Document Detail


Neuromuscular Blockade and Lung Function during Resuscitation of Infants with Congenital Diaphragmatic Hernia.
MedLine Citation:
PMID:  23182955     Owner:  NLM     Status:  Publisher    
Abstract/OtherAbstract:
Background: There is no consensus or evidence as to whether a neuromuscular blocking agent should be used during the initial resuscitation of infants with congenital diaphragmatic hernia (CDH) in the labour ward. Objective: To determine if administration of a neuromuscular blocking agent affected the lung function of infants with CDH during their initial resuscitation in the labour ward. Methods: Fifteen infants with CDH were studied (median gestational age 38 weeks, range 34-41; birth weight 2,790 g, range 1,780-3,976). Six infants had undergone feto-endotracheal occlusion (FETO). Flow, airway pressure, tidal volume and dynamic lung compliance changes were recorded using a respiratory function monitor (NM3, Respironics). Twenty inflations immediately before, immediately after and 5 min after administration of a neuromuscular blocking agent (pancuronium bromide) were analysed. Results: The median dynamic lung compliance of the 15 infants was 0.22 ml/cm H(2)O/kg (range 0.1-0.4) before and 0.16 ml/cm H(2)O/kg (range 0.1-0.3) immediately after pancuronium bromide administration (p < 0.001) and remained at a similar low level 5 min after pancuronium bromide administration. The FETO compared to the non-FETO infants had a lower median dynamic compliance both before (p < 0.0001) and 5 min after pancuronium administration (p < 0.001) and required significantly longer durations of ventilation (p = 0.004), supplementary oxygen (p = 0.003) and hospitalisation (p = 0.007). Conclusions: Infants with CDH, particularly those who have undergone FETO, have a low lung compliance at birth, and this is further reduced by administration of a neuromuscular blocking agent.
Authors:
Vadivelam Murthy; Walton D'Costa; Kypros Nicolaides; Mark Davenport; Grenville Fox; Anthony D Milner; Morag Campbell; Anne Greenough
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Publication Detail:
Type:  JOURNAL ARTICLE     Date:  2012-11-24
Journal Detail:
Title:  Neonatology     Volume:  103     ISSN:  1661-7819     ISO Abbreviation:  Neonatology     Publication Date:  2012 Nov 
Date Detail:
Created Date:  2012-11-27     Completed Date:  -     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  101286577     Medline TA:  Neonatology     Country:  -    
Other Details:
Languages:  ENG     Pagination:  112-117     Citation Subset:  -    
Copyright Information:
Copyright © 2012 S. Karger AG, Basel.
Affiliation:
Division of Asthma, Allergy and Lung Biology, King's College London, London, UK.
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