American journal of perinatology
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We tested the hypothesis that in preterm infants, prolonged apneas (apneas > or = 20 sec) are not random events but are preceded by frequent and progressively longer respiratory pauses associated with changes in ventilatory variables. We studied 36 preterm infants with apnea [birth weight 1190 +/- 60 g (mean +/- SEM), study weight 1300 +/- 60 g, gestational age 28 +/- 1 weeks, and postnatal age 23 +/- 2 days]. A nosepiece with a flow-through system was used to measure ventilation and alveolar gases. ⋯ When the 1 min before prolonged apnea was compared with the 1 min of similar sleep state not having prolonged apnea, minute ventilation decreased, primarily due to a decrease in respiratory frequency. Oxygen saturation decreased and alveolar PCO2 did not change. These findings suggest that prolonged apnea is not a random event but is preceded by a disturbance of the respiratory control system characterized by (1) frequent apneas of progressive duration, (2) decrease in respiratory minute volume and frequency, and (3) decreased O2 saturation.
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Fetal bradycardia is a well-known response to maternal hypothermia, as induced at open-heart surgery, but heretofore has not been reported in conjunction with hypothermia from urosepsis. A 24-year-old Vietnamese woman admitted at 33 weeks estimated gestational age with pyelonephritis secondary to Escherichia coli developed several episodes of maternal hypothermia to 35-36 degrees C. ⋯ Interpretation of fetal bradycardia during episodes of maternal urosepsis is complex. If seen in conjunction with maternal hypothermia, and in the presence of normal maternal cardiac and respiratory function, bradycardia is unlikely to represent fetal distress.
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The objective of this study was assess whether residual amniotic fluid volume (AFV) following premature rupture of the membranes (PROM) is associated with fetal presentation, or the prevalence of either clinical or histologic infection in patients delivering below 32 weeks' gestation. From an established database of 465 deliveries below 32 weeks' gestation, patients with singleton, nonanomalous fetuses with AFV assessment within 24 hours of delivery were studied (n = 146). Fetal presentation was confirmed by ultrasound identifying 46 breech and 100 vertex-presenting fetuses. ⋯ No significant difference was noted in the rupture-to-delivery interval, gestational age at delivery, neonatal morbidity parameters, or histologic evidence of maternal and/or fetal acute inflammation (50% vs. 42%, p > .2) between gestations with breech or vertex presentations. The incidence of clinical chorioamnionitis was significantly lower in breech compared with vertex presentation (40% vs. 60%, p < .05). We conclude that following PROM below 32 weeks' gestation, in breech-presenting fetuses, the residual AFV and incidence of clinical chorioamnionitis are significantly decreased compared with vertex-presenting fetuses.
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Review Case Reports
Unusual misplacement sites of percutaneous central venous lines in the very low birth weight neonate.
Percutaneously placed central venous lines have become an intricate part of the medical management of the very low birth weight infant. It is critically important that health care providers involved with the placement of these catheters be familiar with the possible subtle sites for catheter misplacement. We present two case reports of inadvertent ascending lumbar vein catheterization with a percutaneously placed Silastic catheter where the saphenous vein was used for venous access. The literature is reviewed with regard to the history of use, indications, placement, and associated complications of these catheters.
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Comparative Study
Increased intrapartum antibiotic administration associated with epidural analgesia in labor.
To determine whether women who receive continuous epidural analgesia for labor and delivery are more likely to receive antibiotic therapy compared to those parturients who do not use epidural analgesia, a chart review was performed for 300 women 100 in each group using narcotics alone epidural alone, or parenteral narcotics followed by epidural analgesia. While only 2% of women with narcotics alone developed an intrapartum temperature > or = 37.8 degrees C, 16% and 24% of women with epidural use alone or in addition to narcotics did so, respectively. ⋯ A probable causal relationship between maternal temperature elevation and epidural use in labor is supported. Rather than treating all women with temperature elevations and epidurals for presumed chorioamnionitis, it is reasonable to target treatment to those with fetal tachycardia, meconium stained fluid, or abnormal amniotic fluid studies.