RESUMO
The perinatal mortality rate for Asian babies born in Bradford during the five years 1974-8 was persistently higher than for babies born to United Kingdom mothers. A comparative review of 18 924 British indigenous and 6443 Asian immigrant maternity patients delivered in Bradford from 1974-8 demonstrated several differences between the two ethnic groups. Factors operating in favour of Asian women were fewer teenage mothers, lower rates of illegitimacy, and fewer smokers. On the other hand, a greater number of factors presented increased risks to Asian patients-more women aged over 35, lower social class, higher parity, shorter pregnancy intervals, previous perinatal deaths, shorter duration of antenatal care, anaemia, shorter gestations, more babies born without professional help, and more low-birthweight babies. Local health education programmes are now concentrating on encouraging expectant mothers to attend early and regularly for antenatal care, to breast-feed their babies, and to increase the interval between pregnancies to at least one year.
Assuntos
Mortalidade Infantil , Adolescente , Adulto , Ásia/etnologia , Peso ao Nascer , Inglaterra , Feminino , Humanos , Idade Materna , Pessoa de Meia-Idade , Paridade , Gravidez , Cuidado Pré-Natal , RiscoRESUMO
The patterns of mortality from birth to 1 year in Bradford were studied in the seven year period 1975-81. Large differences in mortality between the Asian and non-Asian population were shown. In 1981 77% of Bradford Asian families were of Pakistani origin, the remaining 23% consisting of families from other parts of the Indian subcontinent and a few from East Africa. There were excess mortality with associated congenital abnormality in the Asian population. From 1975 to 1981 there were 133 deaths associated with congenital abnormality (a rate of 12.4 per 1000 total births) in the Asian population compared with a figure of 129 (4.8 per 1000) in the non-Asian population. The differences between the two groups are shown to be largely independent of social class, and other possible reasons for the discrepancy between the Asian and non-Asian populations are discussed.
Assuntos
Etnicidade , Morte Fetal/epidemiologia , Mortalidade Infantil , Adulto , Ásia/etnologia , Anormalidades Congênitas/epidemiologia , Inglaterra , Feminino , Humanos , Lactente , Recém-Nascido , Idade Materna , Pessoa de Meia-Idade , Paridade , Gravidez , Classe SocialRESUMO
A dedicated cotside microcomputer unit is described. It is designed to collect and to display graphically all continuously recorded variables from an infant in a neonatal intensive care unit. The data are collected from existing monitoring equipment and the graphical displays demonstrate both short and long term trends in data. In addition, the system allows data collected intermittently to be entered on a simple keyboard and to be displayed on plots that are time-correlated with the on-line data displays. A permanent record of the monitoring interval may be generated and the facility for closed-loop control of the partial pressure of arterial oxygen is being developed for integration into the system.
Assuntos
Computadores , Unidades de Terapia Intensiva Neonatal , Microcomputadores , Monitorização Fisiológica/instrumentação , Coleta de Dados/métodos , Humanos , Recém-Nascido , Monitorização Fisiológica/métodos , Sistemas On-Line/instrumentaçãoRESUMO
The effect of posture on gastro-oesophageal reflux was studied by giving 72 orogastric tube feeds to 18 low birthweight babies. Each infant was studied in each of 4 positions: prone, supine, right, and left lateral. Brilliant blue was added to feeds and reflux was determined by staining of a cotton thread opposite the holes in a feeding tube passing from the nose to the distal oesophagus. A comparison of the prone and supine positions showed that significantly less reflux occurred in the prone position.
Assuntos
Nutrição Enteral/métodos , Refluxo Gastroesofágico/prevenção & controle , Doenças do Recém-Nascido/prevenção & controle , Postura , Humanos , Recém-Nascido de Baixo Peso , Recém-NascidoRESUMO
A closed-loop control system has been developed to regulate automatically the partial pressure of arterial oxygen (PaO2) to a pre-set level in neonates with RDS (Respiratory Distress Syndrome). A microcomputer-based system is described which uses the PaO2 value from an indwelling umbilical artery electrode as the input to a robust control algorithm. The derived control signal is used to modify the position of a motor driven oxygen/air blender, thus regulating the percentage of oxygen delivered in the inspired gas mixture. The parameters of the control algorithm were conservatively chosen, and the safety aspects of the system are discussed. A total of 48 h of closed-loop control were recorded on seven pre-term infants with mild-to-moderate RDS being nursed in headboxes. Ten separate closed-loop control intervals were recorded, and overall the results showed a marked improvement over comparable periods of manual control. The percentage of time for which the recorded PaO2 was within +/- 1 kPa of the chosen target value (10 kPa) was 74.9 +/- 10.2% when averaged over the ten closed-loop control periods. The corresponding figure for the comparable manual control intervals was 45.2 +/- 16.0%.
Assuntos
Oxigênio/sangue , Síndrome do Desconforto Respiratório do Recém-Nascido/sangue , Algoritmos , Técnicas Biossensoriais , Oxigenação por Membrana Extracorpórea/instrumentação , Oxigenação por Membrana Extracorpórea/métodos , Humanos , Recém-Nascido , Recém-Nascido Prematuro , Microcomputadores , Monitorização Fisiológica/instrumentação , Monitorização Fisiológica/métodos , Pressão Parcial , Síndrome do Desconforto Respiratório do Recém-Nascido/terapia , Artérias UmbilicaisRESUMO
The effect of feed temperaturae and phototherapy on the rate of stomach emptying was studied in healthy infants during the first week. Emptying rate was measured by the modified serial test meal technique using 10% Dextrose feeds. The results show that emptying rate is independent of feed temperature and is not affected by phototherapy.
Assuntos
Alimentação com Mamadeira , Esvaziamento Gástrico , Recém-Nascido , Fototerapia , Alimentação com Mamadeira/métodos , Esvaziamento Gástrico/efeitos da radiação , Humanos , TemperaturaRESUMO
A preterm baby boy with blood and bone changes of copper deficiency is described. Copper deficiency was suspected after fracture of the left femur during examination of the hip joint. A low serum copper concentration (2.7 mumol/l; 17.2 micrograms/100 ml) and caeruloplasmin (0.04 g/l; 0.004 g/100 ml) confirmed the diagnosis. Despite the introduction of solids at 18 weeks the copper concentration remained low, and treatment with copper sulphate (2.5 mg daily) was started at 6 months. Treatment was stopped at 9 months, when he was both physically and developmentally normal. When given a choline-containing vitamin preparation (Ketovite) he developed a fish odour because of the accumulation of trimethylamine. Withdrawal of this preparation at 6 weeks and substitution with a choline-free preparation (Abidec) was soon followed by disappearance of the odour. It is speculated that prematurity rather than copper deficiency was responsible for the poor activity of liver enzyme, trimethylamine oxidase.
Assuntos
Cobre/deficiência , Fraturas do Fêmur/etiologia , Doenças do Prematuro/metabolismo , Odorantes , Cobre/uso terapêutico , Humanos , Recém-Nascido , Doenças do Prematuro/tratamento farmacológico , Masculino , Metilaminas/metabolismoRESUMO
Evidence is presented that oral theophylline doses of 3 mg per kg per 24 h in premature babies produces plasma levels of theophylline and caffeine of about 5 and 1-2 mg/l respectively in most subjects.
Assuntos
Apneia/tratamento farmacológico , Doenças do Prematuro/tratamento farmacológico , Teofilina/uso terapêutico , Xantinas/sangue , Apneia/sangue , Cafeína/sangue , Humanos , Recém-Nascido , Doenças do Prematuro/sangue , Cinética , Teofilina/sangueRESUMO
A female patient with isovaleric acidaemia had a successful outcome from pregnancy.
Assuntos
Erros Inatos do Metabolismo/complicações , Ácidos Pentanoicos/sangue , Gravidez/fisiologia , Adulto , Amônia/sangue , Índice de Apgar , Consanguinidade , Feminino , Hemiterpenos , Humanos , Recém-Nascido , Masculino , Resultado da GravidezRESUMO
The effectiveness of the use of objective data available at birth to predict and prevent child abuse was assessed in a group of 2802 non-Asian infants born in Bradford in 1979. Two-thirds of the actual abuse occurred in the 18% predicted to be at risk, but supportive measures did not prevent abuse. Those who needed and received the most attention from social workers and health visitors fared worst. Other indices suggested poor parenting in the at-risk families. Child abuse seems to be predictable but prevention is more difficult.
Assuntos
Maus-Tratos Infantis/prevenção & controle , Características da Família , Feminino , Crescimento , Hospitalização , Humanos , Lactente , RiscoRESUMO
Serial changes in plasma levels of calcium, phosphorus, magnesium, alkaline phosphatase, and total proteins have been investigated in 138 healthy, term Caucasian infants. Blood samples were obtained for each infant from cord blood and on day 1 and day 6. The infants were studied in three groups according to whether they were breast fed, received 'Ostermilk No. 1' or 'Cow and Gate V' formulas. Levels of calcium, phosphorus, magnesium, alkaline phosphatase, and total proteins did not differ between the groups at birth or on day 1. By day 6 calcium levels were higher and phosphorus levels lower in the breast-fed infants compared with either of the artificially-fed groups. Phosphorus levels were lower in the V Formula group compared with the Ostermilk group but the mean calcium levels of these two groups did not differ significantly. However, only 2-8% of the V Formula group developed hypocalcaemia compared with 18-2% of the Ostermilk group. The only infant developing clinical tetany belonged to the group fed Ostermilk. Evidence is also given which suggests that those infants with low calcium levels on day 1 who were fed the high-solute milk tended to show a fall in calcium by day 6. This did not apply to the two other groups. It is concluded that the use of adapted cows' milk preparations for infant feeding should lead to a reduction in the incidence of neonatal tetany.
Assuntos
Cálcio/sangue , Fenômenos Fisiológicos da Nutrição do Lactente , Recém-Nascido , Magnésio/sangue , Leite , Fósforo/sangue , Fosfatase Alcalina/sangue , Animais , Proteínas Sanguíneas , Sangue Fetal/análise , Humanos , Doenças do Recém-Nascido/etiologia , Leite Humano , Tetania/etiologiaRESUMO
We report a family with pachydermoperiostosis (idiopathic hypertrophic osteoarthropathy) spanning four generations with 10 affected individuals, four of whom are children although pachydermoperiostosis is rare in childhood. In this family, with intermarriage, the inheritance is autosomal recessive and it is possible that there are individuals who are homozygous for the pachydermoperiostosis gene. These individuals do not appear to be more severely affected, although one of them had a cleft palate and congenital heart defect which may be a manifestation of being homozygous.
Assuntos
Osteoartropatia Hipertrófica Primária/complicações , Asma/complicações , Criança , Pré-Escolar , Fissura Palatina/complicações , Consanguinidade , Permeabilidade do Canal Arterial/complicações , Feminino , Humanos , Masculino , Osteoartropatia Hipertrófica Primária/diagnóstico por imagem , Osteoartropatia Hipertrófica Primária/genética , Linhagem , RadiografiaRESUMO
One-hundred-sixty-five children without known neurological disorder who presented with their first febrile convulsion between the ages of six months and three years were assigned to daily phenobarbitone treatment or to a control group and followed up at a special clinic for six months. One-hundred-and-sixty-one-one children completed the trial, and of the 88 children assigned to phenobarbitone treatment 10 had further convulsions during this period compared with 14 of the 73 control children. Only 49 of those assigned to phenobarbitone took the drug regularly throughout the trial, and four of these had further febrile convulsions, a proportion not significantly different from that in the controls. All four had mean plasma phenobarbitone concentrations over 69 mumol/l (16 mug/ml) during the trial and in three the plasma concentration was at or over this figure within eight hours over 69 mumol/l (16 mug/ml) during the trial and in three the plasma concentration was at or over this figure within eight hours of the repeat convulsion. Regular phenobarbitone does not seem to prevent febrile convulsions. Attention should instead be directed to organising emergency services to allow early termination of fevrile convulsions, whether first or subsequent, to prevent irreversible brain damage.