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Biomedical subjects

Doris Fischer

Publications and source records attributed to Doris Fischer.

13 recordsLinked to original sources
PubMed2006

Outcome of preterm and term neonates of mothers with malignant diseases diagnosed during pregnancy.

OBJECTIVE: To investigate the outcome of preterm and term neonates born to mothers with malignant diseases diagnosed during pregnancy. METHODS: A retrospective analysis with a matched-paired control group in a third level obstetric department and third level neonatal department of the University Hospital Frankfurt. Patients were preterm and term neonates from mothers with oncologic diseases diagnosed during pregnancy and matched-paired preterm and term neonates from healthy mothers. MEASUREMENTS AND RESULTS: Nineteen preterm and three term (1 x twins) neonates from 21 mothers with oncologic diseases and matched-paired neonates from 21 healthy mothers were included. With the exception of one case, pregnancy was terminated because of the necessity for maternal oncological treatment. Children from mothers with malignant diseases had a significantly lower birth weight and a tendency towards a higher incidence of high-grade respiratory distress syndrome. No significant differences concerning Apgar scores, red blood cell (RBC), white blood cell (WBC), and platelet (PLT) counts postpartum, and duration of hospital days between the two groups of neonates were observed. CONCLUSION: Direct perinatal outcome of preterm or term neonates from mothers with malignant diseases diagnosed during ongoing intact pregnancy does not differ from the outcome of a comparable group of neonates from healthy mothers. This might be in contrast to the long-term outcome of this special patient group. In our study we could find no elevated mortality in neonates where pregnancy was terminated because of the need for maternal chemotherapeutic therapy.

Adult↗
PubMed2006

A prospective pilot study of prophylactic treatment of preterm neonates with recombinant activated factor VII during the first 72 hours of life.

OBJECTIVE: Intraventricular hemorrhage (IVH) in the preterm infant is a devastating complication, causing marked mortality and morbidity. A general hemostatic agent such as recombinant activated factor VII (rFVIIa) might have the potential to reduce the extent of severe IVH. DESIGN: Prospective, single-arm pilot study. SETTING: Level III neonatal intensive care unit. PATIENTS: Ten preterm infants between 23 and 28 wks of gestation. INTERVENTION: Administration of a 100-microg/kg rFVIIa bolus injection within the first 2 hrs of life, followed by 100 microg/kg rFVIIa every 4 hrs, for the first 72 hrs of life. MEASUREMENTS AND MAIN RESULTS: Cranial ultrasonography and flow studies of the major arteries and the venae cava, aorta, vena portae, and venae renales, was performed at study enrollment and at 12 hrs, 24 hrs, 48 hrs, and 72 hrs. Blood cell counts and coagulation studies were performed. End points of the study were occurrences of adverse events, with an emphasis on thrombotic events or disseminated intravascular coagulation (DIC). Ten preterm infants with a gestational age of 23 wks 1 day to 28 wks 3 days were included. None had venous thrombosis or cerebral infarction during or after the treatment. Neither platelet consumption nor DIC was observed. Two infants with an umbilical artery catheter had a thrombus at the catheter tip (one during infusion of the study drug), which was successfully treated with heparin. One had grade III IVH and died on day 6 of life; in another, grade II IVH progressed to grade III after termination of the drug. CONCLUSION: One hundred microg/kg rFVIIa does not accumulate if administered prophylactically to preterm infants of <28 wks of gestation every 4 hrs in the first 72 hrs of life. In this population, rFVIIa does not cause DIC. Thrombus formation was observed in two infants with umbilical artery catheters but in none of the infants with venous catheters. Embolic events were not observed. In this pilot study, which did not provide the sample size to assess any effect of rFVIIa on the incidence of IVH, 20% of the neonates went on to have grade III or IV IVH, which is similar to the rate in studies in which rFVIIa was not given.

Cerebral Ventricles↗
PubMed2006

Characteristics and outcome of unplanned extubation in ventilated preterm and term newborns on a neonatal intensive care unit.

BACKGROUND: Unplanned extubation events (UEE) are a serious hazard to patient safety, especially on a neonatal intensive care unit (NICU), where reestablishing a secure airway can be difficult. The following study was undertaken to analyze characteristics of UEE and develop prevention strategies. METHODS: A retrospective cohort study on a level III single center NICU was undertaken. Patient records of a 12-month period from December 2003 to December 2004 were analyzed using a standardized evaluation form. Fischer's exact t-test and the Mann-Whitney U-Ranked Sum test were used for statistical analysis. RESULTS: One hundred and four neonates with a total ventilation time of 14 495 h were included in this study. Of these patients 12 UEE were observed (1 UEE/1208 h of ventilation time). Neither median birth weight [1445 g (range 460-4650) vs 1755 g (range 460-3570 g)] nor median gestational age [31.5 weeks (range 25.6-39.6 weeks) vs 32.7 weeks (range 23.9-41.5 weeks)] differed significantly between neonates with UEE compared with the total group. When the UEE occurred, the neonates were cared for by experienced nursing staff with a median of 10 years nursing experience. The workload for the individual nurse was high: during shifts when UEE happened, each nurse had to take care of 3.85 patients (range 1.8-5 patients). This workload was higher than the average of 3 (range 1.6-6) patients/nurse during the study period. The most frequently reported reason for UEE was difficult fixation of the tracheal tube (TT) (four patients), followed by handling of the infant by nursing staff or physiotherapy (two patients) or an active infant in whom dislocation of the TT occurred without external manipulations (three patients). In three instances, the reason for the UEE was not documented. Of the 12 UEE observed in 10 patients, three required immediate reintubation, five were managed with nasal continuous positive airway pressure and four did not require further respiratory support. Of those who required support, FiO(2) increased by 14% over baseline compared with the FiO(2) prior to UEE. CONCLUSIONS: Inadequate TT fixation could be identified as the main contributor to UEE and should be targeted in prevention strategies. The reintubation rate after UEE was only 25%. Overall, UEE did not result in an adverse outcome in terms of mortality. Length of stay on NICU was significantly longer in UEE patients.

Humans↗
PubMed2003

N-carbamylglutamate enhances ammonia detoxification in a patient with decompensated methylmalonic aciduria.

In patients with methylmalonic aciduria (MMA), the accumulating metabolite propiony-CoA results in an inhibition of the urea circle via the decreased synthesis of N-acetylglutamate, an essential activator of carbamylphosphat synthetase (CPS). This results in one of the major clinical problems which is hyperammonaemia. In a patient with decompensated MMA, the CPS activator carbamylglutamate was tested for its ability to antagonize the propionyl-CoA-induced hyperammonaemia. Oral carbamylgutamate administration resulted in an impressive increase in ammonia detoxification compared to peritoneal dialysis. Safe, fast and easy to administer, carbamylglutamate improves the acute therapy of decompensated MMA by increasing ammonia detoxification and avoiding hyperammonaemia.

Amino Acid Metabolism, Inborn Errors↗
PubMed2003

Acute ethanol intoxication during pregnancy and consecutive fetal cardiac arrest: a case report.

Chronic alcohol exposure during pregnancy and the resulting toxic effects for the fetus has been the subject of many investigations. In contrast, acute alcohol intoxication during pregnancy is a rare event and less is known about the consequences for fetal life. We report a case of the acute ethanol intoxication of a pregnant woman at the 35th week of gestation and the consecutive cardiac arrest of the neonate. Despite the life threatening event, the newborn recovered after resuscitation and intensive care treatment and could be discharged from hospital in good physical condition. We suggest that acute alcoholized pregnant women should be transferred to Perinatal Centers to cater for the possible need for emergency cesarean section and resuscitation of the newborn.

Acute Disease↗
PubMed2002

Life-threatening hemorrhage in neonates: management with recombinant activated factor VII.

OBJECTIVE: Massive hemorrhage with shock is a common problem for the intensivist. The use of recombinant activated factor VII (rFVIIa), known as efficient treatment for hemophilia, has been reported to control severe bleeding episodes in critically care patients, but never in preterm neonates. DESIGN: Case report (two cases) and review of the literature. SETTING: Neonatal intensive care unit, university teaching hospital. PATIENTS: Two preterm neonates with life-threatening hemorrhages, from the liver and spleen in one patient and from the lung in the other. INTERVENTION: Intravenous administration of 150/200 microg/kg of rFVIIa (Novoseven, NovoNordisk, Copenhagen, Denmark). MEASUREMENTS AND RESULTS: Complete hemostasis 10 min after the second bolus in the two patients. CONCLUSION: For the intensivist, the successful use of rFVIIa in these patients and others lacking pre-existing coagulopathies points to rFVIIa as a novel therapeutic approach for patients presenting with massive life-threatening hemorrhage.

Factor VII↗
PubMed2002

Comparison of effects of perflubron and surfactant lung lavage on pulmonary gas exchange in a piglet model of meconium aspiration.

In a piglet model of meconium aspiration we compared lavage with surfactant with that with perflubron (PFOB) and a control group. A human meconium suspension was instilled into piglets which were randomized in 3 (n = 6 each) groups. After lung injury, the control group was ventilated with high-frequency oscillatory ventilation (HFOV) without suctioning and lavage. A second group was lavaged with 10 ml/kg diluted surfactant, a third with 10 ml/kg pre-oxygenated PFOB. Thereafter, the animals of both groups were ventilated with HFOV. After lung injury by instillation of meconium, no further improvement in oxygenation was possible in animals of the control group and 3 piglets died during the ventilation. The subjects of the surfactant group improved promptly, and at the end of the study the arterial pO(2) was significantly better than immediately after injury as compared with the other groups. Lavage with PFOB had intermediate effects in gas exchange and oxygenation compared to surfactant lavage. No differences were observed in arterial blood pressure and heart rate as well as in histological lung injury score between all groups. Lavage with exogenous surfactant as well as with PFOB improve pulmonary gas exchange in a piglet model of meconium aspiration.

Animals↗
PubMedDate not supplied

Long-distance transport of ventilated patients: advantages and limitations of air medical repatriation on commercial airlines.

INTRODUCTION: To illustrate the advantages and limitations of transporting ventilated intensive care unit patients over intercontinental distances on commercial airlines, this case series reports 8 ventilated patients repatriated by an air medical transport company. PATIENTS: Eight ventilated patients, 3 suffering from internal and 5 from neurologic diseases. Distances ranged from 1700 to 10280 nautical miles with transport times from 04:10 hours to 21:55 hours. For 3 patients, a dedicated patient transport compartment (PTC) in the aircraft cabin was used. All patients were ventilator-dependent for a minimum of 11 days before transport (48 days median, 113 days maximum). RESULTS: One patient went into cardiac arrest during the flight and died. None of the other patients experienced any emergency or invasive procedures, other than peripheral venous access necessary during the flight. In all patients, ventilation was adjusted with respect to the blood gas analysis at least once during the transport. No technical failures or drop-outs occurred during the flights. None of the flights had to be diverted for technical or medical reasons. CONCLUSION: Long distance international transport of ventilated intensive care unit patients is an extremely cost intensive and logistically challenging task. In a certain subgroup of relatively stable ventilated patients, transport on commercial airlines offers advantages in terms of cost effectiveness and reduced transport time and acceleration/deceleration trauma as a result of multiple fuel stops.

Adult↗
PubMedDate not supplied

Bacterial colonization of patients undergoing international air transport: a prospective epidemiologic study.

OBJECTIVE: To investigate the incidence of multiresistant bacteria in patients treated in foreign hospitals and repatriated by international interhospital air transport. METHODS: This was a prospective epidemiologic study on patients who were hospitalized in a foreign country and repatriated to a hospital in their home country by international aeromedical transport on scheduled airlines or ambulance jets. The study was carried out by the Department of Pediatrics, Department of Medical Microbiology, University Hospital Frankfurt, Germany, and MedCall Germany, the organizing company for repatriation. One hundred and three patients, who were hospitalized abroad, required repatriation by international interhospital air transport and met the entry criteria. RESULTS: Four hundred and eighty-three swabs from brow, nose, ear, throat, groin or axilla were taken from 103 patients, mean age 62 years. They were transported from southern and eastern European countries, Morocco, Egypt, Ghana, Tunisia, Pakistan, the United States and the Bahamas to destinations in Germany, the UK, Belgium, Switzerland, the United States and Japan. Forty-four patients were in an intensive care unit (ICU) for 6.5 days (median) prior to transport. Forty patients received antibiotics at the time of repatriation. Acinetobacter, Enterobacter, Pseudomonas, Proteus, Staphylococcus aureus and Candida were found. Methicillin-resistant Staphylococcus aureus (MRSA) was found in three patients (3%), ventilated for 17 days, and treated in the ICU for a median of 23 days. In 2 patients, multiresistant Acinetobacter baumanii and multiresistant Klebsiella pneumoniae were found. CONCLUSIONS: Bacterial colonization of patients undergoing international interhospital air transport does not differ from that of patients in a European hospital. Multiresistant bacteria, especially MRSA, were found only in ICU patients. There is no elevated risk of transmission of multiresistant bacteria in this patient group compared to other patients treated in hospital, especially in ICUs.

Adolescent↗