morphine and Hyaline-Membrane-Disease

Topics: Bronchopulmonary Dysplasia; Humans; Hyaline Membrane Disease; Hypertension, Pulmonary; Infant, Newborn; Meconium; Respiratory Distress Syndrome, Newborn

Measurement of the production of surfactant is the most direct means of prenatally assessing fetal pulmonary maturity. We review assays which have evolved for measuring surfactant, classifying them into two general categories: biochemical quantitation and biophysical measurements. Biochemical quantitation assays include the amniotic fluid lecithin/sphingomyelin ratio and quantitation of lecithin and other surfactant phospholipids. Biophysical measurements include measurement of surface-tension-lowering ability of extracts of amniotic fluid lipid and evaluation of surface-tension-related properties such as foam stability and microviscosity. Assays of surfactant are subject to certain pre-analysis sources of variation over which the analyst has no control, such as variability in total in vivo amniotic fluid volume, incomplete in vivo mixing of surfactant with amniotic fluid, and presence of contaminating blood or meconium. We also examine other factors such as centrifugation speed and time, and storage of the amniotic specimen before analysis. These factors can dramatically affect analyses, and must be carefully controlled by the analyst. In general, both biochemical and biophysical approaches to surfactant analysis are useful diagnostically. When properly performed, both approaches give results that correlate well, both with each other and with clinical outcome. Because "mature" and "immature" values overlap, none of the assays can completely eliminate false predictions, whether of fetal maturity or fetal immaturity.

Topics: Amniotic Fluid; Blood; Centrifugation; False Positive Reactions; Fatty Acids; Female; Fetal Organ Maturity; Fluorescence Polarization; Gestational Age; Humans; Hyaline Membrane Disease; Inclusion Bodies; Infant, Newborn; Lung; Meconium; Phosphatidylcholines; Phosphatidylglycerols; Pregnancy; Prenatal Diagnosis; Pulmonary Surfactants; Reference Values; Respiratory Distress Syndrome, Newborn; Specimen Handling; Sphingomyelins; Surface Properties; Viscosity

Topics: Acid-Base Equilibrium; Acidosis; Asphyxia Neonatorum; Blood Circulation; Blood Glucose; Body Temperature Regulation; Calcium; Central Nervous System Diseases; Humans; Hyaline Membrane Disease; Hypoxia; Infant, Newborn; Meconium; Oxygen Consumption; Pneumonia, Aspiration

The Amniostat-FLM rapid slide test (Hana Biologics, Inc., Alameda, Calif.) for detection of phosphatidylglycerol has previously been evaluated and has shown good correlation with the more sophisticated two-dimensional thin-layer chromatographic method. A new, ultrasensitive kit has now been released with a lower level of detection of 0.5 microgram of phosphatidylglycerol per milliliter of fluid. This is the first report of this new kit, which we used with vaginal pool samples and with contaminated amniocentesis samples. We evaluated this kit for concordance with thin-layer chromatography results as well as fetal outcome. Of 48 vaginal pool samples, 41 (85%) showed concordance, whereas 39 of 42 (93%) contaminated amniocentesis samples were concordant, for an overall concordance of 89% (80 of 90 samples). Sixty-seven infants were delivered within 72 hours of the test and there were no cases of hyaline membrane disease in the presence of a positive test result. We conclude that this new, ultrasensitive kit is a good, time-saving, and reliable test for the detection of phosphatidylglycerol without the development of false-positive results even when tested on the worst possible fluid samples. A review of clinical studies involving the Amniostat-FLM is also presented.

Topics: Amniocentesis; Amniotic Fluid; Blood; Chromatography, Thin Layer; Evaluation Studies as Topic; Female; Humans; Hyaline Membrane Disease; Infant, Newborn; Meconium; Phosphatidylglycerols; Pregnancy; Reagent Kits, Diagnostic; Respiratory Distress Syndrome, Newborn

The pattern of arginine vasopressin (AVP) secretion in the immediate neonatal period is unclear. Plasma concentrations of AVP are reflected by its urinary excretion, thus providing a noninvasive method for studying the pattern of AVP release in the neonate. In these studies, we determined the pattern of urinary AVP excretion (microU/mg creatinine) during the first 2-4 days after birth in 78 neonates, 53 of whom had various prenatal and/or neonatal complications. In well term (n = 12) and preterm (n = 13) infants mean urinary AVP excretion decreased gradually during the first 24-36 h after birth. Although term and preterm infants with perinatal asphyxia had highest initial levels of urinary AVP (greater than 200 microU/mg creatinine) and a significant negative correlation with the 1-min Apgar score was obtained, their pattern of excretion was similar to respective controls. After delivery, elevated values for urinary AVP excretion were found among infants with neonatal courses complicated by intracranial hemorrhage, hypoxic encephalopathy, and pneumothorax. Urine osmolality did not correlate linearly with urinary AVP levels, but rather attained a maximum value of approximately 400 mosmol/kg at urinary AVP levels less than 200 microU/mg creatinine and then plateaued. It is concluded that the decrease in urinary AVP excretion observed soon after birth generally reflects diminution of the hypersecretion of AVP during parturition; neonates with evidence of intrapartum asphyxia initially have increased urinary AVP excretion; however, the pattern of excretion is similar to normal infants. During the neonatal period insults such as pneumothorax and intracranial hemorrhage may cause hypersecretion of this hormone.

Topics: Amniotic Fluid; Apgar Score; Arginine Vasopressin; Asphyxia Neonatorum; Cerebral Hemorrhage; Creatinine; Female; Humans; Hyaline Membrane Disease; Infant, Newborn; Infant, Premature; Male; Meconium; Osmolar Concentration; Pneumothorax; Time Factors

Topics: Female; Fetal Diseases; Humans; Hyaline Membrane Disease; Infant, Newborn; Inhalation; Lung Diseases; Male; Meconium; Pneumonia, Aspiration; Pregnancy; Respiration; Syndrome

The short-term effects of muscle relaxation with pancuronium bromide on arterial blood gas values, heart rate, and arterial blood pressure were studied in 49 neonates receiving mechanical ventilation. After pancuronium administration, mean PaO2 increased from 61.9 +/- 30.0 to 80.9 +/- 52.8 mm Hg (P = 0.006), mean PaCO2 decreased from 40.1 +/- 13.0 to 37.5 +/- 13.3 mm Hg (P = 0.03), and mean heart rate rose from 146.2 +/- 24.9 to 161.0 +/- 20.5 beats/min (P less than 0.001). Arterial blood pressure did not change significantly. When results were analyzed by diagnosis (meconium aspiration syndrome, hyaline membrane disease, pneumonia), only infants with meconium aspiration syndrome had a significant improvement in oxygenation (P = 0.008). Six of 18 patients with hyaline membrane disease responded to muscle relaxation, with a decrease in PaO2 of 10 mm Hg or more. No significant correlation was found between change in PaO2 and birth weight, gestational age, postnatal age, or change in heart rate. A weak correlation (r = -0.37, P less than 0.006) was observed between change in PaO2 and change in PaCO2. Although the reasons for the divergence in response in different groups of patients are not entirely clear, the risk of deterioration with pancuronium therapy should be kept in mind, particularly if treatment in an infant with hyaline membrane disease is being considered.

Topics: Blood Gas Analysis; Blood Pressure; Heart Rate; Humans; Hyaline Membrane Disease; Hypoxia; Infant, Newborn; Meconium; Pancuronium; Pneumonia; Pneumonia, Aspiration; Respiration, Artificial

Topics: Amniotic Fluid; Apgar Score; Asphyxia Neonatorum; Female; Fetal Hypoxia; Fetus; Gestational Age; Humans; Hyaline Membrane Disease; Infant, Newborn; Infant, Postmature; Infant, Premature; Meconium; Pregnancy

Topics: Congenital Hypothyroidism; Female; Gestational Age; Humans; Hyaline Membrane Disease; Hypothyroidism; Infant, Newborn; Jaundice, Neonatal; Meconium; Thyrotropin; Thyroxine

The authors studied the effects on the child of 196 caesarian sections performed in the absence of foetal distress. The following were noted for each child: the time before the first cry, the Apgar score, pH and the need or not for resuscitation techniques. Each feature was studied in terms of different factors: foetal, obstetric, anaesthetic and surgical. The conclusions were as follows: caesarian section, which remains the best means of preventing obstetric trauma, has its own direct complications which are linked to the conditions in which the operation takes place. These can be reduced to a minimum or even completely suppressed if the caesarian section is performed under ideal conditions: few or no depressant drugs before the operation (the use of diazepam for induction should be abandoned); inclined position of 15 degrees, even of the mother has never suffered from utero-caval syndrome and if possible on a heated mattress; extraction of the infant between the 5th and 15th minutes; finally, and above all, prior labour is desirable whenever obstetric conditions permit.

Topics: Amniotic Fluid; Apgar Score; Cesarean Section; Female; Humans; Hyaline Membrane Disease; Infant, Newborn; Infant, Premature; Inhalation; Meconium; Obstetric Labor Complications; Posture; Pregnancy; Respiration, Artificial

Three patients with Meconium Aspiration Syndrome (S.A.M.) and severe hypoxemia are reported. From the first hours of life they needed mechanical ventilation, showing no improvement in PaO2 in spite of usual respiratory support measures. In one case, pulmonary hypertension and ductal right to left shunt through ductus arteriosus and foramen ovale was objetivated by cardiac catheterization. Following intravenous prefusion of a pulmonary vasodilator (Tolazoline) patients showed a clinical amelioration and a definite increase in PaO2. Results and evolution with the use of this drug are commented.

Topics: Ductus Arteriosus, Patent; Female; Humans; Hyaline Membrane Disease; Hypertension, Pulmonary; Hypoxia; Infant, Newborn; Injections, Intravenous; Male; Meconium; Oxygen; Partial Pressure; Tolazoline

Twenty seven newborn with serious meconial aspiration syndrome are studied. Two groups are stablish weather they require or not mechanical ventilation during evolution. When comparing various perinatal and clinical data, only the Silverman test showed statistically significant differences; pH and gases in blood during the first hours of life did not showed differences. Pneumothorax incidency in both groups was 33%. Twelve newborn required mechanical ventilation. The starting age was 24 hours of life range 3-54 hours. Most frequent indication was hipoxemia and apnea. Use of intermitent positive pressure improved PaCO2 with a light increase in PaO2 though it also increased alveolo-arterial oxygen gradient. Hipoxemia was the most relevant data in evolution of these patients. In seven cases continuous distending pressure was applied, with a light increase in PaO2 only in three patients. No patient suffered pneumothorax during mechanical ventilation. In patients with mechanical ventilation mortality was 25%. The possibility of an addition in certain cases of pulmonary hypertension with right-to-left shunting ductal and atrial is reported.

Topics: Age Factors; Female; Humans; Hyaline Membrane Disease; Infant, Newborn; Male; Meconium; Respiration, Artificial; Respiratory Function Tests; Spain

Thirty-nine critically ill infants with pulmonary disease received tolazoline because of severe hypoxemia refractory to administration of 100% O2 and mechanical ventilation. Twenty-seven (69%) of the infants responded with an increase in PaO2 greater than or equal to 20 torr in the first umbilical arterial gas after completion of the initial ten-minute infusion (1 to 2 mg/kg) of the drug. A response was not correlated with survival. The overall survival was 46%, essentially unchanged from our previous report (44%). Infants with hyaline membrane disease had the poorest survival rate (33%). Complications associated with the use of tolazoline occurred in 82% of the infants. A hypotensive reaction, defined as a 25% decrease in mean arterial pressure from the pre-tolazoline level, occurred in 67% of the infants, and more commonly in the infants with RDS (87%). In 11 infants who did not respond to the initial dose of tolazoline, the dose was increased up to 10 mg/kg/hour; only one infant responded, and eight (73%) had a hypotensive reaction.

Topics: Carbon Dioxide; Humans; Hyaline Membrane Disease; Hypoxia; Infant, Newborn; Infant, Newborn, Diseases; Inhalation; Lung Diseases; Meconium; Oxygen; Oxygen Inhalation Therapy; Respiration, Artificial; Respiratory Distress Syndrome, Newborn; Syndrome; Tolazoline; Umbilical Arteries

Topics: Asphyxia Neonatorum; Female; Gestational Age; Humans; Hyaline Membrane Disease; Infant, Low Birth Weight; Infant, Newborn; Infant, Newborn, Diseases; Male; Massachusetts; Meconium; Mediastinal Emphysema; Pneumonia, Aspiration; Pneumopericardium; Pneumothorax; Pulmonary Emphysema; Respiration, Artificial; Respiratory Function Tests; Retrospective Studies

The clinical course and follow-up of 14 neonates who developed acute renal failure are reported. Renal failure in these patients was secondary to major perinatal disorders, e.g., hyaline membrane disease, pneumonia, hemorrhage, or sepsis. Thirteen patients had hypoxia and nine were in shock when renal failure developed. Five patients died during the acute stage of renal failure. Of nine survivors, five patients sustained residual renal damage.

Topics: Acute Kidney Injury; Anuria; Follow-Up Studies; Humans; Hyaline Membrane Disease; Infant, Newborn; Infant, Newborn, Diseases; Meconium; Pneumonia; Shock

The intracranial pressure was monitored via the anterior fontanel, using a noninvasive technique, in 78 acutely ill, 39 normal term, and 6 normal preterm infants. In normal term and preterm infants the anterior fontanel pressure (AFP) was 10.2 +/- 0.4 and 9.5 +/- 0.8 cm H2O, respectively. Infants with hyaline membrane disease had elevated pressure (13.3 +/- 0.6 cm H2O), which was higher than that of normal preterm infants. Following an episode of intracranial hemorrhage in four infants, the AFP increased to 26.2 +/- 2.5 cm H2O. Elevated pressure was noted in infants with meconium aspiration syndrome (24.1 +/- 1.8 cm H2O); the pressure decreased during the phase of recovery (15.6 +/- 3.5 cm H2O). Elevated pressure was noted in infants with meningitis and hydrocephalus. Repeated measurements helped to diagnose shunt obstruction in an infant with hydrocephalus.

Topics: Cerebral Hemorrhage; Cerebrospinal Fluid Shunts; Humans; Hyaline Membrane Disease; Hydrocephalus; Infant; Infant, Newborn; Infant, Newborn, Diseases; Inhalation; Intracranial Pressure; Meconium; Meningitis; Monitoring, Physiologic; Syndrome

Hypoxia in newborn infants is becoming much easier to prevent, detect and treat. Nevertheless the successful management of potentially hypoxic fetuses and newborn infants remains the major challenge to all physicians concerned with perinatal care. What is at stake is not only that sick infants should survive, but equally or more importantly that the survivors should be normal children. Recent follow-up studies show that this aim can, with few exceptions, now be achieved (Stewart and Reynolds, 1974; Davies and Stewart, 1975; Durbin et al, 1976).

Topics: Apnea; Asphyxia Neonatorum; Blood Circulation; Humans; Hyaline Membrane Disease; Hypoxia; Infant, Newborn; Infant, Newborn, Diseases; Infant, Premature, Diseases; Lung Diseases; Meconium; Pneumothorax; Pulmonary Edema; Pulmonary Surfactants; Respiration; Vitamin K Deficiency Bleeding

The roentgenographic presentations of 11 newborn infants with hypoxemia secondary to pulmonary vasospasm and subsequent right-to-left shunting of blood through the foramen ovale and/or ductus arteriosus (persistent fetal circulation) are described (P. F. C. Syndrome). One infant had radiographically normal lungs, while ten had pulmonary parenchymal abnormalities including hyaline membrane disease [4], meconium aspiration syndrome [4], or an ill defined pattern of retained lung fluid [2]. The roentgenographic appearance of the lungs, however, was discordant with the severe hypoxemia observed in most. Heart size was variable but some degree of cardiomegaly was commonly present. Tolazoline, a potent vasodilator, was useful diagnostically and may have resulted in increased survival. An expanded clinical and roentgeonographic concept of the PFC syndrome is suggested.

Topics: Female; Humans; Hyaline Membrane Disease; Hypertension, Pulmonary; Hypoxia; Infant, Newborn; Male; Meconium; Pneumonia, Aspiration; Radiography; Syndrome; Truncus Arteriosus, Persistent

Meconium staining of the placenta and/or fetal body was present at birth in 10.3 per cent of 42,000 live-born infants, but present disproportionately in 18.1 per cent of 788 neonatal deaths. The neonatal mortality rate was 3.3 per cent in the stained group and 1.7 per cent in the nonstained group. Among infants who died, the incidence of erythroblastosis was quadrupled and that of cardiovascular malformation was doubled in the stained group. Meconium staining was associated with a decrease in the expected frequency of hyaline membranes and atelectasis even in premature infants; hypotheses for this phenomenon were presented. Meconium staining of the fetus or placenta requires several hours of exposure. As a hypothesis, the observed increase of deaths in stained neonates may be related to the stresses of cumulative or chronic hypoxia which may occur after the initial passage of meconium if delivery is prolonged.?23AUTHOR

Topics: Amniotic Fluid; Autopsy; Birth Weight; Congenital Abnormalities; Erythroblastosis, Fetal; Female; Fetal Diseases; Hemorrhage; Humans; Hyaline Membrane Disease; Hypoxia; Infant, Newborn; Infant, Newborn, Diseases; Meconium; Obstetric Labor Complications; Placenta; Pneumonia; Pregnancy; Pregnancy Complications; Pregnancy in Diabetics; Pulmonary Atelectasis; Time Factors

Topics: Drainage; Humans; Hyaline Membrane Disease; Infant; Infant, Newborn; Infant, Newborn, Diseases; Infant, Premature, Diseases; Inhalation; Meconium; Methods; Pneumothorax; Respiration, Artificial

Topics: Amniotic Fluid; Blood; Cesarean Section; Female; Gestational Age; Humans; Hyaline Membrane Disease; Infant, Newborn; Inhalation; Meconium; Phosphatidylcholines; Pregnancy; Pregnancy in Diabetics; Pulmonary Surfactants; Respiratory Distress Syndrome, Newborn; Sphingomyelins

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: Birth Weight; Blood Gas Analysis; Cyanosis; Helium; Humans; Hyaline Membrane Disease; Infant, Newborn; Infant, Premature; Inhalation; Meconium; Methods; Oxygen; Pulmonary Atelectasis; Radiography, Thoracic; Respiration; Spirometry

Topics: Asphyxia Neonatorum; Brain; Gestational Age; Humans; Hyaline Membrane Disease; Infant, Newborn; Lung; Male; Meconium; Pneumonia, Aspiration

Topics: Birth Weight; Delivery, Obstetric; Drainage; Female; Humans; Hyaline Membrane Disease; Infant, Newborn; Infant, Newborn, Diseases; Male; Meconium; Mediastinal Emphysema; Methods; Pneumothorax; Radiography; Respiration, Artificial; Respiratory Distress Syndrome, Newborn

Topics: Biopsy; Birth Weight; Female; Humans; Hyaline Membrane Disease; Infant; Infant, Newborn; Infant, Premature; Inhalation; Lung; Male; Meconium; Oxygen; Oxygen Inhalation Therapy; Radiography; Respiratory Distress Syndrome, Newborn; Respiratory Insufficiency; Ventilation-Perfusion Ratio

Topics: Asphyxia Neonatorum; Humans; Hyaline Membrane Disease; Infant, Newborn; Infant, Newborn, Diseases; Infant, Premature, Diseases; Meconium; Pneumonia; Pneumothorax; Respiratory System Abnormalities; Respiratory Tract Diseases