The Journal of pediatrics
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The Journal of pediatrics · Mar 1992
Arterial oxygen saturation in preterm infants at discharge from the hospital and six weeks later.
To obtain normal data on arterial oxygen saturation (SaO2) in preterm infants and to study early developmental changes in SaO2, we obtained overnight tape recordings of SaO2 and breathing movements in 160 preterm infants at their discharge from three special care baby units (mean gestational age at birth 33 weeks; at time of study, 37 weeks). One hundred ten infants (69%) underwent a second recording 6 weeks later. Median baseline SaO2 during regular breathing was 99.5% (range 88.7% to 100%) at discharge, and 100% (range 95.3% to 100%) at follow-up (p less than 0.001). ⋯ The preterm infants had a significantly higher baseline SaO2 and no more desaturation than the infants born at term. Knowledge of normal ranges of oxygenation and their changes with age may be of value in identifying clinically undetected hypoxemia in preterm infants at discharge from the hospital. The potential influence of such hypoxemia on clinical outcome remains to be determined.
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The Journal of pediatrics · Mar 1992
Case ReportsStroke in a cohort of patients with homozygous sickle cell disease.
Strokes occurred in 17 of 310 children with homozygous sickle cell disease who were followed from birth, representing an incidence of 7.8% by the age of 14 years. Two children had subarachnoid hemorrhage, one having resolution of symptoms after aneurysm surgery and another dying of a presumed second hemorrhage 14 days later. The remaining 15 strokes were presumed to be cerebral infarction, although autopsy, angiographic, or computed tomographic evidence was available in only 8 children. ⋯ Steady-state hematologic data revealed significantly higher leukocyte counts than in control subjects without strokes at age 1 year and in the last study preceding the stroke. The initial stroke coincided with an acutely lowered hemoglobin value in 5 patients (3 aplastic crises, 1 acute splenic sequestration, 1 probable pulmonary sequestration) and with painful crises in another 7 patients. We conclude that a high leukocyte count and an acute decrease of hemoglobin are risk factors for stroke in patients with homozygous sickle cell disease.
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The Journal of pediatrics · Mar 1992
Case ReportsIntentional infantile ethylene glycol poisoning presenting as an inherited metabolic disorder.
A 6-month-old girl was hospitalized on three occasions for irritability, vomiting, acidosis, and hypotonia. During the third hospitalization hyperglycinemia and urinary glycolic acid were detected. Ethylene glycol was discovered in the infant's blood and bottled formula. Clinicians must consider ethylene glycol intoxication as a cause of recurrent infantile metabolic acidosis.
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The Journal of pediatrics · Feb 1992
Limitations of the Glasgow Coma Scale in predicting outcome in children with traumatic brain injury.
To study the hypothesis that, in the absence of an ischemic-hypoxic state, children with severe traumatic brain injury and with unfavorable Glasgow Coma Scale scores may have good recovery. ⋯ A low Glasgow Coma Scale score does not always accurately predict the outcome of severe traumatic brain injury; in the absence of hypoxic-ischemic injury, children with traumatic brain injury and Glasgow Coma Scale scores of 3 to 5 can recover independent function.
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The Journal of pediatrics · Jan 1992
Randomized Controlled Trial Comparative Study Clinical TrialSodium restriction versus daily maintenance replacement in very low birth weight premature neonates: a randomized, blind therapeutic trial.
To test the hypothesis that restriction of sodium intake during the first 3 to 5 days of life will prevent the occurrence of hypernatremia and the need for administration of large fluid volumes, we prospectively and randomly assigned 17 babies (mean +/- SD: 850 +/- 120 gm; 27 +/- 1 weeks of gestation) to receive in blind fashion either daily maintenance sodium or salt restriction with physician-prescribed parenteral fluid intake. Maintenance-group infants received 3 to 4 mEq of sodium per kilogram per day; restricted infants received no sodium supplement other than with such treatments as transfusion. Sodium balance studies conducted for 5 days demonstrated that maintenance salt intake resulted in a daily sodium balance near zero, whereas sodium-restricted infants continued to excrete urinary sodium at a high rate, which promoted a more negative balance (average daily sodium balance -0.30 +/- 1.78 SD in maintenance group vs -3.71 +/- 1.47 mEq/kg per day in restriction group; p less than 0.001). ⋯ Both groups of infants produced urine that was neither concentrated nor dilute, with a high fractional excretion of sodium; renal failure was not observed. The mortality rate was not affected, but the incidence of bronchopulmonary dysplasia was significantly less in the sodium-restricted babies (p less than 0.02). We conclude that in tiny premature infants, a fluid regimen that restricts sodium may simplify parenteral fluid therapy targeted to prevent hypernatremia and excessive administration of parenteral fluids.