RESUMEN
We prospectively studied newborn infants with sepsis and neutropenia who were randomly selected to receive standard supportive care and either adjuvant granulocyte transfusions or intravenous immune globulin (IVIG) infusions; 21 infants received granulocyte transfusions and 14 received IVIG infusions. Half of the patients were premature (gestational age less than or equal to 32 weeks); the average postnatal age was 5 days (range 3 to 8 days). All infants had neutropenia by the criteria of Manroe et al., and the mean average bone marrow neutrophil storage pool ranged between 35% and 37%. There were no significant differences with respect to serum IgG, IgA, IgM, and total hemolytic complement values between treatment groups or between survivors and nonsurvivors. Clinical severity as defined by hypoxia, acidosis, and hypotension was similar between treatment groups. Group B streptococcus was the most common organism identified and accounted for almost 33% of all bacterial isolates. There was a significantly different survival rate in the group receiving polymorphonuclear leukocyte transfusions (100%, 21/21) compared with the group receiving IVIG infusions (64%, 9/14; p = less than 0.03). There were no significant complications in either treatment group with respect to fluid overload, secondary infection, blood group sensitization, pulmonary complications, or graft-versus-host disease. This pilot study suggests a possible benefit of granulocyte transfusions compared with 'IVIG therapy in the adjuvant treatment of neonatal neutropenia and overwhelming bacterial sepsis.
Asunto(s)
Infecciones Bacterianas/terapia , Transfusión Sanguínea , Inmunoglobulinas Intravenosas/administración & dosificación , Neutropenia/terapia , Neutrófilos/trasplante , Infecciones Bacterianas/complicaciones , Infecciones Bacterianas/mortalidad , Humanos , Inmunoglobulinas Intravenosas/efectos adversos , Recién Nacido , Infusiones Intravenosas , Neutropenia/complicaciones , Estudios Prospectivos , Reacción a la TransfusiónRESUMEN
The neonatal drug transport box provides a readily available drug supply in appropriate dilutions for newborns. It also supplies a visible neonatal emergency drug dosage list. The use of this box has demonstrated a saving in nursing time, assured an appropriate supply of all necessary drugs, made drugs readily available for emergency use, and provided dosage check.
Asunto(s)
Urgencias Médicas , Enfermedades del Recién Nacido/tratamiento farmacológico , Sistemas de Medicación , Transporte de Pacientes , California , Femenino , Hospitales con 300 a 499 Camas , Humanos , Incubadoras para Lactantes , Recién Nacido , EmbarazoRESUMEN
Mechanically evoked short-latency potentials were recorded from ten newborn infants ranging in gestational age from 36 to 42 wk and from a 3-month-old infant during natural sleep. Potentials were recorded from four electrode configurations: (1) over the peripheral nerve at the wrist: distal-proximal; (2) over the peripheral nerve at the axilla-deltoid insertion; (3) over the cervical spinal cord and cerebrum: CII-Fpz; and (4) over the cerebrum: C4-Fpz. All subjects produced clear potentials from configurations 1, 2 and 3. Configuration 4 produced reliable potentials only in one newborn who was large for gestational age (42 wk) and the 3-month-old infant. Average peripheral nerve conduction velocities were 26 m/sec from wrist to axilla and 29 m/sec from axilla to neck. No significant correlation was found between conceptional age and nerve conduction velocity. The application of this technique could allow lesion localization in peripheral as well as central portions of the somatosensory pathway of newborns.
Asunto(s)
Potenciales Evocados , Recién Nacido , Nervios Periféricos/fisiología , Corteza Somatosensorial/fisiología , Encéfalo/fisiología , Femenino , Edad Gestacional , Humanos , Lactante , Recien Nacido Prematuro , Masculino , Estimulación Física , Médula Espinal/fisiología , MuñecaRESUMEN
No congenital malformation in infants is more profound than anterior craniofacial duplication. The precise term for this rare anomaly is diprosopus, referring to a fetus with a single trunk, normal limbs, and varying degrees of facial duplication. A search of the world literature produced only 16 cases of diprosopus since 1864. Despite the rarity of this anomaly, three such infants were born in the Southern California area during the past year, making this the largest reported series to date. The three infants were born with two distinctly formed faces. Each had four separate eyes, two mouths, two noses, and two ears with a primitive ear or sinus tract at the plane of fusion. In addition, multiple congenital aberrations existed which involved a variety of internal organs. The pathogenesis of diprosopus is not well understood, but environmental stress early in embryologic development has been suggested as a possible factor. The apparent mechanism is a slowing of pregastrulation oxidation with resultant focal developmental arrests.
Asunto(s)
Anomalías Teratoides Graves/patología , Anomalías Teratoides Graves/epidemiología , California , Humanos , Recién NacidoRESUMEN
Sixteen neonatal patients diagnosed as having the meconium aspiration syndrome were selected for management with extracorporeal circulation with a membrane oxygenator (ECMO) with 8 survivors over 4 yr. All patients weighed greater than 2 kg. Each was placed in the 100% mortality group according to a Neonatal Pulmonary Insufficiency Index (NPII) based on hourly pH and FiO2 determinations. The typical patient course on ECMO was stabilization for the first 12 hr then improvement on high bypass flow rates for 12-24 hr to maintain a pAO2 for 50-60 mm Hg with minimal ventilator settings with an FiO2 of 0.3-0.4. Bypass flow rates were reduced to maintain adequate pAO2 with similar ventilator settings for another 24 hr. Survivors were taken off bypass and decannulated while on similar ventilator settings. Nonsurvivors did stabilize or improve but usually exhibited symptoms of intracranial hemorrhage by 48 hr. Intracranial hemorrhage appeared to be related to the degree of prebypass acidosis. Successful ECMO support reduced the expected mortality from severe meconium aspiration from 100% to 50%. Early institution of ECMO, before acidosis worsens, seems to be indicated to reduce the morbidity of conventional ventilator management and to prevent intracranial hemorrhage from severe prebypass acidosis. Long term followup indicates that these patients have progressed satisfactorily according to developmental testing for as long as 4 yr.
Asunto(s)
Circulación Extracorporea/métodos , Enfermedades del Recién Nacido/terapia , Meconio , Neumonía por Aspiración/terapia , Insuficiencia Respiratoria/terapia , Cateterismo/métodos , Femenino , Humanos , Recién Nacido , Enfermedades del Recién Nacido/diagnóstico , Masculino , Neumonía por Aspiración/diagnóstico , Insuficiencia Respiratoria/etiologíaRESUMEN
Somatosensory potentials evoked by mechanical stimulation were recorded by surface electrodes over (1) the digital nerves in the index finger, (2) the median nerve at the wrist, (3) the median nerve near the axilla, (4) the brachial plexus, (5) the cervical cord at CII, (6) the scalp overlying the somatosensory cortex. Nerve conduction velocities varied inversely with age and ranged from 43 to 68 m/sec. Mechanically evoked potentials recorded from the electrodes overlying the digital nerves were an artifact of the finger movement. All other electrode configurations recorded potentials comparable to those evoked by electrical stimulation of nerves. These mechanically evoked potentials could prove useful in the assessment of clinical disorders of somatosensory function from receptor to cortex in man.
Asunto(s)
Nervios Periféricos/fisiología , Corteza Somatosensorial/fisiología , Adolescente , Adulto , Anciano , Electroencefalografía , Potenciales Evocados , Humanos , Nervio Mediano/fisiología , Persona de Mediana Edad , Vías Nerviosas/fisiología , Tiempo de ReacciónRESUMEN
Somatosensory potentials evoked by mechanical stimulation of the fingernail and electrical stimulation of the nerve in the finger and at the wrist were recorded by surface electrodes over; (1) the digital nerve in the index finger, (2) the median nerve at the wrist, (3) the median nerve at the axilla, (4) the brachial plexus at Erb's point, (5) the cervical cord at C2, and (6) the scalp overlying the somatosensory cortex. Nerve conduction velocities were computed for two portions of the median nerve. Conduction times along the somatosensory pathway between spinal cord and cerebral cortex were also defined. The mechanically evoked potentials had less temporal dispersion, were of lower amplitude, and occasionally consisted of fewer components than the electrically evoked potentials. Electrical stimulation of the nerve trunk at the wrist evoked some additional components not detected by the other stimulation methods. Nerve conduction velocities and conduction times were comparable among the three methods of stimulation.
Asunto(s)
Corteza Somatosensorial/fisiología , Brazo , Plexo Braquial/fisiología , Estimulación Eléctrica , Potenciales Evocados , Mano , Humanos , Conducción Nerviosa , Estrés MecánicoRESUMEN
Auditory brainstem potentials were recorded from scalp electrodes in 42 infants ranging in gestational age from 25 to 44 weeks. The latencies of the various potential components decreased with maturation. Wave V, evoked by 65-dB sensation level clicks, changed in latency from 9.9 msec at 26 weeks of gestation of 6.9 msec at 40 weeks of gestation. Central conduction times in the auditory pathway also decreased with maturation from 7.2 msec at 26 weeks to 5.2 msec at 40 weeks. The effects of brainstem and cochlear disorders on auditory brainstem potentials were noted in several abnormal infants. The application of all of these techniques could permit an objective definition of both normal and abnormal sensory processes in newborn infants.
Asunto(s)
Potenciales de Acción , Vías Auditivas/fisiología , Tronco Encefálico , Sordera/diagnóstico , Enfermedades del Recién Nacido/diagnóstico , Recién Nacido , Conducción Ósea , Tronco Encefálico/fisiología , Cóclea/inervación , Cóclea/fisiología , Electrodos , Femenino , HumanosRESUMEN
This report of transient priapism in a preterm newborn with respiratory distress syndrome discusses clinical course, therapy, possible etiologic factors, and previously reported cases in newborns. Possible causes include use of arterial catheter, red cell transfusion, hemodynamic changes from a patent ductus arteriosus, and hypoxia.