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Biomedical subjects

T W Hansen

Publications and source records attributed to T W Hansen.

At least 73 records · Page 4Linked to original sources
PubMed1994

[Administration of naloxone to newborn infants at obstetric departments in Norway].

Recommendations for the dosage of naloxone to reverse opiate depression in neonates were revised by the American Academy of Pediatrics in 1989. In order to ascertain the extent to which these new recommendations have been implemented in Norway, we sent questionnaires to the maternity centres by mail. The responses from 60 different centres covered 88% of the total births in Norway in 1991. The dosages of naloxone used varied from 0.01-0.1 mg/kg, and the reported frequency of use in newborns varied between < 10-50%. Similarly, the use of opiate analgesia in parturients varied considerably, with frequencies ranging from < 10 to 90%. We conclude that there is wide variation in use of naloxone to treat neonates in Norway and in the prescribed dose, and suggest that most centres should re-evaluate the dose. Some centres also need to re-evaluate the rate of usage.

Analgesia, Obstetrical↗
PubMed1994

[The TORCH study. A reevaluation].

The TORCH panel is used to screen for congenital infection. The purpose of this study was to evaluate the use of TORCH by pediatricians and pediatric trainees in a university pediatric department. The patient charts corresponding to the 109 samples submitted to the Institute of Bacteriology from 1987-91 were reexamined for evidence suggestive of congenital infection. Generally, the charts contained little information that might explain the reason for ordering a full TORCH panel. None of the submitted samples yielded conclusive evidence of congenital infection. TORCH studies appeared to have been requested on very liberal indications. We conclude that the TORCH panel as used at present creates a lot of work for microbiologists, but yields little information. A more targeted approach to testing for congenital infection seems called for.

Cytomegalovirus Infections↗
PubMed1993

[Diagnosis and treatment of infections in a neonatal unit--viral infections, spirochete infections and toxoplasma infections].

Viral and protozoal infections are often suspected as causes of neonatal illness or congenital anomalies. The TORCH titer has traditionally been the foremost diagnostic tool in this context, but it is now becoming increasingly clear that this tool is inadequate, partly for conceptual reasons, but also because of the often uncritical way in which it is used. During a recent critical review of our routines and practices for diagnosis and treatment of neonatal infections we also revised our approach to the diagnosis and treatment of suspected pre- or perinatally acquired viral, spirochetal, and protozoal illnesses. The resulting guidelines, originally intended for our house staff, are presented here.

Humans↗
PubMed1993

[Diagnosis and treatment of infections in a neonatal unit--bacterial and fungal infections].

Following an outbreak of Candida septicemia in our intensive care nursery we reviewed our routines for diagnosis and treatment of neonatal infections. The revision resulted in a set of written guidelines for septic work-ups, initiation and discontinuation of antibiotic therapy, and choice of antibiotics. In this article we present the guidelines for dealing with bacterial and fungal infections, along with relevant comments.

Anti-Bacterial Agents↗
PubMed1993

Prognostic value of clinical and radiological status on day 28 of life for subsequent course in very low birthweight (< 1,500g) babies with bronchopulmonary dysplasia.

To test the hypothesis that the short-term (approximately 6 months) course of babies with bronchopulmonary dysplasia (BPD) could be predicted from the clinical and radiological status on day 28 of life, we retrospectively examined the medical records of 79 infants born between 1985 and 1988 who required supplemental oxygen and/or ventilatory support on day 28. Chest roentgenographs taken close to day 28 (+/- 7 days) were scored on a scale of 0-10. Four babies died from causes not related to BPD. Four of the remaining 75 died from BPD, and the rest are alive. Forty-six of 71 were weaned from supplementary oxygen by 37 weeks corrected gestational age, and only 13/71 remained on supplemental oxygen after 40 weeks gestational age. To determine which variables contributed most to the outcome, defined as total days on supplemental oxygen, a multiple regression analysis was performed, including only those variables the tolerance of which exceeded 0.7 (sex, FiO2, ventilatory mode, and infectious status). FiO2 and ventilatory mode together predicted 15% of the variability in outcome, so that a high FiO2 and ventilator dependence on day 28 of life were highly correlated with a prolonged need for supplemental oxygen (F = 4.28, P < 0.05).

Bronchopulmonary Dysplasia↗
PubMed1993

In vitro binding of [3H]bilirubin to neurons in rat brain sections.

Slide-mounted 12-microns cryostat sections of rat brain were incubated with [3H]bilirubin, washed, dried, and apposed to emulsion-coated coverslips for autoradiography. The binding appeared to be nonsaturable. Within the gray matter, binding was concentrated over neuronal cell bodies (particularly evident over hippocampal pyramidal and granular cells, and over cerebellar Purkinje cells), suggesting that the preferential neuronal toxicity of bilirubin may be related to neuronal binding. Regional differences in bilirubin binding were not demonstrated.

Animals↗
PubMed1993

Endotoxemia and brain bilirubin in the rat.

To investigate the possible role of sepsis with endotoxemia in kernicterus, we studied the effect of endotoxin on accumulation of bilirubin and albumin in rat brain. Male Sprague-Dawley rats were given Escherichia coli endotoxin i.v. After 150 min 10 microCi 125I-bovine serum albumin was given intravenously, followed by a 1-hour bilirubin infusion. Brain bilirubin was significantly higher in the endotoxin group than in the controls (1.34 +/- 0.47 vs. 0.83 +/- 0.31 microgram/g, p < 0.05). However, the difference between the ratios of brain bilirubin to total serum bilirubin at the time of sacrifice were not significant. Total and unbound bilirubin values were significantly higher in the endotoxin-treated group at 165 min. Endotoxemia increased the net accumulation of bilirubin in rat brain, but this increase was probably secondary to an increase in total and unbound bilirubin, rather than an increase in the transfer per se of bilirubin across the blood-brain barrier.

Albumins↗
PubMed1992

[Disseminated fungal infections in neonates--risk factors, treatment and course].

During 10 1/2 months in 1990/91 eight premature babies and one mature baby with an intra-abdominal disease had disseminated Candida albicans infections. The incidence in premature newborns was 9% (8/92 patients). Risk factors such as respirator therapy, the use of broad spectrum antibiotics, supplemental parenteral nutrition and central intravascular catheters were frequently seen. Four patients survived the fungal infection. These included three of five babies treated with amphotericin B 0.5 mg/kg/day. Two patients who received fluconazole 3 mg/kg/day died after three days. In one patient the diagnosis was obtained post-mortem, and one patient with possible fungemia survived without therapy. The treatment of these patients depends on optimal fungal cultures and good co-operation between paediatricians and microbiologists.

Anti-Bacterial Agents↗
PubMed1992

[Pain and pain relief in neonates and infants].

We review the development of the anatomical and physiological basis for nociception. We point out the ability of babies, even those who are born very prematurely, to feel pain. Procedures which would be painful to older children and adults are also painful to newborns and infants. A sick infant in intensive care may be particularly sensitive to the destabilizing effects of pain, and analgesics will very often be indicated in such infants. We discuss various types of analgesia suitable for infants, and doses of commonly used analgesics.

Analgesia↗
PubMed1992

The effects of hypoxanthine, xanthine oxidase and hyperoxia on the accumulation of bilirubin and albumin in young rat brain.

Hyperoxia has been suggested as a risk factor for kernicterus. The toxicity of hyperoxia may be mediated by free radicals. We investigated the effects of free radicals, formed by the hypoxanthine/xanthine oxidase system, with and without additional hyperoxia, on the accumulation of bilirubin and albumin in rat brain. Hypoxanthine was infused for 60 min into retrograde carotid catheters in awake, young, male SPRD rats. After 30 min the infusion was briefly interrupted to inject xanthine oxidase 1 U/kg through the same catheter. Group I (controls) received 0.9% NaCl in lieu of hypoxanthine/xanthine oxidase. Groups I and II breathed room air at all times, while group III breathed 90% O2. After 60 min all groups received a bolus dose of 125I-albumin through a peripheral venous catheter, followed by bilirubin 25 mg/kg for 5 min, then bilirubin 35 mg/kg for 55 min. There were no significant differences between the groups as regards serum bilirubin, serum albumin, brain bilirubin, or brain albumin. Neither during normoxic nor hyperoxic conditions did the hypoxanthine/xanthine oxidase system increase the accumulation of bilirubin or albumin in rat brain.

Albumins↗
PubMed1992

Hypertrophic cardiomyopathy associated with dexamethasone therapy for bronchopulmonary dysplasia.

The potential induction of cardiac effects by high-dose dexamethasone therapy was evaluated prospectively in 13 respirator-dependent infants with bronchopulmonary dysplasia by means of two-dimensional and M-mode echocardiography. The initial divided dose of dexamethasone was 500 micrograms/kg per day, tapered progressively for as long as 6 weeks. Evaluations were made before treatment and at 3, 7, 14, 21, 28, 35, and 42 days after the start of dexamethasone therapy. This regimen was associated with a significant (p less than 0.01) increase in thickness of the interventricular septum (2.60 +/- 0.09 to 4.00 +/- 0.16 mm), diastolic left ventricular free wall (2.80 +/- 0.13 to 4.06 +/- 0.20 mm), and diastolic right ventricular free wall (1.55 +/- 0.08 to 2.02 +/- 0.12 mm). In addition, seven dexamethasone-treated infants but no control infants had systolic anterior motion of the mitral valve (p less than 0.001). These effects were transient, reached their maximal degree by the third week of treatment, and approached pretreatment conditions by the sixth week of treatment. Ejection fraction was not affected; heart rate and mean arterial pressure were transiently increased during dexamethasone therapy. We conclude that a transient absolute myocardial hypertrophy is associated with dexamethasone therapy in infants with bronchopulmonary dysplasia. The mechanism or mechanisms through which this hypertrophy arises and the cardiopulmonary implications are unclear.

Bronchopulmonary Dysplasia↗
PubMed1992

Changes in piglet auditory brainstem response amplitudes without increases in serum or cerebrospinal fluid neuron-specific enolase.

We studied the relationship between changes in auditory brainstem responses (ABR) and serum and cerebrospinal fluid levels of neuron-specific enolase (NSE) in hyperbilirubinemic 2- to 8-d-old piglets. Infusion of a stabilized solution of bilirubin resulted in serum bilirubin levels of 571.1 +/- 48.8 mumol/L (mean +/- SEM) after 6 h. ABR were obtained at baseline and then hourly until the piglets were killed. We measured peak amplitudes and latencies for waves I-V, as well as latency for the post-V trough. Changes in amplitudes and latencies were analyzed as slopes because of heterogeneous variances. Over time, a significant reduction was observed in peak II-V amplitudes of bilirubin-infused piglets, but not in those of corresponding controls. No change was observed in latencies. NSE was analyzed by RIA. Serum NSE remained stable throughout the experiment (means 5.1-6.6 micrograms/L) and did not differ between the groups. Cerebrospinal fluid NSE values also remained stable, and no differences that could be ascribed to hyperbilirubinemia were detected. We conclude that hyperbilirubinemia induced significant changes in piglet ABR amplitudes without concomitant evidence of severe neuronal compromise, as might have been indicated by significant increases in serum and/or cerebrospinal fluid NSE levels. This provides further support to the clinical impression that early ABR changes during hyperbilirubinemia may be reversible.

Animals↗