The cardiovascular effects of partial liquid ventilation in newborn lambs after experimental meconium aspiration.

OBJECTIVE: To study the effects of partial liquid ventilation with perfluorocarbon on cardiovascular function, pulmonary gas exchange, and lung mechanics in term newborn lambs with pulmonary hypertension induced by tracheal instillation of human meconium. DESIGN: Prospective, randomized study. SETTING: Research Unit at a university-affiliated hospital. SUBJECTS: Twelve term newborn lambs (<6 days old). INTERVENTIONS: Lambs were studied in two groups (n = 6): meconium aspiration (3-5 ml/kg 20% meconium solution) managed on pressure-limited conventional mechanical ventilation with or without partial liquid ventilation with perfluorocarbon. MEASUREMENTS AND MAIN RESULTS: Heart rate, systemic and pulmonary arterial pressures, arterial pH and blood gases, cardiac output, and pulmonary mechanics were measured. Partial liquid ventilation in term newborn lambs with experimental meconium aspiration did not alter cardiovascular profile: heart rate, systemic arterial pressure, and cardiac output maintained initial values throughout the experiment. There was a significant improvement in gas exchange (oxygenation increased from values of <100 torr to 338 torr, and ventilation reached normal values in 15 mins). Dynamic compliance increased in 30 mins, reaching basal values (1.1 +/- 0.3 ml/cm H(2)O per kg). Despite the good response (blood gases and cardiovascular profile) to partial liquid ventilation in meconium aspiration syndrome, pulmonary hypertension did not decrease. CONCLUSIONS: Partial liquid ventilation with perfluorocarbon could be a good noninvasive alternative technique that improves gas exchange and pulmonary mechanics in meconium aspiration syndrome without impairing cardiovascular function.

[Extracorporeal membrane oxygenation (ECMO). II. The development of an experimental model in newborn lambs]. / Oxigenación por membrana extracorpórea (ECMO). II. Desarrollo de un modelo experimental en corderos recién nacidos.

OBJECTIVE: Extracorporeal membrane oxygenation (ECMO) is a technique used for cardiorespiratory support in the treatment of newborns with severe respiratory insufficiency. ECMO has not been used yet in newborns in Spain. The aim of this work was to develop an experimental veno-arterial ECMO model in newborn lambs for training the NICU medical and nursing staff before the clinical application of this technique. MATERIAL AND METHODS: Six newborn lambs were anesthetized, traqueotomized and connected to a neonatal ventilator. The right jugular vein and left carotid artery were cannulated and the catheters were located in the right atrium and aortic arch, respectively. A venous-arterial ECMO was performed during three hours, with an experimental ECMO circuit developed by us. Arterial pH and blood gases, systemic and airway pressures, heart rate, and rectal temperature were monitored. RESULTS: The experimental ECMO circuit developed by use had a very low cost, but was capable of maintaining adequate gas exchange, acid-base balance and a normal rectal temperature. CONCLUSIONS: The development of an experimental ECMO model in newborn lambs may allow the establishment of an initial training program and to maintain the expertise of the NICU staff of a perinatal center planning to start an ECMO program.

[Severe malformations associated with congenital diaphragmatic hernia: conditioning factors for mortality]. / Malformaciones mayores asociadas a la hernia diafragmática congénita: condicionantes de la mortalidad.

We have retrospectively reviewed the clinical records of 42 newborns with congenital diaphragmatic hernia (CDH) treated in our Neonatal Unit between January 1974 and December 1991. In 20 of the children, the CDH was associated with other malformations, which were major in 11 cases (26.2%). The malformations which occurred most frequently were cardiovascular, followed by chromosomal anomalies and those affecting the central nervous system (CNS). All of the newborns with major malformations are included in the high risk group or those with early diagnosis. Overall mortality was 57.1%. Nine out of the 11 cases with major malformations died (81.8%).

[Poisoning by viper bites in children]. / Intoxicación por mordedura de víbora en niños.

Our experience with 36 cases of adder bites, collected during 13 years (1976-1989), is presented. The severity of the clinical picture was minimal to moderate in most of the cases, with mainly local symptomatology noted. Only 4 of the cases had symptoms such as vomiting and abdominal pain. Good results wee obtain in all cases with the prescribed medical treatment, except in one case which had partial necrosis of the skin on one finger on the side of viper bite. Antibiotics were used in all cases except three and anti-tetanus therapy was used in those cases where needed. Corticosteroids and antihistamines were used on selected occasions. We recommend the use of antiofidic serum, although the possibilities of anaphylactic reaction must be noted. We do not recommended local incisions and suction for this type of bites.