Die bronchopulmonale Dysplasie Frühgeborener

In very preterm neonates, bronchopulmonary dysplasia (BPD) complicates the course of respiratory distress syndrome, i.e., primary surfactant deficiency in a structural immature lung. In Germany, about 11 000 preterms having a gestational age below 32 weeks are born and treated in neonatal intensive care units per year. Within this high risk group, the rate of BPD is about 15%. Relevant prenatal risk factors include intrauterine inflammatory fetal reaction as a consequence of ascending maternal infections, intrauterine growth retardation apart from the main risk factor immaturity. Postnatal risk factors include genetic predisposition, mechanical ventilation, infections and hemodynamically relevant patent ductus arteriosus.Preventive measures include intratracheal surfactant administration; new studies indicate preventive effects of caffeine, vitamin A and hydrocortisone in a subgroup of neonates with prenatal fetal inflammatory response.Due to long-term detrimental effects of BPD on lung function and psychomotor development, further experimental and clinical studies are mandatory in order to continue to reduce the BPD rate.     

Evaluation of tetracycline on theophylline disposition in patients with chronic obstructive airways disease

Theophylline is a commonly used bronchodilator in the treatment of chronic obstructive airways disease (COAD) with a narrow therapeutic range of 10 to 20 micrograms/ml. Patients with COAD frequently receive concomitant antibiotic therapy for respiratory infections. This study evaluated the effect of tetracycline therapy on theophylline disposition in adults with COAD. Six males (five nonsmokers) with obstructive ventilatory defects were studied in two phases: control, after receiving sustained-release theophylline in the same dosage regimen for four days, and treatment, after receiving tetracycline 250 mg po qid for five days in addition to theophylline. During each phase, 10 blood samples were obtained over one dosing interval and analyzed for theophylline content. The following pharmacokinetic parameters were calculated: Cmin, Cmax, Css, percentage fluctuation and Cl. Differences for each value were tested as paired data with Student's two-tailed t-test. When all patients were evaluated, the only statistically significant difference was for Cmax. However, when the five nonsmokers were evaluated separately, differences were observed for Css (micrograms/ml; mean +/- SD) 9.3 +/- 3.0, control, and 10.6 +/- 3.8, treatment (p = 0.041); and for Cl [( ml/h]/kg; mean +/- SD) 49.0 +/- 11.1, control, and 43.6 +/- 10.2, treatment (p = 0.019). This study demonstrates that tetracycline may weakly inhibit theophylline clearance in nonsmoking adults with COAD.     

Influence of the histamine control on skin reactivity in skin testing

We investigated the effect of the histamine control (1 mg/ml) on the results of skin prick and intradermal testing with bee and wasp venom. Skin tests were done on the patients' forearms: on the right arm the histamine control and the bee venom dilutions, on the left arm the wasp venom dilutions only, at distances of 4-5 cm. In intradermal testing 11 (9%) of 122 patients showed a positive wheal and flare reaction to the bee venom solution positioned next to the histamine control. The subsequent solutions in higher concentrations did not produce any skin reactions. The results of intradermal testing with bee venom did not occur in intradermal testing with wasp venom or in skin prick testing with both allergens. Our results show clearly that in skin prick tests a distance of 4-5 cm is sufficient to avoid false positive skin reactions. However, using the same distance in intradermal testing showed that histamine affects the skin reactions produced by adjacent allergen solutions. Therefore false positive results may occur.     

Topiramate‐induced nephrolithiasis

Nephrolithiasis is a less common side effect of the antiepileptic drug topiramate. We report the case of a 3‐year‐old boy who presented to the emergency department with abdominal pain; examinations revealed a large calcification in the left kidney. Regular ultrasound examinations are recommended in children using topiramate.     

Peritoneal dialysis in the treatment of metabolic crises caused by inherited disorders of organic and amino acid metabolism

Four neonates who presented with coma secondary to hyperammonaemia resulting in central respiratory failure were treated with peritoneal dialysis for between 16 and 120 hours. Underlying diseases were maple-syrup-urine disease, propionic acidaemia and citrullinaemia in two patients. Clinical improvement was observed in three patients within 16 to 72 hours after institution of peritoneal dialysis. Biochemical analysis revealed a rapid reduction in plasma concentration of leucine, isoleucine and valine as well as their alpha-keto-analogues in the infant suffering from maple-syrup-urine disease. Correction of ammonia, glycine, alanine and propionic acid concentrations was observed in the infant with propionic acidaemia 24-72 hours after institution of peritoneal dialysis. Severe hyperammonaemia (1,000-2,500mumol/l) in two infants with citrullinaemia before peritoneal dialysis was treated successfully in one infant; whereas the second infant showed no clinical improvement despite amelioration of biochemical parameters. Glucose-absorption from peritoneal dialysis solution was in the range of 216-441 mg/kg/h.     

Effect of a bovine surfactant in very low birth weight premature infants with congenital pneumonia

15 VLBW-infants, who were classified to suffer from congenital pneumonia, were treated with a bovine surfactant. Mean gestational age was 25.5 weeks (range 23-27 weeks), mean birth weight was 700 g (range 530-930 g). Surfactant was instilled intratracheally at a mean dose of 41 mg/kg body weight (b.w.) (range 30-50 mg) 8 h after birth (range 6-12 h), if the fraction of inspired oxygen (FiO2) was greater than 0.5 or the peak inspiratory pressure (PIP) was greater than 22 cm H2O (b.w. less than 750 g) or greater than 25 cm H2O (b.w. 751-1000 g). Retreatment up to a total maximum of 4 doses of surfactant was permitted. Surfactant treatment reduced FiO2 from a pretreatment value of 0.79 to 0.50 one hour after application, however, 12 h later FiO2 had increased again to 0.75. Ventilation pressures showed a slight decrease during 12 h after surfactant treatment. 6 infants received 1 dose, multiple doses were given to 9 infants. 5 infants survived, 4 infants died from respiratory failure, 4 from sepsis and 2 from severe intracranial haemorrhage.