[Indications and concept of follow-up care of home-monitoring for premature and risk infants]. / Indikation und Nachsorgekonzept zur Heimmonitorüberwachung in der Komplexbetreuung von Früh- und Risikoneugeborenen.

The pros and cons of home monitoring especially for premature infants with continuing apneic episodes and/or chronic lung disease are an ongoing discussion. The controversy spans socio-economic requirements, medical indication as well as patient and family needs. Here, the costs of home monitoring and follow-up care on the one hand and longer hospitalization times on the other need to be considered. This article aims to create a basis for this discussion by summarizing current evidence for the indications and considerations for differential diagnoses while also outlining the established follow-up program for these patients at the Dr. v. Hauner Children's Hospital at the Ludwig-Maximilians-University Munich, Germany.

Effects of theophylline on the pattern of spontaneous breathing in preterm infants less than 1000 g of birth weight.

Proportional assist ventilation (PAV) amplifies the ventilatory effect of the spontaneous respiratory effort and therefore allows analysis of drug-induced changes in the spontaneous breathing pattern of subjects who depend on mechanical ventilatory assistance. We hypothesized that theophylline will reduce the number and duration of respiratory pauses and apneic events in infants less than 1000 g of birth weight on PAV. Twelve infants were studied: median birth weight was 773 g; gestational age 26.0 weeks and postnatal age 9 days. Measurements were obtained over a 2-h period before and after 5 mg/kg of intravenous theophylline. A respiratory pause was defined as cessation of breathing for at least the duration of three preceeding breaths. The total number of respiratory pauses and the number of apneas followed by either cardiac slowing (decrease in heart rate more than 10%) or bradycardia decreased significantly. Minute ventilation increased due to a rise in tidal volume from 5.6+/-1.3 to 6.1+/-1.2 ml/kg (p=0.004). The duration of respiratory pauses, the respiratory rate, and the number of apneas followed by desaturation did not change significantly. We conclude that theophylline stimulates spontaneous breathing in infants less than 1000 g, reduces the number of apneas, and increases minute volume by increasing the tidal volumes.

[Primary hyperparathyroidism with persistent hypercalcemia in pregnancy]. / Primärer Hyperparathyreoidismus mit persistierender Hyperkalziämie in der Schwangerschaft.

Parathyroidectomy is effective in avoiding complications of primary hyperparathyroidism (pHPT) during pregnancy, because in about 90% of cases, it is caused by parathyroid adenomas. We present a case of severe pHPT during pregnancy of unknown etiology and without detectable parathyroid adenoma so that surgery was not a therapeutic option. The patient was a 29-year-old gravida 1 who presented with pHPT at 11 weeks of gestation. Although her serum calcium levels were elevated throughout pregnancy (>3.05 mmol/l; reference range: 2.05-2.65), a vigorous premature infant was delivered at 35 weeks of gestation. The infant received calcium intravenously, vitamin D(3) orally and was fed with raw human milk (low phosphorus) to prevent hypocalcemia. The baby did not develop clinical signs of hypocalcemia. Her initial parathyroid hormone level was suppressed (1.1 pg/ml; reference range: 15-65) and was normal at the age of 8 weeks. She was discharged from hospital at 14 days of life. Her physical, cognitive and motor development was normal through infancy and early childhood. In conclusion, pHPT during pregnancy does not necessarily lead to fetal or neonatal morbidity or mortality.