RESUMO
AIM: To explore the effects of a large volume lung lavage procedure in ventilated infants with meconium aspiration syndrome. METHODS: Infants with severe meconium aspiration requiring high-frequency ventilation underwent lung lavage using dilute bovine surfactant at a phospholipid concentration of 5 mg/mL. Lavage aliquot volumes were increased through the case series, aiming to deliver two aliquots of 15 mL/kg in rapid sequence. Physiological effects of lavage were documented, and comparison was made with a group of infants with meconium aspiration requiring high-frequency ventilation, in whom lavage was not performed. RESULTS: Nine episodes of lavage were performed in eight infants at a median age of 23 h (range 8-83 h). Three infants underwent a lavage that was defined as potentially therapeutic (total lavage volume of at least 25 mL/kg administered before 24 h of age). Lavage was not associated with bradycardia or hypotension. Recovery of arterial oxygen saturation to above 80% was achieved within 12 min in all but one infant in whom oxygen saturation was below 80% at the outset. Mean airway pressure was significantly lower in the Therapeutic lavage group compared with non-lavaged infants in the first 48 h, with a trend towards improved oxygenation. CONCLUSION: Dilute surfactant lavage with aliquots of up to 15 mL/kg appears to be feasible in haemodynamically stable ventilated infants with meconium aspiration syndrome, and its efficacy deserves further investigation in a randomised controlled trial.
Assuntos
Lavagem Broncoalveolar/métodos , Síndrome de Aspiração de Mecônio/terapia , Surfactantes Pulmonares/administração & dosagem , Animais , Bovinos , Humanos , Recém-Nascido , Síndrome de Aspiração de Mecônio/fisiopatologia , Resultado do Tratamento , Ventiladores MecânicosRESUMO
Pulmonary hypertension can complicate the early clinical course in newborn infants with congenital diaphragmatic hernia. We report the successful use of combination therapy with enteral sildenafil and intravenous prostaglandin E1 in a preterm infant with severe pulmonary hypertension and right heart failure early after congenital diaphragmatic hernia repair.
Assuntos
Alprostadil/uso terapêutico , Hérnia Diafragmática/cirurgia , Hérnias Diafragmáticas Congênitas , Hipertensão Pulmonar/tratamento farmacológico , Piperazinas/uso terapêutico , Sulfonas/uso terapêutico , Vasodilatadores/uso terapêutico , Alprostadil/administração & dosagem , Quimioterapia Combinada , Insuficiência Cardíaca/etiologia , Insuficiência Cardíaca/prevenção & controle , Hérnia Diafragmática/complicações , Humanos , Hipertensão Pulmonar/complicações , Recém-Nascido , Piperazinas/administração & dosagem , Cuidados Pós-Operatórios , Nascimento Prematuro , Purinas/administração & dosagem , Purinas/uso terapêutico , Citrato de Sildenafila , Sulfonas/administração & dosagem , Resultado do Tratamento , Vasodilatadores/administração & dosagemRESUMO
Early-onset respiratory distress and a radiographic appearance of an aspiration syndrome occurred in three neonates who had not passed meconium before delivery. In each case there was evidence of inhalation of blood, associated with very high plasma protein concentration in lung fluid. Blood aspiration syndrome is a distinct diagnostic entity that can result in significant respiratory distress in the neonate.