Heliox tolerance in spontaneously breathing neonates with bronchopulmonary dysplasia.

The use of a gas mixture in which helium is substituted for nitrogen allows a decrease in pulmonary resistances and in resistive work of breathing. This treatment might allow a reduction in energy expenditure in infants with bronchopulmonary dysplasia (BPD) and spare calories for growth. In a preliminary study designed to assess tolerance to Heliox(R), 4 infants with BPD and 4 controls were studied firstly when breathing air and secondly when breathing Heliox(R), at 10, 20 and 30 min exposure (T10, T20, T30). The following parameters were recorded: respiratory and cardiac rates, room (RT) and skin temperatures (ST) and transcutaneous (Tc) blood gases. When breathing air, TcPO2 was normal in the two groups (mean +/- SEM: 70 +/- 4 mm Hg in BPD vs. 78 +/-4 in controls). TcPCO2 was higher in the BPD group (41 +/- 2 vs. 35 +/- 1 mm Hg in controls; p = 0.028). Spontaneously breathing Heliox had immediate consequences such as wakening, crying, decrease in ST and hypoxia. Hypoxia was more serious and more rapid in the BPD group. At the 10-min exposure, mean TcPO2 was 39 +/- 4 mm Hg in BPD vs. 69 +/- 7 in controls (p = 0.042). Hypoxia was immediately corrected when breathing room air. TcPCO2 was unchanged in both groups.

Congenital chylothorax with hydrops: postnatal care and outcome following antenatal diagnosis.

We consecutively managed 25 cases of fetal chylothorax with hydrops (pleuroamniotic shunting in 20/25 cases). Three of the 16 liveborn infants died before day 5 from malformations (n = 1) or complications of antenatal origin (n = 2). Eleven of the 13 survivors were treated in our unit. Four infants whose chylothorax had resolved before birth following antenatal shunting were delivered at term, and had no respiratory disease. Seven infants, whose chylothorax persisted, were delivered prematurely and required intensive respiratory care (with mechanical ventilation for a median duration of 34 days). The 11 infants were maintained on total parenteral nutrition for a median duration of 31 days. They were discharged home after complete clinical recovery at a median age of 64 days. Antenatal pleuroamniotic shunting may improve the prognosis of congenital chylothorax with hydrops. Chylothorax persisting at birth resolves progressively with medical management.

Energy expenditure in premature newborns with bronchopulmonary dysplasia.

Five premature newborns (birth weight, mean +/- SD, 960 +/- 145 g; gestational age 28 +/- 1 weeks) with bronchopulmonary dysplasia (BPD) according to the criteria of Bancalari, and 6 controls (birth weight 1,320 +/- 210 g; gestational age 30 +/- 2 weeks) were studied for energy expenditure (EE) by indirect calorimetry. The measurement of total EE was performed when the intake of the infants in both groups was the same and when the respiratory condition had stabilized (control group: postnatal age 31 +/- 6 days, 1,950 +/- 200 g; BPD group: postnatal age 105 +/- 45, postnatal weight 2,440 +/- 380). The BPD group had a higher VO2 (11.15 vs. 8.04 ml/kg/min, p less than 0.01), VCO2 (9.13 vs. 7.74 ml/kg/min, p less than 0.02) and total EE (76 vs. 61 kcal/kg/day, p less than 0.02). The highest values were encountered in the 3 more severely ill infants: mean VO2 11.03 ml/kg/min, mean EE 82 kcal/kg/min. In these cases, administration of medium chain triglycerides limits the increase in VCO2 and lowers the respiratory quotient (0.87 vs. 0.96 in controls.

[Treatment of severe hyaline membrane disease with a single-dose of natural exogenous surfactant of porcine origin. A randomized trial: immediate effects and outcome at 28 days of life]. / Traitement de formes sévères de la maladie des membranes hyalines par une dose unique d'un surfactant exogène naturel d'origine porcine. Un essai randomisé: effets immédiats et devenir à 28 jours de vie.

The results obtained with porcine surfactant (Curosurf) administration for the treatment of hyaline membrane disease (HMD) are reported. Thirty premature infants weighing 700 to 2,000 g with severe HMD (mechanical ventilation and oxygen requirement (FiO2) greater than 60% were randomly allocated at 2 to 15 hours postnatal age. Eight of the 30 patients included in this group participated in a multicenter european trial. The fifteen infants with mean gestational age (GA) of 29.5 weeks included in the treatment group (T), were treated at 8.6 hours of life with a single dose of 200 mg/kg Curosurf given intratracheally while 15 infants of mean GA 30 weeks formed the control group (C). Infants in the T group showed an immediate, dramatic and sustained improvement of oxygenation as reflected by increased PaO2/FiO2 and arterial to alveolar PO2 ratios within 1 hour. This significant improvement in favor of T group (p less than 0.005) persisted for 2 days when control infants began to recover. This improvement in oxygenation allowed a significant decrease of FiO2 (p less than 0.005) and mean airway pressure (p less than 0.01) in the T group within 1 hour and up till the second day. Despite this early improvement obtained with Curosurf the survival rate at 28 days of life and the incidence of associated HMD complications were not significantly modified. However the tendency was towards decreased respiratory morbidity. The discussion will consider the value of multiple doses.

[Comparison of 2 semi-quantitative methods for evaluating blood glucose in newborn infants]. / Comparaison de deux méthodes d'estimation semi-quantitative de la glycémie chez le nouveau-né.

Blood glucose levels were assessed in 49 neonates, using 2 blood glucose test strips. Results were compared to blood glucose levels. Correlations between values from the test strips and values from the laboratory were better using the Haemo-Glukotest (r = 0.91) than using the Dextrostix (r = 0.82). As compared to values from the laboratory, however, both glucose test strips gave higher values and did not properly identify all cases of hypoglycemia.

[Nitrogen fractions of human milk during the first week of lactation. Comparison of milk from mothers of term and premature newborn infants]. / Etude des fractions azotées du lait de femme pendant la première semaine de la lactation. Comparaison des laits de mères de nouveau-nés à terme et prématurés.

Nitrogen fractions in human milk (total nitrogen, non protein nitrogen, casein nitrogen and soluble protein nitrogen) were determined by direct dosage or by calculation during the first 7 days of lactation in 61 mothers feeding artificially. Twenty-five delivered at term and 36 prematurely. In all cases a decrease in all nitrogen fractions was observed. The amounts of total nitrogen and soluble proteins were similar in both groups. A difference in the distribution of the nitrogen fractions occurs only on the 8th day following delivery. Milk from mothers who deliver prematurely contains more casein and less non protein nitrogen amounts.

Comparative efficacy of theophylline and caffeine in the treatment of idiopathic apnea in premature infants.

The purpose of our prospective randomized study was to compare the efficacy of theophylline ethylenediamine and caffeine sodium citrate in the treatment of idiopathic apnea in premature infants. Sixteen infants with three or more severe apneic attacks were studied. Twenty-four-hour cardiorespiratory recordings immediately before and after randomization and four days later showed similar significant decreases of the apnea frequency in both theophylline- (group 1, n = 8) and caffeine-treated infants (group 2, n = 8). No undesirable side effects were observed, except for tachycardia in one infant in group 1. We suggest reasons for preferring caffeine to theophylline in the control of idiopathic apnea in premature infants: caffeine is as efficient and easier to administer.

[Role of fibrinogen among the inflammatory proteins in neonatal infections]. / Place du fibrinogène parmi les protéines de l'inflammation dans les infections néonatales.

The increase of the fibrinogen level appears to be an important feature in the neonatal infection as well for diagnosis as for prognosis. Levels above 3,50 g per liter during the first days after birth is in favor of bacterial materno-foetal infection and will return to normal in the next 3 days after antibiotics therapy. Conversely high fibrinogen levels persist as long as the infection remains active and must be an indication to modify antibiotics prescription even when bacteriological results are not known.

Necrotizing enterocolitis in full-term newborns.

During a 17-month period, 19 full-term newborn infants were hospitalized for necrotizing enterocolitis (NEC). 10 of these infants had no apparent risk factors. Only 7 suffered acute fetal distress. 16 of the 19 infants were born in the same hospital. Toxicological and bacteriological investigations of possible cause revealed no specific agent. Virological analysis of 8 stool samples revealed the presence of corona virus in 5 of the 8.

[Arterial pressure in newborn infants during the first 72 hours of life]. / Pression artérielle chez le nouveau-né pendant les 72 premières heures de vie.

Arterial pressure (AP) (systolic, mean and diastolic) was recorded during the first 72 hours of life in 93 neonates, 27 to 42 weeks of gestational age and weighing 800 to 4,600 g, i.e. in stable hemodynamic and respiratory conditions. 4,464 measurements were performed. Results show that the 3 AP parameters increase with gestational age and birth weight and that AP increases with age after birth in full term as well as premature children. The physiologic variability of AP in full term and premature children accounts for the difficulty of establishing standards and for the need of a permanent recording of this parameter.

[Very low birth weight neonates. Results of management. Future prospects]. / Nouveau-nés de très faible poids de naissance. Résultats. Perspectives d'avenir.

70 neonates with birth weights (BW) less than 1 250 g were treated at the intensive care unit for neonates (USINN), hôpital Port-Royal, from April 1st 1976 to July 31st 1977. 16 of them had intra-uterine growth retardation. In 20, BW cas under 1 000 g. Assisted ventilation was necessary in 54 (77%). 43 children (61%) survived, those who were born in the same hospital did so more often (88%) than those who came from other hospitals (53%) (p less than 0.01). These results show the needs and risks of the management of very low birth weight neonates: preventing hypothermia, assisted ventilation of long duration and risk of persisting ductus arteriosus, prolonged parenteral nutrition, risk of intracranial hemorrhage more especially as respiratory distress is more severe. In survivors, the high rate of respiratory sequellae (around 30%) suggests that the duration and intensity of assisted ventilation should be reduced as much as possible.

[Percutaneous catheterization. Experience in a neonatal intensive care unit]. / Cathéters percutanés. Expérience d'un service de soins intensifs pour nouveau-nés.

157 percutaneous catheterizations were performed in 114 neonates. Besides the advantages of a central catheter, this easier technique allows to save the large vessels. However, the risks of severe complications (5 septicemias, 5 intrathoracic effusions of which 5 deaths) lead to strictly restrict its indications. Complications should be avoided with a perfect technique: strict asepsis and positioning of the end of catheter.

The efficacy of caffeine in the treatment of recurrent idiopathic apnea in premature infants.

This prospective controlled study was aimed at evaluating the efficacy of caffeine in treating recurrent idiopathic apnea in the premature infant. Eighteen preterm infants (29 to 35 weeks' gestation) were studied. Recordings during the first 24 hours and on the fifth day of caffeine treatment showed a significant decrease of severe apnea (P less than 0.01) and of mild apnea (P less than 0.001) in the treated group (group 1) as compared with the control group (group II). No treatment of apnea other than caffeine was required in group I, whereas six neonates in group II had such severe and frequent apneic episodes for more than 48 hours that withholding additional treatment was believed to be unethical. No undesirable side effects of caffeine treatment were observed.

[Acute retinopathy of prematurity following oxygen therapy: current concepts (author's transl)]. / Données actuelles sur la rétinopathie aiguë du prématuré sous oxygénothérapie.

Five cases of retinopathy of prematurity have been observed among 1,750 premature infants at the Florence Geller Center in Cochin-Port-Royal--C.H.U. over a period of four years. In all cases, arterial PaO2 was more than 100 mmHg at least once. In the two worst cases, oxygen therapy given only during the first had been hours of life. The authors insist on the dangers of oxygen overdose immediately after birth or during transport to a Premature Infants Center. Laser photocoagulation was employed in four eyes: 2 with regression, 1 with cicatrisation, 1 with fibroplasia. Retinopathy of prematurity remains a danger in France, even if it is not as frequent as in the U.S.A. or Japan. Indirect ophthalmoscopy is essential for diagnosis and fluorography very useful to determine prognosis and treatment.

[The value of fibrinogen concentrations in neonatal bacterial infections of maternal origin (author's transl)]. / Surveillance du taux de fibrinogéne chez le nouveau-né. Intérêt au cours de l'évolution des infections bactériennes par contamination d'origine maternelle.

The changes of fibrinogen levels in the neonatal period have been systematically studied in the neonatal intensive care unit at Port-Royal Hospital. A prospective study has been performed in 29 children with bacterial infections which were definitely of maternal origin. High fibrinogen levels persist as long as the infection remains active. Return of fibrinogen levels to normal could be considered as a criterion, if not of cure, at least of the efficacy of treatment.

[Glucose and insulin blood levels in low birth weight neonates under exclusive parenteral nutrition (author's transl)]. / Taux de glycémie et d'insuline chez des nouveau-nés de faible poids, en nutrition parentérale exclusive.

In 31 low birth weight neonates under exclusive parenteral nutrition, insulin levels were studied and compared to blood glucose levels. Mean birth weight was 1,261 g (950 to 1,500). Gestational age was 30 weeks (27 to 40). Before the 48th hour of life, mean blood glucose level (+/- standard error) was 3.61 (+/- 0.24) mmol/l. Insulin level was 116 (+/- 30) pmole/l. After the 48th hour, the values were 4.36 (+/- 0.58) and 158 (+/- 46) respectively. There is a significant correlation between blood glucose and insulin levels (r = 0.62 p < 0.001). Hyperglycemia was present in 4 cases (> 7 mmol/l) and revealed severe pathology. These 4 children were those with the highest insulin levels. There was no significant relationship between insulin level, gestational age, postnatal age or birth weight.