Werner Sauseng

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.

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.

Non-Nutritive Sucking Habits in Sleeping Infants

Background: Pacifier use has been postulated to decrease the risk of sudden infant death syndrome (SIDS). The responsible mechanisms are, however, unclear. Objectives: Since little is known about the non-nutritive sucking (NNS) habits of infants during sleep, we investigated NNS patterns and changes of physiological parameters during NNS in sleeping infants. Methods: Polygraphic recordings were performed in 12 infants with a median age of 55 days (range 7–82) who regularly used a pacifier during sleep. Episodes of active suckling (bursts) and quiescent periods were differentiated by video observations. We evaluated the time of suckling in relation to the total time of pacifier use, the median number of bursts per min, the median duration of single bursts and the median interval between 2 sequent bursts. In 48 randomly selected bursts, we additionally analyzed changes in heart rate, respiratory frequency and oxygen saturation compared to the 10-second period preceding the burst. Results: Median sleep time with a pacifier held in mouth was 31.3 min (13.0–117.6), of which 15.5% (6.4–36.7%) was spent with active suckling. The median number of bursts per min was 2.2 (1.2–4.5). The median duration of a burst was 3 s (1–22) and the median interval between 2 bursts was 10 s (1–1,434). Heart rate, respiratory frequency and oxygen saturation did not change significantly during suckling bursts. Conclusions: This pilot study presents important data for sucking habits in pacifier users which may provide a basis for further investigations concerning the efficacy of pacifiers in SIDS prophylaxis.

Classification of sudden infant death (SID) cases in a multidisciplinary setting. Ten years experience in Styria (Austria).

ZusammenfassungHintergrundDer plötzliche Säuglingstod (sudden infant death syndrome, SIDS) bleibt trotz weltweit rückläufiger Zahlen eine Herausforderung für Professionisten im Gesundheitsbereich. Aufgrund unterschiedlicher Untersuchungsbedingungen und Klassifikationskriterien sind die Zahlen verschiedener Regionen und Zeiträume kaum vergleichbar. 1992 wurde von derEuropean Society for the Study and Prevention of Infant Deaths (ESPID) ein Klassifikationsvorschlag vorgestellt. Im Bundesland Steiermark wurde diese Klassifikation seit 1993 für alle plötzlichen Säuglingstode angewandt.Methoden56 im Bundesland Steiermark zwischen 1993 und 2002 plötzlich und unvorhergesehen eintretende Säuglingstode wurden von einem multidisziplinären Team untersucht (Todesfallanalysen). Die Mitglieder kamen aus den Bereichen Kinder- und Jugendheilkunde, Gerichtsmedizin, Pathologie, Psychologie, Kinderkrankenpflege, Elternselbsthilfegruppe sowie der Gesundheitsbehörden. Die Analysen erfolgten mit besonderer Berücksichtigung eventuell vorhandener Risikofaktoren für den plötzlichen Säuglingstod (SIDS), der Umstände des Todes („deah scene”) sowie der post mortem erhobenen Befunde. Schließlich erfolgte für jeden Todesfall eine Klassifiaktion entweder als 1) klassisches SIDS, 2) „borderline” SIDS, 3) nicht obduzierter plötzlicher Säuglingstod oder 4) Säuglingstod mit geklärter Ursache.Ergebnis22 der 56 plötzlichen Säuglingstode wurden der Kategorie 1 zugeordnet, 19 der Kategorie 2. In vier Fällen erfolgte keine Obduktion, in 11 Fällen konnte eine den Todeseintritt erklärende Ursache gefunden werden. In 17/22 Fällen der Kategorie 1 und 11/19 Fällen der Kategorie 2 ergab die Erhebung der Umgebungsfaktoren eine klassische Risikokonstellation (Bauchlage und/oder Überwärmung bzw. Nikotinbelastung). In drei Fällen wurde Kindesmisshandlung oder Kindstötung in Betracht gezogen, konnte aber trotz sorgfältiger Analysen nicht definitiv nachgewiesen oder ausgeschlossen werden. In den letzten Jahren sank die SIDS-Inzidenz in Bundesland Steiermark auf durchschnittlich 0,18 Promille, die wenigen Todesfälle zeigten mehrheitlich das charakteristische Risikoprofil.SchlussfolgerungEine genaue Analyse von plötzlichen Todesfällen im Säuglingsalter ist Voraussetzung für verlässliche und vergleichbare SIDS-Statistiken. Unsere Daten belegen, dass bei zahlreichen plötzlichen Säuglingstoden sorgfältige post-mortem Analysen den Todeseintritt erklären können. Bei anderen Fällen können geringfügige Veränderungen den Todeseintritt begünstigt haben. Diese Befunde sollten daher bei der Klassifikation plötzlicher Säuglingstode entsprechend berücksichtigt werden. Die ESPID Klassifikation von 1992 erweist sich für diesen Zweck als gut anwendbar und eine Anwendung in anderen Studien kann empfohlen werden.SummaryObjectiveSudden infant death syndrome (SIDS) remains a challenge for health professionals despite decreasing rates in recent years. The figures for different areas and time periods are hardly comparable, because of differences in postmortem investigations and classification criteria. In 1992, theEuropean Society for the Study and Prevention of Infant Deaths (ESPID) proposed a classification for any sudden and unexpected death in infancy. This proposal has been used in our study since 1993 to better classify sudden infant death (SID) cases.Method56 consecutive SID cases observed between 1993 and 2002 in Styria, the south-eastern province of Austria, were analysed by a multidisciplinary team of health professionals. The study group consisted of pediatricians, forensic pathologists, pathologists, psychologists, nurses, members of the parents’ association and health authorities. SID cases were analysed with regard to potential risk factors during pregnancy and early life, the circumstances of death (death scene) and post-mortem findings. From the latter, every SID was classified as either 1) classic SIDS, 2) borderline SIDS, 3) non-autopsied SID or 4) explained death.ResultsOf the 56 SID cases, 22 were assigned to category 1, 19 to category 2, four to category 3, and in 11 cases death could be explained by major post-mortem findings. For 17/22 cases in category 1 and 11/19 cases in category 2, the death scene investigation showed the typical risk profile of manner of bedding and/or environmental conditions. In three cases, child abuse or infanticide was considered possible but could not be proven despite careful autopsy. In recent years, SIDS incidence in Styria has decreased to approximately 0.18/1,000 liveborn infants, and the few deaths still occurring mainly present with the typical risk profile.ConclusionAn extensive analysis of SID events is a prerequisite for reliable and comparable SIDS statistics. Our data show that in several SID cases careful postmortem examinations led to an explanation of death. In other cases, minor alterations may have contributed to the lethal event. These findings should therefore be considered in the classification of SIDs. The ESPID classification of 1992 appears to be very useful for this purpose and its use may therefore be recommended.

Effects of TRH administration on plasma leptin levels in infants, children and adolescents

The aim of this study was to investigate the effect of thyrotropin-releasing hormone (TRH) administration (standard TRH stimulation test) on plasma leptin levels in infants, children and adolescents. Plasma leptin levels were analyzed with regard to age, body mass index (BMI) and results in standard TRH stimulation test. The study population consisted of 79 infants, children and adolescents (age: 4.50 [0.04-20.49] years; BMI: 16.47 [12.46-38.32] kg/m2; BMI SDS: 0.21 [-2.97 to 3.26]) (median [range]). Plasma leptin levels significantly decreased 30 minutes after TRH administration (5 microg/kg; maximum 200 microg i.v.) (p <0.0001). No correlation was found in leptin decrease when comparing the different groups with regard to age, BMI and results in the TRH stimulation test. Positive correlation was found when comparing BMI SDS to plasma leptin levels before (r = 0.74; p <0.001) and 30 minutes after TRH injection (r = 0.73; p <0.001). There was poor correlation when age of patients was compared to plasma leptin levels before (r = 0.46; p <0.05) and 30 minutes after TRH injection (r = 0.47; p <0.05). In summary, we found that TRH administration decreases plasma leptin levels in infants and adolescents independent of age, BMI and thyroid function.

Non-nutritives Saugen am Beruhigungsschnuller

Das Saugen eines Babys an der mütterlichen Brust bzw. am Beruhigungsschnuller stellt einen angeborenen Reflex dar, der durch Berührung von Lippen oder Mundschleimhaut ausgelöst wird. Untersuchungen haben gezeigt, dass der Saugreflex bereits in utero vorhanden ist, und zwar etwa ab der 24. Schwangerschaftswoche (SSW). Ab der 28. SSW existiert ein Saug-Schluck-Reflex, wohingegen die Koordination von Saugen, Schlucken und Atmen erst ab der 32.-34. SSW vollständig funktioniert. Vor diesem Zeitpunkt geborene Frühgeborene müssen deshalb zumeist vorübergehend über eine nasogastrale Sonde ernährt werden. Saugen stellt eine komplexe motorische Aktivität dar, die unter der Kontrolle des Hirnstamms steht und die Funktion der Hirnnerven V, VII und XII erfordert. Verschiedene neurologische Störungen können somit mit einem pathologischen Saugmuster bzw. einem Fortbestehen des Saugreflexes über das 6. Lebensmonat hinaus einhergehen.

A new method to evaluate nicotine exposure in infants.

Exposure of infants to parental smoking has been associated with several adverse health effects [6]. It was the aim of this study to find an easily applicable method to collect urine samples from infants and to correlate cotinine concentrations with parental smoking habits. This study was approved by the local Ethics Committee. Filter paper strips (Schleicher and Schuell, Germany) were placed in the nappies of infants. After wetting, the paper strips were air-dried, cut into small pieces, and extracted with 0.01 M phosphate buffer solution for 24 h. From this eluate, cotinine was analysed by ELISA and correlated to creatinine concentration (expressed as ng cotinine/mg creatinine, CCR). The parents’ smoking habits were evaluated by a structured questionnaire. CCR was determined in 93 infants (38 females) with a median age of 63 days (range 25–221 days). Exclusion criteria were questionnaires with incomplete information and urine creatinine levels 30 ng/mg, a cut-off level based on a previous study [2]. We found a significant correlation ( P <0.01) between maternal smoking habits and cotinine concentrations of infants (Table 1). This new method was used to avoid the inconvenience and higher failure rate of paediatric collection bags, especially in female infants [4]. A good correlation between urine collected on filter paper and native urine samples had been shown previously [5]. The method is inexpensive and therefore well suited for large series. By use of this technique, we confirmed the findings of previous reports describing a good correlation between the CCR of infants and maternal smoking habits, but not paternal smoking habits [1]. This is the first study to demonstrate this simple-touse, inexpensive way of verifying nicotine exposure in infants. The results of using filter paper strips are comparable to those using standard methods. Moreover, the method is easier to handle than any other used previously.