Biomedical subjects

J T Wung

Publications and source records attributed to J T Wung.

12 recordsLinked to original sources

PubMed1992

Benign gaseous distension of the bowel in premature infants treated with nasal continuous airway pressure: a study of contributing factors.

Continuous positive airway pressure (CPAP) administered as a mixture of oxygen and compressed air via nasal prongs has dramatically improved survival rates and lessened the frequency of barotrauma and bronchopulmonary dysplasia in the premature infant with respiratory distress syndrome. Associated with the increased use of nasal CPAP has been the development of marked bowel distension (CPAP belly syndrome), which occurs as the infant's respiratory status improves and the baby becomes more vigorous. To identify contributing factors, we prospectively compared 25 premature infants treated with nasal CPAP with 29 premature infants not treated with nasal CPAP. Infants were followed up for development of distension, defined clinically as bulging flanks, increased abdominal girth, and visibly dilated intestinal loops. We evaluated birth weight, weight at time of distension, method of feeding (oral, orogastric tube), and treatment with nasal CPAP and correlated these factors with radiologic findings. Of the infants who received nasal CPAP therapy, gaseous bowel distension developed in 83% (10/12) of infants weighing less than 1000 g, but in only 14% (2/14) of those weighing at least 1000 g. Only 10% (3/29) of infants not treated with nasal CPAP had distension, and all three weighed less than 1000 g. Presence of sepsis and method of feeding did not correlate with occurrence of distension. Neither necrotizing enterocolitis nor bowel obstruction developed in any of the patients with a diagnosis of CPAP belly syndrome. Our study shows that nasal CPAP, aerophagia, and immaturity of bowel motility in very small infants were the major contributors to the development of benign gaseous bowel distension.

Gases↗

PubMed1992

Hearing and neurodevelopmental outcome in survivors of persistent pulmonary hypertension of the newborn.

Thirty-four infants who had a diagnosis of severe persistent pulmonary hypertension of the newborn at birth (alveolar-arterial oxygen difference greater than 600) were treated without paralysis or hyperventilation to induce alkalosis. All survived. Twenty-seven of these 34 eligible infants (79%) underwent neurologic, intelligence, and audiologic testing between 10 months and 6 years of age. Children who were younger than 1 year of age at the initial hearing test were retested after they reached 2 years of age. The average IQ was within the normal range (mean = 96.23). None had sensorineural hearing loss. Severe neurologic abnormalities were seen in 4 children, 3 of whom had been severely asphyxiated at birth (determined by biochemical criteria). Mild neurologic abnormalities were observed in 5 children. Two infants had bronchopulmonary dysplasia because they required supplemental oxygen for 29 and 66 days, respectively, and had abnormal chest roentgenograms; 1 patient takes intermittent doses of albuterol (Ventolin) and neither currently requires supplemental oxygen. This study of 27 infants with severe persistent pulmonary hypertension of the newborn suggests that conservative management without induced alkalosis or respiratory paralysis is accompanied by no sensorineural hearing loss and a good neurologic outcome.

Apgar Score↗

PubMed1988

Right pneumonectomy syndrome: a lethal complication of lung resection in a newborn with cystic adenomatoid malformation.

A newborn girl underwent a right pneumonectomy for cystic adenomatoid malformation. She subsequently developed compression of the trachea and left mainstem bronchus by a combination of aortic arch, pulmonary artery, and ductus arteriosus. She died while planning aortic suspension, and the anatomic relationships were confirmed by autopsy. This problem is potentially treatable by a variety of means.

Coronary Angiography↗

PubMed1987

Experience with percutaneous indwelling peripheral arterial catheterization in neonates.

We present an experience with indwelling peripheral arterial catheters in preterm and term neonates. During a 12-month interval, 158 peripheral arterial lines were inserted in 115 infants. Eighty-eight infants required a single line while 27 infants required more than one line. Ninety-one catheters (57.6%) were electively removed, and 67 (42.4%) had to be discontinued prematurely. Vessels used included 110 radial arteries (69.6%), 27 posterior tibial arteries (17.1%), and 21 temporal arteries (13.3%). There were only two major complications (1.27%), both related to infections. The technique is described in detail. In our experience, with appropriate precaution, peripheral arterial cannulation has been a safe and reliable alternative to umbilical arterial catheterization.

Arteries↗

PubMed1986

Retrocardiac pneumomediastinum in association with tracheal and esophageal perforations.

Retrocardiac pneumomediastinum was encountered in two premature infants; one had a tracheal perforation and one an esophageal perforation. Contrast studies showed communication between the sites of perforation and the retrocardiac air. Clinical signs suggestive of such perforation include abnormal course of tubes on plain chest films and bloody aspirates.

Esophageal Perforation↗

PubMed1985

Management of infants with severe respiratory failure and persistence of the fetal circulation, without hyperventilation.

The successful management of 15 infants suffering from persistence of fetal pulmonary circulation and in severe respiratory failure is presented. The treatment regimen focused on minimizing barotrauma. Infants were intubated nasotracheally and ventilated with intermittent mandatory ventilation. Peak inspiratory pressures were determined by the clinical assessment of chest excursion. Ventilator settings and fractional inspiratory oxygen (FiO2) were selected to maintain a PaO2 between 50 and 70 mm Hg; PaCO2 was not a controlling parameter and was allowed to increase as high as 60 mm Hg. Hyperventilation and muscle relaxants were not used. High ventilator rate was used in ten infants who required high inspiratory pressure to maintain chest excursion, with a favorable response in five. Tolazoline was given to 14 infants of whom ten showed an improvement in oxygenation; dopamine was given to three infants who were oliguric. All infants survived, and only one infant developed chronic lung disease which was defined by the infant's need for supplemental oxygen beyond 30 days of life.

Birth Weight↗

PubMed1985