Archives of disease in childhood
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Randomized Controlled Trial Clinical Trial
Respiratory compliance in premature babies treated with artificial surfactant (ALEC).
In a randomised trial of artificial surfactant (ALEC) given at birth to 294 babies less than 34 weeks' gestation, the respiratory compliance was measured at 1, 6, 24, 48, and 168 hours after birth. In babies less than 29 weeks' gestation ALEC significantly improved the mean (SEM) compliance at 6 hours from 0.54 (0.06) to 0.91 (0.13) ml/cm H2O/kg and at 24 hours from 0.57 (0.04) to 0.92 (0.10) ml/cm H2O/kg. ⋯ In babies of over 29 weeks' gestation the compliance was lower in the ALEC treated babies. This was significant only at one hour: 0.52 (0.03) compared with 0.71 (0.07) ml/cm H2O/kg and only occurred in babies who were not ventilated.
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Randomized Controlled Trial Comparative Study Clinical Trial
Rewarming preterm infants on a heated, water filled mattress.
Sixty low birthweight infants (1000-2000 g) admitted to a neonatal care unit in Turkey were studied. Those not requiring intensive care were randomly assigned for treatment either in a cot on a heated, water filled mattress kept at 37 degrees C (n = 28) or in air heated incubators with a mean air temperature of 35 degrees C (n = 32). On admission 53 (88.3%) of the infants had body temperatures between 30 degrees and 36 degrees C. ⋯ Normal temperatures were achieved within the first day and remained within this range during the subsequent days after admission in all the infants treated on the heated, water filled mattress, whereas they were not achieved until three days later in the incubator group. The neonatal mortality among those treated on the heated, water filled mattress was 21%, and among those treated in the incubator 34%. The heated, water filled mattress provides a good alternative to skin to skin contact with the mother, and to the use of a complex and expensive incubator for rapidly attaining and maintaining normal temperatures in the low birthweight newborn.
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Randomized Controlled Trial Clinical Trial
Breast milk jaundice in premature infants.
In randomised study of 186 preterm infants those fed on maternal or banked breast milk had a significantly higher peak bilirubin concentration and a more prolonged jaundice than infants fed an artificial preterm formula and were over four times more likely to achieve plasma bilirubin values above 200 mumol/l (11.7 mg/100 ml). This dietary effect was seen even in a high risk subgroup of sick ventilated infants below 1500 g who were receiving restricted enteral intakes. We suggest that breast milk jaundice in preterm infants may increase clinical intervention. Our findings are discussed in the light of epidemiological data suggesting an association between moderate hyperbilirubinaemia (greater than 170 mumol/l) and neurodevelopmental outcome.
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Randomized Controlled Trial Comparative Study Clinical Trial
Multicentre trial on feeding low birthweight infants: effects of diet on early growth.
A large multicentre study on the short and long term clinical and developmental outcome of infants randomised to different diets is being undertaken. This report represents an interim analysis of the early postnatal growth performance of an unselected population of 194 preterm infants (gestation, mean (SD) 31 . 0 (2 . 9) weeks; birthweight, mean (SD) 1364 (294) g), both ill and well, examined in two (of four) parallel trials. One trial compared banked breast milk with a new preterm formula (primary trial); the other compared these diets as supplements to maternal milk (supplement trial). ⋯ By the time they reach 2000 g, infants of birthweights 1200 to 1849 g fed on banked breast milk and infants below 1200 g fed on either banked breast milk or maternal milk supplemented (as necessary) with banked breast milk, fulfilled stringent criteria for failure to thrive (weight less than 2 SD below the mean for age). Only infants fed the preterm formula as their sole diet had maintained their birth centile by discharge from hospital. The misleading nature of comparisons between extrauterine and intrauterine steady state weight gains is emphasised.
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Randomized Controlled Trial Comparative Study Clinical Trial
Failure of intrathecal antitetanus serum to improve survival in neonatal tetanus.
In a prospective study, 161 infants with neonatal tetanus were randomised to receive (a) standard treatment, or (b) standard treatment together with intrathecal equine antitetanus serum, or (c) intrathecal antitetanus serum with systemic betamethasone. There was no difference in survival between the three treatment groups in infants with severe tetanus, but in mild tetanus those who received standard treatment alone had an improved survival rate. Parenteral intramuscular diazepam as a sedative was found to be preferable to paraldehyde, as the latter was associated with a higher incidence of secondary infections.