Association of pneumothorax and hypotension with intraventricular haemorrhage

Article Abstract:

Pneumothorax (an abnormal pocket of air around the lungs) occurs in up to 35 percent of very-low-birth-weight (VLBW) infants who have respiratory distress syndrome and who are treated with artificial ventilation. Some studies have suggested an association between pneumothorax and intraventricular hemorrhage (bleeding in the brain ventricles), while others have not. Due to pressure relationships, it is possible that appreciable pneumothorax, when accompanied by low blood pressure, would cause poor oxygenation of the brain, and subsequent restoration of normal blood pressure could be followed by brain hemorrhage. The effect of different blood pressures on the incidence of brain injuries accompanying appreciable pneumothorax was evaluated from the records of 67 VLBW infants with respiratory distress syndrome. One group of 36 infants was hypotensive (had low blood pressure); their birth weights were significantly lower and there were significantly more boys in this group. The second group of 31 infants had normal blood pressure. Blood pressure was similar in both groups before occurrence of pneumothorax. In the hypotensive group, blood oxygen levels dropped significantly after pneumothorax. One hypotensive infant and 24 normotensive infants had normal brain ultrasound scans. Significant brain hemorrhages occurred in 89 percent of the hypotensive group and 10 percent of the normotensive group. Brain scans were done before and after pneumothorax in 17 infants and showed that significant brain hemorrhages most likely occurred after pneumothorax. The hypotensive group had a significantly higher death rate and incidence of residual brain damage. The results suggest that pneumothorax accompanied by hypotension in VLBW infants with respiratory distress syndrome is a risk factor for subsequent development of significant brain hemorrhage; further research is needed. (Consumer Summary produced by Reliance Medical Information, Inc.)

Complications and side effects, Risk factors, Brain, Hemorrhage, Brain hemorrhage, Pneumothorax, Respiratory distress syndrome, Hypotension

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Pathophysiology of apnoea in preterm infants

Article Abstract:

Apnea, a temporary halt in breathing, is usually classified as three types: central (related to brain function), obstructive (blockage in the airway), or mixed (combination of the other types). However, the differences among these groups may not be as distinct as previously thought, and such classification may be misleading. The pathophysiology (abnormal changes in function) associated with each of these groupings is reviewed in this article. Purely obstructive apnea is found in only 12 percent of premature newborns with apnea. Studies have found airway closure during mixed apnea as well as during pure central apnea. The larynx, or voice box, and pharynx (throat) are the most likely sites of collapse or muscle closure. Immature development of brain centers controlling respiration significantly contributes to apnea in premature infants. This can lead to defective responses to high blood and tissue levels of carbon dioxide. In addition, slow nerve function and muscular responses to reflexes may also contribute to central mechanisms of apnea. Some cases of apnea are caused by anemia, infection, or patent ductus arteriosus (failure of a fetal blood vessel to close at birth), and these disorders should be identified and treated. If apnea recurs frequently and is severe, leading to hypoxia (low blood oxygen) and slowed heart beat, drug therapy with xanthines (caffeine-like drugs) or doxapram may be helpful, as is mechanical ventilation using continuous positive airway pressure. Respiratory monitors are relatively poor detectors, but monitors of heartbeat and oxygen levels have worked well. The former practice of reserving use of drug therapy for only centrally-caused apnea, and ventilation only for obstructive apnea, should be changed in favor of flexible treatment, as the distinctions between causes of infantile apnea become blurred. (Consumer Summary produced by Reliance Medical Information, Inc.)

Care and treatment, Physiological aspects, Demographic aspects, Apnea

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