Assisted ventilation and the Servo ventilator in infants

A laboratory assessment was made of systems used for Continuous Positive Airway Pressure/Intermittent Mandatory Ventilation (CPAP/IMV) with the Servo 900B and 900C ventilators. Pressure-volume loops recorded during sine wave oscillation using an external CPAP/IMV system were similar to those found during normal respiration. Pressure-volume loops using the systems based on the ventilator's inbuilt trigger mechanism were very different, particularly for the 900B. The results were confirmed by measurements in two infants. The implications of these findings with reference to the weaning of infants from mechanical ventilation are discussed.     

Teratomas of the sacrococcygeal region in newborn infants and infants

The clinical manifestations, diagnosis and results of the treatment of 52 children, suffering from teratomas of the sacrococcygeal region, are presented. The optimal time for the performance of surgical intervention is defined. Three newborns and 3 children, operated on at the age over 1 year with malignization of teratoma, died.     

A new technique for intestinal anastomosis in surgery of newborn infants

Through a cuff-like resection of different intestinal wall layers an intramural step-like and edge-to-edge-sutured anastomosis can be performed without any tendency of narrowing. In segments with different lumen, in combination with a lobed resection from the distal segment this technique has a good advantage because the sutures are not lying upon each other.     

Ascites in newborn infants

Neonatal ascites is reviewed, and a case due to posterior urethral valves is presented. Treatment was, for the most part, conservative in contrast to aggressive surgical intervention which is taught and advocated. The result was satisfactory.     

Resuscitation of newborn infants

Successful resuscitation of newborn infants depends on adequate preparation, exact evaluation and prompt initiation of support according to the recently updated recommendations by trained personnel. The key step in postnatal adaptation is the initiation of breathing with a subsequent increase in pulmonary blood flow and pulmonary gas exchange. Therefore, in compromised newborn infants, adequate ventilation is the most important step in cardiopulmonary resuscitation. Ventilation should be initiated with room air in term infants and with low concentrations of supplemental oxygen in preterm infants. Subsequently, oxygen supplementation should always be guided by pulse oximetry. Chest compressions are only effective if adequate ventilation has been ensured. The compression ventilation ratio remains 3:1. The prevention of heat loss and maintaining a normal body temperature by adequate measures is an essential part of the care for healthy as well as asphyxiated infants. Therapeutic hypothermia should only be initiated after successful resuscitation and consultation with the regional neonatal intensive care unit.     

A safer system for percutaneous subclavian venous catheterization in newborn infants.

Percutaneous infraclavicular cannulation of the subclavian vein in even the tiniest infants can be performed with safety and ease using a plastic cannula metal needle stylet and following plastic catheter. This route for achieving superior vena caval catheterization provides a most satisfactory method for central pressure monitoring, long term antibiotic administration, total parenteral nutrition, and exchange transfusion. Few serious complications have been noted in over a hundred infant cannulations. The procedure can be performed in the intensive care nursery with a success rate of over 95%. Sepsis rates in clean cases are acceptably low. Most sepsis is due to other clearly identifiable sources of infection in these already critically ill infants.