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Biomedical subjects

F Ebbesen

Publications and source records attributed to F Ebbesen.

At least 55 records · Page 3Linked to original sources

[Surfactant treatment of newborn infants with respiratory distress syndrome primarily treated with nasal continuous positive air pressure. A pilot study].

In this pilot study, Curosurf (200 mg/kg) was administrated to 34 patients with the respiratory distress syndrome in nasal-CPAP therapy with FiO2 requirements greater than 0.60 and/or TcPCO2 greater than 8 kPa. The surfactant was instilled during a short period of intubation or in a few cases via an intratracheal catheter (Ch. 6). The age of the patients on surfactant treatment ranged from two to 72 hours. Eighteen patients could be maintained on nasal-CPAP after treatment with Curosurf and only a few complications were seen in these infants. The other 16 patients subsequently required artificial ventilation and had a higher incidence of pulmonary and extrapulmonary complications. On the basis of these observations, we plan a randomized trial to investigate whether, administration of surfactant reduces the need for ventilator treatment and improves the odds for uneventful recovery in this category of patients.

Biological Products↗

[Ondine's syndrome (alveolar hypoventilation)].

Ondine's syndrome is a rare condition characterised by alveolar hypoventilation during sleep on account of an abnormality in the automatic control of respiration. The respiration centre does not react adequately to the carbon dioxide tension in the blood required to maintain normal ventilation. We present a description of the course in an infant with congenital Ondine's syndrome because a therapeutic possibility is now available, viz, implantation of a phrenic nerve pacemaker. The infants showed respiratory insufficiency shortly after delivery. This disappeared on tactile stimulation. The infant had generalised hypotonia with absent patellar reflexes and weak sucking reflexes and, at the age of one week, seizures developed. The infant was treated with assisted ventilation but this could be reduced to use only during the period when the infant slept. The infant was in good health with normal psychomotor development until the age of two years. Plans had been made to implant a phrenic nerve pacemaker. Unfortunately, the infant developed Syncytial-virus pneumonia complicated by bacterial superinfection and developed severe anoxic brain damage which subsequently proved fatal.

Child, Preschool↗

[Late hemorrhagic disease in newborn infants. Is the current preventive treatment with oral vitamin K adequate?].

During recent years, we have observed two cases of haemorrhage due to vitamin K deficiency which developed late in the neonatal period. One patient was a female infant aged six weeks with severe intracranial bleeding and the other was a female infant aged three weeks with marked haemorrhage from the umbilicus. Both of these infants were entirely breast-fed and had received vitamin K (1 mg fytomenadion) orally at birth. Both infants had unrecognized alfa-1-antitrypsin deficiency with liver involvement. In other European countries, many cases of late haemorrhagic disease of the newborn due to vitamin K deficiency have been registered in infants who had received oral vitamin K prophylaxis. On the basis of these observations and investigations which suggest that oral vitamin K prophylaxis is not so effective as intramuscular administration, it is suggested that the present oral vitamin K prophylaxis should be altered.

Administration, Oral↗

The possible risk of bilirubin encephalopathy as predicted by plasma parameters in neonates with previous severe asphyxia.

The study group consisted of nine mature newborn infants with a previous history of severe asphyxia and a control group of 18 mature, healthy newborns with the same postnatal age and sex. The object of the investigation was to compare the possible risk of development of bilirubin encephalopathy between the two groups as estimated by plasma parameters. The asphyxia group had a significantly lower reserve albumin concentrations for binding of monoacetyldiaminodiphenyl sulphone (P = 0.008), a measure of binding of unconjugated bilirubin, and significantly lower total albumin concentrations (P = 0.02). No significant difference was observed in unconjugated bilirubin concentration. It is suggested that mature newborns with previous severe asphyxia are at a slightly increased risk of developing bilirubin encephalopathy over and above the well-known risk associated with increased permeability of the blood brain barrier.

Asphyxia Neonatorum↗

[Neonatal mortality in infants with very low birth weights in the county of North Jutland. Retrospective study].

The object of this investigation was to review the neonatal mortality among infants with very low birthweights (less than or equal to 1,500 gram) in the County of North Jutland and to determine the distribution of the main causes of death. It is important to note that, in a review of this type, the material was unselected. The period involved was 1988-1989. During this period, 86 infants with very low birthweights were born and 63 of these survived for longer than 28 days, corresponding to a neonatal survival of 73%. The survival increased from 11% in infants weighing 500-700 gram at birth to 93% for infants with birthweights between 1,250-1,500 gram from 0% with gestational ages of 24-25 weeks to 98% with gestational ages greater than or equal to 30 weeks. No significant differences in survival were observed as regards sex, place of delivery, method of delivery and singleton/twin delivery but survival was markedly dependent on whether the infants had asphyxia on delivery. The commonest causes of death were the respiratory distress syndrome, periventricular haemorrhage and asphyxia, followed by sepsis, enterocolitis necrotans and immaturity. The incidence of immediate sequelae in the form of chronic pulmonary disease and the retinopathy of prematurity were low.

Denmark↗

[Periventricular cerebral hemorrhage in children with very low birth weights in the county of North Jutland. Retrospective study].

The object of this investigation was to determine the frequency of intracerebral periventricular haemorrhage in neonates with very low birthweights in an unselected material from the County of North Jutland. During the years 1988-1989 a total of 86 infants with low birthweights were born in the county. Intracerebral periventricular haemorrhage was diagnosed by means of ultrasonic scanning of the cerebrum and/or postmortem examination. Seven infants had to be excluded as neither of these examinations had been performed. The material thus consisted of 79 infants with a median weight of 1,196 gram (range 565-1,500 g) and a median gestational age of 30 weeks (range 25-37 weeks). Periventricular haemorrhage was found in a total of 13 infants, corresponding to 16% and the haemorrhages were found mainly in infants with gestational ages less than or equal to 29 weeks (32%). Haemorrhages with involvement of the parenchyma and/or dilation of the ventricular system comprised more than half of the cases of haemorrhage (8 out 13). The frequency of periventricular haemorrhage fell with gestational ages less than or equal to 30 weeks and the haemorrhages were less extensive. The respiratory distress syndrome and asphyxia were found to important risk factors for the development of periventricular haemorrhage.

Cerebral Hemorrhage↗

[Early onset of neonatal sepsis with non-encapsulated Haemophilus influenzae--a new problem in Denmark].

During the past decade an increasing incidence of neonatal septicaemia caused by non-encapsulated Haemophilus influenzae has been reported in both the USA and Europe. From the Danish county of Northern Jutland four cases are reported in premature infants. Respiratory distress and septicaemia were apparent within the first 12 hours after birth, and clinical findings were similar to early onset neonatal septicaemia caused by group B haemolytic streptococci or pneumococci. One neonate born at the 28th week of gestation died, and three other neonates of gestational age 30 to 34 weeks recovered. The non-encapsulated strains were sensitive to ampicillin and belonged to biotypes II, III, and V.

Denmark↗

[Phototherapy of newborn infants].

The effect of light treatment on neonates with jaundice was discovered in 1958. Since then, many hundred thousand infants have been treated with light. The presumed mechanism of effect is photo-excitation of bilirubin extravascularly in the skin with the formation of bilirubin isomers which can be excreted in unconjugated form in the bile and photo-oxidation products which can be excreted in the urine. The quantitative relationships have only been partially elucidated. Blue light is the most effective. Green light causes lowering of bilirubin but, on the basis of present knowledge, there is no basis to recommend this as ye. Intermittent phototherapy has limited distribution. If intensive phototherapy is required, double light is effective. No long-term side effects of light treatment have been observed but, during treatment, side effects in the form of diarrhoea, drowsiness and transient exanthemata may occur.

Bilirubin↗

Non-capsulated Haemophilus influenzae in the genital flora of pregnant and post-puerperal women.

Non-capsulated Haemophilus influenzae may cause neonatal septicaemia. Genital carriage of this pathogen was studied in 3 mothers of infected neonates and in 2 pregnant women in the first trimester. A carrier state in 2 of the females was terminated by antibiotic therapy after 3 and 7 months, respectively. A previous carrier had no recurrence of H. influenzae in a subsequent pregnancy. A survey of 544 parturient women revealed a carrier rate of 1.8/1,000 (95% confidence limits: 0.1-11). Carriage of non-capsulated H. influenzae is thus rare, and pregnant women may be successfully treated in order to reduce the risk of neonatal infection. There was no evidence of immunodeficiency in women with non-capsulated H. influenzae in the genital tract.

Adult↗

[Spontaneous perforation of the biliary tract during the neonatal period].

Spontaneous perforation of the biliary passages is a rare condition during the first months of life. The course of the condition may be acute or more chronic. The symptoms are jaundice, clay-coloured stools, dark urine, distended abdomen, regurgitation and failure to thrive. The diagnosis can be established by scanning of the abdomen and 99mTc-HIDA-scintigraphy of the biliary passages. The perforation is usually found to be localized to the transition between the cystic duct and the common hepatic duct and is probably due to a localized development defect in the biliary passages. Operation is always required. The prognosis is good and the infants do well after operation.

Age Factors↗

[Infantile constipation and Allomin-lactulose. Treatment of infantile obstipation in infants fed with breast milk substitutes. A controlled clinical trial of 2 per cent and 4 per cent Allomin-lactulose].

The Authors investigated the effects of Allomin with admixture of 2% and 4% lactulose on constipation in infants aged 0-6 months reared on breast-milk substitutes. The investigation was randomized and double-blind and was carried out during the period 1.4.1987-31.7.1988 on non-hospitalized infants in the counties of Funen and North Jutland in cooperation with the health visitors in these regions. Constipation was defined as hard and difficult defaecation and the trial period lasted for 14 days. Parents of the infants who participated classified the infants' motions according to consistence and degree of difficulty in defaecation on special forms. A total of 220 children participated and these received, after randomizing, either Allomin-lactulose 2% or 4% as the only breast-milk substitute during the period of observation. The effect of treatment was defined as "no constipation" i.e. all motions during 24 hours described as easy and of normal or thin consistence. In addition, the effect was measured by the parents' general impression of what the infant thrived best on. With both of the preparations, treatment was effective in over 90% of the infants in both the groups without significant difference. The effect occurred gradually and, in some cases, up to 8-10 days after initiation of treatment without significant difference in the rate of effect between the groups. After the effect had commenced, significantly fewer thin motions occurred in the 2% group than in the 4% group. 92% of the infants in the 2% group and 91% in the 4% group wanted to continue the Allomin-lactulose preparation rather than the usual breast-milk substitute. A retrospective questionnaire to parents of 97 infants who had continued with Allomin-lactulose 2% was answered by 84.(ABSTRACT TRUNCATED AT 250 WORDS)

Breast Feeding↗

[Intracranial hemorrhage in mature infants without predisposing factors].

Four mature infants developed intracranial haemorrhage at ages from ten hours to five weeks. No predisposing or provoking factors could be demonstrated. The symptoms were apnoea, vomiting, pyrexia, irritability, tremor, hypertonicity, seizures and tense fontanelle. The diagnosis was established by ultrasound scanning and confirmed by computed tomographic scanning. The infants developed hydrocephalus requiring treatment. During the period of observation, these infants showed normal psychomotor development and the neurological findings were normal.

Cerebral Hemorrhage↗

Basophil histamine release in the diagnosis of house dust mite and dander allergy of asthmatic children. Comparison between prick test, RAST, basophil histamine release and bronchial provocation.

The aim of the study is to compare the glass fibre-based basophil histamine release test with skin test (Phazet), RAST (Phadebas) and bronchial provocation test in children with allergic asthma. The study comprised 68 selected children with a case history of extrinsic allergic asthma to danders (cat and dog) and house-dust mite. Skin prick test, RAST, and histamine release were performed in all children and the bronchial provocation test was used as a reference of "true allergic asthma". A total of 81 allergen bronchial challenges were performed and 44 children experienced 49 positive provocations. In 2.9% (2/68) of the children histamine release could not be performed due to technical difficulties (low histamine release with anti-IgE). Concordances in the range 76-87% were observed with no significant difference between the tests. The highest concordance (87%) was found between histamine release and bronchial provocation test followed by skin prick test vs bronchial provocation (84%) and RAST vs bronchial provocation (80%). The sensitivity and specificity were calculated for each test. All tests showed sensitivities in the range 90-94% and no significant difference between them was observed. The specificity of histamine release, skin prick test, and RAST was 0.78, 0.69, and 0.63, respectively. The specificity of histamine release was better than RAST demonstrated by 95% confidence intervals. In conclusion, it was found that the histamine release test is a convenient diagnostic method and the study indicates a diagnostic value comparable to the common diagnostic methods in clinical allergy.

Animals↗

Gamma-aminobutyric acid concentration in lumbar cerebrospinal fluid from patients with febrile convulsions and controls.

The cerebrospinal fluid (CSF) concentration of the inhibitory neurotransmitter gamma-aminobutyric acid (GABA) was analysed in 41 children with febrile convulsions (FC), 41 febrile controls of similar age (control group 1), and 59 controls, who had no fever and/or were outside the age range for FC (control group 2). A significant correlation between CSF-GABA and age was demonstrated for controls (1 + 2) (r = 0.63, p less than 0.00001), as well as for patients with FC (r = 0.42, p = 0.003). Patients with FC did not differ significantly from control group 1 in respect to CSF-GABA. Duration of FC was related to both CSF-GABA and age (GABA: r = -0.29, p less than 0.05; age: r = -0.32, p less than 0.05). For 56 controls (1 + 2) greater than 1 year of age, a significant negative correlation between CFC-GABA and body temperature was found (r = -0.34, p = 0.01). The low CSF-GABA in the FC-labile age group, the negative correlation of CSF-GABA to body temperature, and the negative correlation of the duration of FC to both CSF-GABA and age, all indicate that GABA could be of importance in the pathophysiology of FC.

Adolescent↗

Polyhydramnios with maternal lithium treatment.

Severe polyhydramnios, probably due to fetal lithium toxicity, is described. The mother had been treated with lithium because of manic-depressive psychosis. The plasma lithium level during the pregnancy was in or below the therapeutic range. From the 26th week of gestation, polyhydramnios developed. In the 35th week, 11.5 L of amniotic fluid was removed over a period of 12 hours by transabdominal amniocentesis. A cesarean delivery was performed in the 39th week of gestation because of fetal distress. The infant presented with the following symptoms, which in previous reports have been associated with lithium toxicity: asphyxia, apnea, cardiac decompensation, respiratory distress, hypoglycemia, thrombocytopenia, diabetes insipidus, hypotonia, and convulsions. The polyhydramnios was probably caused by fetal diabetes insipidus, possibly combined with cardiac decompensation. Lithium can be toxic to the infant and the fetus even though the mother is not affected and has a normal or low plasma lithium level. Polyhydramnios may be a sign of fetal lithium toxicity.

Adult↗

Albumin binding of MADDS--a measure of bilirubin binding--in women during pregnancy and after delivery and in their infants.

The purpose of this study was to investigate the binding potential of MADDS (monoacetyldiaminodiphenyl sulphone) to albumin, a measure for binding of unconjugated bilirubin, in healthy women during pregnancy, during and after delivery, and in their infants. The serum concentrations of unconjugated bilirubin, reserve albumin for binding of MADDS and total albumin were measured in: (a) 21 non-pregnant women; (b) 16 pregnant women in the 16th-24th, 28th-32nd, and 36th-38th gestational weeks, and at the time of delivery from both mother and infant; and (c) 15 women at the time of delivery, and 24 and 72 hours after delivery. The bilirubin concentrations did not change during pregnancy or at delivery and were very small compared with the concentrations of reserve albumin for binding of MADDS and total albumin. Therefore, the ratio of reserve albumin to total albumin was an expression of the binding potential of the albumin for MADDS in women. During pregnancy, the reserve albumin decreased equal to total albumin, so that the ratio was not significantly changed (p greater than 0.05). In contrast, at delivery the reserve albumin was significantly lower (p less than 0.01) than in the 36th-38th gestational weeks, without any significant difference in total albumin, i.e. the ratio was significantly lower than during pregnancy (p less than 0.01). During the first 3 days after delivery the reserve albumin increased significantly (p less than 0.05), also without any significant change in total albumin, so that the ratio increased significantly (p less than 0.05) and was normalized. The binding potential for MADDS to albumin in newborn infants was even lower than that of their mothers. Since the binding-potential is reduced in both mother and infant at delivery, a relation is suggested.

Adolescent↗

Basophil histamine release in cord blood. Regulatory role of IgE.

Thirty-two cord blood samples were studied for histamine releasing capability by using a sensitive glass microfibre-based histamine analysis. Histamine was obtained after challenge with anti-IgE in 24 of the 32 samples. However, the net release in cord blood was only 25% of that in adult blood and no relationship was found between histamine release response, total IgE in cord plasma, and a family history of atopic diseases. The low histamine release in cord blood seemed to be associated with the immunological IgE receptor complex activation and not with an immature basic cell function, since the calcium ionophore A23187 which bypasses the receptor complex induced identical histamine release curves in cord and adult blood. Furthermore, when comparing the results of passive sensitization of basophils from new-born and adult persons, the new-born basophils possessed a significant fraction of free IgE receptors, whereas in adults most of the receptors were occupied by IgE.

Adult↗