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Biomedical subjects

H B von Stockhausen

Publications and source records attributed to H B von Stockhausen.

At least 19 recordsLinked to original sources
PubMed2001

Randomized, multicenter trial of two different formulas for very early enteral feeding advancement in extremely-low-birth-weight infants.

BACKGROUND: In extremely-low-birth-weight (ELBW) infants, formula feeding is required if human milk is not available. The tolerance of a new 'high' lactose (55 g/L), low protein, low phosphate, hydrolyzed protein formula (HLF) for early enteral feeding advancement of ELBW infants was compared with that of a low lactose (1 g/L) hydrolyzed protein formula (LLF). METHODS: In a randomized multicenter trial, 99 ELBW infants were fed according to a standardized protocol beginning at 48 hours of age with 12 ml/kg daily increments. Primary outcome was the cumulative milk feeding volume (CFV) from days 3 to 14. The authors hypothesized that feeding HLF as a supplement to human milk would increase the CFV at least by 20% in at least 60% of matched pairs compared with LLF. A secondary issue was to investigate whether human milk would increase the CFV compared with formula. RESULTS: The CFV was 720 mL/kg (range, 0-962 mL/kg) with HLF and 613 mL/kg (range, 3-1,283 mL/kg) with LLF feeding. There was no 20% difference. On day 14, the median feeding volume was 103 mL/kg. The CFV was 533 mL/kg (range, 0-962 mL/kg) in infants who received less than 10% of human milk and 832 mL/kg (range, 74-1,283 mL/kg) in infants who received more than 10%. Necrotizing enterocolitis (Bell stage > or =2) occurred only with LLF feeding (n = 5; P < 0.05). CONCLUSIONS: The study failed to find the hypothesized 20% advantage of the new HLF. The observed advantage of human milk supports the hypothesis that it should be the first diet in ELBW infants; however, this hypothesis still must be confirmed in a controlled, randomized trial.

Enteral Nutrition↗
PubMed2000

Unusual pattern of leukoencephalopathy after morphine sulphate intoxication.

We report a 14-year-old girl with an unusual pattern of leukoencephalopathy after intentional intoxication with morphine sulphate tablets. Toxicological analysis showed exceedingly high levels of morphine and its metabolites. MRI disclosed a leukoencephalopathy with high signal from the centrum semiovale, corpus callosum and cerebellar white matter on T2-weighted images. These findings could be only partially explained by a hypoxic-ischaemic event; neurotoxic effects must be considered in this atypical leukoencephalopathy.

Adolescent↗
PubMed1998

Perioperative fluid and electrolyte management in children undergoing surgery for craniopharyngioma. A 10-year experience in a single institution.

In a retrospective study, the intra- and early postoperative data of 39 children with 46 operations for craniopharyngioma were analyzed. Diabetes insipidus (DI) occurred in 30 out of 32 cases without preoperative evidence of DI. We observed that all children who did not have a pituitary stalk preserved and 5 out of 7 patients with preserved pituitary stalk developed DI within 18 h of surgery. Short-term inappropriate secretion of antidiuretic hormone (SIADH) occurred in 2 children, but was quickly followed by DI. The time of onset of DI and SIADH did not correlate with sex, age, body weight, location of tumor, or duration or extent of surgery. Parenteral desmopressin was an effective treatment for intra- and postoperative DI. The duration of the clinical effect of desmopressin administration varied in different patients between 4 and 23 h. An approach to the immediate intra- and postoperative management of children with craniopharyngioma is presented.

Administration, Intranasal↗
PubMed1996

Chemiluminescence activity of phagocytes from tracheal aspirates of premature infants after surfactant therapy.

The effect of surfactant on the respiratory burst of phagocytic cells was studied in the tracheobronchial tract of 40 mechanically ventilated neonates (gestational age 24-37 weeks) over the first week of life. We measured the luminol-dependent chemiluminescence (CL) activity of granulocytes and macrophages isolated from tracheal aspirates in 23 preterm infants 1-6 days after administration of bovine surfactant and in 17 untreated controls. Following stimulation by the chemotactic peptide N-formylmethionylleucylphenylalanine, CL activity was not or only slightly impaired in the surfactant group. In contrast, treatment with exogenous surfactant significantly reduced CL response to opsonized zymosan (OPZ), which involves phagocytosis, for up to 6 days (p < 0.05). The impairment of CL activity seemed to be dose dependent, as repeated surfactant applications (cumulative phospholipid dose of 200 mg/kg) reduced OPZ-elicited CL activity to a greater extent than application of a single dose of 100 mg/kg. In agreement with in vitro studies, our data suggest that high-dose application of exogenous surfactant may affect the antibacterial function of phagocytic cells in the lung.

Dose-Response Relationship, Drug↗
PubMed1996

Immunologic parameters in cord blood indicating early-onset sepsis.

Different immunologic parameters were measured in cord blood to test their usefulness in the early diagnosis of early onset sepsis. Cord blood levels of circulating intercellular adhesion molecule-1 (cICAM-1), interleukin-6 (IL-6) and interleukin-8 (IL-8) were significantly elevated in septic compared to nonseptic neonates. No significant difference between either population was seen for cord blood C3a and elastase-alpha 1-proteinase inhibitor complex (E alpha 1 PI). Measured concentrations of cICAM-1, IL-6 and IL-8 in fetal and maternal blood did not correlate, indicating that the neonate's response to sepsis is clearly different from the mother. Our data suggest that cord blood measurements of cICAM-1, IL-6 and IL-8 might be useful in identifying neonates with early-onset sepsis.

Escherichia coli Infections↗
PubMed1996

Inappropriate secretion of umbilical plasma catecholamines in preterm compared to term neonates.

To investigate the gestation and stimulus related catecholamine secretion and degradation at birth free and sulfoconjugated adrenaline, noradrenaline and dopamine were analysed in the umbilical artery and vein of 35 preterm and 75 term neonates. A highly sensitive radioenzymatic assay was used for the determination of free catecholamine levels, sulfoconjugated catecholamines were analysed after addition of 25 mU arylsulfatase type VI. Levels of free catecholamines were significantly lower in preterm as compared to term newborns. Hereby, adrenaline levels significantly correlated with the gestational age, birth weight, and birth length. Sulfoconjugated catecholamine levels were similarly lower, but only sulfoconjugated noradrenaline reached differences of statistical significance. The placental extraction rate of adrenaline and noradrenaline was significantly lower in preterm as compared to term neonates. Only in term but not in preterm neonates, arterial pH- and pCO2-levels significantly correlated with arterial plasma catecholamine levels. Therefore, lower catecholamine levels in preterm compared to term neonates result from lower secretion of catecholamines rather than increased degradation and may contribute to their frequent surfactant deficiency. In addition, the inadequate and diminished catecholamine secretion of preterm neonates may play a significant part in their postnatal adaptation problems like hypoglycaemia, hypothermia and occurrence of wet lungs.

Apgar Score↗
PubMed1994

Plasma catecholamines after endotracheal administration of adrenaline during postnatal resuscitation.

To analyse the degradation of adrenaline after cardiopulmonary resuscitation of preterm neonates, free and sulphoconjugated adrenaline, noradrenaline, and dopamine were determined in 31 preterm neonates by a radioenzymatic method. Nine of the neonates received a high dose (250 micrograms/kg) of endotracheally administered adrenaline (1:1000); three of them had more than one dose of adrenaline. With the exception of sulphoconjugated dopamine, the free and sulphoconjugated catecholamine concentrations in preterm infants treated with adrenaline initially exceeded those in the untreated group. The concentrations decreased to the same range about two hours after birth. Free and sulphoconjugated adrenaline concentrations remained significantly increased in the adrenaline treated group, however, indicating a plateau effect. The correlation between free adrenaline and noradrenaline concentrations with their respective sulphoconjugated concentrations was highly significant. It is concluded that free catecholamines are rapidly degraded by sulphoconjugation in preterm neonates.

Cardiopulmonary Resuscitation↗
PubMed1992

Complement fragment C3a in plasma of asphyxiated neonates.

Recent clinical studies with adult polytrauma patients indicate that elevated plasma levels of anaphylatoxin C3a correlate with the subsequent development of the adult respiratory distress syndrome (ARDS). However, there are no parameters which allow a reliable diagnosis of ARDS in neonates. As the most predisposing condition for ARDS seems to be shock, plasma C3a was determined in 30 ventilated premature infants and neonates with respiratory distress syndrome (birth weights 660-3350 g) within the first 24 h post partum or 6-24 h after acute asphyxia or shock during the neonatal period. The range of C3a, measured by ELISA, was between 57 and 1000 ng/ml. In the asphyxia group (n = 15) peak levels of C3a in plasma (mean 388 ng/ml) were significantly higher (P less than 0.001) than in the control group (mean 153 ng/ml). In some neonates with suspected ARDS, additional samples were taken. A rise in C3a between days 2 and 8 was associated with a fatal outcome of the disease. As in adults, C3a might be a useful indicator for ARDS in neonates.

Asphyxia Neonatorum↗
PubMed1992

Polymerase chain reaction-amplification of urease genes: rapid screening for ureaplasma urealyticum infection in endotracheal aspirates of ventilated newborns.

Ureaplasma urealyticum infection has been considered to play an important role in the development of bronchopulmonary dysplasia (BPD) in premature infants. Since standard culture methods of U. urealyticum are difficult to perform, new rapid and sensitive methods are needed to detect lung infection of ventilated newborns. Here we describe the polymerase chain reaction as a rapid method to screen endotracheal aspirates for ureaplasma infection. Urease-specific sequences could only be detected in 1 out of 36 ventilated newborns. The procedure described in this paper may facilitate further studies to determine the role of U. urealyticum in development of BPD.

Bronchopulmonary Dysplasia↗
PubMed1991

[Dexamethasone in the treatment of bronchopulmonary dysplasia].

Dexamethasone has been reported to benefit premature infants with bronchopulmonary dysplasia. 13 ventilator-dependent premature infants (birth weight 780-1270 g) with chronic lung disease received dexamethasone 0.5 mg/kg/day with tapering doses over 3 weeks. Dexamethasone therapy was associated with a temporary increase in urine output and blood pressure. All infants showed a significant fall in oxygen requirement and an increase of total pulmonary compliance during the first week. The endotracheal tube was successfully removed in all infants with Northway stage I/II BPD within the first week of treatment and no infant relapsed. But in Northway stage III/IV, only 2/9 infants could be weaned from the ventilator during the first course of treatment and in the majority treatment led only to a temporary improvement of pulmonary status. In parallel to the improvement of lung function we found in 7 infants a decrease of the total cell counts, the ratio PMN/macrophages and albumin in relation to urea in the bronchial lavages with a secondary rise in cases of a clinical relapse. Free elastase and fibronectin/albumin ratio in the bronchial lavage did not correlate to the clinical course. Dexamethasone seems to have not only an effect on fluid balance but also on the alveolar capillary leakage and the PMN influx into the lung. This might explain the superior effect of dexamethasone in patients with Northway stage I/II BPD in comparison to infants with Northway stage III/IV.

Bronchoalveolar Lavage Fluid↗
PubMed1991

[Diagnosis of monozygosity in multiple births by DNA fingerprinting].

The incidence of monozygotic twins is one in 250 pregnancies. Triplets are estimated to occur in 1 of 86(2) pregnancies. Determination of zygosity may be done by comparison of physical characteristics, blood group or tissue typing, chromosome studies, or examination of various other polymorphic protein markers. Here we describe the differentiation between monozygotic and dizygotic twins and triplets by DNA-fingerprinting. This is a fast, non-invasive and reliable (error probability 0.003%) method to determine monozygosity of twins or triplets. It is also a reliable paternity test.

Cesarean Section↗
PubMed1990

Effects of highly overdosed indomethacin in a preterm infant with symptomatic patent ductus arteriosus.

We describe a preterm infant with severe idiopathic respiratory distress syndrome (iRDS, hyaline membrane disease) who needed artificial ventilation with high inspiratory pressure, high frequencies, 100% oxygen and developed a symptomatic patent ductus arteriosus (sPDA) in the course of the disease. The infant was given indomethacin to induce constriction of sPDA. Due to an error in drug dilution the patient received a 100-fold overdose of indomethacin. Compared to the normal study protocol side-effects such as renal failure were not observed probably due to sufficient fluid intake and good clinical condition prior to treatment and to the rapid and persistent ductal closure.

Drug Overdose↗
PubMed1990

Aluminium loading in premature infants during intensive care as related to clinical aspects.

Serum concentration and urine excretion of aluminium were examined during intensive care in 26 premature infants receiving long-time parenteral nutrition. In addition, aluminium content was analysed in all fluids and medicaments used for intravenous therapy and oral feeding. Several fluids for parenteral nutrition and milk formulae were highly contaminated with aluminium, especially serum conserves, human albumin, calcium gluconicum, and special diets for enteral disorders. Small premature infants have a predisposition to aluminium loading during intensive care. In 22 premature infants serum aluminium levels exceeded 10 micrograms/L. There was a significantly negative correlation between serum aluminium levels and gestational ages. Altogether, infants with high aluminium levels showed significantly more complications, especially bronchopulmonary dysplasia, necrotizing enterocolitis, cholestasis, and osteopenia.

Aluminum↗
PubMed1988

The effect of feeding human milk and adapted milk formulae on serum lipid and lipoprotein levels in young infants.

The effect of feeding with human milk and commercially available milk substitutes was studied in a group of 154 healthy infants during the first 3 months of life by assessment of body weight, body length, head circumference, skinfold thickness, serum lipid and lipoprotein concentrations. Human milk and the different milk formulae have the same energy content (kcal/100 ml) and total fat, total protein and total carbohydrate contents are comparable but they differ in respect of their fatty acid compositions. The various diets were chosen freely by the parents and the newborns were exclusively fed either human milk (n = 56), Multival 1 (n = 31), Humana 1 (n = 33), or Pre Aptamil (n = 34). No significant differences in body weight, body length or head circumference were observed between any of the different dietary groups. Fat storage, as assessed by measurements of skinfold thickness, was significantly less in breast-fed children compared to those on the formula diets. Breast-fed and Pre Aptamil-fed infants had the highest levels of total serum cholesterol, low density lipoprotein (LDL)-cholesterol and LDL. No differences were observed in the levels of total serum triglycerides, very low density lipoprotein (VLDL)- and high density lipoproteins (HDL)-cholesterol, VLDL and HDL. There were no strong correlations between the physical and the biochemical parameters. No indication of an increased risk of developing atherosclerosis was associated with any of the dietary treatments for the duration of this study. However, these investigations support the hypothesis that subtle early nutritional variation can influence mechanisms that regulate lipoprotein and cholesterol levels in later life.

Adipose Tissue↗