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  • 1
    Electronic Resource
    Electronic Resource
    Kartagener syndrome: An uncommon cause of neonatal respiratory distress? (1995)
    Springer
    European journal of pediatrics 154 (1995), S. 236-238 
    Details
    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
    URL: http://dx.doi.org/10.1007/BF01954280
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  • 2
    Electronic Resource
    Electronic Resource
    Early vitamin K deficiency bleeding after maternal phenobarbital intake: management of massive intracranial haemorrhage by minimal surgical intervention (1998)
    Springer
    European journal of pediatrics 157 (1998), S. 663-665 
    Details
    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
    URL: http://dx.doi.org/10.1007/s004310050907
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  • 3
    Electronic Resource
    Electronic Resource
    Hemodynamic effects of sodium bicarbonate—authors reply (1994)
    Springer
    Intensive care medicine 20 (1994), S. 306-307 
    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/BF01708973
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  • 4
    Electronic Resource
    Electronic Resource
    The automatic selection of ventilation parameters during the initial phase of mechanical ventilation (1996)
    Springer
    Intensive care medicine 22 (1996), S. 199-207 
    Details
    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
    URL: http://dx.doi.org/10.1007/BF01712237
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  • 5
    Electronic Resource
    Electronic Resource
    Neonatal lupus erythematosus with congenital heart block and severe heart failure due to myocarditis and endocardititis of the mitral valve (1996)
    Springer
    Intensive care medicine 22 (1996), S. 464-466 
    Details
    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
    URL: http://dx.doi.org/10.1007/BF01712168
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  • 6
    Electronic Resource
    Electronic Resource
    Dexamethasone therapy and endogenous cortisol production in severe pediatric head injury (1988)
    Springer
    Intensive care medicine 14 (1988), S. 163-166 
    Details
    ISSN: 1432-1238
    Keywords: Dexamethasone ; Cortisol ; Head injury ; Pediatric
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract A prospective randomised study was performed on 25 children aged 1.4 to 15.8 years with severe head injury (Glasgow Coma Scale⪕7) to determine the clinical effectiveness and the impact on endogenous cortisol production of high-dose steroid therapy. Thirteen patients (group 1) received dexamethasone 1 mg/kg/day during the first 3 days and 12 (group 2) not. All patients were treated with a standardized regimen. Urinary free cortisol was measured by radioimmunoassay, and the clinical data were recorded at hourly intervals. Outcome was assessed 6 months later using the Glasgow Outcome Scale. We found a higher frequency of bacterial pneumonias in the dexamethasone-treated patients (7/13 versus 2/12). Group 1 showed a suppression of endogenous cortisol production from day 1 to day 6. In group 2, menu free cortisol was up to 5-fold higher than under basal conditions. The results in group 2 showed taht the endogenous steroid production reacts adequately to the stress of severe head injury. It probably is sufficient to elicit maximum glucocorticoid effects. There was no other statistically significant difference in the clinical and laboratory data between the two groups. We conclude that dexamethasone in high doses suppresses endogenous cortisol production up to 6 days and may increase the risk of bacterial infection without affecting the outcome or the clinical and laboratory data.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/BF00257471
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  • 7
    Electronic Resource
    Electronic Resource
    Hemodynamic effects of sodium bicarbonate in critically ill neonates (1993)
    Springer
    Intensive care medicine 19 (1993), S. 65-69 
    Details
    ISSN: 1432-1238
    Keywords: Sodium bicarbonate ; Neonates ; Metabolic acidosis ; Hemodynamics ; Pulsed Doppler ; Cardiac output
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract Objective To analyze the cardiovascular effects of sodium bicarbonate in neonates with metabolic acidosis. Design Prospective, open, non-randomized, before-after intervention study with hemodynamic measurements performed before and 1, 5, 10, 20, and 30 min after bicarbonate administration. Setting Neonatal intensive care unit, tertiary care center. Patients Sequential sample of 16 paralysed and mechanically ventilated newborn infants with a metabolic acidosis (pH〈7.25 in premature and 〈7.30 in term infants, base deficit〉−8). Intervention An 8.4% sodium bicarbonate solution diluted 1∶1 with water (final osmolality of 1000 mOsm/l) was administered in two equal portions at a rate of 0.5 mmol/min. The dose in mmol was calculated using the formula “base deficit x body weight (kg)×1/3×1/2”. Measurements and results Sodium bicarbonate induced a significant but transient rise in pulsed Doppler cardiac output (CO) (+27.7%), aortic blood flow velocity (+15.3%), systolic blood pressure (BP) (+9.3%), (+14.6%), transcutaneous carbon dioxide pressure (PtcCO2) (+11.8%), and transcutaneous oxygen pressure (PtcO2) (+8%). In spite of the PaCO2 elevation, pH significantly improved (from a mean of 7.24 to 7.30), and the base deficit decreased (−39.3%). Calculated systemic vascular resistance (SVR) (−10.7%) and diastolic BP (−11.7%) decreased significantly, while PaO2 and heart rate (HR) did not change. Central venous pressure (CVP) (+6.5%) increased only slightly. By 30 min after bicarbonate administration all hemodynamic parameters, with the exception of the diastolic BP, had returned to baseline. Conclusion Sodium bicarbonate in neonates with metabolic acidosis induces an increase in contractility and a reduction in afterload.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/BF01708362
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  • 8
    Electronic Resource
    Electronic Resource
    Objectifying psychomental stress in the workplace – an example (2000)
    Springer
    International archives of occupational and environmental health 73 (2000), S. S46 
    Details
    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
    URL: http://dx.doi.org/10.1007/PL00014626
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  • 9
    Electronic Resource
    Electronic Resource
    Neonatal lupus erythematosus with congenital heart block and severe heart failure due to myocarditis and endocardititis of the mitral valve (1996)
    Springer
    Intensive care medicine 22 (1996), S. 464-466 
    Details
    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
    URL: http://dx.doi.org/10.1007/BF01712168
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  • 10
    Electronic Resource
    Electronic Resource
    Delay of extubation in neonates and children after cardiac surgery: impact of ventilator-associated pneumonia (2000)
    Springer
    Intensive care medicine 26 (2000), S. 942-949 
    Details
    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
    URL: http://dx.doi.org/10.1007/s001340051285
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