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Biomedical subjects

D G Batton

Publications and source records attributed to D G Batton.

8 recordsLinked to original sources
PubMed1992

Cerebral blood flow velocity in normal, full-term newborns is not related to ductal closure.

OBJECTIVE: To correlate changes in blood flow velocity in the anterior and middle cerebral arteries with closure of the ductus arteriosus in normal, full-term newborns during the first 2 days following delivery. DESIGN: Survey. SETTING: Large community hospital. PARTICIPANTS: Twenty-three normal, full-term neonates. SELECTION PROCEDURES: Volunteer sample. INTERVENTIONS: None. MEASUREMENTS AND RESULTS: We measured blood flow velocity in the anterior and middle cerebral arteries, cardiac output, and patency of the ductus arteriosus using pulsed Doppler, M-mode, and real-time ultrasound. The initial examination was performed at (mean +/- SD) 7.6 +/- 2 hours and the second examination was performed at 30 +/- 3 hours. The systolic, diastolic, and mean blood flow velocity in the anterior and middle cerebral arteries increased significantly from day 1 to day 2. Cardiac output did not change significantly (252 +/- 49 vs 279 +/- 69 cm3/kg per minute). Thirteen newborns on day 1, but only two newborns on day 2, had echocardiographic evidence of a patent ductus arteriosus. Newborns whose ductus was already closed on day 1 had similar increases in blood flow velocity in the anterior and middle cerebral arteries from day 1 to day 2 compared with newborns whose ductus had closed from day 1 to day 2. CONCLUSION: The normal increase in blood flow velocity in the anterior and middle cerebral arteries in the first 2 days following delivery is not related to changes in cardiac output or ductal closure.

Aorta↗
PubMed1992

Respiratory complications associated with cryotherapy in premature infants.

We reviewed the frequency of respiratory complications associated with cryotherapy in 14 premature infants who underwent 17 cryotherapy procedures. Five of the procedures were performed on infants already being mechanically ventilated. Two of these infants required increased ventilatory support during and following the procedure for decreased spontaneous respirations. For the 12 procedures performed on 11 infants who were not being mechanically ventilated at the time of cryotherapy, four infants had no complications, three infants had minor respiratory deteriorations, and five infants required positive pressure ventilation for severe apnea and bradycardia episodes (one just after narcotic administration, four during the procedure). Excluding the three infants (five procedures) who were already receiving mechanical ventilation at the time of cryotherapy, the infants who had severe apnea requiring the initiation of positive pressure ventilation weighed less and were younger than those infants not having a serious respiratory complication (p less than 0.05).

Apnea↗
PubMed1992

Severe retinopathy of prematurity and steroid exposure.

During a 3-year period (1988 through 1990) an increase was observed in the number of infants born at 23- to 26-weeks' gestation who required cryotherapy for severe retinopathy of prematurity (0/20, 1988; 3/14, 1989; 6/18, 1990; P = .015). Inasmuch as this was not related to improved survival, a retrospective case-control study was conducted to try to explain this observation. Of 52 surviving infants who had been born at 23 to 26 weeks' gestation, 9 required cryotherapy and the other 43 served as control subjects. There were no differences between groups in birthweight, gestational age, or the number of infants with hyaline membrane disease, intraventricular hemorrhage, or hydrocephalus. Factors related to the need for cryotherapy included patent ductus arteriosus (P = .046), mechanical ventilation for more than 21 days (P = .045), and the use of steroids for lung disease (P < .001). In this neonatal intensive care unit, steroids are administered according to the attending neonatologist's preference. Inasmuch as steroids are considered only for infants still ventilator dependent at 21 days, this group was analyzed separately (n = 36). Of the 21 factors examined, only the use of steroids for lung disease was associated with the need for cryotherapy (P < .001).

Case-Control Studies↗
PubMed1992

Reducing neonatal transfusions.

In an attempt to prevent blood transfusions from being ordered unnecessarily in our neonatal intensive care unit (NICU), we developed transfusion guidelines and prospectively evaluated their impact on our transfusion practices. Initially, 17% of our packed red blood cell transfusions (PRBCT) did not meet our guidelines. However, 6 months following development of the guidelines, this decreased to 9%, and 12 months later, it decreased to 1%. Although the guidelines are clearly arbitrary, they do provide for consistency within our NICU and a method of evaluating our own use of PRBCT.

Apnea↗
PubMed1991

Complications associated with central venous catheters inserted in critically ill neonates.

OBJECTIVE: To assess the incidence and spectrum of complications associated with central venous catheter (CVC) placement in the critically ill infant. DESIGN: A prospective study of all babies hospitalized in a neonatal intensive care unit (NICU) from January 1989 to December 1989. Potential risk factors associated with infection were evaluated by a case-control comparison. SETTING: Conducted at a university-affiliated, tertiary care community hospital. PATIENTS: Neonates requiring intensive care and a central venous catheter. Controls consisted of noninfected babies. RESULTS: Of 263 critically ill neonates, only 13 (4.9%) required a CVC insertion. Seventeen CVCs were placed in these 13 neonates for a total duration of 600 days (median, 32 days/cannula). Fifteen (88%) of these cannulas had one or more complications during its catheter life including dislodgement or leakage (53%), occlusion or thrombosis (47%), infections (29%), or minor bleeding (12%). Five babies (29%) developed 6 episodes of bloodstream infection including 3 sporadic cases due to Staphylococcus epidermidis and a cluster of fungemia due to Malassezia furfur associated with lipid emulsion therapy. Infants with a CVC-associated infection were a younger gestational age (24 weeks versus 32 weeks, p = .04) and weighed less at birth (580 g versus 1285 g, p = .02). The overall rate of bloodstream infection was one episode per 100 days of catheter use. CONCLUSIONS: CVCs may be lifesaving to a critically ill neonate, but complications occur frequently. Use must be restricted to infants in whom alternate delivery routes of intravenous therapy or support are otherwise unavailable.

Birth Weight↗
PubMed1990

A comparison of chromogen test strip (Chemstrip bG) and serum glucose values in newborns.

Although glucose oxidase-peroxidase chromogen test strips are frequently used to estimate serum glucose values in newborns, previous studies have not evaluated multiobserver variability of test strip readings and have included few infants with hypoglycemia. We compared values of 272 samples of serum glucose with values simultaneously obtained by chromogen test strips (Chemstrip bG) in newborns. The diagnostic sensitivity of a chromogen test strip less than 2.2 mmol/L for predicting a serum glucose level less than 1.9 mmol/L was 86% (95% confidence interval [CI], 75% to 94%), with 78% specificity (95% CI, 73% to 84%). The positive predictive value in our specimens, with a 21% prevalence of serum glucose levels less than 1.9 mmol/L, was 52% (95% CI, 41% to 62%), with a negative predictive value of 95% (95% CI, 91% to 100%). Fifty-eight of our serum glucose values were less than 1.9 mmol/L and the levels obtained by chromogen test strip were greater than or equal to 2.2 mmol/L in 8 of these cases. Review of these 8 cases showed that a delay in performing the laboratory glucose oxidase serum glucose could account for the discrepancy in 2 cases. Chromogen test strips are readily available and easy to use, but more sensitive, specific, accurate, and precise methods of serum glucose screening in newborns are needed.

Blood Glucose↗