Biomedical subjects
R Sosulski
Publications and source records attributed to R Sosulski.
Early pulmonary interstitial emphysema in the newborn: a grave prognostic sign.
Chest radiographs and clinical records of 58 newborns with pulmonary interstitial emphysema (PIE) were reviewed to determine the diagnostic and prognostic significance of this finding in the first 24 hours of life. Thirty-nine infants developed PIE before 1 day of age (early PIE). In the absence of infection, early PIE was associated with younger gestational age, lower birth weight, lower 1 and 5 minute Apgar scores, and higher mortality, as compared with patients in whom air leak occurred later. Survival in infants with PIE seemed to be influenced mainly by coexisting risk factors such as extreme prematurity, birth asphyxia, and perinatal infection. Most cases of early PIE in newborns less than 30 weeks gestational age occurred at peak ventilation pressures less than 25 cm H2O, and probably reflect increased sensitivity of the underdeveloped lung to barotrauma. In infants older than 30 weeks gestational age, early PIE was strongly associated with bacterial sepsis. These data indicate that the occurrence of PIE in the first 24 hours of life is a particularly ominous sign, and is frequently associated with clinical conditions which carry a poor prognosis.
Persistent pulmonary abnormalities in newborns: the changing picture of bronchopulmonary dysplasia.
Significant changes in the radiographic features of bronchopulmonary dysplasia (BPD) have accompanied recent advances in treatment of neonatal respiratory distress syndrome. Retrospective study of 709 newborns showed atypical radiographic findings in many patients with clinical BPD. While 12/20 infants with clinical BPD showed changes identical to Northway's stage 4 disease, the remaining 8 (40% of patients with significant respiratory dysfunction) had diffuse, fine infiltrates without emphysema. Radiographic progression from RDS through all Northway stages was observed in only 4 patients. Diagnosis of stage 2 BPD was complicated by the presence of PDA in 9/17 cases. Stage 3 BPD was identified with certainty in only 5 infants, but may have coexisted with PIE in as many as 22 cases. Nevertheless, there was close agreement between the radiographic findings and clinical severity of chronic lung disease. Mild (type 1) infiltrates following RDS may be distinguished from chronic pulmonary insufficiency of prematurity (CPIP) or "immature lung." In patients who require only short-term supplemental O2, type 1 changes may reflect delayed resolution of RDS in an underdeveloped lung. These same findings in infants with prolonged O2 dependence usually indicate a mild form of BPD. Coarse infiltrates and emphysema (type 2) are almost always associated with severe respiratory impairment.
Transition phase during hyperventilation therapy for persistent pulmonary hypertension of the neonate.
It is important for the clinician who is hyperventilating infants with persistent pulmonary hypertension (PPHN) to recognize a transition phase during therapy when pulmonary hypertension is no longer the primary cause of hypoxemia, because infants who are hyperventilated develop parenchymal lung disease after 2 to 3 days. This study reports ten infants who showed PaO2 lability early in the course of PPHN, with an inverse relationship between PaO2 and PaCO2. At a mean age of 79 +/- 14 (SEM) there was a transition phase, after which PaO2 lability decreased and the infants did not require hyperventilation. The mean change in PaO2 per change in PaCO2 was significantly (p less than .05) higher pretransition (22.4 +/- 5.2) compared to during transition (5.1 +/- 1.4) or post-transition (1.9 +/- 1.2). Mean alveolar-arterial oxygen gradient was higher (p less than .05) pretransition (495 +/- 36) vs. post-transition (405 +/- 52) and was more labile relative to PaCO2 change pretransition (20.3 +/- 5.9) compared to post-transition (.3 +/- 2.4). When ventilator settings were reduced after the transition phase, PaCO2 rose by 12.2 torr.
Respiratory water loss and heat balance in intubated infants receiving humidified air.
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Fluid, electrolyte, and glucose maintenance in the very low birth weight infant.
The low birth weight premature newborn, less than 1000 gm, represents a difficult problem in the management of parenteral fluid, electrolyte, and glucose maintenance. To assess this problem, six infants (mean weight 720 gm, range 575-835 gm; mean gestation 26.5 +/- 0.4 SEM wk) nursed under radiant warmers were evaluated during the first three days of life to determine volume of fluid intake, sodium and dextrose intakes, and urine output. Insensible water loss (IWL) was measured on a metabolic scale. In accordance with current recommendations, infant received fluid volumes of 111 +/- 10, 152 +/- 16, and 191 +/- 27 ml/kg/day on days 1, 2, and 3, respectively. Sodium intake (usually as 0.2% saline) ranges 0-8.5 mEq/kg/day. Dextrose infusions (as 10% solution) ran from 3.3 to 13.7 mg/kg/min. Insensible water loss measured 159 +/- 15 ml/kg/day. Despite increasing fluid intake, serum sodium concentration increased from 141 +/- 3 mEq/l on day 1 to 155 +/- 7 mEq/l on day 3 (p less than 0.05). None of the infants became oliguric and only two urine specimens had specific gravity greater than 1.015. These data demonstrate a larger insensible water loss than reported previously in small infants, but increasing the administration of standard 10% dextrose and 0.2% saline solution to balance insensible losses may result in sodium and glucose overload. Recommendations are made for adjusting parenteral fluid therapy for birth weight groups 600-800, 801-1000, 1001-1500, and 1501-2000 grams and for environmental conditions or radiant warmer or incubator, with or without plastic shielding or phototherapy.
Physiologic effects of terbutaline on pulmonary function of infants with bronchopulmonary dysplasia.
This study defines the physiologic changes in pulmonary mechanics induced by subcutaneous terbutaline administration in ventilator-dependent infants with severe bronchopulmonary dysplasia (BPD). Eight such infants (mean +/- SEM weight = 2.56 +/- 0.32 kg, postnatal age = 13.0 +/- 3.2 weeks) were chosen for the study. Pulmonary mechanics and arterial blood gases were measured in the control state and at 30 and 60 minutes following the subcutaneous injection of 5 micrograms/kg terbutaline. There was a significant (p less than 0.001) improvement in lung compliance from baseline values at 30 minutes and at 60 minutes (38%). A significant (p less than 0.05) decrease of 23% in the average pulmonary resistance at 30 minutes and a 26% decrease at 60 minutes from control values were observed. An increase in the I/E ratio occurred in all patients at 60 minutes (p less than 0.01). In addition, clinical improvement was noted in six of eight infants. Administration of terbutaline demonstrated a significant improvement in the pulmonary mechanics of infants with severe BPD.