Archives of disease in childhood
-
After a difficult nasal intubation a premature infant leaked cerebrospinal fluid (CSF) from one nostril. After developing bacterial meningitis, the baby was referred for neurosurgical management of the CSF fistula. Transaxial computed tomograms demonstrated a nasal encephalocele, but coronal scans were needed to show the defect in the cribriform plate.
-
The study of gastric emptying in the preterm infant has been hampered by the absence of a suitable, valid technique. We have evaluated gastric antral clearance using serial ultrasonic measurement of the antral cross sectional area (ACSA). The study was easy to perform, providing successful results in 15 of 17 low birth-weight infants, with feed volumes of 8-31 ml/kg. ⋯ Gastric antral clearance was observed as a fall in ACSA that began shortly after completion of the feed and returned to prefeed values at a variable rate. The pattern of gastric antral transit was entirely consistent with recognised patterns of gastric emptying and half gastric antral clearance times ranged from 20-63 minutes. Ultrasonic measurement of gastric antral clearance is a new technique allowing the study of gastric emptying in the preterm infant.
-
Clinical Trial Controlled Clinical Trial
Pulse oximetry in sickle cell disease.
Patients with sickle cell disease usually have mild hypoxaemia and their oxyhaemoglobin dissociation curve is shifted to the right. It follows that oxygen saturation in sickle cell disease should be lower than normal. Most subjects in this clinic had normal oxygen saturation by pulse oximetry, however. ⋯ It was found that saturation measured by pulse oximetry was, on the whole, similar to that calculated from the sampled blood. Individual deviations were not random, however, and were partly explained by differences in P50 values. It is concluded that pulse oximetry gives variable results in patients with sickle cell disease and should be used with caution to predict arterial saturation in this patient group.
-
Randomized Controlled Trial Comparative Study Clinical Trial
Randomised trial of methods of extubation in acute and chronic respiratory distress.
Sixty infants (median gestational age 29 weeks) with acute and 60 infants (median gestational age 25 weeks) with chronic respiratory distress were randomised to be extubated either directly into a headbox or onto 3 cm H2O nasal continuous positive airway pressure (CPAP). Our aim was to test the hypothesis that extubation onto nasal CPAP rather than directly into a headbox was more likely to be associated with successful extubation in infants with acute rather than chronic respiratory distress. Overall the failure rate of extubation was approximately 33%, with no significant difference between the infants with acute and chronic respiratory distress. There was no significant difference in the failure rate of extubation among infants randomised to receive nasal CPAP or headbox oxygen in either the acute or chronic respiratory distress groups.
-
A raised respiratory rate is a useful sign in the diagnosis of pneumonia in children. It was observed that children with malaria and other febrile illnesses may also present with a raised respiratory rate. To determine the extent to which increased body temperature contributes to the raised respiratory rate observed in these children the effect of change in body temperature on respiratory rate was measured in 186 sick Gambian children with a raised respiratory rate, including those with pneumonia or malaria. ⋯ It is concluded that respiratory rate is to some extent dependent on body temperature in children with febrile illnesses such as pneumonia and malaria, but that this does not alone account for the raised respiratory rate seen in these children. The effect of reduction in body temperature on respiratory rate does not help to distinguish children with pneumonia from those with malaria. A history of recent use of an antipyretic or other measures to control fever is important when evaluating children for possible pneumonia.