Increased intracranial pressure in a neonate with citrullinaemia.
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Amino Acid Metabolism, Inborn Errors↗
Biomedical subjects
D Vermeylen
Publications and source records attributed to D Vermeylen.
Detection and evaluation of fetal goitre by ultrasound.
Antenatal diagnosis of fetal goitre has been reported rarely. Once detected, however, it is important to evaluate fetal thyroid function so early treatment can be initiated if necessary. In reporting three new cases, the authors analyse the various methods of evaluation. The normal sequence of appearance of the various epiphyseal ossification centres is an indirect illustration of thyroid function and can be followed by ultrasound. Direct evaluation of hormone levels through cord blood sampling under sonographic guidance is a complementary method in doubtful cases. The mechanisms predisposing to the development of fetal goitres and the possible implications of these findings are also discussed.
Diseases in Twins↗
[Prematurity: developments during the last decade at Erasmus Hospital. II. Long-term follow-up].
Morbidity and mortality of these preterm infants weighing < 1000 g at birth was reported in another paper. The mortality and neuro-developmental prognosis improved clearly in the last 3 years. A particular attention is given for protecting these babies against brain lesions. These ELBW have a high risk of neurodevelopmental disturbances. Therefore, a multidisciplinary team follows the neurological evolution to assess the quality of neonatal care and detect and treat developmental abnormalities as early as possible. We present the weight and height evolutions, the neurological, social and familial outcome of our 15 survivors. Economical and ethical discussions are open.
Child Development↗
[Prematurity: development during the last decade at Erasme Hospital, neonatal evaluation].
Our institution admitted 39 ELBW (less than 1 kg) between November 1978 and December 1990. In our center, mortality has decreased from 61% to 33% within a decade. Improvements in neonatal intensive care have lowered the limit for these possible survival to 26 weeks of gestational age and 700g of birthweight. Morbidity is still very high. The mean hospital stay is 96 days. Perinatal asphyxia is frequent (3/4) as well as infections, nutritional problems and renal failure. Sixty-six % of this population suffer from respiratory distress syndrome which is the main cause of death. Morbidity and mortality are explained and compared to the recent literature.
Belgium↗
[Cordocentesis: experience in 391 initial samples].
The first diagnostic cordocentesis was performed in our unit in october 1985. Our 4-year experience is reported: 391 cordocentesis were performed in 360 patients during gestational weeks 14 to 42. The first attempt was successful in 90% of the procedures, 4 samplings failed, there were 4 fetal deaths within one week after diagnostic cordocentesis, one of them appears to be directly linked to the punction. A transient fetal bradycardia was observed in 9.9% of the cases, bleeding occurred in 19% of the cases. The indications for cordocentesis were: risk of fetal infection, karyotyping, hemopathy, search for paternity, assessment of fetal acid-base status, biochemical dosage. Our data confirm that cordocentesis is a safe and reliable diagnostic procedure providing guidelines for management of the pregnancy.
Chromosome Aberrations↗
Long-term follow up of a case of severe congenital chloride diarrhoea.
A patient with congenital chloride diarrhoea (CCD) is reported. The diagnosis on the 5th day of life was based on the watery stools with characteristic ionic composition. The neonate presented with abdominal distension necessitating laparotomy on day 1, followed by transverse colostomy on day 3, owing to persistent abdominal swelling. Total parenteral nutrition (from 1 to 3 months) followed by an enteral semi-elemental diet (from 3 to 5 months) was required to reduce the quantity of stools and to obtain a satisfactory nutritional state. The colostomy was closed at 16 months. Growth, psychomotor development and renal function are normal at 6 years. Criteria for therapeutic evaluation are discussed.
Blood Chemical Analysis↗
Fatal ureaplasma infection in second twin born 60 days after delivery of the first in a patient with recurrent spontaneous abortion--a case report.
A delay of more than one month between the birth of twins is an unusual occurrence presenting the obstetrician and the neonatalogist with many questions regarding the management of the case. There is the risk of prematurity for the second twin as labor has already occurred in the pregnancy. There is also a risk of infection to both mother and fetus during the interval between the two deliveries, since the stump of the first twin's cord may precipitate ascending colonization from vagina and cervix. Germs frequently recovered from the vagina e.g. Ureaplasma urealyticum, are associated with prematurity. The latter has also been responsible for lethal interstitial pneumonia in the neonate. We present a case of a patient who though she delivered twice normally, had suffered 4 first trimester abortions and one late abortion, all spontaneous. Her eighth pregnancy was a twin pregnancy. She underwent a cerclage at 14 weeks, but went into labor at 17 weeks, when she delivered the first macerated twin. She was then treated with fenoterol and ampicillin; nevertheless she delivered twin the second at 26 weeks. This 750 g baby-girl presented with severe respiratory distress. Repeated chest X rays showed perihilar infiltrates which became nodular. All cultures were negative. At the end of the first week, when her condition was considered satisfactory, she deteriorated dramatically and died in respiratory failure and DIC. Tracheal aspirates were positive for Ureaplasma urealyticum.
Abortion, Habitual↗
Sonographic demonstration of malabsorption in neonates.
A new sonographic pattern is described that has been found in eight infants having syndromes associated with malabsorption. Five infants had hepatobiliary disease and three infants had transient or permanent cow-milk intolerance. In all cases, upper abdominal sonographic examinations revealed hyperechoic tubular and round masses which, most probably, represent small bowel loops filled with malabsorbed milk. Control examinations, before hepatic failure or under corrected diet, showed absence of the pattern. It is believed by the authors that in some ambiguous cases, the finding of this pattern should direct the pediatrician toward syndromes associated with malabsorption.
Bile Ducts↗
Partial bronchial stenosis following inadvertent right bronchial intubation in a neonate.
This case reports difficulties encountered in weaning a premature infant with bronchopulmonary dysplasia from prolonged mechanical ventilation. On chest X-ray alternating atelectasis and hyperinflation of the right lung were observed. This resulted from a short episode of misplaced endotracheal tube that produced a traumatic bronchial stenosis. Treatment by prednisolone allowed the detubation.
Bronchi↗
Neonatal necrotizing enterocolitis: from reduction of mortality to reduction of morbidity.
A prospective protocol was applied from October 1978 to December 1980 to 22 newborns presenting with necrotizing enterocolitis (Stages II and III). The total mortality was 32% (7/22) with a 100% mortality in the surgical group (4/4). The prospective protocol was changed and applied to 53 newborns from January 81 to December 84, showing a decrease in total mortality: 28% (81 and 82) and 4% (1983 and 1984), with a global mortality of zero in 1983. The main changes in the protocol are: Addition of metronidazole. More precocious and radical two stages surgical procedure. Earlier diagnostic, resuscitation and transfer to the surgical department. Improvement of anaesthesia and intensive care therapy. Duration of hospital stay fell by 50%. Despite significant intestinal resections, most infants were on a normal diet by the age of one year.
Anesthesia, General↗