PEDIATRICS Vol. 38 No. 2 August 1966, pp. 244-253
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STUDIES ON HYALINE MEMBRANE DISEASE

IV. Diagnostic and Prognostic Problems

David H. Weintraub M.D.1, Clara M. Ambrus M.D., Ph.D.1, and Julian L. Ambrus M.D., Ph.D.1

1 Children's Hospital of Buffalo, Roswell Park Memorial Institute, and State University of New York at Buffalo

In a group of 60 infants treated on a double-blind basis with placebo- or urokinase- activated human plasmin, clinical and laboratory data were analyzed in order to evaluate their diagnostic and prognostic value. Blood samples for laboratory studies were obtained at the time of final diagnosis and initiation of treatment, 4 hours later, and at additional time intervals if necessary.

Respiratory rate and its changes during the first 4 hours appeared to be of little diagnostic or prognostic value.

Chest x-rays alone did not appear to be useful in establishing diagnosis during the first 4 hours of life. In older infants, however, high diagnostic accuracy was obtained. Positive findings were generally dependable, but false negatives occurred in half of the cases. Improvement during serial x-ray examinations was a good prognostic sign but negative findings turning to positive ones were followed by survival in only one of two cases.

Initial pH and pCO2 values varied widely. Changes in these parameters appeared to be of prognostic value in the placebo-treated infants but not in the urokinase-activated plasmin-treated group. In the latter, improvement in pH and pCO2, apparently due to increased respiratory gas exchange, was not sufficient to result in survival of the patient in the presence of additional pathology (e.g., pulmonary or intracranial hemorrhage, pneumonia). Generally, pH appeared to be a more sensitive predictive parameter than pCO2.

Potassium levels and their changes during the first 4 hours were of no diagnostic or prognostic significance.

Submitted on September 20, 1965
Accepted on April 5, 1966