morphine and Respiratory-Distress-Syndrome--Newborn

Over the past 5 years, increasing understanding about the pathophysiology of meconium-stained amniotic fluid (MSAF) and the meconium aspiration syndrome (MAS) has occurred. Many new therapies are being used in an attempt to prevent MAS and to treat the disorder. The authors review the current status of knowledge concerning the MSAF and MAS and management of these entities.

Topics: Amniotic Fluid; Chorioamnionitis; Female; Humans; Infant, Newborn; Inflammation; Intensive Care, Neonatal; Meconium; Meconium Aspiration Syndrome; Pregnancy; Pregnancy Outcome; Respiratory Distress Syndrome, Newborn

Recent reports indicate that cocaine metabolites have biologic activity and could be toxic. To explore this possibility, two studies were initiated. The first study aimed to define the distribution of cocaine species by quantifying levels of cocaine and its metabolites norcocaine, benzoylecgonine, and benzoylnorecgonine in newborn cord blood and meconium. The second study sought to determine whether they produced a clinical effect. Compared to cord blood, meconium had a greater number of metabolites and a higher concentration of cocaine metabolites, including the previously undetectable norcocaine and benzoylnorecgonine derivatives. Benzoylecgonine was the most common species found in both sources and was usually lower in concentration in blood. An inverse relation existed between meconium benzoylecgonine levels and the serum catabolic enzyme pseudocholinesterase, implying genetic variability in cocaine metabolism. To determine whether cocaine and/or its metabolites could be linked to a distinct clinical state, a second study focusing on newborn behavior was performed with an independent large cohort of cocaine-exposed infants. Neonates with increased signs of "neuroexcitation" had benzoylecgonine and no cocaine in urine, whereas lethargic neonates had detectable urinary cocaine. These findings support the hypothesis that cocaine metabolites, especially benzoylecgonine, may play a role in altering newborn behavior and produce a clinical syndrome distinct from that related to the parent compound.

Topics: Butyrylcholinesterase; Central Nervous System Diseases; Cocaine; Female; Fetal Blood; Fever; Humans; Infant, Newborn; Maternal-Fetal Exchange; Meconium; Neonatal Abstinence Syndrome; Pregnancy; Prospective Studies; Respiratory Distress Syndrome, Newborn

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

Topics: Bronchopulmonary Dysplasia; Female; Humans; Infant, Newborn; Infant, Premature, Diseases; Inhalation; Male; Meconium; Respiratory Distress Syndrome, Newborn; Respiratory Tract Diseases; Respiratory Tract Infections

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: Asphyxia Neonatorum; Humans; Infant, Newborn; Inhalation; Meconium; Respiratory Distress Syndrome, Newborn; Therapeutic Irrigation; Trachea

In an effort to minimise the stress and pain of mechanically ventilated neonates, the application of opioids has increased markedly. Abdominal adverse effects of opioid analgesics are constipation and increased pressure in the biliary system. Our aim was to evaluate the impact of continuous intravenous infusion of fentanyl on the volume of the neonatal gallbladder and to assess potential gastrointestinal side effects.. We prospectively matched pairs of 40 mechanically ventilated neonates (28-42 gestational weeks) under total parenteral nutrition and midazolam sedation. One group (20 patients) received continuous fentanyl infusions (dose 0.5-2 microg kg(-1) h(-1)) the other group (20 patients) served as controls. Sonographic measurements of gallbladder length, depth and width were performed to calculate gallbladder volume using the ellipsoid method. Repeated ultrasound images, date of meconium release and serum bilirubin levels were documented.. Fentanyl application was not associated with gallbladder sludge/stones, gallbladder hydrops, hyperbilirubinemia or prolonged meconium release. Neonatal gallbladder length, width and volume did not differ significantly (data expressed as mean, standard deviation, median, interquartile range: length (cm) 3.16+/-0.68, 3.3, 0.675 vs 3.06+/-0.62, 3.3, 1.1; P=0.645; width (cm) 1.02+/-0.23, 1.0, 0.28 vs 0.89+/-0.27, 0.9, 0.38, P=0.12; volume (cm(3)) 1.52+/-0.67, 1.7, 0.86 vs 1.22+/-0.77, 1.09, 1.19, P=0.20).. In our study fentanyl caused no major complications in the biliary system and intestine of ventilated preterm and term neonates. Sonographic investigations of the gallbladder under fentanyl treatment may be dispensable. Further investigations are required to assess adverse gastrointestinal effects.

Topics: Age Factors; Anesthetics, Intravenous; Bilirubin; Birth Weight; Data Interpretation, Statistical; Female; Fentanyl; Gallbladder; Gestational Age; Humans; Infant; Infant, Newborn; Infant, Premature; Infusions, Intravenous; Male; Meconium; Organ Size; Parenteral Nutrition; Pilot Projects; Prospective Studies; Respiration, Artificial; Respiratory Distress Syndrome, Newborn; Single-Blind Method; Time Factors; Ultrasonography

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

To evaluate the efficacy of glucocorticoids in the treatment of infants with meconium aspiration syndrome, a double-blind study using hydrocortisone or a lactose placebo was undertaken. Thirty-five infants were included in the study. No significant differences in arterial Po2, Pco2, pH, A-aDo2 gradients, in requirement for assisted ventilation, or in survival were domonstrated between the groups. In control infants, a significant decrease (p less than 0.01) in respiratory distress score was found at 48 to 72 hours of age; in treated infants, it was seen only after 72 hours. The infants in the treated group took a significantly longer (p less than 0.01) period of time to wean to room air than those in the control group (68.9 +/- 9.6 hours vs 36.6 +/- 6.9 hours). On the basis of these observations, hydrocortisone is not recommended for treatment of MAS.

Topics: Drug Evaluation; Humans; Hydrocortisone; Infant, Newborn; Meconium; Placebos; Pneumonia, Aspiration; Respiratory Distress Syndrome, Newborn

Despite its prevalence and potential maternal and neonatal implications, the literature on the thickness levels of meconium stained amniotic fluid (MSAF) and its impact on neonatal outcomes is relatively outdated and relies on relatively small sample sizes.. To study if different thickness levels of MSAF correlate with adverse neonatal outcome.. A retrospective cohort study.. The medical records and neonatal charts of all women with a singleton pregnancy, who underwent a trial of labor, at 37 + 0/7 weeks or beyond, between 10/2008 and 7/2018 were reviewed.. The cohort was divided according to the level of meconium reported during labor into four groups: Clear (C group), Light meconium (LM group), Intermediate meconium (IM group), and Heavy meconium (HM group). Composite neonatal outcome included at least one of the following: umbilical artery pH ≤ 7.1, sepsis, need for blood transfusion, need for phototherapy, respiratory distress syndrome, meconium aspiration syndrome, need for mechanical ventilation support, necrotizing enterocolitis, intraventricular hemorrhage, hypoxic ischemic encephalopathy, periventricular leukomalacia, seizures, hypoglycemia, hypothermia, and death. Continuous parameters were compared with Anova's test or Kruskal Wallis, and categorical variables by chi-square test or Fisher exact test, as appropriate. Multivariant logistic regression was performed in order to eliminate possible cofounders.. Overall, 24,445 deliveries were reviewed (C-20,185, LM-1074, IM-2736, HM-450). Composite adverse neonatal outcome was more common with increasing thickness of MSAF. On multivariable analysis, IM and HM were independently associated with composite adverse neonatal outcome.. The degree of meconium thickness independently correlates with composite adverse neonatal outcome.

Topics: Adult; Amniotic Fluid; Enterocolitis, Necrotizing; Female; Humans; Hypoxia-Ischemia, Brain; Infant, Newborn; Male; Meconium; Meconium Aspiration Syndrome; Pregnancy; Respiratory Distress Syndrome, Newborn

Topics: Ascites; Fatal Outcome; Fetal Diseases; Humans; Ileum; Infant, Newborn; Intestinal Perforation; Male; Meconium; Peritonitis; Respiratory Distress Syndrome, Newborn

The present study aimed to determine the effect of perceived stress during pregnancy on neonatal outcomes and cortisol and leptin levels in mothers and their newborns.. This longitudinal study was carried out on 110 pregnant women in Miandoab city, Iran. Mothers, who had singleton pregnancies and gestational age of 24 to 28 weeks, were included in the study. The participants were asked to fill out Cohen's Perceived Stress Scale (PSS). The mothers were then tracked in gestational ages of 28-32 weeks, 32-36 weeks, and the time of delivery. The maternal and umbilical cord blood samples were obtained during labor in order to measure leptin and cortisol levels.. Umbilical cortisol level was significantly higher in newborns who had meconium stained amniotic fluid than those who did not. Maternal blood leptin levels at delivery were significantly higher in the mothers whose neonates had respiratory distress, low birth weight, low head circumference, low Apgar score, and were premature than those whose neonates did not have such problems. The level of leptin in umbilical cord blood was significantly higher in neonates who had respiratory distress than those who did not. The results also showed a significant correlation between maternal cortisol levels and PSS during weeks 24-28 and the entire pregnancy. A significant relationship was observed between umbilical leptin and maternal leptin levels.. It can be concluded that stress during pregnancy is accompanied by fetal distress. The probable reason for newborns distress may be related to increased maternal leptin levels.

Topics: Adolescent; Adult; Amniotic Fluid; Apgar Score; Body Height; Female; Fetal Blood; Fetal Growth Retardation; Head; Humans; Hydrocortisone; Infant, Low Birth Weight; Infant, Newborn; Leptin; Male; Meconium; Pregnancy; Pregnancy Complications; Premature Birth; Respiratory Distress Syndrome, Newborn; Stress, Psychological; Young Adult

Topics: Adult; Amniotic Fluid; Apgar Score; Gestational Age; Humans; Infant, Newborn; Intensive Care Units, Neonatal; Israel; Jaundice, Neonatal; Meconium; Meconium Aspiration Syndrome; Patient Admission; Phototherapy; Respiration Disorders; Respiration, Artificial; Respiratory Distress Syndrome, Newborn; Retrospective Studies; Risk Factors; Sepsis; Tachypnea; Term Birth; Young Adult

The Apgar score is universally used for fetal assessment at the time of birth, whereas, the collection of fetal cord blood gases is performed commonly in high-risk situations or in the setting of Apgar scores of <7, which is a less standardized approach. It has been well-established that neonatal acidemia at the time of delivery can result in significant neonatal morbidity and death. Because of this association, knowledge of the fetal acid-base status and detection of acidemia at the time of delivery can serve as a sensitive and useful component in the assessment of a neonate's risk. Umbilical cord blood gas analysis is an accurate and validated tool for the assessment of neonatal acidemia at the time of delivery. Because the collection of fetal cord blood gases is not a standardized practice, it is possible that, with such a varied approach, some cases of neonatal acidemia are not detected, particularly in the setting of reassuring Apgar scores.. In a setting of universally obtained cord blood gases, we sought to identify the rates of acidemia and associated factors in neonates with 5-minute Apgar scores of ≥7.. This retrospective cohort study identified all term, singleton, nonanomolous neonates with 5-minute Apgar scores of ≥7. The incidence of umbilical artery pH ≤7.0 or ≤7.1 and base excess ≤-12 mmol/L or ≤-10 mmol/L were examined overall and in association with obstetric complications and adverse neonatal outcomes. Chi-squared tests were used to compare proportions, and multivariable logistic regression was used to control for potential confounders.. In this cohort, the incidence of an umbilical artery pH of ≤7.0 was 0.5%, of a pH ≤7.1 was 3.4%, of a base excess ≤-12 mmol/L was 1.4%, and of ≤-10 mmol/L was 4.0%. Rates of neonatal acidemia were greater in the setting of meconium (4.3% vs 3.2%; P<.001), placental abruption (13.2% vs 3.4%; P<.001), and cesarean deliveries (5.8% vs 2.8%; P<.001), despite normal 5-minute Apgar scores. Additionally, umbilical artery pH ≤7.0 was associated with an increased risk of respiratory distress syndrome (adjusted odds ratio, 6.5; 95% confidence interval, 2.9-14.3) and neonatal intensive care unit admission (adjusted odds ratio, 10.8; 95% confidence interval, 6.8-17.4). Base excess of ≤-12 mmol/L was also associated with an increased risk of neonatal sepsis (adjusted odds ratio, 4.7; 95% confidence interval, 1.9-12.1). Finally, when examined together, neonates with both a pH of ≤7.0 and base excess of ≤-12 mmol/L continued to demonstrate an increased risk of neonatal intensive care unit admission and respiratory distress syndrome, with adjusted odds ratios of 9.6 and 6.0, respectively. This risk persisted in neonates with a pH of ≤7.1 and base excess of ≤-10 mmol/L as well, with adjusted odds ratios of 4.5 and 1.1, respectively.. Because neonates with reassuring Apgar scores have a residual risk of neonatal acidemia that is associated with higher rates of adverse outcomes, the potential utility of obtaining universal cord blood gases should be further investigated.

Topics: Abruptio Placentae; Acidosis; Apgar Score; Blood Gas Analysis; Cesarean Section; Cohort Studies; Female; Fetal Blood; Humans; Hydrogen-Ion Concentration; Infant, Newborn; Intensive Care, Neonatal; Meconium; Neonatal Sepsis; Patient Outcome Assessment; Pregnancy; Prognosis; Respiratory Distress Syndrome, Newborn; Retrospective Studies; Risk Factors; Term Birth; Umbilical Arteries

To evaluate cord blood concentrations of adrenocorticotropic hormone (ACTH) and cortisol in well term infants born with and without meconium-stained amniotic fluid (MSAF) and term infants born with MSAF who experienced respiratory distress (RD).. This was a prospective observational study. Fifty-four term infants were enrolled in the study in three groups: group 1 consisted of 18 well infants who were born with clear amniotic fluid, group 2 had 18 well infants born with MSAF, and group 3 had 18 infants born with MSAF who experienced RD in the first 24 h of age. Cord blood ACTH and cortisol concentrations were measured in infants born in all three groups. Groups 2 and 3 had serum ACTH and cortisol levels re-measured at 22-26 h of age.. The mean ACTH and cortisol levels at birth in group 3 infants were 18.3 pg/mL and 12.6 mg/dL, respectively. These were significantly lower than those in group 2 infants.. Term infants born with MSAF and who experienced respiratory distress had significantly lower levels of ACTH and cortisol at birth compared with well term infants born with MSAF or clear amniotic fluid. This study suggests that inadequate response of ACTH and cortisol hormones may play a role in the development of respiratory distress in term infants with MSAF.

Topics: Adrenocorticotropic Hormone; Amniotic Fluid; Female; Fetal Blood; Humans; Hydrocortisone; Infant, Newborn; Male; Meconium; Prospective Studies; Respiratory Distress Syndrome, Newborn; Term Birth

This study aimed to find out incidence, predictors, onset and severity of respiratory distress including meconium aspiration syndrome (MAS) among vigorous neonates born through meconium stained amniotic fluid (MSAF), which may or may not be evident at birth.. Two hundred ninety vigorous neonates were studied. Data were collected on perinatal risk factors, clinical course and development of respiratory distress. Predictors of respiratory distress were identified by logistic regression and a score based on adjusted OR was assigned for each. Diagnostic performance of the score (0-24) was assessed on another 247 vigorous neonates using receiver operator characteristic analysis (ROC).. Respiratory distress developed in 97(33.4 %) infants, MAS in 75(25.9 %). The distress appeared within 12 h in 97.9 %, was severe in only 21.7 %. Of 10 risk factors significantly associated with respiratory distress, seven entered in regression analysis. Fetal distress(adj OR = 11.8; 95%CI = 6.2-22.5), prolonged labor(adj OR = 5.2; 95%CI = 2.5-10.7), and absent/poor cry(adj OR = 5.6; 95%CI = 2.4-13.3) were identified as independent predictors; each assigned a score of 12, 6 and 6, respectively. To predict respiratory distress, a cut-off score of 9 points had sensitivity-74.1 % (95%CI = 63.3 %-82.7 %), specificity-84.6 % (95 % CI = 77.9 %-89.6 %), positive predictive value- 71.6 % (95%CI = 60.8 %-80.4 %), negative predictive value- 86.2 % (95 % CI = 79.6 %-90.9 %), likelihood ratio (LR) + ve 4.8(95%CI = 3.3-7.0) and LR-ve 0.3(95%CI = 0.2-0.4).. Respiratory distress occurred in one third neonates, mostly had onset within 12 h of birth, and it was mild to moderate in majority. Fetal distress, prolonged labor, and absent/poor cry predicted respiratory distress and were validated. However, larger studies in different settings are required to confirm its utility.

Topics: Amniotic Fluid; Apgar Score; Female; Humans; Incidence; India; Infant, Newborn; Male; Meconium; Meconium Aspiration Syndrome; Predictive Value of Tests; Pregnancy; Prospective Studies; Respiratory Distress Syndrome, Newborn; Risk Factors

Meconium obstruction (MO) of prematurity can result in increased morbidity or mortality and prolonged hospitalization if not diagnosed and treated appropriately.. The aims of our study were to identify the incidence and risk factors associated with MO and to review the treatment outcomes.. A retrospective analysis was undertaken of 101 extremely low birth weight infants (ELBWIs) who were born between January 1, 2007, and April 1, 2009, at Seoul National University Hospital. Prenatal and neonatal factors were compared between the MO and control groups. The treatment outcomes were also reviewed.. Twenty-two (22%) patients were diagnosed as having MO. Eighteen of these patients (82%) had prenatal risk factors for MO. Respiratory distress syndrome was more prevalent in the MO group than in the control group (p = 0.001). Overall, 17 of the 22 patients (77%) were relieved with medical treatment and the rest underwent ileostomy. The times to full enteral feeding did not differ between the medically treated group and the control group. However, the surgically treated group required more time to achieve full enteral feeding, and some patients had persistent gastrointestinal problems.. MO is not a rare condition in ELBWIs, and the majority of ELBWIs have prenatal risk factors. Medical management was effective, and medically manageable cases had good prognoses for subsequent feeding, whereas some surgically managed cases had persistent gastrointestinal problems.

Topics: Adult; Comorbidity; Ductus Arteriosus, Patent; Female; Gestational Age; Humans; Ileostomy; Infant, Extremely Low Birth Weight; Infant, Newborn; Intensive Care Units, Neonatal; Intestinal Obstruction; Male; Meconium; Placental Insufficiency; Pregnancy; Republic of Korea; Respiratory Distress Syndrome, Newborn; Retrospective Studies; Sex Ratio; Ultrasonography, Prenatal

Histological studies show that amniotic fluid cellular content (AFCC) causes in the middle ear a foreign body reaction, the extent and severity of which depends upon the massiveness of contamination. We studied how factors related to birth and environment affect proneness to acute otitis media (AOM) in infants born through meconium contaminated amniotic fluid.. From the birth records of infants born from 1996 to 2000 a list was made of those born through meconium contaminated amniotic fluid with pulmonary aspiration and tracheal suctioning, followed by treatment in a neonatal intensive care unit. Thirty-seven such children formed the study group, 43 children matching the study cases but born through clear fluids formed the control group. Birth and environmental factors together with the frequency and number of episodes of AOM were analyzed in all, based on a verified questionnaire. In addition, 27 children in the study group and 21 in the control group received a specialist ENT examination, hearing tests and tympanometry.. The events at delivery were highly significantly different between the two groups, manifested by the lower Apgar points in the study group (p<0.001) while other birth and environmental factors appeared equalized. The first episode of AOM in the study group came earlier than in the control group and their frequency was significantly higher during the 1st and 2nd year of life and during the entire observation period (p<0.001). Tympanostomy was performed more often in the study group. Tympanometry showed more cases of reduced static admittance and negative pressure than in the control group and hearing was poorer.. Cases with compromised delivery through meconium contaminated fluids, resulting in pulmonary aspiration and in need of intensive care treatment, form a risk group, which should be closely followed. Early nasopharyngeal suctioning of AFCC may reduce its entry into the middle ear. A prolonged episode of AOM suggests mucosal involvement of several middle ear compartments, shown by histological studies to occur in all cases of massive contamination. Placement of a ventilation tube after the first prolonged AOM allows regression of the granulation tissue in the air spaces together with the secretory elements in the mucosa.

Topics: Acoustic Impedance Tests; Amniotic Fluid; Ear, Middle; Humans; Infant; Infant, Newborn; Meconium; Meconium Aspiration Syndrome; Otitis Media; Respiratory Distress Syndrome, Newborn; Risk Factors

To determine whether there is a difference in maternal and neonatal outcomes if a sequential operative vaginal or cesarean delivery follows failed vacuum delivery.. A cross sectional study. We have analyzed maternal and neonatal outcomes of 215 vacuum extractions (group 1), 106 forceps assisted deliveries (group 2), 28 deliveries in which failed vacuum extraction were followed by forceps delivery (group 3) and 22 deliveries in which failed vacuum extraction were followed by cesarean delivery (group 4).. Compared to other groups, patients in group 4 had significantly more post partum anemia, meconium stained amniotic fluid and hospital stay (both maternal and neonatal) as well as lower pH. Apgar scores were similar in groups 3 and 4. Incidence of respiratory distress syndrome, cephalhematoma and jaundice were similar in neonates of all groups.. If an attempted vacuum delivery has failed, the risk of adverse neonatal outcome is increased with either subsequent forceps or cesarean delivery. It should remain in the judgment of the attending obstetrician to choose the method most suitable under the given circumstances.

Topics: Adult; Amniotic Fluid; Anemia; Apgar Score; Cesarean Section; Cross-Sectional Studies; Delivery, Obstetric; Dystocia; Female; Fetal Distress; Humans; Hydrogen-Ion Concentration; Infant, Newborn; Labor Stage, Second; Length of Stay; Meconium; Obstetrical Forceps; Pregnancy; Pregnancy Outcome; Respiratory Distress Syndrome, Newborn; Shoulder; Time Factors; Treatment Failure; Vacuum Extraction, Obstetrical

To investigate the impact of preterm premature rupture of membranes on neonatal outcome.. A retrospective study was conducted among singleton pregnancies with or without intact amniochorional membranes. The impact of maternal age, gestational age at birth, 1- and 5-min Apgar scores, birthweight, presence of meconium, use of tocolytics, corticosteroids and antibiotics, mode of delivery, umbilical artery pH, histologic presence of chorioamnionitis, and state of the membranes were analyzed in relation to neonatal outcome. Neonatal outcomes were categorized into: none, presence of respiratory distress syndrome, early neonatal sepsis, neonatal death, and days at neonatal intensive care unit.. A total of 180 preterm deliveries with ruptured (n=80) and intact membranes (n=100) constituted the study group (group 1) and the control group (group 2), respectively. Compared with group 2, there were more cases in group 1 of maternal antibiotic use (P<0.001), short-term tocolysis (P=0.03), and histologic chorioamnionitis (P<0.001). Multiple logistic regression analysis showed that gestational age at delivery (P=0.009), 1-min Apgar score (P=0.013), and umbilical artery pH (P=0.05) were the independent factors affecting neonatal outcome.. Neonatal outcome was mainly affected by prematurity rather than by preterm premature rupture of membranes.

Topics: Adult; Apgar Score; Case-Control Studies; Chorioamnionitis; Delivery, Obstetric; Female; Fetal Membranes, Premature Rupture; Gestational Age; Humans; Infant Mortality; Infant, Low Birth Weight; Infant, Newborn; Infant, Premature; Intensive Care Units, Neonatal; Length of Stay; Logistic Models; Maternal Age; Meconium; Obstetric Labor, Premature; Pregnancy; Pregnancy Outcome; Respiratory Distress Syndrome, Newborn; Retrospective Studies; Risk Factors; Sepsis; Tocolysis

In vitro studies and animal experiments have provided evidence that albumin, bilirubin, meconium and inflammatory mediators act as surfactant inhibitors. The aim of this research was to establish whether their elevated concentrations in gastric aspirates, as representative samples of amniotic fluid, could contribute to the development of respiratory distress syndrome (RDS) in preterm infants.. Infants born before the 35th week of gestation between 1 March 1996 and 1 April 1997 were included. They were divided into two groups: the RDS and non RDS group. Gastric aspirates, taken immediately after birth, were used for biochemical measurements of albumin, bilirubin, meconium and E-alpha 1-PI concentrations.. Sixty-one preterm infants were enrolled: 23 in the RDS group. The concentrations of albumin, bilirubin and meconium in gastric aspirates were higher in the RDS group (p < 0.01, p = 0.01 and p = 0.02, respectively). The E-alpha 1-PI concentration showed no significant difference between the two groups. Logistic regression analysis showed that a markedly increased risk of RDS was only represented by albumin concentrations of over 1.6 mmol/l and gestational age of under 31 weeks.. Our observations indicate that increased levels of albumin in the gastric aspirate, taken immediately after birth, may contribute to the development of RDS in preterm infants. Despite the established inhibitory effects of bilirubin, meconium and inflammatory mediators in vitro, we could not confirm their influence on the development of RDS.

Topics: Albumins; alpha 1-Antitrypsin; Amniotic Fluid; Bilirubin; Birth Weight; Female; Gastric Juice; Gestational Age; Humans; Infant, Newborn; Infant, Premature; Leukocyte Elastase; Logistic Models; Male; Meconium; Pulmonary Surfactants; Respiration, Artificial; Respiratory Distress Syndrome, Newborn; ROC Curve

A disease similar to acute respiratory distress syndrome may occur in neonates after aspiration of meconium. The aim of the study was to compare the inhibitory effects of human meconium on the following surfactant preparations suspended at a concentration of 2.5 mg/mL: Curosurf, Alveofact, Survanta, Exosurf, Pumactant, rabbit natural surfactant from bronchoalveolar lavage, and two synthetic surfactants based on recombinant surfactant protein-C (Venticute) or a leucine/lysine polypeptide. Minimum surface tension, determined with a pulsating bubble surfactometer, was increased >10 mN/m at meconium concentrations >or=0.04 mg/mL for Curosurf, Alveofact, or Survanta, >or=0.32 mg/mL for recombinant surfactant protein-C, >or=1.25 mg/mL for leucine/lysine polypeptide, and >or=20 mg/mL for rabbit natural surfactant. The protein-free synthetic surfactants Exosurf and Pumactant did not reach minimum surface tension <10 mN/m even in the absence of meconium. We conclude that surfactant activity is inhibited by meconium in a dose-dependent manner. Recombinant surfactant protein-C and leucine/lysine polypeptide surfactant were more resistant to inhibition than the modified natural surfactants Curosurf, Alveofact, or Survanta but less resistant than natural lavage surfactant containing surfactant protein-A. We speculate that recombinant hydrophobic surfactant proteins or synthetic analogs of these proteins can be used for the design of new surfactant preparations that are relatively resistant to inactivation and therefore suitable for treatment of acute respiratory distress syndrome.

Topics: Animals; Humans; Hydrogen-Ion Concentration; Infant, Newborn; Meconium; Proteolipids; Pulmonary Surfactants; Rabbits; Respiratory Distress Syndrome, Newborn; Surface Properties

The purpose of this study was to evaluate the meconium staining of amniotic fluid (AF) in term of fetal distress, meconium aspiration syndrome, and perinatal morbidity and mortality. In a prospective study at Princess Badeea Teaching Hospital from April to November 1999, women with a singleton cephalic pregnancy of completed 37-42 weeks and with no pre-defined risk factor were recruited into the study. Study patients comprised 390 (10%) patients with meconium and 400 patients as controls but with clear amniotic fluid. Virtually meconium staining of the amniotic fluid was significantly associated with poor neonatal outcome in all outcomes measures assessed. Perinatal mortality increased from 2 per 1000 births with clear AF to 10 per 1000 with meconium (P<0.001). Other adverse outcomes also increased; e. g., severe fetal acidemia, Apgar score < or = 3 at 1 min and 5 min, and meconium aspiration syndrome. Delivery by cesarean section also increased with meconium from 7-14% (P<0.001). We concluded that meconium in the amniotic fluids associated with an obstetric hazard and significantly increase risks of adverse neonatal outcomes. Women with thin meconium in the presence of normal fetal heart rate can be safely managed at the clinical level. Mod-thick meconium alone should alert the obstetrician to a high risk fetal condition. Continuous fetal heart rate monitoring during labour and reassurance of fetal well-being by acid-base assessment were most significant factors in the reduction of meconium aspiration syndrome.

Topics: Adult; Amniotic Fluid; Birth Weight; Cesarean Section; Chorioamnionitis; Female; Fetal Blood; Heart Rate, Fetal; Humans; Hydrogen-Ion Concentration; Infant, Newborn; Labor, Induced; Labor, Obstetric; Meconium; Meconium Aspiration Syndrome; Pregnancy; Pregnancy Outcome; Respiration, Artificial; Respiratory Distress Syndrome, Newborn; Suction

To evaluate the reliability of the dipalmitoyl phosphatidylcholine test in predicting respiratory distress syndrome (RDS) in the presence of common contaminants of amniotic fluid.. Forty specimens of amniotic fluid collected within 72 hours of delivery were divided in five 25 microL aliquots and diluted with either phosphate-buffered saline (control), meconium, blood, vaginal fluid, or semen. The concentration of dipalmitoyl phosphatidylcholine in all five groups of samples, as measured by the dipalmitoyl phosphatidylcholine test, was compared by paired t test, Dunnett test, and analysis of variance, and correlated with the neonatal respiratory status of the newborns.. No significant differences in the concentration of dipalmitoyl phosphatidylcholine were found between control and the corresponding contaminated samples (P = .33). Of the 200 samples evaluated, 80 had dipalmitoyl phosphatidylcholine concentrations below 12 micrograms/mL and 120 had at least 12 micrograms/mL. Using a cutoff dipalmitoyl phosphatidylcholine concentration of 12 micrograms/mL, the presence of RDS was predicted accurately in all 15 control and in 61 of 65 contaminated samples. The absence of RDS, as predicted by a dipalmitoyl phosphatidylcholine value at least 12 micrograms/mL, was predicted accurately in 24 of 25 control samples and 96 of 100 contaminated samples. The overall accuracy of the dipalmitoyl phosphatidylcholine test in predicting RDS in contaminated samples was 98%.. The dipalmitoyl phosphatidylcholine test is a reliable predictor of RDS in contaminated samples.

Topics: 1,2-Dipalmitoylphosphatidylcholine; Amniotic Fluid; Analysis of Variance; Blood; Female; Humans; Infant, Newborn; Meconium; Predictive Value of Tests; Reproducibility of Results; Respiratory Distress Syndrome, Newborn; Semen; Specimen Handling; Vagina

Surfactant protein A (SP-A), a major protein component of natural pulmonary surfactant, is absent in exogenous surfactants currently used in clinical practice. We investigated the physical and physiological properties of one of these modified natural surfactants (Curosurf) after enrichment with 5% SP-A (SP-A-Curosurf). A pulsating bubble system was used for in vitro assessments and ventilated newborn rabbits for evaluation of in vivo effects. In the presence of various potential inhibitors (meconium 5 mg.mL-1, fibrinogen 5 mg.mL-1, albumin 25 mg.mL-1, or whole serum proteins 25 mg.mL-1), Curosurf at a concentration of 5 mg.mL-1 was inactivated while SP-A-Curosurf and natural porcine surfactant at the same concentration had normal maximum and minimum surface tension. This protective effect of SP-A was calcium dependent. In immature newborn rabbits, the improvement of lung-thorax compliance observed after treatment with 100 mg.kg-1 of SP-A-Curosurf was equivalent to that obtained with 200 mg.kg-1 of Curosurf. Similarly, in near-term newborn rabbits with respiratory failure induced by instillation of fibrinogen via the airways, the increase in compliance after administration of 100 mg.kg-1 of SP-A-Curosurf corresponded to that seen after treatment with 200 mg.kg-1 of Curosurf, whereas Curosurf at a dose of 100 mg.kg-1 had no substantial effect. Our data thus indicate that surfactant protein A increases the resistance of Curosurf to inactivation under in vivo conditions.

Topics: Albumins; Animals; Animals, Newborn; Biological Products; Edetic Acid; Fibrinogen; Heart Rate; Humans; Hydrogen-Ion Concentration; Infant, Newborn; Lung Compliance; Meconium; Molecular Weight; Phospholipids; Proteolipids; Pulmonary Surfactant-Associated Protein A; Pulmonary Surfactant-Associated Proteins; Pulmonary Surfactants; Rabbits; Respiratory Distress Syndrome, Newborn; Surface Properties; Swine

Passage of meconium in utero and subsequent pulmonary aspiration of meconium admixed with amniotic fluid is a major cause of neonatal respiratory distress. Airway clearance is the first defense of the lung, and clearance is dependent on the bulk physical (rheologic) as well as the surface properties of airway material. We therefore evaluated the surface adhesive properties and the transport properties of freshly passed meconium and of two dilutions of reconstituted, blended, meconium as used to mimic the effect of meconium passage into the amniotic fluid in animal models of meconium aspiration syndrome. Reconstituted and fresh meconium had similar physical and transport properties, including an extremely high interfacial (adhesion) tension and very poor transportability by either airflow or cilia. The similarities between the freshly passed and reconstituted meconium suggest that the latter is an adequate substitute for use in animal models of meconium aspiration syndrome. The high adhesiveness of meconium suggests a potential role for surfactant administration as an adhesive to improve airway clearance after meconium aspiration.

Topics: Adhesives; Adult; Amniotic Fluid; Animals; Cilia; Cough; Female; Gestational Age; Humans; Infant, Newborn; Male; Meconium; Pregnancy; Rana pipiens; Reference Values; Respiratory Distress Syndrome, Newborn; Rheology; Surface Properties

A total of 3472 deliveries were studied over a year to evaluate (i) the importance of thin meconium stained liquor (MSL) in the causation of meconium aspiration syndrome (MAS), and (ii) the efficacy of intrapartum plus endotracheal suction at birth in the prevention of MAS due to thin meconium. Two hundred and ninety four (8.5%) of deliveries had meconium stained liquor of which thin MSL was present in 101. MAS occurred in 98 babies. Thin MSL was responsible for 19.4% of cases of MAS. Inspite of intrapartum suction, a high proportion (55-78%) of infants had meconium in the trachea, though thin meconium was found in the trachea significantly less often than thick meconium. Combined intrapartum and endotracheal suction reduced the incidence of MAS due to thin meconium from 26% to 16%. MAS due to thin meconium occurred in asphyxiated as well as vigorous babies inspite of combined suction. Thin meconium accounts for a significant proportion of deliveries with MSL and causes a considerable number of cases of MAS. To prevent meconium aspiration syndrome caused by thin meconium, all neonates born through thin MSL, whether they are asphyxiated or not should undergo intrapartum suction followed by immediate endotracheal suction at birth.

Topics: Asphyxia Neonatorum; Delivery, Obstetric; Female; Humans; Incidence; Infant Care; Infant, Newborn; Meconium; Meconium Aspiration Syndrome; Mouth; Nasopharynx; Pneumonia, Aspiration; Pregnancy; Prospective Studies; Respiratory Distress Syndrome, Newborn; Suction; Trachea

End-tidal PCO2 (PETCO2) measurements from two commercially available neonatal infrared capnometers with different sampling systems and a mass spectrometer were compared with arterial PCO2 (PaCO2) to determine whether the former could predict the latter in mechanically ventilated rabbits with and without lung injury. The effects of tidal volume, ventilator frequency and type of lung injury on the gradient between PETCO2 and PaCO2 (delta P(a-ET)CO2) were evaluated. Twenty rabbits were studied: 10 without lung injury, 5 with saline lavage and 5 with lung injury by meconium instillation. Paired measurements of PETCO2 by two infrared capnometers and a mass spectrometer were compared to PaCO2. In the rabbits without lung injury, the values from the infrared capnometers and mass spectrometer correlated strongly with PaCO2 (r > or = 0.91) despite differences in the slopes of the linear regression between PETCO2 and PaCO2 and in delta P(a-ET)CO2 (P < 0.05). Values from the mainstream IR-capnometer more closely approximated the line of identity than the regression between the sidestream IR-capnometer values or the mass spectrometer and PaCO2, but tended to overestimate PaCO2. The delta P(a-ET)CO2 was similar at all tidal volumes and ventilator frequencies, regardless of capnometer type. In the rabbits with induced lung injury, while there was a positive correlation between the slopes of the regression between PETCO2 and PaCO2 for both capnometers (r > or = 0.70), none of the regression slopes approximated the line of identity. The delta P(a-ET)CO2 was greater in rabbits with injured than noninjured lungs (P < 0.05). The delta P(a-ET)CO2 was similar among capnometers regardless of tidal volume, ventilator frequency, or type of lung injury. The 95% confidence interval of plots PaCO2 against PETCO2 was large for rabbits with injured and noninjured lungs.(ABSTRACT TRUNCATED AT 250 WORDS)

Topics: Animals; Animals, Newborn; Blood Gas Analysis; Blood Gas Monitoring, Transcutaneous; Humans; Infant, Newborn; Infrared Rays; Lung; Mass Spectrometry; Meconium; Models, Biological; Predictive Value of Tests; Pulmonary Gas Exchange; Rabbits; Respiration, Artificial; Respiratory Distress Syndrome, Newborn; Sodium Chloride; Therapeutic Irrigation; Tidal Volume

Extracorporeal membrane oxygenation (ECMO) is a lifesaving therapy for neonatal pulmonary hypertension but carries a significant risk for transfusion-related complications. Packed red blood cell (PRBC) and platelet exposure were quantified and reviewed in 17 ECMO survivors prior (Group I, n = 9) and subsequent to (Group II, n = 8) changes in transfusion protocols. Blood product requirements included ECMO circuit priming, maintenance of haematocrit > 0.40 or platelet count > 50 x 10(9)/l, and colloid volume expansion. Group I was exposed to 13.8 +/- 10.2 (x +/- SD) different PRBC units. In Group II, multiple transfusions from single donor units decreased exposure 71% to 3.9 +/- 0.7 units (P < 0.05). Decreases in blood withdrawn (11%) and transfusion volume (7%) were coincident with a 15% reduction in mean bypass time. Platelet volume transfusion decreased from 159 +/- 213 to 93 +/- 64 ml using volume-reduced platelet packs. Total transfusion exposure decreased 59% from 20.8 +/- 17.8 units to 8.6 +/- 2.4 donor units. No transfusion complications occurred during the aggregate 1,926 h on bypass. We conclude that neonates on ECMO have a significant transfusion exposure risk increasing with prolonged duration of ECMO therapy. In addition we noted that concentrated platelet packs decreased transfusion volume by 41%, and multiple PRBC transfusions from single donor units decreased donor exposure by 71% while both strategies decreased the overall transfusion exposure risk by 59%.

Topics: Blood Component Transfusion; Blood Transfusion; Erythrocyte Transfusion; Extracorporeal Membrane Oxygenation; Female; Humans; Hypertension, Pulmonary; Infant, Newborn; Inhalation; Male; Meconium; Platelet Transfusion; Prospective Studies; Respiratory Distress Syndrome, Newborn; Respiratory Insufficiency; Retrospective Studies; Risk; Sepsis; Transfusion Reaction

The cause of fetal distress and neonatal respiratory distress (RD) in association with meconium-stained liquor is not always clear. To clarify this, a prospective study was undertaken in a tertiary referral maternity hospital for 1 year. In all infants born after meconium-stained liquor who developed RD, evidence was sought for 1) fetal distress (from the cardiotocograph (CTG), the cord blood pH, the Apgar score and the asphyxial complications in the neonate) 2) causes of fetal distress (including maternal risk factors, fetal infection and fetal malnutrition) 3) causes of respiratory distress (including meconium aspiration syndrome (MAS), persistent pulmonary hypertension of the newborn (PPHN) and infection). Of 4,026 livebirths, 717 (17.8%) had meconium-stained liquor and 44 term and 5 preterm infants developed RD. In the 44 term infants, there was frequent evidence of fetal distress possibly caused by previously unrecognized factors such as fetal malnutrition with reduced neonatal skinfold thickness in 35% triceps and 41% subscapular measurements, and histological chorioamnionitis (CA) in 74%. The cause for respiratory distress was identified in only 48% of infants, and included clinical evidence of PPHN (41%), MAS (16%) and infection (2%). However in preterm infants, 80% had definite or suspected infection. The findings indicate that fetal distress is common in infants who develop respiratory distress after meconium-stained liquor. A role for histological CA and reduced nutrition in the fetus, as factors contributing to the vulnerability of the term infant to intrapartum fetal distress, is suggested.

Topics: Apgar Score; Chorioamnionitis; Female; Fetal Blood; Fetal Diseases; Fetal Distress; Heart Rate, Fetal; Hospitals, Maternity; Humans; Infant, Newborn; Infant, Premature; Kidney Diseases; Meconium; Meconium Aspiration Syndrome; New South Wales; Nutritional Status; Persistent Fetal Circulation Syndrome; Pregnancy; Prospective Studies; Radiography; Respiratory Distress Syndrome, Newborn; Risk Factors; Sepsis; Skinfold Thickness

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

Plasma concentrations of immunoreactive human atrial natriuretic peptide (human ANP) were sequentially determined in 12 infants with respiratory distress syndrome (RDS) or meconium aspiration syndrome (MAS) during various phases of diuresis to elucidate the role of human ANP in the occurrence of spontaneous diuresis in the newborn. Plasma immunoreactive ANP concentrations during the diuretic as well as the maximum diuretic phase were significantly (p less than 0.001) higher than during the prediuretic phase. A gradual decrease occurred during the post diuretic phase, returning to prediuretic values after one week of life. Significant natriuresis, increased glomerular filtration rate, mild hyponatremia, and decreased blood pressure were observed in the diuretic phase in all the cases studied. These results suggest that hypersecretion of human ANP may play an important part in initiating spontaneous diuresis in sick neonates.

Topics: Atrial Natriuretic Factor; Diuresis; Female; Humans; Infant, Newborn; Kidney; Male; Meconium; Pneumonia, Aspiration; Respiratory Distress Syndrome, Newborn; Syndrome; Urine

Times of first stool passage were studied in 171 infants who weighed less than 1,500 g at birth. Delayed passage (greater than 48 hours) was noted in 20.4% of this group. Significant differences were noted between the delayed and nondelayed groups for gestational age, presence of severe respiratory distress syndrome, and the time of the first enteral feeding. In very low birth weight infants, delay in the passage of the first stool is a common occurrence. This delay is probably due to physiologic immaturity of the motor mechanisms of the gut, lack of triggering effect of enteral feeds on gut hormones, and the presence of severe respiratory distress syndrome, which may singly or in concert adversely affect gastrointestinal motility.

Topics: Defecation; Enteral Nutrition; Gastrointestinal Motility; Humans; Infant, Low Birth Weight; Infant, Newborn; Meconium; Prospective Studies; Respiratory Distress Syndrome, Newborn; Time Factors

Topics: Amniotic Fluid; Female; Humans; Infant, Newborn; Meconium; Pregnancy; Pregnancy Trimester, Third; Prenatal Diagnosis; Respiratory Distress Syndrome, Newborn; Risk

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

The successful management of 15 infants suffering from persistence of fetal pulmonary circulation and in severe respiratory failure is presented. The treatment regimen focused on minimizing barotrauma. Infants were intubated nasotracheally and ventilated with intermittent mandatory ventilation. Peak inspiratory pressures were determined by the clinical assessment of chest excursion. Ventilator settings and fractional inspiratory oxygen (FiO2) were selected to maintain a PaO2 between 50 and 70 mm Hg; PaCO2 was not a controlling parameter and was allowed to increase as high as 60 mm Hg. Hyperventilation and muscle relaxants were not used. High ventilator rate was used in ten infants who required high inspiratory pressure to maintain chest excursion, with a favorable response in five. Tolazoline was given to 14 infants of whom ten showed an improvement in oxygenation; dopamine was given to three infants who were oliguric. All infants survived, and only one infant developed chronic lung disease which was defined by the infant's need for supplemental oxygen beyond 30 days of life.

Topics: Birth Weight; Dopamine; Humans; Hyperventilation; Infant, Newborn; Intubation, Intratracheal; Meconium; Persistent Fetal Circulation Syndrome; Pneumonia, Aspiration; Respiration, Artificial; Respiratory Distress Syndrome, Newborn; Respiratory Insufficiency; Tolazoline

Seven lambs (0.93 term gestation) were delivered by cesarean section with evidence of meconium in the amniotic fluid, meconium staining, and respiratory distress. The initial arterial blood gas and acid-base status indicated severe hypoxemia and acidosis. Three of these lambs developed pneumothoraces and died on control gas ventilation with positive end expiratory pressure. During the control period (90 min) with ventilatory support, there were no significant alterations in mean arterial oxygen tension (PaO2) and alveolar-arterial oxygen gradient (A-aDO2). The initial hypercarbia and acidosis were effectively controlled and corrected using mechanical ventilation and bicarbonate infusion. Fifteen min after the onset of fluorocarbon ventilation mean PaO2 significantly increased and A-aDo2 decreased. After 90 min of fluorocarbon ventilation, lambs were returned to gas ventilation. During this recovery period, PaO2 and A-aDo2 remained significantly improved compared with control gas values. Dynamic lung compliance increased, alveolar and peak tracheal pressure decreased and inspiratory elastic work of breathing decreased during liquid ventilation.

Topics: Animals; Animals, Newborn; Carbon Dioxide; Female; Fluorocarbons; Humans; Infant, Newborn; Lung; Meconium; Oxygen; Positive-Pressure Respiration; Pregnancy; Respiration, Artificial; Respiratory Distress Syndrome, Newborn; Sheep

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: Humans; Infant, Newborn; Lung Compliance; Meconium; Positive-Pressure Respiration; Respiratory Distress Syndrome, Newborn

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

The long-term outcome of infants subjected to perinatal asphyxia can be improved if they are recognized as high risk before birth and managed so as to reduce the period of hypoxemia to a minimum. Prompt and effective resuscitation of asphyxiated infants at the time of birth can contribute much to improving the long-term outcome of these infants.

Topics: Airway Obstruction; Apgar Score; Asphyxia Neonatorum; Congenital Abnormalities; Female; Fetal Distress; Fetal Hypoxia; Humans; Infant, Newborn; Intensive Care Units, Neonatal; Meconium; Pregnancy; Pregnancy Complications; Respiratory Distress Syndrome, Newborn; Resuscitation

Fifty samples of amniotic fluid, obtained from intrapartum women whose period of gestation ranged from 28 to 42 weeks, were evaluated for the presence of pulmonary surfactant activity by means of "modified foam stability test (MFS test)." This test is based on the functional surfactant activity of forming the stable foam when absolute ethanol is added to amniotic fluid and shaken for a short period. The results of the modified foam stability test were well correlated to those of Clements' shake test so far as it was concerned with high titer group. While the four cases showed entirely "negative" in the modified foam stability test when the newborn infant developed respiratory problems, one of them presented "positive" Clements' test. The contamination with blood or meconium within 1%, which implied a little staining by blood or meconium, did not affect the outcome of the modified foam stability test. This test is a valuable and simple screening test for the determination of the presence of pulmonary surfactant activity.

Topics: Amniotic Fluid; Blood; Female; Fetal Blood; Fetal Organ Maturity; Humans; Infant, Newborn; Meconium; Pregnancy; Prenatal Diagnosis; Pulmonary Surfactants; Respiratory Distress Syndrome, Newborn

Topics: Adult; Female; Humans; India; Infant, Newborn; Infant, Newborn, Diseases; Male; Meconium; Pneumonia, Aspiration; Pregnancy; Respiratory Distress Syndrome, Newborn; Retrospective Studies

Chest physical therapy for neonates with pulmonary dysfunction is a growing specialty of physical therapy practice. The purpose of this article is to provide physical therapists current information regarding chest physical therapy for the newborn infant. The neonatal diagnoses for which chest physical therapy is useful or has good rationale are discussed. Common complications are reviewed that affect physical therapy and medical treatment for infants with respiratory diseases and prematurity. Specific indications, contraindications, and precautions for physical therapy techniques are listed. Chest physical therapy evaluation and treatment are described and rationale for the application of various techniques is provided. Literature is reviewed dealing with the effects of chest physical therapy on neonates with pulmonary dysfunction. The strengths and weaknesses of each reviewed study are analyzed and suggestions for direction of future research for physical therapists are provided.

Topics: Adult; Bronchopulmonary Dysplasia; Child; Humans; Infant, Newborn; Infant, Newborn, Diseases; Meconium; Percussion; Physical Therapy Modalities; Pneumonia; Posture; Respiratory Distress Syndrome, Newborn; Respiratory Tract Diseases

Topics: Apgar Score; Female; Gestational Age; Humans; Infant, Newborn; Meconium; Mexico; Pregnancy; Prenatal Diagnosis; Respiratory Distress Syndrome, Newborn

Severe hypoxia unresponsive to maximum ventilatory support occurs both in idiopathic respiratory distress syndrome and meconium aspiration. We recently encountered a 980 g female infant with respiratory distress syndrome and 3 300 g female infant with meconium aspiration and persistant fetal circulation whose clinical course necessitated the use of tolazoline and dopamine to reduce pulmonary and to stabilize systemic pressures. The infant with respiratory distress syndrome responded with a PaO2 increase of 2.7 kPa while the infant with persistant fetal circulation and meconium aspiration showed a 51.6 kPa rise. Combined pharmacologic therapy may have a role in improving oxygenation status in severely hypoxemic infants receiving maximum support.

Topics: Dopamine; Female; Humans; Hypoxia; Infant, Newborn; Infant, Newborn, Diseases; Infant, Premature, Diseases; Lung; Meconium; Pneumonia, Aspiration; Respiratory Distress Syndrome, Newborn; Tolazoline; Vascular Resistance; Vasoconstriction

The bacteriology of tracheal aspirates from 28 intubated newborn babies was studied. There was no correlation between such colonization and the respiratory distress syndrome. Endotracheal suction of intubated infants did provide a reliable specimen source for determining the etiology of perinatal pneumonia. Presence of polymorphonuclear leukocytes in the aspirate correlated well with infection. Anaerobic bacteria were found to play a role in three of the five cases of pneumonia.

Topics: Bacteria; Critical Care; Exudates and Transudates; Female; Humans; Infant Care; Infant, Newborn; Infant, Newborn, Diseases; Intubation, Intratracheal; Male; Meconium; Pneumonia; Pneumonia, Aspiration; Respiratory Distress Syndrome, Newborn; Trachea

The results of foam tests carried out on postnatal stomach contents from 267 neonates were analyzed to see whether a correlation can be found between the incidence of RDS and the foam-test values. The test proved to be a good indicator in the recognition of RDS. If ++, + positive, on negative foam-tests are obtained development of RDS can be expected in about 60% of the cases. By this quick and simple test neonates with the risk of RDS can be screened off and transported in time to centres of intensive care.

Topics: Birth Weight; Humans; Infant, Newborn; Meconium; Methods; Respiratory Distress Syndrome, Newborn; Risk

Aspiration of meconium produces respiratory distress of various severity and outcome. To evaluate whether the initial chest roentgenogram (0 to 8 hours of age) can be used to predict the outcome, an analysis of 80 cases with clinical and roentgenographic features of aspiration syndrome was undertaken. Infiltration was seen in 62, consolidation or atelectasis in 44, hyperinflation in 37, air leak in 25, pleural effusion in 16, and increased cardiothymic shadow in 16. Consolidation or atelectasis, most commonly associated with thick meconium aspiration, appeared to be the most significant determinant of poor outcome. Infants who had consolidation or atelectasis were more ill, had lower pH, higher fraction of inspired oxygen, higher alveolar-arterial oxygen gradients, and required longer duration of oxygen intake than those infants who had no consolidation or atelectasis. Thus, the initial chest roentgenogram can be used for predicting outcome in infants with meconium aspiration syndrome.

Topics: Humans; Infant, Newborn; Inhalation; Meconium; Pleural Effusion; Prognosis; Pulmonary Atelectasis; Radiography; Respiratory Distress Syndrome, Newborn

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

One year's experience with MAS in a neonatal intensive-care unit is analyzed with follow-up information. Seventeen patients or 3.7% of all admissions had MAS. Four patients (23.5%) died of acute respiratory failure. Two patients with MAS and persistence of the fetal circulation required cardiac catheterization to exclude cyanotic congenital heart disease. No survivors had persistent chronic lung disease. However, two of three patients with MAS and seizures had significant psychomotor retardation at follow-up examination.

Topics: Amniotic Fluid; Developmental Disabilities; Female; Follow-Up Studies; Humans; Infant; Infant, Newborn; Inhalation; Meconium; Oxygen Inhalation Therapy; Pneumonia, Aspiration; Pregnancy; Prognosis; Radiography; Respiratory Distress Syndrome, Newborn; Syndrome

Respiratory distress following aspiration of meconium stained amniotic fluid can be found in about 3% of newborn infants. The lethality rate of this disease is high. Pathophysiology and variability of the clinical course as well as radiological findings and further diagnostic procedures are being described. The therapeutic concept requires recognition of meconium stained amniotic fluid as early as possible, early suctioning of the nasopharynx, intubation and endotracheal suction. Further therapy consists in physical procedures, i. e. lavage, suctioning, positioning, vibration and percussing of the chest, and inhalation. Antibiotics can only be recommended if infection of the amniotic fluid has been proven.

Topics: Amniotic Fluid; Humans; Infant, Newborn; Inhalation; Intubation, Intratracheal; Meconium; Respiratory Distress Syndrome, Newborn; Respiratory Therapy; Resuscitation; Suction; Vibration

Topics: Adult; Female; Humans; Infant, Newborn; Inhalation; Meconium; Pregnancy; Respiration; Respiratory Distress Syndrome, Newborn

Topics: Amniocentesis; Amniotic Fluid; Bacterial Infections; Congenital Abnormalities; Female; Fetal Diseases; Fetal Membranes, Premature Rupture; Gestational Age; Humans; Infant, Newborn; Meconium; Phospholipids; Pregnancy; Pregnancy Trimester, Third; Prenatal Diagnosis; Radiography; Respiratory Distress Syndrome, Newborn; Time Factors

Palmitic acid concentrations in amniotic fluid (AF) were determined in 135 patients with normal and pathological pregnancies between the 27th and 42nd week of gestation. There was a sharp rise in the mean palmitic acid concentration after the 34th weeks of gestation from 2.7 mug/ml to 9.9 mug/ml at term. This increase is almost identical with the rise of AF-lecithin. It was found that between 70% and 100% of AF-palmitic acid originates from lecithin. 65 patients were delivered within 24 h after amniotic fluid sampling. 7 infants of these patients developed a respiratory distress syndrome (RDS). In all cases with RDS AF-palmitic acid concentration was far below 5 mug/ml. Assuming an AF-palmitic acid concentration greater than 5 mug/ml for characterising fetal lung maturity (=no RDS), there were no false negative results, but 16% false positive results. However, the determination of AF-palmitic acid concentration seems to be a most reliable method for the assessment of fetal lung maturity.

Topics: Amniotic Fluid; Female; Fetus; Gestational Age; Growth; Humans; Infant, Newborn; Lung; Meconium; Palmitic Acids; Pregnancy; Respiratory Distress Syndrome, Newborn

Topics: Critical Care; Humans; Infant Mortality; Infant, Newborn; Inhalation; Intensive Care Units; Intubation, Intratracheal; Meconium; Nurseries, Hospital; Oxygen Inhalation Therapy; Respiratory Distress Syndrome, Newborn; Resuscitation; Suction

The surface tension (ST)-lowering properties of an amniotic fluid lipid extract can provide a rapid and reliable means of predicting pulmonary maturity. One hundred and eleven samples from 91 patients were analyzed. A surface tension of less than 56 dynes per centimeter at 120 microliter of extract and less than 46 dynes per centimeter at 220 microliter of extract denoted pulmonary maturity. Values greater than these indicated immaturity. Among fluid samples studied within 48 hours of delivery for the presence or absence of respiratory distress syndrome (RDS) in 71 patients, there were no false positive ST values, while 7 of 22 patients with immature values developed RDS. Surface tension correlates well with the lecithin/sphingomyelin (L/S) ratio but provides clearer definition than the L/S ratio when compared to outcome. Blood and meconium contamination make the surface tension of fluid from babies with pulmonary immaturity appear mature. Identical twins with dissimilar ST values and outcome, as well as serial samples from individual patients, are analyzed and discussed.

Topics: Amniotic Fluid; Blood; False Positive Reactions; Female; Humans; Infant, Newborn; Lipids; Lung; Meconium; Phosphatidylcholines; Pregnancy; Prenatal Diagnosis; Respiratory Distress Syndrome, Newborn; Sphingomyelins; Surface Tension

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

In a retrospective analysis of infants born with meconium staining over an 18-month period at Cook County Hospital, 32 infants met two of the three criteria for the diagnosis of meconium aspiration syndrome: (1) history of meconium in the oropharynx or trachea; (2) clinical evidence of respiratory distress; and (3) x-ray evidence of aspiration pneumonia. Seventeen infants developed respiratory failure; nine of these infants died. One infant without respiratory failure died of sepsis. Analysis of sequential arterial blood pH and gas tension showed that nonsurviving infants had persistently high PCO2 and A-a gradient in spite of initiation of assisted ventilation. These changes seem to be related to severe right-to-left shunting and ventilation perfusion abnormalities. The data further suggest that asphyxia and acidosis occur well before the infant is born and that intrapartum monitoring to recognize fetal asphyxia may help in improving morbidity and mortality from meconium aspiration syndrome.

Topics: Blood Gas Analysis; Humans; Hydrogen-Ion Concentration; Infant, Newborn; Infant, Newborn, Diseases; Inhalation; Intermittent Positive-Pressure Breathing; Intubation, Intratracheal; Meconium; Pneumonia, Aspiration; Radiography; Respiration; Respiratory Distress Syndrome, Newborn; Resuscitation; Syndrome; Ventilators, Mechanical

The effectiveness of end-expiratory pressure (EEP) in relieving hypoxemia in the meconium aspiration syndrome (MAS) was studied in 14 patients with the disorder. These infants demonstrated a direct, mean PO2 response of 12 torr/cm H2O EEP. A maximum PO2 response was observed in an EEP range of 4 to 7 cm H2O. EEP was equally effective whether patients were breathing spontaneously or were being mechanically ventilated. EEP is useful in the treatment of hypoxemia in the infants with meconium aspiration syndrome.

Topics: Blood Gas Analysis; Humans; Infant, Newborn; Infant, Newborn, Diseases; Inhalation; Intubation, Intratracheal; Meconium; Positive-Pressure Respiration; Respiration; Respiratory Distress Syndrome, Newborn; Syndrome

We performed a retrospective study of the morbidity and mortality rates of 125 infants, born through meconium-stained amniotic fluid, and admitted to the newborn intensive-care unit for observation. A comparison was made of maternal age, history of toxemia, type of anesthesia, duration of analgesia, presence of cord complications, abnormalities of fetal heart rate, duration of meconium staining, birth weight, gestational age, 1 and 5 minute Apgar scores, and type of resuscitation between infants who were symptomatic or asymptomatic in the unit. Forty-three developed respiratory distress (symptomatic) and eight died; 82 were asymptomatic. The only difference between the two groups was a history of immediate tracheal suction in the delivery room. Of 97 infants receiving immediate tracheal suction, 27 became symptomatic and one died--an infant with Down's syndrome and endocardial cushion defect. On the other hand, of 28 infants who did not receive immediate tracheal suction, 16 became symptomatic and seven died of massive meconium aspiration pneumonitis (P less than 0.001). We concluded that in infants born through meconium-stained amniotic fluid, immediate tracheal suction is a safe procedure that significantly lowers the morbidity and mortality rates and produces no further respiratory depression of the infant.

Topics: Amniotic Fluid; Apgar Score; Autopsy; Birth Weight; Catheterization; Drainage; Female; Gestational Age; Humans; Infant, Newborn; Infant, Newborn, Diseases; Inhalation; Intubation, Intratracheal; Laryngoscopy; Meconium; Methods; Pneumonia, Aspiration; Pregnancy; Respiratory Distress Syndrome, Newborn; Retrospective Studies; Trachea

Topics: Amniocentesis; Amniotic Fluid; Anemia, Sickle Cell; Bilirubin; Birth Weight; Blood; Color; Coloring Agents; Delivery, Obstetric; Embryonic and Fetal Development; Erythroblastosis, Fetal; Female; Gestational Age; Humans; Hyperbilirubinemia; Infant, Newborn; Meconium; Oxazines; Placenta Diseases; Pre-Eclampsia; Pregnancy; Pregnancy Complications; Pregnancy in Diabetics; Prospective Studies; Respiratory Distress Syndrome, Newborn; Staining and Labeling; Vagina

Topics: Birth Weight; Chromatography, Thin Layer; Gestational Age; Humans; Infant, Newborn; Intubation, Intratracheal; Lung; Meconium; Pharynx; Phosphatidylcholines; Pneumonia; Pneumonia, Aspiration; Prognosis; Respiratory Distress Syndrome, Newborn; Sphingomyelins; Trachea

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: Amniotic Fluid; Anesthesia, Epidural; Anesthesia, Obstetrical; Asphyxia Neonatorum; Caudate Nucleus; Delivery, Obstetric; Female; Fetal Death; Fetal Diseases; Heart Rate; Humans; Infant, Newborn; Infant, Premature; Inhalation; Meconium; Pregnancy; Pregnancy Complications; Prognosis; Radiography; Respiratory Distress Syndrome, Newborn

Topics: Diagnosis, Differential; Female; Humans; Infant, Newborn; Inhalation; Meconium; Obstetric Labor Complications; Oxygen Inhalation Therapy; Pregnancy; Respiratory Distress Syndrome, Newborn

Topics: Asphyxia Neonatorum; Brain Damage, Chronic; Follow-Up Studies; Humans; Infant, Newborn; Infant, Premature; Inhalation; Meconium; Pneumonia; Respiration, Artificial; Respiratory Distress Syndrome, Newborn; Tetanus

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: Asphyxia Neonatorum; Female; Humans; Infant Mortality; Infant, Newborn; Infant, Newborn, Diseases; Meconium; Oxygen Inhalation Therapy; Pregnancy; Respiratory Distress Syndrome, Newborn

Topics: Amniotic Fluid; Chromatography, Thin Layer; Female; Fetal Diseases; Gestational Age; Humans; Indicators and Reagents; Infant, Newborn; Meconium; Methods; Phosphatidylcholines; Pregnancy; Respiratory Distress Syndrome, Newborn; Specimen Handling; Sphingomyelins; Temperature

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

Topics: Catheterization; Diagnosis, Differential; Female; Humans; Infant, Newborn; Infant, Newborn, Diseases; Infusions, Parenteral; Intestinal Obstruction; Male; Meconium; Megacolon; Pregnancy; Respiratory Distress Syndrome, Newborn; Sepsis; Umbilical Veins

Topics: Age Factors; Apnea; Birth Weight; Body Temperature; Female; Humans; Infant Mortality; Infant, Newborn; Infant, Premature; Inhalation; Male; Meconium; Respiration, Artificial; Respiratory Distress Syndrome, Newborn; Respiratory Insufficiency; Time Factors

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; Birth Weight; Brain Diseases; Child; Child, Preschool; Female; Follow-Up Studies; Gestational Age; Humans; Infant; Infant, Newborn; Infant, Newborn, Diseases; Male; Meconium; Motor Skills; Neurologic Examination; Pregnancy; Psychological Tests; Respiratory Distress Syndrome, Newborn

Topics: Female; Humans; Infant, Newborn; Infant, Newborn, Diseases; Male; Meconium; Pyridoxine; Respiratory Distress Syndrome, Newborn; Seizures; Vitamin B 6 Deficiency