Limitations of Transcutaneous Po2 and Pco2 Monitoring in Infants with Bronchopulmonary Dysplasia

PEDIATRICS ◽  
1984 ◽  
Vol 74 (2) ◽  
pp. 217-220
Author(s):  
Ellen S. Rome ◽  
Eileen K. Stork ◽  
Waldemar A. Carlo ◽  
Richard J. Martin
Keyword(s):  
Bronchopulmonary Dysplasia ◽  
Premature Infants ◽  
Neonatal Period ◽  
Postnatal Life ◽  
Pco2 Monitoring ◽  
Arterial Po2 ◽  
Transcutaneous Po2

Despite the well-documented correlation between transcutaneous and arterial Po2 and Pco2 in sick neonates, the effect of maturation on this relationship has not been well characterized. Eight premature infants with bronchopulmonary dysplasia (BPD) and indwelling arterial lines beyond the immediate neonatal period were studied. Transcutaneous Po2 always underestimated Pao2 beyond 10 weeks of postnatal life, such that transcutaneous Po2 - Pao2 was -16 ± 5 torr (P < .001). Corrected transcutaneous Pco2 simultaneously overestimated PaCo2 by 9 ± 3 torr (P < .001), although this occurred over a wider range of postnatal ages. Transcutaneous Po2 monitoring may be a useful tool for estimating Pao2 in this population, provided an appropriate correction is made beyond 10 weeks of age. It is suggested that caution be exercised when using transcutaneous Pco2 measurements to estimate absolute arterial values in older infants with bronchopulmonary dysplasia.

Skin Oxygen Permeability in Premature Infants

PEDIATRICS ◽  
1978 ◽  
Vol 62 (4) ◽  
pp. 488-491
Author(s):  
Hans T. Versmold ◽  
Mathäus Holzmann ◽  
Otwin Linderkamp ◽  
Klaus P. Riegel
Keyword(s):  
Blood Flow ◽  
Premature Infants ◽  
Oxygen Diffusion ◽  
Oxygen Permeability ◽  
Newborn Infants ◽  
Skin Surface ◽  
The Mean ◽  
Arterial Po2 ◽  
Skin Temperatures ◽  
Transcutaneous Po2

While 24 newborn infants (ages, 2 to 48 hours; gestational ages, 24 to 42 weeks) breathed various concentrations of oxygen, the PO2 values on their unheated skin surface were measured by an unheated microcathode electrode for transcutaneous PO2 monitoring. In infants with arterial PO2 values in the range of 50 to 100 torr and with similar skin temperatures, the mean surface PO2 of unheated skin was inversely related to birth weight: 27.2 torr in infants weighing less than 1,500 gm, 14.3 torr in infants weighing 1,500 to 2,500 gm, and 2.9 torr in infants weighing more than 2,500 gm. In the smallest infants, the skin surface PO2 was significantly related to arterial P02: it was about one third of arterial PO2 as estimated by a second electrode for transcutaneous PO2 monitoring heated to 44°C. Phototherapy, crying, or blood transfusion increased the surface P02 of unheated skin, but not the tcPO2 measured at 44°C. These findings suggest that blood flow to the skin in excess of its metabolic needs due to immature control of cutaneous circulation, along with low resistance to oxygen diffusion, determines the high oxygen permeability of skin in premature infants.

Transcutaneous Oxygen Monitors Are Reliable Indicators of Arterial Oxygen Tension (If Used Correctly)

PEDIATRICS ◽  
1987 ◽  
Vol 79 (2) ◽  
pp. 283-286 ◽  
Author(s):  
G. ROOTH ◽  
A. HUCH ◽  
R. HUCH
Keyword(s):  
Premature Infants ◽  
Arterial Oxygen Tension ◽  
Arterial Oxygen ◽  
Term Infants ◽  
Transcutaneous Oxygen ◽  
Basic Understanding ◽  
Arterial Po2 ◽  
Transcutaneous Po2

The following recommendations should always be kept in mind: 1. Each new transcutaneous equipment, or modification of equipment, must be adequately tested in vivo as well as in vitro. 2. The users must have basic understanding of the principles and the major requirements for applying the tcPo2 technique. 3. Calibration procedures must be carefully adhered to according to the manufacturer's instruction. 4. The temperature of the electrode must be kept at 44°C for premature infants and at 44° or 45°C for term infants if the clinical aim is to estimate arterial Po2 levels. Resetting of the electrode must then be done every two hours. For sick infants, this may be needed more frequently. 5. Whenever there is cause to compare tcPo2 values with arterial ones, the latter must be obtained from an appropriate vessel. Great care must be taken when drawing and analyzing blood for Po2. The infant should not be crying. 6. Significantly lower transcutaneous Po2 values than arterial Po2 values are due to either one or several of the errors indicated above or to an insufficient circulation under the electrode. In recent years, technical or clinical errors seem to have become more and more common. Thereby the technique has unjustly fallen into disrepute. 7. Insufficient circulation under the electrode rarely occurs in the newborn infant and then only in those who are in overt shock.

Pulse Oximetry in Very Low Birth Weight Infants With Acute and Chronic Lung Disease

PEDIATRICS ◽  
1987 ◽  
Vol 79 (4) ◽  
pp. 612-617
Author(s):  
Rangasamy Ramanathan ◽  
Manuel Durand ◽  
Carlos Larrazabal
Keyword(s):  
Birth Weight ◽  
Low Birth Weight ◽  
Pulse Oximetry ◽  
Bronchopulmonary Dysplasia ◽  
Pulse Oximeter ◽  
Very Low Birth Weight ◽  
Fetal Hemoglobin ◽  
Low Birth Weight Infants ◽  
Arterial Po2 ◽  
Transcutaneous Po2

With improved survival of very low birth weight infants, the incidence of bronchopulmonary dysplasia has significantly increased. Pulse oximetry appears to be an adequate alternative to transcutaneous Po2, for continuous arterial oxygen saturation (Sao2) monitoring in neonates; however, its usefulness has not been very well documented in very low birth weight infants. We studied 68 patients with birth weight < 1,250 g; 44 neonates had respiratory distress syndrome and 24 had bronchopulmonary dysplasia. Using a Nellcor N-100 pulse oximeter, we compared transcutaneous oxygen saturation with simultaneous arterial samples analyzed for Sao2 (range 78% to 100%) using an IL 282 co-oximeter. Fetal hemoglobin was measured in 66 patients. We also evaluated the accuracy of transcutaneous Po2 in reflecting arterial Po2 in patients with bronchopulmonary dysplasia. Over a wide range of Po2, Pco2, pH, heart rate, BP, hematocrit, and fetal hemoglobin, linear regression analysis revealed a close correlation between pulse oximeter values and co-oximeter measured Sao2 in patients with acute (r = .88, Y = 19.41 + 0.79X) and chronic (r = .90, Y = 9.72 + 0.92X) disease. Regression analysis of transcutaneous v arterial Po2 in infants with bronchopulmonary dysplasia showed an r value of .78. In addition, in these patients with chronic disease, the mean difference between pulse oximeter Sao2 and co-oximeter measured Sao2 was 2.7 ± 1.9% (SD); whereas the mean difference between transcutaneous and arterial Po2 was -14 ± 10.7 mm Hg. Our findings indicate that pulse oximetry can be used reliably in very low birth weight infants with acute and chronic lung disease, for Sao2 values greater than 78%. This technique is more advantageous than transcutaneous Po2 in infants with bronchopulmonary dysplasia. Additional studies are needed to evaluate the performance of the pulse oximeter in tiny infants with Sao2 values < 78%.

scholarly journals SCENARIOS OF THE COURSE OF BRONCHOPULMONARY DYSPLASIA IN PREMATURE INFANTS WITH PATENT DUCTUS ARTERIOSUS IN FOLLOW-UP TO 3 YEARS

2021 ◽  
Vol 11 (4(42)) ◽  
pp. 15-20
Author(s):  
Y. Sorokolat ◽  
T. Klimenko ◽  
O. Karapetian ◽  
O. Kalutska
Keyword(s):  
Patent Ductus Arteriosus ◽  
Bronchopulmonary Dysplasia ◽  
Premature Infants ◽  
Neonatal Period ◽  
Ductus Arteriosus ◽  
Surgical Closure ◽  
Group I ◽  
Perinatal Center ◽  
Patent Ductus

Summary. Bronchopulmonary dysplasia (BPD) is one of the most common long-term complications associated with preterm birth. The severity of BPD is associated with immaturity of a child's body, perinatal infections, and patent ductus arteriosus (PDA).The aim of the study was to identify the features of BPD in the 1st year of life of a child and in the follow- up to 3 years, depending on the condition of the ductus arteriosus.Material and methods. The observations of 146 premature infants with BPD, who were divided into groups depending on the state of the ductus arteriosus, were analyzed: Group I consisted of 58 children with BPD whose ductus arteriosus closed spontaneously in the early neonatal period; II group – 60 children with hemodynamically insignificant PDA, which remained open for 6-12 months; III group – 28 children with hemodynamically significant (HS) PDA, which required surgical closure during the stay of a child in the perinatal center. Results. There were significantly more cases of severe BPD among children of group II compared to group I: 23.3 vs. 8.6 % (p <0.01) and, accordingly, fewer cases of moderate course: 41.7 vs. 58.6 % (p <0.05) at the stage of children treatment in the perinatal center. At the age of 3 years, there were significantly more healthy children who underwent BPD in group I compared to group III: 62.5 vs. 25.9 % (p <0.01), and severe course was significantly more common in both groups II and III compared to group I: 6.8 and 7.4 % vs. 0 % (p <0.01). No significant differences in the severity of BPD at the age of 2-3 months and in the follow-up to 1 year from the date of surgical closure of HS PDA were detected. Conclusions. Sexual dimorphism was found, namely the prevalence of males among preterm infants with delayed closure of the ductus arteriosus. The presence of hemodynamic disorders connected with PDA is associated with a more severe course of BPD at the age of 3 years compared to children whose ductus arteriosus closed on its own in the early neonatal period. At the average term of surgical closure of PDA 21.5 ± 1.6 days of life, significant differences in the severity of BPD from the term of surgical closure of PDA weren`t detected.

scholarly journals Bronchopulmonary dysplasia in extremely premature infant with congenital lobar emphysema: a case report

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Bingchun Lin ◽  
Huitao Li ◽  
Chuanzhong Yang
Keyword(s):  
Premature Infant ◽  
Bronchopulmonary Dysplasia ◽  
Premature Infants ◽  
Gestational Age ◽  
Middle Lobe ◽  
Severe Respiratory Distress ◽  
Congenital Lobar Emphysema ◽  
X Ray ◽  
Chest X Ray ◽  
Lobar Emphysema

Abstract Background Congenital lobar emphysema (CLE) is a congenital pulmonary cystic disease, characterized by overinflation of the pulmonary lobe and compression of the surrounding areas. Most patients with symptoms need an urgent surgical intervention. Caution and alertness for CLE is required in cases of local emphysema on chest X-ray images of extremely premature infants with bronchopulmonary dysplasia (BPD). Case presentation Here, we report a case of premature infant with 27 + 4 weeks of gestational age who suddenly presented with severe respiratory distress at 60 days after birth. Chest X-ray and computed tomography (CT) indicated emphysema in the middle lobe of the right lung. The diagnosis of CLE was confirmed by histopathological examinations. Conclusions Although extremely premature infants have high-risk factors of bronchopulmonary dysplasia due to their small gestational age, alertness for CLE is necessary if local emphysema is present. Timely pulmonary CT scan and surgical interventions should be performed to avoid the delay of the diagnosis and treatment.

scholarly journals Non-Invasive Ventilatory Strategies to Decrease Bronchopulmonary Dysplasia—Where Are We in 2021?

Children ◽  
2021 ◽  
Vol 8 (2) ◽  
pp. 132
Author(s):  
Vikramaditya Dumpa ◽  
Vineet Bhandari
Keyword(s):  
Lung Injury ◽  
Bronchopulmonary Dysplasia ◽  
Premature Infants ◽  
Extremely Low Birth Weight ◽  
Positive Pressure ◽  
Invasive Ventilation ◽  
Clinical Practices ◽  
Non Invasive ◽  
Non Invasive Ventilation ◽  
Increased Risk

Recent advances in neonatology have led to the increased survival of extremely low-birth weight infants. However, the incidence of bronchopulmonary dysplasia (BPD) has not improved proportionally, partly due to increased survival of extremely premature infants born at the late-canalicular stage of lung development. Due to minimal surfactant production at this stage, these infants are at risk for severe respiratory distress syndrome, needing prolonged ventilation. While the etiology of BPD is multifactorial with antenatal, postnatal, and genetic factors playing a role, ventilator-induced lung injury is a major, potentially modifiable, risk factor implicated in its causation. Infants with BPD are at a higher risk of developing complications including sepsis, pulmonary arterial hypertension, respiratory failure, and death. Long-term problems include increased risk of hospital readmissions, respiratory infections, and asthma-like symptoms during infancy and childhood. Survivors who have BPD are also at increased risk of poor neurodevelopmental outcomes. While the ultimate solution for avoiding BPD lies in the prevention of preterm births, strategies to decrease its incidence are the need of the hour. It is time to focus on gentler modes of ventilation and the use of less invasive surfactant administration techniques to mitigate lung injury, thereby potentially decreasing the burden of BPD. In this article, we discuss the use of non-invasive ventilation in premature infants, with an emphasis on studies showing an effect on BPD with different modes of non-invasive ventilation. Practical considerations in the use of nasal intermittent positive pressure ventilation are also discussed, considering the significant heterogeneity in clinical practices and management strategies in its use.

ANALYSIS OF FETAL AND NEONATAL DEATHS IN 4117 CONSECUTIVE BIRTHS

PEDIATRICS ◽  
1950 ◽  
Vol 5 (2) ◽  
pp. 184-192
Author(s):  
HERBERT C. MILLER
Keyword(s):  
Cause Of Death ◽  
Premature Infants ◽  
Neonatal Death ◽  
Causes Of Death ◽  
Neonatal Period ◽  
Full Term ◽  
Maternal Complications ◽  
Term Infants ◽  
Neonatal Deaths ◽  
Postmortem Examinations

An analysis of the significant causes of death in 4117 consecutive births was made; there were 66 fetal deaths and 85 neonatal deaths. A significant cause of death was determined in 51 fetuses and 56 live-born infants. Eighty-five per cent of the live-born infants who weighed over 1000 gm. at birth and had postmortem examinations had causes of death which were considered to be significant. Almost half of the live-born premature infants with birth weights between 1000 and 2500 gm. were considered to have had more than one significant cause of death. The so-called significant causes of death among live-born infants differed from those determined for fetuses dying before birth. Among the former, pathologic conditions in the infants were determined four times more frequently than in those dying before birth and, in the latter, maternal complications of pregnancy and labor were diagnosed as significant causes of death five times more frequently than in infants dying in the neonatal period. Hyaline-like material in the lung was considered to be the most frequent significant cause of death in live-born premature infants; congenital malformation and anoxia resulting from complications of labor were the most frequently determined significant causes of death in live-born full term infants. No differences were found in the significant causes of death in premature and full term fetuses. Anoxia resulting from accidental and unexpected interruption of the blood flow in the placenta and umbilical cord and from dystocia was the most frequently determined significant cause of death in both groups. A plea has been made for the adoption by obstetricians, pathologists and pediatricians of a formal uniform plan of classifying the causes of fetal and neonatal death which would divest current efforts to determine the cause of death of as much vague terminology and arbitrary opinion as possible.

Effect of Acute Hemorrhage on Transcutaneous, Subcutaneous, Intramuscular, and Arterial Oxygen Tensions

PEDIATRICS ◽  
1980 ◽  
Vol 65 (5) ◽  
pp. 881-883
Author(s):  
Frederick A. Matsen ◽  
Craig R. Wyss ◽  
Racheal V. King ◽  
Charles W. Simmons
Keyword(s):  
Arterial Oxygen ◽  
Peripheral Blood Flow ◽  
Danger Signal ◽  
Close Approximation ◽  
Monitoring Method ◽  
Acute Hemorrhage ◽  
Tissue Po2 ◽  
Oxygen Tensions ◽  
Arterial Po2 ◽  
Transcutaneous Po2

Although transcutaneous Po2 is a close approximation of arterial Po2 in most neonates, infants in shock often show lower transcutaneous than arterial Po2 values. For a better understanding of this discrepancy, we investigated the effect of acute hemorrhage on transcutaneous, tissue, and arterial Po2 in rabbits. With progressive hemorrhage, transcutaneous and tissue Po2 values declined steeply while arterial Po2 values did not. We speculate that the progressive decrement in transcutaneous and tissue Po2 values with hemorrhage is produced by diminished peripheral blood flow. Rather than representing a failure of the transcutaneous Po2 monitoring method, we speculate that transcutaneous hypoxia with shock may be a clinically valuable danger signal.

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