Browsing by Author "Pieper, C. H."

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    Born too soon, too small, to die - a plea for a fair innings
    (Health & Medical Publishing Group, 1999) Smith, J.; Pieper, C. H.; Kirsten, G. F.
    [No abstract available]
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    Compliance of the respiratory system as a predictor for successful extubation in very-low-birth-weight infants recovering from respiratory distress syndrome
    (Health & Medical Publishing Group, 1999) Smith, J.; Pieper, C. H.; Maree, D.; Gie, R. P.
    Objective. To develop additional criteria to predict for successful extubation of very-low-birth-weight infants recovering from respiratory distress syndrome. Design. Prospective study. Setting. Neonatal intensive care unit at a university teaching hospital. Interventions. Infants ready for extubation according to clinical, ventilatory and blood gas criteria were studied. Before extubation, tidal volume (Vt), minute ventilation, respiratory rate/Vt and mean inspiratory flow were measured during two different ventilatory settings: (i) during intermittent mandatory ventilation (IMV); and (ii) while breathing spontaneously with endotracheal continuous positive airway pressure (CPAP). Tidal volume was obtained through electronically integrated flow measured by a hot-wire anemometer. Total respiratory compliance (Crs) was determined during IMV and was derived from the formula Vt/PIP-PEEP, where the difference between peak inspiratory pressure (PIP) and positive end-expiratory pressure (PEEP) represented the ventilator inflation pressure. Measurements and main results. Each of 49 infants was studied once before extubation. 33 infants (67%) were successfully extubated and 16 (32.6%) required reintubation. Infants in the success and failure groups were matched for gestation, post-conceptional age, study weight and methylxanthine therapy at the time of study. Successful extubation was associated with a higher mean absolute Crs value (ml/cm H2O) specific Crs value (standardised for body length; ml/cm H2O/cm) compared with infants in whom extubation failed (0.67 v. 0.46; P = 0.01 and 0.018 v. 0.014; P = 0.03, respectively). Analysis of ROC curves detected thresholds for Crs (0.5 ml/cm H2O) and Vt (7 ml) for predicting successful extubation. An absolute Crs value 0.5 ml/cm H2O or more improved the likelihood of successful extubation when compared with clinical/ventilator and blood gas criteria. The likelihood of successful extubation was 81% if the Crs value was ≥ 0.5 ml/cm H2O. A tidal volume of 7 ml or more was less sensitive in contributing to successful extubation (sensitivity 69%). The major causes for extubation failure included atelectasis (diffuse and/or localised) and the presence of a patent ductus arteriosus. Conclusions. In addition to following very precise ventilatory criteria for extubation, we found that bedside measurement of total respiratory system compliance added to the likelihood of extubation success in infants recovering from respiratory distress syndrome. Prospective studies are needed to validate the findings of this study.
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    High-frequency oscillatory ventilation - rescue treatment for infants with severe respiratory failure
    (Health & Medical Publishing Group, 1998) Smith, J.; Pieper, C. H.; Kirsten, G. F.; Maree, D.; Van Zyl, J.; Pretorius, M. L.
    Objective. To assess the efficacy of high-frequency oscillatory ventilation (HFOV) as a rescue mode of therapy in newborn infants with severe respiratory failure poorly responsive or unresponsive to conventional ventilation and supportive management. Design. Prospective, descriptive clinical study. Setting. Tertiary care neonatal intensive care unit. Patients and methods. All infants with radiographic evidence of diffuse bilateral lung disease and failure to maintain adequate blood gas values while receiving conventional support were offered HFOV. Intervention. HFOV, utilising a high-pressure/volume strategy. Outcome variables. Improvement in arterial/alveolar oxygen tension ratio (a/APO2) of the infants subsequent to their transferral to HFOV; survival rate; and outcome of infants weighing more than 2 000 g who met criteria for extracorporeal membrane oxygenation (ECMO). Identifying the infants who met ECMO entry criteria allowed the success of HFOV to be compared with that of ECMO, the 'standard' treatment for infants considered unventilatable. Neonatal complications such as bronchopulmonary dysplasia, intraventricular haemorrhage and air leaks were documented. Results. Conventional support failed in 34 consecutive infants; they were transferred to HFOV at a mean postnatal age of 30 hours. Their respiratory diagnoses included respiratory distress syndrome (RDS) (N = 19), neonatal 'adult respiratory distress syndrome' (ARDS) (N = 3) and meconium aspiration syndrome (MAS) (N = 12). Owing to similarities in the underlying pathophysiology, RDS and ARDS were grouped together for the purposes of analysis. After starting HFOV the a/APO2 had significantly improved (P < 0.05) by 6 hours in the RDS group and by 12 hours in the infants with MAS. This improvement was sustained throughout the first 48 hours of HFOV. Twenty-six (76%) of the infants ultimately survived. Among those who met the criteria for ECMO (N = 13), the survival rate was 92%. Air leaks occurred on HFOV in 6 infants, 3 each in the MAS and RDS groups. Bronchopulmonary dysplasia was diagnosed in 6 (40%) of the 15 RDS infants and in 2 (18%) of the 11 infants with MAS. Eight infants died, 3 following nosocomial sepsis (Pseudomonas sp.), 3 due to extensive air leaks, 1 due to irreversible shock (unproven sepsis), and 1 due to ARDS. At a median age of 13.5 months the neurological development of 11 (5%) of 17 infants was normal; in 3 (18%) it was suspect and in 3 abnormal. Conclusions. The study demonstrates that a high-pressure/volume approach to HFOV is an effective mode of rescue ventilation for infants who present with severe respiratory failure caused by a variety of lung conditions during the neonatal period.
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    Human metapneumovirus infection in hospital referred South African children
    (2004) Ijpma, F. F. A.; Beekhuis, D.; Cotton, M. F.; Pieper, C. H.; Kimpen, J. L. L.; Van Den Hoogen, B. G.; Van Doornum, G. J. J.; Osterhaus, D. M. E.
    Human metapneumovirus (hMPV) was first described in Dutch children with acute respiratory symptoms. A prospective analysis of the epidemiology, clinical manifestation, and seroprevalence of hMPV and other respiratory viruses in South African children referred to hospital for upper or lower respiratory tract infection were carried out during a single winter season, by using RT-PCR, viral culture, and enzyme-linked immunosorbent assays. In nasopharyngeal aspirates from 137 children, hMPV was detected by RT-PCR in 8 (5.8%) children (2-43 months of age) as a sole viral pathogen, respiratory syncytial virus (RSV) in 21 (15%), influenza A virus in 18 (13%) and influenza B virus in 20 (15%). Pneumonia was diagnosed in seven children and upper respiratory tract infection in one of the hMPV-infected children. One hMPV-infected child was admitted to the intensive care unit in need of mechanical ventilation and one child was infected with human immunodeficiency virus (HIV). No statistically significant differences were found between hMPV, RSV, and influenza virus infected groups with regard to clinical signs and symptoms and chest radiograph findings. The seropositive rate of hMPV specific IgG antibodies was 92% in children aged 24-36 months, the oldest seronegative child in our study was 7 years and 6 months of age. In conclusion, hMPV contributes to upper and lower respiratory tract morbidity in South African children. © 2004 Wiley-Liss, Inc.
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    Necrotising enterocolitis as an infectious disease : evidence from an outbreak of invasive disease due to extended-spectrum beta-lactamase-producing Klebsiella pneumoniae [2]
    (Health & Medical Publishing Group, 2001) Cotton, M. F.; Pieper, C. H.; Kirsten, G. F.; Orth, H.; Theron, D. C.
    Necrotising enterocolitis (NEC) is a severe gastro-intestinal disorder, predominantly seen in hospitalised low-birth-weight newborn infants. It is associated with significant morbidity and mortality. Infants with NEC require parenteral nutrition and intravenous antibiotics with prolongation of hospitalisation. Severe cases require surgical resection of necrotic bowel wall with the attendant problems of the short gut syndrome.' NEC places an enormous burden on resource-poor institutions.