Assuntos
Oxigenação por Membrana Extracorpórea , Insuficiência Respiratória/terapia , Contraindicações , Falha de Equipamento , Oxigenação por Membrana Extracorpórea/efeitos adversos , Oxigenação por Membrana Extracorpórea/métodos , Oxigenação por Membrana Extracorpórea/mortalidade , Idade Gestacional , Humanos , Hipóxia/terapia , Recém-Nascido , Síndrome do Desconforto Respiratório do Recém-Nascido/terapia , Taxa de Sobrevida , Resultado do TratamentoRESUMO
We previously reported a predominance of left focal motor seizures in infants receiving extracorporeal membrane oxygenation (ECMO), raising concerns about possible ischemia resulting from the right common carotid artery ligation. We therefore evaluated the neurologic and psychologic outcome at 2 years of age of all infants with ECMO-related seizures. Although 8 of 12 infants had left focal seizures in infancy, there was no lateralization of motor findings at 2 years of age; left hemiparesis was present in three of the infants and right hemiparesis in three. The developmental quotient was normal in 6 of 12 infants, low-average in three, borderline in two, and in the mentally handicapped range in one. We conclude that any ischemia resulting from carotid ligation is not great enough to produce long-term lateralizing findings but that seizures during ECMO are a risk factor for later cerebral palsy or developmental delay.
Assuntos
Oxigenação por Membrana Extracorpórea/estatística & dados numéricos , Convulsões/epidemiologia , Comportamento Infantil , Pré-Escolar , Seguimentos , Georgia/epidemiologia , Hemiplegia/epidemiologia , Humanos , Lactente , Recém-Nascido , Deficiência Intelectual/epidemiologia , Inteligência , Exame Neurológico , Fatores de Risco , Convulsões/fisiopatologia , Convulsões/psicologiaRESUMO
We reviewed the outcome of all infants referred to, and accepted in, our extracorporeal membrane oxygenation (ECMO) program during a 52-month period. One hundred sixty-seven referrals, representing 158 infants and nine mothers who had not yet delivered their infants, were accepted. Eighteen infants (11.3% of all neonates transported) died before leaving the referring hospital, during transport, or shortly after admission to our unit. Contraindications to ECMO excluded 17 (10.1%) of the 167 referrals. Sixty-two infants (37.1%) initially did not meet ECMO criteria. Two died before ECMO could be started. Sixty-eight infants (40.7%) were given ECMO therapy, and 11 died (16.1%). Nine mothers were referred because of fetal conditions that might require ECMO; of these infants, two died during delivery and three had contraindications to the use of ECMO. The four remaining infants were given ECMO therapy; three survived. The overall mortality rate was 27.5% (46/167); 18 (39.1%) of the 46 deaths were associated with transfer. The mortality rate associated with congenital diaphragmatic hernia was 63.6%. We recommend early transport of infants with this type of hernia during the postoperative "honeymoon" or during in utero transport with delivery at an ECMO center. We also recommend that infants with meconium aspiration syndrome be transported to an ECMO center when an oxygenation index of 25 is reached. The mortality rate associated with transport needs to be considered in evaluating ECMO programs. Earlier, expedited transfers may increase the survival rate.
Assuntos
Oxigenação por Membrana Extracorpórea , Mortalidade Infantil , Doenças do Recém-Nascido/terapia , Transferência de Pacientes , Estudos de Avaliação como Assunto , Humanos , Recém-Nascido , PrognósticoRESUMO
To determine the presence and extent of thrombus formation in the apparatus used for extracorporeal membrane oxygenation we studied various portions of the polyvinylchloride circuit from five infants who received extracorporeal membrane oxygenation for 70 to 330 hours. All infants had right-sided cannulation. Sections were cut from the circuit at the time of decannulation and subjected to light and scanning electron microscopy. The site that contained the most thrombus formation was the membrane oxygenator bypass circuit, which is subjected to repeated periods of unclamping and clamping to direct blood flow through the membrane oxygenator. Autopsy results from nonsurvivors showed evidence of pulmonary and renal infarcts, a left frontal lobe infarct, a thromboembolus of the left external and internal carotid arteries, and thrombi in the lungs, kidney, brain, and coronary arteries. One survivor had computed tomographic evidence of infarction of the left middle cerebral artery distribution. We suggest that the areas of the extracorporeal membrane oxygenation circuit subjected to repeated changes in flow dynamics may be the source of microemboli.
Assuntos
Oxigenação por Membrana Extracorpórea/efeitos adversos , Tromboembolia/etiologia , Cateteres de Demora , Humanos , Recém-Nascido , Infarto/etiologia , Microscopia Eletrônica de Varredura , Cloreto de PolivinilaRESUMO
The effect of right common carotid artery ligation required for arteriovenous extracorporeal membrane oxygenation (ECMO) was investigated in 35 infants. Their neonatal course was reviewed for evidence of right-sided ischemia of the brain, as suggested by the presence of focal seizures, hemiparesis, focal abnormalities on electroencephalography, or infarct or hemorrhage demonstrable on neuroimaging studies. A significant incidence of left focal seizures (9/35) versus right focal seizures (2/35) was noted, suggesting an effect of the carotid ligation on right hemisphere function. Computed tomographic scans (20/35 infants), electroencephalograms (18/35), ultrasound scans (31/35), and neurologic examinations did not reveal an increased incidence of right hemisphere abnormalities. These data suggest that systematic evaluation of the effects of right common carotid ligation should proceed as discussion continues on expanding the use of ECMO.
Assuntos
Encéfalo/fisiopatologia , Artérias Carótidas/fisiopatologia , Circulação Extracorpórea , Oxigenadores de Membrana , Infarto Cerebral/etiologia , Infarto Cerebral/fisiopatologia , Eletroencefalografia , Humanos , Recém-Nascido , Ligadura/efeitos adversos , Monitorização Fisiológica , Convulsões/etiologia , Convulsões/fisiopatologiaAssuntos
Hemorragia Cerebral/epidemiologia , Educação Continuada , Hospitais Comunitários , Doenças do Prematuro/epidemiologia , Peso ao Nascer , Hemorragia Cerebral/diagnóstico por imagem , Hemorragia Cerebral/prevenção & controle , Cuidados Críticos , Humanos , Recém-Nascido , Doenças do Prematuro/diagnóstico por imagem , Doenças do Prematuro/prevenção & controle , Estudos Prospectivos , Tomografia Computadorizada por Raios X , Transporte de PacientesRESUMO
All neonates with necrotizing enterocoltis cared for at Grady Memorial Hospital from July, 1977, through February, 1979, were compared with controls matched for birth weight and time of admission to the nursery, to examine risk factors which have been implicated in the etiology of the disease. Data on maternal history, birth history, and hospital course were uniformly collected and contrasted for 35 cases and 98 controls. Low birth weight was associated with an increased incidence of NEC and an increased case fatality rate. All babies 36 weeks or more at birth were diagnosed by seven days. More immature infants developed the disease later in their hospital course. In addition, preterm babies who developed NEC after 2 weeks of age appear to be smaller and sicker. Factors previously thought to predispose an infant to the development of the disease, such as prolonged rupture of membranes, infectious complications of pregnancy, low Apgar scores, patent ductus arteriosus, and use of umbilical catheters, were found with equal frequency in cases and controls and may simply represent the descriptive characteristics of a population of sick premature infants. Feeding history and antibiotic use were examined in depth and were not correlated with the development of NEC.
Assuntos
Enterocolite Pseudomembranosa/etiologia , Doenças do Recém-Nascido/etiologia , Antibacterianos/uso terapêutico , Peso ao Nascer , Enterocolite Pseudomembranosa/mortalidade , Enterocolite Pseudomembranosa/terapia , Métodos Epidemiológicos , Feminino , Georgia , Idade Gestacional , Humanos , Lactente , Alimentos Infantis , Fenômenos Fisiológicos da Nutrição do Lactente , Recém-Nascido , Doenças do Prematuro/etiologia , Nutrição Parenteral , GravidezRESUMO
Mesenteric blood vessels were examined in postmortem specimens of 30 selected infants. The infants had had necrotizing enterocolitis (16 cases) or other lesions (14 cases). Mesenteric thromboemboli were observed in 12 of the infants with necrotizing enterocolitis (P less than 0.001). Umbilical vessel catheters were apparently responsible for the emboli. Multiple instances of thrombosis and thromboembolism were detected in other organs. Ninety-four percent of infants with necrotizing enterocolitis were orally fed (P less than 0.001). Mesenteric thromboemboli were more frequent in infants who were fed via the digestive route while an umbilical arterial catheter was in place. Mesenteric thromboembolism in these infants was postulated to have been attributable to increased postprandial blood flow in the mesenteric vessels.
Assuntos
Cateterismo/efeitos adversos , Enterocolite Pseudomembranosa/etiologia , Comportamento Alimentar , Doenças do Recém-Nascido , Artérias Mesentéricas , Tromboembolia/complicações , Artérias Umbilicais , Humanos , Recém-Nascido , Artérias Mesentéricas/patologia , Tromboembolia/patologia , Veias UmbilicaisRESUMO
In thirty infants with severe respiratory distress syndrome who required endotracheal intubation, serial tracheal aspirate lecithin/sphingomyelin ratios were determined. There was 19 survivors and 11 nonsurvivors. The L/S ratios were plotted as a function of postnatal age; the ratios of the survivors demonstrated a significant increase between 24 and 96 hours. Nonsurvivors did not show this change. There was a significant difference on Days 3, 4, and 5 between survivors and nonsurvivors in the percentage of L/S ratios greater than 2.5. Daily mean L/S ratios correctly identified the outcome of 23 of 24 infants alive on Days 4 and/or 5 and were a more accurate prediction of survival than a single L/S ratio. The changes in the L/S ratios of the tracheal aspirates were not related to gestational age.