Thieme E-Journals - AINS - Anästhesiologie · Intensivmedizin · Notfallmedizin

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http://www.thieme-connect.de/products/ejournals/pdf/10.1055%2Fs-2007-1002484.pdf %0D%0A %0D%0AFree sample issue %0D%0Ahttp://www.thieme-connect.de/products/ejournals/sampleIssue/10.1055/s-00000001"></a> <a href="https://profile.thieme.de/HTML/sso/THIEME/login.htm?hook_url=https://www.thieme-connect.de/products/all/alerts&rdeLocaleAttr=en" id="setAlertLink" class="functionItem" title="Subscribe to Alert Service"></a> </div> <div class="divPdfIcon"> <div class="divPdfIconInNewline"> <a href="/products/ejournals/pdf/10.1055/s-2007-1002484.pdf" class="linkNotUnderlined"> Download PDF </a> </div> <div> <a href="/products/ejournals/pdf/10.1055/s-2007-1002484.pdf" id="pdfDownloadLink" class="functionItem" title="PDF Download"></a> </div> </div> <input type="hidden" name="ebookDoi" value=""> <script type="text/javascript"> function facebook(url) { ajaxSubmitStatisticEvent("10.1055/s-2007-1002484", "facebook") window.open('https://www.facebook.com/sharer/sharer.php?u=' + 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+ "/json/submitStatisticEvent?doi=" + doi + "&type=" + type; var request = $.ajax({ type : 'GET', dataType : 'json', async : true, cache: false, url : url, success : function(data) { } }); } </script> </div>   <div class="articleHeader"> <div class="doi">Anästhesiol Intensivmed Notfallmed Schmerzther 1986; 21(5): 280-283<br>DOI: 10.1055/s-2007-1002484</div> <div class="articleType"> </div> <span class="articleCategories">© Georg Thieme Verlag Stuttgart · New York</span> <h1>Die Primärversorgung respiratorisch insuffizienter Neugeborener mit kongenitalem Zwerchfelldefekt</h1> <span class="subtitle">Primary Treatment of Neonates with Congenital Defects of the Diaphragm and Respiratory Insufficiency</span><span class="authors">M. Abel, Ch. Blum, W. Pringsheim, H. Ortlieb<A HREF="#A058609-1"><SUP>1</SUP></A> , D. Waldmann<A HREF="#A058609-1"><SUP>1</SUP></A> </span> <div class="authorsAffiliationsList"> <ul> <li>Universitäts-Kinderklinik Freiburg (Direktor: Prof. Dr. W. Künzer) und</li> <li> <A NAME="A058609-1"></A><SUP>1</SUP>Chirurgische Universitätsklinik, Abt. Allgemeine Chirurgie mit Poliklinik (Direktor: Prof. Dr. E. H. Farthmann), Freiburg</li> </ul> </div> <div class="toggleMenu articleToggleMenu"> <div class="toggleButton">Further Information<div class="toggleContent"> <div class="wrapper twoCols"> <div class="col"> <h3>Publication History</h3> <p>Publication Date:<br>22 January 2008 (online)</p> </div> </div> </div> </div> <div class="platformLink"> <span class="label"><a style="color: #000000; text-decoration: none" class="virtualLink">Also available at</a></span><a data-url="https://eref.thieme.de/10.1055/s-2007-1002484" data-id="eRef" data-target="eRef" target="_blank" class="btnPlatformLink linkFunction" href="https://eref.thieme.de/10.1055/s-2007-1002484"><img src="/media/10.1055-s-00000000/btn-eRef-desktop.png"></a> </div> </div> </div><ul class="tabBar borderBottom" id="articleTabs"> <li class="tab active"> <a href="#abstract">Abstract</a> </li> <li class="tab"> <a href="/products/ejournals/pdf/10.1055/s-2007-1002484.pdf" id="pdfLinkTab">PDF (415 kb)</a> </li> </ul><div id="sections"> <section id="abstract"> <div class="articleFunctions"> <input value="ai10.1055/s-2007-1002484,10.1055/s-2007-1002484" name="ai" type="hidden"> <div style="display: none" id="sfx10.1055/s-2007-1002484"> <a id="sfxServer" data-href="?id=doi:10.1055/s-2007-1002484&sid=Thieme:Connect&jtitle=AINS - Anästhesiologie · Intensivmedizin · Notfallmedizin · Schmerztherapie&issue=05&volume=21&date=1986&issn=0939-2661&spage=280&epage=283&aulast=Abel&aufirst=M.&__char_set=utf8&atitle=Die Primärversorgung respiratorisch insuffizienter Neugeborener mit kongenitalem Zwerchfelldefekt" target="sfx"><span class="articleAccessLabel sfx"><img id="sfxImageUrl" src="" alt="SFX Search" height="15" width="52"></span></a> </div> <a class="gotoLink" href="/products/ejournals/pdf/10.1055/s-2007-1002484.pdf" id="pdfLink">PDF Download</a> <a style="display: none" href="/products/ejournals/buyDocument/10.1055/s-2007-1002484" class="gotoLink" id="sasLink">Buy Article</a> <a data-url="https://s100.copyright.com/AppDispatchServlet" data-id="CCC RightsLink" data-target="CCC RightsLink" onClick="RightslinkPopUp("1439-1074", "Die Primärversorgung respiratorisch insuffizienter Neugeborener mit kongenitalem Zwerchfelldefekt", "01/22/2008", "M. Abel, Ch. Blum, W. Pringsheim, H. Ortlieb, D. Waldmann", "", "10.1055/s-2007-1002484", "280", "283", "21", "05", "")" class="gotoLink linkFunction" href="javascript:;">Permissions and Reprints</a> </div> <figure style="margin-left: 30px" class="floatRight"> <a data-doi="10.1055/s-2007-1002484" data-caption="" data-id="10.1055-s-2007-1002484-1.jpg" data-cssClass="previewOverlay" href="https://www.thieme-connect.de/media/ains/198605/lookinside/10.1055-s-2007-1002484-1.jpg" class="zoomFunction alignLeft"><img src="https://www.thieme-connect.de/media/ains/198605/lookinside/thumbnails/10.1055-s-2007-1002484-1.jpg"></a> <figcaption></figcaption> </figure> <h3>Zusammenfassung</h3> <P>Berichtet wird über 36 früh- und reifgeborene Kinder mit kongenitalem Zwerchfelldefekt, darunter 17 Patienten, die bereits postpartal oder innerhalb der ersten dreißig Lebensminuten eine schwere respiratorische Insuffizienz entwickelten. Die Behandlungsergebnisse waren bei einer Gesamtmortalität von 64 % durch eine in der Gruppe der respiratorisch früh insuffizienten Patienten besonders hohe Mortalität gekennzeichnet: von 17 Patienten verstarben 12. Die Auswertung der Krankheitsverläufe bestätigte die große prognostische Bedeutung einer adäquaten präoperativen Primärversorgung für diese respiratorisch früh insuffizienten Patienten. Folgende diagnostischtherapeutischen Verbesserungsempfehlungen resultieren aus unseren Erfahrungen für diese Betreuungsphase:</P> <P>- ein vermehrter Einsatz sonographischer Untersuchungstechniken zur präpartalen Diagnostik kongenitaler Zwerchfelldefekte mit der Möglichkeit zur frühzeitigen Betreuung entsprechender Risikoschwangerschaften in neonatologisch-kinderchirurgisch ausgestatteten Klinikzentren</P> <P>- eine frühe Intubationsbeatmung mit schonender Ventilationstechnik bei respiratorisch auffälligen Neugeborenen mit Verdacht auf einen kongenitalen Zwerchfelldefekt</P> <P>- der hohe diagnostische Stellwert einer Röntgen-Thorax- und Abdomenübersichtsaufnahme</P> <P>- die Durchführung einer neonatologisch-intensivmedizinischen Stabilisierungsbehandlung bei metabolisch schwer supprimierten Patienten vor den anästhesiologisch-operativen Belastungen des Zwerchfelldefektverschlusses.</P> <h3>Summary</h3> <P>The authors report on 36 premature and term infants with congenital defects of the diaphragm, including 17 patients who developed a severe respiratory insufficiency either immediately after birth or during the first 30 minutes of life. The overall mortality rate was 64 %; the results of treatment were marked by a particularly high mortality rate among the patients with early respiratory insufficiency: out of 17 patients, 12 died. The evaluation of the courses confirmed that adequate preoperative primary care is of major prognostic importance in patients with early respiratory insufficiency. On the basis of personal experience the authors have formulated the following recommendations for improving diagnosis and therapy at this stage of care:</P> <P>- greater use of sonography examination methods for antepartal diagnosis of congenital defects of the diaphragm, making it possible to treat the corresponding high-risk pregnancies at an early stage in clinics equipped for neonatologic and pediatric surgical treatment;</P> <P>- early intubation respiration with a ventilation technique which does not overstrain the patient, in newborns with abnormal respiration and suspected congenital defects of the diaphragm;</P> <P>- the great diagnostic importance of plain radiographs of the thorax and abdomen;</P> <P>- neonatologic and intensive medical stabilization treatment in patients with severely suppressed metabolism prior to the anesthesiologic and surgical stress of closure of the diaphragm defect.</P> </section> <section id="htmlfulltext"></section> <section id="references"></section> <section id="images"></section> <section id="supmat"> <ul class="tabBar borderBottom" id="supmatTabs"></ul> <div class="tabContentContainer"> <div style="padding-top: 0.5em" id="supportingMaterial" class="tabContent"> <ul class="linkList"></ul> </div> </div> </section> </div>  </article> <div class="metrics-container-main"> <div class="metrics-container-left"> <div class="metrics-container-cell"> <div class="metrics-altmetrics"></div> </div> </div> <div class="metrics-container-right"> <div class="metrics-container-cell">  <div id="crossrefcites" class="crossrefcites" data-doi="10.1055/s-2007-1002484"/></div> </div> </div> </div>  <div id="adSidebarOverBottom"> <script type="text/javascript"> window.TCFUtility.writeScript([ 'https://adfarm1.adition.com/js?wp_id=4863507&gdpr=${GDPR}&gdpr_consent=${GDPR_CONSENT_39}&prf[DOI]=10.1055-s-00000001&prf[UserLogin]=false&prf[IPLogin]=false&prf[MASTERKEY]=10.1055-s-00000001, false, false&prf[HWG]=false' ]); 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var doi = $(this).attr("data-doi"); var mediaType = "image"; if ($(this).attr('class').indexOf('podcastFunction') > -1) { mediaType = "podcast"; } else if ($(this).attr('class').indexOf('audioFunction') > -1) { mediaType = "audio"; } else if ($(this).attr('class').indexOf('videoFunction') > -1) { mediaType = "video"; } submitMediaEvent(mediaType, id, caption, doi); }); function submitMediaEvent(mediaType, id, caption, doi) { const url = '/products/json/submitMediaStatisticsEvent?mediaType=' + mediaType + '&id=' + id + '&caption=' + caption + '&doi=' + doi; const request = $.ajax({ type : 'GET', async : true, cache: false, url, success : function(data) { } }); } $(".linkFunction").click(function() { var target = $(this).attr("data-target"); var id = $(this).attr("data-id"); var uri = encodeURIComponent($(this).attr("data-url")); const url = '/products/json/submitLinkStatisticsEvent?target=' + target + '&id=' + id + '&url=' + uri; const request = $.ajax({ type : 'GET', async : true, cache: false, url, success : function(data) { } }); 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