Elsevier

The Journal of Pediatrics

Volume 113, Issue 6, December 1988, Pages 1074-1077
The Journal of Pediatrics

Abnormalities of diaphragmatic muscle in neonates with ventilated lungs*

https://doi.org/10.1016/S0022-3476(88)80585-7Get rights and content

Several infants and neonates who had received long-term ventilatory assistance had subnormal diaphragmatic muscle mass on gross necropsy examination. We conducted a retrospective study of our hospital infant necropsy files to determine whether prolonged ventilatory support was associated with diminution in myofiber cross-sectional area selectively affecting the diaphragm. We found that long-term ventilatory assistance may predispose diaphragmatic myofibers to disuse atrophy or to failure of normal growth. This phenomenon may contribute to difficulties in weaning infants from ventilatory support.

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    Before these 2 studies, only 1 retrospective study of human neonates and 1 study in animals (rats) had provided evidence to support the theory of VIDD. In brief, these landmark studies revealed that 48 hours of controlled MV in humans and animals could lead to a significant loss of diaphragm mass and strength.57,58 The cause seems to stem from the rise in reactive oxygen species in the diaphragm muscle fibers exposed to MV; the dominant site of oxidant production is the mitochondrion, which leads to a rapid decline in protein synthesis.59

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*

Presented in part at the 76th annual meeting of the United States and Canadian Academy of Pathology, Chicago, Ill., March 8–13, 1987.

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