Archives of disease in childhood
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To compare the accuracy of clinical observation and detailed respiratory recordings in identifying infants at high risk of developing pneumothoraces 10 infants, with idiopathic respiratory distress syndrome, were studied at three different ventilator rates. All infants with synchronous respiration at fast rates were correctly identified by clinical observation. ⋯ These criteria enabled correct identification of 'high risk' respiratory patterns on 15 (88%) of the 17 study occasions. These clinical criteria were then used as criteria for selective paralysis; no infant developed a pneumothorax during ventilation.
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A new valveless ventilator, which uses an air jet to provide the driving force for positive pressure ventilation, was used on 13 newborn babies (10 of very low birthweight) who had severe respiratory disease. The ventilator differs from 'true' jet ventilators in that its driving gas does not take part in gas exchange. Functionally it is a pressure pre-set, time-cycled ventilator, whose performance is characterised by the rapid and precise maintenance of both inspiratory and expiratory airway opening pressure. ⋯ On the new ventilator, with the same settings, there was a dramatic and highly significant improvement within 20 to 30 minutes (mean values of arterial pCO2 were 6.45 kPa, pH 7.26, and inspired oxygen concentration 85.7%). This improvement was maintained. The new ventilator represents an important advance in the management of babies with severe respiratory failure.
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Patient triggered ventilation using oesophageal pressure changes was assessed in eight premature neonates. Respiratory activity was reliably recorded and positive pressure inflation occurred synchronously with inspiration. Peristalsis resulted in only minimal interference. During patient triggered ventilation, inflating volume and oxygenation increased significantly compared with periods of conventional ventilation.
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In 50 infants born to women who continued to take heroin during all or part of their pregnancy the drug withdrawal symptoms were mild and were noted in 21 infants (42%). Only nine infants required treatment. Sudden infant death syndrome occurred in two infants at 4 and 6 months.
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Five years' experience of paediatric intensive care in a district general hospital were analysed retrospectively. A total of 54 infants and children required respiratory support during this time--21 on a high dependency area of the children's ward and 33 on a general intensive care unit. Forty two (78%) of the patients survived, and 33 (61%) of the patients required respiratory support within four hours of admission, thus the experience of the local paediatric and anaesthetic team was crucial to the management of these children. Good intensive care for children can be provided within a district general hospital.