SUNScholar - Browsing by Author "Kirsten, G. F."

Browsing by Author "Kirsten, G. F."

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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]
The effect of severe pre-eclampsia on maternal and cord erythrocyte membrane essential fatty acid profiles
(Health & Medical Publishing Group, 1998) Kirsten, G. F.; Smuts, C. M.; Tichelaar, H. Y.; Smith, J.; Hall, D.; Faber, M.; Dhansay, M. A.
Objective. To examine the effect of severe pre-eclampsia on maternal and cord erythrocyte membrane essential fatty acid profiles. Design. Clinical trial. Setting. Obstetric High Care Unit, Tygerberg Hospital. Patients. Erythrocyte membrane (EM) essential fatty acid profiles were determined in 17 women with severe preeclampsia, in 17 normotensive pregnant women, and in the cord blood of their respective infants. Results. Pre-eclamptic women had lower EM phosphatidylcholine linoleic acid (C18:2n-6; LA) and cclinolenic acid (C18:3n-3; ALA) levels and lower EM phosphatidylethanolamine ALA levels than the normotensive women with lower cord blood docosahexaenoic acid levels (C22:6n-3; DHA) in both phospholipid fractions. All cord blood arachidonic acid (C20:4n-6; AA) levels were higher than the maternal levels. Conclusions. Pre-eclamptic women have lower LA and ALA levels than normotensive pregnant women, but AA and DHA levels in the two groups are similar. The cord blood DHA levels of infants of pre-eclamptic women are lower than those of the infants of normotensive women. Infants born to pre-eclamptic women may need dietary DHA to replenish DHA stores. This can be obtained from breast-milk or from a formula enriched with DHA.
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.
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.
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.
The outcome at 12 months of very-low-birth-weight infants ventilated at Tygerberg Hospital
(Health & Medical Publishing Group, 1995) Kirsten, G. F.; Van Zyl, J. I.; Le Grange, M.; Ancker, E.; Van Zyl, F.
Objective. To determine the outcome at 1 year of age of a group of very-low-birth-weight (VLBW) infants, from urban and rural communities, ventilated at Tygerberg Hospital, W. Cape. Study design. Prospective descriptive study in which the prevalence of bronchopulmonary dysplasia (BPD), sensorineural deafness, intraventricular haemorrhage (IVH), retinopathy of prematurity (ROP) and abnormal motor developmental outcomes were determined in 153 ventilated VLBW infants from rural and urban areas. Of these, 69% were from lower socio-economic backgrounds. Main outcome measures. Attrition rates for rural and urban babies, BPD, ROP, IVH and abnormal motor development. Study population and setting. All ventilated VLBW infants discharged from the neonatal intensive care unit at Tygerberg Hospital over a 1-year period were followed up at 3-monthly intervals for 12 months. Results. BPD was diagnosed in 19% of the babies, with significantly more babies with birth weights under 1 000 g and gestational ages under 28 weeks having BPD. Of the babies with BPD, 25% had abnormal motor development at 1 year of age. Seven per cent of the babies had grade 3 or 4 ROP and 2.6% had sensorineural hearing loss. One hundred and seventeen (79%) of the infants attended the follow-up clinic until 12 months of age (corrected for prematurity), there were no significant differences in the number of babies followed up from rural or urban areas. Fourteen (11.9%) of the babies had abnormal motor development. A disturbing finding was that so many babies had spastic quadriplegia (8;57%) versus diplegia (6;43%),
Persistent 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.
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.
A prospective study of long-term use of amikacin in a paediatrics department : indications, administration, side-effects, bacterial isolates and resistance
(Health & Medical Publishing Group, 1990) Hesseling, P. B.; Mouton, W. L.; Henning, P. A.; Kirsten, G. F.; Spruyt, L. L.; Schraader, E. B.; Wessels, G.; Grassman, R.
Amikacin (Amikin; B-M) was used as the only aminoglycoside for 18 months in a paediatric department within a general hospital because of high levels of resistance of Klebsiella pneumoniae, Pseudomonas aeruginosa and Enterobacter cloacae isolates to tobramycin, gentamicin and netilmicin. Between 1 February 1987 and 31 July 1988, 816 children were treated with a slow intravenous injection at a standardised dose adjusted for weight and age. Respiratory disease was present in 35,8% of 537 neonates, 56,4% of 190 infants and 70,9% of 89 older children. Escherichia coli (65 isolates), Klebsiella species (59 isolates), Enterobacter species (26 isolates) and P. aeruginosa (22 isolates) constituted the most common Gram-negative pathogens. The positive blood culture yield was 7,8%. Satisfactory median peak and trough serum amikacin levels were achieved. No significant renal side-effects were noted. Severe bilateral hearing loss in 1 low-birthweight infant resulted from inadvertent overdosage. At the end of this 18-month surveillance period 97,7% of E. coli, 98,6% of K. pneumoniae, 96,3% of E. cloacae, and 98,0% of P. aeruginosa isolates remained sensitive to amikacin, while resistance of K. pneumoniae to tobramycin, netilmicin and gentamicin decreased significantly (P < 0,003, P < 0,001 and P < 0,007 respectively; chi-square test).
Therapeutic monitoring as an aid in rationalising aminoglycoside dosage techniques in the neonate
(Health & Medical Publishing Group, 1987) Spruyt, L. L.; Kirsten, G. F.; Parkin, D. P.; Muller, G. J.; Kriegler, A.
General pharmacokinetic parameters applicable to adults are not suitable in neonatal practice owing to wide interpatient variations in respect of fluid balance, renal clearance and metabolic rates. We attempted to determine whether acceptable blood levels of gentamicin or tobramycin are obtained with dosage regimens and dosage techniques which are generally recommended. Forty neonates receiving aminoglycosides were studied. After administration of the drug as a slow, constant intravenous infusion into the 'Y' connection of the infusion set, peak levels were found to be subtherapeutic. Trough levels were also very low. After administration of the same dose of gentamicin or tobramycin as a bolus into the butterfly connection of the infusion set, however, high therapeutic levels were obtained. We therefore recommend that gentamicin and tobramycin be administered as an intravenous bolus injection and that blood levels be monitored constantly in order to individualise therapy.

Browsing by Author "Kirsten, G. F."

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