Nutrition in infancy: implications for practice.
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Humans↗
Biomedical subjects
C Bunyapen
Publications and source records attributed to C Bunyapen.
Extracorporeal membrane oxygenation. Controversies in selection of patients and management.
This article reviews controversies associated with the selection of patients for extracorporeal membrane oxygenation (ECMO) and their management. Although there has been a raging debate regarding the use of ECMO in the management of hypoxic respiratory failure in the near-term and term newborn, the authors maintain that this issue is resolved and that ECMO is now a standard of care and should be offered to every neonate who is likely to fail conventional treatment. It is the authors' contention, that there is no apparent increase in morbidity associated with the use of ECMO and that better results might be achieved if ECMO were employed earlier in the patient's course, before hypoxic-ischemia organ damage occurs.
Extracorporeal Membrane Oxygenation↗
Significance of seizures associated with extracorporeal membrane oxygenation.
We previously reported a predominance of left focal motor seizures in infants receiving extracorporeal membrane oxygenation (ECMO), raising concerns about possible ischemia resulting from the right common carotid artery ligation. We therefore evaluated the neurologic and psychologic outcome at 2 years of age of all infants with ECMO-related seizures. Although 8 of 12 infants had left focal seizures in infancy, there was no lateralization of motor findings at 2 years of age; left hemiparesis was present in three of the infants and right hemiparesis in three. The developmental quotient was normal in 6 of 12 infants, low-average in three, borderline in two, and in the mentally handicapped range in one. We conclude that any ischemia resulting from carotid ligation is not great enough to produce long-term lateralizing findings but that seizures during ECMO are a risk factor for later cerebral palsy or developmental delay.
Child Behavior↗
Right common carotid artery ligation in extracorporeal membrane oxygenation.
The effect of right common carotid artery ligation required for arteriovenous extracorporeal membrane oxygenation (ECMO) was investigated in 35 infants. Their neonatal course was reviewed for evidence of right-sided ischemia of the brain, as suggested by the presence of focal seizures, hemiparesis, focal abnormalities on electroencephalography, or infarct or hemorrhage demonstrable on neuroimaging studies. A significant incidence of left focal seizures (9/35) versus right focal seizures (2/35) was noted, suggesting an effect of the carotid ligation on right hemisphere function. Computed tomographic scans (20/35 infants), electroencephalograms (18/35), ultrasound scans (31/35), and neurologic examinations did not reveal an increased incidence of right hemisphere abnormalities. These data suggest that systematic evaluation of the effects of right common carotid ligation should proceed as discussion continues on expanding the use of ECMO.
Brain↗
Cholecystitis in a preterm infant.
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Anti-Bacterial Agents↗
Predicting the need for exchange transfusion in newborn infants. A comparison of five methods.
The need for exchange transfusion was analyzed retrospectively using several different methods (total bilirubin binding capacity, birth weight, plasma protein level, and two published charts). These predictive methods were applied to 175 jaundiced infants for whom all the data were available and to 19 infants who were actually exchanged. Most of the patients were sick, premature infants. This study demonstrates the lack of agreement among the predictive methods.
Bilirubin↗
Clinical and chemical correlates of the bilirubin-binding capacity in newborns.
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Apgar Score↗
ABO hemolytic disease: a comparative study of clinical severity and delayed anemia.
The hospital and clinic records of 230 neonates with ABO hemolytic disease (HD) were reviewed. There was no significant difference in clinical severity between AO-HD and BO-HD as measured by (1) number of neonates with hyperbilirubinemia and/or those requiring exchange transfusion; (2) hemoglobin concentration; (3) reticulocyte count; (4) bilirubin concentration; and (5) incidence of anemia after discharge from the hospital. There was no difference in the hemoglobin concentrations measured at between four and eight weeks of age in 39 control infants and infants with either AO-HD or BO-HD who did not require an exchange transfusion. Our data do not indicate a clinical difference in the severity of AO-HD and BO-HD. Infants with ABO-HD who do not require exchange transfusion and/or phototherapy and whose hemoglobin concentration at discharge is greater than 15 gm/dl do not need a hemoglobin measurement before 6 weeks of age.
ABO Blood-Group System↗