Archives of disease in childhood
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Mismatches between provision of paediatric cardiopulmonary resuscitation (CPR) and potential to benefit are examined. Deficiencies are most likely to occur in peripheral maternity units but futile CPR is more common in emergency departments where the child is unknown. Decision making in individual cases is best retained by the medical profession for the sake of the child and family. American style intervention by the legislature is likely to dissipate scarce resources and perhaps harm infants not capable of benefiting.
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Randomized Controlled Trial Comparative Study Clinical Trial
Randomised controlled trial of colloid infusions in hypotensive preterm infants.
Colloid infusions are often given to treat hypotension in preterm infants. The aim of this work was to assess whether it was the amount of protein or the volume of the colloid infused which accounted for the observed increase in blood pressure. Sixty preterm infants were randomised (20 in each group) to receive 5 ml/kg 20% albumin, 15 ml/kg fresh frozen plasma, or 15 ml/kg 4.5% albumin. ⋯ There was no significant difference in the blood pressure of the three groups before or one hour after beginning the infusion. The mean increase in blood pressure one hour after completing the infusion, however, was significantly lower in infants receiving 20% albumin: 9% compared with 17% in the group receiving 4.5% albumin, and 19% in the group receiving fresh frozen plasma. It is concluded that the volume infused rather than albumin load is important in producing a sustained increase in blood pressure.
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The length of stay of preterm babies discharged from a neonatal nursery was determined and the predictive value of perinatal factors on the duration of stay was assessed on 762 preterm Salford born babies admitted to Hope Hospital neonatal unit between April 1986 and November 1990. The data were analysed using multiple logistical regression and forward stepwise regression analysis. Babies were discharged at a median (quartile range) postconceptional age of 36.3 (35.3-37.6) weeks. ⋯ The most significant predictive factor was gestational age accounting for 40% of variability compared with respiratory difficulties (6%), low birth weight (4%), sepsis (2%), and metabolic problems (1%). Most babies are discharged at approximately the same postconceptional age despite variations in their clinical course. Gestational age at birth is the most powerful predictive factor of time of discharge.
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Comparative Study
Cerebrovascular carbon dioxide reactivity and failure of autoregulation in preterm infants.
Changes in cerebral blood flow velocity (CBFV) in response to a rise in arterial carbon dioxide tension (PaCO2) in 94 ventilated preterm infants were determined using Doppler ultrasound to assess whether the nature of this change might predict subsequent neurological injury. Concomitant changes in mean arterial pressure (MAP) were recorded. Both CBFV and MAP rose significantly in response to the rise in PaCO2, the response being significantly less in the first 24 hours. ⋯ This dependency lasted for the duration of paralysis. Changes in CBFV after a rise in PaCO2 did not predict subsequent neurological injury. The influence of pancuronium on cerebrovascular regulation warrants further study.