Biomedical subjects
Publications and source records attributed to S Imong.
Total parenteral nutrition is often necessary for the survival of neonates, but obtaining central venous access can be very difficult. A case is reported in which malpositioning of a 27 gauge central venous catheter resulted in the misdiagnosis of necrotising enterocolitis and hypoglycaemia.
OBJECTIVE: To compare the measurement of haemoglobin concentration ([Hb]) using the HemoCue haemoglobinometer with that using the Coulter STKS haemoglobinometer. DESIGN: Thirty two EDTA samples were taken from neonates. [Hb] was measured in these samples using the HemoCue; the samples were then transferred to the haematology laboratory for [Hb] determination with the Coulter STKS. In addition, [Hb] was determined in 50 different random EDTA neonatal samples already held in the laboratory, using the HemoCue and Coulter STKS. PATIENTS: Neonates in the intensive care and low dependency Units of the Royal Devon and Exeter Hospital. INTERVENTIONS: Samples were collected from arterial lines or by venepuncture or heel prick into an EDTA bottle. MAIN OUTCOME MEASURES: [Hb] using the HemoCue and Coulter STKS methods. RESULTS: The mean [Hb] measured using the HemoCue was 150.3 g/l (range 78-215) compared with 152.8 g/l (range 78-217) measured using the Coulter STKS, with a mean of the differences of 2.5 g/l. The standard deviation of the differences of the 82 samples was 3.73 g/l. The limits of agreement of the two methods (mean difference +/- 2SD) were -4.8 to +9.8 g/l. CONCLUSION: With adequate training and monitoring, the HemoCue can be used directly on the neonatal unit for rapid determination of [Hb] to within 7.5 g/l compared with the laboratory Coulter STKS, using much smaller sample volumes.
A questionnaire survey identified 55 neonatal units in the UK currently providing high frequency oscil latory ventilation (HFOV) for respiratory distress syndrome (RDS). Criteria used to select infants for both rescue and elective HFOV were found to vary widely between units. Personal clinical experience was the most common factor determining these criteria.
A group of 60 infants representative of a rural Thai population were studied longitudinally over the first year of life. Their breast milk intake, supplementary food intake and nursing patterns were measured for 2 consecutive days at about 15, 45, 90, 180, 270 and 360 days of age. For the sample as a whole, the estimated peak value for energy intake from breast milk was 529 kcal (2213 kJ) and occurred at 34 days post-partum. Thereafter milk intake declined, with 40% of infants fully weaned by the end of the first year. Supplements were introduced early, with 15% of infants supplemented by 2 weeks and 68% by 6 weeks. Higher levels of supplementation were associated with lower breast milk intake. In addition there was an independent positive effect of nursing patterns (number of breast feeds per day). Interaction terms show that both supplementary feeding and number of feeds have quantitatively different effects at different ages: breast milk intake varies more with level of supplementation in younger infants than in older infants, and varies more with number of feeds in older infants than in younger infants. Higher peak levels of breast milk intake were followed by a steeper decline, and infants who took more breast milk at 15 days were more likely to be fully weaned by their first birthday.
The Chiang Mai lactation project is a longitudinal field study of human lactation carried out among northern Thai women living in the Sanpatong area of Chiang Mai Province. Its aim was to measure the volume and composition of breast milk transferred from mothers to their infants in the first year postpartum, and to relate it to predictors of milk production, and to the growth of the child. Breast milk and supplementary food intake, and nursing patterns, were recorded over two consecutive 24-hour periods six times during the first year. Samples of breast milk and of supplementary foods were analysed for energy and protein. Supplementary foods were also analysed for bacterial contamination. The growth of the child was measured, and health assessed using a combination of health diaries and examination by a physician. Recruitment to the study was excellent. After recruitment, two subjects left the study area, but otherwise only two dropped out, so complete sets of data covering these variables are available for 58 of the 62 recruited subjects.