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Endotracheal suctioning of neonates ventilated with high-frequency oscillatory ventilation: Near infrared spectroscopy study
were retrospectively reviewed at Children's Hospital from January, 1981 to December, 1990. There were 38 boys and 16 girls with the male to female ratio of 2.2:1. The ages ranged from 3 months to 14 years (mean: 7.15 --- 3.48 years). The common symptoms and signs were as follows: nausea and vomiting (72.2%), headache (75.92%), fever (68.51%), and changing of consciousness (57.41%). The common underlying disease was congenital cyanotic heart disease especially tetralogy of Fallot. The diagnosis was made by CT in 46 patients and by cerebral angiography in 7 patients. The sites of brain abscesses were parietal (37%) and frontal (25.9%). Multiple abscesses were present in 28.3%. Microbiologic study of the pus taken from the brain abscess showed anarobe peptostreptococcus in 20%. The overall mortality rate was 24.07%.
296. FACTORS ASSOCIATED WITH PRECOCIOUS PUBERTY IN GIRLS WITH SPINA BIFIDA CYSTICA G. Ahlsten, M. Dahl, L. Proos, J. Gustafsson, and T. Tuvemo, Uppsala, Sweden The risk of developing precocious puberty (PP) has been reported to be increased in children with spina bifida cystica. In order to evaluate this further and to study possible factors associated with PP, the medical records of all girls with spina bifida cystica born since 1970 (n = 64) and coming for check-ups at our unit were reviewed. PP was defined as breast development or pubic hair Tanner stage 2 before the age of 9.2 years. In 28 of 64 patients data were sufficient for such evaluation. Eighteen girls had PP and 10 girls normal data for puberty. The medical histories of the 2 groups did not differ regarding length of pregnancy or birth weight. Girls with PP had a significantly higher frequency of increased intracranial pressure during the perinatal period and were treated with intraventricular shunts more often than those with normal data for puberty (P < .01 and P < .05, respectively). The group of girls with PP, in general, seems to have more severe problems. In conclusion, PP is frequent in girls with spina bifida cystica and seems to be associated with increased intracranial pressure in early life.
297. ENDOTRACHEAL SUCTIONING OF NEONATES VENTILATED WITH HIGH-FREQUENCY OSCILLATORY VENTILATION: NEAR INFRARED SPECTROSCOPY STUDY G. Bernert, C. Kohlhauser, M. Hermon, R. Seidl, and A. Pollak, Vienna, Austria Endotracheal suctioning is associated with changes in cerebral circulation as shown in studies using Doppler ultrasound technique, noninvasive intracranial pressure monitoring, and near infrared spectroscopy (NIRS). The effect of high-frequency oscillatory ventilation (HFOV) on cerebral hemodynamics has not been studied until now. In an open prospective design, we studied 13 suctioning periods in 10 infants on HFOV (Sensormedics 3100). Gestational ages ranged 24-34 weeks (mean: 29 wks) and birth weights 520-2920 gm (mean: 1,337 gm). The measurements were done on days 1-28 (mean: 6.2). NIRS (NIRO 500, Hamamatsu KK) was used to monitor changes in cerebral concentration of oxygenated (HbO2) and reduced hemoglobin
(Hb) and cytochrome aa3 (cytaa3). Heart rate (Hrt), mean arterial blood pressure (MAP), arterial oxygen saturation (SatO2), and carbon dioxide tension (TcPco2) were monitored continuously. Behavioral state (BS) observations were made by the investigator and documented as well. In all measurements, a significant decrease in HbO 2 and an increase in Hb were seen during endotracheal suctioning. The magnitude of these changes was quantiffed by comparing them to baseline values, established before the onset of suctioning. NIRS is useful for evaluating the effects of new ventilatory techniques, such as HFOV, on cerebral circulation.
298. E F F E C T OF B E H A V I O R A L S T A T E S ON CHANGES OF CEREBRAL BLOOD VOLUME AND OXYGENATION DURING ENDOTRACHEAL SUCTIONING: NEAR INFRARED SPECTROSCOPY STUDY IN VENTILATED PRETERM NEONATES G. Bernert, K.V. Siebenthal, R. Seidl, Ch. Vanhole, H. Devlieger, and P. Casaer, Vienna, Austria and Leuven, Belgium Controversial results have been reported concerning changes of oxygenated hemoglobin (HbO2), reduced hemoglobin (Hb), and total hemoglobin (Hbtot), during endotracheal suctioning. To explain these differences, some authors proposed a possible relationship to differences in the activity level of the infants. In an open prospective design, we studied 20 suctioning periods in 13 infants who had been admitted to the neonatal intensive care unit of the Department of Pediatrics at the University Hospital of Leuven. Gestational ages ranged 26-32 weeks (mean: 29 wks, S.D. 2) and birth weights 694-1,750 gm (mean: 1,329 gm, S.D. 277). For NIRS measurements, a commercial system (NIR 1000, Hamamatsu KK) was used. Heart rate (Hrt), mean arterial blood pressure (MAP), arterial oxygen saturation (SatO2), and carbon dioxide tension (TcPco2) were monitored continuously. Behavioral state (BS) observations were made and documented as well. Statistical analyses (Mann-Whitney-U) showed that in patients who were active, with crying periods during suctioning, changes of Hb, HbO 2, and SatO 2 were significantly greater than in patients with predominant behavioral states 1, 2, and 3 (P < .05). These results underline the potential risk of high airway pressure, coughing, and fighting the ventilator. NIRS proved to be a valuable tool in re-evaluating the possible harmful effects of different suctioning techniques.
299. POLYSOMNOGRAM REAL-TIME PROCESSING SYSTEM: CLINICAL USE IN CHILDHOOD EPILEPSY Komei Kumagai, Susumu Ohi, Mana Kurihara, Hideki Horita, and Kihei Maekawa, Atsugi, Kanagawa and Tokyo, Japan In childhood epilepsy, especially epileptic syndrome in childhood, it is recognized that EEG usually shows a marked contrast between the waking record, which typically displays focal paroxysms, and sleep tracings which demonstrate almost continuous diffuse, slow spike-and-wave activity. In the EEG investigation of epileptic syndromes, there has been a need for a simple-to-use analytic system giving consistent results. An all-night real-time polysomnogram (PSG) processing system equipped with a per-
PEDIATRIC NEUROLOGY Vol. 11 No. 2 163
296. FACTORS ASSOCIATED WITH PRECOCIOUS PUBERTY IN GIRLS WITH SPINA BIFIDA CYSTICA G. Ahlsten, M. Dahl, L. Proos, J. Gustafsson, and T. Tuvemo, Uppsala, Sweden The risk of developing precocious puberty (PP) has been reported to be increased in children with spina bifida cystica. In order to evaluate this further and to study possible factors associated with PP, the medical records of all girls with spina bifida cystica born since 1970 (n = 64) and coming for check-ups at our unit were reviewed. PP was defined as breast development or pubic hair Tanner stage 2 before the age of 9.2 years. In 28 of 64 patients data were sufficient for such evaluation. Eighteen girls had PP and 10 girls normal data for puberty. The medical histories of the 2 groups did not differ regarding length of pregnancy or birth weight. Girls with PP had a significantly higher frequency of increased intracranial pressure during the perinatal period and were treated with intraventricular shunts more often than those with normal data for puberty (P < .01 and P < .05, respectively). The group of girls with PP, in general, seems to have more severe problems. In conclusion, PP is frequent in girls with spina bifida cystica and seems to be associated with increased intracranial pressure in early life.
297. ENDOTRACHEAL SUCTIONING OF NEONATES VENTILATED WITH HIGH-FREQUENCY OSCILLATORY VENTILATION: NEAR INFRARED SPECTROSCOPY STUDY G. Bernert, C. Kohlhauser, M. Hermon, R. Seidl, and A. Pollak, Vienna, Austria Endotracheal suctioning is associated with changes in cerebral circulation as shown in studies using Doppler ultrasound technique, noninvasive intracranial pressure monitoring, and near infrared spectroscopy (NIRS). The effect of high-frequency oscillatory ventilation (HFOV) on cerebral hemodynamics has not been studied until now. In an open prospective design, we studied 13 suctioning periods in 10 infants on HFOV (Sensormedics 3100). Gestational ages ranged 24-34 weeks (mean: 29 wks) and birth weights 520-2920 gm (mean: 1,337 gm). The measurements were done on days 1-28 (mean: 6.2). NIRS (NIRO 500, Hamamatsu KK) was used to monitor changes in cerebral concentration of oxygenated (HbO2) and reduced hemoglobin
(Hb) and cytochrome aa3 (cytaa3). Heart rate (Hrt), mean arterial blood pressure (MAP), arterial oxygen saturation (SatO2), and carbon dioxide tension (TcPco2) were monitored continuously. Behavioral state (BS) observations were made by the investigator and documented as well. In all measurements, a significant decrease in HbO 2 and an increase in Hb were seen during endotracheal suctioning. The magnitude of these changes was quantiffed by comparing them to baseline values, established before the onset of suctioning. NIRS is useful for evaluating the effects of new ventilatory techniques, such as HFOV, on cerebral circulation.
298. E F F E C T OF B E H A V I O R A L S T A T E S ON CHANGES OF CEREBRAL BLOOD VOLUME AND OXYGENATION DURING ENDOTRACHEAL SUCTIONING: NEAR INFRARED SPECTROSCOPY STUDY IN VENTILATED PRETERM NEONATES G. Bernert, K.V. Siebenthal, R. Seidl, Ch. Vanhole, H. Devlieger, and P. Casaer, Vienna, Austria and Leuven, Belgium Controversial results have been reported concerning changes of oxygenated hemoglobin (HbO2), reduced hemoglobin (Hb), and total hemoglobin (Hbtot), during endotracheal suctioning. To explain these differences, some authors proposed a possible relationship to differences in the activity level of the infants. In an open prospective design, we studied 20 suctioning periods in 13 infants who had been admitted to the neonatal intensive care unit of the Department of Pediatrics at the University Hospital of Leuven. Gestational ages ranged 26-32 weeks (mean: 29 wks, S.D. 2) and birth weights 694-1,750 gm (mean: 1,329 gm, S.D. 277). For NIRS measurements, a commercial system (NIR 1000, Hamamatsu KK) was used. Heart rate (Hrt), mean arterial blood pressure (MAP), arterial oxygen saturation (SatO2), and carbon dioxide tension (TcPco2) were monitored continuously. Behavioral state (BS) observations were made and documented as well. Statistical analyses (Mann-Whitney-U) showed that in patients who were active, with crying periods during suctioning, changes of Hb, HbO 2, and SatO 2 were significantly greater than in patients with predominant behavioral states 1, 2, and 3 (P < .05). These results underline the potential risk of high airway pressure, coughing, and fighting the ventilator. NIRS proved to be a valuable tool in re-evaluating the possible harmful effects of different suctioning techniques.
299. POLYSOMNOGRAM REAL-TIME PROCESSING SYSTEM: CLINICAL USE IN CHILDHOOD EPILEPSY Komei Kumagai, Susumu Ohi, Mana Kurihara, Hideki Horita, and Kihei Maekawa, Atsugi, Kanagawa and Tokyo, Japan In childhood epilepsy, especially epileptic syndrome in childhood, it is recognized that EEG usually shows a marked contrast between the waking record, which typically displays focal paroxysms, and sleep tracings which demonstrate almost continuous diffuse, slow spike-and-wave activity. In the EEG investigation of epileptic syndromes, there has been a need for a simple-to-use analytic system giving consistent results. An all-night real-time polysomnogram (PSG) processing system equipped with a per-
PEDIATRIC NEUROLOGY Vol. 11 No. 2 163