Surgical emergencies of the newborn

• Published in: Pediatrics (Evanston) 1955-02, Vol.15 (2), p.231-233
• Main Authors: CLATWORTHY, Jr, H W, INGALLS, T H, WHITE, H
• Format: Article
• Language: English
• Subjects: Emergencies; Humans; Infant; Infant, Newborn; Infant, Newborn, Diseases; Old Medline
• ISSN: 0031-4005; 1098-4275
• DOI: 10.1542/peds.15.2.231

NATAL day mortality has not changed in the past 40 years and today neonatal deaths represent over half of all infant deaths. Pre-existing malformations, ofttimes surgically remediable, cause 15 per cent of neonatal deaths. In newborn infants, respiratory distress (tachypnea over 60 per minute, dyspnea, or cyanosis) is produced by medical lesions such as atelectasis, pulmonary hyaline membranes, brain damage, cardiac malformations, and oversedation. Dr. Clatworthy explained that similar symptoms result from surgically correctable defects such as "air block," lung cysts, endobronchial plugs, intrathoracic tumors, and diaphragmatic hernia. When presented with a newborn infant in respiratory distress, clear his upper airway of mucus, give oxygen if indicated, and after a physical examination, obtain roentgenograms of the chest. Dr. White stressed the importance of good radiographic examination, best achieved by obtaining upright lateral and AP chest films. "Air block" may occur in resuscitated babies with atelectasis or aspiration pneumonia. The trapped air in the perivascular and interstitial tissues prevents adequate aeration of the lungs and this air may dissect along the great vessels and cause mediastinal emphysema or tension pneumothorax. While the former is treated expectantly, tension pneumothorax frequently requires judicious aspiration and occasionally closed thoracotomy. Congenital lung cysts are frequently single, large ovoid defects with thickened walls and occasionally fluid levels. They require surgical removal. By contrast, treat postpneumonic pulmonary pneumatocele (usually secondary to staphylococcal infections) expectantly. Do not confuse obstructive lobar or pulmonary emphysema of endobronchial origin with compensatory emphysema. Obstructive emphysema is manifested by a mediastinal shift to the normal side and spreading of the intercostal spaces with a depressed, immobile diaphragm on the affected side and is treated by immediate lobectomy or pneumonectomy.