Thomas K. Oliver

Neonatal necrotizing enterocolitis. A report of twenty-one cases with fourteen survivors.

Abstract Prompt medical and particularly surgical therapy has caused a marked improvement in the survival of infants with necrotizing enterocolitis. In this series, the second largest reported to date, the survival is 67 per cent.

Aggressive treatment of neonatal necrotizing enterocolitis: 38 patients with 25 survivors

Abstract Neonatal necrotizing enterocolitis was first described by Genersich 1 in 1891. Although there have been several descriptive reports of this entity in the European literature, until recently there were fewer than 80 cases reported in the English literature, with about 15 survivors. With the exception of two papers from Columbia Presbyterian Hospital, New York City, in 1965 and 1967, reporting 25 cases with six survivors; 2,3 the University Hospital in Seattle, in August 1969, reporting 21 cases and 14 survivors; 4 and the Los Angeles Childrens Hospitals report, in November 1969, of 16 cases with four survivors, 5 most of these earlier papers appeared as individual case reports. In newborn nurseries and premature centers where the pediatricians are alerted to this condition the incidence is about 2 per cent of the admissions. Unfortunately, in most instances, it still is a condition that goes unrecognized by pediatricians, surgeons, and pathologists alike. Unless recognized and treated, necrotizing enterocolitis is a highly lethal disease in most cases. Although the etiology of this condition is not known, the pathogenesis is probably due to decreased mesenteric blood flow during periods of hypotension or stress in the perinatal period. The mesenteric ischemia may be secondary to a redistribution of blood flow to more vital organs. Since mesenteric arterioles terminate as preferential channels, most of the mucosal blood flow may be shunted away from capillary beds as mesenteric arteriolar resistance increases and mesenteric arteriolar pressure falls below critical closing pressure. Hypoxia results in secondary muscle spasm further reducing effective blood supply to the mucosa with resulting necrosis. 2–6

Cardiac arrhythmias in premature infants: An indication of autonomic immaturity?

Sinus arrhythmia was demonstrated in all of 30 healthy infants whose birth weights were less than 1,500 grams, and in 90 per cent of them there were also more marked arrhythmias. The severity and frequency of arrhythmias decreased as the weight and development of the infant increased.

Positive pressure ventilation in the newborn infant: the use of a face mask.

Over an 18 month period, 118 infants have been ventilated with positive pressure. The need for intermittent positive pressure breathing (IPPB) was based on determinations of arterial blood gases or on prolonged apnea, neither of which were related to the outcome. Twenty-three infants survived (19.4 per cent). Only 8 per cent of infants weighing less than 1,500 grams lived, whereas the survival of infants weighing more than 1,500 grams was 40.5 per cent. It was possible to ventilate 96 of these infants with a face mask, as evidenced by a favorable change in blood gases. The use of a face mask has many advantages and the complications are minimal. It appears that the salvage of apneic infants was increased, but the over-all efficacy of IPPB is difficult to assess.

Graduate medical education

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