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2.
Am J Respir Crit Care Med ; 162(3 Pt 1): 826-31, 2000 Sep.
Article in English | MEDLINE | ID: mdl-10988090

ABSTRACT

In mechanically ventilated neonates, the instrumental dead space is a major determinant of total minute ventilation. By flushing this dead space, continuous tracheal gas insufflation (CTGI) may allow reduction of the risk of overinflation. We conducted a randomized trial to evaluate the efficacy of CTGI in reducing airway pressure over the entire period of mechanical ventilation while maintaining oxygenation. A total of 34 preterm newborns, ventilated in conventional pressure-limited mode, were enrolled in two study arms, to receive or not receive CTGI. Transcutaneous Pa(CO(2)) (tcPa(CO(2))) was maintained at 40 to 46 mm Hg in both groups to ensure comparable alveolar ventilation. Respiratory data were collected several times during the first day and daily until Day 28. Both groups were similar at the time of inclusion. During the first 4 d of the study, the difference between peak pressure and positive end-expiratory pressure was significantly lower in the CTGI group by 18% to 35%, with the same tcPa(CO(2)) level and with no difference in the ratio of tcPa(O(2)) to fraction of inspired oxygen (245 +/- 29 versus 261 +/- 46 mm Hg [mean +/- SD] over the first 4 d). Extubation occurred sooner in the CTGI group (p < 0.05), and the duration of mechanical ventilation was shorter (median: 3.6 d; 25th to 75th quartiles: 1.5 to 12.0 d; versus median: 15.6 d; 25th to 75th quartiles: 7.9 to 22.2; p < 0.05) than in the non-CTGI group. CTGI allows the use of low-volume ventilation over a prolonged period and reduces the duration of mechanical ventilation.


Subject(s)
Hyaline Membrane Disease/therapy , Insufflation/instrumentation , Oxygen Inhalation Therapy/instrumentation , Positive-Pressure Respiration/instrumentation , Blood Gas Monitoring, Transcutaneous , Combined Modality Therapy , Equipment Design , Female , Humans , Hyaline Membrane Disease/diagnosis , Hyaline Membrane Disease/mortality , Infant, Newborn , Intensive Care Units, Neonatal , Male , Prospective Studies , Survival Rate , Treatment Outcome
3.
Arch Pediatr ; 7(2): 143-7, 2000 Feb.
Article in French | MEDLINE | ID: mdl-10701058

ABSTRACT

UNLABELLED: Most of the drugs prescribed in pediatric units have no product licence. The lack of clinical studies in children and appropriate drug formulations decrease their safety. The lack of a legal framework makes the prescriber insecure. Even if the debate is not recent, few studies have been carried out in this field. The aim of the present study was to evaluate the rate of prescriptions of unlicensed and off-label drugs in a neonatal intensive care unit. PATIENTS AND METHODS: The present study was carried out in our neonatal intensive care unit, from January 12 to February 12, 1998. Forty babies aged 0 to 128 days were included (90% newborns), with a gestational age between 25 to 40 weeks (88% were premature, with a birth weight lower than 1000 g). RESULTS: Two hundred and fifty-seven prescriptions were administered with 55 different types of drugs during this period. Ten percent of the prescribed drugs had no product licence. Sixty-two percent were off-label for premature infants and 64% for newborns: 90% due to age, 9.3% due to dose and 0.7% to method of administration. No therapeutic alternatives to these prescriptions were found among the few available licensed drugs. CONCLUSION: The prescriptions of unlicensed and off-label drugs in neonatal intensive care units are daily and repeated events. The prescribers are usually not aware of the exact status of the drug and do not realize neither he importance of the problem nor the legal and potential consequences. The lack of pediatric clinical studies is to a large extent responsible for the absence of drug registration in pediatrics. The pharmaceutical industry has few incentives to develop the pediatric product licences.


Subject(s)
Drug Prescriptions/classification , Intensive Care, Neonatal/legislation & jurisprudence , Legislation, Drug , Age Factors , Chemistry, Pharmaceutical/legislation & jurisprudence , Drug Industry/legislation & jurisprudence , Drug Labeling/legislation & jurisprudence , France , Gestational Age , Humans , Incidence , Infant, Newborn , Infant, Premature , Infant, Very Low Birth Weight , Pharmaceutical Preparations/administration & dosage , Safety
4.
Presse Med ; 27(23): 1135-9, 1998 Jun 27.
Article in French | MEDLINE | ID: mdl-9767794

ABSTRACT

OBJECTIVES: In young children with meningitis, blood or cerebrospinal fluid (CSF) analysis cannot differentiate all cases of viral meningitis (VM) from bacterial meningitis (BM). Empirical antibiotic therapy is often given. As new markers are needed, we compared serum proCalcitonin (PCT) with CSF analysis for C-reactive protein (CRP) and interleukin-6 (IL6). PATIENTS AND METHODS: PCT was measured with a chemoluminescent assay in the sera of 23 children (aged 3 months to 14 years) hospitalized for BM and in 51 patients with VM. RESULTS: Initial CRP (mean 143.3 mg/l, range 28-351 and mean 13.9, range 1-48), CSF proteins (mean 2.2, range 0.4-4.74 and mean 0.57, range 0.12-2.72) and white blood cell count in CSF (range 240-17500 and 20-3200) in BM and VM respectively, were not sufficiently discriminative to distinguish between BM and VM. Twenty-four of the 51 patients with VM were given antibiotics. IL6 values at admission showed an overlap zone (> 100 pg/ml in 7/19 patients with VM and < 100 pg/ml in 1/8 patients with BM. PCT was discriminative in all cases: mean PCT in BM was 61 micrograms/l (range 4.8-335) and 0.33 in VM (range 0-1.7; p < 0.001). No production of PCT was detected in CSF. After antibiotic therapy, PCT decreased and reached undetectable levels after recovery. CONCLUSION: PCT is a sensitive and specific marker for early diagnosis of viral meningitis versus bacterial meningitis in children.


Subject(s)
C-Reactive Protein/analysis , Calcitonin/blood , Interleukin-6/blood , Meningitis, Bacterial/blood , Meningitis, Viral/blood , Protein Precursors/blood , Adolescent , Biomarkers/blood , Calcitonin Gene-Related Peptide , Child , Child, Preschool , Humans , Infant , Reference Values
6.
Physiol Behav ; 52(2): 339-44, 1992 Aug.
Article in English | MEDLINE | ID: mdl-1523262

ABSTRACT

Adult control and cerebellectomized DA/HAN-strained male rats were submitted to habituation of exploration behavior in a test environment consisting of a novel cage in which four objects were displayed. Seven days after the initial session of habituation, retention of the habituation was tested. Within-session habituation was observed in cerebellectomized and control rats. However, retention of habituation was impaired in rats that were cerebellectomized after the initial session but not in those cerebellectomized before the session. These results are consistent with the hypothesis that the cerebellum has a role in memory of habituation to environmental stimuli.


Subject(s)
Cerebellum/physiology , Exploratory Behavior/physiology , Habituation, Psychophysiologic/physiology , Animals , Cerebellum/anatomy & histology , Male , Rats , Rats, Inbred Strains
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