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G Jorch

Publications and source records attributed to G Jorch.

At least 55 records · Page 3Linked to original sources
PubMed1994

Prognostic significance of spontaneous motility in very immature preterm infants under intensive care treatment.

Qualitative analysis of spontaneous motility was performed in 22 preterm infants (gestational age 25-31 weeks) on the intensive care unit. The infants were videorecorded once a week in the late afternoon during 1 h until 36 weeks of gestation. Quality of movement was analyzed by 8 observers using visual 'Gestalt perception' and compared with the neurological outcome 1 year after term. A normal quality of movement consistently predicted a normal neurological outcome with a probability of 90-100%. An abnormal quality of movement predicted an abnormal outcome with a probability of only 56% in the first, but with a probability of 82% in the third postnatal week. The average interobserver agreement was 78%. The analysis of spontaneous motility for the early diagnosis of neurological dysfunctions can reliably be applied on very immature preterms under intensive care conditions from the 3rd postnatal week on.

Age Factors↗
PubMed1994

Ultrasound imaging.

Ultrasonographic imaging has achieved a widespread use in neonatal intensive care units for diagnostic and screening purposes. Investigated sites are brain > heart > kidney > abdomen. In preterms < 33 gestational weeks and terms after asphyxia brain imaging has prognostic significance.

Gestational Age↗
PubMed1993

Adaptive multipurpose probe fixation device for use on newborns.

Detailed information on the construction and assembly of a noncommercial hood-like multipurpose probe fixation device is given. A vacuum technique is used to individually mold the device to the skull of newborn infants and to attach sensors firmly with minimum pressure. By design, in the range of 22 to 38 cm head circumference for transfontanellar Doppler monitoring, no more than four different sizes of the hood are required to match individual positions of the anterior fontanelle. A ball-and-socket joint facility is integrated. The flexibility of the design allows for an easy adaptation of the device to different probe requirements. This provides the opportunity to investigate cerebral circulation by using various methods simultaneously.

Blood Flow Velocity↗
PubMed1993

Resuscitation of the very immature infant: cerebral Doppler flow velocities in the first 20 minutes of life.

Blood flow velocity of the anterior cerebral artery was investigated by Doppler ultrasonography in five time intervals up to 20 min after birth in 16 non-asphyxiated very immature infants (median birth weight 1,058 g, range 720-1,930 g; median gestational age 30 weeks, range 27-32 weeks) delivered by caesarean section and intubated after birth. Heart frequency, oscillometric mean arterial blood pressure and blood gases were recorded as well. There was a transitory increase in both systolic and end-diastolic velocities (from 29 to 35 and from 1 to 10 cm/s) during the first 5 min after birth which occurred together with an increase in heart frequency. The overall incidence of intracranial haemorrhage was low (3/16, 19%). This observation study shows a transitory increase in cerebral blood flow velocity with a peak at about 5 min after birth in preterm infants < 33 weeks of gestation undergoing standard resuscitation.

Birth Weight↗
PubMed1993

Simultaneous influence of blood pressure, PCO2, and PO2 on cerebral blood flow velocity in preterm infants of less than 33 weeks' gestation.

In extremely preterm infants, the protective capacity for cerebral blood flow (CBF) autoregulation may be impaired or absent, which increases the risk for developing cerebral lesions. The purpose of this study was to quantify the simultaneous influence of several vital parameters, such as mean arterial blood pressure (MABP), PCO2, and PO2, on cerebral blood flow velocity (CBFv), which is used as a measure for CBF. In 16 mechanically ventilated infants of < 33 wk gestation, the CBFv in the internal carotid artery was measured every minute for 1 h by a computer-controlled pulsed Doppler device. MABP and transcutaneous PCO2 and PO2 were recorded as well. A multiple linear regression analysis was performed in each patient to determine the individual MABP, PCO2, and PO2 reactivities as a measure for CBF autoregulation. The medians (and ranges) of the whole group were an MABP reactivity of 7.5% (-12.5 to 20.1%) rise in CBFv/1 kPa rise in MABP, a PCO2 reactivity of 32.7% (-8.1 to 79.5%) rise in CBFv/1 kPa rise in PCO2, and a PO2 reactivity of -3.1% (-14.2 to 7.9%) fall in CBFv/1 kPa rise in PO2. In preterm infants, the individual's capacity for MABP-, PCO2-, and PO2-dependent CBF autoregulation can be estimated by means of the present method, even if the vital parameters change simultaneously.

Blood Flow Velocity↗
PubMed1993

[Current percentile curves for body weight, body length and head circumference of newborn infants after the 25th week of pregnancy].

Up-to-date regional standard curves of birth weight, body length and head circumference have been derived from a survey of perinatal data (Perinatalerhebung) including 96.3% of all neonates born in 1988/89 in an area of northern Germany (westfalian districts of Münster, Detmold and Arnsberg). After exclusion of nongerman neonates, multiple births and those with doubtful date, complete data of 129,858 neonates (including 410 prematures of 25-28 gestational weeks) were evaluated. Mathematical analysis resulted in standard curves reliable between the 25 and 42 gestational weeks and between the 3rd and 97th percentile. Mean male birth weight at 40 weeks was 3612 g versus 3469 g in females. The normal range for boys was 2800-4500 g, and 2650-4350 g for girls. Irrespective of sex, mean body length of term neonates was 52.3 cm (48-57), mean head circumference was 35.2 cm (33-38). We suggest the use of these standard curves for newborns in northern Germany.

Birth Weight↗
PubMed1993

[Periventricular leukomalacia].

The present knowledge on periventricular leucomalacia is reviewed. Its incidence is about 10% in preterms infants < 32 gestational weeks. By careful ultrasonographic scanning four stages can be distinguished: Prolonged flares, resolution, cystic leucomalacia, ventriculomegaly. Periventricular leucomalacia (PVL) is much more correlated with later neurologic impairment than intraventricular haemorrhage (apart from grade IV). PVL is caused by ischemia of the periventricular white matter mainly due to arterial hypotension and disturbed regulation of cerebral blood flow. The interactions between blood pressure, pCO2, pO2 and cerebral blood flow are complex and poorly understood. Regarding the clinical management it seems important to avoid hypotension, fluctuating pCO2 and hypoxemia/anemia in order to prevent white matter ischemia. Research should be focussed on the development of monitoring methods (doppler sonography, near infrared spectroscopy, time compressed electroencephalography), which allow to detect ischemic events to prevent neurologic impairment in about 1000 preterm infants per year in Germany.

Blood Flow Velocity↗
PubMed1992

Early treatment of respiratory distress syndrome with bovine surfactant in very preterm infants: a multicenter controlled clinical trial.

OBJECTIVE: To determine the effect of bovine surfactant (SF-RI 1, Alveofact) administered during the first hour following birth to very premature infants [gestational age (GA), 25-30 weeks] in a multicenter, controlled trial. HYPOTHESIS: Survival without bronchopulmonary dysplasia (BPD; definition: ventilator dependency or FiO2 greater than 0.3 during spontaneous respiration) at day 28 is increased in surfactant-treated infants (sequential analysis). PATIENTS AND METHODS: Thirty-four infants [GA 28.0 +/- 1.5 SD weeks, birth weight (BW), 1,048 +/- 299 g] received 50 mg/kg BW surfactant, whereas 35 infants (GA, 27.6 +/- 1.5 weeks, BW 969 +/- 269 g) served as controls. Retreatment with surfactant (up to three identical doses) 12-24 hours after the previous dose was permitted if FiO2 was greater than 0.5. RESULTS: Survival without BPD was significantly higher in surfactant treated infants (26/34) compared to controls (14/35; P = 0.003), but in the incidence of pulmonary air leaks, patent ductus arteriosus, intracranial hemorrhage, and nosocomial infections they were not different. CONCLUSION: Bovine surfactant treatment improves survival without BPD in very premature infants at risk for neonatal respiratory distress syndrome (RDS).

Bacteria↗
PubMed1992

Therapeutic use of surfactant in neonatal respiratory distress syndrome. Correlation between pulmonary X-ray changes and clinical data.

As part of a multicenter surfactant rescue study, the chest X-rays of 239 preterm and term infants were analyzed. To study the influence of surfactant administration on radiographic appearance, 130 patients with a clinical and radiological diagnosis of typical respiratory distress syndrome were selected, in whom adequate chest x-rays before and within 48 h after treatment were available. Median gestational age was 30 weeks (range 25-38 weeks), median birth weight was 1335 g (range 625-3450). The time of surfactant application ranged between 90 min and 24 h after birth (median 6 h). The most common finding after surfactant administration was uniform (n = 47) or disproportionate (n = 46) improvement of pulmonary aeration, which showed a significant correlation to posttreatment reduction of oxygen requirement (p less than 0.0001). Asymmetric clearance was more often localized on the right side and usually disappeared within two to five days. Only in 13 patients no change of ventilation was found. Development of interstitial emphysema (n = 24, including three patients with pneumothorax) after surfactant treatment was an unfavourable prognostic sign. 54% of these patients (13 of 24) died within the first month of life, compared to 8% (7 of 93) in the group of patients with initial improvement of ventilation.

Female↗
PubMed1992

Delayed primary reconstruction of an esophageal atresia with distal esophagotracheal fistula in an infant weighing less than 500 g.

Delayed primary reconstruction of an esophageal atresia (Vogt IIIb) was undertaken in an extremely small-for-date baby (second twin, 36th week) with a birth weight of 445 g. After initial insertion of a gastrostomy under local anesthesia on the 29th day of life, ligation of the fistula and end-to-end anastomosis were performed by transpleural access (weight then, 535 g). There were no complications related to the operative procedure. The baby weighed 1,600 g at the age of 8 months.

Diseases in Twins↗
PubMed1992

Hemotherapy in neonatology.

The intensive care of very immature preterm infants is of special significance in the treatment of neonates with blood and blood components. A new, practicable transfusion concept has been developed for this group with its high and often acute need of hemotherapeutic measures: 30-ml packs containing packed red cells of blood group 0 Rh neg, free of 'immune' anti-A/B and anti-CMV-free, or deep-frozen fresh plasma of blood group AB. This concept has the advantages of simplified pretransfusional serology, reduced blood requirement with simplified storage, fresher stored blood due to more rapid turnover, reduced risk of infection through reduction in number of donors per patient, implying a reduced strain on patients and personnel, and the opportunity provided by the reduced thawing time and the eliminated risk of error to commence therapy immediately after the decision.

Blood Component Transfusion↗
PubMed1991

Cerebral hemodynamics in perinatal pharmacology.

The influence on cerebral hemodynamics of drugs given to infants less than 32 gestational weeks, at high risk for intracerebral hemorrhage, can be easily assessed by pulsed Doppler technique. We report on our studies in these infants who were treated with the following drugs: diazepam (0.5 mg/kg BW i.v.), pethidine (1 mg/kg BW i.v.), pancuronium bromide (0.1 mg/kg BW i.v.), phenobarbitone (loading dose = 20 mg/kg BW, maintenance dose 5 mg/kg BW i.v.), theophylline (loading dose = 6 mg/kg BW, maintenance dose = 1.5 mg/kg BW i.v.) and bovine surfactant SF-RI 1 (50 mg/kg BW intratracheally). All studied drugs proved to be safe at the administered dosage with regard to their influence on cerebral hemodynamics in very immature infants.

Cerebrovascular Circulation↗
PubMed1991

Drug utilization in very premature infants in neonatal intensive care units.

Neonatal drug utilization in very premature infants (gestational age (GA) 24-29 weeks), requiring intubation and mechanical ventilation at birth was registered as part of a multicenter controlled clinical trial of high-dose versus low-dose bovine surfactant (initial doses 100 mg/kg birth weight (b.w.) versus 50 mg/kg b.w.). Drug utilization during 4 weeks after birth was analyzed in 164 infants (mean GA 27.2 +/- 1.2 (SD) weeks, b.w. 970 +/- 145 g (SD)). More than half of the study infants received antibiotics (98.8%), sedatives and analgesics (91.5%), sodium bicarbonate (78%), solutions for volume replacement (62.8%), methylxanthines (56.7%) and catecholamines (52.4%). It may be concluded that the pattern of drug usage indicates a high incidence of proven or suspected infections and circulatory and respiratory disorders reflecting the high-risk state of study infants.

Dose-Response Relationship, Drug↗
PubMed1991

Does prophylactic use of bovine surfactant change drug utilization in very premature infants during neonatal period?

The efficacy of a bovine surfactant preparation (SF-RI 1) to increase survival without bronchopulmonary dysplasia (BPD) was studied in very premature infants in a multicenter, randomized sequential trial. Thirty-four infants were randomized to surfactant treatment, whereas 35 infants served as controls. As part of the study, pharmacotherapy with antibiotics, sedatives, catecholamines, diuretics, methylxanthines, mucolytics, muscle relaxants, digoxin, and indomethacin was registered during week 1 and weeks 2-4. As to the endpoint of the study a significantly increased survival rate without BPD was observed in surfactant-treated infants (76%) compared to controls (40%). Significant differences concerning drug utilization were found through week 1 with increased use of methylxanthines in surfactant-treated infants, which persisted during weeks 2-4 as well as a reduced incidence of diuretic therapy in surfactant-treated infants during weeks 2-4. These differences may be attributed to the shorter interval of mechanical ventilation in surfactant-treated infants (11 days) compared to controls (27 days), and to the above mentioned increased survival rate without BPD.

Animals↗
PubMed1990

Acoustic power measurements of Doppler ultrasound devices used for perinatal and infant examinations.

Acoustic power output levels were measured in four different pulsed Doppler systems (transcranial, Duplex mode, colour mode, miniature for continuous monitoring) currently used for examination of fetal and infant blood flow velocities. The frequencies of the transducers ranged from 2 to 8 MHz. The devices were studied at three to five different intensity settings. The measurements were performed using the radiation force balance of the Fraunhofer-Institut, which was especially adapted for this study. Each of the four devices was tested while running in its commonly used mode, and comparison showed that their acoustic power values varied widely: 96.8 mW (2 MHz, EME TC2-64B), 8.7 mW (5 MHz, ATL Mk 500), 61.9 mW (3.5 MHz, Acuson 128) and 13.5 mW (5 MHz, HP 77020). All transducers had total power output levels below the limits recommended by the American Institute for Ultrasound in Medicine and Biology in the conclusions on a thermal bioeffects mechanism, which were approved in October 1987.

Acoustics↗