Arterial Oxygen Studies in Premature Newborns With
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Arch. Dis. Childh., 1967, 42, 174. Arterial Oxygen Studies in Premature Newborns with and without Mild Respiratory Disorders MARCELLO M. ORZALESI, MODESTO MENDICINI, GIOVANNI BUCCI, ANTONIO SCALAMANDRP, and PIER GIORGIO SAVIGNONI From the Department of Paediatrics, University of Rome Medical School, Rome, Italy Arterial oxygen studies in full-term infants at various ages have been made by numerous authors (Stahlman, 1957; Weisbrot, James, Prince, Holaday, and Apgar, 1958; Graham, Koeff, Tsao, Sloan, and Wilson, 1959; Reardon, Baumann, and Hadded, 1960; Oliver, Demis, and Bates, 1961; Nelson, Prod'hom, Cherry, Lipsitz, and Smith, 1963). Few similar studies have been performed on premature infants (Graham, Reardon, Wilson, Tsao, and Baumann, 1950; Prod'hom, Levison, Cherry, Drorbaugh, Hubbell, and Smith, 1964). In 1965 Moss, Emmanouilides, Rettori, Higashimo, and Adams published data from premature infants in the first 72 hours of life, showing that 'normal' prema- tures had lower arterial oxygen tensions than adults, and that this difference was accentuated in prema- tures with 'mild respiratory distress': the criteria for classifying the babies as 'normal' were not explained in detail and the type and the severity of respiratory distress were not defined clearly. Furthermore, no studies were performed in infants of more than 72 hours. The present paper provides data on arterial blood gases in normal premature infants from 3 hours to 40 days of age. The criteria for normality were based on clinical grounds and on chest x-ray findings. In addition, data from premature infants with tachypnoea and with transient mild respiratory distress, but without x-ray changes suggestive of pneumonia or hyaline membrane disease (Iannac- cone, Bucci, and Savignoni, 1965), are also presented. Material and Methods The study includes 59 premature infants admitted between December 1964 and February 1966, and ranging in age from 3 hours to 40 days; the birthweight ranged between 1130 and 2480 g., and the gestational age from 28 to 40 weeks. All were admitted to the pre- mature unit within 24 hours of birth. A physical examina- Received August 25, 1966. tion and two antero-posterior chest x-ray films were taken on admission on each baby; Silverman's retraction score (Silverman and Andersen, 1956), the respiratory rate, skin colour, heart rate, and other physical findings were recorded every 3 hours during the first two days of life (or longer if abnormal) and less frequently thereafter. The chest x-ray films were evaluated separately by the radiologist and were graded according to previously published criteria (Iannaccone et al., 1965). On the basis of the clinical and radiological findings the infants were divided into 3 groups (Table I). The first group included 40 infants with birthweights between 1260 and 2480 g., who were both clinically and radiologically normal (i.e. Silverman's score < 2, respiratory rate < 65/min., skin colour normal, cardiac murmurs absent, and, on x-ray films, absence of vascular engorgement, atelectasis, emphysema, air broncho- grams, or fine granularity). The second group comprised 14 infants with birth- weights between 1130 and 2260 g., who had respiratory rates above 65/min. for at least 24 hours and no other signs of respiratory or cardiac disorders (Silverman's score always < 2). The chest x-ray films were normal in all except 2 babies in whom mild patchy atelectasis was present. The third group comprised 5 infants with birthweights between 1790 and 2310 g., who had Silverman's scores of 3 in the first 24 hours of life and respiratory rates above 60/min. during the first 48 hours. The chest x-ray films showed mild patchy atelectasis in 2 babies and were normal in 3. None of the infants studied had the radiological features of hyaline membrane disease (decreased translucency, reticulo-granular pattern, and air broncho- gram) or pneumonia (coarse nodularity, severe patchy atelectasis, and emphysema), and all recovered and survived. Respiratory distress in infants of the second and third group was always mild, so that, on clinical grounds, it was judged safe to study them while breathing room air. Thirteen normal adults were also studied and served as controls. Using the techniques described in previous papers (Scalamandre, Bucci, Orzalesi, Mendicini and Savignoni, 1966; Bucci, Scalamandre, Savignoni, Orzalesi, and 174
Arterial Oxygen Studies in Premature Newborns With
Arterial Oxygen Studies in Premature Newborns with
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