Assessment of cereal-grain warming pad as a heat source for newborn transport.

OBJECTIVE: The study assessed warming pad (WP) filled with either mung beans or dry corn used in feeding livestocks as a heat source for newborn transport. Its use was to compensate for lack of transport incubator or to employ as a supplemental heat source for warming the infant or incubator when transport made in cold weather. MATERIAL AND METHOD: The WP was made of a strong-cotton-cloth bag (the fabric for making jeans) with a size of A4 paper sheet. The bag was filled with one kilogram of either mung beans or dry corn (used in feeding livestocks). The WP was heated in a 800-watts microwave oven for 2 minutes with grains thoroughly mixed inside to distribute heat evenly and put in a disposable A4-size brown envelope. The temperature at the surface of the brown envelope with the WP inside was recorded every 5 minutes for 120 minutes to assess which cereal grain could emit more heat and keep the heat longer Then the WP was heated in the microwave oven for 1, 1 1/2 and 2 minutes, placed in the same size of brown envelope and covered with two towels. The temperatures at the surface of the brown envelope and each layer of towels were recorded with the same frequency and duration. RESULTS: The cereal-grain WPs, both mung beans and dry corn, were equally effective in producing heat when warmed in the microwave oven. The mean maximal temperatures at the surface of brown envelope were too high for direct application to newborns. The mean maximal temperatures of towels covering the paper envelope with WP heated in the microwave oven for 1 minute were as followed. At the first towel, which was close to the WP, the mean temperature reached 42 degrees C (107.6 degrees F) in 10 minutes after warming and was maintained > or = 42 degrees C for 10 minutes. All temperature measurements at the first towel was < or = 42 degrees C at 35 minutes. At 2 hours the mean temperature of the first towel was 35.6 degrees C (96.1 degrees F) which was higher than room temperature by 5.3 degrees C (41.5 degrees F). The maximal mean temperature measured at the second towel, representing the infant's skin contact surface, was 39.7 degrees C (103.5 degrees F) at 15 minutes of which the peak temperature was 41.0 degrees C (105.8 degrees F). CONCLUSION: The cereal-grain WP, when used along with traditional nursing interventions as a heat source during newborn transport, should be safe with careful handling. It should be heated in the microwave oven exactly for one minute. A towel is placed above an A4-size brown envelope with the WP inside and the bundled infant is placed on it. Remove the towel at 35 minutes and lay the bundled infant on the brown envelope. It should be effective and safe in providing a warm transport for at least 2 hours since the temperature of the WP at the towel representing skin contact surface is not higher than 42 degrees C (107.6 degrees F) and there is no risk for hot water leakage.

Thai healthy newborns have a higher risk.

Kernicterus is a preventable but devastating neurologic disorder with life long complications. It is caused by severe and inadequately treated hyperbilirubinemia during the newborn period. In the present paper potential causes and risk factors for the occurrence of kernicterus related to the Thai health system that are responsible for the care of newborn infants before and after discharge are discussed. Potential risk reduction strategies for the Thai health system are purposed Some efforts to improve the quality of Thai newborn care particularly newborns with jaundice that have been made are mentioned. An adherence to the American Academy of Pediatrics clinical guideline for management of hyperbilirubinemia in the newborn infant 35 or more weeks of gestation for those strategies that are feasible to follow will help reduce the prevalence of severe hyperbilirubinemia and bilirubin encephalopathy.

Sterility and storage period of placental blood from neonates delivered by caesarian section.

A prospective study was conducted to evaluate the storage period and sterility of placental blood from neonates delivered by caesarian section. Following caesarian section of the infant and placenta, the placenta was immediately placed in a sterile tray and the umbilical cord near the clamps was rinsed with sterile saline and cut 2 cm below the clamps with sterile scissors. An Fr 8 feeding tube was inserted into an umbilical vein and 43 ml of placental blood was drawn into a 50 ml disposable syringe which contained 7 mls of CPDA-1 solution. Five-ml aliquots of blood retrieved from the placenta were inoculated into aerobic and anaerobic blood culture bottles. Sixty-four specimens of CODA-1 anticoagulant blood were retrieved from the placenta and evaluated for biochemical changes to determine the recommended storage period. The mean plasma potassium concentrations were 4.9 + 1.1, 9.1 + 2.6, 13.1 + 2.0 mM/l at 0, 48 and 72 hours after collection, respectively. The 72-hour potassium concentration was higher than the value in adult whole blood stored for 7 days, which is considered fresh blood and recommended for transfusing newborn infants. The 107 paired aerobic/anaerobic culture specimens showed an overall contamination rate of 13%. These findungs suggest that placental blood in CPDA-1 can be stored for 48 hours for autologous transfusion and that rinsing the umbilical cord in sterile saline cannot prevent bacterial contamination in the retrieved placental blood.

The relationship between the flow rate delivered by nasal cannula and the fraction of inspired oxygen in newborn infants.

To determine the relationship between the oxygen flow rate delivered by nasal consular and the fraction of inspired oxygen (FiO2) and to evaluate if the nasal consular influenced the infant’s respiratory status, 46 newborn infants, half with a birth weight (BW) of more than 2 kg, were enrolled in this study. In this sample, 23 had a respiratory rate (RR) of more than 60 bum and the otter half had a RR of or less than 60 bum. Their mean age at the time of study was 12.5 days (SD = 15.9). Oxygen saturation (SaO2) was recorded by the Critic are 503 Pulse Ox meter and the FiO2 was measured by the Minion I Oxygen Analyzer. Each infant was first examined using the traditional techniques of oxygen delivery. The Silverman-Anderson retraction score was assigned and the respiratory rate was counted visually for one minute. Each infant was then evaluated in the same way with a nasal canella in place. Humidified oxygen was delivered at a flow rate con-trolled by a low-flow floweret which was adjusted until the SaO2 reading reached the exact value obtained by the traditional techniques. A significant positive correlation between the FiO2 and flow rate was found in both BW and RR categories. The correlation coefficients were 0.86 (p = 0.0000) and 0.70 (p = 0.002) in the larger and the smaller infants, respectively; and 0.77 (p = 0.0000) and 0.87 (p = 0.0000) in the higher and lower RR groups, respectively. The differences of the slopes between groups in both BW and RR categories were not statistically significant (P = 0.82 AND 0.92, respectively). The relationship of oxygen flow rate, birthright, and respiratory rate to the FiO2 examined by stepwise multiple regression analysis showed that the combination of these three independent variables explained 67% of the variation in the FiO2 (p = 0000). However, the regression coefficients suggested a statistically significant contribution of flow rate (p = 0.000), nut not BW or RR. The highest FiO2 delivered by nasal cannel was 0.81 There was a significant decrease in the mean RR from 64.0 to 61.2 bum when changing from traditional methods to nasal cannel (p = 0.029). The difference of the Silverman-Anderson retraction scores was not significant. The regression lines of the FiO2 on flow rates are provided.

Tolazoline in persistent pulmonary hypertension of the newborn.

Thirteen critically ill infants received tolazoline because of sever hypoxaemia refractory to administration of 100 percent oxygen and mechanical ventilation (in 12 infants). Six (46.15%) responded with a mean increase in PaO2 of 151.32 torr within one hour after starting tolazoline. Only 4 of these receiving tolazaline could have the treatment stopped when oxygen requirement was 60 percent without recurrent hypoxaemia. The survival in the responders was 83 percent. Seven patients had little or no improvement in PaO2 following tolazoline and only 3 (42%) of these infants survived. The overall survival was 61 percent. All infants experienced complications possibly related to tolazoline.