Aortic root blood flow increases after pancuronium in neonates with hyaline membrane disease

1991 ◽  
Vol 19 (2) ◽  
pp. 187-190 ◽  
Author(s):  
DENNIS T. COSTAKOS ◽  
CHRISTINE E. BLACKWELL ◽  
ALFRED N. KRAUSS ◽  
CAROLYN EISEN ◽  
KIMON VIOLARIS ◽  
...  
PEDIATRICS ◽  
1996 ◽  
Vol 98 (6) ◽  
pp. 1149-1153
Author(s):  
Ernest Z. Phillipos ◽  
Murray A. Robertson ◽  
Paul J. Byrne

Objectives. To assess the efficacy of Doppler echocardiography (DE) in the quantification of patent ductus arteriosus (PDA) shunt volume and to correlate PDA shunt volume with clinical outcome in infants with hyaline membrane disease. Methods. Ninety-eight DE studies were performed in 30 preterm ventilated infants with hyaline membrane disease within the first 24 hours of age and then at 48-hour intervals to a maximum of three studies while ventilated with a final study after extubation. Right and left ventricular outputs (QRV and QLV, respectively) and PDA flow were calculated using cross-sectional area and flow velocity integrals. Left atrial-to-aortic root diameter measurements were also taken. Clinical outcomes were correlated with the shunt fraction (QLV/QRV). Results. QLV/QRV demonstrated a linear relationship with the left atrial-to-aortic root diameter ratio (n = 92; r = .79). In the absence of a PDA (n = 33 studies), QRV versus QLV demonstrated a linear relationship (r = .88). In the presence of a PDA (n = 64 studies) the mean QLV (334 ± 133 ml/kg per minute) was significantly greater than the mean QRV (237 ± 84 ml/kg per minute). There was a linear relationship between QLV - QRV (PDA shunt volume) and PDA flow (n = 60; r = .84). In studies with exclusive left-to-right shunting at the PDA (n = 48), the mean QLV - QRV (112 ± 83 ml/kg per minute) was significantly higher than in those with bidirectional shunting (n = 16; mean QLV - QRV = 50 ± 27 ml/kg per minute). Two infants with severe intraventricular hemorrhage (IVH grade 3) and two infants with periventricular leukomalacia (PVL) had significantly higher QLV/QRV (2.09 ± 0.36 and 1.67 ± 0.02 respectively) than those with no IVH (n = 6; QLV/QRV = 1.31 ± 0.18) or those with IVH grades 1 and 2 (n = 8; QLV/QRV = 1.48 ± 0.27). There was no difference in QLV/QRV in infants with or without bronchopulmonary dysplasia retinopathy of prematurity. Necrotizing enterocolitis did not develop in any of the 30 infants. Conclusion. PDA shunt volume can be quantified by DE. Larger studies are needed to correlate clinical outcome with QLV/QRV.


PEDIATRICS ◽  
1967 ◽  
Vol 39 (5) ◽  
pp. 791-792
Author(s):  
FORREST H. ADAMS ◽  
ADEL EL-SALAWY

A very interesting brief case report, entitled "Pulmonary Hyaline Membranes and Vascular Anomalies of the Lung," was published in Pediatrics by Bozic. This case is commonly referred to as the "Lausanne baby" and is used by many to support the hypothesis that hyaline membrane disease is primarily related to reduced pulmonary blood flow. Although there are good reasons from observations in both man and animal to implicate reduced pulmonary blood flow as an important factor in the pathophysiology of hyaline membrane disease, we do not believe the "Lausanne baby" can be used to support this hypothesis.


1974 ◽  
Vol 8 (4) ◽  
pp. 443-443
Author(s):  
Alexander C Allen ◽  
Dora A Stinson ◽  
Hugh M MacDonald ◽  
Paul M Taylor

1991 ◽  
Vol 261 (4) ◽  
pp. H1148-H1154 ◽  
Author(s):  
J. P. Kinsella ◽  
D. R. Gerstmann ◽  
R. A. Delemos

The premature baboon delivered by hysterotomy at 140 +/- 2 days (75%) gestation develops hyaline membrane disease (HMD) and left-to-right (L-R) shunting through the patent ductus arteriosus (PDA). To characterize hemodynamic changes that follow premature delivery, we measured systemic and organ blood flow, oxygen transport, and systemic vascular resistance over the first 96 h of life. We compared these measurements with those from more mature animals of the same species. Radiolabeled microspheres were used to measure organ blood flow (in ml.min-1.g-1) at 3 (n = 18), 23 (n = 17), and 96 h (n = 4) in the premature animals, and at 13 +/- 4 mo in the older animals (n = 5). Premature animals demonstrated over the first 96 h of life significant hemodynamic changes that included decreased systemic vascular resistance (P less than 0.001), increased systemic (P less than 0.05), intestinal (P less than 0.05), and hepatic blood flow (P less than 0.05), as well as resolution of L-R PDA shunting. These 96-h values were similar to those of the more mature infant baboons. Blood flow and oxygen transport to the kidneys and cerebrum did not significantly increase over the first 96 h in premature baboons and were significantly less than those of 13-mo-old animals (P less than 0.01, both). We speculate that low renal and cerebral blood flow in the 140-day premature baboon are manifestations of multisystem immaturity and, as such, may represent persistent physiological disturbances that are distinct from the severity of underlying lung disease in HMD.


PEDIATRICS ◽  
1965 ◽  
Vol 36 (1) ◽  
pp. 149-149 ◽  
Author(s):  
ERNEST K. COTTON

In line with the report on pulmonary hypoperfusion as a possible mechanism in the etiology of hyaline membrane disease, we have been carrying out studies on newly born infants with this disease in order to correct the diminished pulmonary blood flow. We have used drug therapy on a total of 5 infants, and this has been associated with considerable normalizing in various abnormalities caused by the disease. We have first corrected acidosis when present, and then given tolazoline HC1 (Priscoline).


1974 ◽  
Vol 8 (4) ◽  
pp. 443-443 ◽  
Author(s):  
Bruce D Ackerman ◽  
Michael D Goldberg ◽  
Kristina S Mrozinska ◽  
Norman Gootman

PEDIATRICS ◽  
1981 ◽  
Vol 68 (4) ◽  
pp. 510-514
Author(s):  
David H. Levine ◽  
David S. Trump ◽  
Glenn Waterkotte

Pulmonary interstitial emphysema is a condition that has become a significant problem chiefly as a complication of mechanical ventilation of the newborn. In its severe forms, it may compromise ventilation and restrict pulmonary blood flow to the degree that it becomes a significant cause of mortality. When its occurrence is unilateral, or predominantly so, it becomes more amenable to therapy. A number of different approaches have been described, especially for milder forms of the disease, but none has proved entirely satisfactory. A surgical approach has been used in four patients with severe unilateral pulmonary interstitial emphysema complicating ventilator therapy for hyaline membrane disease. The technique was successful in three of the four infants. An illustrative case is described, as well as the selective criteria for application of the technique.


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