- Email: [email protected]
Resuscitation of the newborn
886
AMFXICAN
JOURNAL
OF
OBSTETRICS
AND
GYNECOLOGY
muscular apparatus of the eyes-7. Among the 41 children no less than 13 were delivered by means of forceps and one child which presented by the breech had an instrumental delivery. The author feels that the prognosis for children who survive intracranial birth hemorrhage must be considered “dubious but not pessimistic. ” J. P. GREENHILL. Munro, Donald: & Obst. 47:
the
Cranial and 622, 1928.
Intracranial
The end-results of a series of I17 newborn, collected and followed
Damage
cases during
of
in the
cranial the past
Newborn.
Surg.
Gynee.
and intracranial damage in seven years, are presented.
The diagnosis of intracranial hemorrhage of the newborn must be expanded to include cerebral edema and fracture of the skull and should be stated as “cranial Postmortem gross and microscopic studies and intracranial damage in the newborn.” conducted on 45 of the 50 primarily fatal cases show that meningeal and intracortical hemorrhage, congestion and edema are the most common pathologic entities. Gross intracranial hemorrhage may occur from the rupture of any of the large venous sinuses, the most common sites being the great vein of Galen or the lateral sinus. Intracortical edema and congestion alone may cause death in the newborn. Forty-eight of the 58 babies discharged living and relieved have been followed up to December, 1927. Thirty-nine of the 48 may be classed as cured; 5 are still too young to allow for a satisfactory estimation of the end-result. The most common late result of cerebral damage associated with either epilepsy or idiocy. Convulsions with idiocy have also occurred.
in the newborn is hydrocephalus alone and spasticity associated
Active treatment in this series was limited to lumbar decompression after recovery from surgical shock. In addition, parental blood was given intramuscularly in the hemorrhagic disease group. Depressed fractures were elevated as soon as possible. Ventricular puncture was done twice, as was a typical subtemporal deeompression. WM. C.HENSKE. Eatz,
II.:
Resuscitation
of the
Newborn.
Wien.
klin.
Wehnschr.
42:
590,
1929.
Asphyxia of the newborn is the term applied simply to indicate absence of breathing. Asphyxiation is most often the result of interference in the gaseous Examples are cord compression, exchange between mother and fetus before birth. premature separation of the placenta, prolapse of the cord, and deficient oxygenation in the mother due to disease of the heart or lungs. In other eases asphyxia is caused by increased intracranial pressure due to cerebral hemorrhage as well as by drugs including the anesthetic used during delivery. These influence the respiratory center. The newborn then has the appearance of suffocation, being blue or pallid, the latter being more serious and indicating a condition such as cerebral hemorrhage. Measures to be employed in resuscitation are: (1) The removal of fluid, blood, meconium, etc., from the mouth and throat with the finger. (2) Suction through a rubber tube introduced into the trachea. (3) Warm bath followed by cold. (4) Friction suspending the child by its feet. (5) Artificial respiration by Sylvester ‘8 method together with oxygen inhalation. (6) Flexion and extension of hips upon abdomen. (7) Ogata’s method-with the spinal column of the child hyperextended the region of the heart is tapped with the hand, about 15 to 20 taps per minute, (8) Subcutaneous at regular intervals corresponding to inhalation and exhalation.
REVIEWS
AND
887
ABSTRACTS
injections of lobelin, caffeine, and camphor are helpful. (9) As a last resort intracardiac adrenalin. Schultze’s method and mouth to mouth insufflation as well as oxygen administered through a machine are not to be recommended. The sistence
careful execution as long as there
of the above maneuvers in their order, as well is evidence of any heartbeat, is strongly stressed. FRANK
Eobes, Rudolf: GynHk. 53:
The Transmission 42, 1929.
of “Pernocton”
to the
as per-
SPIELMAN.
Newborn.
Zentralbl.
f.
All authorities agree that Pernocton is useful as an aualgesie in the parturient woman. Opinions, however, differ on the question of possible harm to the newborn child; some men recognizing none, and others recording definitely intoxicated babies of an ash-gray appearance. The author, after a six months’ trial, holds the latter view. He believes that the children show symptoms of drowsiness for at least one day postpartum. Pernocton is a brom-barbituric acid compound. Transmission of the drug to the newborn was shown by proving the presence of bromine in the fetal urine up to four days postpartum, and of barbiturio acid up to three days. Bromine was found also in umbilical cord blood, and in amniotic fluid, but not in mothers’ milk. WILLIAM
Eades, 201:
M. F.: Retinal 151, 1929.
Hemorrhages
in
the
Newborn.
New
F.
MENGERT.
England
J.
Med.
In this extensive study the eyes of 138 newborn infants were examined in the Boston Lying-in Hospital, mostly within the first twenty-four hours after delivery. In this latter group the incidence of retinal hemorrhages amounted to 17 per cent. Analyzing the exact obstetric history in each instance the writer arrived at the following conclusions: Operative deliveries and espeeialIy forceps play a major role in the causation of hemorrhages, while, at least in this series, duration of labor, time of rupture of membranes, contracted pelvis! fetal asphyxia or syphilis failed to show a primary association with the eye condition. Ophthalmologic study of the retinal hemorrhage is of no value in regard to prognosis and only of secondary diagnostic importance in relation to a concomitant intracranial injury. EHRENFEST.
Lundquist, Acta
B. : Intrathoracic and Obst. et Gynec. Scandinav.
Intra-abdominal 9: 331, 1930.
Hemorrhages
in
the
Newborn.
The author collected 52 cases of intrathoracic and intra-abdominal hemorrhages in the newborn. Only 3 of the cases were intrathoracic of which 2 mere thymic in origin and one mediastinal. Of the 49 intra-abdominal cases, 5 were due to rupture in the liver parenchyma, 14 had subcapsular hemorrhage in the liver, 17 had suprarenal hemorrhage, 1 had a rupture of the spleen and in 12 the source was unknown. The primary etiologic factor was circulatory disturbances in the fetus as the result of labor itself and perhaps also the changes in the circulation produced by the first breath of the child. The parenchymatous ruptures in the liver and spleen may be due to mechanical injury such as direct pressure against them by the symphysis. In the case of subcapsular liver hemorrhages and bleeding into the snprarenak and thymus, there is no mechanical factor, but asphyxia is a fairly constant occurrence. Since asphyxia alone does not explain these hemorrhages, the
AMFXICAN
JOURNAL
OF
OBSTETRICS
AND
GYNECOLOGY
muscular apparatus of the eyes-7. Among the 41 children no less than 13 were delivered by means of forceps and one child which presented by the breech had an instrumental delivery. The author feels that the prognosis for children who survive intracranial birth hemorrhage must be considered “dubious but not pessimistic. ” J. P. GREENHILL. Munro, Donald: & Obst. 47:
the
Cranial and 622, 1928.
Intracranial
The end-results of a series of I17 newborn, collected and followed
Damage
cases during
of
in the
cranial the past
Newborn.
Surg.
Gynee.
and intracranial damage in seven years, are presented.
The diagnosis of intracranial hemorrhage of the newborn must be expanded to include cerebral edema and fracture of the skull and should be stated as “cranial Postmortem gross and microscopic studies and intracranial damage in the newborn.” conducted on 45 of the 50 primarily fatal cases show that meningeal and intracortical hemorrhage, congestion and edema are the most common pathologic entities. Gross intracranial hemorrhage may occur from the rupture of any of the large venous sinuses, the most common sites being the great vein of Galen or the lateral sinus. Intracortical edema and congestion alone may cause death in the newborn. Forty-eight of the 58 babies discharged living and relieved have been followed up to December, 1927. Thirty-nine of the 48 may be classed as cured; 5 are still too young to allow for a satisfactory estimation of the end-result. The most common late result of cerebral damage associated with either epilepsy or idiocy. Convulsions with idiocy have also occurred.
in the newborn is hydrocephalus alone and spasticity associated
Active treatment in this series was limited to lumbar decompression after recovery from surgical shock. In addition, parental blood was given intramuscularly in the hemorrhagic disease group. Depressed fractures were elevated as soon as possible. Ventricular puncture was done twice, as was a typical subtemporal deeompression. WM. C.HENSKE. Eatz,
II.:
Resuscitation
of the
Newborn.
Wien.
klin.
Wehnschr.
42:
590,
1929.
Asphyxia of the newborn is the term applied simply to indicate absence of breathing. Asphyxiation is most often the result of interference in the gaseous Examples are cord compression, exchange between mother and fetus before birth. premature separation of the placenta, prolapse of the cord, and deficient oxygenation in the mother due to disease of the heart or lungs. In other eases asphyxia is caused by increased intracranial pressure due to cerebral hemorrhage as well as by drugs including the anesthetic used during delivery. These influence the respiratory center. The newborn then has the appearance of suffocation, being blue or pallid, the latter being more serious and indicating a condition such as cerebral hemorrhage. Measures to be employed in resuscitation are: (1) The removal of fluid, blood, meconium, etc., from the mouth and throat with the finger. (2) Suction through a rubber tube introduced into the trachea. (3) Warm bath followed by cold. (4) Friction suspending the child by its feet. (5) Artificial respiration by Sylvester ‘8 method together with oxygen inhalation. (6) Flexion and extension of hips upon abdomen. (7) Ogata’s method-with the spinal column of the child hyperextended the region of the heart is tapped with the hand, about 15 to 20 taps per minute, (8) Subcutaneous at regular intervals corresponding to inhalation and exhalation.
REVIEWS
AND
887
ABSTRACTS
injections of lobelin, caffeine, and camphor are helpful. (9) As a last resort intracardiac adrenalin. Schultze’s method and mouth to mouth insufflation as well as oxygen administered through a machine are not to be recommended. The sistence
careful execution as long as there
of the above maneuvers in their order, as well is evidence of any heartbeat, is strongly stressed. FRANK
Eobes, Rudolf: GynHk. 53:
The Transmission 42, 1929.
of “Pernocton”
to the
as per-
SPIELMAN.
Newborn.
Zentralbl.
f.
All authorities agree that Pernocton is useful as an aualgesie in the parturient woman. Opinions, however, differ on the question of possible harm to the newborn child; some men recognizing none, and others recording definitely intoxicated babies of an ash-gray appearance. The author, after a six months’ trial, holds the latter view. He believes that the children show symptoms of drowsiness for at least one day postpartum. Pernocton is a brom-barbituric acid compound. Transmission of the drug to the newborn was shown by proving the presence of bromine in the fetal urine up to four days postpartum, and of barbiturio acid up to three days. Bromine was found also in umbilical cord blood, and in amniotic fluid, but not in mothers’ milk. WILLIAM
Eades, 201:
M. F.: Retinal 151, 1929.
Hemorrhages
in
the
Newborn.
New
F.
MENGERT.
England
J.
Med.
In this extensive study the eyes of 138 newborn infants were examined in the Boston Lying-in Hospital, mostly within the first twenty-four hours after delivery. In this latter group the incidence of retinal hemorrhages amounted to 17 per cent. Analyzing the exact obstetric history in each instance the writer arrived at the following conclusions: Operative deliveries and espeeialIy forceps play a major role in the causation of hemorrhages, while, at least in this series, duration of labor, time of rupture of membranes, contracted pelvis! fetal asphyxia or syphilis failed to show a primary association with the eye condition. Ophthalmologic study of the retinal hemorrhage is of no value in regard to prognosis and only of secondary diagnostic importance in relation to a concomitant intracranial injury. EHRENFEST.
Lundquist, Acta
B. : Intrathoracic and Obst. et Gynec. Scandinav.
Intra-abdominal 9: 331, 1930.
Hemorrhages
in
the
Newborn.
The author collected 52 cases of intrathoracic and intra-abdominal hemorrhages in the newborn. Only 3 of the cases were intrathoracic of which 2 mere thymic in origin and one mediastinal. Of the 49 intra-abdominal cases, 5 were due to rupture in the liver parenchyma, 14 had subcapsular hemorrhage in the liver, 17 had suprarenal hemorrhage, 1 had a rupture of the spleen and in 12 the source was unknown. The primary etiologic factor was circulatory disturbances in the fetus as the result of labor itself and perhaps also the changes in the circulation produced by the first breath of the child. The parenchymatous ruptures in the liver and spleen may be due to mechanical injury such as direct pressure against them by the symphysis. In the case of subcapsular liver hemorrhages and bleeding into the snprarenak and thymus, there is no mechanical factor, but asphyxia is a fairly constant occurrence. Since asphyxia alone does not explain these hemorrhages, the