A large ductus arteriosus aneurysm can lead to potentially serious and life-threatening complications. We report a case of aneurysmal dilatation of the ductus arteriosus in a premature infant that was successfully treated with indomethacin. Thus, surgical intervention with general anesthesia could be avoided.

Aneurysm↗

PubMedDate not supplied

Huge fetal sacrococcygeal teratoma with a completely formed eye and intratumoral DNA ploidy heterogeneity.

Preterm infants and newborns with sacrococcygeal teratomas are at high risk for prenatal and perinatal complications. The prognosis depends on size and histology of the tumor, degree of prematurity, associated malformations, route of delivery, and prompt and complete surgical removal. Virtually any tissue can be present in a sacrococcygeal teratoma, but to date, ocular lens has been documented only as lentinoids (lens-like cells), whereas flow-cytometric data have been variably interpreted. We describe a case of a sacrococcygeal teratoma in an infant of 29 weeks gestational age that is remarkable for the weight (4500 g), the presence of a completely formed eye, and intratumoral DNA ploidy heterogeneity.

Choristoma↗

PubMedDate not supplied

[Dexamethasone therapy in bronchopulmonary dysplasia].

Dexamethasone has recently been introduced for the treatment of bronchopulmonary dysplasia (BPD). Whereas the short-term effect of dexamethasone has been documented in previous publications, studies on the long-term effect do not appear to exist in the literature. The aim of this retrospective study was to investigate the influence of dexamethasone on respiratory parameters, the long-term efficacy, and the side-effects. Dexamethasone was given to premature babies with BPD who could not be weaned from the respirator. Twelve infants were included in this study. The gestational ages ranged from 26 to 30 weeks and the birth weights ranged from 640 to 1410 g. Dexamethasone treatment was initiated at the age of 14 to 44 days. After 6 days of dexamethasone therapy, ventilation rates and FiO2 values improved significantly. All infants were successfully weaned from mechanical ventilation and extubated at 2 to 40 days after the start of dexamethasone therapy. The follow-up for the estimation of the long-term efficacy ranged from 3 to 18 months. Ten out of twelve patients had been weaned permanently from the ventilator; one 12-months-old infant is still respirator-dependent. One patient died at 8 months from BPD. In 5 out of 12 infants we observed a leukocytosis with neither clinical signs nor microbiological signs of an infection. Septicaemia developed in one case and one patient suffered from pneumonia. Arterial hypertension was observed in one infant during dexamethasone therapy. The results suggest that dexamethasone facilitates the weaning of preterm infants with BPD from the ventilator. This treatment may prevent some infants from long-term ventilation.

Bronchopulmonary Dysplasia↗

PubMedDate not supplied

Rheological properties of blood and their possible role in the circulation and development of intracranial hemorrhage in preterm infants.

Blood viscosity and other rheological properties of blood have important effects on blood circulation. In preterm infants, blood viscosity (at given hematocrit), plasma viscosity and red cell aggregation are decreased compared to term neonates and adults. In addition, the Fahraeus-Lindqvist effect (i.e., decrease in blood viscosity with decreasing vessel diameter) is more pronounced in preterm infants. This suggests that blood flow through arteries, arterioles and veins is facilitated in preterm infants. The large neonatal red cells are less filterable and less able to enter small capillaries than adult red cells. This suggests that the passage of neonatal red cells through narrow capillaries and splenic pores is impaired. The high risk of intracranial hemorrhage in small preterm infants may in part result from poor red cell aggregation, impeded passage of their large red cells through narrow cerebral capillaries and raised blood viscosity due to rapid transfusion of adult blood.

Blood Flow Velocity↗

PubMedDate not supplied

[Application of indirect calorimetry in monitoring feeding of low birth-weight preterm infants].

BACKGROUND: We investigated the practical use of indirect calorimetry for the individual nutritional support of preterm infants in order to answer the question whether it is possible to reliably calculate energy expenditure, fat and carbohydrate oxidation in preterm infants individually by using the results of a timed 6-hour-measurement of oxygen consumption and carbon dioxide production. PATIENTS: Measurements were performed in 20 preterm infants (gestational age 30.2 +/- 0.6 weeks, birth weight 1.09 +/- 0.07; mean +/- SEM) at a mean postnatal age of 25 +/- 4 days and with a body weight of 1.35 +/- 0.06 kg. METHODS: Carbon dioxide production (24 h-VCO2), oxygen consumption (24 h-VO2) and respiratory quotient (24 h-RQ) were measured by indirect calorimetry for 24 hours using the Deltatrac II metabolic monitor (Datex, Helsinki, Finland). Additionally, 6 h-VCO2, 6 h-VO2 and 6 h-RQ were determined by measurement over 6 hours. The patients' energy expenditure, fat and carbohydrate oxidation were calculated from VCO2 and VO2 measured over a 24 hour- and 6 hour-period with or without consideration of urinary nitrogen excretion (NU). RESULTS: If NU was not included in the calculation of energy expenditure, the values differed by maximally 1.1% from the calculations including NU. The correlations between the 24 h-RQ and the calculated 24 h-fat or 24 h-carbohydrate oxidation values were statistically significant (r = -0.99; p = 0.0001 and r = 0.773; p = 0.0002 respectively). However, in individual patients, it was not possible to predict 24 h energy expenditure, fat and carbohydrate oxidation of preterm infants using values determined by 6 h indirect calorimetry. CONCLUSION: The determination of the urine-nitrogen excretion is not necessary for calculation of energy expenditure of preterm infants. It is possible to estimate fat and carbohydrate oxidation of preterm infants by the measured 24 h-RQ, but 6 h indirect calorimetry is not accurate enough for calculating the individual nutritional needs of preterm infants in clinical practice. Indirect calorimetry over 24 h may be helpful in the management of selected patients with nutritional problems.

Calorimetry, Indirect↗

PubMedDate not supplied

[Bronchopulmonary dysplasia. Retrospective analysis of various forms of treatment and development of a staged therapeutic plan].

50 premature infants with bronchopulmonary dysplasia (BPD) were treated in the Perinatal Center of the University of Heidelberg from January 1990 to December 1992. Gestational age was 24-31 weeks and birthweight was 500 to 1430 grams. 27 infants received dexamethasone only and 14 were initially given dexamethasone followed by beclomethasone inhalation. Nine infants without assisted ventilation were only treated with inhaled beclomethasone. Infants with fluid intake > 150 ml/kg/d and < or = 150 ml/kg/d were analysed separately. Extubation in ventilated infants was possible 1 to 29 days after the beginning of dexamethasone treatment. Most infants who were not ventilated any more could be weaned from oxygen during the period of dexamethasone treatment. Inhaled beclomethasone allowed reduction in supplemental oxygen in all infants. Effects of treatment with dexamethasone and beclomethasone were similar in infants with fluid intake of < 150 ml/kg/d and > 150 ml/kg/d. Our data show that dexamethasone and inhaled beclomethasone improved the clinical course of BPD in premature infants. Fluid intake had no influence on clinical outcome. Based on our results, we suggest guidelines for the treatment of BPD.

Administration, Inhalation↗

PubMedDate not supplied

Influence of nutrition on growth in premature infants: assessment by knemometry.

Lower leg length measurements in 19 healthy preterm infants were obtained by knemometry to assess short term growth. Eight infants received fortified human milk and 11 infants commercially available preterm formulas. Two independent observers measured lower leg length in each infant daily during the study period, weight was measured daily with a neonatal scale. While weight gain showed linearity in all infants, lower leg length growth showed mini growth spurts of 5 +/- 1.7 days, growth periods of 20 +/- 11 days or both types of short term growth. The overall weight gain was 35 +/- 5.6 g/day in infants fed human milk and 33 +/- 7 g/day in infants fed preterm formula. The overall lower leg length growth velocity was 0.51 +/- 0.04 mm/day versus 0.54 +/- 0.09 mm/day, respectively. Both groups had comparable weight and length increments. No correlation existed between the type of nonlinear lower leg length growth (mini growth spurts versus growth periods) and the feedings received by the infants.

Female↗

PubMedDate not supplied

Validation of a newly developed mini-knemometer for premature infants.

A newly developed knemometric device for lower leg length measurement in premature and newborn infants is presented and validated. The present study was performed to establish a standardized method of use of this instrument. Two independent observers obtained 10 subsequential readings per measurement in three infants over 43 days, after which analysis showed that 5 subsequential readings per measurement gave comparable technical errors. Thirty-one premature infants were assessed by knemometry by two independent observers. The correlation coefficient of all measurements was 0.998. The acquired technical error (mean Standard Deviation (SD) of 5 sequential readings) over a total observation period of 294 days in all studied infants was 0.06 and 0.05 mm, respectively. By a mean lower leg length growth velocity of 0.52 mm per day the technical error amounted to 11% of daily bone growth. The described mini-knemometer is an accurate device for the detection of daily individual growth. A learning period of 21 days is necessary to obtain reliable results.

Anthropometry↗

PubMedDate not supplied

Cellular and membrane deformability of red blood cells in preterm infants with and without growth retardation.

Membrane and whole red cell deformability are essential for effective blood flow, oxygen uptake and release. Whole cell deformability (rheoscope with shear stresses of 0.6-30 Pa) and membrane shear elastic modulus (flow channel) of red blood cells (RBC) were studied in appropriate and small for gestational age preterm infants (28-32 wk of gestation), in healthy full-term neonates and in adults. No significant differences were found between the two groups of preterm infants. The preterm infants showed significantly increased RBC deformation in the rheoscope when compared to the full-term neonates who, in turn, showed more RBC deformation than adults. Correspondingly, the membrane shear elastic modulus (i.e., the resistance to elastic membrane deformation) was lower in the preterm infants than in the full-term neonates and lower in full-term infants than in adults. Thus, both whole cell and membrane deformability appear to be increased in preterm infants. Improved RBC deformability may aid in the maintenance of adequate blood circulation in preterm infants in spite of low vascular pressures.

Adult↗

PubMedDate not supplied

[Incidence of typical nephrocalcinosis ultrasound findings in premature infants during enteral calcium and phosphate administration].

Supplementation of calcium and phosphate is recommended in nutrition of low birth weight infants to ensure a physiological development of postnatal bone mineralisation. To investigate whether high dose calcium supplementation increases the risk of renal calcification in preterm infants, serial ultrasound examinations were performed in 30 preterm infants (gestational age 29.5 (26-35) weeks; birth weight 1382 (610-2010) g) before, during and after oral calcium and phosphate supplementation. Total calcium input was on average 3.1 mmol/kg/d, total phosphate input on average 2.1 mmol/kg/d). All children showed normal kidney ultrasound before entering the study. During mineral supplementation three children developed hyperechoic renal medullary pyramids, the typical ultrasound pattern of nephrocalcinosis. Supplementation was stopped immediately and pathologic ultrasound patterns disappeared in all 3 children.

Calcium, Dietary↗