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Biomedical subjects

A Lapillonne

Publications and source records attributed to A Lapillonne.

At least 55 records · Page 3Linked to original sources
PubMed1996

Assessment of the bone mineral density in the lumbar vertebrae of newborns by quantitative computed tomography.

OBJECTIVE: To assess the true mineral density (BMD, in g/cm3) of the lumbar spine in newborns. DESIGN AND PATIENTS: A postmortem analysis of five infants with gestational ages ranging from 35 to 40 weeks, and birth weights from 2765 to 3200 g, was conducted using dual-energy quantitative computed tomography (QCT; Siemens Somatom DR). A 2 or 4 mm thick slice was obtained for each lumbar vertebra from L1 to L4. The density measured in these vertebrae was corrected by reference to a solid phantom (Osteo-CT) measured simultaneously. A three-dimensional image of the spine (Elscint CT Twin), as well as a photomicrograph of histological preparation from L2 vertebra, were also obtained in another term baby for comparison with the CT results. RESULTS AND CONCLUSIONS: In the range of values studied, the vertebral densities were not dependent on birth weight. BMD values measured in L2, L3 and L4 were not significantly different, but were 10% lower than in L1 in four of five infants. The spatial resolution of the QCT protocol used (0.4 mm) did not permit the differentiation of trabecular and cortical bone, and the vertebral bodies appeared very homogeneous and dense, with a mean density value of 210 +/- 30 mg Ca/cm3, which is 2.5 times higher than the mean maximum value found in young normal adults. These preliminary results highlight the potential of QCT in neonatology. Special protocols will, however, need to be developed for in vivo measurements in this particular paediatric field.

Absorptiometry, Photon↗
PubMed1996

[New technique of nasal continuous positive pressure in neonatology].

BACKGROUND: Early treatment with nasal continuous positive airway pressure (CPAP) in newborns with respiratory distress syndrome is useful, by recruiting alveoli and restoring the functional residual capacity. POPULATION AND METHODS: Nasal CPAP was supplied by the Infant Flow Driver (Electro Medical Equipment). From 15 June 1994 to 15 December 1994, 42 neonates received nasal CPAP. Their mean birthweight and gestational age were 1511 +/- 411 g and 30.9 +/- 2.5 weeks, respectively. Fifteen infants had been ventilated for hyaline membrane disease and nasal CPAP was applied immediately after extubation. In the other 27 infants, nasal CPAP was given soon after birth (respiratory distress syndrome: 20 neonates; apneic spells: seven neonates). RESULTS: Three infants needed subsequent mechanical ventilation because of the severity of the disease (one had spontaneous pneumothorax); four infants received exogenous surfactant (Curosurf, one single dose) within a brief period of mechanical ventilation (30-45 min). There were no failure of extubation, and no intracranial lesions. Excess of pharyngeal secretion and abdominal distension were common. CONCLUSION: Early treatment with nasal CPAP reduces the need for mechanical ventilation. Furthermore, surfactant therapy required by a moderate to severe disease is possible with a rather short period of artificial ventilation.

Apnea↗
PubMed1996

Incidence of ischemic-hemorrhagic cerebral lesions in premature infants of gestational age < or = 28 weeks: a prospective ultrasound study.

While it is well accepted that the incidence of intraventricular hemorrhage (IVH) increases with decreasing gestational age (GA), the majority of studies report their findings on the basis of birthweight (BW) rather than GA. Over a 5-year period, 199 infants born at or below 28 weeks of gestation were entered into a prospective cranial ultrasound study stratified according to GA. One hundred and five (53%) had normal ultrasound findings. The overall incidence of IVH, as expected, rose with decreasing GA but we were unable to show any clear influence of BW or growth retardation on its occurrence. Incidence of grades I, IIa, IIb and III IVH were 8, 10, 16 and 11%, respectively. Leukomalacia, bleeding in the posterior fossa and in the cerebellum occurred in 4, 7 and 2% of the population, respectively.

Birth Weight↗
PubMed1995

Spontaneous and evoked otoacoustic emissions in pre-term and full-term neonates: is there a clinical application?

In neonates and infants, hearing impairment leads to impaired language and cognitive development. For that reason, early detection of this sensory deficit is of outstanding importance, particularly in pre-term neonates, who constitute a high risk population in regard to very early acquired hearing loss. Evoked (EOAE) and spontaneous otoacoustic emission (SOAE) recording in 93 pre-term and full-term neonates revealed that this technique is potentially useful for auditory screening in neonatology units. EOAEs and SOAEs can be recorded successfully from 30 weeks of conceptional age. SOAEs were found to be prevalent in females and presented higher peak numbers in right than in left ears. Furthermore, SOAE incidence in pre-term and full-term neonates was found to be high in EOAE positive ears, associated with strong and robust EOAEs.

Acoustic Stimulation↗
PubMed1995

Spontaneous otoacoustic emissions in preterm neonates: prevalence and gender effects.

A number of lines of evidence indicate that the human cochlea is fully functional as a mature sound transducer by 6 months of age. However, information about the development of the active cochlear mechanisms and notably the development of outer hair cell (OHC) activity is yet incomplete. Recording and analysis of otoacoustic emissions (OAEs), probably generated by the OHCs of the organ of Corti, have led to a better understanding, in humans, of how sounds are analysed in the cochlea by means of active mechanisms. Evoked OAEs (EOAEs) and spontaneous OAEs (SOAEs), when they can be recorded in full-term and preterm neonates, show different characteristics from those in adults, suggesting that maturation of the peripheral auditory system is incomplete at birth. To learn more about this maturation, using the best-established facts concerning SOAEs in adults, such as their greater prevalence in females and also in right ears, SOAEs were studied in more detail in 81 preterm neonates, from 30 to 40 weeks of conceptional age, all presenting bilateral EOAEs according to objective criteria. The first finding of this study was that SOAEs existed and could be recorded as of 30 weeks of conceptional age in humans. Some SOAE characteristics in preterm neonates, such as prevalence, peak number and acoustic frequencies, showed similarity with full-term neonates. Comparison of other criteria between the two populations, such as greater SOAE prevalence in right ears and higher SOAE peak number in females, suggested that these developmental factors emerge around term in humans. Comparison of SOAE characteristics between male and female preterms suggested that male preterms were less advanced in peripheral auditory development than were female preterms.

Acoustic Stimulation↗
PubMed1994

Preoperative stabilization using high-frequency oscillatory ventilation in the management of congenital diaphragmatic hernia.

OBJECTIVES: a) To assess the efficiency of preoperative stabilization with the use of high-frequency oscillatory ventilation in the treatment of congenital diaphragmatic hernia; b) to determine early prognosis factors. DESIGN: Prospective, consecutive patient study. SETTING: A tertiary neonatal intensive care unit in a university hospital. PATIENTS: All patients admitted to the neonatal intensive care unit with a diagnosis of congenital diaphragmatic hernia between April 1990 and June 1993 (n = 18). INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: Eleven infants had an antenatal diagnosis. Ventilatory settings, blood gas values, arterial-alveolar oxygen ratio, and oxygenation index were recorded on admission and every 3 hrs thereafter until surgery. Surgery was performed if the FIO2 was < 0.3 and mean airway pressure was approximately 9 cm H2O, while the infants were ventilated with high-frequency oscillation. Mean duration of high-frequency oscillatory ventilation was 57 +/- 52 hrs before surgery and 60 +/- 104 hrs after surgery. Overall survival rate was 72%. Infants were divided into two groups, according to the time of surgery. Group 1 (n = 12) patients were operated on in the first 48 hrs of life; on admission, all group 1 patients had an arterial-alveolar oxygen ratio of > or = 0.3 and an oxygenation index of < or = 10, and all recovered. Group 2 (n = 6) consisted of patients for whom preoperative stabilization was difficult to achieve. One infant died before surgery. Four other infants had congenital malformations and subsequently died. Only one infant survived. In this group, the arterial-alveolar oxygen ratio and oxygenation index on admission were 0.08 +/- 0.05 and 33.2 +/- 14.6, respectively (p < .01 vs. group 1). CONCLUSIONS: a) This study demonstrated the efficiency of preoperative stabilization using high-frequency oscillation in the treatment of congenital diaphragmatic hernia. b) An arterial-alveolar oxygen ratio of > or = 0.3 and an oxygenation index of < or = 10 on admission are associated with a rapidly completed surgical procedure and a good outcome.

Female↗
PubMed1994

Red blood cell fatty acid composition in low-birth-weight infants fed either human milk or formula during the first months of life.

The fatty acid composition of red blood cell (RBC) phospholipids in low-birth-weight infants was determined immediately after delivery and during the first 3 months of life. In the first study, infants were fed either human milk or two formulas with different fatty acid compositions but no long chain polyunsaturated fatty acids (LCPUFA). Both groups of formula-fed infants had significantly lower levels of docosahexaenoic acid (DHA) in RBC phospholipids compared with breast-fed infants. RBC phospholipid DHA was similar in the two formula groups at all ages. In the second study, infants received either a non-supplemented or a LCPUFA-supplemented formula. DHA remained stable in RBC phospholipids of infants supplemented with LCPUFA, whereas DHA decreased in RBC phospholipids of unsupplemented infants. These results confirm that adding DHA to formulas is more effective than increasing 18:3 n-3 content, in maintaining RBC phospholipid DHA levels.

Breast Feeding↗
PubMed1994

[Persistence of fetal circulation and high frequency oscillation].

High frequency ventilation (HVF) was used in 17 newborns with severe respiratory distress due to persistent fetal circulation. All patients except one had been treated previously but not satisfactorily by conventional ventilation. Four children died from neurological causes despite respiratory improvement. HVF failed in one case. Twelve newborns recovered without any sequelae. Thus HVF appears to be a most valuable ventilation technique in this situation.

Blood Gas Monitoring, Transcutaneous↗
PubMed1994

[High frequency oscillation ventilation after surfactant use in hyaline membrane disease. Outcome of ventilation parameters].

Surfactant therapy in hyaline membrane disease (HMD) does not suppress all risks of subsequent broncho-pulmonary dysplasia. This study aimed to estimate the efficacy of Surfexo followed by high frequency ventilation (HFV) on respiratory parameters and long term outcome. 47 neonates (44 premature) with HMD received first Surfexo then HFV whenever hypercarbia (pH < 7.25, PaCO2 > 7 kPa) and/or hypoxaemia (PaO2 < 7kPa, FiO2 = 0.5) continued. Surfactant was given at 3 hours of life (mean), HFV was started at 5 h (mean) and continued for 36 h (mean). FiO2 was lowered after a HFV of 3 h (p < 0.01) and mean broncho-tracheal pressure decreased after 12 h (p < 0.001). Six children deceased (1 from massive pulmonary haemorrhage, 5 from neurological complications), 1 developed pneumothorax (this was the only barotraumatic complication in our series), 2 children had a mild broncho-pulmonary dysplasia. All the 38 remaining patients had a good uncomplicated outcome. Thus Surfexo -HFV association appears to be an excellent therapy of HMD in newborns.

Birth Weight↗
PubMed1994

[High frequency ventilation in neonatal surgery].

High frequency oscillatory ventilation (HFOV) is one of the artificial ventilation techniques used for the treatment of severe respiratory distress in the neonatal period. We studied (between 1987 and 1992) 57 newborn infants ventilated by HFOV during surgery. The aim was to facilitate the surgical procedure without having any deleterious effects on the gas exchange or the hemodynamic state of the infant. Three groups were studied. Group I (thoracic procedures: oesophageal atresia and pulmonary malformations, n = 25), group II (diaphragmatic hernia, n = 22), group III (abdominal procedures, n = 10). In the thoracic surgery group, no deleterious effect related to the HFOV was reported. The hyperventilation noticed after anaesthetic induction was rapidly corrected by placing the patient in a lateral position. In the three groups, no intraoperative complications related to the HFOV were observed. The diaphragmatic hernia group was divided into two subgroups according to the timing of surgery (emergency surgery, surgery after stabilization). In the latter subgroup, surgery was performed when the ventilation and gas exchange conditions had significantly improved. This subgroup showed the highest survival rate. This technique of peroperative ventilation is specifically used in the thoracic and diaphragmatic procedures of term and preterm newborn infants. It achieves a more stable operative field with less pulmonary expansions and diaphragmatic movements. In spite of the fact that HFOV is seldom used during anaesthesia, this study confirms its safety as well as the simplicity of its monitoring.

Birth Weight↗
PubMed1994

[Congenital diaphragmatic hernia: results of the association of preoperative stabilization and oscillation ventilation. (A prospective study of 17 patients)].

The authors studied the efficacy of ventilation by high frequency oscillation in preoperative stabilization of 17 newborns with diaphragmatic hernia. This prospective study covered the pre-, intra- and postoperative periods. The preparation to surgery lasted 57 +/- 52 hr. The newborns were operated at 61 +/- 46 hr of life and the duration of postoperative mechanical ventilation was 184 +/- 200 hours. Two groups were differentiated retrospectively. The first group (n = 11) comprises neonates in whom a good preoperative stabilization was obtained and who underwent surgery before 48 hours. In this group all children survived at one month of life (one infant died at six months from cardiac malformation during heart surgery). The second group (n = 6) consists of neonates having required a longer time for stabilization. The operation was performed on the fifth day only. After one month, 5 children survived (one newborn died from intractable hypoxaemia at 5 days of life, surgical cure being impossible; 3 infants died belatedly from associated severe malformations). Predictive factors can be individualized: arteriolar-alveolar ratio, associated abnormalities and particularly these concerning heart, oxygenation index at birth, time required to stabilize the newborn condition. Nevertheless, the association of preoperative stabilization and ventilation by high frequency oscillation appears to improve the prognosis of congenital diaphragmatic hernia.

Birth Weight↗
PubMed1992

[Neonatal gastric necrosis].

BACKGROUND: Neonatal necrotizing gastritis is rare. It is usually a complication of acute anoxia or shock and its diagnosis is essentially radiological. CASE REPORTS: Case no. 1: a boy was born at the 36th week of a pregnancy complicated by preeclampsia. Perinatal asphyxia necessitated delivery by cesarean section. He presented with neonatal respiratory distress which was complicated by pneumothorax. On the 5th day of life, the abdomen was distended and the newborn had still not been fed. On the 6th day, X-rays showed pneumatosis of the gastric wall associated with pneumoperitoneum. Surgery showed an area of necrosis on the posterior surface of the stomach with a small perforation, which was stitched. The child was fed 5 days later and was in good condition at the age of 6 months. Case no. 2: a girl was born at the 35th week of a pregnancy complicated by asthma during the second trimester. Perinatal asphyxia and abnormal fetal rhythm led to delivery by cesarean section. At 24 hour of life, she vomited blood and fibroscopy confirmed the presence of blood in the stomach. On the 3rd day, blood vomiting appeared again, associated with abdominal distension. X-rays showed pneumatosis of the gastric wall; fibroscopy showed necrosis of the lower 2/3 of the stomach. Feeding was stopped and the child was given cimetidine. Refeeding was possible when the girl was 10 days old, and she was in good condition at the age of 6 months. CONCLUSION: Neonatal gastric necroses and necrotizing enterocolitis have many similar features. Medical therapy is often effective, but surgery is mandatory when necrotizing gastritis is complicated by perforation.

Female↗