[The compliance of the respiratory system in healthy and respiratory ill newborns after birth and its prognostic value for ventilatory support (author's transl)].
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Humans↗
Biomedical subjects
G Simbruner
Publications and source records attributed to G Simbruner.
Evidence of H2 receptor activity on glomerular cells.
The role of histamine in physiological and pathological states has not been fully elucidated. In the pathological state histamine release can be induced by several mechanisms. The most frequent events are IgE-mediated release, complement-mediated release and release by chemical agents. During inflammation histamine is set free and contributes to the course of inflammatory processes, either enhancing or inhibiting inflammatory reactions. In order to look for a target in the glomerulum we examined H2 receptor binding to isolated glomerular cells using 3H-cimetidine as ligand. Two binding sites were detected, a low affinity site with a kD = 6.3 microM and a high affinity site exhibiting a kD = 0.18 microM. These findings are comparable to properties of 3H-cimetidine receptor binding to brain membranes.
Animals↗
[Dynamic surface tension measurements and L/S-ratio in amniotic fluid before birth in comparison with the respiratory compliance of the newborns immediately after parturition (author's transl)].
In 65 pregnant women between 27th and 42nd gestational week amniotic fluid was collected on average of 4,2 hours before birth and its amount of surfactant determined by means of the dynamic surface tension measurement in the Wilhelmy-balance and the L/S-ratio. These values were compared to the respiratory compliance of the newborns after birth. The respiratory compliance was measured by means of the airway occlusion technique. So far the measurement of dynamic surface tension has made it possible to predict the lungmaturity and the incidence of RDS. Our study for the first time describes a quantitative relationship between the surface tension of the amniotic fluid and the surface tension of the lungs in form of the respiratory compliance. The surface tension, measured by the Wilhelmy-balance, was better correlated (r = -0.85) than the L/S-ration (r = 0,58) with the respiratory compliance of the newborns. The surface tension measurement allows therefore a better prediction of the severity of the RDS than the determination of the L/S-ratio. This can be explained by the fact that the surface tension measurement in the amniotic fluid represents the total effect of SAM (Surface active material) while the L/S-ratio represents only about 60% of SAM. On the other hand the L/S-ratio gave a better correlation to the general maturity of the fetus than the surface tension; therefore we consider that the L/S-ratio is partially influenced by the lungmaturity and partially by gestational age of the fetus.
Amniotic Fluid↗
[Chronic fetomaternal bloodtransfusion with signs of heart failure (author's transl)].
A case of chronic fetomaternal bloodtransfusion with signs of heart failure is described. More than 200 ml blood were lost into the mother's circulation. Heartfailure did not fully account for the marked enlargement of the liver and the slight splenomegoly, so that reactivation of the extramedullary erythropoesis presumably was an additional causative factor for it.
Anemia, Neonatal↗
Transcutaneous blood gas measurement using a mass spectrometer.
We use a Perkin Elmer MGA 1100 mass spectrometer modified for blood gas tension measurements to study transcutaneous measurements of oxygen, carbon dioxide, nitrogen and helium in normal subjects. We use an aluminum sampling chamber heated to 42--44 degree C and connected to the mass spectrometer by about 2 m of stainless steel tubing. The sampling area of 5 cm2 is covered with a polytrifluorochloroethylene membrane 18 micrometer thick (Allied Chemical Co., Aclar 33c). The membrane is supported by sintered stainless steel disc with a thermistor incorporated for measurement of "membrane" temperature. The chamber is heated with a printed circuit heater (Minco) and is temperature regulated by a servo circuit. We have used the system to measure, O2, CO2 N2 and He via the heated skin in four normal subjects, breathing air and then 100% oxygen. We also observed the response to a single breath of helium. Helium appears at the skin within 10--15 sec. The time constant of its disappearance is about 70 sec. The average uncorrected gas tensions which we obtained breathing air were 11.2 kPa for oxygen, 5.1 kPa for carbon dioxide and 67.1 kPa for nitrogen. The corresponding values breathing oxygen were 41.1 kPa for oxygen, 4.4 kPa for carbon dioxide and 13.1 kPa for nitrogen.
Blood Gas Analysis↗
[Birth weight and gestational age in the indication for CPAP (Continuous Positive Airway Pressure) therapy].
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Birth Weight↗
[Timing of a letal intracranial hemorrhage by means of the HbA/HbF ratio (author's transl)].
Possibilities and limits of the method for timing an intracranial hemorrhage by means of the HbA/HbF erythrocyte ratio are investigated in six newborns. The effect of labeling HbF erythrocyte containing newborn blood by transfusion and exchange transfusion of HbA erythrocyte containing donor blood as well as "self-labeling" after the first transfusion as a result of HbA--and HbF erythrocytes decaying at a different rate, is described. If a coagulum can be clearly allocated to the blood where it originates from, depends a) on the alteration of the HbA/HbF erythrocyte ratio by the above mentioned ways of labeling and b) on the size of the sample i.e. on the number of erythrocytes counted to determine the HbA/HbF erythrocyte ratio. The confidence limits of the HbA/HbF erythrocyte ratio for a given number of counted erythrocytes have been determined. It was taken into account whether the blood was labelled by a transfusion or by "self-labeling". The analysis of the period before, during and after the intracranial hemorrhage made a preliminary evaluation of etiological factors and some symptoms possible. The hypothesis that sodium bicarbonate dosages of 8 mEqu/kg/24 h are an important cause of intracranial hemorrhage has to be rejected on the grounds of this study's results.
Cerebral Hemorrhage↗
[Bloodvolume determination in the newborn using blood of adults as an indicator (author's transl)].
A method allowing the determination of the bloodvolume of newborns by means of transfused blood of adults, is presented. Hb A containing erythrocytes of the adult can be distinguished from mainly Hb F containing erythrocytes of the newborn by means of the Kleihauer staining method. The ratio of the red blood cell volume of the donor to that of the patient is represented by the ratio of Hb A to Hb F containing erythrocytes. Bloodsmears taken before and after transfusion are stained with the "Fetal Hemoglobin Set" (BOERINGER), then photographed and approximately 1000 cells counted on the photo. The bloodvolume is calculated from the dilution of Hb A-containing in Hb F-containing erythrocytes. The reproducibility of the method was tested on 10 newborns, who were transfused twice and whose bloodvolumes were determined four times (two correlating bloodvolumes twice). The error of the method lies between 7.5 and 10% of the total bloodvolume. While an optimal determination of the bloodvolume through the first transfusion is already obtained by counting about 1000 cells, increasing the number of counted cells raises the quality of the bloodvolume determination through further transfusions. The bloodvolumes found are lower than those described in the literature. Its causes are discussed.
Blood Transfusion↗
Prospective and retrospective examination of an easily applicable score to predict the probability of premature birth defined by weight.
An easily applicable score to predict the risk of prematurity (Tab. I) (defined by weight) is examined prospectively (scoring during 6 th month of pregnancy) in 431 and retrospectively (obtained after delivery) in 1183 pregnancies. In the prospective study (Tab. II) 71.4% of all pregnancies resulting in babies below 2501 g exceed the proposed 50 points risk probabilty limit whereas only 18.7% of pregnancies with babies of more than 3000 g do so. Excluding pregnancies with 20 or more risk points and excellent prenatal care (8 or more consultations) - which should change the outcome of risk-pregnancies - the percentages are 77.8% and 12.2% respectively (Tab. III). Pregnancies resulting in babies with birth weight of 2501 g -2750 g exceeded the limit in 38.9% and those with babies of 2751 g-3000 g in 20.7%. If 60 risk points are used as the limit the percentages for more than 3000 g until less than 2501 g would be 8.2%, 6.9%, 33.3% and 66.7%. In the resrospective study (Tab. V) 14.7% of all pregnancies with babies above 3000 g exceeded the 50 risk points limit compared with 57.2 of those with babies below 2501 g. Excluding pregnancies with 20 or more risk points and excellent prental care the percentages are 7.6 and 59.4 respectively. In the retrospective study the influence of the quality of prenatal care by the number of consultations (3-4; 5-7; 8 or more) is clearly demonstrable: Pregnancies with more than 50 risk points resulted in 80.7%, 57.1% and 19.8% depending on the quality of care in babies below 2501 g. Pregnancies with 31-50 risk points did so in 47.2%, 20.4% and 11.8%. In 334 women the score could be applied twice, in the 6th month and at delivery. Comparing both scores it was found that only 1.8% of these women exceeded the 50 risk points limit by events occurring after the 6th month scoring (Tab. IV). The score, simple enough to be applied by nurses and midwives, seems to be able to select 77.8% of pregnancies resulting in babies below 2501 g already during the 6th month of pregnancy, i.e. early enough for preventive measures to be taken that decrease the frequency of underweight births by three quarters.
Birth Weight↗
A fluidic-controlled, miniature respirator with a new positive airway pressure device.
A simple and miniature respirator was developed providing controlled ventilation and application of a positive airway pressure. The positive airway pressure is achieved by an airflow through a canula into the airways. During expiration the direction of this insufflated air-flow is changed and the dynamic pressure necessary for it manifests itself as a positive airway pressure. Mechanical ventilation functions according to the principle of the Ayre-T-Piece: flow direction and, therefore ventilation, is controlled by occlusion of the expiratory limb. Occlusion is brought about by inflating a balloon. The inflation of the balloon is controlled by fluidic-circuits. They allow setting of frequency, duration of inspiration and pressure limit. As the above mentioned system for creating a positive airway pressure is integrated, mechanical ventilation with PEEP is achieved. Tests on a lung model were performed to establish the variables which influence the amount of positive pressure produced by an air-flow through a canula into a tube. Results indicate that the positive pressure obtained is inversely correlated to the diameter of tube and canula and varies with the angle of inflow (Tab. I, II, Fig. 4). The pressure-rise-velocity depicted in Fig. 5 suggests that sighing is possible in an open system. On an anencephalic newborn pressure-flow-ratios were established (Fig. 6). Pressure-time curves during spontaneous breathing, CPAP assisted breathing and sighing combined with CPAP were recorded in a 3 month old baby (Fig. 7, 8, 9). The discussion states the technical performance of the respirator (frequency 100/min-1/3 min., tidal volume 5-100 ml, controlled ventilation with pressure limitation, application of PEEP) and additional advantages (no apparatus deadspace, disposable i.e. sterile air supply-system, the miniature dimensions 10 x 10 x 5 cm, versatility and simple therefore technically reliable construction).
Humans↗
Neonatal respirator allowing simultaneous ventilation and suction.
A new type of respirator for newborns allowing tracheal suction and ventilation simultaneously is presented. Additional characteristics are: a partly disposable air supply system, no apparatus deadspace and with one exception no moving parts. The performance of the respirator under varied conditions of lung mechanics was tested using a pneumatic lung thorax analogue. The procedure of tracheal suction was simulated and the effect on tidal volume and alveolar pressure investigated. Triggervolume and response time were also determined. Analysis shows that the respirator has qualities of flow- and pressure preset ventilators. Tracheal suction during ventilation does not impair the delivery of tidal volume. In mechanical ventilation with PEEP the alveolar pressure remains positive throughout the respiratory cycle despite suction.
Humans↗
[Wilson-Mikity-syndrome in twins (author's transl)].
The course of a Wilson-Mikity-syndrome in biovular twins born 19 weeks prematurely is reported. The disease started in the second week of life, reached its peak in the ninth week and it was complicated by a bronchopneumonia as well as a spastic bronchitis resulting in cardiac failure in both infants. On infant suffered spontaneous fracture of the ribs. Both patients were stationary for 26 weeks and 31 weeks respectively. A routine-examination at the age of 1 year revealed still distinct lung abnormalities, but nevertheless showing a tendency of improvement. Signs of right ventricular hypertrophy were found in the ECG of both children but more distinctly in the girl. The neurological development of the infants were found to be normal.
Bronchitis↗
[A scheme for RDS-prediction (author's transl)].
The presented scheme combines perinatal data through a formal-logic conclusion to a prediction concerning the occurrence of a respiratory disease, respiratory symptoms within the first 6 postnatal hours, RDS and death from RDS. The quality of prediction was examined on 140 prematures by calculating predictiv value, sensitivity and specificity of the selectiv scheme. In addition the prognosis for the selected groups was determined at four different times.
Birth Weight↗
Fluorescence angiography of the paramacular retinal vessels and altered glomerular basement membrane in children with juvenile onset diabetes mellitus.
Eighteen diabetic children aged between 8.5 and 16.5 years (mean 12.5 years) who had been diabetic for 1 to 10 years (mean 4.1 years) were examined for their urinary glomerular basement membrane (GBM) antigen excretion by means of immunoelectrophoresis and for alterations of the retinal vessels by fluorescence angiography. None of these patients showed albuminuria or hypertension. As compared to 40 healthy controls aged between 5 and 17 years, altered GBM antigen mobility (alpha-1) was found in 9 out of these 18 diabetics, whereas the remaining 9 children had normal GBM antigen mobility (alpha-2). Pathological fluorescence angiography findings on the other hand were evident in 7 children with altered GBM mobility, but only in 4 diabetics with normal GBM antigen mobility. This trend reflects the similarity of biochemical and functional characteristics of basement membranes in the retinal and kidney vessels supporting the well established association of vascular changes in both organs in patients with diabetes mellitus. GBM antigen excretion into urine could be useful for detecting early microvascular alterations in the kidneys in juvenile diabetics where diagnosis of early glomerulosclerosis is important.
Adolescent↗
[The anion gap--screening for hyperlactatemia in critically ill children?].
Serum lactate provides important information about tissue perfusion in critically ill patients. Aim of this study is to evaluate anion gap as a screening method to detect hyperlactatemia at a pediatric intensive care unit. In infants and children of different ages and diagnosis we determined blood gases, electrolytes and lactate. Sensitivity of anion gap was increasing with increasing hyperlactatemia. For the total population the test exhibited a sensitivity of 64% and a specificity of 76%, respectively. The power of anion gap as a screening method to detect hyperlactatemia was similarly fair for all age groups. Therefore hyperlactatemia has also to be included in the differential diagnosis of non-anion gap metabolic acidosis.
Acid-Base Equilibrium↗
[New aspects in the treatment of patent ductus arteriosus in premature newborns with respiratory insufficiency].
The efficacy of prolonged indomethacin treatment of sPDA was studied using a new, diagnostic method, the two-dimensional Doppler echocardiography (2-DDE). 35 ventilated preterm infants with sPDA (gestational age: 31.6 +/- 2.6; birth weight: 1535 +/- 565 gms) were studied prospectively. Therapy consisted of a loading and maintenance dose (3 x 0.3 mg/kg I. 12 h, 2 x 0.15 mg/kg I. 24 h). Therapy was initiated at postnatal age 1 to 17 days. Echocardiographycally verified closure of sPDA was achieved in 27/35 patients (77%), one patient had a relapse (4%), 8/35 (23%) did not respond to indomethacin. Responders were treated earlier (4.5 vs 9.6 days), were ventilated over a shorter period (30 vs 57 days) and exposure time to more than 30% of FiO2 was shorter (28 vs 56 days). Prolonged indomethacin is an effective treatment of sPDA in ventilated prematures. Early start of therapy increases rate of closure. For precise diagnosis of hemodynamic effectiveness 2-DDE method is mandatory.
Drug Administration Schedule↗
[Ambroxol versus betamethasone for stimulating antepartal lung maturity--a multicenter study].
In a multicenter, randomized double-blind study, the effect of Betamethasone and Ambroxol, both used for prenatal prevention of RDS in premature and newborn infants, is compared in a total of 185 patients with premature labour or an induced termination of pregnancy between the 28 and 36th week of gestation. The Ambroxol group of 93 patients is reduced to 77 due to a break up of therapy in 16 patients. The Betamethasone group is likewise reduced from 92 to 85 due to a break up of therapy in 7 patients. The main reason for breaking up therapy in these patients is the impossibility of stopping labour and delivery within 72 hours after admission to the hospital. Both treatment groups show no significant differences with regard to age, weight, history, rate of premature rupture of membranes, gestational age at beginning of therapy and at time of delivery, mode of delivery, rate of tocolytic therapy and prematurity. RDS morbidity, established by a standardized evaluation of the infants considering X-ray, clinical and blood-gas analyses findings, is 9% (7 out of 79 infants) in the Ambroxol group, and 6% (5 out of 86 infants) in the Betamethasone group. Statistically seen, the difference between the two groups is insignificant. Amniotic fluid analyses carried out in a total of 46 patients of both groups show increased surfactant parameters after therapy as compared to initial values before therapy. A significant difference between the two groups is not manifest. The objections against corticosteroids regarding there indications and side effects are generally known. The results of this study indicate that Ambroxol compared to Betamethasone can be considered as an effective drug for prevention of neonatal respiratory distress syndrome.
Ambroxol↗
Breathing pattern and efficiency of the respiratory muscles in healthy prematures and in prematures with respiratory distress syndrome.
The relationship between the compliance of the respiratory system (Crs), measured by mouth occlusion technique, and the the breathing pattern, the central inspiratory activity, and the performance of the respiratory muscles respectively, was studied in healthy prematures and in prematures presenting with the respiratory distress syndrome. With decreasing Crs, respiratory rate, instantaneous minute-ventilation, airway pressure at 0.1 s after end-expiratory occlusion (P0.1), effective inspiratory impedance, the average rate of change of the pressure generated during the inspiratory effort against closed airways, and the work of breathing increased; inspiratory and expiratory times decreased overproportionally. We conclude that the changes in lung mechanics predispose prematures with a Crs of less than 1 ml X cmH2O-1 to develop respiratory failure because they cannot perform the respiratory work demanded by intact central regulation mechanisms.
Airway Resistance↗