RESUMEN
OBJECTIVE: To determine risk factors for the development of bronchopulmonary dysplasia (BPD) after treatment with extracorporeal membrane oxygenation (ECMO). DESIGN: Retrospective case-control study. SETTING: Tertiary care level 3 neonatal intensive care unit. PARTICIPANTS: Seventy-three newborns treated with ECMO for severe respiratory failure during a 5-year period, who survived until day of life 28, and who did not have pulmonary hypoplasia as the initial cause for respiratory failure. INTERVENTIONS: None. MAIN OUTCOME MEASURE: The presence of BPD after treatment with ECMO, which was defined as oxygen and/or ventilatory requirements at day of life 28, with characteristic abnormalities seen on chest x-ray film. RESULTS: The age at ECMO initiation was significantly greater for patients with BPD compared with patients without BPD (mean +/- SD, 135 +/- 68 hours vs 50 +/- 37 hours; P < .001). There was an 11.5-fold increased risk for the development of BPD if ECMO was initiated at greater than 96 hours of age. The primary diagnosis of respiratory distress syndrome imparted a 5.2-fold increased risk for the development of BPD. Patients with BPD required ECMO significantly longer than patients without BPD (203 +/- 73 hours vs 122 +/- 51 hours; P < .001). CONCLUSION: These results demonstrate that delayed use of ECMO in treating neonatal respiratory failure is associated with an increased risk for the development of BPD and a longer duration of ECMO therapy.
Asunto(s)
Displasia Broncopulmonar/epidemiología , Displasia Broncopulmonar/etiología , Oxigenación por Membrana Extracorpórea/efectos adversos , Insuficiencia Respiratoria/terapia , Factores de Edad , Análisis de los Gases de la Sangre , Displasia Broncopulmonar/diagnóstico por imagen , Displasia Broncopulmonar/terapia , Estudios de Casos y Controles , Femenino , Humanos , Recién Nacido , Unidades de Cuidado Intensivo Neonatal , Modelos Logísticos , Masculino , Terapia por Inhalación de Oxígeno , Radiografía , Respiración Artificial , Insuficiencia Respiratoria/sangre , Insuficiencia Respiratoria/mortalidad , Factores de Riesgo , Tasa de Supervivencia , Factores de TiempoRESUMEN
Neonates treated with extracorporeal membrane oxygenation (ECMO) for respiratory failure have a high frequency of complications related to systemic anticoagulation, ECMO and other life-support lines and catheters, and the antecedent pulmonary disease. Many of these complications involve the thorax and can be defined on chest radiographs or thoracic sonograms. The purpose of this essay is to illustrate the findings of the various thoracic complications of ECMO on chest radiographs and sonograms. This study is based on a review of the medical records and findings on chest radiographs and sonograms of 150 neonates who were treated with ECMO at our institution.
Asunto(s)
Oxigenación por Membrana Extracorpórea/efectos adversos , Migración de Cuerpo Extraño , Enfermedades Pulmonares/etiología , Enfermedades Torácicas/etiología , Migración de Cuerpo Extraño/diagnóstico por imagen , Humanos , Recién Nacido , Enfermedades Pulmonares/diagnóstico por imagen , Radiografía , Enfermedades Torácicas/diagnóstico por imagen , UltrasonografíaAsunto(s)
Absceso/microbiología , Enfermedades Renales/microbiología , Infecciones Estafilocócicas/diagnóstico , Absceso/diagnóstico , Absceso/terapia , Terapia Combinada , Dicloxacilina/uso terapéutico , Drenaje , Quimioterapia Combinada/uso terapéutico , Humanos , Recién Nacido , Enfermedades Renales/diagnóstico , Enfermedades Renales/terapia , Masculino , Nafcilina/uso terapéutico , Infecciones Estafilocócicas/terapia , Staphylococcus aureus/aislamiento & purificaciónRESUMEN
Transient renal insufficiency in the neonate is frequently the result of hypoperfusion of the kidneys due to circulatory compromise and is associated with a normal renal ultrasound scan. We describe an infant with transient renal insufficiency associated with hyperuricemia, hyperuricosuria and increased echogenicity of the renal medullary pyramids. Transient uric acid nephropathy may be a more common occurrence in the neonate than previously recognized.
Asunto(s)
Lesión Renal Aguda/etiología , Ácido Úrico/sangre , Ácido Úrico/orina , Lesión Renal Aguda/sangre , Creatinina/sangre , Femenino , Humanos , Recién Nacido , Riñón/diagnóstico por imagen , UltrasonografíaRESUMEN
Only one of the 65 ECMO patients treated at Thomas Jefferson University Hospital to date has shown progression of pulmonary parenchymal cystic change on serial portable chest radiographs while on ECMO. The radiographic and clinical findings of this unique case are presented.