345 Fulminant hepatic failure is associated with a high mortality rate. The lack of an immediate supply of cadaveric organs suitable for transplantation or an extra-corporeal liver support device contribute to this high mortality. In the pediatric patient population this situation is made worse by the lack of size-matched donor organs suitable for transplantation. We have instituted innovative strategies to increase the availability of hepatic grafts for the pediatric population. These strategies have included the use of reduced-size cadaveric grafts and segmental grafts from live donors. Methods: Between November 1987 and December 1997, a total of 42 pediatric patients underwent orthotopic liver transplant for the diagnosis of fulminant hepatic failure. Thirty-six patients received a cadaveric graft and six patients received a segmental graft from a live donor. Results:TableConclusions: There is a trend toward increased survival for patients in fulminant hepatic failure who have a suitable live donor option. Although the time on the waiting list is not statistically significant it is most likely clinically significant when outcome may be changed by hours rather than days. Therefore, utilization of allografts from live donors is an acceptable option when caring for children with fulminant hepatic failure in need of liver transplantation.
Objective To evaluate the effectiveness of continuous glucose monitoring during pregnancy on maternal glycaemic control, infant birth weight, and risk of macrosomia in women with type 1 and type 2 diabetes. Design Prospective, open label randomised controlled trial. Setting Two secondary care multidisciplinary obstetric clinics for diabetes in the United Kingdom. Participants 71 women with type 1 diabetes (n=46) or type 2 diabetes (n=25) allocated to antenatal care plus continuous glucose monitoring (n=38) or to standard antenatal care (n=33). Intervention Continuous glucose monitoring was used as an educational tool to inform shared decision making and future therapeutic changes at intervals of 4-6 weeks during pregnancy. All other aspects of antenatal care were equal between the groups. Main outcome measures The primary outcome was maternal glycaemic control during the second and third trimesters from measurements of HbA1c levels every four weeks. Secondary outcomes were birth weight and risk of macrosomia using birthweight standard deviation scores and customised birthweight centiles. Statistical analyses were done on an intention to treat basis. Results Women randomised to continuous glucose monitoring had lower mean HbA1c levels from 32 to 36 weeks' gestation compared with women randomised to standard antenatal care: 5.8% (SD 0.6) v 6.4% (SD 0.7). Compared with infants of mothers in the control arm those of mothers in the intervention arm had decreased mean birthweight standard deviation scores (0.9 v 1.6; effect size 0.7 SD, 95% confidence interval 0.0 to 1.3), decreased median customised birthweight centiles (69% v 93%), and a reduced risk of macrosomia (odds ratio 0.36, 95% confidence interval 0.13 to 0.98). Conclusion Continuous glucose monitoring during pregnancy is associated with improved glycaemic control in the third trimester, lower birth weight, and reduced risk of macrosomia. Trial registration Current Controlled Trials ISRCTN84461581.
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