The safety of inhaled steroids in childhood asthma.
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Biomedical subjects
Publications and source records attributed to J Paton.
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Evaluations of state organization at 36 weeks postconceptional age (PCA) were conducted in the special care nursery on 24 low birth weight preterm neonates who were subsequently assessed on three dimensions of outcome at 1 year postterm. Half the subjects (N = 12) had been cared for in an alternative supportive nursery from 32 to 36 weeks PCA; the other half had remained in the regular intermediate care nursery. Although subjects from the alternative nursery demonstrated superior state organization before nursery discharge at 36 weeks PCA (p less than .05), they were not superior on any outcome measures at 1 year postterm. Subjects demonstrating superior state organization within their nursery group were compared with subjects demonstrating inferior state organization within their nursery group. Significant differences in 1-year outcome were found between these two groups of good and poor neonatal state organizers on gross morbidity, on the Bayley motor scale, and on a measure of recovery of state organization observed in the Strange Situation (p less than .05).
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Auditory brainstem response screening at 40 and 60 dB was conducted in 100 infants in the neonatal intensive care unit to determine initial failure rate and prevalence of abnormality on follow-up. Of our NICU population, 20% failed one or both of the screening levels: 9% failed at 60 dB in both ears, and 11% failed at 40 dB in one or both ears. On follow-up, half of the 60 dB failure group were found to have sensorineural or conductive impairment and represent the 2% to 4% prevalence of serious otologic-audiologic problems generally found in an NICU population. Subsequent improvement (reversal) of the retest ABR records of the remaining infants in the 60 dB failure group was thought to be related to neural changes in the brainstem associated with recovery from hypoxic episodes. A transient or reversible conductive deficit appeared to account for the majority of failures at 40 dB. We recommend the screening protocol be expanded to include threshold and latency measures in infants who fail the initial screening. The transient nature of many ABR abnormalities makes postdischarge ABR, otologic, audiologic, and neurologic examinations mandatory before any inferences are made about hearing loss or neurodevelopmental disorders.
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