[The first Danish experiences with neonatal extracorporeal membrane oxygenation]. / De første danske erfaringer med neonatal ekstrakorporal membranoxygenering.

In 1995, neonatal extra-corporeal membrane oxygenation (ECMO) was established at the Department of Neonatology, Rigshospitalet, Copenhagen. The indication for ECMO is circulatory or respiratory failure with arterial oxygen tension below 8 kPa despite maximal conventional treatment. During the first two and a half years 17 newborn infants and one child of 21 months have been treated with ECMO at the Rigshospital. Fifteen survived, of 12 followed at least nine months, 11 have normal development and one has cerebral palsy. There were problems including surgical placement of the cannula, technical difficulties or bleeding in 12 patients. During the same two years at least eight newborns in Denmark fulfilled the ECMO indication, but were not treated, half were not transferred to the Rigshospital. Seven of these eight infants died. The need for ECMO treatment in newborn infants is documented but small. We have succeeded in establishing this complicated treatment due to teamwork between different specialities with a good result.

[Intrauterine growth retardation and premature delivery. The effect of smoking and psychosocial factors]. / Intrauterin vaeksthaemning og praematur fødsel. Effekten af rygning og psykosociale faktorer.

The purpose of the study is to investigate the influence of psychosocial stress, maternal schooling, social support, psychological well-being, alcohol and smoking on intrauterine growth retardation and premature delivery. At a Copenhagen university hospital 2432 consecutive Danish-speaking women in 20th week of pregnancy completed a questionnaire including the General Health Questionnaire and Severity of Psychosocial Stressor Scale and questions about social network, education, smoking and drinking habits. In 212 cases (8.7%) the women delivered before day 259 of gestation. In a multiple logistic regression model, pre-term delivery proved to be associated with psychosocial stress and poor school education. In 152 cases (6.3%) infants had a birth weight below the defined 10th percentile. In a multiple logistic regression model, IUGR was associated with smoking. In preventive programmes, such as anti-smoking campaigns, it should be kept in mind that women who smoke are also the least educated and have the poorest support from a social network.

[Oxygen during delivery and cerebral vasoconstriction in preterm infants]. / Ilttilskud ved fødslen og konstriktion af hjernens kar hos for tidligt fødte børn.

To determine if the use of oxygen in the delivery room influences subsequent global cerebral blood flow (CBF), 70 infants of gestational age of less than 33 completed weeks were randomly assigned to receive room air (group I) or 80% oxygen (group II) during the initial stabilisation at birth. In group I supplemental oxygen was administered on clinical indications, when required. After being admitted to the neonatal intensive care unit all infants were treated according to our normal practice. At a postnatal age of two hours CBF was measured by xenon clearance. Seventy four per cent of the infants in group I were successfully established without the need for supplemental oxygen. CBF was significantly higher in group I than in group II (CBF median (interquartile range): 15.9 (13.6-21.9) vs 12.2 (10.7-13.8) ml/100 g/minute). Differences in oxygen exposure seemed to be the only explanation for the differences in CBF. No differences in short term outcome were found between the groups.

[The significance of psychosocial stress for pregnancy course and fetal development]. / Betydningen af psykosocialt stress for graviditetsforløb og fosterudvikling.

In a population-based study, 3021 women in a central Copenhagen district received a questionnaire on environmental and psychological factors during mid-gestation. Of these, 70 women were selected consecutively on the basis of moderate to severe stressful life-events (DSM-III-R categories 3 to 5), in combination with an inadequate social network. They were compared with 50 non-stressed women with an intact social network. Stress and smoking significantly affected birthweight and head circumference. When birthweight was corrected, stress remained a significant determinant of small head circumference, indicating a specific effect on brain development. Stress also led to a suboptimal Prechtl neonatal neurological score. These findings suggest the existence of a fetal stress syndrome with adverse effects on fetal development, including deficient brain development.

[Neonatal hypoglycemia--new limits for treatment?]. / Neonatal hypoglykaemi--nye groenser for behandling?

Neonatal hypoglycaemia is the commonest clinical manifestation af disordered energy metabolism and is important because sustained hypoglycaemia may cause neuronal damage. Infants at high risk of developing low brain energy levels are those who have increased metabolic demands, low glycogen reserves, insufficient counter-regulatory responses or hyperinsuliaemia, and there is accumulating evidence that blood glucose should be maintained above 2.5 mM in this group. If possible, early and regular feeding at a volume of 120 ml/kg/dag should be established, but supplementation with intravenous glucose may be necessary.

[Pulmonary hypertension in children treated with ventriculo-atrial shunt in hydrocephalus]. / Pulmonal hypertension hos børn behandlet med ventrikulo-atrial shunt for hydrocephalus.

Four infants treated with ventriculo-atrial shunt for hydrocephalus developed sudden pulmonary hypertension, several years after the first operation. All infants died in spite of replacement of the distal shunt and AK treatment. At necropsy, old microemboli were found in the small lung vessels in two infants whereas the two other infants were suspected of having the same lesions from clinical investigations. The overall frequency for this complication was estimated to be 6.7% (95% CI 1.4-14.3%).