Search

The blood flow velocities in the basal cerebral arteries can be recorded at any age by transcranial Doppler sonography. We examined nine children with either initial or developing clinical signs of brain death. Soon after successful resuscitation increased diastolic flow velocities indicated a probable decrease in cerebrovascular resistance; this was of no particular prognostic importance. As soon as there was a clinical deterioration, there was a reduction in flow velocities with retrograde flow during early diastole, probably due to an increase in cerebrovascular resistance; this indicated a doubtful prognosis. In eight of the nine children with clinical signs of brain death a typical reverberating flow pattern was found, which was characterised by a counterbalancing short forward flow in systole and a short retrograde flow in early diastole. This indicated arrest of cerebral blood flow. One newborn showed normal systolic and end diastolic flow velocities in the basal cerebral arteries for two days despite clinical and electroencephalographic signs of brain death. Shunting of blood through the circle of Willis without effective cerebral perfusion may explain this phenomenon. No patient had the typical reverberating flow pattern without being clinically brain dead. Transcranial Doppler sonography is a reliable technique, which can be used at the bedside for the confirmation or the exclusion of brain death in children in addition to the clinical examination. [ABSTRACT FROM AUTHOR]

Thrombosis of the great arteries rarely occurs in the neonate. We report a case of thrombosis of the aortic arch, the brachiocephalic truncus, the left carotid and subclavian arteries, seen in a one-day-old neonate. The clinical findings were at first misdiagnosed as interrupted aortic arch syndrome, though, in retrospect echocardiography was very suggestive of the correct diagnosis. On the basis of the histological examination we assume, as the most likely cause for thrombosis, an aortitis in the prenatal period. Following thrombectomy and Gore-Tex bypass from the ascending to the descending aorta, combined with ligature of a PDA, the child developed a low output state and died on the table. The postmortem examination revealed that the latter was due to multiple infarcts of the left ventricular myocardium.

Xipho-omphalopagus twins with a pericardial bridge, extended liver tissue union and considerable intestinal herniation from one abdominal cavity to the other were separated successfully at the age of three months. Special diagnostic procedures including cardiac and abdominal sonography, catheterism of the umbilical vein with portal angiography, radionucleotide liver and bile duct imaging and separate oral glucose tolerance tests provided important information for perioperative and surgical patient management. Relevant items for determination of the favourable data and method of surgery are discussed.

Neonatal arterial occlusion is a rare condition of obscure aetiology, when not associated with catheterization of the umbilical artery. Embolic occlusion of the left iliac artery was diagnosed in a preterm baby weighing 1000 g, who presented with a cold, pale and pulseless left leg on the 6th day of life. Surgical embolectomy was contraindicated in this very small baby. Fibrinolytic therapy with urokinase and administration of low-dose heparin resulted in a complete recovery of skin colour, skin temperature and blood pressure. After three weeks of urokinase therapy, no pulse differences could be detected between right and left femoral and popliteal arteries by Doppler examination, and only minimal differences were present between right and left tibial arteries.