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Biomedical subjects

J H Baumer

Publications and source records attributed to J H Baumer.

At least 19 recordsLinked to original sources
PubMed2006

Salicylate for the treatment of Kawasaki disease in children.

BACKGROUND: Kawasaki disease is the most common cause of acquired heart disease in children in developed countries. The coronary arteries supplying the heart can be damaged in Kawasaki disease. The principal advantage of timely diagnosis is the potential to prevent this complication with early treatment. Salicylate (acetyl salicylate acid (ASA), aspirin) and intravenous immunoglobulin (IVIG) are widely used for this purpose. Salicylate is largely otherwise avoided in children because of concerns about serious side effects, particularly the risk of Reyes syndrome. OBJECTIVES: The objective of this review was to evaluate the effectiveness of salicylate in treating and preventing cardiac consequences of Kawasaki disease in children. SEARCH STRATEGY: The Cochrane Peripheral Vascular Disease Group searched their trials register (last searched July 2006) and the Cochrane Central Register of Controlled Trials (CENTRAL) (last searched Issue 3, 2006). We searched MEDLINE (January 1966 to July 2006), EMBASE (January 1980 to July 2006), and CINAHL (1982 to July 2006), and reference list of articles. In addition we contacted experts in the field. SELECTION CRITERIA: Randomised controlled trials (RCTs) of salicylate to treat Kawasaki disease in children were eligible for inclusion. DATA COLLECTION AND ANALYSIS: Two authors independently assessed trial quality and extracted data. Study authors were contacted for additional information. MAIN RESULTS: We found one trial involving 102 children which was described as randomised, but it was not possible to confirm the method of treatment allocation. A second comparative study, possibly with a randomised treatment allocation, was also identified. The one randomised trial reported no association between the addition of ASA to IVIG treatment on the rate of coronary artery abnormalities at follow up, but with wide confidence limits. The second, possibly randomised trial did demonstrate a reduction in duration of fever with high dose ASA compared to low dose ASA, but was insufficiently powered to establish the effect on coronary artery abnormalities at follow up. AUTHORS' CONCLUSIONS: Until good quality RCTs are carried out, there is insufficient evidence to indicate whether children with Kawasaki disease should continue to receive salicylate as part of their treatment regimen.

Anti-Inflammatory Agents, Non-Steroidal↗
PubMed2005

Early growth and childhood obesity: a historical cohort study.

OBJECTIVE: To investigate to what extent prenatal, early postnatal, and late postnatal growth predicts risk of childhood obesity. METHODS: This was a historical cohort study of 1335 full term singletons born in southwest England in 1989. The main outcome measure was body mass index (BMI) at age 7. Absolute weights at birth, 6 weeks, and 18 months, and change in weights during the intervening periods were measured. Measures were examined as z scores standardised to the 1990 UK reference population. RESULTS: BMI at age 7 was positively associated with z scores for weight at all ages. Regression coefficients (95% confidence intervals) were: 0.16 (0.11 to 0.22), 0.19 (0.15 to 0.24), and 0.29 (0.26 to 0.33) for weights at birth, 6 weeks, and 18 months, respectively. Regression coefficients for birth weight, early weight gain (change in weight z score between birth and 6 weeks), and late weight gain (change in weight z score between 6 weeks and 18 months), adjusted for each other were: 0.32 (0.27 to 0.38), 0.31 (0.26 to 0.37), and 0.28 (0.23 to 0.32), respectively. There was no statistical evidence for interaction among weights, weight gains, or social deprivation. Social deprivation independently predicted BMI at age 7, the major influence being weight gain after 6 weeks of life. CONCLUSIONS: These data suggest that obesity risk is acquired gradually over the perinatal and postnatal periods, instead of during a prenatal or early postnatal critical window. The association of obesity risk with social circumstances and the timing of its origin offer pointers to some underlying determinants of obesity.

Anthropometry↗
PubMed2003

Intravenous immunoglobulin for the treatment of Kawasaki disease in children.

BACKGROUND: Kawasaki disease is the most common cause of acquired heart disease in children in developed countries. The coronary arteries supplying the heart can be damaged in Kawasaki disease. The principal advantage of timely diagnosis is the potential to prevent this complication with early treatment. Intravenous immunoglobulin (IVIG) is widely used for this purpose. OBJECTIVES: The objective of this review was to evaluate the effectiveness of IVIG in treating, and preventing cardiac consequences, of Kawasaki disease in children. SEARCH STRATEGY: Electronic searches of the Cochrane Peripheral Vascular Disease Group Specialised Register, CENTRAL, MEDLINE, EMBASE, and CINAHL were performed (last searched April 2003). We also searched references from relevant articles and contacted authors where necessary. In addition we contacted experts in the field for unpublished works. SELECTION CRITERIA: Randomised controlled trials of intravenous immunoglobulin to treat Kawasaki disease were eligible for inclusion. DATA COLLECTION AND ANALYSIS: Fifty-nine trials were identified in the initial search. On careful inspection only sixteen of these met all the inclusion criteria. Trials were data extracted and assessed for quality by at least two reviewers. Data were combined for meta-analysis using relative risk ratios for dichotomous data or weighted mean difference for continuous data. A random effects statistical model was used. MAIN RESULTS: The meta-analysis of IVIG versus placebo, including all children, showed a significant decrease in new coronary artery abnormalities (CAAs) in favour of IVIG, at thirty days RR (95% CI) = 0.74 (0.61 to 0.90). No statistically significant difference was found thereafter. A subgroup analysis excluding children with CAAs at enrollment also found a significant reduction of new CAAs in children receiving IVIG RR (95%) = 0.67 (0.46 to 1.00). There was a trend towards benefit from IVIG at sixty days (p=0.06). Results of dose comparisons showed a decrease in the number of new CAAs with increased dose. The meta-analysis of 400 mg/kg/day for five days versus 2 gm/kg in a single dose showed statistically significant reduction in CAAs at thirty days RR (95%) = 4.47 (1.55 to 12.86). This comparison also showed a significant reduction in duration of fever with the higher dose. There was no statistically significant difference noted between different preparations of IVIG. There was no statistically significant difference of adverse effects in any group. REVIEWER'S CONCLUSIONS: Children fulfilling the diagnostic criteria for Kawasaki disease should be treated with IVIG (2 gm/kg single dose) within 10 days of onset of symptoms.

Child↗
PubMed2003

Evidence based guidelines for the performance of the sweat test for the investigation of cystic fibrosis in the UK.

A well produced evidence based guideline has been developed in response to a national audit that demonstrated wide variations in the performance of sweat tests. Accurate and reliable sweat test results will be particularly important with the advent of neonatal screening. The guideline recommendations include the collection and analysis of sweat samples, and interpretation of results. It emphasises the importance of sweat chloride as the best discriminator.

Chlorides↗
PubMed2003

Changes in resuscitation practice at birth.

AIM: To investigate secular changes in neonatal resuscitation at birth. METHODS: Single centre observational study of 17 890 infants born between May 1993 and April 1997. T-piece ventilation was introduced in April 1995. OBSERVATIONS: Rates and modes of ventilatory resuscitation, early neonatal encephalopathy, neonatal convulsions, and meconium aspiration syndrome; 1 and 5 min Apgar scores; maternal age and method of delivery; paediatric attendance at delivery and resuscitation. RESULTS: The rate of all forms of ventilatory resuscitation fell during the four year period from 11.0% to 8.9%. The rate of intubation fell from 2.4% to 1.2%. A reduced rate of intubation was seen at all gestations of 30 weeks and above. There was no difference in rates of relevant neonatal problems during the period except for a reduction in neonatal convulsions. The introduction of T-piece ventilation did not contribute to the reduction in intubation in a logistic regression model that included time trend. CONCLUSION: A marked reduction in the rate of intubation was observed, without any reduction in the efficacy of resuscitation. This may reflect improvements and changing emphasis in resuscitation training.

Adult↗
PubMed2001

Patient-triggered ventilation in premature neonates.

Observed short-term benefits of patient-triggered ventilation include improvements in oxygenation and carbon dioxide elimination, reduced cerebral blood flow variability, more rapid weaning from ventilation and reduced adrenaline levels. The three multicentre randomized controlled trials in which longer term outcomes were investigated failed to demonstrate any consistent reductions in rates of pneumothorax, chronic lung disease, cranial ultrasound changes, duration of ventilation or mortality. Two of these studies were conducted wholly or predominantly using the SLE 2000 ventilator, with the Drager Babylog 8000 used in a minority of infants. The results therefore reflect only the performance of these ventilators, with the ventilation techniques used. As the degree to which synchrony was achieved was not measured in any of these studies, they provide no evidence for a lack of benefit from achieving synchronous ventilation. It is possible that the findings were influenced by the use of drugs, especially morphine and theophylline. In one study the pneumothorax rate was significantly lower in infants recruited within 3 mo of the first patient enrolled at that centre, and was seen with both modes of ventilation. This suggests that staff education in ventilation techniques may be important in reducing pneumothorax rates.

Humans↗
PubMed2001

Randomised study comparing extent of hypocarbia in preterm infants during conventional and patient triggered ventilation.

AIM: To determine whether patient triggered ventilation (PTV) leads to greater exposure to significant hypocarbia than conventional ventilation (CMV) in premature infants during the first 72 hours of life. METHODS: Infants of 32 weeks gestation or less were included. Randomisation yielded 74 infants on PTV and 68 infants on CMV. Arterial PaCO(2) measurements were taken four hourly for the first 72 hours of life. RESULTS: The mean PaCO(2) levels on days 1, 2, and 3 were not significantly different between the two groups. The proportion of infants with PaCO(2) levels of 3.33 kPa or less did not differ between PTV and CMV infants. Mean percentages of infants with this level of hypocarbia at any time were 31.4%, 18.9%, 8.8% on days 1, 2, and 3 respectively. Cumulative hypocarbia, below a 3.33 kPa threshold, was 0.0084 kPa.h (PTV) versus 0.0263 kPa.h (CMV) per hour ventilated during the first 24 hours (p = 0.259). Risk factors associated with hypocarbia on day 1 were peak inspiratory pressure below 14 cm H(2)O (odds ratio 4.79) as well as FiO(2) below 0.30 (odds ratio 3.42). CONCLUSION: Exposure to hypocarbia (PaCO(2) 3.33 kPa or below) was not significantly different between PTV and CMV infants during the first 72 hours of life. Hypocarbia was common in both groups on day 1 and to a lesser extent on day 2. Infants with the least requirements for ventilatory support were at highest risk of hypocarbia on day 1 of life. Preterm infants with mild hyaline membrane disease require a more aggressive approach to weaning on both modes of ventilation, followed by extubation to limit the risk of hypocarbia.

Analysis of Variance↗
PubMed2000

Improved clinical practice but continuing service deficiencies following a regional audit of childhood diabetes mellitus.

AIM: To assess the changes in services for children with diabetes in the south west of England between two region-wide audits performed in 1994 and 1998. METHODS: Questionnaires were sent to consultant paediatricians, specialist diabetes nurses, dietitians, and Local Diabetes Service Advisory Groups. Information was gathered on consultant and nursing caseload, clinic structure, dietetic and psychological services, glycated haemoglobin use, and screening services. RESULTS: In 1994 there were 21 consultant paediatricians caring for children with diabetes, only seven of whom fulfilled the British Paediatric Association definition of a specialist. By 1998 there were 14, 12 of whom fulfilled this definition. In 1994 a significant number of children were being seen in general paediatric clinics; by 1998 all centres stated that children were being seen in designated diabetes clinics. Between the two audits, despite a decrease in the average caseload of specialist diabetes nurses, nursing services in many centres remained deficient, as did dietetic and psychology services. Glycated haemoglobin use increased from 16 of 21 consultants to all consultants. In 1998 there was still patchy paediatric representation on Local Diabetes Service Advisory Groups. CONCLUSIONS: The 1994 audit was followed by a change in clinical practice, in contrast to continuing deficiencies in resources, despite the availability of national recommendations and the widespread distribution of the audit report to those in a position of influence.

Child↗
PubMed2000

International randomised controlled trial of patient triggered ventilation in neonatal respiratory distress syndrome.

AIM: To compare the effects of patient triggered ventilation (PTV) with conventional ventilation (IMV) in preterm infants ventilated for respiratory distress syndrome (RDS). METHODS: Nine hundred and twenty four babies from 22 neonatal intensive care units were assessed. They were under 32 weeks of gestation and had been ventilated for respiratory distress syndrome (RDS) for less than 6 hours within 72 hours of birth. The infants were randomly allocated to receive either PTV or IMV. Analysis was on an "intention to treat" basis. Death before discharge home or oxygen therapy at 36 weeks of gestation; pneumothorax while ventilated; cerebral ultrasound abnormality nearest to 6 weeks; and duration of ventilation in survivors were the main outcome measures. RESULTS: There was no significant difference in outcome between the two groups. Unadjusted rates for death or oxygen dependency at 36 weeks of gestation were 47.4% and 48.7%, for PTV and IMV, respectively; for pneumothorax these were 13.4% and 10.3%; and for cerebral ultrasound abnormality nearest to 6 weeks these were 35.4% and 36.9%. Median duration of ventilation for survivors in both groups was 6 days. Overall, 79% of babies received only their assigned ventilation. PTV babies were more likely to depart from their intended ventilation (27% vs 15%). The trend towards higher pneumothorax rates with PTV occurred only in infants below 28 weeks of gestation (18.8% vs 11.8%). CONCLUSIONS: There was no observed benefit from the use of PTV, with a trend towards a higher rate of pneumothorax under 28 weeks of gestation. Although PTV has a similar outcome to IMV for treatment of RDS in infants of 28 weeks or more gestation, within 72 hours of birth, it was abandoned more often. It cannot be recommended for infants of less than 28 weeks' gestation with the ventilators used in this study.

Brain Diseases↗
PubMed1999

Early house moves, indoor air, heating methods and asthma.

OBJECTIVES: To assess whether house moves or certain housing conditions are a risk factor for the development of childhood asthma. DESIGN: A case-control study of asthmatic and non-atopic children aged 4-16 years. SUBJECTS: One hundred children with confirmed asthma in a group general practice of 11000 patients in Plymouth, U.K. Each was matched by age and gender with a child with no history of wheeze, eczema or hay fever. MAIN OUTCOME MEASURES: House moves and main heating methods, prior to the age of onset of asthma in cases and controls. RESULTS: There was a non-significant association between early house moves and the subsequent development of asthma. No association was found with heating methods, except for ducted-air heating which, because of the small numbers involved could have occurred by chance. None of the other factors studied affecting indoor air showed an association. CONCLUSION: Moving house at an early age may increase the risk of developing asthma, or may be associated with other more important risk factors, such as increased general mobility and hence, exposure to viral infections. Heating methods or other factors likely to affect the indoor air quality in early life were not useful predictors of subsequent asthma in children.

Adolescent↗
PubMed1999

Incidence of childhood-onset Type 1 diabetes mellitus in Devon and Cornwall, England, 1975-1996.

AIMS: To determine the incidence of Type 1 diabetes mellitus (DM) in children aged 0-15 years in the far south-west of England between 1975 and 1996. METHODS: Patient information was collected to set up the Cornwall and Plymouth Children's Diabetes Register (CPCDR) through two main data sources; hospitals and the general practitioners in all surgeries in the study region. All children under 16 years living within Cornwall and the Isles of Scilly, and the former Plymouth Health Authorities and diagnosed as having Type 1 DM during the study period were included. The case ascertainment was estimated by a capture-recapture method. Trends and differences in incidence of sex, age, time period and district of diagnosis were analysed by Poisson regression analysis. Roger's method was used to estimate the seasonal variations. RESULTS: A total of 522 subjects aged between 0 and 15 years were identified from 01/01/1975 to 31/12/1996, giving an overall crude incidence of 14.9/ 100 000 population/year. The case ascertainment was 94.4% (95% confidence interval (CI) 91.4- 97.6%) for the whole register. Poisson regression analysis showed that a significant increase of incidence (2.49% per year) was observed throughout the 22-year study period, which was mainly a result of the significant increase in the 0-4 year age-group (6.29% per year). The incidence significantly differed among the 22-years (P = 0.007), the three age groups (0-4, 5-9 and 10-14 years, P<0.001) and different sexes (P=0.049). The significant seasonal variations were detected with peak incidence appearing in autumn and winter. CONCLUSIONS: The first validated childhood-onset diabetes register has been set up in the far south-west of England. The incidence of childhood Type 1 DM in this region has increased significantly over the past two decades, especially in children under 5 years.

Adolescent↗
PubMed1998

Social disadvantage, family composition, and diabetes mellitus: prevalence and outcome.

OBJECTIVE: To investigate the relation between social disadvantage and family composition on diabetes prevalence and diabetes care outcome. DESIGN: Retrospective audit in the south west of England of 801 children with diabetes mellitus. MAIN OUTCOME MEASURES: Prevalence of diabetes in relation to the Townsend index. Admissions to hospital with diabetes related problems, glycated haemoglobin, time spent in hospital, outpatient attendance rates. RESULTS: There was no association between social status and diabetes prevalence. Social deprivation increased the likelihood of admission for hypoglycaemia. Children living with a single parent were more likely to be admitted to hospital with a diabetes related problem and stay in hospital longer. Having either a parent with diabetes or a single parent increased the rates of clinic non-attendance. No association was identified between medium term diabetes control and either social disadvantage or single parent status. CONCLUSIONS: Social disadvantage has no effect on diabetes prevalence and little on diabetes outcome in childhood. Family structure and parental diabetes have adverse effects on some aspects of diabetes outcome.

Adolescent↗
PubMed1998

Stress response and mode of ventilation in preterm infants.

AIM: To assess the change in stress response in preterm babies changed from patient triggered ventilation (PTV) to conventional mandatory ventilation (CMV) and vice versa; to determine outcome in relation to stress hormone concentrations. METHODS: A randomised controlled study was conducted in two district general hospital neonatal intensive care units. Thirty babies, treated initially with CMV, were randomly assigned to remain on CMV or to change to PTV. A second group of 29 babies, treated initially with PTV, were randomly assigned to remain on PTV or to change to CMV. The babies were less than 32 weeks of gestation, ventilated within 72 hours of birth, with clinical and radiological features compatible with respiratory distress syndrome (RDS). Stress hormone concentrations and clinical distress score were measured before and 20 minutes after allocation of mode of ventilation. RESULTS: Babies changed from CMV to PTV had significantly reduced adrenaline concentrations (median change -0.4 nmol/l) compared with those who remained on CMV. There was no increase in adrenaline in babies changed from PTV to CMV. There were no significant changes in noradrenaline concentrations or clinical distress score. Babies who died had significantly higher adrenaline and noradrenaline concentrations than those who survived. CONCLUSION: A change in mode of ventilation significantly reduces adrenaline concentrations. Raised catecholamine values are associated with a poor outcome.

Epinephrine↗