Browsing by Author "Kirsten, G. F."
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- ItemBorn 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]
- ItemThe 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.
- ItemPersistent pulmonary hypertension of the neonate in a developing country - does extracorporeal membrane oxygenation have a role to play?(Health & Medical Publishing Group, 1993) Smith, J.; Kirsten, G. F.A retrospective study was undertaken of survival after conventional management of 35 infants suffering from persistent pulmonary hypertension of the neonate (PPHN). The outcome of infants weighing more than 2000 g and who also qualified for extracorporeal membrane oxygenation (ECMO) therapy on the grounds of published criteria was assessed. The admission incidence of patients with PPHN was 1,1%. Secondary PPHN was more common than primary. The overall survival rate of 69% in this study reflects the trend in recently reported improved survival rates of infants with PPHN, treated with conventional techniques. Sixteen of 28 infants weighing more than 2000 g qualified for ECMO therapy; 4 of them died. Had ECMO been available as an alternative mode of therapy, only 2 of the 4 might have been saved. The other 2 were considered to have conditions incompatible with a normal quality of life. We therefore assessed the requirement for ECMO in our population to be approximately 0,6/1000 live births. Although ECMO may be promising, the introduction of this technique in developing countries should rather be delayed until more substantial data refute this. Because PPHN could be related to a potential preventable cause in almost 80% of cases, we propose the support of more cost-effective strategies such as continuing obstetric and perinatal education programmes.
- ItemPhototherapy 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.