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Biomedical subjects

A Bochner

Publications and source records attributed to A Bochner.

16 recordsLinked to original sources
PubMed1993

Clinical symptoms associated with brief obstructive sleep apnea in normal infants.

Relatively little data exist concerning the manifestations of repeated obstructive sleep apnea in normal infants. A questionnaire concerning daytime and sleep habits was completed by the parents of 4,100 healthy infants before they underwent a 9-hour night monitoring study. One hundred infants with an obstructive apnea index above 1.2 were randomly selected. They formed the "apnea" group. From the initial population, 300 infants with no apnea were also selected to form the "no-apnea" group. Both groups were matched for sex, gestational age, post conceptional age, birth weight, mother's age, parity and a family history of sudden infant death. Five variables from the questionnaires significantly differentiated the two groups of infants. When awake, the infants with apnea were characterized by a greater frequency of breathholding spells (22% of apnea infants) and episodes of fatigue during feeding (28%) than the non-apnea infants. During sleep, they exhibited a greater frequency of profuse sweating (15%), snoring (26%) or noisy breathing (44%). Multiple symptoms were present in some infants. A stepwise logistic regression resulted in two significant independent variables: profuse sweating during sleep (p = 0.008) and noisy breathing (p = 0.002). The predictive value of these two symptoms was tested on a new group of 650 healthy infants. The two independent variables led to the correct classification of 60 of the 67 infants with apnea (89.67%) and 382 of the 583 non-apnea infants (65.5%). A positive history alone had a positive predictive value of 0.21.(ABSTRACT TRUNCATED AT 250 WORDS)

Electrocardiography↗
PubMed1992

Sleep and cardiorespiratory characteristics of infant victims of sudden death: a prospective case-control study.

We studied the polygraphic sleep recordings of 30 infants who eventually died of sudden infant death syndrome (SIDS) and those of 60 matched control infants. All records were extracted from 20,750 sleep studies collected prospectively in 10 sleep laboratories. Of the 30 future SIDS victims, 5 were siblings of SIDS victims and 9 were studied after an apparent life-threatening event. For each SIDS victim, two normal control infants were matched for sex, gestational age, postnatal age and weight at birth. The future SIDS infants were reported to have more frequent episodes of regurgitations after feeding (p = 0.01) and profuse sweating during sleep (p = 0.01) than the control subjects. Only two polysomnographic variables characterized the future SIDS infants. Compared to control subjects, the SIDS infants moved less during sleep (p = 0.04) and had significantly more frequent obstructed breathing events. Obstructive and mixed apneas were seen in 23 of 30 future SIDS victims, but in only 9 of 60 control subjects (p = 0.01). The obstructed and mixed apneas lasted longer in the SIDS than in the control infants (p = 0.01) but did not exceed 15 seconds. The obstructed breaths occurred mainly in rapid eye movement sleep (78% of the events) and were accompanied by drops in heart rates to 68 beats per minute and in SaO2 levels to 75%. The present report adds further indirect evidence for a possible sleep-related impairment of respiratory control in some infants who eventually died of SIDS.

Case-Control Studies↗
PubMed1991

Prevention of airway obstructions during sleep in infants with breath-holding spells by means of oral belladonna: a prospective double-blind crossover evaluation.

We investigated whether the brief airway obstructions seen during sleep in infants with breath-holding spells were controlled by the autonomic nervous system. We studied 20 infants, with a history of breath-holding spells and a median age of 12 wk (range 4-46 wk). During sleep they had a median of 6 airway obstructions per 10-hr recording (range 3-16 events), with a median duration of 8 sec (range 4-12 sec). No explanation was found for the airway obstructions. In every infant, a double-blind crossover challenge was conducted. It included oral administration of tincture of belladonna, equivalent to 0.01 mg/kg weight of atropine, and placebo syrup containing no belladonna. The belladonna, or the placebo, was administered at bedtime for 7 days, followed by a 7-day washout period. Another 7-day series of syrup administration was then undertaken. A nighttime polygraphic recording was made after each 7-day series. It was the belladonna, and not the placebo, that induced the disappearance of the obstructions in 10 infants; these were called "drug responsive". In 5 children no effect was observed after either the placebo or belladonna; these infants were defined as "drug unresponsive". In 4 subjects the obstructions disappeared after both belladonna and the placebo; the children were considered to have an "inconclusive response". One infant was excluded from the study because he developed an airway infection. It is concluded that in some breath-holding infants, obstructed breathing episodes during sleep disappear after the administration of an atropinic drug. The observation could indicate a role of the autonomic nervous system in the control of the upper airways during sleep in infants.

Airway Obstruction↗
PubMed1991

Gastroesophageal reflux in infants with a history of near-miss sudden infant death.

From January 1984 through August 1986, 130 infants were referred to our department with a history of apnea, hypotonia, and cyanosis or pallor, suggesting near-miss sudden infant death syndrome. Protocol consisted of medical history, clinical examination, overnight polygraphic recording, and cardiologic, gastrointestinal, metabolic, neurologic, and toxicologic workups. In 49 of these infants who needed vigorous stimulation or mouth to mouth resuscitation, the event occurred shortly after feeding. Combined, continuous esophageal pH monitoring and polygraphic recording in these 49 infants showed pathologic gastroesophageal reflux (GER) in 34 patients. An abnormal overnight polygraphic recording was observed in 8 of 34 infants with pathologic GER. Other investigations led to etiologic diagnoses in 42 of the remaining infants. Severe GER was frequently found in children with apnea after feeding but clearly is not the only mechanism involved. Infants with a history of apnea after a feeding should be investigated for GER and appropriately treated.

Apnea↗
PubMed1990

[Chemical pneumonia in children].

Between 1980 and 1989 the Children's Hospital of Antwerp admitted 954 children with signs of intoxication. In 83 cases (9%) these were due to ingestion of hydrocarbons, 17 of these 83 children (21%) had chemical pneumonia. The most frequent chemicals were turpentine, petrol and lamp oil. The main symptoms were vomiting, skin rash, coughing and fever accompanied by an infectious blood count. Roentgen abnormalities in this group were less frequent than reported in the literature. A chest X-ray immediately after admission does not always provide information about pneumonia because abnormalities may already be present, e.g. due to an acute lung condition; nevertheless it is necessary for further study, if any. An X-ray after 24 hours is indispensable to confirm or exclude chemical pneumonia. As regards treatment, only supportive therapy is possible. Pulmonary function studies after a few weeks may be useful. A survey is presented of the epidemiology, clinical findings, diagnostics, pathophysiology, symptomatic therapy, prevention and prognosis.

Child, Preschool↗
PubMed1990

Home monitors for infants: use, misuse, and "over-the-counter" use.

The prevalence of "over-the-counter" monitors, was surveyed in infants referred to five Belgian paediatric centres between September 1987 and March 1988 for evaluation of their risk for sudden infant death (SID). Questionnaires were collected from 1625 families. Of the infants, 8.9% were already being monitored at home. For 78.1% of the infants no medical advice had been solicited, and for 21.9%, a paediatrician or a general practitioner had advised home monitoring without previous evaluation. Forty of 824 infants referred with no history of SID, and no history of apparent life-threatening event (ALTE), were monitored (4.8%). Monitoring was started for 3.8% (5 out of 130) of the infants who had lost a cousin or an uncle to SID, and for 22.2% (69 of 310) of the younger siblings of a SID victim. Of the 341 infants who had presented with an ALTE, monitoring was started in 32 (9.4%). The infants were monitored with respiratory monitors only, and in 86% of the monitors, the alarm delay had been regulated unnecessarily low.

Belgium↗
PubMed1990

Brief airway obstructions during sleep in infants with breath-holding spells.

We investigated the possibility that infants with breath-holding spells have breathing disorders during sleep. Seventy-one breath holders with a median age of 14 weeks were selected from a well babies clinic because of their histories: 34 infants without loss of consciousness, and 37 with loss of consciousness (21 of the latter had had cyanotic spells, 14 pallid spells, and 2 combined cyanotic and pallid spells). For each breath holder, one control infant without a history of breath holding was chosen from the same clinic. All infants were healthy and had no known cause of disrupted breathing during sleep. Their histories indicated that the breath holders were covered with sweat during sleep (p = 0.005) or wakefulness (p = 0.006) significantly more often than were the control infants. The infants were studied during a one-night monitoring session, and the 142 sleep recordings were analyzed without knowledge of the history. The breath holders had significantly less nonrapid eye movement (stage III) sleep, more indeterminate sleep, more arousals, and more sleep-stage changes than the control infants had. Central apneas were evenly distributed in the two groups. Airway obstructions were found in 41 breath holders and six control infants; the obstruction lasted longer in the breath holders. The infants with airway obstruction during sleep snored more often (p = 0.023) and sweated more (p = 0.035) during sleep. The water evaporation rate, measured on the forehead with an evaporation meter, was significantly greater in the breath holders (p = 0.001). Ocular compression induced longer asystoles in the infants with pallid syncopes than in either those with cyanotic syncopes (p = 0.036) or those without loss of consciousness (p = 0.031). We conclude that the obstructed breathing during both wakefulness and sleep could be related to a common immature breathing control.

Female↗
PubMed1989

Cat-scratch disease with reversible encephalopathy.

A case of cat-scratch disease (CSD) complicated by reversible encephalopathy is presented. Neurological complications of CSD are uncommon. Laboratory and radiological examinations were negative. There was complete recovery.

Cat-Scratch Disease↗
PubMed1988

Polysomnographic studies of infants who subsequently died of sudden infant death syndrome.

The polygraphic findings from 11 future victims of sudden infant death syndrome (SIDS) are reported and compared with those of matched pairs of control infants. The recordings had been done to alleviate parental anxiety about sleep apnea. Four infants had siblings who were victims of SIDS. Two infants were studied 3.5 to 9.5 weeks before their deaths because of an unexplained apparent life-threatening event that had occurred during sleep. For each victim of SIDS, two control infants were selected from the 2,000 infants who had been tested in the same hospitals. They were matched for sex, gestational age, postnatal age, and weight at birth with the SIDS victims. Their polygraphic recordings had been performed within similar conditions. Each record was allocated a random code number and was analyzed without knowledge of the patient's identity by two independent scorers. Most sleep and cardiorespiratory variables studied did not differentiate SIDS victims from control infants. Only four variables significantly characterized the future SIDS victims: the maximal duration of central apneas, the number of sighs followed by a central apnea, the presence of obstructive apneas, and the presence of mixed apneas. Central apneas were longer during all sleep states in the SIDS victims compared with their matched controls, but none exceeded 14 seconds. Sighs immediately followed by an apnea were significantly less frequent in the future SIDS group. Obstructive and mixed sleep apneas were seen in eight of 11 SIDS victims and in only three of 22 control infants.(ABSTRACT TRUNCATED AT 250 WORDS)

Female↗
PubMed1986

Sudden infant death syndrome in a twin: a comparison of sibling histories.

To determine possible characteristics of infant victims of sudden death, we examined 114 items related to the pre- and postnatal histories of 42 pairs of twins one of whom died of sudden infant death syndrome (SIDS) leaving a surviving sibling. Interviews with the parents were conducted after the occurrence of SIDS, and the data were checked with records held by gynecologists and pediatricians. To evaluate the specificity of any factors, we studied a control group of 42 age- and sex-matched pairs of twins, both of whom survived the first year of life. Only 11 of 114 characteristics were significantly related to SIDS: future victims had a smaller weight and height at birth, stayed longer in the nursery, and followed a moving object with their eyes, had head control, and smiled at a later age than their surviving siblings. They also fatigued more often during feeding (11/42) and had reduced arm and neck tonus (9/42). They were described as longer sleepers than their surviving siblings. During sleep, some SIDS twins, but no surviving twin, were found to be cyanotic at least once or pale (4/42) and were repeatedly covered with abundant sweat (8/42). In the control group of normal twins, the occurrence of most of these characteristics was found with a frequency comparable to that seen in the SIDS infants; the specificity of these characteristics is thus considered doubtful. The mean birth weight and height were significantly greater in the control group, and no control infant had an episode of cyanosis or pallor or repeated episodes of profuse sweating observed during their sleep.(ABSTRACT TRUNCATED AT 250 WORDS)

Body Height↗