Diagnosis of pneumothorax or pneumomediastinum in the neonate by transillumination.

Transillumination of the neonatal chest is described as an aid in the diagnosis of pneumothorax or pneumomediastinum. Sudden severe tension pneumothorax or pneumomediastinum can be localized for immediate treatment and the success of therapy can be immediately assessed using transillumination.

Fiberoptic transillumination: a new tool for the pediatric surgeon.

Transillumination (TI) is a safe and reliable technique for evaluating masses or the presence of free air in the thorax or abdomen. TI can also be of help in the accurate placement of catheters or needles in the chest, abdomen, bladder, or vessels. Its use in several hundred cases has been documented by this report.

Functional residual capacity and severity of respiratory distress syndrome in infants.

Infants with respiratory distress syndrome (RDS) have insufficient surfactant systems and decreased functional residual capacity (FRC). This study attempts to relate FRC with severity of disease course. Measurements were made on 36 newborn infants with clinically diagnosed RDS. All infants were intubated and breathing on continuous positive airway pressure (CPAP) at the time studied. Infant CPAP levels were adjusted to 10 cm H2O; then FRC and arterial blood gas measurements were made. The infants were grouped according to their FRC per birth weight (BW). Volumes larger than or equal to 2 SD (larger than or equal to 42 ml/kg) of normal term infants not on CPAP were placed in the "large FRC" group. Volumes within +/- 2 SD (15-41 ml/kg) were in the "medium FRC: group, and infants smaller than or equal to 2 SD (< 14 ml/kg) of normal were in the "small FRC" group. The severity of RDS disease course was judged by the time duration the infants were managed on CPAP and FIO2 > 0.21 and by the maximum CPAP and FIO2 levels used. Twelve infants (33%) had small FRC, 18 (50%) medium FRC, and 6 (17%) large FRC. The time duration the infants with large FRC were on CPAP was significantly less than infants with medium FRC and the medium FRC group time was less than the small FRC group. The time duration on increased FIO2 and maximum FIO2 level used on the large FRC group was less than the medium and small FRC groups. Thus, FRC/BW appears related to the severity of RDS disease course. It is possible that the infants with FRC/BW larger than or equal to 42 ml/kg had pneumonia and were misdiagnosed as RDS. If so, FRC monitoring could have assisted in their diagnosis. BW and gestational ages of the groups were not different. Thus, variables other than these two play an important role in the degree of atelectasis occurring in infants with RDS. In patient management, where frequent changes in airway pressure and FIO2 are made, knowing the FRC/BW as well as blood gas values could aid the clinician in his choice of CPAP and FIO2 levels.

Defective oxidative metabolic responses of neutrophils from stressed neonates.

Oxidative metabolic responses of polymorphonuclear leukocytes were assessed in 24 stressed neonates and 22 well, term infants utilizing particulate and soluble stimuli. Stressed neonatal PMNs demonstrated a depressed CL response to zymosan, whereas O2- production for both normal and stressed PMNs of neonates was significantly elevated compared to that in PMNs from adults. These results were not ascribable to phagocytosis since it was comparable in all groups using radiolabeled bacteria. Stressed neonates' PMN responses to soluble stimuli were significantly elevated when compared with those from well neonate and adult controls. Enhanced responses were most prominent in the most severely stressed infants. Treatment of neonates' PMNs with the antioxidants vitamin E and DHB partially corrected the abnormalities, suggesting peroxidative damage to the PMN membrane had occurred. The oxidative metabolic abnormalities of neonates' PMNs are consistent with either a defect in HMPS activity, a defect in functioning of the later portions of the respiratory burst, or a stimulus-specific abnormality in respiratory burst activity.

A computerized single entry system for recording and reporting data on high-risk newborn infants.

A computer-assisted system for data collection in an intensive care nursery is described. Maternal history, infant history, diagnoses, and treatment are sequentially identified on a single form and then entered in batches into a computer at the time of patient discharge. Computer production of a discharge summary and letters to referring and follow-up physicians from a single data-entry form account for an approximately 80% savings in physician record-keeping time per patient. Accuracy of the data is approximately two and one-half times greater than with existing methods of data gathering. Survey of disease occurrence and case fatality rates are rapidly available.