Resuscitation of the Asphyxiated Infant

Kw, Cross

doi:10.1093/oxfordjournals.bmb.a070442

Cited by 36 publications

(7 citation statements)

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“…With the increasing survival rate of such infants it is possible that the myocardial lesions may assume a greater importance. Since an essential feature of resuscitation from asphyxia is an adequate cardiovascular response (Cross, 1966), it is reasonable to suggest that the lesions seen in this small series of infants could be regarded as a handicap to resuscitation, and a hazard to be considered seriously if intensive therapy is to be successful.…”

Section: Discussionmentioning

confidence: 99%

Myocardial changes in immature infants requiring prolonged ventilation.

Desa¹

1977

Archives of Disease in Childhood

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SUMMARY Fourteen infants who had required prolonged ventilation with high concentrations of oxygen for 14 days or more, were studied at necropsy. 11 infants of immature gestation at birth had gross cardiac hypertrophy, defined as a heart weight greater than 2 SD above the mean for their age. No congenital malformation of valves or septum was found, and in the 7 youngest infants with hypertrophy, the ductus arteriosus was anatomically patent. 3 of these 7 infants had an accompanying murmur. All 11 infants had severe bronchopulmonary dysplasia. The cardiac hypertrophy affected both ventricles and septum in an irregular fashion and was associated with areas of necrosis, progressing to coarse fibroelastotic scars. The intramural vessels showed marked intimal thickening but the main coronary vessels were normal. The 2 youngest infants with cardiac hypertrophy showed the presence of intravascular and endocardial platelet thrombi. In the 3 infants without cardiac hypertrophy less severe zones of necrosis and scarring were present, and only occasional bundles of hypertrophied muscle fibres were seen.In an attempt to understand these hitherto undescribed lesions, a group of 50 fresh stillbirths and 50 first-week neonatal deaths of comparable gestational age were studied. In 19 of these infants foci of myocardial fibre necrosis were present. It is suggested that the lesions in the older infants represent a more advanced and continuing stage of that seen in the younger infants, and that the foci of necrosis are the result of continuing hypoxia and related problems to a failing coronary circulation. The possibility of myocardial damage represents a serious hazard to the successful therapy of the immature asphyxiated infants.Congestive cardiac failure and hypertrophy of the right ventricle are relatively common complications in infants who develop bronchopulmonary dysplasia after prolonged ventilation using high 02 concentrations (Rosan, 1975). Though reports of large series of infants with bronchopulmonary dysplasia have been published (Northway, et al., 1967;Bannerjee et al., 1972;Taghizadeh and Reynolds, 1976), myocardial changes were not described in any detail.This report presents a series of immature, low birthweight infants who were maintained on prolonged ventilation and hyperoxygenation for 14 days or more and who had evidence of cardiac enlargement due to hypertrophy of both left and right ventricles. Several unexpected histological changes in the myocardium were noted, and in an attempt to understand their pathogenesis a group of stillbirths and neonatal deaths occurring within the first week Received 11 May 1976 of life was collected and histological preparations ot the myocardium studied in detail. Material and methodsOver a period of 2 years, 14 infants who died after 14 days or more of assisted ventilation and hyperoxygenation were studied at necropsy. All necropsies were conducted personally and the hearts were weighed in a uniform fashion after removal of blood clot from the chambers. Multiple histologica...

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Section: Discussionmentioning

confidence: 99%

Myocardial changes in immature infants requiring prolonged ventilation.

Desa¹

1977

Archives of Disease in Childhood

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“…It is well established that asphyxia induces a vagally mediated bradycardia in fetuses 3 7 8. These experiments were either conducted on fetuses in utero (in amniotic fluid) or ex utero by placing a liquid-filled bag over the newborn animal's head to induce asphyxia 3–6.…”

Section: Introductionmentioning

confidence: 99%

The cardiovascular response to birth asphyxia is altered by the surrounding environment

Ong

Sobotka

Siew

et al. 2016

Arch Dis Child Fetal Neonatal Ed

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“…It has been known for a long time that the adequacy of the fetus' and infant's response to asphyxia to a great extent depends on the integrity of the cardiovascular system (Cross, 1966). If the cardiovascular system is damaged the fetus is compromised.…”

Section: Discussionmentioning

confidence: 99%

Coronary arterial lesions and myocardial necrosis in stillbirths and infants.

De¹

1979

Archives of Disease in Childhood

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SUMMARY In a detailed study of the coronary arterial tree and myocardium in 256 stillbirths and infants, abnormalities of the coronary arterial tree were noticed in 79 infants, and necrotic lesions of the myocardium in 111 infants. Of the 79 infants with arterial lesions, 70 had associated myocardial necrosis or scarring, or both; the group with coronary arterial lesions, therefore, accounted for the majority of cases with myocardial damage.The myocardial lesions varied from small zones of subendocardial damage, to larger 'geographical' zones of necrosis scattered haphazardly through the myocardium, and a small group where massive necrotic lesions of the papillary muscles were present. While the coronary arterial lesions were associated with all three patterns, they were particularly found in association with the 'geographical' and papillary muscle changes.The coronary arterial lesions varied from zones of acute focal, medial necrosis to severe proliferative intimal lesions and medial defects, with a distinct progression of changes from the acute to the more established lesions. The coronary arterial lesions were seen most commonly in association with conditions that could produce severe hypoxia, and it is argued that they result from hypoxia. It is suggested further that the myocardial damage, so commonly associated with the coronary arterial lesions, could compromise the ability ofthe hypoxic infant to respond to such an insult.The coronary arterial lesions seen in this group of young infants could offer one explanation for the later development of a variety of other pathological conditions seen in adolescents and young adults.In 1946 Dock described proliferative intimal changes in the coronary arterial tree of infants and young adults, and his findings were confirmed and extended by many others (Fangman

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Resuscitation of the Asphyxiated Infant

Cited by 36 publications

References 0 publications

Myocardial changes in immature infants requiring prolonged ventilation.

Myocardial changes in immature infants requiring prolonged ventilation.

The cardiovascular response to birth asphyxia is altered by the surrounding environment

Coronary arterial lesions and myocardial necrosis in stillbirths and infants.

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