Uncoordinated sucking patterns in preterm infants are associated with abnormal general movements.

Objective: To examine the association between sucking patterns and the quality of fidgety movements in preterm infants.

Study Design: We studied the sucking patterns and fidgety movements of 44 preterm infants (gestational age <35 weeks) longitudinally from 34 weeks' postmenstrual age up to 14 weeks postterm. We used the Neonatal Oral-Motor Assessment Scale during feeding and scored the sucking patterns as normal or abnormal.

Functional outcomes and participation in young adulthood for very preterm and very low birth weight infants: the Dutch Project on Preterm and Small for Gestational Age Infants at 19 years of age.

Objective: Young adults who were born very preterm or with a very low birth weight remain at risk for physical and neurodevelopmental problems and lower academic achievement scores. Data, however, are scarce, hospital based, mostly done in small populations, and need additional confirmation.

Methods: Infants who were born at < 32 weeks of gestation and/or with a birth weight of < 1500 g in The Netherlands in 1983 (Project on Preterm and Small for Gestational Age Infants) were reexamined at age 19.

Fetal thrombotic vasculopathy in the placenta: a thrombophilic connection between pregnancy complications and neonatal thrombosis?

Objective: Fetal thrombotic vasculopathy (FTV) has been related to pregnancy complications and neonatal thrombosis separately. We assessed whether a relationship existed in our population of women with neonates who were admitted to our Neonatal Intensive Care Unit (NICU). In addition, the presence of thrombophilic factors in children and parents was investigated.

Activation of the inflammatory reaction within minutes after birth in ventilated preterm lambs with neonatal respiratory distress syndrome.

To study the activation of the inflammatory reaction within minutes after birth, we measured parameters of inflammation before and immediately after birth. To assess whether respiratory distress syndrome (RDS) or birth itself initiates activation, we compared preterm ventilated lambs with term nonventilated lambs. Preterm lambs were delivered by cesarean section at 132 days gestational age (term 145 days) and were ventilated by conventional ventilation (n = 9).

Antenatal glucocorticoids attenuate activation of the inflammatory reaction and clotting in preterm lambs.

Recently we have shown that activation of inflammatory reaction and clotting can be found immediately after delivery in preterm lambs ventilated for respiratory distress syndrome (RDS). To investigate whether antenatal glucocorticoids would attenuate postnatal activation of the inflammatory reaction and clotting, we studied ventilated preterm lambs delivered by cesarean section, 24 h after antenatal administration of betamethasone or placebo. Blood was sampled before clamping the cord, 5, 10, and 15 min after delivery, and 2-hourly afterwards.

Hemodynamic changes during opening of the bridge in venoarterial extracorporeal membrane oxygenation.

OBJECTIVE: To investigate the cause of the hemodynamic changes occurring during opening of the bridge in venoarterial (VA) extracorporeal membrane oxygenation (ECMO). DESIGN: Prospective intervention study in animals. SETTING: Animal research laboratory of a university medical center.

Referral and transportation for neonatal extracorporeal membrane oxygenation.

Data from 32 patients who were transported for neonatal extracorporeal membrane oxygenation (ECMO) over a 66-month period were reviewed. One ground ambulance transport had to be postponed because of poor weather conditions; the patient died. One patient was excluded for ECMO on arrival at the ECMO centre.

Early activation of inflammation and clotting in the preterm lamb with neonatal RDS: comparison of conventional ventilation and high frequency oscillatory ventilation.

In neonatal respiratory distress syndrome activation of inflammation and clotting is demonstrated. High frequency oscillatory ventilation (HFOV) is considered to be less damaging to the human preterm lung, resulting in less activation of inflammation and clotting compared with conventional ventilation (CV). To assess the sequence of events of activation of inflammation and clotting and to compare the impact of HFOV to CV, we ventilated preterm lambs delivered by cesarean section at 132 d gestational age (term 145 d) for 8 h by CV (n = 10) or HFOV (n = 11).

Recirculation in double lumen catheter veno-venous extracorporeal membrane oxygenation measured by an ultrasound dilution technique.

Recirculation is a limiting factor for oxygen delivery in double lumen catheter veno-venous extracorporeal membrane oxygenation (DLVV-ECMO). This study compares three different methods for the determination of the recirculation fraction during double lumen catheter veno-venous ECMO at ECMO flow rates of 150, 125, 100, 75, and 50 ml/kg.min in nine lambs: (1) an ultrasound dilution method, in which the change in ultrasound velocity in blood after injection of a saline bolus as a marker is used for determination of recirculation; (2) an SvO2 method using real mixed venous blood oxygen saturation, the gold standard, for determination of recirculation fraction; and (3) the CVL method, in which oxygen saturation of a blood sample of the inferior vena cava is considered to represent mixed venous oxygen saturation.

A multistate Kalman filter for neonatal clotting time prediction and early detection of coagulation disturbances.

The multistate Kalman filter was applied to develop a heparin dose proposal system and to detect coagulation disturbances during neonatal extracorporeal membrane oxygenation (ECMO). A system containing this filter was based on the activated clotting time (ACT) values and the heparin doses administered every hour during ECMO. If the ACT value can be predicted accurately from the previous heparin dose, a heparin dose proposal can be given to achieve or maintain the required ACT level.

[Results of extracorporeal membrane oxygenation in 100 newborns with cardiorespiratory insufficiency].

Objective: To describe the results of treatment with extracorporeal membrane oxygenation (ECMO) in newborns with severe cardiorespiratory insufficiency.

Design: Prospective, descriptive.

Methods: For all 100 newborns treated with ECMO in 1989-1997 in the Academic Hospital Nijmegen, department of Neonatology, the Netherlands, indications for treatment, complications during treatment and mortality within 6 weeks after cessation of ECMO were registered.

Surgical repair of congenital diaphragmatic hernia during extracorporeal membrane oxygenation: hemorrhagic complications and the effect of tranexamic acid.

Extracorporeal membrane oxygenation (ECMO) was incorporated in a strategy of delayed repair of congenital diaphragmatic hernia (CDH) and was used for preoperative stabilization in patients who were unresponsive to maximal conventional treatment. If ECMO was required for preoperative stabilization the diaphragmatic defect was repaired while the patient was on ECMO. In the early experience with this approach all patients suffered from bleeding complications.

Simulation models in the planning of health care facilities: an application in the case of neonatal extracorporeal membrane oxygenation.

Objectives: To investigate whether modelling techniques can be used in the planning of health care facilities for patients requiring neonatal extracorporeal membrane oxygenation (ECMO).

Methods: In a micro-simulation model the number of patients that will have to be referred to facilities abroad is estimated for any number of neonatal ECMO patients presenting annually for treatment in The Netherlands, and any number of ECMO facilities. The inputs to the model consist of the number of ECMO facilities, the number of patients presenting annually, the duration of treatment and the date on which patients present for ECMO treatment.

Improving survival for patients with high-risk congenital diaphragmatic hernia by using extracorporeal membrane oxygenation.

The benefit of extracorporeal membrane oxygenation (ECMO) in cases of high-risk congenital diaphragmatic hernia (CDH) was studied by comparing pre-ECMO (1987-1990) and post-ECMO (1991-1994) 3-month survival statistics. Fifty-five CDH patients who presented in respiratory distress within 6 hours after birth were referred--18 in the pre-ECMO era and 37 in the ECMO era. During the entire study period (December 1987 through July 1994) the patients were treated by the same protocol of preoperative stabilization and delayed surgery; the only difference was the addition of ECMO beginning in January 1991.

Follow-up in neonatal extracorporeal membrane oxygenation (ECMO).

In 34 survivors of the first 43 ECMO patients from our institution before discharge to another hospital or home an EEG, BAER, Head Ultrasonography, cerebral CT scan, Dubowitz score and ophthalmological inspection were performed. At one year of age Mental Developmental Index of the Bayley scales, Motor Quotient as well as pulmonary and neurological status were assessed. In 29 patients follow-up took place in our hospital.

Disturbance of cerebral oxygenation and hemodynamics related to the opening of the bypass bridge during veno-arterial extracorporeal membrane oxygenation.

The objective of this study was to investigate changes of cerebral oxygenation and hemodynamics related to opening of the bypass bridge during veno-arterial extracorporeal membrane oxygenation (ECMO). Ten newborn infants and 12 piglets were studied during opening of the bridge for 10 and 1 s, respectively. Changes in cerebral concentration of oxyhemoglobin (cO2Hb), deoxyhemoglobin (cHHb), (oxidized-reduced) cytochrome aa3 (cCyt.

The prognostic value of the EEG in asphyxiated newborns.

Peripartal asphyxia is still one of the most important factors of neonatal morbidity and mortality and accounts for the majority of non-progressive neurological deficits seen in children. A set of evaluations that may consistently predict outcome in this patient population would be valuable. The purpose of the present retrospective study was to investigate the prognostic value of the early neonatal EEG and Sarnat scoring obtained in 23 asphyxiated term newborns.

Seldinger technique as an alternative approach for percutaneous insertion of hydrophilic polyurethane central venous catheters in newborns.

The use of hydrophilic central venous catheters, percutaneously inserted by means of the Seldinger technique, was evaluated in this prospective study. Between 1988 and 1991, 138 catheters were inserted in newborns who were admitted to our neonatal intensive care unit. An adequate position of the tip, evaluated radiographically, was achieved in 130 (94.

Urokinase therapy in neonates with catheter related central venous thrombosis.

The results of fibrinolytic therapy with urokinase were evaluated in 26 neonates with catheter related central venous thrombosis. Complete thrombolysis could be achieved in 13 patients (50%), partial thrombolysis in 3 patients (12%). No effect was seen in 10 patients (38%).

Defibrination essential in the assay of ionized magnesium in mononuclear cells.

Intracellular free (ionized) magnesium concentration was measured in mononuclear cells isolated from healthy volunteers by use of dual wavelength fluorescence (indicator: mag-fura-2). We found a free Mg2+ concentration of 1.28 +/- 0.

Do we use the right entry criteria for extracorporeal membrane oxygenation in congenital diaphragmatic hernia?

In a retrospective review we analysed alveolar-arterial oxygen difference (AaDO2) as an entry criterion for extracorporeal membrane oxygenation (ECMO) in neonates with several forms of acute respiratory insufficiency. Although for meconium aspiration syndrome, respiratory distress syndrome, sepsis, and idiopathic pulmonary hypertension of the newborn we found values in accordance with the literature, patients with congenital diaphragmatic hernia (CDH) met 80% mortality criteria with significant lower AaDO2 values. Several patients died before ever reaching usual entry criteria for ECMO, because serious lung deterioration makes AaDO2 values unreliable.

Magnesium metabolism in childhood.

Hypomagnesemia in childhood is relatively frequently noted in the neonatal period due to maternal causes, such as decreased intake due to vomiting, overuse of laxatives, and neonatal causes such as intrauterine growth retardation, birth asphyxia and exchange transfusion. A very rare cause of neonatal magnesium deficiency is called primary hypomagnesemia caused by impaired intestinal absorption of magnesium. Reference values of serum magnesium in cord blood are slightly lowered.

Absent thumb, immune disorder, and congenital anemia presenting with hydrops fetalis.

A patient is described who presented with severe congenital anemia, hydrops fetalis, immune disorder, and absent thumbs. No toxic, infectious, or metabolic cause was found to explain these symptoms. Immunologic and cytogenetic studies excluded several syndromes that combine radial ray anomalies with hematological involvement.