Intracraniële bloedingen bij preterm geborenen: een echografische studie

In de afgelopen decennia heeft de medische zorg voor de zieke pasgeborene zich ontwikkeld tot een zeer gespecialiseerd vakgebied (Cockburn en Drillien 1974, Avery 1981, Avery en Taeusch 1984, Fanaroff en Martin 1983). Door een explosieve toename van de kennis van de foetale en neonatale fysiologie (Dawes 1968, Smith en Nelson 1976) en door ontwikkelingen in de medische technologie verbeterde het inzicht in de adaptatieproblematiek van de pasgeborene en werd het mogelijk stoornissen tijdig te herkennen en te behandelen. Dankzij de ontwikkeling van methoden ter bewaking en ondersteuning van vitale functies bleken ernstige ventilatoire en circulatoire problemen in vele gevallen adequaat te kunnen worden opgevangen (Gregory et al. 1971, Reynolds 1971, Reynolds en Taghizadeh 1974, Heicher et al. 1981). Door nieuw verworven kennis over immuniteit en bacteriële kolonisatie en de ontwikkeling van bruikbare antibiotica werd een effectieve bestrijding van levensbedreigende infecties meestal mogelijk. Dankzij nieuwe kennis over stofwisseling en lichaamssamenstelling konden een toenemend aantal stoornissen in het interne milieu tijdig worden gesignaleerd en verholpen. Ook de obstetrische zorg maakte in de afgelopen jaren belangrijke ontwikkelingen door. Het werd mogelijk meer dan 100 verschillende hereditaire ziekten in een vroeg stadium van de zwangerschap door middel van vruchtwateronderzoek bij de foetus vast te stellen. In geval van therapeutisch niet-beinvloedbare ziekte kan dan de geboorte van een kind met ernstige defecten worden voorkomen. De toestand van de foetus in utero bleek met behulp van echografische technieken en de cardiotocografie beter te kunnen worden beoordeeld (Donald et al. 1958, Hon 1958, Taylor et al. 1967, Campbellen Dewhurst 1971, Dunne en Johnson 1979). Het bleek mogelijk de longrijping van het ongeboren kind door toediening van corticosteroiden aan de moeder te bevorderen (Liggins en Howie 1972). Met behulp van medicamenteuze weeënremming en weeënstimulatie werd het mogelijk het tijdstip van een bevalling in hoge mate te beïnvloeden. Bovenstaande en andere pediatrische en obstetrische verworvenheden hadden een belangrijke invloed op de mortaliteit en morbiditeit van de pasgeborene. Tussen 1960 en 1980 daalde de perinatale sterfte in Nederland van 27 per 1000 levendgeborenen tot 11 per 1000. In Finland daalde de perinatale sterfte plaatselijk zelfs tot minder dan 10 per 1000, een getal dat de geschatte minimaal mogelijke mortaliteit van 8.5 per 1000 dicht nadert. De invloed van de neonatale intensieve zorg op de daling van de perinatale mortaliteit is met name gelegen in de verbeterde overlevingskansen van neonaten met een geboortegewicht onder de 1500 gram. Deze minder dan 1% van alle pasgeborenen tellende groep omvat 30 tot 50% van de opnamen op een afdeling voor neonatale intensieve zorg. Dankzij de geavanceerde medische techniek steeg de overlevingskans van deze groep patiënten van ongeveer 30% in 1960 tot ongeveer 70% in 1980 (Stewart et al. 1981). De sterk verbeterde mortaliteitscijfers gingen gepaard met een geringe daling van het percentage ernstig gehandicapte overlevenden. Tien tot 15% van de overlevenden lijden echter aan min of meer ernstige motorische, zintuiglijke, of intellectuele stoornissen

Do ethnobotanical and laboratory data predict clinical safety and efficacy of anti-malarial plants?

<p>Abstract</p> <p>Background</p> <p>Over 1200 plant species are reported in ethnobotanical studies for the treatment of malaria and fevers, so it is important to prioritize plants for further development of anti-malarials.</p> <p>Methods</p> <p>The “RITAM score” was designed to combine information from systematic literature searches of published ethnobotanical studies and laboratory pharmacological studies of efficacy and safety, in order to prioritize plants for further research. It was evaluated by correlating it with the results of clinical trials.</p> <p>Results and discussion</p> <p>The laboratory efficacy score correlated with clinical parasite clearance (r_s=0.7). The ethnobotanical component correlated weakly with clinical symptom clearance but not with parasite clearance. The safety component was difficult to validate as all plants entering clinical trials were generally considered safe, so there was no clinical data on toxic plants.</p> <p>Conclusion</p> <p>The RITAM score (especially the efficacy and safety components) can be used as part of the selection process for prioritising plants for further research as anti-malarial drug candidates. The validation in this study was limited by the very small number of available clinical studies, and the heterogeneity of patients included.</p

No association between glucocorticoid receptor polymorphisms and long-term respiratory outcome after very preterm birth

Developmen

Gender differences in respiratory symptoms in 19-year-old adults born preterm

Objective: To study the prevalence of respiratory and atopic symptoms in (young) adults born prematurely, differences between those who did and did not develop Bronchopulmonary Disease (BPD) at neonatal age and differences in respiratory health between males and females. Methods: Design: Prospective cohort study. Setting: Nation wide follow-up study, the Netherlands. Participants: 690 adults (19 year old) born with a gestational age below 32 completed weeks and/or with a birth weight less than 1500g. Controls were Dutch participants of the European Community Respiratory Health Survey (ECRHS). Main outcome measures: Presence of wheeze, shortness of breath, asthma, hay fever and eczema using the ECRHS-questionnaire

EFFECTS OF BIOLOGICAL AND SOCIAL-FACTORS ON THE COGNITIVE-DEVELOPMENT OF VERY-LOW-BIRTH-WEIGHT CHILDREN

Objective. To investigate the effects of biological and social factors on the cognitive development of very low birth weight children, a longitudinal follow-up study was conducted from birth to 3.6 years of age. Methodology. The study group consisted of a cohort of 79 surviving high-risk, very low birth weight infants. Neonatal cerebral ultrasonographic findings and a neurological score were used as indicators of biological risk. A sociodemographic risk score and the Home Observation for Measurement of the Environment inventory were used as indicators of social risk. Cognitive development was assessed at ages 1 and 2 years by the Mental scale of the Bayley Scales of Infant Development and at age 3.6 years by the Kaufman Assessment Battery for Children. Results. The mean mental index at 1 year of age was 96 (SD 19), at 2 years of age 86 (SD 26), and at 3.6 years of age for intelligence 87 (SD 13) and for achievement 86 (SD 14). In a stepwise multiple regression analysis of biological as well as social factors, the neurological score alone was the best predictor for cognitive development at 1 year of age, explaining 46% of the variance. From 2 years of age onward, the best predictors for cognitive development were the neurological score together with the home environment, explaining 46% of the variance for the Mental Developmental Index at age 2, 34% for intelligence, and 56% for achievement at age 3.6. Conclusions. Children at high biological risk were able to catch up on their cognitive delay in a highly stimulating home environment. Children at low as well as high biological risk in a less stimulating home environment showed a decline in cognitive development. For these children, early intervention programs might be important in the prevention of cognitive disabilities

Systematic review of the optimal fluid for dilutional exchange transfusion in neonatal polycythaemia

OBJECTIVES: Several studies have shown the efficacy of dilutional exchange transfusion (DET) in reducing haematocrit (Ht) and relieving clinical symptoms in neonatal polycythaemia. We conducted a systematic review to determine the efficacy of crystalloid versus colloid solutions used in DET in an effort to identify the best solution to replace red blood cells. METHODS: The Cochrane Library, MEDLINE, and EMBASE were searched for relevant randomised controlled trials. Quality assessment and data analysis were performed using the methods and software of the Cochrane Collaboration. Relative risk (RR) and weighted mean difference (WMD) were calculated as measures of effect for categorical and continuous outcome data, respectively. Ninety five percent confidence intervals (95% CI) were calculated and a fixed effect model was used for meta-analysis. RESULTS: Six studies with a total of 235 newborns matched our inclusion criteria. When comparing crystalloid and colloid replacement solutions for DET, there was a clinically unimportant difference in Ht at 2-6 h and at 24 h in favour of colloidal solutions (WMD 2.29% (95% CI 1.28 to 3.31) and 1.74% (95% CI 0.80 to 2.68), respectively). This difference in post DET Ht was more evident when normal saline was compared to plasma but absent when normal saline was compared to 5% albumin. CONCLUSION: There is little difference in effectiveness between plasma, 5% albumin, and crystalloid solutions. Since normal saline is cheap, readily available, and does not carry the potential risk of transfusion associated infection, normal saline is the optimal dilutional fluid for exchange transfusion in polycythaemic neonate