THE JOURNAL OF PEDIATRICS www.jpeds.com Volume 194 weight neonates. The Newborn Lung Project. J Pediatr 1991;119:285- 44. Côté A, Bairam A, Deschenes M, Hatzakis G. Sudden infant deaths in sitting 92. devices. Arch Dis Child 2008;93:384-9. 41. Laughon M, Langer J, Bose C, Smith P, Ambalavanan N, Kennedy K, et al. 45. Freyne B, Hamilton K, McGarvey C, Shannon B, Matthews T, Nichol- Prediction of bronchopulmonary dysplasia by postnatal age in ex- son A. Sudden unexpected death study underlines risks of infants sleep- tremely premature infants. Am J Respir Crit Care Med 2011;183:1715- ing in sitting devices. Acta Paediatr 2014;103:e130-2. 22. 46. Kinane TB, Murphy J, Bass JL, Corwin MJ. Comparison of respiratory 42. Southall D, Richards J, Rhoden K, Alexander J, Shinebourne E, Arrowsmith physiologic features when infants are placed in car safety seats or car beds. W, et al. Prolonged apnea and cardiac arrhythmias in infants dis- Pediatrics 2006;118:522-7. charged from neonatal intensive care units: failure to predict an in- 47. Salhab WA, Khattak A, Tyson JE, Crandell S, Sumner J, Goodman B, et al. creased risk for sudden infant death syndrome. Pediatrics 1982;70:844- Car seat or car bed for very low birth weight infants at discharge home. 51. J Pediatr 2007;150:224-8. 43. Eichenwald E, Aina A, Stark A. Apnea frequently persists beyond term 48. Martin J, Hamilton B, Osterman M. Births in the United States, 2015. gestation in infants delivered at 24 to 28 weeks. Pediatrics 1997;100:354- NCHS data brief, no 258. Hyattsville, MD: National Center for Health 9. Statistics; 2016 No. 258. Alveolar Arterial Oxygen Gradient in Premature Infants Breathing 100% Oxygen Thibeault DW, Poblete E, Auld PAM. J Pediatr 1967;71:814-24 very neonatologist knows that premature infants with respiratory distress syndrome (RDS) have reduced lung volume E and atelectasis. We know that many develop ﬁbrosis and a condition we call bronchopulmonary dysplasia (BPD), which was perhaps not known when Thibeault et al published their study in The Journal 50 years ago. A condition named Mikity-Wilson syndrome had many similarities to the condition we call BPD, which was described by Northway et al 10 months earlier. By measuring the alveolar arterial oxygen gradient in 38 premature and 5 term infants, Thibeault et al measured the extent of the shunt and the degree of atelectasis. Today, we would probably not have performed serial arterial punctures to obtain arterial PaO values. However, when I started my training in the end of the 1970s, this method was still occasionally applied. In addition, today we probably would not have chosen to give these infants 100% oxygen for up to an hour. Thibeault et al found that babies with RDS, especially the smallest ones, initially had large alveolar atrial oxygen differences, probably because of extensive atelectasis or nonventilated alveoli. Patients with Mikity-Wilson syndrome had larger gradients for a longer time. After 1-2 weeks, these changes resolved. Thoracic gas volume decreased during the ﬁrst days of life, and the authors suggested this is caused by gas trap- ping. After 1-2 weeks, the thoracic gas volume had returned to initial values. This was especially marked in babies with birth weight <1200 g. In the larger babies who survived, a large oxygen gradient was found with a faster normalization. It is often worthwhile to read older publications. Thibeault et al described what we today consider as common fea- tures of lungs in infants with RDS and early BPD development. We should appreciate the work performed by these authors and others that helps us to understand the features of a condition that still is a challenge for neonatologists. Ola Didrik Saugstad,MD,PhD Department of Pediatric Research University of Oslo Oslo University Hospital Oslo, Norway Reference 1. Northway WH Jr, Rosan RC, Porter DY. Pulmonary disease following respirator therapy of hyaline-membrane disease. Bronchopulmonary dys- plasia. NEJM 1967;276:357-68. Jensen et al
The Journal of Pediatrics – Elsevier
Published: Mar 1, 2018
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