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Biomedical subjects

T A Clarke

Publications and source records attributed to T A Clarke.

At least 37 records · Page 2Linked to original sources
PubMed1988

Neonatal seizures: the Dublin Collaborative Study.

Asphyxial seizures occurred in 89 of 101,829 infants born alive at term (0.87/1000) in three large maternity hospitals from January 1980 to December 1984. These seizures were significantly associated with antenatal complications, primiparity, and prolonged pregnancy. Meconium staining of the amniotic fluid was also associated with asphyxial seizures, but there were high false positive (11%) and false negative (50%) rates. Fifteen of the infants who had seizures died (18%) and 21 (25%) were handicapped at 1 year. Outcome was most successfully predicted by the way the infant was feeding at 1-2 weeks. All infants taking more than half their estimated requirements by mouth at 1 week were normal, and those still being fed by tube at 2 weeks were handicapped.

Asphyxia Neonatorum↗
PubMed1985

Early seizures indicate quality of perinatal care.

An analysis of antepartum, intrapartum, and postpartum variables was performed in a retrospective controlled study of 34 normally formed term infants who had perinatal asphyxia and subsequently displayed generalised seizures within 48 hours of birth. The aim was to identify any association, firstly between these variables and seizures, and secondly between these variables and subsequent morbidity and mortality among the seizure group. Maternal age greater than 35 years, duration of labour, meconium stained liquor, abnormal intrapartum fetal heart rate trace, and operative delivery were associated with seizures. A low Apgar score at five minutes, and intermittent positive pressure ventilation at birth of longer than 10 minutes were associated with subsequent morbidity and mortality. A striking relation between poor intrauterine growth and either death or handicap in the asphyxia group emphasised the value of growth measurements as a predictor of outcome. The overall incidence of seizures was 1.6 per 1000 term deliveries. There was a significant correlation between the seizure incidence and the intrapartum mortality rate. The incidence of seizures secondary to asphyxia in term infants, occurring less than 48 hours after delivery, may be a valuable index of the quality of perinatal care.

Adolescent↗
PubMed1984

Job satisfaction and stress among neonatologists.

Neonatology is reputed to be a stressful pediatric subspecialty. To quantify objectively this stress and to assess the factors involved, a questionnaire was mailed to neonatologists in the northeastern United States. Ninety-six (70%) replied. A five-point scale was used to determine the level of satisfaction with neonatology as a career and the level and type of stress experienced at work. Almost all neonatologists experienced stress at work: 34% moderately severe and 16% very severe stress. Open-ended questions indicated that the major causes of stress were excessive work load, eg, on call too often or calls at night; problems in patient care, especially dealing with infant death; and staff disagreements, especially nurse or housestaff conflicts. Twenty percent of those surveyed suffered a stress-related illness in the previous 5 years. One sixth of the neonatologists were either moderately or very dissatisfied with their career. Major dissatisfactions were: too much work, especially managing many sick patients; lack of resources, including inadequate salary; too much stress at work; and administrative demands. Job satisfaction was derived from patient care, teaching, intellectual stimulation, and research. Altering subspecialty had been considered at some time by 58% (15% very seriously). This study confirms that neonatology, in the eyes of those who practice it, is a highly stressful career. It also suggests that job stress is a greater problem than job dissatisfaction.

Adult↗
PubMed1983

Necrotizing enterocolitis in premature infants transferred back to community hospitals.

The return of stable premature infants to community hospitals from level III neonatal intensive care units is becoming more common. While these infants usually need only to gain weight, they are still at risk for significant neonatal problems. We report four cases of necrotizing enterocolitis (NEC) in nine stable, growing premature infants who weighed less than 1,300 g and returned to community hospitals. The onset of NEC was within 60 hours of transport, suggesting that transport and early feeding after transport may have been contributory to NEC.

Enteral Nutrition↗
PubMed1982

Factors influencing neonatal autopsy rate.

To determine if common clinical factors are associated with the neonatal autopsy rate, we conducted a retrospective analysis of 117 deaths in a neonatal intensive care unit. The autopsy rate of neonatal deaths was significantly greater than the autopsy rate of adult and non-neonatal pediatric deaths. In the newborn period, the autopsy rate of transported patients was significantly less than that of inborn patients. Among those transported, autopsies were significantly less common in patients of low birth weight or low gestational age. Furthermore, among all newborns dying within two days of admission, transported patients were less likely to undergo autopsies than inborn patients. Other factors, including maternal age, race, and marital status, did not affect the autopsy rate of newborn deaths. These data suggest that early separation of the mother from her infant and the medical team caring for the infant adversely affect the process of autopsy request and consent.

Autopsy↗
PubMed1982

Concurrent outbreaks of rhinovirus and respiratory syncytial virus in an intensive care nursery: epidemiology and associated risk factors.

An outbreak of viral respiratory disease occurred in eight infants in a neonatal intensive care unit during the 1980 winter respiratory season. Four infections with respiratory syncytial virus and four infections with rhinovirus were identified. Epidemiologic investigation revealed that viral respiratory infection was significantly associated with intubation with orotracheal tubes (P = 0.001), with the presence of both a nasal feeding tube plus an orotracheal tube together (P = 0.007), and with assisted ventilation (P = 0.009) when compared to uninfected controls. Twenty-seven of 85 (30.6%) personnel working in the unit at the time of the outbreak reported a history of upper respiratory illness during the week prior to the outbreak, and 46 (54.1%) of them had had contact with patients in areas of the hospital where patients infected with RSV and rhinovirus were housed. The data suggest that both viruses were transmitted to the babies by hospital personnel. Rhinoviruses can be nosocomial pathogen in neonates with compromised pulmonary function, and the clinical presentation of rhinovirus infection in neonates may be difficult to distinguish from that produced by RSV.

Cross Infection↗
PubMed1980

Esophageal perforations in premature infants and comments on the diagnosis.

Traumatic perforation of the esophagus follows oropharyngeal suctioning or endotracheal intubation. The diagnosis frequently is made from a routine chest roentgenogram that shows a nasogastric tube in the right pleural space with or without a pneumothorax. The lesion is seen most often in infants of low birth weight.

Esophageal Perforation↗
PubMed1980

Transcutaneous oxygen monitoring during neonatal transport.

The use of transcutaneous PO2 monitoring during neonatal transport was found to be feasible and clinically useful in maintaining the partial pressure of arterial oxygen within a desired range. Adjustment of fractional inspiratory oxygen (FIO2) to maintain transcutaneous PO2 between 50 to 70 torr resulted in a greater number of infants arriving at a tertiary center without either hypoxemia or hyperoxemia.

Humans↗