Impaired lung function after intubation and mechanical ventilation for surgical ligation of the ductus arteriosus in preterm infants.

OBJECTIVE: Significant patent ductus arteriosus (PDA) in the preterm infant has been associated with pulmonary edema and impaired gas exchange. Therefore, surgical ligature of the DA may be required. However, the effects of intubation and mechanical ventilation on the PDA-induced lung dysfunction presently are unknown. The aim of the study was to investigate whether intubation and mechanical ventilation alter pulmonary function in the preterm infant with significant PDA. DESIGN: A prospective study. SETTING: The neonatal intensive care unit and department of anesthesiology in a university hospital. PARTICIPANTS: Preterm infants <32 weeks' gestational age treated with nasal continuous positive airway pressure (NCPAP) and requiring mechanical ventilation for undergoing surgical DA ligature. INTERVENTIONS: Respiratory, Doppler echocardiographic parameters, and chest x-ray transparencies of the lungs were measured during NCPAP and 2 hours after intubation and starting mechanical ventilation. MEASUREMENTS AND MAIN RESULTS: Twenty preterm infants (gestational age = 27 ± 1 wk, birth weight = 950 ± 140 g) were included. Heart rate, O(2) need, PaCO(2), and plasma lactate concentrations were significantly higher after intubation. The mean oxygenation index increased from 1.5 ± 0.6 to 7.2 ± 3 (p < 0.05). The overall transparencies of the lungs decreased after intubation. DA diameter, shortening fraction of the left ventricle, left pulmonary artery blood flow velocities, and left atrium/aorta did not change. CONCLUSION: In preterm infants with significant PDA, intubation and mechanical ventilation before surgical DA ligation may increase the O(2) need and PaCO(2) and may promote lung edema formation. Mechanical ventilation-induced impairment in lung function is not associated with a change in pulmonary or systemic circulation or DA flow. Special care should be taken to prevent respiratory failure when intubation and mechanical ventilation are required for undergoing surgical DA ligation in the preterm infant.

[Fibrodysplasia ossificans progressiva in children. The interest of early diagnosis and treatment]. / Fibrose ossifiante progressive de l'enfant. Intérêt d'un diagnostic et d'une prise en charge précoces.

INTRODUCTION: A rare genetic disease (with around a hundred cases in France), fibrodysplasia ossificans progressiva is characterized by heterotopic ossification and congenital malformation of the bones. It is worsened by physical trauma, progresses in successive flares and slowly results in total confinement of the children because of the calcification of the muscles and ankylosis of all the joints. OBSERVATIONS: We report the case of two children exhibiting fibrodysplasia ossificans progressiva in whom diagnosis was delayed at the age of 4 and 18 months respectively. DISCUSSION: Fibrodysplasia ossificans progressiva must be diagnosed during the neonate period. Early treatment will help to avoid the factors of aggravation, slow the progression of the disease and provide the children with improved quality of life. Unfortunately, there is no efficient treatment, bisphosphonates and corticosteroids are only beneficial during the flares. Hope for the future relies on gene therapy.