piperidines and Infant--Premature--Diseases

A systematic computerized search of all databases was performed to review the scientific evidence in support of the efficacy of cisapride in reducing feeding intolerance in premature infants. Reference lists from these articles were used to identify relevant scientific literature to address important aspects of the use of cisapride. Three open prospective, uncontrolled studies were found. All studies reported improved clinical outcomes as evidenced by decreased gastric residuals, decreased incidence of vomiting, increased feeding volume, decrease in all reflux parameters measured, and increased weight gain. These observational studies reflect the current state of knowledge and have important research and clinical implications because of the profound effects of feeding intolerance on infant growth and development and on length of stay within NICUs.

Topics: Cisapride; Feeding and Eating Disorders of Childhood; Gastrointestinal Motility; Humans; Infant Nutritional Physiological Phenomena; Infant, Newborn; Infant, Premature, Diseases; Neonatal Nursing; Piperidines; Serotonin Antagonists

Prospective survey of the effects of cisapride on QTc interval in neonates given cisapride.. QTc interval was determined just before and 2.9 (0.9) days after outset of the treatment in 49 neonates treated with cisapride between 1 August 1995 and 29 February 1996.. Cisapride significantly increased QTc interval (p = 0.0001), and this was higher when birthweight or gestational age were lower. The prolongation of QTc interval above the arbitrary value of 0.450 (n = 7) was clinically asymptomatic and was significantly more common in the infants born with a gestational age < or = 33 weeks (n = 6).. The findings indicate that cisapride accumulates in less mature neonates. Further pharmacokinetic studies are needed.

Topics: Cisapride; Electrocardiography; Gastroesophageal Reflux; Gestational Age; Humans; Infant, Newborn; Infant, Premature; Infant, Premature, Diseases; Male; Piperidines; Prospective Studies; Serotonin Antagonists

Topics: Analgesics, Opioid; Anesthetics, Intravenous; Enterocolitis, Necrotizing; Humans; Infant, Premature, Diseases; Laparotomy; Piperidines

To give new insights into how an infant responded to naloxone, given after acquiring a maternal opiate by recording the breathing pattern directly after birth.. A respiratory recording is presented of an infant during resuscitation in the delivery room after receiving naloxone for respiratory depression, resulting from maternal remifentanyl use.. The infant was born apneic and bradycardic. Normal resuscitation manoeuvres had no effect on the respiratory drive. Directly after administration of naloxone, a tachypneic breathing pattern with sporadic expiratory breaking manoeuvres was observed.. The immediate tachypnoea is most likely a direct effect of the naloxone causing an immediate 'rebound response' after the release of the opiate-induced inhibition of the respiratory drive.

Topics: Analgesics, Opioid; Anesthetics, Intravenous; Apnea; Female; Humans; Infant, Newborn; Infant, Premature; Infant, Premature, Diseases; Naloxone; Narcotic Antagonists; Piperidines; Pregnancy; Remifentanil; Respiratory Rate

Premature babies experience pain and require adequate analgesia for any painful procedure. Fentanyl and morphine resulted in safe and effective anesthesia in the past; however, their pharmacokinetics may be impaired in preterm babies with multiorgan failure. Remifentanil, despite the absence of available pharmacokinetic data in preterm infants and few reports in newborns, demonstrated its advantages in children undergoing either major surgery or minor painful procedures and has been shown to be useful even in neonates, because its elimination is independent of organ function. We report two cases of babies born at 26 weeks' and 27 weeks' gestation, weighing 580 g and 400 g, respectively, undergoing laparotomy for necrotizing enterocolitis. Both received midazolam bolus and remifentanil infusion at high doses. This technique seems to be an advantageous alternative even in extremely low-birth-weight prematures. Furthermore, it becomes a technique of choice in these babies because the available ventilators are often not equipped with halogenated vaporizers. Particularly in intensive care, where there are no scavenger systems, it could allow to operate without moving out the preterm babies and avoiding stress and hypothermia.

Topics: Anesthetics, Intravenous; Enterocolitis, Necrotizing; Fatal Outcome; Humans; Infant, Extremely Low Birth Weight; Infant, Newborn; Infant, Premature, Diseases; Infusions, Intravenous; Laparotomy; Piperidines; Remifentanil

Topics: Cisapride; Gastroesophageal Reflux; Humans; Infant; Infant, Newborn; Infant, Premature; Infant, Premature, Diseases; Long QT Syndrome; Piperidines

We report on one patient in whom segmental colic intestinal pseudo-obstruction (IPO) following the surgical treatment of a grade III necrotising enterocolitis (NEC) was responsible for a severe failure to thrive. Further intestinal resection in an already short gut was avoided by using Cisapride, a new intestinal prokinetic agent (1 mg/kg/d in 4 doses, orally), which dramatically improved the symptoms and allowed weight gain and intestinal adaptation. After 6 months, Cisapride was withdrawn. IPO did not recur after 2 years of follow-up, although proximal distention persisted.

Topics: Cisapride; Colonic Pseudo-Obstruction; Enteral Nutrition; Enterocolitis, Pseudomembranous; Follow-Up Studies; Humans; Ileostomy; Infant; Infant, Newborn; Infant, Premature, Diseases; Male; Piperidines; Postoperative Complications; Serotonin Antagonists

Four premature infants presenting with episodes of bradycardia in the first weeks of life were given diphemanil. One of them received an overdose accidentally. Paradoxically, this induced a permanent bradycardia leading to the discovery of a grade II A-V block as well as a prolonged QT interval. Discontinuation of the drug resulted in a prompt normalization of these changes. It is felt that this anticholinergic therapy may have caused a prolongation of the QT interval and, therefore, a partial A-V block in case of sinus tachycardia. Thus, such a therapy should not be given to young premature infants without having checked the QT interval on a ECG tracing and having made sure that it is adapted to the actual heart rate. It is also advised to reduce usual doses.

Topics: Bradycardia; Electrocardiography; Female; Heart Block; Humans; Infant, Newborn; Infant, Premature, Diseases; Male; Parasympatholytics; Piperidines