[Rickets in children in Norway--an epidemic of concern for the Norwegian authorities?].
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Child↗
Biomedical subjects
R Lindemann
Publications and source records attributed to R Lindemann.
Ductus venosus blood velocity in persistent pulmonary hypertension of the newborn.
AIMS: To investigate the ductus venosus flow velocity (DVFV) in infants with persistent pulmonary hypertension of the newborn (PPHN); to evaluate the DVFV pattern as a possible diagnostic supplement in neonates with PPHN and other conditions with increased right atrial pressure. METHODS: DVFV was studied in 16 neonates with PPHN on days 1-4 of postnatal life using Doppler echocardiography. DVFV was compared with that in mechanically ventilated neonates with increased intrathoracic pressure, but without signs of PPHN (n=11); with neonates with congenital heart defects resulting in right atrial pressure (n=6); and with preterm neonates without PPHN (n=46); and healthy term neonates (n=50). RESULTS: Infants with PPHN and congenital heart defects with increased right atrial pressure were regularly associated with an increased pulsatile pattern and a reversed flow velocity in ductus venosus during atrial contraction. A few short instances of reversed velocity were also noted in normal neonates before the circulation had settled during the first day after birth. CONCLUSIONS: A reversed velocity in the ductus venosus during atrial contraction at this time signifies that central venous pressure exceeds portal pressure. This negative velocity deflection is easily recognised during Doppler examination and can be recommended for diagnosing increased right atrial pressure and PPHN.
Blood Flow Velocity↗
Respiratory muscle rigidity in a preterm infant after use of fentanyl during Caesarean section.
UNLABELLED: Fentanyl is in many neonatal intensive care units the sedative of choice. One side-effect is, however, the possibility of muscle and/or chest wall rigidity. A pregnant woman with a critical pulmonary valve stenosis had a balloon dilatation at 26 weeks of gestation. She was put on propranolol, but went into a severe cardiac failure. In week 31, she developed pregnancy induced hypertension. Periodically absent diastolic flow in the umbilical cord was demonstrated. A Caesarean section was performed using fentanyl as analgesia. A boy weighing 1440 g, had a 1 min Apgar score of 3 without respiratory movements. Mask ventilation was tried, but chest wall expansion was not achieved despite using high pressures. He was intubated and positive pressure ventilation attempted, with the same result. Despite the use of high pressures up to 60-70 cm H2O, no chest movement could be achieved. An intravenous line was established in order to give naloxone and pancuronium. Just before the drugs were given, chest wall movements were achieved and the heart rate normalized. CONCLUSION: This is the first report on chest wall rigidity in a neonate after administration of fentanyl to the mother during Caesarean section.
Adult↗
Postnatal closure of ductus venosus in preterm infants < or = 32 weeks. An ultrasonographic study.
AIM: To assess ultrasonographically the flow pattern and the time of postnatal closure of ductus venosus in preterm infants < or = 32 weeks. METHODS: Thirty-three preterm infants < or = 32 weeks were studied within the first 1 to 5 days of life and followed every second day with ultrasound until no flow was detected either through the ductus venosus or the ductus arteriosus. RESULTS: The ductus venosus was closed in only 9% by day 3, in 40% by day 8 and 88% by day 18. All were closed by day 37. This is significantly later than in healthy term neonates. Closure of the ductus venosus was not significantly correlated with closure of ductus arteriosus. CONCLUSION: The ductus venosus shows a delayed closure in preterm infants, with no significant correlation to the closure of the ductus arteriosus or the condition of the infant. We speculate that immaturity of the ductus venosus and possibly increased levels of dilating prostaglandins leads to a delayed obliteration of the vessel. An open ductus venosus represents a portocaval shunt and may have metabolical and pharmacological consequences.
Aging↗
Nicotine concentration in the hair of nonsmoking mothers and size of offspring.
OBJECTIVES: The purpose of this study was to estimate the risk of small-for-gestational-age birth by levels of nicotine in the hair of mothers and offspring. METHODS: In a sample of 58 case subjects and 105 control subjects, hair nicotine concentrations were measured by gas chromatography and mass spectrometry. RESULTS: With women whose hair nicotine concentrations were in the lowest quartile as the reference group, the odds ratio (OR) for small-for-gestational-age birth was increased among women with concentrations in the upper and two middle quartiles (OR=4.2, 95% confidence interval [CI]=1.5, 11.5, and OR = 3.2, 95% CI=1.3, 8.0). When smoking mothers were excluded from the analysis, the corresponding odds ratios were 2.1 (95% CI=0.4, 10.1) and 3.4 (95 % CI= 1.3, 8.6). CONCLUSIONS: The results suggest that passive maternal smoking increases the risk of small-for-gestational-age births.
Case-Control Studies↗
Diabetes patient education.
Not all medical practices are equipped to provide diabetes self-management training. Physicians can incorporate a team approach in their practice by establishing collaborative relationships with recognized diabetes education programs. The ADA's education recognition program has identified diabetes education programs that meet the National Standards for Diabetes Self-Management Education Programs. This list is available on the ADA's web site at http://www.diabetes.org/recognition and is printed twice a year in Diabetes Forecast. The National Certification Board for Diabetes Educators (NDEA) can provide a list of CDEs in your area. The South Carolina Model Diabetes Patient Education Program of DSC and SCDCP/DHEC is an excellent critical step towards obtaining ADA recognition.
Diabetes Mellitus↗
Effect of low and moderate doses of recombinant human erythropoietin on the haematological response in premature infants on a high protein and iron intake.
UNLABELLED: There is no consensus regarding protein intake and the doses of recombinant human erythropoietin (r-HuEpo) and iron in the treatment of anaemia of prematurity (AOP). This open, randomized study has compared the effectiveness of 50 IU r-HuEpo/kg with that of 100 IU/kg, both given subcutaneously thrice weekly. In addition, two different protein supplements have been compared; lyophilized human milk protein and a commercial cow's milk product. Total protein intake was 3 g/kg per day. Daily iron dose was 18-36 mg. "Healthy" preterm infants (n = 32, birth weight: 800-1400 g, gestational age < or = 31 weeks) were studied from age 3 to 8 weeks. The two protein regimens yielded no differences in body growth, reticulocyte count or Hb concentration. In both r-HuEpo dose groups increased number of reticulocytes followed start of treatment; higher levels were, however, found in the group receiving 100 IU/kg. Mean Hb concentration plateaued at 12 g/dl for infants receiving 100 IU/kg, at 11 g/dl in the 50 IU/kg group. Even though serum levels of ferritin and transferrin saturation indicated no iron deficiency, soluble transferrin receptor increased in both groups, more rapidly and to higher levels in the 100 IU/kg group. In addition, the number of infants having more than 8% hypochromic red cells increased in both groups. CONCLUSIONS: Commercial cow's milk protein added to human milk was as good as human milk protein supplementation in supporting growth and erythropoiesis. Fifty IU/kg r-HuEpo thrice weekly during AOP stimulated erythropoiesis significantly, but less so than 100 IU/kg. Even when using high oral doses of iron to preterms receiving r-HuEpo, our data suggested a certain degree of iron deficient erythropoiesis.
Anemia, Neonatal↗
Ultrasonographic study of ductus venosus in healthy neonates.
AIM: To assess ultrasonographically the flow pattern and the time of postnatal closure of ductus venosus related to the other fetal shunts. METHODS: Fifty healthy, term neonates were studied from day 1 up to day 18 using a VingMed CFM 800A ultrasound scanner. RESULTS: Ductus arteriosus was closed in 94% of the infants before day 3. Ductus venosus, however, was closed in only 12% at the same time, in 76% before day 7, and in all infants before day 18. A closed ductus venosus or ductus arteriosus did not show signs of reopening. Pulsed and colour Doppler flow could be detected across the foramen ovale in all infants during the sequential investigation. At day 1, when the pulmonary vascular resistance was still high, a reversed Doppler flow velocity signal was seen in ductus venosus in 10 infants (20%) and a bidirectional flow in ductus arteriosus in 26 (52%). Closure of the ductus venosus was not significantly correlated with closure of the ductus arteriosus nor related to sex nor weight loss. CONCLUSIONS: The time of closure of the ductus venosus evaluated by ultrasonography is much later than that of the ductus arteriosus. The flow pattern in ductus venosus reflects the portocaval pressure gradient and the pressure on the right side of the heart and in the pulmonary arteries. Both the flow pattern in the ductus venosus as well as that in the ductus arteriosus may be an indication of compromised neonatal haemodynamics.
Ductus Arteriosus↗
[Maternal blood group 0 as a risk factor of neonatal hyperbilirubinemia requiring treatment].
The present prospective study indicates that children of mothers with blood group O run a double risk of hyperbilirubinemia requiring treatment as compared to children of mothers of blood group A, and 5-10 times increased risk of needing exchange transfusion. The most frequent cause of need for exchange transfusion was ABO-incompatibility between mother and child. A positive direct antiglobulin reaction in an ABO-incompatible child in need of treatment doubles the risk of exchange transfusion being required. Blood group O in the mother should be considered to be an independent risk factor for the child, and O-pregnant women should be ABO-grouped for this reason.
ABO Blood-Group System↗
Interleukin-1 beta and tumor necrosis factor-alpha production by human monocytes cultured with L-thyroxine and thyrocalcitonin: relation to severe root shortening.
The objectives of this study were to determine whether L-thyroxine (T4) and thyrocalcitonin (TCA) influence monocyte production of interleukin-1 beta (IL-1 beta) and tumor necrosis factor-alpha (TNF-alpha) and to examine IL-1 beta and TNF-alpha production in monocytes from a group of orthodontic patients with severe root shortening. Human monocytes were incubated with varying concentrations of T4 and TCA for 24 hours, and IL-1 beta and TNF-alpha levels were measured by ELISA. At a concentration of 0.1 microgram/ml, T4 and TCA induced significantly more IL-1 beta than untreated controls, and T4 induced more IL-1 beta than TCA. Neither hormone induced significant TNF-alpha release, conversely, TCA had an inhibitory effect on unstimulated monocyte release of TNF-alpha. TCA was also shown to inhibit, but not reverse, the activational effect of lipopolysaccharide on monocyte TNF-alpha release. T4 and TCA concentrations as low as 0.1 pg/ml caused monocytes to release significant amounts of IL-1 beta. The highest concentration of T4 tested (1.0 microgram/ml) induced significantly less IL-1 beta production than lower concentrations. T4- and TCA-treated monocytes bound more labeled IL-1 beta than untreated controls, which suggests that these hormones increase IL-1 receptor expression. There was a wide range of unstimulated and stimulated IL-1 beta and TNF-alpha production by root resorption subject monocytes with no significant differences between resorption and nonresorption group means. This data suggest that patient monocytes did not differ from control monocytes in regard to these cytokine parameters, and therefore in vitro IL-1 beta and TNF-alpha levels could not distinguish resorption subjects.
Adult↗
[Antipsychotic agents and pregnant women. A case report].
Teratogenic effects of drugs are not limited to visual malformations but also include developmental disturbances. Probably drugs that inhibit nerve signals such as dopamine in the central nervous system can affect the maturing of the foetal brain in the last trimester and in the postpartum period, as shown in animal studies. We have observed an infant girl with psychomotoric disturbances which occurred at the age of two weeks. The mother had received 108 mg perfenazin decanoate intramuscular injections four times during the second and third trimester, the last two times were three weeks and two days before delivery, which was at term. The symptoms resembled tardive dyskinesia. Periodically the baby showed restlessness and uttered high-pitched cries. The literature on neuroleptics indicates no major teratogenic risk, but possible risk of behavioural teratogenicity. We recommend greater caution in connection with prescribing neuroleptics in pregnancy.
Abnormalities, Drug-Induced↗
[Premature infants at double risk].
Premature infants risk neurological and neuropsychological sequelae. Usually, however, the outcome bears no strong relation to perinatal medical events. This study examines the outcome for 105 infants with very low birth weights up to age three years. The data suggest that the assessment of processing ability and parental socioeconomic status may provide a better foundation for detecting developmental delay than a medical main-effect model does. Children at "double risk", who had poor processing abilities and came from families with few social resources, were especially vulnerable to sequelae. The results have implications for intervention in the case of infants with low birth weights.
Child Development↗
Infant death and consanguineous marriage.
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Consanguinity↗
[Perinatal care yesterday, today, tomorrow--which way does the pendulum swing?].
Based on knowledge of foetal physiology and circulation, time for cord clamping and placement of the infant after delivery, we discuss the conditions around ABC (Alternative Birth Care) deliveries, the baby-friendly initiative and early discharge from the maternal ward. When ABO-incompatibility is present, the number of infants needing phototherapy is doubled. With use of a reflectometric bilirubin determination and new phototherapy units, diagnosis and treatment can be performed at home. In the wake of high technology, the introduction of new and the reintroduction of old routines, it is easy to forget the sensible dimensions of the interaction between mother and infant. These are probably the most important factors connected to the development of mother and child interaction and the infant's way of managing its future life.
Delivery, Obstetric↗
Very low birth weight infants (< 1501 g) at double risk.
This study examines the outcome at ages 2 and 3 years of very-low-birth-weight infants (N = 105) at double risk. Double risk was defined with reference to Fagan's model of intelligence. According to this model, cognitive-processing ability and culturally provided information produce knowledge. The Fagan Test of Infant Intelligence was used to assess processing ability, whereas parental socioeconomic status (SES) was used as an indicator of available information. Knowledge was measured by means of well-known psychometric tests of young children's abilities. Children at double risk were consistently delayed with respect to knowledge of intellectual skills and language as compared with children who were not at double risk. The data suggest that the assessment of processing ability and parental SES may provide a better foundation for detecting developmental delay than does a medical main-effect model.
Brain Damage, Chronic↗
Patient-triggered ventilation fooled by patency of ductus arteriosus.
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Ductus Arteriosus, Patent↗
Prevention of neonatal infections by vaginal chlorhexidine disinfection during labour.
Comparison of two different methods of vaginal disinfection was made with regard to prevention of neonatal infections. In method I, an antepartum vaginal douche with a chlorhexidine solution was used; method II involved the use of chlorhexidine gluconate obstetrical gel during vaginal exploration. We studied 2853 normal deliveries from a total number of 3236 deliveries: 1467 deliveries were allocated randomly to receive a vaginal douche whereas 1386 underwent vaginal exploration using chlorhexidine gel. A total of 203 neonates were transferred to the neonatal unit (120 males and 83 females): 101 belonged to the group where the mothers were subjected to method I, whereas in 102 method II had been used. Within 48 h postpartum 30 neonates from the method I group and 34 neonates from the method II group received systemic antibiotics. There was a tendency towards a higher proportion of full-term neonates with verified septicaemia in the method II group (6 versus 2), whereas the numbers of probable infections were 8 versus 12. The corresponding total numbers in preterm infants were 3 and 2, respectively. These differences were not statistically significant. We conclude that the use of chlorhexidine douche compared with vaginal exploration with chlorhexidine gel provides no additional advantages.
Administration, Intravaginal↗
Prenatal diagnosis of urinary tract anomalies. The value of two ultrasound examinations.
OBJECTIVE: To determine when fetal urinary tract anomalies were detected by ultrasound screening during pregnancy and to discuss the possible consequences if only one early ultrasound examination is performed. DESIGN: A retrospective study of 47 cases where fetal urinary tract malformations were diagnosed in a two-stage screening program (17th and 32nd week of gestation) covering 22,310 women over ten years, 1982-91. SETTING: Ullevål University Hospital in Oslo which serves as a referral center for obstetric and neonatal diseases. RESULTS: Urinary tract anomalies were diagnosed in 0.18% of the pregnancies. Of these, 61.7% were found at the second routine ultrasound screening. The most difficult differential diagnoses were those of hydronephrosis without megaureter and a multicystic kidney. Hydronephrosis was found in 51% and a multicystic kidney in 21% of the cases. The tentative prenatal diagnoses were confirmed postnatally in 83% of the cases. Six of the fetuses had anomalies regarded as incompatible with postnatal life. These pregnancies were terminated, and the diagnoses verified by autopsy. Two other infants died perinatally, one of them as a result of the urinary tract anomalies. CONCLUSION: If only one ultrasound scanning had been performed in the 17th week, approximately two-thirds of the cases would not have been detected. Early intervention and follow-up after delivery would only have been performed if the infants had developed symptoms or complications related to the urinary tract anomalies.
Abortion, Induced↗