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1.
Klin Padiatr ; 221(2): 74-5, 2009.
Article in German | MEDLINE | ID: mdl-19263326

ABSTRACT

BACKGROUND: Although salmonellosis is one of the most common childhood illnesses associated with enteric bacteria, breastfed babies do not often get infected with Salmonella. In such cases it is therefore necessary to look carefully for the source of infection. PATIENT: It is reported an 8-week-old female infant with acute haemorrhagic diarrhoea and fever. With symptomatic therapy and breast-feeding her condition improved without antibiotic therapy. Microbiological diagnosis and subtyping identified infection with Salmonella enterica serovar Pomona. The source of the infection was a bearded dragon ( Pogona SPP.) living in a neighborhood household. Monitoring of the child showed shedding of the bacterium over a nine month period. CONCLUSION: In all cases of salmonellosis in breastfed babies, the source of infection should be carefully determined. Small numbers of bacteria can cause a symptomatic infection in this age group. Therefore an intensive search of the transmission route is indicated to develop prevention strategies.


Subject(s)
Animals, Domestic/microbiology , Breast Feeding , Gastroenteritis/microbiology , Reptiles/microbiology , Salmonella Infections/transmission , Salmonella enterica , Animals , Escherichia coli , Feces/microbiology , Gastroenteritis/therapy , Humans , Infant , Lizards/microbiology , Probiotics , Salmonella Infections/microbiology , Salmonella Infections/therapy , Salmonella enterica/classification , Serotyping
2.
J Med Ethics ; 34(9): e4, 2008 Sep.
Article in English | MEDLINE | ID: mdl-18757623

ABSTRACT

The medical response to suicide is generally resuscitation, followed by attempts to maximise the patient's recovery. Care is generally withdrawn when it is futile and there is no hope for recovery. Suicidal patients who have completed an advance directive may complicate matters. Should medical providers not resuscitate a patient with an advance directive who has attempted to commit suicide? If stated wishes for care are ignored in the emergency setting, how should decisions be made over time in the event of a successful resuscitation resulting in the need for prolonged therapy counter to the wishes of the advance directive? What are the merits of the stated the wishes of suicidal patient? What if they were depressed at the time of the advance directive? This case highlights the need for consideration of these and other concerns in the care of patients who commit suicide and have an advance directive.


Subject(s)
Advance Directive Adherence/ethics , Advance Directives/ethics , Suicide, Attempted/ethics , Withholding Treatment/ethics , Attitude of Health Personnel , Depressive Disorder/complications , Female , Humans , Middle Aged , United States
6.
Early Hum Dev ; 57(1): 33-47, 2000 Jan.
Article in English | MEDLINE | ID: mdl-10690710

ABSTRACT

Improvements in perinatal and neonatal management have not only led to a higher survival rate of very low birth weight infants (VLBW; < or = 1,500 g or < 32 weeks gestational age), but also to a better outcome of these children. However the percentage of VLBW children who need special education because of later school problems remains high even in children considered neurologically normal during infancy. We assessed 40 VLBW children and 83 healthy full-term children at age 3 to 4 years by means of a simple and short test for visual-motor deficits. The test included the copying and cutting-out of geometric shapes, the building of models, the recognition of colours and the observation of the concentration and cooperation during the test. All VLBW children had had a good perinatal outcome and had been considered neurologically normal at one year of age. Most VLBW children scored within 1 standard deviation (S.D.) of the test mean, but on average the VLBW children scored significantly lower than the full-term infants in the copying of figures, the cutting-out of geometric forms, the building of models and in the overall concentration and cooperation during the test. Children who attended a nursery school achieved significantly better test results. Girls tended to have better results, but this was not statistically significant. Social factors and age had a significantly greater impact on results than perinatal factors. In summary, VLBW children scored significantly less in almost every test item compared to their term peers. Our test battery could serve as a short introductory test to screen for deficits in visual-motor skills, especially in VLBW children.


Subject(s)
Infant, Very Low Birth Weight , Psychomotor Performance , Adolescent , Adult , Attention , Child, Preschool , Female , Humans , Infant, Newborn , Male , Oxygen/administration & dosage , Respiration, Artificial , Sepsis , Sex Characteristics
7.
Early Hum Dev ; 52(2): 145-53, 1998 Sep.
Article in English | MEDLINE | ID: mdl-9783816

ABSTRACT

The objective of the investigation was to study the stability of the cardiorespiratory system of 20 premature boys and girls during maternal kangaroo care (KC) and in the incubator. Stability of heart rate, respiration and oxygen saturation was compared in a pretest-test-posttest design by means of a stability score. The three stability items and the total stability did not change significantly during the three conditions. In some individuals the stability either increased or decreased markedly during Kangaroo Care. The boys showed significantly less cardiorespiratory stability both during kangaroo care and in the incubator compared to the girls.


Subject(s)
Heart/physiology , Infant, Premature/physiology , Maternal Behavior , Respiration , Female , Heart Rate , Humans , Infant, Newborn , Male , Oxygen/blood , Sex Characteristics , Skin
8.
Eur J Orthod ; 20(2): 111-4, 1998 Apr.
Article in English | MEDLINE | ID: mdl-9633164

ABSTRACT

A non-surgical technique for the treatment of upper airway obstruction in oculoauriculovertebral dysplasia using an intra-oral orthopaedic appliance is described, which resulted in respiratory and feeding problems being solved without side-effects. This non-invasive management might also be of major benefit in the treatment of airway obstruction associated with Pierre Robin sequence, mandibular micrognathia in other craniofacial anomalies, or obstructive sleep apnoea.


Subject(s)
Airway Obstruction/therapy , Goldenhar Syndrome , Occlusal Splints , Airway Obstruction/etiology , Dental Care for Chronically Ill , Female , Goldenhar Syndrome/complications , Humans , Infant
9.
Lancet ; 349(9062): 1361-3, 1997 May 10.
Article in English | MEDLINE | ID: mdl-9149699

ABSTRACT

BACKGROUND: In normal awake infants, fidgety movements are seen from the age of 6 weeks to 20 weeks. The aim of the study was to test the predictive value of absent or abnormal spontaneous movements in young infants for the later development of neurological deficits. METHODS: In a collaborative study involving five hospitals we collected data on the normal and abnormal quality of fidgety movements of 130 infants and compared it with assessments of neurological development done longitudinally until the age of 2 years. On the basis of ultrasound scans infants were classified as at low-risk or at high-risk of neurological deficits. Infants were videoed for 1 h every week from birth to discharge and then for 15 min every 3 to 4 weeks; quality of general movements was assessed. Repeated neurological assessments were also done until 24 months of corrected age. FINDINGS: 67 (96%) of 70 infants with normal fidgety movements had a normal neurological outcome. Abnormal quality or total absence of fidgety movements was followed by neurological abnormalities in 57 (95%) of the 60 infants (49 had cerebral palsy and eight had developmental retardation or minor neurological signs). Specificity and sensitivity of fidgety movement assessment were higher (96% and 95%, respectively) than of ultrasound imaging of the infants' brain (83% and 80%, respectively). INTERPRETATION: Our technique of assessing spontaneous motor activity can identify and distinguish between those infants who require early intervention for neurological abnormalities and those who do not. Our technique is simple, non-intrusive, reliable, quick, and can be done on very young infants.


Subject(s)
Cerebral Palsy/physiopathology , Developmental Disabilities/physiopathology , Infant Behavior/physiology , Motor Activity/physiology , Psychomotor Agitation/physiopathology , Biomarkers , Child, Preschool , Echoencephalography , Female , Humans , Infant , Infant, Newborn , Infant, Premature/physiology , Longitudinal Studies , Male , Risk Factors , Sensitivity and Specificity , Videotape Recording
10.
J Pediatr ; 129(4): 608-11, 1996 Oct.
Article in English | MEDLINE | ID: mdl-8859271

ABSTRACT

The aim of the study was to compare effects of maternal and paternal kangaroo care on oxygen consumption, carbon dioxide production, energy expenditure, skin and rectal temperatures, heart and respiratory rates, arterial saturation, and behavioral states. Eleven preterm infants with gestational age of 28 to 31 weeks, birth weight of 560 to 1390 gm, and postnatal age of 8 to 48 days were studied before, during, and after maternal and paternal kangaroo care. Skin temperature (lower leg) increased significantly during both maternal (36.2 +/- 0.9 degrees vs 36.9 +/- 1.2 degrees C) and paternal (36.3 +/- 0.9 degrees vs 36.8 +/- 0.9 degrees C) kangaroo care. The other parameter changed neither during maternal nor during paternal kangaroo care. We conclude that both maternal and paternal kangaroo care have no adverse effects on energy expenditure.


Subject(s)
Father-Child Relations , Infant Care/methods , Infant, Very Low Birth Weight/physiology , Mother-Child Relations , Body Temperature , Carbon Dioxide/physiology , Energy Metabolism , Heart Rate , Humans , Infant, Newborn , Infant, Very Low Birth Weight/metabolism , Oxygen/blood , Oxygen Consumption , Rectum , Respiration , Skin Temperature
11.
Eur J Pediatr ; 155(9): 796-9, 1996 Sep.
Article in English | MEDLINE | ID: mdl-8874115

ABSTRACT

UNLABELLED: We report on a 13-month old boy with microcephalic osteodysplastic primordial dwarfism (MOPD), whose radiographic signs correspond with type II of this entity. Some of his clinical signs, such as the anomalies of the external genitalia and the urinary tract, are common to this subgroup of MOPD, but he also shows unusual clinical signs including bilateral knee dislocation and hypoplasia of the anterior corpus callosum. His clinical course was unusual with several episodes of breathing difficulties and increased intracranial pressure secondary to craniosynostosis at the age of 16 months. After front-orbital advancement for the treatment of brachycephaly, his psychomotor development improved remarkably. CONCLUSION: MOPD type II may have a wider range of expression than previously delineated.


Subject(s)
Abnormalities, Multiple , Dwarfism , Microcephaly , Craniosynostoses/diagnostic imaging , Craniosynostoses/surgery , Fetal Growth Retardation , Humans , Infant , Joint Dislocations/congenital , Joint Dislocations/diagnostic imaging , Knee/diagnostic imaging , Male , Radiography , Respiratory System Abnormalities , Syndrome
12.
Klin Padiatr ; 208(2): 56-60, 1996.
Article in German | MEDLINE | ID: mdl-8901183

ABSTRACT

50 premature infants with bronchopulmonary dysplasia (BPD) were treated in the Perinatal Center of the University of Heidelberg from January 1990 to December 1992. Gestational age was 24-31 weeks and birthweight was 500 to 1430 grams. 27 infants received dexamethasone only and 14 were initially given dexamethasone followed by beclomethasone inhalation. Nine infants without assisted ventilation were only treated with inhaled beclomethasone. Infants with fluid intake > 150 ml/kg/d and < or = 150 ml/kg/d were analysed separately. Extubation in ventilated infants was possible 1 to 29 days after the beginning of dexamethasone treatment. Most infants who were not ventilated any more could be weaned from oxygen during the period of dexamethasone treatment. Inhaled beclomethasone allowed reduction in supplemental oxygen in all infants. Effects of treatment with dexamethasone and beclomethasone were similar in infants with fluid intake of < 150 ml/kg/d and > 150 ml/kg/d. Our data show that dexamethasone and inhaled beclomethasone improved the clinical course of BPD in premature infants. Fluid intake had no influence on clinical outcome. Based on our results, we suggest guidelines for the treatment of BPD.


Subject(s)
Beclomethasone/administration & dosage , Bronchopulmonary Dysplasia/drug therapy , Dexamethasone/administration & dosage , Glucocorticoids/administration & dosage , Oxygen Inhalation Therapy , Ventilator Weaning , Administration, Inhalation , Beclomethasone/adverse effects , Blood Glucose/metabolism , Combined Modality Therapy , Dexamethasone/adverse effects , Drug Therapy, Combination , Female , Fluid Therapy , Glucocorticoids/adverse effects , Humans , Infant , Infant, Newborn , Male , Retrospective Studies , Treatment Outcome
16.
Arch Dis Child Fetal Neonatal Ed ; 72(2): F115-7, 1995 Mar.
Article in English | MEDLINE | ID: mdl-7712268

ABSTRACT

The reliability of respiratory monitoring, using either chest or back electrodes, was studied in 13 preterm infants during kangaroo care (infant-parent skin to skin contact). In three out of four infants with chest electrodes both infant and parental respiration were clearly visible on pneumograms. In these infants apnoeic pauses were not registered because parental respiration was recorded as infant breathing. Bradycardia and oxygen saturation were, however, properly registered. In infants with electrodes placed on the back infant respiration was less superimposed by parental breathing. However, even in some of these infants parental respiration was visible in the pneumograms. It is concluded that during kangaroo care the electrodes should be placed on the back and monitoring should always include heart rate and oxygen saturation.


Subject(s)
Apnea/diagnosis , Infant, Premature, Diseases/diagnosis , Intensive Care, Neonatal/methods , Respiration/physiology , Apnea/physiopathology , Electrodes , Heart Rate/physiology , Humans , Infant, Newborn , Infant, Premature , Infant, Premature, Diseases/blood , Infant, Premature, Diseases/physiopathology , Monitoring, Physiologic/methods , Oxygen/blood
17.
Epilepsia ; 34(4): 757-63, 1993.
Article in English | MEDLINE | ID: mdl-8330589

ABSTRACT

High-dose vitamin B6 (pyridoxine-HCl, 300 mg/kg/day orally) was introduced as the initial treatment of recently manifested infantile spasms in 17 children (13 symptomatic cases with identified brain lesion and 4 cryptogenic cases). 5 of 17 children (2 cryptogenic, 2 with severe pre/perinatal brain damage and one with Sturge-Weber syndrome) were classified as responders to high-dose vitamin B6. In all 5 cases the response to vitamin B6 occurred within the first 2 weeks of treatment and within 4 weeks all patients were free of seizures. Two patients developed other seizures (partial seizures, etiologically unclear blinking attacks), but no relapse of infantile spasms was observed among the five responders to vitamin B6. No serious adverse reactions were noted. Side effects were mainly gastrointestinal symptoms, which were reversible after reduction of the dosage. Considering the life-threatening side effects of treatment with ACTH/corticosteroids or valproate, a controlled clinical trial with high-dose vitamin B6 would appear justified to either prove or disprove efficacy.


Subject(s)
Pyridoxine/therapeutic use , Spasms, Infantile/drug therapy , Administration, Oral , Child, Preschool , Dose-Response Relationship, Drug , Drug Administration Schedule , Electroencephalography , Epilepsy/diagnosis , Epilepsy/drug therapy , Female , Follow-Up Studies , Humans , Infant , Male , Pilot Projects , Pyridoxine/administration & dosage , Pyridoxine/adverse effects , Recurrence , Spasms, Infantile/diagnosis
18.
Acta Paediatr Scand ; 80(1): 129-32, 1991 Jan.
Article in English | MEDLINE | ID: mdl-2028785

ABSTRACT

We report the successful treatment of neonatal alloimmune thrombocytopenia with repeated infusions of high-dose immunoglobulin G (400 mg/kg/d for 5 days) in twins. Platelet counts increased within 3 days from less than 20 x 10(9)/l to more than 70 x 10(9)/l. The first twin survived without neurological or other sequelae. The second twin had probably developed intracranial hemorrhage (ICH) in utero. This infant developed long-term neurological sequelae with blindness, cerebral palsy and infantile spasms. Implications of the therapeutic approach and prevention of severe complications in pregnancies with known risk for neonatal alloimmune thrombocytopenia are discussed.


Subject(s)
Autoimmune Diseases/therapy , Diseases in Twins/therapy , Immunization, Passive , Immunoglobulin G/administration & dosage , Thrombocytopenia/therapy , Autoimmune Diseases/complications , Blood Platelets/immunology , Cerebral Hemorrhage/etiology , Fetal Diseases/etiology , Humans , Infant, Newborn , Infant, Small for Gestational Age , Infusions, Intravenous , Prognosis , Thrombocytopenia/complications , Thrombocytopenia/immunology
19.
Eur J Pediatr ; 149 Suppl 1: S28-33, 1990.
Article in English | MEDLINE | ID: mdl-2091928

ABSTRACT

In 126 early treated PKU patients (type I and type II) a close EEG follow up was performed from birth up to 6 years of age. A total of 1465 EEGs were performed before and after onset of dietary treatment and on 11 more subsequent occasions. The composition of the background activity was normal up to 6 years when only a small number of the children (19) showed no dominant alpha activity. The frequency of epileptiform activity of generalised as well as focal type was low in the first 2 years of life, but afterwards slightly enhanced in comparison to normal control groups. Other findings like generalised theta paroxysms or focal slow waves were rarely observed. Under a standardised protein load at 6 months (52 patients) and at 5 years of age (42 patients) a moderate generalised slowing of the background activity but no other abnormalities were noted.


Subject(s)
Aging/physiology , Electroencephalography , Phenylketonurias/physiopathology , Humans , Infant, Newborn , Phenylalanine/blood , Phenylketonurias/diet therapy
20.
Dev Med Child Neurol ; 31(6): 787-96, 1989 Dec.
Article in English | MEDLINE | ID: mdl-2599271

ABSTRACT

The author examined the construct validity of visual information processing in infancy (preference for novel visual targets) as a predictor of later neurological outcome. 104 infants with definite (N = 25), questionable (N = 27) or no evidence of neurological dysfunction (N = 52) were tested at three to seven months (corrected age). The mean novelty preference scores differed significantly between the three groups. These differences were not related to demographic data and still existed when the data were corrected for preterm birth and birthweight. These results support the hypothesis that visual information processing at three to seven months (corrected age) is a reflection of neurological intactness and may be useful in the clinical assessment of cortical function in infants.


Subject(s)
Central Nervous System Diseases/physiopathology , Child Development , Form Perception/physiology , Pattern Recognition, Visual/physiology , Visual Pathways/physiology , Humans , Infant , Infant, Newborn
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