A HAZARD OF EXCHANGE TRANSFUSION IN NEWBORN INFANTS—NEGATIVE PRESSURE IN THE UMBILICAL VEIN

PEDIATRICS ◽  
1960 ◽  
Vol 26 (4) ◽  
pp. 661-664
Author(s):  
A. A. Mintz ◽  
C. Vallbona
Keyword(s):  
Negative Pressure ◽  
Exchange Transfusion ◽  
Umbilical Vein ◽  
Present Report ◽  
Newborn Infants ◽  
Inspiratory Stridor ◽  
Endotracheal Aspiration ◽  
Pressure Changes ◽  
Physiologic Data ◽  
Second Twin

The development of the replacement transfusion for the prevention of brain damage associated with elevated levels of bilirubin in the blood has prompted numerous papers related to this procedure. The present report deals with a frequently observed phenomenon occurring during exchange transfusion, which seldom attracts attention until a disastrous episode takes place. This was our experience, and it therefore seemed desirable to re-evaluate the pathophysiology associated with pressure changes in the umbilical vein of the neonate. This report will present a case of marked negative pressure in the umbilical vein of a neonate exhibiting inspiratory stridor of partial airway obstruction, and also the physiologic data from some animal experi ments to demonstrate this phenomenon. CASE REPORT Infant B was the second-born, male twin of a 24-year-old, Rh-negative, gravida 4, para 3 mother. At term the maternal Rh antibody titer was 1:32. The membranes ruptured spontaneously 48 hours prior to delivery. Labor was induced with oxytocin (Pitocin) administered intravenously. Twin Infant A was delivered spontaneously, unassisted; it was then found that twin B presented as a "transverse lie." This second twin was delivered in 15 minutes by version and extraction. Respiration was initiated after endotracheal aspiration and was normal for 1 hour, after which an inspiratory stridor was noted associated with moderate cyanosis. The stridor and cyanosis improved with oxygen-mist therapy. The baby weighed 2,930 gm and the blood was Rh-positive and Coombs' positive, as was the blood of his twin. Bilirubin in the serum at birth was 3 mg/100 ml; hemoglobin, 14.5 gm/100 ml.

THE GASTROINTESTINAL COMPLICATIONS OF NEONATAL UMBILICAL VENOUS EXCHANGE TRANSFUSION: A CLINICAL AND EXPERIMENTAL STUDY

PEDIATRICS ◽  
1973 ◽  
Vol 51 (1) ◽  
pp. 36-43
Author(s):  
Robert J. Touloukian ◽  
Andrew Kadar ◽  
Richard P. Spencer
Keyword(s):  
Exchange Transfusion ◽  
Umbilical Vein ◽  
Venous Pressure ◽  
Newborn Infants ◽  
Vena Cava ◽  
Gastrointestinal Complications ◽  
Gastrointestinal Lesions ◽  
Rh Incompatibility ◽  
Umbilical Vein Catheter ◽  
Injection Phase

Two newborn infants having umbilical venous exchange transfusion for Rh incompatibility developed serious gastrointestinal complications preceded by abdominal distention, bilious vomiting, and blood-streaked meconium stools; 21 other infants with similar findings are reviewed. The clinical material suggests that a vascular mechanism, possibly related to hemodynamic alterations accompanying exchange transfusion may be responsible for the gastrointestinal lesions observed. Significant increase in portal venous pressure (0.8 ± 0.3 to 4.5 ± 0.4 mm Hg) during the injection phase of exchange occurred during experimental exchange transfusion via the umbilical vein of newborn piglets. The authors advise roentgen verification of the umbilical vein catheter within the inferior vena cava prior to undertaking exchange transfusion, eliminating the potential risk of portal venous congestion.

Study of Toynbee Phenomenon by Combined Intranasopharyngeal and Tympanometric Measurements

1988 ◽  
Vol 97 (2) ◽  
pp. 199-206 ◽  
Author(s):  
Yehuda Finkelstein ◽  
Yuval Zohar ◽  
Yoav P. Talmi ◽  
Nelu Laurian
Keyword(s):  
Middle Ear ◽  
Negative Pressure ◽  
Pressure Change ◽  
Positive Pressure ◽  
New Information ◽  
Pressure Changes ◽  
Rapid Pressure

The Toynbee maneuver, swallowing when the nose is obstructed, leads in most cases to pressure changes in one or both middle ears, resulting in a sensation of fullness. Since first described, many varying and contradictory comments have been reported in the literature concerning the type and amount of pressure changes both in the nasopharynx and in the middle ear. In our study, the pressure changes were determined by catheters placed into the nasopharynx and repeated tympanometric measurements. New information concerning the rapid pressure variations in the nasopharynx and middle ear during deglutition with an obstructed nose was obtained. Typical individual nasopharyngeal pressure change patterns were recorded, ranging from a maximal positive pressure of + 450 to a negative pressure as low as −320 mm H2O.

UMBILICAL VESSEL ANGIOCARDIOGRAPHY IN THE NEWBORN INFANT

PEDIATRICS ◽  
1963 ◽  
Vol 31 (6) ◽  
pp. 946-951
Author(s):  
Samuel O. Sapin ◽  
Leonard M. Linde ◽  
George C. Emmanouilides
Keyword(s):  
Newborn Infant ◽  
Umbilical Artery ◽  
Umbilical Vein ◽  
Newborn Infants ◽  
Umbilical Vessel ◽  
Accurate Interpretation ◽  
Sick Newborn

Angiocardiography from an umbilical vessel approach was performed in 10 critically sick newborn infants. The umbilical vein route was successfully employed up to the eighth day of life, while the umbilical artery was safely used as late as age 5 days. This approach has advantages over other methods of catheterization and angiocardiography. Angiocardiographic quality was satisfactory for accurate interpretation.

Neonatal Polycythemia: II. Plasma, Blood, and Red Cell Volume Estimates in Relation to Hematocrit Levels and Quality of Intrauterine Growth

PEDIATRICS ◽  
1981 ◽  
Vol 68 (2) ◽  
pp. 175-182
Author(s):  
Yves W. Brans ◽  
Donna L. Shannon ◽  
Rajam S. Ramamurthy
Keyword(s):  
Birth Weight ◽  
Exchange Transfusion ◽  
Intrauterine Growth Retardation ◽  
Umbilical Vein ◽  
Normal Growth ◽  
Red Cell ◽  
Intrauterine Growth ◽  
The Mean ◽  
Volume Estimates

Volumes of plasma (PV), blood (BV), and red cells (RCV) were estimated within 32 hours of birth in 39 neonates with normal growth, 14 neonates with intrauterine growth retardation, and 20 neonates with macrosomia. Total PV, BV, and RCV increased linearly with birth weight and were unaffected by deviation in the quality of fetal growth. In proportion to body weight, PV/kg, BV/kg, and RCV/kg correlated neither with birth weight nor with the quality of intrauterine growth. Neonates with umbilical vein hematocrit (UV Hct) levels 51% to 60%, 61% to 65%, and 66% to 77% had progressively lower, but not statistically different, mean PV/kg (38.1 ± 4.49, 37.6 ± 5.41, and 34.8 ± 5.16 ml/kg, respectively). On the other hand, they had progressively higher mean BV/kg (90 ± 10.1 vs 101 ± 13.7 ml/kg, P < .002, and vs 110 ± 19.0 ml/kg, P < .001). They also had progressively higher mean RCV/kg (52 ± 7.4, 64 ± 8.7, and 75 ± 16.4 ml/kg, P < .001). Although PV/kg did not correlate with UV Hct, both BV/kg and RCV/kg increased linearly with increasing UV Hct (r = .58 and r = .79, respectively). Volume estimates were repeated after partial exchange transfusion in 29 neonates. Mean UV Hct decreased from 63 ± 5.9% preexchange to 51 ± 5.2% postexchange (P < .001), mean PV increased from 37.7 ± 5.56 to 47.6 ± 7.99 ml/kg (P < .001) and mean RCV decreased from 67 ± 16.5 to 51 ± 12.3 ml/kg (P < .001). Despite precautions to keep the partial exchange isovolemic, mean BV decreased from 105 ± 18.7 to 98 ± 18.0 ml/kg (P = .001) and the mean PV increase (10 ml/kg) was less than the mean RCV decrease (16 ml/kg). These data suggest that neonates with polycythemia have normal PV but their RCV and BV are elevated in direct proportion to UV Hct. "Isovolemic" partial exchange transfusion decreases UV Hct, RCV, and BV and increases PV.

ADMINISTRATION OF GLUCURONIC ACID TO ICTERIC NEWBORN INFANTS

PEDIATRICS ◽  
1959 ◽  
Vol 23 (1) ◽  
pp. 92-97
Author(s):  
Gloria Jeliu ◽  
Rudi Schmid ◽  
Sydney Gellis
Keyword(s):  
Experimental Evidence ◽  
Exchange Transfusion ◽  
Glucuronic Acid ◽  
Newborn Infants ◽  
Significant Change ◽  
High Concentrations

Fourteen icteric newborn infants were treated with varying amounts of glucuronic acid or sodium glucuronate, administered by oral or intravenous routes. No significant change in concentration of bilirubin in the serum was observed. Experimental evidence and biochemical considerations do not suggest that the administration of glucuronic acid enhances the formation of bilirubin glucuronide. It is the authors' opinion that at present the use of glucuronic acid should not be considered as an alternative for exchange transfusion in the treatment of newborn infants with high concentrations of bilirubin in the serum.

Exchange Transfusion Using Peripheral Vessels Is Safe and Effective in Newborn Infants

PEDIATRICS ◽  
2008 ◽  
Vol 122 (4) ◽  
pp. e905-e910 ◽  
Author(s):  
Hsiao-Neng Chen ◽  
Meng-Luen Lee ◽  
Lon-Yen Tsao
Keyword(s):  
Exchange Transfusion ◽  
Newborn Infants

ELECTRIC BUNTING TO MAINTAIN BODY TEMPERATURE DURING EXCHANGE TRANSFUSION IN THE NEWBORN INFANT

PEDIATRICS ◽  
1951 ◽  
Vol 7 (2) ◽  
pp. 207-209
Author(s):  
P. VOGEL ◽  
R. E. ROSENFIELD ◽  
M. STEINBERG
Keyword(s):  
Body Temperature ◽  
Exchange Transfusion ◽  
Prolonged Exposure ◽  
Newborn Infants ◽  
Electric Heating ◽  
Hot Water ◽  
Maximum Temperature ◽  
Ideal Situation ◽  
The Many ◽  
Water Proof

THE maintenance of proper body temperature has been a serious problem in the performance of exchange transfusions on newborn infants suffering from hemolytic disease. Many of these infants are in such poor condition that extreme care in their handling is required, including incubation, oxygen and tracheal aspiration. The many procedures necessary create the hazard of prolonged exposure to room temperature, and a number of deaths may have resulted directly or indirectly from hypothermia. In the Children's Hospital in Boston, the entire exchange transfusion is carried out with the infant lying in a Hess bed; this is an ideal situation which undoubtedly is not readily available in most institutions where an exchange transfusion must be performed. The maintenance of body temperature with electric heating pads and/or hot water bottles has proved cumbersome and unsatisfactory, and has resulted in a number of burns, particularly about the buttocks. A washable electric blanket bunting has been designed (see Figs. and 2) to maintain the temperature of newborn infants throughout the procedure of an exchange transfusion, as well as for a period following the procedure, if a heated crib is not available. This bunting was constructed by the General Electric Company using water-proof washable material and employing the principles of the commercial electric blanket. The bunting can be regulated to any desired temperature although the maximum temperature obtainable is 42°C., which avoids the possibility of skin burns. The design of the bunting is simple: it is a bag with a zipper along one side to allow for easy insertion and removal of the baby, and a "U" shaped zippered flap which can be opened to provide a window at the approximate position of the umbilical cord.

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