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Query: UMLS:C0029713 (immaturity)
 4,335 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Although brainstem immaturity has been postulated as one of the pathogenesis underlying cyanosis during feeding (CDF), there has been no widely accepted physiologic parameter that reflects brainstem function. We recently proposed that the dissociation index (DI), one of the phasic sleep parameters, is a reliable and quantitative sleep parameter for assessing brainstem maturation during early infancy. In the present study, we evaluated brainstem impairment in infants with CDF using phasic sleep components. Polysomnographies were obtained for 12 infants with CDF who were equally divided into 2 groups: one had or subsequently experienced apparent life-threatening events or sudden infant death syndrome (ALTE-SIDS group) and the other did not (CDF group). Rapid eye movement density and the number of gross movements (body movements, including the trunk, lasting greater than or equal to 2 sec) in the patients were identical to those in the controls. In the CDF group, the decrease of the average DI value from the controls was significantly less than the decrease in the ALTE-SIDS group. CDF may be a mild expression of brainstem immaturity. DI appears to be useful when evaluating infants with cyanosis during feeding.
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PMID:Phasic sleep components in infants with cyanosis during feeding. 187

The greater survival of premature infants, the frequency with which these children present a pathology of surgical treatment, and their physiological immaturity, particularly in the respiratory system, entail a great many difficulties in the postoperative process. With the aim of decreasing these postoperative difficulties and because of the publications of several articles with the same goal, it is implemented a study of spinal anesthesia with isobaric bupivacaine in the premature babies put under a treatment or surgery of the inguinal canal, in order to asses the efficiency of this technique and the cardiovascular consequences. The average duration of the anesthesia was 59 +/- 13 minutes. The latency period is practically nonexistent and the average level that was achieved is situated between D4-D6, which is enough so as to carry out the operation without problems and achieving a complete analgesia in the inguinal area. It has not been observed relevant hemodynamic alterations. The outcomes are obvious, for the difficulties disappear, especially those coming from the respiratory system in the general anesthesia with intubation such as apnea, cyanosis and bradycardia, stridor and atelectasis. This kind of anesthesia allows the surgeon a perfect relaxation and analgesia and the children a comfort throughout the surgical event. By way of conclusion, the spinal anesthesia is a good option instead of the general anesthesia for suckling babies because of the risk of respiratory difficulties they present, alone all when they are premature and they are recovering from a syndrome of respiratory difficulty.
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PMID:[Intradural anesthesia: an alternative in surgery on premature infants]. 207 65

Prenatal starvation causes pulmonary hypoplasia in newborn guinea pigs, and is associated with postnatal cyanosis, hypothermia, and respiratory failure. To determine the effects of such starvation on ventilation, neonates from litters either fed ad libitum throughout gestation (control) or given 50% rations in the last trimester of pregnancy (starved) were studied at 29 degrees C by plethysmography in 21, 11, and 5% O2. After 15 min (steady-state) in 11% and then 5% O2, 13 of 14 controls (mean = 95 g) sustained increases in weight-specific minute ventilation of 46 and 75% compared to values in air (p less than 0.01), due to increases in respiratory frequency. Seven of 11 starved neonates (mean = 76 g) also sustained increases in respiratory frequency and weight-specific minute ventilation in 11 and 5% O2 similar in magnitude to those of the normal controls, although at higher weight-specific tidal volumes. One abnormal control (85 g) and four starved neonates (mean = 70 g) hyperventilated in air, did not respond to 11% O2, and then hypoventilated in 5% O2 due to a reduced weight-specific tidal volume. Neonates with normal ventilatory patterns did not alter weight-specific minute ventilation in 100% O2 and did not show a biphasic response in acute (1-5 min) exposures to moderate hypoxia, as noted for newborn of other species. Thus, hypoxia identified those starved neonates in which pulmonary immaturity or other starvation-induced pathologies necessitated a maximal ventilatory effect in air. The sustainable hyperventilation among normal guinea pigs during hypoxia emphasizes the precocial development in this species at birth, which may be compromised by intrauterine starvation.
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PMID:Prenatal starvation retards development of the ventilatory response to hypoxia in newborn guinea pigs. 377 4

Cardiopulmonary bypass (CPB) creates a pro-coagulant state by causing platelet activation and inflammation leading to thrombin generation and platelet dysfunction. It is associated with severe derangements in normal homeostasis resulting in both thrombotic and hemorrhagic complications. This derangement is greater in children with congenital heart disease than in adults because of the immaturity of the coagulation system, hemodilution of coagulation factors, hyperreactive platelets, and in some patients, physiologic changes associated with cyanosis. During CPB, an appropriate amount of heparin is given with the goal of minimizing the risk of thrombosis and platelet activation and at the same time reducing the risk of bleeding from over anticoagulation. In young children, this balance is more difficult to achieve because of inherent characteristics of the hemostatic system in these patients. Historically, protocols for heparin dosing and monitoring in children have been adapted from adult protocols without re-validation for children. Extreme hemodilution of coagulation factors and platelets in young children affects the accuracy of anticoagulation monitoring in children. The activated clotting time does not correlate with plasma levels of heparin. In addition, recent studies suggest that children need larger doses of heparin than adults, because they have lower antithrombin levels, and they metabolize heparin more rapidly. Preliminary studies demonstrated that the use of individualized heparin and protamine monitoring and management in children is associated with reduced platelet activation and dysfunction and improved clinical outcomes. However, this review article clearly establishes that further studies are necessary to obtain evidence-based protocols for the proper management of anticoagulation of children undergoing cardiopulmonary bypass.
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PMID:Management and monitoring of anticoagulation for children undergoing cardiopulmonary bypass in cardiac surgery. 2043 87