To evaluate the efficacy of intravenous administration of nicardipine as a second-line temporizin... more To evaluate the efficacy of intravenous administration of nicardipine as a second-line temporizing treatment in severe, early-onset, pre-eclamptic patients. An open, prospective, evaluation study. A high-care obstetric ward in a tertiary care centre. Twenty-seven early-onset, pre-eclamptic patients with a median gestational age of 27 weeks 1 day (range, 21 weeks 2 days-32 weeks 4 days) with treatment failure on standard intravenous antihypertensive drugs (ketanserin, dihydralazin or labetalol). Nicardipine infusion was started for temporizing management of pre-eclampsia at a dosage of 3 mg/h and was subsequently titrated according to blood pressure. Nicardipine treatment was continued for as long as the maternal and foetal conditions allowed. The endpoints of the study were defined as the percentage of patients reaching the target diastolic intra-arterial blood pressure (< 100 mmHg or < 90 mmHg in Haemolysis, Elevated Liver Enzymes, Low Platelet Count syndrome patients) within 1 h after the start of treatment, and the number of days of prolongation of pregnancy under nicardipine treatment. Maternal and foetal side effects, foetal death and neonatal outcome were assessed. In all patients the target diastolic intra-arterial blood pressure was obtained within a median of 23 min (range, 5-60 min). Delivery was postponed for a median of 4.7 days (range, 1-26 days) using nicardipine treatment, in a maximum dosage ranging from 3 to 9 mg/h. Detailed haemodynamic parameters with corresponding nicardipine dosages were obtained in nine patients. In one-fifth of the patients, unwanted hypotensive periods were registered during treatment, manageable with dosage adaptation. Foetal well-being did not seem adversely affected. This evaluation shows that nicardipine is a potent antihypertensive drug and can be used for temporizing management in severe, early-onset pre-eclampsia when other antihypertensive drugs have failed.
... Epileptische aanvallen zijn beschreven bij vier van de vijftien tot nu toe in de litera-tuur ... more ... Epileptische aanvallen zijn beschreven bij vier van de vijftien tot nu toe in de litera-tuur gerapporteerde patie¨nten met neonatale ontwen-ningsverschijnselen van clomipramine (tabel I).1-4 Deze interpretatie was voornamelijk gebaseerd op klinische observaties, omdat bij drie ...
To evaluate the efficacy of intravenous administration of nicardipine as a second-line temporizin... more To evaluate the efficacy of intravenous administration of nicardipine as a second-line temporizing treatment in severe, early-onset, pre-eclamptic patients. An open, prospective, evaluation study. A high-care obstetric ward in a tertiary care centre. Twenty-seven early-onset, pre-eclamptic patients with a median gestational age of 27 weeks 1 day (range, 21 weeks 2 days-32 weeks 4 days) with treatment failure on standard intravenous antihypertensive drugs (ketanserin, dihydralazin or labetalol). Nicardipine infusion was started for temporizing management of pre-eclampsia at a dosage of 3 mg/h and was subsequently titrated according to blood pressure. Nicardipine treatment was continued for as long as the maternal and foetal conditions allowed. The endpoints of the study were defined as the percentage of patients reaching the target diastolic intra-arterial blood pressure (< 100 mmHg or < 90 mmHg in Haemolysis, Elevated Liver Enzymes, Low Platelet Count syndrome patients) within 1 h after the start of treatment, and the number of days of prolongation of pregnancy under nicardipine treatment. Maternal and foetal side effects, foetal death and neonatal outcome were assessed. In all patients the target diastolic intra-arterial blood pressure was obtained within a median of 23 min (range, 5-60 min). Delivery was postponed for a median of 4.7 days (range, 1-26 days) using nicardipine treatment, in a maximum dosage ranging from 3 to 9 mg/h. Detailed haemodynamic parameters with corresponding nicardipine dosages were obtained in nine patients. In one-fifth of the patients, unwanted hypotensive periods were registered during treatment, manageable with dosage adaptation. Foetal well-being did not seem adversely affected. This evaluation shows that nicardipine is a potent antihypertensive drug and can be used for temporizing management in severe, early-onset pre-eclampsia when other antihypertensive drugs have failed.
Incontinentia pigmenti (IP) is a rare X-linked dominant neuroectodermal multisystem disorder char... more Incontinentia pigmenti (IP) is a rare X-linked dominant neuroectodermal multisystem disorder characterized by skin lesions following Blaschko lines. In almost all patients the skin is involved and in 30-50% the central nervous system (CNS) is. Vascular occlusive phenomena probably play a role in CNS involvement. Whether these vascular changes are based on macro- or microvascular disease in the neonatal presentation is not fully understood. We describe two patients with IP with neonatal seizures related to cerebral infarction. In comparison, we reviewed reports of ischaemic cerebrovascular injury in neonatal IP. No descriptions of documented large artery occlusion in neonatal IP was found in the literature. One of our patients showed striatal arteriopathy, never described before in IP. Extensive injury in one of our cases was heterogeneous, mixing healthy with diseased areas within large arterial fields. We postulate that neonatal cerebral infarction in IP is a macrovascular disorder of medium sized or small arteries. The pattern of arterial involvement might follow hypothetical brain Blaschko lines. The extent of cerebral involvement probably results from genetic mosaicism in which Lyonisation leads to endothelial apoptosis, similar to the process in the skin.
To evaluate the efficacy of intravenous administration of nicardipine as a second-line temporizin... more To evaluate the efficacy of intravenous administration of nicardipine as a second-line temporizing treatment in severe, early-onset, pre-eclamptic patients. An open, prospective, evaluation study. A high-care obstetric ward in a tertiary care centre. Twenty-seven early-onset, pre-eclamptic patients with a median gestational age of 27 weeks 1 day (range, 21 weeks 2 days-32 weeks 4 days) with treatment failure on standard intravenous antihypertensive drugs (ketanserin, dihydralazin or labetalol). Nicardipine infusion was started for temporizing management of pre-eclampsia at a dosage of 3 mg/h and was subsequently titrated according to blood pressure. Nicardipine treatment was continued for as long as the maternal and foetal conditions allowed. The endpoints of the study were defined as the percentage of patients reaching the target diastolic intra-arterial blood pressure (< 100 mmHg or < 90 mmHg in Haemolysis, Elevated Liver Enzymes, Low Platelet Count syndrome patients) within 1 h after the start of treatment, and the number of days of prolongation of pregnancy under nicardipine treatment. Maternal and foetal side effects, foetal death and neonatal outcome were assessed. In all patients the target diastolic intra-arterial blood pressure was obtained within a median of 23 min (range, 5-60 min). Delivery was postponed for a median of 4.7 days (range, 1-26 days) using nicardipine treatment, in a maximum dosage ranging from 3 to 9 mg/h. Detailed haemodynamic parameters with corresponding nicardipine dosages were obtained in nine patients. In one-fifth of the patients, unwanted hypotensive periods were registered during treatment, manageable with dosage adaptation. Foetal well-being did not seem adversely affected. This evaluation shows that nicardipine is a potent antihypertensive drug and can be used for temporizing management in severe, early-onset pre-eclampsia when other antihypertensive drugs have failed.
... Epileptische aanvallen zijn beschreven bij vier van de vijftien tot nu toe in de litera-tuur ... more ... Epileptische aanvallen zijn beschreven bij vier van de vijftien tot nu toe in de litera-tuur gerapporteerde patie¨nten met neonatale ontwen-ningsverschijnselen van clomipramine (tabel I).1-4 Deze interpretatie was voornamelijk gebaseerd op klinische observaties, omdat bij drie ...
To evaluate the efficacy of intravenous administration of nicardipine as a second-line temporizin... more To evaluate the efficacy of intravenous administration of nicardipine as a second-line temporizing treatment in severe, early-onset, pre-eclamptic patients. An open, prospective, evaluation study. A high-care obstetric ward in a tertiary care centre. Twenty-seven early-onset, pre-eclamptic patients with a median gestational age of 27 weeks 1 day (range, 21 weeks 2 days-32 weeks 4 days) with treatment failure on standard intravenous antihypertensive drugs (ketanserin, dihydralazin or labetalol). Nicardipine infusion was started for temporizing management of pre-eclampsia at a dosage of 3 mg/h and was subsequently titrated according to blood pressure. Nicardipine treatment was continued for as long as the maternal and foetal conditions allowed. The endpoints of the study were defined as the percentage of patients reaching the target diastolic intra-arterial blood pressure (< 100 mmHg or < 90 mmHg in Haemolysis, Elevated Liver Enzymes, Low Platelet Count syndrome patients) within 1 h after the start of treatment, and the number of days of prolongation of pregnancy under nicardipine treatment. Maternal and foetal side effects, foetal death and neonatal outcome were assessed. In all patients the target diastolic intra-arterial blood pressure was obtained within a median of 23 min (range, 5-60 min). Delivery was postponed for a median of 4.7 days (range, 1-26 days) using nicardipine treatment, in a maximum dosage ranging from 3 to 9 mg/h. Detailed haemodynamic parameters with corresponding nicardipine dosages were obtained in nine patients. In one-fifth of the patients, unwanted hypotensive periods were registered during treatment, manageable with dosage adaptation. Foetal well-being did not seem adversely affected. This evaluation shows that nicardipine is a potent antihypertensive drug and can be used for temporizing management in severe, early-onset pre-eclampsia when other antihypertensive drugs have failed.
Incontinentia pigmenti (IP) is a rare X-linked dominant neuroectodermal multisystem disorder char... more Incontinentia pigmenti (IP) is a rare X-linked dominant neuroectodermal multisystem disorder characterized by skin lesions following Blaschko lines. In almost all patients the skin is involved and in 30-50% the central nervous system (CNS) is. Vascular occlusive phenomena probably play a role in CNS involvement. Whether these vascular changes are based on macro- or microvascular disease in the neonatal presentation is not fully understood. We describe two patients with IP with neonatal seizures related to cerebral infarction. In comparison, we reviewed reports of ischaemic cerebrovascular injury in neonatal IP. No descriptions of documented large artery occlusion in neonatal IP was found in the literature. One of our patients showed striatal arteriopathy, never described before in IP. Extensive injury in one of our cases was heterogeneous, mixing healthy with diseased areas within large arterial fields. We postulate that neonatal cerebral infarction in IP is a macrovascular disorder of medium sized or small arteries. The pattern of arterial involvement might follow hypothetical brain Blaschko lines. The extent of cerebral involvement probably results from genetic mosaicism in which Lyonisation leads to endothelial apoptosis, similar to the process in the skin.
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