Archives of disease in childhood
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Randomized Controlled Trial Comparative Study Clinical Trial
Multicentre trial on feeding low birthweight infants: effects of diet on early growth.
A large multicentre study on the short and long term clinical and developmental outcome of infants randomised to different diets is being undertaken. This report represents an interim analysis of the early postnatal growth performance of an unselected population of 194 preterm infants (gestation, mean (SD) 31 . 0 (2 . 9) weeks; birthweight, mean (SD) 1364 (294) g), both ill and well, examined in two (of four) parallel trials. One trial compared banked breast milk with a new preterm formula (primary trial); the other compared these diets as supplements to maternal milk (supplement trial). ⋯ By the time they reach 2000 g, infants of birthweights 1200 to 1849 g fed on banked breast milk and infants below 1200 g fed on either banked breast milk or maternal milk supplemented (as necessary) with banked breast milk, fulfilled stringent criteria for failure to thrive (weight less than 2 SD below the mean for age). Only infants fed the preterm formula as their sole diet had maintained their birth centile by discharge from hospital. The misleading nature of comparisons between extrauterine and intrauterine steady state weight gains is emphasised.
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We report three siblings who presented with a clinical picture of persistent pulmonary hypertension of newborn and died between 4 and 15 days of age. Pulmonary artery pressure in all was above systemic values, with a right to left shunt via either the foramen ovale or ductus arteriosus, or both. Histology of the pulmonary vascular bed showed extension of muscle into small arteries which are normally non-muscular.
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Comparative Study Clinical Trial Controlled Clinical Trial
Treatment choice in acute rheumatic carditis.
A trial was conducted using sequential analysis by pairs to compare the efficacy of corticosteroids and salicylates in the treatment of acute rheumatic carditis. The results show a significantly favourable effect of steroid treatment both in clinical response and in reduction of the erythrocyte sedimentation rate. In addition, patients receiving steroids usually had a shorter hospital stay. The use of steroids in acute rheumatic fever with carditis is recommended.
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Doxapram infusion was given to five preterm infants in whom therapeutic concentrations of theophylline had failed to control episodes of apnoea. Doxapram successfully controlled the apnoea, the arterial blood PCO2 value decreased significantly, and no side effects were reported.
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Eighty nine children under 2 years of age with skull fracture were studied retrospectively--29 children with definite non-accidental injury serially recorded by the Departments of Paediatrics and Forensic Medicine, and 60 children consecutively admitted to hospital with skull fractures after accidents. There were 20 deaths including 19 among abused children. Multiple injuries and an inadequate history assisted in diagnosing abuse. ⋯ No fractures measuring more than 5.0 mm on presentation were found after accidents, but 6 of these 'growing fractures' were found in abused children. Accidents usually resulted in single, narrow, linear fractures most commonly of the parietal, with no associated intracranial injury. The results suggest that in skull fracture in young children where a minor fall is alleged, it is possible to recognise abuse by consideration of the fracture alone.