The Journal of pediatrics
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The Journal of pediatrics · Jul 1994
Randomized Controlled Trial Comparative Study Clinical TrialRandomized, blind trial of dopamine versus dobutamine for treatment of hypotension in preterm infants with respiratory distress syndrome.
To compare the efficacy of dopamine and dobutamine for the treatment of hypotension (mean arterial blood pressure, < or = 30 mm Hg) in preterm (< or = 34 weeks of gestation) infants with respiratory distress syndrome in the first 24 hours of life, we enrolled 63 hypotensive preterm infants in a randomized, blind trial. Inclusion criteria required an arterial catheter for measurement of mean arterial blood pressure, treatment with exogenous surfactant, and persistent hypotension after volume expansion with 20 ml/kg (packed erythrocytes if hematocrit < 0.40, 5% albumin if > or = 0.40). Intravenous study drug infusions were initiated at 5 micrograms/kg per minute and then increased in increments of 5 micrograms/kg per minute at 20-minute intervals until a mean arterial blood pressure > 30 mm Hg was attained and sustained for > or = 30 minutes (success) or a maximum rate of 20 micrograms/kg per minute was reached without resolution of hypotension (failure). ⋯ Success was attained at < or = 10 micrograms/kg per minute in 30 (97%) of 31 infants given dopamine and in 22 (69%) of 32 infants given dobutamine (p < 0.01). Among those treated successfully, the increase in mean arterial blood pressure was significantly higher in those given dopamine (mean, 11.3 vs 6.8 mm Hg; p = 0.003). We conclude that dopamine is more effective than dobutamine for the early treatment of hypotension in preterm infants with respiratory distress syndrome.
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The Journal of pediatrics · Jul 1994
Urine testing in young febrile children: a risk-benefit analysis.
To assess the relative risks and benefits of 10 potential urine testing strategies (compared with no testing) involving urinalysis and urine culture for children aged 3 to 24 months with fever but no focus of bacterial infection. ⋯ Up to 50% of the long-term sequelae of occult urinary tract infections in young febrile children appear preventable by urine testing, but even the most favorable strategies require testing of thousands of children, and unnecessarily treating hundreds, for every case prevented. Our analysis reveals those strategies with more favorable RB profiles and emphasizes the need for rapid and convenient urine tests with much higher sensitivity and specificity or the need for less aggressive management strategies for febrile infants and young children with urinary tract infection.
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The Journal of pediatrics · Jul 1994
Comparative StudySevere respiratory failure in neonates: mortality and morbidity rates and neurodevelopmental outcomes.
To compare the survival, neurodevelopmental, and health outcomes of children with severe respiratory illness treated with and without extracorporeal membrane oxygenation (ECMO). ⋯ Survivors of severe neonatal respiratory illness have significant pulmonary and neurodevelopmental impairment, regardless of the treatment used. Neonates treated with ECMO had neurodevelopmental outcomes similar to those of patients treated conventionally, but better pulmonary outcomes.
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The Journal of pediatrics · Jul 1994
Prolonged cardiorespiratory monitoring of children more than twelve months of age: characterization of events and approach to discontinuation.
We assessed children referred to our apnea program who were > or = 12 months of age, beyond the at-risk period for sudden infant death syndrome (SIDS), but for whom home cardiorespiratory monitoring had continued. Our objectives were to (1) determine reasons for initiation and continuation of monitoring, (2) apply documented monitoring of transthoracic impedance, electrocardiographic signals, and, in a subset of patients, pulse oximetry, to determine the types of cardiorespiratory events that these children experienced, and (3) describe how documented monitoring was applied for eventual discontinuation of monitoring. Among 45 patients (median age, 22 months), 263 disks were collected, representing 2982 monitor days. ⋯ By extension of the audible apnea alarm to 25 or 30 seconds, lowering of the cutoff point for bradycardia alarm, or lowering of the cutoff point for the oximetry alarm, a recommendation to discontinue monitoring could be made for 41 patients. Of these, no child had a recurrence of cardiorespiratory events or died of SIDS. Documented monitoring proved to be a useful clinical tool for investigation of the clinical and physiologic importance of these cardiorespiratory events in children beyond the at-risk period for SIDS; recommendations about discontinuation of monitoring could be made knowledgeably and safely.
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The Journal of pediatrics · Jul 1994
Comparative StudyCuffed endotracheal tubes in pediatric intensive care.
We prospectively studied 282 consecutive tracheal intubations (243 patients) in a pediatric intensive care unit during a 7-month period to compare cuffed and uncuffed endotracheal tube (ETT) utilization and outcome. The incidence of postextubation stridor in each ETT group was the major outcome measure after controlling for various patient risk factors. Patients whose ETTs were inserted in the operating room, who were less than 1 year of age, or who had ETTs in place for less than 72 hours were more likely to have had insertion of an uncuffed ETT. ⋯ None of these was admitted with an upper airway problem. Two patients who previously had insertion of a cuffed ETT subsequently received tracheostomies for the primary purpose of long-term mechanical ventilation unrelated to any problem with the upper airway. We conclude that cuffed endotracheal intubation is not associated with an increased risk of postextubation stridor or significant long-term sequelae.