L. J. Murton

Perinatal factors, periventricular haemorrhage and mortality in very low birthweight infants

In a population of 225 very low birthweight infants born over a 21 month period the cerebroventricular system was scanned by ultrasound. One third of the infants developed a periventricular haemorrhage; in 41% of infants the haemorrhage was detected before an hour of age and 66% of all haemorrhages occurred within the first 24 hours.

Intraventricular haemorrhage in term neonates: diagnosis by ultrasound.

ABSTRACT. The occurrence of intraventricular haemorrhage in three term babies, diagnosed by real‐time ultrasound, is described. Two babies presented with apnoeic spells followed by seizures, but no history of significant asphyxia or trauma. The third suffered an intraventricular haemorrhage in association with a severe respiratory illness. Real‐time ultrasound has proven to be a useful diagnostic tool in detection of intraventricular bleeding in preterm neonates. Ultrasound or computerized axial tomographic scanning is recommended in term babies with apnoea or seizures which are not otherwise explained by an abnormal perinatal history, physical examination or biochemical investigations.

Real-time scanning of the neonatal brain

ABSTRACT. Forty‐five high risk infants were examined in a neonatal nursery with a real‐time ultrasound scanner. The relevant normal and abnormal intracranial features are described. There was a good correlation betwen the site and size of the 12 intraventricular haemorrhages (IVH) found on ultrasound scanning with subsequent computerised axial tomography (CAT) scans and postmortem results. There was also close agreement between CAT and ultrasound scan assessment of ventricular size. Our data suggest that IVH occurs within the first 48 hours of life. In the light of our experience and because of its convenience and safety we have largely abandoned CAT scanning in favour of real‐time ultrasound scanning in the investigation of neonatal IVH and hydrocephaly.

Selective intubation in pulmonary interstitial emphysema: experience in five patients

Abstract Selective bronchial intubation can be useful in the management of severe localized pulmonary interstitial emphysema (PIE). Five infants between 9 and 20 days old with severe left sided PIE had the right main bronchus intubated for between 4 to 30 h. Four patients showed permanent and one patient temporary improvement and the experience from these cases suggests that prolonging the procedure after obtaining radiological evidence of improvement may not be necessary. There were no serious complications although right upper lobe atelectasis occurred in three cases and could not be prevented by using an endotracheal tube with a side hole. Nevertheless, active management should only be considered in PIE causing respiratory failure or pressure effects on surrounding structures.

A case of neonatal bilateral diaphragmatic paralysis requiring surgery.

Abstract Diaphragmatic paralysis may cause life threatening respiratory distress especially in infancy. A case is reported of a 32 week gestation infant with bilateral phrenic nerve palsies and associated brachial plexus injury who remained severely compromised despite spontaneous recovery of the right hemidiaphragm after 13 weeks. Operative plication of the left hemidiaphragm produced a marked improvement. Surgery should be considered after an adequate trial of expectant management in symptomatic patients.

Extracorporeal membrane oxygenation (ECMO) for non-ECMO intensive care nurseries.

An extracorporeal membrane oxygenation (ECMO) centre has been established in the sole outborn‐only level 3 nursery in Melbourne. In the absence of other guidelines, an infant may qualify for ECMO if the expected mortality, based on assessment of the severity of hypoxia, exceeds 80%. However, for a non‐ECMO centre, this involves the additional hazard of transport for an already critically‐ill infant. The aim of this study was to determine the predictors of at least 80% mortality in babies who might have qualified for ECMO but who were cared for in a non‐ECMO level 3 nursery. Regardless of the severity or duration of hypoxia, we were unable to identify a group of infants whose mortality exceeded 80%. Since outborn infants were disproportionately over‐represented amongst those who might qualify for ECMO, it would be advisable to admit preferentially those born outside the level 3 perinatal centres who might qualify for ECMO directly to the ECMO centre. For infants born within our level 3 perinatal centre, it is recommended not to transfer those who might qualify based on data from other centres until the exact role of ECMO is determined. Alternatively, a randomized controlled trial of transfer versus non‐transfer to the ECMO centre for severely hypoxic infants cared for in non‐ECMO level 3 nurseries could be considered.