Acta paediatrica
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Randomized Controlled Trial Clinical Trial
Food intake and oral sucrose in preterms prior to heel prick.
To investigate the soothing effect of feeding on infants in distress, the effects of 2 mL 15% and 1 mL 25% sucrose given orally 2 min before heel prick in fasting preterms to reduce the pain response were assessed. The effects of milk intake by nasogastric tube were also assessed once during the last hour before heel prick, and the effects of milk intake by nasogastric tube once during the last hour before heel prick together with 1 mL 25% sucrose given orally 2 min before heel prick. The pain response was measured as changes in crying time, behavioural state, skin conductance and heart rate. ⋯ Differences in the measured variables before and during heel prick showed that only the crying time was reduced when the infants received milk or 25% sucrose prior to heel prick (p < 0.05). If the infants received milk and 25% sucrose before heel prick, the crying time and the level of behavioural state were reduced (p < 0.05). The increase from before to during heel prick in skin conductance (number and amplitude of the waves) and heart rate correlated with the crying time (p < 0.01).
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Comparative Study
Postnatal adaptation after Caesarean section or vaginal delivery, studied with the static-charge-sensitive bed.
To compare postnatal adaptation between Caesarean and vaginal deliveries, by studying sleep states, oxygenation, heart rate and body movements. Another aim was to follow the adaptation of healthy, term, vaginally born babies. ⋯ Delivery mode did not affect sleep state distribution but, unexpectedly, the vaginal group had more oxyhaemoglobin desaturation events and fewer body movements than the Caesarean section group. These differences during the first postnatal day remain unexplained, but they may reflect stress and pain during labour. After a few days, changes in sleep organization, and increases in oxyhaemoglobin saturation and frequency of body movements were noted in the vaginal group, which may represent recovery and adaptation to extrauterine life.
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The objective of this study was to compare the results of polysomnography between infants with a history of apparent life-threatening event (ALTE) and controls. In this case-control study, 40 full-term ALTE infants, aged 2-36 wk at the time of the event, were compared with 40 age- and sex-matched randomly selected controls. SaO2, tcpO2, tcpCO2, heart rate (HR), vector of rib cage and abdominal respiratory movements (phase angle, as an index of inspiratory effort) were recorded during natural nocturnal active and quiet sleep (AS, QS). SaO2, tcpO2, tcpCO2 were similar in ALTE and controls in both sleep states. Phase angle was increased in ALTE infants in both AS (59+/-46 vs 26+/-17 degrees) and QS (53+/-46 vs 18+/-14, p < 0.001). Eleven ALTE infants (27.5%) experienced SaO2 < 90%, with a mean decrease in SaO2 to 86+/-1.6% (mean +/- SD), compared with 10% for controls (p=0.003). In eight ALTE infants, SaO2 values <90% were linked to thoracoabdominal asynchrony. SaO2 < 90% in conjunction with HR <100 bpm were detected in three ALTE infants and one control. Periodic breathing was observed in 45% of ALTE infants and 40% of controls. ⋯ The mean values of oxygen saturation, tcpO2 and carbon dioxide levels in ALTE infants are comparable with those of healthy controls but the ALTE infants exhibit more hypoxaemic episodes and increased inspiratory effort during sleep.
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To determine instantaneous cardiac variability responses to increased carbon dioxide (CO2) during quiet sleep in infants who may be at risk for the Sudden Infant Death syndrome (SIDS). ⋯ ALTE infants, particularly ALTE boys, have an autonomic dysfunction-lower sympathetic stimulation and/or inhibited vagal withdrawal when stressed with CO2. The outcome might provide clues to the mechanisms underlying the cardiovascular processes contributing to the terminal event in SIDS.
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Comparative Study
Agreement between capillary and arterial lactate in the newborn.
Arterial blood lactate is a reliable indicator of tissue oxygen debt and is of value in expressing the degree and prognosis of circulatory failure as a result of various diseases. Therefore, the practical issue of whether capillary lactate measurements might be of equal value was investigated in newborns. In total, 193 simultaneous measurements of capillary and arterial blood lactate concentrations were performed in 25 newborn babies with an indwelling umbilical arterial catheter. A strong linear correlation was found between capillary and arterial lactate concentration (Lcap = 1.02 Lart + 0.04; r = 0.98; p < 0.001). The mean difference was -0.08 mmol/l and the limits of agreement (+/- 2 SD) were +/- 0.69 mmol/l (-0.77 to 0.61 mmol/l). ⋯ Our data show that capillary blood lactate measurements in newborn babies yield lactate concentrations equivalent to arterial measurements over a large concentration range.