Airway complications in neonates who received mechanical ventilation.

OBJECTIVE: To determine the incidence, type and severity of airway complications in high risk neonates who received conventional mechanical ventilation. METHOD: Forty-five infants who had received conventional mechanical ventilation in the Neonatal Intensive Care Unit, Department of Pediatrics, Faculty of Medicine Siriraj Hospital for at least 4 days were enrolled. Orotracheal intubation with blue line, non-cuffed, non-shouldered polyvinylchloride tube was used exclusively. The average number of intubations was 2 (range 1-7), and the average duration for intubation was 25 days. The details of the intubation, and the presence of respiratory distress after extubation were recorded. All of the infants had endoscopic examination of the airway within 5 days of extubation. RESULTS: Following extubation, 14 (31.1%) infants developed signs of upper airway obstruction, of which inspiratory dyspnea was the most common manifestation. Only 4 infants developed inspiratory stridor, three of them had a birth weight greater than 2,500 g. Abnormal bronchoscopic findings were found in 42 infants, 68.8 per cent had multiple sites of injury. Supraglottic lesions were found in 55.7 per cent of cases. Laryngomalacia was an associated finding in 8 and gastroesophageal reflux (GER) in 1 occasion. CONCLUSIONS: From the result of this study, the authors found that airway complications related to endotracheal intubation are common among survivors from the Neonatal Intensive Care Unit. When the diagnosis of airway complications only depends on symptoms and signs of upper airway obstruction, the incidence and extent of injuries may be under-estimated. When attempted extubation fails or when VLBW infants develop increasing respiratory distress that is not clearly explained by an apparent disorder involving the pulmonary parenchyma, flexible bronchoscopic examination should be performed at the bedside with minimal risk.

Pulmonary function in infants exposed to pethidine.

OBJECTIVE: To investigate the effects of maternal pethidine administration on pulmonary function tests in newborn infants. PATIENTS AND METHOD: The study was carried out in the Department of Obstetrics and Gynecology, Faculty of Medicine Siriraj Hospital. The study group consisted of 20 infants exposed to pethidine within 4 hours prior to delivery. Twenty infants whose mothers received no analgesic drug or regional anesthesia were randomly selected as the controls. Narcotic related respiratory depression was determined by Apgar scores, the need for ventilatory support in the delivery room and abnormal pulmonary function measurements. RESULTS: There was no difference in birth weight and gestational age between the two groups of infants. Pethidine was given to mothers at a dose of 72.5 +/- 7.6 mg/kg with a mean drug-delivery interval of 152 +/- 61 minutes. One infant in each group had a 1-minute Apgar score less than 7, but there was no statistical difference in the mean Apgar score between the two groups. None of the infants whose mothers received pethidine required ventilatory support, but oxygen was provided to eight infants who were apparently cyanosed at birth. Pulmonary function measurements were performed at the age of 7.4 +/- 2.3 hours in the controls and 6.0 +/- 2.5 hours in the study group. There was no significant difference in respiratory rate, tidal volume, inspiratory time, functional residual capacity, compliance and resistance between the two groups of infants. CONCLUSION: Severe narcotic related respiratory depression was uncommon in this study. In the first 12 hours of life, there was no significant difference in pulmonary function of the infants exposed to pethidine. It is quite safe to allow the baby to room-in with the mother if respiratory depression is not presented at birth.

Antiseptics for preventing omphalitis.

BACKGROUND: Omphalitis may cause serious complications and contribute to neonatal morbidity and mortality. From January 1997 to August 1998, the incidence of omphalitis in the Department of Obstetrics and Gynecology, Faculty of Medicine Siriraj Hospital had been increased from 0.9 to 17.4 per 1,000 live births. A prospective randomized trial using antiseptic applied directly to the umbilical stump was conducted aiming to reduce an epidemic outbreak of omphalitis in the newborn nursery. OBJECTIVE: To determine which antiseptic is appropriate for preventing omphalitis in the newborn infants. PATIENTS AND METHOD: Newborn infants delivered in the Department of Obstetrics and Gynecology, Faculty of Medicine Siriraj Hospital were randomized into group A (Triple dye) or group B (70% Alcohol). The infant with omphalitis was assessed by a pediatrician or a neonatology fellow. At home, the same antiseptic will be continually applied to the umbilical stump daily until a few days after cord detachment. Relative risk was calculated and statistical significance was tested by Chi-square test. RESULTS: Four hundred and twenty-seven infants were enrolled. Birth weight, gestational age and gender of the infants in both groups were not different. There were no known maternal risk factors for omphalitis. Omphalitis was observed in 9/213 (4.2%) infants in group A and 23/214 (10.7%) infants in group B. The relative incidence rate between each group was statistically significant (p<0.01). Triple dye group was 60 per cent less likely to develop omphalitis compared to 70 per cent Alcohol group (RR 0.39, 95% CI: 0.19-0.83). The mean duration for cord detachment were 13.6 and 11.5 days in group A and group B, respectively. CONCLUSION: During an epidemic outbreak of omphalitis, Triple dye was the most appropriate and effective antiseptic to prevent omphalitis but could delay cord separation.

Detection of congenital syphilis by using fluorescent treponemal antibody absorption test on fractionated sera (FTA-ABS 19s IgM).

The fluorescent treponemal antibody absorption test used with fractionated serum (FTA-ABS 19s IgM test) was evaluated as a test for congenital syphilis. From 1994 to 1995, 32 high-risk infants of mothers with untreated or inadequately treated syphilis and eight adults with primary or secondary syphilis were studied. The FTA-ABS 19s IgM was positive in 6 of 13 symptomatic babies (46 percent) with was a better rate than that given by the older method (38 percent), but only one adult gave a positive test (17 percent). This test was negative in all 50 controls studied, so the specificity was 100 percent. Although a negative FTA-ABS 19s IgM cannot be used to rule out congenital syphilis, a positive test should confirm suspected cases. The clinical features of congenital syphilis, as well as other laboratory investigations, re also discussed.

Transcutaneous bilirubinometry: Effect of postnatal age and serum bilirubin concentration.

Transcutaneous bilirubinometry (TcB) is a new diagnostic tool for neonatal hyperbilirubinemia. It can be used as a screening tool to identify full-term infants who require serum bilirubin determination. In Thai infants, it yields a positive prediction with serum bilirubin. The correlation coefficient was 0.8. The best correlation was obtained when serum bilirubin was over 15 mg/dl. The postnatal age of the infant affects the accuracy of TcB measured at the forehead. We recommend TcB be measured at the forehead during the first three days of life.