THE EFFECT OF BUFFERED AND NON-BUFFERED ACD BLOOD ON ELECTROLYTE AND ACID-BASE HOMEOSTASIS DURING EXCHANGE TRANSFUSION

PEDIATRICS ◽  
1968 ◽  
Vol 41 (4) ◽  
pp. 802-814
Author(s):  
W. E. Pierson ◽  
Cynthia T. Barrett ◽  
T. K. Oliver
Keyword(s):  
High Risk ◽  
Exchange Transfusion ◽  
Low Risk ◽  
Acid Base ◽  
High Risk Infants

Exchange transfusions have been performed using buffered and non-buffered ACD blood. In 15 low risk infants receiving unbuffered blood, severe acidosis occurred in one during the transfusion. Other investigators have recently observed similar findings. In contrast, when blood was buffered prior to exchange transfusion in 26 high risk infants (i.e., with cardiorespiratory insufficiency), acidemia did not occur. Since the mortality of exchange transfusion is increased in infants with cardiorespiratory insufficiency, it appears that buffered ACD blood will lessen the risks. It is recommended that, ACD blood is used for exchange transfusion in any infant, the blood should be buffered immediately prior to transfusion using 10 mM of 1.0-1.2 M THAM.

Comparison of infant heart rate assessment by auscultation, ECG and oximetry in the delivery room

2018 ◽  
Vol 103 (5) ◽  
pp. F490-F492 ◽  
Author(s):  
Madeleine C Murphy ◽  
Laura De Angelis ◽  
Lisa K McCarthy ◽  
Colm Patrick Finbarr O’Donnell
Keyword(s):  
Heart Rate ◽  
High Risk ◽  
Pulse Oximetry ◽  
Clinical Assessment ◽  
Newborn Infants ◽  
Mean Difference ◽  
Low Risk ◽  
Delivery Room ◽  
Reasonable Accuracy ◽  
High Risk Infants

Clinical assessment of an infant’s heart rate (HR) in the delivery room (DR) has been reported to be inaccurate. We compared auscultation of the HR using a stethoscope with electrocardiography (ECG) and pulse oximetry (PO) for determining the HR in 92 low-risk newborn infants in the DR. Caregivers auscultated the HR while masked to the HR on the monitor. Auscultation underestimated ECG HR (mean difference (95% CI) by −9 (−15 to –2) beats per minute (bpm)) and PO HR (mean difference (95% CI) by −5 (−12 to 2) bpm). The median (IQR) time to HR by auscultation was 14 (10–18) s. As HR was determined quickly and with reasonable accuracy by auscultation in low-risk newborns, study in high-risk infants is warranted.

THE DEVELOPMENT OF HIGH-RISK INFANTS IN LOW-RISK FAMILIES

1989 ◽  
pp. 81-137
Author(s):  
Deborah L. Holmes ◽  
Jill Nagy Reich ◽  
James S. Gyurke
Keyword(s):  
High Risk ◽  
Low Risk ◽  
High Risk Infants

scholarly journals Gut Microbiome Differences in Infants at High vs. Low Risk of Early Obesity

2020 ◽  
Vol 4 (Supplement_2) ◽  
pp. 1103-1103
Author(s):  
Jessica Woo ◽  
Nicholas Ollberding ◽  
Nancy Crimmins ◽  
David Haslam
Keyword(s):  
High Risk ◽  
Beta Diversity ◽  
Negative Binomial ◽  
Low Risk ◽  
Group Differences ◽  
Lactobacillus Species ◽  
Older Children ◽  
Genome Database ◽  
High Risk Infants ◽  
Overweight Or Obesity

Abstract Objectives Fifty % of infants above the BMI 85th percentile will develop overweight or obesity by age 6. This study aimed to evaluate differences in the gut microbial ecology of infants at high- and low-risk of developing overweight or obesity. Methods Infants enrolled at age 6 months were classified into high-risk or low-risk based on BMI ≥85th or <85th percentile; stool samples were collected from the diaper and microbial DNA extracted. Metagenomic shotgun sequencing was performed on the Illumina HiSeq at an average depth of 15 million paired-end reads per sample. Taxonomic profiling was performed using Kraken against a custom genome database. Multiple linear regression was used to test for group differences in observed species richness and Shannon diversity, adjusted for age, delivery type, breast feeding, and introduction of solid food. Beta-diversity ordinations assessed group clustering according to species community composition. Moderated negative binomial regression using DESeq2 was used to identify differentially abundant species. Functional profiling of microbial pathways was conducted using HUMAnN2, and group differences assessed using ALDEx2. Results Sixty-one infants (46% male, 69% black) were enrolled; 13 (21%) were high-risk. Low-risk and high-risk infants differed by race (mixed race more common in high-risk, P = 0.02), and marginally by parent marital status and number of older children in the household (both P = 0.06). Number of observed species were marginally higher in the high-risk group (P = 0.09), with no group differences in beta-diversity ordinations. Several Streptococcus, Enterobacter, Bacteroides and Lactobacillus species were more abundant in high-risk infants, while Haemophilus, Bifidobacterium and Prevotella species were more abundant in low-risk infants. High-risk infants had a more “mature” microbiome characterized by increased abundance of Ruminococcus, Blautia, and Lachnospiraceae. The PWY.5676 Acetyl-CoA fermentation to butyrate pathway was also significantly enriched in high-risk infants. Conclusions Infants at high risk for obesity are characterized by a microbiome more abundant in species seen in older children, and with a greater functional capacity to harvest energy from complex carbohydrates. Funding Sources Digestive Health Center Pilot Grant.

Stability of the Bayley II Scales of Infant Development in a sample of low-risk and high-risk infants

2005 ◽  
Vol 47 (12) ◽  
pp. 820 ◽  
Author(s):  
Susan R Harris ◽  
Antoinette M Megens ◽  
Catherine L Backman ◽  
Virginia E Hayes
Keyword(s):  
High Risk ◽  
Infant Development ◽  
Low Risk ◽  
High Risk Infants

Randomised study comparing heart rate measurement in newly born infants using a monitor incorporating electrocardiogram and pulse oximeter versus pulse oximeter alone

2018 ◽  
Vol 104 (5) ◽  
pp. F547-F550 ◽  
Author(s):  
Madeleine C Murphy ◽  
Laura De Angelis ◽  
Lisa K McCarthy ◽  
Colm Patrick Finbarr O’Donnell
Keyword(s):  
Heart Rate ◽  
High Risk ◽  
Pulse Oximeter ◽  
Low Risk ◽  
Rate Measurement ◽  
Randomised Study ◽  
Heart Rate Measurement ◽  
Parallel Group ◽  
High Risk Infants

AimTo determine whether IntelliVue (ECG plus Masimo pulse oximeter (PO)) measures heart rate (HR) in low-risk newborns more quickly than Nellcor PO (PO alone).MethodsUnmasked parallel group randomised (1:1) study.ResultsWe studied 100 infants, 47 randomised to IntelliVue, 53 to Nellcor. Time to first HR was shorter with IntelliVue ECG than Nellcor (median (IQR) 24 (19, 39) vs 48 (36, 69) s, p<0.001). There was no difference in time to display both HR and SpO2 (52 (47, 76) vs 48 (36, 69) s, p=0.507). IntelliVue PO displayed initial bradycardia more often than the Nellcor (55% vs 6%). Infants monitored with IntelliVue were handled more frequently and for longer.ConclusionsIntelliVue ECG displayed HR more quickly than Nellcor PO. IntelliVue PO often displayed initial bradycardia. Infants monitored with IntelliVue were handled more often. Study of ECG in high-risk infants is warranted.

scholarly journals Stability of the Bayley II Scales of Infant Development in a sample of low-risk and high-risk infants

2007 ◽  
Vol 47 (12) ◽  
pp. 820-823 ◽  
Author(s):  
Susan R Harris ◽  
Antoinette M Megens ◽  
Catherine L Backman ◽  
Virginia E Hayes
Keyword(s):  
High Risk ◽  
Infant Development ◽  
Low Risk ◽  
High Risk Infants

Those Baby Blues

2020 ◽  
pp. 45-50
Author(s):  
Tracey Wagner
Keyword(s):  
High Risk ◽  
Risk Stratification ◽  
Marked Change ◽  
Low Risk ◽  
Altered Level ◽  
American Academy Of Pediatrics ◽  
Baby Blues ◽  
Life Threatening ◽  
High Risk Infants ◽  
Life Threatening Event

Background: Per American Academy of Pediatrics (AAP) guidelines, the term “brief resolved unexplained event” (BRUE) has replaced the previous term “apparent life threatening event” (ALTE). A BRUE is defined as an event occurring in infants younger than 12 months of age who were reported as having a sudden brief episode with at least one of the following symptoms: (a) cyanosis or pallor, (b) absent or irregular breathing, (c) marked change in tone, and/or (d) an altered level of responsiveness. There must be no other etiology or diagnosis that better explains the event. Management: The recommended management of a BRUE depends upon risk stratification. All low risk criteria must be present for a patient to be considered low risk. Low risk infants require limited diagnostics and do not require admission to the hospital. The AAP did not provide specific recommendations for high risk infants.

The Choice of Population and Outcomes in Neonatal Trials on Hyperbilirubinemia: Are They Relevant? An Analysis of Cochrane Neonatal Reviews

Neonatology ◽  
2020 ◽  
pp. 1-7
Author(s):  
Nai Ming Lai ◽  
Shaun Wen Huey Lee ◽  
Sheng Xuan Wai ◽  
Zhi Wei Teh ◽  
Min Yao Chan ◽  
...  
Keyword(s):  
High Risk ◽  
Primary Outcome ◽  
Serum Bilirubin ◽  
Surrogate Marker ◽  
Low Risk ◽  
Use Of Resources ◽  
Cochrane Reviews ◽  
High Risk Populations ◽  
High Risk Infants ◽  
Event Rates

<b><i>Background:</i></b> Neonates with jaundice are usually managed according to their serum bilirubin despite an unclear overall correlation between bilirubin levels and patient-important outcomes (PIOs) such as kernicterus spectrum disorder (KSD). <b><i>Objectives:</i></b> We examined data from Cochrane Neonatal reviews to assess whether conditions that constituted KSD were included as key outcomes and how commonly they occurred in the population studied. <b><i>Methods:</i></b> We identified Cochrane reviews, published till November 2017 that evaluated interventions for neonatal jaundice (NNJ). We extracted the following information at the review and study levels: included population, outcomes assessed (in particular, whether PIOs such as KSD were listed as the primary outcomes), as well as their cumulative incidence in the reviews. <b><i>Results:</i></b> Out of 311 reviews, 11 evaluated interventions for NNJ with 78 randomized controlled trials (RCTs) included. Among the reviews, a total number of 148 outcomes were predefined and 30 (20.3%) were PIOs related to KSD, with 11 (36.7%) listed as primary outcomes. Among the 78 included RCTs (total participants = 8,232), 38 (48.7%) enrolled predominantly high-risk and 40 (51.3%) enrolled predominantly low-risk population. A total number of 431 outcomes were reported, and 40 (9.2%) were PIOs related to KSD (of which 37 were from studies with high-risk infants), with 13 (32.5%) listed as primary outcome. Cumulatively, no infant developed KSD across all studies. <b><i>Conclusions:</i></b> There is suboptimal representation of PIOs such as KSD in neonatal trials and Cochrane reviews on NNJ. Over half of the trials included populations with very low risk of KSD, which does not represent judicious use of resources. Amidst our continued search for a more reliable surrogate marker for NNJ, studies should evaluate the whole spectrum KSD alongside serum bilirubin in high-risk populations with sufficiently significant event rates, as this will make the trial methodologically feasible, with findings that will impact the population concerned.

scholarly journals Known-Groups Analysis of the Harris Infant Neuromotor Test

2007 ◽  
Vol 87 (2) ◽  
pp. 164-169 ◽  
Author(s):  
Antoinette M Megens ◽  
Susan R Harris ◽  
Catherine L Backman ◽  
Virginia E Hayes
Keyword(s):  
Health Care ◽  
High Risk ◽  
Health Care Professionals ◽  
Screening Tool ◽  
T Test ◽  
Low Risk ◽  
Cognitive Behavioral ◽  
First Year ◽  
High Risk Infants ◽  
First Year Of Life

Background and Purpose The Harris Infant Neuromotor Test (HINT) is a screening tool designed to identify neuromotor or cognitive/behavioral concerns in infants who are healthy or at high risk between the ages of 3 and 12 months. The purpose of this study was to determine whether the HINT could distinguish between infants at high risk and infants at low risk for neuromotor delays. Subjects and Methods Following HINT administration by trained health care professionals, scores were compared for 54 high-risk infants and 412 low-risk infants with a t test. Results Mean HINT scores for infants at low risk were lower than mean scores for infants at high risk, as would be expected in that higher scores indicate higher risk. Significant differences were found at 4, 5, 7, and 8 months. At 6 months, there were no significant differences. There were not enough high-risk infants in other subgroups for reliable comparison. Discussion and Conclusion The HINT appears to discriminate effectively between infants who are at low risk and infants who are at high risk for neuromotor delays, supporting the use of the HINT as a screening tool for infants in the first year of life.

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