Randomised clinical trial of two treatment regimens of natural surfactant preparations in neonatal respiratory distress syndrome.

AIMS: To compare treatment regimens of two widely used natural surfactant preparations Curosurf and Survanta in respiratory distress syndrome (RDS). METHODS: The effects of the two treatment regimens on gas exchange, ventilatory requirements, and 28 day outcome in infants with RDS were compared. Seventy five preterm infants (birth weight 700-1500 g) with RDS requiring artificial ventilation with an FIO2 of > or = 0.4, were randomly selected at 1-24 hours of age. One group received an initial dose of Curosurf (200 mg/kg); the other group Survanta (100 mg/kg). Patients who remained dependent on artificial ventilation with an FIO2 of > or = 0.3 received up to two additional doses of Curosurf (each of 100 mg/kg) after 12 and 24 hours or up to three additional doses of Survanta (each of 100 mg/kg) between six and 48 hours after the initial dose. RESULTS: There was a rapid improvement in oxygenation and ventilatory requirements were reduced in both groups. However, infants treated with Curosurf had a higher arterial:alveolar oxygen tension ratio and required a lower peak inspiratory pressure and mean airway pressure at several time points within 24 hours of randomisation (p < 0.05-0.001). The incidences of pneumothorax in the Curosurf and Survanta groups were 6% and 12.5%, respectively; the corresponding figures for grades 3-4 intracerebral haemorrhage were 3% and 12.5%, respectively. Mortality was 3% in the Curosurf group and 12.5% in the Survanta group. However, these differences did not reach significance. CONCLUSION: The Curosurf treatment regimen resulted in a more rapid improvement in oxygenation than Survanta and reduced ventilatory requirements up to 24 hours after start of treatment. This was associated with a trend towards reduced incidence of serious pulmonary and non-pulmonary complications.

High-dose intravenous immune globulin therapy for hyperbilirubinemia caused by Rh hemolytic disease.

We conducted a multicenter controlled trial to test the hypothesis that high-dose intravenous immune globulin (HDivIG) therapy can modulate bilirubin production and reduce the frequency of exchange transfusions in newborn infants with Rh hemolytic disease. Thirty-four patients with Rh incompatibility proved by positive direct antiglobulin test (Coombs test) results were randomly assigned to receive conventional treatment including phototherapy, with or without additional HDivIG therapy at 500 mg/kg given for a 2-hour period as soon as the diagnosis was established. Exchange transfusions were performed if serum bilirubin concentrations exceeded the modified curves of Polácek by more than 2 mg/dl. Two patients were excluded because of protocol violations. The results in 32 infants were analyzed. In the HDivIG group, 2 (12.5%) of 16 children required exchange transfusions, whereas it became necessary in 11 (69%) of 16 children in the control group (p less than 0.005). Bilirubin levels in the HDivIG group were lower despite reduced frequency of exchange transfusions. No side effects of HDivIG treatment were observed. We conclude that HDivIG therapy by a yet unknown mechanism reduces serum bilirubin levels and the need for blood exchange transfusions in children with Rh hemolytic disease.

[Thermal epiglottitis in a 3-month-old infant following feeding of hot vegetables]. / Thermische Epiglottitis bei einem 3 Monate alten Säugling nach Fütterung mit heissem Gemüse.

A thermal epiglottitis after feeding hot food is a rare event in infancy. A 3 month old infant developed typical symptoms of an acute epiglottitis after feeding him hot vegetables. The child was intubated and treated with steroids and antibiotics. A laryngo-tracheobronchoscopy was performed. After 48 h he was extubated.

[Diagnosis and differential diagnosis of heart tumors in infancy and childhood]. / Diagnostik und Differentialdiagnose der Herztumoren im Säuglings- und Kindesalter.

The clinical features of 10 children, in whom the diagnosis of a cardiac tumor has been made, are reviewed. There were nonspecific systolic murmurs in 9 patients, depression of the S-T segment in the ECG of 7 children, and premature extrasystoles or supraventricular tachycardia in 4 children. X-ray always showed mild to moderate enlargement of the heart, but an abnormal contour could be detected only in 2 of the patients. While findings of cardiac catheterization were unspecific, the diagnosis could be made angiographically in 8 cases. Invasive studies, however, are now only indicated, if a proper diagnosis cannot be made by means of echocardiography. The diagnosis should be suspected in children with a nonspecific murmur, cardiomegaly and ECG-changes. Usually the diagnosis of a cardiac tumor is an indication for operation.

[Psycho- and neurovegetative effects on the ECG of children and adolescents]. / Psycho- und neurovegetative Einflüsse auf das EKG von Kindern und Jugendlichen.

In six patients between 10 and 21 years of age vegetative function disorders were diagnosed. All of them showed an inversion of T in lead II and/or III and in V4 to V6. After exercise-testing the ECG signs normalized. Other clinical investigations, echocardiography, and in one case heart-catheterization revealed no pathological findings. It is necessary to distinguish these rare ECG findings from pathological ECG changes.

[Changes in blood pressure in children with valvular aortic stenosis in bicycle ergometer stress]. / Blutdruckveränderungen bei Kindern mit valvulärer Aortenstenose unter fahrradergometrischer Belastung.

Children with aortic stenosis (n = 25) show a lower systolic blood pressure elevation during exercise than normal subjects (n = 47). The post-exercise systolic blood pressure minus the pre-exercise systolic pressure was calculated in both groups (23.60 +/- 10.8 mm Hg versus 47.23 +/- 14.9 mm Hg). There is no significant correlation between pressure response during exercise and the pull back gradient during heart catheterization. But if the difference between post-exercise systolic pressure and pre-exercise pressure is greater than 25 mm Hg there is a very low probability of a pull back gradient greater than 50 mm Hg. We conclude that exercise testing may be helpful in selecting those patients with aortic stenosis for catheterization who are likely to require surgery.