11/14. Intercostal muscle reflexes and sleep breathing patterns in the human infant.Breathing variability and apnea characteristic of rapid eye movement (REM) sleep was investigated in a newborn infant with complete interruption of intercostal to phrenic neural pathways due to intrapartem transection of the cervical spinal cord. Breath-to-breath variability in inspiratory duration (TI), breath duration (Ttot), tidal volume (VT), and ventilation (VI) was significantly greater in REM than in quiet sleep and was similar to the variability in these parameters seen in normal infants. In addition, brief periods of diaphragmeatic apnea were observed during REM sleep. The phenomenon of shortened TI during airway occlusion previously attributed to intercostal-to-phrenic reflexes was examined in the quadriplegic infant and in seven healthy term infants. The frequency of this response was increased when airway occlusion was delayed until after onset of inspiration. Shortening of TI by occlusion occurred no less frequently in the quadriplegic than in the control infants. The constant paradoxical inward movement of the rib cage during inspiration observed in the quadriplegic infant suggests that supraspinal innervation of intercostal muscle limits such paradoxical movements in the normal infant. The quadriplegic infant's end-expiratory volume was consistently above his passive functional residual capacity, as inferred from respiratory volume and pressure measurements.- - - - - - - - - - ranking = 1keywords = breathing (Clic here for more details about this article) |
12/14. Is birth trauma responsible for idiopathic perforation of the biliary tract in infancy?This case report details the clinical presentation and surgical management of a neonate with idiopathic perforation of the biliary tract. A three-day-old baby girl presented with a right-upper-quadrant mass and signs of peritonitis following a prolonged, difficult vaginal delivery. At surgery, she was found to have a perforation at the junction of the cystic and common bile duct. Simple drainage of the right upper quadrant was performed, and the patient recovered uneventfully. Early presentation and the nature of delivery suggests the possibility of birth trauma as an etiological factor in this condition.- - - - - - - - - - ranking = 0.0064360483464554keywords = upper (Clic here for more details about this article) |
13/14. Case report: unilateral combined facial nerve and brachial plexus palsies in a neonate following a midlevel forceps delivery.A case is described in which the 2.7-kg fetus of a nonobese primigravid patient, delivered by midlevel forceps manipulation sustained neurapraxias of both the marginal mandibular branch of the seventh cranial nerve and the upper trunks of the ipsilateral brachial plexus. The pregnancy was uneventful, but labor was complicated by an occipitoposterior presentation and a prolonged second stage. Examination of the neonate revealed bruising and skin markings consistent with injury by obstetric forceps and the anatomic location of these marks suggested that cervical and mandibular compression from the forceps, rather than traction by the accoucheur, would account for the observed findings. A review of the English language literature over the past 30 years revealed only four cases in which a combination of facial nerve and brachial plexus injuries could both be linked to obstetric instrumentation.- - - - - - - - - - ranking = 0.0032180241732277keywords = upper (Clic here for more details about this article) |
14/14. Eyelid laceration in a neonate by fetal monitoring spiral electrode.PURPOSE: To report an unusual case of birth injury caused by an internal fetal monitoring spiral electrode. METHOD: Case report. RESULTS: A neonate with eyelid lacerations was examined within the first hour of life after a fetal scalp electrode was inadvertently affixed to the left upper eyelid during labor. The superficial lacerations healed without sequelae, and there was no globe injury. CONCLUSIONS: Ocular adnexal birth injury by a fetal monitoring scalp electrode has been reported rarely. Because fetal brow malpresentation is uncommon, the occurrence of this injury is unusual. Although alarming, the periorbital edema associated with this malpresentation probably protects the eyelid from perforation and the globe from injury.- - - - - - - - - - ranking = 0.0032180241732277keywords = upper (Clic here for more details about this article) |
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