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Biomedical subjects

L Wille

Publications and source records attributed to L Wille.

At least 37 records · Page 2Linked to original sources
PubMed1983

[Therapeutic problems with indomethacin in preterm infants with persistent ductus arteriosus].

Inhibition of PGE production in eight preterm infants with persistent ductus arteriosus and respiratory distress syndrome was associated with marked improvement in the respiratory and circulatory function in all of them. However, in six of them this effect was only transient. In the posttreatment period of five and a half days reopening of the ductus arteriosus was frequently associated with increased PGE production and a drop of indomethacin serum levels. Three of these six infants were transferred for surgical ligation and the other three infants were successfully treated with a second course of indomethacin. The margin between closure of the ductus arteriosus and the deterioration of kidney function in preterm infants treated with a presently recommended indomethacin dosage is too narrow. Before an improved therapeutic procedure has been developed indomethacin treatment for the closure of persistent ductus arteriosus should not generally be recommended in preterm infants.

Ductus Arteriosus, Patent↗
PubMed1982

Variability of serum indomethacin concentrations after oral and intravenous administration to preterm infants.

Fifteen preterm infants with patent ductus arteriosus and respiratory distress syndrome were given indomethacin (0.2 mg/kg) at 12 h intervals up to three times, either orally or intravenously, in an uncontrolled, non-randomized study. Serum indomethacin concentrations were determined in blood samples taken 12 h after dosing. There was considerable variability in the serum indomethacin concentrations, especially after oral administration, although the mean concentrations after each of the three doses were similar after both oral and intravenous administration. The frequency of closures and transient closures of the ductus arteriosus was also similar for both routes of administration. There was, however, no relation between concentration and effect in individual patients. The sustained exposure to indomethacin which appears to be necessary for ductal closure can sometimes be attained by oral administration.

Administration, Oral↗
PubMed1982

Recovery of prostaglandin production associated with reopening of the ductus arteriosus after indomethacin treatment in preterm infants with respiratory distress syndrome.

Increased PGE production has been demonstrated in 9 of 17 preterm infants with patent ductus arteriosus (PDA) associated with respiratory distress syndrome (RDS). Inhibition of PGE production in eight preterm infants with PDA and RDS was associated with marked improvement in the respiratory and circulatory function of all of them. However, in six of them this effect was only transient. In the posttreatment period of five and a half days reopening of the ductus arteriosus was frequently associated with increased PGE production and a drop of indomethacin serum levels. Three of these six infants were transferred for surgical ligation whereas the other three were successfully treated with a second course of indomethacin. However, the margin between closure of the ductus arteriosus and the deterioration of kidney function in preterm infants treated with a presently recommended indomethacin dosage was narrow. In conclusion, until an acceptable therapeutic serum level of indomethacin for ductal closure in preterm infants has been established and the duration of effective prostaglandin synthesis inhibition is known, it is too early for a general recommendation of a dosage regime of indomethacin for the pharmacological closure of PDA in infants with RDS.

Child↗
PubMed1981

[Retrolental fibroplasia--a preventable disease? (author's transl)].

Retrolental Fibroplasia has a high incidence in premature infants of low gestational age. The most susceptible period for developing retrolental fibroplasia is the immature vascularisation of the retina during the 28th to 40th gestational week. The disease is caused by the direct effect of oxygen administration. Retrolental fibroplasia is associated with the concentration of oxygen administered and the length of time in supplemental oxygen. There is also a significant association between its development and severe apnea requiring bag and mask resuscitation maintaining ambient oxygen concentration during the procedure. Furthermore there is an association between retrolental fibroplasia and the amount of adult blood transfused. Infants with these factors are at high risk to develop retrolental fibroplasia. Preductal PaO2-level should be kept between 60 and 70 mm Hg and supervised by continuous transcutaneous readings. There is some concern about intermittent arterial sampling. Problems of interpreting PaO2-analyses are discussed. 25 mg Vitamin E are recommended for prevention. There are many management protocols and techniques during neonatal intensive care of premature infants for prevention of the disease. Premature infants at risk should have a close time schedule for ophthalmoscopy.

Blood Transfusion↗
PubMed1981

[Pyrexia during delivery (author's transl)].

Amnionitis with pyrexia during labor and delivery and the perinatal complications of this syndrome are described. In our series the incidence of pyrexia during delivery was 0.54%. In 70 of 83 cases (84%) an intra-uterine infection was assumed to be the cause of the pyrexia. In 13 of 83 cases (16%) an extra-genital infection was the presumed cause. Intra-uterine infections are a grave danger for the mother and the newborn and constitute a severe complication. The mortality in cases with pyrexia during labor and delivery was elevated to 7 of 83 newborns (9%). Rapid delivery and the timely administration of antibiotics in sufficiently high dosages can prevent the manifestations of severe infections. Recommendations for the obstetric management of cases with pyrexia during labor and delivery are given.

Amnion↗
PubMed1981

[Technique for intraventricular application of antibiotics in bacterial meningitis of the newborn (author's transl)].

A new technique for intraventricular application of antibiotics by means of an indwelling catheter is described for the treatment of bacterial meningitis in the newborn. In cases of neonatal gram-negative meningitis with proven ventriculitis resistant to systemic therapy alone, a ventricular tap is performed. Through the needle an indwelling catheter is inserted into the right lateral ventricle. After removal of the needle the remaining catheter is used for obtaining ventricular fluid for diagnostic purposes as well as for direct intraventricular injection of antibiotics. This catheter can easily be inserted while the child is in the incubator in a neonatal intensive care unit, avoiding neurosurgery. Our present treatment procedure for neonatal meningitis is described.

Ampicillin↗
PubMed1980

Hemothorax in the newborn.

Twenty cases of hemothorax in newborns, including 4 of our own patients, are reviewed in detail. This unusual cause of acute respiratory distress within the neonatal period was observed in 14 males and 6 females. Most of the patients were fullterm newborns. As causal factors hemorrhagic disease of the newborn (vitamin K deficiency), disseminated intravascular coagulation, arteriovenous malformations and pleural/vascular rupture are considered. The time of occurrence of bleeding symptoms ranged from 1 to 28 days of life. Sixteen out of 20 patients survived without sequelae, but in 4 cases the outcome was lethal.

Adult↗
PubMed1980

[Intensive care in pediatrics (author's transl)].

Centralized treatment of critically ill pediatric patients and related problems are presented. Pediatric intensive care allows to overbridge deranged or interrupted organ functions while simultaneously treating the disease causing the disturbance. Its efficiency depends on continuity of medical care. Medical and nursing staff should be trained in the use of specialized equipment, especially monitoring equipment and ventilators. Medical and nursing staff must know who is responsible for the patients all the time. Undivided medical responsibility and coordinated specialist care are essential. Some general points concerning design features, equipment and organisation of a pediatric intensive care unit are made. Some special aspects such as staffing, transportation of high-risk neonates, economy of operation and personal training programm are discussed. Results of pediatric intensive care at the University Children's Hospital Heidelberg are documented. Regionalisation of neonatal care is discussed based on the actuell situation in Baden-Württemberg.

Child↗
PubMed1979

Systemic air embolism in the respiratory distress syndrome of the newborn.

Details of 25 cases of neonatal systemic air embolism, including three of our patients, are reviewed. This rare complication of respiratory distress syndrome (RDS) was observed in 21 premature infants and 4 fullterm newborns, of whom 23 required intermittent positive pressure ventilation (IPPV). In 21 of these patients air embolism was preceded by pulmonary interstitial emphysema, pneumomediastinum, pneumothorax and/or pneumopericardium. Air embolism occurred between 3 and 288 hours after delivery. The outcome was lethal in 24 cases, only one patient survived. Two main pathogenic mechanisms are discussed; entrance of air from ruptured alveoli into the lung capillaries and introduction of air via catheters in umbilical vessels.

Embolism, Air↗
PubMed1979

Neonatal respiratory insufficiency due to centronuclear myopathy.

Two neonates showing generalized hypotonia, weakness of limbs, trunk, and oral musculature died because of muscular respiratory distress. The diagnosis of centronuclear (or myotubular) myopathy was established by histological and histochemical techniques. The genetic situation and routine laboratory data including electromyography were compared with similar cases in the literature; findings were inconclusive with respect to this diagnosis. These results indicate the need for a muscle biopsy and the use of histochemical stainings and/or electronmicroscopical investigation for a proper diagnosis in hypotonic newborns under respiratory distress after exclusion of etiologies other than neuromuscular diseases. Still the diagnosis of centronuclear myopathy in a neonate does not allow a precise prognosis. Increased awareness of this disorder and adequate diagnostic workup is needed in order to extend our understanding and to clarify the prognosis.

Humans↗
PubMed1978

Maple syrup urine disease: treatment of the acutely ill newborn.

Three patients with maple syrup urine disease were treated during the acute neonatal stage. Multiple exchange transfusions proved to be a satisfactory means of achieving rapid clinical and biochemical improvement during this phase. On the other hand, evidence is provided suggesting that in addition to exchange transfusions, a high calorie intake above 150 Cal/kg body weight/day is necessary to lower the plasma concentration of the branched chain amino acids to near-normal levels. As long as this calorie intake was not provided, further exchange transfusions failed to lower the plasma leucine concentration to below 17 mg/100 ml in one patient. It is assumed that this high calorie intake is necessary to prevent the breakdown of endogenous protein. Treatment of acute episodes in maple syrup urine disease should therefore not only eliminate the elevated alpha-keto acids and branched chain amino acids quickly (i.e. by multiple exchange transfusions or peritoneal dialysis), but in addition should provide a high calorie intake.

Energy Intake↗
PubMed1977

Group B streptococci: a new threat to the newborn.

8 newborns with early onset group B streptococcal infection and two patients with late onset meningitis were observed during a period of three years. Respiratory distress, early onset of apnoic spells, and roentgenographic signs of hyaline membrane disease or perinatal pneumonia may lead to early diagnosis, especially if shock develops. The fatal course can only be prevented by prompt antibiotic treatment.

Female↗
PubMed1977

Bronchopulmonary dysplasia in premature infants. A radiological and pathological correlation.

In a group of 70 premature and newborn infants, treated with artificial ventilation, 24.3% developed bronchopulmonary dysplasia (BPD). Only in a very few cases did the typical radiological stages, as described by Northway, succeed each other in a chronological order. It is impossible to differentiate BPD stage I or II from RDS stage III and IV without a knowledge of the clinical course and of the duration of artificial ventilation. The lower the gestational age, the more severe and earlier do the radiological and histological changes occur. The radiological differential diagnosis of BPD includes Wilson-Mikity-syndrome, congenital pulmonary lymphangiectasia, neonatal tuberculosis, cystic fibrosis and Hamman-Rich-syndrome.

Bronchial Diseases↗