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Query: UMLS:C0020440 (hypercapnia)
 7,939 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Massive pulmonary hemorrhage is a complication which frequently leads to death in newborns with conditions susceptible to surgical treatment. Out of 112 postmortem studies, focal hemorrhage was found in 38 (33.9%) and massive in 34 cases (30.3%). In this series, congenital anomalies were found in digestive tract in 70.5% of the patients. Prematurity andlow weight were not important factors as was hypoxia, which was evident in 70.5% of the cases. Manifestations of respiratory insufficiency, shock, rales in lung fields, bleeding in other places different from the lung, blood leaking through upper respiratory ducts, are all clinical features of diagnostic aid. Disturbances in coagulation tests were detected, the same as drop in figures of hemoglobin, acidosis, hypoxia and hypercapnia. Gram-negative germs, with a predominance of Klebsiella, were isolated in 33 cultures. The radiographic finding with reticulogranular image was unfrequent. Among other precipitating factors of pulmonary hemorrhage, identification was made of the surgical disease by itself, surgical and anesthetic procedures, of ventilatory assistance and therapy with oxygen at high concentration for long periods of time.
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PMID:[Massive pulmonary hemorrhage in surgical pathology of the newborn infant]. 87 35

Heart rate was studied in 47 newborns babies during 67 polygraphic recordings by histograms and sequential curves of the length of 600 consecutive R-R-intervals selected during sleep stages lasting at least 5 minutes. In normal babies: (14 babies born at Gestational Age, G.A., 37 weeks, 6 babies born between 28 and 36 weeks). Before 37 weeks of G.A., the sequential curves show periodic variations of heart rate (including 15 to 70 beats) present both in active and quiet sleep. After 37 weeks of G.A., slow periodic variations are still present in active sleep but superimposed by fast variations synchronous to respiratory cycles. Fast variations are prevailing in quiet sleep. In pathological babies: Small variability is favoured by prematurity, young age at recording, and hypercapnia but can be very transient. Pronounced variations similar to those of normal babies are observed in 2/3 of the cases with or without respiratory assistance, with or without PEEP.
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PMID:Sleep and heart rate variations in premature and full term babies. 98 63

High serum bilirubin levels (SBL), over 20-25 mg/dl are toxic for the Central Nervous System (CNS) of newborn infants. However, the possible toxicity on the CNS of "intermediate" SBL both in term and preterm neonates are still a matter of debate. An extensive review of the literature in this respect did not provide conclusive evidence for a dose-response pattern of toxicity for SBL 18-20 mg/dl in infants without hemolysis and/or other risk factors (such as extreme prematurity, hypoxia, hypercapnia, acidosis, sepsis, hyperosmolarity, etc.). Therefore, an aggressive approach to the treatment and/or prophylaxis of neonatal jaundice when SBL are below 20 or even 25 mg/dl is not justified on the basis of the present knowledge. This is particularly true when treatment includes phototherapy and/or exchange-transfusion which are associated with clinically significant complications and side effects. Guidelines for treatment of neonatal hyperbilirubinemia in full-term and preterm infants, with and without added complications and/or risk factors, are provided in the attempt of encouraging a more critical approach to neonatal jaundice, which is coherent with the data available in the literature and which should optimize the risk/benefit ratio.
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PMID:[Controversial aspects and rational bases of the treatment in neonatal jaundice]. 158 31

Biophysical profile (BPP) score was assessed immediately before fetal blood sampling by cordocentesis in 150 fetuses referred to our hospital, 95 after and 55 before 30 weeks of gestation. In 95 fetuses after 30 weeks of gestation, 39 fetuses were evaluated with BPP scores of 12, 35 were from 8 to 11 and 21 were less than 7. In 55 fetuses before 30 weeks of gestation, 8 fetuses were evaluated with BPP scores of 12, 27 were from 8 to 11 and 20 were less than 7. pO2, pH and pCO2 in fetuses with a score less than 7, either before or after 30 weeks of gestation, (with a score less than 7) did not significantly differ, in comparison to the other two groups. No variables in the biophysical profile precisely reflect fetal hypoxemia, acidemia or hypercarbia. Since even the fetus with a BPP score of greater than 8 may not always be assured of well-being and not all fetuses with a score of less than 7 are necessarily in a deteriorated condition, it is necessary to evaluate fetal condition on the basis of fetal blood gas data obtained by cordocentesis, especially when the fetus is additionally handicapped by prematurity or morbidities such as growth-retardation.
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PMID:Biophysical profile and its relation to fetal blood gas level obtained by cordocentesis. 194 May 56

Infants with esophageal atresia and a distal tracheoesophageal fistula are predisposed to respiratory failure on the basis of prematurity, respiratory distress syndrome, aspiration of saliva, and reflux of gastric contents into the tracheobronchial tree. Thoracotomy and primary repair may be delayed to allow time for complete evaluation of the infant and respiratory stabilization. Poorly compliant lungs and a large distal fistula can result in selective passage of ventilatory gases into the gastrointestinal tract with resultant hypercarbia. Fogarty balloon occlusion of the distal esophageal segment halts this air shunt and facilitates effective mechanical ventilation.
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PMID:Esophageal atresia, distal tracheoesophageal fistula, and an air shunt that compromised mechanical ventilation. 194 74

The newborn brain, and even more so the brain of the premature child, can be considered as an authentic target organ for numerous pathological conditions, some of which exist outside the central nervous system (changes involving primarily both respiratory function and cardiocirculatory function with serious repercussions at encephalic level). In the premature, this greater "vulnerability" is related to the reduced or absent capacity for self-regulation of the cerebral blood low (mechanism influenced negatively by hypoxia, hypercapnia and metabolic acidosis conditions) and the important role played by numerous factors in protecting newborns from haemorrhagic damage. Of these the most important are the state of prematurity, the presence of vascular, intravascular and extravascular changes, the effects exerted on cerebral haemodynamics by mechanical ventilation and by certain drugs employed in treatment. In mechanically ventilated newborns and premature, prevention of haemorrhagic damage (periendoventricular) is currently based on the application of clear-cut protocols of intensive and rehabilitative treatment. The following form part of these protocols: low damage ventilation techniques (high frequencies, low PJP, low MAP), curarisation (to avoid fluctuations in cerebral blood flow), neuroprotection (phenobarbital), the use of substances and drugs which, by exploiting different mechanisms, go to reduce the extent of the haemorrhage (vitamin E, indomethacin, ethamosylate, tranexamic acid).(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:[Prevention of hemorrhagic cerebral injury in newborn and premature infants subjected to mechanical ventilation]. 269 3

During the winter of 1986-1987, 64 children with respiratory syncytial virus (RSV) infection were admitted to our hospital. The diagnosis was made by direct immunofluorescent antibody technique. Twenty-three children (36%) needed intensive care treatment. Nearly 11 (52%) had a preexisting disease state, identified as a risk factor i.e., prematurity (n = 8), bronchopulmonary dysplasia (n = 2), congenital heart disease (n = 1). Twelve patients (50%) were intubated and ventilated. Conditions for intubation and ventilation were repetitive apnea with or without bradycardia (n = 4), clinical deterioration (n = 3) or hypercarbia (n = 5). Seventy-five percent of the patients who needed intensive care management were under three months of age compared to 34% of the children who were admitted to the clinical ward. The mean age for ventilated patients was 7.9 weeks. The mean duration of ventilation was 5.5 days. Volume controlled ventilation was initially applied to all patients. Pulmonary complications (atelectasis, pneumonia, pneumothorax or adult respiratory distress syndrome) were present in 15 (65%) IC patients. Nine (39%) of them also had symptoms of inappropriate antidiuretic hormone secretion (IADHS). Only two patients had symptoms of IADHS and two others had convulsions. Three children (5%) died as a result of respiratory insufficiency. Two of these infants belonged to the risk group.
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PMID:Respiratory syncytial virus infections in children admitted to the intensive care unit. 281 76

A review of 52 consecutive cases of congenital diaphragmatic hernia composed of 36 cases of Bochdalek hernia (B.H.) 13 of diaphragmatic eventration (D.E.), and 3 of diaphragmatic agenesis (D.A.) is reviewed critically. The operative mortality rate in Bochdalek hernia was 8.3% but became 20% with reference to the 15 infants with B.H. operated in the first 24 hrs. of life and 31.5% with reference to all 19 infants requiring repair of the diaphragmatic defect during the first day after birth. The operative mortality in D.A. was 100% and was nil in D.E. The mortality appeared related directly to prematurity, early age at operation, preoperative hypoxemia (PaO2 less than or equal to 60), hypercarbia, (PaCO2 greater than or equal to 60), and acidosis (pH less than or equal to 7.0), association with life-threatening anomalies affecting the lungs and its vessels, the heart, the size of the diaphragmatic defect and of the celomic cavity, the postoperative development of NEC and of obstructing intestinal adhesions. Eight of the 33 survivors (24%) with B.H. developed intestinal obstruction secondary to adhesions 2 months to 14 years after operation, of whom 7 required surgical intervention, and 3 bowel resections. The total mortality rate in B.H. was 14% and the rate in this series of combined defects was 15%.
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PMID:Congenital diaphragmatic hernia and eventration. 361 33

A mathematical model of neonatal respiratory control is proposed which can be used to stimulate the system under different physiological conditions. The model consists of a continuous plant and a discrete controller. Included in the plant are lungs, body tissue, brain tissue, a cerebrospinal fluid compartment, and central and peripheral receptors. The effect of shunt in the lungs is included in the model and the lung volume and the dead space are time varying. The controller utilizes outputs from peripheral and central receptors to adjust the depth and rate of breathing and the effects of prematurity of peripheral receptors are included in the system. Hering-Breuer type reflexes are embodied in the controller to accomplish respiratory synchronization. The model is examined and its simulation results under test conditions in hypoxia and hypercapnia are presented.
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PMID:Mathematical analysis and computer simulation of the respiratory system in the newborn infant. 822 36

A key element of neonatal regionalization is the establishment of transport links between centres of tertiary care and subregional centres. During the 11-year period 1982-92, 186 transports were undertaken from the neonatal unit, Vestfold Central Hospital, for a total of 180 patients, or 0.8% of all live born infants (n = 23,652). 64 patients (36%) were referred for prematurity/respiratory distress syndrome (IRDS), 81 (45%) for congenital malformations, and 35 (19%) for other conditions. Transports for prematurity/IRDS declined significantly from the the first 6-year period 1982-87 to the last 5-year period 1988-92 (3.6 vs. 1.8 per 1,000 live born infants; p < 0.01), owing to the establishment of a local respirator treatment programme for severe IRDS. In 71 (38%) transports the infants were mechanically ventilated. Seven (10%) suffered in-transport complications related to the endotracheal tube. At arrival, significantly more patients were anaemic (Hb < 14 g%; transports before 48 hours after birth), alcalotic (pH > 7.50), hypocapnic (PCO2 < 4 kPa) or had a base excess < -10 mmol/l than before transportation (p < 0.05). There was a tendency towards more patients with hypothermia (tp < 36 degrees C), acidosis (pH (< 7.20) and hypercapnia (PCO2 > 10 kPa) at arrival than before transportation (p > 0.05). No deaths occurred during transport. However, two infants died within two hours after arrival, giving a transport-related mortality rate of 1%. Transporting critically ill neonates implies discontinuity of treatment and monitoring of these infants. Optimal stabilization before transportation, and scrupulous work on technical details are of utmost importance.
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PMID:[Transport from a subregional neonatal unit. Experiences from Vestfold Central Hospital during an 11-year period 1982-92]. 825 80


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