Surgical management of neonatal interstitial emphysema.

In the past 6 years, 50 patients with interstitial emphysema in our newborn nursery were treated with open operative procedures to remove interstitial air. Thirty-one were critically ill newborns with severe progressive pulmonary interstitial emphysema treated with pleurotomies. Five underwent pleurotomies on both sides, for a total of 36 operations in the 31 patients. All of the 31 patients underwent aggressive medical management to reduce airway pressure before resorting to operation. Ventilator manipulations, selective bronchial intubation, Forgerty catheter occlusion of the bronchus, and percutaneous lung needling were among the methods used to reduce emphysema in these patients. The operation for all 31 patients consisted of multiple linear pleurotomies to lyse blebs. The hilum was skeletonized to release perihilar blebs. A downhill course was reversed by the operation in over 50% of patients. The operation almost always permanently cured the tension emphysema on that side. Seventeen of the 31 patients lived. Eight of ten patients with unilateral disease lived. All of those patients who died had either very low birth weight, severe preoperative hypoxia, shock, or a combination of these problems.

Pancreaticobiliary common channel associated with common duct stricture.

The etiology of diffuse or cystic dilatation of the common bile duct is still uncertain. Several authors have reported a long common pancreaticobiliary channel in association with a choledochal cyst. We report a similar case of a two-year-old female in which ERCP identified a common duct stricture. The common channel anomaly was seen by intraoperative cholangiography.

Indomethacin versus immediate ligation in the treatment of 82 newborns with patent ductus arteriosus.

In the past 10 years, echocardiography and prostaglandin inhibition have changed the management of the patent ductus arteriosus (PDA) in newborns with respiratory distress syndrome (RDS). To judge the results of our present management for morbidity and survival, we analyzed data retrospectively on 82 newborns who were treated from 1977 to 1983 for PDA. We compared their hospital courses and outcomes with a similar group of 45 infants reported by us 10 years ago who were treated by early ductal ligation. The 82 recent patients were divided into two groups, A and B. Group A, 62 consecutive newborns with PDA, was treated primarily with indomethacin. A subsequent group of 20 newborns was treated for PDA primarily with early ductal ligation, group B. There was a 67.8% survival in group A versus 66.7% in the original group of patients 10 years ago--no significant improvement in survival in recent patients using indomethacin. Group B, with early ductal ligation similar to the original patients, had a survival rate of 75%. We identified a group of high-risk infants under 1500 grams with severe RDS whose prognoses varied significantly, depending on the treatment. In the original patients 10 years ago, 41.2% of newborns under 1500 grams with severe RDS survived; 33.3% survived in group A whereas, 71.4% survived in group B. In this high-risk group, treatment for PDA with indomethacin had the worst prognosis, and treatment with ductal ligation combined with modern supportive measures had the best prognosis.

Unilateral pulmonary interstitial emphysema: a surgical approach to treatment.

Pulmonary interstitial emphysema is a condition that has become a significant problem chiefly as a complication of mechanical ventilation of the newborn. In its severe forms, it may compromise ventilation and restrict pulmonary blood flow to the degree that it becomes a significant cause of mortality. When its occurrence is unilateral, or predominantly so, it becomes more amenable to therapy. A number of different approaches have been described, especially for milder forms of the disease, but none has proved entirely satisfactory. A surgical approach has been used in four patients with severe unilateral pulmonary interstitial emphysema complicating ventilator therapy for hyaline membrane disease. The technique was successful in three of the four infants. The technique was successful in three of the for infants. An illustrative case is described, as well as the selective criteria for application of the technique.