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Biomedical subjects

N Rutter

Publications and source records attributed to N Rutter.

At least 37 records · Page 2Linked to original sources
PubMed1993

The pharmacokinetics and physiological effects of buprenorphine infusion in premature neonates.

1. The pharmacokinetics and physiological effects of buprenorphine were studied in 12 newborn premature neonates (27 to 32 weeks gestational age) who were given a loading dose of 3.0 micrograms kg-1 of buprenorphine followed by an intravenous infusion of 0.72 micrograms kg-1 h-1 of buprenorphine. Plasma concentrations of buprenorphine were measured during the infusion, at steady-state and for 24 h after the cessation of the buprenorphine infusion. 2. The mean steady-state plasma buprenorphine concentration (+/- s.d.) for an infusion rate of 0.72 micrograms kg-1 h-1 was 4.3 +/- 2.6 ng ml-1. 3. Buprenorphine clearance was 0.23 +/- 0.07 l h-1 kg-1, the elimination half-life was 20 +/- 8 h and the volume of distribution was 6.2 +/- 2.11 l kg-1. 4. Small but significant falls were noted in systolic blood pressure at 6 h and heart rate at 1, 6 and 12 h after the administration of buprenorphine, but these did not appear to cause any clinical deterioration. 5. Four of the 12 subjects studied required an increase in the infusion rate of buprenorphine to achieve adequate sedation. 6. The results suggest that this dosing regimen of buprenorphine is safe but may not be as effective as other opioids in producing sedation and analgesia in premature newborns.

Analgesics, Opioid↗
PubMed1993

Do preterm infants always have flattened heads?

It has previously been shown that a soft mattress lessens the degree of head flattening that occurs in preterm infants in the early weeks of life. A follow up study of 31 infants of < 32 weeks' gestation found head flattening had resolved by 3-4 years of age, regardless of the type of mattress used in the neonatal period, and the children had heads similar in shape to full term controls.

Age Factors↗
PubMed1993

Sex linked valvular dysplasia.

A family is described in which three males have been affected by congenital valvular dysplasia of one or more heart valves, in one case leading to neonatal death. The pedigree is consistent with sex linked inheritance.

Adult↗
PubMed1991

Morphine kinetics after diamorphine infusion in premature neonates.

1. The pharmacokinetics of morphine were studied in 26 newborn premature neonates (26-38 weeks gestational age) who were given a loading dose of 50 micrograms kg-1 of diamorphine followed by an intravenous infusion of 15 micrograms kg-1 h-1 of diamorphine. Plasma concentrations of morphine were measured during the infusion at steady-state and for 24 h after the cessation of the diamorphine infusion. 2. The mean steady-state plasma morphine concentration (+/- s.d.) for a diamorphine infusion rate of 15 micrograms kg-1 h-1 was 62.5 +/- 22.8 ng ml-1. 3. Morphine clearance was 3.6 +/- 0.9 ml min-1 kg-1, the elimination half-life was 8.9 +/- 3.3 h and the volume of distribution was 2.7 +/- 1.01 kg-1. 4. Morphine elimination kinetics were described by a mono-exponential function. 5. There was a direct relationship between the gestational age of the patients and the clearance (r2 = 0.31, P = 0.003) and half-life (r2 = 0.35, P = 0.01) of morphine, but no relationship was found between gestational age and volume of distribution. 6. The results suggest that the currently used dosing regimen of diamorphine achieves a safe and effective morphine concentration in the premature newborn but that the loading dose could be modified to achieve a more rapid onset of analgesia.

Birth Weight↗
PubMed1991

Hemimegalencephaly: diagnosis and treatment.

Three boys with hemimegalencephaly are reported. Two suffered neonatal convulsions and the third presented with seizures at seven months. In each case the EEG was grossly abnormal, with spike and wave activity. All three have significant developmental delay and demonstrate other manifestations of the condition: macrocephaly in two, contralateral hemiparesis in one and one boy has ipsilateral facial hemihypertrophy and linear naevus. Hemimegalencephaly can be recognised on cranial ultrasonography, and the seizures may respond to benzodiazepine therapy.

Adolescent↗
PubMed1991

Diamorphine infusion in the preterm neonate.

The effects of diamorphine were studied in 34 premature neonates who were given a loading dose of 50 micrograms/kg of diamorphine followed by a constant rate intravenous infusion of 15 micrograms/kg/hour. Small but significant falls were noted in blood pressure (at 30 minutes) and heart rate (at 30 minutes, six hours, and 12 hours) after administration of diamorphine, but these did not appear to cause any clinical deterioration and were thought to be related to the sedative effect of the drug. A significant fall in respiration rate at 30 and 60 minutes reflected the desired intention to encourage synchronisation of the infants' breathing with the ventilator. The mean (SD) plasma concentration of morphine measured during the infusion at steady state was 62.5 (22.8) ng/ml (range 20 to 98 ng/ml). The data suggest that this dosage regimen of diamorphine is safe. It results in plasma concentrations of morphine in the premature neonate which are comparable with those that are known to provide effective analgesia in the child and adult.

Analgesia↗
PubMed1990

Percutaneous carbon dioxide excretion in the newborn infant.

Percutaneous carbon dioxide excretion was studied in 42 newborn infants between 25 and 39 weeks gestation, using a closed skin cell attached to the abdomen. The rate of excretion during the first few days of life was inversely related to gestation, increasing from a mean of 31 ml/m2/h at term to 198 ml/m2/h below 30 weeks gestation. Postnatally there was a rapid fall in the rate of excretion in very preterm infants to values about twice those found at term. The rate of excretion was linearly related to the CO2 diffusion gradient, and zero diffusion would be expected when there was no diffusion gradient. It is estimated that up to 15% of resting CO2 excretion occurs through the skin of very preterm infants, and more if the tissue PCO2 is elevated.

Carbon Dioxide↗
PubMed1990

The scars of newborn intensive care.

Many techniques used in neonatal intensive care are invasive and the risk of producing skin damage is high. To investigate this, 100 consecutive survivors of neonatal intensive care (gestation 26-42 weeks, median 32) were examined in detail by a single observer at 16-29 months of age, and the scar severity, site and likely cause noted. Scarring was present in all infants although it was usually trivial. The total number of scars was inversely related to gestational age and directly related to the duration of intensive care. Eleven children had cosmetically or functionally significant lesions caused by chest drain insertion, extravasation of intravenous fluid or skin stripping by adhesive tape. To reduce the frequency and severity of skin damage, neonatal staff need to be aware that many routine procedures may lead to long term scarring. In particular, more careful wound closure after chest drain removal is needed.

Cicatrix↗
PubMed1990

Transdermal delivery of theophylline to premature infants using a hydrogel disc system.

1. Preterm infants show incompletely developed skin with reduced barrier function. The possibility of transdermal delivery of theophylline from hydrogel discs swollen with choline theophyllinate has been investigated. 2. Drug loaded hydrogel discs 2 cm2 in area were applied to the abdomen and occluded. Serum theophylline concentrations were measured in twenty-one infants of less than 31 weeks gestation. 3. Therapeutic concentrations were achieved in 18 individuals, and maintained for up to 15 days after repeated application of discs. A correlation between maximum serum drug concentration and transepidermal water loss, gestation and birthweight was demonstrated.

Administration, Cutaneous↗
PubMed1989

Organ donation.

Explore the source record for details and available documents.

Brain Death↗
PubMed1988

Percutaneous oxygen delivery to the preterm infant.

The feasibility of delivering therapeutically useful amounts of oxygen percutaneously was investigated in 13 preterm infants. Their gestation ranged from 25 to 31 weeks and all were being ventilated for severe respiratory distress. Raising the ambient oxygen concentration resulted in an increase in arterial oxygen tension of 4.5 to 13.8 mm Hg (mean 8.9 mm Hg) as a result of percutaneous oxygen absorption. The change was greatest in the least mature infants and in those with the weakest epidermal barrier. Transdermal oxygen therapy can usefully supplement oxygen delivery to very premature infants with poor pulmonary gas exchange.

Gestational Age↗
PubMed1988

Clinical risk factors and periventricular leucomalacia.

Two hundred infants of below 1501 g at birth were regularly examined with real time ultrasound using a 7.5 MHz transducer. Abnormalities were categorized as periventricular haemorrhage (PVH) (n = 107) or periventricular leucomalacia (PVL), with or without PVH (n = 52). Of the group with PVL, 25 had the appearances of prolonged flare without cavitation. Prospective assessments of up to 50 potential clinical risk factors were made wherever possible on each infant including stratification of all blood gas and systolic blood pressure data. Multivariate logistic regression analyses confirmed a strong correlation between immaturity and PVH but this was not found in cases of PVL. Independent variables associated with PVL included pneumothorax, maximum bilirubin concentration, surgery, and the proportion of time the infant's PaCO2 remained above 7 kPa. There was a very strong inverse correlation between anaemia and PVL. Systolic blood pressure data were carefully analysed and there was no relation between either hypotension or antepartum haemorrhage and the development of PVL.

Encephalomalacia↗
PubMed1988

Reduction of head flattening in preterm infants.

During the first few weeks of life many preterm infants develop flattened heads. We have shown that this deformity can be reduced by nursing preterm infants on soft, air filled mattresses of the type used for detecting apnoea.

Beds↗
PubMed1988

Percutaneous respiration in the new-born infant. Effect of ambient oxygen concentration on pulmonary oxygen uptake.

The effect of increasing ambient oxygen concentration on percutaneous oxygen absorption was studied by measuring pulmonary oxygen uptake before and after exposure of the skin to 90% oxygen; assuming the metabolic demands of the infant remain unchanged, the pulmonary oxygen uptake should fall as percutaneous absorption increases. During the first few days of life, in infants between 28 and 30 weeks gestation, there was a significant reduction in the mean pulmonary oxygen uptake of 0.27 ml/kg/min (6.2%) when the trunk and limbs were surrounded by 90% oxygen. The calculated fall in pulmonary uptake if the whole body was surrounded by 90% oxygen would be 8-10%. In contrast, the changes seen in more mature infants (32-39 weeks gestation) and older infants (28-29 weeks gestation and 7-17 days old) were small and not significant. Percutaneous oxygen delivery may usefully contribute to the total oxygen requirements of very preterm infants during the early neonatal period.

Gestational Age↗
PubMed1987

Prediction of cerebral palsy in very low birthweight infants: prospective ultrasound study.

The value of regular cerebral ultrasound scanning in predicting cerebral palsy (CP) was assessed in very low birthweight infants. The infants were scanned before discharge, and their vision and hearing were assessed at age 9 months and neurodevelopment was assessed at 18 months. Ultrasound abnormalities, defined before the study, were periventricular haemorrhage (PVH), "prolonged flare" (echodensity persisting in the periventricular white-matter for more than 2 weeks without cavitating), and cystic periventricular leukomalacia (PVL). The incidence of these three conditions in surviving infants was 49%, 15%, and 8%, respectively. 158 infants survived to be discharged from hospital and 156 had neurodevelopmental assessment at 18 months of corrected age. All infants with PVH alone and confined to the lateral ventricles were normal at follow-up. The presence of cysts accurately predicted abnormal outcome (94%) and was highly specific (96%). Prolonged flare predicted adverse outcome but the accuracy (79%) was less good than for cystic PVL. 12 infants had CP, and 10 of these had ultrasound evidence of PVL. 8 of the 13 infants with cysts had spastic CP. 4 of these were walking independently and had mild CP. No infant with ultrasound evidence of a single cyst or with cysts confined to the frontal region or centrum semiovale had severe CP. Cysts involving the periventricular white-matter in the occipital region were associated with a poor prognosis. Echolucent cystic lesions detected by ultrasound in the neonatal period accurately predict adverse outcome, and if multiple and present in the occipital region, confer a very high risk of severe CP.

Cerebral Hemorrhage↗