W. Müller

Procalcitonin and interleukin-6 in the diagnosis of early-onset sepsis of the neonate

The reliability of procalcitonin (PCT) and interleukin‐6 (IL‐6) was determined and compared with that of C‐reactive protein (CRP) in the diagnosis of early‐onset sepsis of the neonate within the first 12 h of life. ROC analysis of values of 41 neonates with blood‐cultures‐positive and clinical sepsis compared with those of 27 uninfected neonates revealed sensitivities for PCT (≥6ng/mL), IL‐6 (≥60pg/mL), and CRP (≥2.5 mg/L) of 77%, 54%, and 69% and specificities of 91%, 100% and 96%, respectively. Sensitivity of CRP at ≥8 mg/L was 49% (p= 0.012 compared to PCT).

Neurodevelopmental outcome of hydrocephalus following intra-/periventricular hemorrhage in preterm infants: short- and long-term results

Over a 5-year period (1984–1988) intra- and periventricular hemorrhage (IVH/PVH) was observed in 299 preterm infants. Sixty-eight infants developed posthemorrhagic hydrocephalus (PH); of these, 23 infants died and 40 infants could be followed up for assessment of neurological development (5 patients were lost to follow-up). At 1 year of corrected age 15% (25% at 5 year follow-up) of the infants were determined to have developed normally, 35% (25% at 5-year follow-up) showed mild neurological symptoms and/or slight developmental delay, 32.5% (28% at 5-year follow-up) had handicaps and/or moderate mental retardation, and 17.5% (22% at 5-year follow-up) had severe handicaps and/or severe mental retardation. There was a significantly worse outcome in infants with grade 4 IVH/PVH (P<0.05) and a significantly worse outcome in the group requiring ventriculoperitoneal (VP) shunt (P<0.05). The results at 1 year of corrected age proved to be a quite realistic predictor of neurological functioning at 5 years of age (80% predicted correctly in the nonshunted-group — one patient lost to follow-up; 95% predicted correctly in the shunted group — four patients lost to follow-up). Cystic periventricular leukomalacia had been diagnosed in 7 (10%) patients and was associated with poor neurodevelopmental outcome. Gestational age, birth weight, time of shunt placement, and peripartum asphyxia had no significant influence on neurodevelopmental outcome. Infants with shunt infections and a high number of shunt revisions were found to have a significantly worse neurodevelopmental outcome (P<0.01).

Absent or reversed end-diastolic blood flow in the umbilical artery and abnormal Doppler cerebroplacental ratio--cognitive, neurological and somatic development at 3 to 6 years.

UNLABELLED The objective of this study was to examine the cognitive, neurological and somatic developments of children who had in utero an absent or reversed end-diastolic blood flow (ARED) in the umbilical artery or an abnormal cerebroplacental ratio (ABF). METHODS 16 children with ARED blood flow and 15 children with ABF were each matched to children with the same gestational age, appropriate for gestational age, the same sex and born within 4 months. Data were assessed at the age of 3-6 years. Children with asphyxia, neonatal infection, malformation or major surgical interventions in the neonatal period were excluded. Each child underwent a neuropediatrical examination; furthermore, a Kaufman Assessment Battery for Children, a Snijders-Oomen Intelligence Scale for Children and a Man-Drawing Test were used to evaluate cognitive development. The socioeconomic status was also assessed. RESULTS Children in the ARED group remained lighter and had a higher frequency of microcephaly. In the Kaufman Assessment Battery for Children and the Snijders-Oomen Intelligence Scale for Young Children, cognitive development was impaired in the ARED and the ABF groups compared to the control group. The ARED and the ABF groups, however, showed no differences. The Man-Drawing Test and the Denver Development Test did not show any differences. DISCUSSION ARED blood flow and ABF showed impaired cognitive development. The degree of impairment was the same in the ARED and the ABF groups. Long-term follow-up studies until adulthood are necessary to see if impaired cognitive development remains significant in these groups of patients.

Correlation of ventricular size and head circumference after severe intra-periventricular haemorrhage in preterm infants.

No detailed information is available about the timing and correlation of objectively gauged ventricular width (VW) and the rate of growth of the occipitofrontal circumference in premature infants with intraventricular haemorrhage preceding progressive ventricular dilation. For this study, two groups were selected according to clinical course: group A(n = 6) had ventriculomegaly with no signs of raised intracranial pressure, while patients in group B (n = 7) developed progressive ventricular dilation after a period of latency. A VW between 0.9 and 1.4 cm (group A) did not affect normal head growth, whereas a VW greater than 1.5 cm was always associated with the development of hydrocephalus. Our data further suggest that the widely used criterion of a head growth rate of more than 2 cm/week is a relatively poor criterion for the definition of post-haemorrhagic hydrocephatus.

The influence of head position on the intracranial pressure in preterm infants with posthemorrhagic hydrocephalus

In order to measure the intracranial pressure (ICP) of 8 newborn with posthemorrhagic hydrocephalus (group A) we used the noninvasive technique via the anterior fontanel (Ladd monitor). The ICP was monitored in two different head positions (30° elevated, horizontal). The median measurements were: elevated head position, 13 mm Hg, horizontal head position, 16 mm Hg. For comparative reasons, we also measured the ICP of 12 healthy newborns (group B). The median results were: elevated head position, 4 mm Hg, horizontal head position, 6.5 mm Hg. Significant differences were found between groups.

Non-invasive oscillometric blood pressure measurement in very-low-birthweight infants: a comparison of two different monitor systems

Sir, Over the last 20 y, non-invasive oscillometric blood pressure measurement has become a widespread and accepted technique, even in very-low-birthweight infants (VLBW), for use when invasive measurement is inappropriate or impossible. However, the accuracy of this oscillometric method is still under debate (1–3). The aim of this study was to compare two different commonly used oscillometric systems for blood pressure measurement in VLBW-infants: HP-Monitor CMS Model 68 S with Modul HP M-1008B (HP) (HewlettPackard Co., Palo Alto, CA, USA) and Dinamap 8100 (Dinamap). (Critikon Inc., Tampa, FL, USA) In 20 VLBW-infants, paired measurements were obtained by making a single measurement with each system within 3–5 min, whereby the sequence of the devices was randomized. Series of paired blood pressure measurements were obtained by making records six times a day. Gestational age and birth weight of the patients were 28 (25–31) wk (mean and range) and 841 (540–1200) g, respectively. Age, body weight and circumference of the extremities at the time of taking the measurement series were 14 (1–79) d (median and range), 972 (570–1470) g, and 6 (4.5– 7.3) cm, respectively. The patients had neither clinical signs of cardiac failure nor received inotropic agents at the time of measurement. Measurements were performed using the cuff size recommended by the manufacturers. For each paired measurement the same cuff size, extremity and position of the infant were used. In a total of 44 series, 2 (1–6) (median and range) series per patient, 264 paired measurements were performed. A total of 72 paired measurements were excluded, either because the heart rate exceeded normal values (4) or because of movements of the extremity during measurement. A total of 192 paired measurements, i.e. 5 (2–6) (median range) per series, were analysed. In 63 paired measurements cuff size 1 was used and in 129 cuff size 2 was used. The cuff width to arm circumference ratio was 0.48 0.04. A total of 42 paired measurements were performed on the upper and 150 on the lower extremity. In 98 paired measurements Dinamap was used first and in 94 paired measurements HP was used first. No difference (paired t-test;p> 0.05) was observed in heart rate during paired measurements: 154 13 per min with Dinamap and 155 12 per min with HP. Systolic, diastolic and mean blood pressures measured with Dinamap were 65.2 11.9 mmHg, 39.4 8.1 mmHg and 47.9 9.3 mmHg, respectively; and with HP, 59 10.4 mmHg, 35.2 8.1 mmHg and 43.3 8.4 mmHg, respectively. The mean differences (Dinamap minus HP) for systolic, diastolic and mean blood pressures were 6.2 10.3 mmHg, 4.2 8.8 mmHg and 4.6 9.0 mmHg, respectively. Figures 1–3 show the differences between Dinamap and HP, based on a graphical technique suggested by Bland and Altmann (5). Mean blood pressure values measured with Dinamap were higher than with HP in our study. 95% prediction intervals of the mean differences (Dinamap minus HP)

Akupunkturpunkte am Ohr bei Neugeborenen mit Neonatalem Abstinenzsyndrom (NAS) aufgrund mütterlicher Substitutionstherapie

BACKGROUND This is a prospective observational study performed at a university teaching hospital. The aim of the study was to determine the presence and absence of acupuncture ear points in neonates with neonatal abstinence syndrome (NAS). PATIENTS AND METHOD The patients are neonates with neonatal abstinence syndrome. The examination took place on the third day (mean value: 72.3 h) after delivery and was performed by a neuronal pen (PS 3 Silberbauer, Vienna, Austria). A integrated optical and sound signal detects the ear points that were assigned to the ear map. RESULTS We investigate 5 neonates (3 males, 2 females, mean gestational age: 37+3, mean birth weight: 2,655 g). All investigated neonates showed the presence of active ear acupuncture points. The psychovegetative rim was the most common point in 100% of the children. In all neonates we found the presence of psychic ear points. The detectable psychic ear points are frustration point, R point and the psychotropic field nasal from the incisura intertragica. CONCLUSION Ear points are detectable in neonates with NAS and do not depend on the side of the ear lobe. The most important point is the psychovegetative rim and, in all neonates with NAS, psychic ear points were detectable. So for the first time it is possible to identify psychic ear acupuncture points in neonates. In the future it could be possible to use active ear points in neonates for diagnostic and therapeutic options.

Early Episodes of Hypocarbia and Early-Onset Sepsis are Risk Factors for Cystic Periventricular Leukomalacia in the Preterm Infant

Background: The pathogenesis of cystic periventricular leukomalacia (cPVL) is based on an either hypoxic-ischemic and/or inflammatory processes with different risk factors having been postulated to be associated with its development. We aimed to evaluate risk factors for cPVL focussing on the influence of hypocarbia.Patients and Methods: Single centre retrospective cohort study at a tertiary care university NICU between 1999 and 2008. All preterm infants ≤ 35 weeks gestational age with diagnosis of cPVL by serial cranial ultrasound were compared with two controls matched for gestational age (± 1 week), birth weight (± 200 grams), sex, and year of birth.Results: 47 preterm infants were diagnosed as having cPVL. Univariate analysis of risk factors revealed lower 5 and 10 minutes Apgar scores, and higher rates of neonatal seizures, early-onset sepsis, neonatal steroids, respiratory distress syndrome with surfactant replacement therapy, and episodes of hypocarbia significantly being associated with cPVL. In-vitro fertilisation, caesarean section, and preeclampsia were negatively correlated with cPVL. Following multivariate analysis using a logistic regression model and including all parameters with a level of significance below 0.1 early-onset sepsis and hypocarbia remained the only significantly associated risk factors (p = 0.022 and 0.024, respectively). Lowest PaCO2 values did not differ between cPVL cases and controls as did not the duration of hypocarbia, but the onset of hypocarbia was significantly later in cPVL cases.Conclusion: Early episodes of hypocarbia and sepsis are risk factors for the development of cPVL in the preterm infant.

Neonatal Diabetes Mellitus: Treatment with Sulfonylurea in a Preterm Born Infant

Diabetes mellitus beim Fr ü hgeborenenKlin Padiatr 2009; 221: 100 DOI 10.1055/s-0029-1202867 Diabetes mellitus beim Fr ü hgeborenen: Erstmalige Behandlung mit Sulfonylharnstoff Neonatal Diabetes Mellitus: Treatment with Sulfonylurea in a Preterm Born Infant 7-t ä gige Kortisonsto ß therapie bei drohender bronchopulmonaler Dysplasie zwischen 3. und 4. Lebenswoche. Infolge unzureichender Energieversorgung keine Gewichtszunahme im 1. Lebensmonat. Deshalb wurde bei noch ausstehendem Genetikbefund in Ermangelung therapeutischer Alternativen empirisch mit einer oralen Therapie mit Glibenclamid in einer Dosis von 0,05 mg / kgKG zweimal t ä glich begonnen. Die Applikation erfolgte in Form einer Tablettenverreibung ü ber die Sonde. Das Ansprechen war prompt, die Serum-Glukose-Spiegel lagen bereits 24 h sp ä ter unter 200 mg / dl und nach 48 h konnte die intraven ö se Insulinzufuhr gestoppt werden. Die orale Glukosetoleranz normalisierte sich w ä hrend der n ä chsten Tage. Nach 5 Wochen mit normalen Blutzuckerwerten konnte Glibenclamid schrittweise abgesetzt werden. Die Untersuchung der f ü r einen transienten NDM ma ß geblichen Regionen auf Chromosom 6 erbrachte ebenso wie die Sequenzierung der ABCC8und KCNJ11-Gene einen unauff ä lligen Befund. In einem Nachbeobachtungszeitraum von bisher 18 Monaten blieb das M ä dchen normoglyk ä misch.

322 Oropharyngeal Suctioning in Newborn Infants Impairs Cerebral Oxygenation During Transition After Birth

Background: Oropharyngeal suctioning during transition after birth can induce bradycardia and/ or apnoea. These are reasons for restrictive approach. Objectives: Aim of the study was to investigate the influence of oropharyngeal suctioning on cerebral and peripheral oxygen saturation during transition after birth. Methods: In a prospective randomized study term newborn infants were measured during the first ten minutes after elective caesarean section. In the suctioning group oropharyngeal suctioning was done for five seconds in the first minute of life. In the control group no suctioning was done. Regional tissue oxygenation (rSO2) was measured of the brain, preductal peripheral tissue (right forearm) and postductal (left calf) peripheral tissue using near-infrared-spectroscopy (INVOS 5100, Somanetics). Heart rate and arterial oxygen saturation (SaO2) were measured preductal (right hand) and postductal (left foot) with pulseoxymetry. Results: 20 newborn infants were included in each group. All showed normal adaptation. Five minutes after birth in the suctioning group cerebral rSO2 (58±23% vs. 70±13%) and postductal SaO2 (70±19% vs. 82±11%) were significantly lower compared to the control group rSo2 of preductal (44±22% vs. 51±17%) and postductal peripheral tissue (36±19% vs. 39± 13%), as well as preductal SaO2 (80±13% vs 84±8%) tended to be lower in the suctioning group compared to the control group, but without reaching significance. Ten minutes after birth, there were no significant differences. Heart rate did not show significant differences between both groups. Conclusion: This study demonstrated that oropharyngeal suctioning impairs cerebral tissue oxygenation (rSO2) and postductal SaO2 during transition after birth.