The Journal of pediatrics
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The Journal of pediatrics · Sep 1988
Clinical Trial Controlled Clinical TrialClinical trial of naloxone in birth asphyxia.
To determine whether endogenous opiates play a role in the pathogenesis of perinatal asphyxia, a blinded clinical trial of naloxone, a competitive opiate receptor blocker, was undertaken in infants with low 1-minute Apgar scores. Of 85 infants with 1-minute Apgar score 0 to 3, 44 received an injection of naloxone (approximately 0.4 mg/kg) and 41 received saline solution. ⋯ In both groups active muscle tone of upper and lower limbs was increased by naloxone, a response that may not be beneficial in the face of inadequate oxygen delivery to vital organs. We conclude that naloxone at this dose had no readily apparent benefit in the resuscitation of the asphyxiated newborn infant.
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The Journal of pediatrics · Sep 1988
Percutaneous infraclavicular subclavian vein catheterization in critically ill infants and children.
The safety and risks of percutaneous infraclavicular subclavian vein catheterization, when performed by nonsurgical staff, were studied prospectively in 100 consecutive patients. The overall success rate was 92% (with one attempt, 45%; with two attempts, 85%). The procedure was performed under emergency conditions in 35% of the patients, with a success rate of 88.6%. ⋯ No mortality was associated with this procedure. We have found percutaneous infraclavicular subclavian vein catheterization to be a rapid alternative to surgical cutdown for venous access during cardiopulmonary resuscitation. Pediatric residents can be trained, under direct supervision, to perform this procedure with a high success rate and a low complication rate.
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The Journal of pediatrics · Aug 1988
Perinatal asphyxia in infants of insulin-dependent diabetic mothers.
Infants of diabetic mothers are thought to be at risk for perinatal asphyxia. We hypothesized that the following are significant risk factors for perinatal asphyxia: poor third-trimester glycemic control, diabetic vascular disease (nephropathy, retinopathy) appearing in pregnancy, pregnancy-associated hypertension, smoking, prematurity, fetal macrosomia, and maternal hyperglycemia and hypoglycemia within 6 hours preceding delivery. We prospectively studied 162 infants born to 149 diabetic mothers (White classes B through R-T). ⋯ Forty-four infants (26.7%) had perinatal asphyxia. The presence of perinatal asphyxia did not correlate with third-trimester glycemic control, pregnancy-associated hypertension, smoking, fetal macrosomia, or maternal hypoglycemia before delivery, but it did correlate significantly with nephropathy appearing in pregnancy, maternal hyperglycemia before delivery, and prematurity. We speculate that (1) the appearance of diabetic vasculopathy (nephropathy) during pregnancy is accompanied by placental vascular disease and subsequently by fetal compromise and (2) in pregnancy complicated by diabetes, maternal and subsequently fetal hyperglycemia before delivery leads to fetal hypoxemia.
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The Journal of pediatrics · Jul 1988
Comparative StudyEffects of left-to-right ductus shunting on left ventricular output and cerebral blood flow velocity in 3-day-old preterm infants with and without severe lung disease.
The effects of early left-to-right ductus shunting on left ventricular output (LVO) and cerebral blood flow velocity (CBV) were investigated in 3-day-old preterm infants by means of two-dimensional Doppler and M-mode echocardiography. Nineteen infants required mechanical ventilation because of severe lung disease (group A), and 19 had mild or no lung disease (group B). Six infants in each group had predetermined Doppler and M-mode criteria of a hemodynamically significant left-to-right ductus shunt (hsPDA). ⋯ In infants without hsPDA, those in group A had higher LVO (p = 0.012), lower mean arterial pressure (p = 0.003), and lower estimated systemic vascular resistance (p = 0.004) than those in group B. These results indicate that severely ill preterm infants receiving mechanical ventilation are less able than spontaneously breathing infants to defend systemic pressures and cerebral perfusion through an increase of LVO when a large ductus shunt develops. Possible reasons include an elevated baseline LVO, caused by systemic vasodilation, and hence a low preload reserve.