Multilocular hydrocephalus: ultrasound studies of origin and development.

Multilocular hydrocephalus is a complication of neonatal hydrocephalus. Its main feature is the presence of multiple cysts inside the ventricles, which requires a specific therapeutic approach. The case of a preterm infant with intracranial hemorrhage grade II-III and central nervous system infection is reported. The cysts developed at the subependymal layer in the posterior area of the patient's thalamus. Their growth and development were charted by ultrasound imaging for several weeks. These types of cysts may grow to occupy the totality of the lateral ventricles, isolating the temporal horns. Of all the reviewed pathogenic mechanisms, we support the hypothesis of an inflammatory vasculitis at the subependymal level, with the subsequent infarct giving rise to the cysts. The osmotic pressure within the cavities, rather than intraventricular fluid, would account for the enlargement of the cysts.

[High-frequency oscillatory ventilation as salvage strategy in the newborn infant. Spanish multicenter study. I]. / Ventilación de alta frecuencia oscilatoria como estrategia de rescate en el recién nacido. Estudio multicéntrico Español. I.

OBJECTIVE: The aim of this study was to evaluate the results of high frequency ventilation (HFV) used as a rescue strategy in newborn infants with severe lung disease who either failed conventional mechanical ventilation (CMV) or had an air block. PATIENTS AND METHODS: From April 1995 to June 1998, 241 infants with severe lung disease and managed according to a common protocol of HFV used as a rescue strategy were prospectively evaluated in the nine participating level III Spanish Neonatal Intensive Care Units. The most frequent diagnoses were respiratory distress syndrome (119), meconium aspiration (24), pneumonia (19) and congenital diaphragm hernia (18). RESULTS: Mean +/- SD gestational age and birth weight were 32.0 +/- 5.5 weeks and 1,187 +/- 1,071 g, respectively. All babies were previously manages with CMV for a mean of 59 hours. HFV was started at a mean postnatal age of 82 hrs, with a mean oxygenation index (OI) of 28.3 +/- 15.3 and an a/A DO2 of 0.10 +/- 0.08. Initial mean HFV settings were: mean airway pressure 12.8 +/- 3.4 mbar, frequency 8.3 +/- 1.4 Hz, amplitude 53 +/- 20 percent, tidal volume 2.2 +/- 0.7 ml/kg and FiO2 0.88 +/- 0.2. At two hours of HFV there was a significant increase in the mean PaO2 (from 48 to 80 mmHg), with a concomitant decrease in FiO2 (from 0.88 to 0.79), PaCO2 (from 60 to 46 mmHg) and OI (from 28 to 18). Mean a/A DO2 increased from 0.10 to 0.19; these changes remained similar thereafter. HFV was suspended after a mean of 95 hrs because of improvement in 70%, death in 19% and failure to improve the clinical condition in the remaining 19%. Intrahospital death rate was 32%. The following complications were observed: pneumothorax (10%), interstitial emphysema (4%), intraventricular hemorrhage grades III and IV (14.5%) and bronchopulmonary dysplasia (35%). CONCLUSIONS: HFV is an effective rescue strategy that improves pulmonary gas exchange within two hours of its initiation.

A simplified surfactant dosing procedure in respiratory distress syndrome: the "side-hole" randomized study. Spanish Surfactant Collaborative Group.

The aim of this study was to compare the incidence of acute adverse events and long-term outcome of two different surfactant dosing procedures in respiratory distress syndrome (RDS). The effects of two surfactant dosing procedures on the incidence of transient hypoxia and bradycardia, gas exchange, ventilatory requirements and 28 d outcome were compared. The patients, comprising 102 infants (birthweight 600-2000 g) with RDS on mechanical ventilation with FiO2 > or = 0.4, were randomized at 2-24 h to receive 200 mg kg(-1) of Curosurf; in 56 it was given by bolus delivery, and in 55 by a simplified technique (dose given in 1 min via a catheter introduced through a side-hole in the tracheal tube adaptor. The baby's position was not changed and ventilation was not interrupted). Two additional surfactant doses (100 mg kg(-1)) were also given, by the same method, if ventilation with FiO2 > or = 0.3 was needed 12 and 24 h after the initial dose. The number of episodes of hypoxia and/or bradycardia was similar in both groups. A slight and transient increase in PaCO2 was observed in the side-hole group. The efficacy of the surfactant, based on oxygenation improvement, ventilator requirements, number of doses required and incidence of air leaks, was similar. No differences were observed in the incidence of intraventricular haemorrhage, patent ductus arteriosus, bronchopulmonary dysplasia or survival. In conclusion, a simplified surfactant dosing procedure not requiring fractional doses, ventilator disconnection, changes in the baby's position or manual bagging was found to be as effective as bolus delivery. The number of dosing-related transient episodes of hypoxia and bradycardia was not decreased by the slow, 1 min, side-hole instillation procedure.

Hydrops fetalis and fibrosarcoma: case report of an uncommon association.

UNLABELLED: Fetal hydrops associated with neonatal tumours is an uncommon occurrence. The diagnosis can be established prenatally by ultrasound examination. The treatment of choice is surgery which may be curative. We report the case of a male born at 32 weeks gestation who presented with severe hydrops fetalis and a thoracic mass. The child could not be operated upon because of rapid clinical deterioration. The autopsy findings confirmed the diagnosis of congenital fibrosarcoma. This is, to our knowledge, the first case of hydrops fetalis associated with fibrosarcoma. CONCLUSION: The association of hydrops fetalis and fibrosarcoma is an exceptional observation but can be added to the long list of differential diagnoses of non-immune hydrops.

The effects of multiple small doses of exogenous surfactant on experimental respiratory failure induced by lung lavage in rats.

AIM: To test the effect on pulmonary gas exchange and mechanics of multiple small doses of exogenous surfactant as an alternative to bolus delivery in experimental respiratory failure induced by lung lavage. METHOD: After anesthesia, tracheostomy and constant volume ventilation, respiratory failure was induced by lung lavage in 20 rats. Animals were randomly assigned to an untreated control group or two experimental groups. Equal total doses of modified porcine surfactant (200 mg.kg-1 body weight), were given by tracheal instillation, either as a single bolus or in four (50 mg.kg-1 b.w.) fractional doses at 10-min intervals. Arterial pH and blood gases, and peak inspiratory pressure (PIP) were measured. RESULTS: After lavage, a rapid decrease in arterial pH and PaO2, and an increase in PaCO2 and PIP were observed in all animals. In both surfactant-treated groups, PaO2 increased after surfactant instillation, and remained significantly higher than controls throughout the experiment. Arterial pH was significantly higher and PaCO2 significantly lower only in the single bolus group. In the multiple dose group, these levels were similar to those of controls. CONCLUSION: In surfactant-depleted rats with respiratory failure, instillation of four fractional surfactant doses did not result in the same enhancement on gas exchange and PIP, in the following 60 min, as same total dose given by a single bolus.

[Regional organization of a neonatal transportation system]. / Organización regional de un sistema de transporte neonatal.

Organization, operational plans, and initial experience of a Regional Neonatal Transport System is described. The system covers provinces of Bizcaia, and Alava in Northern Spain, with a total of 17,500 annual deliveries. In the first 10 months 31 newborn infants were transported. Their mean birth weight was 2,066 +/- +/- 931 Gm. Ten infants had a birth weight less than 1,500 Gm, and in 22 (71%) of them gestational age was under 37 weeks. Some types of respiratory distress was present in 71% of them, and 25.8% required mechanical ventilation during transport. Hypothermia was present in 36% of the infants at referral center, percentage that decreased to only 9% at their arrival to the NICU. During transport mean body temperature increased from 35.33 +/- 1.07 degrees to 35.84 +/- 0.9 degrees C (p less than 0.01). Infants condition was judged to improve in 13% of them. Overall survival rate was 74.2%, being 80.9% in those weighting from 1,000 to 1,500 Gm. Infants who were hypothermic had a lower survival (45.5%) than those who were not (90%) (p less than 0.05).