Neonatology in the emerging countries: the strategies and health-economics challenges related to prevention of neonatal and infant infections.

The prevalence of neonatal and infant infections is higher in emerging countries when compared to the developed world. Major factors associated to this increased frequency include the scarcity of trained health personnel, overcrowding of the neonatal units, late onset and slow advance of feeding, use of formula instead of breastfeeding, failure to comply with handwashing recommendations, and excessive use of antibiotics, resulting in the emergence of resistant strains. Infants discharged home frequently share rooms with a large number of siblings and other cohabitants, increasing the risk of infection by respiratory viruses. Several strategies are described that could decrease these serious problems which impact increasing significantly neonatal and infant mortality rates in developing countries.

Regulation of oxygen concentration delivered to infants via nasal cannulas.

The administration of oxygen to infants via nasal cannulas is now a common practice in neonatal units although the inspired oxygen concentration reaching the patient's airway is unknown. We measured the hypopharyngeal oxygen concentration in 10 infants who were receiving oxygen via nasal cannulas and assessed the impact of changes in the flow rate and inspired oxygen concentration. Weaning these infants by reducing the flow rate, even if changes are slight, produces clinically important changes in the oxygen concentration reaching the airway. Such changes are poorly tolerated by infants with chronic lung disease. Changing the flow rate and inspired oxygen concentration, rather than the flow rate alone, provides greater precision and is likely to avoid excessive and abrupt changes in the oxygen concentration reaching the airway.

Role of exchange transfusion in the treatment of severe septicemia.

Ten critically ill newborn infants presenting with documented septicemia were treated with antibiotics and supportive measures that included assisted ventilation, large blood transfusions and other volume expanders, sodium bicarbonate, and vasoactive drugs. Upon failure of the above treatment to improve the infants' rapidly deteriorating condition and the development of sclerema, exchange transfusions with fresh whole blood were performed and repeated up to four times. Seven of the ten infants showed immediate improvement and ultimately survived. IgM and IgA rose consistently with exchange transfusions. We postulate that these infants improved following exchange transfusion as the result of the removal of endotoxins, improvement of perfusion and of tissue oxygenation, decrease of hemorrhagic complications, and enhancement of the humoral and cellular inflammatory response. The development of sclerema in septicemic newborn infants continues to be an ominous sign despite the use of antibiotics and supportive measures. Our data suggest that exchange transfusions decrease the mortality of this group of critically ill infants.

Neonatal chylothorax: a report and discussion of nine consecutive cases.

We here report the clinical findings and management of 9 consecutive cases of chylothorax, 5 of which occurred spontaneously. One cases followed cardiac surgery. Three cases occurred in low-birth-weight, premature infants concurrently with other symptoms of the superior vena cava syndrome secondary to central intravenous nutrition. To our knowledge, this is the first description of chylothorax as a possible complication of total parenteral nutrition in newborn babies. In our treatment of chylothorax in the newborn, we employed diagnostic thoracentesis followed by chest tube drainage and a medium chain triglyceride diet.

Treatment of isoimmune thrombocytopenia of the newborn with transfusion of maternal platelets.

Isoimmune neonatal thrombocytopenia is a rare condition with potentially serious complications and mortality of 10%. There are several ways of diagnosing and treating this potential neonatal emergency, but the most simple and effective method we have found is that of transfusing maternal platelets. Two cases are reported in which this type of management was successful.