American journal of perinatology
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The survival rate of very low birthweight infants (weighing less than 1500 gm) has dramatically increased over the past two decades. Consequently, high-tech intensive care is offered to an increasing number of infants with borderline viability, previously considered as miscarriages. We reviewed the most recent literature on the results of intensive care used in the subgroup of extremely low birthweight infants, weighting less than 750 gm or 800 gm. ⋯ The available data show that virtually for every "healthy" surviving extremely low birthweight infant there is also at least one surviving child who is moderately to severely handicapped. The overall consequences and implications of high-tech care of these borderline viability infants, once considered as nonviable, are not necessarily improved over those of the former, less aggressive, approach. Since these results have grave consequences for the involved families and society, we urgently need to involve these parties more actively in decision making.
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Case Reports
General anesthesia for surgical repair of intracranial aneurysm in pregnancy: effects on fetal heart rate.
A 30-year-old nulliparous woman underwent surgery for a ruptured aneurysm of the left vertebral artery in gestational week 27. The fetal heart rate (FHR) was monitored continuously with an abdominal Doppler transducer. Anesthesia was induced with midazolam, fentanyl, and thiopental and maintained with fentanyl, isoflurane, and nitrous oxide 67% in oxygen. ⋯ Despite this sedation, some FHR variability reappeared within 40 minutes after discontinuation of the inhalation anesthetics. After discontinuation of parenteral midazolam and fentanyl, normal FHR variability returned within 60 minutes. In week 41 of pregnancy, a healthy girl of 4015 gm was born.
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To evaluate the outcome of pregnancy in diabetic women who had an episode of ketoacidosis during gestation, 20 consecutive cases of ketoacidosis in type I diabetic pregnant women were studied. They were divided into two groups for comparison: Group 1, 13 patients (65%), had a live fetus and group 2, seven patients (35%), had a fetal death on admission. Both groups were similar in age, gravidity, parity, abortions, height, weight, serum sodium and potassium, arterial pH, carbon dioxide tension, bicarbonate, base excess, and anion gap. ⋯ A high fetal mortality (35%) was found but there were no fetal losses once therapy was initiated. The unrecognized new onset diabetics accounted for almost a third (30%) of the cases of ketoacidosis and for 57% of the fetal deaths. Attentiveness to the symptoms of uncontrolled diabetes and appropriate screening can be effective preventive measures.
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Extracorporeal membrane oxygenation is now an accepted method of treatment for neonatal hypoxemia due to a number of causes. We extend the indications of ECMO to hypoxemia secondary to dysplastic tricuspid valve. We report the case of a neonate with congenital dysplastic tricuspid valve who responded to ECMO.
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The study was designed to determine the flow rate necessary to achieve adequate oxygen delivery from self-inflating resuscitation bags. When no reservoir was used the fraction of inspired oxygen (FiO2) was between 0.5 and 0.6 for all flow rates greater than 7 liters/min. ⋯ Individuals should become thoroughly familiar with the equipment they select for use. Most will find it necessary to provide an oxygen flow of at least 10 to 12 liters/min to provide an oxygen concentration of at least 80%.