Inhaled nitric oxide reduces the extent to which extracorporeal membrane oxygenation is needed in neonates with hypoxemic respiratory failure and pulmonary hypertension.

Among premature newborns with respiratory failure, low-dose inhaled nitric oxide did not reduce the overall incidence of bronchopulmonary dysplasia, except among infants with a birth weight of at least 1000 g, but it did reduce the overall risk of brain injury. (ClinicalTrials.gov number, NCT00006401 [ClinicalTrials.gov].).

No abstract

Extracorporeal membrane oxygenation (ECMO) has been used in more than 1,000 infants in 50 centers in the United States. The extracorporeal circuit contains approximately 400 ml of blood, an amount exceeding the blood volume of most full-term neonates. The effect of this additional blood volume on drug disposition is unknown. In this study, we determined the pharmacokinetic parameters of gentamicin in 10 infants on ECMO. Gentamicin concentrations were determined by a fluorescence polarization immunoassay. Pharmacokinetic parameters were determined from these concentrations by using a two-compartment model. Our study demonstrated a mean steady-state volume of distribution of 0.51 ± 0.11 liters/kg, a figure similar to that in previous studies of full-term infants. The elimination half-life was found to be prolonged (mean, 573 ± 263 min). The creatinine level in the plasma of the infants was found to be a statistically significant predictor of elimination half-life. Recommendations regarding initial dosing levels of gentamicin in infants on ECMO are made.Extracorporeal membrane oxygenation (ECMO) is a process involving prolonged partial cardiopulmonary bypass which is used to support life in infants dying of reversible cardiopulmonary disease. The technique has been used in more than 1,000 infants in 50 centers in the United States, with approximately 80% surviving (2). During ECMO, blood is drained from the right atrium, pumped through a silicon membrane oxygenator, rewarmed, and then returned to the aortic arch of the infant. The extracorporeal circuit contains approximately 400 ml of blood, an amount exceeding the blood volume of most full-term neonates (9). The effect of this additional volume on drug disposition (distribution and elimination) is not known. If drug disposition is substantially altered in infants on ECMO, standard drug dosages and dosing intervals may not be appropriate in these infants.The purposes of this study were to determine the pharmacokinetics of gentamicin in infants on ECMO and to formulate an approach to gentamicin dosing regimens for this group of babies.

Lactobezoar is a compact mass of undigested milk concretions located within the gastrointestinal tract. Most often found in infants, they can precipitate gastric outlet obstruction, mimicking a variety of medical and surgical conditions. A common etiology and method of cure have yet to be elucidated. A review of the literature provides some insight into causes, clinical presentations, diagnosis, and management. Data from the Medical University of South Carolina further help dispel the belief that lactobezoars are isolated to pre-term infants on caloric-dense formulas. Findings suggest bezoar formation may be more common than previously thought and a high index of suspicion could help avoid costly evaluations for obstructive symptoms.