Archives of disease in childhood
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The blood flow velocities in the basal cerebral arteries can be recorded at any age by transcranial Doppler sonography. We examined nine children with either initial or developing clinical signs of brain death. Soon after successful resuscitation increased diastolic flow velocities indicated a probable decrease in cerebrovascular resistance; this was of no particular prognostic importance. ⋯ Shunting of blood through the circle of Willis without effective cerebral perfusion may explain this phenomenon. No patient had the typical reverberating flow pattern without being clinically brain dead. Transcranial Doppler sonography is a reliable technique, which can be used at the bedside for the confirmation or the exclusion of brain death in children in addition to the clinical examination.
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It was calculated that in the 962 family members of 36 patients with ataxic cerebral palsy there were 75 (8%) with a history of neurodevelopmental disorder and 31 (3%) with a major congenital malformation. This was not significantly greater than expected, and does not support the hypothesis of a genetic non-Mendelian role in the aetiology of ataxic cerebral palsy.
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Fifty one neonatal tumours were diagnosed in Glasgow over a 32 year period. The most common tumours were teratomas (n=19), others being renal tumours (n=9), soft tissue sarcomas (n=8), neuroblastomas (n=7), and others (n=8). Of the total, 31% were malignant. Neonatal tumours pose difficult problems of management, and because of their comparative rarity and the great potential for cure we recommend that all centres dealing with such patients should contribute to and benefit from a Neonatal Tumour Registry.
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The timing of immunisations for preterm infants is controversial. Because of the statement by the British Paediatric Association/Joint Committee on Vaccination and Immunisation Liaison group that immunisations should normally begin three months after the date of birth, the records of all infants born in 1984 and currently (June 1986) resident in the London Borough of Newham were studied to find out if this recommendation was being implemented. Subjects were divided into groups by birth weight and where possible by gestational age. ⋯ Final overall uptake was poor for all groups. Differences among groups in numbers consenting were not an important factor. Informing those responsible for giving the immunisations of these findings has stimulated their interest in improving practice by implementing the recommendations.
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Patient triggered ventilation was assessed in 14 neonates (gestational age 24-40 weeks). Inspiratory changes in airflow, monitored by a pneumotachograph, were used to trigger the ventilator and this was not associated with complications. Patient triggered ventilation was maintained for up to eight hours (mean duration five hours). ⋯ A greater improvement in oxygenation was shown when trigger mode was used during the recovery phase of respiratory distress syndrome. Only one infant, who made very little respiratory effort, failed to improve. We conclude that patient triggered ventilation may be used as an effective form of neonatal ventilation.