RESUMO
Cerebrospinal fluid (CSF) lactate dehydrogenase (LDH) was measured in 54 neonates with intracranial hemorrhage and compared with 82 control, 27 traumatic lumbar puncture, seven meningitis, and 30 asphyxiated newborns. Hospital data, neonatal outcomes, and long-term neurodevelopmental follow-up results were reviewed. CSF LDH was not significantly affected by traumatic lumbar puncture but was elevated in proportion to the severity of CNS hemorrhage as scored by computerized tomography. LDH was also significantly associated with subsequent seizures and hydrocephalus and abnormal long-term developmental outcome.
Assuntos
Hemorragia Cerebral/líquido cefalorraquidiano , L-Lactato Desidrogenase/líquido cefalorraquidiano , Asfixia Neonatal/líquido cefalorraquidiano , Hemorragia Cerebral/diagnóstico , Hemorragia Cerebral/diagnóstico por imagem , Hemorragia Cerebral/enzimologia , Ensaios Enzimáticos Clínicos , Humanos , Recém-Nascido , Isoenzimas , Meningite/líquido cefalorraquidiano , Radiografia , Punção EspinalRESUMO
Current federal policy, as reflected in the final Baby Doe rule, will have a chilling effect on the ability of doctors to care appropriately for severely disabled infants. The policy threatens to prolong life unjustifiably for such infants. It will force physicians to violate a duty to do no harm without compensating benefit. And it raises serious problems for the just distribution of health care.
KIE: The authors argue that the Department of Health and Human Services' final rule, "Child Abuse and Neglect Prevention and Treatment Program," (April 1985) will prevent physicians from providing appropriate care for severely handicapped infants. The regulations stipulate that treatment must be provided unless the infant is permanently and irreversibly comatose and treatment would only prolong dying. Appropriate nutrition, hydration, and medication must be provided to all infants. Moskop and Saldanha fear that physicians will respond to the rule by aggressive overtreatment that will prolong suffering without any compensating benefit. They contend that the high cost of extended intensive care under restrictive public spending policies raises serious questions about the general distribution of health care.
Assuntos
Anormalidades Congênitas/terapia , Tomada de Decisões , Governo Federal , Regulamentação Governamental , Cuidados para Prolongar a Vida/legislação & jurisprudência , Suspensão de Tratamento , Atenção à Saúde , Comitês de Ética Clínica , Ética Médica , Humanos , Recém-Nascido , Cuidados para Prolongar a Vida/economia , Alocação de Recursos , Medição de Risco , Estresse Psicológico , Estados UnidosRESUMO
Four ill preterm infants each had a severely dilated gallbladder that was detected as a right-upper-quadrant abdominal mass. In each infant, the diagnosis was suspected on physical examination and confirmed by ultrasound study. One extremely premature infant with respiratory distress syndrome died, and at autopsy, the gallbladder and biliary tree showed no abnormalities, except for severe gallbladder distention. In the other three infants, distention of the gallbladder resolved spontaneously.
