Ernest Phillipos

Unilateral Vocal Cord Paralysis Following Patent Ductus Arteriosus Ligation in Extremely Low-Birth-Weight Infants

OBJECTIVEnTo determine if unilateral vocal cord paralysis (UVCP) following patent ductus arteriosus (PDA) ligation is associated with respiratory and swallowing morbidities in extremely low-birth-weight (ELBW) infants.nnnDESIGNnCase-control study.nnnSETTINGnTertiary care neonatal intensive care units and pediatric hospital.nnnPARTICIPANTSnTwenty-three infants undergoing PDA ligation (subdivided into the main study group of 12 infants with UVCP and 11 without paralysis) and 12 weight- and gestational age-matched ELBW controls.nnnMAIN OUTCOME MEASURESnIncidence of UVCP, time requiring supplemental oxygen and ventilatory support, length of hospital stay, incidence and duration of tube feeding following discharge, and incidence of chronic lung disease.nnnRESULTSnThe overall incidence of UVCP was 52% (12/23), increasing to 67% (12/18) in ELBW infants. Infants without UVCP following PDA ligation were heavier (P = .006), with a more advanced gestational age (P = .03). Patients with UVCP required longer tube feeding (relative risk, 8.25; 95% confidence interval, 1.93-46.98; P = .003), supplemental oxygen (P = .004), and ventilatory support (P = .001) and had a longer hospital stay (P < .001). In comparison to matched controls, infants with UVCP required longer tube feeding (relative risk, 9.00; 95% confidence interval, 2.08-51.30; P = .003), supplemental oxygen (P = .03), and ventilatory support (P = .002) and had a longer hospital stay (P < .001).nnnCONCLUSIONSnThere was a high incidence of occurrence of UVCP (67%) associated with PDA ligation in ELBW infants. Unilateral vocal cord paralysis following PDA ligation does seem to be associated with increased requirements for tube feeding, respiratory support, and hospital stay in these ELBW infants.

Inhaled nitric oxide and inhibition of platelet aggregation in critically ill neonates

favourable changes in autonomic nervous cardiac control, in diastolic and systolic left ventricular function, and in myocardial energy balance. The cardiology community has long proposed the need for large-scale survival studies with beta-blockers in congestive heart failure. Several such studies are underway. Results from these studies including over 10 000 patients, are expected at the turn of the millennium.

The Echocardiographic Assessment of the Human Fetal Foramen Ovale

The foramen ovale size and interatrial flow patterns were studied by combined real-time and Doppler echocardiography in 100 normal human fetuses between 20 and 38 weeks gestation. The foramen ovale, atrioventricular, and semilunar valve diameters increased linearly with gestational age. The foramen flap motion and interatrial flow patterns showed biphasic flow patterns with interatrial flow reversal with atrial systole. Color flow mapping of the diameter of the interatrial flow profile showed good correlation with the foramen ovale size as measured by two-dimensional echocardiography. These data represent the first large study of the normal human foramen ovale correlated with gestational age, thus expanding the reference base for ultrasound assessment of fetal heart.

DOPAMINE (D) VERSUS EPINEPHRINE (E) FOR INOTROPIC SUPPORT IN THE NEONATE: A RANDOMIZED DOUBLE BLINDED CONTROLLED TRIAL. † 1414

DOPAMINE (D) VERSUS EPINEPHRINE (E) FOR INOTROPIC SUPPORT IN THE NEONATE: A RANDOMIZED DOUBLE BLINDED CONTROLLED TRIAL. † 1414

Pulmonary Interstitial Glycogenosis Associated With Pulmonary Hypertension and Hypertrophic Cardiomyopathy

A neonate with pulmonary interstitial glycogenosis, pulmonary hypertension, and hypertrophic cardiomyopathy is described. The fatal outcome for this patient contrasts with the reported favorable prognosis associated with isolated pulmonary interstitial glycogenosis. To the authors’ knowledge, the association of pulmonary interstitial glycogenosis and hypertrophic cardiomyopathy has not been reported previously. The authors have broadened the phenotype of pulmonary interstitial glycogenosis and demonstrate the diagnostic value of lung biopsy in cases of unexplained neonatal pulmonary hypertension.

The Effect of Milrinone on Splanchnic and Cerebral Perfusion in Infants With Congenital Heart Disease Prior to Surgery: An Observational Study.

ABSTRACT Despite the advancement in the postoperative care of neonates with congenital heart disease (CHD), there is little information on preoperative management of systemic and regional hemodynamics, which may be related to outcomes. We aimed to determine the preoperative effect of milrinone, a phosphodiesterase III inhibitor, on cardiac output and splanchnic and cerebral perfusion in neonates with CHD. Neonates with CHD requiring cardiac surgery were enrolled in a prospective, single-blinded study once a clinical decision of starting milrinone (0.75 &mgr;g/kg per minute intravenously) using institutional criteria was made. Demographic and clinical variables and outcomes were recorded. Combined cardiac output and measures of splanchnic (superior mesenteric and celiac arteries) and cerebral (anterior and middle cerebral arteries) perfusion were determined by Doppler studies at 0, 6, 24, and 48 h after milrinone infusion. Investigators were unaware of intervention time points and patients in analyzing blood flow measurements. Seventeen term (39.2 ± 1.3 weeks) neonates were included with hypoplastic left-sided heart syndrome (78.5%) as the most common diagnosis. Combined cardiac output increased by 28% within 48 h (613 ± 154 vs. 479 ± 147 mL/kg per minute at baseline, P < 0.05). Superior mesenteric artery mean velocity increased at 6 h and throughout 48 h of milrinone infusion (P < 0.05). Peak and mean velocities at cerebral arteries increased with milrinone infusion (P < 0.05∼0.08), and the corresponding changes at celiac artery were modest. There were no significant changes in splanchnic and cerebral resistive and pulsatility indices during milrinone infusion. Milrinone increases cardiac output with concurrent effects on splanchnic and cerebral blood flows during the short-term preoperative use in neonates with CHD.

Pilot randomized controlled trial on early and late remote ischemic preconditioning prior to complex cardiac surgery in young infants

Remote ischemic preconditioning involves providing a brief ischemia–reperfusion event to a tissue to create subsequent protection from a more severe ischemia–reperfusion event to a different tissue/organ. The few pediatric remote ischemic preconditioning studies in the literature show conflicting results.

THE EFFECTS OF DOPAMINE (D) VS EPINEPHRINE (E) ON THE PULMONARY CIRCULATION IN THE SICK NEWBORN (SN):A RANDOMIZED DOUBLE BLINDED CONTROLLED TRIAL.|[dagger]| 1415

Inotropes are commonly used in hypotensive SN. Their effects on the pulmonary circulation is poorly understood in SN. 20 hypotensive newborns>1750 gm. were randomly assigned to start with either D or E and increased in stepwise fashion (D 5,10,15 and 20 Mcg/kg/min and E 0.125, 0.25, 0.375 and 0.5 Mcg/kg/min) every 20 min until the desired mean blood pressure (MBP) is achieved. If MBP is not achieved at the maximum dose the other medication is added. Data collected were, heart rate, MBP, and pulsed doppler of patent ductus arteriosus (PDA). To calculate the mean pulmonary pressure (MPP), the mean pressure gradient (MPG) across the PDA was subtracted from a simultaneous MBP. The MPG across the PDA was calculated by tracing the doppler signal over the entire cardiac cycle.12 SN had a PDA during the duration of the study shown in the table.

Congenital tuberculosis presenting as otorrhoea in a preterm infant

A premature infant of 25 weeks’ gestational age presented at 8 weeks after birth with otorrhoea from the left ear. Following a course of topical and systemic antibiotics, the patient deteriorated developing facial nerve paralysis and cervical lymphadenitis. Contrast-enhanced CT and MRI of the head showed a destructive process of the left temporal bone. These findings prompted the clinicians to send swabs from the purulent discharge from the ear for acid-fast bacilli stain. Furthermore, surgical exploration and debridement were undertaken. Cultures from ear discharge and biopsy—taken during surgical procedure—revealed the presence of Mycobacterium tuberculosis complex. The patient developed necrotizing otitis media, left temporal bone osteomyelitis and cervical lymphadenitis. The infant’s mother was found to have an endometrial biopsy positive for M. tuberculosis suggesting the diagnosis of congenital tuberculosis.

Feeding Practices and Outcomes of Infants Undergoing the Norwood Procedure

Objective. To determine if early pre- and postoperative enteral feeding was associated with improved postoperative outcomes in infants with hypoplastic left heart syndrome undergoing the Norwood pr...