Congenital Atelectasis

child, lungs, treatment, examination, little, time, movements and noticed

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The after-symptoms vary according to the extent of the useless portion of the lungs. If this be the weakness continues ; the breath ing remains shalitiw and short ; lividity increases; the eyes are motionless; the pupils dilated, and the skin is cool. Soon the temperature falls still further, twitches and spasmodic movements are noticed in the face and limbs, and the child sinking into a state of stupor, dies asphyxiated on the second, third, or fourth day.

In the less severe cases, or in cases where judicious treatment has suc ceeded in increasing the area of inflated tissue, the child at first may seem to be going on well, although he never exhibits in his movements the vigour of one whose lungs are well expanded. His movements are more or less languid, and he sucks feebly or cannot be persuaded to take the bottle or the breast. After a time he seems to grow weaker and can only be kept warm with difficulty. His respirations get more and more shallow and his cry feebler. The child is always sleepy, and lies dosing with livid mouth and eyelids, the latter often incompletely closed. The fontanelle is depressed. From this point he may sink gradually and die after a series of convulsive fits, or may be roused by energetic treatment which again inflates the closed air-cells. But in such a case, although the child may be apparently restored, the unfavourable symptoms usually return, and it is rare for the patient to recover. In most cases after a time remedies seem to be useless and the infant can no longer be revived. Thrombosis of the cerebral sinuses, according to Stiffen, is often found in these cases.

Even in cases where recovery is apparently complete, the lung is not always perfectly expanded, and a slight catarrh may cause sudden and unexpected death. Mr. W. Burke Ryan has related the case of a child, aged five weeks and in good condition, who one evening was noticed to cough, and the next morning died quite suddenly. On examination of the body, both lungs were found to be shrunken and firmly contracted so as to leave-the greater part of the pericardium exposed. They sank instantly in water ; and when cut into little pieces, not the smallest bit floated. An examination with a small lens showed no trace of cellular structure, and an examination by Mr. Quekett of small sections with a higher power dis covered many of the alveoli to be filled up by small granules or cells which rendered them solid.

Cases of congenital atelectasis which recover completely are usually those in which energetic treatment has been adopted within a few hours of birth and has resulted in healthy inflation of the whole lung. Ill the beginning this may be often accomplished ; but delay leads to such change in the closed air-cells that they can be rarely sufficiently inflated to take useful part in the respiratory process. Moreover, from the observations of F. Weber and Stiffen, it appears that in eases where the child survives with permanent atelectasis of a portion of the lungs, the constant obstruction to the pulmonary circulation leads to hypertrophy of the right side of the heart, prevents the closure of the foramen ovale and ductus arteriosus, and may eventually induce hypertrophy of the left auricle and ventricle.

Diagnosis. —The history of these cases reveals a constant state of weak ness and torpor. This want of power, combined with lividity of the face, inability to suck, shallow breathing, and low temperature, is very suggestive. If in addition we notice the signs and symptoms of imperfect expansion of the chest, and on a physical examination fail to find evidence of marked consolidation, we can have little difficulty in ascribing the symptoms to their true origin.

Prognosis.—The prospect of recovery depends partly upon the cause of the atelectasis, partly upon the strength of the child, and partly upon the period after birth at which restorative measures are adopted. If the im perfect expansion of the lungs be due to some obstacle in the tubes them selves, or to some temporary accident occurring at the time of birth, the child's strength is usually good and treatment employed promptly is gen erally successful. If, however, means are not adopted early to enforce ex pansion of the unused alveoli, the prognosis is little less unfavourable than when the atelectasis is due to general weakness of the patient. In the latter case the chances of permanent improvement are not good, but vary according to the strength of the child. The unfavourable signs are : in ability to suck ; increasing liviclity ; a sub-normal and falling tempera ture and great apathy of manner. If the child ceases to be able to swallow, or if tonic or clonic spasms are noticed in the muscles of the face or limbs, we can entertain little hope of his recovery.

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