BACKGROUND:Approximately 15% of children experience a syncope before the age of 18 years. Tilt table testing represents the diagnostic gold standard whenever a neurocardiogenic spell is suspected. Two methods of continuous, non-invasive hemodynamic monitoring during the tilt table test are presented and their usefulness for clinical routine is discussed.PATIENTS:4 patients with suspected neurocardiogenic syncope.METHODS:Tilt table testing according to standard protocol; non-invasive, continuous blood-pressure measurement by finger cuffs; impedance cardiography for the assessment of cardiac output.RESULTS:In 3 patients a syncope occured during the tilt table test. In pt. 4 characteristic symptoms led to diagnosis prior to syncope. Every patient represents a definite type of neurocardiogenic syncope (cardioinhibitory with asystolia, vasodepressory, mixed as well as postural tachycardia syndrome).CONCLUSIONS:Both monitoringmethods allow a differentiated analysis of the cardiovascular interactions during the tilt table test. Thus, specific regulatory patterns may be diagnosed and specific treatment strategies may be offered.

Background. Baroreceptor control of beat-to-beat blood pressure in heart and heart-lung-transplanted children is impaired. Time-related trends of baroreceptor function recovery are studied and a possible correlation of baroreflex impairment and systolic hypertension may give evidence for supplemental medical treatment of hypertension.Methods. Seventeen patients (six female) 6.1 +/- 3.7 years (range 0.8-13.0 years) after heart (n = 14) and heart-lung (n=3) transplantation (TX) were studied. Twelve healthy children and 10 children after liver and bone marrow TX taking cyclosporine A (CyA) served as control groups 1 and 2, respectively. Baroreceptor sensitivity (BRS) was calculated from noninvasive systolic beat-to-beat blood pressure (sBP) measurement during a resting phase and a tilt-table test.Results. BRS was significantly impaired in the study group at rest and during tilting; mean sBP was slightly elevated. Significant difference between patients on CyA and healthy controls was not observed. Discrete recovery of BRS occurred after 4 years postTX with decreased sBP (n=12 pts, BRS 6.78 +/- 7.44 msec/mmHg, sBP 116.2 +/- 12.4 mmHg) when compared to a postTX time course of less than 4 years (n=5 pts, BRS 4.02 +/- 4.21 msec/mmHg, sBP 122.0 +/- 6.7 mmHg, P=NS).Conclusion. BRS is disturbed after TX in children; four years postTX, a minimal recovery of BRS and a discrete reduction of sBP seem to occur. Those patients with a persistent low BRS and elevated sBP may profit from pharmacological influence in sympathovagal imbalance.

Syncope represents a diagnostic challenge in patients affected by long-QT syndrome (LQTS). It is crucial for the therapeutic decision to distinguish between potentially life-threatening ventricular tachycardias (Torsadede-pointes) and-especially during adolescence-neurocardiogenic syncopes. This case report presents a patient with LQTS2 (mutation in the HERG gene) on medication with beta-blocker, in whom a head-up-tilt table test was performed after syncope of unknown origin. The test was chosen in order to reproduce the circumstances under which the syncope had happened. The monitoring device consisted of impedance cardiography as well as non-invasive beat-to-beat blood-pressure measurement. By these means it was possible to register a reduced peripheral vascular resistance after tilting the patient, a reduced cardiac output and bradycardia leading to syncope after four minutes of upright posture. This was suggestive for neurocardiogenic syncope as a cause for the spell experienced. Further non-invasive diagnostic methods were normal. As the patient's family history was negative for syncopes, Torsade-de-pointes seemed unlikely.In this special case the non-invasive monitoring system of cardiac output, peripheral vascular resistance and beat-to-beat blood pressure measurements was useful as a supplemental tool during evaluation of syncope and helpful in decision-making against implantation of an ICD and for a more intense treatment with betablockers. Such monitoring devices offer new insights into the orthostatic regulation in young patients.

The head-up-tilt-test in pediatric patients for the evaluation of syncope shows a sensitivity of 35-85% and often requires pharmacological stimulation in order to improve its diagnostic value. We used a new device for beat-to-beat blood pressure monitoring combined with impedance cardiography in a 12-year-old girl during tilt testing. A seven seconds asystolia was provoked. The haemodynamic parameters showed clearly the drop in heart rate as well as in cardiac output, and returned to normal values after tilting back the patient. With the help of this new monitoring device, the sensitivity and specificity of head-up-tilt-testing can probably be improved.

Fragestellung: Vergleich von Drillingen und deren Familien mit ehemals reif geborenen Einlingskindern und ihren Familien, um anhand dieser Daten eine Verbesserung der präpartalen Beratung zu erreichen.

Die Inzidenz von Thrombosen nach Anlage zentraler Venenkatheter bei Frühgeborenen wird in der Literatur mit 2–10% angegeben. Es gibt keine einheitlich verbindlichen therapeutischen Richtlinien. Neben der chirurgischen Intervention gegebenenfalls mit kardiopulmonalem Bypass und hohem perioperativen Risiko, der systemischen Lysetherapie verbunden mit der Gefahr für schwerwiegende Blutungen, stellt die lokale Applikation von rekombinantem Tissue Plasminogen Aktivator (rTPA) in subsystemischer Dosierung eine therapeutische Alternative dar.

Purpose: This study compares a cohort of triplets and their families with matched term singletons and their families in an attempt to provide recent outcome data for antenatal counseling.Methods: Forty eight three-year-old triplets born between 1996 and 1998 (gestational age 31.8 +/- 2.1 weeks, birth weight 1586 +/- 352 g, mean +/- SD) were compared with 44 term singletons of the same age (gestational age 39.3 +/- 1.1 weeks, birth weight 3349 +/- 395 g) with regard to cognitive and motor development (Denver Developmental Screening Test/DDST), their influence on family life (Kansas Family Life Satisfaction Scale/ KFLSS) and the individual parental stress level (Parenting Stress Index/PSI).Results: The triplets achieved normal mean scores in the DDST, PSI and KFLSS. The triplets' DDST scores were significantly lower (15.0 +/- 2.9 vs. 16.4 +/- 1.9; p < 0.01), but remained within the normal range (> 12). The triplet parents (2.3 +/- 1.1) and the control parents (2.1 +/- 1.1) were both "satisfied" with their family life according to the KFLSS. There was a trend towards higher total PSI scores in triplet parents (231 +/- 29.8 vs. 219.4 +/- 42.9). In some subscales of the PSI Parent Domain the triplets' parents reported strongly elevated stress levels.Conclusion: When compared with previous similar studies, this data indicates a more favorable outcome for triplets with regard to their average cognitive and neuromotor development in early childhood and with regard to the parental perception of the quality of family life.