I read plant et al’s short report ‘Does antenatal pelvic dilation
predict renal scarring’ with interest.[1] They conclude that moderate
renal pelvic dilation of 5-15 mm is not a marker for increased risk of
urine infection or renal scarring, and suggest that it is inappropriate to
perform cystograms on these babies.
I want to bring to their attention 2 recent cases that we dealt with
– bot...
I read plant et al’s short report ‘Does antenatal pelvic dilation
predict renal scarring’ with interest.[1] They conclude that moderate
renal pelvic dilation of 5-15 mm is not a marker for increased risk of
urine infection or renal scarring, and suggest that it is inappropriate to
perform cystograms on these babies.
I want to bring to their attention 2 recent cases that we dealt with
– both with borderline antenatal renal pelvic dilation but subsequently
developing very significant renal problems.
Case 1: Antenatal scans showed borderline dilation of renal pelvis –
6.6 mm on the right and 6.7 mm on the left. She was born at term with
birth weight of 3.24 kg. Postnatal scan showed left renal pelvis measuring
7 mm. The right pelvis was normal. She was commenced on trimethoprim
prophylaxis. Cystogram done at 6 months of age confirmed bilateral grade 3
vesico-ureteric reflux. DMSA scan showed no evidence of focal scarring and
split renal function was normal on both sides.
Case 2: Antenatal scans showed R renal pelvic dilation of 6.5 mm.
Born at 34 weeks’ gestation with birth weight of 2.42 kg. Postnatal scan
on day 4 was normal. He was discharged from neonatal unit on day 17.
Presented with projectile vomiting at 5 weeks age. Abdominal ultrasound
scan performed to rule out pyloric stenosis confirmed L hydronephrosis
with hydroureter. Cystogram showed no evidence of vesicoureteric reflux or
posterior urethral valves. MAG 3 renogram confirmed obstruction to left
ureteric system with L hydronephrosis. R kidney was normal. He was treated
with a course of antibiotics and is awaiting review from paediatric
surgeons.
In the light of our recent experience, it is fair to say that
clinicians may be falsely reassured by borderline dilation of renal pelvis
on antenatal scans and hence there may be a case for undertaking further
investigations to rule out significant renal problems.
Reference
1. Plant ND, Hornung RJ, Coulthard MG, Keir MJ et al. Does antenatal
pelvic dilation predict renal scarring? Arch Dis Child Fetal Neonatal Ed
2005; 90: F339-F340.
First, were there concurrent recordings of associative movements in
the prone position? The prone position has been implicated as a risk
factor for years yet research has been lying prone on it as a blanket
description for just as long. Is it the prone position per se which is at
risk? Or, could it be the base point from which a series of movements is
initi...
First, were there concurrent recordings of associative movements in
the prone position? The prone position has been implicated as a risk
factor for years yet research has been lying prone on it as a blanket
description for just as long. Is it the prone position per se which is at
risk? Or, could it be the base point from which a series of movements is
initiated to impact the system and result in SIDS?
Secondly, is there a valid analogy with animals which curl up to
hibernate in winter with drastically reduced body temperature,
cardiorespiratory rate and brain wave activity? Some cellular and
molecular responses are well known but it is not the mechanism of
hibernation. The physical manoeuvre in combination with the wintry cue may
somehow stun the brain.
There is an obvious similarity to SIDS suggesting a parallel
pathogenesis. Whereas it is temporary and reversible with spontaneous
arousal for hibernating animals, SIDS may represent the irreversible
endstage of near-death parameters. Among other factors the low birth
weight observed could contribute to the physical accommodation and a
generally increased vulnerability.
A recent article by Nestaas et al.[1] deserves comment. This meta-
analysis attempts to evaluate the relative efficacy and toxicity of
“extended interval dosing” (EID), compared to “traditional dosing” (TD),
of aminoglycosides administered to newborn infants. The conclusion of the
analysis was that “extended interval dosing of aminoglycosides in neonates
is safe and effective, with a reduced risk of se...
A recent article by Nestaas et al.[1] deserves comment. This meta-
analysis attempts to evaluate the relative efficacy and toxicity of
“extended interval dosing” (EID), compared to “traditional dosing” (TD),
of aminoglycosides administered to newborn infants. The conclusion of the
analysis was that “extended interval dosing of aminoglycosides in neonates
is safe and effective, with a reduced risk of serum drug concentrations
outside the therapeutic range”.
This interpretation of the data presented can be questioned on
several grounds. Even with meta-analysis, the number of reported treatment
failures (2 in the TD group, none in the EID group from a total of 555
patients) was too small to establish a statistically significant
difference between the two regimes in relation to efficacy.[1]
There were certainly more serum drug concentrations, both peak and
trough, which were outside the defined therapeutic range using TD,
compared to EID. However, this difference was only seen in trials which
were aiming for a higher (usually 5-12 mg/L) peak serum drug
concentration.[1] This observation is a self-fulfilling prophecy. With
EID, the drug is given at the same maintenance dose rate (mg/kg/day), but
with higher single doses and longer dosage intervals than with TD. Basic
pharmacokinetic principles indicate that during EID, peak serum drug
concentrations will be higher and trough concentrations lower, than when
smaller drug doses are given at shorter dosage intervals (TD).[2]
The finding of increased numbers of serum drug concentrations outside
the desired therapeutic range seems compelling, but is per se not
necessarily a strong argument in favour of EID. The efficacy of
aminoglycosides should not be based on this observation alone, even though
there are theoretical and in vitro data to support the concept of ‘post
antibiotic effect’.[1,3] Because treatment failures with TD are extremely
rare,[1] the possible benefit in efficacy of EID becomes less important
than establishing with confidence that this regime has similar or less
toxicity than TD.
Clinically significant renal impairment in neonates receiving
aminoglycosides is extremely rare,[3,4] and is nearly always transient.[4]
Of greater significance is the potential for ototoxicity which can occur
with excessively high serum drug concentrations.[3] In 1979, Finitzo-
Hieber et al,[5] published a comprehensive evaluation of ototoxicity in
newborns receiving TD aminoglycosides (gentamicin or kanamycin). More than
one hundred infants in each of 3 groups (gentamicin-treated, kanamycin-
treated and controls) were followed annually for up to 4 years. Detailed
audiological testing, together with measures of vestibular function and
psychometric assessment were performed. There were no significant
differences between the 3 groups in any of these measures.
By contrast, only 4 of the 16 studies included in this meta-analysis
provided any data regarding ototoxicity. Brain stem evoked responses were
only measured during, or shortly after, a course of an aminoglycoside
(gentamicin or amikacin).[3,4,6,7] No adequate long term assessment of the
incidence of hearing impairment has yet been reported in studies using
EID. Until conclusive ototoxicity data are available in infants treated
with EID, we will continue to use traditional dose aminoglycoside therapy.
References
1. Nestaas E, Bangstad H-J, SandviK L et al. Aminoglycoside extended
interval dosing in neonates is safe and effective: a meta-analysis. Arch
Dis Child Fetal Neonatal Ed 2005;90:F294-300.
2. Benet LZ, Kroetz DL, Sheiner LB Pharmacokinetics In Hardman JG,
Limbird LE, Eds. Goodman & Gilman’s The pharmacological basis of
therapeutics 9th ed, McGraw-Hill, New York, 1996:17-27.
3. Lundergan FS, Glasscock GF, Kim EH et al. Once-daily gentamicin
dosing in newborn infants. Pediatrics 1999;103:1228-34.
4. Kotze A, Bartel PR, Sommers De K. Once versus twice daily amikacin
in neonates: prospective study on toxicity. J Paediatr Child Health
1999;35:283-6.
5. Finitzo-Hieber T, McCracken GH Jr, Roeser RJ et al. Ototoxicity in
neonates treated with gentamicin and Kanamicin: Results of a four-year
controlled follow-up study. Pediatrics 1979;63:443-50.
6. Landhendries JP, Battisi O, Bertrand JM et al. Once-a-day
administration of amikacin in neonates: assessment of nephrotoxicity and
ototoxicity. Dev Pharmacol Ther 1993;20:220-30.
7. Agarwal G, Rastogi A, Pyati S et al. Comparison of once-daily
versus twice-daily gentamicin dosing regimens in infants > or = 2500 g.
J Perinatol 2002;22:268-70.
We read with interest the review on exhaled breath measures of inflammation by Harrison et al.[1] We agree that there is a need to develop and standardise methods for the collection of exhaled breath markers as part of clinical monitoring of neonates on respiratory support. A major limitation we encountered with collecting exhaled breath condensates (EBC) using a method we published earlier was that hydr...
We read with interest the review on exhaled breath measures of inflammation by Harrison et al.[1] We agree that there is a need to develop and standardise methods for the collection of exhaled breath markers as part of clinical monitoring of neonates on respiratory support. A major limitation we encountered with collecting exhaled breath condensates (EBC) using a method we published earlier was that hydrogen
peroxide concentrations were not significantly different between condensates from babies and "dummy" controls.[2] This could be a result of signal dilution of small expired gas volumes from infants by relatively large bias flow, mixture of gases and airway humidification in the
ventilator/continuous positive airway pressure circuits.[2]
Nevertheless, their article prompted us to analyse if there were any trends in exhaled hydrogen peroxide concentrations from 44 ventilated infants with respiratory distress syndrome (RDS) (median gestation and birthweight of 28 weeks and 1025 g respectively) in relation to the development of chronic lung disease (CLD) (oxygen requirement at 36 weeks
post-menstrual age). The median hydrogen peroxide concentration in infants who developed CLD was 0.30 uM (interquartile range 0.21 - 0.46 uM) compared with 0.21 uM (interquartile range 0.16 - 0.37 uM) of those with
resolved RDS (p=0.042). There was no significant correlation between fractional inspired oxygen and hydrogen peroxide concentrations.
We emphasise that these results are still inconclusive due to deficiencies in our collecting system. Further evaluation is required using more refined methods of collection. In this respect, Hitka et al attempted to capture only expired gases from ventilated preterm infants using a double
valve outlet system.[3] This looks promising, although validation of the method with various modes of ventilation and settings, and with a larger and more diverse patient group is necessary before exhaled hydrogen peroxide is considered for monitoring of ventilated neonates at risk for
CLD.
FC Cheah
Department of Paediatrics, Faculty of Medicine, Universiti Kebangsaan
Malaysia,
Bandar Tun Razak, 56000 Kuala Lumpur, Malaysia
BA Darlow, CC Winterbourn
Departments of Paediatrics and Pathology, Christchurch School of Medicine
and Health Sciences, Christchurch, New Zealand
References
1. Harrison CM, Andersen CC. Exhaled breath measures of inflammation:
are they useful in neonatal chronic lung disease? Arch Dis Child Fetal
Neonatal Ed. 2005;90:F6-10.
2. Cheah FC, Darlow BA, Winterbourn CC. Problems associated with
collecting breath condensate for the measurement of exhaled hydrogen
peroxide from neonates on respiratory support. Biol Neonate. 2003;84:338-
341.
3. Hitka P, Cerny M, Vizek M, Wilhelm J, Zoban P. Assessment of
exhaled gases in ventilated preterm infants. Physiol Res. 2004;53:561-564.
I read with interest the report by Plant et al.[1] , in which it is suggested that children with antenatal renal pelvic diameter of 5-15 mm do not require postnatal investigations or treatment as their rate of renal scarring with DMSA after the age of 4 years (1/189 children) was 0.5% (95% confidence interval 0 to 2.9) for both sexes combined. It is not clear however if their results represent antenatal...
I read with interest the report by Plant et al.[1] , in which it is suggested that children with antenatal renal pelvic diameter of 5-15 mm do not require postnatal investigations or treatment as their rate of renal scarring with DMSA after the age of 4 years (1/189 children) was 0.5% (95% confidence interval 0 to 2.9) for both sexes combined. It is not clear however if their results represent antenatal renal dilatation diagnosed at 20 or at 28 weeks of gestation; as more than half of such findings subside
between 20 and 28 weeks, the resulting calculation of prevalence of abnormalities could vary by a factor of at least 2 if the cases they reported were diagnosed at 20 weeks of gestation.
Their results contrast with our findings, hereby described. Over a 5-year period, out of 355 children with antenatal pelvic dilatation at 20 weeks of gestation, 137 children were found to have an antenatal renal pelvic diameter of 5-15 mm at 28 week gestation and were investigated
postnatally while on antibiotic prophylaxis. Those with a defined multicystic kidney, pelvic dilatation over 15 mm, suggestive findings of posterior urethral valve, or with multiple congenital anomalies, were not included in the study. None of the 137 children developed a urinary tract
infection throughout the study period. Postnatal investigations within few months of birth, including ultrasonographic evidence of increase in renal
pelvic diameter in 50 infants, confirmed the presence of obstructive uropathy in 4 children, with a prevalence of 2.9% (95% CI 0.7 to 7.4), including one child with posterior urethral valve and 3 with unilateral
pelvi-ureteral junction obstruction. A high prevalence of obstructive uropathies has already been well documented in infants with pelvic dilatation > 8mm at 28 weeks, well below the 15 mm upper limit suggested by Plant.[2]
Renal scarring on DMSA (in the few months of life) was found in 2 children with a prevalence of 1.4% (95% CI 0.1 to 5.3) and vesicoureteric reflux was diagnosed in 5 children with a prevalence of 3.6% (95% CI 1.1 to 8.5). No DMSA scans were carried out after the age of 4 years in our study. Without dwelling on the controversy surrounding the clinical significance (or lack of it) of vesicoureteric reflux, the
relative risk of renal scarring in our series was therefore 2.75 times that in Plant's report (if their infants were scanned at 28 weeks of gestation) but this was not statistically significant (95% CI 0.3 to 10.1; p value 0.2). However, and more importantly, without postnatal imaging of these children with moderate antenatal renal pelvic dilatation, 4 cases of obstructive uropathy (2.9% of these children) would not have been detected early nor benefited from antibiotic prophylaxis and prompt evaluation by a paediatric urologist. They may still have probably been
diagnosed later, with the occurrence of obstructive symptoms or urinary tract infections, but after some possible damage to the affected kidney(s), which would have been, to some extent, preventable if the diagnosis was made earlier. If, like in Plant's report, postnatal imaging had not been carried out in this cohort and the DMSA scans were carried
out at 4 years of age, a higher number of infants with scarred kidneys on DMSA would be expected, in addition to the 2 we reported, due to potential renal damage resulting from diagnostic and therapeutic delays in the 4 infants with obstructive uropathies who would not have been identified in
the newborn period.
While we strongly agree that the majority of children with moderate antenatal pelvic dilatation would not benefit from antibiotic prophylaxis and postnatal imaging, and with the absence of other published evidence to support such a change in practice at this stage, we cannot yet agree with
Plant's recommendations of not offering postnatal evaluation unless the antenatal pelvic dilatation is more than 15 mm, as this would miss approximately 3% who have an underlying obstructive uropathy. While we recognise that invasive imaging studies with exposure to radiation, such as cystogram, DMSA or MAG scintigraphy, may not be required in the majority, we strongly feel that a postnatal ultrasound still remains indicated in all these children, with antibiotic prophylaxis and further imaging reserved to those with persistent or worsening ultrasound findings until a significant uropathy has been ruled out. Such a strategy based on postnatal ultrasound for antenatal pelvis dilatation up to 10 mm (below the limit of 15 mm suggested by Plant) is recommended to exclude an underlying uropathy.[3]
Until better criteria and/or diagnostic tools have been developed, we cannot at this stage endorse Plant's recommendation of avoiding any postnatal investigation in many such infants(at risk) because only a few (with significant problems) may benefit.
2. Adra AM, Mejides AA, Dennaoui MS, Beydoun SN. Fetal pyelectasis:
is it always "physiologic"? Am.J.Obstet.Gynecol 1995;173:1263-1266.
3. Harding LJ, Malone PS, Wellesley DG. Antenatal minimal
hydronephrosis: is its follow-up an unnecessary cause of concern?
Prenat.Diagn 1999;19:701-705.
In the study by P Bala et al. [1] it seems that interpretations on cost
effectiveness of Palivizumab are made based on the number of admissions
for bronchiolitis alone.
We conducted an epidemiological study to determine the importance of
RSV in the region on 412 consecutive 1 month to 2 year old children
admitted to a tertiary hospital in Kelantan, Malaysia, because of lower
respiratory t...
In the study by P Bala et al. [1] it seems that interpretations on cost
effectiveness of Palivizumab are made based on the number of admissions
for bronchiolitis alone.
We conducted an epidemiological study to determine the importance of
RSV in the region on 412 consecutive 1 month to 2 year old children
admitted to a tertiary hospital in Kelantan, Malaysia, because of lower
respiratory tract infections (1 January - 31 December 2001). We based our
diagnosis of RSV on viral antigen detection in nasopharyngeal aspirates
from the children.
We found that in our setting only 26.2% of babies with bronchiolitis
were RSV positive. On the other hand among the babies, diagnosed to have
pneumonia, 21 percent was RSV positive. We identified also a clear
seasonal trend with a strong peak in the raining season and RSV infection
being extremely rare in the dry season.
Our data caution against just taking clinical bronchiolitis as a sole
indicator of RSV infection. On one hand there may be an overestimation of
RSV infection since by far not all bronchiolitis is due to RSV. On the
other hand the more severe or complicated RSV infections may be missed,
underestimating the burden of RSV for a given population.
Calculations on the true burden of RSV should take into consideration
also the pneumonia cases resulting from or complicating RSV infection and
also the potential long term effects of RSV infections.[2]
References
1. P Bala, C A Ryan, and B P Murphy. Hospital admissions for
bronchiolitis in preterm infants in the absence of respiratory syncytial
virus prophylaxis.Arch. Dis. Child. Fetal Neonatal Ed. 2005; 90: F92.
2. A. Greenough, S Cox, J Alexander, W Lenney, F Tumbuli, SBurgess,
PAJ Chetcuti, NJ Shaw, A woods, J Boorman, S Coles, J Turner, Georges
Russell. Health care utilisation of infants with chronic lung disease,
related to hospitalisation for RSV infection. Arch. Dis. Child.
2001;85;463-468.
We read with great interest the publication of the audit on the use
of peripherally inserted central catheter (PICC) by D W Cartwright.
A 25-gauge polyurethane double-lumen PICC (PI catheter Kit®
double-lumen, Nippon Sherwood, Tokyo) is used in the neonatal intensive
care unit since July 2001. The advantages include an insertion approach
similar to that for single-lumen PICC insertion, simul...
We read with great interest the publication of the audit on the use
of peripherally inserted central catheter (PICC) by D W Cartwright.
A 25-gauge polyurethane double-lumen PICC (PI catheter Kit®
double-lumen, Nippon Sherwood, Tokyo) is used in the neonatal intensive
care unit since July 2001. The advantages include an insertion approach
similar to that for single-lumen PICC insertion, simultaneous
administration of incompatible drugs, and a reduction in the required
number of catheter insertions.
Double-lumen PICC was utilized in 163 infants with the mean birth
weight of 1230 g (range: 373-3610 g), the mean gestational age of 28.9
weeks (range: 22-41 weeks), and the mean duration with the catheter in
place of 15.8 days (range: 1-95 days). Complications included occlusions,
mechanical and accidental failures of the catheter in 23 cases (14.1%),
and septicemia in 5 cases (3.1%). Myocardial perforation, pericardial
effusion and thrombosis did not occur in any infants. Double-lumen PICC
was inserted at the initiation of treatment and no further insertion was
required until infusion was complete in 79 cases (54.9% survivors).
These results suggest that the incidence of complications with double-lumen PICC is similar to or lower than that with single-lumen PICC.
In conclusion, the usefulness of double-lumen PICC is equivalent to
that of single-lumen PICC and we suggest that double-lumen PICC can
replace with single-lumen PICC in the near future.
Dr Stenson claims that Fugelseth et al's article [1] showed that "The
use of 100% oxygen offered no benefit in terms of restoration of cardiac
output or normalisation of pulmonary artery pressure after severe
asphyxia". However, if we still take a-sphyxia to mean without-pulse, the
pigs were not asphyxiated; they were just rendered hypoxic.
Fugelseth et al. largely avoid the term asphyxia i...
Dr Stenson claims that Fugelseth et al's article [1] showed that "The
use of 100% oxygen offered no benefit in terms of restoration of cardiac
output or normalisation of pulmonary artery pressure after severe
asphyxia". However, if we still take a-sphyxia to mean without-pulse, the
pigs were not asphyxiated; they were just rendered hypoxic.
Fugelseth et al. largely avoid the term asphyxia in their article, but
cite another study from Oslo [2] which they state involved asyphyxiated
pigs (though actually that also involved hypoxia alone).
My dictionary doesn't help much here. It states that asphyxia used to
mean "without pulse", but now just means the same as suffocation. It
clearly doesn't. Perhaps it's time for us medics to reclaim this useful,
and quite descriptive word.
References
1. D Fugelseth, W B Børke, K Lenes, I Matthews, O D Saugstad, and E
Thaulow. Arch. Dis. Child. Fetal Neonatal Ed. 2005 90: 229-234.
2. Borke WB, Munkeby BH, Morkrid L, et al. Resuscitation with 100%
O2 does not protect the myocardium in hypoxic newborn piglets. Arch Dis
Child Fetal Neonatal Ed. 2004;89:F156–60.
I read with great interest the article "Pharyngeal pressure in
preterm infants receiving nasal CPAP" by AG De Paoli et al. in the January
2005 issue of ADC Fetal and Neonatal edition. It is a well designed study
assessing the transmission of applied CPAP to the upper airway by
employing active mouth closure.
In the study, active mouth closure was achieved by gentle pressure to
the chin by...
I read with great interest the article "Pharyngeal pressure in
preterm infants receiving nasal CPAP" by AG De Paoli et al. in the January
2005 issue of ADC Fetal and Neonatal edition. It is a well designed study
assessing the transmission of applied CPAP to the upper airway by
employing active mouth closure.
In the study, active mouth closure was achieved by gentle pressure to
the chin by a single finger. It is not unlikely to have fluctuations in
such applied pressure as a result of inter and intra observer
variability. Chin straps could have been a more objective way of achieving
active mouth closure. Favourable results from such studies and similar ones
in the future could be implemented in the NICU on a practical basis if a
standardized, objective measure of active mouth closure is used, viz chin
straps or a similar device.
Although the author mentions about the use of chin straps in some
NICUs, there is little documentation of its use in literature. Mention of
chin strap use in neonates is found in a randomised control trial
comparing early to late use of CPAP [1] and a retrospective study looking
at outcomes following a CPAP based approach [2]. There has been no report
of any complications related to the use of chin straps in these studies.
There appears to be a short term improved transmission of applied
CPAP to the upper airway but long term effects and complications of
prolonged active mouth closure especially when instituted in the immediate
newborn period ,needs to be determined.
Vijayakumar Praveen MD
Senior Pediatric Resident
Bronx -Lebanon Hospital Center
New York 10457 USA
References
1) Krouskop RW, Brown EG, Sweet AY.The early use of continuous positive
airway pressure in the treatment of idiopathic respiratory distress
syndrome.J Pediatr. 1975 Aug;87(2):263-7.
2) AM De Klerk and RK De Klerk ,Nasal continuous positive airway pressure
and outcomes of preterm infants.Journal of Paediatrics and Child
Health,April 2001;37(2):161.
We read the article by Jackson et al with interest [1]. Following
points are noteworthy:
Firstly, the two study groups were not compared in terms of severity
of Neonatal Abstinence Syndrome i.e. Lipitz scores. This may be
significantly different in the two groups, making it difficult to assess
the superiority of morphine over phenobarbitone [2]. Though the maternal
methadone dose was compa...
We read the article by Jackson et al with interest [1]. Following
points are noteworthy:
Firstly, the two study groups were not compared in terms of severity
of Neonatal Abstinence Syndrome i.e. Lipitz scores. This may be
significantly different in the two groups, making it difficult to assess
the superiority of morphine over phenobarbitone [2]. Though the maternal
methadone dose was comparable in both groups, it may or may not be related
to the severity of withdrawal [3,4]. A number of investigators have been
unable to demonstrate any dose-withdrawal relationship. A positive
correlation found by some authors is only to the central nervous system
signs of withdrawal and maternal methadone dose at delivery or last
maternal dose. Neonatal withdrawal symptoms appear to be related to
individual variation in maternal metabolism of the drug, placental
transfer of methadone, and most importantly, to the individual variations
in the rate of excretion of methadone as reflected in the neonatal plasma
t 1/2.Also the maternal methadone dose does not predict the need for
treatment [5] and its direct relation with Lipitz score has not been
studied to the best of our knowledge.
Secondly, the Phenobarbitone group received significantly more 2nd
line therapy (47% versus 35%). It follows that the treatment duration in
Phenobarbitone group was affected by giving a 2nd line therapy and may
have been still longer i.e. Morphine may be even more superior than the
present study suggests.
K.Garcg, G.Morris
Department of Paediatrics and Child Health
Singleton Hospital
Swansea SA2 8QA
Correspondence to Dr Gargh: kapilgargh22{at}yahoo.co.uk
References
1. Jackson L, Ting A, McKay S, et al. A Randomised controlled trial of
morphine versus phenobarbitone for neonatal abstinence syndrome. Arch Dis
Child Fetal Neonatal Ed 2004 ;89: F300-F303.
2. American Academy of Paediatrics Committee on Drugs. Neonatal drug
withdrawal. Paediatrics 1998;101:1079-88.
3. Doberczak TM, Kandall SR, Friedmann P. Relationship between maternal
methadone dosage, maternal-neonatal methadone levels, and neonatal
withdrawal. Obstet Gynecol 1993 ;81: 936-40.
4. Mack G, Thomas D, Giles W. Methadone levels and neonatal withdrawal.
J Pediatr Child Health 1991 ; 27: 96-100.
5. Kuschel CA, Austerberry L, Cornwell M. Can methadone concentrations
predict the severity of withdrawal in infants at risk of neonatal
abstinence syndrome? Arch Dis Child Fetal Neonatal Ed 2004 ;89: F390-F393.
Dear Editor,
I read plant et al’s short report ‘Does antenatal pelvic dilation predict renal scarring’ with interest.[1] They conclude that moderate renal pelvic dilation of 5-15 mm is not a marker for increased risk of urine infection or renal scarring, and suggest that it is inappropriate to perform cystograms on these babies.
I want to bring to their attention 2 recent cases that we dealt with – bot...
Dear Editor,
Simply 2 questions for 3 keywords.
First, were there concurrent recordings of associative movements in the prone position? The prone position has been implicated as a risk factor for years yet research has been lying prone on it as a blanket description for just as long. Is it the prone position per se which is at risk? Or, could it be the base point from which a series of movements is initi...
Dear Editor,
A recent article by Nestaas et al.[1] deserves comment. This meta- analysis attempts to evaluate the relative efficacy and toxicity of “extended interval dosing” (EID), compared to “traditional dosing” (TD), of aminoglycosides administered to newborn infants. The conclusion of the analysis was that “extended interval dosing of aminoglycosides in neonates is safe and effective, with a reduced risk of se...
Dear Editor,
We read with interest the review on exhaled breath measures of inflammation by Harrison et al.[1] We agree that there is a need to develop and standardise methods for the collection of exhaled breath markers as part of clinical monitoring of neonates on respiratory support. A major limitation we encountered with collecting exhaled breath condensates (EBC) using a method we published earlier was that hydr...
Dear Editor,
I read with interest the report by Plant et al.[1] , in which it is suggested that children with antenatal renal pelvic diameter of 5-15 mm do not require postnatal investigations or treatment as their rate of renal scarring with DMSA after the age of 4 years (1/189 children) was 0.5% (95% confidence interval 0 to 2.9) for both sexes combined. It is not clear however if their results represent antenatal...
Dear Editor,
In the study by P Bala et al. [1] it seems that interpretations on cost effectiveness of Palivizumab are made based on the number of admissions for bronchiolitis alone.
We conducted an epidemiological study to determine the importance of RSV in the region on 412 consecutive 1 month to 2 year old children admitted to a tertiary hospital in Kelantan, Malaysia, because of lower respiratory t...
Dear Editor,
We read with great interest the publication of the audit on the use of peripherally inserted central catheter (PICC) by D W Cartwright.
A 25-gauge polyurethane double-lumen PICC (PI catheter Kit® double-lumen, Nippon Sherwood, Tokyo) is used in the neonatal intensive care unit since July 2001. The advantages include an insertion approach similar to that for single-lumen PICC insertion, simul...
Dear Editor,
Dr Stenson claims that Fugelseth et al's article [1] showed that "The use of 100% oxygen offered no benefit in terms of restoration of cardiac output or normalisation of pulmonary artery pressure after severe asphyxia". However, if we still take a-sphyxia to mean without-pulse, the pigs were not asphyxiated; they were just rendered hypoxic.
Fugelseth et al. largely avoid the term asphyxia i...
Dear Editor,
I read with great interest the article "Pharyngeal pressure in preterm infants receiving nasal CPAP" by AG De Paoli et al. in the January 2005 issue of ADC Fetal and Neonatal edition. It is a well designed study assessing the transmission of applied CPAP to the upper airway by employing active mouth closure.
In the study, active mouth closure was achieved by gentle pressure to the chin by...
Dear Editor,
We read the article by Jackson et al with interest [1]. Following points are noteworthy:
Firstly, the two study groups were not compared in terms of severity of Neonatal Abstinence Syndrome i.e. Lipitz scores. This may be significantly different in the two groups, making it difficult to assess the superiority of morphine over phenobarbitone [2]. Though the maternal methadone dose was compa...
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