Bronchopulmonary dysplasia: clinical presentation.
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Biomedical subjects
Publications and source records attributed to E Bancalari.
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Twenty newborn infants (gestational age 30--40 weeks, weight 980--3400 g) were studied in two groups to compare two commercially available systems for continuous in vivo oxygen monitoring: the So2 catheter and the transcutaneous Po2 (TcPo2) electrode, and their respective electronic systems. Measurements from these systems were correlated with determinations made from samples intermittently drawn and measured by conventional So2 and Pao2 in vitro methods , respectively. Information about these two in vivo oxygen monitoring systems was then related to our previous experience with the bare-wire earlobe O2a electrode. Measurements from the two in vivo monitoring techniques studied showed good correlations with their respective in vitro oxygen measurements: So2 catheter, y = x - 3.08, r = 0.98 (range studied 74% to 100%) and transcutaneous electrode, y = 0.98x + 0.57, r = 0.89 (range studied 34 to 92 mm Hg). It was concluded that all three systems give a good reflection of central arterial oxygen (either Sao2 or Pao2)). The system to be used in specific clinical situations should depend on condition of the baby and stage of treatment, need for an umbilical line to measure other variables, equipment available, and training of personnel.
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The case of an infant born in association with a large chorioangioma of the placenta is presented. The maternal complications of polyhydramnios, preeclampsia, and premature labor are those described in the "syndrome" of a chorioangioma. The immediate neonatal course was unusually complicated by severe microangiopathic anemia with persistent thrombocytopenia and hemolysis which required three exchange blood transfusions. The relationship between the neonatal complications and the placental tumor is discussed in terms of possible pathophysiologic mechanisms.
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The effect of aminophylline on lung function was studied in 14 premature infants with apnea (gestational age, 30.2 weeks; birth weight, 1.052 gm). The infants showed compromised pulmonary function with a large difference in alveolar-arterial PO2 gradient (83.9 mm Hg), a low normal lung compliance of 1.1 ml/cm H2O . kg, and a normal inspiratory resistance of 45.3 cm H2O/liter/sec. Aminophylline therapy did not change these functions significantly, but it decreased the incidence of apneic episodes from 29.7 to 4.4 per day. The effectiveness of aminophylline in treating apnea in premature infants must be related to its central stimulating effect and not to an improvement in lung function and oxygenation.
The purpose of this investigation was to determine the value of ventilatory measurements and Apgar score in the diagnosis of respiratory depression in the newborn infant. The following were the results of the determinations made in 24 neonates whose mothers had received meperidine in a total dose up to 3 mg/kg within three hours prior to delivery; Respiratory rate, 51+/-3.7/minute; tidal volume, 21.4 +/- 1.5 ml; minute ventilation, 339 +/- 24 ml/kg X minute; end tidal CO2, 40.8 +/- 1.3 mm Hg; ventilatory response to CO2, 21.8 +/- 2.7 ML/KG X minute X mm Hg PACO2. The mean Apgar score was 7.1 and 9.0 at 1 and 5 minutes, respectively. None of the determinations were indicative of respiratory depression with the exception of the slope of the CO2 response curve; it was considered to be below the normal range. No correlations existed between the CO2 response curve and any other values. It is concluded that meperidine administered to mothers in labor in the described dose will not significantly alter Apgar score, VE, VT, RR, AND PAco2 in the newborn infant. The extent of respiratory center depression could be determined only by the decreased ventilatory response to CO2.
Twenty neonates whose mothers had received meperidine (1.0 to 1.5 mg/kg) intravenously within three hours of delivery were studied to determine the effectiveness of naloxone in reversing neonatal respiratory depression. The following measurements were carried out within 20 to 30 minutes after delivery: minute ventilation, end tidal CO2, and ventilatory response to CO2. These determinations were repeated after administration of either placebo or naloxone, 0.01 mg/kg intramuscularly. Minute ventilation and PAco were within a normal range before medication in both groups, but the slope of the CO2 response curve was decreased, indicating mild-to-moderate respiratory depression. After administration of placebo the test results did not change significantly. After administration of naloxone, VE increased significantly (P less than 0.05) and the slope of the CO2 response curve doubled (P less than 0.001). Naloxone effectively reverses narcotic depression of the respiratory center in the newborn infant.
Respiratory rate, tidal volume, dynamic lung compliance, functional residual capacity, and pulmonary resistance were measured withim 24 hours of cardiac catheterization in 25 infants, 12 of whom had increased pulmonary blood flow and 13 of whom had decreased PBF. There were no differences in the two groups of patients with respect to VT and FRC. Respiratory rate and pulmonary resistance were higher in infants with increased PBF. Lung compliance was significantly lower in infants with increased PBF (4.9 ml/cm H2O) than in those with decreased PBF (8.9 ml/cm H2O) (P less than 0.01). The decrease in CL in infants with increased PBF significantly correlated with mean pulmonary artery pressure (r = 0.798). No correaltion was found between CL and left atrial pressure or magnitude of the left-to-right shunt. Compliance was normal in patients with increased PBF and normal PAP, suggesting that PAP and not PBF is the primary factor that affects CL in patients with intracardiac left-to-right shunts.
This report describes 20 premature infants who have undergone surgical ligation of a patent ductus arteriosus (PDA), diagnosed solely by physical examination in all but 2 instances. There were no operative deaths. Eleven of these 20 infants had severe associated hyaline membrane disease (HMD) necessitating mechanical ventilatory support from the first or second day of life. Only 3 of these 11 infants (27%) ultimately survived to leave the hospital. In contrast, 8 of 9 premature meonates (89%) with severe congestive heart failure but without HMD were discharged alive. Surgical ligation of the PDA in a premature infant is an appropriate and successful mode of treatment when congestive heart failure is refractory to medical management. Proof is lacking, however, to establish the efficacy of PDA ligation in the premature infant with HMD.
Drowning is the third most common cause of death in the pediatric age group in Florida. The clinical presentation, laboratory data, modes of therapy and outcome of 34 cases of near-drowning in children under the age of 14 years were reviewed. The most common clinical findings on admission were a history of cardiopulmonary resuscitation, tachypnea, pulmonary edema, and acidosis. Twenty-eight (82%) patients survived. Twelve (35%) required mechanical ventilation. Of these only six survived, four of them with severe neurological sequelae. Modern management of respiratory failure is important for the ultimate survival of these patients; however, the final neurological outcome seems to be related to brain damage at the time of the asphyxia rather than to subsequent management.
Resuscitation of the newborn is not different from resuscitation of any other patient, but in newborns, resuscitation requires special skills and considerations because of the size of the patient. If properly done, it can save many lives. If done incorrectly, however, it can save many lives. If done incorrectly, however, it can result in death or permanent neurologic damage to the infant. Because it is difficult to predict the status of the infant before birth, any delivery room must have experienced personnel and adequate equipment necessary for the resuscitation of the newborn.
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