864
Letters to the Editor
The .IournaI of Pediatrics November 1976
for the eaily, and periodic screening, diagnosis and treatment program under Medicaid, U.S. D e p a r t m e n t of Health. Education, and Welfare, 1974.
T a b l e I. P a r e n t r e s p o n s e s to s a m p l e a c c i d e n t s c r e e n i n g questions
Question Do you know how to prevent infant smothering or choking?
Age group
% at risk
0-5
85
61
42
Do you use safety belts in your car?
6-12 13-18
50 17
86 25
63 60
Does your child know how to swim?
6-12 13-18
52 38
74 10
59 21
of health, and schools can use the data as a locus of mass educational campaigning. Finally, a systematic screening device will force health care providers to learn about these problems in a scientific m a n n e r in order to counsel parents effectively. The literature on this topic o f accident prevention is extensive. Our feeling is that m a n y pediatricians have only a passing acquaint ance with it. The above study certainly represents only a small first step. We realized from our results that our own screening will have to be more precise and more detailed. Hopefully, we will be able to develop a valid instrument for safety screening in pediatric practice. .Ioel L. Bass, M.D. Associate Director of Pediatrics Eramingham Union Hospital 25 Evergreen St. Framingham, MA 01701 Instructor of Pediatrics Boston University Medical Center Boston, MA 02118 Kishor A. Mehta, M.D. Director of" Pediatrics Framingham Union Hospital 25 Evergreen Street Framingham, MA 01701 Associate Clinical Professor el" Pediatrics Boston University Boston, MA 02118 Linda Truitt, R.N. Health Coordinator Headstart Program 19 A Harrison A re, Framingham, MA O1701 REFERENCES
1.
Barnett HL, editor: Pediatrics, New York, 1972, AppletonCentury-Crofts, Inc. 2. Kelly VC, editor: Metabolic, endocrine, and genetic disorders of children, vol. 2, New York, 1974, Harper and Row Publishers Inc. 3. Frankenburg W K , and North AF Jr.: A guide to screening
Unilateral pulmonary interstitial emphysema To the Editor: The recent letters' of Drs. W y m a n and K u h n s and Flail and associates regarding in the etiology and treatment of unilateral p u h n o n a r y interstitial e m p h y s e m a are interesting, Although improper placement of the endotracheal tube may be the etiology of the problem, it m a y also be therapeutic in selected cases. I propose that in cases were unilateral pulmonary interstitial emphysema has progressed to the point of hyperinflation of one side and atelectasis o f the contralateral side selective intubation of a mainstem bronchus may be quite beneficial. It will allow for reabsorption of the hyperinflated side and inflation of the collapsed lung. It really is a dramatic procedure. 1 have utilized this treatment on a moribund neonate recently and in less than 24 hours was able to extubate her with no need for reintubation. G. f . Dickman, D.O. Oklahoma Memorial Childrens Hospital 940 NE 13th St. Oklahoma City, Okla. 73104 REFERENCE
1.
Letters to the Editor: J PEDIArR 88:902, 1976.
Reply To the Editor: Unilateral interstitial p u l m o n a r y e m p h y s e m a (PIE) under tension occurring in a newborn infant in the course o f assisted or mechanical ventilation for respiratory distress syndrome may be life threatening unless corrected promptly. The proper management has generated considerable interest, and methods of treatment have been described ranging from [obectomy" '-' to endotracheal suction of the involved side combined with intermittent high oxygen administration as a method of interstitial space wash-out? Dr. Dickman refers to another modality of nonoperative management, that of selective intubation of the bronchus of the contralateral side effectively bypassing the overinfiated lung. This procedure was recently presented by Brooks and associates ~ resulting in successful resolution of the unilateral PIE in four patients. Two maintained resolution after five days of intubation: however, the other two patients developed a recurrence following removal of the endotracheal tube after 36 and 48 hours of intubation, respectively. We have recently had experience with an infant whose PIE was confined primarily to the right upper lobe. Complete resolution was obtained which persisted following five days of intubation of
Letters to the Editor
The .IournaI of Pediatrics November 1976
for the eaily, and periodic screening, diagnosis and treatment program under Medicaid, U.S. D e p a r t m e n t of Health. Education, and Welfare, 1974.
T a b l e I. P a r e n t r e s p o n s e s to s a m p l e a c c i d e n t s c r e e n i n g questions
Question Do you know how to prevent infant smothering or choking?
Age group
% at risk
0-5
85
61
42
Do you use safety belts in your car?
6-12 13-18
50 17
86 25
63 60
Does your child know how to swim?
6-12 13-18
52 38
74 10
59 21
of health, and schools can use the data as a locus of mass educational campaigning. Finally, a systematic screening device will force health care providers to learn about these problems in a scientific m a n n e r in order to counsel parents effectively. The literature on this topic o f accident prevention is extensive. Our feeling is that m a n y pediatricians have only a passing acquaint ance with it. The above study certainly represents only a small first step. We realized from our results that our own screening will have to be more precise and more detailed. Hopefully, we will be able to develop a valid instrument for safety screening in pediatric practice. .Ioel L. Bass, M.D. Associate Director of Pediatrics Eramingham Union Hospital 25 Evergreen St. Framingham, MA 01701 Instructor of Pediatrics Boston University Medical Center Boston, MA 02118 Kishor A. Mehta, M.D. Director of" Pediatrics Framingham Union Hospital 25 Evergreen Street Framingham, MA 01701 Associate Clinical Professor el" Pediatrics Boston University Boston, MA 02118 Linda Truitt, R.N. Health Coordinator Headstart Program 19 A Harrison A re, Framingham, MA O1701 REFERENCES
1.
Barnett HL, editor: Pediatrics, New York, 1972, AppletonCentury-Crofts, Inc. 2. Kelly VC, editor: Metabolic, endocrine, and genetic disorders of children, vol. 2, New York, 1974, Harper and Row Publishers Inc. 3. Frankenburg W K , and North AF Jr.: A guide to screening
Unilateral pulmonary interstitial emphysema To the Editor: The recent letters' of Drs. W y m a n and K u h n s and Flail and associates regarding in the etiology and treatment of unilateral p u h n o n a r y interstitial e m p h y s e m a are interesting, Although improper placement of the endotracheal tube may be the etiology of the problem, it m a y also be therapeutic in selected cases. I propose that in cases were unilateral pulmonary interstitial emphysema has progressed to the point of hyperinflation of one side and atelectasis o f the contralateral side selective intubation of a mainstem bronchus may be quite beneficial. It will allow for reabsorption of the hyperinflated side and inflation of the collapsed lung. It really is a dramatic procedure. 1 have utilized this treatment on a moribund neonate recently and in less than 24 hours was able to extubate her with no need for reintubation. G. f . Dickman, D.O. Oklahoma Memorial Childrens Hospital 940 NE 13th St. Oklahoma City, Okla. 73104 REFERENCE
1.
Letters to the Editor: J PEDIArR 88:902, 1976.
Reply To the Editor: Unilateral interstitial p u l m o n a r y e m p h y s e m a (PIE) under tension occurring in a newborn infant in the course o f assisted or mechanical ventilation for respiratory distress syndrome may be life threatening unless corrected promptly. The proper management has generated considerable interest, and methods of treatment have been described ranging from [obectomy" '-' to endotracheal suction of the involved side combined with intermittent high oxygen administration as a method of interstitial space wash-out? Dr. Dickman refers to another modality of nonoperative management, that of selective intubation of the bronchus of the contralateral side effectively bypassing the overinfiated lung. This procedure was recently presented by Brooks and associates ~ resulting in successful resolution of the unilateral PIE in four patients. Two maintained resolution after five days of intubation: however, the other two patients developed a recurrence following removal of the endotracheal tube after 36 and 48 hours of intubation, respectively. We have recently had experience with an infant whose PIE was confined primarily to the right upper lobe. Complete resolution was obtained which persisted following five days of intubation of
