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  • 1
    Electronic Resource
    Electronic Resource
    Springer
    European journal of pediatrics 154 (1995), S. 236-238 
    ISSN: 1432-1076
    Keywords: Primary ciliary dyskinesia ; Immotile cilia syndrome ; Kartagener syndrome ; Respiratory distress syndrome ; Newborn
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract We report a newborn with respiratory distress and situs inversus totalis. The diagnosis of primary ciliary dyskinesia was confirmed by both ultrastructural and functional investigations. The immotile cilia syndrome was suspected because of respiratory distress, situs inversus, abnormal nasal discharge and hyperinflated chest X-ray. We suggest that ultrastructural and functional investigations of the respiratory mucosa should be done in any newborn with respiratory distress without explanation for the respiratory problems. Establishment of the correct diagnosis at an early stage may allow to improve the prognosis provided prophylactic physiotherapy, vaccinations, and aggressive antibiotic treatment of intercurrent respiratory infections are instituted. Conclusion Despite its rarity, primany ciliary dyskinesia should be considered in unexplained cases of neonatal distress
    Type of Medium: Electronic Resource
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  • 2
    ISSN: 1432-1076
    Keywords: Key Words Vitamin K deficiency bleeding ; Phenobarbital ; Cerebral haemorrhage ; Surgery
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract Vitamin K deficiency bleeding within the first 24 h of life is caused in most cases by maternal drug intake (e.g. coumarins, anticonvulsants, tuberculostatics) during pregnancy. Haemorrhage is often life-threatening and usually not prevented by vitamin K prophylaxis at birth. We report a case of severe intracranial bleeding at birth secondary to phenobarbital-induced vitamin K deficiency and traumatic delivery. Burr hole trepanations of the skull were performed and the subdural haematoma was evacuated. Despite the severe prognosis, the infant showed an unexpected good recovery. At the age of 3 years, neurological examinations were normal as was the EEG at the age of 9 months. CT showed close to normal intracranial structures. Conclusion This case report stresses the importance of antenatal vitamin K prophylaxis and the consideration of a primary Caesarean section in maternal vitamin K deficiency states and demonstrates the successful management of massive subdural haemorrhage by a limited surgical approach.
    Type of Medium: Electronic Resource
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  • 3
    ISSN: 1432-1238
    Keywords: Closed-loop controlled ventilation ; Human ; Initial settings ; Computer ; Mechanical ventilation
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract Objective To test a method that allows automatic set-up of the ventilator controls at the onset of ventilation. Design Prospective randomized crossover study. Setting ICUs in one adult and one children's hospital in Switzerland. Patients Thirty intubated stable, critically ill patients (20 adults and 10 children). Interventions The patients were ventilated during two 20-min periods using a modified Hamilton AMADEUS ventilator. During the control period the ventilator settings were chosen immediately prior to the study. During the other period individual settings were automatically determined by the ventilator (AutoInit). Measurements and results Pressure, flow, and instantaneous CO2 concentration were measured at the airway opening. From these measurements, series dead space (V DS), expiratory time constant (RC), tidal volume (V T), total respiratory frequency (f tot), minute ventilation (MV), and maximal and mean airway pressure (P aw, max andP aw, mean) were calculated. Arterial blood gases were analyzed at the end of each period.P aw, max was significantly less with the AutoInit ventilator settings whilef tot was significantly greater (P〈0.05). The other values were not statistically significant. Conclusions The AutoInit ventilator settings, which were automatically derived, were acceptable for all patients for a period of 20 min and were not found to be inferior to the control ventilator settings. This makes the AutoInit method potentially useful as an automatic startup procedure for mechanical ventilation.
    Type of Medium: Electronic Resource
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  • 4
    ISSN: 1432-1238
    Keywords: Neonatal lupus erythematosus ; Heart block ; Steroids ; Myocarditis
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract We report a case of neonatal lupus erythematosus (NLE) with congenital heart block and severe myocardial failure, which was followed from the 25th week of gestation because of fetal bradycardia. The child was delivered at the 37th week of gestation by elective cesarean section because of echocardiographically documented heart enlargement, pericardial effusion and moderate insufficiency of the mitral and tricuspid valves. In spite of immediate pacing, intubation and supportive treatment, the newborn developed progressive heart failure. Echocardiography showed endocarditis of the mitral valve and diffuse myocarditis. The heart failure resolved under steroid treatment. Our experience supports the early use of steroids in treating myocarditis due to NLE. Intrauterine steroid treatment in the presence of fetal hydrops and congenital heart block is discussed.
    Type of Medium: Electronic Resource
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  • 5
    Electronic Resource
    Electronic Resource
    Springer
    International archives of occupational and environmental health 73 (2000), S. S46 
    ISSN: 1432-1246
    Keywords: Key words Intensive care units ; Pediatric ; Nursing staff hospital ; Stress ; psychological ; Hydrocortisone ; secretion ; Psychomental stress
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract  Background: Psychomental stress is a major source of illness and reduced productivity. Data objectifying physiological stress responses are scarce. We studied salivary cortisol levels in a highly stressful environment, the pediatric critical care unit. The aim was to identify targets for organizational changes, to implement these changes and to assess their impact on cortisol levels. Design: Repeated measurements observational cohort study (before and after intervention). Subjects: 84 nurses working in two independent teams (A and B) in a 19 bed pediatric intensive care unit. Between study periods team A experienced a major exchange of experienced staff while the turnover rate in team B remained average. Measurements and interventions: Salivary cortisol samples were collected every 2 h and after stressful events. Nurses in study period I showed elevated cortisol levels at the beginning of the late shift, interpreted as an anticipatory stress reaction. To ease conditions during the early part of the late shift (conflicting tasks, noise and crowding), we postponed the afternoon ward round, limited non-urgent procedures and introduced a change in visiting hours. The early shift, which was not affected by the intervention, served as control. Main results: Both crude and adjusted analysis revealed a decrease of cortisol levels at the beginning of the late shift in team B (p = 0.0009), but not in team A (p = 0.464). The control situation showed no difference between teams and study periods. Interpretation: We demonstrated reduced cortisol secretions in one team following organizational changes, which was probably overridden by the disruption of social coherence in the second team.
    Type of Medium: Electronic Resource
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  • 6
    ISSN: 1432-1238
    Keywords: Key words Neonatal lupus erythematosus ; Heart block ; Steroids ; Myocarditis
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract We report a case of neonatal lupus erythematosus (NLE) with congenital heart block and severe myocardial failure, which was followed from the 25th week of gestation because of fetal bradycardia. The child was delivered at the 37th week of gestation by elective cesarean section because of echocardiographically documented heart enlargement, pericardial effusion and moderate insufficiency of the mitral and tricuspid valves. In spite of immediate pacing, intubation and supportive treatment, the newborn developed progressive heart failure. Echocardiography showed endocarditis of the mitral valve and diffuse myocarditis. The heart failure resolved under steroid treatment. Our experience supports the early use of steroids in treating myocarditis due to NLE. Intrauterine steroid treatment in the presence of fetal hydrops and congenital heart block is discussed.
    Type of Medium: Electronic Resource
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  • 7
    Electronic Resource
    Electronic Resource
    Springer
    Intensive care medicine 26 (2000), S. 942-949 
    ISSN: 1432-1238
    Keywords: Key words Ventilator-associated pneumonia ; Cardiac surgery ; Children ; Pediatric intensive care ; Complications ; Extubation
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract Objective: This study was undertaken to determine the delay of extubation attributable to ventilator-associated pneumonia (VAP) in comparison to other complications and complexity of surgery after repair of congenital heart lesions in neonates and children.¶Methods: Cohort study in a pediatric intensive care unit of a tertiary referral center. All patients who had cardiac operations during a 22-month period and who survived surgery were eligible (n = 272, median age 1.3 years). Primary outcome was time to successful extubation. Primary variable of interest was VAP. Surgical procedures were classified according to complexity. Cox proportional hazards models were calculated to adjust for confounding. Potential confounders comprised other known risk factors for delayed extubation.¶Results: Median time to extubation was 3 days. VAP occurred in 26 patients (9.6 %). The rate of VAP was not associated with complexity of surgery (P = 0.22), or cardiopulmonary bypass (P = 0.23). The adjusted analysis revealed as further factors associated with delayed extubation: other respiratory complications (n = 28, chylothorax, airway stenosis, diaphragm paresis), prolonged inotropic support (n = 48, 17.6 %), and the need for secondary surgery (n = 51, 18.8 %; e. g., re-operation, secondary closure of thorax). Older age promoted early extubation. The median delay of extubation attributable to VAP was 3.7 days (hazards ratio HR = 0.29, 95 % CI 0.18–0.49), exceeding the effect size of secondary surgery (HR = 0.48) and other respiratory complications (HR = 0.50).¶Conclusion: VAP accounts for a major delay of extubation in pediatric cardiac surgery.
    Type of Medium: Electronic Resource
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  • 8
    Electronic Resource
    Electronic Resource
    Springer
    Intensive care medicine 26 (2000), S. 959-966 
    ISSN: 1432-1238
    Keywords: Key words Antibiotics Utilisation ; Pediatric intensive care ; Ventilator-associated pneumonia
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract Objective: Minimizing unwarranted prescription of antibiotics remains an important objective. Because of the heterogeneity between units regarding patient mix and other characteristics, site-specific targets for reduction must be identified. Here we present a model to address the issue by means of an observational cohort study.¶Setting: A tertiary, multidisciplinary, neonatal, and pediatric intensive care unit of a university teaching hospital.¶Patients: All newborns and children present in the unit (n = 456) between September 1998 and March 1999. Reasons for admission included postoperative care after cardiac surgery, major neonatal or pediatric surgery, severe trauma, and medical conditions requiring critical care.¶Methods: Daily recording of antibiotics given and of indications for initiation. After discontinuation, each treatment episode was assessed as to the presence or absence of infection.¶Results: Of the 456 patients 258 (56.6 %) received systemic antibiotics, amounting to 1815 exposure days (54.6 %) during 3322 hospitalization days. Of these, 512 (28 %) were prescribed as prophylaxis and 1303 for suspected infection. Treatment for suspected ventilator-associated pneumonia accounted for 616 (47 %) of 1303 treatment days and suspected sepsis for 255 days (20 %). Patients were classified as having no infection or viral infection during 552 (40 %) treatment days. The average weekly exposure rate in the unit varied considerably during the 29-week study period (range: 40–77/100 hospitalization days). Patient characteristics did not explain this variation.¶Conclusion: In this unit the largest reduction in antibiotic treatment would result from measures assisting suspected ventilator-associated pneumonia to be ruled out and from curtailing extended prophylaxis.
    Type of Medium: Electronic Resource
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  • 9
    Electronic Resource
    Electronic Resource
    Springer
    Intensive care medicine 26 (2000), S. 776-779 
    ISSN: 1432-1238
    Keywords: Key words Syringe pump ; Infusion line ; Infusion tube ; Compliance ; Drug delivery
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract Objective: To determine whether infusion line compliance contributes to irregular drug delivery during vertical displacement of syringe pumps.¶Design: Five different commercially available infusion lines were studied at infusion rates of 0.5, 1.0, and 1.5 ml/h. Zero drug delivery time was measured after acute line loop formation (70 cm) using an electronic balance. Compliance of each infusion line was calculated using a pressure transducer and measurement of the occlusion release bolus at 300 mmHg occlusion pressure. Finally, the influence of infusion line compliance on drug delivery during acute lowering of the syringe pump was studied using low- and high-compliance infusion lines.¶Results: Acute line loop formation resulted in zero drug delivery time from 5.1 ± 1.5 to 44.0 ± 6.8 s at flow rates of 0.5 ml/h. Increased flow rates significantly reduced loop-induced flow variability. A close correlation was found between zero drug delivery time and calculated infusion line compliance at 0.5 ml/h (linear regression R 2 = 0.79). Lowering of the syringe pump 50 cm prolonged zero drug delivery time from 295.8 ± 20.7 s with the low-compliance tube to 463.3 ± 24.0 s with the high-compliance infusion line.¶Conclusions: Infusion line compliance contributes to irregular drug delivery associated with vertical displacement of syringe pumps. Siphoning of the infusion line during patient care should be avoided, and flow rates of 1 ml/h or higher are recommended. Low-compliance infusion lines are indicated whenever highly short-acting vasoactive drugs at low delivery rates are administered.
    Type of Medium: Electronic Resource
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  • 10
    ISSN: 1432-1238
    Keywords: Key words Closed-loop controlled ventilation ; Human ; Initial settings ; Computer ; Mechanical ventilation
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract Objective: To test a method that allows automatic set-up of the ventilator controls at the onset of ventilation. Design: Prospective randomized crossover study. Setting: ICUs in one adult and one children’s hospital in Switzerland. Patients: Thirty intubated stable, critically ill patients (20 adults and 10 children). Interventions: The patients were ventilated during two 20-min periods using a modified Hamilton AMADEUS ventilator. During the control period the ventilator settings were chosen immediately prior to the study. During the other period individual settings were automatically determined by the ventilator (AutoInit). Measurements and results: Pressure, flow, and instantaneous CO2 concentration were measured at the airway opening. From these measurements, series dead space (V DS), expiratory time constant M28.6n(RC), tidal volume (V T), total respiratory frequency (f tot), minute ventilation (MV), and maximal and mean airway pressure (P aw,max and P aw,mean) were calculated. Arterial blood gases were analyzed at the end of each period. P aw,max was significantly less with the AutoInit ventilator settings while f tot was significantly greater (P〈0.05). The other values were not statistically significant. Conclusions: The AutoInit ventilator settings, which were automatically derived, were acceptable for all patients for a period of 20 min and were not found to be inferior to the control ventilator settings. This makes the AutoInit method potentially useful as an automatic start-up procedure for mechanical ventilation.
    Type of Medium: Electronic Resource
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