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M Obladen

Publications and source records attributed to M Obladen.

At least 109 records · Page 6Linked to original sources
PubMed1992

Long-term variability of heart rate increases with successful closure of patent ductus arteriosus in preterm infants.

Long-term variability (LTV) of heart rate was calculated continuously by a microprocessor in 25 preterm infants undergoing indomethacin treatment for closure of patent ductus arteriosus (PDA), in 24 preterm infants without signs of PDA, and in 10 neonates treated with prostaglandin E1 for cyanotic heart malformation. In infants with patent ductus arteriosus, LTV was lower than in controls. Following indomethacin, LTV increased most markedly (from 1.5 to 3.2; p less than 0.01) in infants with improved ventilation. The increase was less marked (from 1.8 to 2.5; p less than 0.05) in infants whose degree of respiratory failure did not change. LTV remained largely unchanged in infants who deteriorated. In 9 out of the 10 neonates treated with prostaglandin E1, LTV increased. We conclude that LTV corresponds to brain stem oxygenation and may be a useful tool to monitor treatment of PDA.

Alprostadil↗
PubMed1992

Accelerated lung maturation following maternal steroid treatment in infants born before 30 weeks gestation.

A meta-analysis was performed of 9 controlled trials of maternal beta-/dexamethasone treatment in which the incidence of RDS in infants born before 30 weeks gestation was reported. A significant decrease could be shown in 250 immature infants. The number of cases was to small for analysis of lower gestational ages or for the demonstration of a reduction in mortality. In a separate study of 135 infants born before 30 weeks gestation tracheal aspirate phospholipid analysis was performed using thin layer chromatography. 64 of them had been exposed prenatally to steroids. Significantly more of these infants had a mature L/S ratio > or = 2.7 (p < 0.02) and prenatal glucocorticoid treatment was associated with a markedly increased survival rate (odds ratio 2.4, p < 0.02). We conclude from the meta-analysis of the literature and from the findings of our study, that accelerated lung maturation follows prenatal steroid treatment with a reduction in RDS-incidence even in very immature fetuses. Consequently it would be appropriate to administer glucocorticoids combined with tocolysis since this has been shown to be beneficial for those women threatening to deliver prematurely at less than 30 weeks gestation.

Betamethasone↗
PubMed1991

Surfactant substitution in ventilated very low birth weight infants: factors related to response types.

We investigated factors than may influence the response to surfactant substitution. Thirty-five very low birth weight infants with respiratory distress syndrome were treated with Curosurf at 3-12 h of age. From the changes in oxygenation, the therapeutic response was categorized as rapid and sustained, rapid with relapse, or poor. Phospholipids and surfactant protein A were quantified in gastric aspirate samples obtained immediately after birth. They showed that 16 infants had accelerated lung maturity, despite clinical and radiologic signs of respiratory distress syndrome. Ten of them had suffered from birth asphyxia or connatal infection. Nevertheless, 12 of these 16 infants responded rapidly to surfactant substitution. Poor response was seen in four infants with connatal infection. Of 19 infants with immature lung profile, 18 showed a rapid initial response to surfactant substitution. Dynamic compliance of the respiratory system or arterial blood pressure before substitution, the ultrastructure of the surfactant preparation, or persistence of the ductus arteriosus did not influence the response type, but fraction of inspired oxygen was higher before surfactant substitution in infants with poor response. Prognosis was related to short-term response: Of 17 infants who showed a rapid and sustained response, none died, whereas eight of 18 infants with relapse after rapid initial response or poor response died (p less than 0.05). We conclude that surfactant substitution may be beneficial not only in babies with primary surfactant deficiency but also in other pulmonary disorders that are common in very low birth weight infants. The type of response may be of prognostic value.

Biological Products↗
PubMed1991

[Surfactant substitution in very small premature infants].

In addition to the established treatment of neonatal respiratory distress syndrome by oxygen supplementation, artificial ventilation and thermoneutrality, substitution of surfactant offers a new therapeutic perspective. Up to now, either artificial mixtures of surface active components or surfactant extracts from minced animal lungs, lung lavage fluid, or human amniotic fluid have been used in controlled trials of prophylactic and rescue surfactant treatment. Meta-analysis of controlled prevention trials including about 2,400 preterm infants shows decreased mortality (21% in controls, 9.5% in infants treated with natural preparations, p less than 0.001; 17% in controls, 11% in infants treated with artificial preparations, p less than 0.001) and fewer complications of artificial ventilation (pneumothorax: 24 vs. 7.2% with natural preparations, p less than 0.001; 20 vs. 15% with artificial preparations, p less than 0.05). In rescue studies on more than 1,900 preterm infants, natural surfactant preparations decreased complications of artificial ventilation such as pulmonary interstitial emphysema and pneumothorax (32 vs. 13%, p less than 0.001). Although the immediate effect of artificial preparations is mild, the incidence of pneumothorax also could be reduced (30 vs. 19%, p less than 0.001). Mortality could be reduced by 1/3 with natural (31 vs. 20%, p less than 0.001) and with artificial preparations (23 vs. 16%, p less than 0.01). The incidence of bronchopulmonary dysplasia and intracerebral hemorrhage, however, did not drop significantly. Severe adverse side effects of this treatment seem to be rare. There are, however, potential hazards of surfactant substitution. Its use should be restricted to fully staffed and equipped neonatal intensive care units.

Combined Modality Therapy↗
PubMed1990

Airway anomalies in newborn infants: detection by tracheoscopy via endotracheal tube.

In 6 of 24 infants studied (27th-40th weeks of gestation), acquired and congenital structural anomalies of the airways were detected with an ultrathin flexible fiberscope (Olympus PF18 S, 1.8 mm). Introduction of the fiberscope via a modified four-way T-adapter enabled us to continue artificial ventilation without interrupting oxygen flow or positive pressure ventilation. Tube position, mucus accumulation and partial tube obstruction were determined quickly at the infants' bedside, when problems in artificial ventilation arose.

Bronchi↗
PubMed1990

Infrequent neonatal opiate withdrawal following maternal methadone detoxification during pregnancy.

The influence of maternal participation in a methadone detoxification program as compared to street drug use on intrauterine growth and neonatal morbidity was analysed in 75 newborns. -58 of 75 pregnant addicts joined the methadone program; in 17 women with successful prepartal detoxification, we found a longer course of pregnancy as well as normalized birth weight, head circumference and respiratory status of the neonates. The HIV-status showed no influence on prenatal growth. 63% of all infants developed a neonatal abstinence syndrome; this incidence was lower after maternal participation in the methadone detoxification program: 55 vs. 88%, p less than 0.05. Postnatal respiratory insufficiency occurred more frequently after methadone exposure than after heroin exposure before birth (p less than 0.05).

Adult↗
PubMed1990

[Prenatal development and postnatal morbidity of newborn infants of HIV positive mothers].

Does the maternal HIV-infection itself influence fetal development and neonatal morbidity or are adverse effects related to maternal opiate and nicotine abuse? 17 neonates of HIV-positive women (7 drug users) and 37 controls (17 healthy and 21 opiate exposed newborns) were examined prospectively. A discriminant analysis showed that opiate and nicotine abuse during pregnancy were associated with fetal growth retardation and neonatal morbidity, while HIV-infection of the mother did not influence these parameters. Symptoms of an HIV-embryopathy were not seen.

Birth Weight↗
PubMed1990

[A new amino acid solution for parenteral nutrition of premature infants, newborn infants and infants].

A new amino acid solution (Aminopäd 5% and Aminopäd 10%) was used for intravenous feeding of 240 preterm and term newborn infants in 4 hospitals. Indications, dosages and infusion sites were up to the policies of the 4 hospitals. Plasma amino acid concentrations were measured in 491 samples which were obtained during steady 24 h infusions of the daily doses. Results were analyzed in four subgroups formed according to the postmenstrual ages of the patients at the time of blood withdrawal and showed good agreement with the reference values. Acute cholestasis was observed in 22 infants which could be explained by bacterial infection alone in 18 patients.

Amino Acids↗
PubMed1988

Blood sampling in very low birth weight infants receiving different levels of intensive care.

Sixty very low birth weight infants (birth weight 560-1450 g) were studied during the first 28 days of life. The infants were classified as group A (n = 19 infants who never required ventilator support), group B (n = 20 infants mechanically ventilated for minor respiratory problems), and group C (n = 21 infants ventilated for respiratory distress syndrome). Diagnostic blood sampling was measured, infants were checked for clinical symptoms and laboratory signs of anaemia 24 h before and after the transfusion of packed red cells. A total of 7998 punctures (average: 4.8 per infant per day) were performed, the mean blood loss due to diagnostic sampling was 50.3 ml/kg per 28 days (range 7-142) for all infants. A high correlation (rs = +0.91) was found between the blood volumes sampled and transfused. In group A, the mean blood loss was 24 ml/kg, and a total of 29 blood transfusions were administered. The most frequent symptoms of anaemia were poor weight gain and apnoeic spells. In group B, the mean blood loss was 60 ml/kg and a total of 97 blood transfusions were administered. In group C, the mean blood loss was 67 ml/kg and a total of 116 blood transfusions were administered. In both groups B and C, poor weight gain, pallor and distended abdomen were the most frequent symptoms of anaemia. Following the blood transfusion, haematocrit rose and blood pressure remained unchanged. The symptoms that responded most favourably to the blood transfusion were: poor weight gain, oxygen requirement, and distended abdomen. The results emphasize the need for miniaturizing laboratory techniques and monitoring blood sampling.

Anemia↗
PubMed1988

[Acquired--accepted--adopted? On the status of neonatology in West Germany].

The worldwide reduction in infant mortality and low birthweight lethality has also been observed in the Federal Republic of Germany during the past two decades. In many countries, neonatology has emerged as a scientifically active subspecialty of pediatrics. Its main characteristic is an understanding of partially mature function and perinatal adaptation. In West Germany, however, education programs for neonatologists have not been inaugurated and neonatology has been identified with pediatric intensive care. Sophisticated neonatal transport systems, expensive special care units, and highly aggressive therapeutic approaches have resulted. Neither perinatal centers for high-risk deliveries nor regionalization programs for intrauterine transport to the neonatal special care unit have been created. Neonatology may drift towards obstetrics if established pediatrics continues to ignore educational, organizational and manpower needs of neonatal care.

Ethics, Medical↗
PubMed1986

High-performance liquid chromatography of adult human bronchoalveolar lavage: assay for phospholipid lung profile.

High-performance liquid chromatography has been used to separate pulmonary phospholipids from adult human bronchoalveolar lavage. A solvent system consisting of acetonitrile-water (80:20) as solvent A and pure acetonitrile as solvent B was used with a silica column (Bio-Sil HP 10) coupled to an Si-100 Polyol precolumn. A linear gradient from 87.5 to 25% of solvent B was found to separate all biologically relevant surfactant phospholipids in the following sequence and composition: phosphatidic acid (1.1%), phosphatidylglycerol (10.6%), phosphatidylinositol (9.9%), phosphatidylethanolamine (3.6%), phosphatidylserine (4.5%), phosphatidylcholine (60.8%), sphingomyelin (8.1%) and lysophosphatidylcholine (1.6%). These results were very similar to the phospholipid pattern obtained by two-dimensional thin-layer chromatography. It is concluded that high-performance liquid chromatography is a useful and rapid method for the separation of phospholipids in biological fluids containing pulmonary surfactant.

Adult↗
PubMed1986

[Necrotizing enterocolitis. Pathogenesis and iatrogenic factors].

Following clinical observations, measurements of osmolarity of liquid drugs, and determination of blood loss due to sampling in very low birthweight infants, the following hypothesis on iatrogenic factors contributing to the pathogenesis of necrotizing enterocolitis is proposed: Due to diagnostic blood sampling during intensive care, premature infants may become severely anemic. Therefore their intestinal perfusion is reduced, causing hypoxia and hypoperfusion in the submucosa. Especially in infants with oral feeding and hyperosmolar medication, mechanical factors, hyperosmolarity and infection can affect the mucosa from the luminal side. Simultaneous hypoperfusion and hyperosmolar load may contribute to the pathogenesis of necrotizing enterocolitis. This hypothesis, which needs experimental verification, explains the different incidence of the disease in different hospitals.

Blood Volume↗
PubMed1985

Artificial surfactant in preterm rabbits with and without respiratory distress syndrome: difference of in vitro and in vivo activities.

Sixty-eight rabbit fetuses of 27 days gestation were tracheotomised, artificially ventilated, and their lung mechanics studied in a body-enclosing plethysmograph. The animals were treated by tracheal instillation of natural surfactant concentrate or large unilamellar vesicles containing dipalmitoylphosphatidylcholine:egg phosphatidylglycerol, 9:1. Both preparations were highly surface active in terms of film adsorption and surface tension-lowering potential. Before treatment, the lung mechanics were analysed to indicate the presence of respiratory distress syndrome (RDS). Controls received 0.15 M saline. Differences were found between the in vitro and in vivo activities of both preparations in some animals. In 30 preterm animals with partial lung maturity and without respiratory distress syndrome, no significant effect could be achieved with either the natural or the artificial surfactant. In 38 animals with severe RDS, the tidal volume and compliance increased markedly within 15 min of substitution of both preparations. Compliance increased to 178% of the initial value in ventilated, control animals, to 391% in animals treated with natural, and to 344% in animals treated with artificial surfactant.

Animals↗
PubMed1985

[Oral medication in premature infants? Physical properties of liquid drug preparations].

The aim of our study was to investigate a possible connection of oral medication administered to preterm infants and the pathogenesis of necrotizing enterocolitis. Therefore, we measured pH, surface tension, colloid osmotic pressure and osmolality of 66 liquid drugs distributed in Germany. Most of the preparations had neutral or faint acid pH. Most drugs were hyperosmolar, we found osmolalities as high as 16,850 mOsm/l. Only 8 drugs had physiological osmolality. The colloid osmotic pressure ranged from 0 to 57 mm Hg. Surface tension was as low as 23.3 mN/m in alcoholic, as high as 76,3 mN/m in water solution. The effect of water dilution on surface tension and drop volume is shown by a linear dilution of Novodigal.

Administration, Oral↗