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Biomedical subjects

S R Wealthall

Publications and source records attributed to S R Wealthall.

14 recordsLinked to original sources
PubMed1994

A randomized, controlled trial of antepartum thyrotropin-releasing hormone and betamethasone in the prevention of respiratory disease in preterm infants.

OBJECTIVE: The objective was to investigate whether the addition of thyrotropin-releasing hormone to antepartum betamethasone further reduces the incidence of respiratory disease in preterm infants. STUDY DESIGN: A randomized, placebo-controlled, double-blind trial of antepartum thyrotropin-releasing hormone (400 micrograms given intravenously four times) and betamethasone (5 mg given intramuscularly four times) was conducted in 378 mothers likely to be delivered between 24 and 32.6 weeks' gestation. Statistical analysis was by relative risk, chi 2, t tests, and multiple logistic regression analysis. RESULTS: Four hundred five live-born infants were delivered. In infants without lethal abnormalities delivered between 24 hours and 10 days from entry (n = 175) the incidence of respiratory distress syndrome was reduced from 52% to 31% (relative risk 0.61, 95% confidence interval 0.41 to 0.89) and that of severe respiratory distress syndrome from 42% to 20% (relative risk 0.48, 95% confidence interval 0.29 to 0.78) in the placebo and thyrotropin-releasing hormone groups, respectively. The number of deaths fell from 14 to one (relative risk 0.08, 95% confidence interval 0.01 to 0.63). The incidence of chronic lung disease was not significantly different, but that of an adverse outcome (chronic lung disease or death by 36 weeks' gestation) fell from 29% in the placebo group to 16% with thyrotropin-releasing hormone (relative risk 0.55, 95% confidence interval 0.31 to 0.99). CONCLUSION: The addition of thyrotropin-releasing hormone to antepartum glucocorticoid treatment reduces the incidence of respiratory distress syndrome and improves survival in preterm infants.

Betamethasone↗
PubMed1985

Tests for autonomic neuropathy in diabetic children.

Five simple tests of autonomic nerve function were studied in 38 children (12.0 years, s.d. = 3.3) with insulin-dependent diabetes mellitus and a further 38 age and sex matched controls in order to validate the use of these tests in children. The five tests included one test (immediate heart rate response to standing) previously reported. Compared to controls, diabetics showed a significantly faster heart rate at rest (P = 0.022), a reduced heart rate variation during quite respiration (P = 0.003), a smaller change in heart rate following a single deep breath (P = 0.006), a lower Valsalva ratio (P = 0.084) and a lower maximum R-R/minimum R-R ratio in response to standing (P = 0.033). The heart rate response to the Valsalva manoeuvre is less suitable for use in children than adults as it requires considerable co-ordination and co-operation and it did not correlate with the other tests of autonomic nerve function. The other tests significantly correlated with each other and were quick and easy to perform. They required no special co-operation and required no special equipment other than a standard ECG machine. Three diabetics had abnormalities in four of the tests (mean heart rate, heart rate variations during quiet respirations, change in heart rate produced by a single deep breath and the previously reported immediate heart rate response to standing). None of the controls had abnormalities in more than two of the tests.

Autonomic Nervous System Diseases↗
PubMed1985

Cystic fibrosis heterozygotes have normal autonomic innervation of the heart.

Five simple tests of autonomic nerve function based on measurements of cardiovascular responses to various stimuli were used to investigate possible autonomic dysfunction in obligate heterozygotes for cystic fibrosis. There were no significant differences between the heterozygotes and control groups in any of the tests, suggesting that cystic fibrosis heterozygotes have normal autonomic innervation of the heart.

Adult↗
PubMed1983

Diabetic autonomic neuropathy in children: immediate heart-rate response to standing.

The immediate heart-rate response to standing was used to investigate possible autonomic neuropathy in a group of 38 insulin-dependent diabetic patients in the paediatric age group. The controls and most of the diabetics showed the characteristic response to standing of a rapid increase in heart-rate and a fall to the resting rate within 15 seconds. Some diabetics showed a flat response or a prolonged gradual increase of heart-rate on standing. The usual method of describing the change in heart rate that occurs in response to standing is to compare the R-R intervals at the 30th and 15th beats (30:15 ratio). This is considered less appropriate in children because of the wider variability in heart rate due to sinus arrhythmia. An alternative ratio, the "maximum R-R/minimum R-R ratio" is proposed. This ratio is calculated by dividing the length of the maximum R-R interval (which occurred after the minimum R-R interval during the 30 second recording) by the length of the minimum R-R interval. Compared to 38 index-selected age and sex matched controls, the diabetics showed a significantly lower mean "maximum R-R/minimum R-R ratio (P = 0.033). Six of the diabetics had results lower than the lowest control result. This test gives a prevalence rate of changes suggestive of diabetic autonomic neuropathy of approximately 15% in this age group.

Adolescent↗
PubMed1975

Mycoplasma meningitis in infants with spina bifida.

Infants with myelomeningocele are liable to develop bacterial colonisation of the lesion which, in the case of Gram-negative bacteria, often progresses to meningitis because of the infants' immature immune status. The time and origin of the bacterial colonisation usually are uncertain. This study reports seven cases of meningitis caused by Mycoplasma hominis, an organism not previously reported to cause meningitis. The commensal status of Mycoplasma hominis in the vagina of many women, and its isolation from the mother of one patient in this group, suggests that the infant acquired the organism in the birth canal and that infection developed over a period of days. Routine cultures from the sac or wound did not show the presence of organisms until after the child had developed signs and symptoms of meningitis. Commensal organisms from the vagina may lie dormant for several days within the closed myelomeningocele and their more virulent strains may then produce meningitis. It is suggested that neonatal meningitis may be caused by organisms acquired during birth, as well as by those to which the infant is exposed later.

Humans↗
PubMed1974

Methods of measuring intracranial pressure via the fontanelle without puncture.

It is suggested that non-invasive techniques for measuring intracranial pressure should be suitable for use in the unsedated infant and should be capable of measuring pressure continuously. Methods described by other authors are reviewed. After investigation of 18 patients the technique relying upon the pulsation of the fontanelle described by Purin was rejected as being difficult to perform and applicable only in certain patients with large fontanelles. The technique of using a modified Schiotz tonometer was examined but rejected on grounds of inaccuracy, the need to perform the measurement with the infant in a vertical position, and the varying compressibility of the fontanelle. A method for indirectly estimating intracranial pressure using a modified aplanation principle is described, and a comparison of the pressures so measured and needle pressures is reported. The possible uses of a `fontanometer' using the aplanation principle are discussed and a preliminary report given of its use to monitor the changes of intracranial pressure caused by drugs.

Age Factors↗