Tracheobronchomalacia is common in neonates with bronchopulmonary dysplasia who undergo bronchoscopy and is associated with longer and more complicated hospitalizations.

The effects of surgical bowel manipulation and anesthesia on intestinal glucose absorption were determined in chronically catheterized rats. Total and passive rates of glucose absorption were measured using 3-0-methyl-glucose (30MG) and L-glucose, metabolically inert analogues of D-glucose. The rates of 30MG absorption immediately postoperative and 4 h later were 86 and 62% less than the absorption rate 6 d postoperative. The absorption rates of 30MG 1 and 2 d postoperative were not different from 6 d postoperative. Absorption of L-glucose was not altered by bowel manipulation and anesthesia. Even after correction for the increased resistance of the unstirred water layer (UWL) after bowel manipulation, the rates of total and active intestinal glucose absorption immediately postoperative were only 11 and 15% of predicted rates of absorption. In chronically catheterized rats, > 75% of luminal 30MG at a concentration of 400 mM was absorbed by active transport. The K. and Vm.. of 30MG active transport corrected for the resistance of the UWL were 11.3 mM and 15.6 !Lmoles/min, respectively. We conclude that measurements of intestinal glucose absorption performed within 24 h of surgical bowel manipulation greatly underestimate active absorption even if corrections are made to account for the increased resistance of the UWL. (J. Clin. Invest. 1995.95:2790-2798

Background Continuous opioid infusion (COI) remains the mainstay of analgesic therapy in the Neonatal Intensive Care Unit (NICU). Parent/Nurse Controlled Analgesia (PNCA) has been accepted as safe and effective for pediatric patients, but few reports include use in neonates. This study sought to compare outcomes of PNCA and COI in post-surgical neonates and young infants. Methods Twenty infants treated with morphine PNCA were retrospectively compared to 13 infants treated with fentanyl COI in a Midwestern pediatric hospital in the United States. Outcome measures included opioid consumption, pain scores, frequency of adverse events and subsequent methadone use. Results The PNCA group (median 6.4 mcg/kg/hr morphine equivalents, range 0.0 – 31.4) received significantly less opioid (P < .001) than the COI group (median 40.0 mcg/kg/hr morphine equivalents; range 20.0 – 153.3), across post-operative days 0-3. Average daily pain scores (based on 0-10 scale) were low for both groups, but median scores differed nonetheless (0.8 PNCA vs 0.3 COI, P < .05). There was no significant difference in the frequency of adverse events or methadone use. Conclusion Results suggest PNCA may be a feasible and effective alternative to COI for pain management in post-surgical infants in the NICU. Results also suggest PNCA may provide more individualized care for this vulnerable population and in doing so, may potentially reduce opioid consumption, however more studies are needed.

In this cohort of at-risk infants, topical timolol appeared to provide safe treatment for IHs in full-term infants receiving a dose of less than 0.2 mg/kg/day, but infants with a PMA of less than 44 weeks and weight at treatment initiation of less than 2,500 g may be at risk of adverse events, including bradycardia, hypotension, apnea, and hypothermia. We recommend close monitoring of temperature, blood pressure, and heart rate in premature and low-birthweight infants with IHs at initiation of and during therapy with topical timolol.

A method is described for determining the fraction of intestinal 3-0-methyl-glucose (30MG) absorption that occurs by active transport in chronically catheterized rats without the influence of anesthesia or surgical bowel manipulation. That fraction was determined by simultaneously measuring portal venous-aortic blood concentration gradients (AC) of 3-0-methyl-glucose (30MG) and L-glucose, metabolically inert analogues of D-glucose. 30MG is actively and passively absorbed by the same mechanisms as D-glucose. L-glucose is only passively absorbed. The fraction of 30MG that is actively transported was calculated from the difference between 30MG and L-glucose absorption, divided by total 30MG absorption. We found that more than 94% of 3-0-methyl-glucose is absorbed by active transport when luminal concentrations range from 50 to 400 mM. We conclude that in unrestrained, unanesthetized chronically catheterized rats, most 30MG is actively absorbed by the intestine even at high luminal concentrations. (J. Clin. Invest 1995. 95:2799-2805

Prospectively compare parent/nurse controlled analgesia (PNCA) to continuous opioid infusion (COI) in the post-operative neonatal intensive care unit (NICU) population. Design/Methods: A randomized controlled trial compared neonates treated with morphine PNCA to those treated with morphine COI. The primary outcome was average opioid consumption up to 3 post-operative days. Secondary outcomes included 1) pain intensity, 2) adverse events that may be directly related to opioid consumption, and 3) parent and nurse satisfaction. Results: The sample consisted of 25 post-operative neonates and young infants randomized to either morphine PNCA (n ¼ 16) or COI (n ¼ 9). Groups differed significantly on daily opioid consumption, with the PNCA group receiving significantly less opioid (P ¼ .02). Groups did not differ on average pain score or frequency of adverse events (P values > .05). Parents in both groups were satisfied with their infant's pain management and parents in the PNCA group were slightly more satisfied with their level of involvement (P ¼ .03). Groups did not differ in nursing satisfaction. Conclusions: PNCA may be an effective alternative to COI for pain management in the NICU population. This method may also substantially reduce opioid consumption, provide more individualized care, and improve parent satisfaction with their level of participation. Clinical Implications: Patients in the NICU represent one of our most vulnerable patient populations. As nurses strive to provide safe and effective pain management, results of this study suggest PNCA may allow nurses to maintain their patients' comfort while providing less opioid and potentially improving parental perception of involvement. Study Type: Treatment study. Level of Evidence: I.

Objective: The purpose of this pilot trial was to determine whether rates of contact dermatitis following cutaneous antisepsis for central catheter placement were similar among neonates treated with chlorhexidine gluconate and povidone-iodine. Chlorhexidine gluconate absorption was also evaluated.Study Design: Infants weighing X1500 g and X7 days of age were randomized to a 10% povidone-iodine or 2% chlorhexidine gluconate site scrub before catheter placement. Primary outcomes evaluated included dermatitis, catheter colonization and chlorhexidine gluconate absorption.Result: A total of 48 neonates were enrolled. Colonization rates were similar among treatment groups (P<0.6). Dermatitis did not occur at chlorhexidine gluconate (central catheters, n ¼ 24; peripheral catheters, n ¼ 29) sites. Seven neonates had measurable chlorhexidine gluconate concentrations (range 13 to 100 ng ml À1 ) during catheterization. Conclusion:In this small trial chlorhexidine gluconate antisepsis was tolerated by study neonates. Chlorhexidine gluconate was cutaneously absorbed. Larger trials are needed to determine efficacy and tolerance of chlorhexidine gluconate in neonates.

Infants with hypoplastic left heart syndrome (HLHS) commonly undergo initial surgical palliation during the first week of life. Few data exist on optimal preoperative management strategies; therefore, the management of these infants prior to surgery is anecdotal and variable. To more fully define this variability in preoperative care of infants with HLHS, a survey was designed to describe current preoperative management practices in the infant with HLHS. The questionnaire explored management styles as well as preoperative monitoring techniques and characteristics of the respondent's health care institution. The responses were compiled and are reported. A striking lack of consistency in preoperative management techniques for infants with HLHS is apparent. The impact of these preoperative strategies is unknown. Despite challenges in anatomic and hemodynamic variability at presentation, a prospective randomized controlled trial comparing ventilatory management techniques, enteral feeding strategies, and the utility of various monitoring tools on short- and long-term outcome is needed.