Neonates and small infants with congenital heart disease and complex cardiac and vascular anatomy are particularly prone to episodes of complete or incomplete regional ischemia during cardiopulmonary bypass. These episodes may result either from inhomogeneous distribution of arterial blood flow via the aortic cannula or from impaired drainage of blood ...

OBJECTIVE: Although extracorporeal membrane oxygenation (ECMO) is an acceptable strategy for children with refractory cardiac dysfunction after cardiac surgery, its role after stage I reconstruction for hypoplastic left heart syndrome and its variants is controversial. Our objective is to describe the outcome of "nonelective" ECMO after stage I reconstruction. DESIGN: ...

OBJECTIVES: To use intravenous adenosine as a rescue therapy for neonatal refractory pulmonary hypertension in a low-weight premature infant. STUDY LINE: We report the successful use of a continuous intravenous adenosine infusion in a 1150-g premature baby with severe persistent pulmonary hypertension, refractory to classic management with high-frequency oscillatory ventilation, ...

Infants born prematurely have a plethora of medical problems. Some have cerebral palsy, resulting in limited mobility, while others require oxygen, hearing aids, and/or glasses for medical problems. Most of these could have been prevented if preterm birth was avoided, but efforts to curb this have been slow. This article ...

Micro-oxygenation is usually applied to red wines as a cheaper alternative to oak aging. It has been suggested, however, that micro-oxygenation can also be used to complement oak aging in order to improve the quality of very astringent and herbaceous red wines. In this paper we study how applying the ...

OBJECTIVE: To determine if a change in the pulse oximeter goal range and high alarm limit for oxygen saturation (SpO2) alters the distribution of SpO2 for premature infants in oxygen. STUDY DESIGN: This was a prospective, observational analysis. For group 1 (February 2002 to April 2002, n = 23), pulse ...

BACKGROUND: Many neonates with severe persistent pulmonary hypertension of the newborn (PPHN) are nonresponders to inhaled nitric oxide (iNO). Milrinone is a promising adjunctive therapy because of its pulmonary vasodilator properties and cardiotropic effects. DESIGN: Case series of neonates with severe PPHN (defined as oxygenation index [OI] >20, failure of ...

OBJECTIVE: Because the optimal concentration of oxygen (FiO2) required for stabilization of the newly born infant has not been established, the FiO2 is commonly adjusted according to the infant's oxygen saturation (SpO2). We aimed to determine the range of pre-ductal SpO2 in the first minutes of life in healthy newborn ...

Nitric oxide (NO) is a gas that has potent vasodilator properties. It can be administered via inhalation in situations where NO production is impaired and results in vasodilatation of the pulmonary capillaries. In term infants, the administration of inhaled NO, at a dose of 20 parts per million, may reduce ...

Optical methods provide a means of monitoring cerebral oxygenation in newborn infants at risk of brain injury. A 32-channel optical imaging system has been developed with the aim of reconstructing three-dimensional images of regional blood volume and oxygenation. Full image data sets were acquired from 14 out of 24 infants ...

OBJECTIVE: No reliable clinical markers of histologic chorioamnionitis (HCA), a major and often subclinical cause of prematurity leading to high neonatal morbidity and mortality, are available to date. Increasing evidence indicates myocardial dysfunctions in affected fetuses and newborns. We sought to assess the value of nonlinear dynamics from pulse oximetry ...

BACKGROUND: Inhaled nitric oxide (iNO) is used widely in newborn infants with hypoxic respiratory failure, despite the known and theoretical toxicity of iNO, and a relative lack of information about appropriate doses. AIM: To determine whether a dose-response relationship existed for iNO in preterm infants. DESIGN: A four-period, four-dose, cross-over ...

OBJECTIVE: To determine the value of regional cerebral oxygen saturation (rSo2), fractional cerebral tissue oxygen extraction (FTOE) measured by near-infrared spectroscopy (NIRS), and amplitude integrated electroencephalogram (aEEG) after birth asphyxia in relation to neurodevelopmental outcome. METHODS: NIRS measured rSo2, FTOE, and aEEG were monitored simultaneously, together with arterial oxygen saturation ...

BACKGROUND: Chronic lung disease (CLD) of prematurity is associated with significant morbidity, and infants discharged home in oxygen are particularly vulnerable. Aim: To assess the incidence of acute life threatening events (ALTEs) during 12-month follow-up of CLD infants discharged home receiving supplemental oxygen. METHOD: All infants discharged over a one-year ...

The increased survival of infants born at mid-gestation in the last decade is associated with significant oxygen free radical-mediated morbidities. Resuscitation with 100% oxygen, oxidant load from parenteral nutrition fluids, and oxidant stress inherent to the systemic inflammatory state subsequent to infection and tissue injury are all contributory. Improving early ...

BACKGROUND: The low oxygen environment during air travel may result in hypoxia in patients with respiratory disease. However, little information exists on the oxygen requirements of infants with respiratory disease planning to fly. A study was undertaken to identify the clinical factors predictive of an in-flight oxygen requirement from a ...

Bronchiolitis is a recognized syndrome seen in infants following viral infections. The pattern is different in different countries related to the socio-economic conditions. A sequel that needs to be addressed is post-viral wheeze. Oxygen is the major beneficial pharmacological agent. Bronchodilators may be effective in some. There is a role ...

BACKGROUND: Nitric oxide is a major endogenous regulator of vascular tone. Inhaled nitric oxide gas has been investigated as a treatment for persistent pulmonary hypertension of the newborn. OBJECTIVES: To determine whether treatment of hypoxaemic term and near-term newborn infants with inhaled nitric oxide (iNO) improves oxygenation and reduces the ...

AIM: To determine whether inhaled nitric oxide might reduce the need for excessive respiratory alkalosis to maintain systemic oxygenation in infants with persistent pulmonary hypertension of the newborn (PPHN). MATERIALS AND METHODS: A retrospective historical cohort study of 34 infants with PPHN with oxygenation index (OI) of 25 or more, ...

BACKGROUND: Midazolam sedation and morphine analgesia are commonly used in ventilated premature infants. OBJECTIVES: To evaluate the effects of midazolam versus morphine infusion on cerebral oxygenation and hemodynamics in ventilated premature infants. METHODS: 11 patients (GA 26.6-33.0 weeks, BW 780-2,335 g) were sedated with midazolam (loading dose 0.2 mg/kg, maintenance ...

OBJECTIVE: To report the survival of fungal sepsis in extracorporeal membrane oxygenation. DESIGN: Single case report. SETTING: Tertiary referral children's hospital pediatric intensive care unit. PATIENTS: A single case report of an infant with congenital heart disease who developed candida sepsis while supported postoperatively with extracorporeal membrane oxygenation. RESULTS: This ...

BACKGROUND: Respiratory diseases are the commonest cause of morbidity and mortality in newborns. Inhaled nitric oxide (iNO) has been shown to be effective in the management of persistent pulmonory hypertension of newborn (PPHN). OBJECTIVES: To retrospectively analyse data to determine the effectiveness of inhaled nitric oxide (iNO) in the management ...

OBJECTIVE: Oxygen delivery through nasal cannulae to convalescent preterm infants is a common but largely unstudied practice. To learn more about current nasal cannula oxygen delivery practices, we examined the variations in oxygen delivery through nasal cannulae among the centers of the Neonatal Research Network, the frequency of prescription of ...

On the basis of a carbon isotopic record of both marine carbonates and organic matter from the Triassic-Jurassic boundary to the present, we modeled oxygen concentrations over the past 205 million years. Our analysis indicates that atmospheric oxygen approximately doubled over this period, with relatively rapid increases in the early ...

OBJECTIVE: To describe the later health status of newborn infants who received extracorporeal membrane oxygenation (ECMO) for acute respiratory failure in the era after the UK ECMO trial. DESIGN: Prospective follow up study of newborn infants who received ECMO at a single centre between January 1997 and January 2001. SETTING: ...

BACKGROUND: Inhaled nitric oxide (iNO) is an effective adjunct in the treatment of infants with respiratory failure. Although there are clear benefits to this therapy, potential toxicity could result from reactive nitrosylated species. OBJECTIVE: To evaluate whether iNO therapy is associated with increased serum markers of oxidative stress. DESIGN/METHOD: Multiple ...

BACKGROUND: Despite the emergence of new therapies for respiratory failure of the newborn with meconium aspiration syndrome (MAS), extracorporeal membrane oxygenation (ECMO) has a significant role as a rescue modality in these infants. Our objective was to compare the use of venovenous (VV) vs venoarterial (VA) ECMO in newborns with ...

International guidelines for newborn resuscitation recommend the use of 100% oxygen. However, high concentrations of oxygen after asphyxiation activate reactive oxygen species that may contribute to a number of morbidities. Animal models have been useful in describing their mechanisms, but only large-scale clinical trials can provide evidence that may be ...

BACKGROUND: Bronchopulmonary dysplasia is an inflammatory fibrotic condition produced as a consequence of injurious influences in the neonatal lung. Exposing the premature lung to high concentrations of oxygen is thought to play an important part in lung injury pathogenesis. OBJECTIVE: To see if the amount of oxygen used during resuscitation ...

The role for fetal surgery in treating fetuses with congenital diaphragmatic hernia (CDH) is unclear. Two decades of investigation have improved our understanding of the prenatal natural history, pathophysiology, and outcomes of these patients. During this same period, there have been advances in fetal surgery techniques including improvements in fetal ...

Many infants with CDH can be managed with conventional mechanical ventilation and pharmacotherapy. However, some infants will require levels of ventilator support that are not compatible with survival. In these circumstances, extracorporeal membrane oxygenation (ECMO) has been used with varying results. The indication, type, and timing of ECMO in relation ...

The mortality rate associated with congenital diaphragmatic hernia (CDH) varies widely between centers and remains relatively high despite widespread use of new therapeutic modalities. Many of these have been implemented without properly controlled studies. Over the past 10 to 15 years, only 9 randomized trials enrolling a total of approximately ...

BACKGROUND: Although inhaled nitric oxide (iNO) may be a promising treatment for newborn infants with severe respiratory failure, the results from 3 previous small trials were inconclusive. METHODS: Infants of <34 weeks' gestation, <28 days old, and with severe respiratory failure requiring ventilatory support were randomized to receive or not ...

OBJECTIVE: To determine whether infants with chronic lung disease (CLD), ready for neonatal unit discharge, maintain cardiorespiratory stability while sleeping supine. METHODS: Subjects were 15 infants born < 32 weeks gestational age (GA) and ready for discharge from the regional tertiary neonatal intensive care unit. Polysomnography recordings of sleep state, ...

OBJECTIVE: To explore the acute effects of inhaled nitric oxide (iNO) on oxygenation, respiratory rate, and CO2 levels in spontaneously breathing preterm infants treated with nasal continuous positive airway pressure (nCPAP) for moderate respiratory distress syndrome (RDS). DESIGN AND SETTING: Randomized, prospective, double-blind, cross-over study in the neonatal intensive care ...

Inhaled nitric oxide (iNO) improves oxygenation in premature infants, but concern has been raised about its potential oxidative toxicity. We designed this study to assess the oxidative balance in premature infants who were exposed to low dose iNO and the relationship with their clinical outcome on day 28 of life. ...

OBJECTIVE: To determine whether the presence of histologic chorioamnionitis is associated with the severity of Persistent Pulmonary Hypertension of the Newborn (PPHN) as evidenced by the use of exogenous nitric oxide (iNO), high-frequency oscillatory ventilation (HFOV), extra-corporeal membrane oxygenation (ECMO) and/or death. METHODS: Retrospective chart review of term neonates > ...

To evaluate whether the system-based strategy for management of meconium aspiration syndrome (MAS) could reduce the morbidity and mortality rate of MAS in our institute, a prospective consecutive clinical observation was conducted. System-based strategy including appropriately trained the relevant medical staff to familiar with neonatal resuscitation program, early surfactant replacement ...

OBJECTIVES: To assess the safety-efficacy balance of low-dose inhaled nitric oxide (iNO) in hypoxemic premature infants because no sustained beneficial effect has been demonstrated clearly and there are concerns about side effects. STUDY DESIGN: Eight hundred and sixty infants <32 weeks were randomized at birth to receive 5 ppm iNO ...

In 1960, the terms "neonatology" and "neonatologist" were introduced. Thereafter, an increasing number of pediatricians devoted themselves to full-time neonatology. In 1975, the first examination of the Sub-Board of Neonatal-Perinatal Medicine of the American Board of Pediatrics and the first meeting of the Perinatal Section of the American Academy of ...

OBJECTIVE: We noted that age-related normal calcium doses in neonates on venoarterial extracorporeal membrane oxygenation result in hypercalcemia. To avoid hypercalcemia and its potential consequences these infants are given one-half the normal calcium dose. We studied the pathogenesis of hypercalcemia and hypomagnesemia by evaluating calcitriol, intact parathyroid hormone, and calcitonin ...

Extracorporeal membrane oxygenation (ECMO) therapy has significantly improved outcome in the newborn, pediatric, and adult patient in respiratory and cardiac failure. Despite this therapy providing a life-saving technology, the morbidity in patients treated with ECMO therapy is primarily related to neurologic alterations and not pulmonary findings. For ECMO, this is ...

The aim of this paper is to review the role of extracorporeal membrane oxygenation (ECMO) in neonates with severe acute hypoxemic respiratory failure secondary to congenital diaphragmatic hernia (CDH). The difficulties in identifying patients with fatal lung hypoplasia are highlighted and the role of adjunctive therapies on ECMO (surfactant, inhaled ...

The therapeutic use of oxygen was pioneered in the early 20(th) century by the respiratory physiologist John Scott Haldane. His work followed Claude Bernard's description of the toxic effects of carbon monoxide. Haldane, having also observed the effects of carbon monoxide poisoning, became aware of the therapeutic benefits of oxygen ...

The in-hospital management of infants with BPD includes minimizing the duration of mechanical ventilation and avoiding the use of high inspired oxygen concentrations while maintaining adequate oxygenation. Fluid restriction, bronchodilators, and diuretic therapy can improve lung function and reduce the need for supplemental oxygen and high ventilator settings, but do ...

With improved survival of very low birth weight infants in China over the last decade, chronic lung disease of prematurity (CLD) is only now becoming prevalent. As a result the management of CLD in China is only now beginning. In this paper, we describe the practice of managing these infants ...

Chronic lung disease is common in extremely preterm infants born in Australasia. In 2002, 53% of surviving infants born before 28 weeks' gestation remained either oxygen-dependent or on other respiratory support at 36 weeks' postmenstrual age. In the first weeks of life oxygenation should be kept generally "lower", although what ...

Objective: This study examines the use of a clinical pathway in the management of infants hospitalised with bronchiolitis. &#13;Study Design: A clinical pathway for the care of infants with bronchiolitis was developed from pathways used in tertiary paediatric institutions in Australia. 229 infants admitted to hospital with acute viral bronchiolitis ...

BACKGROUND: Optimising home oxygen delivery in infants has important logistical and safety implications. This can be aided by having a suitable reference range of normal values for arterial oxygen saturation using pulse oximetry (SpO(2)). OBJECTIVES: To describe oxygenation profiles in healthy preterm and term infants in relation to gestational and ...

BACKGROUND: High altitude is associated with both low pulse oxygen saturation at birth and more pre-term deliveries. The present study was performed to determine pulse oxygen saturation in newborns at term in Cerro de Pasco (4340 m) and Lima (150 m) to test the hypothesis that low pulse oxygen saturation ...