[Neonatal intensive care units in obstetrics departments].
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Female↗
Biomedical subjects
O Linderkamp
Publications and source records attributed to O Linderkamp.
A European multicenter randomized controlled trial of single dose surfactant therapy for idiopathic respiratory distress syndrome.
We performed a multicenter prospective randomized controlled trial to determine the efficacy and safety of the surfactant preparation, Survanta (Abbott Laboratories, Chicago, USA), for 750-1750 g infants with idiopathic respiratory distress syndrome, (IRDS) receiving assisted ventilation with 40% or more oxygen. One hundred and six eligible infants from the eight participating centers were randomly assigned between March 1986 and June 1987 to receive either surfactant (100 mg phospholipid/kg, 4 ml/kg) or air (4 ml/kg) administered into the trachea within 8 h of birth (median time of treatment 6.2 h, range 3.2-9.1 h). The study was stopped before enrollment was completed at the request of the United States Food and Drug Administration when significant differences were observed in incidence of periventricular-intraventricular hemorrhage (PIH), between the surfactant treated and control infants. Surfactant treated infants had larger average increases in the arterial-alveolar oxygen ratio, (a/A ratio) (P less than 0.0001), and larger average decreases in FiO2 (P less than 0.0001) and mean airway pressure, (MAP) (P less than 0.017) than controls over the 48 h following treatment. The magnitude of the differences between the surfactant and control groups were 0.19 (SE = 0.03) for a/A ratio, -0.28 (SE = 0.04) for FiO2 and -1.7 cm H2O (SE = 0.70) for MAP. The clinical status on days 7 and 28 after treatment was classified using four predefined ordered categories: (1) no respiratory support; (2) supplemental O2 with or without continuous positive airway pressure (CPAP); (3) intermittent mandatory ventilation; and (4) death. There were no statistically significant differences in the status categories on days 7 or 28 between surfactant and control infants.(ABSTRACT TRUNCATED AT 250 WORDS)
Administration, Inhalation↗
[A rapid test procedure for the detection of B streptococci in the perinatal period].
At the Hospital of the Department of Gynaecology of the University of Heidelberg, a latex agglutination test (Strep B Patho Dx Test) was applied after extraction of antigens from amniotic fluid and gastric aspirate, parallel to the routine screening programme (vaginal and anal swabs) for maternal colonization with B streptococci. The latex agglutination test was applied in 1336 cases. Maternal vaginal colonization was detected in 14%, anal colonization in 17% of the cases. A comparison of the results obtained with the latex agglutination test and with conventional bacteriological procedures (no gradual bacteriology, incubation 48 hours) showed antigen identification in amniotic fluid in 54%, respectively 24%. In gastric aspirates a B streptococcal contamination was detected by bacteriology in 40% of cases, by the rapid latex agglutination test in 22%. If no streptococci were found in the mother, amniotic fluid or gastric aspirates were contaminated in 4% or 6%, respectively (agglutination test or bacteriology, respectively). With a sensitivity of approximately 50% and a specificity of 98%, the latex agglutination test proved superior to routine bacteriology. All clinically contaminated newborn (positive blood specimens) were clearly identified by this test. With this new latex agglutination test, a procedure is now available to detect B streptococcal contamination in newborns within less than half an hour, thus an intra- or postpartal antibiotic therapy can be applied early.
Anal Canal↗
Blood viscosity and optimal hematocrit in narrow tubes.
Blood viscosity in normal adults was measured in glass tubes with diameters of 50, 100 and 500 microns for a wide range of adjusted feed hematocrits (15-70%). Blood viscosity decreased at each of the adjusted feed hematocrits when going from a 500-micron tube to a 50-micron tube. The viscosity reduction increased with increasing hematocrit. The steepness in the hematocrit-viscosity curves decreased with decreasing tube diameter. Erythrocyte transport efficiency (hematocrit/blood viscosity) was calculated to estimate the optimal hematocrit for oxygen transport. Optimal hematocrit averaged 38% in 500-micron tubes, 44% in 100-micron tubes and 51% in 50-micron tubes. Our results suggest that the strong Fåhraeus-Lindqvist effect at high hematocrits may help to maintain oxygen transport in polycythemic patients as long as the driving pressure is sufficient.
Adult↗
The influence of extracorporeal circulation and hemoseparation on red cell deformability and membrane proteins in coronary artery disease.
Extracorporeal circulation and hemoseparation may lead to coupled mechanical and chemical blood trauma and thus influence red cell deformability. Ten patients with coronary artery disease underwent coronary bypass. Patients' blood samples were drawn preoperatively, after extracorporeal circulation, and after hemoseparation. Ten healthy adults served as control subjects. Red blood cell deformability was determined by direct microscopic observation of red blood cells subjected to shear stresses of 1.2 to 13.3 Pa with a counter-rotating rheoscope. Red cell membrane proteins were separated by one-dimensional polyacrylamide gel electrophoresis in the presence of sodium dodecyl sulfate. At 1.2 Pa, preoperative red cell deformability was significantly greater in patients with coronary artery disease than in control subjects. Neither extracorporeal circulation nor hemoseparation changed red cell deformability significantly. Electrophoretic separation of membrane proteins failed to show any quantitative or qualitative differences between patients and control subjects. Moreover RBC membrane proteins of red blood cells in the patients were not altered as a result of extracorporeal circulation or hemoseparation. The preoperatively increased red cell deformability in the patients may be drug-induced. Our data suggest that the extracorporeal circulation and hemoseparation techniques used in this study do not lead to red blood cell damage.
Blood Transfusion, Autologous↗
Flow behavior of neonatal and adult erythrocytes in narrow capillaries.
This study was designed to analyze the flow behavior of red blood cells (RBCs) in circular vessels with diameters of 3 to 6 microns by means of a mathematical model. According to this model, the RBC flow velocity is 1 mm/sec, RBCs assume axisymmetric shape, and the gap between the RBC and the vessel wall allows sufficient lubrication. The flow resistance depends on the surface area and volume of RBCs, the plasma viscosity, and the vessel diameter. Surface area and volume of RBCs from 10 term neonates and 10 adults were determined by means of a micropipet system and plasma viscosity was measured using a capillary viscometer. Neonatal RBCs had larger volumes (107 +/- 6 fl vs 90 +/- 4 fl) and surface areas (154 +/- 7 microns 2 vs 137 +/- 7 microns 2) than adult RBCs (P less than 0.005). Plasma viscosity was lower in neonates than in adults (1.04 +/- 0.10 cP vs 1.26 +/- 0.13 cP; P less than 0.005). The flow model leads to the following conclusions: During the passage of 3- to 6- microns vessels, the large neonatal RBCs are more elongated than the smaller adult RBCs. In vessels with diameters of less than 3.3 microns, the rear of neonatal RBCs becomes convex, whereas this critical vessel diameter is 3.1 microns for adult RBCs. If the cells are suspended in the same medium, neonatal RBCs require a 31% higher driving pressure than adult RBCs to achieve the necessary elongation for passing through a narrow capillary. However, both cell types require similar driving pressures, if the cells are suspended in the corresponding plasma. The tube/discharge hematocrit ratio of neonatal RBCs is 1 to 6% higher than that of adult cells. Relative viscosity of neonatal RBCs is approximately 7% higher compared with adult RBCs, whereas the blood viscosity (relative viscosity times plasma viscosity) is 12% less in neonates than in adults. We conclude that the large size of neonatal RBCs may cause impaired flow in narrow vessels with diameters below the critical value of 3.3 microns. In vessels with diameters of 3.3-6.0 microns, the disadvantage of the large size of neonatal RBCs appears to be completely compensated for by the lowr plasma viscosity in the neonate.
Adult↗
Management of posthaemorrhagic hydrocephalus with a subcutaneous ventricular catheter reservoir in premature infants.
A subcutaneous ventricular catheter reservoir was inserted between the 16th and 28th (median 23rd) day of life in 13 premature infants (median birth weight 1220 g, range 780-2110) for the treatment of posthaemorrhagic hydrocephalus. Aspiration of cerebrospinal fluid (median 6 ml, range 1-15) one to four (median two) times a day for 6 to 90 (median 40) days controlled the hydrocephalus as judged by clinical and ultrasonographic criteria. There were no serious complications, except skin breakdown in one patient. Intracranial pressure measured in five patients through the reservoir showed the efficacy of the treatment, as well as the unreliability of clinical and ultrasonographic criteria in determining the amount of cerebrospinal fluid that should be aspirated daily.
Cerebral Hemorrhage↗
Viscosity reduction of red blood cells from preterm and full-term neonates and adults in narrow tubes (Fahraeus-Lindqvist effect).
In artificial tubes as well as in blood vessels with diameters less than 500 microns, blood viscosity decreases with decreasing diameter (Fahraeus-Lindqvist effect). Our study measured viscosity of red blood cells (RBC) from 10 preterm infants, 10 term neonates, and 10 adults by means of a capillary viscometer. RBC were suspended in buffer at hematocrits of 0.20, 0.40, and 0.60 1/1 (1.00 1/1 = 100%). Tubes with diameters of 50, 100, and 500 microns were perfused with these suspensions. Viscosity in the 500-microns tubes was not significantly different, at any hematocrit, among the three groups. Viscosity decreased at each of the adjusted hematocrits in the three groups when going from a 500-microns tube to a 50-microns tube. At a hematocrit of 0.60 1/1, viscosity reduction averaged 48 +/- 7% in the preterm infants, 42 +/- 8% in the full-term neonates, and 35 +/- 5% in the adults, whereas the reductions at a hematocrit of 0.20 1/1 were only 32 +/- 6, 27 +/- 4, and 24 +/- 6%, respectively. For the combined data from the neonates and adults, there was a significant inverse relationship of the viscosity in 50-microns tubes at a hematocrit of 0.60 1/1 to the mean corpuscular volume (r = 0.69). To evaluate whether increased membrane elasticity of neonatal RBC contributes to the stronger viscosity reduction of neonatal RBC in narrow tubes, heated neonatal and adult RBC were also studied. The resulting loss of membrane elasticity caused a marked decrease in the viscosity reduction in 50-microns tubes, particularly in the neonates.(ABSTRACT TRUNCATED AT 250 WORDS)
Adult↗
[Acute retinopathy of prematurity: shift of the manifestation risk to extremely premature infants by neonatal intensive care medicine].
A total of 381 surviving prematures (birthweight less than or equal to 2500 g) at the heidelberg University Children's Hospital were examined ophthalmologically between January 1986 and June 1988. Of the 762 eyes, 112 (14.7%) showed acute retinopathy of prematurity (ROP). In our study, a correlation between birthweight, gestational age and retinopathy of prematurity was confirmed. In addition, the results concerning severity, differences between the right and left eye, and the incidence in twins and multiple births were demonstrated. Data were compared with the data in 29 papers dealing with the prevalence of acute ROP since 1968: 12,468 preterm infants were investigated in all papers; 2,087 of these infants (16.7%) showed ROP. In the literature, 8.4% of the premature babies with a birthweight of 1501 to 2500 g were found to have ROP. In our group with the same birthweight, only one baby (birthweight 1510 g) had retinopathy (0.6%). The fact that the average ROP prevalence has not changed significantly indicates that the risk of having retinopathy of prematurity has switched over to the more immature preterms, whose prognosis of survival has improved in the last few years as a result of the improvement in neonatal care.
Female↗
[The transportation problem--transportation in utero compared to transportation of the newborn infant].
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Female↗
Blood rheology in the newborn infant.
The blood in neonates shows several peculiar properties which affect its rheological properties. 1. The haematocrit in neonates may be as high as 0.65 l/l without any clinical signs. 2. Both plasma viscosity and red cell aggregation are markedly lower in neonates than in adults because of low protein levels in neonates. This results in decreased blood viscosity at given haematocrit, particularly at low shear forces. 3. Deformability of neonatal red cells is similar to that of adult cells when studied under controlled conditions (e.g. rheoscope, ektacytometer). However, neonatal red cells are less filterable and require higher pressures for entering narrow micropipettes than adult red cells due to the larger size of neonatal red cells. 4. Neonatal leukocytes require higher pressure for the passage of 5 microns filter pores or 5 microns micropipettes than adult cells. The following haemorheological disorders have been observed in neonates: 1. Polycythaemia in infants with late cord-clamping, severe asphyxia, growth retardation and diabetic mothers. 2. Markedly decreased red cell deformability in septicaemia, necrotizing enterocolitis and in vitamin E deficiency (after exposure to oxidizing agents). 3. Moderately decreased red cell deformability in infants with diabetic mothers, growth retardation and severe acidosis. 4. Increased red cell aggregation in septicaemia. 5. Lack of red cell aggregation in immature neonates. 6. Decreased ability of leukocytes from septic neonates to pass filter pores and micropipettes. Treatment may be either haemodilution (in polycythaemia) or exchange transfusion (in septicaemia and necrotizing enterocolitis). Haemorheological drugs have not been used in neonates.
Blood Flow Velocity↗
[Successful pregnancy after kidney transplantation and cyclosporin A].
A 21-year-old patient is described who, with a kidney transplant and immunosuppressive treatment with Cyclosporin A, successfully concluded pregnancy. Effective immunosuppression is especially important during pregnancy with its increased risk of transplant rejection. Aside from conventional substances such as azathioprine and steroids, Cyclosporin A (Sandimmun) seems to be the most effective substance available in transplantation medicine today. There is, however, still insufficient knowledge of the effects of Cyclosporin A during pregnancy, so that an endangered pregnancy must be expected during this type of therapy. Because of persistent premature labor in spite of tocolytic treatment, a cesarean section was performed in the 36th week of pregnancy after establishing pulmonary maturity. A review of the literature points out the presently known problems connected with Cyclosporin A intake during pregnancy.
Adult↗
Erythrocyte deformability in the fetus, preterm, and term neonate.
Deformability of red blood cells (RBC) is an important determinant of microcirculation, of oxygen transport and release to the tissues, and of RBC life span. Deformability of RBC from five fetuses, 20 preterm infants, 20 term neonates, and 20 adults was determined by direct microscopic observation of RBC subjected to shear stresses of 6 to 85 dyn/cm2 using a counter-rotating rheoscope. There was no significant difference in deformability among RBC from the fetuses, the preterm and term neonates, and the adults at any shear stress. More than 95% of fetal, neonatal, and adult RBC were capable of tank-tread motion. Compared to adults, the frequency distribution of RBC deformability was slightly broader in the fetuses and neonates because of the presence of more highly and poorly deformable RBC. The increased number of rigid RBC may contribute to the shortened life span of fetal RBC.
Adult↗
Filterability of erythrocytes and whole blood in preterm and full-term neonates and adults.
Filtration techniques are widely used to assess red blood cell (RBC) deformability and flow behavior of RBC in microcirculation. In this study filtration rates of RBC from 10 very low birth weight infants (24-30 wk gestation), 10 more mature preterm infants (31-36 wk gestation), 10 full-term neonates, and 10 adults were measured by using Nucleopore filters with pore diameters of 5 micron and filtration pressures of 1, 2, 5, and 10 cm H2O. The major results follow: At each of four filtration pressures, filtration rates of washed RBC were significantly (p less than 0.05) lower in the preterm infants than in the term neonates who in turn showed lower values than adults. The differences among the four groups became less as the pressure was increased from 1 to 10 cm H2O. The filtration rates increased with decreasing MCV (r = -0.86). The filter flow resistance (computed as ratio of filtration pressure and filter flow rate) decreased as the filtration pressure was raised from 1 to 10 cm H2O. The largest drop, 31% (p less than 0.05), was observed in the most immature infants, the smallest, 10% (p greater than 0.05), was seen in adults. At a pressure of 1 cm H2O the calculated mean transit time for RBC through the 5-micron pores was on an average 3.7 times longer in the smallest preterm infants than in the adults (19.7 +/- 7.8 and 5.3 +/- 1.4 ms, respectively), whereas the factor was only 2.7 at a pressure of 10 cm H2O (13 +/- 0.4 and 0.5 +/- 0.1 ms, respectively).(ABSTRACT TRUNCATED AT 250 WORDS)
Adult↗
Deformability and intrinsic material properties of neonatal red blood cells.
Whole cell and membrane deformability are essential for red blood cell (RBC) survival and for effective blood flow. Neonatal RBCs display several specific properties (eg, large size, high hemoglobin F) that could influence their deformation characteristics and contribute to their shortened life span. The present study was designed to compare selected rheologic properties (cellular deformability, pressure required to aspirate RBC into micropipettes, static and dynamic viscoelastic material properties) of neonatal and adult RBCs. RBC deformability, as studied by a rheoscope, was similar for neonates and adults over a shear stress range of 2.5 to 500 dyn/cm2. The pressure required to aspirate RBCs completely into 3.3-micron diameter pipettes was 129 +/- 87 dyn/cm2 for neonatal RBCs and 71 +/- 37 dyn/cm2 for adult RBCs. The aspiration pressure for neonatal and adult RBCs increased with increasing RBC volume, suggesting that the increased mean aspiration pressure for neonatal RBCs resulted from their larger volume. When RBCs with same volume and diameter were compared, the aspiration pressure tended to be smaller for neonatal RBCs than for adult cells. To characterize material properties determining RBC deformability, we measured membrane extensional (shear) and bending elastic moduli, the time constant for elastic recovery from extensional deformation and hemoglobin viscosity (ie, cytoplasmic viscosity) of neonatal and adult RBCs. Membrane surface viscosity and time constant for recovery from bending deformation were calculated. The extensional and bending moduli of neonatal RBCs were slightly smaller (10% and 16%, respectively) compared with adult cells. This suggests that the static resistance of neonatal RBC membrane to deformation and failure in response to a given force is slightly smaller. The time constant for recovery from extensional deformation of neonatal RBCs was larger by 14%, compared with adult cells. The time constant for bending deformation related to the RBC diameter and surface area was increased by 18% in the neonates. Membrane surface viscosity and hemoglobin viscosity were similar for both cell types. These results indicate that the deformability and viscoelastic properties of neonatal RBCs deviate only slightly from those of adult RBCs and that the increased aspiration pressure of neonatal RBCs is solely due to their large size. Some of the specific deformation characteristics observed in this study (increased aspiration pressure, decreased resistance to elastic deformation) may contribute to the shortened life span of neonatal RBCs.
Adult↗
Drug-induced toxic epidermal necrolysis (Lyell's syndrome) in a 4-year-old girl.
Toxic epidermal necrolysis (Lyell's syndrome) with erythematous skin lesions and bulla formation developed in a 4-year-old girl. An accurate diagnosis using the cryostat technique on the top of a bulla was available within 1 h of hospital admission. The course was unusually mild, probably because of early treatment with corticosteroids. Skin prick tests revealed salicylamide as the agent responsible for inducing the disease. The patient was advised to avoid this substance for the rest of her life.
Child, Preschool↗
Fetal alcohol syndrome and malignant disease.
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Abnormalities, Multiple↗
Red blood cell aggregation in preterm and term neonates and adults.
Aggregation of red blood cells (RBC) is a major determinant of blood viscosity and of blood circulation through vessels with slow flow (i.e. veins). RBC aggregation and plasma fibrinogen were studied in placental blood samples from 25 neonates with 24 to 41 wk of gestation and in blood from 13 normal adults. The rate and final extent of RBC aggregation were measured by means of a rheoscope (increase in light transmission during blood stasis). Both the rate and extent of RBC aggregation were low in the premature infants, increased with gestational age, and reached the highest values in the adults. Blood from seven infants with 24 to 28 wk of gestation did not show any significant RBC aggregation during the first minute of stasis. RBC aggregation was closely related to the fibrinogen level. Cross-suspension studies (neonatal RBC in adult plasma and adult RBC in neonatal plasma) showed that neonatal and adult RBC had the same aggregation pattern when they were suspended in the same plasma. Moreover, neonatal and adult RBC demonstrated the same strong aggregation when they were resuspended in 1% dextran. These results indicate that specific plasma properties are responsible for the decreased RBC aggregation observed in the neonates while their specific RBC properties do not affect RBC aggregation.
Adult↗