AIMS: To evaluate the outcome of infants of drug dependent mothers (IDM) after establishing an interdisciplinary attention concept at the University Hospital in Vienna. To compare the influence of different maintenance agents on neonatal morbidity. PATIENTS AND METHODS: All newborns of opiate dependent mothers were prospectively included from III 1995 to IX 1999. The following data were collected: maintenance agent (methadone, slow release morphine, buprenorphine), infectious status, demographic data, congenital malformations, perinatal complications, as well as incidence and duration of the neonatal abstinence syndrome (NAS). Medical treatment with phenobarbital (1995 - 96) or morphine hydrochloride (MoHCl) (1997 - 99), respectively, was indicated when Finnegan score exceeded 10. RESULTS: 88 neonates (38 females/50 males) with a median gestational age of 39 weeks were included, 18 (20.5 %) were born prematurely. The median birthweight was 2905 g, 24 (27.3 %) infants were small for date (< 10th percentile), 15 (17 %) microcephalic. The malformation incidence was 7.4 %. 63 (72 %) of all newborns had to be treated due to abstinence syndrome: in the methadone group 76 %, in the morphine group 93 %, but in the buprenorphine group 19 % only (p < 0.01). Median duration of withdrawal was 15.1 days (d) with significant difference after antenatal buprenorphine exposure compared to methadone and morphine exposure (8.3 d versus 15 d and 16.5 d respectively). In neonates treated with phenobarbital duration of NAS was 17.6 d, whereas NAS in infants with MoHCl therapy lasted 12.8 d (p < 0.05). CONCLUSION: Incidence and duration of NAS after buprenorphine exposure was significantly lower than after methadone and morphine exposure. Withdrawal time under morphin-hydrochloride therapy was reduced by one third compared to treatment with phenobarbital.

Buprenorphine↗

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[Reduction of body height in tall girls by estrogen treatment].

Twenty-six girls with constitutional tall stature were treated with 0.5 mg ethinyloestradiol daily po and 10 mg norethisteronacetate from day 21 to 25 of the cycle for 1.4 +/- 0.4 years. Height, weight, bone age according to Greulich-Pyle (GP) and Tanner (RUS), height predictions according to Bayley Pinneau (BP) and Tanner Whitehouse (TW) were recorded at the onset of therapy, at the end of treatment and 7.4 years later. The mean chronological age at start of treatment was 12.6 +/- 1.1 years, bone age (GP) 12.4 +/- 0.7 years, (RUS) 13.5 +/- 0.7 years. The initial height prediction according to BP was 186.2 +/- 4.1 cm, which was 3.5 cm higher than the prognosis according to Tanner Whitehouse. Depending on the method used for height prediction, the height reduction by treatment was 4.6 +/- 3.0 cm (BP) or 1.4 +/- 2.2 cm (TW), respectively. The reduction of predicted height was more pronounced in girls with a bone age (GP) < 12.5 years at the initiation of therapy (n = 13), than in girls with a bone age > or = 12.5 years (n = 13). Final height was measured 7.4 years after the end of treatment. Chronological age: 21.3 +/- 3.7 years, final height 181.8 +/- 3.7 cm. Mean final height after therapy was 7.7 cm above target height, or, after allowance for the secular trend, 3.8 cm above target height. Body weight, recorded in centiles of body mass index, increased from the 38.5 +/- 26 to the 58.1 +/- 22 centile, weight gain was more pronounced in younger girls. At follow up investigation 18/19 girls, who answered a questionnaire, had a positive view of the previous treatment.

Adolescent↗

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[Articulation disorder as the initial manifestation of facioscapulohumeral muscular dystrophy in childhood].

A five year old boy who had received logopedic treatment for more than two years was seen as an outpatient because of speech retardation. He presented with myopathic face, incomplete closure of both lids and severe weakness of facial muscles, bilateral winging of scapulae and hyperlordosis. Extraocular and pharyngeal muscles were not affected. Motor and sensory nerve fibre conductions and electromyography were within normal limits. CPK was moderately elevated (320 U/I). Muscle biopsy of right deltoid muscle revealed unspecific myopathic changes. The patients brother aged 7 also presented with facial weakness, elevated CPK and neurogenic changes in EMG of deltoid muscle. Both parents were clinically and electrophysiologically unremarkable. Although problems to speak distinctly are usually not the first manifestation, we found in this family facio-scapulo-humeral muscular dystrophy.

Arm↗

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[Associated abnormalities in the VACTERL syndrome--case report with autopsy findings].

We report on a male newborn with a VACTERL-association. Our patient had the characteristics of the syndrome: vertebral defects, anal atresia, cardiac anomalies, tracheal stenosis and radial dysplasia. In addition to this combination of malformations we have found a left pulmonary artery sling, cholecystaplasia and biliary dysplasia-not previously reported. Etiology, embryology, coincidence and differential diagnosis are discussed.

Abnormalities, Multiple↗

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[Comparison of the acetylcholine receptor antibody titer and clinical course in neonatal myasthenia].

Ten to fifteen percent of infants of myasthenic mothers develop neonatal myasthenia independent of the severity of the maternal disease. The antiacetylcholin receptor-protein antibodytiter (AChR-AK) was followed through the first twelve months in a boy who's mother suffered from myasthenia gravis (M.G.) since twelve years. Only unspecific symptoms for an impaired neuromuscular transmission were found, the diagnosis however was confirmed by determination of AChR-AK (alpha-Bungarotoxin binding assay, Lindström 1979). Maternal AChR-AK did not change during the observation period: values were between 120 X 10(-9)mol/l and 140 X 10(-9)mol/l. The neonatal titer on day one was 100 X 10(-9) mol/l, somewhat below the corresponding maternal titer (120 X 10(-9)mol/l). By 7 months the AchR-AK had decreased to the reference value according to the half time for IgG (t/2 = 17 days). In contrast to Keesey and Donaldson we found no relationship between AChR-AK levels and clinical course.

Adult↗

PubMedDate not supplied

L-arginine reduces kidney lipid peroxidation, glycoxidation and collagen accumulation in the aging NMRI mouse.

Collagen accumulation in organs is a main feature of the physiological aging process. There are two main theories for the responsible mechanisms, the free oxygen radical and the glycoxidation theory. Both lead to carbonyle-induced protein modification, increased collagen cross-linking and subsequently to the collagen accumulation. In previous studies we provided evidence for the blocking of reactive carbonyles by L-arginine in the diabetic state and present here data for this effect in the aging NMRI mouse. NMRI mice were fed L-arginine in tap water for a period of 6 months and compared to an untreated control group. Kidney collagen content of the treated group was significantly reduced (treated: 8.83 +/- 0.72 mg collagen/100 mg kidney weight; untreated: 11.95 +/- 0.98 mg collagen (100 mg kidney weight; p < 0.05). Using a colorimetric assay for lipid peroxidation products we found significantly reduced lipid peroxidation-derived aldehydes in the treated group (treated: 0.25 +/- 0.03 extinction; untreated: 0.36 +/- 0.04 extinction; p < 0.05). The parameter for glycoxidation, N-epsilon-carboxymethyllysine (CML) was significantly lower in the experimental group as well (treated: 2.3 +/- 0.5 nM CML/microM hydroxyproline; untreated: 4.3 +/- 0.52 nM CML/microM hydroxyproline; p < 0.05). No differences were observed for the biomarker of hydroxyradical attack, o-tyrosine. L-Arginine could have reduced collagen accumulation by blocking collagen glyc(oxidation) which is known to lead to increased collagen cross-linking, solubility and degradation as a strong correlation between both CML and collagen content (r2 = 0.654, p < 0.05) as well as between lipid peroxidation products and collagen content (r2 = 0.539, p < 0.05) was observed.

Aging↗

PubMedDate not supplied

[New aspects in the treatment of patent ductus arteriosus in premature newborns with respiratory insufficiency].

The efficacy of prolonged indomethacin treatment of sPDA was studied using a new, diagnostic method, the two-dimensional Doppler echocardiography (2-DDE). 35 ventilated preterm infants with sPDA (gestational age: 31.6 +/- 2.6; birth weight: 1535 +/- 565 gms) were studied prospectively. Therapy consisted of a loading and maintenance dose (3 x 0.3 mg/kg I. 12 h, 2 x 0.15 mg/kg I. 24 h). Therapy was initiated at postnatal age 1 to 17 days. Echocardiographycally verified closure of sPDA was achieved in 27/35 patients (77%), one patient had a relapse (4%), 8/35 (23%) did not respond to indomethacin. Responders were treated earlier (4.5 vs 9.6 days), were ventilated over a shorter period (30 vs 57 days) and exposure time to more than 30% of FiO2 was shorter (28 vs 56 days). Prolonged indomethacin is an effective treatment of sPDA in ventilated prematures. Early start of therapy increases rate of closure. For precise diagnosis of hemodynamic effectiveness 2-DDE method is mandatory.

Drug Administration Schedule↗

PubMedDate not supplied

[Morbidity and mortality of retarded and normal weight premature infants].

Differences of fetal outcome between appropriate for gestational age (AGA) and small for gestational age (SGA) preterm newborns with birth weight below 2500 g and gestational age ranging from 27 to 36 weeks have been evaluated. As described by Rohrer SGA have been divided into symmetrical retarded and asymmetrical retarded newborns using ponderal index. Therefore distribution of ponderal index on our local population has been analysed. SGA more often had an Apgar score below 6 five minutes post partum (p = 0.01) and their mothers more often announced abuse of nicotine during pregnancy. AGA have been on respiratory ventilation significantly longer than SGA (p = 0.001) and photo therapy because of hyperbilirubinaemia more often had to be performed on AGA (p = 0.02). AGA have spent a longer time at the neonatal intensive care unit than SGA (p = 0.0006). No differences could be found in mortality between AGA and SGA. Preterms with low ponderal index had no different outcome than SGA with normal ponderal index.

Apgar Score↗