The Journal of pediatrics
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The Journal of pediatrics · Oct 1996
Clinical Trial Controlled Clinical TrialImpaired response to furosemide in hyperprostaglandin E syndrome: evidence for a tubular defect in the loop of Henle.
In hyperprostaglandin E syndrome (HPS) renal wasting of electrolytes and water is consistently associated with enhanced synthesis of prostaglandin E2. In contrast to Bartter or Gitelman syndrome (BS/GS), HPS is characterized by its severe prenatal manifestation, leading to fetal polyuria, development of polyhydramnios, and premature birth. This disorder mimics furosemide treatment with hypokalemic alkalosis, hypochloremia, isosthenuria, and impaired renal conservation of both calcium and magnesium. ⋯ In parallel, the latter also had a markedly impaired saluretic response (delta Cl(urine) 0.14 +/- 0.04 mmol/kg per hour vs 0.85 +/- 0.09 mmol/kg per hour, p < 0.001; delta Na(urine) 0.23 +/- 0.06 mmol/kg per hour vs 0.77 +/- 0.09 mmol/kg per hour, p < 0.001). Furosemide therapy further enhanced prostaglandin E2 excretion in patients with HPS (54 +/- 17 to 107 +/- 28 ng/hr per 1.73 m2, p < 0.05), whereas no significant effect was observed in healthy children (20 +/- 3 to 12 +/- 3 ng/hr per 1.73 m2). We conclude that a defect of electrolyte reabsorption in the thick ascending limb of the loop of Henle plays a major role in HPS.
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The Journal of pediatrics · Oct 1996
High-frequency pressure-control ventilation with high positive end-expiratory pressure in children with acute respiratory distress syndrome.
Animal models suggest that high-frequency ventilation with low tidal volumes and high positive end-expiratory pressure (PEEP) minimize secondary injury to the lung. We hypothesized that using a high-frequency pressure-control mode of ventilation with high PEEP in children with severe acute respiratory distress syndrome (ARDS) would be associated with improved survival. ⋯ The high-frequency positive-pressure mode of ventilation was safe and was associated with an improved survival rate (89%) for children with severe ARDS. Limitation of both inspired oxygen and tidal volume, along with aggressive treatment of air leak, may have contributed to the improved survival rate.
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The Journal of pediatrics · Oct 1996
Evaluation of interleukin-6 and soluble receptors of tumor necrosis factor for early diagnosis of neonatal infection.
To evaluate plasma levels of interleukin-6 (IL-6) and soluble tumor necrosis factor receptors (sTNF-R) 55 and 75 in neonates as a contribution to the early diagnosis of infection. ⋯ A plasma IL-6 level of 100 pg/ml or greater, obtained before the twelfth hour of life, appears to be an ideal marker for detecting early-onset neonatal infection with a high degree of sensitivity and specificity. After the twelfth hour, the combined determination of IL-6 and C-reactive protein may be equally useful. The sTNF-R levels appear to be less useful in the early diagnosis of infection because of their smaller magnitude of variation.
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The Journal of pediatrics · Oct 1996
Relationship between blood pressure and cardiac output in preterm infants requiring mechanical ventilation.
To assess the contribution of cardiac output in determining the blood pressure of preterm infants and to identify other factors that may be important. ⋯ Normal blood pressure cannot necessarily be equated with normal systemic now. These data emphasize the importance of other influences, and in particular that of varying systemic vascular resistance, in the determination of blood pressure in preterm infants.
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The Journal of pediatrics · Sep 1996
Serum lidocaine concentrations after subcutaneous administration in patients undergoing cardiac catheterization in a pediatric institution.
We wished to determine serum lidocaine concentrations after subcutaneous injection during cardiac catheterization. ⋯ Lidocaine dose must be considered when the drug is used for local anesthesia in children.