E.O.R. Reynolds

ULTRASOUND DETECTION OF BRAIN DAMAGE IN PRETERM INFANTS

A linear-array real-time ultrasound scanner with a 5 MHz probe was used to examine the brains of 31 infants born at less than 33 weeks of gestation. The equipment was mounted on a small trolley and the infants could easily be scanned in their incubators. 7 of the 31 infants were shown to have cerebral lesions, including haemorrhages into the germinal layer and ventricles, hydrocephalus, and infarction of the periventricular region and cerebral cortex. The type and extent of the lesions were conformed by computerised tomography and at necropsy. Ultrasound scanning is a safe, simple, non-invasive technique that provides valuable information for the diagnosis, investigation, and treatment of lesions in the brains of newborn infants.

PNEUMOTHORAX AND CEREBRAL HAEMORRHAGE IN PRETERM INFANTS

Real-time ultrasound was used to examine the brains of all 95 infants born at less than 33 weeks of gestation who were admitted to the neonatal unit of University College Hospital in 1979. Evidence was obtained which strongly suggested that pneumothorax causes and aggravates haemorrhage into the germinal layer and ventricles of preterm infants.

MECHANICAL VENTILATION IN NEWBORN INFANTS WITH RESPIRATORY FAILURE

Abstract 40 infants with respiratory failure have been treated with mechanical ventilation during an eighteen-month period. 12 of the infants were considered to have a hopeless prognosis because of extreme immaturity, congenital malformations, or irreversible birth asphyxia. 12 infants survived, giving a survival-rate of 30%, and a survival-rate of 43% among the 28 infants who had some prospect of recovery. It is concluded that mechanical ventilation should produce a small but worthwhile reduction in mortality in units equipped for the intensive care of newborn infants, but that no infant should be mechanically ventilated who could survive without this form of treatment.

Accuracy of imaging of the brains of newborn infants by linear-array real-time ultrasound☆

Comparisons were made in 69 newborn infants of the appearance of the brain as visualised by linear-array real-time ultrasound, computerised tomography and at autopsy, in order to evaluate the accuracy of ultrasound for the detection of lesions in the brain. Ultrasound was found to give a good estimate of the presence and extent of haemorrhage into the germinal layer and ventricles, and also to be very useful for assessing the appearance of the ventricular system. Ultrasound diagnosed extradural haemorrhages but was unhelpful for identifying subarachnoid haemorrhages or lesions in the posterior fossa.

PULMONARY SURFACE TENSION AND PATHOLOGICAL CHANGES IN INFANTS DYING AFTER RESPIRATOR TREATMENT FOR SEVERE HYALINE MEMBRANE DISEASE

Abstract In five infants who died after respirator treatment for hyaline membrane disease, very severe lung damage developed. The principal histological lesions were obstruction of the smaller airways and fibrosis. These abnormalities were not associated with persisting deficiency of pulmonary surfactant.

TRANSCUTANEOUS ESTIMATION OF ARTERIAL PO2 AND PCO2 IN NEWBORN INFANTS WITH A SINGLE ELECTROCHEMICAL SENSOR

A transcutaneous electrochemical sensor designed to estimate arterial oxygen (PaO2) and carbon dioxide (PaCO2) tensions simultaneously and continuously was evaluated in newborn infants with respiratory illnesses. After calibration of the sensor against a sample of arterial blood from the infant, the accuracy of estimation of PaO2 and PaCO2 seemed sufficient for clinical purposes.

CLINICAL ASSESSMENT OF APNŒA-ALARM MATTRESS FOR NEWBORN INFANTS

Abstract The Lewin apnœa-alarm mattress was used to monitor thirty infants at risk of apnœa. Twenty-seven of the infants were premature. 469 episodes of apnœa requiring stimulation of the infant for their termination were detected during 18,733 hours of monitoring. The introduction of this device, which is inexpensive, is a major advance in the care of sick and premature newborn infants.

HÆMORRHAGIC PULMONARY ŒDEMA ("MASSIVE PULMONARY HÆMORRHAGE") IN THE NEWBORN

Abstract In two newborn infants with massive pulmonary haemorrhage, bloody liquid aspirated from the trachea had a haematocrit of 7% and 4%. Smaller protein molecules were present in the liquid in higher concentration, relative to plasma, than larger protein molecules. It was concluded that the material obtained from the trachea was haemorrhagic œdema-fluid and not blood.