Activation of the complement system occurs in several diseases. For reliable identification of complement activation in neonates, we establish reference ranges of several components in cord blood of healthy term newborns. For this study, cord blood samples were taken from 125 healthy term newborns. Concentrations of C1r, C2, C5, C7, Properdin, and factors D, H, and I were determined by single radial immunodiffusion. C3a and C5a were measured by specific EIA and complement function was measured by hemolytic assays. The results were expressed as 5th percentile, median, and 95th percentile. The following respective concentrations were found: C1r: 27, 47, 65 mg/l; C2: 12.0, 18.0, 24.0 mg/l; C5: 64, 92, 127 mg/l; C7: 32, 60, 89 mg/l; Properdin: 5.6, 9.7, 14.2 mg/l; factor D: 3.6, 5.2, 7.3 mg/l; factor H: 178, 234, 296 mg/l; and factor I: 15, 24, 32 mg/l. The functional activity of the whole complement system was 24%, 43%, 97% and for the alternative pathway 39%, 58%, 76%. The concentration of the activated split products C3a was 4, 65, 255 microg/l and of C5a, 0.11, 0.26, 1.19 microg/l. These reference values may be important for the detection of deficiencies of native complement proteins or perinatal processes leading to an activation of the complement system.

Adult↗

PubMedDate not supplied

[The clinical relevance of subcutaneous-thoracic ratio in preterm newborns as a possibility for quantification of capillary leak syndrome].

BACKGROUND: Capillary leak syndrome (CLS) is associated with increased morbidity and mortality in preterm newborns (PN) with sepsis or necrotizing enterocolitis. PATIENTS AND METHODS: In order to provide improved standards for measuring edema and for the definition of CLS, subcutaneous-thoracic ratios (S/T) were calculated from 821 anteroposterior supine chest radiographs of 119 PN with a birth weight below 1500 g. The S/T was computed by 100 % minus ratio of dividing the outer margins of the eighth rib by the total diameter of the thorax at the same position. Birth weight, gestational age, need for assisted ventilation and the position of the diaphragm did not significantly affect S/T. The S/T drifted downwards slightly with postnatal age. RESULTS: To provide normal standards of S/T in PN, the ratio was calculated in percentiles and the higher percentiles correlated with diseases. 771 S/T were lower than 10.1 % (95th percentile), 21 were 10.1 - 12.6 % (97.5th percentile) and 20 were even higher. 3 of the 100 PN (84 %) with an S/T < 10.1 % died because of extreme immaturity. Eight patients (6.7 %) had an S/T between the 95th and the 97.5th percentile in at least one of their radiographs. Four of them had a respiratory distress syndrome and one died. Eleven PN had an S/T > 12.6 %. All of them showed a multiple organ failure and four died. When the SIT was > 15 % the edema became visible. A CLS was diagnosed in two PN with an S/T > 20 %. CONCLUSIONS: The threshold for the capillary leak syndrome was found to be 12.6 % also in reference to the course of diseases. The S/T is a useful tool because it is simple to measure and calculate, and is available from a single frontal film. The ratio can measure objectively the edema and the CLS in PN.

Capillary Leak Syndrome↗

PubMedDate not supplied

[The effect of osteopenia prevention in very small premature infants on hormonal parameters of calcium metabolism and bone mineralization].

In 23 very low birth weight infants the influence of mineral supplementation with 0.4 mmol calciumgluconate and 0.2 mmol glucose-1-phosphate/dl human milk on concentrations of 25-OH-D3, parathyroid hormone, calcitonine, calcium, phosphorus and activity of alkaline phosphatase was studied on days 3, 8, 28 and 56. On days 28 and 56 respectively, degree of bone mineralisation was classified. 8 preterm infants received supplementation before day 28, 7 infants after day 28, 8 infants had no supplementation. All preterm infants received beginning with day 7 vitamin D3 1000 IU/day. In all preterms mean concentrations of 25-OH-D3 were normal and increasing with age. Concentrations of parathyroid hormone and calcitonine were first of all increased and decreased with age, especially in supplemented infants. Light metabolic bone disease without fractures occurred in 4 infants of supplemented groups. Non-supplemented group contains 5 infants with severe metabolic bone disease without fractures. Results indicate intact metabolism and secretion of 25-OH-D3, parathyroid hormone and calcitonine. Decrease of calcitonine concentration in mineral supplemented preterms is a reference to a better mineral supply. Mineral supplementation is followed by an increase in bone mineralisation with prevention of severe metabolic bone disease.

Alkaline Phosphatase↗

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[Regional early mortality in relation to social and hospital structure].

Detailed analysis of governmental mortality statistics yields information on regional differences in the care for preterm infants in West Germany. 68% of newborn infants dying within the first 7 days of life are of low birth weight. In the 11 states, highest/lowest early neonatal mortality fell from 11.6/6.0 to 6.2/3.1 during the years 1978 to 1982. In the 31 administrative districts, a small negative correlation (r = -0.37) exists for neonatal mortality and tax revenue. Increased regional mortality indicates diminished regionalization of perinatal care for preterm infants.

Delivery of Health Care↗

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[Liposome phospholipid substitution and lung function in surfactant deprived rats].

In vivo activity of an artificial surfactant was studied in surfactant depleted rats. After tenfold alveolar lavage, PaO2, tidal volume, and compliance of the respiratory system fell to one third of initial value. Substitution of large unilamellar vesicles containing 90% Dipalmitoylphosphatidylcholine and 10% unsaturated phosphatidylglycerol largely restored oxygenation and lung mechanics in most animals. Complete normalization with weaning from the ventilator, however, was achieved neither with liposomes nor with natural surfactant concentrate.

Animals↗

PubMedDate not supplied

[Cardiovascular diagnosis in thoracopagus twins].

The case of a thoracopagus with atrial and ventricular connection and of a thoracoischiopagus with atrial connection and multiple cardiac defects are reported. For the assessment of cardiac fusion, ECG, radionuclid-studies and CT are of limited value. By means of angiocardiography it is possible to classify patients in those with pericardial union only, with venae-cavae - or atrial connection and with ventricular connection. While separation of twins with pericardial fusion is often performed, successful separation of twins with atrial fusion is only once described, of twins with ventricular fusion never described.

Aorta, Thoracic↗

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Circulatory changes after surfactant bolus instillation in lung-lavaged adult rabbits.

Following surfactant instillation in infants treated for respiratory distress syndrome, a mean arterial blood pressure (MABP) decrease is often observed. Its etiology and pathogenesis are still unknown. In this study various circulatory parameters were recorded continuously after surfactant instillation to elucidate the role of pulmonary vascular resistance as one possible cause for the MABP drop. Seven anesthetized adult New Zealand white rabbits were artificially ventilated after tracheotomy. Arterial and right atrial pressure were recorded continuously. Pulmonary artery pressure and cardiac output were determined by means of a thermodilution catheter. After inducing surfactant deficiency by repeated saline lavages, 200 mg/kg body weight of a natural surfactant preparation was administered by tracheal bolus instillation. PaO2 increased rapidly from 8.0 +/- 1.3 kPa to 51.2 +/- 8.8 kPa (mean +/- standard deviation) within 2 min (p < .05). MABP dropped from 12.1 +/- 1.9 kPa to 8.9 +/- 2.3 kPa within 2 min (p < .05). Pulmonary artery pressure, cardiac output, and right atrial pressure did not change during the observation period of 60 min. The results suggest that a peripheral vasodilatation is the most likely cause for the drop in MABP.

Animals↗

PubMedDate not supplied

Pulmonary vascular changes in bronchopulmonary dysplasia: a clinicopathologic correlation in short- and long-term survivors.

Pulmonary vascular findings in infants with bronchopulmonary dysplasia (BPD) are inconsistent. We compared five infants who fulfilled histologic criteria of BPD (group I; survival up to 1 month) with five controls who died of severe neonatal infection without having been ventilated. Nine infants who survived up to 7 months also fulfilled clinical criteria of BPD (group II). These were compared with three term infants who died of nonpulmonary causes. Lung slices were examined qualitatively and by quantitative histomorphometry. The influence of oxygen concentration and positive pressure ventilation on arterial density was studied. Arterial concentration in group I [2.43 (0.63) vessels/mm2, mean +/- SD] increased significantly compared with the controls [1.64 (0.49) vessels/mm2, mean +/- SD]. Most infants in group II who had cor pulmonale at autopsy had decreased arterial density when compared with normal term infants. Postmortem pulmonary angiography was also consistent with this finding. Total oxygen dose was the factor with the greatest influence on reduced arterial density. Relative wall thickness of vessels less than 75 microns in diameter was not significantly reduced in group I (p greater than .05). Infants from group II with cor pulmonale had an increased wall thickness compared with their controls. The proportion of fully muscularized arteries less than 100 microns in diameter was reduced in group I but increased in group II. We conclude that the reduction of cross-sectional perfusion area and abnormal muscularization of more peripheral vessels are important in the pathogenesis of pulmonary hypertension in infants with BPD.

Angiography↗

PubMedDate not supplied

[Neonatology throughout Europe--accreditation].

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Education, Medical, Continuing↗

PubMedDate not supplied

[Causes of neonatal mortality 1981-1983: a regional analysis].

We studied perinatal care and causes of death in 182 newborn infants who died during the first 28 days of life in the children's hospitals of Bochum, Datteln, and Essen in 1981-1983. Birth weight was below 2 500 g in 73%, cerebral hemorrhage was found in 15% of the infants. Most common causes of death were cardiorespiratory maladaptation (60%), congenital malformation (27%), and severe infection (12%). 90 infants died on the first day, 138 within the first week of life. A matched pair analysis comparing 153 deaths above 750 g with survivors of similar birth weight demonstrated preventable factors in half of the neonatal deaths: hypothermia, acidosis, blindbuffer and volume therapy, and hyperglycemia. More infants survived when born during the daylight hours and when a pediatrician was present at birth. Mortality and incidence of hypothermia were higher in small maternity units. In order to reduce neonatal mortality further, regional perinatal centres for high risk deliveries should be developed in Nordrhein-Westfalen.

Asphyxia Neonatorum↗

PubMedDate not supplied

Comparative studies on the effect of isovolemic large volume blood replacement by colloidal plasma substitutes on erythropoiesis and kidney.

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Animals↗

PubMedDate not supplied

[Epidemiology and therapy of Parkinson disease in inpatient nursing homes].

In 12 nursing homes for older people epidemiological and therapeutic data of patients with Parkinson's disease were collected. The mean rate of Parkinson's disease in all inhabitants was 12.5%, the mean clinical disability was 15.3 +/- 4.5 (Webster score). The mean age was very old (81.3 +/- 7.8 years). All patients showed one or more different diseases. The medical treatment was often not in agreement with symptoms. Physical therapy was applied only in 33% of patients. These and further data support the thesis that patients with Parkinson's disease in nursing homes may benefit from therapeutic patterns.

Activities of Daily Living↗