[Early diagnosis of neonatal infections using C-reactive protein].
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Bacterial Infections↗
Biomedical subjects
G Schmalisch
Publications and source records attributed to G Schmalisch.
[Technical problems with measurements and instruments of transthoracic impedance measurement in newborn infants].
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Cardiography, Impedance↗
[Simultaneous measurements of end-expiratory and transcutaneous carbon dioxide partial pressure in ventilated premature and newborn infants].
BACKGROUND: The aim of the present trial was to study the relationship between end-tidal pCO2 (p(et)CO2) and transcutaneous pCO2 (ptcCO2) after in-vivo calibration in ventilated newborns. PATIENTS: 61 end-tidal and transcutaneous pCO2 measurements were simultaneously performed in 30 ventilated preterm and term newborn infants (weight at birth 1862.6 +/- 981.9 g). METHOD: End-tidal pCO2 was measured in mainstream mode at the end of the endotracheal tubus (Novametrix 7000 Medical Systems Inc., USA, dead volume of the chamber 0.6 ml). Transcutaneous pCO2 was measured by means of a Servomed (SMK 365 Hellige, FRG) analyser. RESULTS: The statistical analysis demonstrated a good correlation (r = 0.72, p < 0.001) between ptcCO2 (mean +/- SD, 44.3 +/- 11.2 mmHg) and p(et)CO2 (32.4 +/- 10.4 mmHg). A considerable difference between transcutaneous and end-tidal pCO2 values was observed (p(tc-et)CO2 = +11.9 +/- 8.7 mmHg). This phenomenon was probably caused by ventilation-perfusion disturbances in the studied critically ill neonates. The statistical analysis revealed that the absolute magnitude of the P(tc-et)CO2 difference was independent from disease, episodes of spontaneous respiration or of respiratory frequency. CONCLUSIONS: Capnographic determination of P(et)CO2 provides informations about alveolar ventilation-perfusion-disturbances. Capnography enables the on-line control of end-tidal pCO2 in neonates with respiratory failure. It cannot replace transcutaneous pCO2 measurements or blood gas analysis but it can reduce its frequency in clinically stable patients. The analysis of the capnogram can be used to optimise artificial ventilation. A quantitative evaluation of the capnogram by calculation of Murányi's-CO2-Index was possible only in 28% of the ventilated newborns which limits its value in such patients.
Birth Weight↗
[Standardized measurement of surface tension of tracheal secretions of newborn infants for diagnosis of surfactant deficiency--secretory immunoglobulin A as a dilution marker].
UNLABELLED: The surface tension value (gamma min) of tracheal aspirate samples (TA) from newborns depends on lung maturity and is determined by concentrations of surfactant components (phospholipids, surfactant proteins, ions). During tracheal aspirate collecting the aspirate is diluted with physiological saline. Information about TA dilution is necessary for a standardized surface tension measurement. The purpose of this study was to establish an ELISA for determination of secretory IgA (SIgA), to determine the cutoff value of SIgA for surface tension measurement in tracheal aspirates and to test SIgA as marker for tracheal aspirate dilution. PATIENTS: In group 1 (normal range determination of gamma min) pharyngeal aspirates of 42 healthy newborns (nb) were investigated. In group 2 (determination of SIgA cutoff value) 15 TA and 8 pharyngeal aspirates of 23 pulmonary healthy nb (group 3) were used for validation of SIgA cutoff value. In group 4 36 TA of 22 nb with respiratory distress syndrome were studied. METHOD: The gamma min of group 1 were measured to establish the range of normal gamma min. The TA of group 2 were diluted stepwise and the dependence of gamma min on SIgA concentration were depicted in a diagram. The SIgA cutoff value was estimated by these dilution curves. Below this value the TA are very diluted and a measurement of gamma min is not useful. To test the reliability of SIgA as dilution marker the gamma min and SIgA values of TA from group 3 were determined. After exclusion of TA with reduced SIgA the gamma min of group 3 and 4 were compared. RESULTS: For the enzyme immunoassay following performance characteristics were determined: the accuracy (recovery): 95.6%, sensitivity: 4 ng/ml, and precision (intra- and interassay coefficient of variation): 9.8 and 19.1%, respectively. The range of normal gamma min (median (5th and 95th percentile)) amounts to 23.0 (14.8 and 28.7) mN/m. A SIgA cutoff value of 80 ng/ml was estimated. The gamma min from 8 of 27 TA (group 3) were above the normal range of gamma min during examination of the estimated SIgA cutoff value. 5 of these 8 TA had concentrations of SIgA below the cutoff point and could be excluded with the help of SIgA as dilution marker. The median of gamma min was significantly lower (p < 0.001) in group 3 (18.3 mN/m) in comparison to the median (35.8 mN/m) of group 4 (nb with respiratory distress syndrome). CONCLUSION: The performance characteristics of the SIgA enzyme immunoassay and the tested reliability of the SIgA cutoff value demonstrate, that a simple determination of surfactant deficiency by surface tension measurement of TA is possible using the concentration of SIgA as dilution marker.
Biomarkers↗
[Treatment of neonatal respiratory distress syndrome with Alveofact--results of a prospective observational study].
AIM: After registration of the bovine Surfactant Alveofact (Fa. Thomae) for treatment of neonatal respiratory distress syndrome (RDS) an observational study was performed in 47 german neonatal departments to register indication, effectivity, mode of administration and unexpected side effects. METHODS: 680 ventilated preterm infants (gestational weeks 29.5 +/- 2.9; birth weight 1359 +/- 507 g) were enrolled in an uncontrolled clinical study with study-protocol, prospectively defined outcomes and covariates, manual of operation, central control system, biometrical control. RESULTS: Surfactant was applicated at a postnatal age of 2 hours 56 minutes (median). Only 2.9% of newborn infants got the first surfactant doses < 6 min postnatally, 19.4% between 6 ... 60 min and 77.7% > 60 min postnatally. Following 1338 instillations in 76% an improved lung function, in 21% no change and in 3% a worsening was observed. During the study the total dose of surfactant increased. Safety considerations determined by the rate of pulmonary and extrapulmonary complications were similar to data of the literature: pneumothorax 12%, pulmonary interstitial emphysema 11.6%, secondary pneumonia 20.4%, broncho-pulmonary dysplasia 27%, pulmonary hemorrhage 2.1%, peri/intraventricular hemorrhage (degree III/IV) 27.9%, ductus arteriosus persistens 24.4%, sepsis/meningitis 12.4%. During the study the mortality reduces from 31% (first period) to 18% (third period) the mean was 20%. In 44 infants (6.5%) a disturbed ventilation (airway obstruction, overdystension of pulmonary areas, atelectasis) after surfactant administration was observed. CONCLUSION: In RDS the surfactant Alveofact is preferably used therapeutically (rescue mode), it is effective but not free of risk. Its administration needs for a clear indication. New unknown side effects of Alveofact were not observed.
Animals↗
[Measuring accuracy of commercial respiratory function equipment and ventilation monitors for newborn infants].
Reliability and accuracy of the measured ventilatory and lung mechanical parameters of different diagnostic systems (SensorMedics 2600, Med-Science RDS 4500) and respiratory monitoring systems (BI-CORE CP-100, monitor of Babylog 8000) were investigated using a mechanical lung model. The accuracy of pressure and volume signals was measured statically over 6h. The errors of estimated lung mechanic parameters (compliance C, resistance R, time constant T = R.C) were determined for the model parameters Ci = 3.9; 6.4; 10.0; 13.0 ml/kPa and Ri = 4.0; 10.0 kPa/l/s without and with endotracheal tubes (12 Ch, 16 Ch). Altogether 27 parameter combinations were used. The lung mechanic parameters were measured by single occlusion tests. The Babylog 8000 permits only the measurement of the endinspiratory quasistatic compliance C = VT/(Pmax - PEEP). The investigations have shown that -excepted the CP-100 (volume measuring error > 14%)-the accuracy of static measurements was sufficient and in conformity with the allowed tolerances. No significant changes were found over 6h. The mean errors of measured lung mechanic parameters differed extremely in relationship to the time constant of the model. They are for T < 80 ms/T > or = 80 ms 7.4%/-3.5% (SM 2600), -8.4%/-5.8% (CP-100) and -22.0%/-17.3% (Babylog 8000) for compliance, 4.6%/-3.8% (SM 2600) and 189.0%/43.4% (CP-100) for resistance. No reliable measurements of lung mechanics were possible with the RDS 4500 due to software problems. We found, the smaller the time constant the higher the measuring errors of lung mechanic parameters. There are big differences between the investigated devices. Up to now for exact measurements expensive diagnostic systems can not be replaced by respiratory monitors.
Airway Resistance↗
Increased incidence of cervical intraepithelial neoplasia in young women in the Mitte district, Berlin, Germany.
OBJECTIVE: To investigate whether the incidence of cervical intraepithelial neoplasia (CIN), in particular of high grade CIN, increased in Berlin during the period 1970-1989 and whether the ages of women with CIN had decreased. STUDY DESIGN: In the former German Democratic Republic, which had a highly centralized public health system, all gynecologic operations performed on women living in the Mitte district of Berlin were carried out during the period 1970-1989 (when the Berlin Wall fell) in the gynecologic clinic of the Charité Hospital. RESULTS: The incidence of all CIN increased from year to year over the observation period: 0.04% (1970-1971), 0.10% (1980-1981), 0.39% (1988-1989). There was a particularly high increase in the incidence of high grade intraepithelial neoplasms (CIN 3): 0.016% (1970-1971), 0.056% (1980-1981), 0.25% (1988-1989). With a virtually unchanged age distribution for women in the Mitte district of Berlin, the median age of women with CIN 3 decreased significantly from 1970 to 1989, from 39.5 (1970) to 33 (1989) (P < .001). CONCLUSION: The increase in the incidence of CIN, especially of high grade CIN, as well as the reduction in age for onset of the disease, makes high participation in screening necessary, above all among young women.
Adult↗