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The intraesophageal pressure difference (delta Pes) was measured in 46 preterm infants, 36 with respiratory distress (RDS). It was 12.7 +/- 2.9 mm Hg (mean +/- SEM) in severe RDS, 9.6 +/- 3.2 mm Hg in moderate RDS, and 5.2 +/- 1.6 mm Hg in infants with mild disease, measured at the age of 8 h. These intergroup differences were highly significant (P less than 0.001). During the first 96 h of life the delta Pes decreased to 6.1 +/- 1.1 mm Hg in severe RDS and to 4.8 +/- 1.2 mm Hg in moderate RDS. These changes were also highly significant (P less than 0.001) when compared with respective initial values. In infants with mild disease and in healthy preterm infants, the delta Pes did not alter significantly during the first 96 h of life. The correlations between gastric aspirate L/S ratio and the delta Pes at the age of 8 h (r = -0.65, P less than 0.001) and at the age of 24 h (r = -0.73, P less than 0.001) were highly significant. It is concluded that intraesophageal pressure monitoring is a valuable tool in the intensive care evaluation of the severity of RDS. [ABSTRACT FROM AUTHOR]

Objective. To characterize different methods of monitoring neonatal effects associated with maternal opioid analgesia. Special focus was on the static-charge-sensitive bed (SCSB), which could potentially serve as a non-invasive neonatal monitor. Methods. 12 healthy, term newborns from normal pregnancies were included in this prospective, randomized, controlled study. Maternal labor analgesia was either intravenous fentanyl ( n= 5) or paracervical bupivacaine blockade ( n= 7). Neonatal recording from delivery to the age of 12 hours included continuous SCSB monitoring with ECG and oximeter for sleep states, respiration, oxygenation, heart rate, and body movements. In addition, umbilical blood pH, Apgar, Amiel-Tison's Neurologic and Adaptive Capacity Scoring (NACS), skin cyanosis scoring, blood pressure, rectal and skin temperatures, and skin blood flow measurements were performed. Results. The study was interrupted, because one baby in the fentanyl group had a significant decrease in oxyhemoglobin saturation (SpO2) to 59%. This was considered to be residual effect of fentanyl and was treated with naloxone. SpO2 was generally lower in the fentanyl group. Epochs with SpO2 < 90% were more frequent in the fentanyl group, especially during active sleep (mean ± SD11.9 ± 10.7% vs. 2.0 ± 1.7% of epochs, p= 0.034). Mean heart rate values were lower in the fentanyl group (121.1 ± 6.4 vs. 132.6 ± 6.8 beats per minute, p= 0.02), and this difference was seen during wake and all sleep states. Maximum heart rate values were lower in the fentanyl group, too. The opiate group had less quiet sleep than controls (9.6 ±2.8% vs. 18.3 ± 8.3%, p = 0.05). NACS after birth was lower in the fentanyl group (median [range] 15[13–26] vs. 22 [20–25], p= 0.004). Conclusions. Several differences were seen between the fentanyl and the control group babies. The SCSB method proved sensitive enough to find neonatal effects of maternal analgesia. Together with ECG and SpO2 monitoring, SCSB gives plentiful information on neonatal well-being in anon-invasive way. Results of this study emphasize the importance of neonatal monitoring after maternal opiate use in labor. [ABSTRACT FROM AUTHOR]

The present study was performed to measure the vasoregulatory reactions to dynamic changes in local skin temperature during open bed phototherapy. Periodic thermal stimulation using warm and cool air currents was applied to the skin of ten term infants with physiological jaundice, before and during open bed phototherapy. The reactivity of skin blood flow (SBF) and heart rate was measured using laser Doppler flowmetry and power spectral analysis. The baseline SBF increased significantly by 70% (P = 0.008) during phototherapy without any significant change in skin or rectal temperature. Before phototherapy, the rhythmic (0.08 Hz) thermal skin stimulation increased the oscillations of SBF (from 89 +/- 26 au to 213 +/- 37 au, P = 0.02) at the stimulation frequency band. This response was further increased (P = 0.03) during phototherapy (from 198 +/- 54 au to 658 +/- 115 au, P = 0.004). Phototherapy increased SBF in icteric otherwise healthy neonates. The cutaneous vasodilatation augments the cardiovascular responsiveness to thermal stimulation. These results suggest that open bed phototherapy does not inhibit the cardiovascular responsiveness to local thermal skin stimulation in healthy term infants. [ABSTRACT FROM AUTHOR]

Seventeen newborns suffering from RDS (verified by X-ray and clinical parameters) had a mean plasma progesterone of 13.9±1.2 ng/ml (mean±S.E.) at 24 h of age. This is only 62% of the normal level (22.6±1.5 ng/ml). [ABSTRACT FROM AUTHOR]

Clinical and radiological classifications of the severity of the respiratory distress syndrome (RDS) were made in 55 infants. According to the clinical classification 17 infants belonged to the first class (mild RDS), 22 to the second (moderate RDS), and 16 to the third class (severe RDS). In the classification based on radiological findings the numbers of infants in classes 1, 2 and 3 were 18, 19 and 18 respectively. On the basis of both the clinical and radiological findings, 11 infants belonged to the mild RDS class, 11 to the moderate, and 12 to the severe RDS class. Thus, 34 infants had the same clinical and radiological classification. In 21 infants there were discrepancies between the clinical and the radiological classifications, but only one infant with the most severe radiological findings belonged to the mild RDS class and only one infant with mild radiological findings belonged to the worst RDS class. [ABSTRACT FROM AUTHOR]

Unlabelled: In a prospective study, brain ultrasound scans were performed in 42 newborns (median birth weight 1700 g, range 1020-3720 g; gestational age 32 weeks, 26-36) to reveal peri-intraventricular haemorrhage (PIVH) (grades I-IV) as well as echodensities (ED) and/or periventricular leucomalacia (PVL). ECG and arterial blood pressure were recorded on magnetic tape at 8-h intervals during the first 24 h of life for further computer analysis. Heart rate (HR) and its variability (HRV) indices RMSM (long-term variability) and RMSSD (short-term variability), together with their coefficients of variation, were computed. Systolic (SBP), diastolic (DBP), and mean blood pressures (MBP) were detected as average values for 2-min stationary segments together with the respective minima and maxima. The indices of variability and their coefficients of variation were computed for the arterial pressure. PIVH was found in 12 newborns and ED in 8 (of whom two developed PVL). The remaining 22 served as controls. Neither HR, HRV nor BP variability differed between the groups. DBP was higher in the group with PIVH (39 mmHg) when compared to both the controls (33 mmHg, P < 0.05) and the ED group (32 mmHg, P < 0.01). MBP behaved respectively (45 mmHg, 38 mmHg, 37 mmHg, P < 0.01). SBP behaved also similarly when gestational age and birth weight were used as covariates (57 mmHg, 48 mmHg, 47 mmHg, P < 0.01).Conclusion: Our results suggest that elevated diastolic, mean and systolic blood pressure are significantly associated with peri-intraventricular haemorrhage in preterm newborn infants. [ABSTRACT FROM AUTHOR]

Infant mortality in a region of Finland with about 450,000 people and 5400 annual births was examined during a 15-year period, 1968-1982. Total infant mortality declined from 15.8 per 1000 live births in 1968 to 5.0 in 1982. The lowering of neonatal mortality accounted for the decline, as postneonatal mortality remained at the same level throughout the study period. Despite a decrease of nearly 80%, perinatal disorders remained the leading category of primary causes of death. Mortality from congenital malformations decreased by 50%, mortality from sudden infant death syndrome increased from 0.2 to 0.9 per 1000 live births while mortality from accidents, infectious diseases and other diseases remained minor causes of death with no change in frequency. In the low birth weight category, postponement of deaths from early to late neonatal and postneonatal periods occurred, but total infant mortality in the low birth weight category declined by about 60%. During the last two 3-year periods, decrease in birth weight-specific infant mortality was found in the 500-999 g and greater than 2500 g categories. The reasonably high standard of living, good educational level of mothers, well organized primary maternal and child health services and the rapid advances in obstetric and neonatal care equally available and regionalized, have contributed to the favourable progress in infant mortality in Finland. [ABSTRACT FROM AUTHOR]

The radiographic and endoscopic findings of 83 consecutive patients with suspected foreign body (FB) inhalation into the tracheobronchial tree were compared and the accuracy of chest radiography was estimated. Typical radiologic signs of FB aspiration, such as localized air trapping, atelectasis and infection occurred on radiographs of patients with and without FB. Twenty-four percent of patients with endoscopically verified FB had no abnormalities on chest radiography. In an analysis of radiographs of 83 consecutive patients, in which the prevalence of FB aspiration was 41%, the diagnostic accuracy was 67%, sensitivity 68% and specificity 67%. Plain film radiology alone is not a sufficiently sensitive nor specific method for the diagnosis of FB aspiration. [ABSTRACT FROM AUTHOR]

Fetal and neonatal mortality of small-for-gestational age (SGA) infants in 1968-1982 were studied in the region of the University Central Hospital of Turku, Finland. During the study period, there were 254 fetal and 127 neonatal deaths in SGA infants. The fetal mortality rate of SGA infants declined from 49.9/1000 to 14.0/1000. The neonatal mortality rate of SGA infants declined from 23.8/1000 to 8.3/1000. The severely SGA infants with a birth weight below the 2.5th percentile had three times higher neonatal mortality rates than SGA infants with a birth weight between the 2.5th and the 10th percentiles. The main causes of fetal deaths were maternal diseases, placental and cord complications and fetal malnutrition, even though there was a decline in all these groups. Malformations remained the main cause of neonatal death during the study period, while there was a decline in deaths due to asphyxia and respiratory distress syndrome (RDS). The high mortality rates of SGA infants emphasize the need for early diagnosis and special attention during pregnancy, delivery and the neonatal period. [ABSTRACT FROM AUTHOR]

Evaluates whether repeated procalcitonin (PCT) determinations could identify the presence and course of bacterial infections in neonates earlier than the currently used C-reactive protein (CRP) level. Monitoring of the PCT levels of neonates admitted to the intensive care unit; Measurement of PCT using an immunoluminometric assay; Conclusion that the usefulness of PCT as a diagnostic marker is limited in neonatology.

Reports on the use of mismatch negativity (MMN) to determine the ability of newborns to detect a change in speech sounds. Statistical significance of MMN responses to acoustically easier deviant stimulus; Data showing that newborn learned to discriminate between the stimuli to which they were exposed to during training, and between stimuli that had different pitches.