[Comparison of effects of endotracheal suction and surfactant administration on hemodynamics and oxygenation of premature infants--a near infrared spectroscopy study]. / Vergleich der Effekte von endotrachealem Absaugen und Surfactantapplikation auf Hämodynamik und Oxygenierung Frühgeborener--Eine Nahinfrarotspektroskopie-Studie.

BACKGROUND: Aim of this study was to assess whether the decrease in heart rate and oxygen saturation occurring acutely after bolus administration of surfactant is different from the effect of endotracheal suctioning and whether there are effects on cerebral haemodynamics and oxygenation. METHODS: Twelve premature infants, birth weight 720-1560 g (Median 935 g), gestational age 25-30 weeks (Median 28 weeks), were investigated during surfactant administration (Curosurf) as a single bolus and a preceding endotracheal suctioning procedure. Using near infrared spectroscopy changes in cerebral blood volume and cerebral oxygenation index were assessed. Heart rate, arterial oxygen saturation, PCO2, and arterial blood pressure were registered continuously. Data were compared at 30, 60 and 120 seconds after the beginning of suctioning and surfactant administration. RESULTS: Endotracheal suctioning and surfactant administration induced a similar decrease in heart rate (-29/min, SD 25, p < 0.01 and -30/min, SD 23, p < 0.001) during the first 30 seconds and in oxygen saturation at the 30 seconds datapoint (-3%, SD 2, p < 0.01 and -3%, SD 6, p < 0.05). The decrease in oxygen saturation persisted at 60 seconds after the start of suctioning (-4%, SD 5, p < 0.05). In contrast, oxygen saturation was no longer different from baseline levels 60 seconds after surfactant administration (+1%, SD 6, p = 0.5). After suctioning, cerebral oxygenation index had decreased significantly from baseline levels at 30, 60, and 120 seconds. In contrast, after surfactant administration, no significant difference from baseline was noted at 30 and 60 seconds and a significant increase occurred at 120 seconds. Mean arterial blood pressure, PCO2, and cerebral blood volume did not change significantly during endotracheal suctioning and during surfactant administration. CONCLUSIONS: Acute decreases in heart rate and oxygen saturation during bolus administration of surfactant are equal to effects occurring during endotracheal suctioning. However, the decrease in oxygen saturation is shorter and more importantly, no decrease in cerebral oxygenation occurs.

[Small premature infants do not tolerate axillary temperature measurement any better than rectal measurement. Study of the effect of axillary and rectal temperature measurement on vital parameters and cerebral hemodynamics and oxygenation]. / Kleine Frühgeborene tolerieren die axilläre Temperaturmessung nicht besser als die rektale. Untersuchung zum Effekt von axillärer und rektaler Temperaturmessung auf Vitalparameter und zerebrale Hämodynamik und Oxygenierung.

BACKGROUND: Aim of this study was to assess, by use of monitoring parameters and near infrared spectroscopy (NIRS), whether premature infants tolerate axillary temperature measurement better than rectal. METHODS: Twenty-one infants were studied. Birth weight was 540-1680 g (median 840 g), weight at the time of investigation 470-1500 g (Median 920 g), gestational age 24-31 weeks (median 29 weeks), age at time of investigation 4-25 days (median 11 days). Four pairs of axillary/rectal temperatures were taken in every infant. Heart rate and oxygen saturation were monitored. Using NIRS cerebral oxygenated and deoxygenated hemoglobin were measured and total cerebral hemoglobin and the cerebral oxygenation index were calculated. RESULTS: Mean heart rate increased slightly but significantly from baseline during axillary and rectal temperature measurement (axillary: +6/min (+/- 7); p < 0.0001; rectal: +4/min (+/- 6); p < 0.0001). Peak increase in heart rate was significantly higher during axillary than during rectal temperature measurement (axillary: +18/min (+/- 10); rectal: +14/min (+/- 8); axillary versus rectal: p = 0.02). There was no difference in the number of measurements during which oxygen saturation dropped intermittently below 88% (rectal: 21% of measurements; axillary: 20% of measurements). NIRS parameters were not significantly different between axillary and rectal measurements: cerebral oxygenated hemoglobin and the oxygenation index showed a decrease in cerebral oxygenation during both, axillary and rectal measurement. CONCLUSIONS: Axillary temperature measurement is not better tolerated than rectal in premature infants.

Effect of surfactant administration on cerebral haemodynamics and oxygenation in premature infants--a near infrared spectroscopy study.

OBJECTIVES: The aim of this study was to assess changes in cerebral haemodynamics and oxygenation induced by surfactant administration using near infrared spectroscopy (NIRS). METHODS: Eighteen premature infants, mean birth weight 960 g (range 550-1560 g), mean gestation age 28 weeks (range 25-30 weeks), were studied during 27 surfactant administrations. Porcine surfactant was administered to treat respiratory distress syndrome in a bolus of 100 mg/kg. Manual bag ventilation was performed for one minute after instillation. Heart rate, arterial oxygen saturation measured by pulse oximetry, transcutaneous PO2 (TcPO2), and PCO2 (TcPCO2), blood pressure, and cerebral oxygenated (O2Hb), deoxygenated (HHb), and total haemoglobin (tHb) concentration changes obtained by NIRS were registered every second from 15 minutes before until 30 minutes after surfactant administration. RESULTS: During surfactant administration, there was a short-lasting but significant drop in heart rate and arterial oxygen saturation. NIRS parameters remained constant during and up to 1 minute after administration. One to three minutes after administration, heart rate, oxygen saturation, and TcPO2 increased significantly concomitantly with an increase in O2Hb and a decrease in HHb. In 10 cases, TcPO2 increased above 100 mmHg. tHb--indicative of cerebral blood volume--did not change significantly. Five to 30 minutes after surfactant administration there was no difference of monitoring data from baseline levels. TcPCO2 and blood pressure remained unchanged during the measurement period. CONCLUSION: Cerebral blood volume remained constant in very-low-birth-weight infants when surfactant was administered by bolus administration followed by manual ventilation according to our protocol. Attention should be directed towards rapid adaptation of inspiratory oxygen concentrations after surfactant administration to avoid hyperoxaemia.

Aplasia cutis congenita--etiological relationship to antiphospholipid syndrome?

A case of aplasia cutis congenita is reported. The mother suffered from antiphospholipid syndrome and a possible etiological relationship between this and aplasia cutis congenita is discussed.

[Axillary versus rectal temperature measurement in premature and newborn infants]. / Axilläre versus rektale Temperaturmessung bei Früh- und Reifgeborenen.

We performed a prospective study to see whether axillary temperature accurately reflects rectal temperature in premature and sick mature newborns nursed in incubators and whether axillary temperature measurement is better tolerated than rectal measurement. 561 pairs of rectal and axillary temperatures were obtained in 20 infants. Mean axillary temperatures were 0.16 degree C (SD 0.33 degree C) lower than rectal temperatures. In infants < 1000 g axillary temperatures were only 0.06 degree C (SD 0.30 degree C) lower than rectal temperatures whereas in infants > 2500 g axillary temperatures were 0.37 degree C (SD 0.38 degree C) lower than rectal temperatures. Our results show that axillary and rectal temperatures are interchangeable in extremely premature infants. In newborn infants however 0.4 degree C should be added to axillary temperatures to make them comparable to rectal temperatures. Assessment of infant behaviour during temperature measurement by the nursing staff showed that infants tolerated rectal better than axillary temperature measurements. The decision which kind of measurement will be performed can be taken individually for every infant.

Effect of umbilical arterial catheters on intestinal blood supply.

Umbilical arterial catheters in the high position reduce the lumen of the aorta and may thereby impair blood supply to the intestine. Thirty-two preterm and three term infants were studied with an umbilical arterial catheter by colour and duplex Doppler sonography. The diameter of the aorta at the level of the coeliac axis was measured to calculate the reduction of the cross-sectional area of the aorta by the catheter. Blood-flow velocities were measured in the coeliac axis, the superior mesenteric artery and the anterior cerebral artery before and after removal of the catheter. The umbilical arterial catheter reduced the cross-sectional area of the aorta by 3.4-27.2% (mean 10.1%). There was no difference between blood-flow velocities in the coeliac axis and the superior mesenteric artery before and after removal of the umbilical arterial catheter, indicating that the catheter did not impair blood supply to the intestine.

Fatal Salmonella enteritidis sepsis acquired prenatally in a premature infant.

BACKGROUND: Before the advent of antibiotic therapy, Salmonella typhi infection during pregnancy was associated with a high incidence of fetal and neonatal death. Little information is available about the risk to the fetus or the newborn of a pregnant woman infected by non-typhoid salmonella, and treatment recommendations do not exist. CASE: We report a case of transplacental infection of a fetus by non-typhoid salmonella in a woman with gastroenteritis. Salmonella enteritidis was cultured from stool of the pregnant woman, who had diarrhea and fever before cesarean was performed at 29 weeks' gestation. The premature girl died 4 hours after birth from septic shock. Salmonella enteritidis was cultured from blood cultures and swabs of the premature infant and from the placenta and uterus. CONCLUSION: This observation argues in favor of antibiotic treatment for non-typhoid salmonella infection in pregnancy because of the risk of transplacental infection of the fetus.

[Reactive hyperemia after arterial occlusion: comparison of infrared telethermography and laser Doppler flowmetry]. / Reaktive Hyperämie nach arterieller Okklusion: Vergleich der Infrarot-Tele-Thermographie und der Laser-Doppler-Fluxmetrie.

Before, during and after arterial occlusion we measured Laser-Doppler Flux (LDF) and skin temperature using Infrared-Thermographie (IRT) in 40 healthy adults (20 female, 20 male). In the region of the hypothenar eminence of the left hand LDF and skin temperature showed significantly higher values in male compared with female subjects prior to occlusion (p < 0.01 resp. p < 0.05). After arterial occlusion for 120 seconds LDF showed a significant overshoot of 71.3% (+/- 39.5%) above baseline. During this phase of hyperemia skin temperature rose from 33.5 to 34.8 degrees C (p < 0.0001). This reaction was similar in men and in women. Changes in skin temperature were slower and more prolonged compared with the rapid changes of LDF. The absolute temperatures were significantly higher when we used IRT compared with temperatures measured by resistance thermometry. Both methods showed a close correlation (p < 0.0001, r = 0.891). Using the IRT technique a large number of skin temperatures can be measured simultaneously and temperature changes can be detected and visualized by colour thermograms. Postocclusive cutaneous hyperemia induces similar responses in LDF parameters and in skin temperatures. IRT therefore could be used as an additional tool for the assessment of physiological and pathological functions of the cutaneous microcirculation.

Randomised clinical trial of two treatment regimens of natural surfactant preparations in neonatal respiratory distress syndrome.

AIMS: To compare treatment regimens of two widely used natural surfactant preparations Curosurf and Survanta in respiratory distress syndrome (RDS). METHODS: The effects of the two treatment regimens on gas exchange, ventilatory requirements, and 28 day outcome in infants with RDS were compared. Seventy five preterm infants (birth weight 700-1500 g) with RDS requiring artificial ventilation with an FIO2 of > or = 0.4, were randomly selected at 1-24 hours of age. One group received an initial dose of Curosurf (200 mg/kg); the other group Survanta (100 mg/kg). Patients who remained dependent on artificial ventilation with an FIO2 of > or = 0.3 received up to two additional doses of Curosurf (each of 100 mg/kg) after 12 and 24 hours or up to three additional doses of Survanta (each of 100 mg/kg) between six and 48 hours after the initial dose. RESULTS: There was a rapid improvement in oxygenation and ventilatory requirements were reduced in both groups. However, infants treated with Curosurf had a higher arterial:alveolar oxygen tension ratio and required a lower peak inspiratory pressure and mean airway pressure at several time points within 24 hours of randomisation (p < 0.05-0.001). The incidences of pneumothorax in the Curosurf and Survanta groups were 6% and 12.5%, respectively; the corresponding figures for grades 3-4 intracerebral haemorrhage were 3% and 12.5%, respectively. Mortality was 3% in the Curosurf group and 12.5% in the Survanta group. However, these differences did not reach significance. CONCLUSION: The Curosurf treatment regimen resulted in a more rapid improvement in oxygenation than Survanta and reduced ventilatory requirements up to 24 hours after start of treatment. This was associated with a trend towards reduced incidence of serious pulmonary and non-pulmonary complications.

[Effect of corticosteroids on lung function and the clinical course of bronchopulmonary dysplasia in premature infants with a birth weight below 1,500 g]. / Einfluss von Kortikosteroiden auf die Lungenfunktion und den klinischen Verlauf bei bronchopulmonaler Dysplasie Frühgeborener mit einem Gerburtsgewicht unter 1500 g.

11 very low birth weight infants (700-1480 g) with bronchopulmonary dysplasia were treated with dexamethasone (0.5 mg/kg/day for 3 days, 0.3 mg/kg/day for 3 days), followed by hydrocortisone (tapering from 2 mg/kg/day-0.5 mg/kg/day, total 4 days). Pulmonary function tests showed a significant improvement of lung compliance from initially 0.36 +/- 0.05 cm/ml H2O/kg to 0.54 +/- 0.16 cm/ml H2O/kg after 24 hours. Compliance remained within levels above baseline during the following 4 days. Steroid therapy was also associated with a significant reduction of FiO2 (0.45 to 0.34) and ventilator rates (48.9 to 29.3/min). Extubation was possible in all infants 11.9 (+/- 10) days after initial treatment.

[A comparison of different respiratory gas-humidifier systems for the respiratory therapy of premature infants in incubators]. / Vergleich verschiedener Atemgas-Anfeuchtersysteme für die Respiratortherapie Frühgeborener im Inkubator.

OBJECTIVE: 7 humidifier systems for neonatology were subjected to a performance test in our laboratory. DESIGN: In 18 measurement combinations, flow (2,6,16 l/minute), respiratory gas temperature (34 and 37 degrees C) and incubator temperature (33, 35, 37 degrees C) were varied. RESULTS: In only 70.6% of 126 measurements the minimum international standard for the absolute humidity in the respiratory gas (30 mg H2O/l air) was achieved or exceeded. In 3 systems this level was not reached in 9 resp. 10 of 18 measurements. Only 1 device that functions according to the "membrane humidification" principle fulfills the requirements with regard to constant high air humidity. In 36 of 126 ( = 28.6%) measurement combinations the respiratory gas temperature near the endotracheal tube varied > 1 degrees C from the system temperature setpoint. CONCLUSION: No controlled clinical tests regarding the importance and long term effects of different levels in the inspiratory air are so far available for the ventilatory treatment of neonates.

[Retinopathy of prematurity: an analysis of risk factors]. / Retinopathia praematurorum: Eine Analyse der Risikofaktoren.

In 29 infants with retinopathy of prematurity we retrospectively studied the influence of various clinical factors on the severity of the disease and compared this group of patients with controls without retinopathy. Infants presenting with different stages of retinopathy showed significant differences in gestational age, length of mechanical ventilation, additional supplemental oxygen, and the number of episodes of acidosis and hypocarbia. Compared with controls, hyperoxemia with paO2-levels above 100 mmHg and hypocarbia with pCO2-levels below 35 mmHg was more often observed in infants with retinopathy (p < 0.05, respectively p < 0.01). Besides, these infants were more often treated with surgical ligation of a patent ductus arteriosus than with indomethacin (p < 0.001). In our patients we were not able to assess the incidence and the severity of retinopathy of prematurity by calculation of risk scores or safety indices.

[Increased thrombocyte count in newborn infants of drug-dependent mothers]. / Erhöhte Thrombocytenzahlen bei Neugeborenen drogenabhängiger Mütter.

In a retrospective study we analysed clinical findings and hematological data of 16 neonates born from mothers using methadone and other drugs during pregnancy. Most infants presented with symptoms of drug withdrawal and needed medication. Hemoglobin concentration and leucocyte counts were within normal limits, whereas all infants showed thrombocytosis after the first week of life with thrombocyte counts (median) of 566,750 (week 2), 628,500 (week 3), 629,500 (week 4), 617,000 (week 5) and 639,150/mm3 (week 6). No thrombocytosis was found in 18 normal control infants which showed significantly lower platelet counts during the first days (p < 0.05) and by the second week of life (p < 0.001). The cause of this phenomenon is not known. Sudden infant death syndrome occurred in 1 infant. There are speculations that the high incidence of SIDS in this group of patients could be explained by thromboembolic complications in some of the cases.

[Effect of different relative humidity in the incubator on skin temperature of newborn infants with low birth weight]. / Einfluss unterschiedlicher relativer Luftfeuchtigkeit im Inkubator auf die Hauttemperatur Neugeborener mit niedrigem Geburtsgewicht.

BACKGROUND: In a group of 8 LWB infants we tried to investigate the influence of different levels of rel. humidity inside the incubator on rectal and skin temperature and on the pattern of temperature distribution over the body surface. METHOD: In low (45 rel.%) and high (83 rel.%) incubator humidity we measured rectal temperature and, using infrared telethermography, skin temperatures at 12 different sites of the body. RESULTS: After increasing ambient humidity mean skin temperature rose significantly (p < 0.01) from 35.87 to 36.10 degrees C. The pattern of temperature distribution also changed with increasing humidity, showing pronounced warming of the periphery. Rectal temperature did not change significantly. CONCLUSION: With rising ambient humidity skin temperature increase in LBW infants, and the distribution of surface temperature becomes more even.

[Interaction of tolazoline and cimetidine in persistent fetal circulation of the newborn infant]. / Interaktion von Tolazolin und Cimetidin bei persistierender fetaler Zirkulation des Neugeborenen.

A newborn was treated with tolazoline for persistent pulmonary hypertension. Oxygenation improved during continuous infusion of the drug, but gastrointestinal bleeding occurred. Therefore, cimetidine was given. After this there was a rapid deterioration with decrease of oxygen saturation and arterial pO2 values. Tolazoline induces a dilatation of the pulmonary vascular system by stimulating H1 and H2 receptors. Blocking of H2 receptors by cimetidine abolishes the effect of tolazoline at least partially. Our case shows that the interaction between tolazoline and cimetidine is of clinical significance. The recommendation to use cimetidine as prophylaxis against gastrointestinal side-effects induced by tolazoline can no longer be maintained.

[Secondary rhabdomyolysis and acute renal failure in gastroenteritis with hypernatremic dehydration]. / Sekundäre Rhabdomyolyse und akutes Nierenversagen bei Gastroenteritis mit hypernatriämischer Dehydratation.

A child with severe gastroenteritis developed acute rhabdomyolysis combined with acute renal failure. The pathophysiological mechanisms of this clinical syndrome are not completely understood. Rhabdomyolysis is mainly due to osmotic changes on both sides of the cell membrane. The preventive and therapeutic measures consist of adequate fluid substitution, correction of electrolyte and acid-base imbalances, administration of diuretics and alkalization of the urine. Dialysis treatment may be necessary. In this particular case renal failure resolved but the child died of other organ failure.

Membrane humidification--a new method for humidification of respiratory gases in ventilator treatment of neonates.

A humidifier system for neonatology that functions according to the 'membrane humidification' principle was subjected to a performance test in our laboratory. Humidification and heating of the respiratory gases took place in a module consisting of a net of hollow fibres placed inside the incubator. In 18 measurement combinations flow, respiratory gas temperature, and incubator temperature were varied. At respiratory gas temperatures within the range of 33-37 degrees C the minimum international standard for the absolute air humidity in the respiratory gas was achieved or exceeded in all measurements. No controlled clinical tests regarding the importance and long term effects of different temperatures and different humidity levels in the inspiratory air are yet available for the ventilation treatment of neonates.

[Laser Doppler flowmetry in newborn infants with low birth weight. The effect of differences in humidity on peripheral circulation]. / Laser-Doppler-Flussmessungen bei Neugeborenen mit niedrigem Geburtsgewicht. Der Einfluss unterschiedlicher relativer Luftfeuchtigkeit auf die periphere Durchblutung.

In a group of 10 low birth weight infants we measured skin temperature using infrared thermography and laser Doppler flow in central and peripheral regions of the body. After elevation of incubator humidity from 40 to 80% skin temperature of the foot rose significantly (p less than 0.01). At the same time there was a significant increase (p less than 0.05) of laser Doppler flow. Temperature and laser Doppler flow in the area of the abdomen did not show significant changes. Low birth weight infants are able to regulate peripheral blood flow after changes of ambient humidity. With the method of laser Doppler flowmetry thermoregulatory responses in the microvascular bed can be measured in these infants.