morphine and Lung-Diseases

Topics: Adolescent; Child; Child, Preschool; Cystic Fibrosis; Humans; Infant; Infant, Newborn; Intestinal Obstruction; Lung Diseases; Mass Screening; Meconium; Prognosis

Topics: Adolescent; Child; Child, Preschool; Cystic Fibrosis; Humans; Infant; Infant, Newborn; Intestinal Obstruction; Lung Diseases; Meconium; Mucoproteins; Pancreas; Prognosis; Sweat

Although meconium ileus (MI) is the earliest manifestation of cystic fibrosis (CF), and is associated with poorer growth, the longitudinal pulmonary progression of CF children with MI is not clear. To test the hypothesis that MI is associated with worse pulmonary outcomes, we prospectively compared from diagnosis to 12 years of age 32 CF children with MI to 50 CF children without MI who were diagnosed during early infancy through neonatal screening. Pulmonary outcome measures included respiratory symptoms, respiratory infections, pathogens, antibiotic usage, hospitalizations, quantitative chest radiology, spirometry, and lung volume determinations. Obstructive lung disease was defined as percent predicted spirometry values below the lower limits of normal. Longitudinal analyses revealed no significant differences in cough, wheezing, respiratory infections, prevalence of and median times to acquisition of Pseudomonas aeruginosa or Staphylococcus aureus, antibiotic usage, and chest radiograph scores between the two groups. However, MI children showed significantly worse forced expiratory volume in 1 sec (FEV(1)), forced vital capacity (FVC), forced expiratory flow between 25-75% of FVC (FEF(25-75)), % predicted FEV(1), % predicted FEF(25-75), and total lung capacity (TLC). These differences were particularly apparent beginning at age 8-10 years. MI children also had higher rates of and shorter median times to obstructive lung disease. Subgroup analyses showed MI children treated surgically and those treated medically had similar pulmonary outcomes. In conclusion, MI children have worse lung function and more obstructive lung disease than those without MI. Such abnormalities are accompanied by reduced lung volume. MI is a distinct CF phenotype with more severe pulmonary dysfunction.

Topics: Airway Obstruction; Cystic Fibrosis; Female; Humans; Ileus; Infant; Infant, Newborn; Lung; Lung Diseases; Male; Meconium; Neonatal Screening; Prognosis; Prospective Studies; Respiratory Function Tests; Time Factors; Wisconsin

To determine prospectively the incidence of several pulmonary diagnoses among infants born through clear or meconium-stained amniotic fluid (AF) managed by a selective approach to tracheal intubation.. All live births greater than 36 weeks' gestation occurring between January 1990 and December 1992 were included. Diagnostic criteria for several respiratory disorders were determined prospectively and monitored. Infants with light meconium and vigorous infants with moderate to thick meconium were selectively not suctioned. A control group of infants with clear AF matched for gestational age and year of birth was randomly selected for comparison. The incidence and severity of respiratory disease were compared between the groups.. Of 4938 live births, 799 (16%) had meconium-stained AF (light, 334; moderate to thick, 465). Compared to 211 infants with moderate to thick meconium selectively not suctioned, 196 suctioned infants had significantly greater rates of abnormal fetal heart rate (FHR) patterns, fetal acidosis, low Apgar scores at 5 minutes, need for resuscitation, and neonatal intensive care unit admission. Meconium aspiration syndrome was significantly more common in suctioned infants as compared to those selectively not suctioned, those with light meconium, and those with clear fluid (11 versus 3 versus 0 versus 0%; P < .01). The need for ventilator or oxygen support was similar between infants with clear fluid, lightly stained fluid, and moderate to thick fluid who were selectively not suctioned, but was significantly greater among suctioned infants (P < .01).. We conclude that a selective approach to tracheal intubation and suction of infants with meconium-stained AF was not associated with increased pulmonary morbidity or mortality. Postnatal management of neonates at greatest risk of meconium aspiration syndrome does not necessarily prevent adverse pulmonary outcome.

Topics: Amniotic Fluid; Humans; Incidence; Infant, Newborn; Intubation, Intratracheal; Lung Diseases; Meconium; Meconium Aspiration Syndrome; Prospective Studies; Risk; Suction

Technological advances in genetics have made feasible and affordable large studies to identify genetic variants that cause or modify a trait. Genetic studies have been carried out to assess variants in candidate genes, as well as polymorphisms throughout the genome, for their associations with heritable clinical outcomes of cystic fibrosis (CF), such as lung disease, meconium ileus, and CF-related diabetes. The candidate gene approach has identified some predicted relationships, while genome-wide surveys have identified several genes that would not have been obvious disease-modifying candidates, such as a methionine sulfoxide transferase gene that influences intestinal obstruction, or a region on chromosome 11 proximate to genes encoding a transcription factor and an apoptosis controller that associates with lung function. These unforeseen associations thus provide novel insight into disease pathophysiology, as well as suggesting new therapeutic strategies for CF.

Topics: Cystic Fibrosis; Cystic Fibrosis Transmembrane Conductance Regulator; Diabetes Mellitus, Type 1; Diabetes Mellitus, Type 2; Genes, Modifier; Genetic Linkage; Genetic Markers; Genome-Wide Association Study; Homozygote; Humans; Liver Diseases; Lung Diseases; Mannose-Binding Lectins; Meconium; Mutation; Phenotype

Our objective was to study meconium-induced lung injury in isolated perfused rat lungs exposed to anoxia. Our working hypothesis was that meconium-induced lung injury is independent of preexisting hypoxia, and that hypoxia will increase severity of lung injury observed after meconium aspiration. We compared five different groups of animals (n = 5) for pulmonary arterial pressure (PAP), weight lung changes, and TNFalpha expression. Group I had lungs instilled with 4 ml of normal saline. Group II had lungs exposed to 5 min of anoxia. Group III had lungs instilled with 4 ml of 30% filtered human meconium. Group IV had lungs exposed to 5 min of anoxia and then instilled with 4 ml of 30% filtered human meconium. Group V had lungs instilled with 4 ml of 30% unfiltered human meconium. Our subjects were adult Sprague-Dawley rats. The isolated rat lung model was prepared according to Levey and Gast (J Appl Physiol 1966;21:313-316). Lungs were ventilated with room air. Anoxia was caused by the use of N(2). The pulmonary artery was cannulated, and pulmonary arterial pressure and lung weight were measured. Lung weight and pulmonary arterial pressure were monitored for 120 min, and TNFalpha levels were measured in effluent at 15, 30, 60, and 120 min. Experiments were done at the Michael Reese Hospital (Chicago, IL). At the end of the experiment, PAP reached its highest values in group V (10.0 +/- 1.7 mmHg). Final PAPs in groups I-IV were: 4.85 +/- 0.3, 4.99 +/- 0.4, 5.93 +/- 0.3, and 7.25 +/- 0.51 mmHg, respectively). Lung wet weight increased significantly only in groups IV and V vs. group I; at 120 min, they were: 0.96 +/- 0.3 g, P < 0.01, and 1.5 g +/- 0.2 g, P < 0.01, respectively. TNFalpha levels did not change significantly over time in group I. TNFalpha is a marker as well as proprietor of pulmonary inflammatory response. TNFalpha reached its highest levels in groups IV and V: 595 and 753 pg/ml at 120 min, respectively. In conclusion, a short episode of anoxia prior to meconium aspiration may increase lung sensitivity to meconium-induced lung injury. This effect may be moderated by the TNFalpha present in the pulmonary circulation.

Topics: Animals; Animals, Newborn; Filtration; Hypertension, Pulmonary; Hypoxia; In Vitro Techniques; Inhalation; Lung Diseases; Meconium; Rats; Rats, Sprague-Dawley; Tumor Necrosis Factor-alpha

The incidence of preterm meconium staining of the amniotic fluid (MSAF) is uncertain. It may be an indicator of possible listeriosis. It is unclear how great this risk is or whether preterm MSAF is a risk factor for adverse neonatal outcome.. To investigate the incidence of preterm MSAF, the incidence of associated maternal and neonatal infection, and the outcomes of the infants at discharge.. Retrospective case-control study.. Infants < 33 weeks gestation with preterm MSAF born in the Simpson Memorial Maternity Pavilion, Edinburgh between 1 January 1994 and 2 January 2001 were matched with the next infant of the same sex and gestation with clear liquor. Maternal and infant characteristics, culture results, placental histology, and clinical outcomes were compared.. Preterm MSAF was observed in 45/1054 (4.3%) infants below 33 weeks gestation. No maternal or infant listeriosis was identified in cases or controls. There was no significant difference in birth weight, Apgar score, or first pH between cases and controls. Preterm MSAF was associated with prolonged rupture of the membranes (odds ratio (OR) 3.34, 95% confidence interval (CI) 1.07 to 10.49), but not maternal hypertension, sepsis, or chorioamnionitis. Severe (grade 3/4) intraventricular haemorrhage was significantly more common in infants with preterm MSAF (OR 2.03, 95% CI 1.62 to 2.53). There was no significant difference in mortality. Early onset sepsis was observed in two cases and three controls.. Preterm meconium staining of the amniotic fluid may be associated with increased risk of intraventricular haemorrhage. It does not appear to be a useful indicator of listeriosis.

Topics: Amniotic Fluid; Birth Weight; Cerebral Hemorrhage; Chronic Disease; Epidemiologic Methods; Female; Humans; Infant, Newborn; Infant, Premature, Diseases; Leukomalacia, Periventricular; Lung Diseases; Male; Meconium; Pregnancy; Pregnancy Complications, Infectious; Prognosis; Scotland; Twins

Respiratory failure caused by meconium aspiration requires combined strategies. We hypothesized that surfactant lung lavage with asymmetric high-frequency jet ventilation (AHFJV) can increase the removal of meconium and improve lung function. During conventional ventilation (CV), a suspension of human meconium (25 mg/ml, 4 ml/kg) was instilled into the tracheal tube of anesthetized rabbits to cause respiratory failure. Animals were then divided into four groups: saline lavage + CV (Sal-CV), surfactant lavage + CV (Surf-CV), saline lavage + HFJV (Sal-HFJV), and surfactant lavage + HFJV (Surf-HFJV). Lung lavage (10 ml/kg in 3 portions) was performed with diluted surfactant (Curosurf, 100 mg of phospholipids/kg) or saline during CV (frequency (f), 30/min; inspiration time (Ti), 50%) or AHFJV (f, 300/min; Ti, 70%). Animals were ventilated for an additional hour with either CV or HFJV (Ti, 50%). Surfactant lavage with both CV and AHFJV removed more meconium than saline lavage. However, the highest removal was found in the Surf-HFJV group vs. all other groups (P < 0.05). The oxygenation index decreased after surfactant lavage in both groups compared to controls (P < 0.001), and more prominently in the Surf-CV group. Elimination of CO(2) was significantly higher in the Surf-HFJV group vs. all other groups (P < 0.05). The ventilation efficiency index increased after lavage in both surfactant groups vs. saline controls (P < 0.05). Dynamic lung-thorax compliance gradually increased, and right-to-left pulmonary shunts decreased in both surfactant groups vs. saline controls after lavage (P < 0.05). Combination of surfactant lavage with both CV and AHFJV was beneficial in rabbits with meconium aspiration syndrome. While AHFJV was more effective in the removal of meconium, CV had a more favorable effect on lung function in the postlavage period.

Topics: Animals; Animals, Newborn; Bronchoalveolar Lavage; Female; High-Frequency Jet Ventilation; Lung; Lung Diseases; Male; Meconium; Models, Animal; Pulmonary Gas Exchange; Pulmonary Surfactants; Rabbits; Respiratory Function Tests; Syndrome; Treatment Outcome

To understand the pathogenesis of meconium aspiration syndrome, we compared the pulmonary and inflammatory effects of the water and lipid extracts of human meconium instilled into the lungs of newborn piglets. The piglets were artificially ventilated, made hypoxemic, and randomized into three groups. At start of reoxygenation, 3 ml/kg of one of the following mixtures was instilled intratracheally: (1) meconium (n = 12); (2) water extract of meconium (n = 12), and (3) lipid extract of meconium (n = 12). During 8 h of reoxygenation, hemodynamics, pulmonary gas exchange, lung mechanics, and interleukin-8 concentrations in tracheobronchial aspirates were monitored. Oxygenation index (p = 0.04) and mean airway pressure (p = 0.04) increased more in the lipid extract group than in the water extract group. Dynamic compliance and mean arterial blood pressure decreased (p < 0.05) in the meconium and lipid extract groups, but not in the water extract group. At 8 h of reoxygenation, the interleukin-8 concentration in the tracheobronchial aspirates was three times higher in the lipid extract group as compared with the water extract group (110 +/- 102 vs. 37 +/- 27 pg/ml; p = 0.02). In conclusion, pulmonary dysfunction in meconium aspiration syndrome is caused by both the water- and lipid-soluble fractions of meconium, with stronger inflammatory and more detrimental effects promoted by the lipid extract than the water extract.

Topics: Animals; Animals, Newborn; Blood Pressure; Humans; Hypoxia; Infant, Newborn; Inflammation; Interleukin-8; Lipids; Lung; Lung Diseases; Meconium; Meconium Aspiration Syndrome; Oxygen; Pulmonary Gas Exchange; Respiration, Artificial; Solubility; Swine; Tissue Extracts; Vascular Resistance; Water

To evaluate the effect of homologous amniotic fluid and meconium inoculated intratracheally into the lungs of neonatal rats.. 153 male 7-day-old Fischer-344 rats.. Amniotic fluid was obtained by cesarean section from the uterus of pregnant rats and meconium was collected at the time of birth from the gastrointestinal tract of neonatal rats. Neonatal rats were randomly allocated into 5 treatment groups. Two groups received 0.05 ml of saline (0.9% NaCl) solution; the third and fourth groups received 0.05 ml of 50% or 100% amniotic fluid, respectively; the fifth group was inoculated with 0.05 ml of a 20% suspension of meconium. Six or 7 rat pups/group were euthanatized by exsanguination under halothane anesthesia at postinoculation days 1, 3, 7, and 14. The magnitude of injury and inflammatory response was determined by biochemical and cytologic analyses of bronchoalveolar lavage fluid.. Inoculation with saline solution and amniotic fluid did not induce pulmonary injury or inflammatory response. Inoculation with meconium induced significant (P < 0.01) injury and inflammatory response, characterized by the release of cytosolic enzymes and recruitment of neutrophils in the lung.. Saline solution is an innocuous vehicle that can be safely used in intratracheal inoculations in neonatal rats. Homologous amniotic fluid, despite containing keratin and epidermal cells, does not cause acute injury or inflammation in the lung. In contrast, meconium acts as a toxic substance injuring respiratory cells and causing a vigorous but transient leukocytic inflammatory reaction in the lungs.

Topics: Alkaline Phosphatase; Amniotic Fluid; Animals; Animals, Newborn; Bronchoalveolar Lavage Fluid; Cell Count; gamma-Glutamyltransferase; L-Lactate Dehydrogenase; Lung Diseases; Male; Meconium; Neutrophils; Random Allocation; Rats; Rats, Inbred F344

Topics: Chlorides; Cystic Fibrosis; Exocrine Pancreatic Insufficiency; Humans; Infant, Newborn; Intestinal Obstruction; Liver Cirrhosis, Biliary; Lung Diseases; Meconium; Sex Factors; Sweat

To compare high frequency positive pressure ventilation (HFV) to conventional ventilation (CV) in experimental meconium aspiration syndrome (MAS) adult rabbits were randomly assigned to one of four groups: sham (G1) n = 10, control (G2) n = 12, CV (G3) n = 6, and HFV (G4) n = 6. All animals were stabilized on an FI O2 of 0.70 after a tracheostomy and arterial line were placed. The alveolar-arterial oxygen difference (A-aDO2) was calculated for each blood gas measurement and mean airway pressure (MAP) measured in CV and HFV at the time of each blood gas. Human meconium (2 ml/kg of 25% solution) was instilled intratracheally (MI) in groups 2-4. Group 3 was then placed on conventional ventilation with a rate of 40 BPM while Group 4 with a rate of 400 BPM. Analysis of variance was used to compare A-aDO2 and MAP. There was no significant difference between group 4 and group 2, while there was a significant difference between group 3 and groups 2 and 4. Sustained inflation of 25 cm H2O as used for 20 seconds was used before HFV in a fifth group (n = 6) that was added to the study and was otherwise identical to HFV. There was no significant difference between the fifth group and group 2 or group 4. Our findings indicate HFV is not efficacious in experimental MAS whether or not sustained inflation is used.

Topics: Animals; Disease Models, Animal; Humans; Infant, Newborn; Infant, Newborn, Diseases; Inhalation; Intermittent Positive-Pressure Ventilation; Lung Diseases; Meconium; Oxygen; Positive-Pressure Respiration; Rabbits; Syndrome

Sodium nitroprusside was administered to 58 neonates, including 11 with severe respiratory distress syndrome, 15 with persistent pulmonary hypertension of the newborn, 28 with clinical shock, three with systemic hypertension, and two with pulmonary hypoplasia, all refractory to conventional intensive therapy. Nitroprusside was infused at 0.2 to 6.0 micrograms/kg/min for periods of 10 minutes to 126 hours. Infants with severe respiratory distress syndrome had increased PaO2 and decreased PaCO2 or peak inspiratory pressure, and nearly all (82%) survived. Infants with persistent pulmonary hypertension of the newborn had variable responses; improvement did not correlate with survival, but survival (47%) was identical to that in an earlier series of infants given tolazoline. Infants in shock had improved perfusion, urine output, and serum bicarbonate levels, and these responses were significantly related to survival. Hypertension was controlled in all three hypertensive infants. Adverse effects were very uncommon. Toxic effects were not observed. Sodium nitroprusside is effective and can be used safely in circulatory disorders in the neonate.

Topics: Bicarbonates; Carbon Dioxide; Drug Evaluation; Ferricyanides; Hemodynamics; Humans; Infant, Newborn; Infant, Newborn, Diseases; Infusions, Parenteral; Inhalation; Lung; Lung Diseases; Meconium; Nitroprusside; Oxygen; Persistent Fetal Circulation Syndrome; Respiratory Distress Syndrome, Newborn; Shock

We compared rapid-rate ventilation using a conventional ventilator with slow-rate ventilation in the normal lung of 7 newborn pigs and in the diseased lung model instilled with 25% meconium solution into the trachea. The flow rate (7.5 1/min) and inspiratory:expiratory ratio (1:3) were kept constant during the experiments by using a constant-flow and time-cycled ventilator; the only change in settings was the rate. Transthoracic electrical impedance at end-expiration increased in the normal and in the diseased lung. Both mean intratracheal pressure and end-expiratory esophageal pressure increased significantly (p less than 0.05) in both models upon changing to rapid-rate ventilation. Following the increase in ventilatory rates from an initial frequency of 37.5 breaths/min to a rapid rate of 150 breaths/min, there was a significant rise in both PaO2 and PaCO2 in the normal and diseased lung models. Although rapid-rate ventilation was maintained for 1 h, the improvement in oxygenation progressively deteriorated and PaCO2 also increased further. This rise in PaCO2 returned to the control levels by decreasing ventilation to the initial rate of 37.5/min. This study demonstrates that rapid-rate ventilation using a constant-flow and time-cycled ventilator is inferior to slow-rate ventilation in the diseased lung model.

Topics: Animals; Animals, Newborn; Carbon Dioxide; Disease Models, Animal; Esophagus; Kinetics; Lung Diseases; Meconium; Oxygen; Pressure; Respiration, Artificial; Swine; Trachea

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

Topics: Asphyxia Neonatorum; Congenital Abnormalities; Female; Fetal Growth Retardation; Glucose; Hematologic Diseases; Hemorrhage; Humans; Hypoglycemia; Hypothermia; Infant Care; Infant Food; Infant, Newborn; Infant, Newborn, Diseases; Infant, Small for Gestational Age; Lung Diseases; Meconium; Pregnancy; Respiratory Distress Syndrome, Newborn; Terminology as Topic; Water-Electrolyte Balance

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

Topics: Dyspnea; Humans; Infant, Newborn; Lung Diseases; Meconium; Pneumonia, Aspiration; Pulmonary Atelectasis; Radiography

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

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 survival rates in 204 patients suffering from cystic fibrosis observed between January 1956 and June 1976 were recorded. The patients were divided into five groups according to the symptoms present at the time of diagnosis and survival rates were recorded separately for each group. Survival was less good in the group of patients presenting initially with pulmonary symptoms compared to the group presenting with gastrointestinal symptoms. In the group presenting with meconium ileus survival was poor initially, but later in the course of the disease it became similar to that observed in the other groups. The differences in survival between the different categories occurred during the first two years after diagnosis. The study shows that, on clinical grounds, a severe form of the disease which is characterized by early manifestation of pulmonary symptoms and poor survival can be distinguished from a more protracted form with a better survival. Because of the great inter-individual variability large numbers of patients will have to be evaluated in order to achieve statistically significant results in studies which attempt to compare different therapeutic approaches. If such numbers cannot be reached, it may be necessary to compare only patients who belong to the same symptomatic category.

Topics: Child, Preschool; Cystic Fibrosis; Gastrointestinal Diseases; Humans; Infant; Infant, Newborn; Intestinal Obstruction; Lung Diseases; Meconium; Switzerland

An infant is described who presented a complex cardiopulmonary problem which was evaluated with the help of new physiological techniques. the infant was born at term after an emergency Caesarian section for fetal distress and was found to have meconium aspiration. He remained persistently tachypnoeic and hypoxic despite high ambient oxygen. Chest radiography suggested cystic lesions at the lung bases, and lung function tests confirmed hyperinflation with delayed nitrogen washout. In addition the child had signs of Fallot's tetralogy, and this diagnosis was confirmed by cardiac catheterization. Because of persistent hypoxia and tachypnoea disproportionate to the cardiac condition, the possibility of localized lung disease was considered. Regional lung function tests were carried out in the neonatal period and again at six months of age useing radioisotopic 13N given by both inhalation and injection. These studies showed gross ventilation/perfusion imbalance in the lungs, particularly marked at the bases, but with enough generalized abnormality to preclude the possibility of surgical intervention. The principles of the measurement of lung mechanics in the newborn by whole-body plethysmography, nitrogen washout, and regional radioisotopic spirometry are outlined. The particular value of these techniques in the evaluation of complex disorders is discussed, especially where both cardiac and pulmonary abnormalities are present.

Topics: Airway Resistance; Cardiac Catheterization; Cesarean Section; Humans; Hypoxia; Infant, Newborn; Lung Compliance; Lung Diseases; Male; Meconium; Oxygen; Plethysmography, Whole Body; Radiography; Spirometry; Tetralogy of Fallot; Ventilation-Perfusion Ratio

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

Topics: Abdomen, Acute; Aerosols; Anti-Bacterial Agents; Breathing Exercises; Cough; Cystic Fibrosis; Drainage; Heat Exhaustion; Humans; Intestinal Obstruction; Lung Diseases; Meconium; Mucus; Nasal Polyps; Physical Therapy Modalities; Pneumonia, Staphylococcal; Pneumothorax; Pulmonary Atelectasis; Rectal Prolapse; Respiratory Tract Infections; Sputum

Topics: Acetylcysteine; Anti-Bacterial Agents; Bronchi; Bronchial Diseases; Child; Cystic Fibrosis; Digestive System; Drainage; Fecal Impaction; Humans; Hyperglycemia; Intestinal Obstruction; Liver Cirrhosis; Lung; Lung Diseases; Meconium; Mucus; Pneumatosis Cystoides Intestinalis; Respiratory Function Tests; Respiratory Insufficiency; Respiratory Therapy; Respiratory Tract Diseases; Salivary Glands; Sweat