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Hypotension and infant

Amanda C Capino, Jamie L Miller, Peter N Johnson
The need for sedation and analgesia and treatment of iatrogenic drug withdrawal is common in critically ill children. First-line therapy typically includes opioid agonists. However, clonidine, a central alpha2 agonist, has been suggested as a treatment option for sedation and analgesia and iatrogenic drug withdrawal. Therefore, we conducted a literature search to identify articles evaluating the use of enteral and transdermal clonidine in critically ill infants and children for sedation and analgesia and treatment of iatrogenic drug withdrawal...
October 25, 2016: Pharmacotherapy
Jessica Chapman, Stephanie Marfurt, Julie Reid
This systematic review evaluates the effectiveness of delayed cord clamping in preterm infants on reducing postdelivery complications of anemia, hemodynamic instability, and the development of intraventricular hemorrhages. Interventions included varying durations of delayed cord clamping with and without cord milking as compared with immediate cord clamping, shorter delays in cord clamping, and delayed cord clamping without cord milking. A comprehensive search of randomized controlled trials, observational, cohort, and before-after studies was conducted between 1946 and 2015 in the electronic databases of Ovid MEDLINE, Embase, and Google Scholar...
October 2016: Journal of Perinatal & Neonatal Nursing
Ankana Daga, Fredrick Dapaah-Siakwan, Sharina Rajbhandari, Cassandra Arevalo, Agnes Salvador
BACKGROUND: Acute kidney injury (AKI) is common in critically ill premature infants. There is a lack of consensus on the diagnostic definition of AKI in very low birth weight (VLBW) infants. The primary aim of this study was to determine the incidence and risk factors for AKI in VLBW infants using the AKI network (AKIN) and pRIFLE (pediatric Risk, Injury, Failure, Loss, End-Stage) criteria and to evaluate whether Clinical Risk Index for Babies (CRIB II) score is a predictor of AKI. The secondary objective was to determine the extent of agreement between the AKIN and pRIFLE criteria in the diagnosis of AKI in VLBW infants...
September 28, 2016: Pediatrics and Neonatology
Patrizia Salice, Mario Giovanni Bianchetti, Alessandra Giavarini, Erica Gondoni, Riccardo Cavalli, Anna Maria Colli, Federico Lombardi
Propranolol is becoming the treatment of choice for complicated infantile hemangioma. We report here data on peripheral blood flow, O2-saturation, electrocardiographic PR-interval, left ventricular function, blood pressure and heart rate that were assessed before and during treatment for ≥4 weeks with propranolol 2 mg/kg of body weight daily in 67 infants <12 months of age in normal sinus rhythm and with structurally normal hearts. Management with propranolol was well tolerated in all and did not modify peripheral blood flow, O2-saturation, electrocardiographic PR-interval and left ventricular fractional shortening or ejection fraction...
October 19, 2016: Pharmacology
Masatsune Ogura, Hisashi Makino, Chizuko Kamiya, Jun Yoshimatsu, Handrean Soran, Ruth Eatough, Giuseppina Perrone, Mariko Harada-Shiba, Claudia Stefanutti
BACKGROUND AND AIMS: For patients with homozygous familial hypercholesterolemia (HoFH), atherogenic lipoprotein changes and increased stress on cardiovascular system during pregnancy may pose substantial risk for both the mother and her fetus. Although lipoprotein apheresis (LA) is reported as the most effective therapy to control LDL-C levels during pregnancy in HoFH patients, only case reports have been published, and there is no guidance for management. METHODS: We report twelve pregnancies and ten deliveries in seven patients with HoFH, and compare the clinical outcomes between patients who received LA during pregnancy and those who did not...
October 8, 2016: Atherosclerosis
Mohammad Khassawneh, Nedaa Al-Ghazo
A 35-year-old woman with a 9-year history of Grave's disease delivered a male infant weighing 2,210 g at 32 weeks of gestation by caesarean section. The neonate developed thyrotoxicosis and, at the age of 24 h, was treated with oral carbimazole (500 µg every 8 h) and propranolol (2 mg/kg/day in two divided doses). He subsequently developed hypertension on day 4, which required therapy with amlodipine (0.1 mg once daily). Severe hypotension developed within 24 h and required discontinuation of amlodipine, with initiation of intravenous inotropic support with dopamine and dobutamine (at a rate of 20 µg/kg/min)...
December 2015: Drug Saf Case Rep
Shailender Mehta, Anjali Joshi, Barbara Bajuk, Nadia Badawi, Sarah McIntyre, Kei Lui
AIM: Whole body therapeutic hypothermia (TH) for hypoxic ischaemic encephalopathy was introduced into clinical practice in New South Wales (NSW) and Australian Capital Territory in 2007. State-wide policy adopting the eligibility criteria and practice based on trial-designs was published in 2009. METHODS: The study was conducted by retrospectively reviewing medical records of all TH infants born between 2007 and 2011 in NSW and Australian Capital Territory to examine if eligibility criteria (assessed against evidence-based policy directives) were met...
October 4, 2016: Journal of Paediatrics and Child Health
Malcolm G Coulthard
Most babies with chronic renal failure are identified antenatally, and over half that are treated with peritoneal dialysis receive kidney transplants before school age. Most infants that develop acute renal failure have hypotension following cardiac surgery, or multiple organ failure. Sometimes the falls in glomerular filtration and urine output are physiological and reversible, and sometimes due to kidney injury, but (illogically) it is now common to define them all as having 'acute kidney injury'. Contrary to widespread opinion, careful interpretation of the plasma creatinine concentrations can provide sensitive evidence of early acute renal failure...
September 25, 2016: Early Human Development
Rachel L Bounds, Joseph Kuebler, Jill M Cholette, George M Alfieris, Sitaram M Emani, Carol A Wittlieb-Weber
A 2-month-old male with dysmorphic facies, neonatal thrombocytopenia, left congenital cataract, and long bone abnormalities became hypotensive with ST depression on induction of anesthesia for congenital cataract repair. Echocardiogram demonstrated decreased left ventricular function (ejection fraction 46%), mild mitral valve regurgitation (MR), and regional wall motion abnormalities. The left coronary artery could not be visualized. Subsequent cardiac catheterization confirmed atresia of the left main coronary artery...
September 12, 2016: World Journal for Pediatric & Congenital Heart Surgery
Jun Shibasaki, Katsuaki Toyoshima, Makoto Kishigami
BACKGROUND: The management of hypotension immediately after the birth of preterm infants is controversial. AIM: To investigate the relationship between blood pressure (BP), amplitude-integrated electroencephalography (aEEG), and neurodevelopmental outcome in extremely preterm infants. METHODS: BP and aEEG were monitored for 96h after birth in 36 infants born at <27weeks gestation. aEEG data were analyzed with Burdjalov scores. Correlations of aEEG findings with BP and several clinical characteristics, including the Score for Neonatal Acute Physiology, Perinatal Extension-II (SNAPPE-II) were explored...
October 2016: Early Human Development
Pak Cheung Ng
Preterm, very low birthweight (VLBW) infants are prone to life-threatening hypotension secondary to hypothalamic-pituitary-adrenal axis immaturity, resulting in adrenocortical insufficiency. Clinical presentations of inotrope-resistant refractory hypotension are usually evident, but interpretation of serum cortisol may pose much difficulty to front-line neonatologists. This review examines the salient pathophysiology of adrenocortical insufficiency in the immediate postnatal period, characterises its endocrinological abnormalities, and describes the typical and variant clinical presentations...
September 6, 2016: Archives of Disease in Childhood. Fetal and Neonatal Edition
Abdelmoneim Khashana, Timo Saarela, Mika Ramet, Mikko Hallman
OBJECTIVE: Therapy-resistant hypotension complicates diseases in neonates. Our objective was to investigate whether lack of therapeutic response to plasma expanders and inotropes associates with serum levels of cortisol and its precursors. METHODS: We investigated 96 infants with hypotension and critical neonatal disease for cortisol metabolism and are divided into responders and non-responders to plasma expanders and inotropes. Serum concentrations of steroids were analysed soon after the onset of volume expansion and inotrope treatment for shock...
August 31, 2016: Journal of Maternal-fetal & Neonatal Medicine
Ting-Lin B Yang, Patrick McMahon, Diva D De Léon, James R Treat
Infantile hemangiomas (IHs) are the most common pediatric vascular tumors. They require therapy when they cause severe complications such as ulceration, amblyopia, or airway constriction. Propranolol is the only treatment that the U.S. Food and Drug Administration has approved for complicated IHs and has become first-line therapy for IHs that need to be treated. Older therapies such as systemic corticosteroids and surgery are now rarely used. Propranolol can have potentially serious adverse side effects, including bradycardia, hypotension, and hypoglycemia...
August 30, 2016: Pediatric Dermatology
Kattiya Manomayangkul, Arunotai Siriussawakul, Akarin Nimmannit, Thassayu Yuyen, Sopapan Ngerncham, Kanit Reesukumal
BACKGROUND: Umbilical cord blood gas values are better indicators of perinatal asphyxia than Apgar scores. Many studies have reported normal ranges of umbilical cord blood gases, which vary greatly due to many factors. This study aimed to establish the reference values of umbilical cord blood gases of normal cesarean newborns in a university hospital setting. MATERIAL AND METHOD: Blood samples from the umbilical artery and vein were collected from 160 newborns delivered by elective cesarean section...
May 2016: Journal of the Medical Association of Thailand, Chotmaihet Thangphaet
Celine Corbisier de Meaulsart, Rebecca M Dyson, Joanna L Latter, Mary J Berry, Vicki L Clifton, Ian M R Wright
BACKGROUND: Microvascular dysregulation following preterm birth is associated with increased illness severity and hypotension, particularly in males. Sympathetic nervous vascular regulation is evident in females. We hypothesized that sympathetic dysfunction in male preterm infants may contribute to a failure of peripheral microvascular vasoconstriction. METHODS: Microvascular blood flow of infants 24-43weeks GA was assessed at 6h, 24h and 72h of age by laser Doppler...
August 6, 2016: Pediatric Research
Ditte J A Løhmann, Jonas Abrahamsson, Shau-Yin Ha, Ólafur G Jónsson, Minna Koskenvuo, Birgitte Lausen, Josefine Palle, Bernward Zeller, Henrik Hasle
Treatment for pediatric acute myeloid leukemia is very toxic and the association between outcome and age and body mass index is unclear. We investigated effect of age and body mass index on toxicity and survival in pediatric acute myeloid leukemia. We studied all patients who completed first induction course of NOPHO-AML 2004 (n=318). Toxicity following induction and consolidation courses (n=6) was analyzed. The probabilities of toxicity and death were determined using time-to-event analyses with Cox multivariate proportional hazard regression for comparative analyses...
July 28, 2016: Haematologica
Eugene M Dempsey
Whilst the prevalence of low blood pressure in preterm infants seems to have fallen over the last number of years, the problem is still frequently encountered in the neonatal intensive care unit and many babies continue to receive intervention. Great variability in practice persists, with a significant number of extremely low gestational age newborns in some institutions receiving some form of intervention, and in other units substantially less. A great degree of this variability relates to the actual criteria used to define hypotension, with some using blood pressure values alone to direct therapy and others using a combination of clinical, biochemical and echocardiography findings...
2015: Children
Nina Méndez-Domínguez, Kikey Achach-Medina, Yareni María Morales-Gual, Salvador Gómez-Carro
INTRODUCTION: The state of Yucatan, in Mexico, is an endemic area for dengue. During 2015, there was an unpredicted increase in the number of expected cases of dengue fever. OBJECTIVE: To describe and analyse the clinical presentation, progress, and management of a case of dengue infection with non-specific clinical manifestations in an infant which resulted in a dengue shock syndrome. CASE REPORT: One month old infant admitted to hospital with a generalised rash and a history of being bitten by an insect...
July 1, 2016: Revista Chilena de Pediatría
Leanna K Darland, Kimberly L Dinh, Shelly Kim, Jennifer L Placencia, Nidhy P Varghese, Fadel Ruiz, George B Mallory, Caraciolo J Fernandes
OBJECTIVE: To compare the occurrence of hypotension following administration of intermittent intravenous (IV) and enteral sildenafil for treatment of pulmonary hypertension (PH) in infants. We hypothesized there may be more adverse effects associated with intermittent IV sildenafil compared with enteral sildenafil. METHODS: This was a retrospective matched-cohort study conducted in a tertiary care children's hospital. Patients were included if they were less than 1 year of age and received intermittent sildenafil for PH...
June 24, 2016: Pediatric Pulmonology
Raja Nandyal, Ganga Moorthy
Hydrops fetalis is a rare manifestation of severe congestive heart failure in a fetus, resulting in pathological fluid accumulation in fetal soft tissues and/or serous cavities. Non-compaction of the ventricular myocardium, frequently referred to as the left ventricular non-compaction (LVNC), is a very rare congenital cardiomyopathy. For LVNC, echocardiography is the diagnostic modality of choice. Various diagnostic criteria exist based on either echocardiography or MRI. Currently, nonimmune hydrops fetalis (NIHF) comprise almost 90% of all hydrops fetalis cases...
April 2016: Journal of the Oklahoma State Medical Association
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