Clinical pharmacology of netilmicin in preterm and term newborn infants.

Sixty-four neonates, with gestational age ranging from 27 1/2 to 40 weeks, postnatal age from 1 to 15 days, and birth weight from 800 to 3400 gm, were given netilmicin 2.5 mg/kg intramuscularly two or three times per day according to postnatal age, for 5 to 14 days. Serum concentrations were measured before and 1 hour after a dose at least twice during treatment. The serum washout profile of the drug was observed in 22 neonates after discontinuation of therapy. Renal function was studied in 37 infants by measuring serum creatinine concentrations and in 27 by urinary excretion of N-acetyl-glucosaminidase during and up to 15 days after therapy. Behavioral and impedance audiometry, and in infants failing those, auditory brainstem evoked response tests, were performed between 6 and 12 months of age. In 23.5% of the neonates, trough serum levels were greater than 3 micrograms/ml. The serum washout followed a multiexponential decay, accounting for distributional, rapid (initial), and slow (tissue) elimination phases. Linear regression analysis performed between each kinetic parameter and gestational age or birth weight showed that initial elimination half-life, steady-state volume of distribution, and total body clearance were significantly correlated with both variables. Netilmicin did not cause detectable renal or auditory damage.

Efficacy and safety of the "integral" phototherapy for neonatal hyperbilirubinemia. Results of a follow-up at 6 years of age.

One hundred and ten full-term newborns were treated with integral phototherapy (IP) in the first week of life for hyperbilirubinemia (peak bilirubin concentration, 19.5 +/- 2.8 mg/dl). IP was provided by an apparatus which irradiated the infants over the entire skin surface with four visible blue light lamps placed around the body at a mean distance of only 20 cm. The irradiance of the lamps at the skin surface was 0.350 mW/sq cm, in the wavelength range between 425 and 475 nm. The IP resulted in a 48-hour bilirubin decline rate of 0.163 mg/dl/h. After a mean exposure of 78 +/- 32 h, the mean plasma bilirubin level was 8.4 +/- 0.8 mg/dl. One hundred and ten comparable nonjaundiced infants were studied as controls. At 6 years of age, both groups of subjects were called for a follow-up concerning growth, visual, and hearing functions, and neuro-developmental status. The follow-up was completed in 81 children of the IP group (73.6%) and in 89 of the controls (80.6%). There were no significant differences in the studied parameters between the two groups. The study concludes that IP appears to be an effective and safe treatment for jaundiced infants. IP employs less radiant energy from the lamp source than the traditional apparatus, but delivers this energy to a larger skin surface area.

Congenital choanal atresia: the postoperative care.

A case of congenital bilateral bony choanal atresia treated by surgery is reported. A new method of insertion and retention of the modelling tubes to prevent stenosis is described. This method has the following advantages: 1. it provides a good insertion and retention of the modelling tubes; 2. it doesn't provoke any trauma of the nasal septum, soft palate and nostril; 3. the insertion of the tubes doesn't require general anesthesia; 4. it's well tolerated.

The importance of acoustic impedance measurements in middle ear pathology during acute viral respiratory illness in the first year of life.

The very high incidence of ME pathology in epidemic bronchiolitis prompted the systematic use of impedance measurement tests in a study of the otitic process. Data were assembled of 44 children admitted to the paediatric clinic with acute viral respiratory infection (in the last year). On account of the high incidence (97%), the precocity of occurrence (1-12 months), the slow rehabilitation and the frequency of relapses, the ME pathology in these children indicates the importance of a correct approach to the problems of relapsing otitis in infants. Patients were treated with aerosol therapy (mucolytic substance), nasal drops (with vasoconstrictors), and only in very serious cases with antibiotics. For the latter, cortisonic therapy is inadvisable, while it is absolutely necessary to follow up with periodic controls until the tympanogram becomes normal. The impedance findings (prevalent type B curves, with inability to evoke the stapedius reflex, over periods of several months) and their resolution in type AC or C curves led us to consider not only the organic problem, but also the functional hearing problem during the first year of life, and the possible longterm repercussion.