Journal of perinatology : official journal of the California Perinatal Association
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Drug-induced paralysis in the mechanically ventilated neonate is prescribed primarily to control breathing and, secondarily, to favorably affect underlying pulmonary disease and associated complications. Although the control of breathing can be achieved, it is controversial when pulmonary disease is favorably influenced by paralysis. However, such therapy may lessen the severity, and the incidence of the complications in specific subgroups of infants. In view of significant adverse effects, muscle paralysis should be used judiciously in neonates.
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We evaluated to what extent acidosis and alkalosis and their respiratory and metabolic components during the first 12 hours of life occurred prior to early neonatal death and postnatal intracranial hemorrhage among 206 low birth weight, intubated premature babies participating in a clinical trial of phenobarbital prophylaxis for intracranial hemorrhage. Time-weighted indices included the time each baby spent with abnormal values of pH, PaCO2 and HCO3-. Babies whose birth weight was less than 1 kg suffered adversities associated with prolonged pH less than 7.35. ⋯ A time-weighted measure of metabolic deficit correlated with death, but not with hemorrhage. Prolonged exposure to pH greater than 7.55 was associated with reduced risk of subependymal/intraventricular hemorrhage and death, especially in babies below 1 kg birth weight. We conclude that acidosis is an antecedent of intracranial hemorrhage in low birth weight premature babies, that duration of exposure might convey important risk information, and that birth weight is a correlate of vulnerability to some pH disturbances.
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Comparative Study
Fathers in the cesarean section room and maternal/neonatal outcomes.
Two hundred twenty-seven consecutive full-term deliveries by cesarean section over a 10-month period were divided into "father present" and "father absent" groups. The father present group tended to have received prenatal care in the private office and to have experienced regional anesthesia more frequently. ⋯ However, when the two groups were further analyzed controlling for anesthesia mode, the differences disappeared with the exception of higher Apgar scores at five minutes with father present and regional anesthesia. No adverse consequences were noted from fathers' presence.