Background: Persistent pulmonary hypertension of the newborn is a clinical syndrome caused by fai... more Background: Persistent pulmonary hypertension of the newborn is a clinical syndrome caused by failure in the transition from fetal to neonatal circulation either to achieve or to maintain low pulmonary vascular resistance after birth. The syndrome is a complex condition associated with different cardiopulmonary disorders. Methods: This article presents a review of the literature and the author's own experience regarding the fetal circulation, the transition to the newborn circulation, and the mechanical and molecular regulatory factors, including a discussion of the pathophysiology, aetiology, diagnostics and main goal of treatment for persistent pulmonary hypertension of the newborn. Results: The pathophysiology of persistent pulmonary hypertension is characterised by high pulmonary vascular resistance and high pulmonary artery pressure. The blood is shunted from the right to the left circuit through the foramen ovale, ductus arteriosus and also by intrapulmonal shunts. The aetiologies can be classified as underdevelopment, maldevelopment and maladaptation of the pulmonary vasculature. The clinical signs are hypoxaemia, higher oxygenation tension and saturation in the upper rather than the lower limbs, respiratory failure, systemic hypotension and systolic cardiac murmur. The differential diagnoses are primarily serious lung disorders without persistent pulmonary hypertension, and congenital cyanotic heart defects. The diagnostic investigations are blood gas analysis, X-ray of the lung, and Doppler echocardiographic examination of the heart. Interpretation: The main treatment goal is good oxygenation, pH in upper normal and pCO2 in lower normal levels. Positive pressure ventilation, sedation, NO gas inhalation and supporting treatment of the systemic blood pressure are usually necessary. Extracorporeal membrane oxygenation is considered as a last option.
Tidsskrift for den Norske lægeforening : tidsskrift for praktisk medicin, ny række, Jan 30, 1994
The aim of high frequency ventilation is to improve survival and to reduce development of chronic... more The aim of high frequency ventilation is to improve survival and to reduce development of chronic lung disease. The most commonly used principles of high frequency ventilation in neonates are discussed on the basis of the pathophysiology and development of lung injuries. During the year 1993, seven critically ill infants were treated with high frequency flow interruption and six with high frequency oscillation ventilation. The treatment was lifesaving, while conventional ventilation had failed. Both oxygenation and ventilation improved rapidly. In the future, our indications for high frequency ventilation will probably be extended.
Background Group B Streptococcus (GBS) is a major cause of serious neonatal infection but its rol... more Background Group B Streptococcus (GBS) is a major cause of serious neonatal infection but its role in maternal morbidity has received little investigation. The aim of this study was to determine whether GBS colonization at delivery is associated with increased risk of maternal peripartum infection. Methods In this prospective cohort study, 1746 unselected women had a vaginal-rectal culture taken at the onset of labor. Diagnosis of maternal peripartum infection was based on a combination of two or more signs or symptoms including fever, breast pain, severe wound or pelvic pain, purulent discharge and abnormal laboratory tests including C-reactive protein and white blood cell count occurring from labor until 2 weeks postpartum. The main outcome measure was the proportion of women with maternal peripartum infection according to GBS colonization status. Results A total of 25.9% (452/1746) women were colonized with GBS. The rate of peripartum infection was almost twice as high in coloniz...
Tidsskrift for Den Norske Laegeforening, Jun 26, 2008
Respiratory alkalosis is an early sign of urea cycle disorder. A high level of plasma ammonia wil... more Respiratory alkalosis is an early sign of urea cycle disorder. A high level of plasma ammonia will strengthen this suspicion. It is of great importance to transfer the infant as soon as possible to a unit capable of giving specific treatment with Na-benzoate, Na-phenylbutyrate, argininchloride and carglumic acid. The early treatment may also include haemodialysis, which is preferred over peritoneal dialysis or exchange transfusion. We here describe an infant with respiratory alkalosis within the first two days of life and a high plasma level of ammonia (> 700 micromol/L). He did not respond to conventional therapy and died 48 hours after birth in spite of specific treatment. DNA-analysis showed a gene defect in the OTC gene, c.67C >T (p.R23X), a known mutation leading to urea cycle disorder (OTC). It is important to detect carriers among older siblings and to inform the parents of the possibility of prenatal diagnostics.
To evaluate the therapeutic strategies used in neonates with congenital diaphragmatic hernia (CDH... more To evaluate the therapeutic strategies used in neonates with congenital diaphragmatic hernia (CDH) during the last 15 years in our department. A retrospective study of 27 neonates with CDH treated at the Neonatal Intensive Care Unit at Ullevaal University Hospital between 1992 and 2006. Since 1992 we have used delayed operative repair and high-frequency ventilation (HFV). Because surfactant replacement and inhaled nitric oxide (iNO) therapy have been used since 1997, we divided the patients into two groups; group 1 from 1992 to 1996 (9 patients) and group 2 from 1997 to 2006 (18 patients). The overall survival was 70%. Group 1 had an exceptionally good outcome, 100% survival versus 56% in the last group. Pulmonary hypoplasia and pulmonary hypertension are still the most challenging factors in treatment of neonates with CDH, despite novel therapeutic modalities, such as HFV, surfactant and iNO. Delayed surgery in CDH allows pre-operative stabilization. Extracorporeal membrane oxygenation must be considered in the most severe cases.
Background: Persistent pulmonary hypertension of the newborn is a clinical syndrome caused by fai... more Background: Persistent pulmonary hypertension of the newborn is a clinical syndrome caused by failure in the transition from fetal to neonatal circulation either to achieve or to maintain low pulmonary vascular resistance after birth. The syndrome is a complex condition associated with different cardiopulmonary disorders. Methods: This article presents a review of the literature and the author's own experience regarding the fetal circulation, the transition to the newborn circulation, and the mechanical and molecular regulatory factors, including a discussion of the pathophysiology, aetiology, diagnostics and main goal of treatment for persistent pulmonary hypertension of the newborn. Results: The pathophysiology of persistent pulmonary hypertension is characterised by high pulmonary vascular resistance and high pulmonary artery pressure. The blood is shunted from the right to the left circuit through the foramen ovale, ductus arteriosus and also by intrapulmonal shunts. The aetiologies can be classified as underdevelopment, maldevelopment and maladaptation of the pulmonary vasculature. The clinical signs are hypoxaemia, higher oxygenation tension and saturation in the upper rather than the lower limbs, respiratory failure, systemic hypotension and systolic cardiac murmur. The differential diagnoses are primarily serious lung disorders without persistent pulmonary hypertension, and congenital cyanotic heart defects. The diagnostic investigations are blood gas analysis, X-ray of the lung, and Doppler echocardiographic examination of the heart. Interpretation: The main treatment goal is good oxygenation, pH in upper normal and pCO2 in lower normal levels. Positive pressure ventilation, sedation, NO gas inhalation and supporting treatment of the systemic blood pressure are usually necessary. Extracorporeal membrane oxygenation is considered as a last option.
Tidsskrift for den Norske lægeforening : tidsskrift for praktisk medicin, ny række, Jan 30, 1994
The aim of high frequency ventilation is to improve survival and to reduce development of chronic... more The aim of high frequency ventilation is to improve survival and to reduce development of chronic lung disease. The most commonly used principles of high frequency ventilation in neonates are discussed on the basis of the pathophysiology and development of lung injuries. During the year 1993, seven critically ill infants were treated with high frequency flow interruption and six with high frequency oscillation ventilation. The treatment was lifesaving, while conventional ventilation had failed. Both oxygenation and ventilation improved rapidly. In the future, our indications for high frequency ventilation will probably be extended.
Background Group B Streptococcus (GBS) is a major cause of serious neonatal infection but its rol... more Background Group B Streptococcus (GBS) is a major cause of serious neonatal infection but its role in maternal morbidity has received little investigation. The aim of this study was to determine whether GBS colonization at delivery is associated with increased risk of maternal peripartum infection. Methods In this prospective cohort study, 1746 unselected women had a vaginal-rectal culture taken at the onset of labor. Diagnosis of maternal peripartum infection was based on a combination of two or more signs or symptoms including fever, breast pain, severe wound or pelvic pain, purulent discharge and abnormal laboratory tests including C-reactive protein and white blood cell count occurring from labor until 2 weeks postpartum. The main outcome measure was the proportion of women with maternal peripartum infection according to GBS colonization status. Results A total of 25.9% (452/1746) women were colonized with GBS. The rate of peripartum infection was almost twice as high in coloniz...
Tidsskrift for Den Norske Laegeforening, Jun 26, 2008
Respiratory alkalosis is an early sign of urea cycle disorder. A high level of plasma ammonia wil... more Respiratory alkalosis is an early sign of urea cycle disorder. A high level of plasma ammonia will strengthen this suspicion. It is of great importance to transfer the infant as soon as possible to a unit capable of giving specific treatment with Na-benzoate, Na-phenylbutyrate, argininchloride and carglumic acid. The early treatment may also include haemodialysis, which is preferred over peritoneal dialysis or exchange transfusion. We here describe an infant with respiratory alkalosis within the first two days of life and a high plasma level of ammonia (> 700 micromol/L). He did not respond to conventional therapy and died 48 hours after birth in spite of specific treatment. DNA-analysis showed a gene defect in the OTC gene, c.67C >T (p.R23X), a known mutation leading to urea cycle disorder (OTC). It is important to detect carriers among older siblings and to inform the parents of the possibility of prenatal diagnostics.
To evaluate the therapeutic strategies used in neonates with congenital diaphragmatic hernia (CDH... more To evaluate the therapeutic strategies used in neonates with congenital diaphragmatic hernia (CDH) during the last 15 years in our department. A retrospective study of 27 neonates with CDH treated at the Neonatal Intensive Care Unit at Ullevaal University Hospital between 1992 and 2006. Since 1992 we have used delayed operative repair and high-frequency ventilation (HFV). Because surfactant replacement and inhaled nitric oxide (iNO) therapy have been used since 1997, we divided the patients into two groups; group 1 from 1992 to 1996 (9 patients) and group 2 from 1997 to 2006 (18 patients). The overall survival was 70%. Group 1 had an exceptionally good outcome, 100% survival versus 56% in the last group. Pulmonary hypoplasia and pulmonary hypertension are still the most challenging factors in treatment of neonates with CDH, despite novel therapeutic modalities, such as HFV, surfactant and iNO. Delayed surgery in CDH allows pre-operative stabilization. Extracorporeal membrane oxygenation must be considered in the most severe cases.
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