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Interdependence of Hygroscopic Polymer Characteristics and Drying Kinetics during Desiccant Drying and Microwave Supported Drying. INT POLYM PROC 2020. [DOI: 10.3139/217.3960] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Abstract
Hygroscopic polymers absorb and bind water. If not dried properly, the residual moisture can cause major problems for converting and affect the product quality significantly. Therefore, an effective drying down to an acceptable moisture level is essential for a successful production. Though data sheets give recommendations for drying parameters, these do not consider the actual current moisture up-take of the plastic pellets or the current ambient conditions. This paper investigates the interdependencies of polymer characteristics, like thermal properties and molecular structure, and the drying kinetics of the respective polymers. Tests are carried out with five different polymers on a State-of-the-Art desiccant dryer. The results show that distinctive drying behaviors can be attributed to the molecular structure of the respective plastic. This is reflected by the activation energy according to Arrhenius, the diffusion coefficient and the Flory-Huggins-Parameter, all showing a positive correlation with drying speed and therefore can be used as indicators to estimate drying times. Also, an industrial scale prototype of a microwave enhanced drying system was used to investigate the effect of microwave application on the drying kinetics. Experimental results show potential for reducing the drying times needed, especially for lower temperatures of the drying air and highly hydrophilic plastics. For higher temperatures, however, the prototype could not compete with the state-of-the-art desiccant dryer, due to heat losses and inefficient tubing of the prototype. Considering this, the benefits of microwave application could be shown representatively for polyamide 6 also at higher temperatures.
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Oxygenation and Lung Morphology in a Rabbit Pediatric ARDS- Model under High Peak Pressure Ventilation plus Nitric Oxide and Surfactant Compared with Veno-venous ECMO. Int J Artif Organs 2018. [DOI: 10.1177/039139889902201108] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
The aim of the study is to investigate which of two treatment options of saline lavage induced ARDS in rabbits is better in terms of oxygenation and prevention of barotrauma: combined high peak pressure ventilation with surfactant administration and inhaled nitric oxide or veno-venous ECMO combined with low peak inspiratory pressure ventilation. Materials and Methods After saline lavage (10 cc/kg repeated as long as foamy retrieval was observed) two combined therapeutic strategies were examined: ventilation with high inspiratory pressures (35 cm H2O) with additional exogenous surfactant administration (100 mg/kg) and inhaled nitric oxide (10 PPM) (n=5, group 1) and low inspiratory pressure (20 cm H2O) ventilation under veno-venous ECMO support (n=5, group 2). The FiO2 was maintained at 1.0 in both groups. The paO2/FiO2 ratio was calculated in 30 minute intervals for 4 hours. After that the animals were sacrificed and the lungs examined macro- and microscopically. Aeration was described in a semiquantitative method using the alveolar expansion index. Oxygenation in group 1 was significantly better than in group 2, it increased significantly after surfactant but not after additional nitric oxide administration. However, the lungs in group 1 showed severe signs of baro/ergotrauma (Hyaline membranes, air leaks, infiltration of polymorphonuclear (PMN) granulocytes and macrophages, break down of alveolar capillary membranes) after 4 hrs of combined therapy, whereas the lungs in group 2 appeared normal. Adding surfactant and NO to a high tidal volume ventilation improved oxygenation, but did not prevent baro/ergotrauma. Ventilation with low inspiratory pressures combined with ECMO caused little baro/ergotrauma but adequate oxygenation could not be achieved, probably due to anatomical features of the rabbit which do not allow appropriate blood flow within the ECMO-circuit.
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Treatment of Severe Non-Neonatal ARDS in Children with Surfactant and Nitric Oxide in a “PRE-ECMO”-Situation. Int J Artif Organs 2018. [DOI: 10.1177/039139889501801009] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
The use of exogenous surfactant and nitric oxide in neonates has reduced the number of infants requiring ECMO. The purpose of this study was to demonstrate whether these two therapeutic options might reduce the number of over 28 days old children with severe ARDS requiring ECMO, without reducing changes of survival and morbidity. Over a 30 month period all non-neonatal ARDS patients transferred to our institution for ECMO evaluation were treated based on a study-algorithm. If they did not fulfill “fast entry criteria” (paO2< 40 for more than 3 hrs.) we first tried different ventilation, vasodilatation, and hemodynamic strategies for max. 4 hrs. (inv. I/E ratio, HFOV, epoprostenol, high doses norepinephrine. If the 01 did not decrease by< 10, 30-280 mg natural surfactant or 1-20 ppm nitric oxide were treatment options depending on the degree of pulmonary hypertension measured by echocardiography and by mixed venous saturation measurements. It was possible to use NO and surfactant sequentially. The patients had different etiologies of ARDS as near drowning, pneumonia, immunosuppression, and sepsis. If their 01 did not decrease by 10 in 8 hrs. ECMO was installed. Nineteen patients were evaluated, 6 improved with conventional therapy, their 01 decreased without a relapse (mean 01 at begin of the study: 38). Six patients improved with surfactant therapy alone (mean 01: 54), 4 patients improved after surfactant and sequential NO-treatment, 3 patients were initially treated with NO, 1 sequentially with surfactant. One patient did not show any benefit from NO or surfactant and was put on ECMO. Three patients died (withdrawal of life support because of severe brain damage caused by the underlying disease). We could not observe any respiratory related failure. No patient had to be discharged on oxygen. A sophisticated treatment algorithm integrating different modern ARDS treatment options can reduce the number of patients requiring ECMO. We speculate however that these options can only be used effectively in centers involved in ARDS treatment quite frequently and that these centers have to provide ECMO as one of their therapeutic tools.
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MR-Lungenperfusion bei 12-jährigen Kindern nach operierter Zwerchfellhernie. ROFO-FORTSCHR RONTG 2017. [DOI: 10.1055/s-0037-1600317] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Prognostische Wertigkeit des MRT-basierten Quotienten aus fetaler Lungen- und Ganzkörpervolumetrie bei angeborener Zwerchfellhernie: Vergleich mit der US-basierten LHR und dem MR-fetalen Lungenvolumen. ROFO-FORTSCHR RONTG 2016. [DOI: 10.1055/s-0036-1581544] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Congenital High Airway Obstruction Syndrome (CHAO-Syndrom) – erfolgreiches Management einer seltenen Erkrankung. Z Geburtshilfe Neonatol 2015. [DOI: 10.1055/s-0035-1566590] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Fetales Steißbeinteratom – eine Gegenüberstellung zweier Fallberichte. Z Geburtshilfe Neonatol 2015. [DOI: 10.1055/s-0035-1566589] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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MR Lungenperfusion bei zweijährigen Kindern nach operierter angeborener Zwerchfellhernie – Vergleich von Kindern ohne und nach ECMO Bedarf. ROFO-FORTSCHR RONTG 2015. [DOI: 10.1055/s-0035-1551135] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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MRT-Lungenvolumetrie bei Feten mit kongenitaler Zwerchfellhernie: Seitengetrennte Evaluation des ipsi- und kontralateralen fetalen Lungenvolumens. ROFO-FORTSCHR RONTG 2015. [DOI: 10.1055/s-0035-1551136] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Adjunctive Therapies for Treatment of Severe Respiratory Failure in Newborns. KLINISCHE PADIATRIE 2015; 227:28-32. [DOI: 10.1055/s-0034-1394456] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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Maternales Saethre-Chotzen Syndrom – Ein Fallbericht. Geburtshilfe Frauenheilkd 2014. [DOI: 10.1055/s-0034-1388221] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022] Open
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High temporal versus high spatial resolution in MR quantitative pulmonary perfusion imaging of two-year old children after congenital diaphragmatic hernia repair. Eur Radiol 2014; 24:2427-34. [PMID: 25038855 DOI: 10.1007/s00330-014-3304-9] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2013] [Revised: 05/15/2014] [Accepted: 06/30/2014] [Indexed: 11/29/2022]
Abstract
OBJECTIVES Congenital diaphragmatic hernia (CDH) leads to lung hypoplasia. Using dynamic contrast-enhanced (DCE) MR imaging, lung perfusion can be quantified. As MR perfusion values depend on temporal resolution, we compared two protocols to investigate whether ipsilateral lung perfusion is impaired after CDH, whether there are protocol-dependent differences, and which protocol is preferred. METHODS DCE-MRI was performed in 36 2-year old children after CDH on a 3 T MRI system; protocol A (n = 18) based on a high spatial (3.0 s; voxel: 1.25 mm(3)) and protocol B (n = 18) on a high temporal resolution (1.5 s; voxel: 2 mm(3)). Pulmonary blood flow (PBF), pulmonary blood volume (PBV), mean transit time (MTT), and peak-contrast-to-noise-ratio (PCNR) were quantified. RESULTS PBF was reduced ipsilaterally, with ipsilateral PBF of 45 ± 26 ml/100 ml/min to contralateral PBF of 63 ± 28 ml/100 ml/min (p = 0.0016) for protocol A; and for protocol B, side differences were equivalent (ipsilateral PBF = 62 ± 24 vs. contralateral PBF = 85 ± 30 ml/100 ml/min; p = 0.0034). PCNR was higher for protocol B (30 ± 18 vs. 20 ± 9; p = 0.0294). Protocol B showed higher values of PBF in comparison to protocol A (p always <0.05). CONCLUSIONS Ipsilateral lung perfusion is reduced in 2-year old children following CDH repair. Higher temporal resolution and increased voxel size show a gain in PCNR and lead to higher perfusion values. Protocol B is therefore preferred. KEY POINTS • Quantitative lung perfusion parameters depend on temporal and spatial resolution. • Reduction of lung perfusion in CDH can be measured with different MR protocols. • Temporal resolution of 1.5 s with spatial resolution of 2 mm (3) is suitable.
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MRT-Lungenvolumetrie bei Feten mit kongenitaler Zwerchfellhernie: Pränatale Vorhersage der Notwendigkeit eines Patch-Verschlusses des Zwerchfelldefektes. ROFO-FORTSCHR RONTG 2014. [DOI: 10.1055/s-0034-1373112] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Quantitative zerebrale MRT-Perfusionsbildgebung bei 2-jährigen Kindern mit operierter kongenitaler Zwerchfellhernie und Verschluss der Arteria carotis communis nach ECMO-Therapie: pASL bei 3 Tesla. ROFO-FORTSCHR RONTG 2014. [DOI: 10.1055/s-0034-1373113] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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[Prenatal diagnosis of and therapy for congenital diaphragmatic hernia]. Z Geburtshilfe Neonatol 2014; 218:6-17. [PMID: 24595910 DOI: 10.1055/s-0034-1367041] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Congenital diaphragmatic hernia is a malformation presenting with varying degrees of severity. An accurate prediction of outcome is crucial for parental counselling and therapeutic planning. In selected cases, foetal endoscopic tracheal occlusion (FETO) can improve foetal outcome. Timely referral to a highly specialised centre is important when the requirement for extracorporeal membrane oxygenation (ECMO) is expected.
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Preferential streaming of the ductus venosus toward the right atrium is associated with a worse outcome despite a higher rate of invasive procedures in human fetuses with left diaphragmatic hernia. ULTRASCHALL IN DER MEDIZIN (STUTTGART, GERMANY : 1980) 2013; 34:568-572. [PMID: 23696063 DOI: 10.1055/s-0032-1330702] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
PURPOSE Preferential streaming of the ductus venosus (DV) toward the right atrium has been observed in fetuses with left diaphragmatic hernia (LDH). The purpose of this retrospective study was to compare survival rates to discharge between a group with preferential streaming of the DV toward the right heart and a group in which this abnormal flow pattern was not present. MATERIALS AND METHODS We retrospectively searched our patient records for fetuses with LDH in whom liver position, DV streaming and postnatal outcome information was available. 55 cases were found and divided into two groups: Group I fetuses exhibited abnormal DV streaming toward the right side of the heart; group II fetuses did not. Various prognostic and outcome parameters were compared. RESULTS 62 % of group I fetuses and 88 % of group II fetuses survived to discharge (p = 0.032). Fetoscopic tracheal balloon occlusion (FETO) was performed in 66 % of group I fetuses and 23 % of group II fetuses (p = 0.003). Postnatal ECMO therapy was performed in 55 % of group I fetuses and 23 % of group II infants (p = 0.025). Moderate to severe chronic lung disease in survivors was observed in 56 % of the survivors of group I and 9 % of the survivors of group II (p = 0.002). CONCLUSION Preferential streaming of the DV toward the right heart in human fetuses with left-sided diaphragmatic hernia was associated with a poorer postnatal outcome despite a higher rate of invasive pre- and postnatal procedures compared to fetuses without this flow abnormality. Specifically, abnormal DV streaming was found to be an independent predictor for FETO.
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MESH Headings
- Echocardiography, Doppler, Color
- Extracorporeal Membrane Oxygenation
- Female
- Gestational Age
- Heart Atria/abnormalities
- Heart Atria/diagnostic imaging
- Heart Defects, Congenital/diagnostic imaging
- Heart Defects, Congenital/embryology
- Heart Defects, Congenital/mortality
- Heart Defects, Congenital/therapy
- Hernia, Diaphragmatic/diagnostic imaging
- Hernia, Diaphragmatic/embryology
- Hernia, Diaphragmatic/mortality
- Hernia, Diaphragmatic/therapy
- Humans
- Infant, Newborn
- Persistent Fetal Circulation Syndrome/diagnostic imaging
- Persistent Fetal Circulation Syndrome/embryology
- Persistent Fetal Circulation Syndrome/mortality
- Persistent Fetal Circulation Syndrome/therapy
- Pregnancy
- Prognosis
- Retrospective Studies
- Survival Rate
- Ultrasonography, Prenatal
- Umbilical Veins/diagnostic imaging
- Vena Cava, Inferior/diagnostic imaging
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Eine fetoskopische Trachealballonokklusion verbessert Dimensionen und -durchblutung gesunder Lungenabschnitte bei Versagen aller anderer Maßnahmen bei riesiger CCAML. Z Geburtshilfe Neonatol 2013. [DOI: 10.1055/s-0033-1361297] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Korrelation von relativem fetalen Lungenvolumen und relativer Lung-to-Head-Ratio zu verschiedenen Gestationszeitpunkten bei Feten mit kongenitaler Zwerchfellhernie. ROFO-FORTSCHR RONTG 2013. [DOI: 10.1055/s-0033-1346208] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Quotient aus fetaler MR Lungen- und Ganzkörpervolumetrie zur Prognoseabschätzung insbesondere bei wachstumsretardierten Feten mit kongenitaler Zwerchfellhernie. ROFO-FORTSCHR RONTG 2013. [DOI: 10.1055/s-0033-1346207] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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[Prognosis and therapy of congenital diaphragmatic hernia depending on the time of clinical presentation - experience of a highly specialized referral centre]. KLINISCHE PADIATRIE 2013; 225:218-22. [PMID: 23599233 DOI: 10.1055/s-0033-1337980] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Congenital diaphragmatic hernia (CDH) is a diagnosis with multiple, mostly unknown origin. Therefore its clinical presentation is highly variable. In case of prenatal detection prognosis and amount of interventions in neonatal intensive care is predictable. The results reported by high volume centres for CDH improved continuously during the last years. In neonates suffering from CDH without prenatal diagnosis severe respiratory distress is the leading clinical sign. Presenting symptom of late-onset CDH can also be gastrointestinal problems. Due to more subtle symptoms late presenting CDH is more difficult to diagnose. Prognosis is good, but it still requires surgical intervention to alleviate the symptoms.
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Abstract
Pulmonary hypertension associated with congenital diaphragmatic hernia is still one of the major challenges in neonatal intensive care units. Several relevant pathways in its pathogenesis have been described and studied, but the absence of well-designed randomized controlled trials and the scattered data on the pharmacokinetics and pharmacodynamics of most of the drugs used in these patients hamper progress significantly. This review aims to give an overview of current management strategies in the antenatal and neonatal phase, and provides founded clinical recommendations.
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Gestationsalterabhängige Evaluation des MR-Lungenvolumens zur pränatalen Vorhersage von Überleben, Bedarf einer ECMO-Therapie und Entwicklung einer chronischen Lungenerkrankung bei Feten mit kongenita. ROFO-FORTSCHR RONTG 2012. [DOI: 10.1055/s-0032-1311023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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Quantitative Lungenperfusion bei 2-jährigen Kindern nach operierter kongenitaler Zwerchfellhernie: erste Ergebnisse bei 3T. ROFO-FORTSCHR RONTG 2012. [DOI: 10.1055/s-0032-1311025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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Intraindividueller Vergleich der prognostischen Wertigkeit der fetalen MR-Lungenvolumetrie vor und nach der 30. SSW bei Kindern mit kongenitaler Zwerchfellhernie. ROFO-FORTSCHR RONTG 2012. [DOI: 10.1055/s-0032-1311024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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Vergleich verschiedener Methoden der LHR-Bestimmung und ihrer prognostischen Aussagekraft hinsichtlich Überleben und ECMO-Notwendigkeit bei der fetalen Zwerchfellhernie. Z Geburtshilfe Neonatol 2012. [DOI: 10.1055/s-0032-1309112] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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Ergebnisse der späten perkutanen fetoskopischen Tracheal-Ballonokklusion bei Ungeborenen mit lebensbedrohlichen rechtsseitigen Zwerchfellhernien. Z Geburtshilfe Neonatol 2012. [DOI: 10.1055/s-0032-1309111] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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Serum Cytokine Levels in Neonates with Congenital Diaphragmatic Hernia. KLINISCHE PADIATRIE 2011; 223:414-8. [DOI: 10.1055/s-0031-1295436] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/15/2022]
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Leberverlagerung als unabhängiger Prognosefaktor bei Feten mit kongenitaler Zwerchfellhernie (CDH): eine 'matched pair'-Analyse. ROFO-FORTSCHR RONTG 2011. [DOI: 10.1055/s-0031-1279392] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Logistische Regressionsanalyse bezüglich der pränatalen Vorhersage der Entwicklung einer chronischen Lungenerkrankung bei kongenitaler Zwerchfellhernie basierend auf der fetalen MR Lungenvolumetrie. ROFO-FORTSCHR RONTG 2011. [DOI: 10.1055/s-0031-1279287] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Prediction of chronic lung disease, survival and need for ECMO therapy in infants with congenital diaphragmatic hernia: additional value of fetal MRI measurements? Eur J Radiol 2011; 81:1076-82. [PMID: 21458944 DOI: 10.1016/j.ejrad.2011.02.060] [Citation(s) in RCA: 46] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2010] [Revised: 02/15/2011] [Accepted: 02/23/2011] [Indexed: 11/30/2022]
Abstract
INTRODUCTION The lung-to-head ratio (LHR), measured by ultrasound, and the fetal lung volume (FLV), measured by MRI, are both used to predict survival and need for extra corporeal membrane oxygenation (ECMO) in infants with congenital diaphragmatic hernia (CDH). The aim of this study is to determine whether MRI measurements of the FLV, in addition to standard ultrasound measurements of the LHR, give better prediction of chronic lung disease, mortality by day 28 and need for ECMO. MATERIALS AND METHODS Patients with unilateral isolated CDH born between January 2002 and December 2008 were eligible for inclusion. LHR and FLV were expressed as observed-to-expected values (O/E LHR and O/E FLV). Univariate and multivariate analyses were performed. Receiver operating characteristic curves were constructed and areas under the curve (AUC) were calculated to determine predictive values. RESULTS 90 patients were included in the analysis. Combined measurement of the O/E LHR and O/E FLV gave a slightly better prediction of chronic lung disease (AUC=0.83 and AUC=0.87) and need for ECMO therapy (AUC=0.77 and AUC=0.81) than standard ultrasound measurements of the O/E LHR alone. Combined measurement of the O/E LHR and O/E FLV did not improve prediction of early mortality (AUC=0.90) compared to measurement of the O/E LHR alone (AUC=0.89). An intrathoracal position of the liver was independently associated with a higher risk of early mortality (p<0.001), chronic lung disease (p=0.007) and need for ECMO therapy (p=0.001). DISCUSSION Chronic lung disease and need for ECMO therapy are slightly better predicted by combined measurement of the O/E LHR and the O/E FLV. Early mortality is very well predicted by measurement of the O/E LHR alone. CONCLUSION Clinical relevance of additional MRI measurements may be debated.
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Fetale MR Lungen- und Ganzkörpervolumetrie zur Prognoseabschätzung bei kongenitaler Zwerchfellhernie (CDH). ROFO-FORTSCHR RONTG 2011. [DOI: 10.1055/s-0031-1279389] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Abstract
BACKGROUND During a period of 12 months 7 newborns with a partially severe fetopathy caused most probably by maternal sartan-intake in pregnancy were treated in 5 German teaching hospitals. Sartans antagonize the effect of angiotensin II at the AT1-receptor and are used to treat arterial hypertension. METHOD We presented 2 cases at the yearly GNPI meeting 2010 and we were informed about similar cases in other German teaching hospitals which we brought together in this publication. RESULTS In the presented cases, maternal sartan intake was noticed at different times in pregnancy and was in part discontinued some weeks before delivery. In all pregnancies oligohydramnios was present and fetal kidneys displayed a hyperechogenic structure on ultrasound. The newborns' postnatal course varied: oligohydramnios sequence with lung hypoplasia, arterial hypotension and renal insufficiency were the predominant problems of the first days of life. The majority (4/7) of infants did not survive this period, in other cases there was a complete (1/7) recovery of renal function whereas others survived with renal impairment (2/7), in part requiring chronic dialysis. Further distinctive features seen frequently were disturbances of cranial ossification and flaccid paralysis of hands and feet with deviations as well as sensorineural hearing loss. CONCLUSION These case reports again underline the hazardousness of maternal sartan intake with potential fatal outcome for the newborn. Though the use of sartans in pregnancy is contraindicated and several case reports of sartan induced fetopathies exist, the risk of sartan treatment generally seems to be underestimated.
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Actual Outcome in Infants with Congenital Diaphragmatic Hernia: The Role of a Standardized Postnatal Treatment Protocol. Fetal Diagn Ther 2011; 29:55-63. [DOI: 10.1159/000322694] [Citation(s) in RCA: 114] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2010] [Accepted: 11/11/2010] [Indexed: 11/19/2022]
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[Massive increase of foetal abdominal circumference due to hereditary polycystic kidney disease]. Z Geburtshilfe Neonatol 2010; 214:119-22. [PMID: 20574939 DOI: 10.1055/s-0029-1225641] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
Autosomal recessive polycystic kidney disease (ARPKD) is a rare condition with a poor prognosis. We report on a 30-year-old primagravid woman in the 34th) week of gestation who was admitted to our hospital. ARPKD of the foetus had been sonographically suspected since the 26th week of gestation. Ultrasound examination showed big polycystic kidneys on both sides. The non-consanguineous parents wanted a maximum therapy for the infant. Foetal digitalisation because of heart insufficiency and prophylactic lung maturation was started. In the further course, Doppler sonographic values worsened and a Caesarean section was performed in the 34th week of gestation at the demand of the parents and due to the expected problems in case of a vaginal delivery. The weight of the newborn was 3,780 g and the abdominal circumference was 50 cm. The newborn was intubated immediately after birth and artificial ventilation was performed. Extracorporeal membrane oxygenation was not possible due to the bad cardial condition. The boy died 16 h after delivery. The parents refused genetic examination and autopsy of the newborn. ARPKD is a severe disease that may have obstetric relevance, due to the massively increased abdominal circumference. Therefore, termination of pregnancy or preterm induction of labor should be considered in order to avoid Caesarean section. Additionally, early prenatal diagnosis with genetic analysis of PRKD1 in cases of suspected ARPKD can be helpful.
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Therapierefraktäres Kreislaufversagen aufgrund einer Fetopathie durch Olmesartan. KLINISCHE PADIATRIE 2010. [DOI: 10.1055/s-0030-1261553] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Serum cytokine levels in congenital diaphragmatic hernia: predictive impact for the need for extracorporeal membrane oxygenation? KLINISCHE PADIATRIE 2010. [DOI: 10.1055/s-0030-1261313] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Pulmonary artery sling: seltene Ursache des akuten respiratorischen Versagens beim Neugeborenen. KLINISCHE PADIATRIE 2010. [DOI: 10.1055/s-0030-1261647] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Langzeitergebnisse nach Carotisrekonstruktion, strukturelle Hirnveränderungen und neurologische Entwicklung nach ECMO-Therapie bei Neugeborenen mit kongenitaler Zwerchfellhernie. KLINISCHE PADIATRIE 2010. [DOI: 10.1055/s-0030-1261383] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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ECMO beim pädiatrischen ARDS. KLINISCHE PADIATRIE 2010. [DOI: 10.1055/s-0030-1261295] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Effektivität der fetoskopischen trachealen Ballonokklusion bei Neugeborenen mit Zwerchfellhernie. KLINISCHE PADIATRIE 2010. [DOI: 10.1055/s-0030-1261549] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Implication of Pulse Oxymetry Screening for Detection of Congenital Heart Defects. KLINISCHE PADIATRIE 2010; 222:291-5. [DOI: 10.1055/s-0030-1253391] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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A 20-year experience on neonatal extracorporeal membrane oxygenation in a referral center. Intensive Care Med 2010; 36:1229-34. [PMID: 20425105 DOI: 10.1007/s00134-010-1886-5] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2009] [Accepted: 03/29/2010] [Indexed: 11/29/2022]
Abstract
OBJECTIVE Advances in treatment of neonatal respiratory failure are responsible for a decline in the number of newborns treated with extracorporeal membrane oxygenation (ECMO). The aim of this study are to determine demographic changes, focusing on time of referral, diagnosis, and respiratory parameters in neonates put on ECMO. DESIGN Retrospective review. SETTING Tertiary ECMO center. PATIENTS A total of 321 neonates were treated with ECMO from January 1987 to December 2006. RESULTS Overall number of patients increased with every 5-year period, whereby congenital diaphragmatic hernia (CDH) was the most common diagnosis (53%), followed by meconium aspiration syndrome (MAS) (21%), sepsis and/or pneumonia (13%), and others such as persistent pulmonary hypertension of the newborn (PPHN), respiratory distress syndrome (RDS), or hypoplasia of the lung (13%). Worsening severity of illness as measured by ECMO duration and days on ventilator has to be stated for all diagnoses. Nevertheless, survival rate remained stable; both overall and diagnosis-specific mortality rates did not change significantly. Of all children, 67% survived to discharge or transfer, while best rates were seen for MAS (94%), followed by sepsis and/or pneumonia (69%), CDH (62%), and other diagnoses (43%). Concerning survival rate, no difference between inborn and outborn children occurred. However, between early- and late-referred children, a referral to the ECMO center during the first 24 h of life was associated with a significantly higher rate of survival (77% versus 54%, p = 0.0004), predominantly seen for CDH (67% versus 35%, p = 0.02). CONCLUSION We strongly recommend timely transfer to an ECMO center in patients with CDH who are at risk of circulatory failure.
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Serielle MRT-Lungenvolumetrie bei Feten mit kongenitaler Zwerchfellhernie (CDH) zur Beurteilung der pulmonalen Lungenhypoplasie im Verlauf der Schwangerschaft. ROFO-FORTSCHR RONTG 2010. [DOI: 10.1055/s-0030-1252788] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Pränatale Vorhersage der Entwicklung einer chronischen Lungenerkrankung bei kongenitaler Zwerchfellhernie basierend auf der fetalen MR Lungenvolumetrie. ROFO-FORTSCHR RONTG 2010. [DOI: 10.1055/s-0030-1252789] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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[Maturation of the autonomic nervous system: differences in heart rate variability at different gestational weeks]. Z Geburtshilfe Neonatol 2010; 214:11-4. [PMID: 20148384 DOI: 10.1055/s-0029-1225642] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
AIMS Heart rate variability (HRV) reveals information on the functional state of the autonomic nervous system (ANS). This study was initiated to assess the physiological and maturational development of the ANS by comparing HRV data of a large number healthy foetus of different gestational ages from the 24(th) to the 42(nd) week. METHODS Cardiotocogram (CTG) recordings of HRV of 172 healthy foetus (24-42 weeks' gestation) were performed to establish normative data. Frequency domain HRV parameters were computed in three frequency bands. RESULTS The gestational ages of the foetuses correlate with HRV. Lower gestational age in weeks showed lower frequency domain parameters than higher gestational age in weeks. The most significant differences were discerned for HRV parameters reflecting sympathetic activity in LF (low frequency) and VLF (very low frequency), due to the adrenergic system. CONCLUSIONS Maturation of the ANS is accompanied by increasing HRV with a pronounced increase of sympathetic activity. These changes are measurable by CTG recordings with a computer algorithm which can calculate short-term variability on the basis of CTG data. Problems of the CTG signal, as shown before, were the parameters of the time domain, which could only be well detected by ECG or foetal magnetocardiography (FMCG).
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Wie beeinflusst das Operationsverfahren die Rezidivrate bei Neugeborenen mit kongenitaler Zwerchfellhernie? Z Geburtshilfe Neonatol 2010. [DOI: 10.1055/s-0030-1248814] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Standardized postnatal management of infants with congenital diaphragmatic hernia in Europe: the CDH EURO Consortium consensus. Neonatology 2010; 98:354-64. [PMID: 20980772 DOI: 10.1159/000320622] [Citation(s) in RCA: 197] [Impact Index Per Article: 14.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/10/2010] [Accepted: 08/24/2010] [Indexed: 11/19/2022]
Abstract
Congenital diaphragmatic hernia (CDH) is associated with high mortality and morbidity. To date, there are no standardized protocols for the treatment of infants with this anomaly. However, protocols based on the literature and expert opinion might improve outcome. This paper is a consensus statement from the CDH EURO Consortium prepared with the aim of achieving standardized postnatal treatment in European countries. During a consensus meeting between high-volume centers with expertise in the treatment of CDH in Europe (CDH EURO Consortium), the most recent literature on CDH was discussed. Thereafter, 5 experts graded the studies according to the Scottish Intercollegiate Guidelines Network (SIGN) Criteria. Differences in opinion were discussed until full consensus was reached. The final consensus statement, therefore, represents the opinion of all consortium members. Multicenter randomized controlled trials on CDH are lacking. Use of a standardized protocol, however, may contribute to more valid comparisons of patient data in multicenter studies and identification of areas for further research.
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Fetal MR lung volumetry in congenital diaphragmatic hernia (CDH): prediction of clinical outcome and the need for extracorporeal membrane oxygenation (ECMO). KLINISCHE PADIATRIE 2009; 221:295-301. [PMID: 19707992 DOI: 10.1055/s-0029-1192022] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
BACKGROUND Despite the ultrasound (US) based lung-to-head ratio (LHR) and first results of fetal lung volume (FLV) determination in magnetic resonance imaging (MRI), there is no reliable prenatal parameter for the clinical course and outcome of fetuses with congenital diaphragmatic hernia (CDH), in particular for the need of extracorporeal membrane oxygenation (ECMO). PATIENTS AND METHOD MR FLV measurement was evaluated in 36 fetuses with CDH using T2-weighted half-Fourier acquisition single-shot turbo spin echo (HASTE) imaging. FLV and liver herniation, respectively, were correlated with survival and the need for ECMO therapy. A total of 18 healthy fetuses served as controls. MR FLV measurement was applied to predict survival and the need for neonatal ECMO therapy and to assess liver herniation as a prognostic parameter. RESULTS On MRI there was a highly significant correlation of the FLV and patients' survival (p=0.0001) and ECMO requirement, respectively (p=0.0029). Compared to normal controls mean FLV in infants who died was 10% (9.4+/-5.8 ml) and 32% in surviving infants (25+/-9.7 ml). Liver herniation significantly decreased lung volume and negatively impacted clinical outcome (p<0.0005). CONCLUSION The MR FLV is a strong predictor of survival in CDH patients. MR FLV measurements are also valuable to identify patients who may benefit from ECMO therapy. Upward liver herniation is the most important additional prognostic parameter.
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Begleitfehlbildungen bei fetaler Zwerchfellhernie. Z Geburtshilfe Neonatol 2009. [DOI: 10.1055/s-0029-1222792] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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O/E LHR and O/E FLV as predictors for chronic lung disease in infants with congenital diaphragmatic hernia. Z Geburtshilfe Neonatol 2009. [DOI: 10.1055/s-0029-1222811] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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