D Pickering

Persistent ductus arteriosus (PDA) complicated the clinical course in 45 (15%) of 299 babies with the respiratory distress syndrome (RDS) presenting over a 3-year period. The incidence of PDA complicating RDS rose with decreasing birthweight and was highest in babies with severe RDS as judged by the use of assisted ventilation. In babies with a birthweight of less than 1500 g, PDA occurred as a complication of RDS in 25% of cases. In babies who recieved intermittent positive pressure ...

Two children presented with sleep disturbances due to enlarged tonsils and adenoids. One child died during induction of anaesthesia, and postmortem examination showed hypertrophy of the right ventricle and atrium. As a result a prospective survey was carried out of children undergoing tonsillectomy or adenoidectomy, or both. During a nine-month period an electrocardiogram was taken in 92 children. Three electrocardiograms (3.3%) showed evidence of right heart strain. The children with ...

Thirty preterm infants (gestational age 26 to 30 weeks) were investigated by cross sectional echocardiography using a 5 or 7.5 MHz transducer positioned in the suprasternal notch or the left subclavicular position to enable visualisation of the aortic arch, main pulmonary artery, left pulmonary artery, and ductus arteriosus. Each infant was investigated on at least one occasion during both the first and second weeks of life and when possible between the ages of 26 and 31 days. There was ...

Administration of oral indomethacin to treat cardiorespiratory failure in 7 low birthweight infants, after failure of conventional therapy, produced an improvement in only 2 infants. These infants had a higher birthweight than the group as a whole. Surgical ligation, rather than oral indomethacin, may be the treatment of choice for persistent ductus arteriosus in very low birthweight infants.

Surgical closure of a patent ductus arteriosus was performed in 8 low birthweight infants suffering from cardiorespiratory failure secondary to a large left-to-right shunt. Mortality from the operation was nil, but only 4 (50%) ultimately survived. Earlier intervention may reduce mortality in these high-risk infants.

The results of 40 Waterston aortico-to-pulmonary anastomoses are reviewed from the experience at The Hospital for Sick Children, Toronto, between June 1966 and October 1969. Over the age of 6 months there was one death associated with the procedure in 12 cases. Under the age of 6 months the mortality associated with the operation in cases of tetralogy of Fallot was 50%. This represents the severer degree of defect as well as the increased technical difficulties in the younger age group.

During an outbreak of gastroenteritis in a paediatric ward astroviruses were found in faeces from 17 to 27 symptomatic children and from four of 14 members of the staff with diarrhoea. No viruses were found in 10 asymptomatic children. Fourteen of the 21 astrovirus excretors were free of any recognised pathogens, but in the other seven, rotaviruses or pathogenic bacteria were also present. Serological evidence of astrovirus infection was obtained in five adults and two children.

Endomyocardial biopsy was attempted in 18 children aged 5 months to 15 years with 82% success. Biopsies obtained from 15 children were examined by light and electron microscope making positive morphological diagnoses in 3 cases. The biopsy findings were actively helpful in 7 other cases, which contrasts with experience in adult biopsy series. This is a low risk procedure which does not add to the hazards of cardiac catheterization in children.

A previously unrecorded cardiac anomaly is described. A defect existed in the lowest part of the atrial septum straddling the orifice of the inferior vena cava so that this vessel opened into both atria. There was an associated anomalous connexion of the right pulmonary veins to the right atrium. The septal defect was recognized only at necropsy. As in the case of a sinus venosus atrial defect, it is suggested that the fundamental embryological error responsible for the production of the ...

In this report we describe a child who had an apical systolic click and murmur, as well as widespread cutaneous neurofibromatosis. We were not able to show an anatomical basis for the click and murmur.