Journal of pediatric surgery
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The authors reviewed the Extracorporeal Life Support Organization (ELSO) data base of all neonates placed on extracorporeal membrane oxygenation for whom CDH was diagnosed between January 1989 and December 1991. For 483 neonates, there were complete data concerning timing of the hernia repair in relation to ECMO. The overall incidence of hemorrhage was 43% (57% among nonsurvivors, 32% among survivors; P < .05). ⋯ The incidence of hemorrhagic complications did not differ significantly among the 3 years (P > .05). Repair of the hernia defect while on bypass was associated with significantly greater bleeding complications. These data should be useful in the planning of future prospective trials.
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Comparative Study
The cerebrovascular response to prolonged hypoxia with carotid artery and jugular vein ligation in the newborn lamb.
This study was designed to evaluate the effect of ligation of the carotid artery and/or jugular vein, after exposure to prolonged (4 hours) hypoxia, and the effect of acute normalization of PaO2 after prolonged hypoxia with vessel ligation, on the cerebral circulation. Twelve 1- to 7-day-old lambs were anesthetized with pentobarbital. Catheters were placed in the femoral artery and vein, left ventricle, lingual artery, and sagittal sinus. ⋯ With regard to physiological variables, there were no differences between the groups. CBF increased 106% (P < .001 compared with the baseline value) after 4 hours of hypoxia, maintaining cerebral oxygen consumption (CMRO2) and oxygen transport (OT) constant in both groups. Ligation of either the carotid artery or jugular vein after 4 hours of hypoxia, did not alter CBF responses to hypoxia.(ABSTRACT TRUNCATED AT 250 WORDS)
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Case Reports
Extracorporeal membrane oxygenation in infants with congenital diaphragmatic hernia and cardiac malformations.
Since the introduction of neonatal extracorporeal membrane oxygenation (ECMO) in Canada, the authors have treated three infants with congenital diaphragmatic hernia (CDH) who had serious congenital cardiac anomalies (among 26 infants with CDH treated with ECMO). To determine the incidence of and outcome for infants with combined lesions who received ECMO, 19 years' data (April 1973 to October 1992) from the Extracorporeal Life Support Organization (ELSO) registry were reviewed. Seventeen infants with combined cardiac and diaphragmatic lesions were registered as receiving ECMO in the United States or Canada. ⋯ Five (29.4%) of the 17 infants survived. A congenital cardiac lesion may not be an absolute contraindication to ECMO in infants with CDH. Decisions to cannulate for ECMO should be based on the potential outcome of the underlying cardiac defect.
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In an effort to maximize staff utilization, all pediatric trauma patients were triaged by emergency room personnel to one of two tiers, based on information reported by prehospital providers over radiotelephones. A total of 952 patients less than 15 years of age were evaluated during a 1-year period. ⋯ All eventual deaths were initially captured from field data by the severely injured triage criteria. The study data suggest that physician-controlled two-tiered field triage criteria can safely serve to maximize staff utilization in the emergency room.
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Foreign body aspiration is the cause of death for more than 300 children each year in the United States. Tracheobronchial inhalation of foreign bodies may result in acute respiratory distress, atelectasis, chronic pulmonary infections, or death. A review of the records of 548 children (aged 4 months to 18 years) was undertaken to identify factors important in diagnosis, to illustrate the effectiveness of current endoscopic techniques and equipment, and to evaluate the results and complications of management. ⋯ Bronchoscopy is required for treatment, and with experience this procedure can be simple and safe. Ninety-nine percent of the foreign bodies identified during bronchoscopy were removed successfully. Minor complications occurred in 5%, and there were no deaths.