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Biomedical subjects

H Devlieger

Publications and source records attributed to H Devlieger.

At least 37 records · Page 2Linked to original sources
PubMed2004

Pharmacokinetics of single dose intravenous propacetamol in neonates: effect of gestational age.

AIM: To investigate the pharmacokinetics and pharmacodynamics of single dose propacetamol in preterm and term infants on the first day of life. METHODS: Neonates were stratified by gestational age. Preterm (< 37 weeks) and term (37-41 weeks) infants received a single dose of propacetamol in the first 24 hours of life when they had minor, painful procedures or as additional treatment in infants receiving opioids. Blood samples were taken from an arterial line, and pain was evaluated by a multidimensional pain scale. Results were reported as mean (SD). Student's t and Wilcoxon tests were used to compare the groups. RESULTS: Thirty neonates were included, 10 of which were term infants. Serum half life was 277 (143) minutes in the preterm infants and 172 (59) minutes in the term infants (p < 0.05). Clearance was 0.116 (0.08) litre/kg/h in the preterm infants and 0.170 (0.06) litre/kg/h in the term infants (p < 0.05). Gestational age correlated with serum half life (r = -0.46). No effect of sex or administration of prenatal steroids was found on the pharmacokinetics of paracetamol. In neonates who only received propacetamol (n = 15), the level of analgesia seemed to be associated with the therapeutic (> 5 mg/l) level. CONCLUSIONS: A correlation was found between gestational age and the serum half life of propacetamol. The maturational trend of clearance and half life in preterm and term neonates is in line with data on the pharmacokinetics of propacetamol beyond the newborn period.

Acetaminophen↗
PubMed2004

Video reveals self-stimulation in infancy.

UNLABELLED: The medical literature on early childhood masturbation is sparse. Only 12 patients who presented with infantile self-stimulation under the age of 1 y are described. During the last 2 y, five girls under 1 y of age presented at our department with self-stimulating behaviour. The diagnosis of this behaviour was difficult, but could be made by watching a video of the attacks. Infantile self-stimulation is often misdiagnosed and unnecessary investigations and useless treatments are often prescribed. Video recording can be of great help to put forward the correct diagnosis. Masturbation is not so uncommon and treatment consists mostly in reassuring the parents. It can, however, be associated with behavioural problems. Few data are available on the clinical outcome of childhood masturbation, but most children seem to develop normally. CONCLUSION: Infantile self-stimulation should always be considered in the differential diagnosis of "strange episodes or attacks".

Diagnosis, Differential↗
PubMed2004

Characteristics of respiratory syncytial virus-related apnoea in three infants.

UNLABELLED: Apnoea is a common sign in respiratory syncytial virus (RSV) infections in young infants and can be the first presentation of an acquired RSV infection. We describe polysomnographic recordings of three infants revealing prolonged RSV-related apnoea before RSV infection was diagnosed. The apnoeas were of central origin. The caregivers had not noted any apparent life-threatening events (ALTE) prior to the polysomnography. Cardiorespiratory monitoring after the acute infection did not reveal any further apnoeas. CONCLUSION: Central, prolonged apnoea can be the first sign of an acquired RSV infection in young infants in the absence of other respiratory symptoms and without any previous observation of apnoea by the caregivers.

Apnea↗
PubMed2003

Cryotherapy for threshold retinopathy: perioperative management in a single center.

Perioperative management and complications during and after surgery were reviewed in a population of premature infants who received cryotherapy because of threshold retinopathy by retrospective analysis of medical, anaesthetic, and ophthalmologic files. Infants (n=31) who received cryotherapy between January 1, 1996 and January 1, 2001 and were treated during the neonatal period in the unit were included in the study. Cryotherapy was performed under general anesthesia on the neonatal ward. Neonatal and preoperative characteristics of this cohort point to a vulnerable group of infants with a preoperative weight of 1622 g (1519 to 1862 g), bronchopulmonary dysplasia criteria applying in 29 of 31 patients and methylxanthins prescribed in 26 of 31 patients. No single cryotherapy session had to be interrupted because of systemic complications. Still marked cardiorespiratory instability was documented until 36 hours postoperative in 8 patients. Performing surgical procedures on the neonatal ward is a feasible option. Perioperative management in infants who received cryotherapy is used as an illustration of this approach.

Anesthesia, General↗
PubMed2003

The respiratory pump: past and present understanding.

UNLABELLED: The history of our understanding of the respiratory system has been long and progressive, probably starting with Galenus who did experimental spinal cord sections, and progressed through the poorly known work of Leonardo da Vinci on the structure-function relation of chest wall components. CONCLUSION: Despite numerous experiments in the past, the respiratory control system remains complex and poorly integrated because of the diversity of the afferent pathways and of the interacting respiratory centres.

Diaphragm↗
PubMed2003

Incidence, perinatal risk factors, visual outcome and management of threshold retinopathy.

The incidence of threshold retinopathy, clinical characteristics and risk factors to develop threshold retinopathy are described in a group of preterm infants admitted between 1996 and 2000 in a single tertiary neonatal intensive care unit. A subset of these infants (n = 31) developed threshold retinopathy (ROP). Incidence of threshold ROP in survivors with a birth weight below 1500 g is 6.4%. Pre-, peri- and postnatal characteristics of these infants are described and compared with matched controls of the same gestational age (GA) and admitted in the same unit in an attempt to focus on relevant risk factors of threshold ROP. We also report on visual outcome data in infants who developed threshold retinopathy. Finally, we describe our experience with perioperative management in this cohort.

Belgium↗
PubMed2002

Effects of non-nutritive sucking on heart rate, respiration and oxygenation: a model-based signal processing approach.

Several studies support the idea that the use of pacifiers can reduce the risk of Sudden Infant Death Syndrome. To investigate the effect of non-nutritive sucking (NNS), we measured heart rate, abdominal respiration, EMG and arterial oxygen saturation of 20 neonates. Also, in 10 of these neonates, changes in cerebral hemoglobin concentrations were acquired by means of near-infrared spectroscopy. Using a parametric technique to model the heart rate as a sum of exponentially damped sinusoids, two main frequency components were found in the heart rate during NNS: a frequency of approximately 0.08 Hz due to the alternation of sucking bursts and pauses, and a frequency of approximately 0.8 Hz that reflects the influence of the respiration. Our analysis shows that it is the alternation of bursts and pauses itself that causes the increased heart rate variability, and that this is not due to increased effort. This suggests that the neuronal mechanism regulating NNS also stimulates the heart rate. From our measurements, no effect of NNS on cerebral or peripheral oxygenation could be found. Furthermore, we show that our model-based signal processing technique is well suited for the analysis of non-stationary biomedical signals.

Electrocardiography↗
PubMed2002

The use of methohexital during neonatal cardioversion.

We report on the use of methohexital during elective neonatal direct current cardioversion. In contrast with the available data on cardiac management in neonates with supraventricular tachycardia and the guidelines on anaesthetic management during cardioversion in adults, data on anaesthetic management in neonates are still lacking. Methohexital might be an option for procedural sedation and anaesthesia during elective cardioversion in neonates.

Anesthetics, Intravenous↗
PubMed2002

Neonatal transthoracic puncture in a case of congenital cystic adenomatoid malformation of the lung.

A patient with congenital cystic adenomatoid malformation of the lung (CCAM) is presented who showed severe respiratory deterioration in the neonatal period caused by hyperinflation of the cystic component and compression of the contralateral lung. Transthoracic drainage of the cyst was performed to avoid preoperative artificial ventilation. On aspiration, air and liquid was removed from the cyst. After stabilization, surgical intervention was performed within 24 hours. Postoperative recovery was uneventful, and the child was discharged at day 13.

Cystic Adenomatoid Malformation of Lung, Congenita↗
PubMed2002

Cerebral tissue oxygenation index in very premature infants.

AIM: To describe normal values of the cerebral tissue oxygenation index (TOI) in premature infants. METHODS: TOI was measured by spatially resolved spectroscopy in preterm infants on the first 3 days of life. Infants with an abnormal cranial ultrasound were excluded. Other simultaneously measured variables were PaO(2), PaCO(2), pH, mean arterial blood pressure, heart rate, haemoglobin, glycaemia, and peripheral oxygen saturation. RESULTS: Fifteen patients with a median postmenstrual age of 28 weeks were measured. There was a significant increase in median TOI over the first 3 days of life: 57% on day 1, 66.1% on day 2, and 76.1% on day 3. Multiple regression analysis showed no correlation between TOI and postmenstrual age, peripheral oxygen saturation, mean arterial blood pressure, PaO(2), PaCO(2), and haemoglobin concentration. CONCLUSION: Cerebral TOI increases significantly in the first 3 days of life in premature babies. This increase probably reflects the increase in cerebral blood flow at this time.

Analysis of Variance↗
PubMed2001

Pulmonary sequestration: a comparison between pediatric and adult patients.

OBJECTIVE: Modern large single institutional reports on pulmonary sequestration (PS) are extremely rare. We were interested in comparing patients with PS referred by our pediatric versus adult pulmonologists. METHODS: Hospital notes of all patients operated on between 1978 and 1997 for a congenital broncho-pulmonary malformation were reviewed. In 28 patients, the parenchymal lesion was vascularized by a systemic artery and was separated from the bronchial tree, thus matching the strict definition of PS. Patient characteristics and outcome were analyzed comparing the pediatric group (< or =16 years: n=13; mean age, 3+/-5 years) versus the adult group (>16 years: n=15; mean age, 33+/-13 years). RESULTS: No significant differences between both groups were observed in sex, side, type of sequestration, pulmonary venous drainage, associated anomalies, hospital and late outcome, and patient's overall score. Patients (n=21) with the intralobar type of sequestration presented significantly more often with an infection when compared with patients (n=7) with the extralobar type (91 versus 14%; P=0.0033). When compared with the pediatric group, patients in the adult group had significantly more respiratory infections (87 versus 38%; P=0.016), and also required a lobectomy more often (67 versus 31%; P=0.056). CONCLUSIONS: The extralobar type of sequestration often remains asymptomatic, and is usually an incidental finding during infancy. The intralobar type mostly presents with recurrent infections in adulthood resulting in more lobectomies. We believe these findings support our current policy to remove any pulmonary malformation whenever diagnosed in order to: (1), prevent infection and other potentially serious late complications which may compromise the surgical outcome; and (2), enhance the chance of a parenchymal-sparing resection.

Adolescent↗
PubMed2001

Aneurysm of the ductus arteriosus in a neonate with 13q-deletion.

Aneurysm of the ductus arteriosus is a rare abnormality for which different ways of pathogenesis are described. We report the case of a fatal thrombosis of an aneurysm of the ductus arteriosus in an infant presenting feeding difficulties and a mild dysmorphic facies. Karyotype analysis revealed a de novo chromosomal deletion 46,XY, del (13)(q12.3,q22.3). To the best of our knowledge, this is the first case of an aneurysm of the ductus arteriosus associated with a chromosomal aberration.

Aneurysm↗
PubMed2000

Right diaphragmatic eventration associated with intralobar pulmonary sequestration: a case report.

A case of right diaphragmatic eventration, associated with a lung sequestration, in a 7-month-old infant is presented. Failure to thrive was the initial symptom. X-ray of the chest, made because of mild respiratory distress, revealed an inhomogeneous opacification of the right lower hemithorax, suggesting a diaphragmatic hernia. A right thoracotomy was performed and a diaphragmatic eventration covered by a thick pleuroperitoneal membrane was found, together with sequestration of the lung. The pathologic findings and the embryology are discussed.

Bronchopulmonary Sequestration↗
PubMed2000

Iron supplementation in preterm infants: a study comparing the effect and tolerance of a Fe2+ and a nonionic FeIII compound.

The more widely used divalent forms of iron (Fe2+) supplementation often lead to gastrointestinal symptoms in preterm infants although little is known about the use of nonionic trivalent iron preparations (FeIII) in these patients. It is especially under this nonionic form that dietary iron is available. For this reason, a randomized controlled study was undertaken to compare the efficacy and the extent of possible side effects in two groups of preterm infants. In one group, the elemental iron was given in the Fe2+ form, while the other group received a nonionic trivalent iron (FeIII) complexed with polysaccharides of low molecular weight. Both groups received 7.5 mg elemental iron daily. Measured parameters in the two study groups did not differ significantly throughout the study period of 14 weeks. Both forms of iron supplementation were well tolerated. However, vomiting, diarrhea, or constipation occurred slightly more often in the group receiving iron supplementation in the Fe2+ form without reaching statistical difference. The authors found a nonionic trivalent polysaccharide-iron complex given as iron supplementation as effective as the generally more favored ferrous sulphate. Since iron therapy is mandatory in the preterm infant, the use of trivalent iron complexes can be considered as a good alternative.

Dietary Supplements↗