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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.  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
4.  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
5.  Pancuronium bromide induced joint contractures in the newborn. 
We report three infants paralysed with pancuronium bromide as an adjunct to mechanical ventilation, who developed multiple joint contractures. In two term infants, gentamicin and phenobarbitone given together with pancuronium may have potentiated its effect, and in one preterm infant contractures, which became more severe after paralysis, were present at birth.
PMCID: PMC1628397  PMID: 6696501
7.  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
8.  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
9.  Umbilical cord clamping in preterm infants. 
BMJ : British Medical Journal  1993;306(6877):578-579.
PMCID: PMC1677179  PMID: 8461780
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
13.  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
14.  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
15.  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
16.  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
20.  Continuous measurement of subarachnoid pressure in the severely asphyxiated newborn. 
Archives of Disease in Childhood  1983;58(12):1013-1015.
We describe a method of monitoring continuously subarachnoid pressure in the severely asphyxiated newborn by a percutaneously placed catheter. Five infants were studied for a total of 180 hours and although opening pressures were not appreciably raised in any, maximum pressures were above 20 mmHg in four infants and reached a peak of 48 mmHg in one.
PMCID: PMC1628586  PMID: 6660885
21.  Measurement of renal size in preterm and term infants by real-time ultrasound 
Archives of Disease in Childhood  1983;58(2):145-147.
The kidneys in term and preterm infants were visualised by real-time ultrasound scanning. A cross-sectional centile chart has been plotted for kidney length in 100 unselected infants ranging in gestational age from 26 to 42 weeks. The ratio of kidney length to crown-to-heel length appeared to remain constant despite abnormalities in intrauterine growth rate.
PMCID: PMC1628122  PMID: 6830292
22.  Developmental and neurological progress of preterm infants with intraventricular haemorrhage and ventricular dilatation. 
Archives of Disease in Childhood  1982;57(10):748-753.
A prospective neurological and developmental assessment was completed at ages 6, 9, and 12 months on 39 preterm infants under 34 weeks' gestation. In the newborn period each infant had an assessment of gestation and sequential neurological and ultrasound examinations and was placed in one of three groups: intraventricular haemorrhage (IVH) (n = 14), IVH followed by ventricular dilatation (n = 11), and control infants with no evidence of IVH (n = 14). When corrected for prematurity the Griffiths's developmental quotients (DQs) were normal at 6, 9, and 12 months for every infant except one aged 12 months. In contrast, the uncorrected DQs at 12 months were under 80 in only one of the 14 preterm infants without haemorrhage, compared with 2 of the 14 with IVH, and with 7 of the 9 with IVH and dilatation. There was also a higher incidence of neurological abnormality at each follow-up age in the infants with IVH plus ventricular dilatation, compared with those with IVH alone, or with infants without IVH. Similar differences were also demonstrated in 5 milestones reflecting gross motor, fine motor, and social or verbal development in the three groups at 6, 9, and 12 months. The neurological and developmental deficits seemed to relate more closely to the presence of post-haemorrhagic ventricular dilatation than to the size of the initial haemorrhage itself. These results may have important implications for therapeutic intervention in the management of newborn infants with IVH and ventricular dilatation.
PMCID: PMC1627927  PMID: 7138063
23.  Nuclear magnetic resonance imaging of the brain in children 
A preliminary study of nuclear magnetic resonance imaging of the brains of four normal children (36 weeks' postmenstrual age to 5 years) showed long T1 areas in the periventricular region of the neonate as well as evidence of progressive myelinisation with increasing age. Study of 18 patients of 40 weeks' postmenstrual age to 4 years showed an apparent deficit in myelinisation in an infant with probable rubella embryopathy and another with ventricular dilatation of unknown cause. Abnormal scans were obtained in an infant with congenital muscular dystrophy, and abnormalities were visualised at the lateral ventricular margins in a case of acute hydrocephalus after shunt blockage. Periventricular regions of increased T2 were seen in a term infant aged 4 days after severe birth asphyxia and convulsions.
Nuclear magnetic resonance imaging appears to provide a unique demonstration of myelinisation in vivo and shows changes in pathological processes of importance in paediatric practice.
PMCID: PMC1499499  PMID: 6810994
24.  Comparison of efficiency of commercially available phototherapy units. 
Archives of Disease in Childhood  1980;55(5):399-401.
The efficiency of two phototherapy units was compared by exposing solutions of bilirubin in vitro. Both units are commercially available.
PMCID: PMC1626885  PMID: 6893649
25.  Uneven distribution of light in standard phototherapy. 
Archives of Disease in Childhood  1980;55(5):398-399.
Maldistribution of light is a potential cause of phototherapy failure in the neonate. Differences in light intensity over the surface can be measured with a radiometer as this detects the radiant energy impinging on the incubator mattress. An infant nursed on the front third of the mattress receives less than 40% of the maximal light incident on the centre of the mattress, and consequently degradation of unconjugated bilirubin will be less effective.
PMCID: PMC1626882  PMID: 7436476

Results 1-25 (62)