Hintergrund: IAH und AKS sind in der Pädiatrie seltene (Inzidenz 1–15%), aber fatale Entitäten mit einer Mortalität von 60–88%. Im Erwachsenenalter haben sie sich als unabhängige Prädiktoren für das Entstehen von MOV und Sepsis erwiesen. Altersabhängig herrscht im Neugeborenen- und Säuglingsalter das primäre AKS vor (Urs.: Gastroschisis, Omphalozele, NEC, Darmperforation/-ileus, Tumor, Transplantation), im Kindesalter findet sich dagegen eher das sekundäre AKS (Urs.: Trauma, Verbrennung, Sepsis, Schock). Bis heute ist unklar, ob die von der WSACS veröffentlichen Definitionen und Empfehlungen auch für das Kindesalter gelten (www.wsacs.org). Fragestellung: Inzidenz, Outcome, Messverhalten und -verfahren, IAD-Grenzwerte, Therapieindikationen und -möglichkeiten samt zugehörigen Evidenzgraden im Kindesalter. Material und Methode: Eine PubMed-Analyse der Suchbegriffe „Abdominal Compartment Syndrome + Children“ ergab 81 Treffer, von denen 67 Artikel auf das AKS bezogen waren (32 Case-Reports, 16 retrospektive Studien, 6 prospektive, nicht-randomisierte Arbeiten sowie Reviews). Anhand der zugehörigen Literaturverzeichnisse wurden zusätzlich 25 relevante Studien und Veröffentlichungen eingeschlossen. Ergebnisse und Diskussion: Mit abnehmendem Alter und zunehmender Unreife sinkt die Bereitschaft, relativ invasive Druckmessmethoden wie die Blasendruckmessung durchzuführen. Peritonealdialysekatheter werden – sofern ohnehin vorhanden – als Druckaufnehmer verwendet. Die intragastrale Messung erfolgt nur selten. Die dekompressive Laparotomie mit temporärem Bauchdeckenverschluss gilt als Standard. Eine zusätzliche Behandlungsoption könnte die Punktion und Drainage von Flüssigkeit sein. Die von der WSACS definierte druckabhängige Stadieneinteilung der IAH ist nicht auf das Kind übertragbar. Der Übergang in ein AKS wurde klinisch bereits bei einem IAD von 10–15mmHg beobachtet. Im klinischen Alltag scheint die Diagnosestellung eher auf Beobachtungen als auf der Anwendung spezifischer, IAD-bezogener Definitionen zu beruhen. Schlussfolgerung: Studien sind dringend notwendig, um eine altersadaptierte Einteilung intraabdomineller Druckverhältnisse und daraus ableitbarer Therapieschemata für das Kindesalter zu erhalten. V.a. in Risikogruppen sollte die IAH-Diagnostik durch IAD-Messungen objektiviert werden.

The diagnosis of Lyme borreliosis is often based on the peripheral facial paralysis – a common clinical manifestation of Lyme borreliosis in childhood. Ataxia is a rare symptom and mostly manifestation of a later stage of neuroborreliosis.

Ertrinken und Beinaheertrinken sind eine der Hauptursachen für Unfalltod im Kindesalter. Wir untersuchten retrospektiv 56 Kinder, die nach Ertrinkungsunfall im Zeitraum 1989 - 1997 in die Kinderklinken München-Schwabing und Passau eingeliefert wurden. Das Alter der Kinder reichte von 13 - 145 Monaten. Unterschieden wurden zwei Gruppen (Tod und schwere neurologische Schäden oder gutes Outcome). Berechnet wurde für verschiedene Faktoren die Signifikanz hinsichtlich des Outcomes der Kinder. Wir kombinierten schließlich fünf objektivierbare klinische und laborchemische Prognosefaktoren zu einem Score, dessen minimale Punktzahl 0 und maximale Punktzahl 12 betrug. Damit konnten wir bei einem Cut-off-point von 5 eine Sensitivität von 100 % und Spezifität von 96 % für dieses Kollektiv erzielen. Zusätzlich analysiert wurde anhand der vorhandenen Notarztprotokolle die präklinische Notfallversorgung. Probleme gab es im Bereich Atemwegs- und Hypothermiemanagement. In speziellen Situationen sollte an die Möglichkeit der extrakorporalen Zirkulation gedacht werden. Ein Algorithmus zur präklinischen Vorgehensweise bei Ertrinkungsunfall wird dargestellt. Hauptaugenmerk bleibt die Prävention mit der Forderung nach Umzäunung von Gartenteichen und Swimmingpools.

Today, intracerebral infections by gas forming bacteria are very rare. They are mostly seen after penetrating injuries and more rarely after trivial trauma. Although prognosis of this kind of infection is severe, the general outcome of these patients after surgical and antibiotic treatment is good. We report a ten months old boy suffering a pecking injury just above the left ear with perforation of the temporal bone and dura. In between 48 hrs he developed a rapidly progressive gas gangrene encephalitis due to infection with C. perfringens and died despite of surgical and antibiotic treatment due to massive brain swelling and cardio-pulmonary failure.

Zusammenfassung Fragestellung: Die Ursache einer konnatalen Hemiplegie bei reifgeborenen Kindern wurde in einer retrospektiven Studie untersucht. Patienten und Methode: Bei 14 Patienten im Alter von 8 Monaten bis 15 Jahren wurden eine zerebrale MR-Tomographie durchgeführt und die klinischen Daten erfaßt. Ergebnisse: Bei allen Patienten fand sich ein morphologisches Korrelat der Bewegungsstörung. Die Läsionen wurden nach pathophysiologischen Gesichtspunkten eingeteilt: zerebrale Entwicklungsstörungen ( n =3), periventrikuläre Leukomalazie ( n =2), periventrikuläre Substanzdefekte ( n =2), subkortikale Leukomalazie ( n =1), subkortikal-kortikale Substanzdefekte ( n =6). Bei 13 von 14 Kindern waren die Schwangerschafts- und Geburtsanamnese unauffällig. Diskussion: Aufgrund reifeabhängiger Reaktionsmechanismen des Gehirns kann von der Morphologie der Läsionen auf den Schädigungszeitpunkt geschlossen werden. Dieser lag bei der Mehrzahl unserer Patienten pränatal.

Today, intracerebral infections by gas forming bacteria are very rare. They are mostly seen after penetrating injuries and more rarely after trivial trauma. Although prognosis of this kind of infection is severe, the general outcome of these patients after surgical and antibiotic treatment is good. We report a ten months old boy suffering a pecking injury just above the left ear with perforation of the temporal bone and dura. In between 48 hrs he developed a rapidly progressive gas gangrene encephalitis due to infection with C. perfringens and died despite of surgical and antibiotic treatment due to massive brain swelling and cardio-pulmonary failure.

几乎每天新生儿科医生都可以听到助产士这样的求救声:"请快来,我们这儿有一个窒息的新生儿."同样,当孩子得不到迅速缓解时,随之而来的不快也并不少见,通常会担心孩子因为缺氧长期接受重症监护治疗,也许出生后很快出现危险而导致缺氧损伤,也许仅出现一般的发育障碍,也许发展为癫痫,也许产生智力或行为缺陷.

Eighteen children with West syndrome underwent MRI-examination of the brain. Five children were examined twice. Myelination of ten regions of the brain was retrospectively assessed on the MRI-examinations. The children could be divided in three groups of main diagnosis (cryptogenic West syndrome, tuberous sclerosis, pre-/perinatally acquired brain lesions). Delays in myelination were found in 17 out of a total of 23 examinations. In children with cryptogenic West syndrome and with tuberous sclerosis myelination was normal or only mildly delayed in the first month after onset of the spasms, but delays seemed to increase in the course of the West syndrome in these groups. In children with pre- or perinatally acquired brain lesions severe delays of myelination could be found already in the first weeks after the onset of the West syndrome. The assessment of myelination can therefore contribute to the diagnosis and understanding of the underlying disease in children with West syndrome.

777 cerebral MRI examinations of children aged 3 days to 14 years were staged for myelination to establish an age standardization. Staging was performed using a system proposed in a previous paper [1], separately ranking 10 different regions of the brain. Interpretation of the results led to the identification of four clinical diagnoses that are frequently associated with delays in myelination: West syndrome, cerebral palsy, developmental retardation, and congenital anomalies. In addition, it was found that assessment of myelination in children with head injuries was not practical as alterations in MRI signal can simulate earlier stages of myelination. Age limits were therefore calculated from the case material after excluding all children with these conditions. When simplifications of the definition of the stages are applied, these age limits for the various stages of myelination of each of the 10 regions of the brain make the staging system applicable for routine assessment of myelination.

In a retrospective study 516 cranial MRI examinations of children aged 1 month to 14 years were reevaluated for myelination. An objective staging system for the assessment of the degree of myelination was designed, based on the characteristic patterns of myelintypical signal which develop in the course of brain maturation. Thus myelination can be estimated using only routine MRI examinations; no additional measurements of signal intensities are necessary. In order to obtain detailed information, ten regions of the brain are ranked separately, with comparisons of the T1- and T2-weighted images for each region. The application of the staging system to the case material revealed typical age ranges for the stages, and retarded myelination in some children. In most cases the observed retardation affected several regions but never the whole brain. Such delays can only be detected by separate assessment of the degree of myelination in each region of the brain.

As part of a multicenter surfactant rescue study, the chest X-rays of 239 preterm and term infants were analyzed. To study the influence of surfactant administration on radiographic appearance, 130 patients with a clinical and radiological diagnosis of typical respiratory distress syndrome were selected, in whom adequate chest x-rays before and within 48 h after treatment were available. Median gestational age was 30 weeks (range 25–38 weeks), median birth weight was 1335 g (range 625–3450). The time of surfactant application ranged between 90 min and 24 h after birth (median 6 h). The most common finding after surfactant administration was uniform (n=47) or disproportionate (n=46) improvement of pulmonary aeration, which showed a significant correlation to posttreatment reduction of oxygen requirement (p<0.001). Asymmetric clearance was more often localized on the right side and usually disappeared within two to five days. Only in 13 patients no change of ventilation was found. Development of interstitial emphysema (n=24, including three patients with pneumothorax) after surfactant treatment was an unfavourable prognostic sign. 54% of these patients (13 of 24) died within the first month of life, compared to 8% (7 of 93) in the group of patients with initial improvement of ventilation.

Two children developed extrapyramidal symptoms after taking an electrolyte drink. There was a good response to Biperidon (Akineton(R)). Only exact investigations showed that both children had accidentally been poisoned by a neuroleptic drug which was added to the electrolyte mixture.

Two children developed extrapyramidal symptoms after taking an electrolyte drink. There was a good response to Biperidon (Akineton). Only exact investigations showed that both children had accidentally been poisoned by a neuroleptic drug which was added to the electrolyte mixture.

The efficiency of spin echo tomography in the differential diagnosis of hip joint pain in children in comparison with other imaging methods was tested in 115 spin echo tomography examinations of 68 patients. By means of the different modes available it was possible to determine joint effusion, necrosed areas and the formation of abscesses with great accuracy. In the case of Legg-Calve-Perthes disease the MRT is especially in the early diagnosis superior to the other Methods, already in the early stage a classification in the four Catterall groups was possible. Furthermore the "head at risk" signs, except the gage-sign, were better to describe by BRI than by conventional x-rays. The MRT allows an exacter staging and a better observation of the course of disease, especially the beginning of the revitalisation of the femora epiphysis in earlier and clearer visible than in other imaging methods. Further diseases like epiphysial dysplasie, specific and unspecific coxitis and slipped capital femora epiphysis were also investigated. We regard spin echo examination in the differential diagnosis of hip pain in children indicated by the following criteria: 1. with over six weeks uncertain differential diagnosis of coxitis fugax and Legg-Calve-Perthes disease 2. with Legg-Calve-Perthes disease in the early stage for therapy option 3. with TBC- and non-TBC-coxitis as a therapy attend and diagnostic measure.

We report on a newborn baby with thrombocytopenia who developed neonatal seizures caused by a temporal lobe hemorrhage as shown by cerebral ultrasonography. This hemorrhage was followed by a cyst isodense to intracerebral fluid. Differentialdiagnostic aspects concerning the etiology of arachnoideal cysts will be discussed in relation to the post-hemorrhagic course and the sonographic or the magnetic resonance tomography findings respectively.

We report on a newborn baby with thrombocytopenia who developed neonatal seizures caused by a temporal lobe hemorrhage as shown by cerebral ultrasonography. This hemorrhage was followed by a cyst isodense to intracerebral fluid. Differential diagnostic aspects concerning the etiology of arachnoideal cysts will be discussed in relation to the post-hemorrhagic course and the sonographic or the magnetic resonance tomography findings respectively.