1317 the Challenge of Neonatal Icu (Nicu) and Mechanical Ventilators (Mv) in a Developing Country: A Two Year Experience

Abstract

Management of prematures in the NICU has reduced neonatal mortali ty and morbidity; however, deficits in cognitive and sensory functioninq persist. The environment of the NICU may be responsible for newly recognized iatrogenic problems and may not be conductive for optimal development. We studied the quantity, quality, organization, and diurnal rhythmicity of physical and social stimulation in the NICU. Observations were conducted every half hour over 3 days. Physical recordings included light and sound levels, sound spectra, and occurrence of nonspeech, speech, and radio sounds. This information was collected both in the units and in incubators. Social data included the frequency of nursing care, feeding, social touching, rocking, and talking when in contact with an infant. There were 405 recordings for each physical var: iable and 1551 infant observations. The same illumination was always present. Infants were exposed incessantly to nonspeech sounds. Sound levels at times were excessively high. Incubators did not shield infants from stimulation. 19% of the observations included social contact of which 17% involved handling. Infants in the NICU suffered not from a lack of visual auditory, and tactile stimulation, but from a low frequency of sensory coordinated experiences. There was no diurnal rhythmicity in the physical or Retrospective studies have implicated fetal head constraint a s one cause for sagittal, coronal and metopic craniostenosis, Early sutural patency is contingent on persistent dural growth stretch. We bypothesize that fetal head constraint in a particular plane is one mechanism through which one or more sutural regions may be relieved of growth stretch, enhancing the liability towards synostosis at that region. This hypothesis is supported by animal studies and we present sutural histology fran 15 instances of sagittal craniostenosis for which gestational histories implicated fetal head constraint as the cause in 13 instances. We also present histology frcm 2 constraint-related cases of metopic craniostenosis. In each case there was ectocranial bone deposition, endocranial bone resorption and demnstrable sutural synostosis. A Sayers partial calvariectany procedure was performed at or before 6 ms. in all instances. This dramatically restored head shape to normal with refonnation of the palvarium and sutures. This sutural histology and restoration to normal form by surgery differed from that found in 6 instances of coronal craniostenosis which occured as part of a broader pattern of intrinsic malformation, such as Pfeiffer or Saethre-Chotzen synclromes. In these latter instances, the altered craniofacial form tended to persist despite early calvariectany. Maximal decreased in serum bilirubin levels were observed at I 457.9 and 488.0 nanometers with significantly less change observed at 476.5 and 514.5 nanometers (P<0.05). These data confirm the maximal effect of "blue light" but the action spectrum appears not to be identical to the absorption spectrum of protein-bound bilirubin. Rather, it exte...