Asunto(s)
Proteínas Portadoras/efectos de los fármacos , Hipertensión Pulmonar/tratamiento farmacológico , Péptidos y Proteínas de Señalización Intracelular/efectos de los fármacos , Neonatología , Piperazinas/uso terapéutico , Sulfonas/uso terapéutico , Vasodilatadores/uso terapéutico , Administración por Inhalación , Administración Oral , Broncodilatadores/administración & dosificación , Proteínas Portadoras/metabolismo , Endotelio Vascular/efectos de los fármacos , Humanos , Hipertensión Pulmonar/metabolismo , Hipertensión Pulmonar/fisiopatología , Recién Nacido , Inyecciones Intravenosas , Péptidos y Proteínas de Señalización Intracelular/metabolismo , Óxido Nítrico/administración & dosificación , Piperazinas/administración & dosificación , Piperazinas/farmacología , Purinas/administración & dosificación , Purinas/farmacología , Purinas/uso terapéutico , Citrato de Sildenafil , Sulfonas/administración & dosificación , Sulfonas/farmacología , Resultado del Tratamiento , Vasodilatadores/administración & dosificación , Vasodilatadores/farmacologíaRESUMEN
Laryngeal atresia is a rare congenital cause of high airway obstruction that can lead to death if not correctly recognized and treated at birth. Postnatal management is difficult and the prognosis is often poor. We report a case of prenatal diagnosis of laryngeal atresia in a fetus that was delivered preterm at 29 weeks of gestation. Tracheotomy was performed as an ex utero intrapartum treatment (EXIT) to guarantee patent airway, and laryngotracheoplasty was performed at 22 months of corrected age. A favorable ventilatory and neurodevelopmental outcome was observed at 33 months of age.
Asunto(s)
Enfermedades Fetales/diagnóstico , Enfermedades del Prematuro/diagnóstico , Laringe/anomalías , Adulto , Preescolar , Femenino , Humanos , Lactante , Recién Nacido , Enfermedades del Prematuro/cirugía , Laringe/cirugía , Imagen por Resonancia Magnética , Masculino , Atención Posnatal/métodos , Diagnóstico Prenatal/métodos , Procedimientos de Cirugía Plástica/métodos , Tráquea/cirugía , Resultado del TratamientoRESUMEN
Volutrauma and pulmonary inflammation are thought to be the most important predisposing factors of chronic lung disease (CLD), a major complication of prematurity. A new option in patient-triggered ventilation (PTV), the volume guarantee (VG), a volume-targeted ventilation, seems to be a promising approach in reducing the risk of CLD, by limiting lung inflammatory injury and volutrauma. Our aim was to evaluate lung inflammatory response in preterm infants with respiratory distress syndrome (RDS), mechanically ventilated with and without VG, as measured by proinflammatory cytokines (IL-6, IL-8, and TNF-alpha) in tracheobronchial aspirate (TA) fluid. Fifty-three preterm infants (GA = 25-32 weeks) with RDS were randomized at birth to be ventilated using pressure support ventilation (PSV) with VG (Vt = 5 ml/kg) (n = 30) and without VG (n = 23) (Draeger Babylog 8000 Plus, 5.n). IL-6, IL-8, and TNF-alpha were determined by ELISA in TA samples on days 1, 3, and 7 of life. We observed a significant difference (ANOVA) in IL-8 and IL-6 levels on day 3 between the two groups (P < 0.05), and an increasing significative trend in IL-8 values in PSV group (P < 0.05). Mechanical ventilation lasted longer in the PSV group (12.3 +/- 3 vs. 8.8 +/- 3 days) (P = no significance). In conclusion, these preliminary data suggest a role for volume-targeted ventilatory strategy in reducing acute inflammatory response in preterm infants with RDS. Further studies are required in order to define whether this ventilatory strategy prevents lung injury.