Göran Wallgren

Alteration of the Infant's Thorax During Vaginal Delivery

In the preceding paper radiographic studies on infants during normal vaginal delivery were reported. The results of these studies were interpreted to show that the infant’s thoracic cage is considerably compressed during its passage through the birth canal but has essentially the same contour prior to this as it does following the establishment of pulmonary ventilation after delivery. Earlier cine-radiographic studies on newborn infants by our group have also shown no significant change in the shape of the thoracic cage between the very short period after delivery prior to the first breath and at end-expiration of the earliest breaths [Geub e l l e et al., 1959; K a r l b e r g et al., 1956). These findings have to be considered in relation to the fact that successful extra-uterine existence of the newborn infant requires zeration of the lungs. It has been suggested that compression of the thoracic cage during

Hemodynamic Studies of Induced Acute Hypo- and Hypervolemia in the Newborn Infant

The following investigation was undertaken as part of a study directed toward a better understanding of the pathogenesis of the sometimes fatal complications of exchange transfusions in erythroblastotic infants. Regarding the circulatory consequences of this therapeutic procedure, it was considered of interest to elucidate the mode of response of the circulatory system to changes in blood volume considerably bigger than those normally induced during replacement transfusions in order to obtain more detailed information about the adaptive capacity of the cardiovascular apparatus of the newborn. As the blood pressure response to changes in blood volume is related to the compliance of the vascular bed as well as to its ability to redistribute the available blood volume, information regarding the vasomotor characteristics of the newborn infant might be gained in this manner. Although our concept of circulatory regulation in the newborn infant is largely based on studies in animals 11s well as on inference from our knowledge of circulatory regulation in adult man, some basic

Studies of the Circulatory Adaptation Immediately after Birth

The most urgent problem the newborn infant has to face is the initiation of breathing and the subsequent respiratory and hemodynamic adaptation to extrauterine life. The literature on this subject during the last years has been abundant; for recent general reviews see Cook e t al. (3). Karlberg (14), James (l?), Stern & Lind (18). Nevertheless knowledge regarding circulatory adaptive changes in connection with the initiation of breathing is limited and for the most part has been extrapolated from studies of the status of the circulation before, as well as after, delivery (6, 14), and from studies in animals (6). Respiratory studies have demonstrated that the transformation of the fetal lungs to an organ which functions adequately for respiratory gas exchange proceeds very rapidly indeed; it is principally achieved during the first few breaths (8, 14). For this reason i t is necessary to register and interpret the circulatory dynamics during this transformation arid to correlate them with studies of the respiratory adaptation. The present communication reports observations on the blood pressure recorded in t,he umbilical vessels in the newborn infant immediately post partum and during the first minutes of extrauterine

NECROTIZING ENTEROCOLITIS AFTER CATHETERIZATION OF THE UMBILICAL VESSELS

Abstract. Livaditis, A., Wallgren, G. and Faxelius, G. (Departments of Pediatrics and Pediatric Surgery, Karolinska Sjukhuset, Stockholm, Sweden). Necrotizing enterocolitis after catheterization of the umbilical vessels. Acta Paediat Scand, 63:277, 1974. –Necrotizing enterocolitis is reported in 7 infants who had undergone umbilical vessel catheterization. Five of them were treated surgically with two fatalities, while the remaining two recovered following conservative management. Necrotizing enterocolitis is a potential complication of umbilical vessel catheterization in particularly predisposed infants. The disorder may occur regardless of the type of vessel used or the indications for the procedure. Unless the ductus venoms is easily passed, umbilical venous catheterization for cardiovascular studies should preferably be avoided.

10. Respiratory Studies in Newborns

9. Concerning the Postural Faults of Elementary School Children in the Town of Turku, Finland MATTI DAHL Turku, Finland A posture examination has been made of 4,524 elementary school children Of the pupils 2,208 were girls, and 2,316 boys. The material was divided equally among the schools in the centre of the On an average, 35 per cent had good posture and about 65 per cent faulty No clear difference between the sexes could be noticed. In upper classes there were 5 per cent more postural faults than in lower In upper classes the faults were worse than those in lower ones. Local stiffness in the lower part of the thoracic spine, evidently caused by Severe postural deformities could be found in about only 2 per cent of this In addition to the spine, deformities of the thorax and the extremities were About 20 per cent of the children had Harrisons groove, and about 25 per cent About 10 per cent were knock-kneed. The length of the way to school had no influence on posture. The pupils with good posture had a mean value of marks in gymnastics of in the town of Turku in Finland.

Artificial Ventilation by Respirator for Newborn and Small Infants During Anaesthesia

Tracheal pressure, gas flow and tidal volume were recorded in 23 children aged from 1 day to 23 months during surgery and respiratory ventilation in order to clarify changes in pulmonary mechanical relationships. Of the surgical procedures, six were intrathoracic, nine abdominal and eight minor external procedures. Through administration of varying tidal volumes it was shown that total compliance remained unchanged with an insufflation pressure of less than 25 cm H2O.

Left ventricular wall dimensions: An angiocardiographic study of the normal variation in children

Abstract The thickness of the left ventricular wall, as revealed by angiocardiography, has been determined for a group of children considered normal with respect to left ventricular hemodynamics. Nine cases without apparent cardiovascular abnormalities and 31 cases with moderate valvular pulmonary stenosis were studied. The wall thickness was measured in enddiastole along the lateral wall of the left ventricle above the apical area and below the left atrial appendage. The mean value of 10 measurements at equidistant points was considered representative of the wall thickness. The evaluated thickness of the left ventricular wall correlated well with the weight of the patient, and the regression equation for this correlation is given. Previous reports on left ventricular wall thickness, made at postmortem examination, give values considerably larger than those found in the present investigation. The reason for this discrepancy is discussed in the light of the various postmortem changes known to occur in the myocardium.

Left Ventricular Hypertrophy and Its Relation to Hemodynamic Findings in Children with Aortic Valvular Stenosis

Abstract Thirty infants and children with congenital valvular aortic stenosis were investigated with respect to pressure conditions in the left ventricle and the transvalvular gradient. In 15 of them, hemodynamic observations were also recorded during a calibrated exercise. A close correlation was found when the recorded systolic peak pressure in the left ventricle during rest was correlated to the left ventricular hypertrophy as assessed by angiocardiography; the coefficient of correlation was 0.845. Corresponding value for the transvalvular gradient was 0.716. During exercise the recorded transvalvular gradient was on an average 30 mm. Hg higher than during rest. The correlation between hemodynamic observations and degree of hypertrophy did not improve further during exercise. It is concluded that left ventricular hypertrophy as assessed by angiocardiography closely reflects the pressure conditions in the left ventricle in children with aortic valvular stenosis. The observation of ventricular hypertrophy in patients when pressure studies cannot easily be obtained may be of practical importance.

LEFT VENTRICULAR HYPERTROPHY; AN ELECTROCARDIOGRAPHIC AND ANGIOCARDIOGRAPHIC STUDY IN CHILDREN WITH SYSTOLIC OVERLOAD OF THE LEFT VENTRICLE.

Abstract The left ventricular wall thickness was measured on angiocardiograms in 83 children and infants with coarctation of the aorta or aortic valvular stenosis. The measurements were not corrected for image distortion from the nonparallel roentgen rays. The degree of hypertrophy was assessed by comparison with “normal” subjects in the same weight group. Twenty-five of the patients were found to have a left ventricular wall thickness within normal limits; 44 cases had a left ventricular wall not more than 50 per cent thicker than normal; in the remaining 14 cases it was more than 50 per cent greater than normal. The most advanced hypertrophy recorded was slightly more than twice the upper normal limit for corresponding weight. A comparison was made between the degree of hypertrophy as assessed by angiocardiography and the electrocardiographic criteria of hypertrophy. Although there seemed to be a general agreement between the degree of anatomic hypertrophy and the R amplitude in left precordial leads, the sum of (RV 5 6 + SV1) and the recorded S-T changes, there was no statistically significant correlation between any one of these electrocardiographic criteria and the presence or absence of hypertrophy of the left ventricle. It is concluded that the electrocardiographic changes in patients with increased systolic overload of the left ventricle are probably related to myocardial factors other than the anatomic dimensions of the left ventricular wall. In our present state of development, the interpretation of the electrocardiogram with respect to moderate left ventricular hypertrophy is unsatisfactory and may be erroneous.

Successful Resuscitation of Two Immature Infants with Cardiac Arrest During Exchange Transfusion

Two instances of asystolic cardiac arrest in immature infants during exchange transfusions are reported. In both cases the collapse came as an unexpected complication at the end of the transfusion. When extrathoracic manipulations to restore spontaneous heart action had been unsuccessfully performed for one and two minutes respectively, thoracotomy was performed and cardiac massage instituted. Spontaneous heart action started in one case shortly after manual compressions had been instituted and in the other case after 10 minutes of massage and the administration of calcium and adrenalin. The recovery of the infants was completely uneventful and no signs of CNS damage could be detected at the age of two and three months respectively. Methods to institute cardiac action are discussed and it is stressed that thoracotomy and cardiac massage are comparatively easy procedures not contraindicated by the small size of these infants. The use of continuous ECG control during exchange transfusion is recommended.