Pediatrics
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An acoustic monitor to detect apnea in infants has been developed. Recordings of a signal derived from breath sounds at the nose were made in eight premature infants and compared with observation of the infant and with transthoracic impedance and ECG monitoring. ⋯ The ECG monitor alarmed during the nine spells in which heart rate dropped below 100 beats per minute, 27.5 +/- 9.7 seconds after breath sounds ceased. Inasmuch as the acoustic device detects absent airflow during central or obstructive apnea before bradycardia occurs and is insensitive to body movements, it represents an improved monitoring technique for infants with apnea.
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To evaluate the effectiveness of the dorsal penile nerve block in reducing the stress of circumcision upon newborns, physiologic measurements in 30 healthy full-term infants (including transcutaneous oxygen levels, crying time, heart rate, and respiratory rate) were monitored continuously before, during, and after the operation. Infants receiving the dorsal penile nerve block with lidocaine (1% Xylocaine) (N = 20) experienced significantly less stress, as evidenced by smaller decreases in transcutaneous oxygen pressure levels, less time spent crying, and smaller increases in heart rate, than infants circumcised in an identical manner without anesthetic (N = 10). No complications resulted from injection of the local anesthetic or from the circumcision procedure itself. Inasmuch as dorsal penile nerve block has a low complication rate, is simple to learn, and adds little time or expense to the overall procedure, and if it proves to be as effective clinically as the physiologic data indicate, the dorsal penile nerve block should be considered for every infant undergoing circumcision.
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Randomized Controlled Trial Clinical Trial
Optimal position for a spinal tap in preterm infants.
Inasmuch as spinal taps in preterm infants are frequently accompanied by clinical deterioration, the optimal position for this procedure was investigated. Three positions were each randomly assigned for five minutes to 17 healthy preterm infants without a spinal tap actually being performed: (1) lateral recumbent with full flexion (flexed position), (2) lateral recumbent with partial neck extension (extended position), and (3) sitting with head support and spine flexion (upright position). Transcutaneous PO2 and PCO2 were monitored in all infants, minute ventilation (VI) in seven, and heart rate and blood pressure in ten infants. ⋯ Heart rate increased in each position whereas blood pressure remained unchanged. These data suggest that although hypoventilation may contribute to the observed decrease in transcutaneous PO2, ventilation/perfusion imbalance appears to be the major mechanism. As spinal taps performed in the widely accepted flexed position carry the greatest risk of potential morbidity, it is recommended that this position be modified with neck extension or that spinal taps be performed in the upright position.
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Comparative Study
A comparison study of parental adaptation following a child's death at home or in the hospital.
Mothers and fathers of 37 deceased pediatric oncology patients were interviewed 3 to 28 months after their child's death. Twenty-four of these families had participated in a formal Home Care Program for dying children, whereas the remaining 13 families had children who died in the hospital. Parental adaptation following the home care experience appeared to be more favorable than following terminal care and death in the hospital. ⋯ Ratings given by parents providing home care indicated a significant reduction in guilt during the home care experience which was maintained at 6 and 12 months following the child's death. In contrast, parents who did not provide home care reported intensified feelings of guilt during their child's terminal hospitalization which were unresolved at one year after the child's death. The results are discussed in terms of the practical and emotional benefits that may be derived from a family's voluntary choice of home care for dying children.