Journal of perinatology : official journal of the California Perinatal Association
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Randomized Controlled Trial Clinical Trial
Effect of sleep position on apnea and bradycardia in high-risk infants.
The purpose of this investigation was to investigate, in high-risk infants, the occurrence of abnormalities in documented monitor downloads during the side versus prone position. ⋯ Clinicians need to be cautious when recommending the side or prone position in this group of high-risk infants. The results in this investigation provide support for the Back to Sleep Campaign recommendations to be applied, not only to healthy term infants, but higher risk infants as well. Studies of the high-risk infant in the supine position are warranted.
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Current and advanced structural and functional neuroimaging techniques are presented along with guidelines for utilization and principles of imaging diagnosis in fetal and neonatal central nervous system abnormalities. Pattern of injury, timing issues, and differential diagnosis are addressed with emphasis on neurovascular disease. Ultrasonography and computed tomography provide relatively rapid and important screening information regarding gross macrostructural abnormalities. However, current and advanced MRI techniques often provide more definitive macrostructural, microstructural, and functional imaging information.
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Case Reports
Case report: total parenteral nutrition extravasation associated with spinal cord compression and necrosis.
A preterm infant, whose course was complicated by sepsis, necrotizing enterocolitis with jejunal perforation, intraventricular hemorrhage and cerebellar hemorrhage, suffered permanent and total paralysis below the neck from extravasation of parenteral nutrition fluids through a femoral venous catheter. MRI imaging revealed extravasation of fluid into the paraspinus musculature with extension into the spinal canal. This fluid was identified as hyperalimentation and intralipid. Postmortem examination found evidence of necrosis of the spinal cord as well as perforation of the right iliac vein.
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This article discusses architectural design and construction and recommends criteria for achieving quiet nursery environments. Designs for new construction or facility renovation should incorporate vibration and noise control methods appropriate to the occupants and activities of the proposed space. ⋯ Facility noise and vibration levels set a threshold that will be increased by operational noise. It is important, therefore, that hospital administrators, clinicians, and facility managers assure that architects, engineers, and builders use appropriate acoustical design criteria, methods, and materials to control noise and vibration.
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We describe a neonate on venoarterial extracorporeal membrane oxygenation (ECMO) with acute renal failure associated with extensive aortic and bilateral renal artery thrombosis. Concurrent anticoagulation and continuous systemic thrombolytic therapy with tissue plasminogen activator (t-PA) resulted in complete thrombolysis as evaluated by Doppler flow. The relative risk and benefits of thrombolytic therapy in heparinized patients undergoing ECMO needs to be further studied.