Karel J. Van Acker

Congenital streptococcal toxic shock syndrome with absence of antibodies against streptococcal pyrogenic exotoxins

Congenital infection with group A beta-hemolytic streptococcus was complicated by toxic shock syndrome in a neonate. We hypothesize that the severity of the clinical syndrome was related to the streptococcal pyrogenic exotoxin in the absence of corresponding antibodies. The outcome may have been favorably influenced by the antibodies to streptococcal pyrogenic exotoxin present in the immunoglobulins given as treatment.

Stress Responses to Tilting and Odor Stimulus in Preterm Neonates After Intrauterine Conditions Associated With Chronic Stress

The effect of conditions linked with chronic intrauterine stress (CIUSTR) on the function of the autonomic nervous system (ANS) has not yet been evaluated systematically in premature neonates. We hypothesized that intrauterine stress deranges the function of the ANS as assessed by the clinical responses to certain stimuli. Twenty-one premature neonates who had suffered from CIUSTR, such as maternal smoking, maternal hypertension, and intrauterine growth retardation (STR Group), and 30 neonates who had not suffered from those intrauterine conditions were studied (C Group). They were exposed to a 10-s postural change test and a 10-s odor test. Heart rate, respiratory rate, and noninvasive blood pressure were measured at 15 s, 30 s, and at 1, 2, 3, 4, and 5 min after the test. The overall reaction pattern after the postural change test was mainly sympathetic, and was more pronounced in the STR Group. After the odor test, the overall response was parasympathetic but less pronounced in the STR Group. We, therefore, speculate that neonates who suffer from conditions known to be associated with CIUSTR exhibit a higher adrenergic state with little reserve to counteract stressful situations that may make them more vulnerable.

Ethical aspects of cardiopulmonary resuscitation in premature neonates: where do we stand?

Advances in diagnosis, techniques, therapeutic interventions, organisation of perinatal care, and socio-economic factors have all contributed to the survival after resuscitation and intensive care of neonates with extremely low birth weight and gestational age. While morbidity during the first years of life in those infants does not increase, at school age multiple dysfunctions may become apparent. What are the limits of intensive care for the newborn? Is it right to use extreme technical and economic measures for neonates with a borderline chance of survival? What is justifiable for the neonate, the family, the society and how does legislation interfere in a decision process which involves starting, stopping or continuing intensive care? A short historical overview for the care of the newborn is given, followed by the outcome after resuscitation and treatment of the very low birth weight infant. Published management strategies and recommendations are discussed.

ONTOGEMY OF NEUROCHEMICAL MARKERS IN THE ADRENAL MEDULLA OF THE PIG

Within the framo of a study on the influence of intra-uterine hypoxia on the maturation of the adrenal medulla, the ontogeny of different neurochemical marker o in the adrenal modulla of the pig was studied. Obtained data are the result of measurements on the extract of the adrenals of all piglete from one litter. Gestational age was determined according to the crown-rump length of the piglets (full term being about day 114 of gestation). Adrenal from pig fetuses with 16 different gestational ages between 43 and 100 daya were investigated. The amount of adrenaline (A) increases with gestational age. The noradrenaline (NA) content as well as the dopamine-β-hydraxylane (DβH) content augment steeply at about day 60, are maximal at about day 75 and decline slightly towards term. The ratio A/NA rises with gestational age. The chromogranin A (CgA) content in maximal at about day 65 and also decreases slightly towarde term (Table).Conclusion: In the pig adrenal medulla A, NA and CgA synthesis early in gestation, before adrenal innervation is completely (around birth). This suggests an important role of the adrenal in the regulation of hemodynamics prior to and shortly after birth.