Browsing by Author "Pieper, C."

Now showing 1 - 3 of 3
  • Thumbnail Image
    Item
    The effectiveness and cost of exogenous pulmonary surfactant replacement therapy
    (Health & Medical Publishing Group, 1995) Smith, J.; Pieper, C.; Gie, R. P.
    The articles"" recently published on surfactant replacement therapy (SR1) in the treatment of newborn infants with hyaline membrane disease (HMD) being ventilated in a country with limited health resources are both timeous and urgently needed. Surfactant, being an expensive drug, needs to be administered in the most costeffective fashion and for this reason research guidelines for its administration in South Africa are needed. We are concerned that the discussions of this series of articles do not sufficiently emphasise their limitations, as well as the enormous impact of SRT on survival rates and other neonatal morbidities in newborn infants ventilated with HMD.
  • Thumbnail Image
    Item
    The necessity for T-cryptantigen activation screening in babies with necrotising enterocolitis
    (Health & Medical Publishing Group, 1996) Kirsten, G. F.; Smith, J.; Pieper, C.; Bird, A.; Wessels, G.; Riphagen, S.; Moore, S.
    Objective. To determine the prevalence of T-cryptantigen activation (TCA) and its predictive value for severity of necrotising enterocolitis (NEC) in babies. Study design. Prospective descriptive. Study population. Thirty-four babies with NEC were prospectively screened for TCA at Tygerberg Hospital over a 6-month period. TGA screening was done by testing for red blood cell agglutination by the common peanut lectin, Arachis hypogea. Once TCA was confirmed, only washed red cells were administered to the babies and plasma-containing blood products were avoided. NEC was divided into suspected NEC (stage 1), classic NEC (stage 2) and fulminant NEC (stage 3). Main outcome measures. Prevalence of TCA in babies with various stages of NEC; the association between TCA and bowel necrosis, need for surgery and mortality. Results. TCA was positive in 8 (24%) of the babies in this study. Six babies (18%) had stage 1 NEC, 10 (29%) had stage 2 NEC and 18 (53%) had fulminating or stage 3 NEC. All 18 babies with stage 3 NEC required surgery and TCA was present in 8 (47%) of them. Twelve babies (35%) died, 3 with TCA and 9 with no TCA. Babies with TCA had portal venous gas on abdominal radiographs (P = 0.037) and stage 3 NEC (P = 0.003) more often than babies with no TCA. Conclusions. A strong association was noted between TCA and the fulminant form of NEC with bower necrosis. TCA in a baby with NEC should alert the surgeon to the possibility of severe disease and the need to avoid plasma-containing blood products. Blood banks are urged to introduce routine screening for TCA in all babies with NEC.
  • Thumbnail Image
    Item
    Phototherapy and exchange transfusion for neonatal hyperbilirubinaemia : national academic hospitals' consensus guidelines for South African hospitals and primary care facilities
    (Health and Medical Publishing Group (HMPG), 2006-09) Horn, A. R.; Kirsten, G. F.; Kroon, S. M.; Henning, P. A.; Moller, G.; Pieper, C.; Adhikari, M.; Cooper, P.; Hoek, B.; Delport, S.; Nazo, M.; Mawela, B.
    The purpose of this document is to address the current lack of consensus regarding the management of hyperbilirubinaemia in neonates in South Africa. If left untreated, severe neonatal hyperbilirubinaemia may cause kernicterus and ultimately death and the severity of neonatal jaundice is often underestimated clinically. However, if phototherapy is instituted timeously and at the correct intensity an exchange transfusion can usually be avoided. The literature describing intervention thresholds for phototherapy and exchange transfusion in both term and preterm infants is therefore reviewed and specific intervention thresholds that can be used throughout South Africa are proposed and presented graphically. A simplified version for use in a primary care setting is also presented. All academic heads of neonatology departments throughout South Africa were consulted in the process of drawing up this document and consensus was achieved.