RESUMEN
Twelve newborn infants were given morphine intravenously for postoperative analgesia. They received a continuous infusion of 6.2 to 40 micrograms/kg/hr for 9 to 105 hours (mean +/- SEM 59.5 +/- 10.2 hours); in four the infusion was preceded by a loading dose of 50 to 100 micrograms/kg. Morphine plasma concentrations correlated with the rate of infusion, but with large variability. There was a tendency for plasma morphine concentrations to decrease in some patients receiving a constant infusion rate, suggesting improvement in morphine clearance rate. Elimination half-life of morphine (13.9 +/- 6.4 hours) was significantly longer than in older children and adults (about 2 hours). Similarly, morphine concentrations in neonates receiving 20 micrograms/kg/hr for 24 hours were three times higher (52 +/- 31 ng/ml) than in older children receiving the same schedule. Two infants who received 32 and 40 micrograms/kg/hr, respectively, developed generalized seizures. Because of the apparently greater sensitivity to morphine and the lower elimination rate in newborn infants, the infused dose should not exceed 15 micrograms/kg/hr.
Asunto(s)
Enfermedades del Recién Nacido/cirugía , Morfina/uso terapéutico , Dolor Postoperatorio/tratamiento farmacológico , Semivida , Humanos , Lactante , Recién Nacido , Cinética , Morfina/administración & dosificación , Morfina/metabolismo , Estudios ProspectivosRESUMEN
Ultrasound brain scans sometimes demonstrate increased echogenicity or cysts, or both, in the periventricular white matter, superolateral to the ventricle, in the most common site of periventricular infarction. Over 33 months, 23 preterm infants dying after 20 or more days of life were entered into this study. Superolateral echogenicity or cysts were found in 13 (57%) cases. Periventricular infarction was present at autopsy in 12 (52%) cases. Ultrasound accurately diagnosed the size, site, and extent of periventricular infarction in 78% of scans. Interpretive errors were made with poor-quality scans and with early and late studies. We conclude that sector ultrasound brain scans accurately diagnose major periventricular infarction. Hemorrhage into the site of infarction is not a prerequisite for diagnosis of periventricular infarction by ultrasound.
Asunto(s)
Infarto Cerebral/diagnóstico , Ventrículos Cerebrales/patología , Enfermedades del Prematuro/diagnóstico , Ultrasonografía , Autopsia , Infarto Cerebral/patología , Femenino , Humanos , Recién Nacido , Enfermedades del Prematuro/patología , MasculinoRESUMEN
The aim of this study was to validate brain imaging techniques in the preterm infant. A homogeneous group of very immature (less than 32 week) neonates dying in the neonatal period were sequentially scanned with linear-array real-time ultrasound scans, and after death with compound B static sector ultrasound and high-resolution computed tomography (CT) scans. All three imaging techniques were correlated with the autopsy results. All germinal matrix bleeds greater than 5mm in size and intraventricular hemorrhages associated with ventricular dilation or distortion were accurately diagnosed. In the immature infant it was difficult to distinguish the normal highly vascular germinal matrix and choroid plexus from hemorrhage into the brain or ventricles, respectively. Further studies that address the questions of accurate timing and incidence of bleeds must consider the spatial resolution of the individual scanner, the maturity of the brain, the site and size of the lesion, and the evolution of the lesion. For the diagnosis of major hemorrhagic lesions in the preterm infant, either ultrasound or CT scans may be used with confidence.
Asunto(s)
Encéfalo/diagnóstico por imagen , Hemorragia Cerebral/diagnóstico por imagen , Enfermedades del Prematuro/diagnóstico por imagen , Hemorragia Cerebral/diagnóstico , Humanos , Recién Nacido , Enfermedades del Prematuro/diagnóstico , Cintigrafía , Tomografía Computarizada por Rayos X , UltrasonografíaRESUMEN
Examination at 18 months post-term of 139 infants of birth weight less than or equal to 1,500 gm revealed 18 instances (13%) of persistent median nerve damage. All affected infants had received frequent percutaneous brachial artery punctures as neonates. Block sections of the cubital fossa done at autopsy on 12 randomly selected very low-birth-weight infants showed perineural hemorrhage, and Wallerian degeneration or traumatic neuroma of the median nerve in eight patients. It is recommended that brachial artery punctures be avoided whenever possible in the neonatal period.
Asunto(s)
Arteria Braquial , Nervio Mediano , Enfermedades del Sistema Nervioso Periférico/etiología , Punciones/efectos adversos , Autopsia , Análisis de los Gases de la Sangre , Hemorragia/etiología , Humanos , Lactante , Recién Nacido de Bajo Peso , Recién Nacido , Nervio Mediano/patología , Neuroma/etiología , Neuroma/patología , Neoplasias del Sistema Nervioso Periférico/etiología , Neoplasias del Sistema Nervioso Periférico/patología , Degeneración WallerianaRESUMEN
A two-year follow-up study of 43 infants of birth weight less than or equal to 1,000 gm born during 1974 revealed the following: average height at two years was between the tenth and twenty-fifth percentiles; average weight between the third and tenth percentiles. Fifteen (35%) developed lower respiratory tract infections during the first two years. Seven (16%) had retrolental fibroplasia. Major neurologic defects occurred in four (9%); severe developmental delay (mean developmental quotient less than 80) was found in nine others (21%). Defects of the central nervous system were closely associated with a neonatal history of intracranial hemorrhage or seizures or both.