[Successful surfactant therapy of ARDS in an immunodepressed child]. / Erfolgreiche Surfactanttherapie eines kindlichen ARDS infolge Immunsuppression.

The acute respiratory distress syndrome in childhood is a rare disease, but as in the past still plagued with a high mortality rate. It is caused by severe pneumoniaes or infectious diseases with multiorgan failure, aspiration, trauma or immunodepression. There are no therapeutic guidelines based on controlled studies. Therefore different therapies i. e. high frequency oscillatory ventilation, nitric oxide application, surfactant therapy, extracorporal membrane oxygenation or a combination of these methods are used. We present the case of a 4 (3)/ 12 year old boy, who suffered from an acute lymphatic leukaemia. Caused by immunosuppressive therapy he got a severe broncho-pneumonia. During ventilation therapy an acute respiratory distress syndrome occurred. Due to a surfactant application over 7 days with a doses of 360 mg/kg body weight this RDS could be dominated. The extubation was possible after 17 days of ventilatory support. 3 weeks later the lung function was normalized and the chemotherapy resumed.

[Nasal glioma as a rare cause of obstructed nasal breathing in a newborn infant]. / Nasales Gliom als seltene Ursache der behinderten Nasenatmung beim Neugeborenen.

Congenital midline nasal masses are rare entities occurring once in 20-40,000 births. They are often misdiagnosed or even missed. These tumors are most commonly present in newborn infants and children, but rarely they can be discovered in adults as well. The differential diagnostic possibilities are dermoids, gliomas, encephaloceles and epidermoid cysts. Although they are benign, they have the potential for disfigurement, destruction and causing a meningitis, therefore they require prompt diagnosis and management. Because of a possible connection to intracranial structures a complete radiologic evaluation is essential. The treatment for these nasal masses is surgical resection, endoscopically controlled procedures are preferred. We report the case of a newborn with respiratory distress shortly after birth. The infant was discharged from the hospital, because the unexplained symptoms were not progressive. After a few days the child was send to an otolaryngologist, who found a suspicious mass near the top of the nose and performed a biopsy. At 20 days of age the infant was brought to our children's hospital for additional diagnostic procedures and therapy. The MRI showed a soft tissue mass (1.2 x 0.7 x 1.1 cm) in the nasal cavity. There was no clear-cut evidence of an intracranial extension, for further evaluation a radionuclide scan was performed. This confirmed the integrity of the base of the skull. 6 weeks after the birth a smooth tumor was successfully removed by an endoscopically controlled operation. Histopathologic studies confirmed neuroglial tissue. Because of ist rare incidence, many physicians are not familiar with the diagnosis and management of these tumors. Respiratory abnormalities in newborn should always lead to a careful physical examination and complete radiologic evaluation, i.e. MRI, CT and radionuclide scan.

Sleep medicine in infants--practicability and limitations.

An increasing amount of polysomnographic studies are performed in early infancy. Complete pediatric sleep laboratory systems are commercially available and provide fast and exhaustive results if operated by trained personnel. Experience in evaluation is necessary, because a broad range of possible diagnostic findings exists, and artifacts are common. Based on longitudinal studies in 31 healthy infants, we present reference values for several polysomnographic parameters. Aberrant results must be interpreted in the context of patient's history, clinical state, and additional laboratory findings. In presence of a clearly defined indication for polysomnographic testing, clear therapeutic and interventional strategies can be derived. Possible consequences include the stimulation of the respiratory drive by drugs with subsequent polysomnographic control of therapeutic effect, a transfusion, the prescription of a home monitor, and the recommendation of further diagnostics or of control polysomnographies. In conclusion, infant polysomnography is an important diagnostic tool in pediatrics.