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The timing of follow-up exami nations is best determined from the findings of the first examination cheap indinavir 400mg otc medications of the same type are known as, using the International Classification of Retinopathy of Prematurity (see also “Treatment and Follow-up Care” later in this section). One examination is sufficient only if it unequivocally shows the retina to be fully vascularized in each eye. Timing of First Eye Examination Based on Gestational Age at Birth* ^ Age at Initial Examination (wk) Gestational Age at Birth (wk) Postmenstrual Chronologic 22† 31 9 23† 31 8 24 31 7 25 31 6 26 31 5 27 31 4 28 32 4 29 33 4 30 34 4 31‡ 35 4 32‡ 36 4 *Shown is a schedule for detecting prethreshold retinopathy of prematurity with 99% confidence, usually well before any required treatment. Section on Ophthalmology, American Academy of Pediatrics; American Academy of Ophthalmology; American Association for Pediatric Ophthalmology and Strabismus. However, outcome trial data compar ing large-scale operational photoscreening systems with remote interpretation to binocular indirect ophthalmoscopy have not been published. Off-site photo interpretation requires close collaboration among neonatologists, imaging staff, and ophthalmologists. Specific responsibilities of each individual must be care fully delineated in a written protocol in advance so that repeat imaging, confir matory examinations, and required treatments can be performed without delay. Treatment and Follow-up Care ^ If intervention is considered necessary, it generally should be performed within 72 hours of the diagnosis, if possible, to minimize the risk of retinal detach ment. However, the number of infants treated was small and there remain unanswered questions involving dosage, timing, safety, visual outcomes, and other long-term effects. Unit-specific criteria for screening and follow-up examinations should be established by consultation and agreement between neonatology and ophthalmology services. These criteria should be recorded and should auto matically trigger ophthalmologic examinations. Management of High-Risk Infants Nutritional Needs of Preterm Infants Optimal nutrition is critical in the management of preterm infants. There is no standard for the precise nutritional needs of preterm infants comparable with the human milk standard for term infants. Present recommendations are designed to provide nutrients to approximate the rate of growth and composi tion of weight gain for a normal fetus of the same postmenstrual age and to maintain normal concentrations of blood and tissue nutrients. Acute illness and organ system immaturity can make provision of optimal nutrition challenging, particularly for the sickest and most immature infants, yet inadequate nutrition during this period may have life-long consequences. Parenteral Nutrition Parenteral administration of amino acids, glucose, and fat is an important aspect of the nutritional care of preterm infants, particularly those who weigh Neonatal Complications and Management of High-Risk Infants 357 Table 9-4. Comparison of Parenteral Intake Recommendations for Growing Preterm Infants in Stable Clinical Condition ^ Consensus Consensus Recommendations Recommendations Less than Less than 1, 000– 1, 000– 1, 000 g/kg 1, 000 g/ 1, 500 g/kg 1, 500 g/ Element per day 100 kcal per day 100 kcal Water/fluids, mL 140–180 122–171 120–160 120–178 Energy, kcal 105–115 100 90–100 100 Protein, g 3. Comparison of Parenteral Intake Recommendations for Growing Preterm Infants in Stable Clinical Condition (continued) Consensus Consensus Recommendations Recommendations Less than Less than 1, 000– 1, 000– 1, 000 g/kg 1, 000 g/ 1, 500 g/kg 1, 500 g/ Element per day 100 kcal per day 100 kcal Manganese, g 1 0.

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Oral ranitidine as prophylaxis for gastric stress ulcers in intensive care unit patients: serum concentrations and cost comparisons buy indinavir 400mg amex medicine man 1992. A prospective study of simplified omeprazole suspension for the prophylaxis of stress-related mucosal damage. A randomized, pharmacokinetic and pharmacodynamic, cross-over study of duodenal or jejunal administration compared to nasogastric administration of omeprazole suspension in patients at risk for stress ulcers. Occurrence of nosocomial pneumonia in mechanically ventilated trauma patients: a comparison of sucralfate and ranitidine. Clinically significant gastrointestinal bleeding in critically ill patients in an era of prophylaxis. Nosocomial pneumonia in mechanically ventilated patients receiving antacid, ranitidine, or sucralfate as prophylaxis for stress ulcer. Stress-induced gastroduodenal lesions and total parenteral nutrition in critically ill patients: frequency, complications, and the value of prophylactic treatment. Nosocomial pneumonia during stress ulcer prophylaxis with cimetidine and sucralfate. Role of gastric colonization in the development of pneumonia in critically ill trauma patients: results of a prospective randomized trial. Nosocomial pneumonia in ventilated trauma patients during stress ulcer prophylaxis with sucralfate, antacid, and ranitidine. Is the incidence of hemorrhagic stress ulceration in surgical critically ill patients affected by modern antacid prophylaxis Impact of trauma stress ulcer prophylaxis guidelines on drug cost and frequency of major gastrointestinal bleeding. Assessment of splanchnic oxygenation by gastric tonometry in patients with acute circulatory failure. Do continuous infusions of omeprazole and ranitidine retain their effect with prolonged dosing Five-year audit of ambulatory 24-hour esophageal pH-manometry in clinical practice. Do proton pump inhibitors increase the incidence of nosocomial pneumonia and related infectious complications when compared with histamine-2 receptor antagonists in critically ill trauma patients Plasma aluminum concentrations in long term mechanically ventilated patients receiving stress ulcer prophylaxis with sucralfate. Evidence-based medicine as it applies to acid suppression in the hospitalized patient. If Class of data duration for stress ulcer Class of data Comments for article which trauma patients require for question so, what Comparison of the effect Continuous of intermittent Prospective infusion is more administration and Crit Care Med. Ranitidine superior for the prevention of 1998 Mar Comparison to sucralfate in Cook D 1998 upper gastrointestinal 19;338(12):791 sucralfate with 1 Did not address this question Yes, ranitidine 1 Did not address this question. Most important risk factors or Respiratory failure, shock, mechanical Risk factors for N Engl J Med.

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