morphine and Hernias--Diaphragmatic--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

A prospective controlled randomized study of the use of extracorporeal membrane oxygenation to treat newborns with respiratory failure was carried out using the "randomized play-the-winner" statistical method. In this method the chance of randomly assigning an infant to one treatment or the other is influenced by the outcome of treatment of each patient in the study. If one treatment is more successful, more patients are randomly assigned to that treatment. A group of 12 infants with birth weight greater than 2 kg met objective criteria for high mortality risk. One patient was randomly assigned to conventional treatment (that patient died); 11 patients were randomly chosen for extracorporeal membrane oxygenation (all survived). Intracerebral hemorrhage occurred in one of 11 surviving children. Extracorporeal membrane oxygenation allows lung rest and improves survival compared to conventional ventilator therapy in newborn infants with severe respiratory failure.

Topics: Birth Weight; Clinical Trials as Topic; Extracorporeal Circulation; Follow-Up Studies; Hernia, Diaphragmatic; Hernias, Diaphragmatic, Congenital; Humans; Infant, Newborn; Meconium; Oxygenators, Membrane; Persistent Fetal Circulation Syndrome; Pneumonia, Aspiration; Prospective Studies; Pulmonary Veins; Random Allocation; Respiratory Distress Syndrome, Newborn; Respiratory Insufficiency

Meconium peritonitis most often is associated with congenital intestinal obstruction and meconium ileus. Uncommonly, other etiologies are identified. Hyperimmunoglobulin E syndrome (Job's syndrome) is a rare genetic disorder that is characterized by recurrent staphylococcal respiratory and skin infections in addition to elevated serum IgE levels. There have been 2 previously reported cases of intestinal complications associated with Job's syndrome. The current case is the third such case and is the first report of meconium peritonitis in a patient with hyperimmunoglobulin E syndrome. The patient presented with a meconium thorax as a result of a concurrent congenital diaphragmatic hernia.

Topics: Cecum; Colonic Diseases; Female; Hernia, Diaphragmatic; Hernias, Diaphragmatic, Congenital; Humans; Infant, Newborn; Intestinal Perforation; Male; Meconium; Muscle, Smooth; Peritonitis; Pregnancy; Thoracic Diseases

The case of a neonate presenting with respiratory distress who had an incarcerated Bochdalek hernia with perforation and meconium peritonitis and pleuritis is reported. The patient had an associated jejunal atresia in an incarcerated segment of intestine, which undoubtedly contributed to the obstruction, strangulation, and perforation in the incarcerated hernia. Gastrointestinal complications attributable to the hernia are most unusual in the neonate, and aggressive preoperative resuscitation and stabilization with the earliest possible surgical intervention are imperative features in management.

Topics: Female; Hernia, Diaphragmatic; Hernias, Diaphragmatic, Congenital; Humans; Infant, Newborn; Intestinal Atresia; Jejunum; Meconium; Peritonitis; Pleurisy; Radiography; Rupture, Spontaneous

Meconium pleuritis developed in a neonate with a perforation of the sigmoid colon, through a diaphragmatic defect. The meconium released in the abdomen communicated with the right pleural space. The association of these defects is unusual, and the cytologic diagnosis of meconium pleuritis has not been previously reported.

Topics: Colonic Diseases; Cytodiagnosis; Hernia, Diaphragmatic; Hernias, Diaphragmatic, Congenital; Humans; Infant, Newborn; Intestinal Perforation; Male; Meconium; Peritonitis; Pleurisy; Radiography

A case of meconium thorax resulting from spontaneous perforation of the colon associated with a right Bochdalek's foramen, without herniation, is presented. The baby had immediate respiratory distress postpartum resulting from the meconium in the pleural cavity. No fetal distress was detected, in spite of electrode monitoring in labor, to account for the colonic perforation.

Topics: Colonic Diseases; Female; Hernias, Diaphragmatic, Congenital; Humans; Infant, Newborn; Intestinal Perforation; Male; Meconium; Pregnancy; Respiratory Distress Syndrome, Newborn; Thoracic Diseases

Topics: Duodenum; Emergencies; Esophageal Atresia; Female; Gastrointestinal Diseases; Hernia, Diaphragmatic; Hernia, Inguinal; Hernia, Umbilical; Hernia, Ventral; Hernias, Diaphragmatic, Congenital; Humans; Infant; Infant, Newborn; Infant, Newborn, Diseases; Intestinal Atresia; Intestinal Obstruction; Intestinal Perforation; Jejunum; Meconium; Pneumothorax; Pregnancy; Pyloric Stenosis; Renal Veins; Rupture; Stomach Diseases; Thrombophlebitis