Why wrapping premature neonates to prevent hypothermia can predispose to overheating.

Wrapping low-birth-weight neonates in a plastic bag prevents body heat loss. A bonnet can also be used, since large amounts of heat can be lost from the head region, but may provide too much thermal insulation, thus increasing the risk of overheating. We assessed the time required to reach warning body temperature (t38 degrees C), heat stroke (t40 degrees C), or extreme value (t43 degrees C) in a mathematical model that involved calculating various local body heat losses. Simulated heat exchanges were based on body surface temperature distribution measured in preterm neonates exposed to 33 degrees C air temperature (relative air humidity: 35%; air velocity: <0.1 m/s) and covered (torso and limbs) or not with a transparent plastic bag. We also compared metabolic heat production with body heat losses when a bonnet (2 or 3.5 mm thick) covered 10%, 40%, or 100% of the head. Wrapping neonates in a bag (combined or not with a bonnet) does not induce a critical situation as long as metabolic heat production does not increase. When endogenous heat production rises, t38 degrees C ranged between 75 and 287, t40 degrees C between 185 and 549, and t43 degrees C between 287 and 702 min. When this increase was accompanied by a fall in skin temperature, overheating risk was accentuated (37

A multicenter, randomized, placebo-controlled trial of prophylactic recombinant granulocyte-colony stimulating factor in preterm neonates with neutropenia.

OBJECTIVE: To test the hypothesis that prophylactic treatment of neutropenic premature neonates with recombinant granulocyte-colony stimulating factor (rG-CSF) would reduce the incidence of nosocomial infections (NIs). STUDY DESIGN: A total of 25 neonatal intensive care units participated in this multicenter, randomized, double-blind, placebo-controlled trial. Premature infants of gestational age (GA)

Pulmonary circulatory effects of norepinephrine in newborn infants with persistent pulmonary hypertension.

OBJECTIVE: To evaluate the respiratory and the pulmonary circulatory effects of norepinephrine in newborn infants with persistent pulmonary hypertension (PPHN)-induced cardiac dysfunction. STUDY DESIGN: Inclusion criteria were: 1) Newborn infants >35 weeks gestational age; 2) PPHN treated with inhaled nitric oxide; and 3) symptoms of circulatory failure despite adequate fluid resuscitation. Lung function and pulmonary hemodynamic variables assessed with Doppler echocardiography were recorded prospectively before and after starting norepinephrine. RESULTS: Eighteen newborns were included (gestational age: 37 +/- 3 weeks; birth weight: 2800 +/- 700 g). After starting norepinephrine, systemic pressure and left ventricular output increased respectively from 33 +/- 4 mm Hg to 49 +/- 4 mm Hg and from 172 +/- 79 mL/kg/min to 209+/-90 mL/kg/min (P < .05). Although the mechanical ventilatory variables have not been changed, the post-ductal transcutaneous arterial oxygen saturation increased from 89% +/- 1% to 95% +/- 4%, whereas the oxygen need decreased from 51% +/- 24% to 41% +/- 20% (P < .05). The pulmonary/systemic pressure ratio decreased from 0.98 +/- 0.1 to 0.87 +/- 0.1 (P < .05). Mean left pulmonary artery blood flow velocity increased by 20% (P < .05). CONCLUSION: Norepinephrine may improve lung function in newborn infants with PPHN through a decrease in pulmonary/systemic artery pressure ratio and improved cardiac performance.

Relationship between functional residual capacity and oxygen desaturation during short central apneic events during sleep in "late preterm" infants.

Apneic episodes are frequent in the preterm neonate and particularly in active sleep (AS), when functional residual capacity (FRC) can be decreased. Furthermore, FRC may be inversely correlated with the speed of blood-O(2)-desaturation. We evaluated the potential involvement of FRC in the mechanisms responsible for blood-O(2)-desaturation during short central apneic events (>3 s) in "late-preterm" infants and analyzed the specific influence of sleep state. Apneic events were scored in 29 neonates (postmenstrual age: 36.1 +/- 1.2 wk) during AS and quiet sleep (QS). FRC was measured during well-established periods of regular breathing. Apneas with blood-O(2)-desaturation (drop in SpO(2) >5% from the baseline, lowest SpO(2) during apnea: 91.4 +/- 1.8%) were more frequent in AS than in QS, whereas no difference was seen for apneas without desaturation. The magnitude of the FRC did not depend on the sleep state. In AS only, there was a negative relationship between FRC and the proportion of apneas with desaturation. Even in late preterm infants who do not experience long-lasting apnea, blood-O(2)-desaturation during short apneic events is related (in AS but not QS) to a low baseline FRC. Sleep stage differences argue for a major role of AS-related mechanisms in the occurrence of these apneas.

Noradrenaline for management of septic shock refractory to fluid loading and dopamine or dobutamine in full-term newborn infants.

AIM: To determine the effects of noradrenaline in full-term newborns with refractory septic shock. METHODS: Newborns of >35 weeks' gestation with persistent septic shock, despite adequate fluid resuscitation and high dose of dopamine/dobutamine were eligible. In this prospective observational study, we recorded respiratory and hemodynamic parameters prior to and 3 h after starting noradrenaline infusion. RESULTS: Twenty-two newborns were included (gestational age [GA] 39 +/- 1.7 weeks, birth weight (BW) 3110 +/- 780 g). Before starting noradrenaline, the infants received a mean volume expansion of 31 +/- 15 mL/kg and a mean infusion rate of dopamine of 14 +/- 5 microg/kg/min or dobutamine of 12 +/- 6 microg/kg/min. Three hours after starting noradrenaline (rate 0.5 +/- 0.4 microg/kg/min), the mean arterial blood pressure rose from 36 +/- 5 to 51 +/- 7 mmHg (p < 0.001). Urine output increased from 1 +/- 0.5 to 1.7 +/- 0.4 mL/kg/h (p < 0.05). Blood lactate concentration decreased from 4.8 +/- 2.3 to 3.3 +/- 1.8 mmol/L (p < 0.01). Despite an initial correction of hypotension, four infants died later. CONCLUSION: Noradrenaline was effective in increasing systemic blood pressure. An increase in urine output and a decrease in blood lactate concentration suggest that noradrenaline may have improved cardiac function and tissue perfusion.

[Kawasaki disease epidemiology in Guadeloupe]. / Epidémiologie de la maladie de Kawasaki en Guadeloupe.

OBJECTIVE: To study the incidence of Kawasaki disease in the population of the French West Indies. METHODS: Fifty-six children where enrolled between January 1, 1995 and December 31, 2000), in this retrospective study in Guadeloupe (French West Indies), according to the diagnostic criteria of the American Heart Association. RESULTS: There were 31 boys and 25 girls. Their mean age at the time of diagnosis was 26.5 +/- 22 months. The mean incidence was 25.4/100 000 children aged under 5, per year. Cardiac involvement was noted in 17.8% of the cases during the first 3 months, with good outcome in all the children followed-up. CONCLUSION: The incidence of Kawasaki disease in Guadeloupe is high. The absence of epidemiological, clinical or biological predictive criteria of cardiac involvement should prompt the early use of immunoglobulins, notably in atypical presentations of the disease.