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To examine the predictive value of family history in detecting children with high blood cholesterol, finger-stick screening was done in children (n=1,118) ages 9-10 with parental and grandparental history of cardiovascular disease and risk factors. Findings showed that screening only children with positive family histories will leave most problems undetected. (SM)

Inhaled nitric oxide may improve oxygenation in newborns with persistent pulmonary hypertension (PPHN). PPHN is an elevation of lung blood pressure and respiratory failure in newborn babies. Researchers from 25 medical centers evaluated 155 infants with PPHN treated with nitric oxide or a placebo, in addition to conventional therapies for the condition. Infants who received nitric oxide had higher concentrations of oxygen in the blood after 30 minutes of treatment, and required less supplemental oxygen. Nitric oxide may dilate blood vessels in the lungs., Objectives. To assess the dose-related effects of inhaled nitric oxide (I-NO) as a specific adjunct to early conventional therapy for term infants with persistent pulmonary hypertension (PPHN), with regard to neonatal outcome, oxygenation, and safety. Methods. Randomized, placebo-controlled, double-masked, dose-response, clinical trial at 25 tertiary centers from April 1994 to June 1996. The primary endpoint was the PPHN Major Sequelae Index ([MSI], including the incidence of death, extracorporeal membrane oxygenation (ECMO), neurologic injury, or bronchopulmonary dysplasia [BPD]). Patients required a fraction of inspired oxygen [Fio.sub.2] of 1.0, a mean airway pressure [is greater than or equal to] 10 cm [H.sub.2]O on a conventional ventilator, and echocardiographic evidence of PPHN. Exogenous surfactant, concomitant high-frequency ventilation, and lung hypoplasia were exclusion factors. Control (0 ppm) or nitric oxide (NO) (5, 20, or 80 ppm) treatments were administered until success or failure criteria were met. Due to slowing recruitment, the trial was stopped at N = 155 (320 planned). Results. The baseline oxygenation index (OI) was 24 [+ or -] 9 at 25 [+ or -] 17 hours old (mean [+ or -] SD). Efficacy results were similar among NO doses. By 30 minutes (no ventilator changes) the [Pao.sub.2] for only the NO groups increased significantly from 64 [+ or -] 39 to 109 [+ or -] 78 Torr (pooled) and systemic arterial pressure remained unchanged. The baseline adjusted time-weighted OI was also significantly reduced in the NO groups (-5 [+ or -] 8) for the first 24 hours of treatment. The MSI rate was 59% for the control and 50% for the NO doses (P = .36). The ECMO rate was 34% for control and 22% for the NO doses (P = .12). Elevated methemoglobin ([is greater than] 7%) and nitrogen dioxide ([NO.sub.2]) [is greater than] 3 ppm) were observed only in the 80 ppm NO group, otherwise no adverse events could be attributed to I-NO, including BPD. Conclusion. For term infants with PPHN, early I-NO as the sole adjunct to conventional management produced an acute and sustained improvement in oxygenation for 24 hours without short-term side effects (5 and 20 ppm doses), and the suggestion that ECMO use may be reduced. Pediatrics 1998,101:325-334; extracorporeal membrane oxygenation, bronchopulmonary dysplasia, neonatal outcome, methemoglobinemia, nitrogen dioxide., Persistent pulmonary hypertension of the newborn (PPHN) is a syndrome of acute respiratory failure, characterized by systemic hypoxemia associated with extrapulmonary shunting of venous blood and evidence of elevated levels [...]

Many problems beset U.S. researchers attempting to conduct trials of high-tech care for critically ill newborns. For example, a multicenter trial of inhaled nitric oxide (iNO) to relieve pulmonary hypertension and respiratory failure is underway. The rarity of the condition means that several centers will be needed, but the sophistication of high-tech experimental care and the need for scientific rigor means that few will qualify. Therefore, many patients will be transfers from other hospitals. The iNO trial is recruiting patients slowly. There are economic disincentives to transferring patients, and those transferred may be those cases in which hope has been abandoned. But the rapid changes in care and financial constraints may ruin trials that take overly long. Transporting newborns back to the referral hospital would help as would keeping neonatologists informed of trials and their locations. The alternative is having new treatments adopted without proper evaluation. This has already happened with a new type of ventilation equipment., ABBREVIATIONS. iNO, inhaled nitric oxide; PPHN, persistent pulmonary hypertension of the newborn; HFOV, high-frequency oscillatory ventilation; ECMO, extracorporeal membrane oxygenation; FDA, Food and Drug Administration; NICU, neonatal intensive care unit. [...]

A review of 19 studies of the effect of dietary oats on cholesterol levels found that people who eat three grams of oat fiber a day can reduce their cholesterol levels by five or six milligrams per deciliter. This is not as great a reduction as some individual studies have claimed. But researchers have found that a cholesterol reduction of one percent can cut deaths from heart disease in the US by two percent. Some of the studies found that those with the highest cholesterol levels experienced the greatest reduction in cholesterol levels. Others have shown that older women experience the greatest declines in cholesterol., Objectives.--To test the a priori hypothesis that consumption of oats will lower the blood total cholesterol level and to assess modifiers and confounders of this association. Data Sources.--A computerized literature (MEDLINE) search and the Quaker Oats Co identified published and unpublished trials as of March 1991. Raw data were requested for all trials. Study Selection.--Trials were included in summary effect size estimates if they were randomized and controlled, if a formal assessment of diet and body weight changes occurred, and, if raw data were not received, if there was enough information in the published report to perform calculations. Data Synthesis.--Twenty trials were identified. Using the methods of DerSimonian and Laird, a summary effect size for change in blood total cholesterol level of -0.13 mmol/L (-5.9 mg/dL) (95% confidence interval [Cl], -0.19 to -0.017 mmol/L [-8.4 to -3.3 mg/dL]) was calculated for the 10 trials meeting the inclusion criteria. The summary effect size for trials using wheat control groups was -0.11 mmol/L (-4.4 mg/dL) (95% Cl, -0.21 to -0.01 mmol/L [-8.3 to -0.38 mg/dL]). Calculation of Keys scores demonstrated that substituting carbohydrates for dietary fats and cholesterol did not account for the majority of blood cholesterol reduction. Larger reductions were seen in trials in which subjects had initially higher blood cholesterol levels ([is greater than or equal to]5.9 mmol/L[is greater than or equal to]229 mg/dL]), particularly when a dose of 3 g or more of soluble fiber was employed. Conclusion.--This analysis supports the hypothesis that incorporating oat products into the diet causes a modest reduction in blood cholesterol level. (JAMA. 1992;267:3317-3325)