Detection of seizure activity in the paralyzed neonate using continuous monitoring.

In experimental animals neurologic damage may occur during seizure activity whether the seizure is accompanied by motor activity and hypoxemia or whether the animal is paralyzed and normoxemic. These findings suggest that it may be important to detect seizure activity in the paralyzed neonate. Nine infants who were mechanically ventilated and paralyzed with pancuronium had their condition diagnosed as seizure activity. Vital signs were continuously monitored and six infants had either oxygen saturation or transcutaneous oxygen measured during seizure activity. For the group as a whole, rhythmic fluctuations in vital signs, cardiac rhythm, and oxygenation occurred every four minutes (range one to seven minutes) and lasted two minutes (range one to four minutes). In seven patients whose seizures were not accompanied by cardiac arrhythmias the following mean increases were noted: systolic arterial blood pressure, 15 mm Hg (range 7 to 36 mm Hg); heart rate, ten beats per minute (-11 to 30/min); oxygen saturation, 12% (range 4% to 20%); and transcutaneous oxygen, 31 mm Hg (range 14 to 45 mm Hg). Seizures in the two patients with cardiac arrhythmias were accompanied by a decrease in systolic arterial blood pressure of 27 mm Hg (range 15 to 40 mm Hg) and in oxygen saturation of 24% (range 20% to 28%). The presence of rhythmic fluctuation in vital signs and oxygenation should alert the physician to the possibility of seizure activity in the paralyzed neonate.

The Neonatal Narcotic Withdrawal Index: a device for the improvement of care in the abstinence syndrome.

Management of 50 experimental newborn infants ill with narcotic withdrawal has been carried out with the aid of an instrument developed for measuring its severity, the Neonatal Narcotic Withdrawal Index (NNWI). With its use, infants exposed to methadone in utero have been successfully cared for with detoxification needed in less than 25% of cases and for durations of less than 2 weeks. The percentage of cases and the length of treatment is much less than is customary for infants who have been prenatally exposed to similar doses of methadone. Validity of the NNWI is shown by the statistically significant difference between the mean scores for experimental and control subjects, a high significant correlation between simultaneously measured scores by separate examiners, statistically significant correlations between subscores and total withdrawal scores for the narcotic-exposed experimental cases, and for this group, a statistically significant correlation between scores of withdrawal and the maternal dose of methadone. The simplicity of the NNWI should help to make it acceptable for use by physicians.

Assessment and treatment of abstinence in the infant of the drug-dependent mother.

To accomplish the assessment and treatment of abstinence in the infant of the drug dependent mother, a scoring system has been devised for use as a clinical and research tool. The score monitors the passively addicted infant in a more comprehensive and precise way than has previously been described, and permits us to be more objective in our clinical estimates of the abstinence syndrome. Further, this scoring system has been used by relating it to the dosage schedule of phenobarbital or paregoric as part of an ongoing research project designed to test the comparative usefulness of recommended treatments for neonates with abstinence symptoms. It has been found useful also in following the progression or diminution of symptomatology before, during and after drug therapy. Moreover, the scoring system provides a basis for developing uniform criteria for the assessment and treatment of the neonate of the addicted mother.

Neonatal abstinence syndrome: assessment and management.

A scoring system for the neonatal abstinence syndrome has been devised and implemented as both a clinical and investigative tool. The score monitors the passively addicted infant in a more comprehensive and objective fashion, and facilitates a more precise evaluation of the clinical status of the infant undergoing withdrawal. In addition, the scoring system has been applied in research designed to test the comparative usefulness of various pharmacologic agents currently recommended for the neonatal abstinence syndrome, and has been found useful in following the progression and diminution of withdrawal symptomatology before, during, and after therapy. Furthermore, the scoring system provides a basis ofr developing uniform criteria for the assessment and treatment of the neonate born to the addicted mother.

The assessment of behavioral change in infants undergoing narcotic withdrawal: comparative data from clinical and objective methods.

Studies comparing objective measures of sucking with data from finegrained clinical assessments of the neonate have shown significant correlations between painstaking and time-comsuming clinical methods which may only be reliably applied by highly trained clinician-investigators, and the data generated by a simple technique which can be rapidly and precisely administered in the nursery by nurses or technicians. Within a few minutes the sucking instrument can generate data that explain 50% or more of the variance in certain relevant factors of the Brazelton neonatal neurobehavioral assessment scale, which in our hands requires the participation of two trained clinician-investigators for a period of almost one hour for each test and recording session. There are certain limitations to the information directly available from the sucking measures. Clinical observations must be made in order to correctly interpret some of the findings such as the biphasic relationship between irritability and sucking. For example, an infant may not suck at all because it is obtunded, or it may not suck because it is overexcited. In the case of irritability, sucking performance provides a measure of the magnitude, but not of the polarity of the CNS arousal sucking correlates directly and gives a good estimate of both polarity as well as amount of these behaviors. Objective measures of sucking behavior are a convenient and reliable means for measuring drug effects in the nursery and may be useful in regulating therapy of the newborn.

Caracteristicas clinicas de recien nacidos internados mielomeningocele en el Hospital del Niño Dr. Ovidio Lara Uria. 1993-2002 / Clinic characteristic of myelomeningocele in newborns admited to the Hospital del niño

Objetivos: determinar las características clínicas de los recién nacidos (RN) con mielomeningocele (MMC) en el Hospital del Niño Dr. Ovidio Aliaga Uría. Diseño: estudio retrospectivo y descriptivo (serie de casos). Lugar: Hospital pediátrico institucional de tercer nivel. Pacientes: 55 RN hospitalizados por MMC en la sala de eonatología del Hospital del Niño, entre enero del 1993 y diciembre del 2002. Método de muestreo: consecutivo no robabilístico. Mediciones de los resultados principales: los casos clínicos se ubicaron revisando los archivos de alta, con el nombre o número de historia clínica se encontraron las fichas en el servicio de estadística. En un formulario preestablecido se registraron las variables y para el análisis se emplearon estadísticas descriptivas. Resultados: los RN con MMC representaron 2.1porciento de los ingresos neonatales. 73 porciento provinieron del área urbana. La mediana de edad materna fue 25 años y fueron multíparas 73 porciento de ellas. 55 porciento realizó control prenatal. 45 porcieno nacieron en sus domicilios. 75 porciento de los pacientes fueron derivados de un centro asistencial. 33 porciento de los RN ingresaron con menos de 24 horas de vida. 71 porciento tuvieron el MMC roto a su ingreso. Los MMC se ubicaron en la región lumbar en 47.28 porciento y en la región lumbosacro en 38.18 porciento; de los casos. 71 porciento de los RN con MMC desarrollaron hidrocefalia. Fallecieron 27 porciento durante el período neonatal. Solo el 12.5 porciento concurrió a controles por neurólogo o pediatra Conclusiones: el diagnostico prenatal del defecto fue ocasional. La derivación al hospital de los RN con MMC fue tardía. La mayoría de los MMC estuvieron ubicados en la región lumbar y lumbosacro, muchos pacientes ingresaron con el MMC roto y un alto porcentaje desarrollaron hidrocefalia. La mortalidad fue mayor a la reportada en la literatura y un mínimo porcentaje realizó controles posteriores al alta