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Updated: May 28, 2026
How to Obtain Reliable Visual Event-related Potentials in Newborns
Published on: October 24, 2019
Neonatal revolution - the introduction of PEEP
1Department of Anaesthesia, RCH, Melbourne, Australia . tckbrown@netspace.net.au
Insights
This study explored early treatments for premature infants with respiratory distress syndrome (RDS). A combination of THAM buffer and isoprenaline showed promise in improving infant survival rates.
Area of Science:
- Neonatal Medicine
- Pediatric Critical Care
Background:
- Respiratory Distress Syndrome (RDS), previously known as hyaline membrane disease, posed a significant threat to premature infants.
- Lack of pulmonary surfactant was a primary cause of RDS, leading to high mortality rates in infants born at 24-26 weeks gestation.
Observation:
- In 1969, two infants with suspected RDS were treated with tris hydroxyl amino methane (THAM) and isoprenaline.
- THAM, a buffer, addressed metabolic and respiratory acidosis without sodium.
- Isoprenaline, a beta-1 stimulant, acted as a pulmonary vasodilator.
Findings:
- Treatment with THAM and isoprenaline led to the disappearance of characteristic RDS X-ray findings.
- One infant recovered, while the other succumbed to portal vein thrombosis, a complication possibly related to umbilical catheter administration.
Implications:
- This early intervention demonstrated potential in managing RDS, suggesting a new therapeutic approach.
- The case highlights the critical role of drug administration routes in neonatal intensive care.
- Despite initial skepticism, the positive outcome in one infant paved the way for further research into RDS treatment.
Abstract:
Fifty years ago, a baby born at 24-26 weeks was not considered viable. It was a tragedy for the mother having carried it for so long. I witnessed such an event as a student. The scourge of premature deliveries was the lack of surfactant in many tiny babies. In general, if a premature infant with hyaline membrane disease, as it was called respiratory distress syndrome (RDS), could not maintain a pO(2) above 60 mmHg in 100% oxygen, it was not expected to survive. In late 1969, two babies with suspected RDS came to ICU and were treated by the author with the buffer (tris hydroxyl amino methane, [THAM] which reduced both metabolic and respiratory acidosis and did not contain sodium) and an isoprenaline infusion (β(1) stimulant and pulmonary vasodilator). The X-ray appearances of RDS disappeared. Unfortunately, one died of portal vein thrombosis because the drugs were administered by umbilical catheter, which were commonly used at the time. The other one recovered but the physicians then said the diagnosis must have been wrong!
