Three-dimensional body scanning: a new method to estimate body surface area in neonates

BACKGROUND

Body surface area (BSA) is usually estimated by calculation with mathematical formulae. Three-dimensional body scanning (3D scan) offers a suitable alternative.

OBJECTIVES

We determined the BSA in healthy term and near-term neonates by 3D scanning. This system should be useful in the setting of intensive care medicine.

METHODS

The measuring system consisted of a projector, two cameras, mirrors and a computer, and used the fringe projection technique with visible light. The infants were examined in a supine position; the hidden parts of the bodies were corrected for using a mathematical factor developed with a baby doll model. Results of the 3D scans were compared with those from five mathematical formulae for each subject.

RESULTS

A total of 209 infants were studied by 3D scanning, of whom 53 had acceptable images and were selected for further analysis. The mean BSA was 2,139 cm(2) (SD 223.72). The minimal BSA was 1,587 cm(2), the maximal 2,670 cm(2), with a good correlation to body weight and length. One mathematical formula (Du Bois and Du Bois) showed a distinct underestimation of BSA compared to 3D scanning, the others an overestimation. Mean percentage similarity was from 96.8 to 100.9%.

CONCLUSIONS

3D scanning is an accurate and practical method to estimate BSA in newborns. Individual and repeated measurements from day to day are possible. Further studies are warranted in preterm and sick neonates.

[Lavage with exogenous surfactant in neonatal meconium aspiration syndrome]

BACKGROUND

Meconium aspiration syndrome is a disease in near term infants which requires invasive techniques to decrease mortality. Lavage of the tracheobronchial tree with exogenous surfactant has been shown to be effective in animal studies. We studied the effectiveness of this technique in newborn infants and compared them with a historical control group.

PATIENTS AND METHODS

From 1987 to 1998, we treated 18 neonates with meconium aspiration syndrome. In 11 babies a lavage with bovine derived diluted surfactant was carried out immediately after admission. In 7 infants of the control group only the meconium was suctioned or a lavage with saline performed. There were no differences between both groups concerning other therapeutic interventions like high frequency ventilation or inhalative NO. The control group contained significantly more outborn patients compared with the lavage group. Criteria of effectiveness were change in oxygenation index (OI), duration of mechanical ventilation and oxygen supplementation greater than 30 %. In addition, the two groups were compared for incidence of death, need for ECMO, and air leaks.

RESULTS

One infant of the lavage group died, one had to be transferred to ECMO (no significant difference). There was a significant decrease in OI after surfactant lavage from 22 at admission to 5.1 one day later (p=0.007), whereas in the control group, OI did not change significantly over time (15.8 to 11.4). There were no differences in the duration of mechanical ventilation or oxygen supplementation.

CONCLUSIONS

In our study, lavage with exogenous surfactant had only a short-term effect in decreasing OI in neonates with meconium aspiration. Larger numbers of patients need to be investigated to demonstrate an improvement in long-term outcome.

Invasive pulmonary aspergillosis in a critically ill neonate: case report and review of invasive aspergillosis during the first 3 months of life

We report a fatal case of invasive pulmonary aspergillosis in a severely ill neonate and review 43 additional cases of invasive aspergillosis reported from 1955 through 1996 that occurred during the first 3 months of life. Eleven of the 44 patients had primary cutaneous aspergillosis, 10 had invasive pulmonary aspergillosis, and 14 had disseminated disease. Most infections were nosocomial in origin. Prematurity (43%); proven chronic granulomatous disease (14%); and a complex of diarrhea, dehydration, malnutrition, and invasive bacterial infections (23%) accounted for the majority of underlying conditions. At least 41% of the patients had received corticosteroid therapy before diagnosis, but only one patient had been neutropenic. Among patients who received medical and/or surgical treatment, outcome was relatively favorable, with an overall survival rate of 73%. Invasive aspergillosis may occur in neonates and young infants and warrants consideration under certain circumstances. Current therapeutic approaches consist of high-dose amphotericin B and appropriate surgical interventions.

[Hemodynamic effects of high-frequency oscillating ventilation in preterm and term infants]

To study the effects of high frequency oscillating ventilation (HFOV) on cerebral and abdominal circulation we measured blood flow velocities in three cerebral arteries and in the A. mesenterica superior by pulsed doppler ultrasound in 13 preterm (mean gestational age 28 weeks [25-31]) and 3 term infants during conventional ventilation (intermitted positive pressure ventilation, IPPV) and HFOV. In the preterm infants systolic blood flow velocities decreased under HFOV in all cerebral arteries. Statistically significant differences were found in the A. cerebri anterior (45.8 cm/s [sd +/- 20.6] versus 34.3 [sd +/- 10.8]; p < 0.02) and in the A. basilaris (52.8 cm/s [sd +/- 26.4] versus 44.1 [sd +/- 18.7]; p < 0.05). There was also a distinct decrease of systolic blood flow velocity in the A. mesenterica (111 cm/s [ +/- 31.3] versus 61.8 cm/s [sd +/- 18.6]; p < 0.002). The enddiastolic blood flow velocity and the Resistance Index of Pourcelot did not change significantly. The systemic blood pressure did not change during conventional ventilation or HFOV. Mean airway pressure and pCO2 were lower during HFOV, but there was not strong correlation with the reduction of flow velocities in the studied arteries (r = 0.48). In the three term infants presenting with a persistent pulmonary hypertension of the newborn, there was an increase in systolic and enddiastolic flow velocities in all studied arteries under HFOV.

[High-frequency oscillating ventilation in premature infants under 1500 gram birth weight]

In 58 premature infants with a birthweight < 1500 g High-Frequency-Oscillating-Ventilation (HFOV) was initiated within the first 48 hours of life. Indications for HFOV were: no response to surfactant application (N = 41), respiratory distress syndrome without surfactant application (N = 9), pulmonary interstitial emphysema (N = 8). Mean gestational age of the enrolled patients was 27.6 weeks (24-32) and mean birthweight was 964 g (490-1450). 23 infants died, 5 from non-pulmonary causes. Of the remainder 2 had B-Strept.-septicemia, 1 lunghypoplasia, and 1 patient died on the 70th day of life from chronic lung disease. There were no statistical differences between survivors and nonsurvivors in gestational age, birthweight, umbilical pH, 1 min APGAR score or time on conventional ventilation prior to HFOV. Alveolar-arterial-O2-difference dropped in the group of surviving patients from x487 mm Hg (sd +/- 60) to 252 mm Hg (sd +/- 89) after 6 hours (p < 0.0001) and in the nonsurvivors from x517 mm Hg (sd +/- 74) to x373 mm Hg (sd +/- 106) (p = 0.002). Oxygenationindex fell from x25 (sd +/- 10) to x5 (sd +/- 1.5) in the survivors and from 25 (sd +/- 11) to x9 (sd +/- 5.5) in the nonsurvivors within 6 hours (p < 0.0001). Mean airway pressure could be lowered in survivors from x7.6 cm H2O (sd +/- 0.6) to 5.3 cm H2O (sd +/- 0.8) and in nonsurvivors from x8.6 cm H2O (sd +/- 0.6) to 5.7 cm H2O (sd +/- 0.9) (p = 0.0002). The promising results of HFOV as a rescue therapy require a controlled study for its use as a primary mode of ventilation in premature infants.

Combined therapy in human immunodeficiency virus-infected children--a 4-year experience

From 1988 to 1991 the long-term efficacy of a combined therapy with a polyvalent immunoglobulin/cytomegalovirus (CMV) hyperimmunoglobulin, oral low dose zidovudine, oral cotrimoxazole or inhaled pentamidine was investigated in three groups of human immunodeficiency virus (HIV)-infected children. Group 1A consisted of three perinatally infected children with a CD4 cell decrease of > 400 cells/microliters per year. Group 1B were 17 perinatally infected children with a CD4 cell decrease of < 400 cells/microliters per year. Group 2 comprised eight haemophilic children infected by clotting factors. Despite combined therapy none of group 1A survived longer than 12 months showing a rapid loss of CD4 cell counts, progressive encephalopathy, wasting syndrome and severe bacterial, fungal and CMV reactivation. Under pure intravenous immunoglobulin (IVIG) therapy severe bacterial infections were seen in 1 of 12 children in group 1B. The majority of these patients showed increases or stabilisation of length and weight percentiles. In this group low dose zidovudine therapy was of benefit in HIV-associated neurological symptoms. Nevertheless combined therapy could not prevent further deterioration of CD4 cell counts. In group 2 severe bacterial infections were not seen under IVIG therapy. In this group a temporary increase (6 months) of CD4 cell counts under IVIG/zidovudine combined therapy occurred. Pneumocystis carinii pneumonia (PCP) prophylaxis with oral cotrimoxazole or inhaled pentamidine successfully prevented PCP in all three groups. Under CMV hyperimmunoglobulin (n = 22), ten out of ten patients did not acquire primary CMV infection, whereas CMV reactivations mainly located in the CNS could not be prevented in 5 of 12 patients.(ABSTRACT TRUNCATED AT 250 WORDS)

[Persistent pulmonary hypertension in the newborn infant caused by aneurysm of the vein of Galen]

A male full-term neonate is described in whom cardiac insufficiency developed within 24 hours post partum. Ultrasound revealed an arterio-venous fistula of the vein of Galen. The patient's condition did not allow surgical correction and he died on the 22nd day of life. Persistent pulmonary hypertension was an important accompanying feature. The literature is reviewed with respect to the prognosis and the up to now seldom reported complication of persistent pulmonary hypertension of the newborn (PPHN).

Experimental investigations on the thrombosis-preventing effect of low-molecular-weight heparins

6 different preparations of low-molecular-weight heparin (LMWH) derivatives and 1 unfractionated heparin (UFH) were tested for their thromboprophylactic effects in an experimental model which closely simulates clinical conditions. Each preparation was tested in 5 rabbits 2 h and in 5 rabbits 12 h after subcutaneous application of 20-200 U/kg body weight (according to the suggestions of the manufacturers). The animals were anesthetized with intravenous pentobarbital sodium about 90 min or 11.5 h after the application of the heparin preparation. The right external jugular vein was dissected free and a thrombogenesis was provoked. There was no significant protection against occluding thrombosis 2 h after LMWH or UFH injection, when plasma levels of heparin-like activities were found to be high in another experimental series. Surprisingly, there were definite thromboprophylactic effects 12 h (when heparin-like plasma activities had disappeared) after application of 4 (out of 6) LMWH preparations. No protection against thrombosis was seen 12 h after application of UFH.