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1.  Intraventricular haemorrhage after aspiration of ventricular reservoirs. 
Archives of Disease in Childhood  1992;67(4 Spec No):448-449.
A previously unrecognised complication of aspirating ventricular reservoirs is described. Four infants developed fresh bleeding into the cerebrospinal fluid after reservoir taps; ultrasound confirmed intraventricular blood clot in one case. The technique for aspirating the reservoir may have an important bearing on the incidence of this complication.
PMCID: PMC1590488  PMID: 1586191
2.  Subdural fat effusion complicating parenteral nutrition. 
Archives of Disease in Childhood  1991;66(11):1350-1351.
A preterm infant fed parenterally through a central venous catheter developed a subdural effusion containing fat emulsion. Subsequent postmortem examination failed to demonstrate any vascular abnormality that might have explained this rarely reported complication. Although retrograde flow of feeding solutions into cerebral veins seems a likely explanation, the exact mechanism remains uncertain.
PMCID: PMC1793292  PMID: 1755651
3.  Reduction of pain response in premature infants using intraoral sucrose. 
The potential of sucrose to reduce the pain response in a group of healthy premature infants was investigated. Fifteen infants of 32-34 weeks postmenstrual age were tested in a blind crossover manner on two separate occasions no more than two days apart. Either 1 ml of 25% sucrose solution or sterile water was syringed into the baby's mouth 2 minutes before routine heel lancing. Response to the painful stimuli was measured by duration of cry and by facial expression (pain score). There was a significant reduction in the duration of first cry, the percentage of time spent crying in the 5 minutes after heel prick, and the pain score in the sucrose treated group. It is concluded that sucrose has analgesic effects in healthy premature infants.
PMCID: PMC2528545  PMID: 8777660
4.  Effect of non-sucrose sweet tasting solution on neonatal heel prick responses. 
A substance commercially described as 'sugar free,' used as a sweetener for paracetamol suspension, was evaluated on measures of neonatal pain. Sixty infants were randomly allocated to receive one of four solutions before heel stab blood sampling: sterile water (placebo); 25 or 50% sucrose (weight/volume); and the commercial sweet-tasting solution. There was a significant reduction in crying time and pain score 3 minutes after the painful stimulus in all groups compared with the controls. It is concluded that this sweet-tasting solution has analgesic effects as potent as those of concentrated sucrose solutions.
PMCID: PMC2528524  PMID: 8777661
6.  Can topical lignocaine reduce behavioural response to heel prick? 
In a randomised, double blind, controlled study the ability of 5% lignocaine ointment to reduce the behavioural response to heel lance in 30 healthy neonates was assessed. Five per cent lignocaine ointment applied to the heel under an occlusive dressing for one hour before heel prick did not reduce the infants' behavioural response to the heel prick procedure.
PMCID: PMC2528406  PMID: 7743286
8.  Neonatal cerebral blood flow velocity responses to changes in posture. 
Archives of Disease in Childhood  1993;69(3 Spec No):304-308.
Maintaining a constant cerebral blood flow during a change in cerebral perfusion pressure is known as autoregulation. The integrity of this phenomenon is considered to be important in preventing cerebral lesions in preterm infants. A study was carried out using Doppler ultrasound measurements of cerebral blood flow velocities (CBFV) as an indicator of alterations in cerebral haemodynamics. CBFV were recorded on a beat to beat basis over 60 second epochs, during which time the cerebral perfusion pressure was changed by rapidly altering the infants' posture from horizontal to either 20 degrees head up or head down. An informative response in CBFV was considered to be either (a) a uniphasic, immediate, passive alteration in velocity occurring with the change in posture and without a subsequent change or (b) a biphasic response of an initial change in CBFV followed within 20 seconds by a second response. This latter response is considered to be consistent with autoregulatory activity. A total of 501 epochs in 60 neonates of gestational age 24-41 weeks was analysed. It was shown that any one infant can make either response, but the reliability of making an active, biphasic response increases with increasing gestational age.
PMCID: PMC1029498  PMID: 8215571
9.  Pharmacokinetics of morphine infusion in premature neonates. 
Archives of Disease in Childhood  1993;69(1 Spec No):55-58.
Morphine pharmacokinetics were studied in 17 premature neonates (26-34 weeks' gestation) after intravenous infusion during the first 24 hours of life. Infants received either standard dose morphine that comprised of a 100 micrograms/kg/hour loading infusion for 2 hours followed by a maintenance infusion of 12.5 micrograms/kg/hour, or a high dose of 200 micrograms/kg/hour for 2 hours followed by 50 micrograms/kg/hour. Mean plasma concentrations of morphine (SD) after 2 and 24 hours were 99 (12.9) and 96.4 (3.2) ng/ml, and 184.2 (37.7) and 319 (71.2) ng/ml for the standard and high dose regimens, respectively. Morphine-3-glucuronide plasma concentrations achieved about 20% and 80% of morphine values at 2 and 24 hours respectively. Morphine-6-glucuronide could not be detected at 2 hours, but attained 20-25% of morphine plasma concentrations by 24 hours. The population mean morphine clearance was 2.4 ml/min/kg, the elimination half life was 8.75 hours and the volume of distribution was 1.82 1/kg. High plasma concentrations of morphine appeared to be well tolerated. Although mean arterial blood pressure decreased during the first six hours of treatment, this was not statistically significant; two infants experienced transient muscle rigidity, but no evidence of seizures was noted. There appears to be no clinical advantage in using the high dose regimen.
PMCID: PMC1029400  PMID: 8346956
10.  Somatosensory evoked potentials and outcome in perinatal asphyxia. 
Archives of Disease in Childhood  1992;67(4 Spec No):393-398.
Somatosensory evoked potentials (SEP) can be measured in the term newborn infant and given an index of function in the areas of the brain most likely to be damaged in perinatal asphyxia. We studied the median nerve SEP in 30 asphyxiated term infants over the course of their encephalopathy and until discharge from the neonatal unit. Three types of response were noted: normal waveform, abnormal waveform, or absence of cortical response. Follow up of the survivors was undertaken at a mean age of 12 months by means of a Griffiths' assessment and neurological examination. Nine infants died of their asphyxial illness and one of spinal muscular atrophy. Of the 20 survivors, three have cerebral palsy, four have minor abnormalities, and 13 are neurodevelopmentally normal. There was a close correlation between outcome and SEP. All 13 infants with normal outcome had normal SEP by 4 days of age, whereas those with abnormal or absent responses beyond 4 days had abnormalities at follow up.
PMCID: PMC1590514  PMID: 1586177
11.  Measurement of plasma volume in neonates. 
Archives of Disease in Childhood  1992;67(1 Spec No):36-40.
There is no reliable and safe method for measuring plasma volume in ill newborn infants. We describe an adaptation of the dye dilution technique using indocyanine green as the plasma label, which can be used in the sickest and smallest of infants with the minimum of disturbance. To avoid the need to take large volumes of blood from the infant, samples were diluted 1:1 with distilled water and pooled adult sera was used to construct the dye dilution standard curves. Eighteen preterm and fullterm infants were studied on 30 occasions. The measured plasma volume ranged between 21.4 and 106 ml/kg. Paired measurements were performed within 30-90 minutes of each other in seven infants. In five infants estimations of plasma volume were made shortly before and 30 minutes after the infusion of a known quantity of plasma. In eight out of 12 infants who had two measurements made there was close agreement between the second measured volume and the first measured volume, taking into account how much plasma had been given to or taken from the infant between the two measurements. The error ranged from 0.2 to 5.2 ml and the plasma recovery error ranged from -2.9% to +4.7%. In the remaining four infants the errors ranged from 2.1 to 9.5 ml and -14.2% to +8.8%. Errors in the measurement of plasma volume may arise as the result of sampling too early before full mixing of the dye has occurred, and there is a potential error in the measurement due to the distribution of albumin in the extracellular space in sick infants resulting in an overestimation of the plasma volume. Proposals for reducing sources of errors are discussed.
PMCID: PMC1590323  PMID: 1536583
12.  Cyclical variations in cerebral blood flow velocity. 
Archives of Disease in Childhood  1991;66(1 Spec No):12-16.
Because little is known about spontaneous changes in cerebral blood flow in neonates, a newly developed online Doppler technique was used to insonate continuously the middle cerebral arteries of a group of sick (n = 20) and full term healthy (n = 16) newborn infants for a period of one minute. A total of 290 recordings of epochs each lasting one minute were analysed, and pronounced regular, cyclical variations were seen in the velocity traces of these infants. The cycles occurred 1.5-5 times/minute and were present for at least one epoch in all 20 of the sick infants and in 15 of the 16 healthy mature neonates. Simultaneous recordings of the systemic blood pressure in the sick infants rarely showed the same cyclical variations. The cyclical variation is different from the beat to beat variability seen in the waveforms previously described, and is an additional factor to account for the wide variation in 'normal' velocity recordings obtained when Doppler ultrasound is measured over a short period of time.
PMCID: PMC1590367  PMID: 1996887
13.  Quantitative changes in faecal microflora preceding necrotising enterocolitis in premature neonates. 
Archives of Disease in Childhood  1990;65(10 Spec No):1057-1059.
Quantitative studies of faecal bacterial flora were carried out during the week preceding the clinical onset of 12 episodes of neonatal necrotising enterocolitis. There were considerable quantitative changes in the faecal flora preceding the clinical onset of both definite and possible episodes of necrotising enterocolitis. There was a decline in the numbers of some species from up to 72 hours before the clinical onset of the disease. Enterobacteriaceae were isolated from samples collected during the 48 hours preceding the clinical onset of all four definite episodes of necrotising enterocolitis. These were 'new' isolates in two episodes, and considerably increased numbers in another. The changes that we found are probably the result of changes in intraluminal conditions that precede the clinical onset of necrotising enterocolitis.
PMCID: PMC1590248  PMID: 2122814
14.  Circulatory effects of fast ventilator rates in preterm infants. 
Archives of Disease in Childhood  1990;65(7 Spec No):662-666.
High frequency positive pressure ventilation has been suggested to result in a lower incidence of respiratory complications in preterm infants with idiopathic respiratory distress syndrome compared with ventilation at conventional rates. A possible disadvantage is compromise of the infant's cardiovascular condition secondary to inadvertent positive end expiratory pressure (PEEP). In a group of 20 such infants treated with high frequency positive pressure ventilation (rates of up to 100/minute) and analysed, changes in arterial blood pressure and cerebral blood flow velocity were largely influenced by changes in arterial blood gases, and no effect could be attributed to inadvertent PEEP. In addition, the observed fall in both arterial carbon dioxide and oxygen tensions could be readily predicted for theoretical reasons. Under certain conditions at the fastest rates used, cerebral blood flow velocity was significantly influenced by changes in blood pressure, which may indicate impaired cerebrovascular regulation. Though other factors (such as the severity of the infants' illness or the use of paralysis) may have been responsible for this apparent blood pressure passivity, the role of high frequency positive pressure ventilation in such infants warrants further study.
PMCID: PMC1590181  PMID: 2117423
15.  On line cerebral blood flow velocity and blood pressure measurement in neonates: a new method. 
Archives of Disease in Childhood  1990;65(1 Spec No):11-14.
To test the hypothesis that impairment of cerebral perfusion and cerebrovascular autoregulation play a part in the pathogenesis of neurological injury in the critically sick neonate, we tested in 33 infants a small, light-weight probe and cable that are attached to the infant's skin to record cerebral blood flow velocity from the middle cerebral artery over a period of hours. This considerably reduced the amount of handling of the infant compared with conventional assessment. Captured data were analysed and displayed graphically at the cotside. The system is applicable for use on infants over a wide range of gestational ages and may give information on the complex haemodynamic changes occurring in the cerebral circulation.
PMCID: PMC1590161  PMID: 2407196
16.  Cerebral haemodynamic effects of changes in positive end expiratory pressure in preterm infants. 
Archives of Disease in Childhood  1989;64(4 Spec No):465-469.
The effects of changes in positive end expiratory pressure (PEEP) on cerebral blood flow velocity, arterial blood gases, and mean arterial pressure were studied in newborn infants. In mechanically ventilated premature infants with severe respiratory disease, an increase in PEEP from 2 to 6 cm H2O was associated with an increase in cerebral blood flow velocity. There was no significant change in mean arterial blood pressure. There was a significant increase in PaO2 and PaCO2 for every stepwise rise in PEEP. Multivariate regression analysis showed that 72% of the effect on cerebral blood flow velocity was attributable to PaCO2 alone and that any change in blood pressure was not likely to contribute to these changes. There was no evidence that changes in PEEP within the commonly used range adversely affected the neonatal cardiovascular or cerebral circulations.
PMCID: PMC1592038  PMID: 2499269
17.  Are severe acute retinopathy of prematurity and severe periventricular leucomalacia both ischaemic insults? 
Over a period of 20 months six preterm infants have been seen who developed severe acute retinopathy of prematurity (ROP) and who also had ultrasound evidence of extensive cerebral parenchymal changes compatible with severe periventricular leucomalacia. Only one of these infants had a birthweight of less than 1000 g, and their gestational ages ranged from 27 to 30 weeks. The association between these two important complications of preterm birth has led us to postulate that an episode of hypoperfusion of the cerebral circulation sufficient to result in cerebral ischaemia could also reduce an already compromised ocular blood flow and further exacerbate retinal ischaemia, thereby increasing the severity of ROP.
PMCID: PMC1041665  PMID: 2930756
18.  Transient hyperoxia and cerebral blood flow velocity in infants born prematurely and at full term. 
Archives of Disease in Childhood  1988;63(10 Spec No):1126-1130.
Little is known about the effects of hyperoxia on the cerebral circulation of human infants. Using duplex Doppler we measured the changes in cerebral blood flow velocity in a group of full term (n = 15) and premature infants (n = 17, median gestational age 31 weeks) in response to a transient threefold increase in oxygen tension. Measurements of blood gas tensions as well as blood pressure and cerebral blood flow velocity were made over a period of 20 minutes on three occasions for each infant; during normal oxygenation, hyperoxia, and normal oxygenation. There was a fall in cerebral blood flow velocity in 15 of the 17 premature infants with hyperoxia and the median reduction was 0.06 cm/second for every 1 kPa increase in oxygen tension. There was no significant change in either PCO2 or blood pressure during the period of hyperoxia. The cerebral blood flow velocity fell in all 15 infants born at full term during hyperoxia, but there was a simultaneous and significant reduction in PCO2 at the same time as the hyperoxia. Analysis of variance suggested that in the infants born at full term the change in carbon dioxide had most effect in the reduction of cerebral blood flow velocity, rather than the hyperoxia itself. We conclude that in premature infants, cerebral vascular resistance may be altered by a fall in cerebral blood flow velocity in the presence of hyperoxia.
PMCID: PMC1590204  PMID: 3196067
19.  Clinical risk factors and periventricular leucomalacia. 
Two hundred infants of below 1501 g at birth were regularly examined with real time ultrasound using a 7.5 MHz transducer. Abnormalities were categorized as periventricular haemorrhage (PVH) (n = 107) or periventricular leucomalacia (PVL), with or without PVH (n = 52). Of the group with PVL, 25 had the appearances of prolonged flare without cavitation. Prospective assessments of up to 50 potential clinical risk factors were made wherever possible on each infant including stratification of all blood gas and systolic blood pressure data. Multivariate logistic regression analyses confirmed a strong correlation between immaturity and PVH but this was not found in cases of PVL. Independent variables associated with PVL included pneumothorax, maximum bilirubin concentration, surgery, and the proportion of time the infant's PaCO2 remained above 7 kPa. There was a very strong inverse correlation between anaemia and PVL. Systolic blood pressure data were carefully analysed and there was no relation between either hypotension or antepartum haemorrhage and the development of PVL.
PMCID: PMC1779324  PMID: 3348645
20.  Hyperkalaemia, cardiac arrhythmias, and cerebral lesions in high risk neonates. 
Archives of Disease in Childhood  1987;62(11):1139-1143.
The case notes of 20 infants with hyperkalaemia (defined as two successive serum potassium measurements of greater than 7.5 mmol/l) were reviewed. The incidence of hyperkalaemia was also looked at in an unselected population of 200 low birthweight infants. The mean gestational age of the 20 affected infants was 29 weeks and the mean birth weight 1235 g. The incidence of hyperkalemia in the cohort of 200 infants weighing less than 1500 g at birth was 3.5%. Hyperkalaemia was associated with a high incidence of cardiac arrhythmia (60%), impaired renal function (50%), and changes on cerebral ultrasonography (88%). Hyperkalaemia responds slowly to conventional treatment with dextrose, insulin, and exchange resins. There is a close temporal relation in some infants between hyperkalaemia and cardiac arrhythmias and periventricular leukomalacia, suggesting a causal association.
PMCID: PMC1778541  PMID: 3688918
21.  Intraventricular haemorrhage and periventricular leucomalacia: ultrasound and autopsy correlation. 
Archives of Disease in Childhood  1986;61(12):1203-1207.
The brains of 30 infants who died after at least one real time ultrasound scan were examined after fixation. The ultrasound diagnosis of either periventricular haemorrhage or periventricular leucomalacia was compared with the macroscopic and histological appearances. Each hemisphere was considered separately for both periventricular haemorrhage and periventricular leucomalacia. The accuracy of ultrasound diagnosis for periventricular haemorrhage was 88%, with sensitivity of 91% and specificity of 85%. The accuracy for periventricular leucomalacia was 90%, with sensitivity of 85% and specificity of 93%. Ultrasound was shown to diagnose the entire range of periventricular leucomalacia lesions. Three hemispheres showed the appearance of prolonged flare, and this correlated with extensive spongiosis and microcalcification of the periventricular white matter, although no macroscopic lesion was seen.
PMCID: PMC1778210  PMID: 3545096
22.  Periventricular leucomalacia and intraventricular haemorrhage in the preterm neonate. 
Archives of Disease in Childhood  1986;61(12):1196-1202.
Two hundred very low birthweight infants were prospectively scanned to ascertain the incidence of periventricular leucomalacia (PVL) and haemorrhage. Before collection of data, clear definitions of ultrasound abnormalities believed to represent PVL and intraventricular haemorrhage were described. These referred to small and moderate intraventricular haemorrhage, paenchymal haemorrhage, and PVL, including prolonged flare (echoes in the periventricular region lasting for two weeks or more and not becoming cystic). Sixty nine infants (34%) had no abnormality on ultrasound scans. Intraventricular haemorrhage occurred in 107 babies (37 grade I and 62 grade II), and only eight infants were thought to have true parenchymal haemorrhage. Ultrasound appearances of PVL were seen in 27 infants, 19 of whom developed cysts and eight died in the precystic stage. Prolonged flare occurred in another 25 babies. Unilateral parenchymal haemorrhage occurred in four infants who subsequently developed cystic PVL in the contralateral hemisphere. Twenty one infants developed ventricular dilatation, 12 of whom had associated parenchymal lesions. Haemorrhage, PVL, and flare occurred commonly in infants of 30 weeks' gestation and below and became markedly less common in more mature infants. We believe prolonged flare represents a form of PVL, and in this study a total of 52 (26%) infants had an ultrasound appearance of periventricular leucomalacia, an incidence considerably higher than previously reported.
PMCID: PMC1778194  PMID: 3545095
23.  Retinopathy of prematurity: age at onset. 
Archives of Disease in Childhood  1986;61(8):774-778.
The age at which retinopathy of prematurity was first seen was determined in 143 infants. In all, the initial ophthalmological examination was normal. Birth weights varied from 630 to 2700 g and gestational ages from 24.5 to 40.0 weeks. The median postnatal age at which acute retinopathy of prematurity was first seen was 51 and 40 days for those less than 28 and greater than or equal to 28 weeks' gestational age, respectively, and this difference is highly significant. Similar results were obtained when infants were grouped according to birth weight less than 1000 or greater than or equal to 1000 g. Using postmenstrual age as the variable, the first signs of retinopathy of prematurity were seen over a fairly narrow age range and 86% of infants developed retinopathy between 32.5 and 38.5 weeks of age. These findings suggest that the age (but not the occurrence or severity) at which retinopathy of prematurity is first seen is controlled predominantly by stage of development rather than neonatal events.
PMCID: PMC1777954  PMID: 3755580
24.  Dinamap fails to detect hypotension in very low birthweight infants. 
Archives of Disease in Childhood  1986;61(8):771-773.
The accuracy of blood pressure measurements obtained from very low birthweight (less than 1500 g) neonates using the Dinamap oscillometric monitor was investigated. Comparisons using umbilical artery measurements showed that the monitor is less reliable in the lower pressure range and specifically that it tends to overestimate pressure in hypotensive infants.
PMCID: PMC1777941  PMID: 3740925
25.  Cause of neonatal convulsions. Towards more precise diagnosis. 
All infants presenting with neonatal seizures over a two year period were carefully investigated for the cause. In 20% either intracranial haemorrhage or infarction of a major cerebral artery was detected by real time ultrasound. Routine imaging techniques should be performed in all infants with neonatal convulsions.
PMCID: PMC1777540  PMID: 3513717

Results 1-25 (62)