morphine and Heart-Defects--Congenital

Discussed in this article are the three main anatomic types of persistent pulmonary hypertension of the newborn; (1) maladaptation of the pulmonary vascular bed; (2) excessive muscularization of the pulmonary vascular bed; and (3) underdevelopment of the pulmonary vascular bed.

Topics: Amniotic Fluid; Animals; Arteries; Diagnosis, Differential; Heart Defects, Congenital; Heart Septal Defects, Ventricular; Hernia, Diaphragmatic; Hernias, Diaphragmatic, Congenital; Humans; Hypertension, Pulmonary; Infant, Newborn; Kidney; Lung; Meconium; Persistent Fetal Circulation Syndrome; Pneumonia, Aspiration; Prognosis; Pulmonary Alveoli; Pulmonary Circulation; Rabbits; Rats; Sheep; Vascular Resistance; Vasoconstriction

The aim of the present study was to determine the role of toxic elements and trace elements in the pathogenesis of conotruncal heart defects by measuring their concentrations in the first meconium specimens of the affected newborns.. Concentrations of lead, cadmium, iron, zinc, and copper were measured in 1st-day meconium specimens that were collected from 60 newborns with conotruncal heart defects (Group I) and 72 healthy newborns (Group II).. The newborns with conotruncal defects and the healthy newborns had statistically similar demographic and clinical characteristics. When compared with healthy newborns, mean concentrations of lead, cadmium, iron, zinc, and copper were significantly higher in newborns with conotruncal heart defects (p=0.001 for each). In total, 51 newborns with conotruncal heart defects had normal karyotype. These newborns had significantly higher concentrations of lead, cadmium, iron, zinc, and copper when compared with healthy newborns. There were significant and positive correlations between the concentrations of lead and cadmium (r=0.618, p=0.001), lead and iron (r=0.368, p=0.001), lead and zinc (r=0.245, p=0.005), lead and copper (r=0.291, p=0.001), cadmium and iron (r=0.485, p=0.001), cadmium and zinc (r=0.386, p=0.001), and cadmium and copper (r=0.329, p=0.001).. Toxic metals and trace elements may disturb DNA repair mechanisms by impairing DNA methylation profiles, and thus have a role in the pathogenesis of conotruncal heart defects.

Topics: Adult; Cadmium; Case-Control Studies; Copper; Female; Heart Defects, Congenital; Heavy Metal Poisoning; Humans; Infant, Newborn; Iron; Male; Meconium; Metals, Heavy; Poisoning; Prospective Studies; Trace Elements; Zinc

Surgical intestinal disorders (SID), such as necrotizing enterocolitis (NEC), focal intestinal perforation (FIP), and meconium-related ileus (MRI), are serious morbidities in extremely low birth weight (ELBW, birth weight <1000 g) infants. From 2010, we performed enteral antifungal prophylaxis (EAP) in ELBWI to prevent for SID. The aim of this study was to identify disease-specific risk factors and to evaluate the efficacy of prevention for SID in ELBW infants.. A retrospective chart review of all consecutive patients between January 2006 and March 2015, which included 323 ELBW infants who were admitted to Shizuoka Children's Hospital, was conducted.. The number of infants with NEC, FIP, and MRI was 9, 12, and 13, respectively; 28 in 323 ELBW infants died. The control group defined the cases were not SID. In-hospital mortality was higher in infants with NEC relative to those in the control group. On logistic regression analysis, low gestational age and cardiac malformations were associated with increased risk of NEC. IUGR were associated with increased risk of MRI. EAP decreased risk of NEC and FIP. Low gestational weight and NEC were associated with increased risk of death.. Survival to hospital discharge after operation for NEC in ELBW infants remains poor. EAP decreased risk of NEC and FIP in ELBW infants.

Topics: Case-Control Studies; Enterocolitis, Necrotizing; Female; Gestational Age; Heart Defects, Congenital; Humans; Ileus; Infant; Infant, Extremely Low Birth Weight; Infant, Newborn; Infant, Premature, Diseases; Intestinal Perforation; Male; Meconium; Retrospective Studies; Risk Factors

In a thirty-month prospective study pleural effusions were found on chest radiographs in 33 of 1482 newborns admitted to intensive care units. Congenital heart disease was the most common cause, accounting for eleven cases. Meconium aspiration was the most common respiratory disease associated with neonatal pleural effusion. Infants whose effusions were first noted after the second day of life were likely to have heart disease (p = 0.02). Infants with moderate or large effusions were unlikely to have heart disease (p = 0.04). Prolonged pleural effusion was associated with a prolonged need for supplemental oxygen. Survivors whose effusions lasted three or more days were at increased risk for needing supplemental oxygen for more than twenty-one days (p = 0.07). The overall mortality was 48 percent (sixteen of thirty-three infants died).

Topics: Cardiovascular Diseases; Heart Defects, Congenital; Humans; Infant, Newborn; Lung; Lung Diseases; Meconium; Pleural Effusion; Pneumonia; Prognosis; Prospective Studies; Radiography; Risk; Streptococcus agalactiae

Sixteen moribund newborn infants with respiratory failure were treated with extracorporeal membrane oxygenation (ECMO) for 1 to 8 days. Cannulation via the right jugular vein and carotid artery was used to establish venoarterial-cardiopulmonary bypass. High flow (80 percent of cardiac output) allowed decreasing FIO2 and airway pressure. Diagnoses and results were as follows: respiratory distress syndrome, four patients (two improved, one survived); meconium aspiration syndrome, eight patients (four improved, three survived); persistent fetal circulation (some with diaphragmatic hernia), four patients (three improved, two survived). Intracranial bleeding occurred in 43 percent, accounting for most of the deaths. In a parallel series of 21 infants treated with conventional ventilator therapy, the mortality rate was 90 percent and intracranial bleeding occurred in 57 percent. ECMO provided life support and gains time in newborn respiratory failure. In high mortality risk infants, the rate of survival is higher and intracranial bleeding lower with ECMO than with optimal ventilator management.

Topics: Cerebral Hemorrhage; Extracorporeal Circulation; Heart Defects, Congenital; Humans; Infant, Newborn; Meconium; Oxygenators, Membrane; Respiration, Artificial; Respiratory Distress Syndrome, Newborn; Respiratory Insufficiency; Thrombocytopenia

Topics: Apgar Score; Asphyxia Neonatorum; Birth Weight; Carbon Dioxide; Cardiac Catheterization; Cyanosis; Diagnosis, Differential; Female; Follow-Up Studies; Gestational Age; Heart Defects, Congenital; Humans; Hypertension, Pulmonary; Infant, Newborn; Infant, Newborn, Diseases; Male; Meconium; Obstetric Labor Complications; Oxygen; Partial Pressure; Pregnancy; Pulmonary Artery; Radiography

Topics: Cysts; Diaphragmatic Eventration; Heart Defects, Congenital; Hernia, Diaphragmatic; Humans; Hyaline Membrane Disease; Infant, Newborn; Meconium; Mediastinal Emphysema; Pneumonia, Aspiration; Pneumothorax; Pulmonary Emphysema; Radiography; Respiratory Distress Syndrome, Newborn

Topics: Asphyxia; Blood Transfusion; Color; Cyanosis; Female; Fetofetal Transfusion; Fetomaternal Transfusion; Gestational Age; Heart Defects, Congenital; Hematocrit; Hemorrhage; Humans; Infant, Newborn; Infant, Newborn, Diseases; Lung Diseases; Meconium; Oxygen Inhalation Therapy; Placenta Diseases; Positive-Pressure Respiration; Pregnancy; Resuscitation; Skin Manifestations