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Biomedical subjects

J M Whitfield

Publications and source records attributed to J M Whitfield.

9 recordsLinked to original sources
PubMed1982

The application of hospice concepts to neonatal care.

Despite impressive improvements in outcome for infants cared for in neonatal intensive care units (NICUs), large tertiary-care referral units still admit a substantial number of infants who will not survive or, because of a predictably very poor outcome, should not be offered modern life-support techniques. Dealing with these infants can be extremely taxing on both the family and the staff. We have recently adapted the concepts first described in adult hospice care to the care of the dying neonate and his family. By providing a "Family Room" that is private yet close to the NICU and by training the staff in more supportive approaches toward these families, we have been able to deal with the problem of the dying newborn in a manner that has been beneficial to both families and staff.

Child Health Services↗
PubMed1981

The effect of transcutaneous Po2 monitoring on the frequency of arterial blood gas analysis in the newborn with respiratory distress.

Nineteen infants with respiratory distress and indwelling arterial lines were monitored with a transcutaneous O2 (PtcO2) monitor for 24 h each. These infants were matched with comparably sick newborns not monitored with PtcO2 and cared for in the intensive care nursery within the previous 18 months. The number of arterial blood gases (ABGs) drawn in each group was examined. Results showed that in all but 1 infant, the patients who had PtcO2 monitoring also had fewer ABGs drawn. The mean number of ABGs in the PtcO2 monitored infants was 12.5 + 2.9 (SD) and the mean number of ABGs in the non-PtcO2 monitored infants was 16.2 + 2.4. The authors conclude that supplementary O2 monitoring of sick infants with PtcO2 reduces the frequency of ABG analysis.

Age Factors↗
PubMed1981

The use of a new ultra-thin fiberoptic bronchoscope to determine endotracheal tube position in the sick newborn infant.

The various techniques available for determining endotracheal tube position after intubation of a newborn are auscultation of the chest, observation of distance rings on the endotracheal tube, and chest radiology. Radiology is considered to be the most reliable method. We evaluated the use of a new ultra-thin fiberoptic bronchoscope on 20 recently intubated newborn infants to determine the position of the endotracheal tube and compared the technique with radiology. The accuracy of the two methods was comparable (correlation 0.91, P less than 0.001). Adverse changes in transcutaneous PO2 were observed during both procedures but were more marked during radiology than bronchoscopy. We conclude that the bronchoscopic technique of determining endotracheal tube position is both as safe and as accurate as radiologic technique.

Airway Resistance↗
PubMed1980

Atelectasis associated with mechanical ventilation for hyaline membrane disease.

The occurrence of atelectasis among infants, who were intubated and mechanically ventilated for hyaline membrane disease and who survived the neonatal period, was examined after omitting atelectasis associated with obvious malposition of the endotracheal tube. Atelectasis occurred both while intubated and after extubation. There was a pronounced effect of birth weight. The incidence among 131 surviving infants increased from 9% while intubated and 15% after extubation in infants with birth weights > 2000 g to 50% while intubated and 56% after extubation in those with birth weights < 1000 g. Although in general, the incidence fell as the duration of intubation diminished, postextubation atelectasis was a problem even in larger infants with comparatively short intubations. The pattern of atelectasis showed a disproportionate involvement of all lobes of the right lung, both while intubated and after extubation. This suggests that the incidence of atelectasis might be lowered by minimizing traumatic damage to the mucosa of the right sided bronchi.

Birth Weight↗
PubMed1979

Neonatal respiratory distress: potential for prevention.

A prospective study was conducted of 100 consecutive admissions to the neonatal intensive care unit of the Hospital for Sick Children, Toronto, of infants with respiratory distress syndrome or transient tachypnea of the newborn. It was found that in 15% of cases the illness was completely preventable, being the result of unintentionally premature termination of pregnancy. Significant intrapartum asphyxia occurred in 44% of the infants in whom respiratory distress syndrome developed. Factors placing the pregnancy at high risk were present antenatally in most cases, and most of the deliveries took place in hospitals without adequate facilities or staff, or both, for the requirements of the infant at and following birth.

Apgar Score↗