Journal of perinatology : official journal of the California Perinatal Association
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Tracheal aspirates (TAs) from mechanically ventilated very low birth weight (VLBW) infants are frequently obtained during the evaluation of suspected sepsis, tracheitis, or ventilator-associated pneumonia (VAP). Purulence and bacteria in Gram stain of bronchopulmonary secretions are considered signs of respiratory infection, and medical decisions are made on the assumption that they are predictors of positive bacterial tracheal cultures (TCs). The purpose of this retrospective investigation was to establish the relationship of purulence and bacteria in TA from ventilated VLBW infants with positive TC and to identify its clinical significance. ⋯ In VLBW infants, purulence in TA is associated with prolonged endotracheal intubation and is temporally related to GNB airway colonization. At the time of the first purulent TA, the majority of mechanically ventilated VLBW infants are asymptomatic. Only a few symptomatic VLBW infants had nosocomial respiratory infection. Understanding the clinical significance of purulence and GNB in TA from this unique patient population is important for management and prognosis, and it may decrease concern for infection and the associated use of antibiotics.
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The authors present a 15-year-old with a second trimester intrauterine pregnancy who developed respiratory failure as the result of status asthmaticus and the development of the adult respiratory distress syndrome. Mechanical ventilation was provided with a combination of oxygen and helium to facilitate gas exchange and limit peak inflating pressures. The physiologic basis for helium's potential beneficial effects on gas exchange are reviewed. Previous reports concerning the use of helium during mechanical ventilation as well as the techniques of delivery are discussed.
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Critically ill neonates frequently require multiple small volume red blood cell (RBC) transfusions. RBC units assigned to individual infants, used sequentially in small aliquots until the original expiration date, can substantially reduce donor exposures. In 1993, adenine-saline solution (AS-3) was introduced by the Canadian Red Cross as the red cell storage medium to replace citrate-phosphate-dextrose-adenine anticoagulant-preservative solution (CPDA-1). We surveyed the safety and efficacy of using AS-3 split packs, stored up to 35 days, for premature infants. ⋯ Designated AS-3-preserved split RBC packs effectively limit donor exposures, can safely be used for neonatal small volume transfusions, and give a constant transfusion effect after up to 35 days of storage.
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Conventional methods for measuring the total bilirubin concentration in blood require the use of serum or plasma, but physically separating red blood cells from plasma by centrifugation is a time-consuming and potentially dangerous process that does not lend itself to rapid, near-patient testing. Therefore, we have sought to determine whether spectrophotometric measurements of total bilirubin concentration are feasible in unaltered whole blood. ⋯ These preliminary findings demonstrate the feasibility of developing a portable instrument to measure total bilirubin in unaltered whole blood. The advantages of this method are speed, elimination of centrifugation or other sample preparation, and instrument portability. The disadvantage is that the concentration units are unconventional, i.e., milligrams of bilirubin per volume of whole blood. However, the instrument can be programmed to display the total bilirubin concentration in traditional units, e.g., milligrams of bilirubin per volume of plasma.