American journal of diseases of children (1960)
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Letter Case Reports
A half shell of a pistachio nut that simulated a tumor.
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We used Guttman scaling procedures to devise a quantitative, reproducible measure among pediatric residents of attitude change concerning neonatal resuscitation. Preliminary cross-sectional testing of an incoming group of pediatric level 1 residents and graduating pediatric level 3 residents indicated that pediatric level 3 residents were more reluctant to resuscitate high-risk infants. This reluctance was not due to age differences. ⋯ Residents showed significantly increased reluctance to resuscitate infants at the end of the first year of training and again at the end of the third year of training. These attitude changes were unrelated to gender, marital status, religious preference, or ethnic background. Data acquired both cross-sectionally and longitudinally indicated that attitudes toward neonatal resuscitation changed during residency training.
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Comparative Study
The heart is under the lower third of the sternum. Implications for external cardiac massage.
Current guidelines for cardiopulmonary resuscitation in children state that the heart lies under the midsternum in infancy and descends with age. To verify this statement, we studied 55 patients, aged 1 day to 19 years, including eight premature infants, during either routine chest x-ray films or right-sided heart angiography. ⋯ Analysis of variance indicated that there was no significant difference in this location between age groups. These results suggest that recommendations for external cardiac massage in infants and children may need to be revised.
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We reviewed our experience with home monitor observations of 83 preterm infants (postconceptional age, 36 to 44 weeks) who had persistent apnea, bradycardia, or cyanosis. Polygraphic recordings before discharge showed that 92% of these infants had cardiorespiratory abnormalities that included prolonged (greater than 20 s) apnea, excessive periodic breathing (greater than 15%), bradycardia (greater than 80 beats per minute), feeding hypoxemia, or elevated carbon dioxide values. ⋯ While polygraphic studies were helpful in documenting specific cardiorespiratory abnormalities, neither these abnormalities nor the clinical characteristics of the infants identified those infants experiencing subsequent home monitor alarms requiring parental intervention. Our data suggest that some preterm infants with persistent episodes of apnea, bradycardia, and cyanosis beyond 36 weeks of postconceptional age remain at risk for future serious episodes for several months.