Stefan Kurath-Koller

Changes of Locoregional Skin Temperature in Neonates Undergoing Laser Needle Acupuncture at the Acupuncture Point Large Intestine 4

Laser acupuncture bears a potential risk for the skin surface, especially in neonates whose skin has histological and physiological peculiarities. We evaluated thermal changes of skin temperature in neonates during laser acupuncture by using a thermal camera (Flir i5, Flir Systems Inc., Portland, USA). Laserneedles (Laserneedle GmbH, Glienicke/Nordbahn, Germany) were fixed to the skin at Large Intestine 4 (LI 4, Hegu), bilaterally. Before application of laser acupuncture (685 nm, 15 mW, 500 μm), as well as after 1, 5, and 10 min, thermographic pictures of both hands were taken. The measuring was carried out on the 23rd day after birth (20 neonates, mean postmenstrual gestational age 38 + 2, mean weight 2604 g). Compared to the initial temperature of 34.2°C on the right hand, the skin temperature had increased to 35.3°C (P < 0.05) after 5 min and up to 36.1°C (P < 0.05) after 10 min of stimulation. Equally, on the left hand, an increase of the skin temperature from 34.5°C to 35.9°C (P < 0.05) and 35.9°C (P < 0.05) was measured. The highest measured skin temperature after 10 min of stimulation amounted to 38.7°C, without any clinically visible changes on the skin surface.

Prematurity and the burden of influenza and respiratory syncytial virus disease.

BackgroundRespiratory morbidity of former preterm infants and especially those with bronchopulmonary dysplasia (BPD) is high during infancy and early childhood.Data sourcesWe performed a review based on a literature search including EMBASE, MEDLINE, and CINAHL databases to identify all relevant papers published in the English and German literature on influenza and respiratory syncytial virus infection associated with preterm infant, prematurity, and BPD between 1980 and 2014.ResultsRecurrent respiratory symptoms remain common at preschool age, school age and even into young adulthood. Acute viral respiratory tract infections due to different pathogens cause significant morbidity and necessitate rehospitalizations during the first years of life. Influenza virus infection plays a minor role compared to respiratory syncytial virus (RSV) associated respiratory tract infection during infancy and early childhood. Nevertheless, particular morbidity to both viruses is high.ConclusionsThe particular burden of both viral diseases in preterm infants is dominated by RSV and its associated rehospitalizations during the first two years of life. Prophylactic measures include vaccination against influenza virus of family members and caregivers and active immunization starting at the age of 6 months, and monthly injections of palivizumab during the cold season to avoid severe RSV disease and its sequelae.

Surfactant Protein B Deficiency Caused by Homozygous C248X Mutation—A Case Report and Review of the Literature

Objective Surfactant protein B (SP-B) deficiency is a rare autosomal recessive disorder that is usually rapidly fatal. The c.397delCinsGAA mutation (121ins2) in exon 4 is found in more than two-thirds of patients. Design We report on a fatal case of SP-B deficiency caused by a homozygous C248X mutation in exon 7 of the SP-B gene. In addition, we provide an update of the current literature. The EMBASE, MEDLINE, and CINAHL databases were systematically searched to identify all papers published in the English and German literature on SP-B deficiency between 1989 and 2013. Results SP-B deficiency is characterized by progressive hypoxemic respiratory failure generally in full-term infants. They present with symptoms of respiratory distress and hypoxemia; chest X-ray resembles hyaline membrane disease. Prenatal diagnosis is possible from amniotic fluid or chorionic villi sampling. Conclusion Thirty-four mutations have been published in the literature. Treatment options are scarce. Gene therapy is hoped to be an option in the future.

Use of NADA ear acupuncture in an adolescent patient with phantom limb pain after surgery for osteosarcoma

Your readers may be interested to hear of our experiences with ear acupuncture, as they may recall the recent letter by Tseng et al 1 describing scalp acupuncture in a 74-year-old patient suffering from phantom limb pain. We used National Acupuncture Detoxification Association (NADA) acupuncture in an adolescent girl suffering from phantom limb pain after hemipelvectomy for osteosarcoma. Positive effects were found on pain and personal well-being evaluated using the Measure Yourself Concerns and Wellbeing (MYCaW) questionnaire.2 Acupuncture is increasingly used as an adjunct therapy in oncology to treat pain and other symptoms such as nausea and vomiting. However, the evidence in paediatric oncology is scarce, and limited to studies describing a reduction in pain or vomiting.3 Contributing factors for the lack of evidence might be fear of needles4 or vulnerability of the patients. Ear acupuncture is used to treat a variety of disorders including both psychological and somatic diseases.5 ,6 Currently, more than 100 ear acupuncture points are known. The NADA protocol combines five ear acupuncture points ( Shenmen (point 55), Liver (point 97), Kidney (point 95), Lung (point 101) and Sympathetic point (point 51) on both ears) with a non-verbal patient approach and group therapy as a simple treatment concept to treat drug withdrawal.7 The NADA protocol has …

Right ventricular base/apex ratio in the assessment of pediatric pulmonary arterial hypertension: Results from the European Pediatric Pulmonary Vascular Disease Network

Echocardiographic determination of RV end‐systolic base/apex (RVES b/a) ratio was proposed to be of clinical value for assessment of pulmonary arterial hypertension (PAH) in adults.

Respiratory syncytial virus hospitalizations in infants of 28 weeks gestational age and less in the palivizumab era

OBJECTIVE To obtain data on respiratory syncytial virus (RSV) associated hospitalization rates in preterm infants of 28 weeks gestational age and less in the era of palivizumab prophylaxis. METHODS Retrospective single-center cohort study including all preterm infants up to 28 weeks+6days gestational age and born between 2004 and 2012 at a tertiary care university hospital. Data on RSV related hospitalizations over the first two years of life covering at least two RSV seasons (November-April) were analyzed. RESULTS Ninety-one of 287 (32%) infants were hospitalized due to respiratory illness, and a total of 17 infants (5.9%) tested RSV positive during the first 2 years of life. Fourteen infants (4.9%) were hospitalized during the first RSV season. RSV hospitalization rate in infants with BPD was 4.5% (2/44) compared to 4.9% (12/243) without BPD. Palivizumab prophylaxis was documented in 74.6% of the infants. Infants with RSV compared to other respiratory tract infection were of younger age (6.8 vs. 9.1 months; p=0.049), had longer hospital stays (median 11 vs. 5 days; p=0.043) and more severe respiratory illness (median LRI score 3 vs. 2; p=0.043). CONCLUSIONS Despite palivizumab prophylaxis the burden of RSV disease and all cause respiratory illness was still remarkable in this vulnerable preterm population and mainly limited to the first season.

Relevance of Right Ventricular Outflow Tract Velocity Time Integral (RVOT VTI) and Tricuspid Regurgitation Velocity/RVOT VTI Ratio Determination in Children Following Heart Transplantation

We read with interest the article “Right Ventricular Dysfunction as an Echocardiographic Measure of Acute Rejection Following Heart Transplantation in Children” by Aggarwal et al. [1]. Authors investigated the role of RV functional parameters as well as pulmonary vascular compliance measures by echocardiography in the detection of acute allograft rejection (AAR) following orthotopic heart transplantation (OHT) in children [1]. The tricuspid regurgitation velocity (TRv)/right ventricular outflow tract velocity time integral (RVOT VTI) ratio, as a reliable measure of pulmonary blood flow in adults with PH [2–4], approximates the ratio of pulmonary artery pressure to pulmonary blood flow. Abbas et al. [2] nicely have shown that the ratio of TRv/RVOT VTI is related to pulmonary vascular resistance (PVR). As the PVR increases, earlier and enhanced reflections of the pressure wave profile of RVOT appear along with substantial changes in RVOT VTI [5]. Aggarwal et al. [1] found that the PVR, as assessed by the TRv/RVOT VTI ratio, was significantly higher at the time of AAR [1]. There was no difference in the TRv but significantly lower VTI values were detected, suggesting a decreased RV output. This is in agreement to recent data [6] showing impaired RVOT VTI in children with increased RV afterload due to pulmonary hypertension (PH). In this patient group, the TRV/RVOT VTI ratio was found to rise with increasing RV pressure [6]. Aggarwal et al. [1] describe that the age range of the children at the time of OHT was 2 months to 12.7 years. In our opinion it would be important to use age-related RVOT VTI values in children as reference, due to the variability of RVOT VTI values due to age and growth. We want to add that data of RVOT VTI normative values and z-scores are currently available [6, 7]. It would be of interest for the audience of Pediatric Cardiology in which way the observed differences of VTI values during AAR would have been more relevant if they were compared to available age-dependent parameters [7]. Using these agerelated normative values the authors would have been able to compare the measured RVOT VTI values of their patients with respective age-related RVOT VTI values, which in our opinion would have improved the statistical power of their analysis. With the currently available data and the fact that the TRv/RVOT VTI ratio [1, 2, 6] provides a non-invasive and simple method for identifying RV flow disturbances, we want to encourage the use of this ratio in clinical practice, implicating that an increased ratio should lead to a more invasive determination. We want to thank the authors for addressing the need for careful and systematic evaluation of RV function and output in children with AAR after OHT and want to highlight their study, which now for the first time provides non-invasive values of RV dysfunction during AAR following OHT in children [1]. These non-invasive echocardiographic parameters of RV function can assist in the evaluation of OHT patients in routine follow-up and may reduce costs by decreasing the number of more advanced investigations such as myocardial biopsies or cardiac magnet resonance imaging [8]. Even more, as a non-invasive parameter to detect impaired pulmonary blood flow in children with PH, we suggest including RVOT VTI and the TRV/ RVOT VTI ratio in echocardiographic protocols when evaluating children with a suspected PH. * Martin Koestenberger Martin.Koestenberger@medunigraz.at; koestenbergerm@gmx.at

Commentary: Echocardiographic Evaluation of Pulmonary Pressures and Right Ventricular Function after Pediatric Cardiac Surgery: A Simple Approach for the Intensivist

Citation: Kurath-Koller S, Schweintzger S and Köestenberger M (2018) Commentary: Echocardiographic Evaluation of Pulmonary Pressures and Right Ventricular Function after Pediatric Cardiac Surgery: A Simple Approach for the Intensivist. Front. Pediatr. 6:136. doi: 10.3389/fped.2018.00136 Commentary: Echocardiographic Evaluation of Pulmonary Pressures and Right Ventricular Function after Pediatric Cardiac Surgery: A Simple Approach for the Intensivist

The right ventricular outflow tract in pediatric pulmonary hypertension-Data from the European Pediatric Pulmonary Vascular Disease Network

The right ventricular outflow tract (RVOT) is pivotal for adequate RV function and known to be adversely affected by elevated pulmonary arterial pressure (PAP) in adults with pulmonary hypertension (PH). Aim of this study was to determine the effects of increased RV pressure afterload in children with PH on RVOT size, function, and flow parameters.

Right Atrial Dilatation, Determined by Echocardiography, and Correlation with Right Atrial Pressure, Determined with Cardiac Catheterization, in Children with Pulmonary Hypertension.

To the Editor, We read with interest the article ‘‘Echocardiographic assessment of right atrial pressure in a pediatric and young adult population’’ by Arya et al. [1]. This manuscript describes the right atrial volume (RAV) to be a relevant echocardiographic variable to estimate right atrial pressure (RAP) in children with a pulmonary hypertension (PH). The authors clearly state that there is a need for a detailed evaluation of various echocardiographic parameters for assessment of RAP, e.g., the inferior vena cava (IVC) diameter, the hepatic vein systolic filling fraction, and the RAV, to provide information of the compliance of the RA. Their study was prompted by the need to find noninvasive methods to measure RAP, because cardiac catheterization has some serious risks in the pediatric age group [2]. Consequently, their data could help clinicians in future to optimize the time point for a cardiac catheterization. In the literature, various echocardiographic parameters were suggested as noninvasive estimates of RAP in healthy children [3]. RA variables were investigated in healthy children [4], but a correlation to respective enlarged RA in children with PH to date is sparse. Recently, the influence of an increased afterload in children with PH on the RAV has been investigated [5]. As a result the increase of the RAV above the ?2 SD of age-related normal values determines a significant dilatation of the RA in children with PH [5]. Arya et al. [1] found the RAV to correlate modestly with the mean RAP. They were able to provide a cutoff value of the RAV of 32.6 ml/m between normal versus elevated mean RAP values in children with PH. For the convenience of the audience of Pediatric Cardiology, we would like to mention that a comparison of their RAV data to available RAV normal values and Z scores [5] would have improved the statistical power of their analysis. It would be of interest for the audience how RAV parameters of PH children in their study [1] compare to available age-dependent parameters [5]. The newly introduced echocardiographic assessment of RAP [1] provides a noninvasive and simple method for identifying RA pressure overload, and therefore, we want to encourage the use of these variables in clinical practice. This implicates that an increased RAV or ICV diameter should lead to a thoroughly echocardiographic investigation or more invasive determination in children with suspected PH. We want to thank the authors for addressing the need for careful and systematic evaluation of RA dilatation in children with PH and want to highlight their study, which now for the first time provides cutoff echo values of RAP in children with PH [1]. Moreover, echocardiographic assessment of RA volume and size can assist in the evaluation of PH patients in routine follow-up and may reduce costs by decreasing the number of more advanced investigations such as cardiac magnetic resonance imaging [6].