RESUMEN
UNLABELLED: Our aim was to identify factors predictive of death in preterm infants in whom inhaled nitric oxide was administered in response to poor oxygenation (oxygenation index > or =15). Of the 23 (median gestational age 28 weeks, range 24-36) infants consecutively so treated, 15 died. Non-survival was commoner in infants with air leaks (12 of 12, P < 0.002) and/or a change in their oxygenation index of less than 30% in response to inhaled nitric oxide administration (P < 0.05). CONCLUSION: In preterm infants given inhaled nitric oxide because of poor oxygenation, a diagnosis of airleak and a lack of initial response are predictive of death.
Asunto(s)
Recien Nacido Prematuro , Óxido Nítrico/administración & dosificación , Síndrome de Dificultad Respiratoria del Recién Nacido/tratamiento farmacológico , Síndrome de Dificultad Respiratoria del Recién Nacido/mortalidad , Administración por Inhalación , Distribución de Chi-Cuadrado , Femenino , Estudios de Seguimiento , Humanos , Recién Nacido , Masculino , Óxido Nítrico/efectos adversos , Consumo de Oxígeno , Valor Predictivo de las Pruebas , Síndrome de Dificultad Respiratoria del Recién Nacido/diagnóstico , Estadísticas no Paramétricas , Análisis de Supervivencia , Tasa de Supervivencia , Resultado del TratamientoRESUMEN
Antenatal haemolysis in association with ABO incompatibility occurs very rarely. Two cases of hydrops fetalis in black infants caused by anti-B haemolysins are reported. The greater severity of ABO incompatibility in black African peoples may have important implications for antibody screening in this ethnic group.
Asunto(s)
Sistema del Grupo Sanguíneo ABO , Incompatibilidad de Grupos Sanguíneos/complicaciones , Hidropesía Fetal/etiología , Población Negra , Incompatibilidad de Grupos Sanguíneos/etnología , Femenino , Humanos , Recién Nacido , MasculinoRESUMEN
The response to three levels (10 ppm, 20 ppm and 40 ppm) of nitric oxide (NO) was assessed in 30 infants, median gestational age 30 (range 24-42) weeks. All the infants required an inspired oxygen concentration of more than 0.5, despite receiving surfactant where appropriate. All but one infant had a positive response to NO (median reduction in the oxygenation index (OI) was 33%, range -9%-90%), but only 20 infants showed a greater than 20% reduction in the OI. There was no obvious relationship of the optimum NO level (i.e. that associated with the maximum reduction in OI) and either diagnosis (congenital diaphragmatic hernia, meconium aspiration syndrome, respiratory distress syndrome, pulmonary interstitial emphysema (PIE), hydrops and sepsis) or maturity, except that five of six infants with PIE responded best to 40 ppm, as did eight of nine infants less than 28 weeks gestational age. We conclude NO dosage should be individualized and NO levels up to 40 ppm should be considered in very immature infants.
Asunto(s)
Hipoxia/terapia , Enfermedades del Prematuro/terapia , Óxido Nítrico/administración & dosificación , Administración por Inhalación , Análisis de Varianza , Femenino , Edad Gestacional , Humanos , Hipoxia/sangre , Hipoxia/etiología , Recién Nacido , Enfermedades del Prematuro/sangre , Enfermedades del Prematuro/etiología , Masculino , Oxígeno/sangre , Terapia por Inhalación de Oxígeno , Estudios ProspectivosRESUMEN
Anorexia, epigastric discomfort, nausea, and vomiting may result from disordered gastric motility and emptying. These features have been found in many adults with anorexia nervosa, but have never been investigated in early onset anorexia nervosa. In 14 patients with early onset anorexia nervosa (eight of whom had upper gastrointestinal tract symptoms), six children with other eating disorders, four children with non-ulcer dyspepsia, and 10 controls matched for age and sex, the non-invasive technique of surface electrogastrography was used to measure fasting and postprandial gastric antral electrical control activity, which underlies antral motility. The electrical signal was recorded by four bipolar silver/silver chloride electrodes attached to the upper abdomen, amplified and low pass filtered at 0.33 Hz before being displayed on a polygraph, digitised at 1 Hz, and stored on the hard disk of a personal computer for later offline analysis. Patients with non-ulcer dyspepsia had gastric antral dysrhythmias. No significant difference was found in the mean (SD) dominant frequency of the antral electrical control activity between patients with early onset anorexia nervosa (2.86 (0.35) cycles/minute (cpm)), patients with other eating disorders (3.14 (0.65) cpm), and controls (3.00 (0.46) cpm). The amplitude of electrical control activity increased postprandially in all but one subject and the fasting/postprandial amplitude ratio did not significantly differ between patients with early onset anorexia nervosa and controls, though patients with longer established disease had a smaller increase in amplitude. Gastric antral electrical dysrhythmias are not a feature of early onset anorexia nervosa and therefore do not induce or perpetuate food refusal in this disorder.
Asunto(s)
Anorexia Nerviosa/fisiopatología , Estómago/fisiopatología , Adolescente , Factores de Edad , Niño , Electromiografía/métodos , Electrofisiología , Ayuno/fisiología , Trastornos de Alimentación y de la Ingestión de Alimentos/fisiopatología , Femenino , Alimentos , Motilidad Gastrointestinal/fisiología , Humanos , Masculino , Antro Pilórico/fisiopatologíaRESUMEN
Disturbed fetal gastrointestinal tract function is associated with hydramnios and may be a marker of later gastrointestinal disease. We investigated gastric motor function in the human fetus to establish the range and rate of fluctuation of gastric volume. Two pairs of orthogonal gastric diameters were measured at 5-min intervals for 1-h periods using a linear-array ultrasound scanner in 12 fetuses in late pregnancy (26-40, median 35.5 weeks gestation). A gastric volume index (GVI) was calculated. Maximum absolute gastric volume index correlated significantly with gestational age. The minimum gastric volume index as a percentage of the maximum (0-60.4%, median 28.1%) showed that marked changes in gastric dimensions occur. Filling (41.5-74.1, median 62.6 degrees) and emptying (46.6-80.9, median 61.7 degrees angles were calculated for the longest continuous filling and emptying periods using a linear model, and showed no difference in the rates of filling and emptying. Peak-to-peak and trough-to-trough durations suggested a periodicity of 35-55 min. Investigation of the development of normal fetal gastric motor activity may lead to a better understanding of postnatal adjustment to enteral feeding, and may provide a diagnostic method for antenatal diagnosis of gastrointestinal functional disturbances.
Asunto(s)
Motilidad Gastrointestinal , Estómago/embriología , Ultrasonografía Prenatal , Femenino , Madurez de los Órganos Fetales , Edad Gestacional , Humanos , Embarazo , Tercer Trimestre del EmbarazoRESUMEN
Chronic idiopathic intestinal pseudoobstruction is a serious disorder of intestinal neuromuscular function resulting in recurrent episodes of intestinal obstruction, and is caused by primary disease of the enteric nerves or enteric smooth muscle. Gastric electrical control activity detected by the non-invasive technique of surface electrogastrography was investigated in 11 children (0.1-16 years) with proven chronic idiopathic intestinal pseudoobstruction (four with known disease of the enteric nerves, three with disease of smooth muscle cells, and four without defined pathology), to determine whether abnormalities were present and whether these were useful in detecting the underlying pathology. Abnormalities were present in eight of 11 patients. Persistent tachygastria (electrical control activity frequency > 5 cycles/minute) was found in three patients, all with a proven neuropathy. A continuously irregular frequency was found in five patients, three with a proven myopathy and two with undefined pathology. A normal electrical control activity frequency was present in three patients, one with a proven neuropathy and two with undefined pathology. It is suggested that this non-invasive technique may provide a useful screening test of the pathophysiological basis of the functional obstruction in children with chronic idiopathic intestinal pseudoobstruction.
Asunto(s)
Motilidad Gastrointestinal/fisiología , Seudoobstrucción Intestinal/fisiopatología , Antro Pilórico/fisiopatología , Adolescente , Niño , Preescolar , Electrofisiología , Humanos , Íleon/patología , Lactante , Seudoobstrucción Intestinal/diagnóstico , Seudoobstrucción Intestinal/patología , Intestino Grueso/patología , ManometríaRESUMEN
Persistent vomiting, diarrhoea, or intolerance of feeding, are well recognised problems in children after surgical correction of intestinal malrotation. Conversely, intestinal malrotation is a common accompaniment of chronic idiopathic intestinal pseudo-obstruction. We investigated motor activity of the small intestine during fasting in eight children who had persistent vomiting, intolerance of full enteral feeding, or severe diarrhoea after surgical correction of intestinal malrotation. Abnormality of motor function similar to that found in neuropathic pseudo-obstruction was found in seven of the eight patients. Persistence of symptoms after surgical correction of a malrotation is associated with a motility disturbance which seems to be due to a defect of intrinsic enteric innervation. Such a defect may be important in the aetiology of the malrotation.
Asunto(s)
Intestino Delgado/anomalías , Intestino Delgado/cirugía , Complicaciones Posoperatorias/etiología , Preescolar , Diarrea/etiología , Conducta Alimentaria/fisiología , Motilidad Gastrointestinal/fisiología , Humanos , Lactante , Recién Nacido , Seudoobstrucción Intestinal/etiología , Seudoobstrucción Intestinal/fisiopatología , Manometría , Anomalía Torsional , Vómitos/etiologíaRESUMEN
A 9 year old boy with intractable postprandial reflex vomiting was taught a self hypnotherapy technique incorporating relaxation exercises, mental imagery, and suggestions of symptom relief. The sequence was recorded on a personal stereo cassette tape. Vomiting was completely eliminated within four weeks. At 12 month review vomiting had not recurred.