Congenital adenomatoid disease of the lung: prenatal diagnosis and perinatal management

Prenatal ultrasonographic (US) detection of congenital adenomatoid malformation (CAM) was made in 18 fetuses at 17 - 36 weeks' gestation and managed in our institution during a 10-year period (1985-1994). The lesion was left-sided in 13 cases, right-sided in 4, and bilateral in 1. According to Stocker's classification, 12 cases were type I, 4 type II, and 2 type III. The prenatal course was followed with serial US examinations in 13 cases; the size of the lesion was stable in 8 and decreased in 5. Mediastinal shift was usually observed, and amniotic fluid volume was increased in 4 cases. One fetus was aborted. Six infants presented with respiratory distress syndrome and required neonatal surgery; delayed surgery was performed in 9 cases. Spontaneous regression of the lesion was observed on follow-up in 2 cases. Surgery consisted in lobectomy in 8 cases and segmentectomy in 6. The presence of fetal hydrops, type III lesions, and bilateral lung involvement are prenatal factors known to be associated with a poor prognosis. However, this series and a review of the literature suggest that caution should be observed with regard to the initial impression when counseling the parents regarding prognosis.

Congenital adenomatoid disease of the lung: prenatal diagnosis and perinatal management.

Prenatal ultrasonographic (US) detection of congenital adenomatoid malformation (CAM) was made in 18 fetuses at 17 - 36 weeks' gestation and managed in our institution during a 10-year period (1985-1994). The lesion was left-sided in 13 cases, right-sided in 4, and bilateral in 1. According to Stocker's classification, 12 cases were type I, 4 type II, and 2 type III. The prenatal course was followed with serial US examinations in 13 cases; the size of the lesion was stable in 8 and decreased in 5. Mediastinal shift was usually observed, and amniotic fluid volume was increased in 4 cases. One fetus was aborted. Six infants presented with respiratory distress syndrome and required neonatal surgery; delayed surgery was performed in 9 cases. Spontaneous regression of the lesion was observed on follow-up in 2 cases. Surgery consisted in lobectomy in 8 cases and segmentectomy in 6. The presence of fetal hydrops, type III lesions, and bilateral lung involvement are prenatal factors known to be associated with a poor prognosis. However, this series and a review of the literature suggest that caution should be observed with regard to the initial impression when counseling the parents regarding prognosis.

Prevention of ischemia-reperfusion lung injury by inhaled nitric oxide in neonatal piglets.

Lung ischemia-reperfusion results in a decrease in the release of nitric oxide (NO) by the pulmonary endothelium. NO may have lung-protective effects by decreasing neutrophil accumulation in the lung. We tested whether NO inhalation would attenuate reperfusion-induced endothelial dysfunction and increases in microvascular permeability and total pulmonary vascular resistance (RT) by preventing neutrophil lung accumulation. After baseline determinations of RT, coefficient of filtration (Kfc), and circulating neutrophil counts, isolated neonatal piglet lungs were subjected to a 1-h period of ischemia followed by a 1-h period of blood reperfusion and reventilation with or without addition of NO (10 ppm). NO prevented reperfusion-induced increases in RT and Kfc, as well as the decrease in circulating neutrophils. After reperfusion, increases in Kfc were correlated with decreases in circulating neutrophils. NO prevented reperfusion-induced decrease in endothelium-dependent relaxation in precontracted pulmonary arterial rings. This demonstrates that inhaled NO prevents microvascular injury, endothelial dysfunction, and pulmonary neutrophil accumulation in a neonatal piglet model of lung ischemia-reperfusion.

Sonographic diagnosis and follow-up of diffuse neutropenic colitis: case report of a child treated for osteogenic sarcoma.

The sonographic features of total neutropenic colitis in a 14-year-old girl with osteogenic sarcoma are presented. Sonography disclosed characteristic diffuse thickening of the colonic wall with hyperechoic bowel mucosa. Serial sonograms were performed to monitor the progress of the disease.

[Practical experience in monitoring the oxygen saturation of central venous blood in pediatric anesthesia-resuscitation]. / Pratique du monitorage de la saturation du sang veineux central en oxygène en anesthésie-réanimation pédiatrique.

Venous central oximetry (ScO2) in high-risk pediatric surgical patients (myopathies, congenital diaphragmatic hernia) is an useful guide to treatment. ScO2 was monitored in 15 patients (4 neonates) during and after thoracic interventions or interventions involving manipulation of the liver. Oximetrix ScO2 is not more invasive than a catheter of common stiffness, but the size 4F remains large for neonates. The physiological or pathological signification of its variation has to be deduced from clinical evaluation. Interpretation may be easier during anesthesia and in the absence of sepsis. ScO2 can be used either as a sensitive monitoring with usually an early response, to evaluate judicious treatment, or as an indirect way to evaluate cardiac output if the other factors of the Fick relation can be estimated or measured.

Central venous catheter-related complications in newborns and infants: a 587-case survey.

In an attempt to identify factors determining central venous catheter-related complications in newborns and infants, 587 cases have been retrospectively analyzed. Attention has been paid to the influence of the incidence of babies' body weight, site of insertion, and technique of placement of the catheter and the material used, ie, silicone (SI) or polyurethane (PU). Overall complications occurred in 28% of the catheters with 2 deaths due to cardiac tamponade. Mechanical complications happened in 22% of the catheters, including dislodgement (11.6%), extracorporeal perforation (5.3%), and obstruction (5%). Septic complications occurred in 4% catheters, including proven bacteriemia (2.5%), abscess at the entry site (1%), and isolated fever (0.8%). Clinically evident caval thrombosis occurred in 1% of the catheters. Overall complications were significantly higher when the body weight was lower than 2,500 g (P less than .01) due to a significantly higher incidence of septic complications (P less than .05). When a proximal site of placement of the catheter was used, both septic and mechanical complications were more frequent than in the distal approach (P less than .01). The incidence of complications was similar in surgically and in percutaneously placed catheters as in SI and PU catheters. Nevertheless, fatal complications occurred only in PU catheters, leading us to avoid the choice of such material in newborns and small infants.

[A rapid bacteriologic method for the diagnosis and surveillance of nosocomial pneumopathies]. / Apport d'une méthode bactériologique rapide dans le diagnostic et la surveillance des pneumopathies nosocomiales.

The authors report a rapid quantitative culture of endotracheal aspiration samples in mechanically ventilated children. There was a good correlation (94.7%) between clinical and radiographic features of pneumonia and a cutoff point of 10(5) cfu.ml-1. The sensitivity of this rapid quantitative culture was 85% when compared with usual quantitative culture.