Warwick Butt

Postoperative morphine infusion in newborn infants: Assessment of disposition characteristics and safety

Twelve newborn infants were given morphine intravenously for postoperative analgesia. They received a continuous infusion of 6.2 to 40 micrograms/kg/hr for 9 to 105 hours (mean +/- SEM 59.5 +/- 10.2 hours); in four the infusion was preceded by a loading dose of 50 to 100 micrograms/kg. Morphine plasma concentrations correlated with the rate of infusion, but with large variability. There was a tendency for plasma morphine concentrations to decrease in some patients receiving a constant infusion rate, suggesting improvement in morphine clearance rate. Elimination half-life of morphine (13.9 +/- 6.4 hours) was significantly longer than in older children and adults (about 2 hours). Similarly, morphine concentrations in neonates receiving 20 micrograms/kg/hr for 24 hours were three times higher (52 +/- 31 ng/ml) than in older children receiving the same schedule. Two infants who received 32 and 40 micrograms/kg/hr, respectively, developed generalized seizures. Because of the apparently greater sensitivity to morphine and the lower elimination rate in newborn infants, the infused dose should not exceed 15 micrograms/kg/hr.

Hypoxia associated with helium-oxygen therapy in neonates

6. Sondheimer JM, Bryan H, Andrews WI Forstner GG: Cholestatic tendencies in premature infants on and off parenteral nutrition. Pediatrics 62:984, 1978. 7. Beale EF, Nelson RM, Bucciarelli RL, et al: Intrahepatic cholestasis associated with parenteral nutrition in premature infants. Pediatrics 64:342, 1979. 8. Rager R, Finegold M J: Cholestasis in immature newborn infants: Is Parenteral alimentation responsible? J PEDIATR 86:264, 1975. 9. Nakai H, Landing BH: Factors in the genesis O f bile stasis in infancy. Pediatrics 27:300, 1961. 10. Brown EG: Prevention. In Brown EG, Sweet AY, editors: Neonatal necrotizing entercolitis. New York, 1980, Grune & Stratton, p 187. 11. Ballard JL, Novak KK, Driver M: A simplified score for assessment of fetal maturation of newly born infants. J PEDIATR 95:769, 1979. 12. Amiel-Tisson C: Epidemiology and prognosis in idiopathic respiratory distress syndrome. In Status of the fetus. Report of the Second Ross Conference on Obstetric Research. Columbus, Ohio, 1971, Ross Laboratories. 13. Versmold HT, Kitterman JA, Phibbs RH, et al: Aortic blood pressure during the first 12 hours of life in infants with birth weight 610 to 4,220 grams. Pediatrics 67:607, 1981. 14. Odell G: Neonatal jaundice. Prog Liver Dis 5:457, 1976. 15. Usmani SS, Sia CG, Harper RG, et al: Conjugated hype~-bilirubinemia (CH): A predictor of perinatal mortality and poor neurological outcome. Pediatr Res 18:353A, 1984.

Positive Predictive Value of Bilateral Absence of Somatosensory Evoked Potentials in Severe Traumatic Brain Injury • 177

Positive Predictive Value of Bilateral Absence of Somatosensory Evoked Potentials in Severe Traumatic Brain Injury • 177

Perfluorochemical Associated Gas Exchange(PAGE) using FC-77:The Effect of PAGE and Inhaled Nitric Oxide(INO) on Oxygenation, Hemodynamics, Pulmonary Mechanics and Lung Injury in a Surfactant Deficient Piglet Model 1750

Perfluorochemical Associated Gas Exchange (Page): The Effect of Page and Inhaled Nitric Oxide (Ino) on Oxygenation, Hemodynamics, Pulmonary Mechanics and Lung Injury in A Surfactant Deficient Piglet Model

OXYGENATION AND LUNG INJURY IN SURFACTANT DEFICIENT RABBITS RECEIVING HIGH FREQUENCY OSCILLATORY VENTILATION (HFOV) WITH OR WITHOUT PERFLUOROCARBON-ASSOCIATED GAS EXCHANGE (PAGE)

OXYGENATION AND LUNG INJURY IN SURFACTANT DEFICIENT RABBITS RECEIVING HIGH FREQUENCY OSCILLATORY VENTILATION (HFOV) WITH OR WITHOUT PERFLUOROCARBON-ASSOCIATED GAS EXCHANGE (PAGE)

359 INTENSIVE CARE MANAGEMENT IN ASTHMATIC CHILDREN

Management and outcome of children with severe acute asthma who were admitted for 8 hours or more to the PICU of the Royal Childrens Hospital, Melbourne, during 1988 to 1991 was reviewed. A total of 180 children were admitted on 202 occasions; the medical records were reviewed for the following data: patient characteristics, treatment before admission to and in PPICU, and outcome. In the referral hospital continuous nebulized undiluted salbutamol was given in 41% (in PICU 73%), 45% of the children did not receive any topic bronchodilators. IV steroids were given in 63% (in PICU 91%), iv salbutamol in 20% (in PICU 35%), iv aminophylline in 50% (in PICU 73%), but only in 8% as a continuous infusion (PICU 79%). Mechanical ventilation was necessary in 25% of admissions, in 65% the children have been intuabted outside of PICU. Six patients died, representing a 3.0%-mortality.It is concluded that delay in seeking medical care, under-diagnosis and undertreatment in the pre-hospital time and at the hospital, patients delay in referral to hospital and delay in referral to a specialised childrens hospital could contribute to mortality and morbidity. The excessive use of inhaled bronchodilators and systemic corticosteroids can avoid intubation and improves the outcome.

BLOOD PRESSURE MONITORING IN NEONATES: COMPARISON OF UMBILICAL AND PERIPHERAL ARTERY PRESSURE MEASUREMENTS

Continuous monitoring of blood pressure is now an integral part of modern neonatal intensive care. The most widely practised method is via an indwelling umbilical arterial catheter for which normal values have been established.In the last few years peripheral artery cannulation has become an increasingly popular technique. Maintenance of blood pressure with volume expansion & inotropes is becoming increasingly recognised as important in the overall management of infants in neonatal intensive care units. As such it is of paramount importance to know whether the normal values established for umbilical arterial catheters can be used for peripheral arterial measurements.Infants of varying gestational ages (26-39wks), weights (740-3200g) & post-delivery age (days 1-7) with both umbilical & peripheral arterial catheters in place were available for study. (Usually infants with necrotising enterocolitis having an umbilical catheter replaced with a peripheral arterial catheter - radial/tibial). 34 simultaneous pressure recordings were done in 11 infants. There was an excellent correlation between the 2 recordings r=0.98 for systolic + r=0.97 for diastolic pressures. Therefore, normal pressure graphs obtained by umbilical arterial pressure measurements are applicable for peripheral arterial catheters.