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Biomedical subjects

C J Morley

Publications and source records attributed to C J Morley.

At least 19 recordsLinked to original sources
PubMed1992

Microscopic observations on tracheal aspirates from ventilated neonates. II. The onset of bronchopulmonary dysplasia and other changes.

A total of 450 undiluted and unprocessed tracheal aspirates from 120 intubated infants were examined microscopically for evidence of bronchopulmonary dysplasia and other changes. In 19 infants desquamated sheets of dysplastic epithelium in the fresh aspirate provided an early indication of developing bronchopulmonary dysplasia. Examination of unstained tracheal aspirates can provide, within minutes, information not only about the onset and development of bronchopulmonary dysplasia, but also provide evidence for milk or formula aspiration and for gastro-oesophageal reflux.

Bile Pigments↗
PubMed1992

Expedition stress and personality change.

There have been few attempts to investigate the widespread assumption that short-term challenges can have beneficial effects on personality. An expedition to India organized by the British Schools Exploring Society provided such an opportunity. The Gordon Personal Profile Inventory showed that the expedition was associated with increased ascendancy, emotional stability, sociability and responsibility, and decreased cautiousness. Women tended to benefit more than men. The results suggest that the expedition was associated with positive personality changes, though other explanations of the findings cannot be ruled out.

Adolescent↗
PubMed1992

Axillary and rectal temperature measurements in infants.

Rectal and axillary temperatures were measured during the daytime in 281 infants seen randomly at home and 656 at hospital under 6 months old, using mercury-in-glass thermometers. The normal temperature range derived from the babies at home was 36.7-37.9 degrees C for rectal temperature and 35.6-37.2 degrees C for axillary temperature. Rectal temperature was higher than axillary in 98% of the measurements. The mean (SD) difference between rectal and axillary temperatures was 0.7 (0.5) degrees C, with a range of 3 degrees C. When used in hospital to detect high temperature, axillary temperature had a sensitivity of 73% compared with rectal temperature. This is too insensitive for accurate detection of an infant's high temperature. Rectal temperature measurement is safer than previously suggested: perforation has occurred in less than one in two million measurements. If an infant's temperature needs to be taken, rectal temperature should be used.

Age Factors↗
PubMed1992

Respiratory timing in intubated neonates with respiratory distress syndrome.

Respiratory timing was studied in 100 babies ventilated for respiratory distress syndrome (RDS) during a brief period of continuous positive airway pressure. For the 76 spontaneously breathing babies the mean (SD) inspiratory and expiratory times were 0.31 (0.06) and 0.41 (0.12) seconds. Respiratory rate was predominantly modulated by expiratory time. The severity of RDS was the main influence on expiratory time.

Female↗
PubMed1991

Baby Check: a scoring system to grade the severity of acute systemic illness in babies under 6 months old.

A scoring system has been developed to grade the severity of acute systemic illness in babies under 6 months of age. Data were collected on 28 symptoms and 47 signs from 1007 babies with a spectrum of illness ranging from well to seriously ill. Ordinal regression analysis identified 19 symptoms and signs which in combination graded the severity of the illness most accurately. The coefficients were converted to scores. The higher the score the more serious the illness. When applied to a theoretical cohort of 10,000 babies at home, a score less than 8 has a specificity of 98%, and a score of 13 or more a sensitivity of 92%. The positive predictive value for serious illness increases from zero at a score of zero to approaching 100% at scores over 30. The scoring system has been developed into score cards for parents and professionals.

Data Collection↗
PubMed1991

Field trials of the Baby Check score card: mothers scoring their babies at home.

The Baby Check score card has been developed to help parents and health professionals grade the severity of acute illness in babies. This paper reports the results of two field trials in which mothers used Baby Check at home, 104 mothers scoring their babies daily for a week and 56 using it for six months. They all found Baby Check easy to use, between 68% and 81% found it useful, and 96% would recommended it to others. Over 70% of those using it daily used it very competently. Those using it infrequently did less well, suggesting that familiarity with the assessment is important. The scores obtained show that Baby Check's use would not increase the number of mothers seeking medical advice. With introduction and practice most mothers should be able to use Baby Check effectively. It should help them assess their babies' illnesses and make appropriate decisions about seeking medical advice.

Attitude↗
PubMed1991

Field trials of the Baby Check score card in general practice.

Sixteen general practitioners (GPs) used the Baby Check score card to assess illness severity in 86 babies under 6 months old. Their reactions to Baby Check were positive: in 79 (92%) it gave an accurate assessment of the baby's illness and 16 (100%) said they would trust it. Fifteen (94%) found it useful, and most of those who did not said the baby was not ill or had an obvious diagnosis. Thirteen (81%) said they would use it and wanted their health visitors and midwives to use it and 15 (94%) wanted the mothers in their practice to use it. The majority (64%) of babies scored 0-7; 31% scored 8 to 19; and only 5% scored over 20. Well babies had low scores, while the two sickest babies, needing urgent hospital treatment, scored 29 and 33. The use of Baby Check by GPs would help them assess babies thoroughly and quantify illness severity objectively.

Family Practice↗
PubMed1991

Field trials of the Baby Check score card in hospital.

The Baby Check score card was used by junior paediatric doctors to assess 262 babies under 6 months old presenting to hospital. The duty registrar and two consultants independently graded the severity of each baby's illness without knowledge of the Baby Check score. The registrars assessed the babies at presentation while the consultants reviewed the notes. The consultants and registrars agreed about the need for hospital admission only about 75% of the time. The score's sensitivity and predictive values were similar to those of the registrars' grading. The score's specificity was 87%. Babies with serious diagnosis scored high, while minor illnesses scored low. The predictive value for requiring hospital admission increased with the score, rising to 100% for scores of 20 or more. The appropriate use of Baby Check should improve the detection of serious illness. It could also reduce the number of babies admitted with minor illness, without putting them at increased risk.

Hospitalization↗
PubMed1991

Respiratory compliance in premature babies treated with artificial surfactant (ALEC).

In a randomised trial of artificial surfactant (ALEC) given at birth to 294 babies less than 34 weeks' gestation, the respiratory compliance was measured at 1, 6, 24, 48, and 168 hours after birth. In babies less than 29 weeks' gestation ALEC significantly improved the mean (SEM) compliance at 6 hours from 0.54 (0.06) to 0.91 (0.13) ml/cm H2O/kg and at 24 hours from 0.57 (0.04) to 0.92 (0.10) ml/cm H2O/kg. The improvements at 1, 48, and 168 hours were not significant. In babies of over 29 weeks' gestation the compliance was lower in the ALEC treated babies. This was significant only at one hour: 0.52 (0.03) compared with 0.71 (0.07) ml/cm H2O/kg and only occurred in babies who were not ventilated.

Female↗
PubMed1991

Baby Check and the Avon infant mortality study.

Thirty seven sudden, unexpected infant deaths from the Avon study were scored retrospectively for serious illness using a modified version of Baby Check. Three cases (8%) scored very highly. In a small proportion of sudden deaths, Baby Check could have identified serious illness before death and led to hospital admission.

Humans↗
PubMed1991

Symptoms and signs in infants younger than 6 months of age correlated with the severity of their illness.

Symptoms and signs were recorded for 1007 infants younger than 6 months of age seen at home (298) or hospital (709) and correlated with four grades of illness severity. Most symptoms, present in the preceding 3 days, were associated with all grades of illness. Only four symptoms were not reported in well infants: a fluid intake less than a third of normal, convulsions, frank blood in the stools, and bile-stained vomiting. By comparison, many signs were seen only in ill infants. Those associated only with moderate or serous illness were marked retraction of the lower ribs, high-pitched or moaning cry, expiratory grunt, loss of alertness, central cyanosis, and severe hypotonia. Although these will not identify all seriously ill infants, parents and professionals should be taught to recognize these important symptoms and signs of serious illness.

Health Status↗
PubMed1990

Symptoms in 298 infants under 6 months old, seen at home.

Symptoms were assessed in 298 infants under 6 months old seen at home. Their mothers were asked if they were concerned about their babies and then questioned about the presence, duration, and severity of 28 predefined symptoms. Forty seven mothers expressed concern about their babies (16%), whereas on direct questioning 241 (81%) reported symptoms present within the last 24 hours. One hundred and twenty three (41%) reported three or more. Many of the symptoms occurred in more than 15 babies (5%). The commonest were cold peripheries (117, 39%), noisy breathing (88, 30%), and rash (68, 23%). These had often been present for many days. Only 257/819 reported symptoms (31%) were of recent onset (less than 4 days) with 168 (21%) graded by the mother as moderate or severe. A few highly specific symptoms that were associated with serious conditions were rare. Symptoms cannot be interpreted without detailed questioning taking their severity and duration into account, and most occur too often to be used as indicators for referral.

Attitude to Health↗
PubMed1990

Follow up of premature babies treated with artificial surfactant (ALEC).

Of 235 survivors who had taken part in a randomised trial of artificial surfactant and who were born in Cambridge, follow up information was available for 231 (98%) infants. In 12 cases information came from local doctors; all others were assessed at 9 and 18 months (n = 212) or 9 months only (n = 7). There was no difference between those who had been treated with surfactant and control babies in the incidence of neurological impairment, mental impairment, respiratory infections, allergies, or hospital admissions up to 18 months after full term. In those born before 30 weeks' gestation (where surfactant most improves survival) the number of surviving randomised children who were normal was 35 of 61 in the treated group (57%) compared with 25 of 61 in the control group (41%). Improved neonatal survival after prophylactic surfactant treatment is not associated with an increased incidence of neurodevelopmental impairment.

1,2-Dipalmitoylphosphatidylcholine↗
PubMed1990

Respiratory rate and severity of illness in babies under 6 months old.

This paper defines the normal range of respiratory rate in babies under 6 months of age. It was counted by two observers in 1007 babies of whom 709 were seen when presenting to hospital for assessment of an acute illness, and 298 on a random basis at home. Whether they were asleep, content, or crying was recorded and the severity of their illness graded. The diagnosis was also recorded. The mean (SD) for the respiratory rate in babies seen awake was 61 (18) breaths/minute at hospital and 61 (14) breaths/minute at home. The respiratory rate when awake did not correlate with the severity of a baby's illness or the presence of serious lower respiratory tract infections. Sleeping babies had a significantly lower mean rate than awake babies at 42 (12) breaths/minute. Crying babies had a significantly lower mean rate than awake and content babies: 51 (14) breaths/minute compared with 61 (18) breaths/minute.

Acute Disease↗