Percutaneous central venous catheterization: three years' experience in a neonatal intensive care unit

Article Abstract:

Percutaneous central venous catheterization (PCVC) is the insertion of a tube-like structure called a catheter through the skin into a peripheral vein and on into a central vein, for monitoring blood pressure in the vein or for obtaining blood samples for analysis. This procedure is now being used in infants with very low birth weights, who would otherwise require frequent venipuncture (puncture of a vein) for blood tests. The effects of PCVC on 317 infants who received a total of 478 percutaneous catheters during a three-year period were assessed. Two hundred and forty-one catheters were placed in infants weighing one kilogram (2.2 pounds) or less. The average length of time that an infant was catheterized was 13 days. Almost half of the catheters placed in the central and thoracic veins were removed, because of leakage or clotting in 43 percent of cases, and because of sepsis (infection) or blockage of a vein in 6 percent of cases. Of 23 cases of suspected sepsis, six resulted from the catheter and 12 were associated with another site of infection. Sepsis due to PCVC was associated with increased duration of catheterization, infection with Staphylococcus epidermidis, and infant weight of one kilogram or less. Sepsis due to infection unrelated to the catheter was associated with the presence of another infection site, previous infection, extremely low birth weight, and persistent clinical problems. PCVC decreased the stress associated with repeated venipuncture, reduced the incidence of complications to less than the rate associated with surgically-inserted central venous catheters, and helped in identifying factors that increase the risk of sepsis. (Consumer Summary produced by Reliance Medical Information, Inc.)

Health aspects, Evaluation, Causes of, Bacteremia, Intravenous catheterization

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Apnea, transient episodes of bradycardia, and periodic breathing in preterm infants

Article Abstract:

Premature infants are now routinely monitored for breathing and heart function. It is not unusual for healthy premature infants to have episodes of apnea (temporary cessation of breathing), accompanied by transient episodes of bradycardia (TEB), abnormally slow heart beat, or periodic breathing (PB). In an effort to define the incidence of apnea, TEB, and PB, eight-hour cardiorespiratory recordings were made for 66 healthy premature infants who were at least one week old; measurements were taken again between 32 and 36 weeks. Central apnea of 15 seconds or more was seen in almost half of the infants. There were numerous incidents of TEB, but many were not associated with apnea. The majority of TEB incidents occurred without the concurrence of central apnea; many were a function of changes in respiratory patterns and body movement. The incidence of TEB was found to increase with longer durations of apnea; it is thought that TEB may be associated with oxygen levels in the infant. Both apnea and TEB decrease with increased gestational and chronological age. It was observed that as much as 40 percent of the infants' time was spent in PB. While infant oxygen levels were reduced during episodes of PB, they were still within normal range. It was concluded that brief episodes of apnea, in conjunction with TEB, are not abnormal, and alone do not indicate the need for long-term cardiorespiratory monitoring. Although successful responses were obtained with oxygen treatment for PB, this therapy is thought to have a role in retrolental fibroplasia of the eye, and may be inadvisable. (Consumer Summary produced by Reliance Medical Information, Inc.)

Demographic aspects, Bradycardia, Pediatric cardiology, Apnea neonatorum

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Longitudinal changes in the bone mineral content of term and premature infants

Article Abstract:

Premature infants with very low birth weights frequently suffer from rickets, a bone mineral deficiency. Improvements in the bone mineral content (BMC) and the bone width (BW) of 12 premature (average 31 weeks gestation) very low birth weight infants were compared with 19 normal term infants. All of the infants were given a formula containing no calciferol. The calciferol, normally contained in formula, was given as a separate daily oral supplement. The BMC and the BW were measured at birth and at 8 and 16 weeks of age. Measurements were taken at the junction of the middle and distal thirds of the radius bone in the arm. This area was chosen because it has the least variation in mineral content. At birth, the BMC and the BW were significantly different in the two groups. When measurements were taken again at 16 weeks, no differences were noted between the premature and the normal infants. These results may be attributed to statistical error, or to the intensive hospital care received by these infants. The bone mineralization rate among these premature infants was significantly higher than reported in previous studies. (Consumer Summary produced by Reliance Medical Information, Inc.)

Bones, Measurement, Minerals (Nutrients), Mineral metabolism, Minerals in the body

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