Discharge outcomes of extremely low birth weight infants with spontaneous intestinal perforations.

OBJECTIVE: To examine discharge outcomes of extremely low birth weight infants (ELBW) with spontaneous intestinal perforation (SIP). STUDY DESIGN: A single-center retrospective cohort study of all ELBW infants admitted to the University of Virginia neonatal intensive care unit between July 1996 and June 2004. RESULTS: We found 35 patients with SIP (incidence 8.4%). The median gestational age was 25 weeks, median birth weight was 722 g, and 71% of the infants were male. Most infants (n=28) with SIP were diagnosed secondary to pneumoperitoneum; however, one-third (7) of infants<25 weeks had occult presentations without pneumoperitoneum. When controlled for gestational age, gender, multiple gestation, indomethacin, and glucocorticoid exposure, infants with SIP have a higher risk of PVL and death than infants without perforation. SUMMARY: Periventricular leukomalacia and death are significantly associated with SIP in ELBW after adjusting for gestational age, multiple gestation, indomethacin, and glucocorticoid exposure.

Cutaneous sparganosis.

Sparganosis is an infection caused by migrating larvae of the cestode genus Spirometra. There have been approximately 62 cases of sparganosis reported in the United States. Although a subcutaneous mass is the most common manifestation, sparganosis is not well-described in the dermatology literature. We present a case of cutaneous sparganosis in a 52-year-old Filipino American woman. Histologically, the sections showed a granulomatous panniculitis and dermatitis containing a section of a sparganum. A transverse section of an intact sparganum reveals an eosinophilic cuticle, loose stroma, calcareous bodies, and smooth muscle fibers.

Persistent pulmonary hypertension of the newborn. An update.

PPHN remains a perplexing and frustrating disorder for primary care physicians and neonatologists. The diagnosis is difficult and the optimal management controversial. ECMO has become a lifesaving technological advance for infants who do not respond to conventional medical management, and neurodevelopmental outcome of infants treated with ECMO has been favorable. The most recent therapy with potential usefulness is inhaled nitric oxide which allows local vasodilator effects without unwanted systemic effects. Inhaled nitric oxide therapy for PPHN is still in the clinical trial phase and results of these trials will direct future use.

Neurodevelopmental outcome in neonates after extracorporeal membrane oxygenation: cranial magnetic resonance imaging and ultrasonography correlation.

Irreversible ligation of the right common carotid artery and right internal jugular vein is usual in venoarterial extracorporeal membrane oxygenation (ECMO) for treatment of severe respiratory failure in neonates. Vessel ligation with ECMO may magnify risks of cerebral hemorrhage or infarction (CHI) and adversely affect neurodevelopmental outcome. To correlate CHI after ECMO with neurodevelopmental outcome, we reviewed cranial ultrasonography (US) and magnetic resonance imaging (MRI) scans in 22 consecutive neonatal ECMO survivors and compared these with results of Bayley Scales of Infant Development obtained at 3, 6, 12, and 24 months of follow-up. All patients had US, and 19 had MRI. No US or MRI had focal abnormal findings attributable to ECMO; specifically, there was no evidence of CHI. Two infants had generalized cerebral atrophy, and one of these had an abnormal Bayley examination. One infant with a normal MRI had a single right focal seizure 4 days after ECMO. Of 20 infants with Bayley developmental tests at 3 to 30 months of age (mental index range, 72 to 135; motor index range, 71 to 150), only 3 were abnormal. In our experience, the incidence of CHI secondary to ECMO is less than that reported. After ECMO, the absence of intracranial hemorrhage, cerebral infarct, or cerebral atrophy on US or MRI usually correlates with normal short-term neurodevelopmental outcome.

Early hemodynamic indicators of gram-negative sepsis and shock in an infant pig model.

To assess the hemodynamics of early shock and to determine to what extent hemodynamic indicators of sepsis and shock can be predictive, we evaluated data from several series of experiments (including 136 piglets) in which animals were subjected to fecal-Escherichia coli peritonitis-induced septic shock. Serial measurements of 39 parameters were obtained and their values taken at baseline, at hyperdynamic sepsis, and at shock were compared by analysis of variance. Piglet weights ranged from 1.2 to 7 kg (mean, 3.5) and ages ranged from 5 to 29 days (mean, 15). Of the 39 parameters assessed, 9 (CO*, CI*, SVI*, LVSWI*, SVR*, a-vDO2, VO2, O2 delivery*, and CaO2*) proved valuable as indicators of sepsis and shock. Of these parameters, seven (*) can be measured or calculated by noninvasive techniques and easily can be determined in human neonates. Serial determinations of these hemodynamics in high-risk neonates may be able to accurately predict gram-negative sepsis and shock before these entities are otherwise clinically apparent.

Decreasing blood donor exposure in neonates on extracorporeal membrane oxygenation.

Extracorporeal membrane oxygenation (ECMO) has been successful treatment (80% survival) in over 2,000 neonates with severe respiratory failure (80% predicted mortality without ECMO). Neonates on ECMO require frequent blood product replacement, which increases donor exposure (DE) and the risk of transfusion related complications. Successful, widespread usage of ECMO in neonatal respiratory failure is placing increased numbers of surviving infants at risk for acute and long-term transfusion related problems. We assessed DE rates in 21 consecutive neonatal ECMO survivors. In the first 12 patients packed red blood cell (PRBC) transfusions were administered as 10 mL/kg body weight for hematocrit less than 45%. PRBC exchange transfusions were used in patients with hematocrit less than 45% and hypervolemia. Fresh frozen plasma (FFP) and cryoprecipitate (CRYO) infusions were used empirically for evidence of hemorrhage. DE rates (donors per ECMO day, mean +/- SD) were: PRBC (2.8 +/- 0.6), FFP/CRYO (0.5 +/- 0.7), and platelet (2.0 +/- 1.0), with a total donor exposure rate of 5.3 +/- 2.0 donors per ECMO day. Mean duration of ECMO was 4.6 +/- 2.0 days and total DE per infant was 22.8 +/- 9.5 donors per ECMO run. In a protocol (n = 9) to minimize DE risks, exchange transfusions were eliminated and PRBC transfusion volumes were increased to 15 mL/kg. Empiric use of FFP and CRYO was discontinued. The blood bank divided standard units of PRBCs into four aliquots and dispensed each aliquot sequentially before dispensing blood from another unit.(ABSTRACT TRUNCATED AT 250 WORDS)

Hypocalcemia complicating deferoxamine therapy in an infant with parenteral nutrition-associated aluminum overload: evidence for a role of aluminum in the bone disease of infants.

Aluminum (Al) contaminates total parenteral nutrition (TPN) solutions given to infants, and high levels of Al have been demonstrated in their bone, serum, and urine. However, it is uncertain whether Al at current levels of contamination of TPN solutions is harmful to bone. We report an 8-month-old infant who developed osteopenic bone disease while receiving TPN, which did not respond to large amounts of calcium, phosphate, and vitamin D2. Serum and urine Al levels were greatly elevated and fell after a short course of deferoxamine. However, shortly after treatment began, serum calcium levels fell in the absence of hypercalciuria. We postulate that chelation of Al from this patient's bone permitted increased bone calcium uptake. This would suggest that Al at current levels of contamination of TPN solutions may impair bone calcium uptake and thus contribute to the pathogenesis or exacerbation of TPN-related osteopenia.