Acta paediatrica
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The aim of this study was to assess whether a family history of atopy influenced lung function at follow-up of infants born prematurely. Analysis was made of thoracic gas volume and airways resistance measurements performed at 1 year of age in 86 infants born at a median gestational age of 29 weeks. ⋯ However, when the results from 18 infants with a family history of atopy were compared with 18 controls who were matched for requirement for neonatal ventilation, parental smoking and were within at least 1 week of gestational age, no significant difference in airways resistance was found between the two groups. Multiple regression analysis demonstrated that gestational age and birth weight explained the apparent relationship between a family history of atopy and an elevated airways resistance at follow-up.
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Fifty-three critically ill infants and children received midazolam as sedation in a regional intensive care unit. Assessment of the level of sedation was carried out at regular intervals on withdrawal of midazolam. Forty-nine patients were fully alert within 4 h of midazolam being stopped. ⋯ The overall incidence of adverse effects to midazolam in the patients studied was 17%. No adverse effects were observed in infants; all adverse effects were observed in children. We have shown that it is possible to prospectively study the toxicity of sedatives in critically ill infants and children.
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Clinical Trial
Improved arterial oxygenation in children with the adult respiratory distress syndrome: the prone position.
Seven ventilated children with the adult respiratory distress syndrome (ARDS) were studied. While supine and haemodynamically stable, baseline arterial blood-gas analyses and haemodynamic measurements, including cardiac output, were performed. Each child was then turned prone and 30 min later a repeat set of measurements were made. ⋯ Similarly, oxygen delivery significantly increased (p < 0.02). The prone position improves arterial oxygenation and oxygen delivery in children with ARDS. By adopting the prone position, in ventilated children with ARDS, we surmise that realistic gas exchange targets may be reachable with lower levels of inspired oxygen and/or peak airway pressures.
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Early neonatal sudden death syndrome (SIDS) is a rare but well known disease entity. Between January 1975 and December 1991, 29 full-term newborn infants delivered in our maternity unit and, considered healthy at birth, suffered early SIDS (n = 15) or early apparent life threatening events (ALTE) (n = 14). Data from the whole population of live full-term infants born in our hospital during the past five years have been used as a reference (n = 27,841). ⋯ No influence of sex, maternal age, gestational age, infant weight presentation, delivery, anesthesia or presence of meconium-stained fluid was found. In our opinion, SIDS can take place even during the first hour of life and it is not possible to predict when a baby might be affected. Pediatrically trained caregivers, close observation by the mother during the first few days and resuscitation facilities in maternity wards may be the most important preventive measures to reduce the risk of early SIDS and the consequences of ALTE in the early newborn period.