Anesthesia in neonatal cardiac surgery.
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Biomedical subjects
Publications and source records attributed to A M Weindling.
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Two infants are described in whom identical strains of meningococcus were isolated from both the eyes and the cerebrospinal fluid. This suggests that the eye may be a portal of entry in at least some cases of perinatally acquired neonatal meningococcal disease and has important implications for the management of purulent conjunctivitis in the newborn.
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Magnetic resonance imaging has potential as an imaging technique in obstetrics. Its application has been limited by the amount of image degradation that occurs as a result of fetal movement during the long imaging times. By use of a fast-scan imaging technique good images are obtained of fetal anatomy in 3 to 14 seconds per image, depending on the setting used. Different organs could be visualized by varying the setting. Magnetic resonance imaging complements the role of ultrasonography in fetal visualization. It also allows clear fetal imaging in such high-risk situations as maternal obesity and oligohydramnios, where it may be difficult to produce clear images by ultrasonography. This technique will allow wider application of magnetic resonance imaging in obstetrics and give additional information about the developing fetus.
OBJECTIVE: To identify those congenital fetal anomalies, previously identified by ultrasound scanning, in which fast-scan magnetic resonance imaging (F-SMRI) would give additional information for the perinatal management of the infants. DESIGN: Observational clinical study. SETTING: Hospital Department of Obstetrics and Gynaecology/Resonance Research Centre. SUBJECTS: Seven women carrying eight fetuses in whom congenital abnormalities had been identified using ultrasound scans. The duration of the pregnancies was 28 to 39 weeks gestation. INTERVENTIONS: Fast-scan magnetic resonance imaging at between 28 and 39 weeks gestation. MAIN OUTCOME MEASURES: Identification of fetal abnormalities. RESULTS AND CONCLUSIONS: F-SMRI was of limited value in the diagnosis of further assessment of fetuses with abnormalities of accumulation of tissue fluid. Renal anomalies were poorly identified unless associated with cystic formation of the kidney. Further study is required in the imaging of fetal central nervous system anomalies. Until echoplanar imaging is more widely available, MRI does not contribute to the diagnosis of cardiac anomalies. F-SMRI appears to be most useful in the diagnosis and management of soft tissue gastro intestinal abnormalities.
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Normal human placental metabolism has been studied in vivo by image localised 31P magnetic resonance spectroscopy in 13 women with anterior placentas; five, however, were too fat for useful spectral signals to be obtained. Magnetic resonance spectra of good quality which were considered to have arisen from the placenta were obtained from seven women with uncomplicated pregnancies (median gestational age 35 weeks, range 28-39). One other woman had a twin pregnancy in which one fetus had died a few days before. The phosphodiester signal from the placenta of the dead fetus was outside the 95% confidence intervals for normal placentas, suggesting that this technique may potentially be useful in the assessment of placental function.
The application of magnetic resonance techniques in the assessment of fetal growth, fetal growth patterns and fetal health was assessed. Eighty-four sets of fetal images were obtained using a fast-scan magnetic resonance imaging technique. Measurements were made of fetal subcutaneous fat thickness, uterine cavity length and width, fetal and uterine cross-sectional areas and fetal volume. Fetal area and fetal volume measurements were found to correlate well with birth weight. Measurement of subcutaneous fat thickness may prove to be a means of differentiating between those fetuses who are constitutionally as opposed to pathologically large or small. Thirteen women had additional spectroscopic studies carried out. Twelve of the women had normal pregnancies. One woman had a twin pregnancy in which one twin died. 31P phosphorus spectra were obtained from seven of the normal pregnancies. In the remainder, the depth of the abdominal wall prevented spectra being obtained from the placenta. Differences in phosphorus metabolites were obtained from the placenta of the dead twin compared to those from the healthy pregnancies.
The smoking habits of 300 consecutive pregnant women and of other members of their household were obtained by interview at 16 and 32 weeks' gestation and after delivery. Urine samples for estimation of cotinine were collected at the same times during pregnancy and on admission in labour. Both self-reports of active maternal smoking and urinary cotinine levels were significantly associated with lighter babies but urinary cotinine correlated the better. Active maternal smoking was associated with a decrease in birth-weight of 12 g for every cigarette smoked in a day while there was a decrease of 25 g in birth-weight for every microgram of cotinine/mg of urinary creatinine. Passive maternal smoking was associated with a decrease of 66 g in mean birth-weight but this decrease was not statistically significant. Self-reports of active and passive smoking accounted for 43% of the variation in urinary cotinine levels suggesting that urinary cotinine assays can be used to assess and monitor exposure to tobacco smoke in pregnancy.
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The pharmacokinetics of alfentanil were studied during the first four days after birth in 22 ventilated preterm infants who were all receiving muscle relaxants. Five minutes after a single dose of 20 micrograms/kg alfentanil median serum concentration was 66 ng/ml (range: 20-606). The median clearance was 0.87 ml/kg/min (range: 0.4-9.62) and median elimination half life 321 mins (64-1251). There were wide differences in the manner in which individual infants handled the drug and transient depression of blood pressure and heart rate was observed. These data were used to calculate an infusion dosage. In four infants 20 micrograms/kg alfentanil given by infusion over 30 minutes followed by 5 micrograms/kg/hour produced steady state median alfentanil concentrations of 54.5 ng/ml (range: 7-73 ng/ml) with no evidence of drug accumulation.
Multiresistant Enterobacter cloacae infection in six premature infants was eradicated with intravenous ciprofloxacin (10 mg/kg/day). Bacterial resistance did not develop. Adequate plasma ciprofloxacin concentrations were achieved in all treated patients. No clinical evidence of side effects was observed.
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The incidence and severity (peak serum bilirubin concentration) of clinically detectable jaundice was determined retrospectively in 110 elution positive cases of ABO incompatibility. Neither the incidence nor the severity of jaundice in the study group differed significantly from a control group. In the individual case Coombs positivity and/or a strongly positive elution test may be a helpful predictor of jaundice occurring but not of its severity.
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