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Biomedical subjects

Martin Wald

Publications and source records attributed to Martin Wald.

12 recordsLinked to original sources
PubMed2006

Amnionitis with Ureaplasma urealyticum or other microbes leads to increased morbidity and prolonged hospitalization in very low birth weight infants.

OBJECTIVE: To investigate the influence of culture proven intrauterine infection on preterm morbidity and to test the effect of antimicrobial treatment. METHODS: Retrospective cohort study conducted between October 1997 and February 2001 in patients with preterm premature rupture of membranes or preterm labor. Vaginal swabs were sampled and amniocentesis for microbiologic culture of the amniotic fluid was performed. Patients with Ureaplasma urealyticum in the amniotic fluid were treated with josamycin. Infants were followed post partum according to birth weight, gestational age, APGAR score and infant morbidity. RESULTS: In 49 eligible patients, 40% of cultures were positive, 22% for Ureaplasma urealyticum, 12% for other bacteria and 6% for candida. Children of mothers with positive amniotic fluid cultures had significantly lower gestational ages (26+4 weeks for Ureaplasma urealyticum [p=0.04] and 25+5 weeks for other microorganisms [p=0.0017] versus 28+6 weeks for mothers with negative amniotic fluid cultures) and lower birth weights (975 g [n.s.] and 828 g [p=0.0072] versus 1,041 g) but were appropriate for their gestational ages. 33.3% and 66.7% versus 24% of the children were mechanically ventilated [n.s.], duration of mechanical ventilation was 5.3 [p=0.02] and 10.1 days [p=0.04] versus 1.4 days, and prevalence of chronic lung disease was 38% and 33% versus 11% [n.s.]. Prevalence of severe intraventricular hemorrhage (12.5% [n.s.] and 33% [p=0.04] versus 3.4%) and nosocomial infections (50% for both groups of positive cultures versus 10.3% for negative cultures, p=0.02 and 0.03, respectively) was higher and median length of stay was significantly longer (121 [p=0.02] and 107 days [p=0.03] versus 60 days) in these patients. Maternal positive vaginal swab cultures were not associated with any of the above-mentioned factors. In none of the patients treated with macrolids for proven Ureaplasma urealyticum amnionitis could the microbes be eradicated. CONCLUSION: Maternal positive amniotic fluid cultures have been associated with lower gestational age and lower birth weight. Rate of infant morbidity was higher and length of stay was significantly longer in this group. Positive vaginal swabs were not predictive for infant morbidity. Treatment of mothers showing positive amniotic fluid cultures with macrolids was not effective.

Chorioamnionitis↗
PubMed2006

Non-random geographical distribution of infant mortality in Austria 1984-2002.

Over the last 20 years in Austria infant mortality has declined from 11.2/1,000 life births (1985) to 4.7/100,000 (1997) but has remained constant since then. This stagnation is in contrast to the trend in Finland, where the infant mortality rate is both lower than in Austria and continues to decline. In attempting to understand this difference we concentrated on the spatial distribution of infant mortality in Austria in addition to the trend over time. We describe the regional distribution of infant mortality adjusted by risk factors over the period from 1984 to 2002 based on data from 1.6 million birth certificates. All variables we examined were significant due to the large number of observations. We calculated an R-squared measure to assess the ability of our regression model to predict the survival status of newborns. Only the variables birth weight, gestational age, infant's length at birth and to a lesser extent year of birth had relevant impacts in terms of predictive ability. All remaining variables did not notably contribute to the prediction of survival status of the newborn despite their significance. In the greater area of Styria, infant mortality is significantly lower than in the rest of Austria even when the mortality rates are adjusted for variables such as birth weight, gestational age, sex of the newborn and sociodemographic status of the mother. In the period from 1984 to 2002 about 1500 more infants would have survived the first year of life if the mortality rate in the rest of Austria had been the same as in this area. In our regression model many important risk factors were included. Nevertheless, we can not explain the observed spatial pattern in infant morality. Further analytic studies are needed to explore the impact of variables other than those contained in the birth certificates.

Austria↗
PubMed2006

A flow sensor suitable for use with split-flow ventilation--first preclinical data.

Volutrauma caused by artificial ventilation represents a major morbidity risk for premature infants. Our working group has recently developed an innovative "split-flow ventilation" system aiming at the reduction of tidal volumes (TVs). The main problem for the practical use of this system is the fact that conventional measurements of commercially available flow sensors are distorted by the split flow. In this study, we present the first preclinical data from testing an adapted flow sensor combination recognizing the split flow. A preterm infant test lung was conventionally ventilated, modified by insertion of a split-flow line. In addition to the customary flow sensor (FS-1), a second flow sensor (FS-2) was integrated into the split-flow line, and a third (FS-3) was placed at the exit of the test lung for reference measurements. The signals of all three flow sensors were read and processed by a computer. The program was set to graphically add up flow curves 1, 2, and 3 during one ventilation loop. After 10 runs, a mean curve of FS-1+2 was calculated and compared to the mean curve of FS-3. Furthermore, the mean TV of 10 runs measured by FS-1+2 was calculated and compared with the mean TV calculated by FS-3. The summation curve FS-1+2 proved identical to the reference curve FS-3. FS-1+2 yielded a TV of 6.6 +/- 0.01 mL (inspiratory) and 6.7 +/- 0.02 mL (expiratory). The corresponding values of FS-3 were 6.5 +/- 0.20 mL and 6.6 +/- 0.09 mL, respectively. According to our results, the presented flow sensor constellation allows exact flow measurements in the experimental setting and appears suitable for usage in a split-flow ventilation circuit under clinical conditions.

Equipment Design↗
PubMed2006

Effects of a combined therapy of erythropoietin, iron, folate, and vitamin B12 on the transfusion requirements of extremely low birth weight infants.

OBJECTIVES: Erythropoietin is frequently administered to premature infants to stimulate erythropoiesis. The primary goal of erythropoietin therapy is to reduce transfusions, but the efficacy of erythropoietin has not been convincingly demonstrated in this regard. The aim of this trial was to investigate whether combined administration of vitamin B12, folic acid, iron, and erythropoietin could decrease transfusion requirements in extremely low birth weight infants. PATIENTS AND METHODS: In a randomized, controlled trial, extremely low birth weight infants with a birth weight < or = 800 g and a gestational age < or = 32 weeks were randomly assigned to a group receiving combination treatment or a control arm. RESULTS: The treatment increased levels of folate in red blood cells, vitamin B12, ferritin, transferrin receptor levels in plasma, and reticulocyte counts. The proportion of infants requiring no transfusions was lower in the treatment group (38%) as compared with controls (5%). The treatment group and the need for mechanical ventilation were independent predictors of the number of transfusions in multiple regression analysis. Cox regression analysis indicated that combined therapy resulted in a 79% risk reduction for any transfusion. CONCLUSION: Combined treatment with erythropoietin, intravenous iron, folate, and vitamin B12 during the first weeks reduces the need for transfusion in extremely low birth weight infants.

Blood Transfusion↗
PubMed2005

Primary structure, recombinant expression, and molecular characterization of Phl p 4, a major allergen of timothy grass (Phleum pratense).

Grass pollen allergy is one of the most important allergic diseases world-wide. Several meadow grasses, like timothy grass and rye grass, contribute to allergic sensitizations, but also allergens from extensively cultivated cereals, especially rye, make a profound contribution. The group 4 allergens are well known as important major allergens of grasses. We have cloned for the first time group 4 sequences from Phleum pratense, Lolium perenne, Secale cereale, Triticum aestivum, and Hordeum vulgare, and investigated the IgE-reactivity of recombinant Phl p 4 as a candidate for allergy diagnostic and therapeutic applications.

Allergens↗
PubMed2005

Dead-space washout by split-flow ventilation. A new method to reduce ventilation needs in premature infants.

OBJECTIVE: Chronic lung disease caused by volutrauma is one of the most important consequences of preterm delivery. In this pilot study a new method is presented that consists of flushing part of the dead space with fresh gas in order to reduce high tidal volumes, the chief cause of volutrauma. The aim of the study was to evaluate if the new method could reduce ventilatory effort in preterm infants by diminishing dead space. DESIGN AND SETTING: In split-flow ventilation, gas required for dead-space washout is split off from the regular ventilation circuit. The split flow bypasses the apparatus dead space and fills it retrogradely with fresh breathing gas, mainly in the pause between exhalation and inspiration. The mean per-minute ventilation and ventilation index after 12 h of conventional ventilation were compared with corresponding mean values after 12 h of split-flow ventilation in 17 preterm infants weighing <2,000 g. Statistical analysis was performed using the T -test for matched pairs. RESULTS: After switching from conventional ventilation to split-flow ventilation, the mean per-minute ventilation per kilogram of body weight decreased significantly from a mean value of 0.314+/-0.097 l/kg/min to 0.190+/-0.043 l/kg/min ( p <0.001), while the ventilation index decreased significantly from 28.47+/-7.48 to 16.10+/-4.13 ( p <0.001). CONCLUSION: Split-flow ventilation significantly reduces apparatus dead space during ventilation in preterm infants. This leads to reduced ventilatory effort.

Bronchopulmonary Dysplasia↗
PubMed2005

Trends in infant mortality in Austria between 1984 and 2002.

Infant mortality rate is an important medical indicator and is often used for comparing countries with respect to welfare and public health. Among other factors, effective medical technology, better access to pre- and postnatal care for all socioeconomic groups and better nutrition have decreased infant mortality in Austria from about 200 deaths per 1000 live births at the beginning of the 20th century to about 5 deaths per 1000 live births at the end. In this study we present the trends in infant mortality, based on 1,654,519 individual birth records, in Austria since 1984. The infant mortality rate dropped rapidly from about 12 per 1000 live births in 1985 to 4.6 per 1000 live births during the last two years of our study (2001/02). Infant mortality rates stratified by cause of death show somewhat differing trends. In particular, the number of deaths due to peripartal problems decreased as the result of improvements in obstetrics and neonatology, but in 1995 a change in the definition of live birth led to a rise of about 20% in the stillbirth rate. At present, Austria has one of the lowest infant mortality rates of all European countries; however, between 1999 and 2002 the mortality rate has been fairly static. A further reduction in mortality clearly cannot be achieved by advances in medicine alone. It remains a challenge for health politicians, physicians and society at large to reduce the prevalence of well-known risk factors such as alcohol abuse, heavy overweight and smoking during pregnancy.

Austria↗
PubMed2003

Fatal air embolism in an extremely low birth weight infant: can it be caused by intravenous injections during resuscitation?

OBJECTIVE: A preterm infant with a birth weight of 384 g who succumbed to vigorous resuscitation for sudden respiratory failure on the third day of life is presented. Postmortem examination revealed, apart from extensive pulmonary hemorrhage, a fatal amount of air mainly in the right ventricle. We believe that this air had been introduced via peripheral venous cannulas due to inadvertent and unavoidable air admixture to each injection volume administered with a syringe, and we develop an experimental model to confirm that fatal amounts of air can indeed accumulate with frequent change over of syringes within a short period of time. DESIGN: An empty 50-ml syringe was connected to a 15-cm-long connection line via a three-way tap. With a 1 ml syringe 100 doses of 0.5 ml aqua were injected into the connection line. The amount of air which had collected in the 50 ml syringe after the 100 injection cycles was measured. This process was repeated three times each by three of the authors and the average air volume introduced with 100 injections calculated for each investigator. RESULTS: The average amounts of air which had entered the closed system after 100 acts of syringe assembly and aqua administration were 1.84, 1.95, and 2.0 ml. This corresponds to an average volume of almost 0.02 ml per injection.

Embolism, Air↗
PubMed2003

First case of confirmed rotavirus meningoencephalitis in Germany.

We report the case of a 9-year-old girl in Germany with acute meningoencephalitis associated with rotavirus gastrointestinal infection. Sequence analysis revealed a genetic relationship of the strain to rotaviruses with subgroup II specificity. Reverse transcription-PCR was positive for rotavirus.

Antiviral Agents↗
PubMed2002

Glucagon therapy as a possible cause of erythema necrolyticum migrans in two neonates with persistent hyperinsulinaemic hypoglycaemia.

UNLABELLED: Erythema necrolyticum migrans (ENM) usually presents as a cutaneous paraneoplastic phenomenon which is in most cases associated with a glucagon-producing tumour. Here it is for the first time described as a side-effect of glucagon treatment in persistent hyperinsulinaemic hypoglycaemia of infancy (PHHI). In both patients, the skin lesions disappeared after discontinuation of glucagon administration. In the first child the erythema resolved without scarring within 10 days after glucagon was substituted with other medication while in the second patient healing followed subtotal pancreatectomy which rendered glucagon infusion unnecessary. Initially the clinical resemblance to atopic dermatitis is prone to cause diagnostic errors, especially in this age group. CONCLUSION: erythema necrolyticum migrans should be considered as a differential diagnosis in patients who develop erythematosquamous skin lesions under glucagon treatment.

Diseases in Twins↗
PubMed2002

Decreased phagocytic capacity of cord blood monocytes in second- and third-born multiplets.

OBJECTIVE: To assess the risk to second- and third-borns of developing perinatal infections based on a diminished first-line immune response in comparison to the first-born. STUDY DESIGN: 11 sets of twins and 2 sets of triplets (27-39 weeks of gestation, 740-3,560 g birth weight) admitted consecutively to our neonatal care unit were investigated. All were delivered by cesarean section. Phagocytosis and the expression of TNF-alpha and IL-1 in cord blood were determined immediately and 72 h after birth from peripheral blood monocytes by FACS analysis and ELISA. RESULTS: In all second- and third-borns, phagocytosis of cord blood monocytes was significantly decreased in comparison to the first-borns (p < 0.001, p < 0.015). 72 h after birth phagocytosis determined from peripheral blood showed no significant difference between the first-borns and the second- and third-borns. Cytokine expression revealed no significant differences dependent on birth order. CONCLUSION: We suggest that the observed temporarily diminished first-line immune response of second- and third-born multiplets might be the result of a short-term reduced cellular oxygenation during delivery, but has no influence on further immunological deficiency leading to a higher risk of perinatal infections.

Birth Order↗