Neonatology
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Most pediatric cardiologists believe that pulse oximetry helps to diagnose critical congenital heart disease in neonates who might otherwise be discharged from the newborn nursery undiagnosed. Some of these patients develop catastrophic cardiac and multi-system failure after the ductus closes and die or suffer severe morbidity. Nevertheless, pulse oximetry is not universally used in the newborn nursery. ⋯ Recent studies, however, show that even cardiologists miss critical congenital heart defects, modern oximeters are stable and reliable, and that the false positive rate is very low, lower than the false positive rate based on physical examination. The benefits probably exceed the cost, and evidence is provided to confirm this. There is no reason not to use pulse oximetry routinely in the newborn nursery.
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Comparative Study
Spectroscopic noninvasive measurement of hemoglobin compared with capillary and venous values in neonates.
Venepuncture-related blood loss is a common cause of neonatal anemia. Currently, this is the only way to obtain hemoglobin levels. This causes distress for the infant but can also lead to the need for blood transfusions. Recently, a new technique for measuring hemoglobin levels non-invasively has been developed to reduce iatrogenic blood loss and pain. ⋯ The results show good correlation between the hemoglobin blood levels and spectroscopic measurements. The slightly lower correlation coefficient for the capillary samples demonstrates a naturally higher variance in these values due to the laboratory method.
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Comparative Study
Resuscitation of severely asphyctic newborn pigs with cardiac arrest by using 21% or 100% oxygen.
In spite of evidence suggesting that resuscitation with 100% O(2) is detrimental, international guidelines still recommend its use. Clinical studies comparing 21% and 100% O(2) included many infants with only mild and moderate asphyxia. ⋯ In this animal model of severe perinatal asphyxia, resuscitation with room air seemed to be as safe and effective as the use of 100% oxygen.
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The authors previously demonstrated the priming effect of intra-amniotic lipopolysaccharide (LPS) on hyperoxic lung injury in a rat model of bronchopulmonary dysplasia (BPD). ⋯ The priming effect of intra-amniotic LPS on hyperoxic lung injury may be associated with IL-6 elevation in the lungs.