The Journal of pediatrics
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The Journal of pediatrics · Jul 1988
Factors associated with brain herniation in the treatment of diabetic ketoacidosis.
To determine factors contributing to life-threatening brain herniation in patients treated for severe diabetic ketoacidosis, we analyzed history, laboratory data, rate and composition of fluid and insulin administration, and time to onset of brain herniation in nine new cases and 33 prior reports. The overall rate of fluid administration was inversely correlated with the time of onset of herniation (r = -0.32, p = 0.04). ⋯ During treatment, "calculated" serum sodium concentrations fell significantly and were less than 130 mEq/L in 33% of cases at the time of herniation. These data indicate that excessive secretion of vasopressin may exacerbate the brain edema, and that limitation of the rate of fluid administration may be prudent.
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The Journal of pediatrics · Apr 1988
Randomized Controlled Trial Clinical TrialNeed for endotracheal intubation and suction in meconium-stained neonates.
In a prospective study, we determined whether routine immediate tracheal aspiration at birth is necessary in meconium-stained but otherwise normal infants delivered vaginally and having a 1-minute Apgar score greater than 8. A total of 572 newborn infants who met these criteria were randomly allocated to one of two groups. ⋯ There was no mortality among infants in the study, but morbidity, mainly pulmonary and laryngeal disorders, occurred in six of 308 group I infants and in none of the group II infants (P less than 0.025). Immediate tracheal suction is not a harmless intervention, and should be considered superfluous in a vigorous term neonate born with meconium-stained amniotic fluid.
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Axial movement of the right hemidiaphragm during tidal breathing was recorded using real-time ultrasonography in 46 healthy term infants. Displacement was 2.6 +/- 0.1, 3.6 +/- 0.2, and 4.5 +/- 0.2 mm (mean +/- SEM) for the anterior, middle, and posterior thirds, respectively. Diaphragmatic movement was significantly greater in the middle and posterior segments than in the anterior segment (P less than 0.0001). ⋯ Diaphragmatic movement was also assessed in nine infants who required mechanical ventilation and pharmacologic paralysis because of respiratory disease. In these infants, axial movement of the right hemidiaphragm was less in the middle and posterior thirds (P less than 0.05 and P less than 0.01, respectively) than in spontaneously breathing infants, and posterior movement was not predominant. Normative data for axial diaphragmatic movement may be of clinical value in the assessment of defects of the diaphragm, rib cage, or abdomen in newborn infants and may allow further understanding of the direct effects of therapeutic interventions on the respiratory system in infancy.
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The Journal of pediatrics · Mar 1988
Ambulatory care of febrile infants younger than 2 months of age classified as being at low risk for having serious bacterial infections.
We prospectively examined whether febrile infants younger than 2 months of age who were defined as being at low risk for having bacterial infection could be observed as outpatients without the usual complete evaluation for sepsis and without antibiotic treatment. A total of 237 previously healthy febrile infants were seen at the Pediatric Emergency Room over 17 1/2 months. One hundred forty-eight infants (63%) fulfilled the criteria for being at low risk: no physical findings consisting of soft tissue or skeletal infections, no purulent otitis media, normal urinalysis, less than 25 white blood cells per high-power field on microsopic stool examination, peripheral leukocyte count 5000 to 15,000/mm3 with less than 1500 band cells/mm3. ⋯ All infants were observed for at least 10 days after the last examination. The fever resolved spontaneously in all infants but two, with otitis media, who were treated as outpatients. Our data suggest that management of fever in selected young infants as outpatients is feasible if meticulous follow-up is provided.