New ways to ventilate newborns in acute respiratory failure.

Out treatment options for acute neonatal failure have expanded greatly in the last 20 to 30 years. This article reviews patient-triggered ventilation, high frequency ventilation, negative extrathoracic pressure ventilation, nitric oxide therapy, liquid ventilation, extracorporeal membrane oxygenation, and advances in pulmonary function monitoring. The authors present background theories, describe equipment, review clinical strategies, and the results of recent trials.

Controversies in neonatal resuscitation.

In the delivery room, pediatricians are frequently required to make immediate decisions about resuscitating infants. Is the baby too small, too immature, or too asphyxiated to be revived? To achieve the best outcome, resuscitation once initiated, must be performed expeditiously, safely, and with the utmost diligence. Not all the tools and medications have undergone the intense scrutiny that might otherwise be assumed. In this article, resuscitation topics are discussed and recommendation offered.

Advantages of dual-lumen umbilical vessel catheters versus single-lumen umbilical vessel catheters and additional peripheral intravenous catheters.

Once the decision to place an umbilical venous catheter has been made, the opportunity to provide some relief to the patient clinically as well as fiscally is possible with the use of a dual-lumen umbilical vessel catheter (UVC). Although the necessity of catheterization of the umbilical vein remains controversial, successful completion of this procedure provides the practitioner immediate access to the venous circulation of a newborn and allows administration of various solutions and blood products. The cost of a dual-lumen UVC was compared with a single-lumen UVC used in conjunction with peripheral intravenous catheters. By limiting the number of peripheral intravenous catheterization attempts, these patients are spared the pain and possible sequelae associated with wide fluctuations in blood pressure, heart rate, and oxygenation. Once a patient requires more than two peripheral intravenous catheterization attempts, the cost savings of a dual-lumen UVC becomes evident and is amplified with each successive peripheral catheterization attempt.

Ethical decisions in the delivery room.

Avoidance of futile therapies that only prolong suffering and the high emotional and economic cost to family and society justifies an attempted differentiation of infants whose defects are so extensive or whose prognoses are so poor that CPR should be withheld. This article discusses the ethical bases for decision making in the DR and the three most common diagnoses in which CPR decisions are most difficult: infants with severe congenital defects, extremely low birthweight infants, and infants with severe perinatal asphyxia.

Hospital care techniques resulting in intact survival of a 380-g infant.

Intact survival of infants delivered before completion of the 26th week of gestation or weighing less than 500 g is a well known phenomenon. We recently cared for an infant whose birth weight was 380 g, making her one of the smallest survivors in the United States. Her hospitalization (including expenses), the techniques of our minimal intervention protocol and her 20-month (corrected) follow-up are presented together with a discussion of the moral, economic and social implications involved in the care of such an infant.

Microspherophakia in association with the rhizomelic form of chondrodysplasia punctata.

Chondrodysplasia punctata is a multisystem disorder, primarily involving the musculoskeletal system, skin, and eyes. Children with the rhizomelic form of this syndrome have characteristic facies with a saddle-nose deformity, hypertelorism, and frontal bossing. The musculoskeletal changes include proximal limb shortening, flexion contractures, congenital hip dislocations, and the characteristic radiographic finding of epiphyseal stippling of the axial skeleton and long bones. The most common ocular findings are cataracts and optic atrophy. We describe herein the first reported case of microspherophakia in association with the rhizomelic form of chondrodysplasia punctata.

Intact survival and 20-month follow-up of a 380-gram infant.

Intact survival of infants delivered before completion of the 26th week of gestation or weighing less than 500 g is a well-known phenomenon. We recently cared for an infant whose birthweight was 380 g, making her the second smallest survivor in the United States. Her hospitalization (including expenses) and 20-month (corrected) follow-up are presented along with a discussion of the implications involved in the care of such an infant.

Hafnia alvei septicemia in an infant with necrotizing enterocolitis.

Hafnia alvei is an infrequently reported pathogen in children, and its isolation in a newborn is even more unusual. This organism is rarely associated with invasive disease. This article reports the first case of a neonate with necrotizing enterocolitis and subsequent ileal perforation who had H. alvei isolated from both blood and stool.