[Unpreventable effects of neonatal intensive care on the later development of extremely small premature infants]. / Unvermeidbare Auswirkungen intensiv-neonatologischer Aktivitäten auf das spätere Schicksal extrem kleiner Frühgeborener.

This review of the literature presents the pooled data from several perinatal centers throughout the world published during the last three years. It regards the longterm prognosis of extremely low birthweight infants (less than 1000 g). Since the introduction of neonatal intensive care the mortality rate dropped from greater than 90% to less than 50%. On the other hand the morbidity rate improved only slowly. Recent reports from the Anglo-American literature show that among the survivors 13.7% are seriously and 25.1% mildly handicapped. 60-70% of the extremely low birthweight infants, despite of normal IQ's, are experiencing school problems. Most of them have cognitive, perceptual and motor deficits combined with behaviour problems ("the new morbidities"). The incidence of cerebral palsy remained unchanged (6-8%) over the last two decades. Until now, there is no significant effect of the surfactant therapy on the morbidity rate. The rate of serious longterm disability increases with decreasing birthweight. The results of the Anglo-American and German follow-up studies differ only slightly.

[Irreversible generalized pulmonary emphysema resulting from destructive bronchitis and bronchiolitis following adenovirus infection]. / Irreversibles generalisiertes Lungenemphysem infolge destruktiver Bronchitis und Bronchiolitis nach Adenovirusinfekt (Williams-Campbell Syndrom).

Report of an 1 1/2 year old boy with the typical features of Williams-Campbell syndrome: chest deformity (thorax piriformis), pulmonary hyperinflation, ballooning of the segmental and subsegmental bronchi during inspiration and collapse with expiration. Atelectasis of the left upper lobe after bronchiolitis obliterans. The literature reports 23 patients with Williams-Campbell syndrome. There is every reason to believe that the extensive bronchiectasis are not due primarily to developmental deficiency of the bronchial cartilage, as the most authors assume, but result from destructive changes after inflammation. In our case very likely an adenovirus infection was the cause. The clinical features of the syndrome look like a severe therapy resistant asthma bronchiale.

[Disorders of bone metabolism in premature infants]. / Knochenstoffwechselstörungen bei Frühgeborenen.

Extremely low birth weight infants are particularly prone to rickets (osteopenia) due to their rapid growth and to deficient intake of calcium and phosphate. In some premature infants suffering from phosphate depletion hypercalcemia syndrome may precede bone demineralisation. Additionally, the adverse effects of calciprivic drugs (phenytoin, phenobarbital, glucocorticoids, furosemide, heparin) contributing to the development of neonatal rickets are discussed. Phosphorus depleted or heparin treated experimental animals develop impairment of mineralisation as manifested by rickets or osteomalacia. Some clinical cases of neonatal rickets are reported and a dosage schedule for parenteral infusion of minerals is given.

[Anaphylactic shock reaction following intravenous administration of 7S immunoglobulin in patients with hypogammaglobulinemia, especially in children with acute lymphoblastic leukemia (ALL)]. / Anaphylaktische Schockreaktion nach intravenöser Gabe von 7S-Immunglobulin bei Patienten mit Hypogammaglobulinämie, insbesondere bei Kindern mit akuter lymphoblastischer Leukämie (ALL).

Severe anaphylactic reactions were observed in 2 children, aged 2 and 14 years, with acute lymphocytic leukemia and a 12 month old infant with a functional T-cell defect after intravenous administration of a polyethyleneglycol (PEG)-treated immunoglobulin preparation. All 3 children suffered additionally from hypogammaglobulinemia. Intravenous infusions of 7S-immunoglobulin preparations with a modification of the Fc portion, however, had been well tolerated by the same patients. Investigations of the immunoglobulin preparations revealed IgG aggregates (approximately 35%) in one batch of the PEG-treated immunoglobulin preparation. Prekallikrein activator and kallikrein were not increased in the immunoglobulin preparations tested. These results in addition to our clinical experiences suggest that only 7S-immunoglobulin preparations with a modification of the Fc portion should be used in patients with hypo- or a-gammaglobulinemia, in order to avoid complement activation released by the intact 7S-preparations.

Reduced urinary serotonin excretion after intake of high doses of hypoxanthine.

Two healthy volunteers were treated with hypoxanthine 3 x 1 g and allopurinol 3 x 100 mg daily for 1 week. During this treatment serum oxypurine concentration and urinary oxypurine excretion increased as expected. No side effects were observed except for some mild daytime drowsiness and lethargy. Measurements of urinary serotonin (5-HT) excretion showed decreases to as much as 60% below initial values. Decreased urinary 5-HT excretion was also found in a patient with incomplete Lesch-Nyhan syndrome during treatment with high doses of hypoxanthine. His neurological symptoms improved slightly. The results suggest that high doses of hypoxanthine exert a nonspecific sedative effect on both patients with Lesch-Nyhan syndrome and healthy controls. The cause is probably a reduced synthesis or release of 5-HT.

[Correlation of obstetrical and clinical data with nevi flammei in the newborn (author's transl)]. / Korrelation schwangerschaftsanamnestischer und klinischer Befunde mit dem Auftreten von Naevi flammei bei Neugeborenen

Nevus flammeus (teleangiectaticus) is the most common variety of congenital nevus. Among 3961 infants checked at the ages of 3--7 days and again at 6 weeks 42% showed nevi flammei mediales in the nape and/or in the eyelids and glabella. The mothers of the infants presenting with n.fl. tended to be overweight, to have circulatory distrubances and prolonged duration of laor. The infants with n.fl. frequently had concomittant edema, navel hernia and minor degenerative stigmata. However malformations did not occur more commonly. This investigation suggests that exogenous factors such as diseases during pregnancy, intake of drugs and difficulties in delivery do not influence the genesis of n.fl. Only constitutional factors could be correlated with the incidence of n.fl. Since there was a higher frequency in female than in male infants and a lower frequency in premature than in term newborns it may be that hormonal inffluences increase the incidence of n.fl., too. These results were obtained from the prospective study: Schwanger-schaftsverlauf und Kindesentwickling (DFG).

[Physiology and pathophysiology of calcium and phosphate metabolism in newborn infants. Personal study results and literature references]. / Physiologie und Pathophysiologie des Kalzium- und Phosphatstoffwechsels im Neugeborenenalter.

This description of the physiology and pathophysiology of the calcium and phosphate balance in neonates is based on our own studies and a short review of the literature. In general, the higher the calcium concentration in the umbilical cord blood the greater its decrease during the first two days of life. With asphyxiated newborns the decrease in the serum level of both the total calcium and the ionized calcium surpasses that in nonasphyxiated newborns by approximately a third. There are various causes for neonatal hypocalcemia. The most striking causes for the early form of hypocalcemia are likely to be a transient hypoparathyroidism or a failure of end-organ responsiveness. In nearly all newborns we found a low urinary cAMP excretion on the first day of life increasing significantly until the fourth day. Measurements of the urinary cAMP excretion are an appropriate parameter for recognizing the parathormone effect. By measuring both the parathormone level in the serum and the urinary cAMP excretion it is possible to distinguish hypoparathyroidism from pseudoparathyroidism . Several cases with different forms of hypocalcemia are discussed.

Oxypurine concentration in the CSF in children with different diseases of the nervous system.

Oxypurine analysis was done in the CSF of 190 children with different diseases. The patients could be divided into four groups: Group A, serving as controls, consisted of 56 children suffering from diseases without neurological signs, for example, leukaemia. 16% of them had raised hypoxanthine values greater than 7.5 mumol/l and 32% raised uric acid values greater than 12.0 mumol/l. Group B comprised 97 children suffering from diseases with neurological signs, for example, meningitis. For these patients the frequency of raised hypoxanthine and uric acid values in the CSF was twice as high as in Group A. Group C comprised 31 patients with different forms of cerebral convulsions. Among these patients 52% had raised hypoxanthine and 70% raised uric acid values. The findings of these patients are described in a previous paper (Manzke et al. 1981). Group D comprises 6 patients from whom CSF samples were taken postmortally. All these deceased patients showed extremely high hypoxanthine + xanthine and uric acid concentrations in their CSF.

[Children of mothers with late gestosis in pregnancy. Results of a prospective "course of pregnancy and child development" study program]. / Kinder von Müttern mit Spätgestose in der Schwangerschaft. Ergebnisse aus dem prospektiven Untersuchungsprogramm "Schwangerschaftsverlauf und Kindesentwicklung".

Within the sample of 1783 children from the prospective study "Schwangerschaftsverlauf und Kindesentwicklung" (Course of pregnancy and development of children) followed-up until the age of 6 years the mothers of 182 suffered from late gestosis (10.2%). The values of the systolic blood pressure and of the protein concentration in the urine of the mothers measured at their last examination before onset of labour were crucial for the diagnosis of gestosis. According to this definition 95 mothers with systolic pressure greater than or equal to 150 mm Hg were classified as hypertensive (group of the hypertension children) and 87 mothers with both systolic pressure greater than or equal to 150 mm Hg and proteinuria greater than 1 g/l as being preeclamptic (group of the preeclamptic children). The control groups contained the same number of children (matched pairs). There were no significant differences in the findings between the different groups. Apparently, the prognosis of the child's development is favourable provided that the gestosis does not last long and does not lead to placental insufficiency.

[Secretory immunoglobulin A in saliva of healthy children and children with airway diseases]. / Sekretorisches Immunglobulin A im Speichel von gesunden Kindern und Kindern mit Atemwegserkrankungen.

Using the Elisa-Test of Dakopatts, Hamburg, described by Ishiguro et al and modified by us (Mikrotitration plates instead of tubes, blocking up free bonding capacities in the plates with 1% gel fluid, altered incubation periods) we determined secretory IgA (SIgA) in saliva samples of 376 infants and children. The probands could be divided in three groups: Group 1, serving as controls, consisted of 163 healthy children. Group 2 comprised 111 children suffering from acute infection of the respiratory tract. Group 3 consisted of 102 children with chronic airways diseases, in particular, asthma. In the healthy infants and children we found age dependent increases of SIgA until the age of 4 years. The median values amounted 16.7 (newborns), 59.2 (1st year), 118.2 (2nd year), 149.2 (3rd year), 185.5 (4th year), 159 (5th year) and 175.8 mg/l (5th-13th year). A similar age dependent increase of SIgA was evident in the saliva samples of children suffering from acute infections of the respiratory tract. In the children with chronic airways diseases there was only a slight increase of SIgA during the first 4 years (mean = 78.0-113.5 mg/l) and an abrupt (statistically significant) rise in the fifth year. The median value of SIgA was 216 mg/l in the children aged 5-13 years. Serum IgA along with salivary IgA were measured in 128 children (r = 0.40, p less than 0.001). 6 children had a complete IgA deficiency and 4 children an incomplete IgA deficiency, i.e. low secretory IgA levels in saliva (36.8-50.0 mg/l) and lacking IgA in serum (less than 14 mg/dl).(ABSTRACT TRUNCATED AT 250 WORDS)

[Bronchial hyperreactivity to physiological saline solution]. / Bronchiale Hyperreaktivität auf physiologische Kochsalzlösung.

A case of a 10-year old boy suffering from asthma bronchiale following pleuropneumonia is reported. Paradoxically, bronchospasmolysis tests using physiological saline + salbutamol or ipratropium bromide impaired the lung function of this patient. Salt solutions inhaled in increasing doses until 1.4% generated severe bronchoconstriction, however, inhalation of DNCG + salbutamol normalized the lung function completely.