[Reversal of a right-left shunt and permanent improvement of oxygenation by inhalation of nitrogen monoxide in a premature infant with lung hypoplasia and asphyxia].

We report the case of a 29 weeks gestation female premature infant who suffered from severe postnatal asphyxia following spontaneous vaginal delivery. Prenatally lung hypoplasia due to prematurely ruptured membranes with subsequent oligohydramnios was suspected sonographically. Echocardiography revealed right-to-left shunting via PDA and foramen ovale, in addition to that tricuspid incompetence with a pulmonary arterial pressure gradient of 40 mmHg was demonstrated.

Zinc deficiency in an exclusively breast-fed preterm infant.

Unlabelled: A formerly premature, exclusively breast-fed infant with severe zinc deficiency syndrome is presented. He showed the characteristic erosive skin changes, including alopecia, as seen in acrodermatitis enteropathica. In addition, he manifested a failure to thrive and irritability.

Serum alpha 1-microglobulin and beta 2-microglobulin for the estimation of fetal glomerular renal function.

As proteins cannot cross the placenta levels of the microproteins alpha 1-microglobulin (alpha 1MG) and beta 2-microglobulin (beta 2 MG) can be used to assess fetal glomerular renal function. alpha 1MG, beta 2MG and creatinine were routinely determined in cord and maternal blood of 133 newborns [gestational age (GA) 25-42 weeks]. Twenty-nine patients with suspected impaired maternal or fetal renal function were studied separately and two fetuses were studied in utero.

Diagnosis of brain death by transcranial Doppler sonography.

The blood flow velocities in the basal cerebral arteries can be recorded at any age by transcranial Doppler sonography. We examined nine children with either initial or developing clinical signs of brain death. Soon after successful resuscitation increased diastolic flow velocities indicated a probable decrease in cerebrovascular resistance; this was of no particular prognostic importance.

[Primary management of newborn infants with respiratory failure due to a congenital defect of the diaphragm].

The authors report on 36 premature and term infants with congenital defects of the diaphragm, including 17 patients who developed a severe respiratory insufficiency either immediately after birth or during the first 30 minutes of life. The overall mortality rate was 64%; the results of treatment were marked by a particularly high mortality rate among the patients with early respiratory insufficiency: out of 17 patients, 12 died. The evaluation of the courses confirmed that adequate preoperative primary care is of major prognostic importance in patients with early respiratory insufficiency.

[Beta 2 microglobulin in the serum as a parameter of glomerular kidney function in the first days of life].

Though serum creatinine is a very reliable parameter for predicting glomerular filtration rate in infancy, this does not apply to the first hours and days of life. As there is no placental barrier for creatinine, serum creatinine at birth reflects maternal renal function at the moment of delivery and, during the first days of life, establishment of the steady state condition between creatinine serum level and actual infantile glomerular filtration rate. Serum creatinine levels of cord blood and maternal blood in term and preterm infants of 25-42 weeks gestational age are almost identical (maternal blood 0.

[Intravascular monitoring by axillary artery cannulation in infants].

In patients with respiratory failure and shock serial arterial blood analyses are important to calculate adequate respiratory therapy. During circulatory insufficiency punction of a radial artery can be difficult or impossible, especially in very young patients. The case report of a 9-month old female infant with septic shock and Waterhouse-Friderichsen's syndrome illustrates these problems and is helpful to describe an alternative technique.

Diagnostic procedures leading to successful separation of xipho-omphalopagus twins.

Xipho-omphalopagus twins with a pericardial bridge, extended liver tissue union and considerable intestinal herniation from one abdominal cavity to the other were separated successfully at the age of three months. Special diagnostic procedures including cardiac and abdominal sonography, catheterism of the umbilical vein with portal angiography, radionucleotide liver and bile duct imaging and separate oral glucose tolerance tests provided important information for perioperative and surgical patient management. Relevant items for determination of the favourable data and method of surgery are discussed.

Cerebral infarction in term neonates: diagnosis by cerebral ultrasound.

Cranial ultrasound (US) through the newborn's open fontanelle can diagnose not only intracerebral hemorrhages but also diffuse and localized hypoxic-ischemic encephalopathies. Sonographically, it was possible to distinguish between different courses of cerebral ischemia in seven neonates: ischemic infarction, usually in the area of the middle cerebral artery: borderline infarction; transient ischemia. The patients showed lateralized seizures during the first days of life with a corresponding focus in the electroencephalogram (EEG).

[Transfusion-induced acid load caused by erythrocyte concentrates in the newborn].

Erythrocyte concentrates are preferred increasingly to whole-blood transfusions in treatment of neonatal anemias. By means of their application even very important restorations of hematocrit are possible without the risk of fluid overload. A possible side-effect of these erythrocyte suspensions is a transfusion mediated acidosis, which depends on the used buffer solution, temperature and storage conditions before and during use.

Dysplastic features, growth retardation, malrotation of the gut, and fatal ventricular septal defect in a 4-month-old girl with ring chromosome 15.

A 20-day-old female neonate was admitted with symptoms caused by a large ventricular septal defect which was subsequently confirmed angiographically. Other clinical findings were pre- and postnatal growth retardation, microcephaly, dysmorphism of ears, fingers and feet. Cytogenetic analysis revealed a ring chromosome 15.

[Leprechaunism (Donohue's syndrome). Clinical and pathologico-anatomical findings].

Leprechaunism is a very rare condition of obscure aetiology. At the age of three weeks the neonate described in this report lost all subcutaneous fat in spite of additional parenteral nutrition. He acquired purulent pneumonia, and finally died of septicaemia.

Plasma elimination of antithrombin III (heparin cofactor activity) is accelerated in term newborn infants.

Antithrombin III (AT III) levels are markedly increased in newborn infants following exchange transfusion with adult blood, and subsequently return to pre-exchange values. This transient rise in AT III (heparin cofactor activity), was used to estimate its plasma elimination half-life. AT III activities were measured serially, before and after double-volume exchange transfusions with heparinised blood in newborn infants requiring therapy for severe hyperbilirubinaemia.

[Therapeutic recommendations for the resuscitation of children].

The general management and steps of cardiopulmonary cerebral resuscitation are the same for infants, children and adults: Airway management; Breathing, Cardiac compressions and Drugs to restart circulation and maintain cerebral and myocardial oxygen supply. However, priorities and techniques differ somewhat because of variations in size, physiology and cause of circulatory arrest. In pharmacological support there are several new aspects: The immediate correction of acidosis is not necessary in CPR and iatrogenic alkalosis has deleterious effects.

Congenital aortic thrombosis with complete obliteration of the aortic arch and the great vessels.

Thrombosis of the great arteries rarely occurs in the neonate. We report a case of thrombosis of the aortic arch, the brachiocephalic truncus, the left carotid and subclavian arteries, seen in a one-day-old neonate. The clinical findings were at first misdiagnosed as interrupted aortic arch syndrome, though, in retrospect echocardiography was very suggestive of the correct diagnosis.

[How to diagnose intracranial haemorrhages in infants by two-dimensional ultrasound scanning (author's transl)].

Applying a rotatory sector-scanner, in 437 infants between the 29th gestational week and 18th month of life, a sonographic study was performed in order to look for an intracranial haemorrhage. The recording was performed real-time, using the anterior fontanelle as an acoustic window. In 42 infants we saw signs of an intracranial haemorrhage, which was confirmed 11 times anatomically and 11 times by CAT.

Arterial occlusion in a preterm infant. Successful non-surgical treatment with urokinase and low-dose heparin.

Neonatal arterial occlusion is a rare condition of obscure aetiology, when not associated with catheterization of the umbilical artery. Embolic occlusion of the left iliac artery was diagnosed in a preterm baby weighing 1000 g, who presented with a cold, pale and pulseless left leg on the 6th day of life. Surgical embolectomy was contraindicated in this very small baby.

Decreased production or increased turnover of antithrombin III in severe acquired coagulopathy?

During the course of severe coagulopathy in an infant suffering from septicaemia and shock, antithrombin III levels were determined repeatedly before and during substitution therapy with human antithrombin. By mathematical analysis of these data, using a biexponential function, the plasma elimination half-life of the antithrombin III was estimated to be 7.5-10.

[Streptococcal infection in the newborn (author's transl)].

28 newborn infants, only 3 of which were female, were treated for early-onset streptococcal septicaemia in the years 1970-1978 at the University Children's Hospital, Freiburg. Overall mortality was 60%, that for premature infants 80%. Almost all infants who died developed D.

[Haemodynamics in congenital pulmonary lymphangiectasis (author's transl)].

Respiratory insufficiency is the clinical principal sign of cystic pulmonary lymphangiectasis. Clarification of cardiovascular morphology and haemodynamics is the basic prerequisite for the classification and therapy of the disease pattern. The prognosis is unfavourable if it is found that the pulmonary circulation does not flow through the lungs, reaching instead the systemic circulation via the persisting ductus arteriosus.

[Epsylon-aminocaproic acid in the treatment of severe and dominating hyperfibrinolysis in a premature infant].

A premature infant of 31 weeks gestational age weighing 1650 g developed pronounced generalized bleeding following exchange transfusion for rhesus-incompatibility. As a consequence there was continuous leakage into a subcutaneous haematoma that had been caused by accidental puncture of the infant's flank during diagnostic amniocentesis. The ensuing massive and prolonged loss of blood required replacement by infusions of heparinized fresh blood over several days.