Gas In Infants Research Articles

Capillary blood gas in infants with bronchiolitis: Can end-tidal capnography replace it?

To explore the predictive ability of capillary blood gas (CBG) pCO2 for respiratory decompensation in infants aged ≤6 months with bronchiolitis admitted from the emergency department; to determine whether end-tidal CO2 (etCO2) capnography can serve as a less invasive substitute for CBG pCO2. This was a prospective cohort study of previously healthy infants aged ≤6 months admitted for bronchiolitis from the emergency department (ED). Initial CBG pCO2 and etCO2 capnography were obtained in the ED prior to inpatient admission. Simple logistic regression modeling was used to examine the associations of CBG pCO2 and etCO2 capnography with respiratory decompensation. Pearson's correlation measured the relationship between CBG pCO2 and etCO2 capnography. Of 134 patients, 61 had respiratory decompensation. There was a significant association between CBG pCO2 and respiratory decompensation (OR = 1.07, p = 0.003), even after outlying values were excluded (OR = 1.06, p = 0.005). End tidal CO2 capnography was not significantly associated with decompensation (OR = 1.02, p = 0.17), even after outlying values were excluded (OR = 1.02, p = 0.24). There was a moderate correlation between etCO2 capnography and CBG pCO2 (r = 0.39, p < 0.001). In infants with bronchiolitis, CBG pCO2 provides an objective measure for predicting respiratory decompensation, and a single etCO2 measurement should not replace its use.

Portal gas in neonates; is it always surgical? A case report.

BACKGROUNDHepatic portal venous gas in infants is frequently due to late presentation of necrotizing enterocolitis which is considered a relative indicator for surgical intervention.CASE SUMMARYA preterm baby underwent an umbilical catheter placement and discovered in abdominal radiograph to have air in the portal venous system due to malpositioning of the umbilical catheter.CONCLUSIONHepatic portal venous gas in infants without signs of necrotizing enterocolitis could result from malposition of umbilical venous catheter, and in that case, should be managed medically, with no need for surgical intervention.

Incidence and importance of portal venous gas in children with hypertrophic pyloric stenosis.

Hypertrophic pyloric stenosis (HPS) is a common cause of gastric outlet obstruction in young infants. Infants with HPS present with projectile vomiting, sometimes have electrolyte abnormalities and typically undergo pyloromyotomy to alleviate the obstruction. Abdominal US is the gold standard imaging study for diagnosis. Case reports of incidental hepatic portal venous gas have been reported in infants with HPS; however, no large studies have been conducted to determine the incidence or possible clinical implications of this finding. To assess the incidence of portal venous gas in infants with HPS and to determine whether the presence of this gas in infants with HPS indicates a more unstable patient, increased length of stay or worse outcome. We conducted a retrospective review of sonographic reports containing "pyloric stenosis," excluding negative descriptor, at a tertiary-care children's hospital from November 2010 to September 2017. Data collected included pyloric thickness/length, liver evaluation, portal venous gas, any additional imaging, demographics, symptomatology days, electrolyte abnormality, and length of hospital stay. In a 7-year period, 545 US exams were positive for HPS. Of these, 334 exams included enough hepatic parenchyma to evaluate for portal venous gas. Infants in 6 of the 334 exams demonstrated portal venous gas (1.8%). Clinical presentation (length of symptoms and electrolyte abnormalities), demographics (male predominance and age at presentation) and imaging characteristics (pyloric thickness and length) were similar for the HPS groups with and without portal venous gas. There was no significant difference in outcome or length of hospital stay. Visualization of portal venous gas in infants with HPS is not rare and appears benign, without need for further imaging. Portal venous gas in infants with HPS does not portend a more severe patient presentation or outcome.

2068783 Overly Bright Echoes Sign for HPS: Gastric Pneumatosis and Portal Venous Gas in Infants: The Combination Suggests Hypertrophic Pyloric Stenosis

2068783 Overly Bright Echoes Sign for HPS: Gastric Pneumatosis and Portal Venous Gas in Infants: The Combination Suggests Hypertrophic Pyloric Stenosis

Dietary treatment of colic caused by excess gas in infants: Biochemical evidence

To evaluate the impact of feeding colicky infants with an adapted formula on the hydrogen breath test and clinical symptoms. Hydrogen expiration was measured by SC MicroLyzer gas chromatography at inclusion and 15 d after treatment with an adapted low-lactose formula in 20 colicky infants. All babies were symptomatic: 85% with excess gas, 75% with abnormal feeding pattern, and 85% with excessive crying. The hydrogen breath test at inclusion was abnormal: 35 ± 3.1 ppm. After 15 d feeding with an adapted low-lactose formula, crying and flatulence decreased in 85% of patients (P < 0.001). For infants in whom no decrease of gas was reported, crying was still reduced (P < 0.01). Moreover, the feeding pattern was improved in 50% of infants when it was initially considered as abnormal. Finally, the hydrogen breath test decreased significantly (10 ± 2.5 ppm, P < 0.01). This study showed an association between clinical improvement and evidence of decreased levels of hydrogen when the infants were fed with a specially designed, low-lactose formula.

The temperature and humidity of inspired gases in infants using a pediatric circle system: effects of high and low‐flow anesthesia

The effects of low-flow anesthesia on the temperature and humidity of the inspired gas in infants during mechanical ventilation is unknown. This study was designed to evaluate the temperature and humidity of the inspired gas in infants using a pediatric circle absorber system with high and low fresh gas flow (HFGF and LFGF) anesthesia. Twenty infants participated in this observational, sequential, cross-over study. Each infant was mechanically ventilated with a Kion Anesthesia Workstation, using a pediatric anesthesia circle circuit with both HFGF (6 l.min(-1)) and LFGF (0.6 l.min(-1)) technique. Airway temperature was recorded continuously at 16 sites throughout the breathing circuit. The relative humidity of the inspired gas was measured at the elbow connector adjacent to the CO2 sampling line. The mean airway temperatures of the inspired gas and the changes in mean airway temperatures throughout the breathing circuit during HFGF and LFGF did not differ significantly. The mean relative humidity of the inspired gas at steady state using a LFGF technique, 33.7 +/- 3.6%, was approximately threefold greater than it was with a HFGF technique, 11.9 +/- 5.1% (P < 0.05). Low-flow anesthesia with a pediatric circle system in infants neither increases the temperature of the inspired gas, nor achieves the minimum humidity of 50% reported to prevent ciliary damage, although the humidity during LFGF did increase threefold compared with HFGF. To maintain the temperature and humidity of the inspired gas during mechanical ventilation in infants, passive or active gas humidification should be used.

Method for assessment of volume of trapped gas in infants during multiple-breath inert gas washout.

A breath-by-breath inert gas washout method for assessment of the volume of trapped gas in the lungs (V(TG)) in sedated sleeping infants is described. It is based on washin using a gas mixture containing 4% sulfur hexafluoride (V(TG,SF6)) and washout with air. A mass spectrometer was used for continuous gas concentration measurements, and a Fleisch no. 0 pneumotachometer for flow measurement. When equilibration of the tracer gas was achieved with tidal breathing washin, five passive inflations with a maximum positive airway pressure of 20 cm of H(2)O were performed to ensure filling of lung spaces not communicating during tidal breathing. After tidal washout of the tracer gas by air until the end-tidal concentration was 1/40th of its starting concentration, five passive inflations with air were instituted again. The V(TG,SF6) was calculated from the volume of SF(6) mobilized by these large breaths, and expressed as the corresponding volume of air. Triplets of V(TG,SF6) determination in 8 infants aged 9-31 months with varying degrees of airway obstruction showed an average volume of 13.7 mL (range, 4.7-25.0). The average SD of the triplets was 2.1 mL (range, 0.1-5.5 mL). Subjects with high V(TG,SF6)/FRC results demonstrated lower maximal expiratory flow at FRC (V'(max)FRC) results (Z-scores) and greater inhomogeneity of ventilation distribution than those with low trapped gas volumes. It is concluded that gas trapping can be assessed with acceptable precision with this washout method. Further studies are needed to establish the sensitivity and usefulness of the method in infants with various types of airway pathology.

Effect of mivacurium 200 and 250 &mgr;g/kg in infants during isoflurane anesthesia: a randomized controlled trial [ISRCTN07742712

BackgroundInfants usually respond differently to a neuromuscular relaxant compared to children or adults. Isoflurane is commonly used as an anesthetic gas in infants. In an RCT design, we investigated whether a dose of mivacurium 250 μg/kg results in faster onset of action than 200 μg/kg in infants under isoflurane anesthesia. Spontaneous recovery times and cardiovascular response were also evaluated.MethodsTwenty-four low surgical risk children, aged 6–24 months, undergoing an elective surgery and requiring tracheal intubation were selected. After anesthetic induction, patients randomly received an iv bolus dose of mivacurium 200 or 250 μg/kg. After maximal relaxation, the patient was intubated. Isoflurane was administered to maintain anesthetic level during the surgical procedure. Neuromuscular function was monitored by accelerometry (TOF-Guard) at the adductor pollicies. The first twitch (T) of the TOF and the T4/T1 were measured. The time-course of heart rate and systolic and diastolic blood pressure were analysed by transforming them into their respective areas under the curve.ResultsMivacurium 250 μg/kg produced a maximal T block faster than 200 μg/kg, i.e. 2.4 ± 1.1 vs. 3.5 ± 1.4 min (p < 0.05). Spontaneous recovery times were similar in both groups. Heart rate was similar between doses while systolic and diastolic blood pressures were lower with the higher dose (p < 0.05). Flushing was observed in two cases, one in each group.ConclusionsThe maximal effect of mivacurium 250 μg/kg, in infants under isoflurane anesthesia, was present one minute faster than 200 μg/kg. However, it produced a significant cardiovascular response.

Low flow oxygen delivery via nasal cannula to neonates.

Neonates with chronic lung disease often require oxygen in the neonatal intensive care unit. The purpose of this study was to determine (1) the actual inspired oxygen concentration (FiO2) delivered to neonates when using a low-flow flowmeter and a nasal cannula, and (2) the accuracy with which FiO2 could be estimated using a formula that we developed. We studied two groups of infants: 18 infants less than 1,500 g and 13 infants greater than 1,500 g. We measured pharyngeal oxygen levels by sampling pharyngeal gas in infants receiving 100% humidified oxygen by nasal cannula from a low range flow flowmeter. The oxygen flow was increased by 25 mL/min increments from 25 to 200 mL/min. The measured FiO2 was compared with the calculated FiO2 using the formula: [formula: see text] where minute ventilation (VE) equals the minute ventilation in mL/min (VE = VT X respiratory rate). For both groups of infants, increments of 25 mL/min of flow produced distinctive changes in FiO2 at all levels (P < 0.001). The calculated FiO2 did not significantly differ from the actual FiO2 at any flow. The calculated FiO2 was most predictive when using an assumed tidal volume of 5.5 mL/kg. We conclude that an accurate flowmeter connected to 100% humidified oxygen can produce a wide range of predictable FiO2s for neonates, especially those with birthweights of less than 1,500 g. The proposed formula allows useful estimation of the infant's FiO2 when we assume a tidal volume of 5.5 mL/kg.

Sonographic detection of portal venous gas in infants with necrotizing enterocolitis.

A characteristic pattern of hepatic parenchymal and portal venous abnormalities was seen with sonography in 12 infants with necrotizing enterocolitis (NEC). In five cases these changes were seen before any radiographic abnormalities were observed. Sonography of 232 infants without NEC did not show these changes. The sonographic abnormalities are believed to be caused by small amounts of gas within the portal venous system and hepatic parenchyma. Because of the simplicity of the sonographic examination and the sensitivity and specificity of the findings, abdominal sonography may be of great value in the early evaluation of infants suspected of having NEC.

Scanty intestinal gas in infants and children. Clinical significance and radiologic diagnosis.

A material of 23 boys and 18 girls attending as abdominal emergencies and covering the age interval of neonates to 15 years of age had only scanty amounts of intestinal gas on films of the abdomen. A wide variety of underlying abnormalities were revealed, some of them calling for immediate operation. Supplementary contrast examinations were frequently needed in order to establish the diagnosis.

Intramural intestinal gas in infants.

Intramural intestinal gas in infants.

Hepatic portal venous gas in infants without subsequent death.

Hepatic portal venous gas (HPVG) was found in 5 of 87 infants with an umbilical catheter in place. All 5 infants recovered uneventfully. The most likely source of hepatic portal venous gas appears to be inadvertent injection during umbilical venous catheterization or during drug administration through the catheter.

NECROTIZING ENTEROCOLITIS IN THE PREMATURE INFANT.

Necrotizing enterocolitis as a usually fatal disease of premature infants has been reported with increasing frequency in recent years, primarily in Europe (2, 11, 12, 14, 15, 23). Though the published cases have appeared under diverse titles including neonatal appendicitis (4, 18, 22), peritonitis (12), colitis (21), ileitis (1), pneumatosis intestinalis (20), or portal vein gas in infants (10, 24), we feel all reflect a basically similar disease process. The current report is based on a study of 21 cases of enterocolitis in newborn premature infants seen between 1954 and 1964; 7 were found in a six-month period in 1963. A more detailed study of the clinical and pathologic findings will be reported separately (9). Clinical Features More than 2,000 infants were admitted to the premature nursery of The Babies Hospital from 1954 to 1964. Seventeen died of enterocolitis (0.9 per cent), and 4 survived. Usually weighing under 1,500 grams at birth, the babies showed a similar clinical pattern. They seemed well d...

Deficiency of intestinal gas in infants with diarrhea; a presentation of three cases.

The presence of moderate amounts of air in the small bowel loops is a normal finding in infants. The newborn infant swallows air with its first breath, and gas can be demonstrated by roentgenograms in the sigmoid colon usually in two to five hours (6, 14, 15). Complete absence of gas in the small bowel, or in the stomach and small intestine, as shown roentgenographically, is commonly interpreted as a sign of high obstruction and of grave significance. There is little in the literature to indicate that complete absence of gas in the infant bowel occurs under any other circumstances. In 3 cases to be presented here this finding was associated with severe diarrhea and dehydration without any mechanical obstruction. Severe diarrhea with resulting dehydration is not a true disease of infants, but rather a sign accompanying disease. In many instances it can be attributed to specific bacterial or viral causative agents (2–5, 7, 10, 13). As is well known, however, it may be due to parenteral infection elsewhere in the body, septicemia, or a host of other conditions. It is beyond the scope of this paper to delve into the causes of infantile diarrhea, nor is it necessary to emphasize its seriousness. The roentgen findings in infants with diarrhea have not received a great deal of attention in the literature, perhaps because the physical findings are obvious and biochemical studies are the important factors in determining the therapeutic measures and following the progress of the condition. The statement that in severe infantile diarrhea the abdomen is distended and the general picture may resemble ileus is frequently encountered (1, 3, 8). Loops of small bowel distended with gas in infants with diarrhea are commonly seen whenever abdominal films are taken in such cases. We were not familiar, however, with the picture of a relatively gasless abdomen in this condition, and a review of the literature failed to disclose any recorded cases. Case Reports Case I: B. F., an apparently healthy male infant, was born at the University of Minnesota Hospitals. Delivery was uncomplicated. The weight at birth was 3,620 gm.; cry and respiration were spontaneous. During the first thirty-six hours glucose and water feedings were tolerated and a meconium stool was passed. Three days after birth, however, the infant, who up to that time was taking his feedings normally, began to regurgitate all supplements and refused the breast. Two green stools were passed. The weight had fallen to 3,170 gm., and the child showed signs of dehydration and jaundice. The abdomen was flat and soft; peristalsis was thought to be normal. A supine film revealed a small amount of gas in the stomach but none in the small or large intestine (Fig. 1). The picture was that commonly seen in pyloric stenosis or obstruction of the duodenum.