677 e-Letters

  • A closer look at neonatal bacterial meningitis
    Gil Klinger


    Bacterial meningitis has its peak incidence in the neonatal period, but there are few data regarding factors affecting outcome. Like Holt and colleagues [1], we studied infants with meningitis, but focused on bacterial culture-proven cases [2]. Prognostic factors were identified by multivariate analysis in 101 infants with bacterial meningitis admitted between 1979 and 1998 to the Hospital for Sick Chi...

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  • Neonatal paroxetine withdrawal syndrome or actually serotonin syndrome? - Authors' response
    Joseph Stiskal

    Dear Editor,

    Isbister and colleagues point out important issues in defining the syndrome we and others described.[1][2] Their argument is that the described syndrome is due to a hyper-serotonergic state, rather than a lack of serotonin effect, as the term "withdrawal" suggests. We agree that this issue must be clearly solved because of the significant implications in the clinical management of some of the patient...

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  • Selection bias in preterm survival studies
    Peter Macfarlane
    Dear Editor,

    The systematic review by Evans and Levine[1] identifies sources of selection bias in reporting preterm survival and recommends cohort characteristics, which should be defined to avoid bias in future studies. To these should be added the more fundamental source of confounding; that of lack of uniformity in defining a ‘live birth’, particularly around the margins of viability. Statute law does not consiste...

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  • Knowledge of neonatal ultrasound for a neonatologist
    Mohan Swaminathan
    Dear Editor,

    I congratulate the authors of this article for highlighting the importance of Neonatal Ultrasound scan interpretation skills needed for a neonatologist.

    I feel that knowledge and skills needed to perform and interpret cranial ultrasound scans in newborns is as important to a Neonatologist as the need for good Echocardiography skills for a Cardiologist.

    Ultrasound scan interpretation should...

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  • Two sacred cows of neonatal intensive care - Authors' response
    Edmund Hey

    Dear Editor,

    I am glad to have a chance to respond to Dr Roberton's assertion that the care of the babies nursed using oximeter settings of 70-90% was "negligent", since I was responsible for these children, but time and space does not allow a full response. Neither does space allow me to respond to the criticism implicit in your own introductory statement that such care "breaches BAPM guidelines".

    Dr R...

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  • Oxygen saturation and retinopathy of prematurity - Authors' response
    Win Tin

    Dear Editor,

    We are happy to make it clear that we have never suggested that hypoxia is "beneficial" to babies with chronic lung disease. Indeed in describing our own practice we said, quite specifically, that "babies who were at least 8 weeks old [and it should be remembered that all our babies were born more than 12 weeks early], and whose retinal vasculature was mature, received liberal oxygen supplementatio...

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  • Dexamethasone, survival and neurological impairment
    William Tarnow-Mordi
    Dear Editor,

    Professor Pharoah questions whether the increased rate of cerebral palsy among newborn infants who were randomly allocated early postnatal dexamethasone therapy in the trial by Shinwell et al[1] might be because dexamethasone increased survival of infants who were impaired before birth, and not because dexamethasone caused cerebral impairment.

    However, two recent systematic reviews of randomise...

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  • Neonatal paroxetine withdrawal syndrome or actually serotonin syndrome?
    Geoffrey K Isbister
    Dear Editor

    We would like to comment on the article “Neonatal paroxetine withdrawal syndrome” in the March 2001 issue of the journal.[1] The authors describe what they have called “neonatal paroxetine withdrawal syndrome”. However the syndrome reported in the 4 neonates appears to be more consistent with serotonin toxicity, rather than withdrawal of paroxetine.

    The literature to date contains one large serie...

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  • Oxygen saturation and retinopathy of prematurity
    Rob Primhak
    Dear Editor,

    The observations of Tin et al have led them to suggest that babies may have better overall outcomes when unit policies aim at oxygen levels of 70-90%, much lower than current practice in most NICUs. While I would support their call for further well-designed research into this question, I have major concerns that this concept of beneficial hypoxia might creep into clinical practice, and even be extended to...

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  • Two sacred cows of neonatal intensive care
    NRC Roberton
    Dear Editor,

    I read the descriptive study of Tin at al[1] with considerable interest. In essence it challenges two sacred cows of neonatal intensive care, whether intra-arterial monitoring is necessary, and what is the appropriate PaO2 at which to nurse critically ill babies.

    Arterial Monitoring
    They do not give us accurate details of arterial catheter use. There is a hint that they are used...

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