Continuous intra-gastral monitoring of intra-abdominal pressure in critically ill children: a validation study.

BACKGROUND: In critically ill children, detection of intra-abdominal hypertension (IAH > 10 mmHg) and abdominal compartment syndrome (ACS = IAH + organ dysfunction) is paramount and usually monitored through intra-vesical pressures (IVP) as current standard. IVP, however, carries important disadvantages, being time-consuming, discontinuous, with infection risk through observer-dependent manipulation, and ill-defined for catheter sizes. Therefore, we sought to validate air-capsule-based measurement of intra-gastric pressure (ACM-IGP). METHODS: We prospectively compared ACM-IGP with IVP both in vivo and in vitro (water column), according to Abdominal-Compartment-Society validation criteria. We controlled for patient age, admission diagnosis, gastric filling/propulsive medication, respiratory status, sedation levels and transurethral catheters, all influencing intra-abdominal pressure (IAP). RESULTS: In tertiary care PICU setting, finally, n = 97 children were enrolled (median age, 1.3 years [range 0 days-17 years], LOS-PICU 8.0 [1-332] days, PRISM-III-Score 13 [0-35]). In n = 2.770 measurements pairs, median IAP was 6.7 [0.9-23.0] mmHg, n = 38 (39%) children suffered from IAH > 10 mmHg, n = 4 from ACS. In vitro against water column, ACM-IGP correlated perfectly (r2 0.99, mean bias - 0.1 ± 0.5 mmHg, limits of agreement (LOA) - 1.1/+ 0.9, percentage error [PE] 12%) as compared with IVP (r2 0.98, bias + 0.7 ± 0.6 mmHg, LOA - 0.5/+ 1.9, PE 15%). With larger IVP catheters at higher pressure levels, IVP underestimated pressures against water column. In vivo, agreement between either technique was strong (r2 0.95, bias 0.3 ± 0.8 mmHg, LOA - 1.3/+ 1.9 mmHg, PE 23%). No impact of predefined control variables on measurement agreement was observed. CONCLUSIONS: In a large PICU population with high IAH prevalence, ACM-IGP agreed favourably with IVP. More widespread usage of ACM-IGP may improve detection rates of ACS in critically ill children. Trial registration WHO-ICTRP-No. DRKS00006556 (German Clinical Trial Register). Registered 12th September 2014, URL: https://www.drks.de/drks_web/navigate.do?navigationId=trial.HTML&TRIAL_ID=DRKS00006556.

Back to the roots? Dual cannulation strategy for ambulatory ECMO in adolescent lung transplant candidates: An alternative?

Bridging critically ill pediatric patients to lung transplantation still remains a major challenge. Although still controversial, within the last 5 years, ECMO has been increasingly used as a bridge to lung transplantation concept in adult and pediatric patients with acceptable outcomes. The outstanding developments in the field of extracorporeal devices and the introduction of awake ECMO concepts with the avoidance of mechanical ventilation have led to a real paradigm shift in the ICU management of pretransplant candidates with severe respiratory failure. Therefore, ECMO is no longer seen as a contraindication for lung transplantation at least at our center. Nevertheless, how to bridge these patients on ECMO still remains controversial. Thus, we introduced an ambulatory ECMO approach in adolescent lung transplant candidates with acute respiratory failure using a dual cannulation strategy and hereby present first results from this procedure.

[Perioperative adverse respiratory events in overweight and obese children]. / Atemwegskomplikationen bei übergewichtigen und adipösen Kindern.

BACKGROUND: Overweight and obesity are increasing problems in pediatric anesthesia. This observational study was designed to examine how airway-related complications occur in overweight children and adolescents during general anesthesia and if this is a relevant problem in Germany. METHODS: From October 2008 until August 2009, at the university clinic in Leipzig, 504 in- and outpatients, aged 2-18 years, ASA I-III, undergoing elective procedures (ENT and pediatric surgery), were observed. With the aid of special data sheets, the following parameters were determined: Mallampati Score, difficult mask ventilation and intubation, use of a Guedel/Wendl tube, Cormack-Lehane Score, number of intubation attempts, airway obstructions (broncho- and laryngospasms), coughing as a sign of airway irritation, and decreases in oxygen saturation >10 %. RESULTS: Overweight and obese children had a significantly higher Mallampati Score and a significantly higher prevalence of coughing (p < 0.05). None of the other parameters showed any significant differences between the groups. However, the incidence of desaturation was 9.5 % in overweight children and 6.3 % in children of normal weight, and that of airway obstructions was 4.1 vs 2.7 %. CONCLUSION: This study demonstrated a very low incidence of respiratory problems, which may be caused by the low proportion of morbidly obese children and the older age of overweight children in comparison with other studies.

Minimal invasive lung support via umbilical vein with a double-lumen cannula in a neonatal lamb model: a proof of principle.

PURPOSE: Acute respiratory distress syndrome, with the need for invasive mechanical ventilation (MV) remains a major cause of neonatal mortality and morbidity. Although venovenous extracorporeal lung support (VV-ECLS) has become a standard of care procedure in neonatal patients with acute pulmonary failure there are no reports regarding the use of a double-lumen cannula for extracorporeal minimal invasive lung support via the umbilical vein. METHODS: A neonatal lamb model was used (n = 3). Umbilical vein was cannulated with a double-lumen catheter allowing venovenous extracorporeal gas exchange. Cannula was positioned with its tip in the right atrium. VV-ECLS was started and ventilation was stopped. Providing oxygenation and CO2 removal solely through VV-ECLS hemodynamics, blood gases were measured. RESULTS: Total VV-ECLS without MV was applied to all three neonatal lambs. Time on venovenous ECLS was 60, 120 and 120 min. Initial pCO2 was 60, 56 and 65 mmHg compared to 31, 32 and 32 mmHg at the end of VV-ECLS. Initial pO2 was 30, 27 and 26 mmHg compared to 22, 19 and 23 mmHg. Initial lactate was 5, 10 and 3.7 mmol/l compared to 13.3, 12.6 and 11.3 mmol/l at the end of VV-ECLS. MAP at baseline was 51, 52 and 65 mmHg compared to 36, 38 and 41 mmHg at the end of VV-ECLS. In all three lambs inotropes were admitted to maintain MAD >35 mmHg. CONCLUSION: Even without mechanical ventilation we were able to sufficiently remove pCO2 with our new minimal invasive VV-ECLS using a double-lumen catheter via the umbilical vein, supporting the idea of a lung protective strategy in neonatal acute respiratory failure. pO2 was measured 22, 19 and 23 mmHg, respectively, at the end of VV-ECLS, at least partially caused by recirculation phenomenon, which could possibly be improved by different cannula design. Inotropic support was necessary during VV-ECLS to achieve targeted MAD > 35 mmHg. While technically feasible, this new approach might allow further research in the field of extracorporeal lung support and therefore will follow the concept of a lung protective strategy in acute neonatal respiratory failure.

"Awake Veno-arterial Extracorporeal Membrane Oxygenation" in Pediatric Cardiogenic Shock: A Single-Center Experience.

In pediatric patients with acute refractory cardiogenic shock (CS), extracorporeal membrane oxygenation (ECMO) remains an established procedure to maintain adequate organ perfusion. In this context, ECMO can be used as a bridging procedure to recovery, VAD or transplantation. While being supported by ECMO, most centers tend to keep their patients well sedated and supported by invasive ventilation. This may be associated with an increased risk of therapy-related morbidity and mortality. In order to optimize clinical management in pediatric patients with ECMO therapy, we report our strategy of veno-arterial ECMO (VA-ECMO) in extubated awake and conscious patients. We therefore present data of six of our patients with CS, who were treated by ECMO being awake without continuous analgosedation and invasive ventilation. Of these six patients, four were <1 year and two >14 years of age. Median time on ECMO was 17.4 days (range 6.9-94.2 days). Median time extubated, while receiving ECMO support was 9.5 days. Mean time extubated was 78 % of the total time on ECMO. Three patients reached full recovery of cardiac function on "Awake-VA-ECMO," whereas the other three were successfully bridged to destination therapy (VAD, heart transplantation, withdrawal). Four out of our six patients are still alive. Complications related to ECMO therapy (i.e., severe bleeding, site infection or dislocation of cannulas) were not observed. We conclude that "Awake-VA-ECMO" in extubated, spontaneously breathing conscious pediatric patients is feasible and safe for the treatment of acute CS and can be used as a "bridging therapy" to recovery, VAD implantation or transplantation.

Managing neonatal severe sepsis in Germany: a preliminary survey of current practices.

BACKGROUND: In 2002 and 2007, the American College of Critical Care Medicine (ACCCM) provided clinical guidelines for hemodynamic support of pediatric and neonatal patients in septic shock. In 2008 and 2013, the Surviving Sepsis Campaign (SSC) Guidelines Committee offered up-to-date clinical guidelines for the management of severe sepsis and septic shock in adults and in pediatric patients. The aim of this study was to assess the standard of care of neonates with severe sepsis and septic shock in German neonatal intensive care units (NICUs) with regard to variability in management and guideline conformity. METHODS: 199 pediatric clinics in Germany were asked to describe their management of septic neonates in a telephone survey. The questionnaire that was used for the preliminary survey was designed based on the ACCCM and SSC clinical guidelines. RESULTS: A total of 90 (45%) surveys were completed and analyzed. Among all hospitals, the guidelines most commonly included in current practice patterns were obtaining cultures before administering antibiotics (100%), determining capillary refill time (99%), and using crystalloids for initial fluid therapy (97%). The guidelines least commonly included in current practice were determination of ammoniac to rule out inborn errors of metabolism (51%) and the use of dopamine as the first choice of hemodynamic support (48%). CONCLUSIONS: The management of sepsis, severe sepsis, and septic shock in neonates is not always guideline consistent, but quite a number of ACCCM and SSC guidelines were included in the current practice pattern.

Detection of the genial spinal canal in atrophic mandibles with a CBCT: a cadaver study.

OBJECTIVES: The use of a single midline implant to retain a complete mandibular denture when more implants cannot be used is an incipient treatment modality. However, in the mandibular symphysis, the genial spinal canal (GSC) is an anatomical structure with neurovascular content that can be harmed during dental implant surgery. The purpose of the present study was to use CBCT of edentulous atrophic cadaver mandibles and evaluate how often the simulated placement of a single midline implant would contact the GSC if present. METHODS: CBCT scans of 47 edentulous cadaver mandibles were performed. A digital simulation of the placement of a single midline implant (3.8 × 11.0 mm) was performed, and the implant-GSC contact was evaluated. RESULTS: A GSC was detected in the CBCT scan of all atrophic mandibles. In 42 cases (89.4%), the single midline implant contacted the GSC. On average, the five cases without GSC contact had a higher alveolar ridge (4.1 mm) and a lower GSC (0.79 mm) than did the cases with GSC contact. CONCLUSIONS: CBCT scans can adequately detect the GSC during pre-surgical diagnostics. There is a high risk of implant-GSC contact during surgery of the anterior mandible. However, the clinical relevance of such a contact is not known yet, because none of the clinical studies evaluating a single midline implant has reported any implant-GSC contact-related complications.

CAD/CAM single retainer zirconia-ceramic resin-bonded fixed dental prostheses: clinical outcome after 5 years.

PURPOSE: This study evaluated the clinical outcome of CAD/CAM zirconia-ceramic resin-bonded fixed dental prostheses (RBFDPs) with a cantilevered single-retainer design. MATERIALS AND METHODS: Thirty anterior zirconia-ceramic RBFDPs fabricated with the Cerec CAD/CAM system were inserted using either a phosphate monomer containing resin (Panavia 21 TC; N = 16) or an adhesive bonding system with a phosphoric acid acrylate primer (Multilink-Automix with Metal/Zirconia primer; N = 14). RESULTS: During a mean observation time of 64.2 months, one debonding occurred in each group. Both RBFDPs could be rebonded successfully resulting in a five-year survival rate of 100%. CONCLUSION: Independent of the bonding system, cantilevered zirconia-ceramic RBFDPs showed promising results during the first five years. (ClinicalTrials.gov Identifier: NCT01411592). CLINICAL SIGNIFICANCE: Single-retainer zirconia ceramic RBFDPs present an alternative treatment option offering good esthetics, a minimally invasive preparation, a high biocompatibility and can even be used to treat juvenile patients who do not yet come into consideration for implant placement. No significant influence of the bonding system used has been detected so far.

Concept of "awake venovenous extracorporeal membrane oxygenation" in pediatric patients awaiting lung transplantation.

In patients awaiting LuTx, MV and ECMO are often the last ways to create a bridge to LuTx. Both interventions are associated with a poor posttransplant outcome and survival rate. To improve the results of these patients, new "bridging-strategies" are necessary. Recent reports demonstrate promising results for the concept of "awake ECMO" in adult patients. To date, no data on this approach in pediatric patients have been available. We therefore describe the use of VV-ECMO as a treatment strategy for RF in awake pediatric patients. It presents our experiences with the first three children treated using this new concept. Mean amount of time on ECMO was 44 days (range, 11.5-109 days). Two patients were successfully bridged to their LuTx. Both are still alive without any recurrences (24 and three months following LuTx). One patient died before a further LuTx after 109 days on ECMO due to adenoviral infection. Although reintubation was necessary in two patients, and total time being awake while on ECMO was <50%, we conclude that the concept of "awake VV-ECMO" is feasible for the treatment of RF and can be used as a "bridging therapy" to LuTx.

[Chest compression without ventilation during basic life support? Confirmation of the validity of the European Resuscitation Council (ERC) guidelines 2005]. / Thoraxkompression ohne Beatmung bei der Laienreanimation? Bestätigung der Gültigkeit der "European Resuscitation Council (ERC) Guidelines 2005".

Basic life support (BLS) refers to maintaining airway patency and supporting breathing and the circulation, without the use of equipment other than infection protection measures. The scientific advisory committee of the American Heart Association (AHA) published recommendations (online-first) on March 31 2008, which promote a call to action for bystanders who are not or not sufficiently trained in cardiopulmonary resuscitation (CPR) and witness an adult out-of-hospital sudden collapse probably of cardiac origin. These bystanders should provide chest compression without ventilation (so-called compression-only CPR). If bystanders were previously trained and thus confident with CPR, they should decide between conventional CPR (chest compression plus ventilation at a ratio of 30:2) and chest compression alone. However, considering current evidence-based medicine and latest scientific data both the European Resuscitation Council (ERC) and the German Resuscitation Council (GRC) do not at present intend to change or supplement the current resuscitation guidelines "Basic life support for adults". Both organisations do not see any need for change or amendments in central European practice and continue to recommend that only those lay rescuers that are not willing or unable to give mouth-to-mouth ventilation should provide CPR solely by uninterrupted chest compressions until professional help arrives. It is also stressed that the training of young people especially teenagers as lay rescuers should be promoted and the establishment of training programs through emergency medical organizations and in schools should be encouraged.

A single center clinical experience in intensive care management of 104 pediatric renal transplantations between 1998 and 2002.

Only a few publications about the treatment in the intensive care unit (ICU) after pediatric renal transplantation have been published yet. As there are no guidelines, we hereby describe the results and recommendations of our transplant unit. A total of 104 renal transplantations have been performed in 96 children at our center since 1998. The age of the children has ranged from 6 months to 18 yr and their body weight from 6 kg to 110 kg. A special fluid management was performed in order to avoid hypotension and hypoperfusion of the graft. Systolic arterial pressure was kept at elevated levels above 100 mmHg during the first day after transplantation. The children remained on the respirator for 4-8 h after transplantation. Anticoagulation was performed using low dose heparin because of the size mismatch of the anastomosed vessels. The mean time in the ICU for the pediatric patients aged <3 yr was 2 days and for children older than 3 yr was 1 day. The main complications after renal transplantation in the ICU were disorders of electrolytes, acute renal failure because of a non-functioning graft (12%), bleeding from the anastomoses (4%), arterial or venous thrombosis (1%), arterial hypertension and pulmonary edema, defined as radiographic evidence (1%). In case of non-function peritoneal- or hemodialysis were performed in the ICU. Young children were more frequently affected than older children. From 1998-2002 one patient died during the ICU time. The 3 yr graft survival rate was 90%. To sum up, children undergoing renal transplantation should be treated in a specialized unit postoperatively to avoid early non-functioning of the graft and extrarenal complications. General guidelines for postoperative care should be established.

Interventional treatment of infantile hepatic hemangioendothelioma.

BACKGROUND/PURPOSE: Hemangioendothelioma is the most frequent liver tumor in infancy. Untreated symptomatic patients with heart failure have a high mortality rate. Symptomatic forms may request nonoperative treatment, because surgery is burdened with high risks in patients with heart failure. The authors report their experience with interventional coil occlusion of infantile hepatic hemangioendothelioma (IHE). METHODS: Four patients (age range, 2 to 146 days; mean, 53 days) suffering from IHE associated with heart failure were treated by endovascular coil occlusion of arterial feeders. Catheter intervention was performed via an arterial (n = 2) or venous (n = 2) approach. RESULTS: Signs of heart failure resolved within 2 to 8 days after occlusion in 3 patients. Tumor regression could be observed sonographically within 4 weeks postinterventionally. In 3 children, tumor size was reduced from a mean of 544 mL (65 to 1,350) to a mean of 4 mL (2 to 6); Mean systolic peak velocity in the hepatic artery was decreased from 170 cm/s (140 to 200) before occlusion to 45 cm/s (36 to 70) during follow-up. In the fourth patient, endovascular intervention could not control a rapidly progressing hemangioendotheliomatosis, and finally a liver transplantation had to be performed. CONCLUSIONS: Interventional occlusion of feeding arteries in symptomatic IHE is a safe and effective alternative to early open surgery. The efficacy of endovascular intervention in multifocal tumors seems questionable.

[Systemic lupus erythematosus-associated endocarditis in a 7-years-old girl]. / Lupus erythematodes-assoziierte Endokarditis bei einem 7 Jahre alten Mädchen.

Systemic Lupus erythematosus (SLE) is a chronic inflammatory disease, caused by a fault of the immune regulation. The etiology of the SLE is still unknown, a possible virus infection is discussed. Libman Sacks endokarditis is the most important cardiac manifestation of this illness. Diagnosis, therapy and clinical course of a 7 years old so far healthy girl, which suffered from an acute Libman-Sacks-Endocarditis, are presented.

Replacement of fetal calf serum in cell cultures by an egg yolk factor with cholecystokinin/gastrin-like immunoreactivity.

The in vitro culture of various cell types is an important scientific tool and is becoming increasingly acceptable as a viable alternative to animal experiments. Fetal calf serum (FCS) is a supplement used in many cell culture media, and provides cells with growth factors and cytokines necessary for successful culture. In view of the animal welfare issues surrounding the production of FCS, an alternative agent allowing the replacement or reduction in the use of FCS is desirable. A yolk extract factor (EYF-X) obtained from chicken eggs is described, which facilitates the in vitro culture of a variety of cell types. When the extract was added to a culture medium used for in vitro fertilisation, the number of successful fertilisations was significantly increased. In a further in vitro model (permanent neuronal cell line N2A), the yolk extract significantly stimulated cell proliferation as well as the growth of cell processes. A set of specific antibodies against different parts of the prepro-cholecystokinin reacted with the extract. The intensity of the reaction depends on the age of the egg (time after the laying date). Analysis by gel chromatography recorded a main protein fraction with an apparent molecular mass of 20-30kDa. This fraction was labelled by Western blot with an antibody with specificity against CCK-octapeptide. These findings suggest that the yolk factor may be a CCK/gastrin-like molecule. Since CCK/gastrin-like molecules have also been detected in the spermatozoa of mammals, the influence on in vitro fertilisation could be explained by the yolk factor replacing the endogenous CCK/gastrin-like molecule destroyed in sperm freezing. The results of this study suggest that it might be possible to replace FCS with EYF-X. The application of the yolk factor to a broad spectrum of cell types remains to be investigated.

Tibiotalar motion--effect of fibular displacement and deltoid ligament transection: in vitro study.

The purpose of this study was to quantify tibiotalar translation and rotation under various stages of fibular displacement and injury to the syndesmotic and deltoid ligaments. Ten unpaired specimens amputated below the knee were studied using an unconstrained testing apparatus. The specimens were moved through a dorsiflexing and plantarflexing arc of 55 degrees (20 degrees dorsiflexion and 35 degrees plantarflexion). Dorsiflexion of the intact lower leg was associated with an average of 4.2 degrees of external talar rotation, and plantarflexion was associated with an average of 1.4 degrees of internal talar rotation. Fibular osteotomy and displacement of the distal fibular fragment did not change the talar rotation significantly. Additional transection of the deltoid ligament, however, decreased external talar rotation significantly, to 1.4 degrees, and decreased talar internal rotation to 0.6 degrees. Talar shift was not affected in dorsiflexion or plantarflexion by fibular fracture, displacement of the distal fibular fragment, or transection of the deltoid ligament. These data may suggest that in dorsiflexion or plantarflexion, an intact lateral malleolus is not necessary for physiological talar tracking. They further suggest that in a fibular fracture with a significant injury to the deltoid ligament, healing of the ligament at its resting length is crucial to restoring physiological talar rotation.

Sotalol associated torsades de pointes tachycardia in a 15-month-old child: successful therapy with magnesium aspartate.

Torsades de points (Tdp) is a form of ventricular tachycardia, and its occurrence in childhood is very rare. In adult patients treated with sotalol, Tdp has been reported to the occur with an incidence of 2%-4%. In children who are treated with sotalol, occurrence of Tdp has been reported in only a single case. A 15-month-old girl with Wolff-Parkinson-White syndrome developed recurrent syncopal attacks. She had been treated with sotalol 1.5 mg/kg daily since shortly after birth because of recurrent episodes of paroxysmal supraventricular tachycardia. ECG monitoring exhibited frequent Tdp tachycardia. Serum electrolyte levels were normal. Echocardiographic analysis excluded a structural heart defect and did not show any signs of myocardial infection. Sotalol treatment was stopped and an infusion with lidocaine was started. Despite this therapy the Tdp continued. Magnesium aspartate was then administered, which immediately stopped the Tdp. As no other reason was evident, Tdp in this child has to be judged as a proarrhythmia related to sotalol therapy.

[Generation and characterization of avian vitelline antibodies against lipopolysaccharide and lipid A. 1. Induction and preparation of specific egg yolk antibodies (IgY) against endotoxins]. / Herstellung und Charakterisierung aviärer vitelliner Antikörper gegen Lipopolysaccharide und Lipid A. 1. Mitteilung: Induktion und Präparation von spezifischen Dotterantikörpern (IgY) gegen Endotoxine.

The immunisation of mammals with LPS- and lipid A-antigens leads to the production of specific antibodies. In the present study, we describe the generation and preparation of antibodies from egg yolks of immunized chickens. Egg yolk antibodies were raised by immunizing laying hens with five LPS- and three lipid A-preparations from various gram-negative bacteria species in different immunisation protocols. Antibodies from collected egg yolks were extracted and purified by means of several standard methods. The purity of antibody-preparations was measured and compared by SDS-PAGE. Specific antibodies were assayed by two different EIA procedures. It could be shown that the immunisation of hens with LPS- and lipid A-Antigens resulted in the production of specific egg yolk antibodies, regardless of immunisation-scheme and amount of antigen.

[Generation and characterization of avian vitelline antibodies against lipopolysaccharide and lipid A. 2. Investigations of specificity of egg yolk antibodies (IgY) against endotoxin]. / Herstellung und Charakterisierung aviärer vitelliner Antikörper gegen Lipopolysaccharide und Lipid A. 2. Mitteilung: Untersuchungen zur Spezifität von Dotterantikörpern (IgY) gegen Endotoxine.

Various preparations of egg yolk antibodies against different endotoxins of gram-negative bacteria were characterized with regard to their immunological properties. To do this, we investigated the reactivity of antibodies against a number of lipopolysaccharides and lipid-A by enzyme-immuno-assays and immunoblot. It could be shown that all antibody preparations contained specific antibodies, reactive with their homologous antigen. Furthermore these antibodies showed cross-reactivity with structural diverse LPS- and lipid A-antigens from different sources. Anti lipid A-antibodies appeared to be highly crossreactive with purified LPS and lipid A from several gram-negative organisms. Egg yolk antibodies raised by immunization with LPS showed cross-reactivity with enterobacterial LPS and only marginal reactivity with both LPS from other gram-negative bacteria and lipid A. The results from immunoblot experiments confirmed our findings from EIA-studies.

[Sotalol-induced torsade de pointes tachycardia in a 15-month-old infant]. / Sotalol-induzierte Torsade-de-Pointes-Tachykardien bei einem 15 Monate alten Kleinkind.

Torsade de pointes (tdp) is a form of ventricular tachycardia whose occurrence in childhood is very rare. In adults treated with sotalol (Sotalex), tdp has been reported to have an incidence of 2-4%. There have been no reports of its occurrence in children treated with sotalol. We report about a 15-month-old girl with Wolff-Parkinson-White syndrome who developed recurrent syncopal attacks. She had been treated with sotalol at 1.5 mg/kg daily since being a newborn because of recurrent episodes of paroxysmal supraventricular tachycardia. Electrocardiogram exhibited frequent tdp tachycardia. Serum electrolyte levels were normal. Echocardiography excluded a structural heart defect and showed no signs of myocardial infection. After sotalol was ceased, infusion with lidocain was started. Despite this therapy the tdp continued. Magnesium aspartate (Magnesiocard) was then administered, and this finally stopped the tdp. As no other cause was evident, tdp in this child must be judged as a proarrhythmia related to sotalol therapy.