scholarly journals Neonatal Respiratory Distress and Airway Emergency: Report of Two Cases

Children ◽  
2021 ◽  
Vol 8 (4) ◽  
pp. 255
Author(s):  
Lorenzo Bresciani ◽  
Paola Grazioli ◽  
Roberta Bosio ◽  
Gaetano Chirico ◽  
Cesare Zambelloni ◽  
...  
Keyword(s):  
Respiratory Distress ◽  
Neonatal Intensive Care ◽  
Renal Dysplasia ◽  
Esophageal Intubation ◽  
Mask Ventilation ◽  
Anal Atresia ◽  
Severe Respiratory Distress ◽  
First Case ◽  
Emergency Tracheostomy ◽  
Vertebral Defects

We discuss two cases of congenital airway malformations seen in our neonatal intensive care unit (NICU). The aim is to report extremely rare events characterized by immediate respiratory distress after delivery and the impossibility to ventilate and intubate the airway. The first case is a male twin born at 34 weeks by emergency caesarean section. Immediately after delivery, the newborn was cyanotic and showed severe respiratory distress. Bag-valve-mask ventilation did not relieve the respiratory distress but allowed for temporary oxygenation during subsequent unsuccessful oral-tracheal intubation (OTI) attempts. Flexible laryngoscopy revealed complete subglottic obstruction. Postmortem analysis revealed a poly-malformative syndrome, unilateral multicystic renal dysplasia with a complete subglottic diaphragm, and a tracheo-esophageal fistula (TEF). The second case is a male patient that was vaginally born at 35 weeks. Antenatally, an ultrasound (US) arose suspicion for a VACTERL association (vertebral defects, anal atresia, TEF with esophageal atresia and radial or renal dysplasia, plus cardiovascular and limb defects) and a TEF, and thus, fetal magnetic resonance (MRI) was scheduled. Spontaneous labor started shortly thereafter, before imaging could be performed. Respiratory distress, cyanosis, and absence of an audible cry was observed immediately at delivery. Attempts at OTI were unsuccessful, whereas bag-valve-mask ventilation and esophageal intubation allowed for sufficient oxygenation. An emergency tracheostomy was attempted, although no trachea could be found on cervical exploration. Postmortem analysis revealed tracheal agenesis (TA), renal dysplasia, anal atresia, and a single umbilical artery. Clinicians need to be aware of congenital airway malformations and subsequent difficulties upon endotracheal intubation and must plan for multidisciplinary management of the airway at delivery, including emergency esophageal intubation and tracheostomy.

DOZ047.33: Neonatal airway emergency: report of two cases

2019 ◽  
Vol 32 (Supplement_1) ◽  
Author(s):  
P Grazioli ◽  
R Bosio ◽  
C Baronchelli ◽  
A Santoro ◽  
G Chirico ◽  
...  
Keyword(s):  
Respiratory Distress ◽  
Main Bronchus ◽  
Vocal Folds ◽  
Renal Dysplasia ◽  
Severe Respiratory Distress ◽  
Vitro Fertilization ◽  
Emergency Tracheostomy ◽  
The Us ◽  
Multicystic Renal Dysplasia

Abstract Objective This paper discusses two cases of congenital airway malformations that presented in NICU in a four-month period. The aim is to present extremely rare evidences that inevitably lead to the death of the patient if not correctly identified during pregnancy. Case 1: male twin born at 34 weeks by emergency caesarean section to a 37-year-old mother. Antenatal history was notable for in vitro fertilization and renal dysplasia. Immediately after delivery, there was respiratory distress, cyanosis, with a 1- and 5-min Apgar score of 0 and 1, respectively. He required ventilation and was supposed intubated orally with significant difficulty with a 2.0 mm ETT. For persistent ventilation problems and severe combined acidosis, the neonatologists tried without success to reintubate the patient. Some hours later, the otolaryngologist was called and was again unable to intubate with flexible laryngoscopy due to an obstruction that prevented advancement of the endotracheal tube past the vocal folds, but since the baby general conditions had been already deteriorated a decision to withdraw the treatment was made. He died after few hours. Postmortem revealed a polymalformative syndrome with subglottic complete diaphragm, a tracheoesophageal fistula 1 cm caudally to the diaphragm and unilateral multicystic renal dysplasia. Case 2: male vaginally delivery at 35 weeks to a 43-year-old mother with gestational diabetes. Antenatally, ‘VACTERL’ association was suspected on the basis of the US and a MRI was planned but not performed because of the early delivery. Following the delivery, there was severe respiratory distress, no audible cry, and ventilation was not effective in relieving the respiratory distress. Subsequent intubation was unsuccessful. An emergency tracheostomy was attempted: the larynx was identified, but only a tracheal stump was present on neck exploration. Postmortem confirmed type II (according to Floyd) tracheal agenesis with the esophagus connect to the main bronchus, renal dysplasia, anal atresia, and single umbilical artery. Conclusion Clinicians need to be aware of congenital airway malformation and subsequent difficulties upon endotracheal intubation and they have to be prepared to plan a multidisciplinary management at the delivery including emergency intubation through esophageal fistula.

Double-Blind, Randomized Trial of a Calf Lung Surfactant Extract Administered at Birth to Very Premature Infants for Prevention of Respiratory Distress Syndrome

PEDIATRICS ◽  
1985 ◽  
Vol 76 (4) ◽  
pp. 593-599 ◽  
Author(s):  
Donald L. Shapiro ◽  
Robert H. Notter ◽  
Frederick C. Morin ◽  
Karl S. Deluga ◽  
Leonard M. Golub ◽  
...  
Keyword(s):  
Respiratory Distress Syndrome ◽  
Respiratory Distress ◽  
Premature Infants ◽  
Neonatal Intensive Care ◽  
Distress Syndrome ◽  
Lung Surfactant ◽  
Treated Group ◽  
Control Group ◽  
Double Blind ◽  
Severe Respiratory Distress

Organic solvent extraction of surfactant obtained by lavage of calf lungs yields a highly surfaceactive material. A double blind, randomized clinical trial to determine the effect of this material on respiratory distress syndrome in premature infants was initiated in the Neonatal Intensive Care Unit at the University of Rochester in December 1983. Infants 25 to 29 weeks gestational age were eligible for entry into the trial. At the time of this interim analysis 32 patients had been randomly selected and entered into the trial, 16 surfactant-treated patients and 16 in a control group who received only saline. At birth, intrapulmonary instillation of the calf lung surfactant extract dispersed in saline or saline alone occurred in the delivery room immediately after intubation and prior to ventilation; infants were then ventilated and treated as usual. At 6, 12, 24, 48, and 72 hours after birth, the severity of respiratory distress was categorized as either minimal, intermediate, or severe based on oxygen and mean airway pressure requirements. Differences observed at six hours after birth were of marginal significance, but at 12 and 24 hours the surfactant-treated group had significantly (P < .01) less severe respiratory distress compared with the control group. Differences between treated and control infants were not statistically significant at 48 and 72 hours after birth. In four surfactant-treated infants the severity of respiratory distress worsened between 24 and 48 hours after birth, suggesting that one dose of surfactant at birth may not be sufficient for some infants.

scholarly journals Neonatal COVID-19 Pneumonia: Report of the First Case in a Preterm Neonate in Mayotte, an Overseas Department of France

Children ◽  
2020 ◽  
Vol 7 (8) ◽  
pp. 87
Author(s):  
Soumeth Abasse ◽  
Laila Essabar ◽  
Tereza Costin ◽  
Voninavoko Mahisatra ◽  
Mohamed Kaci ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Case Report ◽  
Respiratory Distress ◽  
Neonatal Intensive Care ◽  
Preterm Neonate ◽  
Chest Ct ◽  
First Case ◽  
Chest Ct Scan

We report the first case of COVID-19 pneumonia in a preterm neonate in Mayotte, an overseas department of France. The newborn developed an acute respiratory distress by 14 days of life with bilateral ground glass opacities on a chest CT scan and a 6-week-long stay in the neonatal intensive care unit (NICU). This case report emphasizes the need for a cautious and close follow-up period for asymptomatic neonates born to mothers with COVID-19 infection. Vertical transmission cannot be excluded in this case.

scholarly journals Etiological factors, clinical profile and outcome of meconium aspiration syndrome babies

2019 ◽  
Vol 6 (4) ◽  
pp. 1515
Author(s):  
R. Sasivarathan ◽  
A. Logesh Anand
Keyword(s):  
Respiratory Distress ◽  
Tamil Nadu ◽  
Neonatal Intensive Care ◽  
Birth Asphyxia ◽  
Fetal Distress ◽  
Fetal Outcome ◽  
Meconium Aspiration Syndrome ◽  
College Hospital ◽  
Severe Respiratory Distress ◽  
Etiological Factors

Background: Meconium staining of amniotic fluid has for long been considered to be a bad predictor of the fetal outcome because of its direct correlation of fetal distress, and increased the likelihood of inhalation of meconium, resultant deleterious effects on the neonatal lung. To evaluate etiological factors and severity of MAS in the study group.Methods: This study was done in the Neonatal intensive care unit of the Department of Paediatrics, Government Mohan Kumaramangalam Medical College Hospital Salem, Tamil Nadu, India in the year 2018. Complete maternal and neonatal details were recorded in to the proforma. Delivery details, resuscitation did were also recorded.Results: In present study, fetal distress was found to be the most common (42.5%) factor associated with MAS followed by PIH (21.6%) and PROM (17%). 22 (9.1%) cases were associated with Postdatism, 18 (7.5%) cases were associated with placental insufficiency. 88 babies had fetal distress (36.6%) prior to delivery. 138 babies had no fetal distress (57.5%).Conclusions: MAS is known to cause severe respiratory distress and Downe’s score ranging between 4-8, usually a few hours after the onset of respiratory distress. Nearly 73.3% of the cases with MAS had birth asphyxia, out of which 30% had severe birth asphyxia. This indicates that passage of meconium can occur in utero, often considered a feature of the stressed fetus. Undoubtedly aspiration had occurred before delivery in these babies.

scholarly journals Newborn Nasal Obstruction due to Congenital Nasal Pyriform Aperture Stenosis

2016 ◽  
Vol 7 (1) ◽  
pp. ar.2016.7.0146 ◽  
Author(s):  
Thiago L. I. Serrano ◽  
Leopoldo Pfeilsticker ◽  
Vanessa Silva ◽  
Igor Hazboun ◽  
Jorge Paschoal ◽  
...  
Keyword(s):  
Surgical Treatment ◽  
Respiratory Distress ◽  
Nasal Cavity ◽  
Nasal Obstruction ◽  
Treatment Strategies ◽  
Rare Condition ◽  
Surgical Correction ◽  
Severe Respiratory Distress ◽  
First Case ◽  
Pyriform Aperture

Introduction Nasal obstruction is an important condition that can lead to severe respiratory distress in newborns. There are several differential diagnoses, and one of them is congenital nasal pyriform aperture stenosis (CNPAS). CNPAS is a rare case of respiratory distress caused by excessive growth of the nasal process of the maxilla and leads to narrowing of the anterior third of the nasal cavity. Diagnosis, associated anomalies, and treatment strategies are reviewed by the following presentation of two cases. Case Presentation We report two cases of infants diagnosed with CNPAS. The patients in the first case had no concomitant comorbidities, and the outcome was successful after surgical correction of stenosis. The patient in the second case had an associated holoprosencephaly, and although surgical correction and nasal cavity patency, the patient remains dependent on tracheostomy due to dysphagia and neurologic impairment. Discussion Airway obstruction affects 1 in 5000 children, and CNPAS is a diagnosis frequently forgotten and even unknown to neonatal and pediatric intensivists. Newborns are obligate nasal breathers, and, nasal obstruction, therefore, can lead to severe respiratory distress. CNPAS is not only rare but, many times, is not easily recognized. It is important to bear in mind the diagnostic criteria when evaluating infants with nasal obstruction. Conservative treatment should be prioritized, but surgical treatment is required in severe cases with failure to thrive and persistent respiratory distress. Respiratory distress and dysphagia may persist to some degree despite correction of the stenotic pyriform aperture due to associated narrowing of the entire nasal cavity and association with other anomalies. Final Comments CNPAS is a rare condition and may be lethal in newborns. Differential diagnosis of nasal obstruction must be remembered to recognize this anomaly, and the otolaryngologist must be familiarized with this condition and its diagnosis. Precise surgical treatment in severe cases have high rates of success in children without other comorbidities.

scholarly journals Metallic Stents for Proximal Tracheal Stenosis: Is It Worth the Risk?

2012 ◽  
Vol 2012 ◽  
pp. 1-3 ◽  
Author(s):  
Sandeep Bansal ◽  
Shruti Dhingra ◽  
Babita Ghai ◽  
Ashok K. Gupta
Keyword(s):  
Respiratory Distress ◽  
Steel Wire ◽  
Wire Mesh ◽  
Metallic Stent ◽  
Severe Respiratory Distress ◽  
Best Management ◽  
Emergency Tracheostomy ◽  
Stainless Steel Wire Mesh ◽  
History Of ◽  
Steel Wire Mesh

Objective. To demonstrate the risk associated with blocked proximal tracheal stents when a patient presents with acute respiratory distress, with blockage of stent and what is the best management we can offer without damage to the stent and its associated complications.Case Report. A 22-yr-old, male patient, presented in severe respiratory distress. He had history of corrosive poisoning for which he was tracheotomised. A stainless steel wire mesh stent was placed in the trachea, from the subglottis, to just above the carina. One month later, he presented with a critically compromised airway with severe respiratory distress. Emergency tracheostomy was done and the metallic stent had to be cut open, in order to provide an airway.Conclusion. Management of blocked proximal stents with patient in respiratory distress remains a challenge. Formation of granulation tissue is common and fibreoptic bronchoscopic assisted intubation may not always be possible. A regular follow up of all patients with stents is essential. Placement of stents within a few centimetres of cricotracheal junction should not be encouraged for long term indications.

Rhinosporidiosis of trachea: a clinical cause for concern

2008 ◽  
Vol 122 (4) ◽  
Author(s):  
R Arora ◽  
R Gupta ◽  
Amit Kumar Dinda
Keyword(s):  
Sri Lanka ◽  
Respiratory Distress ◽  
Rare Complication ◽  
Pathological Examination ◽  
Complete Excision ◽  
Severe Respiratory Distress ◽  
Risk Of Bleeding ◽  
Emergency Tracheostomy ◽  
Bronchoscopic Biopsy ◽  
Life Threatening

AbstractBackground:Rhinosporidiosis is a granulomatous infection usually affecting the nasal mucosa and conjunctiva. The disease is widely prevalent in India and Sri Lanka. Tracheo-bronchial involvement is extremely rare and is potentially life threatening. Diagnosis of tracheal involvement is a challenge due to the risk of bleeding during attempted bronchoscopic biopsy.Case:A 73-year-old man was admitted with severe respiratory distress, for which emergency tracheostomy was performed. At tracheostomy, a fleshy mass was seen emerging from the wound. Pathological examination of the mass confirmed rhinosporidiosis involving the trachea. Complete excision of the mass was performed after initial stabilisation of the patient.Conclusion:Tracheo-bronchial rhinosporidiosis, a rare complication of nasopharyngeal infection, should be considered in a known case presenting with severe respiratory distress.

Congenital anomalies following use of isotretinoin: Emphasis on its legal aspects

2016 ◽  
Vol 85 (1) ◽  
pp. 33-34 ◽  
Author(s):  
Naimeh Farhidnia ◽  
Azadeh Memarian
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Side Effects ◽  
Neonatal Intensive Care ◽  
Legal Aspects ◽  
Previous Knowledge ◽  
Anal Atresia ◽  
Severe Respiratory Distress ◽  
Multiple Abnormalities ◽  
Legal Consequences

We described a neonate with severe and multiple abnormalities following use of isotretinoin, in spite of the mother's previous knowledge of drug complications. Initial physical examination after delivery showed congenital absence of both eyes and both auricles as well as anal atresia and a cleft palate. Due to severe respiratory distress and atresia of the anus, the neonate was admitted to a neonatal intensive care unit and underwent reconstructive surgery. The drug should not have been used during pregnancy. Using this drug within pregnancy with awareness of its side effects may have legal consequences.

scholarly journals Prehospital administration of surfactant to a premature neonate in respiratory distress

2019 ◽  
Vol 27 (1) ◽  
Author(s):  
Charles Haviland Mize ◽  
Lhab Dorji ◽  
Ken Zafren
Keyword(s):  
Critical Care ◽  
Respiratory Distress ◽  
Neonatal Intensive Care ◽  
Premature Neonate ◽  
Eastern Himalaya ◽  
Severe Respiratory Distress ◽  
Low Birth Weight Infant ◽  
Retrieval Team ◽  
National Referral Hospital ◽  
Extreme Low Birth Weight

Abstract The population of the Kingdom of Bhutan is scattered in small villages throughout the eastern Himalaya. Infants born prematurely in villages have no access to neonatal intensive care until they are transported to the national referral hospital, a process that once took hours, if not days. After the introduction of a helicopter critical-care retrieval team, we were able to send a trained team to a remote location that successfully administered surfactant and initiated critical care to a premature, extreme low birth weight infant in severe respiratory distress in the first hour of life. Although the infant was in shock and in a near-arrest state at the time the team arrived, he made an excellent recovery after resuscitation by the team.

scholarly journals Haemorrhagic pneumonia caused by Stenotrophomonas maltophilia in two newborns

2015 ◽  
Vol 9 (05) ◽  
pp. 533-535 ◽  
Author(s):  
Nilufer Guzoglu ◽  
Fatma Nur Demirkol ◽  
Didem Aliefendioglu
Keyword(s):  
Respiratory Distress Syndrome ◽  
Respiratory Distress ◽  
Stenotrophomonas Maltophilia ◽  
Neonatal Intensive Care ◽  
Distress Syndrome ◽  
Pulmonary Haemorrhage ◽  
Neonatal Intensive Care Units ◽  
Bilateral Pneumothorax ◽  
First Case ◽  
Appropriate Treatment

Invasive procedures and antibiotic treatment increase the risk of nosocomial infections in neonatal intensive care units. Early identification and appropriate treatment is important. Herein we report two cases of massive hemorrhagic pneumonia caused by Stenotrophomonas maltophilia. The first case was diagnosed with congenital pneumonia; a chest tube was inserted because of pneumothorax on the third day of life. The second case had been referred with respiratory distress syndrome, and bilateral pneumothorax was present on admission. Upon follow up, the cases’ clinical condition worsened; acute respiratory distress syndrome and massive pulmonary haemorrhage developed. After Stenotrophomonas maltophilia was isolated in blood cultures, the cases were treated successfully using a combination of trimethoprim/sulfamethoxazole and fluoroquinolone.

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