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Objective: To test the hypothesis that pediatric residents would have shorter time to attempted defibrillation using automated external defibrillators (AEDs) compared with manual defibrillators (MDs)., Study Design: A prospective, randomized, controlled trial of AEDs versus MDs was performed. Pediatric residents responded to a simulated in-hospital ventricular fibrillation cardiac arrest and were randomized to using either an AED or MD. The primary end point was time to attempted defibrillation., Results: Sixty residents, 21 (35%) interns, were randomized to 2 groups (AED = 30, MD = 30). Residents randomized to the AED group had a significantly shorter time to attempted defibrillation [median, 60 seconds (interquartile range, 53 to 71 seconds)] compared with those randomized to the MD group [median, 103 seconds (interquartile range, 68 to 288 seconds)] (P < .001). All residents in the AED group attempted defibrillation at <5 minutes compared with 23 (77%) in the MD group (P = .01)., Conclusions: AEDs improve the time to attempted defibrillation by pediatric residents in simulated cardiac arrests. Further studies are needed to help determine the role of AEDs in pediatric in-hospital cardiac arrests.

Objective: We sought to ascertain whether the timing of feeding initiation affected the development of intestinal lactase activity and whether there are clinical ramifications of lower lactase activity., Study Design: Preterm infants (26 to 30 weeks' gestation; n = 135) were randomly assigned to begin enteral feedings at either 4 (early group) or 15 days of age (standard group). At 10, 28, and 50 days of age lactase activity was determined by measuring the urinary ratio of lactulose/lactose after the 2 sugars were administered., Results: Lactase activity increased significantly over time. Infants in the early group had greater lactase activity at 10 days of age (by 100%) and 28 days of age (by 60%) than the standard group. At 10 days of age lactase activity was greater in milk- versus formula-fed infants. The time required to achieve full enteral feedings, the number of abnormal abdominal x-ray examinations, and the total number of abdominal x-ray examinations were inversely related to lactase activity., Conclusions: Early feeding increases intestinal lactase activity in preterm infants. Lactase activity is a marker of intestinal maturity and may influence clinical outcomes. Whether the effects of milk on lactase activity were due to the greater concentration of lactose in human milk compared with that in formula must be determined.

We studied the effect of heroin and methadone on birth length and 3-year stature of children of untreated heroin addicts (n = 22), women receiving methadone maintenance therapy (95% were polydrug users) (n = 21), and a drug-free comparison group (n = 28), after adjustment for biologic, demographic, and health variables. The mean birth lengths of both groups of drug-exposed infants were significantly below that of a comparison group; however, group means were similar after adjustment for sex, race, prenatal care, pregnancy weight gain, obstetrical risk, maternal education, and smoking. At 3 years of age the mean height was comparable for all groups. When adjusted for birth length, parental height, and smoking, the methadone group was significantly shorter than children exposed to heroin in utero, and the comparison group assumed an intermediate position. These data indicate that the effect of heroin and methadone on intrauterine growth cannot be differentiated from that of associated factors, and that postnatal growth of children exposed to narcotics during pregnancy is no more impaired than that of a high-risk comparison group. Children of all three groups deserve continued observation and efforts to improve their environment in order that their full potential might be achieved.

A longitudinal study of the effect of prematurity on the development of several components of the immunologic system in human milk was performed. Milk was obtained during the second through the twelfth week after parturition. The mean concentrations of lactoferrin and lysozyme were greater in preterm than in term milk during each interval of lactation. The patterns of change in these components were similar for term and preterm milk. Secretory IgA was the predominant form of IgA in preterm milk. The mean concentrations of IgA were greater in preterm milk throughout the study period. Furthermore, total and secretory IgA levels in preterm milk rose linearly during the sixth through the twelfth week, whereas the concentrations of IgA did not change in term milk during that period. In most preterm mothers, secretory IgA antibodies to Escherichia coli somatic antigens increased as lactation proceeded. These increments in specific antibodies usually did not correlate with changes in total secretory IgA. In addition, leukocyte counts in preterm milk were usually lower at two weeks and higher at 12 weeks than in term milk. Thus the concentrations of certain components of the immunologic system in human milk are altered by premature delivery. A decrease in milk volume may account for some changes, whereas certain alterations may be the result of other consequences of premature delivery or less stimulation by the premature infant.

A retrospective study of the outcome of home mechanical ventilation in 54 children with chronic respiratory insufficiency was conducted. The children's ages ranged from 4 months to 18 years. Tracheostomies and positive pressure ventilation were used in 33 patients, and negative pressure ventilation in 21 patients. Nine patients were eventually weaned from the ventilator, including three quadriplegic patients in whom electrophrenic stimulation subsequently was used. Over 20 years, there were 17 deaths, including three from ventilator disconnection. Life table analysis showed 1-year survival to be 84%, and 5-year survival 65%. Home mechanical ventilation, with patients cared for by family and friends, cost less (average less than $1000/mo) than registered nurse or hospital care (average $16,000/mo). There was no significant difference in the number of deaths between patients cared for by registered nurses 24 hours a day and those cared for by family and friends. Home mechanical ventilation may be a reasonably safe and cost-effective alternative to prolonged hospitalization for the ventilator-dependent child.

In a prospective randomized trial, moxalactam administered to 66 children was compared with ampicillin or chloramphenicol given to 68 children for the treatment of Haemophilus influenzae type b meningitis. Acute morbidity and mortality rates were equivalent between the two treatment groups. At 2 years after discharge, the results of psychologic tests (Bayley Scales of Infant Development or McCarthy Scales of Children's Abilities) were also equivalent between the two treatment groups for patients remaining in the study.

The mineral adequacy of fortified mothers' milk for very low birth weight (VLBW) infants was tested during their first two postnatal months. Metabolic balance and serum Ca, P, Mg, Na, and K values were evaluated at 2.5 and 6 weeks of life in 32 VLBW infants (less than 1.3 kg). Infants were fed either their mothers' milk fortified with skim and cream components derived from heat-treated, lyophilized mature human milk (FMM) or commercial cow milk-derived formulas. Despite Ca and P concentrations 50% to 100% higher in the fortified human milk than is usual in unfortified human milk, group FMM's Ca and P intakes remained significantly below those fed formula (P less than 0.001). Serum calcium levels and alkaline phosphatase activity were higher and serum phosphorus lower (P less than 0.002) in group FMM, whereas serum levels of magnesium, sodium, and potassium were similar in both groups. Ninety-six-hour urinary excretion of Ca was greater and 96-hour urinary excretion of P was less in group FMM (P less than 0.02). Retention of Ca and P in both groups was significantly below estimates of intrauterine accretion. Mg retention was significantly higher in group FMM (P less than 0.002) despite intakes of Mg significantly below those in infants fed formula. Although intakes of Na were below recommended levels in both groups, by the second balance period all infants demonstrated Na retention that was greater than expected from the sum of estimates of intrauterine accretion and dermal losses. Similar findings were noted for K. Biochemical and balance data indicate that relative to the needs of the VLBW infant, fortified mothers' milk was deficient in Ca and P, but adequate in Mg, Na, and K.

Milk intake and growth in 45 exclusively breast-fed infants were documented during the first 4 months of life. Energy and protein intakes were substantially less than current nutrient allowances. Energy intake declined significantly from 110 +/- 24 kcal/kg/day at 1 month to 71 +/- 17 kcal/kg/day at 4 months. Protein intake decreased from 1.6 +/- 0.3 gm/kg/day at 1 month to 0.9 +/- 0.2 gm/kg/day at 4 months. Infant growth progressed satisfactorily, compared with National Center for Health Statistics standards. A reevaluation of energy and protein intakes and allowances during infancy is merited.