European journal of pediatrics
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Randomized Controlled Trial Comparative Study Clinical Trial
Randomised controlled trial of weaning by patient triggered ventilation or conventional ventilation.
A group of preterm infants (n = 40) were entered into a randomised controlled trial to compare the duration and efficacy of weaning by patient triggered ventilation (PTV) or conventional ventilation. Once recovery from respiratory distress had begun, enabling the ventilator rate to be reduced to 40 breaths/min, infants were randomised to either regime. Infants randomised to PTV were weaned by reduction in ventilator pressure only, whereas infants randomised to conventional ventilation were weaned by reduction in ventilator rate only. ⋯ Three infants, all of less than 28 weeks gestation, did not tolerate weaning by PTV and were subsequently weaned conventionally. The duration of weaning was analysed according to the original randomisation allocation and was significantly shorter in the PTV group, being a median of 30 h (mean 39, range 3-186) compared to a median of 61 h (mean 65, range 15-262) in the conventional group, P < 0.02. We conclude PTV is the more advantageous form of weaning in preterm infants of greater than 27 weeks gestational age.
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Gastrointestinal (GI) endoscopy was performed in seven patients with Henoch-Schönlein purpura (HSP). In two patients there were no cutaneous lesions at the time of endoscopy, but inflammation of the duodenum, especially of the second part, led to suspicion of the disease. Upper GI endoscopy showed abnormalities in six of seven cases, and sigmoidoscopy in one of four cases. ⋯ Histology of the mucosal biopsy specimens revealed non-specific inflammation with positive staining for IgA in the capillaries, but failed to show vasculitis. Upper GI endoscopy, including study of IgA, can be useful in the diagnosis of HSP. Colonoscopy is less helpful, especially if limited to the sigmoid colon.
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Comparative Study
Non-invasive blood pressure monitoring in preterm infants receiving intensive care.
It is essential to have regular, accurate blood pressure (BP) monitoring of sick preterm infants. Invasive direct arterial BP measurements are often recommended, but it was our clinical experience that such measurements may not be possible in all infants. We therefore assessed the proportion of infants receiving neonatal intensive care in whom reliable arterial BP measurements could be made, the accuracy of a non-invasive method (Doppler technique) and established a reference range of BP results related to postnatal age using this non-invasive technique. ⋯ Doppler systolic BP measurements correlated well with the accurate (non-damped) arterial results (r = 0.96, P less than 0.01). Systolic blood pressure was measured on all 44 infants daily for the 1st week using the Doppler technique and increased linearly with increasing postnatal age (r = 0.92, P less than 0.01) from a mean of 41.7 mmHg on day 1 to 49.3 on day 7. We conclude that Doppler non-invasive BP monitoring is a useful method for regular monitoring of sick preterm neonates as it can be applied accurately, unlike direct arterial monitoring, to all patients.