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Notes: Abstract Forty newborns with severe shock and disseminated intravascular coagulation were randomized for treatment with heparin or placebo. Mortality was equal in both groups. The heparin group required significantly shorter periods of artificial ventilation. The coagulation system improved faster, and the coagulation pattern showed normal values in the treatment group. Due to the low number of cases, these differences could not be statistically confirmed.

Notes: Abstract Counterimmunoelectrophoresis (CIE) is described as a rapid and specific method for early detection of bacterial antigens. This simple and reliable technique was applied to samples of serum and cerebrospinal fluid (CSF) from 67 patients in whom neonatal septicemia or bacterial meningitis was initially suspected. Seven out of 11 patients with culture-proven bacterial infections had positive CIE determinations before results of routine microbiological cultures were available. CIE was especially helpful in children treated with antibiotics prior to admission. All negative CIE results in proven bacterial infections were due to non-available antisera for the specific antigens detected by routine blood or CSF cultures. Shortcomings of the method and a future CIE diagnostic program are discussed.

Notes: Abstract We performed a multicenter prospective randomized controlled trial to determine the efficacy and safety of the surfactant preparation, Survanta (Abbott Laboratories, Chicago, USA), for 750–1750 g infants with idiopathic respiratory distress syndrome, (IRDS) receiving assisted ventilation with 40% or more oxygen. One hundred and six eligible infants from the eight participating centers were randomly assigned between March 1986 and June 1987 to receive either surfactant (100 mg phospholipid/kg, 4 ml/kg) or air (4 ml/kg) administered into the trachea within 8 h of brith (median time of treatment 6.2 h, range 3.2–9.1 h). The study was stopped before enrollment was completed at the request of the United States Food and Drug Administration when significant differences were observed in incidence of periventricular-intraventricular hemorrhage (PIH), between the surfactant treated and control infants. Surfactant treated infants had larger average increases in the arterial-alveolar oxygen ratio, (a/A ratio) (P〈0.0001), and larger average decreases in FiO2 (P〈0.0001) and mean airway pressure, (MAP) (P〈0.017) than controls over the 48 h following treatment. The magnitude of the differences between the surfactant and control groups were 0.19 (SE=0.03) for a/A ratio, −0.28 (SE=0.04) for FiO2 and −1.7 cm H2O (SE=0.70) for MAP. The clinical status on days 7 and 28 after treatment was classified using four predefined ordered categories: (1) no respiratory support; (2) supplemental O2 with or without continuous positive airway pressure (CPAP); (3) intermittent mandatory ventilation; and (4) death. There were no statistically significant differences in the status categories on days 7 or 28 between surfactant and control infants. There were no significant differences between the groups with respect to the incidence of patent ductus arteriosus, bronchopulmonary dysplasia, necrotizing entero-colitis, air leaks or death. There was a statistically significant difference between treated and control infants in the frequency and severity of periventricular-intraventricular hemorrhage (PIH) (Cochran-Mantel-Haenszelχ 2adj=6.36,P=0.01). Hemorrhages occurred in 59.6% of surfactant treated infants and 26.9% of controls. Severe hemorrhages (grades 3 or 4) occurred in 38.5% of surfactant treated infants and 15.4% of controls (χ 2adj=4.01,P=0.045). We conclude that the intratracheal administration of Survanta prior to 8 h of age to infants with IRDS receiving assisted ventilation with 40% or more oxygen results in a reduction in the severity of respiratory distress during the 48 h after therapy. Because of the difference in incidence of PIH between surfactant and control infants in this study, we recommend that future clinical trials of surfactant include more frequent prospective serial ultrasound evaluations for diagnosis of hemorrhage.

Notes: Kaum eine andere in der Notfallmedizin für Kinder wichtige Behandlungsmaßnahme ist so wenig präzise festgelegt und im Einzelfall bedenkenlos anwendbar wie die Volumenersatztherapie. Die heute üblichen Anwendungs- und Dosierungsangaben sind über viele Jahre empirisch entwickelt worden. Randomisierte und kontrollierte Studien für diesen Bereich gibt es bis heute jedoch nicht, im wesentlichen handelt es sich um Handbuch- und Lehrbuchmitteilungen, die Autoren aus einzelnen Publikationen entnommen und für den praktischen Gebrauch fortentwickelt haben. Dieser Beitrag stellt die im Auftrag der Deutschen Gesellschaft für Neonatologie und pädiatrische Intensivmedizin entwickelten Leitlinien für die notfallmäßige Infusionstherapie in der Pädiatrie vor. Zugleich wird die Erstversorgung von Kindern im Schock genauer beschrieben.

Notes: Abstract As part of a multicenter surfactant rescue study, the chest X-rays of 239 preterm and term infants were analyzed. To study the influence of surfactant administration on radiographic appearance, 130 patients with a clinical and radiological diagnosis of typical respiratory distress syndrome were selected, in whom adequate chest x-rays before and within 48 h after treatment were available. Median gestational age was 30 weeks (range 25–38 weeks), median birth weight was 1335 g (range 625–3450). The time of surfactant application ranged between 90 min and 24 h after birth (median 6 h). The most common finding after surfactant administration was uniform (n=47) or disproportionate (n=46) improvement of pulmonary aeration, which showed a significant correlation to posttreatment reduction of oxygen requirement (p〈0.001). Asymmetric clearance was more often localized on the right side and usually disappeared within two to five days. Only in 13 patients no change of ventilation was found. Development of interstitial emphysema (n=24, including three patients with pneumothorax) after surfactant treatment was an unfavourable prognostic sign. 54% of these patients (13 of 24) died within the first month of life, compared to 8% (7 of 93) in the group of patients with initial improvement of ventilation.

Notes: Zum Thema Die Reanimation im Rahmen der postpartalen Erstversorgung ist ein zentrales Problem der Geburtshilfe. Immerhin benötigen 6 % aller Neugeborenen eine Maskenbeatmung, 1–2 % eine Intubation. Wesentliche Voraussetzungen für ein effektives Handeln sind ein aktueller Kenntnisstand und ein regelmäßiges Training von Geburtshelfern und Neonatologen. Grundkenntnisse in der Reanimation Neugeborener müssen aber auch von den Anaesthesisten, von den Hebammen und von den Allgemeinärzten verlangt werden. Zu einem reibungslosen Arbeitsablauf im Kreißsaal und Op-Bereich gehören neben einer funktionsfähigen technischen Standartausstattung auch eine gute Organisation und Aufgabenverteilung. Besonders bei Risikoentbindungen muß die „Rollenverteilung“ schon vor der Geburt feststehen. In Text, Abbildungen und Flußdiagrammen sehr übersichtlich dargestellt, werden Hinweise und Tips aus der Praxis zur Zustandsbeurteilung und zur Primärversorgung des Neugeborenen gegeben. Bei Frühgeburten sollten Zustandsbeurteilung und Reanimation möglichst in Anwesenheit des Pädiaters durchgeführt werden.