The Journal of pediatrics
-
The Journal of pediatrics · Nov 1994
Assessment of ductus arteriosus shunt in preterm infants supported by mechanical ventilation: effect of interatrial shunting.
We studied 51 preterm infants (< 1500 gm) with serial color Doppler echocardiography to determine the impact of incompetence of the foramen ovale on the hemodynamic implications of shunting through a patent ductus arteriosus. Doppler and two-dimensional echocardiographic measures included left atrial/aortic root ratio, right (RVSV) and left ventricular stroke volumes (LVSV), and outputs to determine relative ventricular outputs (RVSV/LVSV) and to calculate the pulmonary/systemic flow ratio (Qp/Qs), the diameter of the color flow Doppler mapping of interatrial and ductal shunts, pulsed Doppler pattern, and velocity of those shunts. The dominant direction of shunting at the ductal and atrial levels was left to right. ⋯ We conclude that atrial shunting has a significant impact on the hemodynamic implications of ductal shunting in many very preterm infants. This renders use of the relative ventricular outputs to calculate Qp/Qs inaccurate as a single measure of shunt size in patent ductus arteriosus. If the shunt is predominantly left to right, the most accurate assessment is provided by color flow ductal shunt diameter.
-
The Journal of pediatrics · Oct 1994
Case ReportsLactic acidosis and renal enlargement at diagnosis and relapse of acute lymphoblastic leukemia.
Bilateral renal enlargement was noted on ultrasonography during an extensive renal evaluation for severe hypokalemic metabolic acidosis with an increased anion gap in a 12-year-old Hispanic boy who had normal results of a physical examination and complete blood count. The patient was found to have acute lymphoblastic leukemia. Resolution of the lactic acidosis and bilateral renal enlargement occurred with initiation of chemotherapy and recurred with each subsequent relapse.
-
The Journal of pediatrics · Oct 1994
A practical and reliable method of measuring blood pressure in the neonate by pulse oximetry.
We investigated the reliability of the plethysmographic waveform of the pulse oximeter to measure systolic blood pressure in sick neonates. ⋯ Measurements of blood pressure in the neonate by means of pulse oximetry waveform analysis are easily obtainable and more accurate than those obtained by the oscillometric method.
-
The Journal of pediatrics · Sep 1994
Randomized Controlled Trial Comparative Study Clinical TrialTreatment of asymptomatic congenital syphilis: benzathine versus procaine penicillin G therapy.
We compared the efficacy of two treatment regimens for asymptomatic congenital syphilis. Between June 1989 and July 1991, we prospectively and randomly assigned 169 patients to receive either one dose of benzathine penicillin G or procaine penicillin G for 10 days. There were no significant differences between the treatment groups in regard to birth weight, sex, race, gestational age, Apgar scores, infant or maternal rapid plasma reagin (RPR) titers, fluorescent treponemal IgM antibody, or maternal treatment. ⋯ Among these 152 patients, none had clinical evidence of congenital syphilis at follow-up, and all the patients tested at 2 to 3 months after treatment (68 in the benzathine penicillin G group and 61 in the procaine penicillin G group) had at least a fourfold decrease in RPR titers. The RPR became nonreactive in all but three of the infants (two in the procaine penicillin G group and one in the benzathine penicillin G group; all three were 2 to 3 months of age when last tested). We conclude that treatment failure did not occur with either regimen and that there was no significant difference in outcome between the two groups.
-
The Journal of pediatrics · Sep 1994
Clinical TrialAbnormal hypoxemia after life-threatening events in infants born before term.
This study aimed to determine whether preterm infants who have a history of apparent life-threatening events (ALTE) have abnormalities in oxygenation and, if so, whether the ALTE would stop with oxygen therapy. We assessed 92 patients (median gestational age at birth, 32 weeks (range, 24 to 36 weeks); median birth weight, 1840 gm (650 to 3500 gm)) who had had a single (n = 20) or recurrent ALTE. Median postnatal age at referral was 3.2 months (0.5 to 44.7 months). ⋯ Monitoring of transcutaneous oxygen tension at home was undertaken in 84 patients. To date, this has been discontinued in 81 after a median duration of 7.3 months (0.3 to 18.9 months). We conclude that recognition and treatment of abnormalities in episodic or baseline hypoxemia may reduce the risk of further ALTE in previously preterm infants.