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Aim: To compare the efficiency of turquoise light with that of TL52 blue in treatment of preterm infants with jaundice at the same level of body irradiance., Methods: Infants with gestational age 28-37 weeks and non-haemolytic hyperbilirubinemia were treated for 24 h with either turquoise light (OSRAM L18W/860 fluorescent lamps) or blue light (Philips TL20W/52 fluorescent lamps). The concentrations of serum total bilirubin and bilirubin isomers were measured by the Vitros routine method and by HPLC, respectively., Results: The decrease in serum concentrations of total bilirubin, total bilirubin isomers and the toxic Z,Z-bilirubin was greatest for infants treated with turquoise light. Further, the increase in Z,E-bilirubin was smaller and there was a trend towards a higher rise in E,Z-bilirubin., Conclusions: Turquoise light has a greater bilirubin reducing effect than TL52 blue light with equal irradiance, expressed both by serum total bilirubin, total bilirubin isomers and Z,Z-bilirubin, i.e. the turquoise spectral range is more efficient than the blue. This is in accordance with deeper penetration into the skin, lower production of the Z,E-bilirubin and greater production of E,Z-bilirubin and lumirubin, in infants under turquoise light. This suggests, given equal irradiances, that light in the turquoise spectral range is preferable to the TL52 blue in treatment of newborn jaundiced infants.

After detection of a few clinical cases of methaemoglobinaemia (methb) in our NICU, a prospective clinical study was undertaken to determine the extent of the problem and to identify the causes. Consequently, during the following 8 months all haemoglobin tests included simultaneous measurements of methb on an OSM 3 hemoximeter (Radiometer): 8% (n = 33) of 415 neonates were found to be methb positive (defined as > or = 6% methb). Mean methb was 19% (range 6.5-45.5%). Maximum methb concentrations were found on day 4-31 postpartum (mean 12 days) and the number of days with a positive methb sample ranged from 1 to 18 days (mean 6 days). About 40% of the neonates born at 25-30 weeks of gestation and 60% with a birth weight < 1000 g were methb positive. Also, there was a negative correlation between the size of the methb positive concentration and gestational age (r = -0.38, p = 0.02). Measurements of C-reactive protein and leucocytes, NADH reductase, pH, Cl, nitrate and nitrite were carried out in methb positive patients. The tests were repeated 1 week after cessation of methb. The only significant difference was an increase in NADH reductase at the second measurement. Likewise, a wide range of clinical parameters were registered and they occurred with a higher frequency among the methb positive patients when compared with a methb negative control group matched with regard to gestational age and the closest possible birth weight. The mean birth weight of methb positive patients was 1170 g and that of negative controls 1380 g (p < 0.006).(ABSTRACT TRUNCATED AT 250 WORDS)

A double-blind cross-over study was undertaken to compare the efficacy of amoxycillin and pivampicillin on Haemophilus influenzae infection of the lower respiratory tract in children. 20 patients with cystic fibrosis (CF) or chronic obstructive pulmonary disease (COPD) due to other causes were included in the study. All patients had a history of regularly harbouring H. influenzae in sputum and repeated treatment failures with pivampicillin. 18 completed two 14-day courses in random order with equimolar doses of pivampicillin (80 mg/kg/day) and amoxycillin (62 mg/kg/day). Both drugs were well tolerated with no serious side effects, but pivampicillin was associated with more pronounced nausea. In steady state the mean serum concentrations of antibiotics 2 and 4 h after medication were 9.7 and 3.7 micrograms/ml for pivampicillin and 19.1 and 7.9 micrograms/ml for amoxycillin (p less than 0.01). Eradication of H. influenzae and clinical improvement was seen in one-third of the courses with both drugs. Betalactamase producing ampicillin-resistant strains emerged during 58% of the amoxycillin courses, but only in 16% of the pivampicillin courses (p less than 0.001). The high number of treatment failures and the development of resistant strains indicate that betalactamase inhibitors may possibly improve the efficacy of these drugs, especially of amoxycillin, in these patients.

Positive expiratory pressure (PEP) on a face mask was compared with conventional lung physiotherapy in 12 patients with cystic fibrosis. Residual volume (p less than 0.02) and functional residual capacity (NS) was reduced and vital capacity increased (NS) during 6-9 months of PEP treatment. The subjective sputum production was significantly greater during the PEP period. PEP is easy to administer and is inexpensive.

We studied the acute effects of 4 different chest physical therapy regimens using a randomised cross-over design in 14 patients with cystic fibrosis. Treatment A consisted of postural drainage, percussion and vibration; treatment B of postural drainage and periodic application of a face mask with positive expiratory pressure (PEP); treatment C of PEP in the sitting position; treatment D of the forced expiration technique in the sitting position. In terms of sputum expectorated, treatments B and C were superior to treatment D and especially to treatment A (p less than 0.05). Skin oxygen tension, PSO2 was monitored continuously during and for 35 min after treatment. A substantial and prolonged decay in PSO2 was observed during treatment A, quite different from other patterns seen. During and even following treatment C, an increase in PSO2 was noted. PEP was well accepted by the patients, who preferred treatment C, and we suggest it is incorporated in chest physical therapy regimens if the therapeutic objective is to increase expectoration.