摘要:

There is an increase in the survival rate of preterm infants due to rapid advances in medical knowledge and technology. However, the research and attention paid to the proper use of pharmacotherapy in these infants is still a relatively underdeveloped field. Effective and safe drug therapy requires a thorough understanding of human developmental biology and of the dynamic ontogeny of drug absorption, drug disposition, drug metabolism, and drug excretion. It is apparent that maturation of organ system function and changes in body composition during gestation and during the neonatal period exert a significant effect on the disposition of drugs. This review focuses on the effects of maturational and drug‐induced changes in renal function on clinical pharmacokinetics in the preterm infan

ISSN:0803-5253    

DOI:10.1111/j.1651-2227.1996.tb13942.x

出版商:Blackwell Publishing Ltd    

年代:1996

数据来源: WILEY

摘要:

Smoking during pregnancy has in many countries replaced poverty as the most important preventable risk factor for an unsuccessful pregnancy outcome. Maternal smoking induces fetal hypoxia and morphological changes of the placenta, which increase the risks of intrauterine growth retardation and placental abruption, which may cause late fetal death and possibly also neonatal mortality. Smoking influences post‐neonatal mortality through increased risk of sudden infant death syndrome (SIDS), but why maternal smoking increases the risk of SIDS is essentially unknown. In reducing the overall smoking prevalence in society, general preventive measures have been successful. Such measures. which aim at preventing young girls from starting to smoke are in the long run the most effective way to reduce smoking during pregnanc

ISSN:0803-5253    

DOI:10.1111/j.1651-2227.1996.tb13943.x

出版商:Blackwell Publishing Ltd    

年代:1996

数据来源: WILEY

摘要:

Blood urea nitrogen (BUN) and plasma and urine amino acid concentrations were compared between three cohorts of healthy growing term infants who were breast‐fed (BF) or randomly assigned to one of two formulas either taurine non‐supplemented (FF) or taurine supplemented (FF + T). The infants were studied from 2 to 12 weeks of age. Weight gain and growth in length was normal and similar in all three feeding groups during the study interval. At 12 weeks BUN was significantly higher in the FF group than in the BF and FF + T groups, 16.5 mg/dl vs 7.0 and 7.3 mg/dl, respectively. Total plasma amino acids (FF group: 240.5 ± 110.1 μmoles/dl; BF group: 180.1 ± 28.7 μmoles/dl; FF + T group: 182.3 ± 89.4 μmoles/dl) and total essential amino acids (FF group: 89.8 ± 37.3 μmoles/dl; BF group: 56.1 ± 16.3 μmoles/dl; FF + T group: 53.0 ± 24.2 μmoles/dl). The urine amino acid concentrations reflected the plasma levels in all groups. These results indicate that taurine supplementation to a high protein formula lowers BUN levels and the plasma and urine amino acid concentrations by some yet unknown mechanism to concentrations similar to those found in breast‐fed infants with a much low

ISSN:0803-5253    

DOI:10.1111/j.1651-2227.1996.tb13944.x

出版商:Blackwell Publishing Ltd    

年代:1996

数据来源: WILEY

摘要:

Dose of acyclovir (ACV) and clinical features of varicella were evaluated in 65 household contacts (0.8‐9 y) who received oral ACV (5‐80 mg/kg daily in four divided doses) during the latter half of the incubation period of varicella. The severity of the disease was compared with that of 23 children who did not receive ACV. Infection was confirmed by a fluorescent antibody to membrane antigen assay. The antibody titers and the rate of apparent infection increased as the dose of ACV administered decreased. The number of skin lesions in patients who received ACV was significantly reduced when compared to the control group. These data suggest dose‐dependence of ACV for modification of varicella during secondary viremia in the incubation of the di

ISSN:0803-5253    

DOI:10.1111/j.1651-2227.1996.tb13945.x

出版商:Blackwell Publishing Ltd    

年代:1996

数据来源: WILEY

摘要:

Objective:Right upper lobe collapse is a common radiographic finding in intubated children. We hypothesized that deep suctioning and uncontrolled negative pressures during endotracheal tube suctioning were significant contributory factors.Methods: The incidence of right upper lobe (RUL) collapse in intubated, ventilated children on a paediatric cardiac intensive care unit was determined over a 3‐month period (n= 102). Graduated suction catheters and suction vacuums of<165 cm H2O were then introduced. Another prospective audit was carried out 3 months later (n= 60).Results: We found that 24% developed RUL collapse and 4 developed an apical pneumothorax. Following the introduction of graduated catheters and controlled vacuums pressures, a significant reduction in the incidence of RUL collapse, to 7%, was observed (p<0.05).Conclusions: We conclude that high negative pressure and deep‐suctioning causes RUL collapse in children. Any lobar collapse not only prolongs the child's stay in intensive care, but can be associated with further morbidity which may have a serious implication. By improving suctioning technique this morbidity can be significantly redu

ISSN:0803-5253    

DOI:10.1111/j.1651-2227.1996.tb13946.x

出版商:Blackwell Publishing Ltd    

年代:1996

数据来源: WILEY

摘要:

Essential fatty acid (EFA) deficiency is a predisposing factor for pulmonary infection withStaphylococcus aureusandPseudomonas aeruginosa, the two major pathogenic microorganisms in cystic fibrosis (CF).Objective: The goal of this study was to investigate the essential fatty acid status of CF patients from infancy to 20 years old.Materials and methods.Plasma fatty acid profiles for phospholipid (PL) were determined for cord (n= 6), 4 months (n= 40), 16 months (n= 25), 3 y (n= 8), 5‐10 y (n= 10), and 10‐20 y (n= 10) aged CF patients and compared to their respective control; cord (n= 22), 1‐36 months (n= 38) and adult (n= 100). Significance was established by Student's t‐test (p<0.05).Results: The plasma PL fatty acid profile for all CF patients, except cord, revealed consistent deficiency in ω3 and ω6 EFAs. These deficiencies were most marked at infancy and more pronounced for patients with meconium ileus.Conclusions and relevance: EFA deficiency may contribute to the predisposition of CF infants to develop respiratory disease and to the excess cytotoxic activity found in bronchoalveolar lavage fluid at 2 months of age in the majority of screene

ISSN:0803-5253    

DOI:10.1111/j.1651-2227.1996.tb13947.x

出版商:Blackwell Publishing Ltd    

年代:1996

数据来源: WILEY

摘要:

Objective: The objective of the study was to determine the occurrence of low back pain and its relationship to back strength and physical activity in children.Methods and materials: The study included 53 boys and 43 girls aged 10 to 19 years from a group of 116 children who had undergone isometric strength testing 4 years previously. No intervention was performed. Each child was asked five questions concerning low back pain. A questionnaire to quantify participation in athletic activities and manual labor was used as the basis for calculation of each child's activity level. Isometric back flexor and extensor strength were measured with the same method used 4 years previously. Statistical analyses were performed with appropriate correction for confounding factors.Results: The frequency of low back pain and the relationship between low back pain and age, between low back pain and back strength, and between low back pain and physical activity were determined. There was a history of low back pain in 51 %, and the frequency of low back pain in the past year was 35%. Eight percent of the children had been limited by low back pain, and 7% had seen a doctor for the pain. The first incident of low back pain occurred at a mean age of 12.3 years. The frequencies of a history of low back pain and of low back pain in the past year increased significantly with age (p= 0.02 and 0.01, respectively). Increased physical activity was significantly associated with a history of low back pain (p= 0.03), and increased back flexor strength was significantly associated with a history of low back pain and of low back pain in the past year (p= 0.03 and 0.008, respectively). The rate of change in back flexor strength over 4 years had a significantly positive association with the occurrence of low back pain in the past year (p= 0.008).Conclusions and relevance: Low back pain is common in children, and, in contrast to adults, low back pain in these children was more common with increased physical activity and stronger back flexors. We believe the main causes of low back pain in children are musculotendinous strains and ligamentous sprains.

ISSN:0803-5253    

DOI:10.1111/j.1651-2227.1996.tb13948.x

出版商:Blackwell Publishing Ltd    

年代:1996

数据来源: WILEY

摘要:

Objective:This retrospective follow‐up study was performed to evaluate the suitability of the recently reported exchange transfusion limits (serum indirect bilirubin level of 428‐496 μmol/1, 25‐29 mg/dl) for Turkey.Material and methods:The study groups totalled 102 children, 8‐13 years of age, who had been born at term with birthweights greater than 3000 g and had been treated for indirect hyperbilirubinemia during their newborn period; the control group consisted of 27 children of the same age‐group without indirect hyperbilirubinemia. Children were grouped according to their maximum serum indirect bilirubin levels and direct Coombs’test results. Physical and neurological examinations, visual and brainstem auditory evoked potentials and the Wechsler Intelligence Scale for Children—Revised for Turkish Children were performed.Results:There was no difference between the groups with regard to mean visual and brainstem auditory evoked potential latencies. Children whose direct Coombs’tests were positive had significantly lower IQ scores and more prominent neurological abnormalities (p<0.05). IQ scores and prominent neurological abnormalities did not differ among the other groups. Nine children had prominent neurological abnormalities associated with abnormal brainstem auditory evoked potentials. An important risk factor was the duration that the infant's serum indirect bilirubin level remained greater than 342 μmol/1 (20 mg/dl).Conclusion:The current limit of 342 μmol/1 should continue to be used for infants whose direct Coombs’tests are positive in our country. Until better criteria for exchange transfusion other than the indirect bilirubin level are established, the current limits should also still be followed for infants whose direct Coombs’tests are negative in Turkey, where regular neonatal follow‐up examinati

ISSN:0803-5253    

DOI:10.1111/j.1651-2227.1996.tb13949.x

出版商:Blackwell Publishing Ltd    

年代:1996

数据来源: WILEY

摘要:

The aim of the present study was to evaluate the long‐term prognostic significance of transient increase in muscle tone during infancy (dystonia) in very low‐birthweight (VLBW) infants without cerebral palsy. Motor (Peabody Developmental Motor Scales), cognitive (Wechsler Preschool and Primary Scale of Intelligence) and behavioural (Personality Inventory for Children, Yale Children's Inventory) development was assessed at 5 years of age. In a population‐based sample of 50 VLBW children, transient dystonia was present in 14. In explorative analyses, transient dystonia was associated with low 1 min Apgar scores, neonatal bacterial infection, and lack of breast‐milk in the neonatal period. Cognitive, neuromotor and behavioural development at 5 years of age was comparable in those with and without transient dystonia, although there was a statistically non‐significant tendency towards more neuromotor problems in the dystonic

ISSN:0803-5253    

DOI:10.1111/j.1651-2227.1996.tb13950.x

出版商:Blackwell Publishing Ltd    

年代:1996

数据来源: WILEY

摘要:

Home visiting is a part of the Swedish child health surveillance programme. In the present study, part of a longitudinal prospective project, the predictive power of observations at home visits to 338 newborn babies was evaluated. The regular home visit was made by the nurse at the Child Welfare Centre also using a check‐list developed for this project. Her check‐list assessments seemed valid in identifying families with stressful psychosocial conditions. When the general home situation was judged as “poor” or “dubious”, the boys showed signs of a delayed mental development at 4‐5 years of age. Assessments of “feeding problems” among boys were associated with behavioural problems at 4‐5 years of age. The results underline the importance of an early home visit as a base for the developmental surveillance at Child Welfare Centres. However, the results of the home visit observations were not followed by any extra interventions at CWC. It seems the nurse should feel confident in her check‐list judgement and initiate interventi

ISSN:0803-5253    

DOI:10.1111/j.1651-2227.1996.tb13951.x

出版商:Blackwell Publishing Ltd    

年代:1996

数据来源: WILEY