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Biomedical subjects

P Hope

Publications and source records attributed to P Hope.

At least 19 recordsLinked to original sources
PubMed2003

The usefulness of ultrasound assessment of amniotic fluid in predicting adverse outcome in prolonged pregnancy: a prospective blinded observational study.

OBJECTIVE: To determine whether a single ultrasound scan at or beyond 40 weeks of gestation to detect a single deepest pool of amniotic fluid <2 cm and amniotic fluid index (AFI) <5 cm is clinically useful in the prediction of subsequent adverse pregnancy outcome. DESIGN: A prospective double blind cohort study. SETTING: A university teaching hospital delivering approximately 6000 women annually. POPULATION: One thousand and five hundred and eighty-four pregnant women at or beyond 40 weeks of gestation. METHODS: Ultrasound assessment of liquor to detect the single deepest pool of amniotic fluid and derive the AFI at or after 40 weeks of gestation. MAIN OUTCOME MEASURES: Perinatal death, meconium aspiration, birth asphyxia, intervention in labour for fetal distress, a cord arterial pH <7 and admission to the neonatal unit. RESULTS: An AFI <5 cm but not a single deepest pool <2 cm was significantly associated with birth asphyxia or meconium aspiration. An AFI <5 cm was also significantly associated with caesarean section for fetal distress in labour, a cord arterial pH <7 at delivery and low Apgar scores. Despite there being a statistically significant association with adverse outcomes the sensitivity of AFI was low at 28.6%, 12% and 11.5% for major adverse outcome, fetal distress in labour or admission to the neonatal unit, respectively. CONCLUSIONS: The AFI is superior to a measure of the single deepest pool as an assessment of the fetus at or after 40 weeks but has a poor sensitivity for adverse pregnancy outcome. Routine use is likely to lead to increased obstetric intervention without improvement in perinatal outcomes.

Adult↗
PubMed2001

Randomized, controlled trial of acetazolamide and furosemide in posthemorrhagic ventricular dilation in infancy: follow-up at 1 year.

OBJECTIVE: Posthemorrhagic ventricular dilation (PHVD) is a complication of intraventricular hemorrhage in preterm infants and is associated with a high risk of long-term disability. Furosemide and acetazolamide are used widely in the treatment of PHVD in the hope of avoiding the need for placement of a ventriculoperitoneal shunt, but these drugs have not been evaluated in a controlled trial. This article reports a multicenter, randomized, controlled trial designed to test the hypothesis that these drugs would reduce the rate of shunt placement (or death) and increase survival to 1 year of age without disability. METHODS: Between 1992 and 1996, 177 infants who were less than 3 months past term and had ventricular width >4 mm above the 97th centile following intraventricular hemorrhage were assigned randomly to either standard therapy or standard therapy plus drug therapy with acetazolamide (100 mg/kg/d) plus furosemide (1 mg/kg/d). Infants who were enrolled in the trial had a median gestational age of 28.6 weeks and were enrolled at a mean postnatal age of 3.6 weeks. Forty-four percent were reported to have a cerebral parenchymal lesion on ultrasound scan at randomization. The primary outcome measure of death or shunt placement (known in all but 1 infant) occurred in 56 of 88 infants who were allocated to drug plus standard therapy compared with 46 of 88 who were allocated to standard therapy. The risk ratio was 1.23 (95% confidence interval: 0.95-1.59). Neurodevelopmental outcome information at a corrected age of 1 year (known in all but 3 of 149 surviving infants) included disability or neuromotor impairment in 54 of 67 infants (81%) who were allocated to drug plus standard therapy and 52 of 69 infants (66%) who were allocated to standard therapy. Seventy-two of 85 infants (85%) who were allocated to drug therapy either died or were disabled or impaired at 1 year compared with 62 of 89 infants (70%) who were treated with standard therapy (risk ratio: 1.22; 95% confidence interval: 1.03-1.4376). The excess risk of these adverse outcomes was greater among infants who did not have a cerebral parenchymal lesion seen on ultrasound examination at trial entry. CONCLUSIONS: These results suggest that the use of acetazolamide and furosemide in preterm infants with PHVD is ineffective in decreasing the rate of shunt placement and is associated with increased neurologic morbidity. This treatment therefore cannot be recommended.

Acetazolamide↗
PubMed1998

Fatal shoulder dystocia: a review of 56 cases reported to the Confidential Enquiry into Stillbirths and Deaths in Infancy.

OBJECTIVE: To use information collected by the Confidential Enquiry into Stillbirths and Deaths in Infancy to help obstetric, midwifery and paediatric practice in the management of shoulder dystocia. DESIGN: Review of casenotes by a multidisciplinary focus group. SAMPLE: All 56 cases reported to the Confidential Enquiry into Stillbirths and Deaths in Infancy from England, Wales and Northern Ireland in 1994 and 1995, where stillbirth or neonatal death was attributed to shoulder dystocia. MAIN OUTCOME MEASURES: Case notes were reviewed with respect to a range of perinatal variables. Comparisons were made with normative data from other studies when appropriate. RESULTS: Maternal obesity and big babies were over-represented in pregnancies complicated by fatal shoulder dystocia. Fetal compromise was recorded in 26% of labours. The median time interval between delivery of the head and the rest of the body was only five minutes. The lead professional at the time the head was delivered was a midwife in 65% of cases. Middle grade or senior obstetric staff were supervising 47% of cases by the time the body was delivered. CONCLUSIONS: Antenatal prediction of shoulder dystocia is imprecise, and the majority of deliveries are attended by midwives. A relatively brief delay in delivery of the shoulders may be associated with a fatal outcome.

Autopsy↗
PubMed1997

Unilateral neonatal cerebral infarction in full term infants.

AIMS: To determine the prevalence of unilateral neonatal cerebral infarction in infants born at 32 weeks gestation and above; to describe the clinical course, imaging results, and outcome of neonatal cerebral infarction; and to investigate possible aetiology. METHODS: Twelve cases of unilateral neonatal cerebral infarction were identified from neonatal unit records for the years 1987-93. Each case was matched with two controls. RESULTS: All cases of neonatal cerebral infarction occurred in full term infants. The prevalence was around 1 in 4000, and neonatal cerebral infarction was found in 12% of infants presenting with neonatal seizures. Cerebral ultrasound scans failed to demonstrate lesions seen by computed tomography in nine of 12 cases. Cases were more likely than controls to require assisted ventilation for resuscitation at birth (OR 7.0, 95% confidence interval 1.04-53.5), but Apgar scores at 5 minutes were no different. One infant with neonatal cerebral infarction developed a hemiparesis, the other 11 had normal motor development when assessed at 11-60 (median 33) months. None had overt cognitive deficits or persisting seizure disorder. CONCLUSIONS: Neonatal cerebral infarction is a relatively common cause of neonatal seizures, but the aetiology remains unclear. Parents need to be made aware of possible neurological sequelae, but most cases in this series had a normal outcome.

Cerebral Infarction↗
PubMed1996

Tissue distribution of opioid receptor gene expression in the rat.

The endogenous opioid peptides have multiple physiological actions at both a central and peripheral level which are mediated by 3 main classes of opioid receptors, mu, delta and kappa. The rat mu, delta and kappa opioid receptors have recently been cloned and their distribution of expression in the central nervous system has been mapped. In these studies we have used the reverse transcriptase polymerase chain reaction and Southern blotting to determine the distribution of expression of the mu, delta and kappa opioid receptors in the peripheral tissues of the rat. All 3 opioid receptors were found to be widely expressed in several peripheral tissues including the small intestine, large intestine, adrenal, kidney, lung, spleen, testis, ovary and uterus. In the stomach, delta and kappa but not mu opioid receptor transcripts were detected. Predominantly delta transcripts were detected in the heart, with no mu and only a weak signal for the kappa receptor. In the liver mu and delta but not kappa transcripts were present. Opioid receptor expression was not detected in endothelium or synovium. There is therefore a broad, but tissue specific distribution of opioid receptor expression in the periphery of the rat, suggesting that the endogenous opioid peptides play an endocrine, paracrine, or autocrine role in the regulation of physiology at a peripheral as well as central level.

Animals↗
PubMed1996

Recurrence of neonatal haemochromatosis in half sibs born of unaffected mothers.

We report two families in which neonatal haemochromatosis was observed in half sibs. In the first family, two successive girls were born of different fathers. In the second family, an affected brother and sister were followed by an affected half brother born after donor insemination. These observations, as well as a previous abstract describing two affected half sisters, revive the debate over the inheritance of neonatal haemochromatosis. Incomplete penetrance or gonadal mosaicism for a dominant disorder, a maternal "environmental factor", or mitochondrial defect may be more suitable explanations than autosomal recessive inheritance in this condition. Alternative modes of fertilisation, such as donor insemination or in vitro fertilisation with donor eggs, should be considered with caution.

Fatal Outcome↗
PubMed1995

Neonatal bullous eruption as a result of transient porphyrinemia in a premature infant with hemolytic disease of the newborn.

We describe the clinical and biochemical features of an infant with marked transient porphyrinemia in whom blistering developed while the infant was undergoing phototherapy for severe Rh isoimmunization. The cause of the transient porphyrinemia was likely to be multifactorial--abnormal porphyrin metabolism or accumulation in a premature infant with multisystem disease and multiple drug therapy. In addition, the infant received an unusually large amount of phototherapy. No evidence for an associated porphyria has been obtained. We believe this is a unique case because transient porphyrinemia associated with neonatal blistering does not appear to have been reported previously. Furthermore, blistering associated with phototherapy is rare.

Erythroblastosis, Fetal↗
PubMed1995

Neonatal carnitine palmitoyltransferase-2 deficiency: a case presenting with myopathy.

Mitochondria were isolated from liver, heart and skeletal muscle of a 34-day-old female infant who died from a myopathic illness. Muscle biopsy showed lipid accumulation and no obvious pathology in any other organ. Enzymatic analysis of skeletal muscle extracts revealed normal activities of the markers pyruvate dehydrogenase and citrate synthase. Malonyl-CoA-sensitive carnitine palmitoyltransferase (CPT1) was detected but malonyl-CoA-insensitive carnitine palmitoyltransferase (CPT2) appeared to be absent. Quantitative immunoblotting revealed the presence of a normal abundance of CPT2 protein in the patient's muscle. It is concluded that enzymically inactive CPT2 protein was present.

Carnitine O-Palmitoyltransferase↗
PubMed1993

Obstetric and neonatal outcome in fetuses with absent end-diastolic velocities of the umbilical artery: a case-controlled study.

Absence of end-diastolic velocities (AEDV) is the most severe waveform abnormality detected by Doppler ultrasound examination of the umbilical artery. It is associated with fetal hypoxemia and acidemia. If AEDV predisposed to more neonatal complications, then it might be an indication for earlier delivery. This was investigated in 21 preterm fetuses with AEDV who were matched for gestational age at delivery with 21 with end-diastolic velocities. All fetuses were delivered electively before 36 weeks' gestation of mothers who were hypertensive. The fetal heart rate (FHR) variability, birthweight, and umbilical arterial blood pH were significantly lower in the AEDV group. However, the neonatal outcomes were similar except for less severe hyaline membrane disease and lower initial platelet counts in the AEDV group. At present, fetuses with umbilical arterial AEDV need not be delivered earlier than indicated by the FHR pattern, nor should neonatal management be altered on the basis of antenatal AEDV.

Acidosis↗
PubMed1986

Ocular sequelae of preterm birth and their relation to ultrasound evidence of cerebral damage.

The eyes of 177 very preterm (less than 33 weeks' gestation) infants, born between 1979 and 1982 and admitted to a neonatal intensive care unit, were examined as part of an ongoing follow-up study of neurodevelopmental outcome. Ocular pathology was diagnosed in 37 (21%) of the 177 infants: 14 (8%) had retinopathy of prematurity (ROP)--progressive in three--and nine (5%) infants had delayed visual maturation (DVM). The ocular pathology was permanent in 26 (15%) of the 177 infants. Refractive errors were the commonest problem and accounted for permanent sequelae in eight of the 14 infants with ROP and two of the nine with DVM. The presence or absence of ROP was related to a wide range of prospectively coded perinatal variables and to the results of routine neonatal ultrasound brain scans and neurodevelopmental follow-up assessments made in the first 18 months of life. As in previous studies, infants with ROP were of shorter gestation, lower birth weight, and required oxygen therapy for longer than unaffected infants, but the condition was only weakly associated with other indices of respiratory illness. In contrast, ROP was strongly associated with evidence of brain damage, often consistent with hypoxic ischaemic injury. We conclude that an underlying lesion in ROP may be hypoxic ischaemic damage to the retinal circulation.

Brain Diseases↗