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Biomedical subjects

D A Ducker

Publications and source records attributed to D A Ducker.

14 recordsLinked to original sources
PubMed1999

Continuous neonatal blood gas monitoring using a multiparameter intra-arterial sensor.

AIMS: To compare arterial blood gas (ABG) readings obtained with a multiparameter intra-arterial sensor with those from an ABG analyser. METHODS: An MPIAS with the ability to measure continuously pH, PaCO2, and PaO2 was introduced via an umbilical arterial catheter in 27 neonates requiring intensive care. They underwent 3260 hours of MPIAS monitoring, during which 753 ABG readings were performed. RESULTS: Overall bias (mean difference: MPIAS-ABG) and precision (standard deviation of differences) values were: -0.002 and 0.022, respectively, for pH; +0.26 and 0.52 for PaCO2 (kPa); and -0.19 and 0.99 for PaO2 (kPa). This gave 95% limits of agreement as: -0.047 to +0.042 for pH, -0.76 to +1.28 kPa for PaCO2, and -2.13 to +1.75 kDa for PaO2. For each variable, precision across readings from the same individual was better than overall precision for all data. No complications related to the use of the catheter were observed. CONCLUSIONS: Continuous MPIAS ABG monitoring is an exciting development, with the potential to reduce blood transfusions and improve ABG homeostasis.

Blood Gas Analysis↗
PubMed1995

Monitoring respiratory activity in neonates using diaphragmatic electromyograph.

The monitoring of the development of respiratory function in low-birth-weight or sick neonates is important in its overall treatment. The most direct approach to obtaining information on respiratory function is to monitor the activity of the diaphragmatic muscular system rather than measure the resultant change in lung volume or ventilator output, which cannot be guaranteed to be directly related to the neonate's own respiratory activity. The system was designed to assess the feasibility of monitoring respiratory activity in such neonates by measuring the diaphragmatic electromyograph. It is hoped that this system can be used to monitor the development of lung function and possibly, if reliability proves adequate, the synchronisation and control of ventilator assistance. To monitor the EMG, the dominant effect of the ECG was removed using a digital processor. Initial clinical measurements indicate that neonatal respiratory activity can be monitored by measuring the diaphragmatic EMG. Comparative measurements show the EMG method is faster in detecting the inspiratory phase of a breath. Measurements on ventilated neonates showed the presence of intermittent respiratory activity. It also is proposed that clinically relevant information may be deduced from the analysis of the morphology of the detected EMG waveform.

Diaphragm↗
PubMed1994

Risk factors at delivery and the need for skilled resuscitation.

A prospective study was devised to investigate how risk factors at delivery contribute to outcome at birth as measured by the type of resuscitation required ('skilled' or 'not skilled') and the Apgar score. In addition the number of unexpected 'crash calls' was recorded. In a 3-month sample, neonatologists attended 494 (38.6%) of 1279 deliveries. Of those attended, 188 (37.2%) required skilled resuscitation including 5 of 20 crash calls. Four risk factors at delivery were associated with skilled resuscitation: meconium, emergency caesarean section, prematurity and multiple births. Following the implementation of a revised resuscitation policy, a subsequent 3-month sample showed that 299 (24.8%) of 1206 deliveries were attended. A total of 175 (58.5%) required skilled resuscitation including 8 of 16 crash calls. The revised resuscitation policy, in our unit, proved to be safe and led to a reduction of attendance by neonatologists at deliveries.

Apgar Score↗
PubMed1991

Temperature instability during nursing procedures in preterm neonates.

The temperature changes associated with total care nursing procedures were studied on 249 occasions during the first week of life in 25 preterm infants weighing less than 1500 g, 16 of whom weighed less than 1100 g. Large drops in both central and peripheral temperature occurred, with widening of the central-peripheral temperature gap. Recovery of the temperature after the total care procedure took up to two hours. These routine nursing procedures are carried out every four to six hours. They cause an important alteration in the environmental temperature with consequent thermal stress to the infants that may influence ultimate outcome.

Body Temperature Regulation↗
PubMed1988

A randomised prospective comparison of cefotaxime versus netilmicin/penicillin for treatment of suspected neonatal sepsis.

In an open prospective study performed in 2 neonatal units, infants with suspected neonatal sepsis (SNS) of unknown microbial cause were randomly allocated to receive treatment with either cefotaxime (CTX) or netilmicin plus penicillin (N + P). 236 patients were entered into the trial, of whom 222 were evaluable. The number of 'definitely' and 'probably' infected babies was similar in both groups. There was no difference in clinical outcome between patients in the 2 treatment groups and no side effects were recorded for either of the antibiotic regimens. Antibiotic sensitivity testing of bacterial isolates from peripheral sites showed almost universal sensitivity of potential pathogens to both antibiotic regimens at the start of treatment in all infants. Thereafter, organisms resistant to CTX were isolated from patients in both treatment groups, possibly reflecting the antibiotic sensitivity profile of the colonising bacteria in both neonatal units. The results of this study indicate that either CTX or N + P are suitable, in our units, for the 'blind' treatment of early SNS. In units where listerial infections are prevalent, specific cover should be added to CTX. For SNS developing after admission, the choice of antibiotics will depend upon the background antibiotic sensitivity profile of the colonising bacteria.

Bacterial Infections↗
PubMed1985

Incubator temperature control: effects on the very low birthweight infant.

We studied temperature stability in 22 infants of birthweight less than 1500 g in the first four days of life. Infants were nursed in incubators using either air mode control or skin temperature servo control. Data were collected continuously using a computer linked monitoring system. Skin temperature control resulted in a less stable thermal environment than air mode control. Increased thermal stability in the incubator on air mode control may well be beneficial, particularly to sick, very low birthweight infants.

Feedback↗
PubMed1983

Total parenteral nutrition in infancy: effect on the liver and suggested pathogenesis.

Biochemical, histological, and electron-microscopic investigation of seven preterm infants who became jaundiced after prolonged total parenteral nutrition showed conjugated hyperbilirubinaemia apparently due to cholestasis without significant primary liver cell injury. In the absence of evidence indicating a direct toxic effect on the liver of this form of nutrition the necropsy findings in one child and analogy with the effects of total parenteral nutrition in animals suggest that the cholestasis is the result of suppression of trophic and/or secretion-stimulating hormone(s) normally produced by the gut, due to absent enteral nutrition. Biochemical and electron-microscopic findings suggest that liver cell damage occurs after resumption of enteral nutrition.

Humans↗
PubMed1982

Adaptation of the small intestine--does it occur in man?

After resection and usually after shunt operations for obesity, the small bowel in-situ or in-continuity develops mucosal hyperplasia and enhanced absorption per unit length of intestine in animals and man, although the studies in man are limited. The opposite occurs in the small bowel deprived of food either by bypass or total parenteral nutrition (TPN). The changes which occur in the bypassed bowel are not consistent and cannot be explained by the luminal nutrition theory alone. The effect of TPN on jejunal function has been assessed in preterm infants using the one hour blood xylose test and potential difference changes after the infusion of glucose. The results of these tests suggest that the absorptive surface area is diminished during TPN, increases following enteral feeding, and is not related to post-natal age. Function at a cellular level probably remains constant. The mechanism of adaptation is poorly defined in man, but animal studies suggest that in addition to luminal nutrition, other factors such as hormones, and pancreatico-biliary secretions, are important but that there is a fine balance of agonists and antagonists.

Adaptation, Physiological↗
PubMed1980

Neonatal gut function, measured by the one hour blood D (+) xylose test: influence of gestational age and size.

D(+) Xylose absorption, assessed by one hour blood xylose levels, has been measured after intraduodenal infusion of the sugar in 35 infants of differing gestational age and size. The test was performed between the 2nd and 6th days of life. Full-term appropriately grown infants had higher blood xylose levels (1.41+/-0.07 mmol/l) at one hour than pre-term appropriately grown infants (1.17+/-0.07 mmol/l; P less than 0.05), or 'light for dates' infants, both full-term (0.73+/-0.06 mmol/l; P less than 0.001) and pre-term (0.96+/-0.17 mmol/l; P less than 0.05). Serial studies of 11 infants were made two to five times between the 3rd and 20th day of life. The levels for one hour xylose rose in all groups, but the 'light for dates' infants showed the least rise. There was no sign of catch-up in this group, and some results appeared to fall further behind those of appropriately grown infants. These results suggest that the primal small intestine is maturing in the perinatal period, and that intrauterine growth retardation may impair intestinal absorption. The nutritional significance is not known.

Administration, Oral↗
PubMedDate not supplied

The influence of gestational age and size on the absorption of D-xylose and D-glucose from the small intestine of the human neonate.

D-Xylose absorption (using the one-hour blood levels) and active D-glucose absorption (calculated from changes in transmural electrical potential difference) have been measured after intraduodenal infusion of the appropriate sugar, in groups of neonates who were full-term or preterm, and who were in addition either appropriately sized for gestational age, or growth-retarded in utero. The one-hour D-xylose blood levels were significantly lower in preterm infants, and were even lower in the growth-retarded group. In follow-up studies D-xylose absorption rose in all groups of infants over the first three weeks of postnatal life but there was no sign of 'catch-up' in the results of the growth-retarded infants. In the studies of D-glucose absorption the theoretical kinetic parameters 'apparent P.D.max' (equivalent to Vmax) and 'apparent Km' were calculated. Normal full-term infants had values for both parameters that were approximately two-thirds of published adult values. Malnourished neonates had significantly lower P.D.max and apparent Km, and preterm infants had a lower P.D.max, than the values obtained in those infants who were full-term and appropriately grown.

Gestational Age↗