Ventilation For Respiratory Distress Research Articles

Subcutaneous fat necrosis (SCFN) secondary to therapeutic hypothermia with persistent leucocytosis in a neonate

We report a term male neonate, born to consanguineous parents through a difficult labour who needed resuscitation at birth, followed by ventilation for respiratory distress. In view of suspected Hypoxic Ischemic Injury, he was started on whole body cooling for 72 hours. He was treated as suspected sepsis with 5 days of intravenous antibiotics. On day 6, he was noted to have hard, painless skin nodules of his back and left arm which was clinically diagnosed as subcutaneous fat necrosis. His serum calcium and phosphate levels remained normal throughout hospital stay. His full blood counts and bone profile were monitored regularly. During follow-up at 6 weeks, his white cell counts continued to be high with 69% lymphocytes. To our knowledge, this is the first case of SCFN of a neonate associated with persistent leucocytosis. Haematological and metabolic complications should be closely monitored in a neonate with subcutaneous fat necrosis.

Case 1: Secondary Structural Cause of Tachypnea Following Congenital Diaphragmatic Hernia Repair in a Term Neonate

A 39-3/7 weeks’ gestation male infant is born to a 29-year-old gravida 1 para 0 woman via urgent cesarean delivery due to failed induction. Prenatal laboratory tests yielded unremarkable results. Rupture of membranes is for 7 days. Apgar scores are 3, 6, and 8 at 1, 5, and 10 minutes, respectively. In the delivery room, the baby requires positive pressure ventilation for respiratory distress. Initial chest radiography reveals a possible diaphragmatic hernia (Fig 1). The patient is intubated for respiratory distress and placed on a conventional ventilator. After placement of umbilical catheters, the infant is transferred to the NICU for further care. Repeat chest radiography reveals bowel-containing diaphragmatic hernia, stomach visible below the diaphragm, and a crescent opacity in the left upper lung field suggestive of a herniated spleen. Initial echocardiography on postnatal day 2 reveals abnormal ventricular septal motion but no significant tricuspid regurgitation consistent with pulmonary hypertension. The patient is taken to the operating room for repair, reduction, and primary closure of the hernia (Fig 2). Following surgery, the patient is weaned to continuous positive airway pressure on postnatal day 4 and subsequently weaned to room air on postnatal day 6. Figure 1. Chest radiograph revealing a possible diaphragmatic hernia, with the stomach visible below the diaphragm. Figure 2. Chest radiograph status post repair of the left diaphragmatic hernia. Seven days after birth, the patient develops tachypnea during feeding without retractions or desaturations, prompting another chest radiograph. ### Diagnosis The chest radiograph revealed retrocardiac opacity suspicious for a pulmonary sequestration. Chest ultrasonography followed by magnetic resonance imaging/magnetic resonance angiography confirmed the diagnosis of pulmonary sequestration (Figs 3 and 4). The size of the pulmonary sequestration was 4.5 cm anteroposterior × 2.8 cm transverse × 3.6 cm craniocaudal. Figure 3. Magnetic resonance imaging showing …

Atypical acute respiratory disorder in late preterm and term newborn infants

Objective: We were to describe the clinical characteristics of late preterm and term newborn infants who needed invasive or non-invasive ventilation for respiratory distress but did not meet the diagnostic criteria of common neonatal respiratory disorders (atypical acute respiratory disorder; aRD). Methods: We retrospectively reviewed electronic medical records of 242 late preterm and term newborn infants born who were admitted to the neonatal intensive care unit for acute respiratory distress developed within 24 h after birth. Results: Newborn infants with aRD had significantly higher mean, maximum blood PCO2 levels and maximum FiO2 levels during the first 72 h after birth than infants with transient tachypnea of the newborn (TTN). Total periods of oxygen supplementation of the infants with aRD were significantly longer than those of infants with TTN, but shorter than those of the infants with meconium aspiration syndrome (MAS). Conclusions: Except for definite diagnosis, higher oxygen need and PCO2 level on blood gas analysis during the initial period of their respiratory illness may be able to predict aRD, and these interventions may be able to decrease neonatal respiratory morbidity.

Work of breathing and volume targeted ventilation in respiratory distress

ObjectiveTo determine the level of volume targeting (VT) associated with the lowest work of breathing (WOB) for prematurely born infants being ventilated with acute respiratory distress.DesignProspective study.SettingTertiary neonatal intensive care...

Synchronized ventilation of very-low-birth-weight infants; report of 6 years' experience

Objectives: To evaluate the effects of long-term patient triggered ventilation (PTV) using assist/control or synchronized intermittent mandatory ventilation (SIMV) in very-low-birth-weight infants with respiratory distress.Methods: Ninety-seven very-low-birth-weight infants who had undergone synchronized ventilation for respiratory distress or insufficiency were assessed from January 1995 to December 2000. Death, oxygen support, pneumothorax development while ventilated, intracranial hemorrhage, necrotizing enterocolitis, periventricular leukomalacia, retinopathy of prematurity and duration of ventilation were noted as the mean outcome measures.Results: The mean birth weight was 1139 ± 268 g (range 450–1500 g) and the mean gestational age was 29.0 ± 2.8 weeks (range 23–36 weeks). Eighty-four per cent of 97 infants survived. Antenatal steroids were administered to only 20% of mothers. Surfactant was administered to all of the 67% of infants with respiratory distress syndrome. The mean duration of ventilator support was 4.7 ± 7.3 days (1–43 days) for survivors and 8.9 ± 11 days (1–45 days) for infants who died. No respiratory paralysis was necessary in any case during ventilation and pneumothorax was diagnosed in only eight infants. Severe intracranial hemorrhage (grade ⩾ III) and periventricular leukomalacia developed in 15% and 12% of infants, respectively. Necrotizing enterocolitis (Bell's classification stage ⩾ 2) and retinopathy of prematurity were noted in two infants. Four infants had evidence of chronic lung disease. The rate of survival without major morbidity was 83.5%.Conclusion: Patient-triggered ventilation, initially PTV with Asist/Control and subsequently with SIMV in very-low-birth-weight infants with respiratory distress is feasible, but optimization of trigger and ventilator performance with respect to respiratory diagnosis is essential.