Heinz Zotter

Impact of smoking during pregnancy on peripheral tissue oxygenation in term neonates.

Background: Smoking during pregnancy is associated with higher blood pressure in neonates. Objective: To analyze whether smoking during pregnancy has an influence on peripheral tissue oxygenation in healthy term neonates within the first days after delivery. Methods: In a prospective cohort study, 15 healthy term neonates of mothers who had smoked during pregnancy (smoking group) were matched for gestational age, actual weight and postnatal age to 15 healthy term neonates of mothers who had not smoked during pregnancy (non-smoking group). Peripheral oxygenation was measured by near-infrared spectroscopy in combination with the venous occlusion method on the left forearm. Measurements were performed within the first 2 days after delivery. Tissue oxygenation index (TOI), fractional oxygen extraction (FOE), oxygen delivery (DO2) and oxygen consumption (VO2) were analyzed. Results: In neonates measured within the first day after delivery, TOI was significantly lower and FOE was significantly higher (63.5 ± 5.5; 0.37 ± 0.04) in the smoking group compared to the non-smoking group (69.2 ± 2.9; 0.30 ± 0.04). DO2 tended to be lower and VO2 tended to be higher in the smoking group. In neonates measured on the second day after delivery, no significant differences were observed between the groups. Conclusions: Smoking during pregnancy reduced TOI and increased FOE in otherwise healthy neonates on the first day of life with normalization on the second day of life.

Correlation between cholesterol, soluble P-selectin, and D-dimer in obese children and adolescents.

Thirty-eight obese children and adolescents were investigated for a possible relation between cholesterol and markers of platelet activation, endothelial cell dysfunction, and activation of the coagulation system. Soluble P-selectin, von Willebrand factor antigen (vWf-Ag), D-dimer, and prothrombin fragment 1 + 2 (F1 + 2) were determined by enzyme-linked immunosorbent assays, and factor VIII coagulant activity (VIIIc) was measured by means of one-stage clotting assay. Cholesterol correlated significantly with log P-selectin (r= 0.43,P= 0.003) and log D-dimer (r= 0.33,P= 0.02). Cholesterol did not correlate with vWf-Ag, factor VIIIc, and F1 + 2. Log P-selectin correlated significantly with log D-dimer (r= 0.42,P= 0.003), which remained significant after adjustment for cholesterol (P= 0.02). Log D-dimer correlated significantly with F1 + 2 (r= 0.38,P= 0.01). Our study demonstrates that, in obese children and adolescents, cholesterol is significantly associated with P-selectin and D-dimer, and suggests an unfavorable intercorrelation between metabolic and hemostatic risk factors for coronary heart disease in childhood obesity.

aEEG and NIRS during transition and resuscitation after birth: Promising additional tools; an observational study

AIM OF THE STUDY During resuscitation no routine cerebral monitoring is available. We aimed at monitoring cerebral activity and oxygenation continuously during neonatal transition and resuscitation. METHODS Neonates ≥34 weeks of gestation born via cesarean section were included. Cerebral activity was continuously measured with amplitude-integrated-EEG (aEEG) and cerebral oxygenation (rSO2) with near-infrared-spectroscopy (NIRS) during the first 10 min after birth. For quantitative analysis of aEEG every minute the mean minimum amplitude (V(min)) and maximum amplitude (V(max)) was determined. Uncompromised neonates were compared to neonates in need of resuscitation. RESULTS Out of 224 eligible neonates 31 uncompromised and 15 in need of respiratory support were included. Uncompromised neonates showed higher values for V(min) in the third minute and higher values for V(max) in the third and fourth minute compared to the tenth minute post-partum. In uncompromised neonates rSO2 values during the first 6 min after birth were lower compared to minute ten. Neonates in need of respiratory support had lower rSO2 values over the first 8 min after birth compared to minute ten. CONCLUSIONS This is the first study demonstrating that monitoring of aEEG and NIRS to measure cerebral activity and oxygenation during immediate postpartum transition is feasible. During transition compromised neonates requiring resuscitation showed a different cerebral activity pattern compared to uncompromised neonates.

Bladder voiding in sleeping infants is consistently accompanied by a cortical arousal

The aim of the study was to find out whether bladder voiding in healthy sleeping infants was accompanied by any arousal reaction. Polygraphic recordings were performed in 21 healthy infants (11 female) born at term. The infants’ age at study entry was 42 ± 4 days and actual body weight was 4852 ± 689 g (mean ± SD). Bladder voiding was recorded by an adapted enuresis detector which was connected to the polygraphic computer unit. Arousals were defined as suggested by the ‘International Paediatric Work Group on Arousals’. Awakenings were excluded from the study. Bladder voiding was recorded at a mean time of 68 ± 7 min after the infant had fallen asleep and occurred during quiet sleep (QS). Electroencephalogram frequency (P < 0.01) and heart rate (P < 0.05) were higher during the 5‐s period before and after bladder voiding when compared with a 30‐s interval before voiding. Furthermore, bladder voiding was accompanied by body movements in all infants. Respiratory frequency did not change significantly. We could demonstrate for the first time in sleeping infants, that bladder voiding during QS was accompanied by a cortical arousal.

Infrared Thermography in Newborns: The First Hour after Birth

Objective: It was the aim of this study to investigate the surface temperature in newborns within the first hour after delivery. Furthermore, the influence of different environmental conditions with regard to surface temperature was documented. Methods: Body surface temperature was recorded under several environmental conditions by use of infrared thermography. 42 newborns, all delivered at term and with weight appropriate for date, were investigated under controlled conditions. Results: The surface temperature immediately after birth shows a uniform picture of the whole body; however, it is significantly lower than the core temperature. Soon after birth, peripheral sites become cooler whereas a constant temperature is maintained at the trunk. Bathing in warm water again leads to a more even temperature profile. Radiant heaters and skin-to-skin contact with the mother are both effective methods to prevent heat loss in neonates. Conclusions: Infrared thermography is a simple and reliable tool for the measurement of skin temperature profiles in neonates. Without the need of direct skin contact, it may be helpful for optimizing environmental conditions at delivery suites and neonatal intensive-care units.

Peripheral oxygenation in term neonates

The aim of this study was to analyse changes in peripheral oxygenation in healthy term neonates within the first week of life with near-infrared spectroscopy and venous occlusion. Oxygen delivery did not change with increasing age. Oxygen consumption and fractional oxygen extraction increased, whereas tissue oxygenation index decreased with increasing age.

Pacifier use: what makes mothers change their mind?

Aim: To find out the reasons for mothers to either use or not use a pacifier and to find out the mothers reasons for changing their mind.

Acylated ghrelin increases after controlled short-time exercise in school-aged children

Ghrelin is a peptide hormone, which plays an important role in appetite regulation. The effects of exercise on ghrelin plasma concentrations are still not clear, especially in children and adolescents. The aim of this study was to investigate the response of acylated and total ghrelin concentrations to controlled exercise in school‐aged children. Thirty‐six healthy school‐aged children (mean age 12.61 years, SD ± 0.39) underwent a controlled bicycle exercise test. Before and immediately after exercise, blood samples were taken in order to measure plasma ghrelin concentrations. The control group consisted of 24 healthy school‐aged children. After controlled short‐time exercise, total ghrelin concentrations showed no significant difference, whereas acylated ghrelin concentrations increased significantly (P<0.001) in the study population compared with the control group. Moreover, we found a correlation between the proportional increase of acylated ghrelin and the duration of exercise (P<0.01), and between the proportional increase of acylated ghrelin and maximal performance (P<0.01). Increased levels of acylated ghrelin after exercise could be a physiological response to ensure a sufficient caloric intake after energy consumption in children and adolescents.

Rewarming index of the lower leg assessed by infrared thermography in adolescents with type 1 diabetes mellitus

The aim of this study was to determine whether infrared thermography before and after challenge of the lower leg in cold water may be a useful tool to detect abnormalities in skin blood flow in adolescent asymptomatic patients with type 1 diabetes mellitus (DM1) and to assess the optimal setting of skin temperature measurements. Twenty-five adolescents (10 female, 15 male, mean age 21.2 +/- 6.2 years, body mass index [BMI] 23.0 +/- 2.1 kg/m2) with a duration of DMI of 13.8 +/- 5.4 years and mean HbA1c levels 8.5 +/- 1.3% were compared to age- and sex-matched controls (BMI 22.9 +/- 2.2 kg/m2). Seven defined sites of the lower leg were assessed by infrared thermography before and for 10 min after exposure of the leg to 14 degrees C cold water. As skin temperature before exposure to cold water differs from individual to individual and basal temperature was significantly warmer in patients at the tip of the first (p < 0.05) and fifth (p < 0.05) toe, the rewarming index was calculated in order to compare data. Rewarming indexes of skin temperature during the whole measurement procedure (0-10 min) were significantly lower at the tip of the first (p < 0.05) and fifth (p < 0.01) toes and from minute 2-10 also at the inner ankle (p < 0.05) in patients compared to healthy controls. Rewarming indexes of the other four sites were not significantly different between patients and controls. Infrared thermography of the lower leg after cold water exposure is an easily applicable method and a useful tool to detect abnormalities of skin blood flow in adolescents with DM1 especially at the tips of the first and fifth toes and the inner ankle.

Detection of Psychic Ear Acupuncture Points in a Newborn Infant with Neonatal Abstinence Syndrome

Dear Editor: We would like to comment about new insights concerning active ear points in neonates. There are only a few data available about the presence or absence of ear acupuncture points in newborn infants. Stähler van Ämerongen et al. demonstrated recently that vegetative points and organ points are detectable in neonates. The most important point was the psychovegetative rim besides other points, such as the mouth-esophagus point, the urinary bladder point, and the Darwin point. However, no psychic points were detectable in these 50 healthy neonates. This corresponds with the fact that psychic diseases in newborns are not known. The aim of this case report was to detect psychic points in a neonate with neonatal abstinence syndrome (NAS). For the detection of ear points, we used the PS 3 (Silberbauer, Vienna, Austria) ear-point detection pen, an electrical device that is placed loosely on the whole ear. Electrical conductivity in ear points differs from that in the surrounding skin surface; this is indicated by a light flash and a silent noise of the PS 3 pen. Active ear points were noted on a schematic ear graph according to the French and Chinese system. The infant was a spontaneously term-delivered female newborn with 39þ3 weeks of gestation (weight at delivery 3258 g, length at delivery 50 cm, Apgar score 9=10=10, umbilical arterial pH 7.28). We investigated the child 22 hours after delivery. The infant was in acute distress caused by a NAS, with periods of crying and fidgetiness (Finnegan score 16). We detected the psychovegetative rim (2=3 and 3=3) on the left and right ear, the mouth-, the esophagus-, and the lung point on the right earlobe. We also detected the R point and the frustration point on the left and right earlobes. Both points are known as psychotropic points. Frustration point is described 3–4 mm cranial from the point external ear on the Incisura supratragica. R point (first described by R.J. Bourdiol) is also known as ‘‘supporting point of psychotherapy’’ and is described close to the nasal border on the rising Helix in the passage to the facial skin. So for the first time it was possible to demonstrate the presence of psychic ear acupuncture points in newborn infants. Using acupuncture as complementary treatment for detoxification based on the National Acupuncture Detoxification Association (NADA) protocol is widely used for 25 years in the United States and in the recent 10 years in Europe. The NADA treatment (NADA protocol) is a basic treatment of addiction, psychiatric diseases, and posttraumatic patients. Ear acupuncture is an important part of the treatment process. There are multiple scientific studies about the effects of ear acupuncture in patients with addictions. Using needle acupuncture for newborns is not practicable, but it seems that using laser acupuncture is a good alternative. In addition to the medical treatment and care program, we decided to use laser acupuncture as alternative therapy to medical treatment, to relieve the withdrawal symptoms using the described protocol.