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B Laubscher

Publications and source records attributed to B Laubscher.

30 records · Page 2Linked to original sources
PubMed1997

Response to nitric oxide in term and preterm infants.

The response to three levels (10 ppm, 20 ppm and 40 ppm) of nitric oxide (NO) was assessed in 30 infants, median gestational age 30 (range 24-42) weeks. All the infants required an inspired oxygen concentration of more than 0.5, despite receiving surfactant where appropriate. All but one infant had a positive response to NO (median reduction in the oxygenation index (OI) was 33%, range -9%-90%), but only 20 infants showed a greater than 20% reduction in the OI. There was no obvious relationship of the optimum NO level (i.e. that associated with the maximum reduction in OI) and either diagnosis (congenital diaphragmatic hernia, meconium aspiration syndrome, respiratory distress syndrome, pulmonary interstitial emphysema (PIE), hydrops and sepsis) or maturity, except that five of six infants with PIE responded best to 40 ppm, as did eight of nine infants less than 28 weeks gestational age. We conclude NO dosage should be individualized and NO levels up to 40 ppm should be considered in very immature infants.

Administration, Inhalation↗
PubMed1997

Perioperative assessment of respiratory compliance and lung volume in infants with congenital diaphragmatic hernia: prediction of outcome.

BACKGROUND/PURPOSE: Infants who have congenital diaphragmatic hernia (CDH) have high mortality and morbidity. The aim of this study was to determine the relative ability of the results of serial measurements of compliance of the respiratory system (CRS) and lung volume (functional residual capacity (FRC)) to predict poor outcome: death or oxygen dependency at 28 days. In addition, the authors wished to document the evolution of any lung function abnormalities during the perioperative period. METHODS: Daily measurements of CRS and FRC were made in the first week of life and subsequently during week 2 in 16 infants who had a median gestational age of 38 weeks and birth weight of 3.2 kg. RESULTS: Seven infants had a poor outcome: five died and two others remained oxygen dependent beyond 28 days. The infants who had a poor outcome were characterized on day 1 by a significantly lower CRS, but not FRC (P < .05). In comparison with results from day 1, the median CRS of the infants overall had significantly improved only by week 2 (P < .05), there was no such significant change in FRC with increasing postnatal age. At week 2, only the CRS results differed significantly between those infants who had and who did not have poor outcome (P < .05). CONCLUSION: The results of serial measurements of CRS, rather than FRC are the more useful predictor of outcome in infants who have CDH.

Female↗
PubMed1997

Ragged-red fibers and complex I deficiency in a neonate with arthrogryposis congenita.

We describe a neonate with hypotonia, weakness, early death owing to respiratory failure, and a severe form of arthrogryposis multiplex congenita. Postmortem studies revealed numerous ragged-red fibers and central nervous system abnormalities consistent with a mitochondrial disease. No NADH:ubiquinone-1 oxidoreductase (complex I) activity could be detected in skeletal muscle. These findings suggest that mitochondrial cytopathies can be associated with arthrogryposis multiplex congenita and should therefore be sought in neonates presenting with severe arthrogryposis.

Arthrogryposis↗
PubMed1997

Comparison of body surface and airway triggered ventilation in extremely premature infants.

Failure of patient triggered ventilation in very premature infants may reflect the use of inappropriate triggering systems. We have therefore compared the performance of an airway and a body surface trigger in 12 infants of median gestational age 26 weeks (range 24-27). Airway flow and oesophageal and ventilator pressure changes were recorded during two periods of patient triggered ventilation. From the traces, the degree of asynchrony (inflation extending beyond inspiration), triggering rate, sensitivity (proportion of the infant's breaths detected) and trigger delay (response time) were calculated. Although with both triggering systems there was a high rate of asynchrony, the triggering rate (p < 0.05), sensitivity (p < 0.05) and trigger delay (p < 0.01) were all better with the body surface trigger. These results suggest that the body surface trigger is the more appropriate system for very immature infants.

Airway Resistance↗
PubMed1996

Lung volume measurements immediately after extubation by prediction of "extubation failure" in premature infants.

To test the hypothesis that premature infants in whom extubation fails in the first 10 days of life have low volume lungs, functional residual capacity (FRC) was measured in the first hour after extubation. Once extubated, infants received the appropriate level of inspired oxygen necessary to maintain acceptable arterial oxygen saturation. After humidification, oxygen was bled into a headbox, and FRC was assessed using a helium gas dilution technique and a specially designed infant circuit. The results were related to extubation failure, which was diagnosed when the infant required nasal continuous positive airway pressure or re-intubation and ventilation within 48 hours. The latter two forms of respiratory support were instituted by the clinical team, whenever the infant developed recurrent or severe apnea or respiratory acidosis. Infants were eligible for entry into the study when born prematurely and extubated within the first 10 days of life. Twenty infants initially ventilated for respiratory distress syndrome at a median gestational age of 29 weeks (range, 26-36 weeks) were studied at a median postnatal age of 3 days (range, 1-7 days). All were receiving theophylline. Extubation failed in seven infants, who did not differ significantly from the rest of the cohort regarding gestational age, birthweight, postnatal age, or inspired oxygen concentration (F(I)O2) at extubation, but their maximum F(I)O2 during ventilation was higher than in those infants who did not require reintubation (P < 0.05). In the infants who failed extubation, the median FRC was 19 ml/kg (range, 12-27 ml/kg), which was lower than that of the infants in whom extubation was successfully accomplished (median, 28 ml/kg; range, 19-37 ml/kg; P < 0.01). An FRC of less than 26 ml/kg had a sensitivity of 71% and specificity of 77% in predicting extubation failure. These results support the hypothesis that a very low lung volume relates to extubation failure in the first 10 days of life.

Female↗
PubMed1996

Haemodynamic changes during high frequency oscillation for respiratory distress syndrome.

In a crossover trial left ventricular output (LVO), cerebral blood flow velocity (CBFV), and resistance index (RI) of the anterior cerebral artery were compared using Doppler ultrasonography, in eight preterm infants with respiratory distress syndrome (RDS) during conventional mechanical ventilation and high frequency oscillation. LVO was 14% to 18% lower with high frequency oscillation. There were no significant changes in CBFV. On the first day of life there was a trend towards lower RI on high frequency oscillation; the fall in LVO on high frequency oscillation was not related to lung hyperinflation. Changes in ventilation type (from conventional mechanical ventilation to high frequency oscillation, or vice versa) can induce significant LVO changes in preterm infants with RDS.

Blood Flow Velocity↗
PubMed1995

Evaluation of a new immunologic test kit for rapid detection of group A streptococci, the Abbott Testpack Strep A plus.

We compared the Testpack Strep A plus (TPSAP) enzyme-linked immunosorbent assay test for group A beta-hemolytic streptococcal (GAS) antigen rapid detection with blood agar culture in 454 pediatric patients with clinical pharyngitis. Of the 454 patients, 118 (25.9%) had positive oropharyngeal cultures for GAS. TPSAP sensitivity was 89.9% (106 of 118) and specificity was 95.8% (322 of 336). We conclude that the TPSAP is specific enough to indicate treatment for a patient with a positive test but that a negative test should be confirmed by culture.

Child↗
PubMed1994

Water, energy and early postnatal growth in preterm infants.

Non-invasive methods, including stable isotope techniques, indirect calorimetry, nutritional balance and skinfold thickness, have given a new insight into early postnatal growth in neonates. Neonates and premature infants in particular, create an unusual opportunity to study the fluid and metabolic adaptation to extrauterine life because their physical environment can be controlled, fluid and energy balance can be measured and the link between metabolism and the energetics of their postnatal growth can be assessed accurately. Thus the postnatal time course of total body water, heat production, energy cost of growth and composition of weight gain have been quantified in a series of "healthy" low-birth-weight premature infants. These results show that total body water is remarkably stable between postnatal days 3-21. Energy expenditure and heat production rates increase postnatally from mean values of 40 kcal/kg/day during the first week to 60 kcal/kg/day in the third week. An apparent energy balance deficit of 180 kcal/kg can be ascribed to premature delivery. The cost of protein metabolism is the highest energy demanding process related to growth. The fact that nitrogen balance becomes positive within 72 h after birth places the newborn in a transitional situation of dissociated balance between energy and protein metabolism during early postnatal growth: skinfold thickness, dry body mass and fat decrease, while there is a gain in protein and increase in supine length. This particular situation ends during the second postnatal week and soon thereafter the rate of weight gain matches statural growth. The goals of the following review are to summarize data on total body water and energy metabolism in premature infants and to discuss how they correlate with physiological aspects of early postnatal growth.

Body Composition↗
PubMed1990

Primitive megalencephaly in children: natural history, medium term prognosis with special reference to external hydrocephalus.

We studied 74 children with primitive megalencephaly retrospectively with attention directed to familial megalencephaly, birth history, enlarged pericerebral subarachnoid space (SAS) (idiopathic external hydrocephalus), head and statural growth dynamics, developmental and school prognosis, morphological findings and development of subdural haematoma. In the megalencephalic children, no significant differences were found between those with normal or those with enlarged pericerebral SAS. Out of 62, 31 children (50%) were already megalencephalic at birth. Of 74, 37 children (50%) showed variable degrees of developmental delay which in 18 was transient. Eight out of 74 were mentally retarded. Of 52 children at school age, 42 attend normal schools and 10, of whom 7 are mentally retarded, attend special schools. Three children showed subdural haematoma resulting from apparently minor trauma or occurring spontaneously. We suggest that idiopathic external hydrocephalus represents a variant of primitive megalencephaly with transient increase of intracranial pressure and that it could predispose to the development of idiopathic (spontaneous or non-traumatic) subdural haematoma.

Brain↗