Recent advances in the use of prosthetics in neonatal surgery

86 advantage of this treatment is that it provides sufficient nutriments to sustain life and maintain normal reparative processes until the repair of the abdominal defect can be completed. Intravenous feeding relieves the necessity of attempting gastrointestinal feeding and lessens the abdominal distension that will delay the repair. Total rest of the gastrointestinal tract can be prolonged until the natural resolution of the fibrinous exudate on the intestinal wall and the adhesions resolve. The chief dangers of total intravenous nutrition are associated with the use of the catheter and meticulous care must be taken to prevent infection of which the commonest is Candida albicans. The authors are at pains to stress that this technique should not be lightly undertaken unless the necessity of parenteral feeding justifies the risk. --Neville K. Connolly

Peripheral Intravenous Alimentation of the Small Premature Infant. Gerda 1. M. Brenda, and S. Gorham Babson. J. Pediat. 79:494-498 (September), 1971.

The feasibility of giving high-calorie feedings through a peripheral vein to the small and weak premature infant was tested in a neonatal center at the University of Oregon Medical School. Fourteen unselected infants whose birth weights were less than 1251 g were given a solution containing 65 calories per 100 ml. The infusion was given at rates up to 120 ml/kg per day for a period of 5 to 22 days while oral feedings were being established. Fluid administrations through umbilica1 vein catheters was limited to the first 2448 hr of life to reduce the danger of sepsis and hepatic or portal vein thrombosis. Osmotic diuresis was not a significant problem. If marked glucosuria was detected, a temporary decrease in the glucose contents of the infusion was necessary. Osmotic overload was suspected when dehydration was observed and not explained by other reasons. A weight loss of more than 2% of body weight after the first 3 days of life is suggestive of this state. In this situation, a temporary dilution of the infused solution may be necessary. This regimen permitted delay in the in-

ABSTRACTS troduction of oral feeding and restraint in increasing the volume offered to infants in order to avoid risk of overfeeding and vomiting with aspiration. The average gain in weight of the ten survivors was satisfactory and was somewhat better than that of 12 healthy infants of similar birth weight and gestation who were fed more conventionally. No apparent complications from this method of feeding was observed. --G. W. Hofcomb

Recent Advances in the Use of Prosthetics in Neonatal Surgery. Jules Lister. Progr. Ped. Surg. 2:171-178, 1971. Plastics for tissue implants must be sterilizable, should be unaffected by the tissues and should not induce an inflammatory response, and should not be carcinogenic. The use of Dacron mesh impregnated with Silastic in the staged closure of an omphalocele and gastroschisis is now well established and effective. In experimental work with Marlex mesh tubes for esophageal replacement in puppies, it was found that esophageal continuity was gradually restored and the Marlex tube separated and passed down the gastrointestinal tract. --R. C. M. Cook

ANESTHESIA AND INHALATION THERAPY Endotracheal Tube Position in the Infant. Lawrence R. Kuhns, and Andrew K. Poznanshi. J. Pediat. 78:991-996 (June), 1971. The locations of endotracheal tubes were assessed radiographically in 36 of 52 intubated infants during a 1% yr period. In 18 of the 36 patients for whom there were radiographs, the endotracheal tubes were in one of the bronchi. Eleven of these 18 patients developed atelectasis. The distance of only 5.7 cm from the larynx to the carina in the average living neotate allows little margin of error in placing the tube. The tip of the tube should be at least 1.2 cm below the vocal cords with the head in neutral position according to the authors. The authors recommend chest radiographs at the bed side immediately after intubation and