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Chest radiographs and clinical records of 58 newborns with pulmonary interstitial emphysema (PIE) were reviewed to determine the diagnostic and prognostic significance of this finding in the first 24 hours of life. Thirty-nine infants developed PIE before 1 day of age (early PIE). In the absence of infection, early PIE was associated with younger gestational age, lower birth weight, lower 1 and 5 minute Apgar scores, and higher mortality, as compared with patients in whom air leak occurred later. Survival in infants with PIE seemed to be influenced mainly by coexisting risk factors such as extreme prematurity, birth asphyxia, and perinatal infection. Most cases of early PIE in newborns less than 30 weeks gestational age occurred at peak ventilation pressures less than 25 cm H2O, and probably reflect increased sensitivity of the underdeveloped lung to barotrauma. In infants older than 30 weeks gestational age, early PIE was strongly associated with bacterial sepsis. These data indicate that the occurrence of PIE in the first 24 hours of life is a particularly ominous sign, and is frequently associated with clinical conditions which carry a poor prognosis.
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PMID:Early pulmonary interstitial emphysema in the newborn: a grave prognostic sign. 359 42

This article discusses the major sources of data on infant and child mortality in India and presents statistics derived from these sources. The 1st Infant and Child Mortality Survey was conducted in 1979 in the units of the Sample Registration System. The results provide valuable insights into socioeconomic and demographic factors that differentially affect mortality. Infant mortality was found to be higher among illiterate women, those married before 18 years of age, at higher partities, and in deliveries not attended by trained medical practitioners. In addition, the existence of indices of development such as water supply, medical facilities, and motorable roads was negatively correlated with infant mortality. The Sample Registration System continues to be the main source for measures of infant mortality on an annual basis at the national and subnational levels and for urban and rural areas. However, the growing demand for estimates of vital rates for small areas such as districts will require either expansion of the Sample Registration System or the strengthening of the Civil Registration System. The latter system is a permanent, compulsory registration of births and deaths, although the completeness and accuracy of the data are inconsistent. Training camps are being organized to train physicians in certification, which should improve the quality of the data. The Survey of Cause of Death, another permanent system that covers primary health centers, is based on an investigation of symptoms and conditions preceding each death. Data from this source indicate that prematurity, respiratory infection, diarrhea, gastrointestinal disorders, and malnutrition are the leading causes of infant deaths, while gastrointestinal disorders, disorders of the respiratory system, and fevers are the major sources of child mortality. Although the basic infrastructure is lacking at this point, it would be desirable to expand the willingness of medical practitioners to certify causes of death in a prescribed manner.
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PMID:Vital statistics system--a major source of information on infant and child mortality. 405 94

A longitudinal survey of child health in Juba was done to secure data on which preventive schemes could be based. 223 pregnant women were identified in a systematic search of a district. 5 infants were stillborn and 10 were born prematurely. The mothers of 5 of 10 premature infants had had acute malaria at or immediately preceding delivery. 2 of these premature babies later died from causes attributable to prematurity and therefore indirectly to the preventable maternal malaria. The causes of neonatal mortality included tetanus caused by cutting the cord with a blade of grass. Between months 1-6, 5 infants died of infective enteritis, 1 of bronchopneumonia, and 1 of pyrexia of undetermined origin associated with convulsions. Growth was much impaired by diarrhea, which caused 85 attacks among 63 babies, and by lower respiratory infections, of which there were 119 among 74 of the babies. Skin and eye infections were also common. Removal of the unerupted canine teeth, believed to cure or prevent illness, caused much distress and some aspiration bronchopneumonia. Health education and improved hygiene and water supplies would greatly reduce the extent of morbidity and mortality.
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PMID:Infants in Juba, Southern Sudan: the first six months of life. 613 86

It has been suggested that apnea of prematurity may be caused by "immaturity" of central control of breathing. To test the validity of this hypothesis tidal volume (VT), alveolar ventilation (VA), alveolar Pco2 (Paco2), esophageal pressure change, and the slope of the CO2 response curve (delta Ve [minute ventilation]/delta Paco2) were determined in 18 infants with apnea (mean of 32 episodes of more than 20 seconds duration per day) and in 18 healthy newborns used as control subjects. The infants were matched for birth weight (1,068 g v 1,065 g), gestational age (30.2 weeks v 30.2 weeks), and postnatal age (8.6 days v 8.3 days). The results were as follows: Vt (4.4 +/- 1.0 mL/kg v 5.3 +/- 1.6 mL/kg), Va (96 +/- 21 mL/kg/min v 129 +/- 33 mL/kg/min), Paco2 (45.4 +/- 8.5 mm Hg v 35.6 +/- 4.7 mm Hg), esophageal pressure change (4.5 +/- 0.9 cm H2O v 6.0 +/- 1.8 cm H2O), delta Ve/delta Paco2 (20.2 +/- 10.6 mL/min/kg/mm Hg CO2 v 40.7 +/- 19.9 mL/min/kg/mm Hg CO2). There was a significant difference between infants with and without apnea for all measurements. The results indicate a decreased respiratory center output and a depressed ventilatory response to CO2 in infants with apnea. As there was no difference between the two groups in pulmonary mechanics or oxygenation, the findings support the hypothesis that a central disturbance in regulation of breathing is the cause of apnea in these infants.
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PMID:Apnea of prematurity: I. Lung function and regulation of breathing. 642 25

Morbidity and mortality patterns were examined among 968 pediatric patients on the island of Dominica. These children, whose ages ranged from newborn to 13 years, were seen by the consulting pediatrician at Princess Margaret Hospital during a 9-month period in 1978-79; 852 children were seen as inpatients. A total of 477 cases of infectious disease were diagnosed among inpatients alone. Stool examination in a subsample of these children revealed parasites (mostly Trichuris) in roughly half. Also found was a relatively high prevalence of chronic health problems, especially rheumatic heart disease (34 cases), mental retardation (28 cases), epilepsy (31 cases), and sickle cell anemia (21 cases). Examination of the hospital records of 100 of the inpatients ages 6 months-5 years demonstrated that 34% were low weight-for-age according to the World Health Organization classification. There were 34 deaths (9 pediatric patients and 255 newborns). The high neonatal mortality is attributed to an unusually high incidence of immaturity and prematurity, irregular and insufficient hospital oxygen supply, and a septicemia epidemic. Although these findings reflect patterns of the more serious diseases, they could be useful in planning preventive health measures. The high prevalence of malnutrition points to a need for nutrition education, promotion of breastfeeding, promotion of vegetable growing, and the introduction of a home-based growth chart. The high incidence of diarrhea, typhoid fever, and helminthiases highlights problems with general hygiene, latrines, and water supply. There is also a need for follow-up facilities for children with rheumatic heart disease, epilepsy, and sickle cell anemia. It is suggested that hospital care could be improved by dividing pediatric and neonatology wards into 5 units: isolation ward, malnutrition ward, semi-intensive care unit, general pediatrics, and pediatric surgery.
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PMID:Morbidity and mortality patterns among pediatric patients in Dominica (West Indies). 662 10

Airway obstruction is a cause of apnea in preterm infants. The activity of protective respiratory reflexes was determined in 18 preterm infants with apnea (mean of 32 episodes of more than 20 seconds duration per day) and in 18 neonates without apnea used as control subjects. This was done in order to elucidate the role of respiratory reflexes in apnea of prematurity. The infants were matched for birth weight (1,068 g v 1,065 g), gestational age (30.2 weeks v 30.2 weeks), and postnatal age (8.6 days v 8.3 days). The airway occlusion technique was used to determine the inspiratory prolongation of the occluded breath and the effective elastance of the respiratory system. Inspiratory prolongation is a measure for the reflex influence on inspiratory duration, and effective elastance reflects load compensating ability. Inspiratory prolongation was 7.3% +/- 33.5% in infants with apnea and 30.6% +/- 22.7% in the control group (P less than .025). Effective elastance was 1.1 +/- 0.5 cm H2O/mL in the apneic group and 1.5 +/- 0.5 cm H2O/mL in the infants without apnea (P less than .025). The results indicate that during exposure to respiratory loads, the infants with apnea maintained inspiratory effort poorly and had a decreased ability for load compensation. Their respiratory reflexes were significantly more immature than the reflex activity of the infants without apnea. This functional immaturity of respiratory reflexes may be a contributing factor in the etiology of apnea of prematurity.
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PMID:Apnea of prematurity: II. Respiratory reflexes. 673 19

Because chlorination of potable surface waters may be associated with increased risk of carcinogenicity, substitute methods for the routine disinfection of public water supplies are being explored. As part of this search, it is especially important that the potential health effects of each alternative method should be considered. Chemical treatment of drinking water by chlorine dioxide (ClO2) is a likely alternative mode of disinfection. Two common by-products of the ClO2 disinfection of surface water are chlorate and chlorite. These oxidants may have negative health effects on certain high risk groups. Newborns, in particular, would seem to be at increased risk to red cell damage from oxidant stress. The historical record study being reported here compares the morbidity and mortality experience of newborns in two similar communities, one of which used chlorination and the other which used high levels of chlorine dioxide for potable water disinfection. A statistically significant positive association was found between exposure of the mother to ClO2-treated water during pregnancy and prematurity of the newborn as assessed by the attending physician and by a greater weight loss after birth. The rates of jaundice, birth defects and fetal and neonatal mortality did not differ significantly between communities. Because of the limitations of the study design, the findings reported here should be considered suggestive rather than definitive.
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PMID:Health effects among newborns after prenatal exposure to ClO2-disinfected drinking water. 715 66

We determined if pulmonary peptidoleukotrienes contribute to the pathogenesis of chronic lung disease of extreme prematurity (CLD) by measuring urinary leukotriene E4 (uLTE4). Study patients had a birth weight < 1000 g and were about 28 d old when they were classified as normal control subjects (n = 8) or as having CLD (n = 26, abnormal chest X-ray, supplemental O2 requirement +/- ventilator). Urinary LTE4 levels were significantly elevated in CLD compared with the control group (288 +/- 92 versus 35 +/- 10 pg/mg creatinine, mean +/- SE, p < 0.05). Ventilator-dependent CLD patients, who required dexamethasone and had demonstrated uLTE4 levels above the normal range, needed significantly higher peak inspiratory pressures (20 +/- 1 cm H2O versus 15 +/- 1 cm H2O) than similar patients with uLTE4 in the normal range, and the former group had a significant reduction in uLTE4 in the first 5 d of dexamethasone therapy (626 +/- 198 to 451 +/- 176 pg/mg Cr) as ventilatory support was reduced. We conclude that peptidoleukotriene production is activated in patients with CLD (and no other detectable organ dysfunction) to pathophysiologic levels described in adults with acute asthma. Prospective studies focused on infants dependent on high levels of ventilatory support may provide insights into the role of leukotriene synthesis inhibitors or receptor antagonists in the treatment of CLD.
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PMID:Elevated urinary leukotriene E4 in chronic lung disease of extreme prematurity. 788 80

Endemic areas of lead poisoning have recently been rediscovered raising an important public health problem, particularly for pregnant women and their offspring. Theoretically, pregnant women can no longer be exposed to occupational sources with the application of public health regulations but other sources including water contamination, wall paint, industrial wastes and automobile exhaust fumes cannot be ignored. The placental barrier is permeable to free serum lead and levels in cord blood reaches 5 to 10% of the maternal blood level. In addition, lead may be released from maternal bone reserves during pregnancy and thus become a major source of intoxication for the fetus. Lead content in fetal organs increases with gestational age and may affect the nervous system and calcium dependent organs. Moderate lead levels of 100 micrograms/L can inhibit fetal haeme and erythropoiesis. Besides the classical signs of lead poisoning, pregnant women risk spontaneous abortion and increased blood pressure. Manifestations in the fetus and newborn include prematurity, fetal hypotrophy and malformations. Other manifestations are not seen until several years after birth and include retarded mental development and muscular and behaviour disorders. Diagnosis is based on screening tests which should be used in cases of suspected accidental or environmental intoxication. Tests should include assay of zinc protoporphyrins and aminolevulinic acid dehydrase. A search for the source of the contamination should be undertaken when blood levels above 250 micrograms/L are observed. Treatment with metal chelators is not recommendable (except in extreme life-threatening cases) during pregnancy due to their teratogenic effect. Prevention is the only adequate treatment.
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PMID:[Lead poisoning in pregnancy]. 806 61

The critically ill neonate with a surgical condition requires transfer to an operating room (OR), a process which may be associated with significant morbidity. In an effort to reduce such morbidity, we performed surgery on critically ill neonates in a designated area of our neonatal intensive care unit (NICU) over the past 4 years and have compared the outcome for infants operated on within the NICU with infants operated on in the OR over the same period. There were 81 procedures performed in the NICU compared with 112 in the OR. Infants operated on in the NICU had lower birthweights (1,758 g v 2,457 g), lower gestational ages (31.3 weeks v 35.8 weeks), and lower presurgical weights (2,118 g v 2,922 g) (all P < .0001). In addition, infants operated on in the NICU had a greater severity of illness with 78% requiring mechanical ventilation versus 26% for the OR group (P < .0001) with a higher presurgical FiO2 (.43 v .31, P = .005), and a higher presurgical mean airway pressure (8.0 cm H2O v 6.2 cm H2O) for infants requiring mechanical ventilation. The overall mortality was higher in the NICU group (14% v 2%), reflecting their underlying prematurity, illness, and anomalies. There was only one surgically related death, which occurred in the NICU group. There was no significant difference in culture-proven sepsis, length of surgery, change in weight, temperature, blood pressure, heart rate, FiO2, mean airway pressure, or oxygen index associated with surgery, but there was a significantly higher incidence of hyperthermia with a temperature of greater than 37.5 degrees C in the OR group (17.8% v 3.7%, P = .002). Our experience suggests that surgical procedures can be performed in the NICU for the unstable critically ill neonate with a morbidity comparable to that seen in the OR. Further experience is needed to compare the risks and benefits of this approach.
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PMID:Neonatal surgery: intensive care unit versus operating room. 834 Aug 48


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