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Objectives: (a) To investigate in a newborn animal model whether nasopharyngeal temperature is more closely related to epidural brain temperature than rectal temperature and (b) to investigate in human neonates whether measurement of nasopharyngeal temperature is dependent on the measurement site and other conditions., Design and Setting: (a) Animal experiment in newborn piglets, at an institute for surgical research. (b) Prospective study in human neonates, at a neonatal intensive care unit of a tertiary care university hospital. ANIMALS AND PATIENTS: (a) Nineteen tracheostomized ventilated newborn piglets. (b) Twenty-two spontaneously breathing human newborns nursed either in an incubator or a cot., Measurements and Results: (a) In the piglets nasopharyngeal temperature (Tnasoph) measured at the nose-ear distance, defined as distance from the inner brim of the nostril to the tragus and inner rim of the meatus accusticus, most closely reflected epidural temperature (Tepidur) at the epidural surface (r2 = 0.89), followed by skin temperature at the temple, rectal temperature (Trectum) at 2 cm depth, and esophageal temperature (Tesoph) in the middle esophagus. Tnasoph did not significantly differ before and after tracheostomy. (b) In the newborns Tnasoph was significantly lower than Trectum. Measurements of Tnasoph at nose-ear distance within a feeding tube had a high precision and were unaffected by breathing or head turning. A nasopharyngeal probe was imaged by magnetic resonance imaging in four newborns of various body weight; its tip when inserted to a depth equal to nose-ear distance was anatomically closest to the brain base but separated from it by tissue layer 2.2 cm thick., Conclusions: Tnasoph measured at a position anatomically closest to the brain reflects epidural brain temperature more closely than Trectum. When measured at nose-ear distance it is unaffected by breathing or head turning. Measuring Tnasoph within a feeding tube and standardizing the measuring position is crucial for its use as brain temperature analogue.

Objective: To assess the physiological effects and adverse side-effects of induced hypothermia in asphyxiated newborn infants as a base for future controlled, randomized trials., Design: Retrospective chart analysis with historical controls., Setting: Tertiary neonatal intensive care unit of the University of Cape Town, South Africa., Patients: Twenty-one asphyxiated newborns treated with induced hypothermia between September 1997 and February 1998 were compared to 15 asphyxiated newborn infants admitted during March to August 1997. The two groups of infants did not differ in patient characteristics or severity of asphyxia (comparison group vs hypothermia group: Apgar at 5 min 5.3 +/- 3.1 vs 5.2 +/- 2.3; base deficit 15.6 +/- 6.3 vs 11.5 +/- 7.2 and Thompson neurological score 10.1 +/- 4.0 vs 9.1 +/- 3.6)., Interventions: Hypothermia was induced by placing a cap formed from coolpacks, at a temperature of about 10 degrees C, around the head of asphyxiated newborn infants to maintain the nasopharyngeal temperature between 34 and 35 degrees C. Hypothermia was maintained for 3 days., Measurements and Results: In the comparison group 4/15 infants died and in the hypothermia group 4/21 died. Hypothermia was induced at a median of 6.0 h (range 45 min to 53 h) post-partum, maintained for an average of 80 h (median 77.5 h, range 22 to 185 h) and resulted in an average nasopharyngeal temperature of 34.6 +/- 0.5 degrees C. Hypothermia reduced abdominal skin temperature from 36.3 +/- 0.5 degrees C to 35.1 +/- 0.35 degrees C (p = 0.0001), heart rate from 139 +/- 21 to 121 +/- 13 beats/min (p < 0.0001) and respiratory rate from 67 +/- 11 to 56 +/- 9 breaths/min (p = 0.005). Neither episodes of bradycardia nor dysrhythmias, apnea, clinical signs of bleeding diathesis in the hypothermia group nor differences in the frequency of hypoglycaemia and urinary output, blood in urine or tracheal secretion between the two groups were observed. In the survivors the neurological score, assessed at day 2 and day 5, fell from 10.9 +/- 3.5 to 8.1 +/- 4.5 in the hypothermia group and rose from 8.1 +/- 2. 5 to 9.0 +/- 3.1 in the comparison group (p = 0.003)., Conclusions: Adverse effects of mild hypothermia induced for 3 days in asphyxiated newborns were significantly less than expected from previous reports on neonates with accidental hypothermia.

Objective: Recent studies have suggested direct pulmonary effects of furosemide in asthmatics and infants with bronchopulmonary dysplasia. We tested the hypothesis that intratracheally administered furosemide also increases respiratory compliance in children after cardiac surgery, and investigated whether furosemide has a topical and/or systemic action., Study Design: Prospective study with intra-individual control. In twelve infants and toddlers (age: 10 +/- 8 months, weight: 6.9 +/- 3 kg) mechanically ventilated for compromised lung mechanics after cardiac surgery, 0.5 mg/kg furosemide was intratracheally administered to the lungs. Lung mechanics were serially assessed using a computerised system (Sensormedics 2600) during a 2 h control and 2 h intervention period. Urine output was measured by an indwelling bladder catheter and levels of furosemide were determined in blood and tracheal aspirates., Results: Static compliance improved within 30 min in all patients, reached a maximum of 44 (20-85)% above baseline and remained improved throughout the study (p < 0.05). An immediate, short and significant diuretic effect of intratracheally applied furosemide was observed. Furosemide levels 1 h after intervention were 795 ng/ml in the blood and 431 micrograms/ml (i.e. 1000-fold higher) in the tracheal aspirate. Changes in compliance were correlated only to urine output values over the 2 h (r = 0.82, p = 0.044, n = 9) after furosemide administration., Conclusion: We conclude that intratracheally applied furosemide improves static compliance in infants and toddlers with compromised lung mechanics after cardiac surgery. We demonstrated that furosemide is absorbed from the lung and has a systemic effect within 15 min after its intratracheal instillation.

A previously healthy 2 year old female child developed fever of unknown origin recurring in monthly cycles. The periodic fever attacks, family history and ethnologic criteria were in agreement with familial mediterranean fever, although further more major symptoms were missing. It was highly unusual to find repeatedly raised levels of angiotensin I converting enzyme, a finding previously not described in literature. Excluding any other differential diagnosis by intensive investigations, together with a positive metaraminol provocation test, the diagnosis of a rare, monosymptomatic variant of familial mediterranean fever was proposed. Amyloidosis was excluded by rectal biopsy. Monosymptomatic familial mediterranean fever is very seldom. We suggest to measure routinely angiotensin I converting enzyme for further evaluation of our findings.

Postterm and growth-retarded fetuses share a common problem which can be characterized by a discrepancy between the supply of oxygen and nutrients to, and the demand of the fetus. But, this "insufficient" placental exchange function may also extend to and affect its thermal homeostasis; e.g. when the capacity of convective (placenta) pathways is shifted towards conductive (surface) pathways for heat loss. Therefore, fetal scalp heat flux measurements, where heat serves as an intrinsic tracer for metabolic activity and placental exchange function, promised a new kind of information. In 81 pregnant women during labor we measured fetal scalp heat flux by means of an heat flux transducer attached to the fetal head and after the cervix had dilated to 3 cm. In the healthy fetuses we found a positive linear relationship between scalp heat flux and different anthropometric variables such as body length (r = 0.432, n = 65, P less than 0.01), head circumference and gestational age. In comparison, postmature and growth-retarded fetuses showed higher heat flux values than appropriately grown fetuses of the same length head size and gestational age. Moreover, in those fetuses scalp heat flux decreased by approximately 4 watt/m2 during the second stage and differed in this regard from the control group who showed stable values during labor and delivery. We conclude that scalp heat flux measurements may indicate disturbances of placental exchange before acute hypoxia occurs.

The possible existence of a chemical substance with cross-reactivity to digoxin antibodies in the neonatal serum or plasma was investigated in this study. Our data show that in contrast to previous reports, the levels of a "digoxin-like substance" in the serum or plasma of healthy newborns are negligible and probably would not affect the reliability of digoxin radioimmunoassay tests.

Fifty children with malignant diseases were vaccinated against hepatitis B. Twenty-nine children suffered from leukaemia or non-Hodgkin's lymphoma; 14 of these were on intensive chemotherapy (group I) and 15 were without intensive therapy (group II). The other 21 children had various forms of solid tumours, 14 of them were on intensive therapy (group III) and 7 were without intensive therapy (group IV). To evaluate the immune response, we determined antibody titres over a period of more than 14 weeks after the first vaccination. As 22 out of 50 patients had received passive immunisation together with either the first or the first and second vaccination, antibody titres at the 14th and 18th week (i.e. more than 10 weeks after passive immunisation) were used to evaluate the vaccination results. An antibody titre of greater than or equal to 10 mIU/ml was considered to be a positive response. All patients of group IV, but only 4 out of 14 in group III, 4 out of 15 in group II, and 0 out of 14 in group I produced antibody titres higher than 50 mIU/ml. In contrast to the full response in group IV, two-thirds of all other patients had no immune response (less than 10 mIU/ml). Based on our experience we recommend vaccinating patients suffering from solid tumours and receiving no intensive therapy (group IV) against hepatitis B and protecting all the other children with malignant diseases by passive immunisation, if necessary.

A case of chronic fetomaternal bloodtransfusion with signs of heart failure is described. More than 200 ml blood were lost into the mother's circulation. Heartfailure did not fully account for the marked enlargement of the liver and the slight splenomegoly, so that reactivation of the extramedullary erythropoesis presumably was an additional causative factor for it.

In 51 deliveries between the 27th and 41st week of gestation amniotic fluid was collected ante partum and surface tension measured with the Wilhelmy-balance. The values obtained was compared with the respiratory compliance of the newborns determined immediately post partum. A highly significant correlation (r = -0.83, p less than 0.001) was ascertained. This finding permits a precise prediction of the pulmonary function of the newborn, especially of the especially of the severity degree of a respiratory distress syndrome already by means of amniotic fluid analysis. The less significant correlation between surfactant activity in the amniotic fluid and gestational age (r = -0,48, p less than 0.01) permits the conclusion that pulmonary maturation represents a dynamic process depending upon a variety of known and unknown factors besides the duration of gestation. On the basis of the results of this study the intrauterine and extrauterine fetal risks associated with placental insufficiency can now be estimated more accurately.