Dilip M. Purohit

The Effect of Anemia on Retinopathy of Prematurity in Extremely Low Birth Weight Infants

OBJECTIVE: Numerous risk factors for development of retinopathy of prematurity (ROP) in very low birth weight infants have been identified in the literature. However, the role of anemia in the development of ROP has not been adequately addressed.STUDY DESIGN: We retrospectively examined the medical records of all infants weighing ≤800 g who were admitted to a university hospital between July 1, 1992 and December 30, 1997. Highest and lowest hemoglobin and hematocrit values and the number of blood transfusions were recorded at each week of life during hospitalization. Gestational age at birth, birth weight, race, sex, oxygen status, history of bronchopulmonary dysplasia, length of hospital stay, and sepsis were also identified as potential risk factors. Data were analyzed using logistic regression to adjust for these confounding variables.RESULTS: Infants were grouped according to ROP status in the following manner: stage 0 to 1 ROP, stage 2 ROP, and stage 3 to threshold ROP. Sex, gestational age at birth, bronchopulmonary dysplasia, ventilator days, length of hospital stay, and number of blood transfusions were significantly associated with severity of ROP by univariate analysis. Using a logistic regression model, only gestational age (p=0.007) and number of blood transfusions (p=0.04) remained statistically significant.CONCLUSIONS: Anemia did not affect severity of ROP as an independent risk factor. However, the number of blood transfusions did affect the highest stage of ROP in this group of premature infants. Infants who remained severely anemic (Hgb≤8 g/dl or Hct≤25%) for longer periods of time developed milder ROP than less anemic infants.

Neonatal renal failure: a complication of maternal antihypertensive therapy.

Persistent anuria was diagnosed in a neonate born to a mother whose pregnancy was complicated by severe hypertension and systemic lupus erythematosus. Severe maternal hypertension necessitated the use of a battery of antihypertensive medications that included enalapril, an angiotensin converting enzyme inhibitor. The role of enalapril in neonatal renal failure is discussed.

Neonatal Hemangiomatosis Associated With Brachial Plexus Palsy

pathic. Our patient was treated with vecuronium for a brief period of time, and this diagnosis is highly unlikely. Thick-filament myopathy, characterized by acute diffuse areflexic weakness with increased creatine kinase levels, occurs mostly in asthmatics with respiratory failure requiring high-dose steroids.18-21 Recovery takes 10 days to 6 months. When compared with patients with prolonged neuromuscular blockade, patients with thick-filament myopathy tend to be younger and free of renal disease. Electrophysiologic and pathologic findings

Brain calcification in severely stressed neonatesreceiving parenteral calcium

Morphologic evidence for calcium salts within the brains of severely stressed neonates at autopsy correlated to the mean daily parenteral dose of calcium gluconate (P less than 0.01). Survival analysis indicated that parenteral administration of calcium contributed a negative effect to predicted survival (P less than 0.05).

Persistent pulmonary hypertension in a neonate with cystic adenomatoid malformation of the lung following lobectomy: survival with prolonged extracorporeal membrane oxygenation therapy.

A full-term neonate is reported with congenital cystic adenomatoid malformation of the lung treated by lobectomy with development of pulmonary hypertension. The infant was successfully treated with extracorporeal membrane oxygenation (ECMO) for persistent pulmonary hypertension, which developed postoperatively. An 18-day course of veno-venous ECMO was necessary to effectively reverse the severe pulmonary hypertension. This was probably a result of significant pulmonary hypoplasia of the compressed lung. Although not all congenital cystic adenomatoid malformations of the lung are associated with pulmonary hypoplasia and persistent pulmonary hypertension, this is one case where severe pulmonary hypertension developed secondary to a mass effect by a large lesion in the chest.

Bronchial laceration in a newborn with persistent posterior pneumomediastinum

A large posterior pneumomediastinum that compromised the respiratory status and reaccumulated promptly after needle aspiration, aroused the suspicion of airway laceration. Tracheogram was consistent with laceration of the right bronchus. Evacuation of air with chest tube resulted in complete resolution of pneumomediastinum and healing of bronchial tear with no recurrence following removal of chest tube after seven days.

Effect of tolazoline on persistent hypoxemia in neonatal respiratory distress.

Twenty-seven infants with respiratory distress and hypoxemia of noncardiac etiology were treated with tolazoline. Thirteen infants had hyaline membrane disease and 14 had respiratory distress attributable to causes other than hyaline membrane disease. An immediate response to tolazoline, a rise in Pao2 of 15 torr or more within 15 min, was seen in 11 infants in the hyaline membrane disease group and in eight infants of the other group. Six infants in the hyaline membrane disease group and 11 infants in the second group survived. Tolazoline should be considered as a therapeutic adjunct in the management of hypoxemia which persists after optimal homeostatic and ventilatory support.

Hanford Miniature Swine Model for Extracorporeal Membrane Oxygenation

Extracorporeal membrane oxygenation (ECMO) is now an accepted therapy for neonatal respiratory failure due to reversible lung disease. There is a continued need to train ECMO team members using animal models. Hanford miniature swine are an appropriate model for this purpose because of the availability and size as well as anatomic and physiologic similarities to humans. This article describes training ECMO team members in venoarterial and venovenous bypass utilizing Hanford miniature swine.

Neonatal pseudoascites: An unusual presentation of long tubular duplication of small bowel

This is a case report of a tubular duplication with a clinical presentation as pseudoascites. It was treated surgically by stripping its mucosal lining.

Management of multifetal gestation.

The use of ovulation-inducing drugs in the treatment of infertility has rekindled interest in the management of multifetal gestation.