Journal of perinatal medicine
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Salbutamol infusion, 4 micrograms/kg in 5 ml of water infused for 20 minutes, was given to treat hyperkalaemia (potassium level > 6.0 mmol/l) in 10 critically ill preterm infants (median gestational age 26 weeks). Seven infants had acute renal failure, two had persistent metabolic acidosis without renal failure and the remaining infant had a combination of acute renal failure and persistent metabolic acidosis. No infant developed a tachycardia or became hyperglycaemic in response to the infusion. ⋯ In response to the infusion the potassium level fell in 7 infants with acute renal failure by a median of 1.1 mmol/l (range 0.7-1.8) at one hour but in the three infants with a persistent metabolic acidosis, the potassium level continued to rise. We conclude that salbutamol infusion achieves, without side-effects, at least a temporary reduction in hyperkalaemia in preterm infants with renal failure, but not metabolic acidosis. Its effect is of sufficient duration to allow ample time for definitive therapy to be instituted and thus may be a useful alternative for infants in whom the possible hypoglycaemic side-effects of glucose and insulin should be avoided.
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Case Reports
Severe localised pulmonary interstitial emphysema--decompression by selective bronchial intubation.
We report three infants (26-28 weeks gestational age) in whom selective bronchial intubation was associated with successful decompression of severe localised pulmonary interstitial emphysema, uniquely in two cases this involved intubation of the left main bronchus. Pulmonary interstitial emphysema did not recur despite maintenance of selective intubation for only 48 hours or less in all three cases.
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The influence of postnatal age on spontaneous respiratory time, measured both on and off continuous positive airways pressure (CPAP), and the occurrence of the Hering Breuer reflex has been investigated. Consecutive ventilated infants were recruited and only studied when making respiratory efforts during mechanical ventilation. Fifty-three infants were studied on 119 occasions, their median gestational age was 29 weeks and birthweight 1142 gms. ⋯ No influence of postnatal age was demonstrated on the proportion of infants in whom the Hering Breuer reflex was demonstrated. Our results suggest that, during the neonatal period, there is no influence of postnatal age on respiratory timings or reflex activity amongst ventilated infants who make spontaneous respiratory efforts during ventilation. These results have important implications regarding the optimum rate at which such infants should be ventilated.