[Reconstruction in coronal and sagittal planes of CT scans compared with two-dimensional echo-encephalography in neonates and infants (author's transl)]. / Rekonstruktion koronaler und sagittaler Ebenen von CT-Bildern im Vergleich zur zweidimensionalen Echoenzephalographie bei Neugeborenen und Säulgligen.

Two-dimensional echo-encephalography using the fontanelle and open sutures as an "acoustic window" for the skull has offered a new possibility of investigating at least in part the morphological conditions inside the skull. We considered it necessary to examine the value of these new methods by checking the sonographic findings by means of cranial CT. The possibility of modern data processing when employing CT enables the visualisation of the coronal and sagittal planes which can be covered by echo-encephalography. Since it involves low stress for the patient and since it is a practicable method, two-dimensional echo-encephalography is very suitable for screening and for checking on the status of the patient. Since CT can visualise the overall situation inside the skull with greater accuracy, it remains indispensable as a basic examination method, depending on the overall clinical signs and symptoms.

[Perinatal herpes simplex infection]. / Perinatale Herpes simplex Infektion.

Neonatal herpes is a rare disease which has to be distinguished from herpes simplex virus infection later on in life. Most neonates in whom HSV infection develops have acquired the virus from the maternal genital tract during delivery. Clinical symptoms and prophylactic measures are discussed. Antiviral therapy with acyclovir is the treatment of choice and appears to improve outcome of neonatal herpes. The prognosis depends on early therapy, but the available diagnostic techniques not always allow early detection of the disease. Therefore treatment should be initiated in relation to clinical findings.

[The prognosis of convulsions in the newborn--the place of EEG in comparison with echoencephalography]. / Zur Prognose von Krampfanfällen bei Neugeborenen--Stellenwert des EEG im Vergleich zur Echoenzephalographie.

The routine-EEG in premature and term infants with cerebral seizures and its additional information are discussed in comparison to clinical and morphological findings. The clinical, electroencephalographic and echoencephalographic data to all 29 neonates that were treated during a four years period are presented. Three of those infants died, eight of them showed pathological results during developmental and neurological follow-up. EEG's were performed during or short by after seizures. A correlation could be shown between poor prognosis and suppression of background activity consisting in inactivity, burst-suppression pattern or moderate suppression. By contrast a normal or mildly suppressed EEG correlated with good longterm prognosis. Paroxysmal discharges in the EEG were helpful in diagnosing seizures and also for prognosis of cerebral convulsions later on. The echoencephalographic findings especially mild intracranial hemorrhages and increased periventricular echogenicity had less prognostic value. The echoencephalographic follow-up showed ventricular dilatation (e vacuo) in children who later on had developmental and neurological impairment. For assessment of prognosis in premature and term babies with cerebral seizures imaging procedures (echoencephalography and CT-scan) as well as electroencephalography are of mutual importance.

[Phenobarbital in newborn infants. Overview]. / Phenobarbital beim Neugeborenen. Eine Ubersicht.

Over the past years the use of phenobarbital in so called "brain orientated neonatal intensive care" has gradually become established. It is the recommended drug for the treatment of seizures in term neonates. It also should be given to neonates who are being treated with curare like muscle relaxants and whose EEG may show paroxysmal activity. It is recommended to administer phenobarbital before curare is given. This may result in more effective mechanical ventilation. Seizures occurring in the premature baby can hardly be influenced. The prophylactic treatment of premature infants to avoid intraventricular haemorrhage is controversial. It is, however, generally accepted that full term babies with neonatal asphyxia should receive phenobarbital. Bacterial meningitis is also an indication for its use in a similar manner. A loading dose of 15-20 mg/kg body weight given intravenously is recommended. The plasma concentration of phenobarbital will usually reach therapeutic levels (15-30 micrograms/ml) within a few minutes of the injection and will hardly change during the following 48 hours. No other anticonvulsant drug should be used until the phenobarbital plasma level exceeds 40 micrograms/ml. As maintenance therapy a dose of 3-4 mg/kg/day is recommended. Due to the long plasma half-life (69-165 h) accumulation of the drug may be possible. It can be avoided if the dose does not exceed 5 mg/kg/day. The duration of therapy depends on the condition of the baby. In general early discontinuation after 1-2 weeks should be possible.

[Extrapyramidal movement disorders after "Isostar Cocktail"]. / Extrapyramidale Bewegungsstörungen nach "Isostar-Cocktail".

Two children developed extrapyramidal symptoms after taking an electrolyte drink. There was a good response to Biperidon (Akineton). Only exact investigations showed that both children had accidentally been poisoned by a neuroleptic drug which was added to the electrolyte mixture.

["Fever convulsions" in children. Current viewpoints on diagnosis, therapy and prognosis]. / "Fieberkrämpfe" im Kindesalter. Aktuelle Gesichtspunkte zur Diagnostik, Therapie und Prognose.

A Consensus Development Conference on Febrile Seizures was held at the National Institutes of Health in USA in May 1980. The purpose of this paper is to present the consensus statement in German and to compare it with the literature. This should be helpful to make accessible the current knowledge about febrile seizures to a larger number of physicians. Special attention has been paid to the consequences of febrile seizures, the diagnostic procedures needed and the risks and benefits of therapy.

[Sonographic detection of post-meningitis subdural effusion]. / Sonographischer Nachweis postmeningitischer Subduralergüsse.

Subdural effusions in childhood are most often seen during the first year of life. In this age group two-dimensional echoencephalography gives excellent images of the brain due to the open fontanelle and the relatively low mineralisation of the cranium. The sonographic findings of two infants with postmeningeal subdural effusions are demonstrated and compared with CT-scan results. The sector-scan is much more useful than the linear-array. Computerized tomography remains necessary but it should be possible to reduce the number of examinations.

[Diphtheria in an infant]. / Diphtherie bei einem Säugling.

A seven week old infant developed pharyngeal diphtheria. The child quickly deteriorated with severe dyspnea and bradycardia. These symptoms made endotracheal intubation necessary. The pharynx and the larynx were covered with pseudomembranes. At the fourth day of hospital stay antitoxin has been administrated. At first the condition of the child became much better. Then progredient paralysis of the diaphragm occurred and led again to intubation. The neurologic complications resolved completely. Diphtheria--above all in an infant--is a rare disease. Our report shows, that it has to be kept in mind to react adequately if necessary. The source of the infection seemed to be visitors from India or Russia. Therefore Diphtheria generally has to be regarded as an "imported disease".

The usefulness of electroencephalography in curarized newborns.

Curare and other muscle relaxants are being used with increasing frequency in the management of infants who are mechanically ventilated for severe respiratory distress. Neurological evaluation of these paralyzed newborns is difficult and neonatal convulsions may go unrecognized. The present study includes 5 curarized infants in whom neurological impairment was suspected because of complicated pregnancies and perinatal asphyxia. All showed very abnormal EEGs with ongoing paroxysmal activity in the absence of clinical seizures or a severely depressed record. In two of these infants an improvement in the values of the blood-gases coincided with the administration of diazepam. In curarized infants the electroencephalogram is of importance in the evaluation of the background activity, the detection of convulsive brain activity, and in the management of anticonvulsive therapy.

[Streptococcal infection in the newborn (author's transl)]. / Die Streptokokken-Infektion bei Neugeborenen.

28 newborn infants, only 3 of which were female, were treated for early-onset streptococcal septicaemia in the years 1970-1978 at the University Children's Hospital, Freiburg. Overall mortality was 60%, that for premature infants 80%. Almost all infants who died developed D.i.C. 60% had X-ray findings consistent with HMD, even among the mature newborns. 90% showed white blood-cell count changes such as Leucocytopenia, Granulocytopenia, rise in percentage of immature granulocytes, Thrombocytopenia. With the help of these signs and using Gram-stain on stomach aspirates early diagnosis and differentiation from HMD seems feasible.

[Differential diagnosis of pediatric hip pain in MR tomography]. / Beitrag zur Differentialdiagnose des kindlichen Hüftschmerzes in der MR-Tomographie.

The efficiency of spin echo tomography in the differential diagnosis of hip joint pain in children in comparison with other imaging methods was tested in 115 spin echo tomography examinations of 68 patients. By means of the different modes available it was possible to determine joint effusion, necrosed areas and the formation of abscesses with great accuracy. In the case of Legg-Calve-Perthes disease the MRT is especially in the early diagnosis superior to the other Methods, already in the early stage a classification in the four Catterall groups was possible. Furthermore the "head at risk" signs, except the gage-sign, were better to describe by BRI than by conventional x-rays. The MRT allows an exacter staging and a better observation of the course of disease, especially the beginning of the revitalisation of the femora epiphysis in earlier and clearer visible than in other imaging methods. Further diseases like epiphysial dysplasie, specific and unspecific coxitis and slipped capital femora epiphysis were also investigated. We regard spin echo examination in the differential diagnosis of hip pain in children indicated by the following criteria: 1. with over six weeks uncertain differential diagnosis of coxitis fugax and Legg-Calve-Perthes disease 2. with Legg-Calve-Perthes disease in the early stage for therapy option 3. with TBC- and non-TBC-coxitis as a therapy attend and diagnostic measure.

[Thrombocytopenia-induced parenchyma hemorrhage in a newborn infant. A contribution to the etiology of so-called arachnoid cysts]. / Thrombozytopenisch bedingte Parenchymblutung bei einem Neugeborenen. Ein Beitrag zur Atiologie von sogenannten Arachnoidalzysten.

We report on a newborn baby with thrombocytopenia who developed neonatal seizures caused by a temporal lobe hemorrhage as shown by cerebral ultrasonography. This hemorrhage was followed by a cyst isodense to intracerebral fluid. Differential diagnostic aspects concerning the etiology of arachnoideal cysts will be discussed in relation to the post-hemorrhagic course and the sonographic or the magnetic resonance tomography findings respectively.

[Classification of intracranial hemorrhage in premature infants]. / Klassifikation der intrakraniellen Blutungen des Frühgeborenen.

The most common classification of intracranial haemorrhage in premature infants into four degrees of severity is based on the results of CT-scans. However, this classification does not adequately account for some pathophysiological and morphological changes. For this reason, the paediatric section of DEGUM developed a new method of classification. This classification distinguishes more precisely between the bleeding itself and secondary changes, such as posthaemorrhagic ventricular dilation, which were excluded from the revised classification. The new system contains three levels: Grade I: subependymal haemorrhage, grade II: intraventricular haemorrhages taking up < 50% of the ventricular volume, grade III: intraventricular haemorrhages of > 50% of ventricular volume. Areas of increased echo levels within the brain tissue (formerly grade IV) which are caused by haemorrhagic infarction are now taken as a separate entity. The morphological description lists the side and the location of the haemorrhagic infarction as well as its size, which is classified into 'small' (< or = 1 cm in diameter), 'medium' (1 < or = 2 cm) and large (> 2 cm). Bleeding into the basal ganglia, cerebellum and brainstem are separate entities. In post-haemorrhagic ventricular dilation the distinction is made between self-limiting transient dilation and hydrocephalus requiring treatment.

[Herpes simplex encephalitis in the newborn infant--a review]. / Herpes simplex-Enzephalitis beim Neugeborenen--Eine Ubersicht.

Neonatal herpes simplex encephalitis is a rare, but very threatening disease which leads to death or to severe cerebral damage with only a few exceptions. In the past few years antiviral agents have become available which have proved to influence the course of the disease in a positive manner. Therefore the problem is a challenge for neonatologists and pediatric neurologists. The virologic and epidemiologic aspects of neonatal herpes encephalitis and its prophylactic, diagnostic and therapeutic possibilities are reviewed. The efficacy of virustatic therapy is related to the onset of therapy which should be started as soon as possible. The typical EEG- and CT-changes are due to an already advanced stage of the disease. Virologic examinations in the first days are of limited value. Brain biopsy should not be performed in this age group. Therefore the indication to start antiviral chemotherapy depends exclusively on the clinical picture.

[Juvenile diabetes mellitus with optic atrophy and labyrinthine deafness. An autosomal-recessive inherited syndrome]. / Juveniler Diabetes mellitus mit Opticusatrophie und Innenohrschwerhörigkeit. Ein autosomal-rezessiv vererbtes Syndrom.

A now 12 year old boy developed diabetes mellitus when he was 7 years old. From 9 years on he developed progressive optic atrophy and deafness. Type I diabetes mellitus, together with progressive optic atrophy and several other symptoms like deafness, diabetes insipidus and ectasy of urinary tract are known for more than 40 years as autosomal-recessively inherited conditions. Therefore, in case of diabetes mellitus combined with optic atrophy it is necessary to search for further symptoms, developing during the course of the disease. Genetic counselling to the families is mandatory.

[Two-dimensional ultrasonic examination of the cerebral ventricles (parallel-scan) in newborns and infants (author's transl)]. / Zweidimensionale Ultraschalluntersuchung (Parallel-Scan) der Hirnventrikel bei Neugeborenen und Säuglingen.

Computer tomography of the head is now firmly established as an examination procedure in pediatric radiology. It is non-invasive, but on the other hand time-consuming and above all costly. Repeated follow-ups represent a level of radiation exposure which should not be underestimated. Two-dimensional sonography (B-scan) has extended the range of possibilities in intracranial diagnostics in neonates and infants, especially since the large fontanelle and the still-open cranial sutures were recognized as "acoustic windows". Five cases are presented, which show that the cranial cavity can be demonstrated reliably and reproducibly, in particular the lateral ventricles. Determining vascular pulsations (real-time) aids orientation and permits conclusions to be drawn regarding the intracranial circulation. Follow-ups can be carried out simply, without submitting the child to exposure stress, and permitting early identification of a developing hydrocephalus. The examination can be performed with standard commercially available parallel-scan units, such as are already used in many clinics for abdominal diagnosis.

[Phlegmona ("cellulitis") and Haemophilus influenzae meningitis]. / Phlegmone ("Cellulitis") und Meningitis durch Haemophilus influenzae.

Soft tissue inflammation is a rare manifestation of H. influenzae infection. It is known in the anglo-american literature as "cellulitis". Usually there is concomitant bacteremia or septicemia. The combination of cellulitis and meningitis is rare and not well known in German pediatric literature. Three children with facial cellulitis together with H. influenzae meningitis are described. In comparison to the literature some unusual observations were made: Early appearance of cellulitis at the age of six weeks in two infants, cellulitis of the lower extremities at the same time in one, and biphasic course with cellulitis and meningitis secondary to mastoiditis in another infant.

[Rhythmic alpha activity in the EEG of premature and newborn infants]. / Rhythmische alpha-Aktivität im EEG von Früh- und Neugeborenen.

The EEG of the newborn consists of a mixed activity which varies from 1 to 22/s. Waves in the alpha band may occur, but they indicate cerebral dysfunction if they are seen in a rhythmic uninterrupted sequence. Eight newborns who showed rhythmic alpha activity in their EEG are included in our study. This activity occurred together with rhythmic theta waves or was followed by them as part of ongoing electrographic seizure activity. All newborns studied were very sick. Three suffered from severe perinatal asphyxia with persistent fetal circulation; in addition one of them had bacterial meningitis. Two infants suffered from herpes encephalitis. In those cases the rhythmic alpha activity temporarily showed a certain periodicity. This EEG pattern was also seen in a small for gestational age premature infant who had septicemia and subarachnoid hemorrhage and in two extremely premature babies with intraventricular hemorrhage. Four infants were curarized. All of the others also had clinically observed seizures. Rhythmic alpha-activity in the neonatal EEG represents an electrical seizure discharge. It may also occur in premature infants who suffer from intraventricular hemorrhage. Obviously it does not have a diagnostic value. The prognostic value depends upon the underlying disease and the grade of background suppression in the EEG. Anticonvulsant therapy should be administered early using a sufficient dosage.

[Seizures in premature and newborn infants under 2,500 grams birth weight]. / Krampfanfälle bei Früh- und Neugeborenen unter 2 500 Gramm Geburtsgewicht.

Seizures in premature babies pose a special problem which occur more often than in term neonates. The data of 156 neonates weighing less than 2 500 grams consecutively admitted to a neonatal intensive care unit during a 6 month period were evaluated. 33 infants (21%), of whom 21 were less than 31 weeks of gestational age suffered from seizures. Almost all of these 33 infants had a very bad outcome. Only 9 of them survived and only 4 showed normal development. In 26 infants a CT or brain autopsy was performed. The outcome was influenced by the presence of intraventricular haemorrhage. But even those preterm neonates without morphological abnormalities of the brain have only a small chance of developing normally in the presence of seizures. The EEG is an important diagnostic tool: Most of the patients showed paroxysmal activity. The background activity of the interictal EEG has prognostic value even in the preterm infant. There is, however, discrepancy between the EEG and the morphological findings. Therefore the EEG has to be seen as functional test which gives important additional information beyond brain imaging methods.

[Fatal intracerebral gas gangrene in a 10-month-old child]. / Tödlich verlaufende intrazerebrale Gasbrandinfektion bei einem zehn Monate alten Kind.

Today, intracerebral infections by gas forming bacteria are very rare. They are mostly seen after penetrating injuries and more rarely after trivial trauma. Although prognosis of this kind of infection is severe, the general outcome of these patients after surgical and antibiotic treatment is good. We report a ten months old boy suffering a pecking injury just above the left ear with perforation of the temporal bone and dura. In between 48 hrs he developed a rapidly progressive gas gangrene encephalitis due to infection with C. perfringens and died despite of surgical and antibiotic treatment due to massive brain swelling and cardio-pulmonary failure.