Randomized controlled trial of early compared with delayed use of inhaled nitric oxide in newborns with a moderate respiratory failure and pulmonary hypertension.

OBJECTIVE: To evaluate whether early treatment with inhaled nitric oxide (iNO) will prevent newborns with moderate respiratory failure from developing severe hypoxemic respiratory failure (oxygenation index (OI)>or=40). STUDY DESIGN: A total of 56 newborns with moderate respiratory failure (OI between 10 and 30) were randomized before 48 h after birth to early treatment with 20 p.p.m. of iNO (Early iNO group, n=28) or conventional mechanical ventilation with FiO(2) 1.0 (Control group, n=28). Infants received iNO and/or high-frequency oscillatory ventilation (HFOV) if they developed an OI>40. RESULT: 7 of 28 early iNO patients (25%) compared to 17 of 28 control patients (61%) developed an OI>40 (P<0.05). In the Early iNO group mean OI significantly decreased from 22 (baseline) to 19 at 4 h (P<0.05) and remained lower over time: 19 (12 h), 18 (24 h) and 16 at 48 h. In contrast, OI increased in the Control group and remained significantly higher than the Early iNO group during the first 48 h of study: 22 (baseline), 29, 35, 32 and 23 at 4, 12, 24 and 48 h, respectively (P<0.01). Of 17, 6 control patients who developed an OI>40 were successfully treated with iNO. Nine of the remaining eleven control patients and six of seven Early iNO patients who had an OI>40 despite use of iNO responded with the addition of HFOV. One patient of the Early iNO group and two of the Control group died. Median (range) duration of oxygen therapy was significantly shorter in the Early iNO group: 11.5 (5 to 90) days compared to 18 (6 to 142) days of the Control group (P<0.03). CONCLUSION: Early use of iNO in newborns with moderate respiratory failure improves oxygenation and decreases the probability of developing severe hypoxemic respiratory failure.

[Radiofrequency fulguration for supraventricular tachycardia in pediatrics]. / Fulguración por radiofrecuencia de las taquicardias supraventriculares en pediatría.

Supraventricular tachycardias (SVT) are the most frequent cause of tachycardia in children. Its pharmacological treatment has adverse effects, is not curative, and is not always effective. During the last few years radiofrequency ablation (RF-A) has changed the treatment. The purpose of this study is to evaluate our experience in RF-A in children with SVT. Between 1990 and 1995, 92 patients (1 month to 17 years old) underwent electrophysiological study after the diagnosis of SVT. RF-A was attempted in 55 patients with accessory pathways (AP), slow-pathway of the atrioventricular node, or ectopic focus. The site of ablation was decided according to the electrical signals and the catheter position. The success of the RF-A was confirmed by the interruption of the tachycardia, the change in the sequence of activation of the intracardiac signals, the regression of the preexcitation, and the inability to reinduce tachycardia. RF-A was successful in 81% of the patients; 88% in those with a left AP, 56% in those with a right AP, and 100% in those with nodal reentry. Complications were seen in 7% of the patients: 3 with arterial obstruction, one with a minimal pneumothorax, and one with cardiac tamponade. During a follow up of 16.6 months there was no relapse nor late complications. We conclude that RF-A is a safe and effective procedure in pediatric patients with SVT.

[Nonimmune fetal hydrops secondary to fetal tachycardia: their intrauterine diagnosis and treatment]. / Hidrops fetal no immune secundario a taquicardia fetal: diagnóstico y tratamiento intrauterino.

A case of nonimmune hydrops fetalis (NIHF) secondary to fetal supraventricular tachycardia (SVT) diagnosed at 33 weeks gestation is presented. Administration of digoxin to the mother yielded normal fetal heart rhythm and frequency as well as progressive resolution of hydrops after 24 hours of initiation of therapy. Causes of NIHF and diagnostic approach are mentioned. Diagnosis and management of fetal arrhythmias are discussed. The successful perinatal outcome obtained in this case and the literature review, recommend the use of antiarrhythmic drugs therapy in cases of NIHF secondary to SVT.

[Cardiac involvement in Kawasaki disease]. / Compromiso cardíaco en la enfermedad de Kawasaki.

Cardiovascular complications (CVC) of Kawasaki disease (KD) are described in 15 affected children (10 boys, mean age 18.5 months). Clinical records, electrocardiographic tracings (ECG) and bidimensional echocardiograms (BDE) were analysed. In each case the first BDE was done at clinical diagnosis (mean time 10 days from initial symptoms of disease), then at weekly intervals for the first month and each two weeks along the second month. In children showing persistent coronary artery lesions (CAL) BDE was repeated monthly and in patients without CVC at three month intervals. During follow up, no definite clinical evidence of miocardial ischemia was found, but abnormal BDE recordings were obtained from 12/15 patient: CAL in 9/15; right ventricular, left ventricular and aortic enlargement in 3/15. CAL were located at the left coronary artery (LCA) in 3/9 (one LCA aneurysm) and at both coronary arteries in 6/9 (including 3 cases with bilateral aneurysms). All patients were given aspirin and seven were also treated with intravenous gammaglobulin, this last at day 9 (mean) of disease, but 5 of them developed CVC, including 3 cases of CAL.