A thin and semipermeable polyurethane membrane adherently applied to premature neonates as an artificial skin was investigated as an atraumatic surface barrier sufficient to reduce transepidermal ...water loss without inhibiting natural infant skin development during the first few days of life. A sample group of 18 neonates (birth weight mean +/- SEM 1.39 +/- 0.12 kg, gestation mean +/- SEM 31 +/- 1 weeks) received two 3 X 3-cm polyurethane patches adherent over the chest and abdomen. Transepidermal water loss was measured before and after application and after membrane removal. During longitudinal study, seven infants were treated day 1 through day 4 of life and were evaluated for skin integrity 24 hours after patch removal on day 5. Polyurethane membranes produced an acute and significant reduction in transepidermal water loss for the 18 subjects: 21.1 +/- 2.0 g/m2/h before application v 10.5 +/- 1.4 g/m2/h with membranes in place (P less than .001). Immediately after patch removal, transepidermal loss returned to 22.8 +/- 3.0 g/m2/h. Throughout the first four days of life, daily measurements of water loss were significantly less: 53% to as much as 72% reduction from polyurethane-covered sites when compared with adjacent naked skin. After polyurethane membrane removal, skin development of transepidermal barrier function was comparable over both sites. Dressings did not lose adhesive or plastic properties during an extended time in either radiant warmer or incubator environments, electronic monitoring through membranes was not impeded, and adhesive injuries were not observed. An adherent, semipermeable polyurethane membrane may be effective as an atraumatic artificial barrier to prevent large transepidermal water loss and protect the skin of the premature neonate.
The use of dietary fat in preference to carbohydrate offers the theoretic advantage of diminishing carbon dioxide production and thus the respiratory quotient, which may be beneficial for babies with ...chronic lung disease. Ten premature infants (birth weight (mean +/- SEM), 1.13 +/- 0.12 kg; postnatal age, 9 +/- 1 weeks) with bronchopulmonary dysplasia were alternately fed a high-fat and a high-carbohydrate formula each for 1 week, in randomized order. Lower rates of carbon dioxide production (6.6 +/- 0.3 versus 7.4 +/- 0.4 ml/kg per minute; p < 0.05), and consequently lower respiratory quotients (0.80 +/- 0.02 versus 0.94 +/- 0.01 ml/kg per minute; p < 0.005), were observed during the administration of the high-fat formula. There were no significant differences in results of pulmonary function tests with the use of either formula. Both formulas were equally well tolerated and able to promote adequate growth and normal biochemical profiles. However, weight gain was significantly greater with the administration of the high-carbohydrate formula, possibly because of an increase in the accretion of body fat. We conclude that the short-term use of high-fat formula for infants with bronchopulmonary dysplasia decreases carbon dioxide production while maintaining adequate growth and nutritional status.
Objective: The relationship between bronchopulmonary dysplasia (BPD) and neurodevelopmental outcome after extracorporeal membrane oxygenation (ECMO) has not been extensively reported. We compared the ...outcomes in a large series of infants with and without BPD after ECMO.
Study design: Hospital charts and follow-up records of 145 infants treated with ECMO (1985 through 1990) were reviewed. Complete long-term respiratory and follow-up outcome data were available in 64 infants. BPD occurred in 17 survivors; the remaining 47 did not have BPD.
Results: Babies with BPD were more likely to have had respiratory distress syndrome. Mean (± SD) age at ECMO initiation was later for the BPD group (127 ± 66 vs 53 ± 39 hours,
p < 0.001), and the duration of ECMO treatment was longer (192 ± 68 vs 119 ± 53 hours,
p < 0.001). Bayley Scales of Infant Development scores at <30 months were lower in infants with BPD (
p < 0.001), as were three of four Mullen Scales of Early Learning scores (≥30 months,
p < 0.001 or p = 0.01). At 57 ± 16 months 11 (64%) patients with BPD had mild neurologic disabilities, and 3 (18%) had severe disabilities. At a similar age (53 ± 16 months,
p = NS) 16 (34%) patients without BPD had mild disabilities, whereas 2 (4%) had severe disabilities (
p < 0.01).
Conclusions:The occurrence of BPD after ECMO is associated with adverse neurodevelopmental outcome. Patients with BPD after ECMO merit close long-term follow-up. (J Pediatr 1998;132:307-11)
Measurements of midrapidity charged particle multiplicity distributions, $dN_{\rm ch}/d\eta$, and midrapidity transverse-energy distributions, $dE_T/d\eta$, are presented for a variety of collision ...systems and energies. Included are distributions for Au$+$Au collisions at $\sqrt{s_{_{NN}}}=200$, 130, 62.4, 39, 27, 19.6, 14.5, and 7.7 GeV, Cu$+$Cu collisions at $\sqrt{s_{_{NN}}}=200$ and 62.4 GeV, Cu$+$Au collisions at $\sqrt{s_{_{NN}}}=200$ GeV, U$+$U collisions at $\sqrt{s_{_{NN}}}=193$ GeV, $d$$+$Au collisions at $\sqrt{s_{_{NN}}}=200$ GeV, $^{3}$He$+$Au collisions at $\sqrt{s_{_{NN}}}=200$ GeV, and $p$$+$$p$ collisions at $\sqrt{s_{_{NN}}}=200$ GeV. Centrality-dependent distributions at midrapidity are presented in terms of the number of nucleon participants, $N_{\rm part}$, and the number of constituent quark participants, $N_{q{\rm p}}$. For all $A$$+$$A$ collisions down to $\sqrt{s_{_{NN}}}=7.7$ GeV, it is observed that the midrapidity data are better described by scaling with $N_{q{\rm p}}$ than scaling with $N_{\rm part}$. Also presented are estimates of the Bjorken energy density, $\varepsilon_{\rm BJ}$, and the ratio of $dE_T/d\eta$ to $dN_{\rm ch}/d\eta$, the latter of which is seen to be constant as a function of centrality for all systems.
Background and Aims:
Azathioprine AZA is recommended for maintenance of steroid-free remission in inflammatory bowel disease IBD. The aim of this study has been to establish the incidence and ...severity of AZA-induced pancreatitis, an idiosyncratic and major side effect, and to identify specific risk factors.
Methods:
We studied 510 IBD patients 338 Crohn’s disease, 157 ulcerative colitis, 15 indeterminate colitis with initiation of AZA treatment in a prospective multicentre registry study. Acute pancreatitis was diagnosed in accordance with international guidelines.
Results:
AZA was continued by 324 63.5% and stopped by 186 36.5% patients. The most common cause of discontinuation was nausea 12.2%. AZA-induced pancreatitis occurred in 37 patients 7.3%. Of these: 43% were hospitalised with a median inpatient time period of 5 days; 10% had peripancreatic fluid collections; 24% had vomiting; and 14% had fever. No patient had to undergo nonsurgical or surgical interventions. Smoking was the strongest risk factor for AZA-induced acute pancreatitis p < 0.0002 in univariate and multivariate analyses.
Conclusions:
AZA-induced acute pancreatitis is a common adverse event in IBD patients, but in this study had a mild course in all patients. Smoking is the most important risk factor.
In the ideal situation, the evaluation for sepsis in the young infant should include collection of multiple blood cultures before the institution of antibiotics. Unfortunately, in some infants, it ...may not be possible to obtain more than a single blood culture at the time of initial evaluation. If this single culture ultimately grows coagulase-negative staphylococci and the infant has been treated with antimicrobial therapy in the interim, it is often difficult to determine whether the positive culture represents true infection or contamination. Our data suggest that peripheral blood cultures yielding high colony counts most likely represent infection. Furthermore, in this high-risk patient population, low colony-count growth should not be ignored as contamination, particularly if there are significant clinical findings or if the infant has a central catheter or hematologic abnormality. Future studies should examine these important issues.
The partition of heat loss into convective and evaporative components, and heat gain into metabolic rate of production and radiant heat needed to maintain thermal equilibrium was determined in ten ...premature neonates (weight 1.39 +/- .08 SEM kg, gestation 31 +/- 1 weeks) who were nursed naked and supine on open radiant warmer beds. Warmer beds were servocontrolled to maintain each infant's abdominal skin temperature at three different levels: 35.5, 36.5, and 37.5 degrees C. The quantity of radiant heat delivered by the warmer in vivo was measured directly and compared with the heat need calculated from the partition. Convective heat loss comprised the major component of net heat loss and increased significantly with servocontrol temperature from 2.86 +/- .24 to 3.27 +/- .23 kcal/kg/h (P less than .01), and to 3.72 +/- .26 kcal/kg/h (P less than .001). Evaporative heat loss increased with servocontrol temperature from .96 +/- .13 to 1.41 +/- .33 kcal/kg/h, and to 1.35 +/- .32 kcal/kg/h, but this increase was not significant. Metabolic rate decreased from 2.08 +/- .17 to 1.90 +/- .14 kcal/kg/h, and to 1.78 +/- .16 kcal/kg/h with increased servocontrol temperature, but this decrease was not significant. Radiant heat needed to maintain infants at higher temperatures increased from 1.73 to 2.80 kcal/kg/h, and to 3.32 kcal/kg/h. The radiant heat delivered by the warmer to infants was directly proportional to the heat need calculated from the partition (r = .68, P less than .001).
Changes in color Doppler imaging measurements of renal artery blood flow velocity have been reported previously during fetal life and during the first week postnatally in term and preterm infants. ...This study reports longitudinal, developmental changes in renal artery and aortic blood flow velocities occurring postnatally, from birth to day 1 of life, at 1 week, and at 2 to 3 weeks of age in 14 premature babies (mean gestation, 30 ± 4 SD weeks; birth weight, 1.45 ± 0.57 kg), and identified by means of color Doppler imaging and pulsed Doppler spectral analysis. Results indicate that a significant increase in renal artery systolic blood flow velocity occurs within the first week of life (from 40 ± 3 SEM cm/sec at birth or on day 1, to 53 ± 3 cm/sec on day 7, to 51 ± 4 cm/sec on day 14 to 21; repeated-measures analysis of variance,
p = 0.004), concurrently with a significant increase in abdominal aortic blood flow velocities, both systolic (from 40 ± 4 at birth or on day 1, to 70 ± 8 on day 7, to 76 ± 8 cm/sec on day 14 to 21;
p <0.001) and diastolic (from 4 ± 2 at birth or on day 1, to 11 ± 2 on day 7, to 11 ± 2 cm/sec on day 14 to 21;
p = 0.001). Systemic blood pressure did not increase concomitantly during the same period. Neither the presence of respiratory distress syndrome or patent ductus arteriosus nor treatment with indomethacin altered developmental increases in observed renal artery blood flow velocities. The presence of an umbilical artery catheter in the high thoracic position in five infants, however, created turbulence at the level of the renal arteries, significantly increasing renal artery systolic flow velocity from 32 ± 4 to 44 ± 5 cm/sec (
p = 0.009) and increasing renal resistive index from 0.90 ± 0.03 to 0.96 ± 0.04 (
p = 0.046). These results suggest that renal artery blood flow velocity increases during the first postnatal week in preterm infants and is likely related to increases in aortic blood flow velocity and reduction in renal vascular resistance. (J P
EDIATR 1996;129:251-7)
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