RESUMEN
Digoxin therapy was evaluated retrospectively in a group of 30, and prospectively in a group of 16 low-birth-weight, premature infants with cardiorespiratory symptoms due to persistent patency of the ductus arteriosus. The response to decongestive therapy was equivocal. Digoxin levels in serum varied between 1.5 and 13 ng/ml. Digoxin half-life in serum exceeded three days in four patients. Fourteen of the combined group of 46 infants had signs of toxicity of digoxin. High dosage, inadvertent overadministration, and variable clearance of digoxin, as well as special characteristics of the patients studied, are postulated as explanations for the high incidence of toxicity. This study suggests that digoxin therapy in low-birth-weight, premature infants with patent ductus arteriosus is not without risk.
Asunto(s)
Digoxina/uso terapéutico , Conducto Arterioso Permeable/complicaciones , Insuficiencia Cardíaca/tratamiento farmacológico , Digoxina/efectos adversos , Digoxina/sangre , Femenino , Semivida , Bloqueo Cardíaco/inducido químicamente , Insuficiencia Cardíaca/etiología , Frecuencia Cardíaca/efectos de los fármacos , Humanos , Recién Nacido de Bajo Peso , Recién Nacido , Masculino , Estudios Prospectivos , Estudios RetrospectivosRESUMEN
Recent experience with implanted cardiac pacemakers in nine young patients is reported. Advance in technology include improved pacemaker generator design and placement, and improved lead design and placement. No patients died; our only complication, failure to capture, required repositioning of the lead. All pacemaker replacements were elective. This series helps to define the more favorable current prognosis for the young patient needing pacemaker therapy.
Asunto(s)
Marcapaso Artificial , Bloqueo Cardíaco/congénito , Bloqueo Cardíaco/terapia , Humanos , PronósticoAsunto(s)
Buceo , Reflejo , Taquicardia Paroxística/terapia , Niño , Ensayos Clínicos como Asunto , Digoxina/uso terapéutico , Cardioversión Eléctrica , Femenino , Humanos , PropranololRESUMEN
Six black infants and young children with high titers of milk precipitins were identified by screening the sera of 160 children with idiopathic chronic lung disease. None of the six had immunoglobulin deficiency, elevation of sweat chlorides, SS hemoglobin, or recurrent aspiration. All six children had typical manifestations of milk-induced pulmonary hemosiderosis: recurrent pulmonary infiltrates (6/6), hemosiderin-laden pulmonary macrophages (5/6), intermittent wheezing (5/6), eosinophilia (4/6), anemia (4/6), iron deficiency (4/4), failure to thrive (4/6), and elevated levels of serum IgE (4/4). Three children also had chronic rhinitis and eventually developed large adenoids, hypercapnia and acidosis during sleep, and right heart failure. Elimination of cow milk from the diet, symptomatic therapy, and adenoidectomy when indicated resulted in improvement of all six patients. Pulmonary hemosiderosis and some cases of upper airway obstruction with pulmonary hypertension appear to be two stages, early and delayed, of the same immunophysiologic process. Early dietary intervention may prevent the cardiovascular complications of this process.