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Biomedical subjects

V Y Yu

Publications and source records attributed to V Y Yu.

At least 55 records · Page 3Linked to original sources
PubMed1986

Outcome of extremely-low-birthweight infants.

The overall 1-year survival rate of 261 infants born at 500 g-999g over a 7-year period was 46%. The survival rate of the 220 inborn infants, corrected for birth defects, would have increased from 47% to 57% if delivery room deaths were excluded and to 62% if postneonatal deaths had also been ignored. Survival improved progressively with increasing 100g weight groups. The disability rate in the 108 survivors who were at least 2 years old corrected for prematurity was 28% with little variation between the 100g weight groups. There were no significant trends in annual perinatal mortality, 1-year survival and disability rate in survivors over the study period for the inborn population. The male infants had significantly lower normal-survival rate than the female infants. Small-for-gestational-age infants, comprising 11% of the inborn group, had significantly better survival but a higher disability rate. Multiple births had significantly lower survival and normal-survival rates than had singleton births. Infants whose mothers were transferred for delivery at the perinatal centre before onset of labour had a significantly better survival rate than those whose mothers had 'booked' and those who were transferred in labour.

Body Weight↗
PubMed1986

Subsequent pregnancy following the birth of an extremely low birth-weight infant.

Of 103 mothers who delivered an extremely low birth-weight (ELBW, less than 1,000g) infant, 29% were primiparous; 51% of those who were multiparous had at least one previous miscarriage or perinatal death. The 41 (40%) mothers who decided against subsequent pregnancy were significantly older than the remaining mothers. Mothers were also significantly more likely to decide against subsequent pregnancy if their ELBW infant had survived. The outcome of subsequent pregnancies within 3 years of the ELBW birth was ascertained; 28% ended in miscarriage, 3% in stillbirth, 1% in neonatal death, 21% in a surviving preterm infant and 51% in a survivor born at term. Mothers diagnosed to have cervical incompetence had a significantly higher risk of a subsequent preterm birth. During the study period, 87% of mothers who became pregnant subsequent to their ELBW infant gave birth to at least one surviving child. Of the subsequent livebirths, 36% were less than 2,500g, 11% were less than 1,500g and 5% were less than 1,000g. Significantly more mothers whose ELBW infant had died conceived again within 1 year compared to those whose ELBW infant had survived. The necessary time for recovery from bereavement may be cut short by the subsequent pregnancy. The psychological problems as a result of unresolved mourning which mothers experience and their effects on subsequent children need to be further studied.

Abortion, Spontaneous↗
PubMed1986

Pulmonary air leak in extremely low birthweight infants.

The incidence of pulmonary air leak in 230 infants with a birth weight of 500-999 g who were ventilated was 41%. Pulmonary interstitial emphysema occurred in 35%, pneumothorax in 20%, pneumomediastinum in 3%, and pneumopericardium in 2%. The survival rates in those with or without pulmonary air leak were not significantly different in the first four years of the study period (46% v 53%). As the survival improved in infants without air leak during the second four years the difference in survival rates in infants with or without air leak became significant (30% v 71%). Effective measures of preventing pulmonary air leak are required before further improvement in the outcome of these extremely low birthweight infants can be achieved.

Air↗
PubMed1986

The surviving monozygotic twin.

It has been suggested that because of vascular interchange between the monozygous twins vascular disruptions from a deceased cotwin with disseminated intravascular coagulation causes embolisation in the surviving twin. This study reports six cases in which all the surviving monozygous twins had central nervous system infarcts and three had multiple organ infarcts, including pulmonary and hepatic infarcts, which have not been reported previously. Fetal death in utero occurred 1-11 weeks before the live birth of the monozygous survivor. In three cases there was pathological confirmation of a continuing process with infarcts ranging in age from a few days to eight weeks. Four infants died in the early neonatal period, and the remaining two survived with considerable handicap. A review of the published reports confirmed the high risk of vascular disruption affecting many organ systems and the extremely poor prognosis for subsequent death or handicap. We recommend that after detection of fetal death in utero in a suspected monozygous twin pregnancy careful consideration should be given to prompt delivery of the survivor and investigations should be carried out to rule out infarction in the central nervous system and other organs that are at risk.

Adult↗
PubMed1986

Contrast echocardiographic assessment of the neonatal ductus arteriosus.

Contrast echocardiography is a safe and accurate method of diagnosing patent ductus arteriosus (PDA) in newborn infants. In this study the presence of PDA in very low birthweight infants receiving mechanical ventilation was investigated by contrast echocardiography. This was used as a basis for determining the accuracy of clinical signs and M mode echocardiography in the diagnosis of PDA. At the first contrast echocardiographic examination at a mean age of 49 hours PDA was found in 75% of infants. Clinical signs were inconsistent; 42% of the infants with PDA at the first examination had a murmur, no relation being found between PDA and heart rate or cardiothoracic ratio. Left atrial and left ventricular dimensions were significantly raised and left systolic time intervals significantly lower in the group with PDA. There was, however, considerable overlap, with the sensitivity of each measurement varying between 52% and 71%. Left systolic time interval combined with left ventricular:aortic root ratio gives the best differentiation between infants with or without PDA.

Ductus Arteriosus, Patent↗
PubMed1986

Postnatal growth in infants born before 30 weeks' gestation.

The postnatal weight pattern up to 14 weeks after birth was determined in 184 singleton survivors born at 23 to 29 weeks' gestation in whom routine parenteral nutrition was used before milk feeding was established. A mean postnatal weight loss of 14% of birth weight occurred at a mean of 6 days. The more immature infants had significantly higher postnatal weight loss and longer time to regain birth weight despite a higher volume intake in the first week. From the fourth postnatal week all gestational subgroups had a mean weight gain at above intrauterine growth rate. As a result of the initial period of weight loss, however, the mean body weight remained below the 10th percentile of the intrauterine growth curve. The early growth rate in infants small for gestational age was higher than those who were appropriate weight for gestation, although the mean body weight of the former group remained significantly lower at 2 years.

Aging↗
PubMed1986

Perinatal factors and adverse outcome in extremely low birthweight infants.

Perinatal factors associated with death or disability at 2 years were identified in an inborn cohort of 196 live births with a birth weight of 500-999 g. Antepartum haemorrhage, multiple pregnancy, breech presentation, perinatal asphyxia, hypothermia on admission, hyaline membrane disease, persistent pulmonary hypertension, severe respiratory failure, and intraventricular haemorrhage were associated with increased mortality. Factors associated with increased survival included maternal hypertension, caesarean birth, increasing maturity or size at birth, female sex, and fetal growth retardation. Stepwise multiple discriminant function analysis showed that six factors correctly classified the outcome in 83% of infants: intraventricular haemorrhage was the most important factor followed by the presence of acidosis and hypoxia in the early neonatal period, birth weight, pre-eclamptic toxaemia, and caesarean birth. This study also showed that intraventricular haemorrhage, seizures, antepartum haemorrhage and delay in regaining birth weight were associated with increased disability among survivors.

Cerebral Hemorrhage↗
PubMed1986

Reduction in periventricular haemorrhage in preterm infants.

Our previous cerebral ultrasound study of antecedents of periventricular haemorrhage in infants weighing 1250 g or less at birth suggested that neonatal events that caused increased or fluctuating cerebral blood flow lead to periventricular haemorrhage. As the risk period for this type of haemorrhage was the first four days of life strict guidelines were introduced to avoid the previously identified neonatal risk factors. No attempt was made to modify obstetric practice. Over the next two years, although the obstetric risk profile, the frequency and severity of hyaline membrane disease, and the gestation, birth weight, and sex distributions of a similar cohort of infants did not change, the incidence of periventricular haemorrhage decreased significantly from 60% to 36%. Significant antecedents of haemorrhage similar to those found in the previous study included severe bruising, low arterial:fractional inspiratory oxygen ratio and low packed cell volume on admission, hyaline membrane disease, hypercarbia, and hypoxaemia. Assisted ventilation, pneumothorax, treatment with tubocurarine, and hypotension were no longer significant risk factors for periventricular haemorrhage. A multivariate discriminant analysis correctly predicted haemorrhage in 86% of the study group when bruising, hypercarbia, hypoxaemia, hyaline membrane disease, and low gestation were considered. These results suggest that changes in neonatal practices can reduce the incidence of periventricular haemorrhage and that drug studies indicating similar reduction in haemorrhage need to be evaluated carefully to ensure that placebo and treated groups are in fact comparable.

Birth Injuries↗
PubMed1985

Neonatal and neurodevelopmental significance of behaviour in very low birthweight children.

73 (34%) of 213 inborn, long term survivors with a birthweight less than 1500 g showed characteristics of Attention Deficit Disorder (ADD) during psychological testing at 2 years of age corrected for prematurity. Agreement on the diagnosis of ADD made by the paediatrician and psychologist in separate examinations was statistically significant. Children with ADD differed from those with normal behaviour on a large number of neonatal variables which were reduced to the following five on stepwise discriminant function analysis: necrotizing enterocolitis, bronchopulmonary dysplasia, major apnoeas requiring bag and mask resuscitation, duration of feeding on intravenous fat and weight percentile at discharge. These neonatal variables correctly classified 69% of children into their actual behaviour group at 2 years. On psychological testing, children with ADD had a significantly lower mental score on the Bayley Scales of Infant Development and were found on their paediatric/neurological examination at 2 years to have a significantly smaller head circumference, more tone disorders, poorer visual tracking and visual motor co-ordination, poorer gross and fine motor co-ordination and significantly more minor physical and neurological disabilities than normally behaved children. The behaviour of very low birthweight infants during formal psychological testing at 2 years is a potent indicator of past neonatal experience and current neurodevelopmental status.

Attention↗
PubMed1985

Outcome of intrauterine periventricular haemorrhage and leukomalacia.

This case study reports five very low birthweight infants with ultrasound evidence of intrauterine insult to the brain. Intrauterine periventricular haemorrhage (PVH) accompanied by ventricular dilation occurred in two preterm infants both of whom survived and were severely handicapped at follow-up. Three preterm infants had intrauterine periventricular leukomalacia (PVL); one survived and is severely handicapped at one year of age. Our experience and rare case reports in the literature indicate that intrauterine PVH and PVL carry a high risk of death in neonatal period and severe neurological sequelae in survivors.

Brain Ischemia↗
PubMed1985

Post-haemorrhagic hydrocephalus in the preterm infant.

This prospective study documents the incidence, clinical features and risk factors for post-haemorrhagic hydrocephalus (PHH) as well as the short-term outcome after serial CSF taps. Serial real-time ultrasound scans were performed on 220 infants: on all admissions less than or equal to 1250 g and on an additional 130 infants with birthweights greater than 1250 g with risk factors for intraventricular haemorrhage (IVH). Based on percentile charts of postnatal increase in ventricular size and head circumference growth rate, PHH was defined as ventricular dilatation greater than 95th centile associated with either a head circumference growth greater than 95th centile or with clinical features of raised intracranial pressure (ICP). Forty-eight (22%) infants were found to have IVH of whom 14 had intracerebral extension of IVH. Sixteen (40%) of 40 infants who survived the acute episode of IVH developed PHH. PHH occurred more commonly in those who survived severe birth asphyxia and/or intracerebral extension of IVH. Fifteen infants who developed clinical features of raised ICP were treated with serial CSF taps. This procedure was effective in a staged treatment for PHH in relieving clinical symptoms and deferring ventriculo-peritoneal (VP) shunting. Morbidity associated with serial CSF taps and VP shunting is minimal. A high red cell count and protein concentration in the CSF at diagnosis of PHH identified all five infants who subsequently required VP shunting.

Cerebral Hemorrhage↗
PubMed1985

Effect of neonatal periventricular haemorrhage on neurodevelopmental outcome.

All 56 infants born between 23 and 28 weeks' gestation admitted to this hospital in 1981 were examined for periventricular haemorrhage with cerebral ultrasonography. Haemorrhage was diagnosed in 34 (61%)-12 (22%) had germinal layer haemorrhage, 18 (32%) had intraventricular haemorrhage, and four (7%) had intracerebral haemorrhage. The two year outcome of survivors with and without periventricular haemorrhage was compared to determine the effect on neurodevelopment. Only three (16%) of 19 infants with normal scans or germinal layer haemorrhages had evidence of major disability but nine (75%) of 12 infants with intraventricular or intracerebral haemorrhage had major disability. The mental and psychomotor performance on the Bayley scales of infant development was also significantly worse in the latter group. All three survivors with intracerebral haemorrhage had major disability. The continuation of life support treatment for extremely preterm infants who are at very high risk of severe handicap is a matter of increasing concern in neonatal intensive care. Our results show that if extensive periventricular haemorrhage, in particular intracerebral haemorrhage, occurs in this gestational group, extreme pessimism is warranted.

Birth Weight↗
PubMed1985

Viability of infants born at 24 to 26 weeks gestation.

81 inborn infants of 24-26 weeks gestation were studied. Overall survival rate excluding 2 lethal malformations was 44%: it was 36% at 24 wk, 32% at 25 wk and 57% at 26 wk. 68% of the multiparous mothers had a previous reproductive loss and 30% had a previous preterm birth. Antepartum haemorrhage and chorioamnionitis were the 2 most common obstetric associations. Perinatal asphyxia and severe respiratory disorders were significantly associated with increased mortality. Management of respiratory failure and provision of adequate nutrition were the 2 main therapeutic challenges. 30% of the deaths occurred in the delivery room and 68% by 24 hours. Periventricular haemorrhage was the most common necropsy finding. The mean gestation at discharge for the 35 survivors was 40 wk. On assessment at 2 years of age, corrected for prematurity, 10 (28%) had cerebral palsy, 3(9%) had developmental delay, 2 (6%) were blind, and 1 (3%) had sensorineural deafness. There were 4 children who had more than 1 disability; 9 of the 12 children with disability were considered to have a significant functional handicap. The proportions of survivors without significant functional handicap, born at 24-25 wk compared with those at 26 wk, were not statistically different (67% versus 80%). Common medical conditions in the first 2 years included respiratory illness, otitis media and gastroenteritis. 13 (37%) children required rehospitalisation for an average of 3 times; total days in hospital averaged 15 d. The most common reason for admission was respiratory illness. At 2 years, 24% were below the 10th centile for weight as were 26% for height; head circumferences were normal.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗