Umbilical vascular catheters are often necessary in the care of critically ill neonates. Position of the catheter tip is usually determined by roentgenography. Location of the umbilical arterial or venous catheter was determined by 2-dimensional echocardio/aortography in 55 consecutive infants and was compared to localization by thoraco-abdominal roentgenography. Most of the infants (76%) had respiratory distress syndrome or congenital heart disease. Echocaortographic localization of the umbilical arterial catheter correlated very closely (N = 50, sr = .90) with roentgenographic determination. For localization of the tip of the umbilical venous catheters, echocardiography was more accurate than roentgenography (employing contrast echocardiography for confirmation of cardiac chamber position). Two-dimensional echocardio/aortographic localization of the tip of indwelling umbilical vascular catheters is as accurate as roentgenography in the arterial system and more accurate than x-ray for umbilical venous catheters. Echocardio/aortography is superior to roentgenography (in localizing the catheter tip) because it 1) avoids ionizing radiation, 2) makes positioning of the patient unnecessary, 3) allows visualization of the catheter in relation to cardiovascular structures, and 4) may allow demonstration of intraarterial thrombo-emboli.
A detailed retrospective analysis was made of 2329 preterm infants who accounted for 1 1 per cent of all births during 1974 and 1975 in the Peninsula Maternity Services, Cape Town. Whereas preterm delivery did not contribute to perinatal mortality in terms of stillbirth (more than 90 per cent occurred before labour), it exceeded all other causes in terms of early neonatal death. Preterm birth was responsible for 81 per cent of early neonatal mortality not attributable to lethal deformities. Early neonatal mortality rates were closely linked to both gestational age and birth weight and to the reason for preterm birth. The rate was high (109.8 per 1000) when preterm labour was spontaneous and without obvious maternal or fetal disease, but relatively low (56.5 per 1000) when preterm delivery was elective. Growth retardation, particularly, was associated with a relatively low neonatal mortality. It is suggested that more emphasis should be placed on the assessment of surface active phospholipids in amniotic fluid in the management of preterm labour. And since most early neonatal deaths were linked to spontaneous preterm delivery of uncertain aetiology, the pathophysiology of premature labour is in urgent need of further investigation.
Circulating platelets have been implicated in the hypoxic pulmonary pressor response. This study was undertaken to assess the effects of acute hypoxia-induced pulmonary hypertension on platelet volume and number across the pulmonary circulation in anesthetized newborn lambs. Seven animals were instrumented for measurement of pulmonary vascular resistance. All measurements were made during normoxia and after 5 and 30 minutes of hypoxia (10 to 12% oxygen breathing). Hypoxia caused a doubling of the pulmonary vascular resistance. During hypoxic vasoconstriction, platelet volume decreased rapidly while traversing the lung but was not affected on return to the lung after traversing the systemic circulation. Platelet numbers were unchanged on leaving the lung but were decreased on entering the lung during hypoxia. Our data are consistent with the release of platelet contents in the lung during hypoxic pulmonary hypertension.
CASE REPORT The patient was a 2800-g black girl delivered by primary cesarean section because of fetal distress and meconium aspiration after 42 weeks' gestation. Her mother's pregnancy had been complicated by cocaine use. The baby's Apgar score was 5 at 1 minute and 7 at 5 minutes. Maternal and neonatal urine toxicology screens were positive for cocaine, and the infant was treated with phenobarbital because of withdrawal symptoms. She was transferred to Children's Hospital and Health Center for treatment of CO2 retention and probable meconium aspiration syndrome. She was mechanically ventilated, and an umbilical artery catheter was inserted. The infant improved and was extubated after 4 days; the umbilical catheter was removed on day 8 of life. She did well until 11 days of life when she became tachypneic and acidotic with a systemic blood pressure of 130/106 mm Hg.
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