Biology of the neonate
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Biology of the neonate · Jan 2005
ReviewMethylxanthine therapy for apnea of prematurity: evaluation of treatment benefits and risks at age 5 years in the international Caffeine for Apnea of Prematurity (CAP) trial.
Methylxanthine therapy reduces the frequency of apnea and the need for mechanical ventilation. Recent research has raised concerns about the safety of methylxanthines in very preterm infants. Possible adverse effects include poor growth, worsening of hypoxic-ischemic brain damage and abnormal childhood behavior. ⋯ We will therefore extend the follow-up to age 5 years. The main outcome at 5 years will be a composite of death or survival with severe disability in at least one of six domains: cognition, neuromotor function, vision, hearing, behavior, and general health. Once this project is completed, caffeine will be one of the most rigorously evaluated neonatal therapies.
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Recent advances in neonatal care have greatly improved the chances for survival of very sick and/or very preterm neonates and have in fact changed the concept and the limits of viability. However, in some situations, when the infant's demise can only be postponed at the price of great suffering or when survival is associated with severe disabilities and an intolerable life for the patient and the parents, it may be unwise to employ the full armamentarium of modern neonatal intensive care. In those circumstances withholding or withdrawing mechanical ventilation and other life-saving, though invasive and painful, procedures might be a better option. This review examines the ethical principles underlying those difficult decisions, the most frequent circumstances where they should be considered, the role of parents and other parties in the decision-making process and the reported behavior of neonatologists in many American and European neonatal intensive care units.
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Biology of the neonate · Jan 2005
Clinical TrialLaryngeal mask airway used as a delivery conduit for the administration of surfactant to preterm infants with respiratory distress syndrome.
The laryngeal mask airway (LMA(TM), Laryngeal Mask Co. Ltd, Jersey, UK) is a supraglottic device used to administer positive pressure ventilation (PPV) in adults, pediatric and neonatal patients. ⋯ The LMA may be a useful and noninvasive conduit for the administration of surfactant therapy. A large randomized comparative clinical trial will be required to confirm the efficacy of this technique.
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Biology of the neonate · Jan 2005
Effect of two amino acid solutions on leucine turnover in preterm infants.
To assess the effect of two different parenteral amino acid mixtures, Trophamine and Primene, on leucine turnover in preterm infants. ⋯ Primene administration results in lower leucine released from proteins, an estimate of protein breakdown, than Trophamine in preterm infants. Increases in whole body leucine turnover in response to administration of i.v. amino acids is influenced by the composition of the amino acid mixture. The factors responsible for this difference remain to be elucidated.
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Biology of the neonate · Jan 2005
Cold perfluorochemical-induced hypothermia protects lung integrity in normal rabbits.
To test the hypothesis that intrapulmonary perfluorochemical (PFC) liquid may induce hypothermia, and to compare the effects of internal (IC), external (EC), and combined cooling techniques (EC + IC), 14 juvenile rabbits were randomized to EC by a cold blanket (4 degrees C, n = 5), IC by intrapulmonary cold PFC liquid lavage (4 degrees C, n = 5), or combined IC with PFC and EC (n = 4). Arterial blood gas, blood pressure, and lung mechanics were monitored, and lung histology was examined by light microscopy. ⋯ Histological assessment revealed varied atelectasis in all lung regions in EC, whereas PFC-filled lungs (IC and EC + IC) demonstrated more homogenous expansion and no evidence of atelectasis. The results indicate that intrapulmonary PFC may be an effective technique to induce and/or augment hypothermia while supporting gas exchange, lung volume and pulmonary architecture.