The increasing incidence of drug abuse in central Europe leads to a growing number of children with intrauterine drug exposure. During pregnancy various risks affect these children. Postnatally severe symptoms of withdrawal are observed frequently. The psychosocial development is endangered. Between 1986 and 1990 30 drug dependent women attended the obstetric department of the University Hospital Basel during pregnancy. The data of 21 children born to mothers drug dependent at birth were evaluated. 11 children were born in 1990. 12 mothers received Methadon, 10 were polydrug abusers. Positive serology was found for hepatitis in 18, for HIV-infection in 9 women. 6 babies were premature, 8 were small for gestational age. 20 newborns presented withdrawal symptoms which required a mean hospitalization time of 45 days. Tonic and/or clonic seizures were observed in 6 neonates. In 9 other children some symptoms were suspicious of seizures. EEG recordings were pathological in 10 of 12 infants. For the control of withdrawal symptoms 16 children received pharmacological treatment for a mean duration of 61 days. Neurodevelopmental examinations were performed in 14 children at an average age of 22 months. Neurological findings were pathological in 2 children. 3 had mild, 2 had severe mental retardation, 5 presented with behavioural disturbances. Our data are compared with those of the literature. Therapeutic proposals for children of drug dependent mothers are presented. The impact of methadon programs on the exposed children is discussed.

Dose-Response Relationship, Drug↗

PubMedDate not supplied

Non calcific vasculopathy in the basal ganglia.

Stripes of high echogenicity in the basal ganglia of infants have been rarely observed on cerebral ultrasound. These lesions, which appear to be due to a non calcific vasculopathy, are caused, in the majority of cases, by congenital infections and trisomy 13. We describe four infants with the characteristic ultrasonic appearance of this vasculopathy. Two children had cytomegalovirus (CMV) infection, one a human immunodeficiency virus (HIV) infection. The fourth child who presented a malformation of the skull and eye anomalies had no definitive diagnosis. Of the three surviving children one was developing normally. One had mild and one severe psychomotor retardation.

Basal Ganglia↗

PubMedDate not supplied

[The slit ventricle syndrome--causes, differential diagnosis and therapeutic problems].

Shunt dependent patients with clinical signs of shunt malfunction and slit ventricles on computerized tomography could suffer either from low pressure or from a slit-ventricle-syndrome with increased pressure. In such cases we recommend a lumbal punction with pressure monitoring to make the diagnosis certain. In case of increased pressure we firstly inject 0.9% NaCl into the proximal part of the ventricular catheter to remove it's obturation. Sometimes shunt revision can so be avoided in the slit-ventricle-syndrome.

Adolescent↗

PubMedDate not supplied

[Craniocerebral dysproportion--a contribution to the significance of extracerebral fluid collections in infancy].

By cranial ultrasound extracerebral fluid collections with a thickness of more than 5 mm were diagnosed in 101 infants under 1 year of age (jan. 84-dec. 85). Well-known etiologic factors were found in many cases (subdural hygroma, bacterial meningitis, shunt-dysfunction, congenital malformations, ACTH-therapy). In 38 children with normal clinical and neurological aspect no definite cause could be detected. In case of normal head circumference we consider this state as a variation of the norm. In case of macrocephalus (greater than 97th percentile) we propose the terminus "cranio-cerebral dysproportion". Possible etiologies, diagnostic procedures and differential diagnosis are discussed. The knowledge of this benign condition is important to prevent children from unnecessary diagnostic and therapeutic procedures.

Atrophy↗

PubMedDate not supplied

[Prognostic value of cerebral angiography].

After a 5 years' experience of cerebral sonography (about 4,500 recordings) in infants we are trying to establish correlations between alterations of anatomical structures and the further clinical development. Obviously there is no constant connexion between a simple subependymal haemorrhage and the further neurological symptoms. At the age of two and more years, about 30% had a normal state, the other part had very different clinical signs. Even an uncomplicated ventricular haemorrhage had no definite influence on the child's development in most cases. Ischemic infarctions seem to have a better prognosis than borderline-infarctions. Real intracranial cysts and slight brain atrophy seem to have only distinct neurological symptoms. Porencephalic defects or brain necrosis, e.g. after parenchymatous haemorrhages and infarctions as well as generalized hypoxic encephalopathies with increased echogenicy and progressive brain atrophy nearly always showed neurological defects, though the dimension of the brain's alteration does not clearly correlate to the clinical symptoms and the child's development. It is not possible to make a prognostic evaluation by cerebral sonography in hypoxic-ischemic brain-lesions within the first 3 weeks post partum. A more exact judgement will be given after further regular sonographic observations in all high-risk infants within the first year. Beyond this, technical and organisation-improvements will probably allow a more exact statement in future.

Brain↗

PubMedDate not supplied

[Spinous process osteomyelitis of the thoracic vertebrae 10 and 11 in a newborn infant].

A case of a newborn with osteomyelitis of the spinous processes 10 and 11 is presented. The first clinical sign was a dorsothoracal abscess. Radiologically a destruction of the 10th, later also the 11th spinous process could be demonstrated. Staphylococcus aureus was isolated. The clinical course was mild. The pathogenesis of the disease is discussed. Such a case of newborn osteomyelitis has apparently not been described in the literature.

Abscess↗

PubMedDate not supplied

[Sonographic position and functional diagnosis of ventricular positioned shunt systems in infants with hydrocephalus].

By cranial sonography through the open fontanelles of infants with hydrocephalus a diagnosis of position and function of ventricular shunts is possible. A malposition of the ventricular catheter was diagnosed sonographically in 11 of 55 patients after primary shunting. Complications after shunting as overdrainage or shunt insufficiency could be demonstrated early and reliable. Controls in due course are diagnostically important. The number of computerized tomographies in infants with hydrocephalus can be reduced significantly. In order to reduce complications after shunting an intraoperative sonographical control of catheter position is intended.

Cerebral Ventricles↗

PubMedDate not supplied

[The tethered cord syndrome].

The "tethered cord syndrome" as a complication of spinal dysraphism is probably more important than assumed earlier. An abnormally low position of the conus medullaris is caused by different anomalies: e.g. adhesions, lumbosacral lipoma, tight filum terminale. In some patients no skinny changes can be detected. A "tethered cord syndrome" should be considered, if neuromuscular skeletal changes as club-foot, scoliosis, muscular atrophy of disturbances of gait, sensibility or function of bladder and rectum are recognized. It is also a result of a inadequately operated meningomyelocele. For experienced examiners sonography is an interesting non-invasive diagnostic procedure during infancy. The diagnosis should be completed by spinal computerized tomography and myelography. Surgery should be performed prophylactically. The "tethered cord syndrome" is explained by case histories of the University Hospital of Children, Freiburg.

Child, Preschool↗

PubMedDate not supplied

[Lung function during tocolysis with beta-stimulators and beta-1-blockers].

The pulmonary function during pregnancy is foremost changed by the elevated diaphragm, which reduces the functional residual capacity. The lungs are less extended, so that the airway resistance increases. The application of a beta-mimetic drug for tocolytic therapy could reduce the airway resistance. Because an additional selective beta-1-blocking drug for cardioprotection could interfere with this effect, the pulmonary function in pregnancy during tocolytic therapy was investigated by body plethysmography in 20 woman of the third trimester of gravidity. There were no apparent differences in the pulmonary function in these woman when an additional selective beta-1-receptor blockade was performed. The airway resistance even diminished during the beta blockade. This unexpected result is probably due to an stabilizing effect of the betablocker on the body fluid and the permeability of capillary membranes during tocolytic therapy.

Adrenergic beta-Agonists↗