Biomedical subjects
P Congdon
Publications and source records attributed to P Congdon.
Cost of neonatal care.
A six month evaluation of the costs of a regional neonatal medical and surgical unit was carried out. The total cost for six months was pounds 970,000 and this covered 4349 inpatient days and 282 admissions. For medical cases the cost ranged from pounds 132 to pounds 27,600 and the mean daily cost for different weight groups ranged from pounds 159 to pounds 274. The average daily cost for regional patients at pounds 258 was greater than for district patients who cost pounds 199. Altogether 23 medical patients weighing less than 1000 g at birth were admitted. The total cost for nine of these infants who died was pounds 30,991-about 3% of the unit's total budget.
Comparison of five tests used in diagnosis of neonatal bacteraemia.
The neutrophil count, immature:total neutrophil ratio, C reactive protein assay, nitroblue tetrazolium test and an acridine orange leucocyte cytospin test were evaluated for the diagnosis of neonatal bacteraemia. The acridine orange leucocyte cytospin test gave the highest specificity and positive predictive accuracy, but was less sensitive than the neutrophil count, C reactive protein assay or nitroblue tetrazolium test, particularly for the diagnosis of bacteraemia caused by coagulase negative staphylococci. No single test gave the sensitivity, specificity, and positive predictive accuracy of the combined results of the acridine orange leucocyte cytospin, C reactive protein, and nitroblue tetrazolium tests.
Electroimmobilization and ovine plasma cortisol concentrations: effect of current intensity, current duration and diazepam.
Whether the increases in plasma cortisol concentrations which are associated with electroimmobilization (E-IM) of conscious sheep are modified by current intensity, current duration or prior treatment with diazepam was assessed. Sheep were electroimmobilized at 30, 40 or 60 mA for one minute and at 40 mA for two or four minutes. After E-IM of one minute's duration, peak plasma cortisol concentrations occurred at 20 minutes and were 39.1 +/- 7.8 ng ml-1 at 0 mA (control), 56.7 +/- 9.6 ng ml-1 at 30 mA, 62.1 +/- 6.9 ng ml-1 at 40 mA and 78.4 +/- 3.2 ng ml-1 at 60 mA. Both the peak plasma cortisol concentrations and the integrated cortisol responses to E-Im were correlated with current intensity (P less than 0.01). The cortisol responses to E-Im at 40 mA for one, two and four minutes were not significantly different and the response to E-IM at 40 mA for one minute was not affected by the administration of diazepam (0.2 mg kg-1 intravenously) 15 minutes before E-IM. These results indicate that the cortisol response to E-IM is directly dependent on current intensity and that adrenocortical activation by E-IM may be minimised by choosing the lowest current at which effective restraint is maintained.
Electro-immobilisation of sheep may not reduce the aversiveness of a painful treatment.
Sheep were repeatedly chased down a race and were then either subjected to the noise of a shearing handpiece or had wool shaved off. An increase in the time that had to be spent pushing the sheep down the race indicated that the latter treatment was aversive. Similar results were obtained when the sheep were subjected to the same two treatments while electro-immobilised. This throws doubt on the analgesic effectiveness of electro-immobilisation.
Pharmacokinetics of aztreonam in very low birthweight neonates.
Explore the source record for details and available documents.
'Methicillin-resistant' Staphylococcus aureus in a regional neonatology unit.
In December 1985 a neonate was transferred to a Yorkshire Regional Neonatology Unit (RNU) from a neighbouring hospital and was subsequently found to be colonized with a 'methicillin-resistant' strain of Staphylococcus aureus (MRSA). Spread of the MRSA was controlled by routine cross-infection methods. The RNU was not closed to new admissions, the economic cost of control measures was small and no neonatal death was attributable to MRSA infection. Eradication of the MRSA from the RNU was associated with a decline in frequency of coagulase-negative staphylococci (CNS) from blood cultures, but the overall frequency of positive blood cultures did not decline and there was a rise in frequency of isolation of Gram-negative bacterial species. The decline in frequency of CNS isolates from blood cultures may have resulted from a reduction in the level of cross-colonization of neonates with antibiotic-resistant CNS strains and also increased usage of erythromycin and vancomycin.
Effect of birthplace on infants with low birth weight.
From December 1983 to June 1985, 162 infants of less than 32 weeks' gestation or weighing less than 1,500 g, or both, were cared for at the regional neonatal intensive care unit in Leeds. Of the 162, 64 (40%) were born in the unit because their mothers had received antenatal care there, 58 (36%) were born in another hospital and subsequently transferred, and 40 (25%) were transferred in utero because of potential complications. The overall mortalities for each group were 14%, 38%, and 18% respectively. These differences were significant, but when they were corrected for gestation, birth weight, and mode of delivery there was no difference in either the mortality or the incidence of intraventricular haemorrhage in the three study populations. Although there seem to be no distinct advantages of in utero transfer in terms of mortality and morbidity, there are other psychological and emotional advantages.
Sheep may be more averse to electro-immobilisation than to shearing.
Explore the source record for details and available documents.
Neonatal systemic candidiasis.
Ten babies who required neonatal intensive care developed systemic candidiasis. Eight were extremely preterm (28 weeks' gestation or less) and all received prolonged ventilation, multiple courses of broad spectrum antibiotics, and intravenous hyperalimentation. Diagnosis was established by culture of yeasts from suprapubic urine specimens; venous blood cultures proved unreliable. Initial treatment with 5-flucytosine alone in eight babies and combined with amphotericin B in two, eradicated the infection in nine babies, the treatment failure arising through diagnostic delay and development of resistance to 5-flucytosine. Prophylactic topical antifungal drugs, regular screening of suprapubic urine specimens, and prompt use of systemic antifungal agents before multifocal infection becomes established may reduce the incidence and improve outcome.
Prognosis for babies born with fused eyelids.
The overall mortality for babies referred to our unit with fused eyelids was 68.7%; but when severe skin bruising was present only one of 18 babies survived (5.6%). This compares with a survival rate of 75% for those not bruised at or soon after birth. Skin bruising invariably indicates a very poor prognosis in babies born with fused eyelids.
Analysis of ethnic influence on stillbirths and infant mortality in Bradford 1975-81.
The patterns of mortality from birth to 1 year in Bradford were studied in the seven year period 1975-81. Large differences in mortality between the Asian and non-Asian population were shown. In 1981 77% of Bradford Asian families were of Pakistani origin, the remaining 23% consisting of families from other parts of the Indian subcontinent and a few from East Africa. There were excess mortality with associated congenital abnormality in the Asian population. From 1975 to 1981 there were 133 deaths associated with congenital abnormality (a rate of 12.4 per 1000 total births) in the Asian population compared with a figure of 129 (4.8 per 1000) in the non-Asian population. The differences between the two groups are shown to be largely independent of social class, and other possible reasons for the discrepancy between the Asian and non-Asian populations are discussed.
Mineral content of the forearms of babies born to Asian and white mothers.
Vitamin D deficiency is common in pregnant Asian women. The effect of maternal vitamin D deficiency on fetal skeletal mineralisation was assessed by measuring the bone mineral content of babies born to 45 Asian women, 19 Asian women who had received 1000 units of vitamin D during the last trimester, and 12 white women. The mean cord blood concentrations of 25-hydroxy vitamin D in the three groups were 5.9 +/- SE 0.9 nmol/l (2.4 +/- SE 0.4 ng/ml), 15.2 +/- 3.2 nmol/l (6.1 +/- 1.3 ng/ml), and 33.4 +/- 3.6 nmol/l (13.4 ng/ml), respectively. Despite this wide variation in values there was no significant difference in the bone mineral content (as assessed by photon absorptiometry) of the forearms of babies born to these women. This suggests that mineralization of the fetal skeleton is not impaired in maternal vitamin D deficiency. Craniotabes (skull softening) was present in seven of the 64 Asian babies. The bone mineral content in these babies was not significantly different from that of babies without this sign, and craniotabes should not therefore be taken as an indication of a generalized impairment in skeletal mineralization.
Clonidine and childhood migraine: a pilot and double-blind study.
Explore the source record for details and available documents.
Small-bowel mucosa in asymptomatic children with celiac disease. Mucosal changes with gluten-free diets.
Even though children with celiac disease may appear to be progressing satisfactorily while taking gluten-free diets, dietary lapses and persisting mucosal abnormalities are common. Of 32 children with celiac disease proven by biopsy only ten kept regularly to their diet, and 11 continued to ingest gluten regularly. Despite satisfactory clinical progress, intestinal biopsy specimens obtained after at least one year of a gluten-free diet were markedly abnormal in eight and were normal in only 14 children. Laboratory criteria also failed to detect those with persisting mucosal abnormalities. The only way to ensure that the small-bowel mucosa returns to normal and remains so is by intestinal biopsy.
Enamel defects of the primary dentition and osteopenia of prematurity.
Explore the source record for details and available documents.