Can an alternative umbilical arterial catheter solution and flush regimen decrease iatrogenic hemolysis while enhancing nutrition? A double-blind, randomized, clinical trial comparing an isotonic amino acid with a hypotonic salt infusion.

Abstract:

OBJECTIVE:In the process of sampling blood through an umbilical arterial catheter (UAC), infant blood comes into stagnant contact with infusion solution in the "waste syringe" before being reinfused. We have previously demonstrated in vitro that this process is associated with less hemolysis of red blood cells (RBCs) with use of an isotonic solution compared with a hypotonic 0.25 normal saline (NS) solution. The objective of this study was to compare the in vivo effect on hemolysis of 2 UAC infusion/flush regimens (an isotonic regimen vs a hypotonic regimen) and to assess the early nutritional benefit of an amino acid solution as the isotonic UAC infusion solution. METHODS:Infants who had a birth weight of < or =1.5 kg and were expected to have a UAC for > or =3 days were enrolled within 24 hours of life into this prospective, double-blind, randomized, clinical trial of 2 UAC infusion solution/flush regimens. Power analysis demonstrated that 40 infants were needed to determine differences in hemolysis quantified by plasma-free hemoglobin (PFH) level. Nutrition from glucose was evaluated by measurement of daily dextrose calories. C-peptide was measured to evaluate endogenous insulin production. Adverse events and protein tolerance were tracked. RESULTS:Twenty-two infants (mean gestational age: 27 weeks; 945 g birth weight) were enrolled in each group, for an average of 4.2 days (range: 2.5-8 days). There were no group differences in demographics. PFH levels were lower for infants who received isotonic amino acid (IAA) in comparison with 0.25 NS (33 +/- 14 mg/dL vs 62 +/- 27 mg/dL, respectively). C-peptide was higher in those who received IAA, as were nonprotein calories received on days 4 to 6 of the study (51 +/- 11 kcal/kg/day vs 44 +/- 12 kcal/kg/day, IAA vs 0.25 NS, respectively). CONCLUSIONS:Lower PFH levels in IAA versus 0.25 NS group were consistent with our hypothesis of decreased hemolysis with an isotonic infusion/flush regimen. IAA use may also allow greater early glucose nutrition, as indicated by the higher level of endogenous insulin production and improved glucose tolerance. IAA seems to be a superior UAC solution to 0.25 NS in that it is associated with less hemolysis and improved nutrition.

journal_name

Pediatrics

journal_title

Pediatrics

authors

Jackson JK,Biondo DJ,Jones JM,Moor PJ,Simon SD,Hall RT,Kilbride HW

doi

10.1542/peds.114.2.377

subject

Has Abstract

pub_date

2004-08-01 00:00:00

pages

377-83

issue

2

eissn

0031-4005

issn

1098-4275

pii

114/2/377

journal_volume

114

pub_type

临床试验,杂志文章,随机对照试验
  • Juvenile delinquency and adolescent trauma: how strong is the connection?

    abstract:OBJECTIVES:To determine whether youth convicted of juvenile offenses have a greater risk of injury resulting in hospitalization compared with nonoffending adolescents. DESIGN:A statewide hospital discharge database was linked to juvenile justice records to identify all hospitalizations occurring at ages 13 to 17 years...

    journal_title:Pediatrics

    pub_type: 杂志文章

    doi:10.1542/peds.99.3.e5

    authors: Conseur A,Rivara FP,Emanuel I

    更新日期:1997-03-01 00:00:00

  • Policy statement--Child abuse, confidentiality, and the health insurance portability and accountability act.

    abstract::The federal Health Insurance Portability and Accountability Act (HIPAA) of 1996 has significantly affected clinical practice, particularly with regard to how patient information is shared. HIPAA addresses the security and privacy of patient health data, ensuring that information is released appropriately with patient ...

    journal_title:Pediatrics

    pub_type: 杂志文章

    doi:10.1542/peds.2009-2864

    authors: Committee on Child Abuse and Neglect.

    更新日期:2010-01-01 00:00:00

  • Recovery of left ventricular function following discontinuation of anthracycline chemotherapy in children.

    abstract::Echocardiographic evaluation of left ventricular (LV) performance was performed in 41 children during and following anthracycline chemotherapy. Prior to treatment LV function was normal in all patients; LV shortening fraction was 35.2 +/- 0.7% and percent of predicted velocity of circumferential fiber shortening was 1...

    journal_title:Pediatrics

    pub_type: 杂志文章

    doi:

    authors: Lewis AB,Crouse VL,Evans W,Takahashi M,Siegel SE

    更新日期:1981-07-01 00:00:00

  • Special requirements of electronic health record systems in pediatrics.

    abstract::Some functions of an electronic health record system are much more important in providing pediatric care than in adult care. Pediatricians commonly complain about the absence of these "pediatric functions" when they are not available in electronic health record systems. To stimulate electronic health record system ven...

    journal_title:Pediatrics

    pub_type: 杂志文章

    doi:10.1542/peds.2006-3527

    authors: Spooner SA,Council on Clinical Information Technology, American Academy of Pediatrics.

    更新日期:2007-03-01 00:00:00

  • Poliomyelitis prevention: revised recommendations for use of inactivated and live oral poliovirus vaccines. American Academy of Pediatrics Committee on Infectious Diseases.

    abstract::Since 1997 when the American Academy of Pediatrics (AAP) issued revised guidelines for the prevention of poliomyelitis, substantial progress in global eradication of poliomyelitis has occurred and the use of inactivated poliovirus vaccine (IPV) has increased considerably in the United States with a corresponding decre...

    journal_title:Pediatrics

    pub_type: 指南,杂志文章,实务指引

    doi:10.1542/peds.103.1.171

    authors:

    更新日期:1999-01-01 00:00:00

  • Erythropoietin concentrations and neurodevelopmental outcome in preterm infants.

    abstract:OBJECTIVE:Erythropoietin therapy is effective in decreasing transfusions to varying degrees in preterm infants. Recent animal studies using erythropoietin doses to achieve serum concentrations > 1000 mU/mL report neuroprotective effects. We evaluated the relationship between erythropoietin concentrations and neurodevel...

    journal_title:Pediatrics

    pub_type: 杂志文章,随机对照试验

    doi:10.1542/peds.2005-3186

    authors: Bierer R,Peceny MC,Hartenberger CH,Ohls RK

    更新日期:2006-09-01 00:00:00

  • Pathophysiology of acetaminophen overdosage toxicity: implications for management.

    abstract::Acute acetaminophen intoxication was studied in the dog to characterize pathogenesis and in the mouse as a model for antidotal research. In the dog, overt toxicity was manifested principally by cyanosis, facial and paw edema, gastrointestinal disturbance, and coma. Typical laboratory findings were methemoglobinemia, h...

    journal_title:Pediatrics

    pub_type: 杂志文章

    doi:

    authors: Piperno E,Mosher AH,Berssenbruegge DA,Winkler JD,Smith RB

    更新日期:1978-11-01 00:00:00

  • Prevalence and health impact of developmental disabilities in US children.

    abstract:OBJECTIVE:Data from the 1988 National Health Interview Survey--Child Health Supplement were used to examine the prevalence of selected developmental disabilities and their impact among children ages 0 through 17 years. DESIGN:The following conditions, identified through a structured in-person interview with a parent o...

    journal_title:Pediatrics

    pub_type: 杂志文章

    doi:

    authors: Boyle CA,Decouflé P,Yeargin-Allsopp M

    更新日期:1994-03-01 00:00:00

  • Self-regulation of slow cortical potentials: a new treatment for children with attention-deficit/hyperactivity disorder.

    abstract:OBJECTIVE:We investigated the effects of self-regulation of slow cortical potentials for children with attention-deficit/hyperactivity disorder. Slow cortical potentials are slow event-related direct-current shifts of the electroencephalogram. Slow cortical potential shifts in the electrical negative direction reflect ...

    journal_title:Pediatrics

    pub_type: 杂志文章

    doi:10.1542/peds.2005-2478

    authors: Strehl U,Leins U,Goth G,Klinger C,Hinterberger T,Birbaumer N

    更新日期:2006-11-01 00:00:00

  • Ifosfamide-induced nephrotoxicity in children: critical review of predictive risk factors.

    abstract::Ifosfamide is widely used in the treatment of pediatric solid tumors. Its main adverse effects are various forms of renal tubular and glomerular damage. Many risk factors have been proposed to play a role in the development and severity of nephrotoxicity in children receiving ifosfamide, among which are 1) patient's a...

    journal_title:Pediatrics

    pub_type: 杂志文章,评审

    doi:10.1542/peds.101.6.e8

    authors: Loebstein R,Koren G

    更新日期:1998-06-01 00:00:00

  • Uninterrupted Infant Sleep, Development, and Maternal Mood.

    abstract:OBJECTIVES:Contrary to the importance of total sleep duration, the association between sleeping through the night and development in early infancy remains unclear. Our aims were to investigate the proportion of infants who sleep through the night (6- or 8-hour sleep blocks) at ages 6 and 12 months in a longitudinal coh...

    journal_title:Pediatrics

    pub_type: 杂志文章

    doi:10.1542/peds.2017-4330

    authors: Pennestri MH,Laganière C,Bouvette-Turcot AA,Pokhvisneva I,Steiner M,Meaney MJ,Gaudreau H,Mavan Research Team.

    更新日期:2018-12-01 00:00:00

  • Cerebral oxygenation in preterm infants.

    abstract:BACKGROUND AND OBJECTIVE:Prone sleeping is a major risk factor for sudden infant death syndrome (SIDS) and preterm infants are at significantly increased risk. In term infants, prone sleeping is associated with reduced mean arterial pressure (MAP) and cerebral tissue oxygenation index (TOI). However, little is known ab...

    journal_title:Pediatrics

    pub_type: 杂志文章

    doi:10.1542/peds.2014-0773

    authors: Fyfe KL,Yiallourou SR,Wong FY,Odoi A,Walker AM,Horne RS

    更新日期:2014-09-01 00:00:00

  • Safety of vaccines used for routine immunization of U.S. children: a systematic review.

    abstract:BACKGROUND:Concerns about vaccine safety have led some parents to decline recommended vaccination of their children, leading to the resurgence of diseases. Reassurance of vaccine safety remains critical for population health. This study systematically reviewed the literature on the safety of routine vaccines recommende...

    journal_title:Pediatrics

    pub_type: 杂志文章,评审

    doi:10.1542/peds.2014-1079

    authors: Maglione MA,Das L,Raaen L,Smith A,Chari R,Newberry S,Shanman R,Perry T,Goetz MB,Gidengil C

    更新日期:2014-08-01 00:00:00

  • The changing role and responsibilities of chairmen in clinical academic departments: the transition from autocracy.

    abstract::There is considerable literature dealing with the responsibilities of clinical department chairmen, which primarily emphasizes the importance of developing a sound and facilitating administration. This is dependent on the hiring of appropriate support personnel, developing a representative committee structure, being a...

    journal_title:Pediatrics

    pub_type: 杂志文章

    doi:

    authors: Brent RL

    更新日期:1992-07-01 00:00:00

  • Evaluation of community-based health projects: the healthy tomorrows experience.

    abstract:OBJECTIVES:To address the "millennial morbidities," pediatricians must partner with community-based organizations to develop interventions. Little is known about the capacity of the resulting programs for program evaluation or the importance of evaluation in project success and sustainability. The objective of this stu...

    journal_title:Pediatrics

    pub_type: 杂志文章

    doi:10.1542/peds.2006-3273

    authors: Ruch-Ross H,Keller D,Miller N,Bassewitz J,Melinkovich P

    更新日期:2008-09-01 00:00:00

  • CHARGE (coloboma, heart defect, atresia choanae, retarded growth and development, genital hypoplasia, ear anomalies/deafness) syndrome and chromosome 22q11.2 deletion syndrome: a comparison of immunologic and nonimmunologic phenotypic features.

    abstract:OBJECTIVES:CHARGE (coloboma, heart defect, atresia choanae, retarded growth and development, genital hypoplasia, ear anomalies/deafness) syndrome and chromosome 22q11.2 deletion syndrome are known to have significant clinical overlap including cardiac anomalies, ear abnormalities, hearing loss, developmental delay, ren...

    journal_title:Pediatrics

    pub_type: 杂志文章

    doi:10.1542/peds.2008-3400

    authors: Jyonouchi S,McDonald-McGinn DM,Bale S,Zackai EH,Sullivan KE

    更新日期:2009-05-01 00:00:00

  • QTc interval prolongation and severe apneas associated with a change in infant positioning.

    abstract::For more than a decade there has been considerable interest in the role of QT interval prolongation in the pathogenesis of sudden infant death syndrome. It has been proposed that the QT interval is a surrogate marker for autonomic instability and can be used to identify infants at risk for significant morbidity and mo...

    journal_title:Pediatrics

    pub_type: 杂志文章

    doi:10.1542/peds.2012-4005

    authors: Ellsworth MA,Ulrich TJ,Carey WA,Colby CE,Ackerman MJ

    更新日期:2013-12-01 00:00:00

  • Families of Children With Medical Complexity: A View From the Front Lines.

    abstract::This article, written by a group of experienced parents of children with medical complexity (CMC), provides an overview of the demands of managing care from their unique perspective. The article articulates why attention to understanding the challenges that families of CMC face with a fragmented health care system, in...

    journal_title:Pediatrics

    pub_type: 杂志文章,评审

    doi:10.1542/peds.2017-1284D

    authors: Allshouse C,Comeau M,Rodgers R,Wells N

    更新日期:2018-03-01 00:00:00

  • Prospective longitudinal study of children with tic disorders and/or obsessive-compulsive disorder: relationship of symptom exacerbations to newly acquired streptococcal infections.

    abstract:BACKGROUND:It has been proposed that infection by group A beta-hemolytic streptococci (GABHS) can trigger acute symptom exacerbations among patients with Tourette's syndrome (TS) or obsessive-compulsive disorder (OCD), via autoimmune mechanisms. OBJECTIVE:To examine the temporal relationship between newly acquired GAB...

    journal_title:Pediatrics

    pub_type: 杂志文章

    doi:10.1542/peds.113.6.e578

    authors: Luo F,Leckman JF,Katsovich L,Findley D,Grantz H,Tucker DM,Lombroso PJ,King RA,Bessen DE

    更新日期:2004-06-01 00:00:00

  • The benefit of pimecrolimus (Elidel, SDZ ASM 981) on parents' quality of life in the treatment of pediatric atopic dermatitis.

    abstract:OBJECTIVE:Two 26-week US clinical trials of identical design were conducted to evaluate the efficacy and safety of pimecrolimus (Elidel, SDZ ASM 981) cream 1% in pediatric atopic dermatitis (AD). A secondary aim of both trials, and the focus of this article, was to evaluate the quality-of-life (QoL) impact of pimecroli...

    journal_title:Pediatrics

    pub_type: 临床试验,杂志文章,随机对照试验

    doi:10.1542/peds.110.6.1133

    authors: Whalley D,Huels J,McKenna SP,Van Assche D

    更新日期:2002-12-01 00:00:00

  • Qualitative brain MRI at term and cognitive outcomes at 9 years after very preterm birth.

    abstract:OBJECTIVE:A prospective study was performed to assess the relationship between the appearance of cerebral MRI at term and the cognitive functioning at 9 years old in very preterm born infants. METHODS:Seventy-six very preterm born infants (birth weight <1500 g or gestational age ≤32 weeks) obtained cerebral MRI at ter...

    journal_title:Pediatrics

    pub_type: 杂志文章

    doi:10.1542/peds.2011-1735

    authors: Iwata S,Nakamura T,Hizume E,Kihara H,Takashima S,Matsuishi T,Iwata O

    更新日期:2012-05-01 00:00:00

  • Pediatric generalized joint hypermobility with and without musculoskeletal complaints: a localized or systemic disorder?

    abstract:OBJECTIVES:Children with generalized hypermobility of the joints and musculoskeletal complaints frequently visit pediatric clinics, but many show no currently known collagen or other possibly related diseases. Whether the symptoms are confined to the musculoskeletal system is unknown. We assessed whether such children ...

    journal_title:Pediatrics

    pub_type: 杂志文章

    doi:10.1542/peds.111.3.e248

    authors: Engelbert RH,Bank RA,Sakkers RJ,Helders PJ,Beemer FA,Uiterwaal CS

    更新日期:2003-03-01 00:00:00

  • Metabolic abnormalities in the idiopathic Fanconi syndrome: studies of carbohydrate metabolism in two patients.

    abstract::Two patients with idiopathic Fanconi syndrome and glucose intolerance were studied from a metabolic perspective. They had fasting hyperglycemia, massive glucosuria, insulinopenia, ketosis, and elevated serum free fatty acids. There was a markedly blunted insulin secretory response to glucagon, tolbutamide, glucose, an...

    journal_title:Pediatrics

    pub_type: 杂志文章

    doi:

    authors: Chesney RW,Kaplan BS,Teitel D,Colle E,McInnes RR,Goldman H,Scriver CR

    更新日期:1981-01-01 00:00:00

  • Swaddling: a systematic review.

    abstract::Swaddling was an almost universal child-care practice before the 18th century. It is still tradition in certain parts of the Middle East and is gaining popularity in the United Kingdom, the United States, and The Netherlands to curb excessive crying. We have systematically reviewed all articles on swaddling to evaluat...

    journal_title:Pediatrics

    pub_type: 杂志文章,评审

    doi:10.1542/peds.2006-2083

    authors: van Sleuwen BE,Engelberts AC,Boere-Boonekamp MM,Kuis W,Schulpen TW,L'Hoir MP

    更新日期:2007-10-01 00:00:00

  • Respiratory Management of the Patient With Duchenne Muscular Dystrophy.

    abstract::In 2010, Care Considerations for Duchenne Muscular Dystrophy, sponsored by the Centers for Disease Control and Prevention, was published in Lancet Neurology, and in 2018, these guidelines were updated. Since the publication of the first set of guidelines, survival of individuals with Duchenne muscular dystrophy has in...

    journal_title:Pediatrics

    pub_type: 杂志文章,实务指引

    doi:10.1542/peds.2018-0333H

    authors: Sheehan DW,Birnkrant DJ,Benditt JO,Eagle M,Finder JD,Kissel J,Kravitz RM,Sawnani H,Shell R,Sussman MD,Wolfe LF

    更新日期:2018-10-01 00:00:00

  • Helping Children and Families Deal With Divorce and Separation.

    abstract::For the past several years in the United States, there have been more than 800 000 divorces and parent separations annually, with over 1 million children affected. Children and their parents can experience emotional trauma before, during, and after a separation or divorce. Pediatricians can be aware of their patients'...

    journal_title:Pediatrics

    pub_type: 杂志文章,评审

    doi:10.1542/peds.2016-3020

    authors: Cohen GJ,Weitzman CC,COMMITTEE ON PSYCHOSOCIAL ASPECTS OF CHILD AND FAMILY HEALTH.,SECTION ON DEVELOPMENTAL AND BEHAVIORAL PEDIATRICS.

    更新日期:2016-12-01 00:00:00

  • Caustic ingestions mimicking anaphylaxis: case studies and literature review.

    abstract::Anaphylaxis presents in children with rapid involvement of typically 2 or more organ systems including cutaneous, gastrointestinal, and respiratory. Caustic ingestions (CI) may also present with acute involvement of cutaneous, gastrointestinal, and respiratory systems. We present 2 cases of "missed diagnosis" that ill...

    journal_title:Pediatrics

    pub_type: 杂志文章,评审

    doi:10.1542/peds.2014-2394

    authors: Sherenian MG,Clee M,Schondelmeyer AC,de Alarcón A,Li J,Assa'ad A,Risma K

    更新日期:2015-02-01 00:00:00

  • Anogenital human papillomavirus in sexually abused and nonabused children: a multicenter study.

    abstract:OBJECTIVES:To characterize the epidemiology of genital human papillomavirus (HPV) infection in children without previous consensual sexual activity, comparing HPV prevalence by certainty of child sexual abuse (CSA). PATIENTS AND METHODS:Patients presenting for evaluation of CSA in 8 sites in Atlanta, Houston, Harrisbu...

    journal_title:Pediatrics

    pub_type: 杂志文章,多中心研究

    doi:10.1542/peds.2010-2247

    authors: Unger ER,Fajman NN,Maloney EM,Onyekwuluje J,Swan DC,Howard L,Beck-Sague CM,Sawyer MK,Girardet RG,Sautter RL,Hammerschlag MR,Black CM

    更新日期:2011-09-01 00:00:00

  • Drugs for pediatric emergencies. Committee on Drugs, Committee on Drugs, 1996 to 1997, Liaison Representatives, and AAP Section Liaisons.

    abstract::This statement provides current recommendations about the use of emergency drugs for acute pediatric problems that require pharmacologic intervention. At each clinical setting, physicians and other providers should evaluate drug, equipment, and training needs. The information provided here is not all-inclusive and is ...

    journal_title:Pediatrics

    pub_type: 指南,杂志文章,实务指引

    doi:

    authors:

    更新日期:1998-01-01 00:00:00

  • Lead exposure in children: prevention, detection, and management.

    abstract::Fatal lead encephalopathy has disappeared and blood lead concentrations have decreased in US children, but approximately 25% still live in housing with deteriorated lead-based paint and are at risk of lead exposure with resulting cognitive impairment and other sequelae. Evidence continues to accrue that commonly encou...

    journal_title:Pediatrics

    pub_type: 指南,杂志文章,实务指引

    doi:10.1542/peds.2005-1947

    authors: American Academy of Pediatrics Committee on Environmental Health.

    更新日期:2005-10-01 00:00:00