morphine and Pneumothorax

Enterolithiasis is an uncommon finding of intraluminal calcified meconium. Whereas extraluminal calcifications are commonly reported and usually indicate intrauterine intestinal perforation with intraperitoneal extravasation of meconium (meconium peritonitis), true intraluminal calcifications of meconium in newborns are rare.. We report a case of a newborn boy with pneumothorax and pneumoperitoneum because of a transmediastinal air leakage who unfortunately died on the fifth postnatal day after a pneumopericard. The baby had lung hypoplasia and a hypoplastic thorax. Oligohydramnion was present because of urethral agenesis and anal atresia with rectourinary fistula. Enterolithiasis was found, distributed from the transverse to the rectosigmoid colon. Enterolithiasis was not diagnosed prenatally in this boy, and any of those preexisting pathologies were therefore not assumed before birth except the suspicion for urethral valves because of oligohydramnion.. Approximately 48 cases of human neonatal enterolithiasis have been described in the medical literature. The etiology of enterolithiasis appears to be intraluminal mixture of meconium und alkaline urine--as it appears in anal atresia with enterourinary fistula. Most cases of enterolithiasis are associated with major urogenital and intestinal malformations--especially VACTERL association. With support of modern high-resolution imaging devices, enterolithiasis can be detected antenatally. We suppose that prenatal diagnosis of enterolithiasis is a warning sign of underlying pathologies.

Topics: Abnormalities, Multiple; Colonic Diseases; Critical Illness; Fatal Outcome; Humans; Hydronephrosis; Infant, Newborn; Infant, Premature; Lithiasis; Male; Meconium; Pneumoperitoneum; Pneumothorax; Rectal Fistula; Urinary Fistula

It has long been recognized that the patient with chronic lung disease, malnutrition, vitamin K deficiency or electrolyte and blood gas disturbances presents a special problem for the surgeon. Patients with cystic fibrosis have all of these abnormalities. Until recently, the patient with cystic fibrosis was exclusively the domain of the pediatrician. Today, with the increasing number of patients over the age of 20 years, internists and surgeons have an increasingly important role in the care of these patients. In addition, since women with cystic fibrosis are capable of bearing children, the need for genetic, obstetric and gynecologic counseling is becoming more apparent. Although the patient with cystic fibrosis is generally at a much greater risk for the complications of surgical treatment than the normal patient, experience in the management of these patients has greatly improved the outlook. However, in most instances, surgical management of the patient with cystic fibrosis represents palliation, since these patients usually die of the medical complications of their disease. Further controlled studies are needed to fully evaluate the role of surgical treatment in the sequelas of cystic fibrosis.

Topics: Adolescent; Adult; Biliary Tract Diseases; Child; Child, Preschool; Cystic Fibrosis; Female; Hemoptysis; Humans; Hypertension, Portal; Infant; Infant, Newborn; Intestinal Obstruction; Meconium; Middle Aged; Mucocele; Nasal Polyps; Pneumothorax; Risk; Surgical Procedures, Operative

Information concerning long-term operative outcomes in patients with cystic fibrosis (CF) is relatively sparse in the operative literature.. A retrospective review of CF patients with operative conditions was performed (1972-2004) at a tertiary children's hospital to analyze outcomes including long-term morbidity and survival.. A total of 226 patients with CF presented with an operative diagnosis (113 men, 113 women). A total of 422 operations were performed in 213 patients (94%). The mean age at operation was 4.1 +/- 6.2 years (range, 1 d to 26 y) and 109 were neonates. Fifteen of 42 (36%) babies with simple meconium ileus (MI) were treated nonoperatively with hypertonic enemas, 27 of 42 and all 45 patients with complicated MI required operation, including 15 with jejunoileal atresia (17%). Seventeen of 27 (63%) patients with meconium ileus equivalent had MI as neonates; 7 of 27 (26%) required operation. Eight of 9 (89%) with fibrosing colonopathy required operation. Organ transplantation was required in 21 patients. Follow-up evaluation was possible in 204 of 213 (96%) patients. The duration of follow-up evaluation was 14.9 +/- 8.5 years (range, 2 mo to 35 y). Operative morbidity was 11% at 1 year, 2% at 2 to 4 years, 1% at 5 to 10 years, and less than 1% at more than 10 years. There were 24 deaths (11%); 22 followed CF-related pulmonary complications and included 8 of 16 (50%) children with pneumothorax.. Long-term survival in CF patients has improved significantly (89%), with many surviving into the fourth decade. MI may predispose to late complications including meconium ileus equivalent and fibrosing colonopathy. Pneumothorax in CF patients is an ominous predictor of mortality. Children with CF are living longer and are good candidates for operation, but require long-term follow-up evaluation because of ongoing exocrine dysfunction.

Topics: Abdomen; Adolescent; Adult; Bile Duct Diseases; Child; Child, Preschool; Cystic Fibrosis; Female; Humans; Ileus; Infant; Infant, Newborn; Intestinal Diseases; Intussusception; Liver Diseases; Male; Meconium; Pneumothorax; Postoperative Complications; Retrospective Studies; Survival Analysis; Thoracic Surgical Procedures; Treatment Outcome

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: Abnormalities, Multiple; Hernia, Diaphragmatic; Humans; Infant, Newborn; Male; Meconium; Peritonitis; Pneumothorax; Radiography

MAS can be divided into 2 stages, distinguishable with respect to morphology of the lungs, clinical symptoms and laboratory data. The reason for the vasoconstriction of the pulmonary vascular bed typical for stage 2 is not yet fully understood. It seems, however, plausible that meconium contains substances (enzymes?) which may trigger the release or the synthesis of vasoactive compounds during the process of an aseptic inflammation. Cleaning the upper respiratory tract of an infant with meconium in the amniotic fluid immediately after birth is the most effective step in the prevention of MAS. This measure has led to a dramatic decline in both morbitity and mortality of the disease. In rare instances rinsing of the trachea with saline can help to remove considerable amounts of meconium too thick and sticky to be removed by simple suction.

Topics: Airway Obstruction; Animals; Humans; Hypoxia; Infant, Newborn; Infant, Newborn, Diseases; Inhalation; Lung; Meconium; Mediastinal Emphysema; Partial Pressure; Pneumothorax; Pulmonary Emphysema; Rabbits; Radiography; Respiration; Respiration, Artificial; Syndrome; Therapeutic Irrigation

Topics: Adult; Delivery, Obstetric; Female; Humans; Infant, Newborn; Inhalation; Meconium; Mediastinal Emphysema; Obstetric Labor Complications; Pneumothorax; Pregnancy; Radiography; Syndrome

Topics: ABO Blood-Group System; Asphyxia Neonatorum; Blood Group Incompatibility; Family Practice; Humans; Hypoglycemia; Infant, Newborn; Infant, Newborn, Diseases; Infant, Small for Gestational Age; Internship and Residency; Meconium; Nurseries, Hospital; Pneumothorax; Risk; Vitamin K Deficiency Bleeding

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

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

A report is presented of a newborn baby who developed a pneumothorax and extensive surgical emphysema after being delivered by Caesarean section for fetal distress soon after the mother had an amniocentesis.

Topics: Adult; Amniocentesis; Amniotic Fluid; Apgar Score; Cesarean Section; Emphysema; Female; Fetal Heart; Heart Rate; Humans; Infant, Newborn; Infant, Newborn, Diseases; Male; Meconium; Pneumothorax; Pregnancy; Radiography

Topics: Amniotic Fluid; Apgar Score; Bradycardia; Cesarean Section; Female; Humans; Infant, Newborn; Inhalation; Meconium; Mediastinal Emphysema; Nose; Obstetric Labor Complications; Oxygen; Pharynx; Pneumothorax; Pregnancy; Respiration; Respiratory Distress Syndrome, Newborn; Trachea; Vacuum Extraction, Obstetrical

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

Topics: Amniocentesis; Amniotic Fluid; Apgar Score; Emphysema; Female; Fetal Diseases; Gestational Age; Humans; Infant, Newborn; Infant, Newborn, Diseases; Labor, Obstetric; Meconium; Pneumothorax; Pregnancy; Pregnancy, Prolonged; Prenatal Diagnosis; Punctures; Radiography; Skin

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: 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

Topics: Humans; Infant, Newborn; Infant, Newborn, Diseases; Inhalation; Meconium; Mediastinal Emphysema; Pleural Effusion; Pneumothorax; Pulmonary Atelectasis; Radiography; Respiratory Distress Syndrome, Newborn; Respiratory Tract Diseases

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

Topics: Child; Cystic Fibrosis; Exhibitions as Topic; Humans; Hypertension; Hypertension, Portal; Infant; Infant, Newborn; Intestinal Obstruction; Intestines; Liver Cirrhosis; Meconium; Nasal Polyps; Osteoarthropathy, Secondary Hypertrophic; Pancreas; Pneumatosis Cystoides Intestinalis; Pneumothorax; Pulmonary Heart Disease; Radiography; Radiography, Thoracic; Sinusitis