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Biomedical subjects

D C Wilson

Publications and source records attributed to D C Wilson.

At least 19 recordsLinked to original sources
PubMed1995

Percutaneous central venous catheter use in the very low birth weight neonate.

UNLABELLED: A retrospective study was carried out comparing 61 very low birth weight infants (VLBW) with percutaneous central venous catheters with 92 infants managed with peripheral cannulae. Eighteen infants developed one or more episodes of catheter-associated bacteraemia. In 70% of cases the infection was successfully treated with the line in situ. Logistic regression analysis was performed to examine risk factors for bacteraemia. The duration of intravenous fluids and of intermittent positive pressure ventilation were both significant risks for infection (odds ratios and 95% confidence limits 4.4, 2.7-12.0 and 2.5, 1.0-6.1 respectively), but the presence of a silastic catheter was not an independent risk factor (odds ratio 0.6, 95% confidence limits 0.1-3.0). CONCLUSION: Percutaneous central venous catheters provide a satisfactory means of delivering parenteral nutrition with minimal disturbance to ill VLBW infants.

Bacteremia↗
PubMed1994

Predictive value of soluble immunological mediators in neonatal infection.

1. Infection in the neonatal period is difficult to diagnose and is a significant cause of morbidity and mortality in preterm infants. 2. We investigated prospectively the predictive value of plasma measurement of bacterial endotoxin (lipopolysaccharide), tumour necrosis factor-alpha, interleukin-6, interleukin-8, intercellular adhesion molecule-1 and C-reactive protein in 60 consecutive newborn infants suspected of having neonatal infection. Plasma samples were taken at the time of acute clinical deterioration. Sixty-two cord blood samples were studied as controls taken at elective Caesarean section. 3. Forty-three infants had confirmed infections, 25 with positive blood cultures. Tumour necrosis factor-alpha and bacterial endotoxin levels were not significantly elevated over controls, whereas interleukin-6, interleukin-8 and intercellular adhesion molecule-1 levels were all significantly increased in the infected group compared with controls (all P < 0.001). 4. Increased plasma intercellular adhesion molecule-1 levels were a highly sensitive (88%) indicator of clinical infection and were independent of C-reactive protein. Use of these two assays in combination improved the diagnostic sensitivity to 95% and gave a negative predictive value of 97%. addition of interleukin-6 or interleukin-8 measurements failed to further significantly enhance the prediction of infection. 5. Measurement of intercellular adhesion molecule-1 level may have a clinical role in rapidly confirming, or predicting, the likely diagnosis in cases of suspected neonatal infection.

Bacterial Infections↗
PubMed1994

Neonatal infection does not affect the immunoreactive trypsinogen screening test for cystic fibrosis.

We aimed to discover whether neonatal infection affected levels of the immunoreactive trypsin (IRT) assay, which is used as a screening test for cystic fibrosis. Forty babies who had clinical features suggesting infection had blood spot specimens for IRT taken at the same time as blood for culture. Of 27 babies believed clinically to have infection, 19 had positive blood cultures and eight had negative culture. In retrospect, 13 were not thought to have infection. The mean (SD) IRT results in these three groups were 15 (8), 11 (4), and 16 (6) micrograms/L, respectively. The mean (SD; range) IRT result for all 40 babies was 14 (7; 10-39). Not only did no babies have elevated IRT results at routine neonatal screening, but none have presented with clinical features suggestive of cystic fibrosis since hospital discharge. Neonatal infection does not appear to cause elevated IRT levels and should therefore not cause false-positive results in mass neonatal screening.

C-Reactive Protein↗
PubMed1994

Energy requirements in sick preterm babies.

The energy requirements of healthy preterm babies are well documented in the literature. However, the clinical load in neonatal intensive care units is due to sick preterm infants requiring prolonged mechanical ventilation, many of whom will develop bronchopulmonary dysplasia. It is this group in which knowledge of energy requirements is scanty. This group also has poor energy reserves and is often intolerant of enteral and parenteral nutrition. In this article, we will review methods of measurement of energy expenditure, methodological problems when applied to ill infants and published results of energy expenditure measurements in sick preterm babies. We will review the link between energy reserves, energy intake and energy expenditure. The problems of undernutrition in early postnatal life and possible consequences in adult life will be discussed.

Adult↗
PubMed1993

Benzoquinazoline inhibitors of thymidylate synthase: enzyme inhibitory activity and cytotoxicity of some 3-amino- and 3-methylbenzo[f]quinazolin-1(2H)-ones.

The synthesis and thymidylate synthase (TS) inhibitory activity of a series of simple benzo[f]-quinazolin-1(2H)-ones are described. Fully aromatic 3-amino compounds with compact lipophilic substituents in the 9-position were found to have I50 values as low as 20 nM on the isolated enzyme, and represent the first examples of potent, folate-based TS inhibitors that completely lack any structural feature corresponding to the (p-aminobenzoyl)glutamate moiety of the cofactor. A number of the compounds also showed moderate growth inhibitory activity against a human colon adenocarcinoma cell line (SW480), with IC50 values as low as 2 microM.

Adenocarcinoma↗
PubMed1993

Progressive neuronal degeneration of childhood (Alpers syndrome) with hepatic cirrhosis.

Four children, from two families, suffered from fatal degeneration of the cerebral grey matter. Their disease was characterised by intractable epilepsy, epilepsia partialis continua, progressive deterioration, and terminal hepatic dysfunction. EEG showed marked and distinctive slow wave abnormality, visual evoked responses were diminished, and cerebral atrophy was seen on CT scan. Pathological findings were of neuronal loss and hepatic cirrhosis. The combination of cerebral degeneration, hepatic disease and familial occurrence suggests an inborn error of metabolism with autosomal recessive inheritance. The features described are those of Alpers syndrome, especially the recently delineated subgroup with progressive neuronal degeneration and liver disease.

Brain↗
PubMed1992

The influence of nutrition on neonatal respiratory muscle function.

Advances in neonatal intensive care have resulted in increasing survival of very small babies, who often require prolonged periods of mechanical ventilation. These babies have limited nutritional reserves, and are difficult to feed by either parenteral or enteral routes. This review article discusses the interaction between undernutrition and respiratory muscle function in the critically ill preterm baby.

Critical Illness↗
PubMed1992

Long term predictive value of Doppler studies in high risk fetuses.

OBJECTIVE: To determine whether the predictive value of Doppler ultrasonography extends beyond the perinatal period. DESIGN: Descriptive follow-up study. SETTING: Specially designated paediatric clinic in Royal Maternity Hospital. SUBJECTS: 40 children who as high risk fetuses had had assessment of umbilical artery flow velocity waveforms. INTERVENTIONS: Parental history, physical examination, anthropometry, Denver developmental screening test. OUTCOME MEASURES: Weight, height, head circumference, neurological impairment, Denver development screening test RESULT: Abnormal waveforms were an accurate predictor of neonatal outcome, with significant differences in birthweight, gestational age, need for nursery admission, and frequency of intrauterine growth retardation between normal and abnormal waveform groups. However, abnormal Doppler studies were not predictive of long-term adverse sequelae. There were no significant differences in height, head circumference, proportion with neurological impairment, or results of Denver developmental screening test at a median age of five years. CONCLUSION: The predictive value of Doppler ultrasonography is less for long-term growth and neurodevelopment than for perinatal outcome in the high risk fetus.

Child↗
PubMed1992

Meningitis and midline facial deformity.

A baby with unilateral cleft lip, midline cleft palate and hypertelorism developed meningitis in the first 48 h of life. Examination of the nasopharynx showed a soft tissue mass, which was confirmed as a basal encephalocele by computed tomography. There was also congenital hydrocephalus and the corpus callosum was absent. Surgical treatment included repair of the anterior basal skull defect, repair of the lip and palate, and ventriculo-peritoneal shunt. There is currently evidence of developmental delay and right-sided visual impairment due to Morning Glory syndrome. This case demonstrates that basal encephalocele should be considered in any baby with midline facial deformity who develops meningitis.

Cleft Lip↗
PubMed1992

Plasma manganese levels in the very low birth weight infant are high in early life.

Plasma manganese levels were determined at birth and then serially to 3 months of age in 40 very low birth weight (VLBW) infants (mean birth weight 1,027 g). Mean plasma manganese concentration was 3.6 micrograms/l at birth and 3.0 micrograms/l at 3 months of age. These levels were approximately 3-fold greater than those of a group of 9 adults analysed using the same methods (mean 1.1 micrograms/l). Manganese was also measured in parenteral nutrition fluids, breast milk and 3 preterm formulas. There was no relationship between manganese intake and plasma manganese concentration.

Adult↗
PubMed1992

Breast milk beta-glucuronidase and exaggerated jaundice in the early neonatal period.

Breast-feeding is associated with jaundice in the early neonatal period. Previous work has shown levels of the enzyme beta-glucuronidase in maternal breast milk to be related to infant serum bilirubin on postnatal day 21. Our aim was to establish if there was a correlation between the level of breast milk beta-glucuronidase and the degree of early (first week) neonatal hyperbilirubinaemia. A study of 55 mother and baby pairs showed that breast milk beta-glucuronidase levels had no relationship with the level of infant serum bilirubin between postnatal days 3 and 6. Breast milk beta-glucuronidase does not directly account for the early neonatal jaundice seen in breast-fed babies.

Bilirubin↗