Early human development
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Early human development · Jul 1993
Assessment of non-invasive techniques for measuring blood pressure in preterm infants of birthweight less than or equal to 750 grams.
Non-invasive techniques for measuring systolic blood pressure (BP) were evaluated in 10 very preterm infants, median gestational age 24 weeks, who were all of birthweight < or = 5750 g. Systolic BP measurements were attempted in all infants using a Doppler technique (Ultrasonic Doppler Flow Detector) and two oscillometers (Sentry and EME). Using each technique five separate measurements were attempted over a 10-min period. ⋯ BP measurements were possible on all 10 infants using the Doppler technique, but only in seven using the EME oscillometer and four using the Sentry oscillometer. The mean difference in measurements from those obtained using the arterial catheter were 0.27 mmHg using the Doppler technique and, in those infants in whom measurements were possible, 1.34 mmHg using the Sentry oscillometer and 1.34 mmHg using the Sentry oscillometer. We conclude that the Doppler technique provides the most useful and reliable non-invasive method of assessment of systolic BP in immature infants of birthweight < or = 750 g.
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Early human development · Feb 1993
Randomized Controlled Trial Multicenter Study Comparative Study Clinical TrialA multicenter randomized trial of high frequency oscillatory ventilation as compared with conventional mechanical ventilation in preterm infants with respiratory failure.
A multicenter randomised trial was conducted in nine neonatal centers in Japan to re-evaluate the safety and the efficacy of high frequency oscillatory ventilation using the piston type oscillator (Hummingbird) in the treatment of respiratory failure in preterm infants weighing between 750 and 2000 g at birth. A total of 92 infants were enrolled in the study. Forty-six infants were allocated to high frequency oscillatory ventilation and 46 infants to conventional mechanical ventilation. ⋯ Mean airway pressure was significantly higher in the high frequency oscillatory ventilation group and the infants on high frequency oscillation showed a significantly higher arterial to alveolar oxygen tension ratio after 6 h of treatment. These results suggest that high frequency oscillatory ventilation does not increase the risk of severe complications such as air leaks, intraventricular hemorrhage or periventricular leukomalacia when it is used by experienced neonatologists. Indeed high frequency oscillatory ventilation helps provide better oxygenation with higher mean airway pressure without increasing the risk of bronchopulmonary dysplasia and severe complications such as air leaks and intraventricular hemorrhage.
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Early human development · Jan 1993
Heart rate variability in healthy term newborns: the contribution of respiratory sinus arrhythmia.
Cardiorespiratory interactions in healthy full term newborns were investigated. Spectral analysis was used on heart rate and breathing data from 22 neonates 2-5 days old to reveal coincident frequencies in the breathing and heart rate variability (HRV) spectra, thus identifying respiratory sinus arrhythmia (RSA). ⋯ The contribution of RSA to HRV was dependent on breathing frequency and absolute RSA power. The mechanisms that produce this cardiorespiratory interaction are considered to be functionally active in the healthy term neonate.
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Early human development · Jun 1992
Ethical problems in neonatal intensive care unit--medical decision making on the neonate with poor prognosis.
In current NICU (neonatal intensive care units), it is inevitable that ethical decisions on neonates with a poor prognosis will have to be made. At Tokyo Women's Medical College, we have been applying our own policy of medical decision making, which is somewhat different to those of most western countries. Most families are not asked to make final decisions, and the ethical committee is not actively involved. ⋯ The position after decision making is not to discontinue the life supporting system but to observe, with no additional treatments and with routine care (class C). From October 1984 to September 1989, 58 out of 1589 neonates admitted to the NICU at Tokyo Women's Medical College died and 32 (55%) of them were classified as class C. The main causes of medical decision making were; non-viable (4/4, 100%), lethal malformations (13/20, 65%) and birth asphyxia (15/19, 79%).
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Early human development · Jul 1991
Inflating pressures for effective resuscitation of preterm infants.
The magnitude of inflating pressure necessary for effective resuscitation was examined in 70 preterm infants. The median pressure to cause adequate chest wall expansion was 22.8 cmH2O; no infant required a peak inflating pressure greater than 30 cmH2O. No further increase in inflation pressure was used during resuscitation and the median 5- and 10-min Apgar scores were 8 and 9, respectively.