Archives of disease in childhood
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The survival of children in the South East Thames region, born between 1970 and 1979 and diagnosed as having some form of cerebral palsy was investigated. Of the 732 children studied, 651 (90%) are still alive, and hence cerebral palsy must be regarded as a condition with which people live rather than a condition of which they die. ⋯ Our evidence suggests that, though immobility and severe mental subnormality are the strongest predictors of mortality in children with cerebral palsy, the majority of even the most severely affected patients survive to adulthood. It is therefore appropriate to plan for their survival by funding and evaluating programmes to maximise health, independence, and quality of life.
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A girl who developed a lung cyst at 24 hours of age during gentle ventilation for respiratory distress syndrome is reported. Instead of resolving as expected of a pseudocyst it continued to expand. Resection at 1 year of age showed a cyst entirely surrounded by capillary haemangioma. Aspiration of this cyst would have been dangerous.
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Comparative Study
Red cell volume and cardiac output in anaemic preterm infants.
To test the hypothesis that haemoglobin concentration is a poor predictor of benefit from transfusion in preterm infants, and that red cell volume is the most important indicator of anaemia, 24 preterm infants receiving red cell transfusions had red cell volume, haemoglobin concentration, and cardiac output measured before and after transfusion. Red cell volume was measured either using dilution of autologous fetal haemoglobin with donor adult haemoglobin, or with a new technique using biotin as a red cell label. The two techniques give similar results. ⋯ The red cell volume before transfusion correlated well with changes in cardiac output following transfusion, infants with a red cell volume before transfusion of less than 25 ml/kg showing a fall in cardiac output, and those with a red cell volume of greater than 25 ml/kg not showing a significant fall. There was no correlation between haemoglobin concentration, packed cell volume, or change in packed cell volume with changes in cardiac output after transfusion. A red cell volume of 25 ml/kg seems to be critical in preterm infants with anaemia, and infants with values below this are those most likely to benefit from transfusion.
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Comparative Study
Circulatory effects of fast ventilator rates in preterm infants.
High frequency positive pressure ventilation has been suggested to result in a lower incidence of respiratory complications in preterm infants with idiopathic respiratory distress syndrome compared with ventilation at conventional rates. A possible disadvantage is compromise of the infant's cardiovascular condition secondary to inadvertent positive end expiratory pressure (PEEP). ⋯ Under certain conditions at the fastest rates used, cerebral blood flow velocity was significantly influenced by changes in blood pressure, which may indicate impaired cerebrovascular regulation. Though other factors (such as the severity of the infants' illness or the use of paralysis) may have been responsible for this apparent blood pressure passivity, the role of high frequency positive pressure ventilation in such infants warrants further study.