Journal of paediatrics and child health
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At the Royal Children's Hospital, Melbourne, extracorporeal membrane oxygenation (ECMO) has been used in the treatment of newborn infants with life-threatening respiratory or cardiac failure since May 1989. The main indications for the use of ECMO are that the disease is reversible, the surviving infant is likely to be normal and there is an 80% likelihood of death without ECMO. Sixteen of 22 (73%) newborn infants have survived at least 6 months after ECMO. ⋯ Two of six infants with congenital diaphragmatic hernia who received ECMO were discharged and survived to have normal neurological and respiratory function at 6 month follow up. These results are similar to results from other centres internationally. It would appear that ECMO is a useful therapy for near-term newborn infants with otherwise fatal cardiorespiratory failure.
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J Paediatr Child Health · Aug 1992
Comparative StudyOutcome of infants with birthweight 2000 g or less who undergo major cardiac surgery.
A retrospective study of all neonates with birthweight 2000 g or less undergoing major cardiac surgery at the Royal Children's Hospital, Melbourne over the last 5 years was performed in order to determine outcome and identify subgroups within this population that may have a poor prognosis. The mean length of stay in intensive care following surgery was 32 days, with non-survivors having a significantly longer duration of stay than survivors. ⋯ None of the survivors suffered incapacitating cardiac, neurological or respiratory handicap. These children in general have a poor prognosis and utilize significant resources; results of cardiac surgery in this group need to be closely followed in the future.
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Errors in prescription, administration, delivery and interaction of drugs are likely in children in intensive care units because of the large number of often unfamiliar medications these children receive. We evaluated prospectively the frequency and consequence of drug errors in a large multidisciplinary intensive care unit. There was a mistake in drug prescription, administration, delivery or drug interaction in 2% of medication orders, with 12% of these mistakes causing actual harm to the patient. The frequency of drug errors must be appreciated and due care must be taken in checking and delivering drugs to children in an intensive care unit.
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J Paediatr Child Health · Feb 1992
Effect of fetal haemoglobin on the accuracy of pulse oximetry in preterm infants.
Pulse oximeters are programmed with a calibration curve derived from studies done in adults. Whether fetal haemoglobin levels affect their reliability is unclear. This study reports the accuracy of pulse oximetry in 22 preterm infants (mean 31 weeks, range 25-36 weeks gestation) between 1 h and 73 days of age. ⋯ Linear regression analysis revealed a close correlation between SpO2 and functional SaO2 (SpO2 = 0.75 SaO2 + 24.43, r = 0.88, P less than 0.001) over a wide range of values for PCV, heart rate, blood pressure, PaO2, PaCO2 and pH. The mean SpO2-SaO2 difference of 1.3, (s.d. 2.5%, P less than 0.001) was unaffected by HgF, HbCO or HbMet but was increased in infants receiving inotropic support. We conclude that the Nellcor N-200 pulse oximeter gives reliable oxygen saturation measurements unaffected by the HbF level in preterm infants.
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Inhalation of aerosols in the mainstay of treatment of asthma and can be useful in treating children with cystic fibrosis. The most efficient method of delivering aerosol to children depends on the age and clinical condition of the child. The most rational dosage schedule for nebulized drugs appears to be to weight-correct the dose added to the nebulizer solution.