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Biomedical subjects

P H Ellison

Publications and source records attributed to P H Ellison.

At least 19 recordsLinked to original sources
PubMed1992

A comparison of neurological assessment scores from two cohorts of low-birthweight children evaluated at age four years: Dublin and Copenhagen.

We compared the neurological condition and functions at age 4 years for two cohorts of children initially treated in the neonatal intensive care units in two countries: Denmark (10) and Ireland (2). The comparisons were made in two ways: first, the more usual comparison between frequencies of cerebral palsy, mental retardation, hydrocephalus, visual and hearing loss. A second comparison was based on the items, subscales, and total scores on a neurological battery developed from the Danish data. Comparisons were made among three different birthweight groups within each country as well as between countries using analysis of variance (ANOVA). In both cohorts, significant differences were shown between two subgroups: those with birthweights less than 2300 gms and those with birthweights over 2500 gms for all subscales except the neurological ones in the Irish cohort. In the Danish cohort, significant differences were shown on all subscales among three birthweight groups: less than 1501 gms; 1501-2300 gms; and over 2500 gms. Significant differences were shown between countries for easy drawing, neurology "b", and fine motor testing.

Blindness↗
PubMed1991

Electronic fetal heart monitoring, auscultation, and neonatal outcome.

In a large randomized, controlled study of fetal heart rate monitoring with either continuous electronic fetal heart monitoring or auscultation at specified intervals, only one pattern of deviation in the fetal heart rate correlated significantly with neonatal neurologic examinations at 0 to 48 hours and 72 hours to 1 week: late decelerations in stage 1 and in stage 2. Other variables from labor and delivery, specifically, duration of labor after hospital admission, failure of labor to progress, number of fetal scalp pH values, and presence of meconium were important predictors of neonatal outcome in the regression analyses. The fetal heart rate deviations did contribute significantly to the percent variance accounted for in the regression analyses with neonatal outcomes of Apgar scores at 1 and 5 minutes and serial neonatal neurologic examinations.

Apgar Score↗
PubMed1991

The relation between perinatal conditions and developmental outcome in low birthweight infants. Comparison of two cohorts.

We have compared the relations between perinatal conditions and developmental outcomes at age four years for two cohorts of children with birthweights 2,300 g or less, who did not develop cerebral palsy--one from Southeastern Wisconsin (children born 1975-76) and the other from Copenhagen (children born 1980-82). We examined the general effects of parental education and socioeconomic status, the use of Cesarean section, the degree of prematurity and neonatal complications on outcome. The methods of latent path structural analysis were used to form two models among 15 latent variables: one for children from Copenhagen and a similar model for children from Wisconsin. The impact of parental education and socioeconomic status was somewhat greater in Wisconsin. Several neonatal complications were related to outcome in Wisconsin: the early condition of the infant, use of a respirator, pneumothorax, and anemia/apnea. The only neonatal complication with a significant relation to outcome in Copenhagen was pneumothorax and to a much lesser degree major germinal layer haemorrhage. The degree of prematurity per se had a greater impact in Copenhagen. The use of Cesarean section and mechanical ventilation in the smallest infants was much more frequent in Denmark, but no association could be shown between this increased use and improved developmental outcome.

Child Development↗
PubMed1991

The construction of a scored neonatal neurological examination for assessment of neurological integrity in full-term neonates.

We describe the construction of a scored form for the neurological examination of the full-term neonate. Extensive data analyses were obtained from a large sample of neonatal neurological examinations performed by one examiner (MSP). Examinations were used from neonates with ages less than or equal to 48 hours (n = 727) and 72 hours to 1 week (n = 510) with gestational ages greater than or equal to 37 weeks. Forty-four items from several neonatal assessments were used in these neurological examinations. Further subdivision yielded a total of 65 items. Correlations were obtained for the 65 items. We factored the matrix of these correlations, using several solutions of factor analysis. Thirty-two items were thus grouped and pruned into seven dimensions (factors) to provide a scorable neonatal neurological examination (Neoneuro) with an internal consistency or reliability of 0.80. From the total scores, cut points are recommended for categories of normality/abnormality: normal, mildly abnormal, moderately abnormal, and severely abnormal. This scoring system is well-based both theoretically and psychometrically. The quantified computer-compatible scoring system permits evaluation of individual neonates, as well as comparison of samples of neonates on item scores, subscores (factor scores), and total scores. Such quantification will permit documentation of the natural history of specific abnormalities and the evaluation of various therapies.

Brain Damage, Chronic↗
PubMed1986

The results of checking a scoring system for neonatal seizures.

We report the result of checking a scoring system for neonatal seizures in which information from the EEG, etiology, neurological examination, seizure type and birth weight are combined to predict neurological sequelae and to make decisions about treatment. The results for two samples are presented and compared. The first sample included 96 neonates; 103 neonates were evaluated in the second sample, yielding data from 199 neonates in the combined samples. The scoring system served to separate neonates who had neurological sequelae at age 10 months or more from those who did not. In addition, the scoring system provided an excellent guide for treatment of neonatal seizures. Neonates with scores less than or equal to 4 can be safely discharged from the hospital without anticonvulsant therapy. At age three months a score of less than or equal to 5 can be used as a guideline for discontinuing anticonvulsant therapy.

Developmental Disabilities↗
PubMed1985

Construction of an Infant Neurological International Battery (Infanib) for the assessment of neurological integrity in infancy.

In this article, we describe the construction of an instrument for the assessment of the neurological integrity of infants. In a follow-up program for infants from the neonatal intensive care unit, 365 evaluations of 308 infants were made by using a 32-item battery with items from four methods. Factor analyses were used for data analyses, which yielded a 20-item instrument with five factors. We named the instrument the Infant Neurological International Battery (Infanib). The Infanib has sufficient reliability for clinical and research purposes. We have formed scoring sheets, which permit clinical use of the instrument. Cut points are recommended for the separation of infants with normal, transiently abnormal, and abnormal neurologic development. The quantified scoring system enables comparison of infants on item scores, subscores (factor scores), and total scores. It also permits entry of these scores in the computer so that more complex descriptions are possible of the relationship of the neurological assessment of infants both to earlier (eg, birth) and later variables (eg, cerebral palsy, cognitive function, and school performance).

Child Development↗
PubMed1985

Follow-up of families of neonates in whom life support was withdrawn.

Grieving patterns and psychosocial functioning were studied in 20 families who had participated in a decision-making conference regarding withdrawal of support of their newborn in the neonatal intensive care unit and for whom the life support had been withdrawn. Prolonged grieving was reported by one father and pathologic grieving by one grandmother. In the majority of families, grieving patterns and psychosocial functioning were similar to those of other families whose newborns have died.

Adult↗
PubMed1985

A note on interdisciplinary research in developmental/behavioral pediatrics/psychology.

In sum, we have offered a few observations about the practice of interdisciplinary research. Now, in addition to our rather specific suggestions, we want to add a few general comments about the interactions of professionals who are actually involved in interdisciplinary research. Collaboration between physicians and psychologists can be enriching, stimulating, and rewarding. But it can also be problematic, because the former do not have much exposure to research and the latter do not have much exposure to clinical issues. Bringing these skills together may require many hours of discussion and reading each other's publications. Overall, physicians need to improve their research skills. Reading statistics texts, taking courses, handling data sets, reviewing other researchers' statistical designs are all reasonable strategies. Psychologists also need to expand their knowledge base. Reading the clinical literature is a start, but this ought to be supplemented by consistent exposure to the clinical milieu. The physician, who has access to the clinical milieu, needs to be sensitive to the question of exposure. Our final comments about collaboration are perhaps the most sensitive ones. The maintenance of a solid physician and psychologist research collaboration requires thoughtfulness, understanding, tact, and nurturance. Consider the status and responsibilities of the physician. He or she often outranks the psychologist, has access to the subject population, daily confronts ethical issues surrounding patient diagnoses, and controls communication of information to child and family. A sense of being in charge develops. Consequently, the psychologist may be perceived as being an adjunct to the research, responsible for day-to-day operations and committing ideas to paper.(ABSTRACT TRUNCATED AT 250 WORDS)

Child↗
PubMed1984

Cerebral blood flow in the newborn infant: comparison of Doppler ultrasound and 133xenon clearance.

Two techniques of Doppler ultrasound examination, continuous-wave and range-gated, applied to the anterior cerebral artery and to the internal carotid artery, were compared with 133xenon clearance after intravenous injection. Thirty-two sets of measurements were obtained in 16 newborn infants. The pulsatility index, the mean flow velocity, and the end-diastolic flow velocity were read from the Doppler recordings. Mean cerebral blood flow was estimated from the 133Xe clearance curves. The correlation coefficients between the Doppler and the 133Xe measurements ranged from 0.41 to 0.82. In the subset of 16 first measurements in each infant, there were no statistically significant differences between the correlation coefficients of the various Doppler ultrasound variables, but the correlation coefficients were consistently lower for the pulsatility index than for mean flow velocity or end-diastolic flow velocity, and they were consistently higher for the range-gated than for the continuous-wave Doppler technique.

Blood Flow Velocity↗
PubMed1984

Neurologic development of the high-risk infant.

Excellent methods of examining infants neurologically have been described and used in studies with follow-up to preschool or early school years. Few children discharged from NICUs returned with major neurologic abnormalities that were not noted on the infancy examinations, unless there had been an intervening event such as meningitis, head injury, or a difficult seizure disorder. Approximately 20 per cent of infants who were discharged from NICUs had lesser neurologic abnormalities on the infancy examinations, and these were transient. These children are at risk for lesser neurologic sequelae in the preschool years and school years, specifically hyperactivity, emotional immaturity, and a variety of learning disorders. There has been a tendency in follow-up studies of children from the NICU to fucus on the severe neurologic sequelae, but the bulk of the sequelae will become obvious when the school system requires compliance for behavior, rewards advancement in learning skills, and draws attention to deficits in complex coordination. For the teachers and parents of these children, these are frustrating years. In our follow-up study of school-age children, while not markedly abnormal, were not normal either. They demanded patience and extra attention that often wore thin by the time the child reached age six or seven. Early recognition of problem children by health care professionals may increase understanding and aid in early identification of children who need special services for behavior modification, remedial reading, and other school-related skills. It should also encourage much needed family support and counseling.

Central Nervous System Diseases↗
PubMed1983

Development of a scoring system for the Milani-Comparetti and Gidoni method of assessing neurologic abnormality in infancy.

This article reports the results of using a scoring system designed for the Milani-Comparetti and Gidoni method of neurologic examination of infants. The system was used in the assessment of 999 infants from the neonatal intensive care units affiliated with the Medical College of Wisconsin. The sample included all neonates who spent more than five days in the units from 1975 to 1978. Full assessments were conducted at 6 months and at 15 to 16 months corrected gestational age; additional assessments were scheduled by the physical therapists. For data analyses, the scores from the Milani-Comparetti and Gidoni method were summed; infants were subdivided into normal, transiently abnormal, and abnormal on the basis of the summed scores. Abnormal infants were further categorized on the basis of all information available. Several data analyses were performed to test the contribution of each item in separating normal, transiently abnormal, and abnormal infants and in distinguishing one type of abnormality from another. We conclude that the scoring system is useful in quantifying the degree of abnormality, in separating normality from abnormality, and in distinguishing among types of abnormality.

Aging↗