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Biomedical subjects

Hans Ulrich Bucher

Publications and source records attributed to Hans Ulrich Bucher.

9 recordsLinked to original sources
PubMed2007

Grief and post-traumatic growth in parents 2-6 years after the death of their extremely premature baby.

OBJECTIVE: To assess grief and post-traumatic growth in parents 2-6 years after the death of a premature baby (24-26 weeks' gestation) and to evaluate Pictorial Representation of Illness and Self-Measure (PRISM) in the assessment of bereavement. METHOD: Fifty-four parents were assessed for their experiences during hospitalization and by questionnaires regarding grief (MTS), post-traumatic growth, affective symptoms and the visual representation of the baby and the self of the parents (PRISM). RESULTS: Even 2-6 years after the loss of their extremely preterm infant the parents still suffer a lot from their bereavement, mothers more so than fathers (Mann-Whitney U test, U = 230.5, p < 0.05). Having another child reduced the level of grief (U = 119.0, p < 0.05). Mothers showed more post-traumatic growth than fathers (U = 140.5, p < 0.001). For all parents a shorter distance between the baby and the self (PRISM) correlated with greater grief (rho = -0.62, p < 0.001); in multiple regression analysis MTS explained 38% of the SBS-variance. CONCLUSIONS: Clinicians should be aware that the death of an extremely premature infant triggers not only a painful long-term process of mourning but also of individual personal growth. Adaptation processes after the death differ depending on gender, with mothers experiencing more intense grief but also more growth than fathers. The modified PRISM test is recommended as a visual, non-verbal and easy-to-use instrument to assess bereavement.

Adult↗
PubMed2006

Acceleration of lung maturation in a human fetus following maternal isotretinoin intake.

The viability of the human fetus increases significantly beyond 25 weeks' gestation as the lung development progresses towards the 'saccular' stage. We report on a fetus of 22 weeks' gestation whose lung maturation was accelerated by 4 weeks, most likely due to the unintentional exposure to the retinoid isotretinoin (13-cis-retinoic acid) during pregnancy. Although retinoids are known to be stored within the lungs and to play a key role in lung differentiation and growth, their storage within the lung is limited during this critical developmental period. Even though glucocorticosteroids are used clinically to enhance lung maturation in the face of impending preterm birth, there are no data yet which demonstrate that glucocorticosteroids, when given alone, are effective in promoting lung maturation prior to 24 weeks' gestation. Strong evidence however, indicates that glucocorticosteroids promote the utilization of lung retinoids immediately before birth. Our observation of increased lung maturation, in conjunction with the above information suggests that retinoids alone or in combination with glucocorticosteroids might promote lung maturation more effectively than glucocorticosteroids alone when birth seems inevitable at a very early gestational age.

Abortion, Induced↗
PubMed2005

Liveborn and stillborn very low birthweight infants in Switzerland: comparison between hospital based birth registers and the national birth register.

BACKGROUND AND AIM: Perinatal and infant mortality rates are considered key indicators of medical care. The aim of this investigation was to examine how representative and reliable the official national figures of Switzerland are by comparing them with the data in local birth registers. METHODS: 124 of 156 maternity hospitals in Switzerland, catering for about 80% of all newborn infants, participated in the study. The hospital based birth registers were screened for the years 1996 and 2000 for live and stillborn infants weighing less than 1500 g. These data were matched with the data in the official register (federal office for statistics). RESULTS: in 1996 a total of 753 newborn infants and in 2000 820 infants weighing between 300 and 1499 g were officially registered. In the hospital based registers in 1996 101 additional infants and in 2000 94 infants were identified that had not been officially registered; 31 of these were stillborn before 24 completed weeks. Infants registered only locally had lower birth weight and lower gestational age than those recorded in both registers. CONCLUSION: In Switzerland a significant number of very low birth weight infants who died soon after birth are not officially registered. If these infants are included, the national perinatal mortality rate would increase from 6.9 per thousand to 8.0 per thousand. Reasons for underreporting are unclear but may be due to varying definitions of stillbirth and different lower limits for reporting in various cantons. We suggest adopting the WHO-rules for reporting all births and to include gestational age, head circumference, Apgar scores and umbilical artery pH in the national birth register.

Female↗
PubMed2005

A framework for ethical decision making in neonatal intensive care.

UNLABELLED: Intensive care for neonates with high risks of severe impairment and the possibility of a prolonged dying process represents a frequent ethical issue in neonatal units. The aim of this paper is to present a framework for structured decision making that has been developed in a neonatal intensive care unit and to demonstrate its impact on the healthcare team and on survival of critically ill neonates. This framework attempts to integrate the best interests of the infants and their parents, the possibilities of high-tech neonatal intensive care interventions, and the perspective of the nurses and doctors. An external evaluation of 84 sessions over 3 y revealed a beneficial effect on the quality of the decision-making process itself and on the quality of the teamwork in the unit. Survival time was shorter (median 2 d, interquartile range 1-7 d) in 26 infants that died after structured decision making compared with 26 controls matched for gestational age, malformation and intracranial haemorrhage (median 7 d, interquartile range 4-15 d). CONCLUSION: The introduction of this framework for structured decision making involving doctors and nurses improved the quality of the teamwork. It shortened futile intensive care, and thereby suffering for both infants and parents.

Adult↗
PubMed2004

Detection of hyperbilirubinaemia in jaundiced full-term neonates by eye or by bilirubinometer?

UNLABELLED: The aim of this study was to compare predictions of hyperbilirubinaemia by eye, performed by trained physicians and nurses, with predictions obtained using two commercial bilirubinometers. Jaundice was assessed in 92 white and 48 non-white healthy full-term neonates using three non-invasive methods and by total serum bilirubin as the reference method. Clinical assessment of cephalocaudal progression of jaundice was carried out independently by a physician and by nurses. Simultaneously, the Minolta Airshields JM-102 was applied on the sternum, the BiliCheck on both the forehead and the sternum, and finally, serum bilirubin concentrations were determined. The Minolta JM-102 showed the best performance with r2 = 0.90, an intraclass correlation coefficient (ICC) of 0.93, and a 95% confidence interval (CI) of +/- 4 units (approx. 56 micromol/l). The BiliCheck performed slightly better on the forehead than over the sternum with r2=0.90, an ICC of 0.88, and a CI of +/- 62 microtmol/l. Assessment of jaundice by eye was least accurate with r2 = 0.74, an ICC of 0.67, and a CI of +/- 1.5 zones (corresponding to 75 Lmol/l). Skin pigmentation and ambient light both adversely affected noninvasive bilirubin estimation. CONCLUSION: All three non-invasive methods are well suited for estimation of serum bilirubin but show large confidence intervals. In healthy term newborns, hyperbilirubinaemia (>250 Lmol/l) can be safely ruled out by eye if jaundice does not reach the abdomen or the extremities (Kramer zones 1 and 2), with < 22 units ( < 230 micromol/l) for the Minolta JM-102, or with a cut-off of 190 microlmol/l for the Bili-Check. If these respective thresholds are exceeded, serum bilirubin concentrations should be measured.

Bilirubin↗
PubMed2003

Slow blood sampling from an umbilical artery catheter prevents a decrease in cerebral oxygenation in the preterm newborn.

OBJECTIVE: Blood sampling from an umbilical artery catheter (UAC) placed in a high position (thoracal 6-9) has the potential to produce clinically significant changes in cerebral blood flow and, thereby, in cerebral oxygenation. This may contribute to cerebral impairment in preterm newborn infants. Therefore, we set up a study to determine the effects of different sampling speeds through a UAC on cerebral oxygenation in preterm infants. METHODS: Thirty pairs of measurements were conducted on 20 preterm infants (median gestational age: 30.14 weeks; median birth weight: 1170 g). For each infant, 2 blood samplings (both 2.3 mL, including flush volume) through the UAC in high position were taken at 2 different speeds (20 and 40 seconds) in alternating sequence. Cerebral oxygenation was measured noninvasively by near-infrared spectroscopy. Concentration changes in cerebral oxygenated hemoglobin (O2Hb) and deoxygenated hemoglobin (HHb), along with the tissue oxygenation index (TOI; O2Hb/[O2Hb + HHb] x 100), were recorded while blood was withdrawn and subsequently reinfused. RESULTS: A significant decrease in O2Hb and TOI occurred during blood sampling within 20 seconds (median DeltaO2Hb: -1.5 micromol/L; range: -4.1-2.3; median DeltaTOI: -0.6%; range: -6.3-2.3), whereas HHb increased (median DeltaHHb: 0.4 micromol/L, range: -1.1-3.9). No significant change was found in O2Hb, HHb, and TOI when sampling time was extended to 40 seconds. CONCLUSION: Our results show that blood withdrawal over 20 seconds from a UAC in high position significantly decreases cerebral O2Hb and TOI in preterm infants. Prolonging sampling time to 40 seconds can prevent this phenomenon.

Blood Specimen Collection↗
PubMed2002

Liver tissue oxygenation as measured by near-infrared spectroscopy in the critically ill child in correlation with central venous oxygen saturation.

OBJECTIVE: To evaluate the clinical usefulness of near-infrared spatially resolved spectroscopic quantitative assessment of liver tissue oxygenation for simple, non-invasive estimation of global tissue oxygenation in critically ill neonates and children. DESIGN: Prospective observational clinical study. SETTING: A tertiary multidisciplinary neonatal and paediatric intensive care unit (23 beds). PATIENTS: One hundred neonates and children consecutively admitted to the paediatric intensive care unit. MEASUREMENTS AND RESULTS: Near-infrared spectroscopic single-point assessment of liver tissue oxygenation index (TOI(Liver)) was compared with global tissue oxygenation as measured by central venous oxygen saturation (SvO(2)) and derived haemodynamic parameters. Data were compared using linear and multiple regression analysis. Overall correlation between TOI(Liver)and SvO(2) was good ( r=0.72, p<0.0001). Multivariable regression revealed that SvO(2) alone explained 51% of the observed variance of TOI(Liver). However, our data demonstrated large inter-individual differences between SvO(2) and TOI(Liver) values. CONCLUSION: Near-infrared spatially resolved spectroscopic quantitative measurement of liver tissue oxygenation correlates well with SvO(2) in critically ill neonates and children. Large inter-individual SvO(2) to TOI(Liver) differences may prevent its use for non-invasive single-point estimation of global tissue oxygenation. Further clinical studies are required to validate the method with other regional and global haemodynamic parameters and to evaluate its clinical use for continuous non-invasive haemodynamic monitoring.

Catheterization, Central Venous↗
PubMed2002

Growth, developmental milestones and health problems in the first 2 years in very preterm infants compared with term infants: a population based study.

UNLABELLED: The outcome of very preterm infants varies widely from centre to centre and from country to country. The aim of this study was to evaluate growth, developmental milestones and post-discharge morbidity of infants born before 32 weeks of gestation in Switzerland. A questionnaire was sent to the parents of 456 survivors born in 1996. A total of 309 (68%) parents responded and their infants were matched with 309 control infants born at term. At the corrected age of 24 months, the very preterm infants had significantly lower weight (-1.0 z-scores), lower length (-1.23 z-scores), and lower head circumference (-.64 z-scores). Very preterm infants were reported to eat with a spoon later than those born at term (50% at 7.5 months corrected for prematurity versus 10 months. P<0.001), to drink later out of a cup (50% at 16.5 months versus 13.5 months, P=0.03) and to walk later independently (50% at 14.5 months versus 13.5 months, P=0.04), whereas timing of sitting unsupported was no different (50% at 7.4 months versus 7.2 months, P=0.9). Of very preterm infants, 16% were not able to walk at least three steps unsupported at 18 months after term which puts them at an increased risk for cerebral palsy. Some 35% of very preterm infants had to be readmitted to hospital during the first 24 months compared with 20% of control infants born at term (P<0.05). There was no difference between very preterm and term infants in respect to episodes of fever > 38.5 degrees C, episodes of coughing > 3 days and treatment with antibiotics. CONCLUSION: these data based on a national survey allow to quantify growth retardation, developmental delay and post-discharge health problems within the first 2 years in preterm infants born before 32(0)/7 weeks.

Child Development↗