Effects of blood transfusion on left ventricular output in premature babies

Objective:   To investigate the acute effects of red blood cell transfusion on haemodynamics in preterm babies.
Setting:   A neonatal unit in a University Hospital.
Patients:   Preterm babies whose postnatal age was less than four weeks and who required red blood cell transfusion.
Measurement:   Cardiac output and left ventricular systolic function was determined using Doppler echocardiography before, one hour and 24  h after red blood cell transfusion. Blood pressure and haematocrit were also recorded at the same time. Mixed-effects regression model was used to analyse the effect of blood transfusion on left ventricular function and cardiac output.
Results:   57 preterm babies were recruited. Univariate analysis showed that cardiac index decreased significantly 24  h after transfusion ( P <0.05). Systemic red cell transport increased by an average of 11.1% 24  h after transfusion ( P <0.05). Multivariate analysis showed that the cardiac index was negatively associated with haematocrit and the index was higher in male babies.
Conclusion:   There was a significant drop in cardiac index and an increase in systemic red cell transport 24  h after transfusion in premature babies.     

Biological factors of prognostic significance in locally advanced breast cancer

Summary The biological features of tumour type, histological grade, vascular invasion, mitotic index, DNA index, and oestrogen receptor (ER) and progesterone receptor (PgR) status have been investigated as prognostic factors in primary operable breast cancer. We have studied these 7 factors in locally advanced primary breast cancer (LAPC): these patients have occult metastases at presentation.Of 60 consecutive patients presenting with locally advanced disease, 36 were treated initially with Tamoxifen and 24 by radiotherapy. Treatment failure was followed by cross-over to the other therapy. All patients were assessed for response in the primary tumour; external review of response was obtained. Survival was compared using the generalised Wilcoxon test.Response to therapy correlated significantly with histological grade (p = 0.02), ER (p = 0.02), PgR status (p = 0.02), mitotic index (p = 0.01), and tumour ploidy (p = 0.04). Survival from initial therapy correlated significantly with ER (p = 0.01) and PgR status (p = 0.04).Histological grade, mitotic index, tumour ploidy, and ER and PgR status of the primary tumour predict response and prognosis in patients with locally advanced (stage III) breast cancer.     

Neonatal outcome after pregnancy complicated by abnormal velocity waveforms in the umbilical artery.

The neonatal outcome of 61 infants born after pregnancies complicated by absent or reversed end diastolic flow velocities (AREDFV) in the fetal umbilical artery was compared with that of 61 controls matched for gestational age born after high risk pregnancies with documented forward end diastolic flow velocities (EDFV). The AREDFV group was significantly more growth retarded, had lower platelet counts at birth, and were more likely to become significantly thrombocytopenic in the first week after birth. Owing to concerns about the possible increased risk of necrotising enterocolitis in newborn infants after AREDFV, this group was started on enteral feeds later and was more likely to receive parenteral nutrition than the EDFV group. Seven infants with AREDFV and one control infant developed necrotising enterocolitis.     

Evaluation of an Antenatal Education Programme: Characteristics of Attenders, Changes in Knowledge and Satisfaction of Participants

The evaluation of the efficiency and effectiveness of antenatal education programmes has been identified as a priority in improving maternity services in Australia. Two hundred and ninety four primiparas completed a brief questionnaire in the 3 days following delivery; 82% of the women surveyed attended antenatal education classes. Women were less likely to attend if they were single, younger than 26 years, had lower levels of education, received care during pregnancy from the antenatal clinic and did not have private health insurance. Attenders at antenatal education were also more likely to plan on breast feeding, to be nonsmokers and to know of a greater number of community organizations to help new mothers. However, logistic regression analyses indicated that, with the exception of number of community organizations known, these differences were attributable to demographic differences between attenders and nonattenders. One hundred and forty two women and their partners attending the major provider of antenatal education classes in Newcastle were surveyed prior to and following classes. Significant increases in knowledge were evident following the programme among both women and their partners. Satisfaction with the programme was high as indicated by a large proportion of respondents attending all 4 classes, most programme components being reported as useful or very useful and only a small proportion of respondents experiencing problems with the programme.     

The value of Doppler assessment of the uteroplacental circulation in predicting preeclampsia or intrauterine growth retardation

Flow velocity waveforms of the uteroplacental arteries were analyzed at 20 and 24 weeks of gestation, by means of duplex pulsed Doppler ultrasonography, in 93 women at risk for preeclampsia or intrauterine growth retardation. The ability of an elevated resistance index to predict these conditions was tested. At 20 and 24 weeks an abnormal resistance index was significantly associated with intrauterine growth retardation but not with preeclampsia, with or without proteinuria. A low fetal abdominal circumference at 20 or 24 weeks or an increasing maternal plasma uric acid concentration at 24 weeks was as predictive as an elevated resistance index. In a second group of 43 women, screened in the same way, the only association was of an elevated resistance index at 20 weeks with intrauterine growth retardation. Although elevated resistance indices occur more commonly in women who develop intrauterine growth retardation and/or preeclampsia, the correlation is not close enough to be clinically useful as a screening test.