NIDCAP-based care for VLBW infants improved short- and long-term outcomes significantly.

No abstract

BACKGROUND: Routine procedures are a large component of the caretaking day for preterm infants. Such procedures can have profound adverse effects on an infant's condition, to the point of disrupting normal growth and development. Despite this evidence, routine procedures are perpetuated in the neonatal ICU. OBJECTIVE: To determine the physiological and behavioral effects of a supposedly beneficial procedure, a sponge bath, on premature infants. METHODS: The study sample consisted of 14 preterm neonates with no neurological abnormalities at two tertiary neonatal ICUs. The ages of the subjects were 28.1 to 31.8 weeks postconception and 4 to 25 days after birth. The study was a prospective, quasi-experimental, repeated-measures design in which each infant acted as his or her own control. Oxygen delivery, heart rate, oxygen saturation, and behavioral responses were continuously recorded by computer or real-time videotape. Physiological and behavioral parameters were compared across three phases: 10 minutes before a bath (baseline), during a standardized bath, and 10 minutes after the bath. RESULTS: Physiological and behavioral disruptions occurred throughout the bath phase and in many cases beyond that phase. These disruptions included significant increases in heart rate, cardiac oxygen demand, and frequency of behavioral motoric cues. Significant decreases in oxygen saturation also accompanied the bath. Nine infants required increased concentrations of ambient oxygen. A significant association was found between physiological components and the frequency and timing of behavioral motoric cues. CONCLUSIONS: The results provide further evidence that routine care is not innocuous to neonates. Routine sponge bathing is not recommended for care of ill premature infants.

We have developed a method t o lower cardiac output (Q) instantaneously, reversibly, and in a controlled, stepwise fashion in conscious lambs, using a balloon tipped (Foley) catheter inflated in the right atrium. The hemodynamic and metabolic effects of selective lowering of Q in the conscious, unsedated lamb has not previously been reported. Under conditions of low Q, we studied lambs at 2 weeks (n=5), 4 weeks (n=6) and 8 weeks (n=5) of age to determine the critical Q necessary t o decrease oxygen consumption (V02) or increase lactate (L) production a t each age. A t each level of balloon inflation we measured: VO C 0 2 production (VC02), venous hemoglobin concentration (Hb?: heart rate, arterial L, and systemic and pulmonary arterial blood gases, % HbO2 and pressures. The actual critical Q varied between lambs at a given age, although it was lower in the older lambs. However, when Q was normalized t o resting cardiac output (Qo), L production increased and V02 decreased in all lambs whenever Q 4 .6 Qo, thereby establishing a critical Q which was similar for a h a g e s . Due to the wide differences with age in Hb and Qo, the critical systemic oxygen transport (SOT) also decreased with age from 15 (2 weeks) t o 11 (8 weeks) m102/min kg.These data provide evidence of a critical Q in the young subject and provide a model for studying the metabolic effects of low Q in the conscious lamb. Furthermore, the relationship between V02 and SOT determined here for low flow states is similar to that established previously for anemia and hypoxemia. LIMITATIONS OF SELF-INFLATING BAGS. Neil F i n e r , Fidel176 El Fadley, Keith Barrington, Kathrine P e t e r s , UniverSi t v of A 1 berta. Roval A1 exandra Hosoi t a l . Deoartment , ..of Neonatology ,-Edmonton, ~i b e r t a , CANADA S e l f -i n f l a t i n g bags a r e frequently used in neonatal and pedia t r i c r e s u s c i t a t i o n . Because of concerns t h a t these devices tend t o be u n r e l i a b l e and i n c o n s i s t e n t we studied a r e p r e s e n t a t i v e number: 12 Ohio (Hope I I ) , 5 Leardal, 5 PMR2 Puritan with and without r e s e r v o i r s (R).These bags were connected to a small test lung v e n t i l a t e d a t r a t e s (RR) from 1 0 Ten children received < 8mg/kg t o t a l morphine dosage f o r the f i r s t nine days of EI. Of t h i s group, only one p a t i e n t developed morphine dependency and only a f t e r receiving > 16mg/kg cumulative morphine dosage over several subsequent weeks of EI.The remaining t h r e e children received >16mg/kg cumulative morphine dosage and each showed s i g n s of dependency. Our conclusion i s t h a t cumulative morphine dosage may help t o i d e n t i f y EI children a t r i s k of withdrawal. PIGTAIL CATHETER TECHNIQUE REDUCES TRAUMA OF CHEST178 TUBE PLACEMENT. B. P. Fuhrman, B. G. Landrum, T. B.F e r r a r a and T. P. Green. P e d i a t r i c C r i t i c a l Care and Neonatology, Univ. of Minnesota, Minneapolis, MN 55455.Chest tube placement f o r drainage of p l e u r a l f l u i d o r evacuat...