Biomedical subjects
Publications and source records attributed to W A Engle.
A newborn had a combination of brachial plexus palsy and phrenic nerve palsy associated with a small left arm, deformed ribs on the left, and an area of subcutaneous calcification on the left side of the neck. These lesions represent a deformation syndrome due to uterine constraint in a bicornuate uterus. Appropriate diagnosis can initiate management to avoid problems in subsequent pregnancies.
Mortality risk indicators may be useful adjuncts to clinical judgment in considering the use of extraordinary and relatively high-risk treatments such as high-frequency ventilation, extracorporeal membrane oxygenation, and nitric oxide therapy. We retrospectively evaluated the reliability of published indications of high mortality, developed additional high-risk indicators, and determined the interval between the time when high-risk indicators were met and when death occurred in near-term and term neonates with respiratory failure. Patients were included in the analysis if they met the following criteria: > or = 35 weeks gestation, > or = 2 kg birth weight, < or = 7 days of age, and receiving a fraction of inspired oxygen of > or = 0.8 and mechanical ventilation. Patients were excluded if they had congenital heart disease, intracranial hemorrhage, untreatable bleeding diathesis, or lethal congenital anomaly. Fifteen patients in the 1980 to 1981 group and 41 patients in the 1985 to 1987 group met these criteria. We observed 100% mortality in our 1980 to 1981 patients who met previously published criteria predictive for > or = 80% mortality in near-term and term neonates with respiratory failure; however, mortality risk was 60% to 80% in the 1985 to 1987 group.(ABSTRACT TRUNCATED AT 250 WORDS)
Patency of the ductus arteriosus is one of the more common problems of the neonate. Although the ductus arteriosus usually closes within the first days of life, persistent patency can complicate the clinical status of a newborn. The ductus arteriosus also may play a role in the pathophysiology of persistent pulmonary hypertension of the newborn and in some forms of congenital heart disease. Diagnosis of patent ductus arteriosus can be suspected clinically but should be verified by echocardiography before treatment. Accurate diagnosis, early intervention and proper treatment are necessary to decrease the immediate risks and minimize the potential for long-term complications.
The objective of this study was to assess the respiratory, neurologic, and developmental status at age 2 years of children treated with extracorporeal membrane oxygenation (ECMO) as neonates. The study population comprised patients treated at a tertiary care neonatal unit and included in a high-risk follow-up program. Eighty-five consecutive patients were treated with ECMO between June 1987 and October 1990, of which 64 (75%) survived. Forty-eight (73%) of the survivors underwent evaluation of growth and respiratory status, neurologic examination, and psychometric testing at ages 1 and 2 years. At age 2 years, 21% of study patients had at least one abnormal growth parameter (weight or length < 5%, head circumference < 2%). Twenty-one percent required respiratory medications and two children had tracheostomies. Six percent had significant abnormalities on neurologic examination. Twenty-five percent scored between 70 and 85 on the mental or psychomotor scales (or both) of the Bayley Scales of Infant Development or the Stanford-Binet, and 12% scored less than 70. Seventy-three percent of children who scored 70 to 85 on one or both subscales of the Bayley Scales of Infant Development or the Stanford-Binet at 2 years had normal scores at 1 year, as did 50% with scores less than 70. Spearman rank analysis suggested a relationship between congenital diaphragmatic hernia, neonatal electroencephalogram, and computed tomography of the head and developmental status at age 2 years (p < 0.05). We conclude that children treated with ECMO are at significant risk for abnormalities in growth and neurodevelopmental and respiratory status at age 2 years, which may not be evident at earlier assessments. This highlights the need for continued follow-up.
OBJECTIVE: The objective of this study was to evaluate the efficacy and safety of high-frequency jet ventilation in near-term and term neonates with persistent pulmonary hypertension. STUDY DESIGN: Subjects for this prospective, randomized, controlled comparison study were recruited from neonates treated in a level-three neonatal intensive care unit that accepts referrals for extracorporeal membrane oxygenation. RESULTS: In patients treated with high-frequency jet ventilation (n = 11) acute improvement in oxygenation (p = 0.008), ventilation (p < 0.001), and oxygen indices (p < or = 0.01) was demonstrated while stable peak and mean airway pressures were maintained. Control group patients receiving high-frequency positive pressure ventilation with a conventional ventilator required increasingly higher peak inspiratory pressures (p = 0.005) to maintain oxygenation, ventilation, and oxygen indices. There were no significant differences in survival without use of extracorporeal membrane oxygenation, nor were there differences in duration of oxygen therapy, ventilation, and hospitalization; need for extracorporeal membrane oxygenation; or incidence of chronic lung disease. CONCLUSIONS: High-frequency jet ventilation acutely improves oxygenation and ventilation without significantly increasing morbidity. Therefore high-frequency jet ventilation may be a useful adjunct for stabilization of the conditions of neonates with severe persistent pulmonary hypertension. Conclusions about the efficacy of high-frequency jet ventilation in improving survival without the need for extracorporeal membrane oxygenation await multicentered, collaborative investigations with large cohorts of patients.
OBJECTIVE: The purpose of this study was to evaluate the impact of exogenous surfactant on the duration of extracorporeal membrane oxygenation needed to support neonates. STUDY DESIGN: Retrospective case review. RESULTS: The duration of extracorporeal membrane oxygenation decreased from 112 +/- 43.3 hours to 76 +/- 17.9 hours. There was no difference in duration of mechanical ventilation, duration of supplemental oxygen, incidence of chronic lung disease, or length of hospital stay. CONCLUSION: Surfactant administered soon after initiation of extracorporeal membrane oxygenation results in a significant reduction in the duration of extracorporeal support for neonates.