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Unknown  |  1992-06-06  |  341.6 KB

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ConfidenceProgramDetectionMatch TypeSupport
66% dexvert OS/2 Installation Package (archive/os2InstallPackage) ext Supported
1% dexvert BeOS Installation Package (archive/beOSInstallPackage) ext Unsupported
1% dexvert Newton Package (archive/newtonPackage) ext Unsupported
1% dexvert Independence War 2 mod Package (other/independenceWar2ModPackage) ext Unsupported
100% file data default
100% ffprobeID raw MPEG-4 video (m4v) default (weak)



hex view
+--------+-------------------------+-------------------------+--------+--------+
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|00000630| 70 6c 61 6e 2c 20 43 0d | 0a 43 6f 78 2c 20 57 7d |plan, C.|.Cox, W}|
|00000640| 0d 0a 24 41 66 66 69 6c | 69 61 74 69 6f 6e 7b 48 |..$Affil|iation{H|
|00000650| 6f 70 20 4e 6f 74 72 65 | 20 44 61 6d 65 20 64 65 |op Notre| Dame de|
|00000660| 20 42 6f 6e 20 53 65 63 | 6f 75 72 73 3b 20 43 65 | Bon Sec|ours; Ce|
|00000670| 6e 74 72 65 20 4e 61 74 | 69 6f 6e 61 6c 20 64 65 |ntre Nat|ional de|
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|000007a0| 61 67 65 7b 39 33 39 2d | 39 34 36 7d 0d 0a 24 44 |age{939-|946}..$D|
|000007b0| 61 74 65 7b 41 70 72 69 | 6c 20 31 39 38 38 7d 0d |ate{Apri|l 1988}.|
|000007c0| 0a 24 59 42 56 6f 6c 7b | 31 39 38 39 20 59 65 61 |.$YBVol{|1989 Yea|
|000007d0| 72 20 42 6f 6f 6b 20 6f | 66 20 4f 62 73 74 65 74 |r Book o|f Obstet|
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|00000800| 30 2d 36 7d 0d 0a 24 59 | 42 45 64 69 74 6f 72 7b |0-6}..$Y|BEditor{|
|00000810| 44 72 73 2e 20 4d 69 73 | 68 65 6c 6c 2c 20 4b 69 |Drs. Mis|hell, Ki|
|00000820| 72 73 63 68 62 61 75 6d | 2c 20 61 6e 64 20 4d 6f |rschbaum|, and Mo|
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|00000840| 62 6c 65 20 4f 6d 69 74 | 74 65 64 7d 0d 0a 24 43 |ble Omit|ted}..$C|
|00000850| 6f 6d 6d 65 6e 74 61 74 | 6f 72 7b 54 2e 48 2e 20 |ommentat|or{T.H. |
|00000860| 4b 69 72 73 63 68 62 61 | 75 6d 2c 20 4d 2e 44 2e |Kirschba|um, M.D.|
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|00000880| 63 29 20 59 65 61 72 20 | 42 6f 6f 6b 20 4d 65 64 |c) Year |Book Med|
|00000890| 69 63 61 6c 20 50 75 62 | 6c 69 73 68 65 72 73 2c |ical Pub|lishers,|
|000008a0| 20 49 6e 63 2e 2c 20 31 | 39 38 39 0d 0a 0d 0a 31 | Inc., 1|989....1|
|000008b0| 39 38 39 20 59 65 61 72 | 20 42 6f 6f 6b 20 6f 66 |989 Year| Book of|
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|000008e0| 0d 0a 4f 62 73 74 65 74 | 72 69 63 73 0d 0a 0d 0a |..Obstet|rics....|
|000008f0| 43 68 61 70 74 65 72 20 | 31 30 2d 2d 46 65 74 61 |Chapter |10--Feta|
|00000900| 6c 20 54 68 65 72 61 70 | 79 0d 0a 0d 0a 2d 2d 2d |l Therap|y....---|
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|00000a50| 39 34 36 2c 20 41 70 72 | 69 6c 20 31 39 38 38 0d |946, Apr|il 1988.|
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|00001be0| 2d 2d 2d 2d 2d 2d 2d 2d | 2d 2d 2d 2d 2d 2d 2d 2d |--------|--------|
|00001bf0| 2d 2d 2d 2d 2d 2d 2d 2d | 2d 2d 2d 2d 2d 2d 2d 2d |--------|--------|
|00001c00| 2d 2d 2d 2d 2d 2d 2d 2d | 2d 2d 2d 2d 2d 2d 2d 2d |--------|--------|
|00001c10| 2d 2d 2d 2d 2d 2d 2d 2d | 2d 2d 2d 2d 2d 2d 2d 2d |--------|--------|
|00001c20| 2d 2d 2d 2d 2d 2d 2d 2d | 0d 0a 45 66 66 65 63 74 |--------|..Effect|
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|00001d00| 2d 2d 2d 2d 2d 2d 2d 2d | 2d 2d 2d 2d 2d 2d 2d 2d |--------|--------|
|00001d10| 2d 2d 2d 2d 2d 2d 2d 2d | 2d 2d 2d 2d 2d 2d 2d 2d |--------|--------|
|00001d20| 2d 2d 2d 2d 2d 2d 2d 2d | 2d 2d 2d 2d 2d 2d 2d 2d |--------|--------|
|00001d30| 2d 2d 2d 2d 2d 2d 2d 2d | 2d 2d 2d 2d 2d 2d 2d 2d |--------|--------|
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|000028f0| 64 20 50 6f 73 74 6e 61 | 74 61 6c 20 46 6f 6c 6c |d Postna|tal Foll|
|00002900| 6f 77 75 70 7d 0d 0a 24 | 41 75 74 68 6f 72 7b 41 |owup}..$|Author{A|
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|000029d0| 73 70 6c 61 73 69 61 20 | 6d 75 6c 74 69 63 79 73 |splasia |multicys|
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|00002a40| 4a 6f 75 72 6e 61 6c 7b | 4a 20 55 72 6f 6c 7d 0d |Journal{|J Urol}.|
|00002a50| 0a 24 56 6f 6c 75 6d 65 | 7b 31 33 38 7d 0d 0a 24 |.$Volume|{138}..$|
|00002a60| 50 61 67 65 7b 31 34 32 | 30 2d 31 34 32 34 7d 0d |Page{142|0-1424}.|
|00002a70| 0a 24 44 61 74 65 7b 44 | 65 63 65 6d 62 65 72 20 |.$Date{D|ecember |
|00002a80| 31 39 38 37 7d 0d 0a 24 | 59 42 56 6f 6c 7b 31 39 |1987}..$|YBVol{19|
|00002a90| 38 39 20 59 65 61 72 20 | 42 6f 6f 6b 20 6f 66 20 |89 Year |Book of |
|00002aa0| 4f 62 73 74 65 74 72 69 | 63 73 20 61 6e 64 20 47 |Obstetri|cs and G|
|00002ab0| 79 6e 65 63 6f 6c 6f 67 | 79 7d 0d 0a 24 43 68 61 |ynecolog|y}..$Cha|
|00002ac0| 70 74 65 72 7b 31 30 2d | 38 7d 0d 0a 24 59 42 45 |pter{10-|8}..$YBE|
|00002ad0| 64 69 74 6f 72 7b 44 72 | 73 2e 20 4d 69 73 68 65 |ditor{Dr|s. Mishe|
|00002ae0| 6c 6c 2c 20 4b 69 72 73 | 63 68 62 61 75 6d 2c 20 |ll, Kirs|chbaum, |
|00002af0| 61 6e 64 20 4d 6f 72 72 | 6f 77 7d 0d 0a 24 54 61 |and Morr|ow}..$Ta|
|00002b00| 62 6c 65 7b 7d 0d 0a 24 | 43 6f 6d 6d 65 6e 74 61 |ble{}..$|Commenta|
|00002b10| 74 6f 72 7b 54 2e 48 2e | 20 4b 69 72 73 63 68 62 |tor{T.H.| Kirschb|
|00002b20| 61 75 6d 2c 20 4d 2e 44 | 2e 7d 0d 0a 0d 0a 43 6f |aum, M.D|.}....Co|
|00002b30| 70 79 72 69 67 68 74 20 | 28 63 29 20 59 65 61 72 |pyright |(c) Year|
|00002b40| 20 42 6f 6f 6b 20 4d 65 | 64 69 63 61 6c 20 50 75 | Book Me|dical Pu|
|00002b50| 62 6c 69 73 68 65 72 73 | 2c 20 49 6e 63 2e 2c 20 |blishers|, Inc., |
|00002b60| 31 39 38 39 0d 0a 0d 0a | 31 39 38 39 20 59 65 61 |1989....|1989 Yea|
|00002b70| 72 20 42 6f 6f 6b 20 6f | 66 20 4f 62 73 74 65 74 |r Book o|f Obstet|
|00002b80| 72 69 63 73 20 61 6e 64 | 20 47 79 6e 65 63 6f 6c |rics and| Gynecol|
|00002b90| 6f 67 79 20 28 52 29 0d | 0a 0d 0a 4f 62 73 74 65 |ogy (R).|...Obste|
|00002ba0| 74 72 69 63 73 0d 0a 0d | 0a 43 68 61 70 74 65 72 |trics...|.Chapter|
|00002bb0| 20 31 30 2d 2d 46 65 74 | 61 6c 20 54 68 65 72 61 | 10--Fet|al Thera|
|00002bc0| 70 79 0d 0a 0d 0a 2d 2d | 2d 2d 2d 2d 2d 2d 2d 2d |py....--|--------|
|00002bd0| 2d 2d 2d 2d 2d 2d 2d 2d | 2d 2d 2d 2d 2d 2d 2d 2d |--------|--------|
|00002be0| 2d 2d 2d 2d 2d 2d 2d 2d | 2d 2d 2d 2d 2d 2d 2d 2d |--------|--------|
|00002bf0| 2d 2d 2d 2d 2d 2d 2d 2d | 2d 2d 2d 2d 2d 2d 2d 2d |--------|--------|
|00002c00| 2d 2d 2d 2d 2d 2d 2d 2d | 2d 2d 2d 2d 2d 2d 2d 2d |--------|--------|
|00002c10| 2d 2d 2d 2d 2d 2d 0d 0a | 4d 75 6c 74 69 63 79 73 |------..|Multicys|
|00002c20| 74 69 63 20 44 79 73 70 | 6c 61 73 74 69 63 20 4b |tic Dysp|lastic K|
|00002c30| 69 64 6e 65 79 3a 20 20 | 4e 61 74 75 72 61 6c 20 |idney: |Natural |
|00002c40| 48 69 73 74 6f 72 79 20 | 46 72 6f 6d 20 49 6e 20 |History |From In |
|00002c50| 55 74 65 72 6f 20 44 69 | 61 67 6e 6f 73 69 73 20 |Utero Di|agnosis |
|00002c60| 61 6e 64 0d 0a 50 6f 73 | 74 6e 61 74 61 6c 20 46 |and..Pos|tnatal F|
|00002c70| 6f 6c 6c 6f 77 75 70 0d | 0a 0d 0a 41 76 6e 69 20 |ollowup.|...Avni |
|00002c80| 45 46 2c 20 54 68 6f 75 | 61 20 41 2c 20 4c 61 6c |EF, Thou|a A, Lal|
|00002c90| 6d 61 6e 64 20 44 2c 20 | 44 69 64 69 65 72 20 46 |mand D, |Didier F|
|00002ca0| 2c 20 44 72 6f 75 6c 6c | 65 20 50 2c 20 53 63 68 |, Droull|e P, Sch|
|00002cb0| 75 6c 6d 61 6e 20 43 43 | 0d 0a 28 55 6e 69 76 20 |ulman CC|..(Univ |
|00002cc0| 43 6c 69 6e 69 63 73 20 | 6f 66 20 42 72 75 73 73 |Clinics |of Bruss|
|00002cd0| 65 6c 73 2c 20 45 72 61 | 73 6d 65 20 48 6f 73 70 |els, Era|sme Hosp|
|00002ce0| 2c 20 42 72 75 73 73 65 | 6c 73 29 0d 0a 4a 20 55 |, Brusse|ls)..J U|
|00002cf0| 72 6f 6c 20 31 33 38 3a | 31 34 32 30 2d 31 34 32 |rol 138:|1420-142|
|00002d00| 34 2c 20 44 65 63 65 6d | 62 65 72 20 31 39 38 37 |4, Decem|ber 1987|
|00002d10| 0d 0a 2d 2d 2d 2d 2d 2d | 2d 2d 2d 2d 2d 2d 2d 2d |..------|--------|
|00002d20| 2d 2d 2d 2d 2d 2d 2d 2d | 2d 2d 2d 2d 2d 2d 2d 2d |--------|--------|
|00002d30| 2d 2d 2d 2d 2d 2d 2d 2d | 2d 2d 2d 2d 2d 2d 2d 2d |--------|--------|
|00002d40| 2d 2d 2d 2d 2d 2d 2d 2d | 2d 2d 2d 2d 2d 2d 2d 2d |--------|--------|
|00002d50| 2d 2d 2d 2d 2d 2d 2d 2d | 2d 2d 2d 2d 2d 2d 2d 2d |--------|--------|
|00002d60| 2d 2d 0d 0a 0d 0a 41 62 | 73 74 72 61 63 74 0d 0a |--....Ab|stract..|
|00002d70| 0d 0a 20 20 20 20 20 55 | 6c 74 72 61 73 6f 75 6e |.. U|ltrasoun|
|00002d80| 64 20 69 73 20 75 73 65 | 66 75 6c 20 66 6f 72 20 |d is use|ful for |
|00002d90| 74 68 65 20 69 6e 20 75 | 74 65 72 6f 20 64 69 61 |the in u|tero dia|
|00002da0| 67 6e 6f 73 69 73 20 6f | 66 20 6d 75 6c 74 69 63 |gnosis o|f multic|
|00002db0| 79 73 74 69 63 20 64 79 | 73 70 6c 61 73 74 69 63 |ystic dy|splastic|
|00002dc0| 0d 0a 6b 69 64 6e 65 79 | 2c 20 62 75 74 20 6c 69 |..kidney|, but li|
|00002dd0| 74 74 6c 65 20 69 73 20 | 6b 6e 6f 77 6e 20 61 62 |ttle is |known ab|
|00002de0| 6f 75 74 20 74 68 65 20 | 6e 61 74 75 72 61 6c 20 |out the |natural |
|00002df0| 68 69 73 74 6f 72 79 20 | 61 6e 64 20 74 68 65 20 |history |and the |
|00002e00| 63 68 61 6e 67 65 73 20 | 74 68 61 74 20 6d 61 79 |changes |that may|
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|00002e20| 61 6e 6f 6d 61 6c 79 20 | 77 69 74 68 20 74 69 6d |anomaly |with tim|
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|00003640| 0a 24 41 75 74 68 6f 72 | 7b 42 69 6e 6b 69 6e 2c |.$Author|{Binkin,|
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|00003660| 69 6c 6c 69 61 6d 73 2c | 20 52 4c 7d 0d 0a 24 41 |illiams,| RL}..$A|
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|00003690| 6f 6e 74 72 6f 6c 2c 20 | 41 74 6c 61 6e 74 61 3b |ontrol, |Atlanta;|
|000036a0| 20 55 6e 69 76 20 6f 66 | 20 43 61 6c 69 66 6f 72 | Univ of| Califor|
|000036b0| 6e 69 61 2c 20 53 61 6e | 74 61 20 42 61 72 62 61 |nia, San|ta Barba|
|000036c0| 72 61 7d 0d 0a 24 53 75 | 62 6a 65 63 74 7b 52 61 |ra}..$Su|bject{Ra|
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|00003700| 74 79 20 6e 65 6f 6e 61 | 74 61 6c 20 72 61 63 69 |ty neona|tal raci|
|00003710| 61 6c 20 64 69 66 66 65 | 72 65 6e 63 65 73 20 69 |al diffe|rences i|
|00003720| 6e 7d 0d 0a 24 4a 6f 75 | 72 6e 61 6c 7b 41 6d 20 |n}..$Jou|rnal{Am |
|00003730| 4a 20 44 69 73 20 43 68 | 69 6c 64 7d 0d 0a 24 56 |J Dis Ch|ild}..$V|
|00003740| 6f 6c 75 6d 65 7b 31 34 | 32 7d 0d 0a 24 50 61 67 |olume{14|2}..$Pag|
|00003750| 65 7b 34 33 34 2d 34 34 | 30 7d 0d 0a 24 44 61 74 |e{434-44|0}..$Dat|
|00003760| 65 7b 41 70 72 69 6c 20 | 31 39 38 38 7d 0d 0a 24 |e{April |1988}..$|
|00003770| 59 42 56 6f 6c 7b 31 39 | 38 39 20 59 65 61 72 20 |YBVol{19|89 Year |
|00003780| 42 6f 6f 6b 20 6f 66 20 | 4f 62 73 74 65 74 72 69 |Book of |Obstetri|
|00003790| 63 73 20 61 6e 64 20 47 | 79 6e 65 63 6f 6c 6f 67 |cs and G|ynecolog|
|000037a0| 79 7d 0d 0a 24 43 68 61 | 70 74 65 72 7b 31 30 2d |y}..$Cha|pter{10-|
|000037b0| 39 7d 0d 0a 24 59 42 45 | 64 69 74 6f 72 7b 44 72 |9}..$YBE|ditor{Dr|
|000037c0| 73 2e 20 4d 69 73 68 65 | 6c 6c 2c 20 4b 69 72 73 |s. Mishe|ll, Kirs|
|000037d0| 63 68 62 61 75 6d 2c 20 | 61 6e 64 20 4d 6f 72 72 |chbaum, |and Morr|
|000037e0| 6f 77 7d 0d 0a 24 54 61 | 62 6c 65 7b 7d 0d 0a 24 |ow}..$Ta|ble{}..$|
|000037f0| 43 6f 6d 6d 65 6e 74 61 | 74 6f 72 7b 54 2e 48 2e |Commenta|tor{T.H.|
|00003800| 20 4b 69 72 73 63 68 62 | 61 75 6d 2c 20 4d 2e 44 | Kirschb|aum, M.D|
|00003810| 2e 7d 0d 0a 0d 0a 43 6f | 70 79 72 69 67 68 74 20 |.}....Co|pyright |
|00003820| 28 63 29 20 59 65 61 72 | 20 42 6f 6f 6b 20 4d 65 |(c) Year| Book Me|
|00003830| 64 69 63 61 6c 20 50 75 | 62 6c 69 73 68 65 72 73 |dical Pu|blishers|
|00003840| 2c 20 49 6e 63 2e 2c 20 | 31 39 38 39 0d 0a 0d 0a |, Inc., |1989....|
|00003850| 31 39 38 39 20 59 65 61 | 72 20 42 6f 6f 6b 20 6f |1989 Yea|r Book o|
|00003860| 66 20 4f 62 73 74 65 74 | 72 69 63 73 20 61 6e 64 |f Obstet|rics and|
|00003870| 20 47 79 6e 65 63 6f 6c | 6f 67 79 20 28 52 29 0d | Gynecol|ogy (R).|
|00003880| 0a 0d 0a 4f 62 73 74 65 | 74 72 69 63 73 0d 0a 0d |...Obste|trics...|
|00003890| 0a 43 68 61 70 74 65 72 | 20 31 30 2d 2d 46 65 74 |.Chapter| 10--Fet|
|000038a0| 61 6c 20 54 68 65 72 61 | 70 79 0d 0a 0d 0a 2d 2d |al Thera|py....--|
|000038b0| 2d 2d 2d 2d 2d 2d 2d 2d | 2d 2d 2d 2d 2d 2d 2d 2d |--------|--------|
|000038c0| 2d 2d 2d 2d 2d 2d 2d 2d | 2d 2d 2d 2d 2d 2d 2d 2d |--------|--------|
|000038d0| 2d 2d 2d 2d 2d 2d 2d 2d | 2d 2d 2d 2d 2d 2d 2d 2d |--------|--------|
|000038e0| 2d 2d 2d 2d 2d 2d 2d 2d | 2d 2d 2d 2d 2d 2d 2d 2d |--------|--------|
|000038f0| 2d 2d 2d 2d 2d 2d 2d 2d | 2d 2d 2d 2d 2d 2d 0d 0a |--------|------..|
|00003900| 52 61 63 69 61 6c 20 44 | 69 66 66 65 72 65 6e 63 |Racial D|ifferenc|
|00003910| 65 73 20 69 6e 20 4e 65 | 6f 6e 61 74 61 6c 20 4d |es in Ne|onatal M|
|00003920| 6f 72 74 61 6c 69 74 79 | 3a 20 20 57 68 61 74 20 |ortality|: What |
|00003930| 43 61 75 73 65 73 20 6f | 66 20 44 65 61 74 68 20 |Causes o|f Death |
|00003940| 45 78 70 6c 61 69 6e 20 | 74 68 65 20 47 61 70 3f |Explain |the Gap?|
|00003950| 0d 0a 0d 0a 42 69 6e 6b | 69 6e 20 4e 4a 2c 20 52 |....Bink|in NJ, R|
|00003960| 75 73 74 20 4b 52 2c 20 | 57 69 6c 6c 69 61 6d 73 |ust KR, |Williams|
|00003970| 20 52 4c 0d 0a 28 43 65 | 6e 74 65 72 73 20 66 6f | RL..(Ce|nters fo|
|00003980| 72 20 44 69 73 65 61 73 | 65 20 43 6f 6e 74 72 6f |r Diseas|e Contro|
|00003990| 6c 2c 20 41 74 6c 61 6e | 74 61 3b 20 55 6e 69 76 |l, Atlan|ta; Univ|
|000039a0| 20 6f 66 20 43 61 6c 69 | 66 6f 72 6e 69 61 2c 20 | of Cali|fornia, |
|000039b0| 53 61 6e 74 61 20 42 61 | 72 62 61 72 61 29 0d 0a |Santa Ba|rbara)..|
|000039c0| 41 6d 20 4a 20 44 69 73 | 20 43 68 69 6c 64 20 31 |Am J Dis| Child 1|
|000039d0| 34 32 3a 34 33 34 2d 34 | 34 30 2c 20 41 70 72 69 |42:434-4|40, Apri|
|000039e0| 6c 20 31 39 38 38 0d 0a | 2d 2d 2d 2d 2d 2d 2d 2d |l 1988..|--------|
|000039f0| 2d 2d 2d 2d 2d 2d 2d 2d | 2d 2d 2d 2d 2d 2d 2d 2d |--------|--------|
|00003a00| 2d 2d 2d 2d 2d 2d 2d 2d | 2d 2d 2d 2d 2d 2d 2d 2d |--------|--------|
|00003a10| 2d 2d 2d 2d 2d 2d 2d 2d | 2d 2d 2d 2d 2d 2d 2d 2d |--------|--------|
|00003a20| 2d 2d 2d 2d 2d 2d 2d 2d | 2d 2d 2d 2d 2d 2d 2d 2d |--------|--------|
|00003a30| 2d 2d 2d 2d 2d 2d 2d 2d | 0d 0a 0d 0a 41 62 73 74 |--------|....Abst|
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|00004a50| 2d 2d 2d 2d 2d 2d 2d 2d | 2d 2d 2d 2d 2d 2d 2d 2d |--------|--------|
|00004a60| 2d 2d 2d 2d 2d 2d 2d 2d | 2d 2d 2d 2d 2d 2d 2d 2d |--------|--------|
|00004a70| 2d 2d 2d 2d 2d 2d 2d 2d | 2d 2d 2d 2d 2d 2d 2d 2d |--------|--------|
|00004a80| 2d 2d 2d 2d 2d 2d 2d 2d | 2d 2d 2d 2d 2d 2d 2d 2d |--------|--------|
|00004a90| 2d 2d 2d 2d 2d 0d 0a 44 | 69 72 65 63 74 20 54 72 |-----..D|irect Tr|
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|00004af0| 70 79 0d 0a 0d 0a 57 65 | 69 6e 65 72 20 43 50 2c |py....We|iner CP,|
|00004b00| 20 54 68 6f 6d 70 73 6f | 6e 20 4d 49 42 0d 0a 28 | Thompso|n MIB..(|
|00004b10| 55 6e 69 76 20 6f 66 20 | 49 6f 77 61 2c 20 49 6f |Univ of |Iowa, Io|
|00004b20| 77 61 20 43 69 74 79 29 | 0d 0a 41 6d 20 4a 20 4f |wa City)|..Am J O|
|00004b30| 62 73 74 65 74 20 47 79 | 6e 65 63 6f 6c 20 31 35 |bstet Gy|necol 15|
|00004b40| 38 3a 35 37 30 2d 35 37 | 33 2c 20 31 39 38 38 0d |8:570-57|3, 1988.|
|00004b50| 0a 2d 2d 2d 2d 2d 2d 2d | 2d 2d 2d 2d 2d 2d 2d 2d |.-------|--------|
|00004b60| 2d 2d 2d 2d 2d 2d 2d 2d | 2d 2d 2d 2d 2d 2d 2d 2d |--------|--------|
|00004b70| 2d 2d 2d 2d 2d 2d 2d 2d | 2d 2d 2d 2d 2d 2d 2d 2d |--------|--------|
|00004b80| 2d 2d 2d 2d 2d 2d 2d 2d | 2d 2d 2d 2d 2d 2d 2d 2d |--------|--------|
|00004b90| 2d 2d 2d 2d 2d 2d 2d 2d | 2d 2d 2d 2d 2d 2d 2d 2d |--------|--------|
|00004ba0| 2d 0d 0a 0d 0a 41 62 73 | 74 72 61 63 74 0d 0a 0d |-....Abs|tract...|
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|00005a40| 2d 2d 2d 2d 2d 2d 2d 2d | 2d 2d 2d 2d 2d 2d 2d 2d |--------|--------|
|00005a50| 2d 2d 2d 2d 2d 2d 2d 2d | 2d 2d 2d 2d 2d 2d 2d 2d |--------|--------|
|00005a60| 2d 2d 2d 2d 2d 2d 2d 2d | 2d 2d 2d 2d 2d 2d 2d 2d |--------|--------|
|00005a70| 2d 2d 2d 2d 2d 2d 2d 2d | 2d 2d 2d 2d 2d 2d 2d 2d |--------|--------|
|00005a80| 2d 2d 2d 2d 2d 2d 2d 2d | 0d 0a 52 65 73 70 69 72 |--------|..Respir|
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|00005b70| 20 4e 65 6f 6e 61 74 65 | 20 35 31 3a 31 38 38 2d | Neonate| 51:188-|
|00005b80| 31 39 37 2c 20 4f 63 74 | 6f 62 65 72 20 31 39 38 |197, Oct|ober 198|
|00005b90| 37 0d 0a 2d 2d 2d 2d 2d | 2d 2d 2d 2d 2d 2d 2d 2d |7..-----|--------|
|00005ba0| 2d 2d 2d 2d 2d 2d 2d 2d | 2d 2d 2d 2d 2d 2d 2d 2d |--------|--------|
|00005bb0| 2d 2d 2d 2d 2d 2d 2d 2d | 2d 2d 2d 2d 2d 2d 2d 2d |--------|--------|
|00005bc0| 2d 2d 2d 2d 2d 2d 2d 2d | 2d 2d 2d 2d 2d 2d 2d 2d |--------|--------|
|00005bd0| 2d 2d 2d 2d 2d 2d 2d 2d | 2d 2d 2d 2d 2d 2d 2d 2d |--------|--------|
|00005be0| 2d 2d 2d 0d 0a 0d 0a 41 | 62 73 74 72 61 63 74 0d |---....A|bstract.|
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|00005e30| 65 6d 6f 67 6c 6f 62 69 | 6e 20 63 6f 6e 63 65 6e |emoglobi|n concen|
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|00005e50| 74 68 61 6e 20 69 6e 20 | 74 68 65 20 6c 61 74 65 |than in |the late|
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|000061b0| 54 68 65 20 61 63 69 64 | 2d 62 61 73 65 20 62 61 |The acid|-base ba|
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|000061d0| 66 66 65 72 65 6e 74 20 | 69 6e 20 74 68 65 20 6d |fferent |in the m|
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|00006250| 20 6f 66 20 6e 6f 72 6d | 61 6c 20 66 65 74 61 6c | of norm|al fetal|
|00006260| 20 70 6c 61 63 65 6e 74 | 61 6c 0d 0a 66 75 6e 63 | placent|al..func|
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|000062c0| 6c 69 67 68 74 6c 79 20 | 65 61 72 6c 69 65 72 20 |lightly |earlier |
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|00006300| 0d 0a 4b 69 6e 67 27 73 | 20 43 6f 6c 6c 65 67 65 |..King's| College|
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|00006340| 6f 6c 6c 65 67 65 20 65 | 78 70 65 72 69 65 6e 63 |ollege e|xperienc|
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|000063a0| 68 65 0d 0a 72 65 73 75 | 6c 74 73 20 6f 66 20 74 |he..resu|lts of t|
|000063b0| 68 65 20 32 20 73 74 75 | 64 69 65 73 20 61 72 65 |he 2 stu|dies are|
|000063c0| 20 69 6e 20 67 65 6e 65 | 72 61 6c 20 61 67 72 65 | in gene|ral agre|
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|000063f0| 65 0d 0a 4d 69 6c 61 6e | 2d 44 65 6e 76 65 72 20 |e..Milan|-Denver |
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