Ramesh Bhat.Y

Manipal Academy of Higher Education | MAHE · Department of Paediatrics

Metabolic disturbances frequently occur in neonatal seizures either as an underlying cause or as an associated abnormality. A prompt recognition of metabolic abnormalities and early therapy are necessary to avoid poor neurological outcome. Neonates with clinical seizures were enrolled in the study. Diagnostic evaluation included complete blood coun...

Meconium aspiration syndrome (MAS) in neonates born through meconium-stained amniotic fluid (MSAF) causes significant morbidity and mortality. Early recognition of at-risk neonates could help optimize treatment. The aim was to determine predictive characteristics of cord blood pH, base deficit and lactate with subsequent MAS. Receiver operating cha...

Torticollis refers to a condition in which the head is persistently tilted to one side, sometimes associated with pain. Torticollis in a child can be congenital or acquired. Torticollis as an initial manifestation of an underlying demyelinating syndrome is quite rare in children. Here, we report a 7-year-old girl who presented with persistent torti...

Acute parotitis progressing to parotid abscess is rare in children. Staphylococcus aureus is the usual pathogen in parotid abscess. Granulomatous parotid abscess due to tubercular aetiology is extremely rare. Authors report a case of chronic parotid abscess in a child who received multiple courses of antibiotics without any cure. The ultrasonograph...

Tonsillar malignancy is the underlying etiology of only a very small percentage of paediatric unilateral tonsillar enlargements. Further, because of rarity of tonsillar malignancy in children, the diagnosis may be delayed. Authors describe a large bleeding tonsillar mass in a child who remained undiagnosed for two months but finally diagnosed with...

Influenza B (IFB) virus belongs to the Orthomyxoviridae family and has two antigenically and genetically distinct lineages; B/Victoria/2/87-like (Victoria lineage) and B/Yamagata/16/88-like (Yamagata lineage). The illness caused by IFB differs from that caused by influenza A. Outbreaks of IFB occur worldwide and young children exposed to IFB are li...

Infants may develop congenital tuberculosis from an infectious mother or acquire the disease postnatally by contact with an infectious adult. Delayed diagnosis is common, especially in infants under 1 year of age, and, if unrecognised, there is an increased risk of death. A 2.5-month-old boy presented with respiratory distress, small inhomogeneous...

Objective: To study the clinical profile, severity, outcome and risk factors for H1N1 influenza infection in children <18 years.

Background: Wilson disease is an inherited disorder of copper metabolism characterised by cirrhosis of the liver, bilateral degeneration of basal ganglia and pigmented rings in the periphery of cornea. The clinical features vary considerably. Early diagnosis and prompt treatment favours good prognosis. Objectives: To study the clinical and biochemi...

Background: Heated humidified high-flow nasal cannula (HHHFNC) is gaining popularity as an alternative to nasal continuous positive airway pressure (nCPAP) therapy in the management of preterm neonates with respiratory distress due to ease of administration and patient comfort. However, limited evidence is available addressing its risks and benefit...

Objective: To assess the level of depressive symptoms and mother-infant-attachment among mothers of preterms admitted in Neonatal Intensive Care Unit (NICU) and find the relationship between of depressive symptoms and mother-infant-attachment. Materials and Methods: A cross sectional survey was conducted among 100 mothers whose preterm babies were...

Objective: Methylxanthines are the most commonly prescribed drug in neonatal setups. However, Clinicians show indecision in choosing the right agent for Apnea of Prematurity in most of the developing countries. Present study aimed to compare rate of mortality and survival with normal neurodevelopment outcome at 18 to 24 months of corrected age, be...

Background: The highly sophisticated Neonatal Intensive Care Unit (NICU) exposes preterm infants to constant unexpected stimuli especially noise, impacting their growth and development. Modifying the environment of the NICU by provision of patterned stimuli like music is essential. There is a paucity of data from large and well-conducted trials on...

Inclusion-cell (I-cell) disease (mucolipidosis II) is a rare inherited metabolic disorder resulting from a defective phosphotransferase, characterized by coarse facial features, skeletal abnormalities and mental retardation. As clinical feature of this condition mimic that of Hurler disease mutation studies help in the diagnosis. We present a case...

Background: Advances in neonatal care have resulted in improved survival of neonates admitted to the intensive care of the Neonatal Intensive Care Unit (NICU). However, the NCU may be an inappropriate milieu, with presence of overwhelming stimuli, most potent being the continuous presence of noise in the ambience of the NICU. Aim and Objectives: To...

Background: Preterm neonates are at a high risk of respiratory depression at birth. Incidence of respiratory distress is reported in 60-80% of the neonates born with the gestational age of less than 28 weeks and 15-30% of the neonates with the gestational age of less than 32-34 weeks. The present study aimed to compare the incidence and risk of fai...

Objective To compare the efficacy and safety of standard doses of Caffeine and Aminophylline for Apnea of prematurity. Study design Randomized controlled trial. Setting Tertiary-care referral centre and a teaching institution in Southern India. Trial was conducted from February 2012 to January 2015. Participants 240 preterm (≤34 wk) neonates wit...

Background: Preterm birth, if not actively managed with developmental supportive care, can significantly contribute to neurodevelopmental compromise. Use of appropriate positioning aids helps with mimicking the intrauterine environment and facilitating neuromuscular development. Herein, we aimed to determine the effectiveness of snuggle up position...

Introduction: Facilitation of child development is usually emphasized in the form of early intervention classes and practical demonstrations. However, non-adherence to home program for such interventions has been reported due to various reasons. Aim: To develop and validate an educational leaflet as a supplement guide for caregivers to promote b...

Background and objectives: Neonatal neurobehavioral organization is a multidimensional holistic phenomenon which involves synchronous working of autonomic, sensory and motor systems to influence the developmental maturation of neonates. Homeostasis of all these systems is well developed in term infants but preterm infants, due to their physiologica...

The tuberous sclerosis complex (TSC) is most commonly diagnosed around the age of 5 years. Neonatal TSC is rare. The important neonatal manifestations include cardiac rhabdomyomas, central nervous system abnormalities, and skin manifestations. We describe a neonate suffering from the TSC with large and multiple cardiac rhabdomyomas. The largest rha...

Bardet-Biedl syndrome is an autosomal recessive disorder characterized by retinitis pigmentosa, obesity, polydactyly, mental retardation and hypogonadism. We present two sisters with this rare genetic condition.

Rowell syndrome is a rare disease consisting of erythema multiforme-like lesions associated with lupus erythematosus. The syndrome occurs mostly in middle-aged women. The authors describe the syndrome in a 15-year-old boy who responded well to systemic steroids and hydroxychloroquine.

Objectives. Relationships of mechanical ventilation to pneumothorax in neonates and care procedures in particular are rarely studied. We aimed to evaluate the relationship of selected ventilator variables and risk events to pneumothorax. Methods. Pneumothorax was defined as accumulation of air in pleural cavity as confirmed by chest radiograph. Re...

Neutropenia in infancy and childhood poses a diagnostic challenge as the aetiology ranges from acute life-threatening conditions to chronic benign diseases. Chronic benign neutropenia of infancy is a rare disorder occurring in 1:100 000. The neutrophil count continues to be low for a prolonged period until spontaneous resolution by the age of 3-4 y...

Hypomelanosis of Ito (HI) is a neurocutaneous syndrome characterized by hypopigmented cutaneous lesions and extracutaneous manifestations frequently affecting the nervous system and the musculoskeletal system. Dysmorphic features, dental, ophthalmic, gastrointestinal, cardiac, and renal abnormalities are described in a minority of patients. The aut...

Hemiconvulsion-hemiplegia-epilepsy (HHE) syndrome involves initial sudden and prolonged unilateral convulsive seizures, followed by transient or permanent hemiplegia and epilepsy during infancy or early childhood. Seizures are prolonged, difficult to control and sometimes may require surgery. Hemiplegia varies in intensity, differs from Todd paraly...

Infection associated haemophagocytic syndrome (HPS) is rare and could be potentially fatal. Reactive HPS has been reported with various infections including tuberculosis. Tuberculosis associated HPS is more common in adults than in children. Severe pancytopenia due to HPS complicating tuberculosis and while on therapy has been rarely described. Suc...

Thrombocytopenia in neonates occurs due to various causes, and pregnancy induced hypertension has been implicated as one of the maternal etiologies. The frequency and severity of thrombocytopenia vary. Severity of thrombocytopenia may influence the morbidity, warrant intervention and rarely may lead to life threatening hemorrhages. A better underst...

Background: Increased incidence and severity of acute lower respiratory tract infection (ALRI) are variably associated with malnutrition. Objectives: We aimed to examine the prevalence of malnutrition in under-five year old hospitalized children with ALRI. Patients and Methods: Children aged from 6 to 60 months, mostly from a low socioeconomic popu...

Blood culture reports in neonatal sepsis aid physician in either optimizing therapy or discontinuing antibiotics. We determined the time taken for neonatal blood cultures to become positive using the aerobic BacT/Alert system. Of 944 blood cultures from 816 neonates, 139(14.7%) were positive. Growth of all definitive bacteria, 95% of possible bacte...

Aim: Incidence, risk factors, morbidity and mortality of pneumothorax in neonates vary widely. We aimed to evaluate characteristics, predisposing factors and associated primary lung conditions of pneumothorax in neonates. Methods: Neonates diagnosed to have pneumothoraces in a neonatal unit of university teaching hospital between May 2006 and Au...

Background: Neonates with ABO hemolytic disease are at greater risk for developing significant hyperbilirubinemia. We aimed to determine whether sixth hour transcutaneous bilirubin (TcB) could predict such a risk. Methods: TcB measurements were obtained at the 6th hour of life in blood group A or B neonates born to blood group O, rhesus factor c...

In developing countries, acute lower respiratory tract infections (ALRTI) cause considerable morbidity, hospitalisation and mortality in children aged <5 years. A prospective case-control study was conducted to identify potential socio-demographic, nutritional and environmental risk factors for ALRTI. The World Health Organization definition for AL...

The epidemiologic features, clinical presentations and severity of malaria influence effective treatment and control strategies. We aimed to study clinical presentations, complications and fever resolution time (FRT) following chloroquine in childhood malaria. Children hospitalised with fever without any obvious cause in whom rapid diagnostic test...

Dengue fever is the most prevalent arboviral infection in the world that is transmitted by mosquitoes. It is an acute illness of sudden onset that usually follows a benign course with symptoms such as headache, fever and rash. Central nervous system manifestations of dengue infection are usually rare. Here, a Dengue case with meningitis as primary...

Bardet-Biedl syndrome is an autosomal recessive disorder characterized by retinitis pigmentosa, obesity, polydactyly, mental retardation and hypogonadism. We present two sisters with this rare genetic condition.

Indoor air pollution is an important risk factor for acute lower respiratory tract infections (ALRTI) in developing countries. To determine the relationship of indoor air pollution with ALRTI in children under 5 years of age. A prospective, case-control study of risk factors, particularly indoor air pollution, for developing ALRTI in children under...

Amitraz is a formamidine insecticide and acaricide which acts on alpha 2-adrenergic receptors. There is little information available in the literature about the toxicity and treatment of poisoning by this compound. The authors report amitraz poisoning in a 13-y-old boy which was managed with supportive care with a good outcome.

Better understanding of the clinical characteristics of ABO haemolytic disease in neonates helps optimise care. To assess the morbidity associated with maternal-neonatal ABO incompatibility. Neonates with blood groups A or B born to mothers with blood group O with simultaneous rhesus blood factor compatibility were studied prospectively. Maternal a...

Antenatal Bartter syndrome (ABS) is a rare autosomal recessive renal tubular disorder. The defective chloride transport in the loop of Henle leads to fetal polyuria resulting in severe hydramnios and premature delivery. Early onset, unexplained maternal polyhydramnios often challenges the treating obstetrician. Increasing polyhydramnios without app...

Antibodies against the Golgi complex (AGAs) have been reported rarely and are associated with disorders like systemic lupus erythematosus, Sjögren's syndrome and rheumatoid arthritis. We report a case of autoimmune haemolytic anemia with Antigolgi antibodies, the first such case in medical literature.

Epidemiology and surveillance of neonatal sepsis helps in implementation of rational empirical antibiotic strategy. To study the frequency of bacterial isolates of early onset neonatal sepsis (EONS) and their sensitivity pattern. In this retrospective study, a case of EONS was defined as an infant who had clinical signs or born to mothers with pote...

Isolated pleural effusion is a rare condition in a fetus or neonate with high mortality. When there are no other findings of hydrops fetalis or documented etiology such as inflammatory, iatrogenic or cardiac problems exist, isolated pleural effusion is considered. Timely diagnosis and management not only avoids mortality but also results in excelle...

A woman presented with polyhydramnios at 22 weeks of gestation with a structurally normal fetus and placenta. Biochemical analysis of amniotic fluid detected a very high level of chloride (582 mmol/L), which led to the diagnosis of Bartter syndrome. With serial amniocentesis and indomethacin therapy, the pregnancy continued to 36 weeks. Neonatal an...

Opsismodysplasia is a rare osteochondrodysplasia with micromelia and platyspondyly. We report on a neonate with opsismodysplasia. During the antenatal period, polyhydramnios was noted. This is the first report of opsismodysplasia from India. Significant observation was antenatal polyhydramnios.

Systemic reactions to contact with a caterpillar are rare in children. A 3-month-old infant presented to the emergency department with acute onset of rash, severe respiratory distress and shock. Her mother volunteered that the infant had been exposed to a tree processionary caterpillar. The infant responded to systemic corticosteroids and antihista...

Candida arthritis is uncommon in neonates. We report a low birth weight neonate who developed septic arthritis of the left hip joint following a stormy course in the early neonatal period. Ultrasonography of the affected hip joint favored the diagnosis. Arthrotomy yielded 3 mL of pus, which grew Candida albicans. Treatment with fluconazole for six...

The common bacterial causes of neonatal meningitis are group B Streptococcus, Escherichia coli, Klebsiella and Listeria. Meningitis due to Alcaligenes in neonates is exceptional. Difficulties in its diagnosis and treatment with high mortality have been scarcely reported. We describe meningitis in a neonate due to multidrug resistant Alcaligenes. Wi...

Twin to twin transfusion syndrome (TTTS) is a specific condition complicating 10-15% of monochorionic multiple pregnancy. Intertwin vascular anastomoses and transfusion is a normal event. Syndrome develops when blood flow is unbalanced. Recent studies suggest a paucity of bi-directional superficial anastomoses failing to compensate for hemodynamic...

Objective: We aimed to evaluate the outcome of early onset-sepsis (EOS) workups in very low birth weight (VLBW) premature neonates Methods: Premature neonates weighing less than 1500g were evaluated for EOS. Haematological screening parameters, CRP and blood cultures were obtained in all. EOS (occurring at <72 hours of life) was the primary outcome...

Teratomas are neoplasms originating in pluripotent cells. They are composed of a wide diversity of tissues representing all three germ cell layers. The sacrococcygeal area is the most common extragonadal site. A sacrococcygeal teratoma is the commonest teratoma presenting in the neonatal period. We present a term neonate who had a large teratoma in...

Postmeningitis subdural effusion is rare in neonates when compared to infants and children. For treatment, various modalities are described. Serial subdural punctures and surgical drain placement are advised for cases having a mass effect on imaging. We report a neonate with symptomatic postmeningitis subdural effusion, who failed to respond to ser...

Fractures in a neonate commonly result from a genetic predisposition and birth trauma. Osteogenesis imperfecta, a rare heterogeneous group of disorders, mainly affecting the bones, remains the commonest cause of genetic osteoporosis. Osteogenesis imperfecta congenita (OIC) is the most severe form among them, with an incidence of 1 in 60000 live bir...

Cutaneous tuberculosis occurring sporadically in atypical sites could cause a diagnostic dilemma and lead to delay in treatment. We describe a 6-year old child who presented with a chronic, non-healing ulcer over the right pre-auricular region. There was no improvement with treatment from various practitioners over 2 months. On evaluation, we found...

Fractures in a neonate commonly result from a genetic predisposition and birth trauma. Osteogenesis imperfecta, a rare heterogeneous group of disorders, mainly affecting the bones, remains the commonest cause of genetic osteoporosis. Osteogenesis imperfecta congenita (OIC) is the most severe form among them, with an incidence of 1 in 60000 live bir...

Townes-Brocks syndrome is a rare malformation syndrome characterized by thumb, auricular, renal, and anal anomalies. Both familial and isolated cases with clinical heterogeneity were reported in the medical literature. We present a sporadic case with typical clinical features and extended spectrum, that has previously not been described. Left sided...

Outcome of neonates with congenital diaphragmatic hernia (CDH) varies widely and the data from developing countries is scanty. We aimed to study the management and outcome of CDH. We also aimed to ascertain prenatal and postnatal factors affecting the outcome. A retrospective review of neonates with CDH admitted to a teaching hospital was conducted...

The incidence of meconium aspiration syndrome (MAS), associated perinatal factors, morbidity and deaths varies widely. This study aimed to assess the perinatal attributes and morbidity associated with MAS. Over a 2-year period, all neonates born through meconium-stained amniotic fluid (MSAF) were observed for respiratory distress (RD). Birth detail...

To evaluate the prevalence of thrombocytopenia in neonates born to mothers with pregnancy induced hypertension (PIH) and identify the associated material and neonatal characteristics. In the current, prospective study, platelet counts were assessed serially. Maternal and neonatal characteristic were recorded in pre-designed proforma. Primary outcom...

Continuous noninvasive monitoring of the partial pressure of arterial carbon dioxide (PaCO2) in ventilated neonates would help clinicians to reduce arterial blood sampling. Our objective was to determine the correlation and agreement between end-tidal carbon dioxide (EtCO2) and PaCO2 in newborns ventilated for various clinical situations. This pros...

To assess the utility of 24 and 48 hours transcutaneous bilirubin (TcB) index for predicting subsequent significant hyperbilirubinemia in healthy term neonates. TcB indices were obtained for healthy, breastfed, term AGA newborns at 24 +/- 2, 48 +/- 2 and subsequently at intervals of 24 hours. Neonates with illness, on treatment and positive Direct...

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One of monozygous twins presented with anuria from birth and was diagnosed on renal biopsy with glomerulocystic kidney disease. There was no associated congenital or hereditary disorder. The other twin was normal and ultrasonography of the renal tracts of both infants was normal. He was managed by peritoneal dialysis. As renal transplantation was n...

An 18-day-old neonate presented with fever and abdominal distension. Renal subcapsular abscess was diagnosed with sonography and CT scan. Percutaneous drainage resulted in aspiration of 20 mL of pus, which grew Staphylococcus aureus.

Cantrell syndrome is a rare syndrome of congenital defects involving the abdominal wall, sternum, diaphragm, pericardium and the heart. The spectrum of anomalies varies widely. A full syndrome, probable syndrome and incomplete expression have been described. Less than 160 cases have been described in the world literature. Only one set of monozygoti...

During early postnatal maturation a significant increase in the rate constant of translocation (Michaelis-Menten constant; Km) for taurocholate uptake occurs in isolated rabbit hepatocytes. This age-dependent change is related to a decrease in the efficiency of uptake for taurocholate and is probably associated with changes in the receptor or its m...

We previously demonstrated that Pediatric level 3 residents (PL3's) expressed attitudes of greater reluctance to resuscitate certain high risk infants than did Pediatric level 1 residents (PL1's) tested on the first day of training. We have followed our original group of PL1's at yearly intervals throughout residency training. Cumulative Guttman sc...

We studied the effects of exogenous surfactant (S-TA,Fujiwara) on the course of HMD in baboons delivered at 76% of term, 100 mg/kg of S-TA in saline was instilled via the E-T tube in 5 animals (Group S) at 2.0 hrs. of age; 3 animals were controls. Blood gases, lung compliance (CL) and mean airway pressure (MAP) were measured for 16 hrs. (Table:±SD,...

Selected parameters of renal function were studied in premature infants with a significant patent ductus arteriosus who were treated with intravenous indomethacin according to a specific protocol. Urine volume, glomerular filtration rate, urine sodium, and the fractional excretion of sodium were analyzed in 17; osmolar, sodium, and free water clear...

Colloid osmotic pressure (COP) was measured serially in 81 critically ill neonates with hyaline membrane disease (HMD) during the first five days of life, and these changes were correlated with the birth weight, gestational age, serum protein level, clinical status, and outcome. Colloid osmotic pressure correlated better with the total protein leve...

The subject of patent ductus arteriosus (PDA) in the premature infant has been discussed extensively in recent years. Although it has been known for some time that PDA occurs commonly in premature infants, the concurrent presence of PDA and hyaline membrane disease and this association leading to respiratory complication have renewed interest in un...

Acute hypoxia is known to increase cerebral blood flow and intracranial pressure in the fetus and newborn. The combined effects of these changes on cerebral perfusion pressure are unknown. We investigated cerebral perfusion pressure changes in newborn puppies of two age groups (group I, mean age 28 days, group II, mean age 11 days) during acute, se...

Thromboembolism of abdominal aorta and its branches after umbilical artery catheterization has been previously reported. In the past, total occlusion of the abdominal aorta and its major branches was associated with high mortality. Successful aortic thrombectomy in the neonatal period has been reported only once in English literature. The successfu...

A case of aortic thrombosis is reported in a 14 days old newborn after extensive review of the world literature is made. It was secondary to sepsis and hypercoagulability syndrome. Emphasis is placed on the early diagnosis, on the usefulness of the Doppler system when studying the vascular system as a non-invasive method in critically ill pediatric...

Metabolism of indomethacin was examined in freshly isolated hepatocytes prepared by liver collagenase perfusion of fetal (28) and neonatal rabbits of 3, 5, 10, 12, and 25 days of age. Initial cell viability was more than 90% and linear rates of metabolism were observed for up to 2 hr of incubation. Deacylation of indomethacin to desbenzoyl indometh...

Clinical usefulness and factors affecting transcutaneous CO2 (PtcCO2) monitoring were studied in 22 critically ill neonates. In 10 of 22 infants, both tissue pH (pHt) and PtcCO2 were monitored simultaneously using Roche pHt and CO2 electrodes. Arterial blood gases were obtained from umbilical artery catheter. The effect of variations in blood press...

Clinical usefulness of colloid osmotic pressure (COP) measurements in adults has been well established. However, data in healthy and sick neonates are sparse. The present study established the COP changes in healthy term and preterm infants and in critically ill neonates. COP in healthy term (16.9 +/- 1.9 mm Hg) and preterm (15.4 +/- 1.3) infants w...

Changes in CPP (mean BP-ICP) to hypoxia were studied in 16 puppies of two age groups: Group I, 9 older puppies, x age 26 days, and Group II, 7 young puppies, x age 11 days. Mean aortic BP, heart rate, respiration and ICP (via epidural space) were recorded while 5-10% O2 breathing. The table shows results (BP, pO2, ICP, CPP are Torr). Within seconds...

Renal functions, cardiac output(CO) and colloid oncotic pressure (COP)were measured during control (C) hypovolemic shock (HS) and recovery (R) in baboons (2-8 weeks). Heart rate, mean blood pressure (MBP) and tissue pH (tpH) were monitored continuously. Shock was induced by bleeding till the MBP dropped from 81 to 41 mmHg. CO, blood gases (ABG), CO...

Since COP plays a vital role in fluid shifts and in the outcome, we studied the sequential changes in COP and total protein (TP) in 33 sick infants with severe HMD. Their birth weight and gest. age ranged from 0.55 to 2.5 kgs and 24 to 36 weeks respectively. COP was measured from 0.3 ml of heparinized arterial blood on day 1,3 & 5 using Wescor coll...

CO, tpH, and BL changes were studied in 8 puppies during acute hypovolemia and reinfusion . Hypovolemia was induced by bleeding 20 ml/kg of blood. Mean blood pressure (MBP),heart rate (HR) and tpH were monitored continuously. CO, BL and arterial blood gases were analyzed every 15′ during the study. After 30′ hypovolemia blood was reinfused and all...

Indomethacin (I) undergoes both microsomal oxidation to desmethyl-indomethacin (DMI) and cytosolic deacylation to desbenzoylchloro-indomethacin (DBI). The in vitro postnatal development of these two pathways was examined in the rabbit liver using collagenase-isolated hepatocytes and liver fractions incubated with 0.5 mM 14C-I and appropriate cofact...

Plasma concentrations of indomethacin were studied in 18 premature infants exhibiting significant patent ductus arteriosus (sPDA) after either intravenous or oral drug administration. Oral absorption of indomethacin was prolonged and bioavailability, based on area under the curve (AUC), was less than 20%. The mean volume of distribution for indomet...

The disposition of oral indomethacin was studied in 9 premature infants with significant patent ductus arteriosus (sPDA) with birth weights ranging from 800 to 1,960 gm and gestational ages of 28 to 36 wk. Peak plasma concentrations in most of the subjects were not observed until 3 to 4 hr after administration and ranged from 0.027 to 0.31 microgra...

Continuous tissue pH was measured using a minaturized glass electrode in 21 sick term and preterm infants. Tissue pH correlated well with arterial (r = 0.87) and capillary pH (r = 0.90) during the steady state. However, tpH was lower than arterial pH during hypoperfusion and state of shock. Improvement in tissue perfusion resulted in improvement in...