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Biomedical subjects

H H Hellwege

Publications and source records attributed to H H Hellwege.

At least 19 recordsLinked to original sources
PubMed1992

Early treatment of respiratory distress syndrome with bovine surfactant in very preterm infants: a multicenter controlled clinical trial.

OBJECTIVE: To determine the effect of bovine surfactant (SF-RI 1, Alveofact) administered during the first hour following birth to very premature infants [gestational age (GA), 25-30 weeks] in a multicenter, controlled trial. HYPOTHESIS: Survival without bronchopulmonary dysplasia (BPD; definition: ventilator dependency or FiO2 greater than 0.3 during spontaneous respiration) at day 28 is increased in surfactant-treated infants (sequential analysis). PATIENTS AND METHODS: Thirty-four infants [GA 28.0 +/- 1.5 SD weeks, birth weight (BW), 1,048 +/- 299 g] received 50 mg/kg BW surfactant, whereas 35 infants (GA, 27.6 +/- 1.5 weeks, BW 969 +/- 269 g) served as controls. Retreatment with surfactant (up to three identical doses) 12-24 hours after the previous dose was permitted if FiO2 was greater than 0.5. RESULTS: Survival without BPD was significantly higher in surfactant treated infants (26/34) compared to controls (14/35; P = 0.003), but in the incidence of pulmonary air leaks, patent ductus arteriosus, intracranial hemorrhage, and nosocomial infections they were not different. CONCLUSION: Bovine surfactant treatment improves survival without BPD in very premature infants at risk for neonatal respiratory distress syndrome (RDS).

Bacteria↗
PubMed1991

Drug utilization in very premature infants in neonatal intensive care units.

Neonatal drug utilization in very premature infants (gestational age (GA) 24-29 weeks), requiring intubation and mechanical ventilation at birth was registered as part of a multicenter controlled clinical trial of high-dose versus low-dose bovine surfactant (initial doses 100 mg/kg birth weight (b.w.) versus 50 mg/kg b.w.). Drug utilization during 4 weeks after birth was analyzed in 164 infants (mean GA 27.2 +/- 1.2 (SD) weeks, b.w. 970 +/- 145 g (SD)). More than half of the study infants received antibiotics (98.8%), sedatives and analgesics (91.5%), sodium bicarbonate (78%), solutions for volume replacement (62.8%), methylxanthines (56.7%) and catecholamines (52.4%). It may be concluded that the pattern of drug usage indicates a high incidence of proven or suspected infections and circulatory and respiratory disorders reflecting the high-risk state of study infants.

Dose-Response Relationship, Drug↗
PubMed1991

Does prophylactic use of bovine surfactant change drug utilization in very premature infants during neonatal period?

The efficacy of a bovine surfactant preparation (SF-RI 1) to increase survival without bronchopulmonary dysplasia (BPD) was studied in very premature infants in a multicenter, randomized sequential trial. Thirty-four infants were randomized to surfactant treatment, whereas 35 infants served as controls. As part of the study, pharmacotherapy with antibiotics, sedatives, catecholamines, diuretics, methylxanthines, mucolytics, muscle relaxants, digoxin, and indomethacin was registered during week 1 and weeks 2-4. As to the endpoint of the study a significantly increased survival rate without BPD was observed in surfactant-treated infants (76%) compared to controls (40%). Significant differences concerning drug utilization were found through week 1 with increased use of methylxanthines in surfactant-treated infants, which persisted during weeks 2-4 as well as a reduced incidence of diuretic therapy in surfactant-treated infants during weeks 2-4. These differences may be attributed to the shorter interval of mechanical ventilation in surfactant-treated infants (11 days) compared to controls (27 days), and to the above mentioned increased survival rate without BPD.

Animals↗
PubMed1989

[Nightly home artificial respiration in juvenile Pompe's disease with pulmonary hypertension and right cardiac insufficiency].

A 17-year-old girl with type II glycogen storage disease (Pompe's) developed severe right-heart failure as a result of pulmonary hypertension due to, predominantly nocturnal, hypoventilation. At night the partial pressure of oxygen was only 30-50 mmHg, pCO2 70-100 mmHg. After persistent nightly intermittent positive pressure ventilation blood gases as well as electrocardiographic and echocardiographic findings have now--after 12 months--become normal and the patient has been completely restored to a normal life. This case demonstrates that life expectancy and quality of patients with chronic forms of Pompe's disease (and probably also with other chronic neuromuscular diseases) can be markedly improved by nightly artificial ventilation which reduces nocturnal hypoventilation and resulting pulmonary hypertension.

Adolescent↗
PubMed1987

Intra-atrial malpositions of Silastic catheters in newborns.

The intra-atrial position of Silastic catheters placed in the center of the right atrium was assessed by two-dimensional echocardiography in 25 newborns. In 32% of the infants, the catheter tip was located in the patent foramen ovale, and in another 40% of the infants, the catheter tip was located close to the patent foramen ovale. This placement increases the risk of systemic air and fat embolism. Consequently, the tip of Silastic catheters should be placed just behind the confluence of the superior-inferior vena cava and the right atrium.

Cardiac Catheterization↗
PubMed1987

Influence of positive end-expiratory pressure on cardiac performance in premature infants: a Doppler-echocardiographic study.

Because determining cardiac output is difficult in premature infants, little is known about the hemodynamic effects of PEEP in this age group. We used pulsed-wave Doppler echocardiography to assess the hemodynamic effects of PEEP increments in ten premature infants with respiratory distress syndrome. At a PEEP of 4 cm H2O, the systemic and pulmonary blood flow and the right (SVRV) and left (SVLV) ventricular stroke volume decreased slightly, while the systemic vascular resistance (Rs) increased slightly. At a PEEP of 8 cm H2O, cardiac performance was impaired significantly, with a profound decrease of the systemic and pulmonary blood flow, SVRV and SVLV and a reflectory increase of the Rs. Surprisingly, the heart rate and mean arterial BP remained constant. The effective left ventricular afterload, which takes into account the changing intrathoracic pressure, increased slightly with increasing PEEP.

Blood Flow Velocity↗
PubMed1985

[Neonatal meningitis caused by Streptococcus mitis].

We report on a female newborn, 37 weeks of gestational age, who - after normal pregnancy and delivery - fell ill with a neonatal meningitis caused by streptococcus mitis. Until now this bacillus has been thought to be apathogen. The disease was cured completely by Penicillin therapy. The infection of a healthy newborn caused by streptococcus mitis, a streptococcus viridans, has not been described before.

Bacteriological Techniques↗
PubMed1985

[Prenatal diagnosis and therapy of hemolytic disease of the newborn].

From 1966 to 1983 a total of 586 intra-uterine fetal transfusions on 268 fetuses suffering from severe Rh-erythroblastosis were performed at the Hamburg university hospital. 149 (56%) fetuses survived. 29% of 268 fetuses exhibited ascitic fluid at the beginning of therapy. The survival rate improved to 63% in the last five years. The diagnostic and therapeutic procedures are explained in detail. The amniotic fluid analysis has been improved. In addition to Rh-antibodies, it is important to detect other blood group antibodies such as anti-Jk(a) and anti-Fy(a), that can diminish the survival rate of the donor erythrocytes in the fetus.

Amniotic Fluid↗
PubMed1978

[Treatment of severe haemolytic-uraemic syndrome by dialysis (author's transl)].

Since 1973 haemodialysis was performed on 30 children with severe haemolytic-uraemic syndrome. Serial measurements were made of blood pressure, blood picture, renal function, complement values, excretion of fibrinogen split-products and beta2-microglobulin in urine. Of 22 children in the acute severe stage two died, in one case treatment having been started too late, in the other as a result of fulminating pneumococcal pneumonia. Twenty children survived without residual symptoms and with normal renal function. Of six children with severe progressive haemolytic-uraemic syndrome two developed terminal renal failure. In one child a renal transplantation has since been performed. One child requires chronic dialysis after nephrectomy. Three children died as a result of arterial hypertension, one of yeast septicaemia. Of two children with recurrent haemolytic-uraemic syndrome one developed terminal renal failure which was successfully treated by renal transplantation. One child died in a hypertensive crisis. The overall death rate of the group was 23%, in the group with the acute severe haemolytic-uraemic syndrome it was 9%. The results suggest that haemodialysis significantly improves the prognosis of severe haemolytic-uraemic syndrome.

Blood Pressure↗
PubMed1976

[Prevention of HBs antigen-positive serum hepatitis with hyperimmune-globulin anti-HBs].

Selection of donors to prevent HBs-antigen positive serum hepatitis has been only partially successful. For this reason the attempt was made to prevent the disease by passive immunisation with anti-HBs antibodies. A prerequisite for the systematic use of such immunisation is the determination of antibody threshold which would still provide protection. Plasma elimination of transmitted. HBs antibodies was serially measured in five children with terminal renal failure and ten normal subjects after intensive contact with HBs antibodies. Half-life values indicated marked individual variations which have to be taken into account with long-term prophylaxis. In the children they were 28.5, 25.9, 16.6, 11.7 and 7.8 days, respectively. In the healthy subjects the half-life averaged 20.3 days. The long-term programme developed by the authors appears to be suitable for revealing the value of hyperimmune-globulin anti-HBs in the prevention of HBs-antigen positive serum hepatitis.

Antibodies, Viral↗
PubMed1976

[Hypocomplementemic membranoproliferative glomerulonephritis in a child with ulcerative colitis (author's transl)].

A 5 1/2 year old girl with hypocomplementemic membranoproliferative glomerulonephritis suffered from severe nephrotic syndrome. Despite intensive treatment with corticosteroids and immunosuppressive drugs the clinical state deteriorated. Three years after clinical onset of the disease the girl entered our regular hemodialysis program because of terminal renal insufficiency. After two weeks of intermittent hemodialysis she presented intestinal bleeding, which could not be stopped. One week later complete ileus developed and the child died. Before the onset of melaena no occult blood or mucus could be detected in the faeces. The autopsy revealed a severe ulcerative colitis with pseudopolyposis of the whole colon. In serum specimens still available colonic antigen could be detected by means of immunodiffusion using a rabbit antiserum against fetal colonic extract. Immunofluorescence studies showed granular deposits of immunoglobulins and complement along the glomerular capillary walls suggesting an immunogenesis of the glomerulonephritis by circulating immune complexes. The possibility of an interrelationship in the pathogenesis of both diseases is discussed. It should not be excluded that immune complexes formed in excess of colonic antigen have caused or perpetuated chronic glomerulonephritis.

Autopsy↗