Nursing audit in a neonatal intensive care unit.

The amount and quality of work conducted by nurses in a neonatal intensive care unit was assessed by analysing records of observations, investigations and treatment. Work had been standardised as much as possible to ensure continuity and to prevent mishaps. Seventy-seven infants were treated over a 5-month period and 6 died of causes unrelated to patient care. Nursing staff were responsible for all observations and for the collection of most specimens for investigations. They also performed 20% of emergency procedures, such as endotracheal intubation and the insertion of venous catheters. The only errors which could be detected were omissions in observations (2.9%), nursing procedures (2.9%), and drug doses (1.2%). The nurse-to-baby ratio of 1:3 was adequate for patient care but not for other recognised functions of an intensive care unit such as education programmes.

Feeding intervals and fat absorption in preterm babies.

Fat absorption studies were conducted on 18 preterm babies to determine whether continuous nasogastric feeding is as effective as intermittent feeding. The infants ranged from 1 290 g to 1 960 g in birth weight and were assessed at a mean postnatal age of 34 days. Each served as a control by receiving an evaporated milk 1-hourly, 2-hourly, 3-hourly or continuously in random order. Equivalent volumes of milk were ingested over each 3-day period irrespective of the method of feeding and the daily weight gain was similar for the various regimens. Stool transit times did not vary and fat absorption and retention showed no significant differences. Continuous feeding appears to be suitable for preterm babies, especially when there is a need to avoid abdominal distension.

Alpha-fetoprotein: a marker for recurrent apnoea of prematurity?

Plasma alpha-fetoprotein was measured each week for 28 days on 132 preterm babies who were admitted to an intensive care unit. Reference values were established on 53 of these infants who were relatively normal and whose gestations ranged from 29 to 33.9 weeks. Similar studies were done on 79 of the 132 infants with comparable gestational ages who suffered from hyaline membrane disease, transient tachypnoea, recurrent apnoea or growth retardation. Plasma AFP was significantly raised in those with recurrent apnoea but a reason was not established for this observation. The risk of apnoea persisted until AFP levels had reached the reference range. Infants with hyaline membrane disease had lower levels of plasma AFP than the recurrent apnoea group but significantly higher values than controls. Babies who are liable to develop recurrent apnoea can probably be identified at birth as their plasma AFP is exceptionally high. These conclusions refer only to babies who receive a maintenance dose of theophylline from the first week.

Fetal ripening.

Babies do not manifest complications of organ immaturity such as hyaline membrane disease when they are born from a hormone milieu dominated by estrogen as shown by vaginal cytology. Those who are delivered from a progesterone-influenced environment are at risk for developing the problems of immaturity. A fetus probably 'ripens' in late pregnancy under the control of estrogen.

Effect of sodium bicarbonate on butterfat absorption in the newborn.

Fat balance studies were conducted on 50 normal full-term babies during their first 11 days of life. The coefficient of absorption of butterfat increased from 74% to 83% when an evaporated milk was partially neutralized with sodium bicarbonate 9 mEq/d. Infants who received bicarbonate gained an average 50,6 g/d, while those who did not receive alkali gained 22,3 g/d. The reasons for this difference were not established but may be partly related to an improved absorption of fat. No recommendation can be made for the long-term neutralization of cow's milk.

Pregnancy after autotransplantation of the Fallopian tube in the ewe.

Vascularised transplantation of the Fallopian tube is a technically feasible operation, but its functional result remains questionable. This article documents a pregnancy after vascularised contralateral autotransplantation of the oviduct in a ewe.

Completed pregnancy following vascularized heterotopic autotransplantation of the Fallopian tube in the ewe.

Transplantation of the Fallopian tube is a technically feasible operation. Previous authors have reported pregnancies following turbo-ovarian transplants, but there appears to be no record of gestation following transplantation of the isolated oviduct. This communication illustrates the method that we have used to perform Fallopian tube transplants in the ewe and documents our first full-term pregnancy following this operation. It provides further evidence of the technical feasibility of Fallopian tube transplants.

Serum cholesterol and bowel flora in the newborn.

Bottle-fed infants have a total serum cholesterol of 147 mg/100 ml on the fifth day of life and their stools contain more Escherichia coli than Lactobacilli organisms. The ratio of these bacteria can be reversed by adding bicarbonate or Lactobacilli to feeds. This change is associated with a decrease in total cholesterol to a mean 119 mg/100 ml over the next 3 days. Lactobacilli organisms predominate in the stools when serum cholesterol is low and may play a role in the metabolism of cholesterol.

Significance of milk pH in newborn infants.

Bottle-fed infants do not gain weight as rapidly as breast-fed babies during the first week of life. This weight lag can be corrected by the addition of a small amount of alkali (sodium bicarbonate or trometamol) to the feeds. The alkali corrects the acidity of cow's milk which now assumes some of the properties of human breast milk. It has a bacteriostatic effect on specific Escherichia coli in vitro, and in infants it produces a stool with a preponderance of lactobacilli over E. coli organisms. When alkali is removed from the milk there is a decrease in the weight of an infant and the stools contain excessive numbers of E. coli bacteria.A pH-corrected milk appears to be more physiological than unaltered cow's milk and may provide some protection against gastroenteritis in early life. Its bacteriostatic effect on specific E. coli may be of practical significance in feed preparations where terminal sterilization and refrigeration are not available. The study was conducted during the week after birth, and no conclusions are derived for older infants. The long-term effects of trometamol are unknown. No recommendation can be given for the addition of sodium bicarbonate to milks containing a higher content of sodium.