Papaverine for Ischemia Following Peripheral Arterial Catheterization in Neonates.

11 Extremely low birth weight neonates who developed skin discoloration after peripheral arterial catheterization were given intra-arterial papaverine before the removal of arterial line. The skin color turned normal in all these neonates and none developed residual damage. In 3 neonates who could not receive papaverine, one developed gangrene of fingers.

ATP-binding Cassette Transporter A3 (ABCA3) Mutation in a Late Preterm with Respiratory Distress Syndrome.

Background: Surfactant protein abnormalities are rare causes of respiratory distress syndrome. Case characteristics: A late preterm (36 wks) who presented with respiratory distress syndrome.Observation: He was found to be a homozygous for a G to T transversion at the first base in intron 24, of ABCA3 gene which is necessary for lamellar body formation and surfactant production. Outcome: He died of severe respiratory failure even after multiple doses of surfactants and ventilation. Message: Surfactant deficiency with ABCA3 gene mutation needs to be suspected in late preterms who present with respiratory distress syndrome.

Respiratory Flutter Syndrome in a Neonate.

Respiratory flutter or diaphragmatic flutter is a rare disorder characterized by involuntary, high frequency contractions of the diaphragm. Only 7 cases are reported in infants till date. The present case presented with life threatening respiratory distress immediately after birth. In view of high respiratory rate of 120-154 per minute, clinical and fluoroscopic evidence of diaphragmatic contraction and absence of any obvious CNS, cardiovascular and respiratory pathology, respiratory flutter was diagnosed. It was also associated with dysphagia and laryngomalacia. The patient was managed with prolonged continuous positive airway pressures (CPAP) with partial success, but symptoms improved with use of chlorpromazine.

Rescue High Frequency Oscillation in Neonates with Acute Respiratory Failure.

The aim was to study the efficacy of rescue High Frequency Oscillatory Ventilation (HFOV) in improving the oxygenation and ventilation in neonates with acute respiratory failure after failing Conventional Mechanical Ventilation (CMV). Primary outcome was short term oxygenation, lung recruitment, and ventilation and secondary outcome studied was survival. 675 babies were ventilated and 97 of them received HFOV. HFOV significantly improved oxygenation index, alveolararterial oxygen gradient, pH, PCO2, PO2 and caused better lung recruitment within 2 hours. Fifty seven babies (58.77%) survived and the mortality was more in <28 weeks, babies with pulmonary hemorrhage, sepsis and CDH.