Front Cover

Neonatal Physiological Measurements

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Table of Contents

Part 1: Newborn General

Chapter 1. The influence of Vernix caseosa on watertransport through semipermeable membranesand the skin of full-term infants

Introduction

Methods

Results

Discussion and conclusion

References

Chapter 2. Small size zero-heat-flux probe for neonatalbody temperature monitoring

Introduction

Method

Results

Discussion

References

Chapter 3. Temperature variability of very low birthweightinfants nursed in infant servo controlledincubators

Introduction

Patients and methods

Results

Discussion

Acknowledgements

References

Chapter 4. Clicks and clunks in congenital dislocation ofthe hip

Introduction

Present methods of screening

'Clicks' and 'clunks'

A new screening technique

Pilot study

Belfast hip screener

Discussion

References

Chapter 5. A comparison of direct arterial pressure andnon-invasive arterial pressure measurement byoscillometry in preterm infants

Introduction

Methods

Results

Discussion

Acknowledgements

References

Chapter 6. Doppler blood velocity measurements in thegreat vessels of newborn infants

Introduction

Methods

Results

Discussion

Acknowledgements

References

Chapter 7. The use of a computer-linked monitoringsystem for the continuous collection ofphysiological and environmental data fromneonates undergoing intensive care

Introduction

The system

Real time data collection

During monitoring

Option list

Off-line data presentation

Conclusion

Acknowledgements

References

Chapter 8. The use of a microcomputer for on-line analysisof heart rate variability in newborn infants

Introduction

Methods and materials

Results

Prediction of clinical course and outcome

On-line calculation of HRV parameters

Results

Conclusion

Acknowledgements

References

Chapter 9. Screening for tetrahydrobiopterin deficiencyDeficiency of tetrahydrobiopterin (BH4), an essential cofactor for the formation ofthe neurotransmitters, dopamine, noradrenaline and serotonin, is a rare metabolicdisorder in the neonate. Children with gross BH4 deficiency in the CNS are unableto form these neurotransmitters and are severely mentally retarded. Most are unableto convert phenylalanine to tyrosine because BH4 is also the coenzyme for thisreaction and are first detected as having hyperphenylalaninaemia, frequently withphenylalanine levels in excess of 240 ìðé/l. These children do not respond clinicallyto the low phenylalanine diet successfully used to treat the hyperphenylalaninaemiaand mental retardation arising from the muc

Screening for tetrahydrobiopterin deficiency

Screening for non-hyperphenylalaninaemic variants

Timing of appearance of BH4 synthesis activity in the fetus

Conclusion

References

Chapter 10. Design of glucose analysis suitable forincorporation into a microprocessor controlledregulator of blood glucose in the newborn

Introduction

Materials and methods

L-DCF/GOD/POD premix

Results and discussion

Acknowledgements

References

Chapter 11. Non-invasive blood pressure measurement inthe neonate

Introduction

Materials and Methods

Results

Blood pressure variability

Discussion

Acknowledgements

References

Part 2: Cerebral Haemodynamics

Chapter 12. Positron emission tomography in the newborn:regional CBF in the preterm infant withintraventricular haemorrhage andhaemorrhagic intracerebral involvement and inthe asphyxiated term infant

Introduction

Methods

Results

Discussion

References

Chapter 13. The effects of interruption to the cranial venousdrainage on cerebral haemodynamics in thenewborn infant

Introduction

Methods

Results and Discussion

Summary

Acknowledgements

References

Chapter 14. The interpretation of cerebral Dopplerultrasound signals in the newborn

Introduction

Duplex Doppler Scanning

Frequency Spectrum Analysis

Volume Flow, Waveform Analysis and Vascular Impedance

Indices of Pulsatility

Factors Influencing Doppler Waveform Shape

Anterior Cerebral Artery Waveform in Newborn Infants

Estimating CVI from the Doppler Waveform

Conclusion

References

Chapter 15. IntroductionCerebral blood flow velocity (CBFV) as measured by Doppler ultrasound has beenput forward as a useful technique for assessing the neonatal cerebral circulation(1,20). In addition to the advantages of its non-invasiveness, its portability, ease ofapplication, and ability to provide immediate and continuous information, recentreports demonstrate positive agreement with direct measurement of cerebral bloodflow. In studies using dogs (2) and piglets (5), specific parameters of ultrasound wavevelocity have correlated with cerebral blood flow. Most recently, correlation ofultrasound determination has been reported with xenon clearance in the humannewborn (4).Several clinical factors have been reported to alter Doppler CBFV in

Introduction

Materials and Methods

Results

Discussion

Acknowledgements

References

Chapter 16. The effect of some physiological variables onthe Doppler ultrasound waveforms in cerebralvessels of healthy newborn infants

Introduction

Preliminary study

Main study

Results

Discussion

Conclusion

References

Chapter 17. IntroductionIntraventricular haemorrhage (IVH) continues to be a major cause of mortality andmorbidity in preterm infants (25). With the advent of computerized tomography andreal-time ultrasound it is realized that this condition occurs much more frequentlythan was previously appreciated and that it is present in approximately one third ofpreterm infants less than or equal to 34 weeks' gestation (10,13). However, thepathogenesis of IVH is not clearly understood, though it is generally considered inmost cases to be related to an increase in blood flow to the subependymal germinalmatrix of the lateral ventricles resulting in rupture of the blood vessels (17). Relativelylittle is known about cerebral blood flow in the newborn period (

Introduction

Patients and Methods

Results

Discussion

Acknowledgements

References

Chapter 18. Cerebral haemodynamics in the humannewborn studied by electrical impedance -methodology

Introduction

Principles of electrical impedance measurement

Methodology

Signal processing

Current developments

Acknowledgements

References

Chapter 19. Low CBF in the preterm neonate

Introduction

Methods and materials

Results

Discussion

References

Chapter 20. Cerebral haemodynamics in the humannewborn studied by an electrical impedancemethod: clinical considerations

Introduction

The development of the method

Clinical evaluation

The effect of endotracheal tube suction

The effect of apnoea

Variability of the impedance signal

Method

Results

Discussion

Conclusion

Acknowledgements

References

Chapter 21. Perinatal cerebral ischaemia and cognitivedysfunctions in childhood

Introduction

Patients and methods

Summary of results of one-year follow-up

Evaluation at four years of age

Results

Discussions and conclusions

References

Chapter 22. Towards non-invasive monitoring of cerebral metabolism

Introduction

Current Instrumentation

Respiration and oxygen

Cytochromes, redox state and spectrophotometry

Non-invasive monitoring of cerebral metabolism

Redox state and intracellular oxygen sufficiency

Instrumentation

Conclusion

Acknowledgements

References

Chapter 23. Ultrasound appearance of the brain in verypreterm infants and probability ofneurodevelopmental disorders at 18 months ofage

Introduction

Infants studied and methods

Results

Discussion

Conclusions

Acknowledgement

References

Chapter 24. Can ultrasound predict developmental outcomeof infants with grade III and grade IVintraventricular haemorrhage

Introduction

Methods

Results

Discussion

References and further reading

Chapter 25. An evaluation of fontanelle pressure measurements

Introduction

The artificial head

Experimental technique

Experimental results

Application to live babies

Conclusion

Acknowledgements

References

Chapter 26. Direct measurement of intracranial pressure inthe newborn

Introduction

Methods

Results

Discussion

References

Chapter 27. Measurement of cerebral ventricular areas inthe newborn - a more sensitive technique forthe diagnosis of early hydrocephalus

Introduction

Method

Results

Conclusions

References

Chapter 28. Prediction of brainstem auditory evoked potentials in very preterm infants of hearing status at 1 year of age (Abstract)

Acknowledgements

References

Part 3. Blood Gas

Chapter 29. Skin surface gas partial pressures and transcutaneous blood gas analysis

Introduction

Oxygen balance equations - the importance of blood flow

Venous and skin surface 0 2 values

Circulatory hyperbola for C 0 2

The capillary loop model

Peripheral vascular resistance

Factors affecting relationship

Linear relation between tcPC(>2 and PaC02

The value of tcP02 and tcPC02 in shock

Conclusion

References

Chapter 30. The development of a disposable skin surfaceoxygen transducer

Introduction

Fabrication techniques

In vitro tests on the metallized membrane

The transducer body construction

In vivo test procedures

Results

Discussion

Acknowledgements

References

Chapter 31. IntroductionThe monitoring of gases using membrane covered electrochemical sensors has generallyinvolved steady state measurements at a polarization voltage, chosen withinthe diffusion controlled region of the reduction wave for the gas concerned, such thatthe device is gas selective, providing the reduction potential is exclusive to the onegas. The method will, however, involve consumption of the species undergoingmeasurement, which may lead to a significant depletion in the total gas concentrationin measurements where low concentrations are involved.The application of a step change in electrode polarizing voltage, to the reductionpotential of an electroactive species in solution, causes the total reduction of thatspecies immediat

Introduction

Investigation of non-faradaic error

Instrumental data

Acknowledgements

References

Chapter 32. Transcutaneous oxygen and carbon dioxide monitoring in sick neonates using a single combined sensor

Introduction

Material and Method

Results

Discussion

Acknowledgements

References

Chapter 33. Tthe effect of carbonic anhydrase inhibition on he tcPC02

Introduction

Method

Conclusion

Acknowledgement

References

Chapter 34. Percutaneous monitoring of tissue pH with apolymer membrane ñ H transducer

Introduction

Material and methods

Results

Discussion

References

Chapter 35. Tissue pH monitoring in critically ill neonates:experience with a disposable wire electrode

Introduction

Materials and Methods

Results

Discussion

Acknowledgements

References

Chapter 36. A microcomputer based monitoring system forthe measurement of transcutaneous oxygentension

General Description

The sub-programs

Evaluation program

Reference

Part 4: Respiratory

Chapter 37. Lung compliance measurements inconvalescent and sick intubated infants

Background

Methods

Results

Discussion

References

Chapter 38. Reliability of dynamic and static compliance measurement in preterm babies

Introduction

Methods

Results

Discussion

References

Chapter 39. Is the measurement of compliance useful forclinical management in preterm infants?

Introduction

Methods

Statistical Analysis

Results

Discussion

References

Chapter 40. Single breath lung mechanics duringmechanical ventilation of very low birthweightinfants

Introduction

Theory of method

Subjects and methods

Results

Discussion

Acknowledgements

References

Chapter 41. Lung volumes in full-term neonates during active and quiet sleep

Introduction

Methods and Patients

Results

Discussion

References

Chapter 42. A simple method to determine functionalresidual capacity in the newborn by N2 washout

Introduction

Method

Results

Discussion

Acknowledgements

References

Chapter 43. Clinical use of a microcomputer-assistedsystem for measuring transcutaneous oxygentension in infants with bronchopulmonarydysplasia and lung hypoplasia

Introduction

Patients and methods

Results

Discussion

References

Chapter 44. Cardiorespirography in differential diagnosisof neonatal apnoea

Introduction

Methodology

Results

Discussion

Conclusions

References

Chapter 45. Computer-assisted evaluation of respiration innewborns and infants during sleep

Introduction

Measuring transducer

Setup for data acquisition and evaluation

Results

Conclusions

References

Chapter 46. The synchronometer: a prototype device tomeasure infant/respirator synchrony

Introduction

Reasoning and methods

Discussion

References

Chapter 47. Continuous recording and analysis ofcardiorespiratory variables in ill preterminfants

Introduction

Objectives

Methods

Graphical analyses

Discussion and conclusion

Acknowledgement

References

Chapter 48. Cord blood hormonal relationship of thyroidand Cortisol

Introduction

Methods and materials

Results

Discussion

Conclusions

References

Chapter 49. Pathogenesis of pneumothorax in mechanicallyventilated newborn infants: a theoretical model

Introduction

Requirements of a theoretical model

A theoretical model for the pathogenesis of pneumothorax

Is active expiration a form of inflation reflex?

Bio-engineering implications

Clinical implications

Acknowledgements

References

Part 5: Sudden Infant Death Syndrome

Chapter 50. Investigations of respiratory control in infantsto assess possible risk for SIDS

Introduction

Subjects and methods

Results

Discussion

Acknowledgements

References

Chapter 51. Comparative analysis of pneumograms andventilatory response to carbon dioxide ininfantile apnoea

Introduction

Methods

Results

References

CHapter 52. Pneumocardiography in high risk newborns:experience and reason

Introduction

Patients and methods

Method

Results

Discussion

Acknowledgements

References

Part 6: Nuclear Magnetic Resonance

Chapter 53. NMR proton relaxation times in the study ofthe neonate

Introduction

Methods

Results

Discussion

Acknowledgements

References

Chapter 54. Tissue localization in surface coil nuclearmagnetic resonance (NMR) spectroscopy

Introduction

Methods of localization

Sensitivity of surface coil with a single-pulse sequence

Estimation of flip angle at the coil centre

Case study - 3 Ø neonatal brain spectra

Discussion

Conclusion

References

Chapter 55. Estimation of cerebral intracellular pH by 3 Øand ¹ nuclear magnetic resonancespectroscopy

Introduction

Methods

Results

Discussion

References

Chapter 56. Cerebral metabolism in newborn infants studiedby phosphorus nuclear magnetic resonancespectroscopy

Introduction

Patients and methods

Results and discussion

Conclusions

Acknowledgements

References

Chapter 57. Nuclear magnetic resonance imaging in theclinical evaluation of neurological problems ofthe newborn and their subsequent evolution

Introduction

Method and materials

Results

Discussion

Acknowledgements

References

Chapter 58. Visual evoked responses to LEDphotostimulation in newborn infants

Introduction

Subjects and methods

Results

Discussion

Acknowledgements

References

Chapter 59. A transport and life support system for newborninfants during NMR spectroscopy

Introduction

NMR transport incubator requirements

Prototype transport system description

The specialized NMR transport incubator

Discussion and conclusions

Acknowledgements

References

Part 7. Developing Countries

Chapter 60. The water-filled heated mattress. An alternativeto incubator care in developed and developingcountries?

Introduction

The technical principles and physical properties of the heated mattress

Physical properties of the heated bed

Preliminary clinical results

Discussion

References

Chapter 61. The design and manufacture of perinatalequipment for the developing countries

Analysis of Product Features

Maintenance and Repair

Importing Procedures

Conclusions

Chapter 62. A simple and sturdy new incubator withmodular storage heater intended for transportof high risk newborns in developing andindustrialized countries

Introduction

Transport of the ill newborn

A new transport incubator

Concluding comments

References

CHapter 63. Birthweight: new and available technologies forprimary health care

Introduction

Birthweight in primary health care practice and planning

Available instrumentation for weighing infants

Summary

Appendix

References

Part 8: Appendix

Chapter 64. Measurement of human umbilical venous bloodflow in utero

Introduction

Theoretical basis of Doppler flow measurement

Instrumentation

Limitations and accuracy

Results

Discussion

Acknowledgements

References

Chapter 65. Measurement of heart rate variation in thehuman fetus

Introduction

Detection of heart rate

Recent technical developments

Recent findings

Acknowledgements

References

Contributors

Index