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Right atrial thrombus formation screening using two-dimensional echocardiograms in neonates with central venous catheters
872 levels, which currently identify only 10% to 30% of affected fetuses. The investigators recommend that fetuses with a thickened nuchal skin fold or shortened femurs on ultrasound examination be evaluated for Down's syndrome by amniocentesis and cytogenetic analysis-Scott Adzick Effects of Indomethacin In Utero on the Pulmonary Vasculature of the Newborn Guinea Pig. D.E. Demello, J.D. Murphy, M.J. Arono-
vitz, et al. Pediatr Res 22:693-697, (December), 1987. The clinical syndrome of persistent pulmonary hypertension of the newborn results from failure of the normal perinatal vascular adaptation. Functionally, it is characterized by persistent rightto-left shunting of blood through the foramen ovale and ductus arteriosus. Exposure of the fetus to drugs that inhibit prostaglandin synthesis and cause closure of the ductus arteriosus has been suggested as one cause of persistent pulmonary hypertension of the newborn. The authors attempted to produce a functional and structural model of persistent pulmonary hypertension of the newborn by administering indomethacin, a cycloozygenase inhibitor, to pregnant guinea pigs. Five pregnant guinea pigs received 3.5 mg/kg indomethacin intravenously twice each day for the 12 to 19 days before delivery, and seven controls received saline. Hemodynamic studies were performed in eight "treated" newborns and in 12 controls. After sacrifce, the ductus was ligated and, for morphometric studies, the pulmonary arteries were distended with barium/ gelatin. The treated animals did not show the intraacinar structural or hemodynamic changes of persistent pulmonary hypertension of the newborn. It seems that the indomethacin did cross the placenta because lung structure was modified. The radial alveolar count and alveolar/artery ratio were increased and the preacinar arteries dilated, with more increase in muscle mass. This could be explained by increased pulmonary blood flow because of ductal constriction, but direct effect of indomethacin cannot be excluded.--Prem Purl The Central Venous Anatomy in Infants. M. Cobb, C.D. Vinocur,
C.W. Wagner, et al. Surg Gynecol Obstet 165:230-234, (September), 1987. A study of 21 consecutive autopsy specimens of infants < 1 year of age and weighing <6 kg was performed to determine the topographic anatomy and regional relationships of the central venous anatomy. This anatomy was compared with 14 additional autopsies performed on older children. There was no significant difference in diameter between the internal jugular and subclavian venous system, on either the right or left side. In the infant, the right and left subclavian veins entered the central system at an acute angle. The left innominate vein joined the right innominate vein at a right angle. These angulations become less acute after one year of age. This adult configuration may account for the relative ease of central venous cannulation through the percutaneous subclavian approach in the older patient. In contrast, the external and internal jugular veins entered centrally in almost a straight line even in the infant. The fingings of this study suggest that the internal and external jugular veins should be considered as safe and reliable portals for percutaneous entry into the central venous system in infants. In the infant < 1 year of age, or when the surgeon is less familiar with the infraclavicular approach, the veins of the neck may, in fact, be the site of choice. Also, the researchers believe that a surgeon should not hesitate to switch to the internal or external jugular site after unsuccessful attempts at percutaneous entry into the subclavian vein.--George Holcomb, Jr Right Atrial Thrombus Formation Screening Using Two-Dimensional Echocardiograms in Neonates With Central Venous Catheters. D. March, S.A. Wilkerson, L.N. Cook, et al. Pediatrics
81:284-286, (February), 1988.
INTERNATIONAL ABSTRACTS Forty-nine patients with 56 central venous catheters (SVC or right atrium) were examined for right atrial thrombus using twodimensional echocardiogram. Initial studies were performed within 3 weeks of insertion, and then at 14-day intervals until the catheter was removed. One patient, a 680 g boy with bronchopulmonary dysplasia, small bowel perforation, and more than one central vein catheter, developed a right atrial thrombus that resolved with urokinase infusion. A review of 11 reported cases of infants with right atrial tbrombus associated with central venous catheters shows that ten had significant gastrointestinal disease requiring operative intervention. While it may be useful in diagnosing patients with right atrial thrombus, routine two-dimensional echocardiograms cannot be recommended as a cost-effective screening measure. Further studies may identify subgroups of infants in whom routine screening may be of benefit.--Jeffrey L. Zitsman Late Ischaemic Sequelae After Umbilical Artery Catheterization. D. Bergqvist, S.E. Bergentz, G. Hermansson, et el. Br J Surg
74:628-629, (July), 1987. The acute complications of umbilical artery catheterization are well recognized, but very little is known about the long-term consequences. Two patients illustrating long-term sequalae are presented. An 11-year-old girl manifested chronic arterial insufficiency of the lower limbs as a result of aortic occlusion just above the bifurcation. The other patient was a 2-year-old who developed malignant hypertension as a consequence of renal artery thrombosis.--Lewis Spitz Intracystic Injection of 0K-432: A New Sclerosing Therapy for Cystic Hygroma in Children. S. Ogita, T. Tsuto, K. Tokiwa, et al. Br
J Surg 74:690-691, (August), 1987. Nine patients with cystic hygroma were treated with intracystic injection of OK-432 (group A Streptococcus pyogenes of human origin). Favorable results, including complete regression in eight patients and marked regression in one, were observed within 2 to 3 months. There were no serious side effects except for fever of 2 to 3 days' duration, and local inflammatory reaction lasting for 3 to 4 days. Local inflammatory reaction did not cause any damage to the overlying skin and did not lead to scar formation.--P. Malone Injuries to Children Younger Than 1 Year of Age. F.P. Rivara, M.D. Kamitsuka, and L. Quan. Pediatrics 81:93-97, (January), 1988.
All injured infants <1 year of age evaluated in two Seattle pediatric emergency rooms were studied prospectively over a 1-year period. In four of 156 infants, the cause of injury could not be determined. Six were believed by both the emergency room physician and the child abuse team to have been abused. Falls were the most common cause of both unintentional injuries and abuse. By comparison, 36% of a retrospective series of abuse cases had no explanation for their injuries. The great majority of injuries in infants <1 year of age are unintentional, accounting for 15 infants seen for every one who had been abused. Injuries occurring at odd hours, unwitnessed by caretakers, and those attributed to siblings may be unintentional, but are usually indicative of abuse.--Jeffrey L Zitsman ANESTHESIA A N D INHALATION THERAPY Comparison of the Induction Characteristics of Thiopentone and Propofol in Children. G. Purcell-Jones, A. Yates, J.R. Baker, et al.
Br J Anaesth 59:1431-1436, (November), 1987. The induction characteristics of propofol were compared with thiopentone in 60 fit children aged 3 to 16 years. The incidence of
vitz, et al. Pediatr Res 22:693-697, (December), 1987. The clinical syndrome of persistent pulmonary hypertension of the newborn results from failure of the normal perinatal vascular adaptation. Functionally, it is characterized by persistent rightto-left shunting of blood through the foramen ovale and ductus arteriosus. Exposure of the fetus to drugs that inhibit prostaglandin synthesis and cause closure of the ductus arteriosus has been suggested as one cause of persistent pulmonary hypertension of the newborn. The authors attempted to produce a functional and structural model of persistent pulmonary hypertension of the newborn by administering indomethacin, a cycloozygenase inhibitor, to pregnant guinea pigs. Five pregnant guinea pigs received 3.5 mg/kg indomethacin intravenously twice each day for the 12 to 19 days before delivery, and seven controls received saline. Hemodynamic studies were performed in eight "treated" newborns and in 12 controls. After sacrifce, the ductus was ligated and, for morphometric studies, the pulmonary arteries were distended with barium/ gelatin. The treated animals did not show the intraacinar structural or hemodynamic changes of persistent pulmonary hypertension of the newborn. It seems that the indomethacin did cross the placenta because lung structure was modified. The radial alveolar count and alveolar/artery ratio were increased and the preacinar arteries dilated, with more increase in muscle mass. This could be explained by increased pulmonary blood flow because of ductal constriction, but direct effect of indomethacin cannot be excluded.--Prem Purl The Central Venous Anatomy in Infants. M. Cobb, C.D. Vinocur,
C.W. Wagner, et al. Surg Gynecol Obstet 165:230-234, (September), 1987. A study of 21 consecutive autopsy specimens of infants < 1 year of age and weighing <6 kg was performed to determine the topographic anatomy and regional relationships of the central venous anatomy. This anatomy was compared with 14 additional autopsies performed on older children. There was no significant difference in diameter between the internal jugular and subclavian venous system, on either the right or left side. In the infant, the right and left subclavian veins entered the central system at an acute angle. The left innominate vein joined the right innominate vein at a right angle. These angulations become less acute after one year of age. This adult configuration may account for the relative ease of central venous cannulation through the percutaneous subclavian approach in the older patient. In contrast, the external and internal jugular veins entered centrally in almost a straight line even in the infant. The fingings of this study suggest that the internal and external jugular veins should be considered as safe and reliable portals for percutaneous entry into the central venous system in infants. In the infant < 1 year of age, or when the surgeon is less familiar with the infraclavicular approach, the veins of the neck may, in fact, be the site of choice. Also, the researchers believe that a surgeon should not hesitate to switch to the internal or external jugular site after unsuccessful attempts at percutaneous entry into the subclavian vein.--George Holcomb, Jr Right Atrial Thrombus Formation Screening Using Two-Dimensional Echocardiograms in Neonates With Central Venous Catheters. D. March, S.A. Wilkerson, L.N. Cook, et al. Pediatrics
81:284-286, (February), 1988.
INTERNATIONAL ABSTRACTS Forty-nine patients with 56 central venous catheters (SVC or right atrium) were examined for right atrial thrombus using twodimensional echocardiogram. Initial studies were performed within 3 weeks of insertion, and then at 14-day intervals until the catheter was removed. One patient, a 680 g boy with bronchopulmonary dysplasia, small bowel perforation, and more than one central vein catheter, developed a right atrial thrombus that resolved with urokinase infusion. A review of 11 reported cases of infants with right atrial tbrombus associated with central venous catheters shows that ten had significant gastrointestinal disease requiring operative intervention. While it may be useful in diagnosing patients with right atrial thrombus, routine two-dimensional echocardiograms cannot be recommended as a cost-effective screening measure. Further studies may identify subgroups of infants in whom routine screening may be of benefit.--Jeffrey L. Zitsman Late Ischaemic Sequelae After Umbilical Artery Catheterization. D. Bergqvist, S.E. Bergentz, G. Hermansson, et el. Br J Surg
74:628-629, (July), 1987. The acute complications of umbilical artery catheterization are well recognized, but very little is known about the long-term consequences. Two patients illustrating long-term sequalae are presented. An 11-year-old girl manifested chronic arterial insufficiency of the lower limbs as a result of aortic occlusion just above the bifurcation. The other patient was a 2-year-old who developed malignant hypertension as a consequence of renal artery thrombosis.--Lewis Spitz Intracystic Injection of 0K-432: A New Sclerosing Therapy for Cystic Hygroma in Children. S. Ogita, T. Tsuto, K. Tokiwa, et al. Br
J Surg 74:690-691, (August), 1987. Nine patients with cystic hygroma were treated with intracystic injection of OK-432 (group A Streptococcus pyogenes of human origin). Favorable results, including complete regression in eight patients and marked regression in one, were observed within 2 to 3 months. There were no serious side effects except for fever of 2 to 3 days' duration, and local inflammatory reaction lasting for 3 to 4 days. Local inflammatory reaction did not cause any damage to the overlying skin and did not lead to scar formation.--P. Malone Injuries to Children Younger Than 1 Year of Age. F.P. Rivara, M.D. Kamitsuka, and L. Quan. Pediatrics 81:93-97, (January), 1988.
All injured infants <1 year of age evaluated in two Seattle pediatric emergency rooms were studied prospectively over a 1-year period. In four of 156 infants, the cause of injury could not be determined. Six were believed by both the emergency room physician and the child abuse team to have been abused. Falls were the most common cause of both unintentional injuries and abuse. By comparison, 36% of a retrospective series of abuse cases had no explanation for their injuries. The great majority of injuries in infants <1 year of age are unintentional, accounting for 15 infants seen for every one who had been abused. Injuries occurring at odd hours, unwitnessed by caretakers, and those attributed to siblings may be unintentional, but are usually indicative of abuse.--Jeffrey L Zitsman ANESTHESIA A N D INHALATION THERAPY Comparison of the Induction Characteristics of Thiopentone and Propofol in Children. G. Purcell-Jones, A. Yates, J.R. Baker, et al.
Br J Anaesth 59:1431-1436, (November), 1987. The induction characteristics of propofol were compared with thiopentone in 60 fit children aged 3 to 16 years. The incidence of