Dose reduction in thorax radiography in simulated neonates with additional filtration and digital luminescence radiography.

PURPOSE: To determine the minimum acceptable radiation dose for an adequate image quality in thorax a.p. radiographs of neonates using mobile X-ray equipment. MATERIAL AND METHODS: The influence of additional filtration (1.0 mm Al + 0.1 mm Cu) on image quality and radiation dose was determined for the speed class 400 screen-film system (SFS) and digital luminescence radiography (DLR) by making radiographs of a test phantom. Conventional and digital thorax a.p. radiographs of a rabbit were produced using various tube current-time products. The quality of the rabbit radiographs was judged by eight radiologists applying image quality criteria according to the German guidelines and the recommendations of the European Community. RESULTS: The added filter resulted in a dose reduction of 39% at 66 kV. DLR gave a further dose reduction of 25% in comparison to the speed class 400 SFS while maintaining adequate image quality, i.e. the radiographs were clinically acceptable with regard to quality criteria. CONCLUSION: The radiation dose resulting from thorax a.p. radiographs of neonates can be reduced by approximately 50% with the use of additional filtration and DLR.

Autosomal recessive lateralization and midline defects: blastogenesis recessive 1.

In this report, we present 2 sibships in which midline and lateralization anomalies are demonstrated. Because midline and lateralization processes are early embryological events, we suggest calling this sequence Blastogenesis Recessive 1 (BGR1). Since connexin 43 gene mutations were demonstrated in some polyasplenia patients and according to connexin 43 temporospatial tissue expression, we hypothesize that this gene could bear mutations responsible for the anomalies reported in these two sibships.

The influence of gastroschisis on plasmatic coagulation, humoral immunity, and C-reactive protein.

Around the 30th week of gestation, patients with gastroschisis (GS) develop chronic inflammatory reactions on the serosal surface of the eventrated loops of intestine that lead to severe hyperfibrinogenemia and hypercoagulability, particularly if they are born prematurely. This result was found on comparison of coagulation studies from 12 patients with GS with those of 4 patients with omphalocele and of healthy premature babies and term infants. Furthermore, the patients with GS showed marked hypogammaglobulinemia, which might also be responsible for the increased numbers of infections complicating the course of this disease. The hypercoagulability increases the risk of thromboembolic complications and disseminated intravascular coagulation, particularly in combination with the surgical closure of the abdominal wall that is undertaken postnatally or with perinatal complications such as asphyxia. Prophylactic therapy with low-dose heparin is indicated.

[Congenital tuberculosis in a premature infant]. / Beitrag zur angeborenen Tuberkulose eines Frühgeborenen.

5 days after birth a premature baby of 1,300 g (31st week of gestation) was examined, because a congenital tuberculosis was suspected. In the stomach secretion mycobacterium tuberculosis could in fact be found. Abdominal symptoms as well as a post-natal anemia could be lead back to the infection. For three months a double parenteral therapy with INH (10 mg/kg/d) and Rifampicin (10 mg/kg/d) was carried through, then a mono therapy with INH for another 6 months. The bacillus had become resistant to streptomycin. At the beginning of the chemotherapy a cholestasis developed. The tuberculosis could be cured.

Plasmapheresis in newborns with hyperbilirubinemia.

With a miniaturized plasmapheresis system consisting of a double head pump and balancing pump, extracorporeal detoxification treatments such as plasmapheresis, hemofiltration, and hemodialysis were carried out. In total 15 premature infants and newborns with Rherythroblastosis and hyperbilirubinemia were treated using this miniaturized system. The average birth weight of the 15 patients was 2,386 g. With a main blood flow of 5.3 ml/min and a filtrate flow of 1.3 ml/min, an average of 192.4 ml of plasma per treatment was exchanged. In all patients 1 to 10 plasmapheresis treatments were necessary to reduce the mean serum bilirubin from 15.6 +/- 4.8 to 7.3 +/- 3.2 mg/dl, and after several days the serum bilirubin subsequently normalized in 12 patients, who improved. Three patients died 5 to 18 days after birth as a result of their primary disease and immaturity. For vascular access small catheters were inserted in the umbilical or the femoral vein. All treatments were well tolerated by the patients.

[Mediastinal cystic lymphangioma as a cause of hydrops fetalis]. / Mediastinales zystisches Lymphangiom als Ursache eines Hydrops fetalis.

This report is upon a case with fetal hydrops on the base of a paracardiac cystic lymphangioma in the mediastinum. The newborn which had hypoplastic lungs and multiple pneumatothoraces died because of a pulmonary insufficiency. An overview is given about the most common causes of the nonimmune fetal hydrops, and the pathomechanisms are discussed.

Hemofiltration and plasmapheresis in newborns using a small blood pump system.

Extracorporeal detoxification methods in newborns and premature infants are unavailable and contraindicated because of technical problems. The authors' experiences with a blood pump unit that was miniaturized for hemodialysis, hemofiltration, and plasmapheresis in newborns are reported. In 28 newborns and premature infants, 32 hemofiltrations, 3 hemodialyses, and 57 plasmaphereses were carried out for different diseases. Thirteen of 28 patients died despite hemofiltration and/or plasmapheresis as a result of their primary disease and/or immaturity, and 15 patients improved.

Hemofiltration and plasmapheresis in premature infants and newborns.

Extracorporal detoxication methods in newborns are most unavailable, contraindicated because of technical problems. Herein are reported the experiences with a blood pump unit that was miniaturized for hemodialysis, hemofiltration, and plasmapheresis in newborns. In three premature infants with acute renal failure of different etiology (two newborns with severe Rh-erythroblastosis, 1 premature infant with hypoproteinemia) 13 single-needle hemofiltrations and 6 single-needle plasmaphereses were performed with double head pump, special tube systems, and small modules. The age of the patients ranged from 1 to 14 days, body weight was between 800 and 2,800 g. Four umbilical veins and two femoral veins were used as vascular access. The ultrafiltration rate during the treatment averaged 0.3 ml/min in single-needle hemofiltration and the plasma filtrate flow rate 1.3 ml/min in single-needle plasmapheresis. All treatments were well tolerated. Four patients died due to complications unrelated to the treatment, two patients recovered. These preliminary results show that both hemofiltration and plasmapheresis may be carried out without major problems in premature infants and newborns.

[Single-needle diafiltration and single-needle plasmapheresis in premature infants]. / Single-needle-Diafiltration und Single-needle-Plasmapherese bei Frühgeborenen.

Extracorporal detoxication methods in newborns are most unavailable, contraindicated because of technical problems. We report our experiences with a blood pump unit developed by our-selves for diafiltration and plasmapheresis in newborns. In 6 newborns with acute renal failure, Rh-ery-throblastosis and hypoproteinemia, 13 single-needle-diafiltrations and 6 single-needle-plasmapheresis were performed with the self-constructed double head pump, special tube systems and small models. Our results show that all extracorporal detoxication methods can be carried without problems.