Johan Smith - Academia.edu (original) (raw)
Papers by Johan Smith
American Journal of Perinatology
n/a
South African medical journal = Suid-Afrikaanse tydskrif vir geneeskunde, 2009
A CS performed for the right indication is in the best interest of the mother and/or baby. Howeve... more A CS performed for the right indication is in the best interest of the mother and/or baby. However, the indications for an elective CS at or near term remain controversial and vary widely. CS on request before 39 weeks’ gestation and/or those performed for physician convenience or after incorrect interpretation of dates are of special interest. These elective CS criteria are unlikely to be in the best interests of the unborn child, mother, or family if performed too early. The interplay between a maternal request based on patient autonomy, (consumer) choice or convenience and physician threshold for choosing it before the due date remains a concern. Our experience is that these ‘reasons’ are rarely accurately recorded in the clinical notes, which often reflect unconvincing medical reason(s) for performing early CS. However, one cannot ignore the trend that an elective CS following a maternal request is regarded as a valid option in some developed countries and is often the major fac...
Neonatology, 2020
In resource-restricted regions, respiratory distress syndrome (RDS) data are often underreported,... more In resource-restricted regions, respiratory distress syndrome (RDS) data are often underreported, making the determination of effective interventions and their outcome difficult. The combination of oxygen, nasal continuous positive airway pressure (CPAP) and surfactant therapy has the potential to prevent 42% of RDS-related deaths in sub-Saharan Africa, despite the financial implications. This article provides a brief overview on the status of RDS management, mainly nasal CPAP and surfactant therapy in very-low-birth-weight infants, in resource-restricted regions of sub-Saharan Africa. Data from the public health sector, as compared to the private health sector, of the Western Cape province, South Africa, are used to illustrate what RDS management strategies are able to accomplish in a resource-restricted region. Upscaling of all components (antenatal care, antenatal corticosteroids, prevention of hypothermia and RDS management strategies) are required to decrease premature infant m...
Cochrane Database of Systematic Reviews, 2017
Owa 2009 Owa JA, Ogunlesi TA. Why we are still doing so many exchange blood transfusion for neona... more Owa 2009 Owa JA, Ogunlesi TA. Why we are still doing so many exchange blood transfusion for neonatal jaundice in Nigeria.
South African medical journal = Suid-Afrikaanse tydskrif vir geneeskunde, 1995
To determine the outcome of babies of mothers with severe rhesus (Rh) incompatibility treated by ... more To determine the outcome of babies of mothers with severe rhesus (Rh) incompatibility treated by elective delivery when the amniotic optical density at 450 nm crossed Whitfield's action line (group 1), by plasmapheresis and immunotherapy (group 2) or by means of intra-uterine intravascular transfusions (group 3). A retrospective study of 55 mothers and their 57 fetuses with severe Rh incompatibility at < 34 weeks' pregnancy duration. Number of mothers in each treatment group, prevalence of intra-uterine death, hydrops, intra-uterine intravascular transfusions, cord haematocrit, cord bilirubin, number of liveborn babies, birth weight, neonatal death, hyaline membrane disease (HMD) and exchange transfusions. All mothers and babies with severe Rh incompatibility (defined as an amniotic optical density of 450 nm in the upper and upper-mid zone on the Liley chart at < 34 weeks' pregnancy duration, previous fetal hydrops or Rh-related intra-uterine death (IUD), fetal hyd...
Journal of Obstetrics and Gynaecology, 2005
SIR:-We are grateful for the opportunity to reply to Dr Rowlands. The purpose of our report was t... more SIR:-We are grateful for the opportunity to reply to Dr Rowlands. The purpose of our report was to highlight some of the difficulties posed by late abortion, and to illustrate the serious paediatric problems faced by one infant after failed late abortion. This child has significant ongoing medical problems. Our information regarding the procedures and drugs used was derived from the documentation sent to us by the clinic. The infant's mother was clear in her belief that her child was thought to have died; if she misunderstood the information given, this would indeed suggest a failure of crisis counselling. Long-term survival after failed late mid-trimester abortion must be exceptional, yet there is an urgent need for data pertaining to even short-term survival. If this correspondence achieves an increased awareness of the real difficulties facing parents and professionals, and even occasionally infants, it will represent a starting point from which an improved system can be developed.
South African journal of …, 2006
We seek to develop a safe and cheap synthetic lung surfactant as a substitute for expensive, mamm... more We seek to develop a safe and cheap synthetic lung surfactant as a substitute for expensive, mammalian-derived products. The post-instillation physiological effects of three synthetic surfactant preparations in three treatment groups of adult New Zealand white rabbits, on gas ...
Journal of Respiratory Diseases and Medicine, 2020
The coronavirus 2 (SARS-CoV-2) has resulted in an international pandemic. The SARS-CoV-2 affects ... more The coronavirus 2 (SARS-CoV-2) has resulted in an international pandemic. The SARS-CoV-2 affects cardiovascular, digestive and urogenital systems. In an attempt to develop a multimodal and targeted approach to the pathophysiology associated with viral lung injury, we reviewed lung histopathology, inflammation, surfactant biology and pathophysiology related to viral associated acute lung injury (ALI / ARDS). Histopathology of viral pneumonia/ARDS cases of the past 100 years has revealed that lung parenchymal and vascular pathologic changes described in the 1918 influenza pandemic, are no different from the histopathology observed in other viral pandemics. Given the inflammatory storm which can occur in COVID-19 infection, the patient is a candidate to develop the classic multi-organ dysfunction and / or failure (MOD/F) which may well include ALI and ARDS. Because there is a well described temporal change in the pathophysiology associated with ALI /ARDS, a "one size fit al" remedy will not suffice, hence our attempt at a targeted functional approach. For instance, variable results in adults treated with surfactant have relegated the use of surfactant in adult ARDS to an uncertainty. We speculate that early and repeated surfactant installation in adults is required in adults. Surfactant may also have beneficial effects on the inflammatory process in the ARDS lung. The increased clotting tendency associated with the inflammation (and ARDS), particularly the effect on the lung vasculature (acute pulmonary hypertension and increased dead space), causes mechanical pressure overload (and failure) of the right ventricle and mechanical respiratory failure. Active management of these should include inhibition of the accelerated coagulation and thrombolysis (via nebulization) and early inotropic support.
South African Journal of Child Health, Jun 25, 2019
This open-access article is distributed under Creative Commons licence CC-BY-NC 4.0.
Journal of Obstetrics and Gynaecology, 2005
Journal of Medical Case Reports, 2021
Background The Cushing reflex does not appear to have been described in preterm neonates. This ca... more Background The Cushing reflex does not appear to have been described in preterm neonates. This case report shows the presence of an active Cushing reflex in a 32-week preterm neonate with hyaline membrane disease. Case presentation The 1.94 kg Caucasian infant was delivered by caesarean section following concerns about possible maternal infection and fetal compromise. Chest X-ray showed mild-to-moderate hyaline membrane disease and treatment was initiated with supplemental oxygen and nasal continuous positive airway pressure. It is probable that a pneumothorax occurred at 5–6 hours of age, with progression during the day. Interstitial air, pneumomediastinum, and tension pneumothorax were diagnosed on subsequent X-ray, and ultrasound of the brain showed a grade IV intraventricular hemorrhage. A review of the nurses’ recordings of heart rate, blood pressure, and respiratory rate showed a progressive increase in blood pressure accompanied by slowing of the heart rate and irregular resp...
Venous access is an essential part of caring for the sick neonate. The primary problem with cathe... more Venous access is an essential part of caring for the sick neonate. The primary problem with catheters, whether peripherally or centrally placed, is the difficulty in maintaining them, the development of phlebitis and systemic infection, and fluid extravasation. A lesser known complication is the development of venous air embolism (VAE), as described in the 4 cases presented. We agree with others that VAE in newborn infants may occur more frequently than expected and emphasise the fact that it is preventable and that careful attention must be given to the techniques of preparing venous infusions. As health professionals (medical and nursing) we should take a harder line and regard these events as medically negligent until proven otherwise. We should take full responsibility for equipment, the connections, the infusate and the monitoring thereof. Unfortunately, the prognosis for this condition remains poor and it is unclear whether an increased awareness of this condition would influe...
Evaluation of a novel surfactant (1,2-dipalmitoyl-sn-phosphatidylcholine and trehalose [C12H220nD... more Evaluation of a novel surfactant (1,2-dipalmitoyl-sn-phosphatidylcholine and trehalose [C12H220nD and comparison with other synthetic formulations
South African Journal of Child Health, 2007
Objective . To compare whether early measurement of blood gases and/or dynamic compliance of the ... more Objective . To compare whether early measurement of blood gases and/or dynamic compliance of the respiratory system (CRS dyn ) predicts outcome in high-risk infants with unilateral congenital diaphragmatic hernia (CDH). Patients and methods. A retrospective study was performed at Tygerberg Children’s Hospital between January 1992 and August 2001. High-risk infants with unilateral CDH, who presented with respiratory distress within 6 hours of birth, were included. Patients with other lethal congenital abnormalities were excluded. The first arterial blood gas value after endotracheal intubation was documented and the arterial-alveolar oxygen tension (a:A) ratio was calculated. CRS dyn was measured within 24 hours of birth. The ability of these measurements to predict outcome (survival or death during the newborn period) was determined. Results . Seventeen of 40 infants with CDH were categorised as high risk and included in the study. Eight of them (47%) survived the neonatal period. T...
Journal of tropical pediatrics, 2020
AIM To determine the growth and prevalence of extrauterine growth restriction (EUGR) in extremely... more AIM To determine the growth and prevalence of extrauterine growth restriction (EUGR) in extremely low birth weight (ELBW) infants receiving enteral-only nutrition in a resource-restricted (RR) environment. METHODS Information on nutritional intake, provided largely from fortified breastmilk, was collected retrospectively for 72 ELBW (<1000 g) infants admitted to Tygerberg Hospital, Cape Town, South Africa over a 1 year period. Anthropometric data for the first 49 postnatal days were compared to gender-specific INTERGROWTH-21st standards. RESULTS Full enteral feeds (150 ml/kg) were reached by Day 10-14 with energy >100 Kcal/kg/day from Day 10, and protein >3.5 mg/kg/day from Day 14, onwards. Growth velocity remained below 15 g/kg/day at Day 49. INTERGROWTH-21st Z-scores decreased from -0.8 ± 1.1 at birth to -2.4 ± 1.5 at Day 49. Adequate weight growth velocity (≥15 g/kg/day) was associated with maternal hypertension, completed antenatal steroids, caesarean section delivery a...
Journal of Clinical Monitoring and Computing, 2021
Bioreactance (BR) is a novel, non-invasive technology that is able to provide minute-to-minute mo... more Bioreactance (BR) is a novel, non-invasive technology that is able to provide minute-to-minute monitoring of cardiac output and additional haemodynamic variables. This study aimed to determine the values for BR-derived haemodynamic variables in stable preterm neonates during the transitional period. A prospective observational study was performed in a group of stable preterm (< 37 weeks) infants in the neonatal service of Tygerberg Children’s Hospital, Cape Town, South Africa. All infants underwent continuous bioreactance (BR) monitoring until 72 h of life. Sixty three preterm infants with a mean gestational age of 31 weeks and mean birth weight of 1563 g were enrolled. Summary data and time series graphs were drawn for BR-derived heart rate, non-invasive blood pressure, stroke volume, cardiac output and total peripheral resistance index. All haemodynamic parameters were significantly associated with postnatal age, after correction for clinical variables (gestational age, birth weight, respiratory support mode). To our knowledge, this is the first paper to present longitudinal BR-derived haemodynamic variable data in a cohort of stable preterm infants, not requiring invasive ventilation or inotropic support, during the first 72 h of life. Bioreactance-derived haemodynamic monitoring is non-invasive and offers the ability to simultaneously monitor numerous haemodynamic parameters of global systemic blood flow. Moreover, it may provide insight into transitional physiology and its pathophysiology.
Pediatric Radiology, 2004
European Journal of Pediatrics, 1996
The aim of this prospective study was to determine the incidence of bronchopulmonary dysplasia (B... more The aim of this prospective study was to determine the incidence of bronchopulmonary dysplasia (BPD) in and the outcome of neonates ventilated for respiratory distress syndrome (RDS). The study was conducted in a developing country prior to the use of surfactant replacement therapy and the results are compared to published reports from the developed world. BPD was defined as oxygen dependency beyond day 28 of life. The incidence of BPD over a 9-month-period was 8.2% of all neonates requiring ventilation (n = 169) and 41% (n = 38) of neonates ventilated for RDS (n = 92). Of those neonates who developed BPD, 26% were still being ventilated on day 28. Of the infants, 21 (55%) developed type 1 BPD and 17 (45%) type 2 BPD. There was no statistical difference in the severity of lung disease on any of the study days between type 1 and type 2 BPD although neonates with type 2 BPD required assisted ventilation and supplemental oxygen for a longer period: 30 versus 12 days and 95 versus 49 days, respectively. Of those neonates who developed BPD, 8 (21%) died prior to discharge from hospital and a further 5 infants (17%) died subsequent to discharge. Of the latter five, three died from treatable causes (gastro-enteritis n = 2, pneumonia n = 1). Of the 25 (83%) children seen at follow up, 68% were developing normally, 20% were classified as having suspect development and 12% had developed cerebral palsy at corrected postnatal ages of 12-24 months. None of the results differed significantly from those of neonates being ventilated in the developed world, except for the causes of post-discharge deaths.
BJOG: An International Journal of Obstetrics and Gynaecology, 2000
American Journal of Perinatology
n/a
South African medical journal = Suid-Afrikaanse tydskrif vir geneeskunde, 2009
A CS performed for the right indication is in the best interest of the mother and/or baby. Howeve... more A CS performed for the right indication is in the best interest of the mother and/or baby. However, the indications for an elective CS at or near term remain controversial and vary widely. CS on request before 39 weeks’ gestation and/or those performed for physician convenience or after incorrect interpretation of dates are of special interest. These elective CS criteria are unlikely to be in the best interests of the unborn child, mother, or family if performed too early. The interplay between a maternal request based on patient autonomy, (consumer) choice or convenience and physician threshold for choosing it before the due date remains a concern. Our experience is that these ‘reasons’ are rarely accurately recorded in the clinical notes, which often reflect unconvincing medical reason(s) for performing early CS. However, one cannot ignore the trend that an elective CS following a maternal request is regarded as a valid option in some developed countries and is often the major fac...
Neonatology, 2020
In resource-restricted regions, respiratory distress syndrome (RDS) data are often underreported,... more In resource-restricted regions, respiratory distress syndrome (RDS) data are often underreported, making the determination of effective interventions and their outcome difficult. The combination of oxygen, nasal continuous positive airway pressure (CPAP) and surfactant therapy has the potential to prevent 42% of RDS-related deaths in sub-Saharan Africa, despite the financial implications. This article provides a brief overview on the status of RDS management, mainly nasal CPAP and surfactant therapy in very-low-birth-weight infants, in resource-restricted regions of sub-Saharan Africa. Data from the public health sector, as compared to the private health sector, of the Western Cape province, South Africa, are used to illustrate what RDS management strategies are able to accomplish in a resource-restricted region. Upscaling of all components (antenatal care, antenatal corticosteroids, prevention of hypothermia and RDS management strategies) are required to decrease premature infant m...
Cochrane Database of Systematic Reviews, 2017
Owa 2009 Owa JA, Ogunlesi TA. Why we are still doing so many exchange blood transfusion for neona... more Owa 2009 Owa JA, Ogunlesi TA. Why we are still doing so many exchange blood transfusion for neonatal jaundice in Nigeria.
South African medical journal = Suid-Afrikaanse tydskrif vir geneeskunde, 1995
To determine the outcome of babies of mothers with severe rhesus (Rh) incompatibility treated by ... more To determine the outcome of babies of mothers with severe rhesus (Rh) incompatibility treated by elective delivery when the amniotic optical density at 450 nm crossed Whitfield's action line (group 1), by plasmapheresis and immunotherapy (group 2) or by means of intra-uterine intravascular transfusions (group 3). A retrospective study of 55 mothers and their 57 fetuses with severe Rh incompatibility at < 34 weeks' pregnancy duration. Number of mothers in each treatment group, prevalence of intra-uterine death, hydrops, intra-uterine intravascular transfusions, cord haematocrit, cord bilirubin, number of liveborn babies, birth weight, neonatal death, hyaline membrane disease (HMD) and exchange transfusions. All mothers and babies with severe Rh incompatibility (defined as an amniotic optical density of 450 nm in the upper and upper-mid zone on the Liley chart at < 34 weeks' pregnancy duration, previous fetal hydrops or Rh-related intra-uterine death (IUD), fetal hyd...
Journal of Obstetrics and Gynaecology, 2005
SIR:-We are grateful for the opportunity to reply to Dr Rowlands. The purpose of our report was t... more SIR:-We are grateful for the opportunity to reply to Dr Rowlands. The purpose of our report was to highlight some of the difficulties posed by late abortion, and to illustrate the serious paediatric problems faced by one infant after failed late abortion. This child has significant ongoing medical problems. Our information regarding the procedures and drugs used was derived from the documentation sent to us by the clinic. The infant's mother was clear in her belief that her child was thought to have died; if she misunderstood the information given, this would indeed suggest a failure of crisis counselling. Long-term survival after failed late mid-trimester abortion must be exceptional, yet there is an urgent need for data pertaining to even short-term survival. If this correspondence achieves an increased awareness of the real difficulties facing parents and professionals, and even occasionally infants, it will represent a starting point from which an improved system can be developed.
South African journal of …, 2006
We seek to develop a safe and cheap synthetic lung surfactant as a substitute for expensive, mamm... more We seek to develop a safe and cheap synthetic lung surfactant as a substitute for expensive, mammalian-derived products. The post-instillation physiological effects of three synthetic surfactant preparations in three treatment groups of adult New Zealand white rabbits, on gas ...
Journal of Respiratory Diseases and Medicine, 2020
The coronavirus 2 (SARS-CoV-2) has resulted in an international pandemic. The SARS-CoV-2 affects ... more The coronavirus 2 (SARS-CoV-2) has resulted in an international pandemic. The SARS-CoV-2 affects cardiovascular, digestive and urogenital systems. In an attempt to develop a multimodal and targeted approach to the pathophysiology associated with viral lung injury, we reviewed lung histopathology, inflammation, surfactant biology and pathophysiology related to viral associated acute lung injury (ALI / ARDS). Histopathology of viral pneumonia/ARDS cases of the past 100 years has revealed that lung parenchymal and vascular pathologic changes described in the 1918 influenza pandemic, are no different from the histopathology observed in other viral pandemics. Given the inflammatory storm which can occur in COVID-19 infection, the patient is a candidate to develop the classic multi-organ dysfunction and / or failure (MOD/F) which may well include ALI and ARDS. Because there is a well described temporal change in the pathophysiology associated with ALI /ARDS, a "one size fit al" remedy will not suffice, hence our attempt at a targeted functional approach. For instance, variable results in adults treated with surfactant have relegated the use of surfactant in adult ARDS to an uncertainty. We speculate that early and repeated surfactant installation in adults is required in adults. Surfactant may also have beneficial effects on the inflammatory process in the ARDS lung. The increased clotting tendency associated with the inflammation (and ARDS), particularly the effect on the lung vasculature (acute pulmonary hypertension and increased dead space), causes mechanical pressure overload (and failure) of the right ventricle and mechanical respiratory failure. Active management of these should include inhibition of the accelerated coagulation and thrombolysis (via nebulization) and early inotropic support.
South African Journal of Child Health, Jun 25, 2019
This open-access article is distributed under Creative Commons licence CC-BY-NC 4.0.
Journal of Obstetrics and Gynaecology, 2005
Journal of Medical Case Reports, 2021
Background The Cushing reflex does not appear to have been described in preterm neonates. This ca... more Background The Cushing reflex does not appear to have been described in preterm neonates. This case report shows the presence of an active Cushing reflex in a 32-week preterm neonate with hyaline membrane disease. Case presentation The 1.94 kg Caucasian infant was delivered by caesarean section following concerns about possible maternal infection and fetal compromise. Chest X-ray showed mild-to-moderate hyaline membrane disease and treatment was initiated with supplemental oxygen and nasal continuous positive airway pressure. It is probable that a pneumothorax occurred at 5–6 hours of age, with progression during the day. Interstitial air, pneumomediastinum, and tension pneumothorax were diagnosed on subsequent X-ray, and ultrasound of the brain showed a grade IV intraventricular hemorrhage. A review of the nurses’ recordings of heart rate, blood pressure, and respiratory rate showed a progressive increase in blood pressure accompanied by slowing of the heart rate and irregular resp...
Venous access is an essential part of caring for the sick neonate. The primary problem with cathe... more Venous access is an essential part of caring for the sick neonate. The primary problem with catheters, whether peripherally or centrally placed, is the difficulty in maintaining them, the development of phlebitis and systemic infection, and fluid extravasation. A lesser known complication is the development of venous air embolism (VAE), as described in the 4 cases presented. We agree with others that VAE in newborn infants may occur more frequently than expected and emphasise the fact that it is preventable and that careful attention must be given to the techniques of preparing venous infusions. As health professionals (medical and nursing) we should take a harder line and regard these events as medically negligent until proven otherwise. We should take full responsibility for equipment, the connections, the infusate and the monitoring thereof. Unfortunately, the prognosis for this condition remains poor and it is unclear whether an increased awareness of this condition would influe...
Evaluation of a novel surfactant (1,2-dipalmitoyl-sn-phosphatidylcholine and trehalose [C12H220nD... more Evaluation of a novel surfactant (1,2-dipalmitoyl-sn-phosphatidylcholine and trehalose [C12H220nD and comparison with other synthetic formulations
South African Journal of Child Health, 2007
Objective . To compare whether early measurement of blood gases and/or dynamic compliance of the ... more Objective . To compare whether early measurement of blood gases and/or dynamic compliance of the respiratory system (CRS dyn ) predicts outcome in high-risk infants with unilateral congenital diaphragmatic hernia (CDH). Patients and methods. A retrospective study was performed at Tygerberg Children’s Hospital between January 1992 and August 2001. High-risk infants with unilateral CDH, who presented with respiratory distress within 6 hours of birth, were included. Patients with other lethal congenital abnormalities were excluded. The first arterial blood gas value after endotracheal intubation was documented and the arterial-alveolar oxygen tension (a:A) ratio was calculated. CRS dyn was measured within 24 hours of birth. The ability of these measurements to predict outcome (survival or death during the newborn period) was determined. Results . Seventeen of 40 infants with CDH were categorised as high risk and included in the study. Eight of them (47%) survived the neonatal period. T...
Journal of tropical pediatrics, 2020
AIM To determine the growth and prevalence of extrauterine growth restriction (EUGR) in extremely... more AIM To determine the growth and prevalence of extrauterine growth restriction (EUGR) in extremely low birth weight (ELBW) infants receiving enteral-only nutrition in a resource-restricted (RR) environment. METHODS Information on nutritional intake, provided largely from fortified breastmilk, was collected retrospectively for 72 ELBW (<1000 g) infants admitted to Tygerberg Hospital, Cape Town, South Africa over a 1 year period. Anthropometric data for the first 49 postnatal days were compared to gender-specific INTERGROWTH-21st standards. RESULTS Full enteral feeds (150 ml/kg) were reached by Day 10-14 with energy >100 Kcal/kg/day from Day 10, and protein >3.5 mg/kg/day from Day 14, onwards. Growth velocity remained below 15 g/kg/day at Day 49. INTERGROWTH-21st Z-scores decreased from -0.8 ± 1.1 at birth to -2.4 ± 1.5 at Day 49. Adequate weight growth velocity (≥15 g/kg/day) was associated with maternal hypertension, completed antenatal steroids, caesarean section delivery a...
Journal of Clinical Monitoring and Computing, 2021
Bioreactance (BR) is a novel, non-invasive technology that is able to provide minute-to-minute mo... more Bioreactance (BR) is a novel, non-invasive technology that is able to provide minute-to-minute monitoring of cardiac output and additional haemodynamic variables. This study aimed to determine the values for BR-derived haemodynamic variables in stable preterm neonates during the transitional period. A prospective observational study was performed in a group of stable preterm (< 37 weeks) infants in the neonatal service of Tygerberg Children’s Hospital, Cape Town, South Africa. All infants underwent continuous bioreactance (BR) monitoring until 72 h of life. Sixty three preterm infants with a mean gestational age of 31 weeks and mean birth weight of 1563 g were enrolled. Summary data and time series graphs were drawn for BR-derived heart rate, non-invasive blood pressure, stroke volume, cardiac output and total peripheral resistance index. All haemodynamic parameters were significantly associated with postnatal age, after correction for clinical variables (gestational age, birth weight, respiratory support mode). To our knowledge, this is the first paper to present longitudinal BR-derived haemodynamic variable data in a cohort of stable preterm infants, not requiring invasive ventilation or inotropic support, during the first 72 h of life. Bioreactance-derived haemodynamic monitoring is non-invasive and offers the ability to simultaneously monitor numerous haemodynamic parameters of global systemic blood flow. Moreover, it may provide insight into transitional physiology and its pathophysiology.
Pediatric Radiology, 2004
European Journal of Pediatrics, 1996
The aim of this prospective study was to determine the incidence of bronchopulmonary dysplasia (B... more The aim of this prospective study was to determine the incidence of bronchopulmonary dysplasia (BPD) in and the outcome of neonates ventilated for respiratory distress syndrome (RDS). The study was conducted in a developing country prior to the use of surfactant replacement therapy and the results are compared to published reports from the developed world. BPD was defined as oxygen dependency beyond day 28 of life. The incidence of BPD over a 9-month-period was 8.2% of all neonates requiring ventilation (n = 169) and 41% (n = 38) of neonates ventilated for RDS (n = 92). Of those neonates who developed BPD, 26% were still being ventilated on day 28. Of the infants, 21 (55%) developed type 1 BPD and 17 (45%) type 2 BPD. There was no statistical difference in the severity of lung disease on any of the study days between type 1 and type 2 BPD although neonates with type 2 BPD required assisted ventilation and supplemental oxygen for a longer period: 30 versus 12 days and 95 versus 49 days, respectively. Of those neonates who developed BPD, 8 (21%) died prior to discharge from hospital and a further 5 infants (17%) died subsequent to discharge. Of the latter five, three died from treatable causes (gastro-enteritis n = 2, pneumonia n = 1). Of the 25 (83%) children seen at follow up, 68% were developing normally, 20% were classified as having suspect development and 12% had developed cerebral palsy at corrected postnatal ages of 12-24 months. None of the results differed significantly from those of neonates being ventilated in the developed world, except for the causes of post-discharge deaths.
BJOG: An International Journal of Obstetrics and Gynaecology, 2000