1/43. Cardiac neoplasm, tachyarrhythmia, and anasarca in an infant.An infant had supraventricular tachycardia and massive anasarca at birth. The supraventricular tachycardia and congestive heart failure were minimally responsive to medical therapy. At 1 month of age, a diagnosis of atrial and ventricular septal defect was made by cardiac catheterization. At 5 months of age, at an operation for pulmonary banding, a peculiar neoplasm of the right atrium was noted. On clamping and resection of the neoplasm, the supraventricular tachyarrhythmia reverted to normal sinus mechanism. The neoplasm, by light and electron microscopy, was thought to be a conduction system hamartoma and was thought to have caused the arrhythmia. A review of the literature showed that no such lesions had been reported previously.- - - - - - - - - - ranking = 1keywords = catheter (Clic here for more details about this article) |
2/43. Infective endocarditis successfully treated in extremely low birth weight infants with recombinant tissue plasminogen activator.Increased survival of extremely low birth weight infants depends on the use of indwelling catheters. These catheters expose the infant to the risk of thrombus formation and line infection. When intracardiac thromboses become infected, the entity is indistinguishable from infective endocarditis and exposes the infant to prolonged sepsis and risk of disseminated infected emboli. Despite prolonged antiinfective therapy and removal of the infected line, resolution of the sepsis and dissolution of the vegetations is frequently not achieved. We describe 2 cases of infective endocarditis in extremely low birth weight infants successfully treated with recombinant tissue plasminogen activator in addition to prolonged antiinfective therapy. Blood cultures became sterile and vegetations disappeared within days of commencing treatment, and there were no systemic complications. A literature search detailed in the article confirms the poor outcome associated with infectious endocarditis in preterm infants. tissue plasminogen activator may play an important role when standard care has failed.- - - - - - - - - - ranking = 2keywords = catheter (Clic here for more details about this article) |
3/43. Serious complications after umbilical artery catheterization for neonatal monitoring.Umbilical artery catheterization in critically ill neonates caused major complications, including five deaths, in 15 of 165 infants with respiratory distress syndrome who underwent autopsy at the UCLA Hospital during the past eight years. Arterial occlusion leading to visceral infarction occurred in 12 patients, and vascular perforation caused hemoperitoneum in three patients. Repeated catheter manipulation and protracted catheter use were common factors identified in patients in whom complications developed. Restricted indications for catheter use, routine roentgenographic confirmation of catheter tip location below the kidneys, low-dosage heparin sodium infusion, use of cannulas with decreased thrombogenicity, avoidance of catheter manipulation, and vigilance to remove catheters when no longer required should reduce the incidence of this iatrogenic neonatal complication while still permitting arterial pressure and blood gas monitoring when clinically indicated.- - - - - - - - - - ranking = 11keywords = catheter (Clic here for more details about this article) |
4/43. Arteriovenous malformation of the vein of Galen: treatment in a neonate.heart failure in a 2-day-old infant was not readily explained by clinical examination. cardiac catheterization suggested an intracranial arteriovenous (AV) fistula, and cerebral arteriography showed a malformation of the vein of Galen. The major feeding arteries were surgically obliterated. At age 27 months, the boy has normal mentation but moderate left hemiparesis. review of the literature disclosed 39 other infants with AV malformations of the vein of Galen producing heart failure before age 3 months. Most of them were boys, and had cyanosis, a systolic murmer, cranial bruit, cardiomegaly, and right bentricular hypertrophy. Only three of the 13 who had surgery for their malformation survived. Removal of the malformation is difficult; obliteration of the nutrient vessels, using the operating microscope, is the currently accepted treatment.- - - - - - - - - - ranking = 1keywords = catheter (Clic here for more details about this article) |
5/43. Single film retrograde umbilical aortography in the diagnosis of hypoplastic left heart syndrome with aortic atresia.Single film retrograde umbilical aortography was used successfully in confirming the diagnosis of hypoplastic left heart in three neonates. The method involves injecting Renografin 75% (1.25 cc/kg body weight) into the umbilical artery catheter according to the following sequence. First, the tip of the catheter is positioned at the level of the ductus arteriosus. The infant heart beats are then counted from one to three. The contrast media injection is begun manually on the count of one and an anterior-posterior chest film is taken on the count of three. Thus the film is taken one diastolic period after completion of the injection. The proper timing of the contrast media injection and filming is essential for obtaining a diagnostic film. This procedure was diagnostic in the three infants studied and eliminated the need of transferring two sick infants from affiliated hospitals.- - - - - - - - - - ranking = 2keywords = catheter (Clic here for more details about this article) |
6/43. Recurrent candidaemia in a neonate with Hirschsprung's disease: fluconazole resistance and genetic relatedness of eight candida tropicalis isolates.The incidence of candidaemia among immunocompromised patients in malaysia is increasing at an alarming rate. Isolation of clinical strains that are resistant to fluconazole has also risen markedly. We report here the repeated isolation of candida tropicalis from the blood of a neonatal patient with Hirschsprung's disease. in vitro fluconazole susceptibility tests of the eight isolates obtained at different time points showed that seven of the isolates were resistant and one isolate was scored as susceptible dose-dependent. Random amplification of polymorphic dna fingerprinting of the isolates using three primers and subsequent phylogenetic analysis revealed that these isolates were highly similar strains having minor genetic divergence, with a mean pairwise similarity coefficient of 0.893 /-0.041. The source of the infectious agent was thought to be the central venous catheter, as culture of its tip produced fluconazole-resistant C. tropicalis. This study demonstrates the utility of applying molecular epidemiology techniques to complement traditional mycological culture and drug susceptibility tests for accurate and appropriate management of recurrent candidaemia and highlights the need for newer antifungals that can combat the emergence of fluconazole-resistant C. tropicalis strains.- - - - - - - - - - ranking = 1keywords = catheter (Clic here for more details about this article) |
7/43. Systemic air embolism in the respiratory distress syndrome of the newborn.Details of 25 cases of neonatal systemic air embolism, including three of our patients, are reviewed. This rare complication of respiratory distress syndrome (RDS) was observed in 21 premature infants and 4 fullterm newborns, of whom 23 required intermittent positive pressure ventilation (IPPV). In 21 of these patients air embolism was preceded by pulmonary interstitial emphysema, pneumomediastinum, pneumothorax and/or pneumopericardium. air embolism occurred between 3 and 288 hours after delivery. The outcome was lethal in 24 cases, only one patient survived. Two main pathogenic mechanisms are discussed; entrance of air from ruptured alveoli into the lung capillaries and introduction of air via catheters in umbilical vessels.- - - - - - - - - - ranking = 1keywords = catheter (Clic here for more details about this article) |
8/43. Total parenteral nutrition using peripheral veins in surgical neonates.A new program of total parenteral nutrition (TPN) for surgical neonates has been described an investigated. The program is based on the use of fat emulsion as the major source of calories and infusion of large volumes of the solution via peripheral veins. This program has three main advantages over conventional hyperalimentation using a central venous catheter: (1) it avoids complications such as septicemia, thrombosis of large vessels, and metabolic complications such as hyperglycemia or osmotic diuresis; (2) it provides physiological nutritive elements containing a normal composition of glucose, protein, and fat; and (3) it is easy to start and manage the TPN using a peripheral vein. Thirty-four neonatal surgical patients with life-threatening gastrointestinal anomalies have been placed on this TPN program. Infusion of fat emulsion and large volumes of fluid were well tolerated and all patients gained weight during the period of observation.- - - - - - - - - - ranking = 1keywords = catheter (Clic here for more details about this article) |
9/43. Swan-Ganz catheterization in the critically ill newborn.The authors placed Swan-Ganz catheters in 11 preterm and 2 term infants with severe cardiopulmonary distress. The infants ranged in weight from 1100-4000 g. The procedure was performed in the neonatal ICU by jugular venous cutdown. Intracardiac pressures and oxygen saturations were measured in each chamber entered. The authors also evaluated the presence of right to left shunting through the patent ductus arteriosus and assessed the degree of pulmonary arterial hypertension. In 5 hypoxemic infants, the authors found a patent ductus arteriosus with pulmonary hypertension. Intermittent measurement of PAP served as a guide to further therapy. In 2 infants, the unexpected diagnosis of cyanotic congenital heart disease was made. The placement of flow directed pulmonary arterial catheters in critically ill infants can be performed safely at the bedside and can provide useful diagnostic and therapeutic information.- - - - - - - - - - ranking = 6keywords = catheter (Clic here for more details about this article) |
10/43. Refractory hypoglycemia associated with a malpositioned umbilical artery catheter.An infant with unexplained hypoglycemia who responded poorly to medical management had the tip of his umbilical artery catheter positioned near the major arteries supplying the pancreas. Catheter repositioning resulted in immediate normoglycemia. A "reactive" response to the direct infusion of glucose is postulated on the basis of the clinical response and a decrease in serum insulin/blood glucose ratio.- - - - - - - - - - ranking = 5keywords = catheter (Clic here for more details about this article) |
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