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This report documents the accuracy of both CR and GA L/S when obtained in the first 24 hrs. of life as highly reliable studies for both the diagnosis and exclusion of RDS. The central circulating blood volume (CCBV) was evaluated in 17 neonates with respiratory distress, 6 of whom had HMD.
LOW BLOOD VOLUME WITH NORMAL SYSTEMIC BLOOD PRESSURE IN INFANTS WITH HYALINE MEMBRANE DISEASE (HMD)
The infants were evaluated clinically and by strict radiograpkic criteria before entering the study at 1-2 hours of age. No small-for-dates infants were included. Measurements using albumin were made on each infant at 4 & 24 hours. Mean pressures were measured in the aorta continuously for 12 hours and at 24 hours. Hematocrit determinations were done at birth, 4 & 24 hours. The mean blood volume of infants with HMD and other forms of respiratory distress was 86.6 and 100 mllkg respectively ( P ( 0 . 0 1 ) .
LOW BLOOD VOLUME WITH NORMAL SYSTEMIC BLOOD PRESSURE IN INFANTS WITH HYALINE MEMBRANE DISEASE (HMD)
The difference was due to low red cell volume, mean 38.2 and 47.5 d / k g (P<0.02).
LOW BLOOD VOLUME WITH NORMAL SYSTEMIC BLOOD PRESSURE IN INFANTS WITH HYALINE MEMBRANE DISEASE (HMD)
The hematocrit values at birth and 4 hours were not statistically different indicating that low CCBV in the HMD group is not the result of an inadequate placental transfusion. It is curious that the CCBV at 4 & 24 hours was not statistically different despite whole blood or other fluid infusion. Mean pressures of each group during the first 12 hours and at 24 hours were not statistically different and correlated well with norms previously established for prematures. Our data show that 1) blood pressure and hematocrit measurements are poor parameters for estimating CCBV; 2) the low red cell volume in HMD appears to exist prior to delivery; 3) and implies that vasomotor activity adequately maintains mean aortic pressures in the HMD group. Oehrle.) D e~t . o f Peds. Los Anqeles Countv-USC Medical Center EKG and beat t o beat h e a r t r a t e (HR) w&e recorded during endotracheal suctioning i n 10 premature i n f a n t s w i t h severe HMD r e c e i v i n g assisted v e n t i l a t i o n . B i r t h weight and gestat i o n a l age ranged from 750-2000 Gms and 24-36 weeks. Studies were c a r r i e d o u t a t a mean age o f 12 days. Each i n f a n t was studied 4 times during suction o f the airway. Two procedures were preceded by 30 sec. o f bagging w i t h increased ambient oxygen. Each record was analyzed f o r changes i n EKG, baseline HR (BLHR), ma nitude o f peak drop i n HR (PM), time o f baseline t o peak drop YBL-PO) and time o f peak drop t o baseline (PD-BL).
CARDIOVASCULAR EFFECTS OF AIRWAY
. BLHR BL-PD (Sec) PO-BL (Sec) l i n c r . 02 T E T l T %.) 6 + 2 7 + 4 B i n c r . 0 2 1 5 1 2 1 6 6 1 1 3 0 9 + 4 15 + 8 p value <0.05 <0.01 -=0.01 I n a d d i t i o n t o more profound HR drop, the duration o f bradycardia was s i g n i f i c a n t l y prolonged i n a l l instances when oxygenation d i d n o t precede suctioning. Severe sinus bradycardia o r sinus a r r e s t were observed i n 5 p a t i e n t s only when suctioned without p r i o r oxygenation. These f i n d i n g s suggest t h a t p r i o r oxygenation prevents severe cardiac arrhythmias associated w i t h hypoxia-inducing procedures comonly used during i n t e n s i v e neonatal care. Recently Cheek and Staub reported no serious complications in 46 infants given continuous nasojejmal tube feeding. We observed serious disturbances in 4 of 13 low-birth-weight infants fed in the same m e r . In the 13 infants, mean gestational age was 29.61+1. 6 8 wks and mean birth weight was 1, 176.15+208.23 gm. All except one had respiratory distress syndrome and/or other problems. None was able to be fed orally or by nasogastric tube. Nasojejunal tube feedingwas initiated from 2 to 9 days of age. Average duration was 16.051.78 days. At the termination ofnasojejmal feeding, 8 infants were heavier and 5 lighter than their respective birth weight. Six died. In 2 the cause of death was unrelated to nasojejunal feeding. In 4 the causes of death were as follows: (1) necrotizing gastroentero-colitis with possible rupture of intestine, (2) jejunal perforation with diffuse peritonitis, ( 3 ) aspiration pneumonia due to distention of jejunum and ilium and vomiting, (4) jejunojejunal intussusception. The safety of this procedure requires careful evaluation by controlled studies before it can be recommended for routine purposes in small low-birth-weight infants. 
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This study was undertaken to assess the Idiopathic Respiratory Distress Syndrome (IRDS) in premature infants whose birth weights exceeded 1820 gms (4 lbs). During the past 3 years 66 (41%) of 160 infants admitted to our Newborn ICU with IRDS weighed more than 1820 gms. Thirty of the 66 were transferred from outlyinr~ hospitals. Estimated gestational ages ranged from 34-38 wks with a m a n of 35.7. Birth weiqhts ranged from 1820-3856 qms with a mean of 2358 gms. There was a predominance of males.
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Of the various prenatal conditions assessed, 80% of the 66 mothers were>20 yrs of aqe and 67% were multiqravid. Twenty percent of the mothers had complications of preqnancy includins 4 diabetics, 2 narcotic addicts, and 1 toxemic. Thirtythree percent were delivered by C-section.
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The severity of IRDS in this group of infants was variable.
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Half of the infants required oxygen in concentrations > 602.
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Assisted ventilation was needed in 87% of those transferred and 470 of those delivered at our hospital. Apqar scores and initial blood gases were not useful in predicting the subsequent need for ventilation assistance. Seven of the 66 infants expired. Pnewothorax and cerebral hemorrhage were encountered in 4 of the 7.
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It is concluded that I m S may be severe in a surprising number of large birthweight prematures. It is unclear whether
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IRoS occurs more frequently at higher altitudes (5000 ft) and is more severe. It is recomnended that these infants be evaluated and followed as closely as their smaller-weight counterparts.
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TRANSPORT OF THE VERY SMALL INFANT: TIME FACTOR ANALYSIS. Although regiornlized care for the sick newborn has resulted in significant decreases in morbidity and mortality, there is little published experience of specific ~roblems related to imnsport of defined groups of_ infants. A referral system w s esiublished to transport all infants (BWc 1500 born at four community hospitals, 40-60 miles from our Neonatal Intensive Care Unit. Upon notification of delivery and transport request, a transport team composed of two neomhl intensive care nurses alone or with a neomtologist were sent by especially-equipped ambulance. Care included monitoring of oxygen concentration, heart rate, and skin a d environmental tempemtures; and when necessary, resuscitation and buffer correction. During the three years' experience, 76 infants were transported. N o deaths occurred during tmnsport, 3 infants expired within 3 hours after admission, and 20 within 48 hours.
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Time analysis of the system performed by studying the steps involved, showed that total imnsport time, i.e., from delivery to arri~l at NICU, could be reduced 20°/0 by prompt initial request. Total transport time w s significantly shorter for infants who survived, and the difference in length of time between delivery and initiation of transport repest was significant for tho^ who survived versus those who expired (X 26.3 minutes for survivors; X 84.5 minutes m o s e who expired). Thus, the outcome of the small infant is improved by early initiation of tronsport.

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