Extracorporeal membrane oxygenation for hydrocarbon aspiration

Article Abstract:

Extracorporeal membrane oxygenation (ECMO) is a technique of oxygenating the blood using an artificial membrane located outside of the body; it is used to treat infants with severe lung disease. Although the technique is associated with a high rate of complications and death, it has been used to maintain children who are at great risk from respiratory damage. The present report concerns two case studies of children who breathed in toxic levels of petroleum household products. One child was a 15-month-old male who aspirated baby oil. When seen at the hospital he respiration was poor and chest X-rays showed his lungs to be abnormal. He received oxygen (50 percent) via a mask, but despite these measures his condition continued to deteriorate. He developed a pneumothorax (air in the chest cavity), which further depressed lung function, and had to undergo an operation to drain his chest of air. He recovered, only to develop a fever; blood cultures were performed and he was given an antibiotic. A second pneumothorax developed on the opposite side of the first, necessitating another draining procedure. His respiratory condition continued to decline, and he was placed on ECMO, which maintained him for nearly one month, but not without difficulties, including repeat infections and neurologic damage. A second patient, a 16-month-old male, was admitted after aspirating furniture polish. His condition deteriorated and he was placed on ECMO using modifications of technique that were developed from experience with the first child. During his seven days on ECMO he underwent a course of antibiotic treatment. The patient was seen for follow-up several months after his discharge and both his respiratory status and neurologic condition were normal. It is important to realize that ECMO is not curative, but allows oxygenation of the body to occur while the lungs are allowed to rest and recover from insult. All liquid hydrocarbons pose risk to the lungs of small children if inhaled or ingested. (Consumer Summary produced by Reliance Medical Information, Inc.)

Health aspects, Care and treatment, Methods, Causes of, Blood oxygenation, Extracorporeal, Extracorporeal membrane oxygenation, Hydrocarbons, Aspiration pneumonia

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Changing spectrum of cholelithiasis and cholecystitis in infants and children

Article Abstract:

Gallbladder disease is not usually considered a cause of abdominal pain in children. Cholecystitis (inflammation of the gallbladder) and cholelithiasis (gallstones), although rare, have been associated in the past with teenage pregnancy and hemolytic blood diseases. The incidence and spectrum of gallbladder disease in children is changing. Recently, new contributors to gallbladder problems have been reported, such as prolonged fasting, total intravenous feeding, diuretic therapy, and ileal (small intestine) abnormalities. Cholelithiasis is now being reported in younger children than previously. A review is presented of 18 years of experience with 47 children who had cholecystitis or cholelithiasis and underwent surgery; a comparison is made between patients seen before 1980 and those seen after 1980. All children were 17 years old or less; 15 children were treated between 1970 and 1979 (group 1) and 32 were treated from 1980 through 1988 (group 2). The average patient age at the time of surgery was 11. The two groups were compared for age, sex, pregnancy status, blood disorders, family history, obesity, use of total parenteral nutrition (TPN, intravenous feeding), and incidence of stones lodged in the bile duct. There was a significant increase in the number of children with gallstones. In the more recent group, there was a higher proportion of infants and young children; many of these children had a history of having received TPN. The more recent group also had a higher incidence of bile duct stones. It is concluded that gallstones should be considered a possible cause of abdominal pain in children. Early diagnosis can prevent potentially life- threatening complications. (Consumer Summary produced by Reliance Medical Information, Inc.)

Children, Demographic aspects, Gallstones, Pediatric surgery, Cholecystitis, Cholecystectomy

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Congenital diaphragmatic hernia beyond infancy

Article Abstract:

In newborns, a common cause of severe difficulty breathing is congenital diaphragmatic hernia, a condition in which the stomach slides up through the diaphragm into the chest cavity. Congenital diaphragmatic hernia is rare in older children and adults. Although the defect is identical to that found in newborns, the symptoms, treatment and complications of congenital diaphragmatic hernia are different in older patients. A report is presented of 13 patients with congenital diaphragmatic hernia; these patients ranged in age from 2 months to 26 years. They had symptoms of chronic respiratory tract infections (6 patients), vomiting (5), weight loss (1), failure to thrive (2), and severe respiratory distress (3). One patient was asymptomatic. On physical examination, clinicians could not hear breath sounds or they heard bowel sounds in the chests of eight patients. Diagnosis was confirmed by X-ray of the chest or gastrointestinal tract. All patients underwent immediate surgical repair of the defect. One patient died (8 percent). Of the 12 survivors, 7 (58 percent) developed severe gastric atony, that is, lack of normal stomach tone, and 4 patients required further surgery. (Consumer Summary produced by Reliance Medical Information, Inc.)

Diagnosis, Physiological aspects, Birth defects, Hernia, Diaphragm, Diaphragmatic hernia

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