Failure to thrive-an analysis of 83 cases

The case histories of 83 children admitted to the hospital with a diagnosis only of failure to thrive were examined. In twenty-six cases there was evidence of maternal deprivation as a factor. Forty patients were found to have significant organic diseases as a possible or probable cause or contributing influence.Twenty-six were found to have some degree of mental retardation, either documented or suspected, but in nearly all of them there were associated factors presumably responsible, at least in part, for failure to thrive.Several children had birth weight less than 2,500 grams, but no child was thought to grow poorly because of prematurity alone. Congenital anomalies such as cleft palate and other problems leading to feeding difficulties were not unusual.In any case of persistent failure of an infant to gain adequately in weight and length, in which the cause is not evident, the child should be admitted to a hospital to determine response in a new environment. Also an adequate social history should be sought and siblings more closely evaluated; and careful study should be made of the renal, gastro-intestinal, cardiac, pulmonary and central nervous systems, even if there are no symptoms or signs referable to these systems.

Alveolar dead space, alveolar shunt, and transpulmonary pressure

The effect of transpulmonary pressure (Ptp) on gas exchange in the dog lung was studied in 10 open-chested dogs. Rates of pulmonary perfusion and ventilation were held constant (right heart bypass and pump respirator) while Ptp was varied. Alveolar dead space ventilation and alveolar shunt perfusion were calculated from CO2 and O2 gradients. The results are finally expressed in terms of a three-compartment lung model. It is shown that a misinterpretation is possible if alveolar dead space or alveolar shunt compartments are expressed as fractions, respectively, of all ventilated or all perfused alveoli, therefore each has been expressed as a fraction of the whole lung. It is concluded that the alveolar shunt compartment decreased as Ptp was increased, over the lower range of Ptp studied. No significant change was detected in the alveolar dead space compartment, as Ptp was varied.

alveolar-arterial O2 gradient; anatomical dead space; arterial-alveolar CO2 gradient; distribution of pulmonary perfusion; distribution of pulmonary ventilation; right heart bypass preparation; ventilation/perfusion relationships

Submitted on February 16, 1965