[Commentary on the paper by Christina Klausing on "Swaddling of children in transient camps"].
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Biomedical subjects
Publications and source records attributed to L Hohenauer.
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The recommended program of Child Health Care in Austria needs some additions: The first routine visit should be done between the 3rd and 5th week of life because of the insecurity of the young mother. The orthopedic examination must comprise the ultrasonographic examination of the hip. At 7-9 months of age the urinary screening for neuroblastoma must be incorporated into the existing program. The vaccination against haemophilus influenzae Type B must be added to the existing vaccination recommendations. During school age three additional examinations are recommended at 6, 10 and 15 years respectively.
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By good perinatal care the perinatal mortality rate can be brought down to 10 promille. A great number of high risk newborns will survive. The developmental prognosis of these at risk babies has strikingly improved. Among these babies the rate of neuromotor defects has been reduced by about 50%. Babies with birth weights of less than 1501 g will develop spastic diplegia in less than 5% and more than 80% of the babies with birth weights of less than 1001 g and the babies after artificial ventilation will develop normally.
For oral treatment of acute dehydration in infants a solution of electrolytes and glucose in water is indicated. Selfmixing of this solution is not advisable. 30 infants with dehydration caused by acute diarrhoea were treated with a granulat (Normolyt) dissolved in water resulting in a solution of appropriate composition. The solution was well accepted and well tolerated. All babies without clinical signs of shock were successfully rehydrated by the solution. No untoward effects were observed.
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This report contains three sections: A general definition of aims and tasks of neonatal intensive care is followed by the description of four regions and four neonatal units of different structure with some relevant statistics. According to this inquiry about 1.5 cots for maximum neonatal care and 4 cots for intermediate care per 1000 live births are needed. Considering efficiency and effectivity the smallest independent intensive care unit should "cover an area" of 4000 deliveries per year; it should be closely connected to a least one obstetrical unit. Where and how this neonatal unit may be integrated into a childrens hospital can be derived from the four examples given. It should be recognized that 1) high quality intensive care depends on the availability of additional pediatric services, 2) comprehensive care of newborn infants necessitates regional organization including a newborn ambulance system. Thus, close contacts with obstetrical, but also with pediatric units offering better facilities should be established. In yearly intervals results are to be self-controlled by statistical means. The following incidences of normal survival of infants referred to childrens hospitals can be gained currently [2]: Birth weights below 1000 g: above 20%; 1000--1499 g: above 85%; above 1500 g: better than 95%. Less favorable figures call for analyses of reasons and measures to abolish them.
The Newborn Intensive Care Centre at the Landeskinderkrankenhaus Linz is the referral centre serving an area in which 20% of births in Austria occur. During a 4-year period ending 1976, after the facilities for intensive care had been introduced, the overall mortality of low birth weight infants (LBWI) was reduced by 44% (from 26% to 14%), whilst the mortality of LBWI born at the Landes-Frauenklinik Linz, which works in close collaboration with the Landeskinderkrankenhaus, went down by 60% (from 24% to 9%). The chances of survival decreased with increasing transportation distance and suboptimum standards of obstetrical care, in spite of intensive treatment after referral. It is suggested that the improved methods of perinatal care applied at the obstetrical and neonatal units are the cause of this remarkable improvement in survival rate of LBWI. These improvements in neonatal survival rate contributed considerably to the 40% decline in infant mortality in Upper Austria from 26.7% in 1973 to 16.2% in 1976..
From 1974 until April 1977 232 babies with acut bronchiolitis were hospitalized at the Landeskinder-krankenhaus Linz. They represented 8% of all babies admitted to the ward during this period. 9 (= 3,9%) of these were sucessfully mechanically ventilated because of respiratory failure. A pCO2 level above 60 mm Hg was taken as an sign of respiratory insufficiency. By application of artificial ventilation mortality rate of acut bronchiolitis can further be decreased.
We report a female small for date neonate, who developed transient diabetes mellitus (TDN) five days after birth and required insulin therapy for five weeks. At the onset of the disease, plasma insulin concentration was extremely low. At four weeks of age, after insulin withdrawal, the patient was still hyperglycemic, and basal insulin values assayed over a period of 24 h were mostly inadequate. Glucagon secretion was not suppressed. Growth hormone levels were lower than those of three small for date infants of the same age. At three months of age, the patient was still intolerant to an oral glucose load, insulin secretion remained inadequate while glucagon paradoxically increased 30 min after glucose challenge. The oral glucose tolerance values were in the normal range at six months of age. We conclude that TDN is caused by a transitory defect of insulin secretion, which would also explain the glucagon response as a consequence of insulin deficiency. We found no evidence associating the insulin antagonists observed in our study with the pathogenesis of this illness.
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In a total of 720 CTG-controlled newborns two cases of severe septic general infections were observed; a full-term baby showed an extensive skin of the head phlegmone and meningitis purulenta, both conditions caused by Bacteria coli. A pre-term baby developed suppuration at the site of the CTG-wound and a pulmonary abscess under a general septic condition. The tracheal secretion culture of the patient contained Bacteria pyozyanea. In the case of the full-term child histologic evidence of a chorion infection was established. Both children recovered. Therefore, as we see it, the application of direct cardiotokography makes extensive antiseptic measures and thorough examination of the newborn for infectious complications imperative, a general antibiotic treatment, however, is not considered indicated.
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