Robert O. Bollinger

Grading the severity of congestive heart failure in infants

SummaryTo determine which variables most accurately define congestive heart failure (CHF) in infants, 41 patients (median age 2.5 months) were graded by four pediatric cardiologists for the presence and severity of CHF based on the following variables: amount of formula consumed per feeding, feeding time, history of diaphoresis or tachypnea, growth parameters, respiratory and heart rates, respiratory pattern, perfusion, presence of edema, diastolic filling sounds, and hepatomegaly. There were 19 patients graded as having no CHF, nine as mild, seven moderate, and six severe CHF. The most sensitive and specific variables (p<0.0001) for the presence of CHF were a history of <3.5 oz/feed, respiratory rate >50/min, an abnormal respiratory pattern, diastolic filling sounds, and hepatomegaly. Moderate to severe CHF was present when patients took <3 oz/feed or >40 min/feed, had and abnormal respiratory pattern with a resting respiratory rate >60/min, and had a diastolic filling sound and moderate hepatomegaly. Severe CHF was accompanied by a heart rate >170/min, decreased perfusion, and severe hepatomegaly. Thus, the grading of the severity of CHF in infants should include an accurate description of these historical and clinical variables.

Human newborns are deficient in natural killer activity

The peripheral blood natural killer (NK) activity of newborns was found to be significantly less than that of adults. In mixing experiments newborn cells inhibited adult NK activity in only one of nine instances. Interferon treatmentin vitro increased newborn NK activity to an even greater degree than adult NK activity. These findings imply that diminished newborn NK activity is due not to inhibitory cells or lack of pre-NK cells but rather to deficientin vivo activation of pre-NK cells. This deficiency may be a major factor in the increased susceptibility of newborns to certain virus infections.

Microwave Effects on Granulocyte and Macrophage Precursor Cells of Mice in Vitro

Colony-forming unit cells from the femurs and tibias of 2-month-old C3H mice were exposed to 2450-MHz CW microwaves in a specially designed fluid-filled waveguide exposure system. The cells were suspended in glass micropipets and exposed to 30 to

Pharmacokinetics of intravenously administered piperacillin in preadolescent children

1000\ {\rm mW}/{\rm cm}^{2}

Acute myelofibrosis terminating in an acute lymphoblastic leukemia. A case report

of incident power densities corresponding to specific absorption rates of 60 to 2000 mW/g for 15 min. There was no reduction in the number of colonies formed on days 6 and 12 at

931 NEWBORNS HAVE DIMINISHED NATURAL KILLER CELL ACTIVITY

30\ {\rm mW}/{\rm cm}^{2}

Implementation of a statewide perinatal automated medical network (PAM/NET) for Michigan.

(60 mW/g), but as the exposure was increased up to a level of

1337 SELECTION OF INFANTS WITH PERSISTENT FETAL CIRCULATION (PFC) FOR EXTRACORPOREAL MEMBRANE OXYGENATION (ECMO)

1000\ {\rm mW}/{\rm cm}^{2}

580 WHY NICU LENGTHS OF STAY DIFFER FROM FEDERAL GUIDE LINES

(2000 mW/g) there was a corresponding reduction in the number of colonies formed by microwave-treated cells, compared to sham-exposed cells. Thus, there was a dose-dependent reduction in the number of colonies formed by microwave-exposed bone marrow cells when compared to their sham-exposed counterparts.

A COMPUTER BASED STATEWIDE PERINATAL NETWORK

We studied the pharmacokinetics of piperacillin in 37 preadolescent children (mean age 52 months, range 1 month to 11 years) after 50 mg/kg IV doses. Pharmacokinetic parameters were determined after the initial dose in 18 instances and after subsequent doses in 32 instances. There were no significant differences between the initial doses and the subsequent doses in the plasma piperacillin concentrations at comparable times, the elimination rate constants, the elimination-phase plasma half-lives, the total body clearances, the apparent volumes of distribution, or the areas under the concentration curves. At the end of a 30-minute infusion of the drug, the plasma concentration was 166.2 +/- 42.2 mg/L (mean +/- SD) and ranged from 91.6 to 268.3 mg/L. The mean half-life was 31.0 +/- 9.4 minutes. The half-life of piperacillin in children 1 to 6 months of age (47.2 minutes) was significantly longer than in older children (28.8 minutes) (P less than 0.05). Likewise, the total body clearance of the drug in the younger age group (71.7 ml/min/m2) was significantly lower than in the older children (130.8 ml/min/m2) (P less than 0.05). The mean renal clearance of the drug was only 63% (range 39% to 85%) of the total body clearance, suggesting a variable but substantial nonrenal route of elimination. The intravenous administration of 50 mg/kg piperacillin every four hours results in adequate plasma concentrations for the treatment of most infections caused by gram-negative and gram-positive organisms.