriction endonuclease digestion for complete characterization of plasmids and their molecular weights. However, the finding that each isolate examined carried the same five plasmids as judged by co-electrophoresis on agarose gels, and expressed the same extent and degree of transferable antibiotic resistance provides evidence to suggest that this outbreak was due to spread of a resistant clone of K. oxytoca (K55).

Carrier State↗
PubMed1984

Prophylactic ethamsylate for periventricular haemorrhage.

Drug prophylaxis with ethamsylate for periventricular haemorrhage in very low birthweight infants significantly reduced the incidence of periventricular haemorrhage in survivors. A reduction in abnormalities at follow up and in insertion of ventriculoperitoneal shunts was also noted.

Benzenesulfonates↗
PubMed1984

Candida albicans skin abscesses.

Two neonates who developed Candida albicans skin abscesses are described. One developed disseminated infection. In the newborn abscesses cannot be assumed to be of bacterial origin.

Abscess↗
PubMed1984

Tranexamic acid in the prevention of periventricular haemorrhage.

Increased fibrinolytic activity in the ganglionic eminence of the preterm human brain has been proposed as a factor in the aetiology of periventricular haemorrhage. The effect of tranexamic acid in preventing periventricular haemorrhage was evaluated in 100 infants in a double blind, randomised controlled trial. Haemorrhages developed in 22 infants who received tranexamic acid and in 20 of those who received placebo. A significant reduction in fibrin degradation products in treated infants was seen. Our study suggests that excessive fibrinolytic activity is not an important factor in the aetiology of periventricular haemorrhage and that treatment with tranexamic acid will not prevent its occurrence.

Cerebral Hemorrhage↗