Eight small, premature infants developed an unusual symptom complex of pulmonary deterioration, thrombocytopenia, liver failure, ascites, and renal failure. five infants died; the health of the other three infants improved and they were discharged from the hospital. This unusual syndrome occurred after introduction of a new intravenous vitamin E product (E-Ferol, α-tocopherol acetate) for routine use in the intensive care nursery. Even though no definite conclusion was reached as to its cause, the administration of this intravenous vitamin E product appears to be a significant risk factor.
20 consecutive prematures with hyaline membrane disease (BMD) were randomized into 10 controls (CG) and 10 treated patientstG) at 7 days of age if they still required ventilator assistance or I oxygen (F10 < 0.21). The TG received a single bolus IV dose of furosemide PF) lmgm/k/day for 4 days and the CG received no diuretic. Mean gestational age of TG was 29 weeks (range 26-31) and of CG was DO weeks(range 27-36). Birth weight of TG was 1024 gm (range 740-1200) and of CG was 1260gm(rarrge 840-2360). All 20 infants had arterial blood gases and lung compliance (CL) measured at 2 hours, diuresis, natriuresis, F excretion and serum F levels monitored for 6 hours. At 2 hours after F dose, the TG demonstrated improved lung compliance(p <.01). This improvement was not sustained over the 72 hour study period. The mean A-a DO2 in the TG tended to decrease over 2 hours after the F dose(p=0.05) with improvement at 72 hours. Mean urine volume during 6 hours in TG was 33.9521 ml and in CG was 25.35 13 ml(p=.35NS). 6 hour sodium excretion was 1.76 mEq(TG) anf 1.45 mEq(CG). There was no correlaLion between 2 hour serum F levels and 2 hour percent CLchange Urine was collected between time 0-2 hours after F dose. On day 4, the 2 hour CL change correlated with this 2 hour urine volume(r=0.82, pd.05) the 2 hour urinary sodium(r=0.94,< 0.05) and the 2 hour urine F(p=0.07). Despite poor renal clearance of P the pulmonary effects are related to its diuretic effect. The lack of sustained pulmonary effect is explained by the brief diuresis.
Although consideration of risks associated with CT scans generally focuses on the effects of radiation and contrast agents, we have identified premedication as an additional risk among infants and children who undergo CT scans. As part of an intensive Pediatric Drug Surveillance (PeDS) Program, we evaluated adverse drug reactions (ADR) attributed t o medications given prior to CT scanning t o sedate 100 infants and children (ages 2 days to 16 yrs). ADR's attributed to premedication were observed in 12 patients (12%); 6 were of major severity, 4 were moderate and 2 were minor. Life-threatening cardiorespiratory depression/arrest occurred in 3 patients after meperidine, meperidine plus diazepam and morphine. Other reactions were CNS depression, behavior changes, voiding problems, respiratory compromise and vomiting. Premedications implicated were morphine, meperidine, promethazine, chlorpromazine, chloral hydrate and diazepam. The risk of an ADR was not materially affected by admission diagnosis or prior receipt of CNS depressants, but ADR risk was increased among older patients (5t yrs.), when > 3 premedication~ were used and when doses were higher than recommended. These observations suggest that ADR's to premedication~ must be considered when assessing the risk of CT scans in children, and that greater attention be paid t o developing appropriate CT scan premedication regimens. ONTCGENY OF THE B-ADRENERGIC RECEPTOR IN RABBIT348 PLACENTA. John J. Moore*, Jeffrey A. Whitsett, U.Cincinnati Coll. of Med., Dept. Peds.8-Adrenergic stimulation of the placenta causes increased glycogenolysis and CAMP production. These effects are presumably mediated through the 8-adrenergic receptor (BAR). In this study the BAR in rabbit placenta was characterized and shown to increase with gestational age. Bi ding of the 6-adrenergic The r a t e of I V drug delivery is affected by many factors including c h a r a c t e r i s t i c s of the drug, I V flow r a t e , and s i t e of injection i n t o the system. Because of the frequent use of CS i n pedi a t r i c patients, we examined the r a t e of CS delivery from a standard pediatric I V infusion s e t (~u r e t r o l~~r a v e n o l ). Using 3 flow r a t e s , and 3 i n j e c t i o n s i t e s (buretrol, y s i t e , f l a s h b a l l ) , timed samples of the I V f l u i d delivered from the s e t were collected f o r 6 h r and analyzed f o r CS by an HPLC method. We found l a r g e differences i n t h e delivery time (min) f o r 95% of the injected CS: S i t e flow r a t e (ml/hr): 29 . . buretrol 150 280 >360 To assess the c l i n i c a l significance of these differences, CS and C steady s t a t e serum concentrations (6 samples over 6 h r ; measured by HPLC) were studied i n f i f t e e n patients (age 0.2-15 yr) receiving CS, 25 mglkg, injected i n t o the buretrol and f l a s h b a l l on consecutive days. Flashball injections resulted i n higher peak CS conc (FO.OO1)-and peak C conc (~0 . 0 0 5 ) i n a shorter time from the s t a r t of infusion (~0 . 0 0 5 ) . A t flow r a t e ...
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