Randomized trial of sterile water by gavage drip in the fluid management of extremely low birth weight infants.

OBJECTIVE: To determine whether extremely low birth weight infants who receive enteral sterile water have a reduction in treated patent ductus arteriosus or death by 28 days compared to infants with routine management. STUDY DESIGN: A total of 214 infants were enrolled and randomized by 36 h of age to receive up to 50 ml kg(-1) per day of enteral sterile water (n=109) for 7 days or routine fluid management (n=104). Patent ductus arteriosus treatment was defined as either indomethacin treatment or surgical ligation. RESULT: The proportion of infants with a treated patent ductus arteriosus or death at <28 days of age was 63% in the sterile water group vs 64% in the control group (relative risk 0.99, 95% confidence interval 0.81 to 1.22). There were no differences in the proportion of infants in the sterile water group vs control group with a treated patent ductus arteriosus (55 vs 48%), death (21 vs 28%), necrotizing enterocolitis or death (24 vs 32%), or bronchopulmonary dysplasia or death at <28 days (80 vs 77%). Daily mean glucose levels were significantly higher (P=0.04) in control infants than sterile water infants. CONCLUSION: The use of sterile water did not decrease the incidence of patent ductus arteriosus or other adverse clinical outcomes. The role of enteral sterile water in the fluid management of extremely low birth weight infants remains uncertain.

Hyperglycemia and morbidity and mortality in extremely low birth weight infants.

OBJECTIVE: The purpose of this study was to determine the association between hyperglycemia and mortality and late-onset infections (>72 h) in extremely low birth weight (ELBW) infants. STUDY DESIGN: Retrospective analysis of a prospective cohort study of 201 ELBW infants who survived greater than 3 days after birth. Mean morning glucose levels were categorized as normoglycemia (<120 mg/dl), mild-moderate hyperglycemia (120 to 179 mg/dl) and severe hyperglycemia (> or =180 mg/dl). Hyperglycemia was further divided into early (first 3 days of age) and persistent (first week of age). Logistic regression was performed to assess whether hyperglycemia was associated with either mortality or late-onset culture-proven infection, measured after 3 and 7 days of age. RESULTS: Adjusting for age, the odds ratio (OR) for either dying or developing a late infection was 5.07 (95% confidence interval (CI): 1.06 to 24.3) for infants with early severe hyperglycemia and 6.26 (95% CI: 0.73 to 54.0) for infants with persistent severe hyperglycemia. Adjusting for age, both severe early and persistent hyperglycemia were associated with increased mortality. Among survivors, there was no significant association between hyperglycemia and length of mechanical ventilation or length of hospital stay. Persistent severe hyperglycemia was associated with the development of Stage II/III necrotizing enterocolitis, after adjusting for age and male gender (OR: 9.49, 95% CI: 1.52 to 59.3). CONCLUSION: Severe hyperglycemia in the first few days after birth is associated with increased odds of death and sepsis in ELBW infants.

Physical abuse of children: a review for orthopedic surgeons.

Statistics show that more than half the victims of child abuse have fractures. The orthopedic surgeon will often be the first person to identify a potentially abused child. In a series at Brenner Children's Hospital, 17% of abused children had a fracture as the initial manifestation of child abuse. For protection of the child, it is essential that the orthopedic surgeon recognize the signs of child abuse and make a referral to the appropriate child protection agency. In this review article, we discuss recognition of common types of child abuse and outline appropriate management of child abuse cases.

Ambulatory clinical trials: from concept to practice.

As long as new technologies and clinical innovations are being pursued, clinical trials will continue. Economics, along with patient desires to be independent and to remain at home, will dictate that many of these trials be performed in ambulatory care settings. With every level of the research team functioning to protect patient rights and to ensure proper rigorous conduct of the trial, even more complex trials will become achievable on an ambulatory basis.

Effect of positional loading of three removable partial denture clasp assemblies on movement of abutment teeth.

Tests demonstrated that the degree of movement of the abutment tooth for a distal-extension base using three different clasp designs was a function of the location of loading. Thus, the null hypothesis, there is no significant difference in the degree of movement of the abutment tooth around the axis of rotation as a function of the position of loading, has been demonstrated to be invalid based on the data obtained in this investigation.

Computer-assisted facility planning: a formidable weapon in project cost management.

What are the goals of space planning? They are to predict the probable future of various alternative combinations of space, their layouts, the operating movement, the economic effect and the visual effect of these solutions. Computer graphics, a simple and reliable communication tool in the hands of experienced space planners, can help planners and clients to make real contributions to the design process. This technology will allow them to become, for the first time, not a client and designer, but rather a true partnership, contributing from a broader base of knowledge in an accountable way to the solution of complex problems. This can make a real difference in the future of healthcare facilities.