Postsurgery analgesic and sedative drug use in a French neonatal intensive care unit: A single-center retrospective cohort study

Objective

To describe pain assessment, the pattern of analgesic and sedative drug use, and adverse drug reactions in a neonatal intensive care unit (NICU) during the postsurgery phase.

Neonatal idiopathic pericardial effusion

The authors describe a case of hydropericardium occurring in a fullterm neonate presenting with a respiratory distress syndrome due to persistent fetal circulation. The baby was treated by surgery. No etiology could be found to explain this hydropericardium.     

Neonatal ischemic necrosis of the arm in a premature infant

A case of gangrene present at birth in the right upper limb of a twin premature infant is reported. As premature rupture of membranes was present, the role of ischemic compression is discussed. The etiology of ischemic lesions observed in the fetus and the newborn and their treatment is reviewed.     

Definition of fetal growth restriction according to constitutional growth potential

Identification of newborn babies with fetal growth restriction remains a problem both from the multi-factorial aspect of fetal growth and from statistical definition. Besides the usual terms: "Small for gestational age" (SGA) and intrauterine growth retardation (IUGR), often used synonymously, the term "fetal growth retardation" was recently introduced in reference to the genetic growth potential of infants. From a sample of 72,000 births, we have designed a statistical model in order to estimate the expected birth weight taking into account gestational age, sex, birth rank, maternal age, height and pregravid weight, we then calculated an individual limit of birth weight under that a newborn must be considered as having a "fetal growth restriction" quoted FwGR. This new approach allowed us to identify 2 groups of newborns with FGR, one classically identified as SGA (noted FwGR(I)) (3.9%), and the other newly identified as FGR (noted FwGR(II)) (1.4%). In contrast, this approach allowed us to identify a group of "constitutionally small" infants according to their constitutional growth potential (1.1%). In other words, among infants usually defined as SGA (5%), 22% appeared in fact to be "constitutionally small" and therefore misclassified. As an initial validation, we observed that the proportion of maternal hypertension during pregnancy was low in the "constitutionally small" infants (close to that of the normal group), and three times higher in the newly identified group FwGR(II) than in the normal group. Following these results, it seems to be meaningful to follow-up this new group of FwGR(II) infants, in terms of catch-up growth and neurodevelopmental outcome.     

3H]noradrenaline-releasing action of vinpocetine in the isolated main pulmonary artery of the rabbit

Vinpocetine (10(-6)-3 X 10(-5) M) increased both the resting and the nerve stimulation-evoked release of [3H]noradrenaline from the isolated main pulmonary artery of the rabbit in the presence of uptake blockers (cocaine, 3 X 10(-5) M; corticosterone, 5 X 10(-5) M), and inhibited the nerve stimulation-evoked postsynaptic response. The resting transmitter releasing action of vinpocetine increased in the absence of cocaine. Exogenously applied (-)noradrenaline [(-)NA] (10(-6) M) or clonidine (10(-6) M) inhibited the vinpocetine (3 X 10(-5) M)-potentiated [3H]NA release and contracted the circular muscle. The clonidine-induced contraction was abolished by 10(-7) M prazosin. The inhibitory action of (-)-NA on vinpocetine-potentiated [3H]NA release was partly antagonized by 3 X 10(-7) M yohimbine, a preferential alpha 2-adrenoceptor blocker. In Ca-free Krebs solution containing 1 mM EGTA the neurotransmitter releasing action of vinpocetine was abolished, however, its stimulating action on the resting [3H]NA outflow was not changed. In Na-pump-inhibited arteries (K-free solution), where both the resting and the nerve stimulation-evoked release of neurotransmitter had already been increased, vinpocetine further enhanced the nerve stimulation-evoked release of [3H]NA. It is concluded that vinpocetine may have alpha 2- and alpha 1-adrenoceptor blocking action, as well as a tyramine-like effect. The presynaptic neurotransmitter releasing action of vinpocetine is presumably the consequence of its inhibitory action on the Ca-pump which is suggested by the finding that in K-free solution vinpocetine was able to enhance further the release of neurotransmitter.     

Gastric necrosis in newborns: a report of 11 cases

Eleven neonates ranging in gestational age from 34 to 40 weeks presented with gastric necrosis. The 4 full-term neonates showed sudden-onset hemorrage and “coffee-ground” vomiting; in the 7 premature babies the initial clinical finding was abdominal distention. The criteria for diagnosis were: perinatal distress in prematures and transient neonatal respiratory distress in full-term babies. Radiographic evidence of gastric distention was typical and preceded clinical signs of hematemesis and gastric perforation. Surgery was performed in 8 patients; 3 received medical treatment. At surgery 1␣total and 3 subtotal gastrectomies and 4 segmental gastric resections were performed. Three of these patients died post-operatively as a consequence of multiorgan failure; a second look was necessary in one patient 1 week after surgery because of prepyloric perforation due to ulcers. Biopsy specimens taken from the site of perforation demonstrated extensive necrosis; ulceration was disseminated in the surrounding gastric mucosa; no signs of phlogosis were detected. The diagnosis, treatment, and physiopathologic considerations are reviewed. Accepted: 6 November 1997     

Neonatal mortality and morbidity of low birth weight premature infants (less than or equal to 1500 g)]

Neonatal mortality and morbidity were reported over a 4-yr period from 1986-1989 in premature infants weighing less than 1,500 g, 278 of whom were born in the same obstetrico-neonatal unit. Total mortality was 15%, and was higher in premature infants weighing less than 1,000 g (38%) and lower if the gestational age was greater than 27 wk. Mortality was lower in small for gestational age (SGA) infants than in appropriate for gestational age (AGA) infants (5% vs 19%, P less than 0.001), and lower in inborn babies than in outborn (12% vs 19%, P less than 0.02) but only in neonates weighing less than 1,000 g. Neonatal morbidity was mainly due to hyaline membrane disease and cerebral haemorrhage. The incidence of broncho-pulmonary dysplasia was low (4%). These results indicate that gestational age, birth weight and place of delivery play a role in mortality and morbidity in very low birth weight premature infants.