Fatal haemorrhagic gastritis associated with oral sulindac treatment for patent ductus arteriosus

We report the first case in a preterm infant given oral sulindac for treatment of symptomatic patent ductus arteriosus who subsequently developed severe acute haemorrhagic gastritis leading to disseminated intravascular coagulation, massive pulmonary haemorrhage and death. The postmortem examination suggested that the mechanism was likely a direct irritant insult causing ischaemia on the gastric mucosa. Although sulindac is supposed to be a renal-sparing non-steroidal anti-inflammatory prodrug associated with minimal renal and gastrointestinal adverse effects, clinicans should be alerted to this potential life-threatening complication in preterm infants. Until the question of safety could be adequately addressed, the use of sulindac for ductal closure should remain experimental.     

Decreased thymus size in formula-fed infants compared with breastfed infants

The objective of this research was to investigate if breastfeeding affects the size of the thymus. Ultrasound assessment of the thymic index (a volume estimate) at birth and age 4 months in 47 healthy infants born in the hospital were used. History of feeding mode, body size and illness were registered. At 4 months the geometric mean thymic index (range) was 38.3 (16.2-83.2) in exclusively breastfed infants ( n = 21), 27.3 (15.6-50.0) in partially breastfed infants ( n = 13) and 18.3 (12.2-32.6) in formula fed infants ( n = 13; p = 0.0001, ANOVA). This finding was independent of weight, length, sex and previous or current illness. There was no significant difference in mean thymic index at birth between the three feeding groups and mean thymic index had increased in all three groups from birth to 4 months. For the formula-fed infants it seems that the thymus remains large for a period and then decreases in size after breastfeeding has been terminated. We conclude that the thymus is considerably larger in breastfed than in formula-fed infants at the age of 4 months. The cause of this difference is unknown but human milk contains many immune modulating factors that might cause this effect.     

A noncomputerized count-based technique for the determination of resting left ventricular ejection fraction

A noncomputerized, count-based technique for the determination of left ventricular ejection fraction (LVEF), which does not use geometric assumptions of left ventricular shape, was developed. The noncomputerized technique and computerized multigated ventriculography using both fixed and variable region-of-interest (ROI) methods were performed on 16 patients. The LVEFs obtained with the noncomputerized technique correlated well with both the fixed ROI computerized technique (r = .87) and the variable ROI computerized technique (r = .86). It is concluded that when a computer is not available, the noncomputerized technique is a valid alternative for the determination of LVEF in resting patients in stable sinus rhythm.     

The effect of systematic care planning after acute stroke in general hospital medical wards

In a multidisciplinary study comprising 280 patients with acute cerebrovascular disease, the functional capacity was followed from the acute stage onwards with a test battery mainly measuring activities of daily living and motor capacity. Systematized care procedures with written care plans in accordance with the nursing process model, together with a booklet of guidelines in stroke care, were introduced during an experimental period in the care of 173 of the stroke victims. The remaining 107 patients received conventional care. The functional improvements were equal from a statistical standpoint in these two groups. However, in the group, which received special activities, there was a significant decrease in bed days, and a slightly larger number were able to return to their own homes. Compared with another stroke population from the same hospital, measured with the same functional instrument 7 years ago, the patients in this study seemed better off from a functional standpoint. For the individual severely-disabled patient, the care planning procedures seemed to be valuable and an effective way of promoting communication between different units. The difficulties in introducing new routines for documentation are discussed.     

Interactions among peripheral perfusion, cardiac activity, oxygen saturation, thermal profile and body position in growing low birth weight infants

Aims: To investigate the correlation between the ‘perfusion index’ (PI) and other commonly used estimates of cutaneous blood flow [heart rate (HR), surface temperatures (ST) and central‐to‐peripheral thermal gradients (C‐P grad)] and to use this new non‐invasive tool to compare differences between prone and supine sleep position in low birth weight (LBW) infants. Methods: Six‐hour continuous recordings of pulse oximetry, cardiac activity and absolute ST from three sites (flank, forearm and leg), along with minute‐to‐minute assessment of behavioural states were performed in 31 LBW infants. Infants were randomly assigned to the prone or supine position for the first 3 h and then reversed for the second 3 h. PI data were correlated with HR and C‐P grad, and compared across sleep positions during quiet sleep (QS) and active sleep (AS). Results: Perfusion index correlated significantly with HR (r² = 0.40) and flank‐to‐forearm thermal gradient (r² = 0.28). In the prone position during QS, infants exhibited higher PI (3.7 ± 0.9 vs. 3.1 ± 0.7), HR (158.4 ± 8.9 vs. 154.1 ± 8.8 bpm), SpO₂ (95.8 ± 2.6 vs. 95.2 ± 2.6%), flank (36.7 ± 0.4 vs. 36.5 ± 0.4°C), forearm (36.1 ± 0.6 vs. 35.5 ± 0.4°C) and leg (35.4 ± 0.7 vs. 34.7 ± 0.7°C) temperatures and narrower flank‐to‐forearm (0.6 ± 0.4 vs. 0.9 ± 0.3°C) and flank‐to‐leg (1.3 ± 0.6 vs. 1.8 ± 0.7°C) gradients, compared to those of the supine position. Similar differences were observed during AS. Conclusion: Perfusion index is a good non‐invasive estimate of tissue perfusion. Prone sleeping position is associated with a higher PI, possibly reflecting thermoregulatory adjustments in cardiovascular control. The effects of these position‐related changes may have important implications for the increased risk for sudden infant death syndrome in prone position.     

Prevention of pre-eclampsia in high risk women with renal disease: A prospective randomized trial of heparin and dipyridamole

Summary: Twenty-one women with primary glomerulonephritis and a history of a poor outcome in previous pregnancies were randomized to receive heparin, 15 000 units subcutaneously and dipyridamole, 400 mg daily ( n = 10) or no treatment ( n = 11) from 14 weeks of gestation. the women were well matched in terms of the type of underlying glomerulonephritis and previous pregnancy complications. the treated group showed a significantly lower incidence of hypertension ( P <0.03) and of overall maternal complication ( P <0.03). the days spent in hospital prior to delivery were 18 in the treated group and 27 in the control group ( P <0.01). In all other parameters which were measured the outcome was better in the treated group although these did not achieve statistical signficance. In the control group the pregnancy complications were similar to those in previous pregnancies but very few complications occurred in treated patients. Heparin and dipyridamole were used because of the activation of coagulation in preeclampsia and because of the prominence of fibrin in renal and uterine vessels in pre-eclampsia. As heparin suppresses both the action and the production of endothelin, the benefit of treatment could have reflected endothelin inhibition.