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4. Cerebral blood flow, cross-brain oxygen extraction, and fontanelle pressure after hypoxic-ischemic injury in newborn infants

Author

Frewen, Timothy C., Kissoon, Niranjan, Kronick, Jonathan, Fox, Mervyn, Lee, Richard, Bradwin, Nora, and Chance, Graham

Subjects
Birth injuries -- Complications, Cerebral anoxia -- Complications, Infants (Newborn) -- Abnormalities, Health
Abstract

A decrease (hypoxia) or loss (ischemia) of oxygen supply to the brain occurring around the time of birth (perinatal) in full-term newborns is still a notable cause of developmental delay or handicap. A decrease in blood flow, altered blood pressure, increased intracranial pressure, and ability of the brain cells to extract oxygen from blood are among the factors thought to influence perinatal brain ischemia. However, the relative importance of these factors in brain damage is unclear. These parameters were measured in 10 newborns who were admitted to a pediatric critical care unit with signs of hypoxic-ischemic brain damage. Cross-brain oxygen extraction was significantly higher during the first three days of life in the five infants who were developmentally normal at the age of two years. Repeated measures of this parameter were important for this to reflect the infant's status. It is not certain if decreased oxygen extraction reflects the degree of nerve injury or if it is an indicator of a cellular process that can be enhanced. Cerebral blood flow measured during the first three days of life was significantly higher in infants who died or had severe brain damage, but the significance of this observation can not be interpreted at this time. Other factors such as intracranial pressure, blood pressure, cerebral perfusion pressure, and metabolic indicators were not significantly different between healthy and developmentally delayed infants. Further research is needed. (Consumer Summary produced by Reliance Medical Information, Inc.)

Published
1991

5. Medical ethics and women

Author

Bocking, Alan D., Burgess, Michael M., Chance, Graham W., Cohen, Gerald S., Coughlin, Michael D., Dickens, Bernard M., Dossetor, John B., Fox, A. Mervyn, Frewen, Timothy C., Green, Robert N., Harding, Paul, Harrigan, John R., Hoffmaster, Barry, Kain, Brian F., Klassen, Gerald A., Kronick, Jonathan B., Lowy, Frederick H., Meslin, Eric M., Seidelman, William E., Senn, John S., Sibbald, William, Stiller, Calvin R., Sumner, L. Wayne, Watts, John L., Webster, George C., and Woodrow, Brian E.

Subjects
Letters
Published
1990

20. Medical ethics and women.

Author

Latimer, Elizabeth J., Hynes, Adrian F., Williams, Wena V. P., Baylis, Françoise, Downie, Jocelyn, Sherwin, Susan, Hennen, Brian K., Kluge, Eike-Henner, Bocking, Alan D., Burgess, Michael M., Chance, Graham W., Cohen, Gerald S., Coughlin, Michael D., Dickens, Bernard M., Dossetor, John B., Fox, A. Mervyn, Frewen, Timothy C., Green, Robert N., Harding, Paul, and Harrigan, John R.

Published
1990

22. Resistance of the Auditory Brain Stem Response to High Barbiturate Levels

Author

Marsh, Roger R., Frewen, Timothy C., Sutton, Leslie N., and Potsic, William P.

Abstract

In the comatose patient the auditory brain stem response may be one of the few indices of CNS function available. Because barbiturates may be administered to control intracranial pressure and its sequelae, demonstration of the effect of barbiturates on the brain stem response is desirable. In cats preloaded with 63 mg/kg of pentobarbital, intravenous injection of an additional 60 mg/kg reduced, but did not abolish, the later waves of the response. One cat that survived a cumulative dose of 183 mg/kg continued to show a well-defined brain stem response. Even doses of barbiturate nearly incompatible with survival do not abolish this response.

Published
1984
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23. Gonococcal Vulvovaginitis in Prepubertal Girls.

Author

Frewen, Timothy C. and Bannatyne, Robert M.

Subjects
VULVOVAGINITIS, VULVAR diseases, DISEASES in girls, DIAGNOSIS, CLINICAL medicine, MEDICAL care
Abstract

Eighteen bacteriologically proven cases of prepubertal gonococcal vulvovaginitis in girls ages 2 to 10 years were treated. Problems of diagnosis and management are discussed. [ABSTRACT FROM AUTHOR]

Published
1979
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36. Jugular venous bulb catheterization in infants and children

Author

GAYLE, MICHAEL O., primary, FREWEN, TIMOTHY C., additional, ARMSTRONG, ROSS F., additional, GILBERT, JOSEPH J., additional, KRONICK, JONATHAN B., additional, KISSOON, NIRANJAN, additional, LEE, RICHARD, additional, TIFFIN, NORMAN, additional, and BROWN, TIMOTHY, additional

Published
1989
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37. Letters

Author

Kissoon, Niranjan, primary and Frewen, Timothy C., additional

Published
1987
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39. Exogenous Surfactant Therapy for Pediatric Patients with Acute Respiratory Distress Syndrome

Author

F Lewis, James, S Dhillon, Jasvinder, N Singh, Ram, C Johnson, Craig, and C Frewen, Timothy

Abstract

Exogenous surfactant administration is currently being tested in patients with the acute respiratory distress syndrome (ARDS). The results of the studies have varied because several factors may influence the host’s response to this therapy. This clinical pilot study was designed to evaluate the safety and efficacy of exogenous surfactant administration in pediatric patients with ARDS. Surfactant was administered to 13 patients with severe lung dysfunction, and eight of these patients experienced a significant improvement in oxygenation after the first dose of surfactant. In these patients the exogenous surfactant was administered within 48 h of the diagnosis of ARDS, whereas in the five patients who did not respond, surfactant was administered several days after the onset of ARDS. Responders also spent fewer days on a mechanical ventilator and less time in intensive care compared with nonresponders. Based on the results of this pilot study, a more appropriate multicentre clinical trial should be designed to evaluate this treatment strategy.

Published
1997
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40. Strategic planning in academic paediatric hospitals: The need for child health input.

Author

Warkentin J and Frewen T

Abstract

Over the past two decades, a number of Canadian paediatric academic programs, previously operated as separate hospitals, have been integrated into larger teaching hospitals or regional health authorities. The present article describes the recent experience of the Children's Hospital of Western Ontario within the London Health Sciences Centre (London, Ontario) to illustrate the potential deleterious effects of planning, system and program changes in a large academic hospital without child health input at the executive decision-making level. The vision of the London Health Sciences Centre Executive Leadership Team and Board of Directors was divergent from that of the paediatric health care providers, which resulted in the resignation of a number of paediatric subspecialists and compromised the ability of the Department of Paediatrics to deliver paediatric care and educate future professionals. The present article highlights the need for the involvement of paediatric stakeholders in strategic planning in the hope that other academic centres can learn from this experience.

Published
2007

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