Disseminated Intravascular Coagulopathy in Hyaline Membrane Disease: Massive Thrombosis Following Umbilical Artery Catheterization

Disseminated intravascular coagulation in the newborn infant has received increasing attention in recent months1,2. In the cases reported so far it occurs in the very sick newborn, including those with hyaline membrane disease and intra-uterine infections, such as rubella, cytomegalic inclusion disease, and herpes simplex. The majority of the cases reported have been associated with severe hyaline membrane disease although the cause of the coagulation defect is not yet clear. Failure to recognize the coagulation defect in the past is probably due to inadequate coagulation studies. The present management of hyaline membrane disease is based on the assumption that adequate ventilation is essential for the child's survival.

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The Heimlich Maneuver as an Aid in Endotracheal Intubation of Neonates

PEDIATRICS ◽

10.1542/peds.60.5.749 ◽

1977 ◽

Vol 60 (5) ◽

pp. 749-750

Author(s):

Jay M. Milstein ◽

Boyd W. Goetzman

Keyword(s):

Respiratory Failure ◽

Endotracheal Intubation ◽

Birth Asphyxia ◽

Hyaline Membrane Disease ◽

Forced Expiration ◽

Vocal Cords ◽

The Past ◽

Hyaline Membrane ◽

Elective Surgical Procedure ◽

Clinical Conditions

Neonates with acute respiratory failure and certain other clinical conditions may require emergency endotracheal intubation. During the procedure, one periodically encounters laryngospasm with the vocal cords tightly apposed to each other, resisting passage of the endotracheal tube. We have encountered four such neonates during the past 12 months. Two neonates suffered from severe birth asphyxia and required intubation in the delivery room. A third infant was intubated because of progressive hypoxemia and hypercarbia secondary to hyaline membrane disease, and the fourth was intubated for an elective surgical procedure. A brief period of forced expiration produced by a depression of the sternum, a modification of the Heimlich maneuver,1 opened the vocal cords, enabling a smooth, relatively atraumatic intubation in all four infants.

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Early Diagnosis of GBS Pneumonia Using Tracheal Aspirates

PEDIATRICS ◽

10.1542/peds.61.2.329 ◽

1978 ◽

Vol 61 (2) ◽

pp. 329-329

Author(s):

K. B. Rajani ◽

B. W. Goetzman ◽

Richard P. Wennberg

Keyword(s):

Early Diagnosis ◽

Respiratory Distress ◽

Clinical Features ◽

Group B Streptococcus ◽

Hyaline Membrane Disease ◽

The Past ◽

Hyaline Membrane ◽

Group B ◽

Culture Positive ◽

Tracheal Aspirates

The association between hyaline membrane disease (HMD) and group B streptococcus (GBS) was once again highlighted in the article by Lilien et al. (Pediatrics 60:360, September 1977). We routinely perform tracheal aspirates on all newborns with respiratory distress as part of their initial evaluation. It has been our experience that GBS pneumonia as evidenced by clinical features and proved by culture-positive tracheal aspirates is not necessarily correlated with positive cultures of blood and CSF. During the past year (July 1, 1976, through June 30, 1977) we have had ten infants with HMD in whom GBS was isolated from the tracheal aspirates, seven of ten from blood, and only four of ten from CSF.

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Thrombotic Complications of Umbilical Artery Catheters: A Clinical and Radiographic Study

PEDIATRICS ◽

10.1542/peds.56.3.374 ◽

1975 ◽

Vol 56 (3) ◽

pp. 374-379

Author(s):

Boyd W. Goetzman ◽

Robert C. Stadalnik ◽

Hugo G. Bogren ◽

Willard J. Blankenship ◽

Richard M. Ikeda ◽

...

Keyword(s):

Umbilical Artery ◽

Newborn Infants ◽

Direct Result ◽

Thrombotic Complication ◽

Reliable Technique ◽

Arterial Blood ◽

Sick Newborn ◽

Thrombotic Complications ◽

Umbilical Artery Catheterization ◽

Blood Specimens

Catheterization of the aorta via the umbilical artery provides a convenient route for monitoring arterial blood pressure, for obtaining blood specimens for measurement of blood gas tensions and chemistries, and for the infusion of fluids and pharmacologic preparations in sick newborn infants. Use of this technique may be accompanied by a number of complications of which thrombotic phenomena are the most common. Twenty-three of 98 (24%) newborn infants undergoing umbilical artery catheterization were found to have thrombotic complications determined by aortography. No correlation was present between the duration of time that the umbilical artery catheters were in place and the occurrence of thrombotic complications. From paired aortographic or aortographic and autopsy studies in 24 patients, it was concluded that if a thrombotic complication did not occur early, none was likely to occur subsequently. One patient was considered to have died as a direct result of a thrombotic complication. Aortography is a safe, simple, and reliable technique for the early detection of thrombotic complications of umbilical artery catheters. Umbilical artery catheterization is not without risk and careful selection of patients for this procedure is indicated.

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The Role of Acidosis at Birth in the Development of Hyaline Membrane Disease

PEDIATRICS ◽

10.1542/peds.58.2.184 ◽

1976 ◽

Vol 58 (2) ◽

pp. 184-191

Author(s):

John D. Kenny ◽

James M. Adams ◽

Anthony J. S. Corbet ◽

Arnold J. Rudolph

Keyword(s):

Respiratory Distress ◽

Umbilical Artery ◽

Distress Syndrome ◽

Hyaline Membrane Disease ◽

Ion Concentration ◽

Hydrogen Ion Concentration ◽

Hyaline Membrane ◽

Base Measurement ◽

Abnormal Pulmonary Function

To test the hypothesis that intrapartum acidosis has a role in the etiology of hyaline membrane disease (HMD), blood was collected from the umbilical artery (UA) at birth from 110 premature infants and analyzed for hydrogen ion concentration ([H·]), Pco2, standard bicarbonate, and lactic acid. The infants were followed until a definite diagnosis was made of HMD (33 infants), type II respiratory distress syndrome (16 infants) or the absence of respiratory distress (61 infants). In general, infants with HMD were more premature and had lower Apgar scores than nondistressed infants; however, there were no significant differences between the two groups in any acid-base measurement. Only in those patients of 32 to 37 weeks' gestational age was it possible to detect a significant increase in UA [H·] in infants with HMD compared to those without respiratory distress. There was evidence that the reduced Apgar score of infants with HMD may be due to immaturity and abnormal pulmonary function secondary to lung disease. It is concluded that acidosis at birth is not a factor in the development of HMD except possibly in more mature infants.

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TYPE OF ANÆSTHESIA AND HYALINE MEMBRANE DISEASE

The Medical Journal of Australia ◽

10.5694/j.1326-5377.1967.tb21625.x ◽

1967 ◽

Vol 1 (15) ◽

pp. 790-790

Keyword(s):

Hyaline Membrane Disease ◽

Hyaline Membrane ◽

Type Of Anaesthesia

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Relationship Between Incidence of Hyaline Membrane Disease and Maternal Hypertension During Pregnancy

Paediatrica Indonesiana ◽

10.14238/pi38.3-4.1998.47-53 ◽

2017 ◽

Vol 38 (3-4) ◽

pp. 47

Author(s):

Lasmida Nazir Nuriman ◽

Dadang Sjarif Hidajat

Keyword(s):

Distress Syndrome ◽

Hyaline Membrane Disease ◽

Cross Sectional Study ◽

Type I ◽

Cross Sectional ◽

Hypertension In Pregnancy ◽

Hyaline Membrane ◽

Neonatal Respiratory Distress ◽

Maternal Hypertension ◽

The Relationship

There have been controversies over the eiTect of hypertension in pregnancy on the incidence of type I neonatal respiratory distress syndrome or hyaline membrane disease (HMD). We investigated the relationship between the incidence of HMD and maternal hypertension during pregnancy in 91 infants at 34 weeks gestation or less. This retrospective cross sectional study included all live born babies between May 1, 1994 and April 30, 1995 at Dr. Hasan Sadikin General Hospital, Bandung. Maternal hypertension during pregnancy was diagnosed in 38 mothers of91 infants studied. The incidence of HMD (5%) in the maternal hypertension during pregnancy group was significantly lower than the 62% in the normotensive group (p<0.01). There was a negative correlation between the occurence of HMD and hypertension during pregnancy. We conclude that the risk of developing HMD in infants born to hypertensive mothers is significantly lower than those born to normotensive mothers.

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