Neonatology
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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.
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Inherited disorders of pulmonary surfactant-associated proteins are rare but provide important insights into unique mechanisms of surfactant dysfunction. Recessive loss-of-function mutations in the surfactant protein-B and the ATP-binding cassette family member A3 (ABCA3) genes present as lethal surfactant deficiency in the newborn, whereas other recessive mutations in ABCA3 and dominant mutations in the surfactant protein-C gene result in interstitial lung disease in older infants and children. The molecular basis and the genetic and tissue-based approaches to the evaluation of children suspected of having one of these disorders are discussed.
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Preterm infants are repeatedly exposed to painful experiences as part of their care in the neonatal intensive care unit. There is evidence from both animal and human studies that exposure to pain during the neonatal period may have persisting consequences for development. ⋯ Healthy preterm infants sensitize to heelstick-induced pain, as measured by their heart rate responses. These data suggest that greater attention to the effects of repeated pain for the neonate is needed.