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Biomedical subjects

H Versmold

Publications and source records attributed to H Versmold.

At least 37 records · Page 2Linked to original sources
PubMed1995

[Extracorporeal membrane oxygenation of the newborn infant--an example of interdisciplinary project management].

In the last three years an interdisciplinary ECMO (extracorporeal membrane oxygenation) team has been set up at the Free University of Berlin in the Steglitz clinic. With this form of management, newborns only a few hours or days old who present with pulmonary failure can temporarily be managed with extracorporeal oxygenation until normal lung function is restored. The set up of this ECMO team, starting with experimental training in animal models, to the bedside clinical use is discussed. The following presentation of the first four cases managed here with ECMO aims to clarify the problems which may be encountered as well as amplifying its use as a life-saving measure.

Asphyxia Neonatorum↗
PubMed1995

Natural course of retinal development in preterm infants without threshold retinopathy.

In a consecutive series, 209 preterm infants with birth weights below 1501 g or a gestational age of < or = 32 weeks were observed. Stage 3 retinopathy of prematurity (ROP) developed in 48 infants (23%) of between 32 and 46 weeks postconceptional age (PCA; mean, 37 weeks). Stage 3 ROP was not seen before 6 weeks after birth. Threshold ROP was seen and treated at between 34 and 42 weeks PCA (mean, 38 weeks PCA; n = 22, 10.5%). A subgroup of 126 untreated infants were followed until complete retinal vascularisation. At estimated term, 38.7% of eyes with vessels ending in zone 3 at the first examination showed complete vascularisation as compared with 17.6% of eyes with vessels ending in peripheral zone 2 and none of those with vessels ending in central zone 2. Occurrence of ROP delayed retinal development. At estimated term, no eye with any stage of ROP showed complete vascularisation as compared with 35.4% of eyes without ROP. Regression of stage 3 ROP below threshold started in all cases before 56 weeks PCA.

Cryosurgery↗
PubMed1995

The influence of lung injury due to mechanical ventilation on the initiation of ECMO.

Before the entry criteria for extracorporeal membrane oxygenation (ECMO) are met, newborns may require aggressive mechanical ventilation which may result in lung injury. The question arises whether the presence of a pneumothorax in these infants plays a role in the prognosis. Of the 21 newborns transferred to our hospital for ECMO, 8 were treated with ECMO. 9 of the 21 newborns developed a pneumothorax with conventional ventilation and 6 of these 9 newborns subsequently required ECMO. Infants who developed a pneumothorax but did not meet ECMO criteria and remained in the oxygenation index (OI) range between 25 and 40 for more than 2 days had a poorer prognosis. If adequate oxygenation cannot be attained with acceptable mechanical ventilation and a more aggressive ventilation results in a pneumothorax, ECMO should be considered even if the oxygenation index is below 40.

Blood Gas Analysis↗
PubMed1995

[Evaluation of published recommendations for screening studies of retinopathy of prematurity].

PURPOSE: Evaluation of different and partially contradictory guidelines for screening for retinopathy of prematurity published in Germany. PATIENTS: The data on 1219 preterm infants examined in Bern (n = 900) and Berlin (n = 319) were analyzed. A total of 680 preterm infants (56%) had a birth weight below 1500 g. The remaining infants were examined because oxygen had to be supplied or surgery done before or around the estimated delivery time. RESULTS: Stage 3 retinopathy was found in 88/1219 (7.2%) preterm infants. Only 5/88 infants weighed more than 1500 g at birth. Three of these infants had a birth weight below 2000 g and needed supplemental oxygen for a prolonged period of time. The other 2 infants had birth weights of more than 2000 g and were severely ill. Of 1219 preterm infants, 37 (3%) developed threshold retinopathy (according to the criteria of the multicenter trial); 35/37 infants weighed less than 1230 g at birth. The remaining 2 children (1650 g and 2185 g birth weight) were severely ill. CONCLUSIONS: Preterm infants should be screened for retinopathy of prematurity: (1) if the birth weight is below 1500 g; (2) if the birth weight is below 2000 g and oxygen supply was necessary for more than 30 days; (3) if infants are very sick or must undergo multiple surgery before term. The first examination should be scheduled for the 6th week postnatal and not before 31 weeks postmenstrual age.

Berlin↗
PubMed1992

Short-term outcome in infants with birth weights less than 1750 g born to mothers with HELLP syndrome.

Premature infants born to mothers with HELLP syndrome were reported to have a less favourable outcome compared to infants with uncomplicated maternal history. We investigated the short term outcome in 21 premature infants with birth weights less than 1750 g born to mothers with HELLP syndrome. Median birth weight was 1050 g (range 420 g-1750 g), corresponding gestational age 29 weeks (range 26-35 weeks). Mechanical ventilation for RDS was necessary in 15 infants. Intracranial hemorrhage was diagnosed in 2 infants, 1 of the surviving infants developed bronchopulmonary dysplasia. Acute renal failure was observed in 3 infants immediately after birth. Mortality was attributed to progressive respiratory failure in 2 patients (b.w. 420 g and 490 g) and persisting acute renal failure in 1 patient (b.w. 520 g) Leucocytopenia (less than 9000/mm3) was observed in 13 infants and thrombocytopenia (less than 115000/mm3) was noted in 4 infants during the first day. Eighteen infants survived. We conclude, that the short term outcome in infants born to mothers with HELLP syndrome is not as poor, as previously reported.

Birth Weight↗
PubMed1991

[Fetal behavior in multiple pregnancy: methodologic, clinical and scientific aspects].

In multiple pregnancy, an intense supervision of the fetal condition is indicated during pregnancy and delivery. With the aid of a recently developed actocardiograph originally described by Maeda, it is possible to monitor the fetal heart rate (FHR) and fetal movements (FM) of twins simultaneously on one tracing by 2 external Doppler transducers. Additional methods (stimulation, real-time and Doppler ultrasound) were tested in combination with the equipment. In addition, FHR tracings of triplets were registered during delivery simultaneously with FM and contractions. First patterns of "twin behaviour" are described. It may be concluded that this way of recording is of definite practical and potential scientific value.

Apgar Score↗
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

[Postnatal weight loss in ventilated premature infants below 1500 g: significance of renal and extra-renal fluid loss].

In 9 ventilated preterm infants (birth weight 810-1310 g, gestational age 26-30 weeks) we measured total body water (D2O dilution), extracellular volume (sucrose dilution) and renal function parameters at birth and when postnatal weight loss exceeded 5% of birth weight together with day to day changes of weight, fluid balance, and serum electrolytes. A significant postnatal weight loss (-89 +/- 47 g) occurred together with a reduction of total body water (-102 +/- 95 ml) and extracellular volume (-98 +/- 59 ml) in the first three days of life. The intracellular volume did not change. At the same time fluid balance was negative due to a high extrarenal water loss on day 1 and an increasing diuresis on the following days. The serum sodium concentration remained unchanged during postnatal water loss, because the negative fluid balance was accompanied by a negative sodium balance.

Birth Weight↗
PubMed1990

Estimation of extracellular volume in preterm infants less than 1500 g, children, and adults by sucrose dilution.

Extracellular volume can be estimated from the distribution volume of sucrose (Vdsucrose). The purpose of this study was to establish sucrose pharmacokinetics in preterm infants less than 1500 g compared to children and adults and to define an optimal sampling scheme. In five preterm infants, 10 children, and five adults Vdsucrose after a single injection was calculated with the two-compartment model (Vdsucrose-TCM) and with the one-compartment model applied only to the elimination phase of the same concentration-time curve (Vdsucrose-OCM). In preterm infants Vdsucrose-TCM was 417 +/- 45 mL/kg (mean +/- SD). Vdsucrose-OCM was only 3.0 +/- 2.3% higher, because sucrose elimination half-life was on average 250 times longer than distribution half-life. Therefore Vdsucrose-OCM, requiring only four blood samples between 2 to 5 h after injection, gave an adequate estimate of Vdsucrose in preterm infants less than 1500 g. Vdsucrose-TCM in children and adults was 188 +/- 26 and 189 +/- 17 mL/kg, respectively. Vdsucrose-OCM was 10 to 65% higher. Therefore, in children and adults only Vdsucrose-TCM gives a reliable estimate of Vdsucrose. This requires 10 to 15 blood samples. The reduced sampling scheme was used in an extension of the study of preterm infants including five additional infants. Vdsucrose-OCM in the preterm infants was 462 +/- 47 mL/kg at birth and 425 +/- 46 mL/kg at maximal postnatal wt loss. Postnatal wt loss (mean -83 +/- 44 g) was not significantly different from postnatal reduction of Vdsucrose-OCM (mean -82 +/- 56 mL), suggesting that postnatal wt loss mainly represents extracellular fluid loss.

Adolescent↗
PubMed1990

[Plasmapheresis and/or intermediate high dosage immunoglobulin therapy--effective measures in threatened premature labor and intrauterine hemolysis in anti-PP1Pk (-Tja)?].

Anti-PP1Pk developed by women has been associated with abortion early in pregnancy and hemolytic disease of the newborn. The case of a 19-year-old woman who had had 2 spontaneous abortions in the first trimester is presented. When treated with plasma exchange and substituted with 5% albumin and intravenous immunoglobulin begun at six weeks' gestation and continued until the 30th week, she delivered a viable female infant without anemia. According to our data and review of literature, the effectiveness of therapy by plasmapheresis and/or immunoglobulin is discussed.

Combined Modality Therapy↗
PubMed1989

Postnatal weight loss in preterm neonates less than 1,500 g is due to isotonic dehydration of the extracellular volume.

Weight, extracellular volume (ECV; distribution volume of sucrose) and renal function were studied in 13 preterm infants at birth (age 6 h (2-12); median, range) and again when postnatal weight loss exceeded 5% of birth weight (age 84 (64-97) h). Gestational age was 28 (26-32) weeks, and birthweight was 1,170 g (810-1,455). The infants were nursed in incubators and mechanically ventilated. Fluid therapy allowed a weight loss of up to 10% of birthweight. Body weight decreased significantly from 1,101 +/- 202 g at birth to 1,016 +/- 198 g at day 3 and ECV from 499 +/- 155 ml to 413 +/- 118 ml. Mean weight loss of 85 +/- 50 g was the same as mean ECV loss of 86 +/- 48 ml, suggesting that postnatal weight loss is water loss from the ECV. Weight loss was preceded by a marked increase in diuresis, exceeding fluid intake on day 2. Creatinine clearance did not change. The increased urine output led to a significant increase of sodium excretion without inducing hyponatremia but resulted in an isotonic reduction of ECV.

Creatinine↗
PubMed1985

Heart rate and systolic time intervals in healthy newborn infants: longitudinal study.

To determine the influence of heart rate (HR) on systolic time intervals (STI) in neonates, serial measurements of right ventricular (RVSTI) and left ventricular systolic time intervals (LVSTI) were made on 30 healthy term newborn infants at age 4-8 h, 24-30 h, eight days, and four weeks. STI was related to HR and age. Age-related changes were similar to previously reported results. The preejection periods (RPEP and LPEP) significantly shortened with increasing age, whereas the right and left ventricular ejection times (RVET and LVET) were unrelated to age. RPEP was unrelated to HR, but tended to be prolonged in restless infants. With increasing HR, RVET decreased and RPEP/RVET increased in all age groups, but less at four weeks. A rise in HR of 50/min resulted in an increase of RPEP/RVET by 26% of the mean value at age 4-8 h and by 20% at four weeks. In 14 infants, RVSTI was recorded during a change in HR. In all these infants, RPEP and RPEP/RVET increased with increasing HR. We conclude that HR-related changes of RVSTI in neonates are different from those in older subjects. It should be considered that in neonates elevated values of RPEP/RVET, suggesting increased pulmonary vascular resistance, may be caused by high HR and unrest.

Age Factors↗
PubMed1984

[Hypoxic-ischemic encephalopathy. Clinical considerations].

The Hypoxic-Ischemic Encephalopathy (HIE) is a severe illness of the unborn, respectively of the newborn. About 90 percent of the causes occur in utero, about 10 percent after birth. The risk for HIE arises from anatomical and pathophysiological particularities: little overlapping between the great cerebral arteries, poor periventricular vascularisation, and a loss of the autoregulation of cerebral blood flow during asphyxia. Most important is the early detection of intrauterine asphyxia. After birth the general measures include: thermoneutral temperature, oxygenation, normal pCO2, regular blood pressure monitoring, glucose infusion, therapy of convulsions and of an inherent brain edema. After birth the five most common clinical settings in which HIE occurs, are: postpartum asphyxia, PFC, septic shock, pneumothorax and apneas. Therapeutic measures (e.g. volume therapy) have to be prompt but subtle, to prevent ischemia, avoiding overtherapy with its risk of intracranial hemorrhage.

Asphyxia Neonatorum↗