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H Versmold

Publications and source records attributed to H Versmold.

64 records · Page 4Linked to original sources
PubMedDate not supplied

[Oral sugar solutions in pain therapy of neonates and premature infants].

OBJECTIVES: We review the efficacy of oral sugar solutions for treating procedural pain in neonates and address the following questions: Do newborns need analgesic therapy for procedural pain during blood sampling? How do sugars influence pain-reactions of neonates? What is the efficacy of sugar solutions in clinical practice? METHODS: We searched for relevant articles in the PubMed database from 1990 to September 2000. RESULTS: Treatment of procedural pain in newborns is desirable because they are more sensitive to pain than adults, they show marked pain reactions during blood sampling and repeated acute pain in the newborn period results in longterm behavioural changes. Oral sugar solutions have been studied for treatment of procedural pain in neonates. Their initial effect is the result of orotactile stimulation by the intraoral fluid. The orogustatory stimulation by the sweet taste prolongs the effect for up to 10 minutes through endorphin release. In randomized-controlled trials oral sugar solutions (2 ml of 25% sucrose or 30% glucose) reduced pain reactions and crying and attenuated the heart rate increase after capillary and venous blood sampling in term and preterm neonates. They are more effective than traditional calming strategies, like cuddling by parents, use of a pacifier, or breast feeding. Yet, sugar solutions provide no adequate analgesia for more severe pain, e.g. during circumcision. CONCLUSIONS: Sugar solutions effectively relieve procedural pain during blood sampling in neonates. Additional studies are needed to determine the minimal effective dose and the efficacy and side effects of repeated sugar doses in the same patient.

Analgesia↗
PubMedDate not supplied

[Results of a National Survey in Germany on incidence and therapy of the nonoliguric hyperkalemia of the premature infant].

BACKGROUND: Although nonoliguric hyperkalemia of the premature infant is a common problem, in many hospitals it is not observed. It is characterized by an excessive increase in serum potassium concentration (serum-[K (+)]) at 24 hours after birth. Recently, salbutamol has been recommended to treat hyperkalemia. There are no controlled trials in premature infants. During the first minutes of salbutamol infusions paradoxical increases in serum-[K (+)] may occur. We asked for possible reasons for the variable incidence of the disorder. We wanted to know if salbutamol is currently applied and if initial increases in serum-[K (+)] during salbutamol infusions have been observed. MATERIALS AND METHODS: National survey in Germany. RESULTS: Questionnaires of 132 hospitals caring for premature infants < 30 gestational weeks. The incidence of hyperkalemia was 0 - 40 %. At least 25 % of all hospitals measured serum-[K (+)] not before the second day after birth. 52 hospitals had applied salbutamol. Nine hospitals reported increases in serum-[K (+)] associated with salbutamol therapy. However, it was common practice to measure serum-[K (+)] 1 hour (median, range 0.25 - 12 hours) after the start of the infusion. Two cases of cardiac arrhythmias during salbutamol infusion were reported. DISCUSSION AND CONCLUSIONS: The variable incidence of hyperkalemia may result from the fact that many hospitals do not measure serum-[K (+)] on the first day after birth. Common practice made it potentially impossible to determine the frequency of initial increases in serum-[K (+)] during salbutamol infusion. However, these data should be available, before controlled trials on salbutamol treatment in premature infants can be initiated.

Albuterol↗
PubMedDate not supplied

[Intrauterine therapy and outcome in four pregnancies of one mother with anti ro-autoantibody positive Sjoegren's syndrome].

Autoantibodies against 52/60kD-Ro proteins, frequently present in patients with Sjoegren's Syndrome or systemic lupus erythematosus, are transmitted to the fetus during pregnancy. These autoantibodies can damage the cardiac conductive system of the fetus and cause a complete atrioventricular block, with a mortality of 30 %. We report the intrauterine therapy during four pregnancies of the same mother with high 52/60kD-Ro autoantibodies and the outcome of her infants. Our patient with primary Sjoegren's Syndrome suffered an early miscarriage during her first pregnancy. During the second pregnancy, a fetal atrioventricular block was observed at 23 weeks of gestation. Although subsequently dexamethasone therapy and daily plasmaphereses were started, a cesarean section was necessary at 26 weeks due to hydrops fetalis. The girl died from the atrioventricular block after two days. During the third and fourth pregnancies, dexamethasone therapy was begun already at 7 weeks, and regular plasmaphereses at 15 weeks. The children were delivered by cesarean section at 32 and 36 weeks because of growth retardation. Both had normal electrocardiograms after birth and after 2 and 4 years. In pregnant women with connective tissue diseases, monitoring of anti Ro-autoantibodies and fetal heart function is important. Intrauterine therapeutic options are dexamethasone therapy to suppress maternal and fetal inflammatory reactions and repeated plasmaphereses to reduce autoantibody levels. Postnatal follow up of the infants for atrioventricular block and rheumatic manifestations is necessary.

Antibodies, Antinuclear↗
PubMedDate not supplied

[Transthoracic pacing in a very low birth weight infant with congenital complete atrioventricular block - Case report].

We report our experience of pacemaker treatment in a premature infant of 832 grams with congenital complete atrioventricular block due to maternal Sjögren's Syndrome. She was delivered by cesarean section at an estimated gestational age of 26 weeks because of fetal bradycardia, decreasing fetal movements and hydrops. Immediate postnatal transesophageal ventricular pacing was not successful, whereas transthoracic pacing with self-adhesive patch electrodes adapted to body size resulted in an effective increase of the infant's heart rate until operative application of temporary epimyocardial pacing wires ensured the external stimulation of the heart.

Adult↗
PubMedDate not supplied

[Parenteral nutrition associated cholestasis in the newborn].

Parenteral nutrition associated cholestasis in preterm infants and newborn children is a frequent and serious disease with an incidence of 23% depended on duration of parenteral nutrition and birthweight. The incidence of liver cirrhosis is 40% when parenteral nutrition is given 74-242 days. The pathogenesis remains unclear. Several predisposing factors are discussed like immaturity, lack of hormonal stimulation by oral feeding, bacterial infection, liver toxicity of aminoacids and their products of photooxidation, lack of taurine, lack of antioxidation substances, hypermanganesaemia and pollution of infusion solutions. Furthermore sepsis during parenteral nutrition seems to multiply the risk of cholestasis. For prevention controlled studies recommend: 1. Early enteral nutrition. 2. The reduction of parenteral amino acids to less than 3 g/kg/d. 3. Light protection for parenteral solutions. 4. Cyclic infusion of parenteral nutrition. 5. The application of antibiotics (metronidazole, gentamicin) during parenteral nutrition. The most important therapeutic intervention is the beginning of oral feeding. Most of the time this leads to a decrease of icterus within two weeks. An icterus persisting longer than 3 weeks should be treated because of the risk of liver cirrhosis. Further therapeutic interventions are: 1. Cholecystokinin, good results in case studies which still has to be verified by a controlled study. 2. Ursodeoxycholic acid, its choleretic effectiveness is verified in several liver diseases by controlled studies, but it is not proven in parenteral nutrition associated cholestasis. 3. Laparoscopic biliary irrigation, successful in several case studies.

Cholestasis↗
PubMedDate not supplied

[How do mothers experience skin contact with their very immature (gestational age 27-30 weeks), only days old premature infants?].

BACKGROUND: Mothers are offered skin-to-skin contact with their preterm infants with the intention to promote bonding. But it is not known if the mother of a very immature fragile infant perceives skin-to-skin contact as a helpful intervention or a stressful situation. PATIENTS AND METHODS: Mothers of singleton preterm infants (gestational age 27-30 weeks) began skin-to-skin contact as soon as the infant was breathing spontaneously. They prospectively documented frequency and duration of skin-to-skin contact, they rated their anxiety or confidence and their attachment to the infant and described their observations of the infant daily for 14 days in a semi-structured questionnaire. RESULTS: 17 of 25 mother-infant-pairs in the observation period fulfilled the entry criteria, 14 questionnaires about 196 skin-to-skin periods could be analyzed (median gestational age 27.5 weeks (27-30), median birth weight 1130 g (695-1300). Skin-to-skin contact began at a median age of 3 days [2-7]. The median duration of the skin-to-skin periods was increased at maternal request from 60 to 120 minutes between day 1 and 14 (p = 0.004). Even then 21% of the mothers wanted a still longer duration of skin-to-skin contact. Mothers reported anxiety only 5 times. 82% of the mothers reported positive own feelings during skin-to-skin contact and 78% felt that skin-to-skin contact increased their attachment to their infant. CONCLUSION: The mothers studied perceived skin-to-skin contact with their very immature infants as a positive and helpful intervention. Skin-to-skin contact took place regularly and for increasing periods of time.

Adult↗
PubMedDate not supplied

[The effect of bovine surfactant in premature infants with respiratory distress syndrome. Results of an open, multicenter study].

We investigated the effects of a bovine surfactant (SF-RI 1, Alveofact) in very low birth weight infants (VLBW, b.w. 500-1500 g) with established respiratory distress syndrome (RDS; definition: FiO2 greater than or equal to 0.6 or peak inspiratory pressure greater than 22-28 cm H2O). Fifty mg/kg b.w. bovine surfactant was administered intratracheally as a bolus, if the acute response was unsatisfactory (FiO2 greater than 0.5), further administrations of surfactant up to a maximum cumulative dose of 200 mg/kg b.w. were permitted. One hundred and sixty-four VLBW infants (gestational age 28.0 +/- 2 wks; b.w. 1054 +/- 251 g; mean +/- SD) with a mean FiO2 of 0.84 +/- 0.15 were enrolled in the study. Maximum improvement in oxygen requirements was observed 1/2 h post administration (FiO2 0.53 +/- 0.22); incidence of complications during the neonatal period: pulmonary interstitial emphysema 26%, pneumothorax 10%, patent ductus arteriosus 37%, intracranial hemorrhage 47%. The overall survival rate was 61%, survival rate without bronchopulmonary dysplasia (BPD) was 47%. A multiple regression analysis was performed in order to identity factors determining survival without BPD (p less than or equal to 0.05). We observed a positive correlation for gestational age and birth weight and a negative correlation for pretreatment oxygen requirements. For further optimizing surfactant-therapy in VLBW infants with RDS, studies are mandatory using intervention criteria at lower FiO2-values and higher initial doses of bovine surfactant.

Humans↗