ABSTRACT
OBJECTIVE: To determine the prevalence and clinical significance of adrenal hemorrhage in infants undergoing ECMO therapy. METHODS: Prospective US evaluation of the adrenal glands was performed in 50 consecutive infants undergoing ECMO. The infants were examined at least every other day while on bypass. Adrenal hemorrhage was diagnosed at US examination when a suprarenal mass or adrenal gland enlargement was identified. RESULTS: Adrenal hemorrhage was identified in two infants (4%); one infant with septicemia, and one with primary pulmonary hypertension. Both hemorrhages were unilateral; one was right-sided, and one left-sided. One hemorrhage occurred on the first day following the onset of ECMO and the other on the third day. The adrenal hemorrhage was not associated with an acute drop in hematocrit nor with adrenal insufficiency in either infant. CONCLUSION: Adrenal hemorrhage is uncommon in infants undergoing ECMO. When hemorrhage did occur in this series, it did not result in clinical complications.
Subject(s)
Adrenal Gland Diseases/etiology , Extracorporeal Membrane Oxygenation/adverse effects , Hemorrhage/etiology , Adrenal Gland Diseases/diagnostic imaging , Female , Hemorrhage/diagnostic imaging , Humans , Infant, Newborn , Male , Prospective Studies , UltrasonographyABSTRACT
One hundred eighty pediatric patients with suspected appendicitis were prospectively examined with graded compression ultrasonography (US) to assess the sensitivity, specificity, and accuracy of graded compression US in the diagnosis of appendicitis in children and to compare those results with results of clinical assessment in the diagnosis of this disorder. Patients were assigned to one of three groups prior to US based on the clinical level of confidence that appendicitis was present and on the planned management decision. Of 141 patients in the low- and intermediate-clinical risk categories, 20 (14%) had appendicitis: US had a sensitivity of 100%, specificity of 97%, and accuracy of 97% in these two groups. Of 39 patients in the high-clinical risk category, 32 (82%) had appendicitis: US had a sensitivity of 81%, specificity of 86%, and accuracy of 82%. Of 52 patients with surgically proved appendicitis, the initial management decision was to discharge to home or admit for observation and further testing in 18 (35%). Results at US were positive for appendicitis in all 18 patients in the latter two categories.
Subject(s)
Appendicitis/diagnostic imaging , Adolescent , Adult , Appendicitis/diagnosis , Appendicitis/pathology , Appendix/diagnostic imaging , Appendix/pathology , Child , Child, Preschool , Diagnosis, Differential , Diagnostic Techniques, Surgical , False Positive Reactions , Female , Follow-Up Studies , Humans , Male , Patient Care Planning , Probability , Prospective Studies , Risk Factors , Sensitivity and Specificity , UltrasonographyABSTRACT
Findings at neuroimaging in 100 consecutive infants treated with extracorporeal membrane oxygenation (ECMO) are presented. Imaging in these infants consisted of pretreatment cranial ultrasonography (US), daily US studies while on ECMO, and follow-up cranial computed tomography (CT) after treatment. There were findings of abnormalities in 43 patients. Thirty had intracranial bleeding, often of unusual extent and distribution. Thirteen additional infants had nonhemorrhagic abnormalities alone. Bleeding considered to be major was seen in 12% of infants. Large parenchymal hemorrhages and infarcts, cerebellar hemorrhages, and diffuse edema were the most significant abnormalities, with a 50% mortality (eight of 16 patients). No lateralization was noted with respect to distribution of bleeding sites or areas of nonhemorrhagic abnormalities. US was a sensitive but imperfect screening tool for intracranial abnormalities. Abnormalities missed with US included peripheral and small parenchymal lesions, subarachnoid hemorrhage, cerebral atrophy, and sagittal sinus thrombosis.
Subject(s)
Brain/abnormalities , Extracorporeal Circulation , Oxygenators, Membrane , Tomography, X-Ray Computed , Ultrasonography , Brain/diagnostic imaging , Brain Edema/diagnosis , Brain Edema/mortality , Cerebral Hemorrhage/diagnosis , Cerebral Hemorrhage/mortality , Cerebral Infarction/diagnosis , Cerebral Infarction/mortality , Extracorporeal Circulation/instrumentation , Extracorporeal Circulation/methods , Humans , Infant, Newborn , Respiratory Insufficiency/diagnosis , Respiratory Insufficiency/mortality , Respiratory Insufficiency/therapyABSTRACT
Transcutaneous Doppler ultrasound was used to monitor changes in intracranial hemodynamics in 13 infants undergoing extracorporeal membrane oxygenation (ECMO). Recordings for the pericallosal portion of an anterior cerebral artery were obtained before ECMO and daily during ECMO bypass, with use of a range-gated, pulsed Doppler imaging system. Obvious changes occurred with the onset of ECMO: the systolic phase broadened, and diastolic flow velocities markedly increased. The mean pulsatility value, as measured with the Pourcelot pulsatility index, decreased significantly at the start of ECMO and over time during ECMO bypass. Marked increases in the area under the velocity curve (AUTC) were also observed with the institution of ECMO bypass (mean percentage change in AUTC from baseline, 133%). Factors that appeared to affect AUTC included PCO2, mean blood pressure, and ECMO bypass rate. AUTC tended to decrease during the course of ECMO. Although the clinical significance of these findings remains unclear, the data indicate that ECMO bypass is associated with marked changes in intracranial hemodynamics.
