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Biomedical subjects

R W Cooke

Publications and source records attributed to R W Cooke.

At least 91 records · Page 5Linked to original sources
PubMed1988

Costs and benefits of neonatal intensive care.

A cohort of very low birthweight infants (less than 1500 g) born in 1979-81 from a geographically defined area was followed up, and a costing of the initial admission to the neonatal intensive care unit was made. A four point scale for the severity of disability was used and estimation of the costs of education and full time residential care was made and discounted at 5% over the appropriate period. During the three years a progressively increasing proportion of infants survived, and this was associated with an increasing proportion of disabilities among the survivors. If costs are related to outcome up to the age of 4 they get progressively less over the three year study period. After the age of 4 the costs of special education and residential care dominate, and the cost trend is reversed.

Child Care↗
PubMed1987

Failure of observation and impedance respirography to detect active expiration in ventilated preterm infants.

Twenty preterm infants ventilated for the respiratory distress syndrome were studied on 44 occasions to identify the pattern of interaction between their spontaneous respiratory efforts and the ventilator, using three techniques: (1) an oesophageal balloon and pneumotachograph, (2) impedance respirography and (3) clinical scoring. The information was in agreement on 23 of the occasions. In 7 infants the balloon and pneumotachograph showed active expiration which was not detected by the other methods. Four of these infants sustained a pneumothorax, one after paralysis with pancuronium. This study shows that only a system incorporating an accurate assessment of the baby's own respiratory pattern is able to detect different patterns of interaction. Impedance respirography and clinical observation appear to be unsatisfactory in this context.

Humans↗
PubMed1987

Epidemiology of strawberry haemangioma in low birthweight infants.

The prevalence of cutaneous haemangiomas in a representative population of low birthweight infants was determined by tracing and assessing survivors of pre-school age. Data from hospital case-notes and follow-up assessments were used to investigate whether prevalence of haemangiomas was related to perinatal factors and childhood morbidity. Eleven point one per cent of 615 infants developed a haemangioma. Haemangiomas were more common in girls than boys, and in infants of lower gestational age. Hypothermia in the first hours of life and neonatal illness were associated with lower prevalence, suggesting that neonatal skin perfusion influences haemangioma development; this is consistent with a tendency for haemangiomas to be distributed centripetally. However, the major aetiological determinants are unknown. Children with a haemangioma were more likely to have had a febrile convulsion than those without a haemangioma.

England↗
PubMed1987

Elevated levels of immunoreactive prostacyclin metabolite in babies who develop intraventricular haemorrhage.

Measurement of 6-ketoprostaglandin F1-alpha by radioimmunoassay was made during the first three days of life in a group of 48 preterm neonates at risk of intraventricular haemorrhage. The babies who developed haemorrhage had significantly higher levels than those who did not, and failed to show the falling levels seen over the first three days of life in the nonhaemorrhage group. It is suggested that high levels of prostacyclin in low birthweight babies may be one factor which contributes to the alterations of cerebral blood flow and capillary bleeding time which predispose to intraventricular haemorrhage.

6-Ketoprostaglandin F1 alpha↗
PubMed1987

Effects of birth weight, gestational age, and maternal obstetric history on birth prevalence of cerebral palsy.

A register of children with cerebral palsy born to mothers resident in the Mersey region from 1966 to 1977 was compiled from health service records. Frequency distributions and prevalences of birth weight and gestational age differed for those with hemiplegia, diplegia, and quadriplegia. In particular, the children with diplegia showed a bimodal frequency distribution. Children of normal birth weight with diplegia had a higher prevalence of severe mental retardation than those of low birth weight. These differences may be due to survival bias and may not be of aetiological importance. Furthermore, the mothers of diplegic infants had a significantly higher proportion of spontaneous abortions, stillbirths, and low birthweight infants in their obstetric history. This suggests that prenatal factors predominate in the aetiology of diplegia.

Abortion, Spontaneous↗
PubMed1987

Outbreak of cephalosporin resistant Enterobacter cloacae infection in a neonatal intensive care unit.

Enterobacter cloacae resistant to third generation cephalosporins emerged rapidly during an outbreak of serious infections due to this organism in a neonatal intensive care unit where ampicillin and gentamicin were used as first line antibiotic treatment. Organisms resistant to cephalosporins were isolated from 12 infants, six of whom developed systemic infection. Two infants died. Isolates of E. cloacae from four of five infants treated with cefotaxime showed a loss of sensitivity to this antibiotic during treatment, but in the three infants who survived sensitive organisms were again isolated after treatment had stopped. Stopping treatment with the cephalosporins, closure of the unit to new admissions, and strict cohorting of colonised infants resulted in a prompt end to the outbreak. This outbreak suggests that the routine use of third generation cephalosporins for suspected sepsis may be inappropriate in the presence of a large reservoir of organisms with the potential for rapidly developing resistance. Routine bacteriological surveillance, however, might permit their use on a rotational basis.

Cephalosporins↗
PubMed1987

Trends in birth prevalence of cerebral palsy.

A register of children with cerebral palsy born in the period 1966-77 to mothers resident in the Mersey region was compiled from several different data sources. There were 685 cases, with a male:female ratio of 1.4:1. The birth prevalence of cerebral palsy ranged from 1.18 to 1.97 per 1000 live births each year, with a mean of 1.51 per 1000 live births. There was no discernible trend in overall prevalence, but there was a highly significant upward trend in the prevalence of cerebral palsy among low birthweight infants, which was evident for all the major types of cerebral palsy. It is postulated that this is due to improved survival rather than a real change in incidence. Alternatively, because the register was compiled from health service records, a diagnostic access bias from improved follow up of low birthweight infants may have led to an apparent increase in prevalence.

Birth Weight↗
PubMed1987

Determinants of major handicap in post-haemorrhagic hydrocephalus.

The outcome of 54 low birthweight (less than 2500 g) infants treated by ventriculoperitoneal or ventriculoatrial shunting for post-haemorrhagic hydrocephalus over six years is reviewed. Prognosis correlated with cranial ultrasound appearances in the neonatal period but not with factors relating to the aetiology or extent or management of the hydrocephalus.

Cerebral Hemorrhage↗
PubMed1987

Early and late cranial ultrasonographic appearances and outcome in very low birthweight infants.

Of 798 very low birthweight infants admitted to a regional neonatal intensive care unit over a five year period, 547 were discharged home and 524 available for follow up at two to five years later. Eighty-seven infants had a major impairment. Both early and late cerebral ultrasonographic appearances gave useful prognostic information, but the presence of cystic lesions, particularly if bilateral, was highly significant. There was a close correlation between late parenchymal lesions and previous ipsilateral intraventricular haemorrhage, suggesting a causal relation.

Brain↗
PubMed1987

Birthweight-specific risk factors for necrotising enterocolitis.

In a multicentre case-control study of necrotising enterocolitis risk factors were found to vary with birthweight of cases. In very low birthweight cases the risk factors identified were those associated with prolonged or recurrent hypoxia (recurrent apnoea, respiratory distress, assisted ventilation, and umbilical artery catheterisation). In heavier birthweight infants the risk factors were, in contrast, related to hypoxia at birth (low 1 minute Apgar score and endotracheal intubation at birth) and umbilical vessel catheterisation used in exchange transfusions. Contradictory findings in published case-control studies carried out in the USA may be due to differences in patient populations and management policies. Hypoxia and umbilical vessel catheterisation should still be considered as risk factors for necrotising enterocolitis.

Apgar Score↗
PubMed1986

Multicentre trial of ethamsylate for prevention of periventricular haemorrhage in very low birthweight infants.

The effectiveness of ethamsylate in the prevention of periventricular haemorrhage (PVH) in very low birthweight infants was evaluated by means of a multicentre, placebo-controlled, double-blind trial. In 330 infants without evidence of PVH on initial cranial ultrasound examination there was little difference between ethamsylate and placebo groups with respect to subependymal haemorrhage, but intraventricular and parenchymal haemorrhages developed in 30/162 infants (18.5%) in the treated group, compared with 50/168 (29.8%) in the control group (p less than 0.02). The incidence of intraventricular and parenchymal haemorrhage in survivors was 20/137 (14.6%) in the ethamsylate group and 37/146 (25.3%) in the controls (p less than 0.05). In 30 infants with evidence of PVH on the initial scan, ethamsylate treatment seemed to limit parenchymal extension. Analysis of the total cohort of 360 infants showed that the proportion of infants in whom an increase of two or more grades of severity of PVH was recorded during the trial was lower in the treated than in the placebo group (p less than 0.01). No adverse effects were attributed to ethamsylate therapy. The reported incidence of patent ductus arterious was lower in the treated than in the placebo group (p less than 0.02). Mortality was similar in the two groups.

Benzenesulfonates↗
PubMed1986

Cost of neonatal intensive care for very-low-birthweight infants.

A detailed costing of the Mersey regional neonatal intensive care unit was made for 1983 (at 1984 prices) for three levels of care; costs per inpatient day were 297 pounds, 138 pounds, and 71 pounds for intensive, special, and nursery care, respectively. Regression of ungrouped patient-specific costs against birthweight showed the explanatory power of birthweight to be negligible. The average cost per very-low-birthweight (less than 1500 g) infant was 4490 pounds for a survivor and 3446 pounds for a non-survivor. A similar study elsewhere showed an almost six-fold difference in cost between survivors and non-survivors. It is postulated that medical management policy largely determines this difference and is crucial to any investigation of cost-efficiency.

Costs and Cost Analysis↗
PubMed1986

Survival and morbidity in a geographically defined population of low birthweight infants.

Rates of survival and of neurological impairment in a geographically defined population of low birthweight infants born during 1979-1981 were determined by tracing infants and assessing survivors at pre-school age. Comparison with data from similar studies relating to earlier years shows that the proportion of low birthweight infants who survive with no major impairment has increased significantly; the risk of surviving with an impairment has not altered sufficiently for a significant difference to be apparent from these comparisons.

Birth Weight↗