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Biomedical subjects

M J O'Callaghan

Publications and source records attributed to M J O'Callaghan.

46 records · Page 3Linked to original sources
PubMed1994

Prognostic factors and long-term outcomes for children who have nearly drowned.

OBJECTIVE: To find predictors of outcome and to describe the long term outcome for children who require mechanical ventilation after nearly drowning. PATIENTS AND SETTING: From 1981 to 1989, all children who underwent ventilation in the Intensive Care Unit of the Master Children's Hospital, Brisbane, after an immersion. Children who died within 24 hours were excluded. Of 57 children eligible for entry, 18 died after 24 hours. DESIGN: Retrospective study of hospital records and prospective assessment of neurodevelopmental outcome. Thirty-eight families of survivors were contacted by questionnaire and 25 children of these families were examined. Follow-up was between 0.8 and 9.6 years after immersion. RESULTS: All children who had a motor response to pain in the hospital's emergency department survived without sequelae. Thirty-one children were in cardiac arrest and, of these, 17 died, six survived with severe spastic quadriplegia and eight are ambulant. Of those ambulant, four have motor coordination difficulties and three have learning difficulties. Children in cardiac arrest who had a delay of more than 20 minutes between rescue and arrival at hospital were more likely to die or sustain severe spastic quadriplegia. No child survived if more than 25 minutes of advanced resuscitation was required after they had been warmed. CONCLUSIONS: Children with a motor response to pain seem to have a good prognosis. However, we could not predict which children in cardiac arrest would die or survive either severely impaired or ambulant. All children in cardiac arrest should receive aggressive resuscitation for at least 25 minutes after being warmed; they have a better prognosis if advanced resuscitation is started less than 20 minutes after rescue. Children who survive a cardiac arrest without spastic quadriplegia warrant long term surveillance as they may have coordination and learning difficulties.

Child↗
PubMed1993

The prevalence and origins of left hand preference in high risk infants, and its implications for intellectual, motor and behavioural performance at four and six years.

This study investigates the origins of hand preference at 4 years in a cohort of 115 high risk and premature infants; the relationship between patterns of hand preference and intellectual, motor, temperament and behavioural status at 4 and 6 years; and evidence for brain injury in mediating the relationship between hand preference and development disorder. Increased left hand preference was independently associated with extreme prematurity, high neonatal risk, increased numbers of minor physical anomalies, lowered intellectual and motor abilities, and more difficult temperament. These findings supported the presence of intrauterine and neonatal pathological mechanisms leading to left hand preference in a small number of children. Neither poor function of the non dominant hand nor absence of a family history of left handedness could further define this pathological subgroup. Support for pathological mechanisms producing left handedness was found predominatly in the infants of high birth weight, whereas prevalence of left handedness was increased mainly among the extremely low birth weight infants. In this latter group the prevalence of left handedness was also increased among children of normal intelligence, suggesting that mechanisms other than brain damage lead to left hand preference in very premature infants.

Birth Weight↗
PubMed1993

Handedness in extremely low birth weight infants: aetiology and relationship to intellectual abilities, motor performance and behaviour at four and six years.

Hand preference was measured in a total group of 71 ELBW children to determine patterns of hand preference at 4 and 6 years, possible aetiological factors leading to handedness, and whether left or non right hand preference were markers for intellectual, motor, temperament or behavioural differences. At both 4 and 6 years the prevalence of left handedness was increased, though this prevalence changed over the period of the study. Results supported brain injury as one mechanism leading to increased left hand preference, though this process did not adequately explain this increase. Possible reasons for this and the apparent change in prevalence with time are examined. Mixed handedness at 4 years was associated with lower intellectual abilities though otherwise children were similar in motor skills, temperament and behaviour independent of hand preference category.

Brain Damage, Chronic↗
PubMed1993

Perinatal hypoxic-ischaemic brain injury: prediction of outcome.

Twenty-six term babies with hypoxic-ischaemic brain injury were studied during the neonatal period to evaluate the prediction of outcome to at least one year of age by means of ultrasonography, CT scanning and Doppler ultrasound assessment of cerebral palsy blood flow velocity (CBFV). Adverse outcome was defined as the occurrence of cerebral palsy, developmental delay or death. At follow-up, 17 infants had an adverse outcome (seven died, 10 had disability); the remainder had no detectable impairment. Abnormalities on cranial ultrasound were not, but generalised decreased tissue density on CT scan was, associated with adverse outcome. Abnormal mean CBFV in the middle cerebral artery had no association with outcome, but abnormal mean CBFV in the anterior cerebral artery and a low resistance index in both arteries were significantly associated with adverse outcome. Such information may be used for appropriate counselling of parents of asphyxiated infants.

Asphyxia Neonatorum↗
PubMed1992

Single daily dose ceftriaxone therapy in epiglottitis.

Ceftriaxone as a single daily intravenous dose for 5 days was used to treat seven patients with proven Haemophilus influenzae epiglottitis. All children responded favourably. The serum levels achieved exceeded the MIC by up to 1500 times at the trough level during and for up to 24 h after the completion of the treatment. Side effects were mild and transient and did not disrupt the continuity of the treatment. Ceftriaxone potentially offers a number of clinical and economic advantages in the management of epiglottitis.

Ceftriaxone↗
PubMed1986

Apnoea in very low birthweight infants: outcome at 2 years.

Follow-up data to 2 years are reported for 164 of an initial cohort of 172 consecutively, surviving very low birth-weight infants. The 13 infants who suffered apnoeic episodes at home were not predicted at discharge from hospital. The mean (s.d.) general developmental quotient at 2 years for the total group was 97.3 (12.0), compared with 99.0 (10.2) for the 72 infants who had nil-mild apnoea in the newborn period and 96.0 (13.4) for the 92 infants with moderate-severe apnoea (P less than 0.1). All six infants with general quotients less than 76 had sustained moderate-severe apnoea (P less than 0.05). Multivariate analysis to assess the influence of confounding variables showed that the presence of chronic lung disease decreased the general quotient by 4.0 units, birthweight less than 1000 g 3.3 units, mechanical ventilation 2.2 units and moderate-severe apnoea only 0.1 unit. Moderate-severe apnoea occurred in six of eight babies with neurological handicap and all eight with sensory handicaps (P less than 0.01). Overall, of the 12 (7.3%) handicapped children, two had no apnoea and 10 moderate-severe apnoea (P = 0.07). Moderate or severe apnoea occurred in 58% of very low birthweight infants and was associated with the smallest and sickest infants who had the most handicaps at 2 years. However, when correction for birthweight less than 1000 g, mechanical ventilation and chronic lung disease is made, apnoea per se, as it was detected and managed between 1978-80, had no additional deleterious effect on average intellectual performance though it may have been an important causative factor in functional handicap.

Analysis of Variance↗
PubMed1978

Hyponatraemia in children with febrile convulsions.

In a study of 23 children admitted to hospital with a febrile convulsion, mild hyponatraemia was found on 8 occasions. In 6 of these cases there was evidence of inappropriate secretion of antidiuretic hormone. The hyponatraemia is unlikely to be the cause of the convulsion, but probably predisposes the child to a subsequent convulsion during the same febrile illness.

Child, Preschool↗
PubMed1978

Failure to thrive or failure to rear?

The study group comprised 40 unselected Caucasian children admitted to hospital whose ages were between 3 months and 3 years and whose weights were less than 3rd centile. A comparison group comprised 34 children from a similar background whose weights were between the 25th and 75th contiles. The mothers of all 74 children were interviewed and information was obtained on physical health of the child, social and family factors, bonding, feeding difficulties, and maternal childhood experience. In 23 of the 40 underweight children the organic disease was considered to be insufficient to explain the child being underweight and to be probably insufficient in a further 9 children. Three factors occurred more frequently in these 32 underweight children. The mother often perceived herself as having a disturbed mood and used the word "depression" to describe these feelings. She also tended to come from a lower social class than the mother in the comparison group, and her infant frequently had a low birthweight. Identification of these children is not difficult; clinical investigations need to be minimal, and therapy should be directed towards supporting the mother emotionally, improving her relationship with her child, and increasing her mothering skills.

Body Weight↗
PubMed1976

Vincristine toxicity unrelated to dose.

Four children with vincristine toxicity unrelated to dose are described. Fever, haematological toxicity, and abdominal distension occurred 2-7 days after vincristine was given. Convulsions occurred 6-8 days after vincristine in all 4. Inappropriate secretion of antidiuretic hormone was thought to have occurred in 3 patients. 2 patients died during the acute toxicity phase. Necropsy findings did not show neuronal changes which could be directly ascribed to vincristine.

Child↗