Early-Onset Haemophilus Sepsis in Newborn Infants: Clinical, Roentgenographic, and Pathologic Features

Nine infants with early-onset Haemophilus sepsis were seen between January 1973 and July 1977. Of the five isolated strains that were typed, only one was type B. All infants had respiratory distress, metabolic acidosis, and large alveolar-arterial oxygen tension difference gradients. Eight infants weighed less than 1,500 gm and died; one infant weighed 1,701 gm and survived. Roentgenograms in six of eight showed hyaline membrane disease. Pulmonary pathologic specimens in eight infants revealed hyaline membranes in six and polymorphonuclear leukocytes in the alveolar spaces in four. In two infants, small Gram-negative bacilli were noted within proteinaceous exudates in alveolar ducts. The route and time of infection in these infants with early-onset Haemophilus sepsis are unclear. However, the possibility that the infection occurs before birth and that these infants represent septically aborted prematures is suggested by the high incidence of prematurity in infants with early-onset Haemophilus sepsis and early detection of bacteremia in three infants.

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THE SIGNIFICANCE OF GRUNTING IN HYALINE MEMBRANE DISEASE

PEDIATRICS ◽

10.1542/peds.41.3.549 ◽

1968 ◽

Vol 41 (3) ◽

pp. 549-559 ◽

Cited By ~ 2

Author(s):

V. C. Harrison ◽

H. de V. Heese ◽

M. Klein

Keyword(s):

Oxygen Tension ◽

Valsalva Maneuver ◽

Arterial Oxygen Tension ◽

Hyaline Membrane Disease ◽

Alveolar Ventilation ◽

Arterial Oxygen ◽

Abdominal Muscles ◽

Intrapleural Pressure ◽

Hyaline Membrane

Grunting was investigated in 22 infants with hyaline membrane disease. It was demonstrated to be a modified Valsalva maneuver, as during expiration intrapleural pressure was increased by closure of the glottis and contraction of the abdominal muscles. Grunting could be prevented if the trachea was intubated; but, during this period the arterial oxygen tension fell. After detubation grunting recommenced and arterial oxygen tension rose to previous levels. Therefore, grunting appears to be a protective form of breathing, aimed at raising the PaO2. This is probably achieved by improvement of alveolar ventilation, but the exact mechanism is not known.

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CARDIORESPIRATORY STATUS OF ERYTHROBLASTOTIC INFANTS

PEDIATRICS ◽

10.1542/peds.49.1.5 ◽

1972 ◽

Vol 49 (1) ◽

pp. 5-14

Author(s):

R. H. Phibbs ◽

P. Johnson ◽

J. A. Kitterman ◽

G. A. Gregory ◽

W. H. Tooley

Keyword(s):

Respiratory Distress ◽

Distress Syndrome ◽

Arterial Oxygen Tension ◽

Hyaline Membrane Disease ◽

Arterial Oxygen ◽

Pathologic Finding ◽

Hyaline Membrane ◽

Idiopathic Respiratory Distress Syndrome ◽

Delayed Recovery ◽

Prematurely Born Infants

We evaluated cardiorespiratory and hematologic status at birth, and changes in arterial oxygen tension and pH during the first hour of life in 61 prematurely born infants with moderate to severe erythroblastosis fetalis and compared the findings with their subsequent neonatal course. Intrapartum asphyxia was common and often followed by respiratory distress of varying severity. Twenty infants died; all had the idiopathic respiratory distress syndrome and pathologic finding of pulmonary hyaline membrane disease. These complications were related to the interacting effects of prematurity, anemia, hydrops fetalis, and intrapartum asphyxia and, in particular, to delayed recovery from asphyxia as manifested by persistent hypoxemia and acidemia during the first hour of life.

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HYPOXEMIA DURING RECOVERY FROM SEVERE HYALINE MEMBRANE DISEASE

PEDIATRICS ◽

10.1542/peds.44.2.168 ◽

1969 ◽

Vol 44 (2) ◽

pp. 168-178

Author(s):

T. M. Adamson ◽

J. M. Hawker ◽

E. O. R. Reynolds ◽

J. L. Shaw

Keyword(s):

Mechanical Ventilation ◽

Arterial Oxygen Tension ◽

Hyaline Membrane Disease ◽

Arterial Oxygen ◽

Mechanically Ventilated ◽

Oxygen Breathing ◽

Arterial Blood ◽

Hyaline Membrane ◽

Blood Gas Analyses ◽

Serial Samples

Serial samples of arterial blood were taken during the illness of 10 infants with severe hyaline membrane disease, four of whom required mechanical ventilation. After the first few days of the illness had passed, there was little true right-to-left shunting of blood, but severe hypoxemia was found during the breathing of room air. Normal gas exchange was present by a mean time of 14 days from birth in infants who did not require mechanical ventilation, but it was delayed for many weeks in mechanically ventilated infants. From the results of blood gas analyses during air and oxygen breathing, it is concluded that hypoxemia during recovery from hyaline membrane disease is probably caused by inequalities of ventilation and perfusion in the lungs. Careful monitoring of the arterial oxygen tension is necessary so that an appropriate concentration of oxygen can be given in the inspired gas.

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THE BLOOD PRESSURE OF NEWBORN INFANTS IN ASPHYXIAL STATES AND IN HYALINE MEMBRANE DISEASE

PEDIATRICS ◽

10.1542/peds.26.5.735 ◽

1960 ◽

Vol 26 (5) ◽

pp. 735-744

Author(s):

Gerald A. Neligan ◽

D. M. Oxon. ◽

Clement A. Smith

Keyword(s):

Initial Level ◽

Newborn Infants ◽

Systolic Pressure ◽

Hyaline Membrane Disease ◽

Elective Cesarean Section ◽

Maternal Illness ◽

Direct Measurements ◽

Hyaline Membrane ◽

Elective Cesarean ◽

Blood Pressures

The early changes in the systolic blood pressures in six clinical groups of newborn infants have been studied. Readings of the sphygmomanometer used have been compared with "direct" measurements during cardiac catheterization, and the results are reported. In 36 normal mature infants the systolic pressure fell by a mean of 25 mm Hg from the initial value recorded within the first 5 minutes after delivery, to the lowest value, reached as a rule between 1 and 4 hours after delivery. In 18 clinically asphyxiated mature infants, the mean fall (38.5 mm Hg) was significantlygreater because the initial level was significantly higher (by 15.1 mm Hg) than the comparable initial level in the infants who breathed promptly. Three episodes of apnea during anesthesia have also been observed in two infants aged less than 48 hours, and on each occasion there has been an abrupt rise in the systolic pressure, with or without a corresponding bradycardia. In a group of premature infants studied from within the first half-hour after delivery, the seven of them diagnosed as hyaline membrane disease had a significant hypotension between 5 minutes and 4 hours after birth, as compared with the lowest systolic pressures found at corresponding times in the 10 infants who remained well. Among infants of diabetic mothers, a similar relative hypotension was observed in the four severe cases of hyaline membrane disease as compared with blood pressures of the 11 who remained well and the three who were mildly affected. A group of 13 mature infants delivered by elective cesarean section, for indications other than maternal illness of any kind, showed no significant differences in the course of their lowest systolic pressures as compared with the group of mature infants delivered from below. Neither the cause nor the significance of the hypotension seen in hyaline membrane disease is yet sufficiently clear to allow recommendation as to treatment.

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120: Comparison of transcutaneous oxygen tension (tcPO2) and arterial oxygen tension (PaO2) in newborn infants

Pediatric Research ◽

10.1203/00006450-197610000-00111 ◽

1976 ◽

Vol 10 (10) ◽

pp. 890-890 ◽

Cited By ~ 3

Author(s):

P Jolly ◽

E O R Reynolds ◽

L P Soutter

Keyword(s):

Oxygen Tension ◽

Newborn Infants ◽

Arterial Oxygen Tension ◽

Arterial Oxygen ◽

Transcutaneous Oxygen Tension ◽

Transcutaneous Oxygen

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THE ADRENAL CORTEX, STEROIDS, AND HYALINE MEMBRANE DISEASE

PEDIATRICS ◽

10.1542/peds.47.4.645 ◽

1971 ◽

Vol 47 (4) ◽

pp. 645-646

Author(s):

John W. Reynolds

Keyword(s):

Adrenal Cortex ◽

Adrenal Glands ◽

Direct Evidence ◽

Matched Control ◽

Newborn Infants ◽

Hyaline Membrane Disease ◽

Type Ii ◽

Hyaline Membrane ◽

Issue Reports ◽

Number Of Cells

The paper by Naeye, et al.,1 in this issue reports a very interesting relation between adrenal gland size and the presence of hyaline membrane disease in newborn infants. Those infants with hyaline membrane disease had smaller adrenal glands than weight matched control infants, due to a decreased number of cells in both the permanent and fetal zones of the adrenal cortex. More direct evidence of possible relation between adrenal cortical size and the capacity of the lung to produce surfactant is brought out by their finding of a correlation between adrenal cortical size in anencephalic infants and the osmiophilic granule content of so-called type II alveolar lining cells.

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Continuous Monitoring of Arterial Oxygen Tension Using a Catheter-Tip Polarographic Electrode in Infants

PEDIATRICS ◽

10.1542/peds.57.2.244 ◽

1976 ◽

Vol 57 (2) ◽

pp. 244-250

Author(s):

M. Conway ◽

G. M. Durbin ◽

D. Ingram ◽

N. McIntosh ◽

D. Parker ◽

...

Keyword(s):

Oxygen Tension ◽

Continuous Monitoring ◽

Newborn Infants ◽

Arterial Oxygen Tension ◽

Oxygen Electrode ◽

Arterial Oxygen ◽

Respiratory Illnesses ◽

Arterial Blood ◽

Reliable Instrument ◽

Catheter Tip

An oxygen electrode mounted in the tip of an umbilical artery catheter was used in 36 newborn infants with severe respiratory illnesses, 28 of whom survived. Thirty-seven electrodes were used. The median age at insertion was 4 hours (range, 30 minutes to 122 hours). Three electrodes failed to work and they were removed or replaced, and two could not be properly evaluated. Thirty-two electrodes functioned satisfactorily for 10 to 190 hours (mean, 75 hours) after a one-point calibration against blood sampled through the catheter. Twenty-two did not need recalibrating before they were removed after 10 to 190 hours (mean, 88 hours). Four of the remaining ten electrodes were recalibrated once after 33 to 97 hours and then functioned until removed 15 to 55 hours later. The other six electrodes failed after 32 to 105 hours (mean, 49 hours). Complications were few. A total of 356 arterial blood samples, obtained after the initial calibration and before any recalibration was necessary, gave a correlation coefficient of 0.93 (P < .0001) against an independent system for measuring arterial oxygen tension (Pao2) (Radiometer Type E.5046 oxygen electrode). We conclude that the catheter-tip electrode is a safe and reliable instrument for continuously recording Pao2 in newborn infants which much simplifies the management of serious respiratory illnesses.

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