Critical Care of the Child

205 Pages·1984·5.954 MB·English

by  P. R. Swyer (auth.), O. Prakash MD (eds.)

CRITICAL CARE OF THE CHILD
DEVELOPMENTS IN CRITICAL CARE
MEDICINE AND ANESTHESIOLOGY
Prakash, O. (ed.): Applied Physiology in Clinical Respiratory Care. 1982.
ISBN 90-247-2662-X.
McGeown, Mary G.: Clinical Management of Electrolyte Disorders. 1983.
ISBN 0-89838-559-8.
Scheck, P.A., Sj ostrand , V.H., and Smith, R.B. (eds.): Perspectives in High
Frequency Ventilation. 1983. ISBN 0-89838-571-7.
Stanley, T.H., and Petty, W.C. (eds.): New Anesthetic Agents, Devices and Mo
nitoring Techniques. 1983. ISBN 0-89838-566-0.
Prakash, O. (ed.): Computing in Anesthesia and Intensive Care. 1983.
ISBN 0-89838-602-0.
Stanley, T.H., and Petty, W.C. (eds.): Anesthesia and the Cardiovascular
System. 1984. ISBN 0-89838-626-8.
Van Kleef, l.W., Burm, A.G.L., and Spierdijk, l. (eds.): Current Concepts in
Regional Anaesthesia. 1984. ISBN 0-89838-644-6.
Prakash, O. (ed.): Critical Care of the Child. 1984. ISBN 0-89838-661-6.
CRITICAL CARE OF
THE CHILD
edited by
O. PRAKASH, MD
Thoraxcentrum
Academic Hospital Dijkzigt
Erasmus University
Rotterdam
The Netherlands
1984 MARTINUS NIJHOFF PUBLISHERS ~.
1111
a member of the KLUWER ACADEMIC PUBLISHERS GROUP
BOSTON / DORDRECHT / LANCASTER •
Distributors
for the United States and Canada: Kluwer Academic Publishers, 190 Old Derby
Street, Hingham, MA 02043, USA
for the UK and Ireland: Kluwer Academic Publishers, MTP Press Limited,
Falcon House, Queen Square, Lancaster LAI lRN, England
for all other countries: Kluwer Academic Publishers Group, Distribution Center,
P.O. Box 322, 3300 AH Dordrecht, The Netherlands
Library of Congress Cataloging in Publication Data
Main entry under title:
Critical care of the child.
(Developments in critical care medicine and
anesthesiology)
Papers presented at the Second International
Symposium on "Applied Physiology in Critical Care with
Emphasis on Children," held in Aruba in 1983.
Includes index.
1. Pediatric intensive care--Congresses. 2. Child
development--Congresses. 3. Infants--Diseases-
Congresses. I. Prakash, Omar. II. International
Symposium on "Applied Physiology in Critical Care
w1.1;h_D.asisQv. Ch1ldren" (2nd: 1983 : Aruba)
III. Title: Applied physiology in critical care with
emphasis ov. childrev.. rv. Series: Developments in
critical care medicine and anaesthesiology. [DNLM:
1. Child Development--congresses. 2. Critical Care-
in infancy & childhood--congresses. 3. Neonatology-
congresses. WS 366 C9333 1983]
RJ370.C745 1984 618.92'0028 84-8146
ISBN-13: 978-94-009-6038-1 e-ISBN-13: 978-94-009-6036-7
DOl: 10.1 007/978-94-009-6036-7
Illustration cover: adapted from the work of Dr. Lynne Reid.
Copyright
© 1984 by Martinus Nijhoff Publishers, Dordrecht.
Softcover reprint of the hardcover 1s t edition 1984
All rights reserved. No part of this publication may be reproduced, stored in a
retrieval system, or transmitted in any form or by any means, mechanical,
photocopying, recording, or otherwise, without the prior written permission of
the publishers,
Martinus Nijhoff Publishers, P.O. Box 163, 3300 AD Dordrecht,
The Netherlands.
v
Table of contents
Preface VII
O. Prakash
List of contributors IX
1. Nutrition, growth and metabolism in the newborn 1
P.R. Swyer
2. The induction of fetal lung maturation 29
I. Gross
3. Cerebral blood flow 39
M.D. Jones, Jr.
4. Surfactant turnover, surfactant therapy, and the developing lung 51
A. Jobe
5. Surfactant supplementation 63
G. Enhorning
6. Management of asphyxia and intracranial hemorrhage in the newborn 71
N. W. Svenningsen
7. Respiratory muscle fatigue in children 87
J. Milic-Emili
8. Pulmonary sequelae after artificial ventilation 95
H. Bryan
9. High-frequency ventilation 101
A.Ch. Bryan
10. Recurrent apnea in newborn infants 107
A.Okken
11. Reye's syndrome - a modern medical mystery 115
J. P. Orlowski
VI
12. Continuous monitoring of P0 and PC0 127
2 2
H.T. Versmold
13. Gas exchange during conventional and high-frequency ventilation 141
P.D. Wagner
14. Home oxygen in infants with chronic lung disease 153
H. Bryan, A.L. Campbell, Y. Zarfin, M. Groenveld
15. Home monitoring in SIDS 161
H. Bryan, P. Duffty
16. Physiology as applied to pediatric anesthesia 167
D.l. Steward
17. Structuraal development of the pulmonary circulation and myocardium 177
M. Rabinovitch
Index of Subjects 205
VII
Preface
This volume represents a review of recent work presented by eminent scientists at
the Second International Symposium on 'Applied Physiology in Critical Care
with Emphasis on Children' at Aruba, Netherlands Antilles, November 28 -
2 December, 1983.
We are grateful to the keynote speakers who accepted our invitation and
completed their chapters in time for the press.
I must thank the Government of Aruba, the Tourist Office of Aruba, Mr Frank
Croes and Mr Betico Croes for their support and generosity for organizing this
symposium.
My sincere thanks go to Mr Rory Arends, Lucy Arends, Simon Meij and
Norma van Toornburg for their untiring efforts and cooperation.
Omar Prakash, MD
IX
List of contributors
Bryan, A.Ch., MB, BS, PhD, FRCP (C), The Hospital for Sick Children, 555
University Avenue, Toronto, Ontario, Canada M5G 1X8
Bryan, H., MD, Department of Pediatrics, Room 1241, Mount Sinai Hospital and
The Hospital for Sick Children, University of Toronto, Ontario, Canada
M5G 1X5
co-authors: A.L. Campbell, Y. Zarfin, M. Groenveld, P. Duffty
Enhorning, G., MD, University of Toronto, Toronto Western Hospital, 399
Bathurst Street, Toronto, Ontario, Canada M5T 2S8
Gross, I., MD, Perinatal Medicine, Yale University School of Medicine, P.O.
Box 3333, New Haven, CT 06510, USA
Jobe, A., MD, Neonatal Intensive Care Unit, Harbor-UCLA Medical Center,
UCLA School of Medicine, 1000W. Carson Street, Torrance, CA 90509, USA
Jones, M.D., Jr., MD, Department of Pediatrics, Eudowood Neonatal Division,
The Johns Hopkins University School of Medicine, Baltimore, MD 21205,
USA
Milic-Emili, J., MD, Meakins-Christie Laboratories, McGill University, 3775
University Street, Montreal, Quebec, Canada H3A 2B4
Okken, A., MD, Division of Neonatology, Department of Pediatrics, State
University, University Hospital, Oostersingel 59, 9713 EZ Groningen, The
Netherlands
Orlowski, J.P. MD, Pediatric and Surgical Intensive Care Unit, Cleveland Clinic
Foundation, 9500 Euclid Avenue, Cleveland, OH 44106, USA
Rabinovitch, M., MD, The Hospital for Sick Children, 555 University Avenue,
Toronto, Ontario, Canada M5G 1X8
Steward, D.J., MD, FRCP (C), The Hospital for Sick Children, 555 University
Avenue, Toronto, Ontario, Canada M5G 1X8
Svenningsen, N. W., MD, Department of Paediatrics, University Hospital Lund,
S-221 85 Lund, Sweden
Swyer, P.R., MA, MB, FRCP (C), DCH, The Hospital for Sick Children, 555
University Avenue, Toronto, Ontario, Canada M5G 1X8
Versmold, H. T., MD, Division of Neonatology, Department of Gynecology and
Obstetrics, Klinikum Grosshadern der Ludwig-Maximilians-Universitat
x
Miinchen, Marchionistrasse 15, D-8000 Miinchen 70, Federal Republic of
Germany
Wagner, P.D., MD, Section of Physiology M-023 , School of Medicine, Uni
versity of California San Diego, La Jolla, CA 92093, USA
1. NUTRITION, GROWTH AND METABOLISM IN THE
NEWBORN
P.R. SWYER
INTRODUCTION
An understanding of the physiology of metabolism, nutrition and growth in the
newborn infant and especially of the implications of pathological deviations in the
very low birth weight or sick neonate is of the greatest importance to management
directed at intact survival.
METABOLIC COMPARISON WITH THE ADULT
Fluid and energy intake
At best, the healthy newborn infant (and his physician) are faced with a gigantic
task of gourmandise in the first few months of life. At worst, i.e., during acute
illness, this task becomes even more formidable because of pathological con
straints on intake in the face of increased catabolic demands. Consider that the
adult, if he had to drink in proportion to the newborn's weight, would need to
engulf 14 liters per day, compared with his usual 1-2 liters. This is, propor
tionately to body weight, 7-10 times as much fluid.
The energy intake required for metabolic maintenance for the newborn is
increased 2-3 fold/kg compared with the adult (i.e, 5(k)0 cf 20 kcallkgld). On top
of this maintenance requirement is that for growth which is obviously lacking for
the adult. Growth necessitates an approximate doubling of the energy for mainte
nance (Figure 1) to over 100 kcallkg/d.
The effects of growth on body composition. Implied macronutrient requirement
Table 1 shows the body composition of the infant at birth weights of 1 kg, 2 kg and
3.5 kg, corresponding to postconceptional ages of 28 weeks, 35 weeks and 40
weeks respectively (1, 2). In comparison with the adult, the fetus of 1 kg or less is
little more than a bag of water (86% ) lightly tinted with protein (8% ). The fetus is