678 e-Letters

  • Embryological and evolutionary considerations may help identify new predictors of visceral dimension
    EC Jesudason

    Dear Editors

    The study by Embleton et al. (Arch Dis Child Fetal Neonatal Ed 2001;85:F60-F64) highlights the difficulty estimating nasotracheal tube length in neonates and provides foot length as a potentially useful surrogate measurement. Evolutionary and embryological insights may explain why these lengths are correlated.

    Lung-based gas exchange and limb-dependent locomotion may be appreciated as adap...

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  • The "holding back" of intensive care.
    Indranil Bagchi

    Dear Editor

    I note with deep interest the article by Dr. Chiswick on the dilemma surrounding the issues of withdrawal of intensive care from a sick newborn infant. I would like to highlight one aspect of 'withdrawal' which I felt was missing in this thought provoking article.

    Although the most common scenario entailing withdrawal of intensive care is either surrounding an 'end of life decision' or 'quality...

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  • Placement of neonatal central venous catheter tips - is the right atrium so dangerous?
    David W Cartwright

    Dear Editor,

    The debate regarding placement of central venous catheter tips in neonates leaves me puzzled. We have been using percutaneously placed central venous catheters in our unit since 1978, with the aim of tip placement to be in the right atrium achieved in approximately 70% of catheters. I have prospectively maintained records of every baby, their diagnoses, managements (including central venous cathete...

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  • Re: Case for ANNPs not yet proven
    Tim Lee

    Dear Editor,

    We thank Dr Cliona Ni Bhrolchain for her interest in our study [1] and for the points she raises, but we disagree with her interpretation.

    She is correct in noting that the referrals for eye and cardiac abnormalities were routed through senior paediatricians, but wrong to conclude that this would invalidate the results. The same individuals at each hospital performed this senior review, an...

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  • Case for ANNPs not yet proven
    Cliona Ni Bhrolchain
    Dear Editor,

    Lee et al compare routine neonatal examinations by SHOs and ANNPs. They claim that ANNPs were more sensitive and equally specific at detecting all three conditions examined. The study proves this however only for hip abnormalities, referred directly by the ANNPs and SHOs for specialist assessment.

    Referrals for eye and heart abnormalities were routed through senior paediatricians in both hospi...

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  • Weighing breastfed babies
    Anthony F Williams
    Dear Editor,

    Harding et al state that the problem of hypernatraemic dehydration in breastfed babies is attributable to: "the reluctance of midwives to weigh breastfed infants". They imply that weighing between 72 and 96 hours would be an effective intervention, but provide no evidence to support this claim.

    It does not surprise me that the views of midwives and consultant neonatologists differ on this point. Whe...

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  • Recombinant human granulocyte colony stimulating factor therapy in neonates
    SM Jog
    Dear Editor,

    We read with interest the article by Bedford Russell et al on the use of rhG-CSF in very low birth weight neonates with presumed sepsis in a prospective randomised, placebo controlled trial. [1] Considering that the safety (primary objective) and efficacy of rhG-CSF (secondary outcome) was evaluated by factors like worsening of respiratory distress syndrome or chronic lung disease (CLD), thrombocytopenia, ri...

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  • Foot length and neonatal intubation
    Stephen W Hancock

    Dear Editor

    We were interested to read Embleton et al's study in which they presented a well researched argument for using foot length as a predictor of nasotracheal tube length in neonates [1]. While we do not doubt the accuracy of this method we question some of the intubation techniques described, particularly in an emergency situation.

    It is generally recommended that emergency intubation should be or...

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  • Re: Detection of inborn errors of metabolism in the newborn
    Jane Hawdon

    Dear Editor,

    We enjoyed the useful and practical article about inborn errors of metabolism (IEM). However, we are concerned about the sentence at the bottom of page 205 - "The likelihood of a metabolic disorder is very high in the presence of ketonuria, as neonates otherwise do not readily produce ketones."

    We, and others, have studied large numbers of babies who are normal and have no IEM, and found high...

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  • Re: Birth order and RDS : Some controversy in the literature
    Doug Hacking

    Dear Sir,

    We noted with interest Noar et al's letter of 20th July 2001 describing their as yet unpublished work on outcomes of infants from multiple gestation pregnancies. We look forward to seeing the data and methods of analysis on which their conclusions were based.

    We discussed Nielsen et al's work in our paper where we noted that 'the sample size and analytical approach may explain discrepancies...

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