Effects of dopamine infusion on plasma catecholamines in preterm and term newborn infants.

Newborn infants (21 preterm and 13 term) received dopamine infusions at a low (2.5-3.4 micrograms/kg per min) and/or high (5-10 micrograms/kg per min) infusion rate and changes in plasma catecholamines were monitored. The mean baseline values for dopamine, noradrenaline and adrenaline were between 240 and 560, 125 and 144 and 62 and 82 pg/ml, respectively. During low-rate infusion of dopamine, there was a significant increase in plasma dopamine (20-100 fold), noradrenaline (three- to five-fold) and adrenaline (threefold). Administration of dopamine at the high rate resulted in an even larger increase in the plasma catecholamines (dopamine, 100-300 fold; noradrenaline, seven- to eightfold; a…

Continuous monitoring of mixed venous oxygen saturation in infants after cardiac surgery

Continuous mixed venous oxygen saturation (SvO2c) was measured in 16 infants immediately after cardiac surgery. A polyurethane 4F, dual channel catheter (Opticath, Modell U440, Oximetrix) with fiberoptic filaments was introduced into the pulmonary artery during cardiothoracic surgery. The catheters were left in place for an average of 67.5 h (range 27 h -125 h) and there were no catheter-related complications. Correlation between continuous in vivo SvO2 values and in vitro values was satisfactory (r = 0.85), whereas a correlation between SvO2c and arterial oxygen saturation (SaO2) was not found (r = 0.07). The sampled arterial lactate values were inversely correlated to the simultaneously m…

Zuverlässigkeit einer neuen Fixierungstechnik für orogastrale Ernährungssonden bei Früh- und Termingeborenen

Eine teilweise Verlegung der Nase beim Fruh- und Termingeborenen erhoht den Atemwegwiderstand mit moglichen negativen Auswirkungen auf Gasaustausch, Atemarbeit und Atemregulation. Eine etablierte Technik zur Fixierung oraler Sonden fehlt bislang. Sonden werden daher im Regelfall nasogastral gelegt. Die Zuverlassigkeit einer neuen Fixierungstechnik fur orale Sonden wurde bei 11 Fruh- und Termingeborenen prospektiv uber einen Zeitraum von 1 Monat gepruft. Bei 7 von 11 Patienten trat keine Dislokation vor dem geplanten Sondenwechsel nach 3–4 Tagen auf. Bei 3 Patienten dislozierte die orale Sonde jeweils 1mal vorzeitig. Nur bei einem 15 Wochen alten Patienten dislozierte die Sonde wiederholt vo…

Niedermolekulares Heparin bei Frühgeborenen mit hereditären Risikofaktoren und venösen Thrombosen

We describe the use of low molecular weight heparin to treat venous thrombosis in two very low-birth-weight pre-term infants (GA: 30 and 27 weeks) both with genetic and acquired prothrombotic risk factors. Initially both infants were treated with unfractionated heparin. Since in one infant no effect on the thrombus size was observed and in the other infant there was an increase in size, the anticoagulation therapy was switched to subcutaneously injected low molecular heparin (Enoxaparin). During enoxaparin therapy the anti-Xa-level was carefully monitored and dosages were adjusted accordingly. Partial resolution of the thrombosis was achieved in both infants during enoxaparin therapy. No cl…

Reanimation bei Neugeborenen

Massive digoxin intoxication in childhood.

In a 10 year old boy 8 hours after taking about 16 mg beta-acetyl-digoxin a maximum serum digoxin level of 31.8 ng/ml was measured radioimmunologically. This is the highest digitalis level in childhood described to date. The serum potassium level rose to 7.4 mmol/l. Complete atrio-ventricular block, and salves of ventricular premature beats were the most serious rhythm disturbances. The absence of life threatening rhythm disturbances is attributed to the early use of diphenylhydantoin in small frequent doses.

Hemodynamic effects of dobutamine in children with cardiovascular failure.

The effect of dobutamine, a synthetic catecholamine, was studied in 12 patients aged one day to 14 years with low cardiac output syndromes. After initial stabilization of the patients dobutamine was administered by continuous infusion in a dosage of 7.5 or 10 μg/kg/min. Heart rate, cardiac output (using thermodilution technique and/or pulse contour method), mean systemic and mean pulmonary artery pressures were determined before and after the dobutamine infusion. Systemic and pulmonary vascular resistances, cardiac index and stroke volume index were calculated. Cardiac output and cardiac index increased significantly in every patient, whereas the heart rate changed only slightly, suggesting…

Echocardiographic diagnosis of Candida endocarditis of the tricuspid valve and of the right atrium in a young infant.

Systemic candidiasis developed in a seven-week-old premature baby after 6 weeks treatment with antibiotics for suspected septicemia. At that time the echocardiogram showed a dense layer of echoes posteriorly to the anterior tricuspid leaflet during atrial systole. The diagnosis of Candida endocarditis with vegetations on the tricuspid valve and with right atrial thrombus secondary to the Candida infection was verified by autopsy.

Kontinuierliche EEG-Ableitung unter submaximaler fahrradergometrischer Belastung epilepsiekranker Kinder

Dreisig epilepsiekranke Kinder wurden unter kontinuierlicher EEG-Ableitung einer fahrradergometrischen Belastung unterzogen. Patienten mit einer primar generalisierten Epilepsie (acht Kinder) zeigten keine pathologischen Veranderungen. Vier von siebzehn Kindern mit einer focalen Epilepsie und zwei von funf mit einer sekundar generalisierten Epilepsie wiesen eine Verschlechterung unter Belastung auf. Hypersynchrone Aktivitaten traten besonders bei den Kindern auf, deren letzter Anfall weniger als zwei Wochen zurucklag. Ein Krampfanfall wurde bei keinem Kind ausgelost. Die individuelle Beurteilung der Sportfahigkeit mus die Epilepsieform und die Anfallshaufigkeit berucksichtigen. Wahrend der …

Congenital mitral regurgitation caused by a perforation in the anterior leaflet: Perioperative evaluation by color-coded Doppler echocardiography

Color-coded two-dimensional (2D) echocardiography confirmed the presence of severe congenital mitral regurgitation in an 8-month-old infant. Intraoperative inspection revealed an isolated perforation in the anterior leaflet.