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  • 1
    Electronic Resource
    Electronic Resource
    Intraoperative Thrombose der V. cava inferior (1995)
    Springer
    Der Anaesthesist 44 (1995), S. 709-711 
    Details
    ISSN: 1432-055X
    Keywords: Schlüsselwörter Kinderanästhesie ; Frühgeborene ; Thrombose ; Vena Cava ; Zentrale Venenkatheter ; Komplikationen ; Vena cava ; inferior ; Katherisierung ; Vena cava ; Ultraschall ; Key words Paediatric anaesthesia ; Pre-term infant ; Thrombosis ; vena cava ; Central venous catheter ; adverse effects ; Vena cava ; inferior ; Catheterisation ; Vena cava ; Ultrasonography
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Description / Table of Contents: Abstract A pre-term infant weighing 900 g, gestational age 25 weeks, developed an acute abdomen. Intravenous lines had been inserted previously in the left (silasticcatheter) and right (24 G cannula) saphenous veins in the neonatal intensive care unit. During surgical exploration, a perforation of the terminal ileum was found. The operation consisted in partial resection of the perforated ileum with an end-to-end anastomosis and a double-lumen colostomy. Major blood loss during the procedure caused serious haemodynamic problems. Despite transfusion of erythrocyte (100 ml), thrombocytes (75 ml), and albumin (50 ml), the patient developed bradycardia and hypotension. Administration of atropine, adrenaline, and calcium IV had no effect. The operation could be finished only with extrathoracic resuscitation. When the drapes were removed, livid, swollen lower limbs raised the suspicion of an acute thrombosis of the inferior vena cava. After insertion of a 24 G IV cannula into a vein of the right upper arm, the circulation stabilised after rapid transfusion of 40 ml blood and 25 ml thrombocytes and resuscitation was successful. Paediatricians and anaesthesiologists must consider the risk of thrombosis of the vena cava. If venous lines in the lower limbs are not visible to the anaesthesiologist during the operation, venipuncture of veins of an upper limb is recommended before starting the surgical procedure. Due to the high incidence of vena cava thrombosis caused by central venous lines and the difficulty of peripheral venipuncture in pre-termintanty, a safe venous line should be inserted if necessary by pre-operative venesection.
    Notes: Zusammenfassung Bei einem 900 g schweren Frühgeborenen der 25. SSW wurde wegen einer Ileumperforation eine Ileumteilresektion mit Dünndarm-Anus praeter durchgeführt. Intraoperativ ergaben sich Probleme von seiten eines nicht korrigierbaren Volumendefizits. Venöse Zugänge befanden sich in der linken (Silastik-Katheter) und rechten (24G Kanüle) V. saphena. Bei faktischem Kreislaufstillstand mußte der Eingriff unter extrathorakaler Reanimation beendet werden. Nach dem Abdecken imponierten livide gestaute Beine, die den Verdacht einer frischen Thrombose der V. cava inferior bestätigten. Nach Anlegen einer Venenverweilkanüle an der oberen Extremität konnte nach adäquatem Volumenersatz innerhalb kurzer Zeit die Reanimation beendet werden.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/s001010050206
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  • 2
    Electronic Resource
    Electronic Resource
    Major reduction in alarm frequency with a new pulse oximeter (1998)
    Springer
    Intensive care medicine 24 (1998), S. 277-278 
    Details
    ISSN: 1432-1238
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/s001340050566
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  • 3
    Electronic Resource
    Electronic Resource
    Effect of blood transfusion on apnoea, bradycardia and hypoxaemia in preterm infants (1997)
    Springer
    European journal of pediatrics 156 (1997), S. 311-316 
    Details
    ISSN: 1432-1076
    Keywords: Keywords Anaemia  ;  Apnoea of prematurity  ;  Blood transfusion
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract We studied the effect of blood transfusion on the frequency of apnoea, bradycardia and hypoxaemia in 21 spontaneously breathing preterm infants with a median gestational age at birth of 28 (range 23–31) weeks. Age at time of study was 22 days (3–84), weight 925 g (640–2120). The patients exhibited frequent episodes of bradycardia and/or hypoxaemia and were anaemic (median haemoglobin level 109 (82–120) g/l). One infant received two transfusions and was thus studied twice. Four-hour recordings of pulse oximeter saturation (SpO2), pulse waveforms, transcutaneous oxygen pressure, electrocardiogram, breathing movements and nasal airflow were performed immediately before and after transfusion, and again after a further interval of 12 h. Recordings were analysed for isolated and periodic apnoeas (〉 4 s), bradycardias (heart rate 〈 2/3 of baseline), and episodic desaturation (SpO2≤ 80%). There were no significant changes in the frequency, severity and/or duration of apnoea, bradycardia or desaturation following transfusion. The average SpO2 nadir reached during each desaturation, however, increased by 3% following transfusion (P 〈 0.05), and there was a trend towards shorter desaturations. Conclusion The occurrence of frequent episodes of apnoea, bradycardia and/or hypoxaemia does not, on its own, justify a blood transfusion in moderately anaemic preterm infants.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/s004310050607
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  • 4
    Electronic Resource
    Electronic Resource
    Necrotising enterocolitis: is there a relationship to specific pathogens? (1999)
    Springer
    European journal of pediatrics 158 (1999), S. 67-70 
    Details
    ISSN: 1432-1076
    Keywords: Key words Necrotising enterocolitis Pathogens ; Temporal distribution
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract Outbreaks of necrotising enterocolitis (NEC) have often been related to specific pathogens such as Enterobacteriaceae. This relationship, however, remains uncertain because of the retrospective nature of the studies addressing this issue. We performed a prospective study to investigate whether there is indeed an association between NEC and specific pathogens. Between April 1993 and March 1997, stools of neonates of 〈36 weeks admitted to our neonatal unit were investigated for bacteria in weekly intervals. Clinical and bacteriological data from each infant who developed NEC were compared with those from two control infants matched for gestational age and date of admission. Eighteen infants developed 19 episodes of NEC (clinical signs + air in portal vein); 8 of these had laparotomy; two died. Occurences of NEC were homogeneously distributed over the 4- year study period. The only significant differences in the clinical course prior to NEC were a more severe stage of respiratory distress syndrome [median 2 (0–4) vs. 0 (0–3), P 〈 0.05] and a higher proportion of infants who had only been formula fed (63 vs. 32%, P 〈 0.05) in the cases. Within the last week prior to NEC, potentially pathogenic bacteria were identified in stools of all cases and 79% of controls (P 〈 0.05). However, there was no significant difference in the occurrence of specific pathogens or groups of pathogens in cases compared with controls. Conclusion Although gut colonisation with potential pathogens appeared to be a prerequisite for the development of NEC, there were no specific bacteria associated with this disease if data from infants with NEC were compared with those from time- and gestational age-matched controls.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/s004310051012
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  • 5
    Electronic Resource
    Electronic Resource
    Kongenitale Alveolarproteinose Hereditärer Mangel an Surfactant-Protein B (1996)
    Springer
    Monatsschrift Kinderheilkunde 144 (1996), S. 1214-1217 
    Details
    ISSN: 1433-0474
    Keywords: Schlüsselwörter Kongenitale Alveolarproteinose ; Surfactantprotein B ; Gendiagnostik ; Key words Congenital alveolar proteinosis ; Surfactant protein B deficiency ; Genetic diagnostics
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Description / Table of Contents: Summary A term female neonate born to healthy, unrelated parents developed signs of respiratory distress shortly after birth, requiring intubation and mechanical ventilation with high inspiratory oxygen concentrations. The chest X-ray showed diffuse reticular opacities with predominance in the more central areas. Neither exogenous surfactant therapy or systemic steroids had any effect. An open lung biopsy suggested alveolar proteinosis. Surfactant analyses in broncho-alveolar lavage and genetic investigations in the patient and her parents helped to establish the diagnosis of congenital surfactant protein B deficiency. The patient died of respiratory failure at 8 weeks of age. In congenital surfactant protein B deficiency, mutations in the SFTP3-gene on chromosome 2 (which encodes SP-B) result in a disturbance in both surfactant homeostasis and -function which is not amenable to therapy. In families where such mutations are known, e. g. the 121ins2 mutation, the diagnosis can already be established antenatally.
    Notes: Zusammenfassung Wir berichten über ein reifes weibliches Neugeborenes mit unauffälliger Familienanamnese, das wenige Stunden postpartal mit einer Tachydyspnoe und zunehmender Zyanose auffällig wurde, so daß Intubation und maschinelle Beatmung mit hohen Sauerstoffkonzentrationen erforderlich wurden. Radiologisch zeigte sich eine zentralbetonte, diffus vermehrte retikuläre Zeichnung beider Lungen. Weder die Gabe von exogenem Surfactant noch eine systemische Steroidtherapie brachten eine Verbesserung der respiratorischen Situation. Eine Lungenbiopsie ergab den Verdacht auf das Vorliegen einer Alveolarproteinose. Mittels Surfactantanalysen in der Bronchiallavage und genetischer Untersuchungen des Kindes und seiner Eltern konnte die Diagnose einer durch einen kongenitalen Surfactant-Protein-B-Mangel bedingten Alveolarproteinose gesichert werden. Das Kind verstarb im Alter von 8 Wochen an seiner respiratorischen Insuffizienz. Beim angeborenen Surfactant-Protein-B-Mangel kommt es aufgrund von Mutationen im für die Kodierung dieses Proteins verantwortlichen SFTP3-Gen auf dem Chromosom 2 zu einer therapierefraktären Störung der Surfactantfunktion und -homöostase. Ist die verantwortliche Mutation bekannt, wie z. B. bei der 121ins2-Mutation, die bei unserer Patientin vorlag, so kann bei weiteren Schwangerschaften die Diagnose dieser autosomal-rezessiv vererbten Erkrankung bereits pränatal erfolgen.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/s001120050077
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  • 6
    Electronic Resource
    Electronic Resource
    Unilaterales pulmonales Emphysem Nichtinvasives Therapiekonzept bei 2 Frühgeborenen (2000)
    Springer
    Monatsschrift Kinderheilkunde 148 (2000), S. 583-587 
    Details
    ISSN: 1433-0474
    Keywords: Schlüsselwörter Unilaterales interstitielles pulmonales Emphysem ; Seitenlagerung ; Antiinflammatorische Therapie ; Key words Unilateral interstitial pulmonary emphysema ; Side positioning ; Antiinflammatory therapy
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Description / Table of Contents: Summary Background. Pulmonary interstitial emphysema is a serious complication of neonatal respiratory distress syndrome carrying an increased risk of intraventricular haemorrhage and development of chronic lung disease of prematurity. Management of unilateral PIE usually includes aggressive methods such as surgical removal of the affected lung tissue or selective intubation of the contralateral bronchus. Case report. We report two cases of unilateral interstitial emphysema resolving completely with non-invasive management consisting of strict lateral decubitus positioning of the affected lung in combination with antiinflammatory therapy. Discussion. We feel that the management of unilateral interstitial emphysema presented in these cases is minimally invasive yet effective. We could not determine whether positional treatment alone would have been equally effective. Although the optimal choice of treatment clearly depends on the condition of the individual patient, we suggest to consider this approach in cases of unilateral interstitial emphysema.
    Notes: Zusammenfassung Hintergrund. Das pulmonale interstitielle Emphysem ist eine schwerwiegende Komplikation des neonatalen Atemnotsyndroms und gilt als Risikofaktor für das Auftreten von Hirnblutung und chronischer Lungenerkrankung. Bei bilateralen Formen gilt die Hochfrequenzoszillationsbeatmung als möglicher Therapieansatz, bei der unilateralen Form sind die selektive Beatmung der kontralateralen Lunge oder die operative Resektion der befallenen Lungenabschnitte gängige, jedoch relativ aggressive therapeutische Optionen. Fallbericht. Wir berichten über 2 Frühgeborene mit unilateralem pulmonalem interstitiellem Emphysem, welches sich unter einer nichtinvasiven Therapie mit konsequenter Lagerung auf die betroffene Seite und einer antiinflammatorischen Behandlung mit Dexamethason vollständig zurückbildete. Diskussion. Eine Minderbelüftung der kranken Lunge aufgrund von Kompression durch das Gewicht der benachbarten Strukturen bewirkte in Kombination mit dem antiinflammatorischen Effekt der Steroide eine Rückbildung des pulmonalen interstitiellen Emphysems. Ob eine alleinige Lagerungstherapie zum gleichen Erfolg geführt hätte, muss offen bleiben. Wegen der offensichtlichen Vorteile eines konservativen Managements sollte beim unilateralen interstitiellen Emphysem ein Therapieversuch mit Seitenlagerung und ggf. antiinflammatorischer Behandlung erwogen werden.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/s001120050599
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