Vivian J. Harris

Hydrocortisone therapy in meconium aspiration syndrome: A controlled study

To evaluate the efficacy of glucocorticoids in the treatment of infants with meconium aspiration syndrome, a double-blind study using hydrocortisone or a lactose placebo was undertaken. Thirty-five infants were included in the study. No significant differences in arterial Po2, Pco2, pH, A-aDo2 gradients, in requirement for assisted ventilation, or in survival were domonstrated between the groups. In control infants, a significant decrease (p less than 0.01) in respiratory distress score was found at 48 to 72 hours of age; in treated infants, it was seen only after 72 hours. The infants in the treated group took a significantly longer (p less than 0.01) period of time to wean to room air than those in the control group (68.9 +/- 9.6 hours vs 36.6 +/- 6.9 hours). On the basis of these observations, hydrocortisone is not recommended for treatment of MAS.

Computed Tomography in Diagnosing Retropharyngeal Abscess in Children

tered the clinical presentation. 7,8 Complications associated with retropharyngeal abscess include meningitis,9 epiglottitis, pneumonia, empyema, spontaneous rupture of the abscess with aspiration, bronchial erosion,l° pyopneumothorax, and purulent pericarditis.l°-1~ The interpretation of the standard lateral neck radiographic film in children is fraught with difficulty, making it hard to differenti-

CARDIORESPIRATORY EVALUATION OF INFANTS OF DIABETIC MOTHERS (IDM)

This prospective study was done in 42 infants. The mean gestational age was 38.02±0.62 weeks and the mean birth weight 3676.57±62.43gm. Apgar scores were < 5 in 7. Tachypnea (RR>60) was present in 12; 7 of these also had retractions. Tachycardia (HR>150) was detected in 7 infants. Hypoglycemia (BS<30mg%) was seen in 17 and hypocalcemia (Ca<7.5 mg%) in 9; these were associated with respiratory distress in 3 and 4 babies, respectively, our patients had clinical heart failure. Cardiorespiratory symptoms abated within a few days. Two had congenital heart disease: a small atrial septal defect and patent ductus arteriosus in one and a small ventricular septal defect and patent ductus arteriosus in the other. Electrocardiograms (EKGs) were obtained throughout the first week and later as required in 32 infants; 15 were abnormal. Long-term followup EKGs were available in 5 cases. Conversion to normal occurred in 4 between 2 and 19 months. Chest x-rays were done throughout the first week in 35 patients; 10 showed “wet lung” pattern, 11 increased bronchovascular markings or infiltrates and 14 were normal. Lung changes cleared within a few days. Enlarged cardiac-thymic shadow was present in 17, and persisted several weeks to months. It is apparent that IDMs may have persistent cardiac abnormalities as indicated by EKGs and x-ray findings in spite of rapid improvement of their clinical symptoms.

X-RAY DIAGNOSIS AND RESPONSE TO SURFACTANT IN PREMATURES WITH LUNG DISEASE 1922

The most consistently cited diagnostic criterion for respiratory distress syndrome (RDS) in premature infants is a reticulogranular pattern on chest x-ray (CXR). RDS is considered the clinical manifestation of surfactant deficiency. We undertook a study to determine the degree to which the x-ray diagnosis of RDS correlates with response to surfactant treatment.

EPIDEMIOLOGY OF ACUTE RESPIRATORY DISORDERS IN THE NEWBORN † 1519

Experience suggests that many newborns with acute respiratory disorders do not fit classical diagnostic patterns. We studied 2,115 consecutive deliveries at a major urban teaching hospital to determine the frequency of respiratory disorders of all types.

PREDICTION OF OUTCOME OF MECONIUM ASPIRATION SYNDROME (MAS) BY ROENTGENOGRAMS

Chest x-rays are helpful in confirming the diagnosis of MAS. In this study, x-rays were evaluated as potential prognosticating tools for predicting the outcome. Eighty infants were studied retrospectively. Initial (0-12hrs) x-ray findings were tabulated without knowledge of clinical outcome. Twenty-five infants needed assisted ventilation; 14 died. X-ray findings were associated with: infiltration in 62 infants, hyperinflation 37, air leaks 25, cardiomegaly 17, segmental or lobar consolidation or atelectasis (C/A) 44. Respiratory failure and mortality were significantly higher (p<.001) in infants who had C/A than in those who showed other x-ray findings (23/44vs2/36; 13/44vsl/36). Pneumothorax was also associated with a higher (p<.05) incidence of respiratory failure but was not related to outcome. Although infants who had C/A had similar gestational age and Apgar score compared to those without C/A, they showed significant differences in initial RDS score (5.3+0.3vs3.9+0.3) and blood gases (Mean±S.E.).From this study, it appears that the initial chest film is of value in predicting outcome and that MAS may be divided into two groups; those associated with C/A having a worse prognosis than those without C/A.