Neurological follow-up of 281 children born in breech presentation: a controlled study

A study was conducted of all children delivered in breech presentation from 1969 to 1977 in the university's department of obstetrics. One-fifth of the deliveries were by caesarean section. Perinatal mortality was high (13.2%) but was due almost exclusively to causes other than the birth itself. The 256 surviving children and their matched controls were neurologically examined at 18 months or at ages varying between 3 and 10 years. The attrition rate was 5.7%, but in most cases data on development were available. Significant differences between the study and control groups existed for only minor neurological dysfunctions. It is concluded that the main danger of breech presentation is in the associated complications of pregnancy and that there is no reason to advocate a higher frequency of abdominal delivery than the 20% found in this study

Ketamine anesthesia with or without diazepam premedication for bone marrow punctures in children with acute lymphoblastic leukemia

Ketamine is a drug widely used for analgesia and sedation of children for diagnostic and therapeutic procedures. The authors investigated in a randomized controlled clinical trial id diazepam premedication would have a beneficial effect on side effects related to ketamine anesthesia for bone marrow punctures (BMPs) in children with acute lymphoblastic leukemia (ALL). Sixteen children 4 years or older at the time of BMP were eligible. The first 2 BMPs after complete remission was obtained were studied. BMPs were performed under ketamine anesthesia (1.0-1.5 mg/kg iv), as usual. Patients were randomized to receive 1 h before the first BMP blinded either diazepam or placebo orally and before the second BMP the other way round. Blood pressure, heart rate and oxygen saturation were monitored, and patients were observed for signs of anxiety pain, and other side effects. The patients were interviewed after each BMP and asked for their preference 1 week after the second BMP. Ketamine anesthesia appeared as safe and effective after diazepam premedication as after placebo premedication. From the interviews and questionnaires, it was clear that half of the children preferred diazepam premedication because of less awful dreaming and more gradual falling asleep and waking up. Diazepam premedication may be useful for selected children with ALL receiving ketamine anesthesia for BMPs