Early morbidity and neurological development in 40 term infants with UApH less than or equal to 7,00 (6,60-7,00) were investigated. Group 1: 18 infants (45%) responded well to the measures of primary resuscitation--they never revealed any neurological symptoms and their growth and development were normal. Group 2: 15 infants (37,5%) who responded less well to primary resuscitation initially had mild to moderate neurological symptoms subsiding during the first few days of life. There were 2 cases of necrotizing enterocolitis and 4 cases of moderate meconium aspiration syndrome. Apgar scores, pH and blood-gases were worse than in group 1. At discharge and on follow-up all children appeared clinically normal. Group 3: 7 infants (17,5%) with severe neurological signs were not responding well to resuscitation. They were referred to the intensive care nursery and treated for cerebral edema (hyperventilation, pentobarbital, steroids). 2 infants with severe meconium aspiration syndrome recovered entirely. Two children had evidence of cerebral involvement as demonstrated by means of computerized tomography of the head, but were normal on follow-up. Three children with distinct signs of cerebral palsy developed cerebral atrophy and microcephaly, presumably due to hypoxic-ischemic encephalopathy. Early morbidity, comprising all 22 infants from group 2 and 3 amounts to 55%, morbidity up to an average age of 14,7 month includes 5 infants from group 3 (suspected cerebral lesions in 2, microcephalus in 3) and thus comes to 12,5% of the total.

Acid-Base Equilibrium↗

PubMedDate not supplied

[Severe peripartum acidoses (umbilical artery pH less than or equal to 7.00)--clinical aspects and therapy].

Severe neonatal acidosis, defined in this study as a pH of 7,00 or less in the blood of the umbilical artery occurred in 0,4% of 8 992 life born term babies between 1980 and 1981. Analysis of high risk factors during pregnancy showed no difference between acidotic and non acidotic newborns, whereas in all newborns with severe acidosis there were more or less unexpected acute complications during delivery, such as abrutio placenta or cord complications or else. 60% of infants were born by cesarian section or forceps. Resuscitation was performed in an aggressive manner by starting IPPV within one minute post partum, correcting the acidosis and by attempting to stabilize circulation by administration of glucose and human albumin. 6 babies required prolonged ventilatory support over 24 hours. 27 newborns received parenteral solutions of glucose and amino-acids for 6 or more days. Severe acidosis was followed in 8 babies by abnormal neurologic symptoms. In infants with severe acidosis Apgar-score at one minute was not found to be significantly related to subsequent outcome. A NapH of less than or equal to 6,90 and/or Apgar-score of less than or equal to 4 at five minutes, especially in connection with additional risk factors, is an ominous finding.

Acid-Base Equilibrium↗

PubMedDate not supplied

Influence of lipid infusion (0.4 g/kg/hr) and positive end expiratory pressure (8 cm H2O) on pulmonary function and hemodynamics in healthy anesthetized pigs.

Fat emulsions are used increasingly for parenteral nutrition in premature infants suffering from various disorders, including respiratory insufficiency necessitating artificial ventilation with positive end expiratory pressure (PEEP). Both PEEP and lipid infusions (LI) may alter pulmonary hemodynamics. The simultaneous effect of LI and PEEP were therefore investigated. Five adult anesthetized Göttinger minipigs were infused with a 20% LI at a high rate of 0.4 g/kg/hr for 30 min, followed by PEEP of 8 cm H2O for 15 min. Catheters were inserted into the upper vena cava, the pulmonary artery, the right and left atrium, and the aorta, and pressures recorded continuously. Ventilation volume, respiratory fractional gas concentrations of O2 and CO2 (mass spectrometer), and blood gases were measured. The following parameters were calculated: total peripheral resistance, pulmonary arteriolar resistance, right-to-left shunt (QS/QT) dead space ventilation (VD/VT) and effective compliance. Total peripheral resistance remained unchanged. Pulmonary arteriolar resistance increased significantly during PEEP, PEEP + LI, but not during LI alone. QS/QT increased significantly during LI and returned to normal when PEEP was applied. VD/VT and effective compliance did not change during LI. The increased right to left shunt, caused by LI, is reduced by means of PEEP, while the pulmonary arteriolar resistance increased with PEEP and LI.

Anesthesia, Inhalation↗

PubMedDate not supplied

[The Graz SIDS Risk Questionnaire: prospective study of 6,000 infants].

In a prospective study (1988-1990) the SIDS risk questionnaire SRFB was applied to 6000 infants born in the Department of Obstetrics, University Hospital Graz. In all infants at an increased statistical risk for SIDS a standardized intervention including pediatric and polysomnographic investigations was performed. As a result the SIDS incidence decreased from an average of 1.92 per thousand lifeborns (1984-1988) to 0.83 per thousand lifeborns (1989-1990) in our test group, which means a striking reduction of the SIDS incidence by 57%. In addition to this effect, the intensified information of parents and physicians about possible signs of an increased risk for SIDS lead to a general reduction of SIDS in Styria.

Austria↗

PubMedDate not supplied

[Intrauterine growth--normal curves for gestational age].

We calculated new birthweight, length and head circumference standards for caucasian boys and girls between 26 and 43 weeks gestation from 28,126 singleton live births at our hospital between 1980 and 1985. Only stillbirths and infants with serious congenital abnormalities were excluded, whereas babies born to mothers suffering from complications known to affect fetal size were considered part of the population to which standards will be applied and thus remained included. The standards were determined from centiles for each gestational week independent of the mode of distribution of the data. The centiles were then "smoothed" using a Hanningfilter. The descriptive analysis showed a skew to the left of all our data and a steep distribution pattern so that the assumption of a normal distribution is incorrect. Comparison with mean values and standard deviations computed from the same data revealed considerable deviations from our results.

Birth Weight↗

PubMedDate not supplied

[Neonatal hyperthyroidism caused by TSH receptor antibodies in maternal autoimmune hyperthyroidism].

Between July 1993 and December 1994 five term infants of mothers with Graves' disease were hospitalised at the Frühgeburtenstation of the Univ.-Frauenklinik Graz. Four Mothers had elevated TSH-receptor-antibody (TRAb)--levels during pregnancy, one had normalised TRAb-titers. In one case hyperthyroidism was first diagnosed during pregnancy. Three newborns had elevated TRAb-titers; in one of them thyrotoxicosis was diagnosed clinically and biochemically at the second day of life, one newborn had mild hyperthyroidism with tachycardia at the end of the first week of life and one newborn was asymptomatic by immediately initiated therapy. The two other newborns had normal thyroid hormone and antibody levels and no symptoms or signs of hyperthyroidism. The cases are reported and discussed in detail and our overall approach to diagnosis and treatment of neonatal hyperthyroidism in case of maternal Graves' disease will be given.

Autoantibodies↗