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F Cowan

Publications and source records attributed to F Cowan.

72 records · Page 4Linked to original sources
PubMed1991

Arm and leg blood pressures--are they really so different in newborns?

Controversy still exists over differences between upper and lower limb blood pressures (BP) in neonates. We measured upper arm and calf systolic (S) and diastolic (D) BP and heart rate (HR) using 2 Dinamap 847 instruments simultaneously every half minute for several measurement periods of 5-10 min. Nine healthy term newborns were studied in active (AS) and quite (QS) sleep on post-natal days 1 and 5. The results were examined using unbalanced analyses of variance. Arm SBP was 62.3 +/- 1.6 mmHg and DBP 35.5 +/- 1.0 mmHg on day 1 in AS and QS. Calf values were not significantly different but were slightly higher (by 2-3 mmHg) in AS. Arm SBP and DBP rose by 8.5 and 5 mmHg, respectively, between days 1 and 5 but calf pressures rose less. Calf SBP and DBP were significantly lower (by 4.6 and 3.4 mmHg, respectively) than the arm values in QS on day 5. Arm SBP and DBP were dependent on post-natal age but not on sleep state while calf SBP and DBP and HR were dependent on both. Mean HR rose with age from 114 to 117.6 bpm in QS and from 118.6 to 122.4 bpm in AS. Our non-invasive BP measurements were similar to available invasive data. We postulate that differences in arm and calf vasoreactivity account for the different dependence on sleep state and for the unequal changes in arm and calf BE from days 1 to 5.

Age Factors↗
PubMed1991

Cardiovascular responses to tilting in healthy newborn babies.

It has been suggested that newborn infants have immature baroreceptor responses and they are unable to maintain their blood pressure (BP) by appropriate reflex peripheral vasoactivity and heart rate (HR) changes in response to tilting. We have measured simultaneously upper arm and calf systolic and diastolic BP and HR every 30 s using an oscillometric method (Dinamap 847) in quiet and active sleep in 9 term babies. Measurements were performed continuously with 5-min periods in each of three positions; horizontal, 30 degrees head up and 30 degrees head down tilt. The results were analysed using unbalanced analyses of variance and multivariate regression. All responses were proportional to the angle of the tilt. The observed values were very close to those predicted from the model. HR increased and decreased by 3.25 beats/min (bpm) on 30 degrees up and down tilting respectively and by twice this amount when tilting through 60 degrees. Arm systolic and diastolic BP both decreased by 1.3 mmHg when tilting through 60 degrees from down to up and increased correspondingly with down-tilting. Calf systolic BP changed appropriately for the change in hydrostatic pressure (+7.37 mmHg with 30 degrees up tilting), but diastolic BP rose only by 60% of this value. The results showed no individual variation, were independent of day, sleep state, the number of tilts, the starting value of the BP and the direction of the previous tilt. This study shows that the healthy newborn has a well developed baroreceptor reflex.

Blood Pressure↗
PubMed1991

Acute effects of acetazolamide on cerebral blood flow velocity and pCO2 in the newborn infant.

Twelve infants with hydrocephalus were treated with acetazolamide. In those treated intravenously middle cerebral artery blood flow velocity increased by a median of 86% (range 54-150%). Maximum increase was reached within 2-20 min. The effect lasted as long as 3.5 hours. Intracranial pressure rose by a median of 4 mmHg (range 0-10 mmHg). There was no significant alteration in blood pressure or heart rate. Respiratory rate increased by approximately 10 breaths/min and the tcpCO2 rose by a median 0.2 kPa in infants with normal lungs. In infants treated orally, blood velocity rose by 35-40% at 60-80 min with no increase in intracranial pressure. In four infants with lung disease pCO2 rose by a median of 2.0 kPa (range 0.6 to 3.4 kPa). Acetazolamide was well tolerated in infants with normal lungs but should be used with caution in the presence of lung disease.

Acetazolamide↗
PubMed1991

Cerebral blood flow velocity changes after rapid administration of surfactant.

A computer linked Doppler system was used to make continuous measurements of cerebral blood flow velocity (CBFV) from the middle cerebral artery, mean arterial blood pressure (MAP) from the umbilical artery, and heart rate before, during, and for 20 minutes after the endotracheal administration of 200 mg/kg of porcine surfactant in 10 preterm infants with respiratory distress syndrome. Within two minutes of surfactant administration, there was a median fall of 6 mm Hg (15%) fall in MAP and 36% in CBFV. There was a change in the Doppler spectra with almost complete loss of diastolic velocities. A rapid reduction in pulmonary vascular resistance with consequent left to right ductal shunting is one possible cause. These acute changes in MAP and CBFV after bolus surfactant administration may increase the risk of intraventricular haemorrhage.

Blood Flow Velocity↗
PubMed1990

31P magnetic resonance spectroscopy of the human paediatric liver.

Localized 31P NMR spectroscopy was used to study the developing human liver in three neonates and one infant, all with neonatal intracranial problems, but normal liver function. A prominent resonance was present in the phosphomonoester (PME) region of the spectrum of the neonates; the PME/ATP ratio was 1.0 +/- 0.4 (repetition time 1 s), compared to the mean adult liver value of 0.2 +/- 0.1. The saturation factor of PME in the neonates was large, indicating that the increase in PME/ATP reflected an increase in relative PME concentration. The chemical shift of the PME peak in the neonatal liver (6.8 +/- 0.1) was similar to that found in neonatal brain, suggesting that phosphorylethanolamine may be a major constituent. The phosphodiester (PDE)/ATP ratio in these patients (0.4 +/- 0.1) was decreased compared with the mean adult value (1.3 +/- 0.2), and the saturation factor of PDE was small. The results from the infant were different from both the neonates and adults; PME/ATP was decreased compared to the neonates, but increased compared to adults. The saturation factor of PDE was increased compared to neonates. The biochemical implications of the observed changes in PME and PDE in paediatric liver are discussed in relation to membrane turnover.

Brain Diseases↗
PubMed1988

Effect of tilting on oxygenation in newborn infants.

Transcutaneous (tc) PO2 in newborn infants increased on head up tilting (median increase 0.5 kPa at term, 1.0 kPa preterm). Head down tilting was associated with an equivalent fall in tcPO2. There was no change in tcPCO2. Tilting of infants mechanically ventilated for respiratory distress syndrome or surgery produced no consistent change in PO2.

Blood Gas Monitoring, Transcutaneous↗
PubMed1987

The effects of intermittent positive pressure ventilation on cerebral arterial and venous blood velocities in the newborn infant.

Cerebral arterial and venous blood velocities were measured using pulsed Doppler ultrasound in 25 newborn infants requiring intermittent positive pressure ventilation (IPPV). The aim was to investigate whether these velocities altered in relation to the peak inflation pressure (PIP) used. Continuous recordings were made on the superior sagittal sinus and an intracranial artery both at the clinically prescribed PIP, and while this was altered in steps. A majority of the infants had, at some stage of their illness, variations in their venous and arterial velocities in phase with IPPV and related to the PIP used. These variations could be reduced by lowering the PIP. This was done in 5 infants whilst we were still able to maintain adequate ventilation.

Blood Flow Velocity↗
PubMed1985

Changes in superior sagittal sinus blood velocities due to postural alterations and pressure on the head of the newborn infant.

A pulsed Doppler bidirectional ultrasound system has been used to measure alterations in the blood velocities in the superior sagittal sinus of the healthy term newborn infant in response to unilateral and bilateral jugular venous occlusion. These maneuvers were performed with the baby lying in different positions: supine, prone, and on the side (both left and right), the neck flexed or extended, and with the head in the midline or turned 90 degrees to the side (both left and right). Transfontanel pressure was also measured in these positions during occlusions. Results show that turning the head effectively occludes the jugular vein on the side to which the head is turned and that occluding the other jugular vein does not force blood through this functional obstruction. The effect of different forms of external pressure to the head on the superior sagittal sinus velocities was also examined. Alterations in velocities were frequently profound although they varied considerably from baby to baby. This work shows how readily large fluctuations in cranial venous velocities and pressures can occur in the course of normal handling of babies.

Blood Flow Velocity↗
PubMed1983

Ultrasound study of the cranial venous system in the human new-born infant and the adult.

A pulsed doppler ultrasound technique has been used to measure changes in blood velocities in the superior sagittal sinus, the jugular veins and intracranial and extracranial arteries in 13 neonates, and in the jugular veins and an extracranial artery in 13 adults, during unilateral and bilateral jugular venous compressions. The results have enabled us to determine how the subject under examination functionally uses his cranial venous drainage system in the resting state, and whether or not he can shunt obstructed venous flow through other cranial venous channels. We have found great variability between the subjects. In the resting situation the range of possibilities from total dependence on one jugular vein alone to usage of both jugular veins and the vertebral veins exists. Shunting of blood on jugular compression from either or both jugular veins to the vertebral veins may occur, and contralateral shunting between the jugular veins may be possible in both directions, in one direction or not at all.

Adult↗
PubMed1983

An evaluation of the plethysmographic method of measuring cranial blood flow in the new-born infant.

Cranial blood flow values obtained plethysmographically in the human new-born infant have been very variable and frequently very low. We have used a doppler ultrasound velocitymeter and skull compliance measurements to investigate whether the technique itself affects the cranial arterial inflow and whether the methods of calculation used introduce bias. Blood velocities were measured in intracranial and extracranial arteries during plethysmography, i.e. before, during and after jugular vein compressions of short duration. Skull expansion after tilting was used to estimate skull compliance. In about 10% of jugular vein compressions, arterial velocities decreased immediately, due to direct pressure on the carotid artery. In the remaining compressions a fall in arterial velocities was seen four or five heartbeats after the onset of the compression. This was probably caused by a decrease in the cranial perfusion pressure consequent on rising venous pressure. Some babies demonstrated very poor skull compliance and these babies had correspondingly low estimates of cranial blood flow. We conclude that jugular venous occlusion plethysmography is not a suitable method for use in the clinical field and is only useful as a research tool in carefully selected situations.

Blood Flow Velocity↗
PubMedDate not supplied

HSV-2 specific serology should not be offered routinely to antenatal patients.

The proposal to introduce antenatal screening for HSV has no evidence for a public or individual health benefit; indeed, it has the potential to increase anxiety for patients, with a minimal likelihood of reducing the risk of neonatal herpes infection. Antenatal screening of an essentially healthy population of women must be validated in settings of different rates of neonatal HSV infection and the purposes and limitations of screening clearly outlined. Identification of pregnant women at risk of acquiring genital herpes in pregnancy is also dependent upon being able to obtain the serostatus of the male sexual partner which will reduce the practical application of the test if both patient and partners need to be screened. We recommend that efforts to improve on the currently established mechanisms for reducing the morbidity of neonatal herpes, namely early diagnosis and prompt treatment, must take priority for resources over new and unevaluated screening programmes, such as routine testing of antenatal patients.

Antibodies, Viral↗
PubMedDate not supplied

Assessment of brain perfusion with MR imaging.

A technique for assessing brain perfusion with magnetic resonance (MR) imaging is described. This technique uses two spin echo sequences that are identical except that the second is sensitised to blood flow by use of a pair of unipolar gradients on either side of the 180 degree pulse. Differences in phase between the two sequences are displayed with a sensitivity to flow rates of +/- 0.5, +/- 1, and +/- 2 mm/s per full scale (+/- pi radians) deflection. The technique was validated for measurement of flow at these rates with a water phantom. Ten patients with cerebrovascular disease, multiple sclerosis, cerebral tumor, periventricular leukomalacia, and meningitis were studied. Differences between grey and white matter were normally seen in adults. Infants displayed differences between central and peripheral regions of the brain. Abnormalities were seen in all clinical cases. The technique will require further validation but it appears to provide a totally noninvasive method for assessing brain perfusion.

Adult↗
PubMedDate not supplied

Value of bacteriological screening of urine samples from HIV infected patients.

A retrospective analysis of the results of bacteriological examination of all urine samples from adult HIV infected patients admitted to the City Hospital, Edinburgh during the year 1 April 1988 to 31 March 1989 was made to assess the usefulness of this investigation in HIV positive patients without clinical evidence of urinary tract infection.

Adolescent↗