Biomedical subjects
Publications and source records attributed to F Pohlandt.
Erythema neonatorum is the most common exanthematous eruption in neonates, which is always associated with an eosinophilic infiltration of the skin. Erythema neonatorum can be present at birth. It is of great importance in the differential diagnosis of pustular eruptions in newborns due to virus or bacteria, of miliaria pustulosa, and of incontinentia pigmenti.
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The case histories of 17 newborns developing septic shock due to gram-negative bacilli were studied for pre- and perinatal risk factors, clinical symptoms, and hematologic changes. Immaturity, resuscitation procedures, and hypothermia on admission were found to be the risk factors most frequently preceding septicemia. A skin color fading and changing from reddish-pink to yellow-green was the most early noticeable clinical symptom in all patients. The total leukocyte counts as well as the relative proportion of bands increased significantly at the onset of illness. When septicemia advanced, a marked drop of leukocytes was found, while the relative proportion of bands increased further. Only 1 in 12 cases showed a decrease in the platelet counts at the height of septicemia. A procedure for the early diagnosis of a neonatal septicemia is proposed: (1) Registration of perinatal risk factors. (2) With perinatal risk factors a skilled and attentive clinical observation is necessary. Particular attention should be paid to changes of skin color. (3) White blood cell picture: (a) every day in patients with perinatal risk factors and (b) every 6 h in patients showing suspicious symptoms.
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A 33 month old healthy girl accidently took 1.5 g phenylbutazone and 2.6 g aminopyrine. She was treated with gastric lavage and forced diuresis. No clinical symptoms were discovered for 17 hours after drug ingestion. She then developed generalized convulsions. After 19 hours reddish discoloration of urine was observed for first time. High serum transaminase indicated later on a toxic hepatocellular damage. It is recommended to treat patients with phenylbutazone aminopyrine insgestions for at least 24 hours even in the absence of reddish urine discoloration and clinical symptoms.
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Explore the source record for details and available documents.
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Pneumonia is one of the major sites of infection in ventilated newborns. We investigated whether the cytokines IL-1 beta and TNF-alpha are detectable in tracheal aspirates of newborns with pneumonia as a diagnostic marker. All 12 infants with pneumonia had elevated levels of IL-1 beta (range 30-300 pg/ml) and TNF-alpha (range 60-680 pg/ml), whereas control infants (n = 21; respiratory distress syndrome, very low birth weight or infants intubated preoperatively) had no detectable levels of IL-1 beta or TNF-alpha. In vitro investigations with mononuclear cells of umbilical cord blood were performed to rule out that exogenously added surfactant influences IL-1 beta and TNF-alpha production. It is concluded that IL-1 beta and TNF-alpha are important and specific mediators of neonatal pneumonia which may be of diagnostic importance.
Fetal tachycardia and signs of hydrops fetalis were diagnosed at 29 weeks of gestation. The heart rate normalized by combined treatment with digoxin and flecainide and was followed by improvement of the hydrops. Premature labor led to delivery at 33 weeks of gestation. The newborn infant showed mild respiratory distress and was in a hemodynamically stable condition. Marked QT segment anomalies on the electrocardiogram during the first postnatal days resolved completely within 3 weeks. They were unlikely to be attributable to myocarditis or myocardial infarction. We speculate that these anomalies were caused by the maternal flecainide therapy.
Asplenia may predispose to fulminant invasive infections caused by encapsulated bacteria. We observed a 13 months old child with (so far unknown) congenital familiar asplenia, who died from pneumococcal sepsis. General vaccination of all infants with pneumococcal conjugate vaccine may prevent this disease, which is associated with a high rate of mortality in infants with asplenia.
Bone demineralization is a common condition in very preterm infants. It can easily be detected on plain chest films which are often taken in these patients for other reasons. On the first day of life each vertebral body is formed by two x-ray dense plates which are separated by a smaller horizontal more radiolucent zone. As a result of a calcium and/or phosphorus deficient nutrition the plates loose their x-ray density. Within four weeks the vertebral bodies appear then as a thin x-ray dense outer border surrounding a radiolucent "empty" center.