PubMed Health⌕ Search

Biomedical subjects

D W Cartwright

Publications and source records attributed to D W Cartwright.

13 recordsLinked to original sources
PubMed2004

Central venous lines in neonates: a study of 2186 catheters.

OBJECTIVE: To describe the use of percutaneously inserted silicone central venous lines (CVLs) in neonates at the Royal Brisbane and Women's Hospital, Australia. DESIGN: Data for all infants admitted from 1 January 1984 until 31 December 2002 who had a CVL were examined in the neonatal database, completed from paper records and patient charts where necessary. Autopsy reports of all babies who died with a catheter in place were reviewed. RESULTS: There were 18,761 admissions, 2186 catheters in 1862 babies for a total of 35,159 days (median 14 days, range 1-99 days). The tip was in the right atrium for 1282 (58.6%) of the catheters. A total of 142 babies (7.6%) died with a CVL in place, 89 (4.8%) with the catheter tip in the right atrium. Thirty two of these 89 babies had an autopsy. No autopsies reported tension in the pericardium or milky fluid resembling intralipid. One case (0.05% of catheters) of non-lethal pericardial effusion occurred in a baby whose catheter was inappropriately left coiled in the right atrium. There were no cases of pleural effusion related to CVL use. Most (1523, 69.7%) were removed electively. Septicaemia occurred during the life of 116 catheters (5.3%). CONCLUSION: This is the largest series of percutaneously inserted silicone central venous catheters reported. It illustrates the safety of these catheters in this context. It highlights the value of keeping prospective records on such catheters. Catheters with their tips in the right atrium and not coiled did not cause pericardial effusion. Strict insertion and management principles for CVLs should be adhered to.

Autopsy↗
PubMed2003

Infant to staff ratios and risk of mortality in very low birthweight infants.

OBJECTIVES: To assess the effect that infant to staff ratios, in the first three days of life, have on the survival to hospital discharge of very low birthweight infants (<1500 g), having adjusted for initial risk and unit workload. DESIGN: In a retrospective analysis of a cohort of patients, the number of infants per nurse per shift were averaged for the first three days after admission and related to risk of mortality by logistic regression analysis. Infant to staff ratio was divided into terciles of low (1.16-1.58), medium (1.59-1.70), and high (1.71-1.97) infants per staff member. SUBJECTS: 692 very low birthweight infants admitted to the Intensive Care Nursery, Royal Women's Hospital, Brisbane over a four year period from January 1996 to December 1999. MAIN OUTCOME MEASURES: Survival to hospital discharge, adjusted for initial risk using the Clinical Risk Index for Babies (CRIB) score, and adjusted for unit workload using dependency scores. RESULTS: There were 80 deaths among the 692 babies analysed for the study period. The odds of mortality, adjusted for initial risk and infant dependency scores (unit workload), were improved by 82% when an infant/staff ratio of greater than 1.71 occurred, suggesting improved survival with the highest infant/staff ratio. The low and medium staffing levels corresponded with similar odds ratios for mortality. CONCLUSIONS: Infants exposed to higher infant to staff ratios have an improved adjusted risk of survival to hospital discharge.

Birth Weight↗
PubMed2002

Poor outcome of very low birthweight babies with serious congenital heart disease.

OBJECTIVE: To evaluate incidence and mortality of congenital heart disease in very low birthweight babies. METHOD: Retrospective analysis of a 12 year period. RESULTS: Forty seven babies were diagnosed with severe congenital heart disease. The most common lesions were ventricular septal defect and coarctation of the aorta. Mortality attributed to congenital heart disease was 32%. Coarctation of the aorta, the second most common lesion, was fatal in 62% of cases. Closure of a patent ductus arteriosus with indomethacin proved to be detrimental in babies with undiagnosed coarctation, causing rapid deterioration in some. CONCLUSION: Very low birthweight neonates with severe congenital heart disease have a higher mortality than babies with higher birth weight. A contributing factor is closure of a patent ductus arteriosus if an underlying lesion has not been recognised. This could be of significance if the use of prophylactic treatment with indomethacin becomes more common.

Aortic Coarctation↗
PubMed1998

Postextubation chest X-rays in neonates: a routine no longer necessary.

OBJECTIVES: To ascertain the incidence of postextubation atelectasis (PEA) in neonates, to delineate any objective differences between those infants with PEA and those without, and to see if any of those differences were predictive of the need for a postextubation chest X-ray (CXR). METHODS: This is a retrospective review of all infants ventilated in 1994. For each separate period of extubation the medical, physiotherapy and nursing notes were examined. Data were collected on birthweight, gestational age, duration of ventilation, age at extubation, ventilation requirements pre-extubation, pre- and postextubation arterial carbon dioxide tensions (PaCO2) and oxygen requirements, the number of episodes of bradycardia and apnoea, the pulse and respiratory rates pre- and postextubation, and the use of nasal continuous positive airway pressure (NCPAP). It was routine practice throughout 1994 for all ventilated babies to have a CXR 6 h postextubation. Each postextubation CXR was examined by one of the authors (MWD) for the presence of atelectasis and other diagnoses. PEA was defined as any atelectasis present on the postextubation CXR that was not present on the pre-extubation CXR. RESULTS: The overall incidence of any PEA was 2.5% (6/236). In those babies with PEA, the increase in oxygen requirement at 1 and 6 h postextubation was higher (change in inspired oxygen (deltaFiO2) of 0.05 vs 0.015, P=0.043 and deltaFiO2 of 0.045 vs 0.0, P=0.033, respectively). There was a higher incidence of the need for NCPAP some time after extubation (2/4 vs 9/163, P<0.001). No infant with PEA required reintubation and ventilation. CONCLUSIONS: In this nursery the incidence of PEA is low with no significant morbidity. Postextubation CXRs should be performed on only those infants who have an increase in oxygen requirement postextubation or become symptomatic with new or increasing respiratory distress, and to follow up atelectasis on the most recent pre-extubation CXR.

Humans↗
PubMed1998

Gentamicin dosage intervals in neonates: longer dosage interval--less toxicity.

OBJECTIVES: The aim of this study was to determine the incidence of toxic trough serum gentamicin levels in neonates in the first week of life, with different dosage intervals. METHODS: This was a retrospective study of neonates born between 01.07.95 and 31.12.95, who received gentamicin. Data were collected on birth weight, gestation, gentamicin dose, the trough level of gentamicin, serum creatinine and urine output. A trough serum gentamicin level of > or =1.5 mg/L was considered toxic. RESULTS: One hundred and seventy infants met the study criteria. All 21 infants in group one (24-29 weeks) received gentamicin with a dosage interval of 24 h. Sixteen (76%) infants had toxic trough serum gentamicin levels. In group two (30-34 weeks) 8 infants had gentamicin q12hly and all (100%) had toxic trough serum gentamicin levels. Fourteen infants had gentamicin every 18 h and 13 (93%) had toxic trough serum gentamicin levels. Sixty-one infants had gentamicin q24hly and 25 (41%) had toxic trough serum gentamicin levels. The differences in proportions with toxic levels were statistically significant. In group three (> or =35 weeks) 29 infants had gentamicin q12hly and 25 (86%) had toxic trough serum gentamicin levels. Six infants had gentamicin every 18 h and 2 (33%) had toxic trough serum gentamicin levels. Thirty-one infants had gentamicin q24hly and 4 (13%) had toxic trough serum gentamicin levels. The differences in proportions comparing infants having gentamicin q12hly with those having it q24hly were statistically significant. CONCLUSIONS: A starting gentamicin dosage interval of 12 h in infants of any gestational age, or a starting dosage interval of 24 h for infants of less than 30 weeks gestational age, leads to most having toxic trough serum gentamicin levels. In infants of 30 weeks gestational age or greater, most have safe non-toxic trough serum gentamicin levels if started on a dosage interval of 24 h.

Drug Administration Schedule↗
PubMed1985

Duplication 5q(5q22----5q33): from an intrachromosomal insertion.

We report on an infant with an as yet undescribed partial duplication 5q(q22----5q33). He had a number of the already recorded manifestations of partial trisomy 5q, namely microcephaly, growth retardation, brachydactyly, long flat philtrum, thin upper lip vermilion and downturned angles of mouth and apparently low set ears. He survived only 6 months. He inherited his duplication from a maternal intrachromosomal insertion; thus he represents a pure dup(5)(q22----5q33).

Abnormalities, Multiple↗
PubMed1984

Functional residual capacity and lung mechanics at different levels of mechanical ventilation.

We assessed the effects of rapid ventilatory rates (60 to 120 breath/min) and high mechanical ventilation pressures (30/5 to 40/10 cm H2O) on lung mechanics and intravascular pressures in 9 paralyzed, sedated rabbits ventilated with a time-cycled, pressure-limited flow generator (Baby bird). Measurements of tidal volume, ventilator line pressure, tracheal pressure, functional residual capacity (FRC), and arterial and venous blood pressures showed that: 68% of the peak pressure developed by the ventilator was transmitted to the trachea at 60 breath/min, 74% at 120 breath/min, and 87% when ventilation pressures were increased to 40/10 cm H2O; when the ventilatory rate and the PEEP were increased, the end-expiratory pressure in the trachea became progressively greater than that indicated on the ventilator pressure gauge; FRC increased when the PEEP and mean tracheal pressure increased; tidal volume and dynamic compliance decreased and minute ventilation increased as ventilatory rate increased; compliance decreased whenever FRC increased, and increased whenever FRC decreased; and there was little effect on mean central venous or arterial pressure. These data indicate that increasing ventilator rates cause gas trapping within the lung. In normal animals, this may interfere with gas exchange and pulmonary blood flow. In abnormal lungs, the gas trapping may increase FRC and improve gas exchange within the lung.

Animals↗
PubMed1983

A respiratory function jacket for measuring tidal volume and changes in FRC.

We describe a simple application of a mercury-in-rubber strain gauge in a jacket used to measure tidal volume in paralyzed, mechanically ventilated rabbits. The jacket produces a record with a straight base line. Shifts of this base line can be used to assess changes in functional residual capacity (FRC).

Animals↗
PubMed1981

The lumbar spinal canal in hypophosphataemic vitamin D-resistant rickets.

Lumbar spine radiographs of 17 adult patients with hypophosphataemic vitamin D-resistant rickets have been examined and measured in their anteroposterior and transverse dimensions. Comparison of these measurements with those of a group of normal individuals showed the HPR patient group to have narrower spinal canals in both diameters. No differences were found between males and females in either group. The lumbar spinal canal stenosis in adult HPR patients may make them more susceptible to spinal cord compromise from space occupying lesions within the canal, causing back pain and lower limb weakness for which surgical intervention may be indicated.

Adult↗