Severe respiratory distress syndrome unresponsive to intensive care treatment--diagnostic and therapeutic considerations.

Respiratory Distress Syndrome (RDS) is a common complication in preterm neonates. If RDS is not responding to conventional treatment modalities (surfactant therapy, ventilatory support, etc.), an underlying pathology (pulmonary lymphangiectasia, capillary alveolar dysplasia, alpha-1 antitrypsin deficiency, etc.) other then prematurity should be taken into consideration.Here, we report on a preterm neonate with the unusual simultaneous occurrence of pulmonary and systemic lymphangiectasia and homozygous alpha-1 antitrypsin deficiency who developed severe RDS that was refractory to conventional treatment. The diagnostic and therapeutic approach in this patient is presented.

Vasopressin in catecholamine-refractory shock in children.

Severe septic and cardiogenic shock is associated with a high mortality in neonates, children and adolescents. Common therapies include the administration of fluids and the use of conventional inotropes. However, in severe forms of shock, cardio-circulatory failure may be secondary to profound vasoparalysis and unresponsive to conventional therapies. We reviewed the literature on the use of arginine-vasopressin (AVP) and terlipressin (TP) as a rescue therapy in neonates, children and adolescents with catecholamine-refractory shock or cardio-circulatory arrest. We identified 17 reports (11 case series, 6 case reports) on a total of 109 patients. Only two studies were prospective. The age of treated patients ranged from extremely low birth weight infants of 23 weeks' gestation to a 19-year-old adolescent. The most common indication for either drug was catecholamine-refractory septic shock (nine reports). Commonly reported responses following AVP/TP administration were a rapid increase in systemic arterial blood pressure, an increase in urine output, and a decrease in serum lactate. In most reports, AVP and TP had a significant impact on the required dose of inotropes which could be reduced. Despite the use of AVP/TP, mortality was high (52/109). In view of the limited number of paediatric patients treated with AVP/TP, no definite recommendations on their use in children with severe forms of cardio-circulatory failure can be issued. There is a need for larger prospective trials assessing the efficacy and safety profiles of these drugs in a defined setting. Until more data are available, and taking into consideration the detrimental impact catecholamine-refractory shock has on children, the use of AVP/TP as a rescue therapy should be considered on an individual basis.

[The role of S100B-protein in neonatology, pediatric intensive care, and pediatrics]. / Neuromonitoring mittels S100B-Protein: Stellenwert für die Neonatologie, pädiatrische Intensivmedizin und Pädiatrie.

During the last years neuromonitoring with various biochemical markers such as S100B protein has been introduced into the clinical settings of neonatal and pediatric intensive care. Several investigations have been undertaken to correlate S100B protein concentrations to the diagnosis and prognosis of neonates and children with severe cerebral disorders. This articles gives a review on the current knowledge, indications and limitations on the use of S100B protein after non-traumatic and traumatic brain injury in neonates and children.

The effect of fasting in Ramadan on the values and interrelations between biochemical, coagulation and hematological factors.

BACKGROUND: The possible consequences of the long intermittent fasting schedule during Ramadan (one month of food and water intake limited to night hours, a practice that is followed by the majority of the Muslims worldwide) on certain biochemical constituents or coagulation variables have not been extensively documented. PATIENTS AND METHODS: During the month of Ramadan and two months after, we monitored the concentration of different plasma lipoproteins, lipoprotein (a) [Lp(a)], apoproteins A(1) and B, fibrinogen, factor VII activity and some selected hematological factors in 50 healthy subjects who were employees of institutes related to the Isfahan University of Medical Sciences and aged between 30 and 45 years. The effect of fasting in Ramadan on the relationship between biochemical and coagulation variables was also investigated. RESULTS: The values of apoprotein B, Lp(a) and low-density lipoprotein cholesterol (LDL-C)/high-density lipoprotein cholesterol (HDL-C) ratio were significantly decreased during Ramadan (P<0.05), while total cholesterol (Tot-C), triglycerides (TG), LDL-C, HDL-C and fasting blood glucose did not change during that month. Among coagulation and hematological factors, fibrinogen level and factor VII activity were significantly decreased during the month (P<0.05). Results also indicated a significant positive association between fibrinogen level and Lp(a), factor VII activity and Tot-C, LDL-C, TG and Apo B during Ramadan. CONCLUSION: Our findings contribute to a better understanding of previous reports, as the metabolic and coagulation changes that are considered as atherosclerosis risk factors are counterbalanced during Ramadan.

[Ventricular tachycardia after erythromycin administration in a newborn with congenital AV-block]. / Ventrikuläre Tachykardie nach Erythromycin-Gabe bei einem Neugeborenen mit angeborenem AV-Block.

UNLABELLED: This report is on a newborn with congenital complete av-block due to a maternal collagenosis. The intravenous application of erythromycin produced premature ventricular beats and non sustained ventricular tachycardias by prolongation of the QT interval. After discontinuation of the erythromycin application, the QT-interval normalised. CONCLUSION: In atrioventricular conduction disorders with severe bradycardia and prolongation of the QT interval, the application of erythromycin--if unavoidable--should be managed by slow intravenous infusion and with permanent ECG monitoring.

[Complicated malaria tropica in an infant]. / Komplizierte Malaria tropica bei einem Säugling.

We report on a five month-old infant from Cameroon, who was admitted because of febrile gastroenteritis after living in Germany for two weeks. Since the patient was somnolent, had a parasitaemia of Plasmodium falciparum of 230,000/microliter, a haemoglobin concentration of 5.3 g/dl and a thrombocytopenia, a complicated falciparum malaria was diagnosed. Treatment was started immediately with intravenous 20 mg quinine/kg bw as a loading dose, followed by 10 mg/kg bw every 12 hours, combined with intravenous clindamycin 10 mg/kg bw bd. Red blood cells were transfused once. The parasitaemia dropped to 2000 trophozoites/microliter within 48 hours. No asexual stages were detectable from the third day of treatment on. Weekly controls for the following four weeks remained negative. The mortality rate of complicated malaria is 50% in the first year of life, which can be reduced by early treatment. We present this case to draw attention to therapeutic options in infants.