RESUMEN
OBJECTIVE: The aim of our study was to determine the impact of treatment with exogenous surfactant (ES) and high frequency oscillatory ventilation (HFOV) on the radiological appearance and clinical course of hyaline membrane disease (HMD) in new-born infants. MATERIALS AND METHODS: New-born infants (18) (median weight, 1010 g) with severe HMD (stages 3.5 and 4) who were treated with ES and HFOV were matched by birth weight and severity of disease with 18 new-born infants treated with ES and conventional mechanical ventilation (CV). Chest radiograms taken on days 1, 2/3, 4/5, 7, 14 and 28 were analyzed to check for the severity of generalized parenchymal opacities (GPO), local opacifications, pulmonary interstitial emphysema (PIE), gross air leak, general and localized overinflation, bronchopulmonary dysplasia (BPD) and clinical variables such as survival rates, duration of mechanical ventilation, mean airway pressure and inspired oxygen concentration. RESULTS: At 4 weeks of age, new-born infants treated by HFOV had less severe GPO (median degree 1.5 vs. 3), less PIE (1 vs. 7 patients) and fewer signs of BPD (median BPD degree 1.5 vs. 2.6). The incidence of pneumothorax and of local opacifications were similar in both groups. New-born infants on HFOV had a lower mortality rate (5 vs. 13), needed fewer days of mechanical ventilation (median 15 vs. 23 days) and lower inspiratory oxygen concentrations (median FiO2 0.38 vs. 0.64). CONCLUSION: In new-born infants with HMD, treatment with ES and HFOV resulted in a favourable radiological and clinical outcome as compared to treatment with ES and CV.
Asunto(s)
Ventilación de Alta Frecuencia , Enfermedad de la Membrana Hialina/diagnóstico por imagen , Enfermedad de la Membrana Hialina/terapia , Fosforilcolina , Surfactantes Pulmonares/uso terapéutico , Respiración Artificial , Displasia Broncopulmonar/diagnóstico por imagen , Estudios de Casos y Controles , Combinación de Medicamentos , Alcoholes Grasos/uso terapéutico , Femenino , Humanos , Enfermedad de la Membrana Hialina/mortalidad , Recién Nacido , Pulmón/diagnóstico por imagen , Masculino , Polietilenglicoles/uso terapéutico , Radiografía , Tasa de Supervivencia , Resultado del TratamientoRESUMEN
An infant presented with prenatal marked fetal cardiac arrhythmia, not related to labour, and had intracardiac tumours. The association of cardiac tumours with tuberous sclerosis (Bourneville-Pringle disease) is described, using ultrasonic, radiological and electrocardiographic data, and reviewing the literature.
Asunto(s)
Cardiopatías Congénitas/diagnóstico por imagen , Esclerosis Tuberosa/diagnóstico por imagen , Ultrasonografía Prenatal , Arritmias Cardíacas/diagnóstico por imagen , Ecocardiografía , Ecoencefalografía , Femenino , Humanos , Recién Nacido , Embarazo , Tercer Trimestre del EmbarazoRESUMEN
We describe a simple, low cost technique for computerized measurements of compliance of the respiratory system (Crs) by airway occlusion technique in intubated newborn infants. Tidal volumes of 5, 7.5, and 10 mL/kg were injected from a calibrated syringe into the endotracheal tube via a three-way stop cock and a t-piece. Airway pressure was measured by means of a differential pressure transducer. The analog pressure signal was fed into an optically isolated signal conditioning termination panel and an analog input board which was connected to the PC bus. The signal was amplified and A/D converted by the input board and processed by the digital computer. Crs was determined as the ratio of the injected tidal volume to the difference between the endexpiratory pressure and the pressure at airway occlusion. The software is written in Turbo Pascal (Borland Int.) and includes a patient data base and facilities for system configuration, calibration of transducers, data acquisition, handling, calculation of Crs, reporting and archive storage. Data sampling frequency may be individually set at 60 to 200 Hz. Synchronous measurements in 10 newborn infants using analog pressure amplification and polygraphic recording showed that pressures were correctly determined by the computer and that amplitude and frequency response of the pressure recordings were adequate.