The Journal of pediatrics
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The Journal of pediatrics · Jul 1994
Prolonged cardiorespiratory monitoring of children more than twelve months of age: characterization of events and approach to discontinuation.
We assessed children referred to our apnea program who were > or = 12 months of age, beyond the at-risk period for sudden infant death syndrome (SIDS), but for whom home cardiorespiratory monitoring had continued. Our objectives were to (1) determine reasons for initiation and continuation of monitoring, (2) apply documented monitoring of transthoracic impedance, electrocardiographic signals, and, in a subset of patients, pulse oximetry, to determine the types of cardiorespiratory events that these children experienced, and (3) describe how documented monitoring was applied for eventual discontinuation of monitoring. Among 45 patients (median age, 22 months), 263 disks were collected, representing 2982 monitor days. ⋯ By extension of the audible apnea alarm to 25 or 30 seconds, lowering of the cutoff point for bradycardia alarm, or lowering of the cutoff point for the oximetry alarm, a recommendation to discontinue monitoring could be made for 41 patients. Of these, no child had a recurrence of cardiorespiratory events or died of SIDS. Documented monitoring proved to be a useful clinical tool for investigation of the clinical and physiologic importance of these cardiorespiratory events in children beyond the at-risk period for SIDS; recommendations about discontinuation of monitoring could be made knowledgeably and safely.
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The Journal of pediatrics · Jun 1994
Acute effects of inhaled nitric oxide in children with severe hypoxemic respiratory failure.
To determine the physiologic effects of inhaled nitric oxide (NO) on oxygenation and hemodynamics in children with severe hypoxemic respiratory failure, we studied the acute response to inhaled NO during mechanical ventilation in 17 pediatric patients. Diagnoses included adult respiratory distress syndrome (ARDS) (10 patients), bronchopulmonary dysplasia with viral pneumonitis (6 patients), and acute pneumonitis, caused by respiratory syncytial virus, without chronic lung disease (1 patient). Gas exchange and hemodynamic measurements were compared before and during exposure to inhaled NO (20 ppm) without changing ventilator settings for 30 minutes. ⋯ Fifteen patients were subsequently treated with low-dose inhaled NO (3 to 10 ppm) for 1 to 24 days; 5 (50%) of 10 patients with ARDS and 7 (100%) of the 7 non-ARDS patients survived. We conclude that inhaled NO acutely improves oxygenation and lowers pulmonary vascular resistance without causing adverse hemodynamic effects in severe hypoxemic respiratory failure in pediatric patients. Inhaled NO may be a useful adjuvant therapy in children with acute hypoxemic respiratory failure, including infants with bronchopulmonary dysplasia, but whether prolonged low-dose inhalational NO therapy can reduce morbidity or improve survival rates remains unknown.
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The Journal of pediatrics · Jun 1994
Randomized Controlled Trial Clinical TrialTwo-year follow-up of infants treated for neonatal respiratory distress syndrome with bovine surfactant. Survanta Multidose Study Group.
In 1988 and 1989, a total of 1228 infants were studied in four double-blind, controlled, multidose clinical trials establishing the safety and efficacy of beractant (Survanta intratracheal suspension, Ross Products Division of Abbott Laboratories), a modified bovine lung extract, in prevention and treatment of neonatal respiratory distress syndrome in premature infants. Data on clinical status were collected for surviving infants at hospital discharge and at 6, 12, and 24 months of adjusted age. Significantly fewer beractant-treated infants required supplemental oxygen at discharge (p = 0.036). ⋯ At 12 months of adjusted age, beractant-treated infants had less wheezing than control infants (p = 0.005), and this finding persisted at 24 months of adjusted age (p = 0.008). No circulating antibodies to the proteins present in beractant were found in serum samples at 6 and 12 months of age. These results suggest that the increased survival rate associated with beractant treatment is followed through 2 years of adjusted age by outcomes equivalent to those of untreated control infants.
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The Journal of pediatrics · Jun 1994
Extracorporeal life support for severe pediatric respiratory failure: an updated experience 1991-1993.
The purpose of this study was to examine our recent experience with children who had acute respiratory failure managed with extracorporeal life support (ECLS) from 1991 to 1993, to determine whether a change in survival rate had occurred in comparison with our previous experience. ⋯ Treatment with ECLS is an evolving pulmonary rescue therapy with an 88% survival rate in our recent experience. The survival rate has improved to levels that may not greatly improve in the near future, especially for patients less than 1 year of age. Better patient selection or improved management strategies or both may be responsible for the improved patient outcome.
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The clinical course and outcome of scorpion envenomation in 52 children treated in a pediatric intensive care unit without specific antivenom were retrospectively evaluated and compared with those of scorpion envenomation in the 52 preceding cases treated with specific scorpion antivenom. The demographic, clinical, and laboratory features on hospital arrival were similar in the two groups. The lengths of stay in the pediatric intensive care unit and in the pediatric wards were comparable. ⋯ Our study did not demonstrate any beneficial effect of therapy with antivenom for scorpion envenomation in children. However, our "control" group (i.e., the treated group) was a historical one; thus a prospective, randomized study appears to be warranted. Such a study may define specific subgroups that may benefit from treatment with antivenom.