CO measurements and serum lactate levels add little information to the decision-making process for blood transfusions, as neither CO nor serum lactate levels correlate with HB levels in an otherwise asymptomatic population of preterm infants. In infants where the indication for blood transfusion is made based on traditionally accepted clinical criteria, serum lactate is an additional laboratory indicator of impaired oxygenation, as it correlates significantly with oxygen delivery. A significant lower oxygen delivery in patients in whom blood transfusion is indicated and an increase in oxygen induced by transfusion demonstrate the value of these criteria in identifying preterm infants who benefit from transfusion.
In conclusion, exogenous surfactant may modulate the inflammatory response of the airways by affecting the chemoattractant-induced polymorphonuclear neutrophil activation. Surfactant preparations with inhibiting properties on neutrophil activation may participate in the prevention of neutrophil-induced lung damage.
For the prophylaxis of septicemia with coagulase-negative
staphylococci in a high-risk very-low-birth-weight population,
we administered 5 mg/kg of vancomycin every 12 h. Distribution
volume and half-life of vancomycin were determined.
Serum peak and trough levels were obtained on day 3 of treatment.
With this low-dose regimen, serum concentrations in
the therapeutic range were achieved in 35 of the 45 patients.
Distribution volume and half-life were 0.692 liters/kg and
7.4 h, respectively. The distribution volume was not related to
the gestational age; the half-life in the group of patients with a
gestational age <30 weeks was considerably higher. The 10
small-for-gestational-age children had a significantly smaller
distribution volume. The vancomycin trough levels correlated
with the serum creatinine concentrations and, therefore, with
the gestational age. Our study indicates that this low vancomycin
dose is sufficient in very-low-birth-weight infants to
achieve therapeutic serum levels, being suitable for both prophylaxis
and sepsis therapy.
A preterm infant with severe hyaline membrane disease requiring extreme mechanical ventilation developed pulmonary air leaks with consecutive shock. The chest roentgenogram showed bilateral pulmonary interstitial emphysema and gas within the heart silhouette as well as in the hepatic veins, inferior v. cava, portal vein, and many abdominal vessels. The respiratory and circulatory failure by massive systemic gas embolism resulted in death.
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