Gastric perforation in a newborn.
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Humans↗
Biomedical subjects
C Vogtmann
Publications and source records attributed to C Vogtmann.
Nosocomial neonatal outbreak of Serratia marcescens--analysis of pathogens by pulsed field gel electrophoresis and polymerase chain reaction.
BACKGROUND: We investigated an outbreak of Serratia marcescens in the neonatal intensive care unit (NICU) and the pediatric intensive care unit (ICU) of the University Children's Hospital Leipzig, Germany. PATIENTS AND METHODS: From September to November 1998 15 patients were infected or colonized by S. marcescens. During the outbreak swabs from eye, blood, throat and nose were taken from every patient hospitalized in the ICUs. RESULTS: In 15 cases (14 from the NICU and one from the pediatric ICU) the cultures yielded S. marcescens. All strains were investigated by pulsed field gel electrophoresis (PFGE) as well as by polymerase chain reaction (PCR) fingerprinting. Both molecular typing methods revealed corresponding fingerprint patterns in all of the 15 isolates. Typing results of the outbreak-related isolates demonstrated that two epidemic strains of distinct genotypes were associated with cross-infections of a group of five and a group of ten patients, respectively. The three invasive and seven of the colonizing isolates were related genotypically. CONCLUSION: This survey shows that PCR and PFGE are comparable in respect to the discrimination and reproducibility for epidemiological studies of S. marcescens strains in nosocomial outbreaks. Genotypic fingerprinting of bacterial isolates is useful and important to limit nosocomial infections. Fingerprinting sources of nosocomial infections can be traced both by PFGE and PCR. All patients infected recovered completely and the nosocomial outbreak could be stopped rapidly.
Cross Infection↗
[Dopplersonographic findings in neonates with significant persistent ductus arteriosus].
BACKGROUND: The aim of the study was the description and review of a diagnostic management for treatment of patent ductus arteriosus in preterm neonates. Indomethacin, widely used to effect nonoperative closure of patent ductus arteriosus, has been implicated in vasoactive side effects and requires an accurate diagnosis. PATIENTS AND METHODS: Firstly, the hemodynamic significance of the ductus arteriosus was assessed by clinical signs, such as tachycardia, disturbed microcirculation and a high difference of central and peripheral temperature. The patent ductus arteriosus was confirmed by echocardiography. The left ventricular systolic time intervals and the cerebral perfusion were obtained by pulsed doppler recordings. 48 preterm infants below 1500 g were investigated within the first 12 hours of life and during the first week. RESULTS: In 32 preterm neonates (67 %) a patent ductus arteriosus without hemodynamic significance and in 9 neonates a patent ductus arteriosus with hemodynamic changes was detected. In 9 neonates there were no signs of patent ductus arteriosus. Neonates with typical clinical signs of patent ductus arteriosus exhibited significantly diminished preejection time, prolonged ejection time and a decreased quotient of preejection and ejection time. We found pathologically changed parameters of anterior cerebral artery in neonates with clinical signs of patent ductus arteriosus. To judge the efficiency of the diagnostic management the groups of neonates were compared concerning the evidence of complications. Neonates with ductus arteriosus but without therapy did not reveal more pulmonary problems as well as intracerebral hemorrhages, renal or intestinal disturbances than the group of neonates with treated ductus arteriosus. CONCLUSIONS: Summarizing, we suggest that the described criteria are to be taken into account before treatment of ductus arteriosus in preterm neonates. In this way a wide clinical and echocardiographical investigation will be performed in risk neonates and a useless therapy can be avoided.
Anterior Cerebral Artery↗
Prenatal hemodynamic disturbances -- pathophysiological background of intestinal motility disturbances in small for gestational age infants.
Uteroplacental insufficiency leads to fetal growth retardation which is a major cause of perinatal and postnatal morbidity. In the present study we investigated the relationship between prenatal hemodynamic disturbances and postnatal intestinal perfusion and gastrointestinal function in small for gestational age neonates. Prospectively, 124 preterm neonates with a birth weight below 1500 g were assigned to one of two groups according to the prenatal Doppler sonographic measurements: neonates with or without prenatal hemodynamic disturbances. We defined a pathological fetal perfusion using a pulsatility index of uterine arteries, umbilical artery and fetal thoracic aorta above the 90th percentile and a pulsatility index of the middle cerebral artery below the 10th percentile of a normal group. We compared intestinal adaptation in both groups as well as the blood flow velocity wave forms of the superior mesenteric artery in all neonates. Postnatally, all 42 neonates with prenatal hemodynamic disturbances were classified to be small for gestational age. Thirty-seven of these neonates developed abdominal problems with delayed meconium passage, abdominal distension, bilious vomiting and a delay in tolerating enteral feeding within the first days of life. Five of them needed surgical intervention, but none of these infants revealed typical signs of necrotizing enterocolitis. In contrast, all neonates born after normal prenatal perfusion were classified as appropriate for gestational age. Only 19 of 82 neonates of this group showed signs of intestinal disturbances postnatally. Doppler sonography demonstrated significantly lower systolic, mean and END-diastolic flow velocities, and higher pulsatility indices of the superior mesenteric artery in neonates with prenatal hemodynamic disturbances. This may occur as a result of a postnatally persistent redistribution of regional blood flow and results in gastrointestinal problems and may adversely affect gut motility.
Case-Control Studies↗
Transcutaneous bilirubinometry in preterm infants.
UNLABELLED: The aim of this study was to evaluate the accuracy and safety of transcutaneous bilirubinometry in preterm infants using the new bilirubin analyser BiliCheck. The study included 145 preterm children (23-36 wk gestation). Capillary blood sampling for determination of serum bilirubin (BS) was combined with transcutaneous bilirubin measurement (BTc) every morning until the sixth postnatal day and related to several clinical data (phototherapy (PT), infection signs, breathing disturbances, skin bleeding, etc.). Overall bilirubin concentration ranged from 17 to 371 micromol/l, and from 21 to 325 micromol/l for BS and BTc, respectively. Mean values obtained by BTc were significantly higher than BS values. The correlation coefficient between BS and BTc was r= 0.64 for the whole group, and r = 0.73 in infants without PT. As demonstrated by multiple regression analysis, BS-BTc correlations were related only to gestational age (beta -0.32) and breathing disturbances (beta 0.29), indicating that the lower the gestational age and the more seriously ill the baby, the higher the incoherence between BS and BTc. CONCLUSION: BiliCheck provides a convenient, non-invasive possibility for bilirubin estimation in preterm infants. However, there are limitations: the method gives reliable results only in newborns older than 30 wk gestation, without PT and artificial ventilation.
Bilirubin↗
Three cases with different presentation of fentanyl-induced muscle rigidity--a rare problem in intensive care of neonates.
We report about two newborns with sudden onset of inability of mechanical ventilation due to transient chest wall rigidity after fentanyl i.v. bolus of 2 and 4 microg/kg, respectively, resulting in severe hypoxemia and secondary bradycardia. A third case developed a rigidity of the tongue after fentanyl bolus, which created some unusual difficulties in bypassing the tongue for insertion an endotracheal tube. Because of common usage of this agent for analgesia we direct attention to the possibility of fentanyl-induced muscle rigidity. We underline the necessity of a slow bolus injection to prevent this dangerous adverse effect and we recommend the administration of naloxone and/or muscle relaxants as therapy in conjunction with mechanical ventilation.
Analgesics, Opioid↗
Aminophylline influences cerebral hyperperfusion after severe birth hypoxia.
Doppler sonographic investigations have presented cerebral hyperperfusion in neonates after severe asphyxia. Neonates with disturbed cerebral blood flow velocity (CBFV) tend to have poor outcomes. The purpose of this clinical study was to examine the influence of aminophylline on cerebral hyperperfusion. An intravenous bolus of 4 mg/kg aminophylline was given to nine neonates with Doppler sonographic signs of cerebral hyperperfusion. CBFV was determined before, 5 min, 60 min and 120 min after aminophylline administration and on the following day. After aminophylline the mean systolic (56.5 vs. 41.6 cm/s) and end diastolic (21.0 vs. 12.3 cm/s) blood flow velocity decreased and the mean pulsatility index (0.83 vs. 1.1) increased significantly. Repeated measurements showed a decrease in blood flow velocities and an increase in pulsatility index on the following days. Heart rate, mean arterial blood pressure and pCO2 were not significantly changed. We conclude that aminophylline influences cerebral hyperperfusion in neonates with disturbed autoregulation.
Aminophylline↗
Determination of secretory IgA and albumin in saliva of newborn infants.
As a first line of defence against microbial invasion, secretory IgA (sIgA) is the dominant immunoglobulin on all mucosal surfaces. In this study sIgA was determined by radial immunodiffusion in saliva samples of 63 newborn infants divided into the following age groups: (1) 1 day and younger, (2) 2-10 days. Concentrations of sIgA and albumin as well as their relation to age, postprandial time, gestational age and birth weight were analysed. sIgA could be detected in 75.0% (group 1) and 77.1% (group 2) of the saliva samples with a mean concentration of 190.2 mg/l (group 1) and 216.4 mg/l (group 2). Differences failed to reach significance. Concentration of sIgA was found to be independent of age but positively related to the concentration of albumin in the same saliva sample. In conclusion, this study provides evidence that high levels of sIgA are found in saliva of newborn infants, indicating the existence of a competent oral mucosal immune system as early as within the first 10 days of life.
Albumins↗
Postnatal intestinal disturbances in small-for-gestational-age premature infants after prenatal haemodynamic disturbances.
Uteroplacental insufficiency leads to fetal growth retardation, which is a major cause of perinatal and postnatal morbidity. In the present study we investigated the relationship between prenatal haemodynamic disturbances and postnatal intestinal perfusion and gastrointestinal function in small-for-gestational-age neonates. Prospectively, 114 preterm neonates with a birthweight below 1500 g were assigned to one of two groups according to their prenatal Doppler sonographic measurements: neonates with or without prenatal haemodynamic disturbances. We defined a pathological fetal perfusion by a pulsatility index of uterine arteries, umbilical artery and fetal thoracic aorta above the 90th percentile and by a pulsatility index of middle cerebral artery below the 10th percentile of a normal group. We compared the postnatal respiratory and intestinal adaptation in both groups as well as the blood flow velocity waveforms of the superior mesenteric artery in all neonates. Postnatally, all 36 neonates with prenatal haemodynamic disturbances were classified to be small for gestational age. Thirty-one of these neonates developed abdominal problems with delayed meconium passage, abdominal distension, bilious vomiting and a delay in tolerating in enteral feeding within the first days of life. Six of them needed surgical intervention, but none of these infants revealed typical signs of necrotizing enterocolitis. In contrast, all neonates after normal prenatal perfusion were classified to be appropriate for gestational age. Only 19 of 78 neonates of this group showed signs of intestinal disturbances postnatally. By Doppler sonographic investigations we found significant lower systolic, mean and end-diastolic flow velocities and higher pulsatility indices of the superior mesenteric artery in neonates with prenatal haemodynamic disturbances. This may occur as a result of postnatal persistent redistribution of regional blood flow and results in gastrointestinal problems and may adversely affect gut motility.
Blood Flow Velocity↗
Effect of erythrocyte transfusion on longitudinal bone growth of premature infants assessed by mini-knemometry.
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Anemia↗
[Bilirubinemia in the newborn--is it a disease?].
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Bilirubin↗
[From resuscitation space in the delivery room of the Women's hospital to the perinatal center of the Leipzig University].
Historical review on the development of neonatal intensive care and new-born nursing at the women hospital of Leipzig University from 1969 up to 1995 and the foundation of a Perinatal Center. The successes of perinatal care are demonstrated best by the decline of neonatal mortality of extremely low birth weight infants from more than 90% up to 20% in 1995. It is attributed to the progress in perinatal medicine as well as to a perfect functioning regionalization of high risk pregnancies.
Female↗
[From infant nurse to "baby-friendly hospital"--promotion of breast feeding in the University Women's Hospital in Leipzig].
The attitude of medical professionals towards natural infant feeding is decisive in the support of mothers who want to breastfeed. The atmosphere in a "Baby-Friendly Hospital" is determined by the creation of conditions for breastfeeding on demand and for early, undisturbed mother-child contact. At the University Women's Hospital in Leipzig the development of good breastfeeding management was supported by the employment of a "breastfeeding nurse" and enhanced by continuing education for physicians, nurses and midwives in lactation and breastfeeding. In this way comprehensive, uniform information as well as practical guidance important for breastfeeding success were ensured for pregnant and young mothers.
Adult↗
[Thermal care in the thermal bed with a gel-mattress].
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Bedding and Linens↗
[External ventricular drainage--a possibility in therapy of progressive posthemorrhagic hydrocephalus in extremely premature newborn infants].
7 premature infants with progressive posthaemorrhagic hydrocephalus were treated by means of external ventricular drainage (birth weight: 1050 gms, gestational age: 27.7 wks). All infants were generally unwell and were ventilated. The progression of hydrocephalus was well controlled during the drainage period in each patient. We believe external ventricular drainage is an effective form of therapy in premature infants with posthaemorrhagic hydrocephalus until the time of insertion of a ventriculo-peritoneal shunt.
Catheters, Indwelling↗
[Value of perinatal characteristics for diagnosis of perinatal infections].
A retrospective case control study was performed in order to evaluate the diagnostic validity of clinical and paraclinical signs for early detection of neonatal sepsis. The perinatal data of 45 newborns with sepsis on day 1 or 2 (early perinatal sepsis) after birth were compared with those of 34 newborns with sepsis on day 3 and 4 (late perinatal sepsis) and with 87 newborns as controls. The groups were comparable in respect of birth weight (1,972-2,114 g), gestational age (33.3-33.5 weeks), gender (prevalence of male), frequency of prematures (82-91%) and mode of delivery. In cases of early perinatal sepsis a significant higher incidence of fetal tachycardia was found (heart rate > 160/min in 50% versus 5% in late perinatal sepsis and 8% in controls respectively), of reduced fetal heart oscillation (56% versus 14 and 38%) and of loss of acceleration (76% versus 56 and 20%) in the CTG ante partum. Therefore, these signs have proved to have a better diagnostic validity for infection than premature rupture of membranes, a prolonged rupture of membranes and the chorioamnionitis. Another predominant finding was the significant greater need for resuscitation due to asphyxia (48% in early sepsis versus 14 and 7%) despite missing differences in pH of blood in umbilical artery at birth (7.28 +/- 0.07). The occurrence of such signs supports a suspicion of a fetal sepsis.
Bacteremia↗
[Gestosis, thrombophilia and pulmonary embolism in a primipara with twin pregnancy].
This is a case report on a course of gemini-pregnancy complicated by gestosis, recurrent submassive pulmonary embolism and discordant growth of the hypotrophic twins. It is concluded from this report that: 1. the AT-III-deficiency in gestosis can be caused by loss and consumption; 2. due to decrease below a critical AT-III-level the coagulation-fibrinolysis system tends to decompensate, reflected in a disseminated intravascular coagulation and/or a pulmonary embolism. The tendency consists particularly in immobilisation and stasis; 3. the daily determination of AT III, better of TAT-complex and D-dimer, the daily clinical examination regarding signs of thrombosis and in cases of heparinization the measurement of PTT several times daily, are necessary to avoid or recognise disorders, of the coagulation-fibrinolysis-system at an early stage. 4. The increased consumption in coagulation systems can be avoided by AT-III substitution and correct heparinisation. 5. In cases of risk of pulmonary embolisation in pregnancy a cava filter should be temporarily implanted. The filter must be changed every 3 days, if it is required for a longer period. 6. In high-risk pregnancy the check for factors of thrombophilia is a basic diagnostic procedure.
Adult↗
[Rate of intrauterine growth retardation at the Leipzig Perinatal Center comparing the years 1982 to 1984 with 1987 to 1989].
Referring to the number of all live-born children, hypotrophic newborn (IUGR) were classified at the Centre for Perinatal Care in Leipzig into two periods of time. Based on the 5th Kyank-percentile 6.5% hypotrophic newborn were classified into period A (1982-1984) and 5.0% hypotrophic newborn were classified in period B (1987-1989). The proportion of hypotrophic newborn with a birth weight < 2500 g amounted to one quarter of all infants (except multiple birth) with low birth weight in period A and to one fifth (20.7%) in period B. The decrease in the rate of hypotrophy in these infants affected nearly exclusively the mature ones. The number of infants with extreme intra-uterine growth retardation amounted to 29% (99 in 329) in period A and to 24% (58 in 238) in period B. The rate of hypotrophy in stillbirths decreased from 44% to 33%. In this process the proportion of extremely hypotrophic stillbirths amounted to 47% in period A, whereas it decreased to only 26% in period B.
Cross-Sectional Studies↗