The respiratory distress syndrome of the newborn. A method of treatment using prolonged nasotracheal intubation and intermittent positive pressure respiration

Nasopharyngeal airways in Pierre Robin Syndrome

Nasopharyngeal airways have been assessed in the management of infants with severe Pierre Robin syndrome. In 12 such infants the positioning and subsequent maintenance of these tubes were found to be important in ensuring adequate relief of the airway obstruction. In five infants measurements of lung mechanics demonstrated the benefits of NP tube placement and confirmed the observed improvements in cyanotic episodes, heart failure, electrocardiograms, and arterial gas tensions. In a retrospective survey of 40 infants with PRS, failure to thrive was found to be significantly correlated with the severity of the airflow obstruction. This failure to thrive was reversed in the infants managed with NP tubes in comparison with an age-matched groups nursed while prone. The lack of significant complications with the NP airway and its acceptability to nursing staff, patients, and their parents suggest that this method deserves more widespread use in PRS and perhaps in other situations in which high upper respiratory tract obstruction is predominant.

Cor pulmonale and the Pierre Robin anomaly. Airway management with a nasopharyngeal tube

An infant with Pierre Robin anomaly was anaesthetised for cardiac catheterisation. There was cor pulmonale with the pulmonary artery pressure at systemic level, a patent foramen ovale and a persistent ductus arteriosus. The effects of alterations in blood gases on the haemodynamics and intracardiac shunts are considered. Subsequent management of the obstructed airway with a nasopharyngeal tube for 4 weeks is described.

The effects of prolonged naso-endotracheal intubation in children. A study in infants and young children after cardiopulmonary bypass

The results of 458 prolonged nasotracheal intubations are described in 435 infants and young children up to 5 years of age after open heart surgery, in whom the upper airway was normal. No deaths occurred which could be attributed to the technique, and no tubes became obstructed. Sub-glottic stenosis did not occur when a loose-fitting endotracheal tube was used, and stridor after extubation was rare. If necessary, the technique can be used with safety for several weeks.

Quality of survival after artificial ventilation of the newborn

Fifty children now aged 4 to 8 years who required artificial ventilation for respiratory failure in the neonatal period were followed up; 44 (88%) had no serious mental or physical handicap. 35 of the ventilated infants were matched with paired controls who had also had respiratory distress but had not required artificial ventilation. Detailed studies of growth, respiratory and neurological function, and psychological testing revealed only minor differences between the two groups. It is concluded that the quality of survival after artificial ventilation of the newborn justifies the procedure.

Ventilating the lungs of newborn infants for prolonged periods

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