Neonatology
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Therapeutic lung lavage is an emerging treatment for meconium aspiration syndrome (MAS), but the ideal fluid volume and lavage technique remain unclear. ⋯ Open suction, vibratory chest squeezing and an aliquot volume of 15 ml/kg each improve the efficacy of lung lavage in MAS, and merit inclusion in the lavage technique in clinical trials of this therapy.
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Many clinicians intubate newborns using a stylet, but how many always check if the device is intact after use? We describe a case of endobronchial obstruction by a plastic sheath coating the metal stylet, and suggest ways to reduce the incidence of this serious iatrogenic complication.
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Several studies have demonstrated the efficiency and safety of mild hypothermia (33 degrees C) used for treating moderate encephalopathy. In animal models, deep hypothermia proved to be neuroprotective. ⋯ The results support the safety of deep hypothermia. Further studies are needed to confirm these results and the neuroprotective effect of this approach.
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With current evidence, no specific oxygen concentration can yet be recommended in the resuscitation of the depressed term neonate. ⋯ We have demonstrated the ability to ventilate, create hypoxic stress, and resuscitate neonatal rats. While resuscitation with 21 or 100% oxygen results in a transient increase in oxidative glutathione levels, the oxygen-resuscitated group alone demonstrated a reduction in reduced glutathione 24 h later. Furthermore, these pups can then be returned to their dams for rearing, allowing ongoing evaluation of long-term effects of hypoxia and various modes of resuscitation.
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Meconium aspiration produces airway obstruction and surfactant inhibition. Bronchoalveolar lavage (BAL) and surfactant replacement have been proposed as treatments for the syndrome. ⋯ BAL with normal saline followed by a supplementary dose of surfactant may improve oxygenation in an experimental piglet model of meconium aspiration syndrome.