Hyaline Membrane Disease
Tolazoline
Hyalin
Pulmonary Surfactants
Respiration, Artificial
Anti-Glomerular Basement Membrane Disease
Infant, Premature, Diseases
Gestational Age
Respiratory Distress Syndrome, Newborn
Hyaline Cartilage
Infant, Low Birth Weight
Lung
Cerebral Hemorrhage
Infant, Very Low Birth Weight
Hyaline membrane disease, alkali, and intraventricular haemorrhage. (1/100)
The relation between intraventricular haemorrhage (IVH) and hyaline membrane disease (HMD) was studied in singletons that came to necropsy at Hammersmith Hospital over the years 1966-73. The incidence of IVH in singleton live births was 3-22/1000 and of HMD 4-44/1000. Although the high figures were partily due to the large number of low birthweight infants born at this hospital, the incidence of IVH in babies weighing 1001-1500 g was three times as great as that reported in the 1658 British Perinatal Mortality Survey. Most IVH deaths were in babies with HMD, but the higher frequency of IVH was not associated with any prolongation of survival time of babies who died with HMD as compared with the 1958 survey. IVH was seen frequently at gestations of up to 36 weeks in babies with HMD but was rare above 30 weeks' gestation in babies without HMD. This indicated that factors associated with HMD must cause most cases of IVH seen at gestations above 30 weeks. Comparison of clinical details in infants with HMD who died with or without IVH (at gestations of 30-37 weeks) showed no significant differences between the groups other than a high incidence of fits and greater use of alkali therapy in the babies with IVH. During the 12 hours when most alkali therapy was given, babies dying with IVD received a mean total alkali dosage of 10-21 mmol/kg and those dying without IVH 6-34 mmol/kg (P less than 0-001). There was no difference in severity of hypoxia or of metabolic acidosis between the 2 groups. Babies who died with HMD and germinal layer haemorrhage (GLH) without IVH had received significantly more alkali than those who died with HMD alone, whereas survivors of severe respiratory distress syndrome had received lower alkali doses than other groups. It is suggested that the greatly increased death rate from IVH in babies with HMD indicates some alteration of management of HMD (since 1958) as a causative factor. Liberal use of hypertonic alkali solutions is the common factor which distinguishes babies dying with GLH and IVH from other groups of babies with HMD. Although the causal nature of this association remains unproved, it seems justifiable to lrge caution in alkali usage. (+info)Randomised controlled trial of low dose fentanyl infusion in preterm infants with hyaline membrane disease. (2/100)
AIM: To evaluate the effects of low dose fentanyl infusion analgesia on behavioural and neuroendocrine stress response and short term outcome in premature infants ventilated for hyaline membrane disease. METHODS: Twenty seven ventilated preterm infants were randomly assigned to receive a mean fentanyl infusion of 1.1 (0.08 SE) micrograms/kg/h for 75 (5) hours, and 28 untreated infants were considered a control group. A behavioural sedation score was used to assess the infants' behaviour. Urinary metanephrine and the normetanephrine:creatinine molar ratio were determined at 0, 24, 48 and 72 hours. Outcome data and ventilatory indexes were recorded for each infant. RESULTS: The fentanyl group showed significantly lower behavioural stress scores and O2 desaturations than controls and lower urinary concentrations of metanephrine and normetanephrine at 24, 48, 72 hours. The two groups showed no significant difference in ventilatory variables or short term outcome. CONCLUSIONS: A short course of low dose fentanyl infusion reduces behavioural sedation scores, O2 desaturations and neuroendocrine stress response in preterm ventilated infants. (+info)Haemodynamic effects of altering arterial oxygen saturation in preterm infants with respiratory failure. (3/100)
AIMS: To examine the haemodynamic effects of brief alteration in arterial oxygenation in preterm infants with respiratory failure. METHODS: Eighteen preterm infants with respiratory failure, aged 9-76 hours, underwent detailed Doppler echocardiographic assessment at 86%, 96%, and 100% SaO2, achieved by altering the FIO2. Sixteen were receiving intermittent positive pressure ventilation, median FIO2 0.45 (0.20-0.65), median mean airway pressure 12 cm H2O (0-20). SaO2 was stable for 15 minutes at each stage. Four parameters of pulmonary arterial pressure were measured: peak velocity of tricuspid regurgitation and peak velocity of left to right ductal flow, TPV:RVET ratio and PEP:RVET ratio, measured at the pulmonary valve, along with flow velocity integrals at the aortic and pulmonary valves, and systemic arterial pressure. Ductal size was graded into closed, small, moderate, large with imaging, pulsed and continuous wave Doppler. RESULTS: Between 86% and 96% SaO2, there were no consistent changes, but in three of the 12 with a patent ductus arteriosus (PDA) there was ductal constriction, with complete closure in one. Between 96% and 100% SaO2, peak ductal flow velocity rose significantly in four of eight with a PDA. Ductal constriction occurred in four infants; in three this was associated with a significant fall in aortic flow integral and a rise in aortic pressure (4-6 mm Hg). Overall, 11 infants went from 86% to 100% SaO2 and pulmonary arterial pressure fell significantly in seven. CONCLUSION: A brief rise in SaO2 within the range maintained by most neonatal units can cause significant ductal constriction. The fall in pulmonary arterial pressure with 100% SaO2 seen in most infants was associated with a fall in pulmonary blood flow (or no change), rather than a rise, indicating that the dominant haemodynamic effect was ductal constriction rather than pulmonary vasodilation. (+info)Pneumothorax in the newborn. Changing pattern. (4/100)
The clinical course of pneumothorax and its allied conditions was studied in 34 newborn infants who presented over a 2 1/2-year period. We found an overall incidence of 3/1000 live births. 11 term infants without obvious pulmonary pathology presented early (9 within minutes of birth); 6 of these had aspirated meconium or blood. The remaining 23 were preterm infants with hyaline membrane disease (HMD) and accounted for 68% of the infants in this series. In contrast, they presented late (mean 45 hours) and 16 were on continuous distending pressure (CDP) or intermittent positive pressure ventilation (IPPV) at the onset of pneumothorax. 15% of all infants with HMD who required CDP/IPPV developed pneumothorax; this increased incidence was most evident in infants who received CDP only. All except 2 of the 11 term infants in the first group were managed conservatively and all survived. Wehn pneumothorax occurred as a complication of HMD in preterm infants, 14 of the 16 infants required intrapleural drainage. Persistence or recurrence of pneumothorax occurred in 9 infants, 7 of whom were receiving CDP/IPPV at the time. Lung expansion was affected only after replacement with a patent chest drain through the same incision or insertion of a second drain on the same side of the chest. All 5 deaths occurred in the group of preterm infants with HMD. 3 resulted directly form respiratory failure due to severe HMD complicated by pneumothorax. We emphasize the increasing importance of pneumothorax as a complication of HMD in preterm infants, particularly in those receiving CDP. Successful management depends on prompt diagnosis and treatment of pneumothorax, which may occur as unexplained sudden deterioration at any time during the course of illness in this group of high risk infants. (+info)Early neonatal hypocalcaemia. (5/100)
In our hospital early neonatal hypocalcaemia is now the major cause of low serum calcium in the neonatal period. Over a 2-year period, only 2 cases of hypocalcaemic convulsions were seen in a total of 8700 deliveries, though 51 infants had early neonatal hypocalcaemia. All sick low birth-weight infants should have daily serum calcium estimations carried out. Calcium supplements should be considered if symptoms of hypocalcaemia are present. (+info)Neonatal pneumopericardium. (6/100)
SUMMARY: Pneumopericardium developed in three newborn infants, including a set of twins, with respiratory distress syndrome. The rarity of this condition and its occurrence in two newborns suggest an anatomic predisposition, especially in premature infants requiring assisted ventilation. Two of the infants died; one had undergone pericardiocentesis. From a review of the literature and from our cases we conclude that conservative therapy appears warranted in cases of isolated pneumopericardium although the number of cases reported is too small to provide a definite answer. (+info)Primary peritonitis in infancy and childhood. (7/100)
Primary peritonitis, rarely diagnosed preoperatively, is an uncommon disease accounting for 2.1% of all pediatric abdominal emergencies. It is often associated with urinary or hepatic pathology, the former the source of the infecting organism in the majority of cases, and presents with characteristic symptoms depending upon whether it occurs in infancy or childhood. The symptoms and signs which allow for a positive prospective diagnosis are illustrated by comparing this disease to those entities with which it is most often confused, e.g. diffuse peritonitis of other etiologies, and include a short duration of symptoms, associated urinary tract infection and an absence of free air on abdominal roentgenograms. In the past, gram positive organisms were the most common infecting agent; however, in this series gram negative bacteria accounted for 69% or the organisms. Antibiotics with a gram negative spectrum and exploratory laparotomy with appendectomy are the hallmarks of therapy, the latter replaced by abdominal tap only in the patient who satisfies the criteria for primary peritonitis and in whom an associated disease makes the risk of surgery prohibitive. (+info)Lactobacillus acidophilus sepsis in a neonate. (8/100)
Lactobacillus species are non-spore-forming, anaerobic, gram-positive rods that cause disease in immunocompromised adults. Few cases have been described in children. We present the case of a 2-month-old infant who apparently developed Lactobacillus acidophilus sepsis from an infected central venous catheter. Physicians should be aware that although Lactobacillus species rarely cause disease in children, they should be considered a possible pathogen when isolated from the blood of a newborn infant. (+info)Hyaline Membrane Disease (HMD) is a medical condition primarily seen in newborns, also known as Infant Respiratory Distress Syndrome (IRDS). It's characterized by the presence of hyaline membranes, which are made up of proteins and cellular debris, on the inside surfaces of the alveoli (air sacs) in the lungs.
These membranes can interfere with the normal gas exchange process, making it difficult for the newborn to breathe effectively. The condition is often associated with premature birth, as the surfactant that coats the inside of the lungs and keeps them inflated isn't fully produced until around the 35th week of gestation.
The lack of sufficient surfactant can lead to collapse of the alveoli (atelectasis), inflammation, and the formation of hyaline membranes. HMD is a significant cause of morbidity and mortality in premature infants, but with early detection and proper medical care, including the use of artificial surfactant, oxygen therapy, and mechanical ventilation, many babies can recover.
Tolazoline is a medication that acts as an alpha-adrenergic antagonist and a weak peripheral vasodilator. It is primarily used in the treatment of digital ischemia, which is a lack of blood flow to the fingers or toes, often caused by diseases such as scleroderma or Raynaud's phenomenon. Tolazoline works by relaxing the blood vessels and improving blood flow to the affected areas.
It is important to note that the use of tolazoline is limited due to its potential for causing serious side effects, including hypotension (low blood pressure), tachycardia (rapid heart rate), and cardiac arrhythmias (irregular heart rhythms). Therefore, it should only be used under the close supervision of a healthcare provider.
A newborn infant is a baby who is within the first 28 days of life. This period is also referred to as the neonatal period. Newborns require specialized care and attention due to their immature bodily systems and increased vulnerability to various health issues. They are closely monitored for signs of well-being, growth, and development during this critical time.
'Hyalin' is not a medical condition or disease, but rather a histological term used to describe a particular type of tissue structure. Hyalin refers to the homogeneous, translucent, and eosinophilic (pink) appearance of a tissue under a microscope due to the accumulation of an amorphous, acellular, and protein-rich matrix.
Hyalinization can occur in various tissues, including blood vessels, cardiac valves, cartilage, and other connective tissues. It is often associated with aging, injury, inflammation, or degenerative changes, such as those seen in hyaline membrane disease (a respiratory disorder in premature infants) or hypertrophic cardiomyopathy (thickening of the heart muscle).
In summary, Hyalin is a histological term used to describe the appearance of tissue under a microscope due to the accumulation of an amorphous, acellular, and protein-rich matrix.
"Fetal organ maturity" refers to the stage of development and functional competency of the various organs in a fetus. It is the point at which an organ has developed enough to be able to perform its intended physiological functions effectively and sustainably. This maturity is determined by a combination of factors including structural development, cellular differentiation, and biochemical functionality.
Fetal organ maturity is a critical aspect of fetal development, as it directly impacts the newborn's ability to survive and thrive outside the womb. The level of maturity varies among different organs, with some becoming mature earlier in gestation while others continue to develop and mature until birth or even after.
Assessment of fetal organ maturity is often used in clinical settings to determine the optimal time for delivery, particularly in cases where there are risks associated with premature birth. This assessment typically involves a combination of imaging studies, such as ultrasound and MRI, as well as laboratory tests and physical examinations.
A premature infant is a baby born before 37 weeks of gestation. They may face various health challenges because their organs are not fully developed. The earlier a baby is born, the higher the risk of complications. Prematurity can lead to short-term and long-term health issues, such as respiratory distress syndrome, jaundice, anemia, infections, hearing problems, vision problems, developmental delays, and cerebral palsy. Intensive medical care and support are often necessary for premature infants to ensure their survival and optimal growth and development.
Pulmonary surfactants are a complex mixture of lipids and proteins that are produced by the alveolar type II cells in the lungs. They play a crucial role in reducing the surface tension at the air-liquid interface within the alveoli, which helps to prevent collapse of the lungs during expiration. Surfactants also have important immunological functions, such as inhibiting the growth of certain bacteria and modulating the immune response. Deficiency or dysfunction of pulmonary surfactants can lead to respiratory distress syndrome (RDS) in premature infants and other lung diseases.
Artificial respiration is an emergency procedure that can be used to provide oxygen to a person who is not breathing or is breathing inadequately. It involves manually forcing air into the lungs, either by compressing the chest or using a device to deliver breaths. The goal of artificial respiration is to maintain adequate oxygenation of the body's tissues and organs until the person can breathe on their own or until advanced medical care arrives. Artificial respiration may be used in conjunction with cardiopulmonary resuscitation (CPR) in cases of cardiac arrest.
Anti-glomerular basement membrane (anti-GBM) disease, also known as Goodpasture's disease, is a rare autoimmune disorder in which the body produces antibodies that attack the glomerular basement membrane (GBM), a component of the filtering units (glomeruli) in the kidneys. This leads to inflammation and damage to the glomeruli, causing hematuria (blood in urine), proteinuria (protein in urine), and potentially kidney failure. In some cases, anti-GBM disease may also affect the lungs, leading to coughing up blood (hemoptysis). The exact cause of anti-GBM disease is not fully understood, but it is believed to be related to both genetic and environmental factors. Treatment typically involves a combination of immunosuppressive therapy and plasma exchange.
A "premature infant" is a newborn delivered before 37 weeks of gestation. They are at greater risk for various health complications and medical conditions compared to full-term infants, due to their immature organ systems and lower birth weight. Some common diseases and health issues that premature infants may face include:
1. Respiratory Distress Syndrome (RDS): A lung disorder caused by the lack of surfactant, a substance that helps keep the lungs inflated. Premature infants, especially those born before 34 weeks, are at higher risk for RDS.
2. Intraventricular Hemorrhage (IVH): Bleeding in the brain's ventricles, which can lead to developmental delays or neurological issues. The risk of IVH is inversely proportional to gestational age, meaning that the earlier the infant is born, the higher the risk.
3. Necrotizing Enterocolitis (NEC): A gastrointestinal disease where the intestinal tissue becomes inflamed and can die. Premature infants are at greater risk for NEC due to their immature digestive systems.
4. Jaundice: A yellowing of the skin and eyes caused by an accumulation of bilirubin, a waste product from broken-down red blood cells. Premature infants may have higher rates of jaundice due to their liver's immaturity.
5. Infections: Premature infants are more susceptible to infections because of their underdeveloped immune systems. Common sources of infection include the mother's genital tract, bloodstream, or hospital environment.
6. Anemia: A condition characterized by a low red blood cell count or insufficient hemoglobin. Premature infants may develop anemia due to frequent blood sampling, rapid growth, or inadequate erythropoietin production.
7. Retinopathy of Prematurity (ROP): An eye disorder affecting premature infants, where abnormal blood vessel growth occurs in the retina. Severe ROP can lead to vision loss or blindness if not treated promptly.
8. Developmental Delays: Premature infants are at risk for developmental delays due to their immature nervous systems and environmental factors such as sensory deprivation or separation from parents.
9. Patent Ductus Arteriosus (PDA): A congenital heart defect where the ductus arteriosus, a blood vessel that connects two major arteries in the fetal heart, fails to close after birth. Premature infants are at higher risk for PDA due to their immature cardiovascular systems.
10. Hypothermia: Premature infants have difficulty maintaining body temperature and are at risk for hypothermia, which can lead to increased metabolic demands, poor feeding, and infection.
Gestational age is the length of time that has passed since the first day of the last menstrual period (LMP) in pregnant women. It is the standard unit used to estimate the age of a pregnancy and is typically expressed in weeks. This measure is used because the exact date of conception is often not known, but the start of the last menstrual period is usually easier to recall.
It's important to note that since ovulation typically occurs around two weeks after the start of the LMP, gestational age is approximately two weeks longer than fetal age, which is the actual time elapsed since conception. Medical professionals use both gestational and fetal age to track the development and growth of the fetus during pregnancy.
Respiratory Distress Syndrome (RDS), Newborn is a common lung disorder in premature infants. It occurs when the lungs lack a substance called surfactant, which helps keep the tiny air sacs in the lungs open. This results in difficulty breathing and oxygenation, causing symptoms such as rapid, shallow breathing, grunting noises, flaring of the nostrils, and retractions (the skin between the ribs pulls in with each breath). RDS is more common in infants born before 34 weeks of gestation and is treated with surfactant replacement therapy, oxygen support, and mechanical ventilation if necessary. In severe cases, it can lead to complications such as bronchopulmonary dysplasia or even death.
Hyaline cartilage is a type of cartilaginous tissue that is primarily found in the articulating surfaces of bones, ribcage, nose, ears, and trachea. It has a smooth, glassy appearance (hence the name "hyaline," derived from the Greek word "hyalos" meaning glass) due to the presence of type II collagen fibers that are arranged in a precise pattern and embedded in a proteoglycan-rich matrix.
The high concentration of proteoglycans, which are complex molecules made up of a protein core and glycosaminoglycan side chains, gives hyaline cartilage its firm yet flexible properties. This type of cartilage is avascular, meaning it does not contain blood vessels, and receives nutrients through diffusion from the surrounding synovial fluid in joints or adjacent tissues.
Hyaline cartilage plays a crucial role in providing structural support, reducing friction between articulating bones, and facilitating smooth movement in joints. It also serves as a template for endochondral ossification, a process by which long bones grow in length during development.
Low birth weight is a term used to describe babies who are born weighing less than 5 pounds, 8 ounces (2,500 grams). It's often defined as a birth weight of 2,499 grams or less. This can be further categorized into very low birth weight (less than 1,500 grams) and extremely low birth weight (less than 1,000 grams). Low birth weight is most commonly caused by premature birth, but it can also be caused by growth restriction in the womb. These babies are at risk for numerous health complications, both in the short and long term.
A lung is a pair of spongy, elastic organs in the chest that work together to enable breathing. They are responsible for taking in oxygen and expelling carbon dioxide through the process of respiration. The left lung has two lobes, while the right lung has three lobes. The lungs are protected by the ribcage and are covered by a double-layered membrane called the pleura. The trachea divides into two bronchi, which further divide into smaller bronchioles, leading to millions of tiny air sacs called alveoli, where the exchange of gases occurs.
A cerebral hemorrhage, also known as an intracranial hemorrhage or intracerebral hemorrhage, is a type of stroke that results from bleeding within the brain tissue. It occurs when a weakened blood vessel bursts and causes localized bleeding in the brain. This bleeding can increase pressure in the skull, damage nearby brain cells, and release toxic substances that further harm brain tissues.
Cerebral hemorrhages are often caused by chronic conditions like hypertension (high blood pressure) or cerebral amyloid angiopathy, which weakens the walls of blood vessels over time. Other potential causes include trauma, aneurysms, arteriovenous malformations, illicit drug use, and brain tumors. Symptoms may include sudden headache, weakness, numbness, difficulty speaking or understanding speech, vision problems, loss of balance, and altered level of consciousness. Immediate medical attention is required to diagnose and manage cerebral hemorrhage through imaging techniques, supportive care, and possible surgical interventions.
A very low birth weight (VLBW) infant is a baby born weighing less than 1500 grams (3 pounds, 5 ounces). This category includes babies who are extremely preterm (born at or before 28 weeks of gestation) and/or have intrauterine growth restriction. VLBW infants often face significant health challenges, including respiratory distress syndrome, brain bleeds, infections, and feeding difficulties. They may require extended hospital stays in the neonatal intensive care unit (NICU) and have a higher risk of long-term neurodevelopmental impairments compared to infants with normal birth weights.
Perinatology is a subspecialty of maternal-fetal medicine in obstetrics that focuses on the care of pregnant women and their unborn babies who are at high risk for complications due to various factors such as prematurity, fetal growth restriction, multiple gestations, congenital anomalies, and other medical conditions.
Perinatologists are trained to provide specialized care for these high-risk pregnancies, which may include advanced diagnostic testing, fetal monitoring, and interventions such as c-sections or medication management. They work closely with obstetricians, pediatricians, and other healthcare providers to ensure the best possible outcomes for both the mother and the baby.
Perinatology is also sometimes referred to as "maternal-fetal medicine" or "high-risk obstetrics."