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Biomedical subjects

J D Baum

Publications and source records attributed to J D Baum.

At least 91 records · Page 5Linked to original sources
PubMed1983

Costs of visiting babies in special care baby units.

Parents of babies who spend long periods in special care baby units are faced with the problem of developing a caring relationship with their baby. The journeys to and from the hospital pose additional financial and social stress on parents who are already under considerable emotional strain. A survey into the financial costs incurred by parents visiting their babies in six hospitals during a period of 2 months was conducted using questionnaires. Complete data were available for analysis from four hospitals on 126 babies (98 inborn and 28 outborn). For babies inborn in a maternity hospital, the mean cost of visiting for parents with a car was 41 pounds (range 1-336) and for those who travelled by public transport the mean cost was 30 pounds (range 2-151). For babies born outside the hospital and transferred to a special care baby unit, the mean cost of visiting for parents with a car was 123 pounds (range 11-518), and for those who travelled by public transport the mean cost was 46 pounds (range 16-80). There was almost no financial assistance available to help these families, one-third of whom had at least one serious social problem.

Costs and Cost Analysis↗
PubMed1983

Clinical application of insulin pumps in the management of insulin dependent diabetes.

Seven volunteers aged 12.0 to 17.9 years participated in a trial to compare conventional insulin treatment with continuous open loop (pump) insulin infusion. After 6 weeks of conventional treatment followed by 6 weeks of insulin pump treatment, 4 children chose to manage their diabetes permanently by means of the insulin pump. The mean blood glucose concentration (based on home blood glucose monitoring) while on conventional insulin treatment showed no appreciable change during the 6 weeks' treatment on an insulin pump. Compared with conventional treatment, however, the mean 24 hour blood glucose profiles of the patients on pump insulin showed less variation in the blood glucose throughout the day, together with an appreciably lower peak after breakfast. These improvements occurred despite increased dietary flexibility while on pump insulin. The insulin pump seems to be an acceptable form of treatment for some children and young adults with diabetes mellitus and gives near physiological control of blood glucose.

Adolescent↗
PubMed1983

The relationship between diabetic control and retinopathy in a group of diabetic teenagers.

Twenty insulin-dependent diabetic teenagers from the Oxford pediatric diabetic clinic were recruited to study the relationship between diabetic control and retinal microvascular disease. Two patients (10%) had evidence of minimal background diabetic retinopathy on careful ophthalmoscopy. Retinal color photography and fluorescein angiography each revealed retinopathy in 5 patients (25%) and together revealed retinopathy in 7 patients (35%). Color photography demonstrated retinopathy which had not been discovered on ophthalmoscopy. The presence of retinopathy was related to the duration of diabetes (p less than 0.02) and the glycosylated hemoglobin level (p less than 0.01). It is concluded that multiple field color photography is a useful method of assessing patients with minimal or no ophthalmoscopic retinopathy.

Adolescent↗
PubMed1982

Individual patterns of milk intake during breast-feeding.

The pattern of milk transfer during breast-feeding was ascertained for individual mother-infant pairs using a 'fractional' weighing technique. This method employs a single, fixed intermediate weighing on each breast, and a flexible, final weighing point at the 'natural' termination of feeding on each breast. The data demonstrate considerable variability between individuals both in feed length and in the rate of milk transfer from mother to baby. They show that the rate of intake tends to be consistent between the first and second breast, and that each mother-infant pair has a characteristic rate of milk transfer. Significant milk intake occurred from four minutes to the end of the feed on each breast. These results imply that breast-feeding 'rules' about the length of a feed can only be offered as helpful guidelines, rather than principles to be strictly followed. The results of a reciprocal nursing experiment suggest that the typical rate of milk transfer is a product of both milk release by the mother and milk demand by the baby.

Body Weight↗
PubMed1982

Support after perinatal death: a study of support and counselling after perinatal bereavement.

After an earlier study into the practical aspects of the management of perinatal death, a counselling service was introduced for parents whose baby had died in the perinatal period. The service was monitored, and the parents who received the service were compared with a group that did not. Fifty families were allocated randomly either to the counselling (supported) group or to the contrast group, who received routine hospital care. Assessment was carried out at six and 14 months after the death, using a semi-structured interview and two self-rating scales (the general health questionnaire and the Leeds scales). Two of 16 mothers in the supported group showed psychiatric disorder at six months, compared with 10 of 19 in the contrast group (p less than 0.01, Fisher's exact test). There was no significant difference between the two groups at 14 months, when 80% of all the women studied had recovered psychiatric symptoms. Socially isolated women and those who marital relations lacked intimacy had a higher incidence of psychiatric symptoms at six months. Early pregnancy (within six months) was associated with a higher incidence of psychiatric symptoms in the unsupported group. The duration of bereavement reaction after perinatal death was appreciably shortened by support and counselling.

Adolescent↗
PubMed1982

At what age do diabetic children give their own injections?

The age at which diabetic children gave themselves insulin injections (injection independence) was investigated by analysis of the notes on 66 children who attend the Oxford (England) Paediatric Diabetic Clinic. The mean age of injection independence was found to be 11.2 years (SD, 2.2 years). Sex, rank in the family, and family experience of diabetes had no effect on the age of injection independence. A group of 11 children were identified as being "late injectors," having not gained injection independence by the age of 14 years. No psychiatric or adverse psychosocial factors were found that distinguished this group from the 45 children who could give their own injections by this age.

Adolescent↗
PubMed1982

Twenty-four hour profiles of plasma C-peptide in type 1 (insulin-dependent) diabetic children.

Twenty-four hour profiles of plasma C-peptide, an index of endogenous insulin secretion, were performed in 15 Type 1 (insulin-dependent) diabetic children. Plasma C-peptide was detectable in six children, of whom four ('C-peptide producers') had peak values above normal fasting levels. In each of the six children with residual B cell function, there was a close correlation between plasma C-peptide and simultaneous blood glucose (r greater than 0.50, p less than 0.05). Post-breakfast peak blood glucose was 10.2 +/- 1.7 mmol/l (mean +/- SEM) in the 'C-peptide producers' and 18.7 +/- 1.7 mmol/l in the 11 children with low or no detectable C-peptide. Mean M-value, an index of deviation from an ideal blood glucose, was lower in the 'C-peptide producers' (p less than 0.05). It is concluded that residual functioning B cells in diabetic children behave physiologically in that insulin secretion fluctuates in accordance with the prevailing blood glucose; and that the pattern of action of injected insulin is more critical in non-C peptide producers who lack the post-prandial dampening effect provided by residual endogenous insulin secretion.

Adolescent↗
PubMed1982

Short-time low-temperature pasteurisation of human milk.

Using the Oxford Human Milk Pasteuriser human milk was exposed to lower temperature and shorter time periods than employed in classical holder pasteurisation. Heating human milk at 62.5 degrees C for 5 min completely destroyed Escherichia coli, Staphylococcus aureus, and group B beta-haemolytic streptococci inoculated into the samples. Heating at 56.0 degrees C for 15 min destroyed over 99% of the inoculated organisms. The mean percentage remaining activity of certain antimicrobial proteins after heat treatment at 62.5 degrees C for 30 min, 62.5 degrees C for 5 min and 56 degrees C for 15 min were as follows: IgA 67, and 90%; lactoferrin 27, 59 and 91%; and lysozyme 67, 96 and 106%, respectively. These results suggest that human milk can be effectively pasteurised using less heat treatment than in classical holder pasteurisation. Lower temperature and shorter heat treatment also preserves substantially more of the activity of the antimicrobial proteins present in human milk.

Escherichia coli↗
PubMed1982

The continuous measurement of milk intake at a feed in breast-fed babies.

A method for the continuous measurement of milk intake during a breast-feed is described. A miniature Doppler ultrasound flow transducer, located in the tip of a latex nipple shield, is interposed between mother and baby during feeding. Preliminary results indicate the scope and current limitations of the method in terms of both populations and individual mother/infant pairs. An initial analysis of individual feeds indicates that two factors may contribute to the curtailment of intake during a feed from one breast: a progressive reduction in intake volume per suck, and/or an increase in the proportion of time spent pausing between bursts of sucking.

Breast Feeding↗
PubMed1982

Donor breast milk.

A simple system for the collection and storage of human milk, as a voluntary community activity, is described. The case is made for preferring drip breast milk as the main source of human milk for the milk bank. The central place of precise pasteurization is emphasised as the essential feature for maintaining bacteriological quality control and simplicity of organisation. The suitability of donor breast milk for the nutrition of the low birthweight infant is discussed and evidence presented to indicate that low birthweight infants fed exclusively on donated human milk are of similar size to control term infants when assessed at 18 months corrected postnatal age. Emphasis is placed on the importance of controlled trials in relation to all innovations in feeding of low birthweight infants.

Freezing↗
PubMed1982

Whole foods and increased dietary fibre improve blood glucose control in diabetic children.

In prescribing a diabetic diet more attention has traditionally been paid to the amount of dietary carbohydrate than to its type or structure. We have compared the effect on blood glucose of substituting unrefined, whole foods for refined, processed foods in liberal carbohydrate diets (50-55% of dietary energy) eaten by 10 diabetic children in a randomised crossover study. All measurements were made at home. The unrefined diet used whole foods (including) dried beans) supplying 60 g/day of dietary fibre. The refined diet used processed foods supplying 20 g/day of dietary fibre. Diets were isocaloric for carbohydrate, fat, and protein. Glycaemic control was assessed by daily urine analysis for glucose, home blood glucose measurements, glycosylated haemoglobin, and by a 24-hour profile of blood and urinary glucose carried out at home after 6 weeks on each diet. Glycaemic control was significantly better on the unrefined diet. On profile days mean blood glucose levels on the unrefined and refined diets respectively were: preprandial: 5.5 and 8.4 mmol/l; postprandial 8.5 and 12.2 mmol/l. The mean 24-hour urinary glucose excretion on the unrefined diet was 9.3 g and on the refined diet was 38.0 g. Six months after the study the children were eating appreciably more dietary fibre than before (mean increase 13.6 g/day). Attention to food type and structure can improve blood glucose control in diabetic children and should provide an acceptable and more rational basis for dietary prescription than one based on carbohydrate quantity alone.

Adolescent↗
PubMed1981

Practical management of perinatal death.

After the loss of a newborn baby the parents are usually too shocked and unfamiliar with the complicated administration procedures to cope with the registration of death and burial (or cremation). The medical and nursing staff also tend to be unfamiliar with the procedures. Some of these can be streamlined, thus reducing the stress caused to parents. By giving positive instruction the staff will in their turn be able to improve their care of the bereaved parents.

Birth Certificates↗
PubMed1981

Differences in the pattern of milk intake between breast and bottle fed infants.

Two hundred and nine 6-day-old healthy term infants were test weighed either during bottle feeding (n= 77) or breast feeding (n=132). Cross-sectional data collection avoided repeated interruptions of individual feeds. Bottle fed infants (fed ad libitum) and breast fed infants consumed a similar feed volume (respectively, 67 +/- 2 ml versus 75 +/- 6ml, mean +/- S.E.M.) over a similar period of time (mean 25 min); yet the pattern of milk flow during feeding was significantly different in the two groups. In bottle fed infants, there was a linear pattern of milk intake over the first 10 min of feeding, by which time 81% of the feed has been consumed, contrasting with a biphasic intake pattern in breast fed infants in whom a total 84% of the feed was consumed either in the first 4 min or between 15 and 19 min after the start of the feed. It is speculated that these differences in the pattern of milk intake could influence the physiological responses to feeding and might account for differences between breast and bottle fed infants in gut hormonal responses to milk feeds.

Bottle Feeding↗
PubMed1981

Nesidioblastosis of the pancreas: definition of the syndrome and the management of the severe neonatal hyperinsulinaemic hypoglycaemia.

Three newborn infants are reported who developed severe non-ketotic hypoglycaemia (blood glucose less than 1.1 mmol/l; 19.8 mg/100 ml) within 6 hours of birth. All had inappropriately raised plasma insulin concentrations for the level of glycaemia, and required high rates of glucose infusion (less than 15 mg glucose/kg per minute) to prevent symptoms of hypoglycaemia. Medical treatment (hydrocortisone, diazoxide, chlorothiazide, phenytoin, propranolol, and depot glucagon) was ineffective in preventing hypoglycaemia and all 3 infants were subjected to partial and then total pancreatectomy. The pathological features of nesidioblastosis are reported from quantitative immunohistochemical studies on the pancreata. These results together with those from metabolic and endocrine studies performed on the 3 infants during the investigation of the cause of the hypoglycaemia and during the preoperative and postoperative period are presented in detail in order to define a practical approach to the management of this difficult clinical problem in the neonate.

Diazoxide↗