RESUMO
OBJECTIVE: The aim of our study was to determine the impact of treatment with exogenous surfactant (ES) and high frequency oscillatory ventilation (HFOV) on the radiological appearance and clinical course of hyaline membrane disease (HMD) in new-born infants. MATERIALS AND METHODS: New-born infants (18) (median weight, 1010 g) with severe HMD (stages 3.5 and 4) who were treated with ES and HFOV were matched by birth weight and severity of disease with 18 new-born infants treated with ES and conventional mechanical ventilation (CV). Chest radiograms taken on days 1, 2/3, 4/5, 7, 14 and 28 were analyzed to check for the severity of generalized parenchymal opacities (GPO), local opacifications, pulmonary interstitial emphysema (PIE), gross air leak, general and localized overinflation, bronchopulmonary dysplasia (BPD) and clinical variables such as survival rates, duration of mechanical ventilation, mean airway pressure and inspired oxygen concentration. RESULTS: At 4 weeks of age, new-born infants treated by HFOV had less severe GPO (median degree 1.5 vs. 3), less PIE (1 vs. 7 patients) and fewer signs of BPD (median BPD degree 1.5 vs. 2.6). The incidence of pneumothorax and of local opacifications were similar in both groups. New-born infants on HFOV had a lower mortality rate (5 vs. 13), needed fewer days of mechanical ventilation (median 15 vs. 23 days) and lower inspiratory oxygen concentrations (median FiO2 0.38 vs. 0.64). CONCLUSION: In new-born infants with HMD, treatment with ES and HFOV resulted in a favourable radiological and clinical outcome as compared to treatment with ES and CV.
Assuntos
Ventilação de Alta Frequência , Doença da Membrana Hialina/diagnóstico por imagem , Doença da Membrana Hialina/terapia , Fosforilcolina , Surfactantes Pulmonares/uso terapêutico , Respiração Artificial , Displasia Broncopulmonar/diagnóstico por imagem , Estudos de Casos e Controles , Combinação de Medicamentos , Álcoois Graxos/uso terapêutico , Feminino , Humanos , Doença da Membrana Hialina/mortalidade , Recém-Nascido , Pulmão/diagnóstico por imagem , Masculino , Polietilenoglicóis/uso terapêutico , Radiografia , Taxa de Sobrevida , Resultado do TratamentoRESUMO
An infant presented with prenatal marked fetal cardiac arrhythmia, not related to labour, and had intracardiac tumours. The association of cardiac tumours with tuberous sclerosis (Bourneville-Pringle disease) is described, using ultrasonic, radiological and electrocardiographic data, and reviewing the literature.