Jürgen Dinger

Effect of positive end expiratory pressure on functional residual capacity and compliance in surfactant-treated preterm infants.

Abstract Positive end expiratory pressure is routinely used when ventilating preterm infants. Elevation of PEEP increases lung volume, as does surfactant treatment. The purpose of this study was to investigate the effect of various levels of PEEP within the range of 0.2 to 0.4 kPa on lung volume, compliance and gas exchange. We measured functional residual capacity, compliance of the respiratory system and arterial blood gases in 20 infants (median birth weight 1240 g, range 660–1690 g; median gestational age 28 weeks, range 24–32 weeks; postnatal age 3–4 days). The infants were studied at 72 hours after their last dose of natural surfactant. At this time the patients were routinely nursed at 0.3 kPa of PEEP, the PEEP level was lowered to 0.2 kPa or raised to 0.4 kPa in random order. The PEEP level was then changed to the third level 0.4 kPa or 0.2 kPa. Each new setting was maintained for 20 min before FRC, compliance and blood gases were measured. FRC was assessed using SF6 washout technique. Increasing PEEP from 0.2 to 0.3 to 0.4 kPa resulted in increases in FRC (p < 0.01) and oxygenation (ns) in all infants. In 16 infants compliance decreased and paCO2 increased with elevation of PEEP. Only in 4 infants compliance increased and CO2 fell. Conclusion: In the majority of our infants reduction of PEEP from 0.4 to 0.2 kPa resulted in increases in compliance and CO2 reduction. Our results might suggest that relatively low levels of PEEP < 0.3 kPa may be appropriate at 72 hours after surfactant replacement. Furthermore, these results underline the importance of PEEP test in clinical practice.

Breast milk transmission of group B streptococcal infection

A term female infant developed late onset group B streptococcal disease on Day 12 of life. The source of the organism appeared to be expressed maternal breast milk in the absence of clinical mastitis. Asymptomatic excretion of group B Streptococcus in breast milk may be an underrecognized cause of neonatal infection.

Transient neonatal Lambert-Eaton syndrome.

JO N 2988 immune disease of the neuromuscular synapse mediated by serum IgG against voltage-gated calcium channel antibodies (anti-VGCC AB). The disorder is 60 % paraneoplastic (small-cell lung cancer) (PLEMS); the remainder presents no cancer-association (NP-LEMS) [7–9]. Placental transfer of antiVGCC antibodies in LEMS similarly resulting in transient neonatal LEMS has not been noted previously. We report on the pregnancy and premature delivery in a 34 year old (I gravida, I para) with NP-LEMS. After diagnosis of LEMS at 30 years, treatment was initiated, initially with pyridostigmine without success, consecutively with 3,4diaminopyridine (100 mg/d) with significant clinical improvement and anti-VGCC AB titres between 453.4–566.4 pmol/L (normal range < 30 pmol/L). During pregnancy the patient remained clinically stable under unmodified pharmacotherapy (anti-VGCC AB titres in Fig. 1), while the foetus presented mild intrauterine growth retardation. In the 24th week of gestation imminent premature labour called for tocolysis, uneventfully performed with magnesium 3 × 200 mg and glyceroltrinitrate 10 mg. In the 36th week of gestation caesarean section was performed because of premature labour and pathologic CTG. Ulrike Reuner Gabriele Kamin Georgia Ramantani Heinz Reichmann Jürgen Dinger

Mandibular Traction—An Alternative Treatment in Infants With Pierre Robin Sequence

PURPOSE In the Pierre Robin sequence, retrognathia and glossoptosis lead to airway obstruction in infants with or without cleft palate. Mandibular distraction has gained acceptance for the treatment of airway obstruction. However, surgical interventions can result in complications. In our institution, mandibular traction is the standard treatment in cases of severe respiratory distress. PATIENTS AND METHODS A retrospective study was performed of all infants treated for Pierre Robin sequence at our institution from 1979 to 2007. The diagnosis and type of treatment (positioning/palatal plate or mandibular traction) were evaluated. The palatal plate had several knobs at the anterior alveolar ridge to direct the tongue forward. Mandibular traction was applied using weights transmitted onto the mandible by a custom-made plate fixed at the mandible with circumferential wiring. RESULTS Nineteen children required airway treatment because of repeated cyanotic episodes and respiratory adaptation disorders. Of these 19 children, 8 had been diagnosed with pure Pierre Robin sequence and 11 also had other congenital abnormalities. Of the 19 patients, 10 (56%) were treated nonoperatively by lateral or prone positioning and/or wearing a palatal plate to stimulate the tongue. In 8 patients, conservative management was not sufficient, and continuous mandibular traction was performed for 2 to 5 weeks using weights of 50 to 200 g. One patient required a tracheostomy because of tracheomalacia. CONCLUSIONS Surgical therapy using mandibular traction is a minimally invasive alternative to more invasive procedures because no serious complications such as scars or damage to the nerves were encountered.

Methamphetamine Consumption during Pregnancy – Effects on Child Health

Methamphetamine abuse during pregnancy represents an emerging health care problem. The consequences are not only of relevance to the pregnant women, but also their unborn child. It is associated with an increased risk of preeclampsia and hypertension, fetal demise, preterm delivery, and intrauterine growth restriction. The deleterious effects of prenatal methamphetamine exposure on the developing fetal brain may lead to long-term neuro-developmental and behavioral problems.Given the current evidence, abuse of methamphetamine during pregnancy must be of utmost concern to health care professionals and to policy-makers. As it has been described for neonatal abstinence syndrome, a multi-professional team is required to improve care of affected women and families. A multi-disciplinary approach is needed, including good prenatal care of pregnant women, perinatal care by specialized obstetricians and neonatologists, and psychiatric treatment by an addiction specialist. Furthermore, families should be integrated into appropriate social support networks.For the development of a structured support program for pregnant women with methamphetamine consumption, methamphetamine use disorder should be considered as a disease that requires medical treatment as well as psychological and social support. The pregnancy should be considered as a window of opportunity to provide the required help.

Suctioning habits in the delivery room and the influence on postnatal adaptation - a video analysis.

Abstract Aims: To determine how often infants are suctioned during delivery and how it affects the neonate. Methods: Single-center analysis of video-recorded delivery room management after c-section from January 2012 until April 2013. Time point, duration, and frequency of suctioning in term and preterm newborns were analyzed along with vital parameters (heart rate (HR) and saturation values). Results: Three hundred forty-six videos were analyzed. Twenty-three percent of term and 66% of preterm newborns were suctioned. Newborns were suctioned up to 14 times; total duration spent for suctioning was between 2 and 154 s. Suctioning before face mask application occurred in 31% of the suctioned newborns requiring respiratory support. No severe bradycardia (<60 bpm) was noticed. Suctioning did not have an effect on HR and saturation in preterm infants but was associated with significantly higher HR in term infants requiring respiratory support. Term infants who did not require respiratory support showed significantly higher saturation values at 3, 5, 6, 7, 8, 9, and 10 min if they were not suctioned. Conclusions: Suctioning of newborns in the delivery room does not adhere to recommendations of international guidelines. However, previously described side effects of suctioning could not be confirmed.

Jejunal atresia related to the use of toluidine blue in genetic amniocentesis in twins

Abstract Since 1990 avoidance of methylene blue as a dye in diagnostic amniocentesis is recommended. This is the result of the observation that a high incidence of jejunoileal atresia appeared in twin pregnancies following intraamniotic injection of methylene blue.We report a case of jejunal atresia in twins after injection of toluidine blue.We describe the clinical course, discuss possible teratogenic mechanisms and emphasize that no synthetic dyes should be used in second trimester amniocentesis.

Novel Mutation in the DKC1 Gene: Neonatal Hoyeraal-Hreidarsson Syndrome As a Rare Differential Diagnosis in Pontocerebellar Hypoplasia, Primary Microcephaly, and Progressive Bone Marrow Failure

Primary microcephaly and severe developmental delay are complex but unspecific signs pointing to various genetic or acquired diseases. A concomitant finding of hematological failure may lead to the differential diagnosis of rare genetic diseases such as chromosome breakage disorders or diseases associated with telomere dysfunction. X-linked Hoyeraal-Hreidarsson syndrome (HHS) is a rare heterogenic disorder characterized by severe neurological impairment and progressive bone marrow failure. The latter represents the main cause of mortality, usually in early childhood. We report on the clinical course of an infant with HHS due to a novel mutation in the DKC1 gene and the particular finding of pontocerebellar hypoplasia.

PO-0746 Respiratory Support In Term Newborns After C-section

Background and aims After c-section term newborns are at risk of respiratory problems. Whereas some newborns require respiratory support only for a short time in the delivery room (DR), others are admitted to the NICU for prolonged therapy. Our aim was to compare differences between newborns with respiratory support in DR only and those admitted to the NICU. Methods Retrospective analysis of video recorded DR-management of term newborns born between January 2012 and November 2013 via c-section. Results 368 newborns were analysed with 82 (22%) receiving respiratory support. From them, 26 (32%) were transported to NICU for further treatment, the remaining 56 (68%) were stabilised after a short period of CPAP treatment. There were no demographic differences between both groups. CPAP-administration started after a median of 3.4 (0.2–27) in NICU and 3.7 (0.03–17) minutes in DR infants. At the start of CPAP administration infants had a median heart rate of 161 (75–195) in NICU and 153 (56–200) in DR newborns and SpO2 of 69 (41–100) and 80 (55–100) respectively (p = 0.01). 8 (31%) NICU and 15 (27%) DR newborns received a sustained inflation; mechanical ventilation via face-mask received 4 and 6 newborns respectively. In infants remaining in the DR respiratory support was stopped after a median of 7.6 (0.2–21) minutes, infants were transferred to the NICU after a respiratory support of 17.7 (4–29.6) minutes respectively. Discussion Except for lower SpO2 values there are no parameters to predict the need for the length of treatment in respiratory depressed term newborns.

Probleme der späten Frühgeborenen

Den späten Frühgeborenen wurde lange Zeit kaum Beachtung geschenkt. Die vorliegende Arbeit gibt nun einen Überblick über die aktuelle Literatur zu dieser Thematik und skizziert die medizinischen Konsequenzen, welche sich sowohl für die unmittelbar postnatale Versorgung als auch die Langzeitbetreuung dieser Patientengruppe ergeben.