RESUMO
In a prospective, randomized trial of once-daily versus twice-daily intravenous or intramuscular dosing with gentamicin, 11 neonates received 5.0 mg/kg once daily and 15 received 2.5 mg/kg twice daily for 2 ro 3 days. The once-daily intravenous dosing group and the twice-daily intravenous or intramuscular dosing group, respectively, had mean steady-state gentamicin peak concentrations of 10.7 versus 6.6 micrograms/ml (p < 0.05), 6-hour postdosing concentrations of 4.7 versus 2.8 micrograms/ml (p < 0.05), trough concentrations of 1.7 versus 1.7 micrograms/ml, elimination half-life of 8.8 versus 5.4 hours (p < 0.05), and volume of distribution at steady state of 0.67 versus 0.46 L/kg. No nephrotoxic effects were identified in any group. Once-daily gentamicin therapy with 5.0 mg/kg in neonates achieves peak serum levels that are more suitable for optimal bacterial killing than those which traditional regimens achieve. Similar trough levels suggest that even larger doses and longer dosing intervals may be ideal in term neonates.
Assuntos
Antibacterianos/farmacocinética , Gentamicinas/farmacocinética , Ampicilina/administração & dosagem , Ampicilina/uso terapêutico , Antibacterianos/administração & dosagem , Antibacterianos/sangue , Infecções Bacterianas/tratamento farmacológico , Creatinina/sangue , Creatinina/urina , Esquema de Medicação , Gentamicinas/administração & dosagem , Gentamicinas/sangue , Taxa de Filtração Glomerular/efeitos dos fármacos , Meia-Vida , Humanos , Recém-Nascido , Injeções Intramusculares , Injeções Intravenosas , Rim/efeitos dos fármacos , Penicilinas/administração & dosagem , Penicilinas/uso terapêutico , Estudos Prospectivos , Microglobulina beta-2/urinaRESUMO
The purpose of this study was to compare the mechanics of sucking for 48 term infants with four different nipple units: Gerber Newborn (Gerber Products Company, Fremont, Mich.), Playtex (Playtex Products, Westport, Conn.), Evenflo (Evenflo Products Co., Canton, Ga.), and Gerber NUK. At 24 hours after birth, infants were assigned randomly to one of the nipple units and were studied twice with that nipple unit. A customized data acquisition system was used to measure and record the following variables: intraoral suction, sucking frequency, work, power, milk flow, milk volume per suck, and oxygen saturation. Although no statistically significant differences among the nipple units were noted for intraoral suction, sucking frequency, power, and oxygen saturation, the data revealed that the Playtex nipple unit was accompanied by higher peak milk flow and greater volume of milk per suck (p < 0.05). Infants fed differently with the Playtex nipple than they did with the other nipples. Our findings indicate that the Playtex nipple permits a greater milk flow in response to similar amounts of suction, work, and power when compared with others. The mean total work per such was significantly lower in the Gerber NUK group compared with the Playtex group. In addition, the total number of sucks per volume ingested was higher, and the total time to ingest a specific quantity of milk was longer for the Gerber NUK nipple.
Assuntos
Alimentação com Mamadeira/instrumentação , Recém-Nascido , Comportamento de Sucção , Fenômenos Biomecânicos , Peso ao Nascer , Idade Gestacional , Humanos , Análise MultivariadaRESUMO
To determine the outcome of apparently stillborn infants who received cardiopulmonary resuscitation, we studied the short- and long-term outcome of 93 infants who had an Apgar score of 0 at 1 minute of age and were resuscitated at birth. Sixty-two (66.6%) responded and left the delivery room alive; 26 (42%) of the 62 infants died in the neonatal period and 36 infants were discharged home; of the 36 infants, three subsequently died during infancy. Of the 33 survivors, ten were lost to follow-up after discharge. Developmental assessment of 23 of 33 long-term survivors revealed normal outcome in 14 (61.7%), abnormal results in 6 (26%), and suspect status in 3 (13%). Fifty-eight infants had an Apgar score of 0 at greater than or equal to 10 minutes of age and all except one died; the surviving infant has an abnormal developmental outcome. We conclude that 39% of apparently stillborn infants who were resuscitated survived beyond the neonatal period and that 61% of the 23 survivors who were available for developmental follow-up had normal development at the time of last examination. Survival was unlikely if there was no response after 10 minutes of resuscitation.
Assuntos
Morte Fetal/terapia , Resultado da Gravidez , Ressuscitação , Índice de Apgar , Desenvolvimento Infantil , Pré-Escolar , Feminino , Morte Fetal/epidemiologia , Seguimentos , Humanos , Illinois/epidemiologia , Lactente , Recém-Nascido , Exame Neurológico , Gravidez , Resultado da Gravidez/epidemiologia , Desempenho PsicomotorRESUMO
The effect of artificial surfactant therapy on renal function and the onset of spontaneous diuresis was prospectively evaluated in 19 infants with hyaline membrane disease in a double-blind, controlled study. Twelve infants were in the surfactant group; seven infants received placebo (0.9% saline solution). There was no difference in the time of onset of spontaneous diuresis (as defined by output greater than or equal to 80% of intake). The glomerular filtration rate, determined by endogenous creatinine clearance, was also similar in the surfactant- and placebo-treated infants during the first 3 days of life. The fractional excretion of sodium was significantly higher in the placebo group at 24 hours and 36 hours. Infants in the placebo group had a higher negative sodium balance than those in the surfactant group. Ventilatory status improved significantly soon after surfactant treatment, as evidenced by improvement in the alveolar/arterial oxygen pressure ratio and by a lower mean airway pressure. These data suggest that ventilatory status can be improved without diuresis; the factors that regulate diuresis are multiple and not fully understood.
Assuntos
Diurese , Doença da Membrana Hialina/tratamento farmacológico , Recém-Nascido de Baixo Peso/fisiologia , Rim/fisiologia , Pulmão/fisiologia , Surfactantes Pulmonares/uso terapêutico , Gasometria , Peso Corporal , Ensaios Clínicos como Assunto , Método Duplo-Cego , Feminino , Humanos , Recém-Nascido , Masculino , Placebos , Estudos Prospectivos , Distribuição AleatóriaAssuntos
Biometria , Pediatria/educação , Humanos , Estatística como Assunto , Inquéritos e QuestionáriosAssuntos
Granulócitos/fisiologia , Recém-Nascido , Adulto , Adesão Celular , Feminino , Hematócrito , Humanos , Contagem de Leucócitos , MasculinoRESUMO
Continuous tissue pH was measured using a minaturized glass electrode in 21 sick term and preterm infants. Tissue pH correlated well with arterial (r = 0.87) and capillary pH (r = 0.90) during the steady state. However, tpH was lower than arterial pH during hypoperfusion and state of shock. Improvement in tissue perfusion resulted in improvement in tpH and good correlation with arterial pH. The electrode was also sensitive to changes in carbon dioxide tension and adminitration of buffer. The good correlation with arterial pH and the feasibility of continuous recording of tissue pH makes it a useful instrument for monitoring the acid-base status of critically ill neonates.
Assuntos
Equilíbrio Ácido-Base , Doenças do Recém-Nascido/fisiopatologia , Monitorização Fisiológica , Humanos , Concentração de Íons de Hidrogênio , Recém-Nascido , Oxigênio/sangueRESUMO
Indomethacin is currently used for the pharmacologic closure of PDA in preterm infants with respiratory distress syndrome. However, the response to the drug has been variable and the disposition of the drug in preterm infants is not well understood. We studied the pharmacokinetics of indomethacin in nine preterm infants with birth weights ranging from 800 to 1,960 gm and gestational ages of 28 to 36 weeks. Three different dose schedules (0.1, 0.25, 0.3 mg/kg dose) were used. The plasma half-life of indomethacin ranged from 11 to 20 hours. Peak levels were achieved within four hours and ranged from 0.027 to 0.310 microgram/ml. The half-life in infants less than 32 weeks' gestation was significantly prolonged compared to that in infants greater than 32 weeks. Protein-binding studies with 14C indomethacin showed that 98% of indomethacin was protein bound. Absorption of orally administered indomethacin appears to be poor and incomplete. No immediate major complications could be correlated to indomethacin therapy in this study.