The effect of gavage feeding on the mechanics of the lung, chest wall, and diaphragm of preterm infants

INTERNATIONAL ABSTRACTS

Endoscopic Correction of Vesicoureteric Reflux. Urinary Infection and Malformations of the Urinary Tract in Infancy ......................................... Value of Postmicturition View in 99~Tc DTPA Diuretic Renography for Pelviureteric Junction Obstruction ....................................................... The Dilated Urinary Tract in Children ............... Role of Percutaneous Nephrostomy in the Management of Obstructing Candidiasis of the Urinary Tract in Infants ........................................ Renal Dysplasia .................................................... Recurrent and Residual Renal Calculi in Children ................................................................... Diagnosis of Hypercalcuria in Children ............... Urologic Management of Patients With Myelodysplasia Dilemmas Associated With Antenatally Detected Urinary Tract Anomalies ................................. Neonatal Ovarian Cysts ....................................... . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

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Diagnostic end Surgical Implications of Child Abuse. D.J. Ledbet-

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ter, E.L Hatch, K.W. Feldman, et al. Arch Surg 123:1101-1105, (September), 1988. During an 8-year period, 156 children < 13 years of age presented with blunt abdominal trauma caused by accidental injuries in 89% and child abuse injuries in 11%. Abused children were younger (mean age, 2~2 years) and all presented late for medical attention

with histories inconsistentwith their physicalfindings. Prior abuse 327 327 327

Neoplasms Significance of Conjugated Versus "Free" Acidic Metabolites of Catecholamines in Random Urine Samples for the Diagnosis of Neuroblastoma .................................................................. Clinical Utility of Fine Needle Aspiration in the Diagnosis and Management of Neuroblastoma Prognostic Factors in Children With Nonmetastatic Rhabdomyosarcoma at Diagnosis .......... Pelvic Rhabdomyosarcorna in Children ............... Comparison of Totally Implanted Reservoirs With External Catheters as Venous Access Devices in Pediatric Oncologic Patients ...........

Fifteen of 96 children with dermatomyositis required surgical treatment other than diagnostic biopsy. Four patients had perforation of the gastrointestinal tract, and 11 required surgical therapy for abcesses, caleific deposits, or treatment of pneumothorax. The life endangering complications of dermatomyositis were the perforations of the esophagus and intestine. The surgical therapy deemed best is closure, resection, and adequate drainage. Prognosis depends on treatment of the underlying medical disease.--George A. Rowe

was demonstrated in 65%; 35% had no signs of prior abuse. The injuries to abdominal viscera differed. Sixty-one percent of accidental injuries were to a single solid organ with only 8% to a hollow viscus. Sixty-five percent of abused children had hollow viscus injuries. Physicians should suspect child abuse when children have unexplained injuries, even when other signs of child abuse are absent, and they should suspect hollow viscus injury in abused children.--George A. Rowe Acute Hemodynamic Effects of Nifedipine in Infants With Bronchopulmonary Dysplasia and Pulmonary Hypertension. J.R. arownlee,

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GENERAL CONSIDERATIONS

Complications of Prematurity That May Require Surgical Intervention. M.Z. Schwartz. S.B. Palder, K.R.T. Tyson, et al. Arch Surg

123:1135-1138, (September), 1988. Potential complications in premature infants that may require surgical intervention are numerous. During a 6-year period, 228 patients with patent ductus arteriosus (PDA), 49 with necrotizing enterocolitis (NEC), and eight with complications of high-pressure ventilation were treated. PDA ligation was performed in 136 patients; there was one death and one complication. There were 35 failures among 92 patients treated with indomethacin. A 73% mortality occurred when PDA was associated with NEC in 49 patients when they took place within 72 hours of each other. Two patients died after pulmonary resection for lung cysts. Two patients with pneumopericardium and pneumoperitoneum survived after treatment with tube drainage.--George A. Rowe Required Surgical Therapy in the Pediatric Patient With Dermato-

myositis. E.C. Downey, M.M. Woolley, and V. Hanson. Arch Surg 123:1117-1120, (September), 1988.

R.H. Beckman, and A. Rosenthal. Pediatr Res 24:186-190, (August), 1988. The acute hemodynamic effects of nifedipine were evaluated and compared with the effects of 95% oxygen in six children with bronchopulmonary dysplasia and pulmonary artery hypertension. The children ranged in age from 7 to 26 months and all were oxygen-dependent. In the cardiac catheterization laboratory, hemodynamic data were collected in 95% oxygen, room air, and 15 and 30 minutes after nifedipine administration (0.5 to 0.6 mg/kg per nasogastric tube). Compared with values in room air, nifedipine resulted in a 34% decrease in mean pulmonary artery pressure (from 69.3 _+2.4 to 45.8 _+ 1.2 mmHg, P = .03), and a 49% decrease in pulmonary vascular resistance (from 14.8 _+ 1.4 to 7.5 _+0.9 U / m 2, P = .03). A linear relationship was found between the arterial pC 2 and the change in the ratio of pulmonary to systemic resistance after nifedipine (% decrease in Rp/Rs ratio = 86.3 to 1.3 x PC2, r = -.95, P = .004), suggesting that nifedipine may act to oppose the vascular effects of arterial hypoxemia. There was no significant change in heart rate, arterial PC2, or pCO2 with nifedipine, but cardiac output increased significantly. Compared with 95% oxygen, nifedipine achieved a lower pulmonary vascular resistance (7.5 _+0.9 v 10.9 +- 1.2 U / m 2, P = .03) and a greater cardiac output (5.25 _+0.71 v 3.54 _+0.35 L / m i n / m 2, P ~ .03) with comparable systemic oxygen delivery (699 +_ 85 m L v 698 +_ 91 mL O2/min/m 2, P = 1.0). Thus, nifedipine is an acute pulmonary vasodilator in some children with bronchopulmonary dysplasia. Should future studies document that these acute effects are sustained and that long-term administration in childhood is safe, nifedipine may prove valuable in the management of infants with bronchopulmonary dysplasia and pulmonary artery hypertension.--Prem Purl The Effect of Gavsge Feeding on the Mechanics of the Lung, Chest Wall, and Diaphragm of Pretarm Infants. G.P. Heldt. Pediatr Res

24:55-58, (July), 1988.

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Preterm infants, when given bolus nasogastric (gavage) feedings, have well-characterized decreases in arterial partial pressure of oxygen, increases in arterial partial pressure of carbon dioxide, a tendency to have apnea, and are reported to have no change in the mechanics of breathing. The purpose of this study was to assess the function of the lungs, chest wall, and diaphragm in preterm infants without lung disease before and after gavage feeding. Lung mechanics were measured with a pneumotachograph and esophageal balloon, and the mechanics of the chest wall and diaphragm were assessed by inductance plethysmography and measurement of transdiaphragmatic pressure. After feeding, there was a significant decrease in dynamic lung compliance and increase in the minute ventilation (P < .05). The work performed on the lungs was unchanged. The chest wall became more stable, with a significant decrease in its dynamic compliance (P < .05). The diaphragmatic volume displacement, expressed as a percentage of the minute ventilation, was unchanged. The diaphragmatic work increased significantly (P < .05), and was greater than four times the work performed on the lungs. These results are consistent with previous reports of a decrease in functional residual capacity after feeding. The mechanical stability of the chest wall may have been improved by an increase in the area of apposition of the diaphragm to it, or by an increase in the central drive to breathing after feeding. The increment in diaphragmatic work after feeding, being nearly as large as the absolute amount of work performed on the lungs, may be enough to cause muscular fatigue and resultant apnea noted in some preterm infants after gavage feeding.--Prem Puri

Prenatal Sonographic Diagnosis of Isolated Congenital Cystic Hygroma, Unassociated With Lymphedema or Other Morphologic Abnormality. B.R. Benacerraf and F.D. Frigoletto. J Ultrasound

Med 6:63-66, (March), 1987. The authors report the prenatal sonographic diagnosis in five cases of isolated cystic hygroma (lymphangioma) unassociated with lymphedema or morphologic abnormalities. This type of cystic hygroma appears different from the ones occurring at the back of the neck, which have other lymphatic anomalies and a poor prognosis. Four of the five fetuses did well after postnatal surgery. The authors stress the differences between isolated congenital cystic hygroma that are frequently seen by the pediatrician or pediatric surgeon and the more common generalized form of nuchal cystic hygroma that has a poor prognosis with associated generalized hydrops and frequent chromosomal abnormalities.--N. Scott Adzick

INTERNATIONAL ABSTRACTS Fetus in F~tu. S.F. Sutherland and S. Singh. Pediatr Surg Int

3:368-372, (July), 1988. Fetus in fetu is a rare condition in which a monozygotic monoamniotic dichorionic twin is included within the body of its sibling. In 1956, Lord (J Pathol Bacterio172:627-641, 1956) presented the first systematic review of the subject, comprising 11 case reports including one of her own. She found that many of the earlier reports dealt with teratomas and not true fetus in fetu. In 1958, Willis (The Borderline of Embryology and Pathology, ed 1. London, Butterworth, 1958, pp 147,641) defined fetus in fetu as a benign mass with a vertebral column, as identified by radiography or at dissection, with other bones and organs arranged around the axis. This is to be differentiated from a true teratoma, which shows no axial arrangements and has definite malignant potential. This report presents a case occurring in a newborn male and a review of the literature since Lord's initial review.--Prem Puri ALIMENTARY TRACT Vomiting and Gastro-oesophageal Reflux. J.Y. Patten, C.F.

Nanayakkhara, and H. Simpson. Arch Dis Child 63:837-838, (July), 1988. In a study of 82 infants assessed for presence of gastroesophageal reflux by radioisotope milk scan, an analysis was made as to how often appreciable radionucleotide in the esophagus was accompanied by vomiting. Scans were conducted because of near-miss sudden infant death in 22 children, a family history of sudden death in 12, and in the remainder because of choking episodes, recurrent wheezing, recurrent vomiting, or mental retardation. All children were <2 years of age. Scans lasted on average 110 minutes, and reflux was graded as moderate (affecting the lower esophagus or larynx) or severe (involving the upper esophagus or larynx). Each examination was accompanied by static images taken every 60 seconds, reflecting an accumulation of radioactivity during that 60-second period. Significant gastroesophageal reflux was detected in 883 frames of such 60-second periods; in 636 of these, reflux to the upper esophagus was demonstrated. However, only 9.5% of these images were associated with vomiting. Conversely, when vomiting was observed, only 56% of vomiting incidents were associated with significant reflux as detected by this means. The authors comment that the absence of vomiting does not preclude gastroesophageal reflux.-D.M. Burge Effect of Nonnutritive Sucking on Infant Gastroesophageal Reflux.

S.R. Orenstien. Pediatr Res 24:38-40, (July), 1988. Prenatal Diagnosis of Congestive Heart Failure in a Fetus With a Saerocoecygeal Teratoma, D.N. Alter, K.L. Reed, G.R. Marx, et al.

Obstet Gynecol 71:978-981, (June), 1988. Maternal ultrasound was performed for indications of size-date inconsistency in a 27-week gestational age fetus with hydrops and a large solid and cystic mass in the sacral region. Fetal echocardiography showed dilated ventricles and a pericardial effusion. Doppler ultrasound demonstrated increased velocities and volume flows, along with tricuspid and mitral regurgitation. During delivery, the mass was bleeding actively, the amniotic fluid was markedly bloody, and the neonatal hematocrit was only 10%. The investigators postulate that intrauterine hemorrhage from the teratoma led to anemia and high-output cardiac failure, which was confirmed by Doppler echocardiography. They suggest that all fetuses with sacrococcygeal teratoma be evaluated by two-dimensional Doppler echocardiography to detect the presence of congestive heart failure in order to allow well-timed therapeutic interventions.--N. Scott Adzick

To evaluate the effect of pacifier use (nonnutritive sucking) on gastroesophageal reflux in infants, 48 infants <6 months of age with pathologic reflux were prospectively evaluated with a pH probe. In each infant, parameters of reflux were blindly quantified during paired periods in a cross-over design when pacifier use was either encouraged or prohibited. To determine whether positioning was a factor in the effect of nonnutritive sucking on reflux, 24 of the infants were studied seated and 24 studied prone. Pacifier use significantly affected only the frequency of reflux episodes, increasing it in prone infants from 7.2 • 1.1 to 12.8 +_ 2.3 episodes per 120 minutes pestprandially (P = .040), and decreasing it in seated infants from 21.1 _+3.1 to 14.8 • 2.6 postprandially (P ~ .003), and from 17.3 _+4.8 to 5.9 _+0.9 in the fasting period (P = .035). It did not significantly affect the clearance of reflux episodes or the total reflux time. These results suggest that, in infants with pathologic reflux, use of the pacifier should be avoided while in the beneficial prone position. When the seated position is necessary, the pacifying effects of nonnutritive sucking may be useful in decreasing reflux events as well as in reducing erying.--Prem Puri