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1.
Purpose
Long-term pulmonary outcomes of congenital diaphragmatic hernia (CDH) have demonstrated airflow obstruction in later childhood. We examined pulmonary function data to assess what factors predict lung function in the first three years of life in children with CDH.Methods
This was a retrospective study of patients treated for CDH who underwent infant pulmonary function testing (IPFT) between 2006 and 2012. IPFT was performed using the raised volume rapid thoracoabdominal compression technique and plethysmography.Results
Twenty-nine neonates with CDH had IPFTs in the first 3 years of life. Their mean predicted survival using the CDH Study Group equation was 63% ± 4%. Fourteen infants (48%) required extracorporeal membrane oxygenation (ECMO). The mean age at IPFT was 85.1 ± 5 weeks. Airflow obstruction was the most common abnormality, seen in 14 subjects. 12 subjects had air trapping, and 9 demonstrated restrictive disease. ECMO (p = 0.002), days on the ventilator (p = 0.028), and days on oxygen (p = 0.023) were associated with restrictive lung disease.Conclusion
Despite following a group of patients with severe CDH, lung function revealed mild deficits in the first three years of life. Clinical markers of increased severity (ECMO, ventilator days, and prolonged oxygen use) are correlated with reduced lung function. 相似文献2.
Rebecca Perry James Stein Guy Young Rangasamy Ramanathan Istvan Seri Laura Klee Philippe Friedlich 《Journal of pediatric surgery》2013
Purpose
To evaluate the effect of Antithrombin III (ATIII) on blood product requirement in neonates receiving extracorporeal membrane oxygenation (ECMO).Methods
A retrospective case control study of neonates presenting with or without congenital diaphragmatic hernia (CDH) requiring ECMO between 2006 and 2010 was performed. Patient demographics, laboratory data, and information on blood products administered were compared in patients treated before (n = 37) and after (n = 38) a protocol for antithrombin-III (ATIII) administration was implemented.Results
During the first three days on ECMO patients with CDH received less fresh frozen plasma (FFP) and platelets after ATIII administration was introduced (78.1 ± 19.2 ml/kg vs. 27.8 ± 6.2 ml/kg, p < 0.007 and 67.8 ± 8.6 ml/kg vs. 47.8 ± 8.4 ml/kg, p = 0.05 respectively), while FFP and platelet administration in patients without CDH was not different between the two periods. Patients both with and without CDH received less packed red blood cell (PRBC) transfusions after the ATIII protocol was introduced (230 ± 51.5 ml/kg vs. 73.8 ± 9.7 ml/kg, p < 0.002 and 173.2 ± 22.2 ml/kg vs. 66.0 ± 6.6 ml/kg, p < 0.001, respectively). Finally, cryoprecipitate administered was not different in patients with and without CDH between the two periods (13 ± 2.9 ml/kg vs. 15.9 ± 7.2 ml/kg, p = NS and 6.1 ± 1.8 ml/kg vs. 3.4 ± 0.6 ml/kg, p = NS, respectively).Conclusions
Introduction of routine ATIII administration was associated with decreases in FFP, platelet, and PRBC exposure in neonates with CDH and decreases in PRBC transfusions in neonates without CDH during the first three days of ECMO support. 相似文献3.
Ayman Y. Khmour Girija G. Konduri Thomas T. Sato Michael R. Uhing Mir A. Basir 《Journal of pediatric surgery》2014
Background/Purpose
Neonates with significant congenital diaphragmatic hernia (CDH) require cardiopulmonary support. Management has been characterized by progressive abandonment of hyperventilation. Ability to prognosticate outcomes using measures of ventilation and oxygenation with gentle ventilation remains unclear. We sought to determine whether assessment of gas exchange at the time of NICU admission is predictive of survival in this current era.Methods
Neonates with CDH admitted to a Children’s Hospital from 1995 to 2006 were evaluated for demographics, blood gas (ABG) measurements and ventilator settings for the first 48 hours, and discharge outcome.Results
One-hundred-and-nineteen CDH patients were admitted, 88 (74%) survived. Mean admission ABG pCO2 was higher in infants who died compared to survivors (86 ± 48 versus 49 ± 20, p ≤ 0.001); positive predictive value (PPV) for mortality of pCO2 ≥ 80 mmHg was 0.71. Mean first hour preductal oxygen saturation (preductalO2Sat) was lower in infants who died compared to survivors (81 ± 17 versus 97 ± 5, p < 0.001); PPV for mortality of preductalO2Sat < 85% was 0.82. Eleven patients met both pCO2 and preductalO2Sat criteria, and 10 (91%) died, PPV of 0.92. Within hours of admission, pCO2 and preductalO2Sat differences between survivors and nonsurvivors lost significance.Conclusion
Admission pCO2 and preductalO2Sat may be useful in predicting survival in neonatal CDH. The differential in gas exchange between survivors and nonsurvivors loses significance with contemporary neonatal care. 相似文献4.
F. Vanhuyse B. Frotscher T. Lecompte P. Maureira J.-P. Villemot T. Folliguet M. Toussaint-Hacquard 《Annales fran?aises d'anesthèsie et de rèanimation》2013
Objective
The purpose of our study is to describe the use of recombinant factor VIIa (rFVIIa) in patients on central veno-arterial ECMO with a particular attention on associated thrombotic complications.Study design
Monocentric retrospective study.Patients and methods
We examined 91 files of patients on ECMO between 2005 and 2010. During this period, eight patients presented refractory bleeding and benefited from rFVIIa treatment.Results
In six of the eight patients, the bleeding stopped. A decrease of the bleeding was noticed after the treatment of rFVIIa (before rFVIIa: 40.1 ± 33.1 mL/kg per 3 hours after rFVIIa: 5.4 ± 3.2 mL/kg per 3 hours (P = 0.01). The transfusional needs were decreased after administration of rFVIIa. No thrombotic event was detected. Fibrinogen, d-dimers, platelet count and lactate were not modified by the treatment. Two patients were weaned from ECMO. One patient died 17 days after the weaning. The other patient survived without neurological damages.Conclusion
The rFVIIa is a treatment of exception for patients on central veno-arterial ECMO and could be a last-resort treatment in the presence of a not curable massive bleeding. 相似文献5.
Emily A. Partridge Christina Bridge Joseph G. Donaher Lisa M. Herkert Elena Grill Enrico Danzer Marsha Gerdes Casey H. Hoffman Jo Ann D’Agostino Judy C. Bernbaum Natalie E. Rintoul William H. Peranteau Alan W. Flake N. Scott Adzick Holly L. Hedrick 《Journal of pediatric surgery》2014
Purpose
The reported incidence of sensorineural hearing loss (SNHL) in long-term survivors of congenital diaphragmatic hernia varies widely in the literature. Conductive hearing loss (CHL) is also known to occur in CDH patients, but has been less widely studied. We sought to characterize the incidence and risk factors associated with SNHL and CHL in a large cohort of CDH patients who underwent standardized treatment and follow-up at a single institution.Methods
We retrospectively reviewed charts of all CDH patients in our pulmonary hypoplasia program from January 2004 through December 2012. Categorical variables were analyzed by Fisher’s exact test and continuous variables by Mann–Whitney t-test (p ≤ 0.05).Results
A total of 112 patients met study inclusion criteria, with 3 (2.7%) patients diagnosed with SNHL and 38 (34.0%) diagnosed with CHL. SNHL was significantly associated with requirement for ECMO (p = 0.0130), prolonged course of hospitalization (p = 0.0011), duration of mechanical ventilation (p = 0.0046), requirement for tracheostomy (p = 0.0013), and duration of loop diuretic (p = 0.0005) and aminoglycoside therapy (p = 0.0003).Conclusions
We have identified hearing anomalies in over 30% of long-term CDH survivors. These findings illustrate the need for routine serial audiologic evaluations throughout childhood for all survivors of CDH and stress the importance of targeted interventions to optimize long-term developmental outcomes pertaining to speech and language. 相似文献6.
Eveline H. Shue Samuel C. Schecter Wenhui Gong Mozziyar Etemadi Michael Johengen Corey Iqbal S. Christopher Derderian Peter Oishi Jeffrey R. Fineman Doug Miniati 《Journal of pediatric surgery》2014
Purpose
Pulmonary hypertension (pHTN), a main determinant of survival in congenital diaphragmatic hernia (CDH), results from in utero vascular remodeling. Phosphodiesterase type 5 (PDE5) inhibitors have never been used antenatally to treat pHTN. The purpose of this study is to determine if antenatal PDE5 inhibitors can prevent pHTN in the fetal lamb model of CDH.Methods
CDH was created in pregnant ewes. Postoperatively, pregnant ewes received oral placebo or tadalafil, a PDE5 inhibitor, until delivery. Near term gestation, lambs underwent resuscitations, and lung tissue was snap frozen for protein analysis.Results
Mean cGMP levels were 0.53 ± 0.11 in placebo-treated fetal lambs and 1.73 ± 0.21 in tadalafil-treated fetal lambs (p = 0.002). Normalized expression of eNOS was 82% ± 12% in Normal-Placebo, 61% ± 5% in CDH-Placebo, 116% ± 6% in Normal-Tadalafil, and 86% ± 8% in CDH-Tadalafil lambs. Normalized expression of β-sGC was 105% ± 15% in Normal-Placebo, 82% ± 3% in CDH-Placebo, 158% ± 16% in Normal-Tadalafil, and 86% ± 8% in CDH-Tadalafil lambs. Endothelial NOS and β-sGC were significantly decreased in CDH (p = 0.0007 and 0.01 for eNOS and β-sGC, respectively), and tadalafil significantly increased eNOS expression (p = 0.0002).Conclusions
PDE5 inhibitors can cross the placental barrier. β-sGC and eNOS are downregulated in fetal lambs with CDH. Antenatal PDE5 inhibitors normalize eNOS and may prevent in utero vascular remodeling in CDH. 相似文献7.
Kate V. Dennett Brian J. Fligor Sarah Tracy Jay M. Wilson David Zurakowski Catherine Chen 《Journal of pediatric surgery》2014
Background/Purpose
We determined the incidence of sensorineural hearing loss (SNHL; > 20 dB at any frequency) in a contemporary cohort of congenital diaphragmatic hernia (CDH) survivors at a single tertiary care center and identified potential risk factors for SNHL.Methods
From 2000 through 2011, clinical and audiologic data were collected on 122 surgically-repaired Bochdalek CDH patients. CDH defect size, duration of ventilation, and cumulative aminoglycoside treatment were used for multivariate logistic regression.Results
Incidence of SNHL was 7.4% (9/122). We identified one significant independent predictor of SNHL: cumulative length of aminoglycoside treatment (P < .001; OR 1.44, 95% CI: 1.13–1.83).Conclusions
Over the last decade, the incidence of SNHL in our CDH patients is low compared to previous reports in the literature (7.4%) and is not associated with CDH defect size or the need for extracorporeal membrane oxygenation. Prolonged duration of aminoglycoside treatment increases the risk of SNHL independent of defect size and duration of ventilation. 相似文献8.
Kate V. Dennett Sarah Tracy Laurie Oliver Taylor David Zurakowski Catherine Chen 《Journal of pediatric surgery》2014
Background/Purpose
The purpose of this paper was to examine the effect of prenatal counseling in the Advanced Fetal Care Center (AFCC) on the well-being of parents of infants with congenital diaphragmatic hernia (CDH).Methods
From 2008 through 2012, 26 mothers and fathers of surgically repaired CDH patients who received prenatal counseling at our institution, and 15 who received no prenatal counseling, each completed the Short-Form 36 version 1 (SF-36v1) at the appropriate time points: prenatal, two weeks, and six months post-surgery.Results
Parents in both groups did not differ by demographic characteristics. Patients who received prenatal counseling had significantly longer ventilatory time and length of stay (LOS) in the ICU and in the hospital compared to those who did not receive prenatal counseling (all P < .01). Mothers and fathers had similar SF-36v1 mental and physical component summary (MCS, PCS) post-surgery scores when compared by counseling status. Prenatal MCS scores for mothers and fathers (47 vs. 41; P = .24) were similar to those at six months post-surgery (47 vs. 47; P = .90).Conclusions
When hospital LOS was controlled between groups stratified by AFCC counseling status, MCS scores were comparable prenatally and were sustained at six months post-surgery for both parents. These findings may reflect the support services parents received beginning in the prenatal period. 相似文献9.
Florian Friedmacher Jan-Hendrik Gosemann Naho Fujiwara Luis A.J. Alvarez Nicolae Corcionivoschi Prem Puri 《Journal of pediatric surgery》2013
Background/Purpose
Pulmonary hypoplasia (PH) is a life-threatening condition of newborns presenting with congenital diaphragmatic hernia (CDH). Sprouty-2 functions as a key regulator of fibroblast growth factor receptor (FGFR) signalling in developing foetal lungs. It has been reported that FGFR-mediated alveolarization is disrupted in nitrofen-induced PH. Sprouty-2 knockouts show severe defects in lung morphogenesis similar to nitrofen-induced PH. Upon FGFR stimulation, Sprouty-2 is tyrosine-phosphorylated, which is essential for its physiological function during foetal lung development. We hypothesized that Sprouty-2 expression and tyrosine phosphorylation are altered in nitrofen-induced PH.Methods
Time-pregnant rats received either nitrofen or vehicle on gestation day 9 (D9). Foetal lungs were dissected on D18 and D21. Pulmonary Sprouty-2 gene and protein expression levels were analyzed by qRT-PCR, Western blotting and immunohistochemical staining.Results
Relative mRNA expression of Sprouty-2 was significantly decreased in hypoplastic lungs without CDH (0.1050 ± 0.01 vs. 0.3125 ± 0.01; P < .0001) and with CDH (0.1671 ± 0.01 vs. 0.3125 ± 0.01; P < .0001) compared to controls on D18. Protein levels of Sprouty-2 were markedly decreased in hypoplastic lungs on D18 with decreased tyrosine phosphorylation levels on D18 and D21 detected at the molecular weight of Sprouty-2 consistent with Sprouty-2 tyrosine phosphorylation. Sprouty-2 immunoreactivity was markedly decreased in hypoplastic lungs on D18 and D21.Conclusion
Spatiotemporal alterations in pulmonary Sprouty-2 expression and tyrosine phosphorylation during the late stages of foetal lung development may interfere with FGFR-mediated alveolarization in nitrofen-induced PH. 相似文献10.
Irving J. Zamora Oluyinka O. Olutoye Darrell L. Cass Sara C. Fallon David A. Lazar Christopher I. Cassady Amy R. Mehollin-Ray Stephen E. Welty Rodrigo Ruano Michael A. Belfort Timothy C. Lee 《Journal of pediatric surgery》2014
Purpose
The purpose of this study was to determine whether prenatal imaging parameters are predictive of postnatal CDH-associated pulmonary morbidity.Methods
The records of all neonates with CDH treated from 2004 to 2012 were reviewed. Patients requiring supplemental oxygen at 30 days of life (DOL) were classified as having chronic lung disease (CLD). Fetal MRI-measured observed/expected total fetal lung volume (O/E-TFLV) and percent liver herniation (%LH) were recorded. Receiver operating characteristic (ROC) curves and multivariate regression were applied to assess the prognostic value of O/E-TFLV and %LH for development of CLD.Results
Of 172 neonates with CDH, 108 had fetal MRIs, and survival was 76%. 82% (89/108) were alive at DOL 30, 46 (52%) of whom had CLD. Neonates with CLD had lower mean O/E-TFLV (30vs.42%; p = 0.001) and higher %LH (21.3 ± 2.8 vs.7.1 ± 1.8%; p < 0.001) compared to neonates without CLD. Using ROC analysis, the best cutoffs in predicting CLD were an O/E-TFLV < 35% (AUC = 0.74; p < 0.001) and %LH > 20% (AUC =0.78; p < 0.001). On logistic regression, O/E-TFLV < 35% and a %LH > 20% were highly associated with indicators of long-term pulmonary sequelae. On multivariate analysis, %LH was the strongest predictor of CLD in patients with CDH (OR: 10.96, 95%CI: 2.5–48.9, p = 0.002).Conclusion
Prenatal measurement of O/E-TFLV and %LH is predictive of CDH pulmonary morbidity and can aid in establishing parental expectations of postnatal outcomes. 相似文献11.
Wang Cheng Zhao Ran Liu Wei Di La-na Zhao Xiao-zhuo Rong Yan-hua Ning Fang-gang Zhang Guo-an 《Burns : journal of the International Society for Burn Injuries》2014
Objective
The study was designed to examine pathological changes of inhalational laryngeal burns of three clinical types: congestive, oedematous and obstructive.Methods
A total of 18 healthy, male, adult Beagle dogs were randomly assigned to inhale hot dry air at room temperature (group C), 80 °C (Group 1), 160 °C (Group 2) or 320 °C (Group 3) for 20 min to induce inhalation injury. Each larynx was evaluated and scored based on the ‘clinical scoring and typing system of laryngeal burns at early stage’. Tissue samples of the epiglottis, laryngeal vestibule, vocal folds and infraglottic cavity of the larynx were observed microscopically and evaluated based on a ‘pathological scoring system’.Results
Pathological changes of the larynxes of groups 1 and 2 were primarily characterised by slight atrophy of the mucosa and mild oedema of the submucosal tissues. Group 3 larynxes showed two distinct pathological changes: oedematous and atrophic types. The larynxes of the atrophic type showed lower clinical scores (29.5 ± 0.7 vs. 44.3 ± 2.1) but higher pathological scores (18.6 ± 3.2 vs. 13.7 ± 1.8) than the larynxes of the oedematous type.Conclusion
Severe laryngeal burns could manifest as severe laryngeal oedema or atrophic change. The laryngeal burns of the atrophic type might suggest an unsatisfactory prognosis, although it had less risk of laryngeal obstruction at an early stage. 相似文献12.
Emmanuel M. Illical Dana J. FarrellPeter A. Siska Andrew R. EvansGary S. Gruen Ivan S. Tarkin 《Injury》2014
Objectives
To compare elbow range of motion (ROM), triceps extension strength, and functional outcome of AO/OTA type A distal humerus fractures treated with a triceps-split or -sparing approach.Design
Retrospective review.Setting
Two level one trauma centres.Patients
Sixty adult distal humerus fractures (AO/OTA 13A2, 13A3) presenting between 2008 and 2012 were reviewed. Exclusion criteria removed 18 total patients from analysis and three patients died before final follow-up.Intervention
Patients were divided into two surgical approach groups chosen by the treating surgeon: triceps split (16 patients) or triceps sparing (23 patients).Main outcome measurements
Elbow ROM and triceps extension strength testing were completed in patients after fractures had healed. All patients were also given the Disabilities of the Arm, Shoulder, and Hand (DASH) questionnaire.Results
Compared to the triceps-split cohort, the triceps-sparing cohort had greater elbow flexion (sparing 143 ± 7° compared to split 130 ± 12°, p = 0.03) and less extension contracture (sparing 6 ± 8° compared to split 23 ± 4°, p < 0.0001). Triceps strength compared to the uninjured arm also favoured the triceps-sparing cohort (sparing 88.9 ± 28.3% compared to split 49.4 ± 17.0%, p = 0.007). DASH scores were not statistically significant between the two cohorts (sparing 14.5 ± 12.2 compared to split 23.6 ± 22.3, p = 0.333).Conclusions
A triceps-sparing approach for surgical treatment of extra-articular distal humerus fractures can result in better elbow ROM and triceps strength than a triceps-splitting approach. Both approaches, however, result in reliable union and similar functional outcome.Level of evidence
Level III. 相似文献13.
Alana J. Coleman Beverly Brozanski Burhan Mahmood Peter D. Wearden Douglas Potoka Bradley A. Kuch 《Journal of pediatric surgery》2013
Background/Purpose
Early clinical predictors for the use of ECMO in patients with congenital diaphragmatic hernia (CDH) are lacking. We sought to evaluate the first 24-h SNAP-II score and highest PaCO2 as predictors of ECMO support and in-hospital mortality in neonates with CDH.Methods
Retrospective review of 47 consecutive neonates with CDH admitted to our institution from January 2007 to December 2010 was performed. Covariates of ECMO use including SNAP-II score and highest PaCO2 within the first 24 h of NICU admission were evaluated.Results
Of the 47 infants in this study, 24 patients were supported with ECMO. The ECMO group had a higher incidence of pulmonary hypertension, higher PaCO2, and higher 24-h SNAP-II scores. Only the SNAP-II score and not highest PaCO2 predicted mortality following multivariate adjustment.Conclusions
The first 24-h SNAP-II score and highest PaCO2 may provide some prognostic value in identifying neonates who undergo ECMO support; however neither measure was independently associated with the use of therapy. Only the SNAP-II score was associated with in-hospital mortality following multivariate adjustment. Additional study is needed to validate these results in a larger data set. 相似文献14.
Franck Bruyère Alexis PuichaudHelder Pereira Benjamin Faivre d’ArcierAntoine Rouanet Aurélie Paule Floc’hThomas Bodin Nicolas Brichart 《European urology》2010
Background
Even though transurethral resection of the prostate remains the gold standard treatment for lower urinary tract symptoms (LUTS) refractory to medical therapy, photoselective vaporization of the prostate (PVP) has become a popular alternative. Early PVP studies seem encouraging, but few data exist regarding the effect of PVP on sexual function at long-term follow-up.Objective
Our aim was to evaluate the impact of PVP on erectile function (EF) at long-term follow-up in men with LUTS due to benign prostatic hyperplasia (BPH).Design, setting, and participants
One hundred forty-nine consecutive patients who underwent a prostate vaporization with the GreenLight laser performed by a single surgeon (FB) were prospectively enrolled in this study.Intervention
All patients underwent PVP with the GreenLight laser performed by one experienced surgeon.Measurements
All patients were evaluated by International Index of Erectile Function (IIEF-5) preoperatively and at 1, 3, 6, and 12 mo and then once a year. At each visit, the questionnaires were collected, and each patient's maximum flow rate and postvoid residual volume were measured with ultrasound. Biologic data were also collected at each visit, including prostate-specific antigen, creatinine, and bacterial urine culture.Results and limitations
One hundred forty-nine patients were enrolled in the study. Median patient age was 74 yr. Urinary function was significantly improved over baseline in both men with normal or abnormal preoperative erectile function. Energy used was 255 ± 129 kJ. Hospitalization stay was 2.2 ± 3.1 d. Other than a temporary difference at 1 yr, IIEF-5 scores were comparable preoperatively and postoperatively if we consider all the population. However, considering patients with preoperative IIEF-5 >19, the postoperative IIEF-5 scores were significantly decreased at 6, 12, and 24 mo.Conclusions
Sexual function appears to be maintained after PVP; however, in patients with normal preoperative EF, we showed a significant decrease in EF after PVP. 相似文献15.
S.M. Littleton D.C. Hughes B. Gopinath B.J. Robinson S.J. Poustie P.N. Smith I.D. Cameron 《Injury》2014
Objective
To compare health outcomes among claimants compared to those who were ineligible or choose not to lodge a compensation claim. We also evaluated the effect of an early intervention programme on the health outcomes of the participants.Design
Prospective comparative study using sequential cohorts.Subjects
People presenting to hospital emergency departments with mild to moderate musculoskeletal injuries following road traffic crashes.Intervention
referral to an early intervention programme for assessment by musculoskeletal physician, pain management education, promotion of self-management and encouragement of early activity.Main outcomes
The 36-Item Short-Form Survey (SF-36); Hospital Anxiety and Depression Scale (HADS) and Functional Rating Index (FRI) scores were assessed at post-crash and at 12 months.Results
At 12 months, mean scores in six and five of the SF-36 domains were significantly lower among participants who claimed compensation versus those who chose not to claim or were ineligible, respectively. Differences in mean SF-36 scores ranged from 3.0 (‘general health perception’) to 8.0 units (‘role limitations due to physical problems’). Participants who claimed compensation had 6.3- and 4.6-units lower SF-36 physical component score compared to those who were ineligible (p = 0.001) or chose not to claim (p = 0.01), respectively. Participants who claimed compensation reported a worse HADS-depression score of 6.46 versus 4.97 and 4.69 observed in those who were ineligible (p = 0.04) or did not claim (p = 0.01). Claimants had worse FRI scores compared to non-claimants (p = 0.01) and those who were ineligible (p = 0.01). The early intervention did not improve health outcomes, 12 months after injury.Conclusions
Claiming compensation was associated with a worse health status for people with soft tissue injuries caused by road traffic crashes. The health status in people claiming compensation was not altered by an early intervention programme. 相似文献16.
Jose H. Salazar Alodia Gabre-Kidan Gezzer Ortega Diana Scorpio Gary Oldenburg Haven Custis Dawn Ruben Melanie Albano Shelly S. Choo Daniel S. Rhee William B. Fulton Qihong Wang Dominic Papandria Jude P. Crino Fizan Abdullah 《Journal of pediatric surgery》2014
Background
Previous models of support for premature sheep fetuses have consisted of cesarean delivery followed by catheterization of umbilical or central vessels and support with extracorporeal membrane oxygenation (ECMO). The limitations of these models have been insufficient blood flow, significant fetal edema, and hemorrhage related to anticoagulation.Methods
We performed a gravid hysterectomy on 13 ewes between 135 and 145 days gestational age. The uterine vessels were cannulated bilaterally and circulatory support was provided via ECMO. Successful transition was defined as maintenance of fetal heart rate for 30 minutes after establishing full extracorporeal support. Circuit flow was titrated to maintain mixed venous oxygen saturation (SvO2) of 70–75%.Results
Seven experiments were successfully transitioned to ECMO, with an average survival time of 2 hours 9 minutes. The longest recorded time from cannulation to death was 6 hours 14 minutes. By delivering a circuit flow of up to 2120 ml/min, all but one of the transitioned uteri were maintained within the desired SvO2 range.Conclusion
We report a novel animal model of fetal ECMO support that preserves the placenta, mitigates the effects of heparin, and allows for increased circuit flow compared to prior techniques. This approach may provide insight into a technique for future studies of fetal physiology. 相似文献17.
Jarod P. McAteer Avram Hecht Anneclaire J. De Roos Adam B. Goldin 《Journal of pediatric surgery》2014
Purpose
Maternal factors contributing to the etiology of congenital diaphragmatic hernia (CDH) remain unclear. We hypothesized that specific maternal medical conditions (pregestational diabetes, hypertension), and behaviors (alcohol, tobacco) would be associated with CDH.Methods
We conducted a population-based case–control study using Washington State birth certificates linked to hospital discharge records (1987–2009). We identified all infants with CDH (n = 492). Controls were randomly selected among non-CDH infants. Maternal data were extracted from the birth record. Logistic regression was used to adjust for covariates.Results
Cases and controls were generally similar regarding demographics, although CDH infants were more likely to be male than controls (58.5% vs. 52.5%). Isolated and complex (multiple-anomaly) CDH had similar characteristics. Each of the exposures of interest was more common among case mothers than among control mothers. In univariate analysis, alcohol use, hypertension, and pregestational diabetes were each significantly associated with the outcome. After multivariate adjustment, only alcohol use (OR = 3.65, p = 0.01) and pregestational diabetes (OR = 12.53, p = 0.003) maintained significance. Results were similar for both isolated and complex CDH.Conclusions
Maternal pregestational diabetes and alcohol use are significantly associated with occurrence of CDH in infants. These are important modifiable risk factors to consider with regard to efforts seeking to impact the incidence of CDH. 相似文献18.
Rupa Seetharamaiah Robert H. Bartlett On behalf of the Congenital Diaphragmatic Hernia Study Group 《Journal of pediatric surgery》2009,44(7):1315-1321
Objective
To identify factors associated with survival in patients with congenital diaphragmatic hernia (CDH) treated with extracorporeal membrane oxygenation (ECMO).Methods
We retrospectively analyzed the data on 3100 patients with CDH in the Congenital Diaphragmatic Hernia Study Group from 82 participating pediatric surgical centers (1995-2004). Covariates considered included prenatal and perinatal clinical information, specifics of surgical repair, and the duration of extracorporeal support.Result
Nine hundred seven patients from the registry were identified as having been both managed with ECMO and undergone attempted surgical repair. The survival rate for the entire Congenital Diaphragmatic Hernia Study Group registry was 67% and 61% for those receiving ECMO in whom repair was attempted (P < .001). Among ECMO-treated children, survivors had a greater estimated gestational age (38 ± 2 vs 37 ± 2 weeks; P < .01), greater birth weights (3.2 ± 0.5 vs 2.9 ± 0.5 kg; P < .001), were less often prenatally diagnosed (53% vs 63%; P < .01), and were on ECMO for a shorter period of time (9 ± 5 vs 12 ± 5 days; P < .001). In logistic regression models, therapy-related variables, including the duration of ECMO, the nature of diaphragmatic repair, and the type of abdominal closure and certain comorbidities, particularly the presence of a concomitant severe cardiac abnormality, were independently associated with outcome.Conclusion
Our model identifies a group of pre-surgical and postsurgical parameters that predict survival rate in patients with CDH on ECMO support. This model was derived from the retrospective data from a large database and will need to be prospectively tested. 相似文献19.
Andrew Omotayo Ugburo Idowu Olusegun Fadeyibi Bolaji Oyawoye Mofikoya Olanrewaju Nurudeen Akanmu Edamisan Olusoji Temiye Okezie Obasi Kanu Muna Kenneth Chira Dennis Emonena Egbikuadje Adetinuwe Majekodunmi 《Burns : journal of the International Society for Burn Injuries》2013
Background
Burns in the neonate are rare and result mostly from iatrogenic sources in developed countries. The socioeconomic settings of developing countries are different from those in the developed countries. A review of the epidemiology and management of burns in the neonates in Lagos, Nigeria is presented.Methods
The case notes of burns in patients less than 29 days-old from 2004 to 2008 in 4 tertiary health institutions in Lagos were retrieved from the Medical Records Department; necessary data were extracted and analyzed.Results
There were 21 neonates with burns within the study period. The incidence of neonatal burns ranged between 0.5 and 2.5%/year. The mean age was 16.38 ± 1.84 days and the mean BSA of 26.00 ± 5.53%. The etiology of burns was thermal in 19(90.5%) and chemical in 2(9.5%). Hypokalemia was common at early stages of their treatment. Burns were sustained at home in 90.5% of the cases. The mortality rate was 43.5%. Inhalation and thermal injuries were associated with most of the deaths.Conclusion
Domestic incidents from flames are the commonest causes of neonatal burns in the study environment. These are associated with prolonged morbidity and high mortality rate. Health education, highlighting methods of prevention should be undertaken in the community. Well equipped burn centers should be established to treat burns in all age groups. 相似文献20.
Laura Lukosiene Danguole Ceslava Rugyte Andrius Macas Lina Kalibatiene Dalius Malcius Vidmantas Barauskas 《Journal of pediatric surgery》2013