European journal of pediatrics
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Twenty-four patients in a paediatric intensive care unit mostly undergoing cardiac surgery, received a midazolam dosage between 50-400 micrograms/kg per hour as a continuous intravenous infusion partly in combination with fentanyl [0,5-2,5 micrograms/kg per hour] for analgesia and sedation. The mean duration of midazolam infusion was 11.6 days (range 38 h-40 days). Blood samples for the HPLC assay of serum midazolam concentration were taken and the clearance estimated. ⋯ Serum midazolam concentrations between 100-400 micrograms/l were sufficient for sedation. Dosage had to be increased during therapy according to an increased midazolam clearance. The evaluation of the sedation score showed that sedation of artificially ventilated infants and young children can be established by continuous intravenous infusion of midazolam.
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Comparative Study
High frequency oscillatory ventilation near resonant frequency of the respiratory system in rabbits with normal and surfactant depleted lungs.
It has been suggested that high frequency oscillatory ventilation (HFV) might improve gas exchange and reduce the risk of pressure-related side-effects compared to conventional mechanical ventilation (CMV). Whereas most studies have used arbitrarily set frequencies for HFV, we evaluated the effects of HFV near resonant frequency (fr). Anaesthetised and tracheotomized adult rabbits (n = 10; 3.8-5.1 kg body weight) were ventilated by alternating periods of CMV and HFV near fr. ⋯ Volume amplitudes of oscillation necessary to achieve normocapnia were slightly above the natural plus equipment (2 ml) dead space. Maximum intra-alveolar pressure (Pmax) was calculated for the HFV runs from MAP, Ctot, and the volume amplitude of oscillation. Pmax during CMV was nearly twice that during HFV at equivalent PaCO2 and equivalent MAPs throughout the experiments.
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The importance of the preterm infant's inspiratory time in determining the optimum inflation time during mechanical ventilation was investigated. The optimum inflation time was defined as that which was most commonly associated with synchronous respiration and maximum minute volume. Twelve preterm infants were studied on 14 occasions. ⋯ Synchrony was most commonly provoked and minute volume greatest at the shortest inflation time (P less than 0.01). We conclude fast ventilator rates are most efficacious for preterm neonates. As previously shown, this rate can be estimated by examining the standard reference range of rates in relation to gestational age.
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The records of 62,107 neonates cared for at three neonatal referral units between 1979 and 1985 were analysed with regard to the number of lumbar punctures (LP) performed and the results obtained. The mean perinatal mortality rate was 9.3/1000 live births and the neonatal mortality rate was 5.9/1000. The units were comparible in this respect. ⋯ Eight of the 17 positive results were obtained during the first 3 postnatal days. Only one VLBW baby had meningitis on the 1st day of life (1.3/1000). In view of the low incidence of meningitis and the risk factors associated with an LP it is questionable whether this procedure should be a routine investigation in the VLBW newborn.
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Primary hyperoxaluria type I is a metabolic disorder caused by the deficiency of the peroxisomal alanine:glyoxylate aminotransferase. The disease is inherited as an autosomal recessive trait. The clinical course is outlined based on data from 330 published cases. ⋯ Principles of conservative treatment, e.g. volume load and pyridoxine substitution, are described as well as experience with different modes of dialysis and transplantation. Kidney transplantation is associated with a high rate of recurrence of the original disease despite excellent management resulting in many instances in early graft loss. Liver transplantation offers the possibility to correct the metabolic defect and to prevent the progression of crystal deposition in the body.