Tn order to assess the impact of the recent upsurge in pediatric drug research, the 1980 edition of the Physicians Desk Reference was reviewed for data and indications pertaining to pediatric and obstetric usage. A total of 1.133 entries were reviewed. Of these 71.9% were oral preparations, 20% parenteral, 1.6% various other routes of administration and 6.5% included multiple routes. Dosing data based on weight or surface area was provided in 27.8% of entries. Specific pediatric dosing data was provided in 40.9% of entries while pediatric usage was specifically contraindicated in 8.9% of entries. In 39.1% of entries no mention was made of pediatric usage and in 11.1% it was mentioned, but without clear recommendations or data. In 2.6% of entries use in pregnancy was approved while 10.3% contained a definite contraindication for such use. The remaining entries either failed to mention use in pregnancy (31.8%) or mentioned use in pregnancy but without definite recommendation (55.3%). Use in breast feeding mothers was mentioned in 27.9% of entries with data provided in 107 entries and a definite contraindication in 104. Data on overdose management was provided in 29.8% of entries. Marked variability was noted between drug classes and manufacturers in terms of the information provided. It is clear from the above analysis that a continued emphasis is needed by manufacturers on providing solid data pertaining to drug usage in pediatrics and obstetrics. York. Butorphanol (B), a new synthetic agonist-antagonist type analgesic, was evaluated in 34 patients aged 4-12 years requiring a parenteral medication for relief of pain following elective surgical procedures. B was administered IM when, in the estimate of the patient or the recovery room staff, an analgesic was required. Doses of B ranged from 0.01 mglkg to 0.02 mglkg, with most patients receiving 0.015 mglkg. Scores of pain intensity (0-3) and relief (0-4) were done prior to dosing and at hourly intervals for six hours following the dose, or until additional medication was required. Surgery inoluded orthopedic (12), abdominal (5))noncardiac thoracic ( 3 ) ) genitourinary (11) and miscellaneous (2) procedures. There were 19 male and 15 female patients. 16/34 patiems continued to experience good pain relief at the end of the six hour observation period. The mean length of time to remedication was 5.0 hr. with a 6 hr. maximum given. The range was 2-6 hr. At any given dose, pain relief tended to be better and more prolonged in the younger patients. This may derive from the increased sedation seen with B in the younger children. There was no significant difference between the three doses used in degree or duration of analgesic effect. Except for one patient who experienced transient urinary retention, sedation was the only significant side effect seen. This is the first reported dose ranging study of pain therapy in children. B, at a dose of 0.01-0.02 mglkg, provided good relief of post-operative pain in children. . . -60-hydr~x~cbrtisol (~~oHF), a normally occurring pol...

Previous studies have shown that Vitamin A levels are low in the growing premature infant. An attempt was made to raise Vitamin A levels by increasing oral intake in one of two groups of premature infants. Each group Jas 1 ma,ched for birth wt., gestational age 09set aqd voluie cc Kg/day) of feedings and caloric inta~e ~kcal/Kg/day. roup I infants were fed an ex-p~rimental formula prepared y Ros~ Laboratories of 500 IU Vit. A/dl while Group II receiv~d PM 60/40 (Ross) formula which contained 325 IU of Vitamin A/dl. Week Group I Group II p ug/dl ± SEM (n) ug/dl ± SEM (n) *-Student 't' test. **-Mann 'ihitney test.

A retrospective study of all infants weighing 701 to 1,500 g born at 11 neonatal intensive care centers during 1983 and 1984 was performed to determine whether two specific 28-day outcomes, survival and survival without the need for supplemental oxygen, varied among the centers. Survival without the need for supplemental oxygen was chosen as a reflection of infants surviving without chronic lung disease. There were 1,776 live-born infants delivered during the 2-year study period. Of these infants, 85% (1,512) survived 28 days, a range of 80% to 92% at the individual centers. A total of 60% (1,056) of the infants were alive without supplemental oxygen on day 28, a range of 5l% to 70% at the individual centers. Multivariate analysis demonstrated that both survival on day 28 (χ2 = 23.9, P < .01) and survival without supplemental oxygen on day 28 (χ2 = 44.2, P < .0001) varied significantly among centers after the effects of birth weight, gender, and race were taken into account. Female gender, nonwhite race, and increased birth weight were factors associated with improved rates of survival and survival without supplemental oxygen. The magnitude of outcome variation among centers was estimated by using the logistic regression models to predict what the outcomes would be if each center were to treat a standardized population consisting of all 1,776 study infants. Predicted survival rates varied by as much as 15% and the predicted rates for survival without supplemental oxygen varied by nearly 17% between centers with the highest and lowest rates. The differences in outcomes observed at the centers did not correlate with the number of live births at the centers or with the scores on a simple respiratory practices questionnaire. It was concluded that 28-day outcomes for very low birth weight infants vary significantly among different neonatal intensive care centers. Potential sources of this variation include undetected population differences in neonatal disease severity and differences in the techniques of both obstetrical and neonatal care.