[Congenital hip dysplasia in Ostfold 1990-96]. / Medfødt hofteleddsdysplasi i østfold 1990-96.

BACKGROUND: The focus in this paper is on the prevalence, risk factors and treatment of developmental dysplasia of the hip (DDH), before and after introduction of sonographic examination in 1993. MATERIAL AND METHODS: 1,469 (8.2%) infants were followed up because of clinical findings or risk factors (542 with X-ray and 927 with sonographic examination). RESULTS: The overall prevalence of DDH was 1.14%; 0.92% in neonates and 0.22% as late DDH. The prevalence of late DDH ranged from 0.07% to 0.52% (p < 0.01) with peaks in spring and autumn. The following changes occurred when sonography was introduced: Newborn DDH decreased from 1.06 to 0.77% (p < 0.05), late DDH decreased from 0.26 to 0.19% (not significant), and treatment duration decreased from 6.2 months (SD 1.4) to 4.2 months (SD 1.3)(p < 0.01). 56 of 198 infants with clinical findings (28%) were confirmed to have sonographic DDH (p < 0.01). Previous risk factors were confirmed. Mothers of infants with late DDH had higher pre-pregnancy weight, 63 kg (SD 11) vs 58.5 kg (SD 7.8), p < 0.02) and lower weight gain in the last trimester, (4.2 kg (SD 2.2) vs 6.6 kg (SD 2.7; p < 0.001), compared to a reference population. INTERPRETATION: Sonography has reduced treatment rate and duration of DDH.

[Perinatal deaths in the county of Ostfold 1989-97]. / Perinatale dødsfall i Ostfold 1989-97.

All perinatal deaths in the county of Ostfold during the nine year period 1989-1997 were assessed by perinatal audit. Each death was allocated to one of two groups: satisfactory or suboptimal perinatal care. The classification of the causes of death includes fetal, obstetrical and neonatal conditions. The audit is supplemented with some epidemiological data. It was concluded that the standard of care was suboptimal in a fourth of the evaluated cases (52 out of 212). Misdiagnosed or ignored growth retardation and inadequate reaction to information of reduced fetal movements, were the two most frequent examples of suboptimal care. Perinatal mortality was 6.7 per thousand. The results of this audit indicate that it should be possible to improve the quality of perinatal care by intensifying the postgraduate training of the personnel involved. Pregnant woman should contribute by refraining from smoking. The national perinatal committees should aim at establishing a common standard for perinatal audits which would allow tenable comparisons of audit results and national surveys.

[Natural surfactant in routine treatment of neonatal respiratory distress syndrome. Experiences from two central hospitals]. / Naturlig surfaktant som rutinebehandling av neonatalt åndenødssyndrom. Erfaringer fra to sentralsykehus.

Regular use of surfactant in the treatment of respiratory distress syndrome started in Norwegian neonatal intensive care units in 1992. The authors present the results for the first 70 babies with respiratory distress syndrome who were treated with natural surfactant from 1991 to 1994 at two level II hospitals. Median time of administration dropped from eight hours after birth in 1991 to three hours in 1994. Treatment soon after birth leads to a greater reduction in oxygen requirement. 12 children died, all of them very immature after complicated pregnancies. The total mortality in babies with a birth weight of less than 1,500 grams was 7%. The incidence of severe bronchopulmonary dysplasia was markedly reduced and the total number of days on a ventilator was reduced by 50%. Use of surfactant was not associated with more complications. Severe respiratory distress syndrome should be prevented with antenatal steroids, and treated early postnatally with natural surfactant.

[Surfactant treatment of acute pulmonary failure. Other indications than neonatal distress syndrome]. / Surfaktantbehandling ved akutt lungesvikt. Andre indikasjoner enn neonatalt åndenødssyndrom.

In 1959 Avery and Mead suggested internationally that respiratory failure in premature infants is due to lack of surfactant. Surfactant is a phospholipid protein complex that is synthesised and stored in alveolar type II pneumocytes in the lungs. The main function of surfactant is to reduce surface tension in the lungs and make respiratory effort easier. Since 1959 much of scientific work has been done in this field, and there is now increasing evidence to support the theory that surfactant is important for normal lung function. Therefore surfactant insufficiency plays a major role in acute respiratory failure of any etiology. In this paper we focus on other possible indications for surfactant replacement therapy, and describe a patient with meconium aspiration syndrome which was treated successfully with exogenous natural surfactant.

[Prenatal steroid treatment--a 4-year material]. / Prenatal steroidbehandling--et fireårsmateriale.

Prenatal steroids have been used for more than 20 years to prevent respiratory distress syndrome and death in preterm infants. Previously the treatment was recommended from the 28th to the 32nd gestational week. It is now recommended, with very few contradictions, from the 24th to the 33rd gestational week. From 1990 to 93, 56 (39%) of 145 infants under 33 weeks were given prenatal steroids. Amongst the steroid-treated infants there were significantly fewer deaths and fewer respiratory distress syndromes (3.6% vs 18%, p < 0.02 and 61% vs 82%, p < 0.01). Mortality at this age fell from 18% in 1990/1991 to 6% in 1992/1993 (p = 0.019), coinciding with an increase in the use of surfactant from 5% to 30% (p < 0.01) and prenatal steroids from 31% to 46% (p = 0.028). No specific complications that could be attributed to steroids were recorded in either mother or infant. Had the new recommendations applied, a further 28 infants under 33 gestational weeks (58% of all) would have been treated with prenatal steroids.

[Neonatal respiratory distress syndrome treated with a natural surfactant. The Norwegian Curosurf study]. / Neonatalt åndenødssyndrom behandlet med naturlig surfaktant. Den norske Curosurfstudien.

43 Norwegian premature infants with respiratory distress syndrome were randomized to receive either a high dose (initial dose 200 mg/kg) or a low dose (initial dose 100 mg/kg) of natural porcine surfactant (Curosurf). In the high dose group, up to five doses of surfactant could be given compared with three in the low dose group. In the high dose group, oxygen requirement was significantly lower during the first 36 hours after surfactant was administered than the requirement in the low dose group. There was no difference in outcome between the high and low dose groups. Outcome was poor for babies with birthweight < 750 gram or gestational age < 26 weeks, in spite of an initial favourable surfactant response in several of them. We conclude that the initial dose of Curosurf should be 100 mg/kg and two more doses can be given if necessary.

Redox-sensitive membrane-electrode based on the organic free radical octachlorophenothiazinyl.

An electrode based on an organic free radical and sensitive to redox systems is described.