早产儿两种喂养方法的比较研究

目的比较两种喂养方法用于早产儿的效果.方法早产儿共58例,出生体重在1 500～2 000 g范围内,随机分为甲、乙两组,甲组30例,乙组28例,甲组以微量泵通过鼻饲管持续均匀泵奶每小时2～3 ml,乙组则采用常规间歇鼻饲法,以注射器通过鼻饲管每2小时注奶4～6 ml,两组均观察3～5 d,比较观察期间两组患儿平均每天进奶量,吐奶例数、残奶例数等指标.结果甲组患儿平均每日喂奶量明显高于乙组（P＜0.05）,且吐奶例数,残奶出现例数明显少于乙组（P＜0.05）.结论早产儿采用微量泵鼻饲持续均匀泵奶效果明显优于常规间歇鼻饲喂奶法.     

Surfactant kinetics in preterm infants on mechanical ventilation who did and did not develop bronchopulmonary dysplasia

OBJECTIVE: To characterize surfactant kinetics in vivo in two groups of premature infants on different levels of mechanical ventilation and at different risk of developing bronchopulmonary dysplasia. DESIGN: Controlled observational study in two independent groups of infants. SETTING: Neonatal intensive care unit. PATIENTS: Thirteen preterm infants (26 +/- 0.5 wks, birth weight 801 +/- 64 g) on high ventilatory setting and who finally all developed bronchopulmonary dysplasia (MechVentBPD), and eight (26 +/- 0.5 wks, birth weight 887 +/- 103 g) who had minimal or no lung disease and of whom none developed bronchopulmonary dysplasia (MechVentNoBPD). MEASUREMENTS AND MAIN RESULTS: Endotracheal 13C-labeled dipalmitoyl-phosphatidylcholine was administered and subsequent measurements of the 13C enrichment of surfactant-disaturated phosphatidylcholine (DSPC) from serial tracheal aspirates were made by gas chromatography-mass spectrometry. We calculated disaturated phosphatidylcholine pharmacokinetic variables in terms of half-life and apparent pool size from the enrichment decay curves over time. DSPC concentration from tracheal aspirates was expressed as milligrams/milliliter epithelial lining fluid (ELF-DSPC). Data are presented as mean +/- se. In MechVentBPD infants vs. MechVentNoBPD, ELF-DSPC was much reduced, 2.9 +/- 0.6 vs. 9.4 +/- 3.0 mg/mL ELF (p =.03), half-life was shorter, 19.4 +/- 2.8 vs. 42.5 +/- 6.3 hrs (p =.002), and apparent pool size larger, 136 +/- 21 vs. 65.8 +/- 16.0 mg/kg (p =.057). In MechVentBPD, apparent DSPC pool size positively correlated with mean airway pressure x Fio(2) and inversely correlated with ELF-DSPC. ELF-DSPC was inversely correlated with mean airway pressure x Fio(2). No significant correlations were found in the MechVentNoBPD group. CONCLUSIONS: MechVentBPD infants showed profound alteration of surfactant kinetics compared with preterm infants with minimal lung disease, and these alterations were correlated with severity of ventilatory support.     

凹陷乳头母乳喂养的护理

对94例患有乳头扁平或凹陷的孕妇，产前指导进行乳头伸展法练习，抽吸，抽吸器抽吸法纠正，辅乳器（乳胶奶头）诱导新生儿早吸吮，结果凹陷扁平乳头纠正，纯母乳喂养成功率达100%。     

肠外营养联合不同肠内喂养添加量对早产儿生长发育的影响

目的探讨在肠外营养的基础上两种不同喂养添加量对早产儿生长发育的影响。方法将64例收住ICU的早产儿在肠外营养的基础上,第1天和第2天以5ml/(kg.d)的乳量喂养,第3天以15ml/(kg.d)的乳量喂养,72h后使用随机数字表分为实验组31例和对照组33例。实验组以30ml/(kg.d)的乳量逐日递增,对照组以20ml/(kg.d)的乳量逐日递增,直至达到完全肠内喂养量150ml/(kg.d)。喂养期间每天测量两组早产儿的体重,每周测量其身长、头围;矫正胎龄40周时进行新生儿神经行为(NBNA)评分。结果实验组1月时的体重明显高于对照组(P<0.05);矫正胎龄40周时的NBNA总分高于对照组,但两组相比差异无显著意义(P>0.05);实验组在行为能力、一般评估的评分高于对照组,差异有显著意义(P<0.05)。结论肠外营养联合30ml/(kg.d)的肠内喂养添加量可以促进早产儿的体格及智能的发育。     

不同喂养方式对早产/低出生体重儿出院后生长状况的影响

目的监测早产/低出生体重儿体重、身长的发育情况,分析不同喂养方式对早产/低出生体重儿出院后生长状况的影响。方法 2006年6月至2009年6月在我院出生的早产/低出生体重儿55例,分别给予母乳加早产儿奶粉(A组)和母乳加足月儿奶粉(B组)喂养,评估其校正胎龄至37周后第1、2、3、4、5、6、9、12月的身长、体重指标。结果两组第1、2、3、4、5、6、9、12月体重和身长净增长量比较,差异无统计学意义(P>0.05)。结论早产/低出生体重儿出院后,无论母乳加早产儿奶粉或是母乳加足月儿奶粉喂养,其体重和身长净增长量均能达到健康足月儿的速度。     

Milk Flow Rates From Bottle Nipples: What We Know and Why It Matters

Feeding difficulties are common in infants hospitalized in the NICU and can be a challenge to manage. The purpose of this article is to explain how and why the flow rate from the bottle nipple affects physiologic stability in infants and to describe the current evidence available on the flow rates of nipples used in the hospital and after discharge. Study results have indicated that flow rate varies widely among different types of nipples. Within the same type of nipple, there can be significant variability in flow from one nipple to another. Other factors, such as type of infant formula and thickening, also affect flow. Altering the flow rate of the bottle nipple is a relatively simple intervention that may support safe oral feeding.     

Comparison of the effects of heat and moisture exchangers and heated humidifiers on ventilation and gas exchange during non-invasive ventilation

OBJECTIVE: To compare the short-term effects of a heat and moisture exchanger (HME) and a heated humidifier (HH) during non-invasive ventilation (NIV). DESIGN: Prospective, clinical investigation. SETTING: Intensive care unit of a university hospital. PATIENTS: Twenty-four patients with acute respiratory failure (ARF). INTERVENTION: Each patient was studied with a HME and a HH in a random order during two consecutive 20min periods of NIV. MEASUREMENTS AND RESULTS: Respiratory rate (RR), expiratory tidal volume (VTe) and expiratory minute ventilation (VE) were measured during the last 5 min of each period and blood gases were measured. Mean pressure support and positive end-expiratory pressure levels were, respectively, 15+/-4 and 6+/-2 cmH(2)O. VE was significantly greater with HME than with HH (14.8+/-4.8 vs 13.2+/-4.3 l/min; p<0.001). This increase in VE was the result of a greater RR for HME than for HH (26.5+/-10.6 vs 24.1+/-9.8 breaths/min; p=0.002), whereas the VT for HME was similar to that for HH (674+/-156 vs 643+/-148 ml; p=0.09). Arterial partial pressure of carbon dioxide (PaCO(2)) was significantly higher with a HME than with a HH (43.4+/-8.9 vs 40.8+/-8.2 mmHg; p<0.005), without significantly changing oxygenation. CONCLUSION: During NIV the increased dead space of a HME can negatively affect ventilatory function and gas exchange. The effect of HME dead space may decrease efficiency of NIV in patients with ARF.     

Nipple confusion, alternative feeding methods, and breast-feeding supplementation: State of the science

Mothers of preterm and term infants frequently experience breast-feeding problems that make it necessary for them to use supplemental or complementary feedings. Although bottle feeding is used most frequently, alternatives to bottle feeding are frequently recommended to avoid nipple confusion. This report reviews the evidence of a relationship between exposure to artificial nipples and the development of nipple confusion. It also examines the effects of alternative feeding methods such as cup feeding, finger feeding, spoon feeding and gavage feeding on physiological responses of infants and long-term breast-feeding outcomes. This report recommends further research before alternatives to bottle feeding are routinely implemented. Copyright © 2001 by W.B. Saunders Company     

Comparison of the oxygen cost of breathing exercises and spontaneous breathing in patients with stable chronic obstructive pulmonary disease

BACKGROUND AND PURPOSE: The oxygen demand of breathing exercises and the clinical implications have not been studied in detail. In this study, the oxygen cost of 3 common breathing exercises believed to reduce oxygen cost (ie, work of breathing) was compared with that of spontaneous breathing in patients with chronic obstructive pulmonary disease (COPD). SUBJECTS: Thirty subjects with stable, moderately severe COPD participated. METHODS: Oxygen consumption (VO2) and respiratory rate (RR) during spontaneous breathing at rest (SB) were recorded for 10 minutes. Subjects then performed 3 breathing exercises in random order, with a rest between exercises: diaphragmatic breathing (DB), pursed-lip breathing (PLB), and a combination of DB and PLB (CB). Oxygen consumption and RR were measured. RESULTS: Mean VO2 ( SD) was lower during the breathing exercises (165.8 +/- 22.3 mL O2/min for DB, 164.8 +/- 20.9 mL O2/min for PLB, and 167.7 +/- 20.7 mL O2/min for CB) compared with SB (174.5 +/- 25.2 mL O2/min). Correspondingly, mean RR (+/- SD) was higher during SB (17.3 +/- 4.23 breaths/min), followed by DB (15.0 +/- 4.32 breaths/min), PLB (12.8 +/- 3.53 breaths/min), and CB (11.2 +/- 2.7 breaths/min). DISCUSSION AND CONCLUSION: Given that patients do not spontaneously adopt the breathing pattern with the least O2 and the lowest RR, the results suggest that determinants of the breathing pattern other than metabolic demand warrant being a primary focus in patients with COPD.     

Infant ventilation and oxygenation by basic life support providers: comparison of methods

INTRODUCTION: Little information is available in the performance of infant ventilation by basic life support (BLS) personnel. HYPOTHESIS: There are no significant differences between mouth-to-mouth (M-M), mouth-to-mask (M-Ma), pediatric bag-mask (PBM), and adult bag-mask (ABM) devices in the percent of acceptable breaths delivered by BLS providers. METHODS: Fifty certified BLS providers performed five ventilation methods in random sequences for 60 seconds each on a 5kg infant mannequin following standardized instructions. Supplemental oxygen, 10 l/min, was supplied with one M-Ma trial and PBM methods. Airway patency, peak airway pressure (PAP), ventilatory rate (VR), tidal volume, and delivered oxygen concentration (FiO 2) were recorded. The percent of breaths with excessive PAP (i.e., greater than 30 mmHg), percent of acceptable breaths using loose (i.e., 25-125ml) and strict (i.e., 50-100ml) criteria, and FiO 2 at 15, 30, 45, and 60 seconds were compared between ventilation methods using ANOVA. RESULTS: For all subjects and those with a patent airway (n=36), there were no significant differences in the percentage of acceptable breaths produced by PBM (56+/-6) (mean+/-SEM; all subjects) and ABM (41+/-6.2) was significantly greater than M-Ma, with and without a patent airway. Although RR and the percentage of excessive breaths were not significantly different, the percentage of acceptable breaths and FiO 2 delivered with each ventilation method was significantly better in the patent airway group.(ABSTRACT TRUNCATED AT 250 WORDS)     

采集母乳在NICU中的实施及对极低出生体重儿的影响

目的探讨采集母乳对无法获得直接母乳喂养的早产儿的喂养效果。方法将2013年1-12月入住NICU的极低出生体重儿60例分为早产儿配方乳组;2014年1-12月入住NICU的极低出生体重儿60例分为母乳喂养组,通过采集母乳的方式对早产儿进行喂养。同时对两种喂养方式的效果进行分析比较。结果通过采集母乳的实施,使早产儿的产妇在母婴分离时的母乳喂养率从原来的58%提高到94%;极低出生体重儿的喂养不耐受发生率由原来的35%降低到16%;极低出生体重儿的坏死性小肠结肠炎的发生率由原来的11%降低到1%;产妇的满意度由原来的86%提高到96%。结论采集母乳提高了母婴分离的母乳喂养率,降低了早产儿的喂养不耐受以及坏死性小肠结肠炎的发生率,提高了患者的满意度。     

早产低出生体质儿胃肠内合理喂养方式的探讨

目的探讨早产低出生体质儿胃肠内合理喂养的方式。方法将265例早产低出生体质儿随机分为3组,实行胃肠内喂养(经口胃管喂养)A组:89例,应用温开水、5%葡萄糖水和1:1早产儿配方奶各喂养3次,每次间隔3h;B组:89例,应用温开水、5%葡萄糖水和1:1早产儿配方奶各喂养6次,每次间隔3h;C组:87例,应用温开水、5%葡萄糖水和1:1早产儿配方奶各喂养1d,每次间隔3h。观察出生至出院每组低出生体质儿每天腹胀、呕吐、胃出血、胃潴留情况及胎便排尽时间、黄疸持续时间、吸吮动作出现时间、体质增长情况及平均住院时间。结果 3组低出生体质儿喂养期间腹胀、呕吐、胃出血和胃潴留情况比较,均P<0.05,差异具有统计学意义,与B组和C组相比,A组低出生体质儿腹胀、呕吐、胃出血及胃潴留发生率较低(均P<0.01);3种喂养方式低出生体质儿胎粪排尽时间、黄疸持续时间、吸吮动作出现时间、体质增长及住院时间比较,均P<0.01,差异具有统计学意义,与B组和C组相比,A组低出生体质儿胎粪排尽时间、黄疸持续时间及平均住院时间均较短(均P<0.001),吸吮动作出现时间较早(P<0.001),出生后至出院体质增长速度较快(P<0.001)。结论应用温开水、5%葡萄糖水和1:1早产儿配方奶各喂养3次,每次间隔3h的喂养方式,降低早产低出生体质儿喂养不耐受发生率,促进生长发育,其是早产低出生体质儿胃肠内合理的喂养方式。     

Pharmacokinetics and renal tolerance of aztreonam in premature infants.

Aztreonam (30 mg/kg of body weight) was administered intravenously over 3 min every 12 h to 30 preterm neonates divided into two groups according to gestational age (mean age for group A was less than 30 weeks and mean age for group B was greater than 30 weeks) and birth weight (mean weight for group A was less than 1,500 g and mean weight for group B was greater than 1,500 g). Blood and urine samples were analyzed by microbiological assay. The pharmacokinetics were described by one-compartment and noncompartment models. The mean half-life and clearance for premature infants weighing less than 1,500 g were 5.33 +/- 3.61 h and 1.52 +/- 1.33 ml/min/kg, respectively; for those weighing more than 1,500 g, the values were 4.08 +/- 2.28 h and 2.41 +/- 2.10 ml/min/kg, respectively. The mean urinary concentration of aztreonam in 15 premature infants during the first 6 h of therapy was 242.72 +/- 188.19 micrograms/ml, with a mean percentage of elimination of 13.29%. Urinary excretion of N-acetyl-beta-D-glucosaminidase (a specific and sensitive test for the detection of drug-induced renal tubule damage) did not show significant differences in our group of premature infants compared with that in a control group. The dose of 30 mg/kg and a dosage interval of 8 to 12 h could be recommended for the treatment of suitable bacterial infections in all premature infants.     

Method for hand-feeding mouse pups with nursing bottles.

The purpose of this study was to establish a hand-feeding method for the mouse by using nursing bottles. Five different-sized nipples were tested. The largest nipple used for pups from 12 to 15 days of age was 5.5 mm in diameter and 10 mm long, with a tip of 1.5 mm in diameter. The size of the nipple was much larger than that of the mothers, and bloating due to air accumulation was observed in the artificially-reared pups. To prevent bloat, the nipple size was increased, and a piece of sponge was stuffed in the nipple. Among the 30 pups fed from 1 day of age, 26 were weaned and 4 died. Three pups died due to aspiration of milk into the lung, and the remaining one died due to bloating. The development of nursing bottles with nipples may be potentially useful for the studies of nutrition, behavior, immunology, psychology, and toxicology.     

Duplex Doppler sonography of changes in portal vein flow in healthy term newborn infants after feeding.

To establish reference values for changes in portal venous diameter, angle- corrected maximal flow velocity, and flow in healthy term newborn infants after formula feeding, we studied 20 subjects using duplex Doppler sonography. After feeding, portal venous diameter increased from 3.6 +/- 0.1 (mean +/- standard error of the mean) to 3.9 +/- 0.1 mm at 15 min and decreased to 3.8 +/- 0.1 at 60 min. Maximal flow velocity increased from 24.1 +/- 1.3 cm/s to a maximum of 35.9 +/- 2.4 cm/s at 15 min and decreased to 28.8 +/- 1.5 cm/s at 60 min. Flow increased from 85.0 +/- 7.5 ml/min to a maximum of 153.6 +/- 14.9 ml/min at 15 min with decrease similar to the maximal flow velocity curve. We conclude that formula feeding produces peak portal blood flows of nearly twice the fasting values at 15 min after feeding and returns almost to fasting value by 60 min.     

Comparison of impedance minute ventilation and direct measured minute ventilation in a rate adaptive pacemaker

Respiration rate (RR) and minute ventilation (MV) provide important clinical information on the state of the patient. This study evaluated the accuracy of determining these using a pacemaker impedance sensor. In 20 patients who were previously implanted with a Guidant PULSAR MAX group of pacemakers, the telemetered impedance sensor waveform was recorded simultaneously with direct volume respiration waveforms as measured by a pneumatometer. Patients underwent 30 minutes of breathing tests while supine and standing, and a 10-minute ergonometer bicycle exercise test at a workload of 50 W. Breathing tests included regular and rapid-shallow breathing sequences. RR was determined by a computerized algorithm, from impedance and respiration signals. The mean RR by impedance was 21.3 +/- 7.7 breaths/min, by direct volume was 21.1 +/- 7.6 breaths/min, range 7-66, the mean difference of RR measured by the impedance sensor, as compared with the true measurement, being 0.2 +/- 2.1 breaths/min. During the entire exercise, the mean correlation coefficient between impedance (iMV) and direct measured MV was 0.96 +/- 0.03, slope 0.13 +/- 0.05 L/Omega and range 0.07-0.26 L/Omega. Bland-Altman limits of agreement were +/- 4.6 L/min for MV versus iMV with each patient calibrated separately. The correlation coefficient for iMV versus MV over the entire 10 minutes of exercise, including the initial 4 minutes of exercise, was 0.99. The transthoracic impedance sensor of an implanted pacemaker can accurately detect respiration parameters. There was a large variation between subjects in the iMV versus MV slope during a bicycle exercise test, whereas for each subject, the slope was stable during submaximal bicycle exercise.     

Cardiorespiratory effects of naloxone in children

BACKGROUND: Data on the cardiorespiratory changes and complications following administration of naloxone in children are limited. OBJECTIVE: To evaluate the cardiorespiratory changes and complications following naloxone treatment in children. METHODS: The maximal changes in respiratory rate (RR), heart rate (HR), systolic (SBP) and diastolic (DBP) blood pressure, and any complications within 1 and 2 hours following naloxone were tabulated. RESULTS: One hundred ninety-five children received naloxone over 3 years. The mean +/- SD age was 9.7 +/- 6 years. The total doses of naloxone ranged from 0.01 to 7 mg (0.001-0.5 mg/kg body weight), with a median dose of 0.1 mg. Group 1 patients consisted of 116 (60%) children who were postoperative and had been given naloxone by an anesthesiologist; group 2 patients consisted of 79 (40%) children who received naloxone in the emergency department or pediatric intensive care unit. Patients in group 1 were older: 10.6 +/- 5.3 versus 8.2 +/- 6.7 years (p < 0.006), but received significantly lower doses of naloxone (0.09 +/- 0.2 vs. 1.1 +/- 0.76 mg; p < 0.001). When the entire cohort was evaluated, a significant increase in RR (15 +/- 7 vs. 21 +/- 8 breaths/min; p < 0.001), HR (102 +/- 29 vs.107 +/- 29 beats/min; p < 0.001), SBP (109 +/- 17 vs. 115 +/- 15 mm Hg; p < 0.001), and DBP (56 +/- 10 vs. 60 +/- 13 mm Hg; p < 0.001) within 1 hour following naloxone was noted. When the 2 groups were compared, only the changes in RR were greater in group 2 patients (6.8 +/- 7.9 vs. 4.7 +/- 5 breaths/min; p < 0.001) following naloxone. Systolic hypertension occurred in 33 of 195 (16.9%) of all patients, while diastolic hypertension occurred in 13 (6.6%) of all patients after naloxone. Only the incidence of diastolic hypertension was higher in group 2 compared with group 1 patients following naloxone (16% vs. 2%; p < 0.001). Hypertension resolved spontaneously. One child developed pulmonary edema and required positive pressure ventilation for 22 hours. CONCLUSIONS: Moderate increases in RR, HR, and BP occur after naloxone administration to children, but development of more serious complications is rare.     

Pharmacokinetics and dynamics of furosemide in the newborn piglet

Furosemide was administered as either an i.v. bolus (6 mg/kg) or primed continuous infusion (4 mg/kg/hr) with quantitative fluid replacement to 10 3-day-old and 9 18-day old piglets. Total and unbound plasma as well as urinary furosemide concentrations were measured for up to 6 hr and drug disposition and renal sodium excretory dynamics were compared at the two ages. The plasma clearance of furosemide was concentration-independent over the range studied (0.1-10 mg/l). Steady-state volume of distribution and unbound fraction of furosemide in plasma were both considerably higher in the younger piglets (618 +/- 320 vs. 201 +/- 71 ml/kg, p less than .01 and 0.22 +/- 0.08 vs. 0.06 +/- 0.02 ml/kg, p less than .001, respectively) while unbound secretory clearance was several-fold lower in this age group (49.2 +/- 23 vs. 107 +/- 55 ml/min/kg, P less than .01). A log-logistic equation was fitted to sigmoidal plots of sodium excretion rate vs. log furosemide excretion rate. While basal response and slope parameters did not differ significantly, maximal response and stimulus required for half-maximal response were both reduced in the younger piglets (0.70 +/- 0.24 vs. 1.18 +/- 0.30 mmol/min and 0.06 +/- 0.04 vs. 0.14 +/- 0.06 mumol/min, respectively, P less than 0.05). Thus, younger piglets were more sensitive to the natriuretic effects of the drug. While term piglets were useful for studying the maturation of protein binding and renal drug excretory processes for furosemide, drug disposition was not comparable to that in human premature infants because of the higher secretory capability of the piglet.     

Algorithms to qualify respiratory data collected during the transport of trauma patients

We developed a quality indexing system to numerically qualify respiratory data collected by vital-sign monitors in order to support reliable post-hoc mining of respiratory data. Each monitor-provided (reference) respiratory rate (RR(R)) is evaluated, second-by-second, to quantify the reliability of the rate with a quality index (QI(R)). The quality index is calculated from: (1) a breath identification algorithm that identifies breaths of 'typical' sizes and recalculates the respiratory rate (RR(C)); (2) an evaluation of the respiratory waveform quality (QI(W)) by assessing waveform ambiguities as they impact the calculation of respiratory rates and (3) decision rules that assign a QI(R) based on RR(R), RR(C) and QI(W). RR(C), QI(W) and QI(R) were compared to rates and quality indices independently determined by human experts, with the human measures used as the 'gold standard', for 163 randomly chosen 15 s respiratory waveform samples from our database. The RR(C) more closely matches the rates determined by human evaluation of the waveforms than does the RR(R) (difference of 3.2 +/- 4.6 breaths min(-1) versus 14.3 +/- 19.3 breaths min(-1), mean +/- STD, p < 0.05). Higher QI(W) is found to be associated with smaller differences between calculated and human-evaluated rates (average differences of 1.7 and 8.1 breaths min(-1) for the best and worst QI(W), respectively). Establishment of QI(W) and QI(R), which ranges from 0 for the worst-quality data to 3 for the best, provides a succinct quantitative measure that allows for automatic and systematic selection of respiratory waveforms and rates based on their data quality.     

Continuous arteriovenous hemofiltration in premature infants

Five critically ill premature infants with acute renal failure (ARF) and hypervolemia were treated by continuous arteriovenous hemofiltration (CAVH). Prostacyclin was used to prevent hemofilter clotting. Mean treatment duration was 53.6 +/- 14 h. Mean blood flow rates of 1.6 +/- 0.22 ml/min and filtration fractions of 17.2 +/- 3.7% produced mean ultrafiltration rates of 8.3 +/- 3.1 ml/kg.h. Fluid overload was easily corrected by means of CAVH. The mean prehemofiltration serum creatinine and urea levels were 2.3 +/- 0.4 and 77 +/- 29.7 mg/dl; the mean posthemofiltration levels were 2.38 +/- 0.43 and 92 +/- 34.4 mg/dl, respectively. Hemofilter clotting occurred every 14 h. Urinary output was restored in three infants. Three of the five infants died, but none of the deaths was related to ARF or CAVH. CAVH is a safe and simple method to control fluid and metabolic imbalances in critically ill premature infants.