Transitional hypothermia in preterm newborns.

Hypothermia remains a significant challenge in the initial care of premature infants. Although a number of prevention strategies have been identified, hypothermia is still a common event, especially in extremely low birth weight infants. Using data from four centers, we documented an incidence of hypothermia on admission to the neonatal intensive care unit from the delivery room of 31-78% for infants < 1500 g birth weight. Increased efforts will be necessary to prevent early hypothermia in very preterm infants, especially with respect to the environmental conditions of the delivery room itself. Journal of Perinatology (2007) 27, S45-S47. doi:10.1038/sj.jp.7211842.

PCO2 and room air saturation values in premature infants at risk for bronchopulmonary dysplasia.

OBJECTIVE: To determine the capillary partial pressure of carbon dioxide (PCO(2)) and room air transcutaneous hemoglobin saturation (RA SAT) at 36 weeks' postmenstrual age (PMA) in infants born with weight between 501 and 1250 g. STUDY DESIGN: Multicenter, prospective investigation with primary data collection within 72 h of 36 weeks PMA or discharge, whichever first. PCO(2) and RA SAT determinations were done at rest on infants not requiring mechanical ventilation or nasal continuous positive airway pressure (NCPAP). RESULT: A total of 220 infants were enrolled (mean gestational age 27.7 weeks, mean birthweight 951 g). In infants with traditionally defined chronic lung disease (CLD) compared to those without CLD, the mean PCO(2) was significantly higher (54 versus 45 mm Hg) and the median RA SAT significantly lower (<80 versus 97%). In infants with the new classification of bronchopulmonary dysplasia (BPD), there was a significant linear trend toward increasing PCO(2) with increasing severity of BPD (45, 47, 54 and 62 mm Hg in No, Mild, Moderate and Severe BPD). There was a significant linear trend toward decreasing RA SAT with increasing severity of BPD (97, 95 <80, <80% in No, Mild, Moderate and Severe BPD). CONCLUSION: Defining CLD as BPD based upon a RA SAT test is a more discriminate, objective method to categorize lung injury. PCO(2) is an objective measure of lung function that inversely correlates with RA SAT. These determinations done together at 36 weeks PMA may provide more precise and accurate estimates of lung injury that might allow for better understanding of pulmonary therapies and clearer comparison of BPD rates and severities among NICUs.

Transitional hypothermia in preterm newborns.

Hypothermia remains a significant challenge in the initial care of premature infants. Although a number of prevention strategies have been identified, hypothermia is still a common event, especially in extremely low birth weight infants. Using data from four centers, we documented an incidence of hypothermia on admission to the neonatal intensive care unit from the delivery room of 31-78% for infants <1500 g birth weight. Increased efforts will be necessary to prevent early hypothermia in very preterm infants, especially with respect to the environmental conditions of the delivery room itself.

Maternal and infant transport program in Louisiana.

The concept of maternal transport has evolved from that of neonatal transport as part of a regionalized perinatal care system. Experience has suggested that perinatal outcome for infants transported before delivery is improved over that for infants transported neonatally. This report describes the initial 2 years' experience of the first such program in Louisiana. When compared with infants transported after delivery, those transported before delivery had a slightly better corrected survival rate (90 versus 87%) and a shorter average stay in the neonatal intensive care unit (11.8 versus 21.4 days), but the differences were not statistically significant as measured by the chi2 test.

Substance P and gastrin releasing peptide in bovine mesenteric lymphatic vessels: chemical characterization and action.

Alcoholic extracts of bovine mesenteric lymphatic vessels were assayed for the presence of SP, GRP, VIP, PHI, GIP and NT using specific radioimmunoassays. SP and GRP immunoreactivities were detected at concentrations of 190 +/- 20 and 1,000 +/- 130 pg.g-1, respectively. No significant levels of immunoreactivity were detected for any of the other peptides. SP and GRP immunoreactivities coeluted with their synthetic counterparts from both Sephadex G-50 and reversed phase HPLC columns. Synthetic SP (10(-9)-10(-7) M) and the naturally occurring analogue of GRP, bombesin (10(-9)-10(-7) M), increased spontaneous contraction rate in isolated vessel segments. This excitatory effect was not blocked by the alpha-adrenoceptor antagonist phentolamine (3 x 10(-6) M).

Improving survival in the treatment of congenital diaphragmatic hernia.

Thirty-two infants were treated for congenital diaphragmatic hernia at our institution from 1979 to 1984. Eight were in no or minimal distress at birth and had operative intervention when they were more than 24 hours old; survival was 100%. The remaining 24 neonates required immediate intubation and ventilation followed by operation at less than 12 hours of age. Overall survival was 54%; survival was 31% (4 of 13 patients, Group 1) in the first three years of the series and 82% (9 of 11 patients, Group 2) in the last three years (p less than 0.001). Apgar score, gestational age, birth weight, and incidence of associated congenital heart disease were equal for the two groups (all, p greater than 0.05). The two groups also were examined with reference to alveolar-arterial oxygen differences P(A-a)O2 and mean airway pressure (MAP). The best preoperative P(A-a)O2 was greater than 600 mm Hg for 7 neonates in Group 1 and 6 in Group 2, and survival was 0% and 71%, respectively (p less than 0.001). Infants with a postoperative MAP of 13 cm H2O or greater had a higher mortality (100% in Group 1 and 50% in Group 2, p greater than 0.05). Our treatment protocol was studied to determine those methods related to improved survival. Sodium bicarbonate infusion was used earlier in Group 2 as a prophylaxis against persistent fetal circulation (PFC) (p greater than 0.05). The incidence of severe PFC dropped from 85 to 54% (p greater than 0.05). Higher ventilator rates rather than pressures were used to achieve equally effective ventilation.(ABSTRACT TRUNCATED AT 250 WORDS)

New ways to ventilate newborns in acute respiratory failure.

Out treatment options for acute neonatal failure have expanded greatly in the last 20 to 30 years. This article reviews patient-triggered ventilation, high frequency ventilation, negative extrathoracic pressure ventilation, nitric oxide therapy, liquid ventilation, extracorporeal membrane oxygenation, and advances in pulmonary function monitoring. The authors present background theories, describe equipment, review clinical strategies, and the results of recent trials.

Hafnia alvei septicemia in an infant with necrotizing enterocolitis.

Hafnia alvei is an infrequently reported pathogen in children, and its isolation in a newborn is even more unusual. This organism is rarely associated with invasive disease. This article reports the first case of a neonate with necrotizing enterocolitis and subsequent ileal perforation who had H. alvei isolated from both blood and stool.

Nonimmune hydrops fetalis associated with intrauterine intussusception.

Intrauterine intussusception has been implicated as a potential cause of intestinal atresia but has not been associated previously with nonimmune hydrops fetalis. We report a patient with a significant family history of intussuception who had intrauterine intussusception associated with nonimmune hydrops fetalis.

Resuscitation of a micropremie: the case of MacDonald v. Milleville.

One of the most unsettling experiences for a neonatologist is having an early gestational-age infant for whom resuscitation has been abandoned or not initiated subsequently begin breathing on his own. That was the experience of Gregory Milleville, MD when at 2:30 AM a nurse brought such an infant with a heart rate of 130 and a temperature of 91.2 degrees F to the neonatal intensive care unit (NICU).

Ventilatory management casebook. Congenital diaphragmatic hernia meeting criteria for extracorporeal membrane oxygenation.

Respiratory distress in newborns with CDH is the result of the interaction of pulmonary hypertension and pulmonary hypoplasia. Many patients will demonstrate adequate pulmonary parenchyma after repair as evidenced by adequate oxygenation and ventilation. Patients should be classified into groups of predicted mortality using Bohn's criteria. Patients in groups A, B, and D may be managed conventionally if blood gases can be kept in the normal range. These patients should be supported with ECMO if unresponsive to conventional management. In those patients with adequate gas exchange who fall into the C group, transfer to an ECMO center should be undertaken early, since mortality with continued conventional management is predictable. Some patients never demonstrate a "honeymoon" period, and mortality can be reliably predicted in this group as well by using Bohn's criteria. Because the relative significance of pulmonary hypoplasia compared with pulmonary hypertension in an individual patient cannot be reliably determined, any patient who has respiratory failure after repair of CDH should be supported with ECMO when conventional techniques fail as long as no contraindications exist. At least one institution will withhold ECMO therapy if lung parenchyma is judged inadequate as predicted by the inability to achieve a preductal PaO2 greater than 100 mm Hg and PaCO2 less than 50 mm Hg with maximal conventional therapy. In our experience, however, some patients can survive with ECMO support when all other indicators would suggest hypoplasia incompatible with life. Therefore, we do not believe any patient should be refused ECMO support when conventional measures fail.(ABSTRACT TRUNCATED AT 250 WORDS)

Intact survival and 20-month follow-up of a 380-gram infant.

Intact survival of infants delivered before completion of the 26th week of gestation or weighing less than 500 g is a well-known phenomenon. We recently cared for an infant whose birthweight was 380 g, making her the second smallest survivor in the United States. Her hospitalization (including expenses) and 20-month (corrected) follow-up are presented along with a discussion of the implications involved in the care of such an infant.

Controversies in neonatal resuscitation.

In the delivery room, pediatricians are frequently required to make immediate decisions about resuscitating infants. Is the baby too small, too immature, or too asphyxiated to be revived? To achieve the best outcome, resuscitation once initiated, must be performed expeditiously, safely, and with the utmost diligence. Not all the tools and medications have undergone the intense scrutiny that might otherwise be assumed. In this article, resuscitation topics are discussed and recommendation offered.

Ethical decisions in the delivery room.

Avoidance of futile therapies that only prolong suffering and the high emotional and economic cost to family and society justifies an attempted differentiation of infants whose defects are so extensive or whose prognoses are so poor that CPR should be withheld. This article discusses the ethical bases for decision making in the DR and the three most common diagnoses in which CPR decisions are most difficult: infants with severe congenital defects, extremely low birthweight infants, and infants with severe perinatal asphyxia.

Hospital care techniques resulting in intact survival of a 380-g infant.

Intact survival of infants delivered before completion of the 26th week of gestation or weighing less than 500 g is a well known phenomenon. We recently cared for an infant whose birth weight was 380 g, making her one of the smallest survivors in the United States. Her hospitalization (including expenses), the techniques of our minimal intervention protocol and her 20-month (corrected) follow-up are presented together with a discussion of the moral, economic and social implications involved in the care of such an infant.

Echoencephalographic findings of Apert syndrome.

Although Apert syndrome has been characterized in the prenatal period and clinically described in the literature, postnatal echoencephalographic findings have not been reported. We present a case of Apert syndrome that shows bilateral periventricular cysts, unusual posterior downward curving of the lateral ventricles without evidence of hydrocephalus, along with a decreased anterior-posterior diameter of the cranial vault. Given that Apert syndrome, characterized by acrocephalosyndactyly, can give rise to numerous CNS abnormalities, echoencephalography could be used to further characterize Apert syndrome in the postnatal period.