Publications by authors named "Hans Proquitté"

56 Publications

Antibody response using six different serological assays in a completely PCR-tested community after a coronavirus disease 2019 outbreak-the CoNAN study.

Clin Microbiol Infect 2020 Nov 20. Epub 2020 Nov 20.

Institute for Infectious Diseases and Infection Control, Jena University Hospital - Friedrich Schiller University, Jena, Germany.

Objectives: Due to a substantial proportion of asymptomatic and mild courses, many severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infections remain unreported. Therefore, assessment of seroprevalence may detect the real burden of disease. We aimed to determine and characterize the rate of SARS-CoV-2 infections and the resulting seroprevalence in a defined population. The primary objective of the study was to assess SARS-CoV-2 antibody seroprevalence using six different IgG-detecting immunoassays. Secondary objectives of the study were: (a) to determine potential risk factors for symptomatic versus asymptomatic coronavirus disease 2019 courses, and (b) to investigate the rate of virus RNA-persistence.

Methods: CoNAN is a population-based cohort study performed in the community Neustadt am Rennsteig, Germany, which was quarantined from 22 March to 5 April after six SARS-CoV-2 cases were detected in the village's population. The SARS-CoV-2 outbreak comprised 51 cases and 3 deaths. The CoNAN study was performed from 13 May to 22 May 2020, 6 weeks after a SARS-CoV-2 outbreak.

Results: We enrolled a total of 626 participants (71% of the community population) for PCR and antibody testing in the study. All actual SARS-CoV-2 PCR tests were negative. Fifty-two out of 620 (8.4%) participants had antibodies against SARS-CoV-2 in at least two different assays. There were 38 participants with previously PCR-confirmed SARS-CoV-2 infection. Of those, only 19 (50%) displayed anti-SARS-CoV-2 antibodies. We also show that antibody-positive participants with symptoms compatible with a respiratory tract infection had significantly higher antibody levels then asymptomatic participants (EU-assay: median 2.9 versus 7.2 IgG-index, p 0.002; DS-assay: median 45.2 versus 143 AU/mL, p 0.002). Persisting viral replication was not detected.

Conclusions: Our data question the relevance and reliability of IgG antibody testing to detect past SARS-CoV-2 infections 6 weeks after an outbreak. We conclude that assessing immunity for SARS-CoV-2 infection should not rely on antibody tests alone.
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http://dx.doi.org/10.1016/j.cmi.2020.11.009DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7677041PMC
November 2020

Comparison of image quality in brain MRI with and without MR compatible incubator and predictive value of brain MRI at expected delivery date in preterm babies.

J Perinat Med 2020 Sep;48(7):733-743

Section of Pediatric Radiology, Institute of Diagnostic and Interventional Radiology, University hospital Jena, Jena, Germany.

Objectives MR compatible incubators (MRcI) offer the examination of preterm and critically ill infants in controlled environment. The aim of the study was to compare objective and subjective image quality as well as diagnostic value of MRI brain examinations with and without using the MRcI. Thus, predictive value of brain MRI at expected delivery date in general was investigated. Methods This retrospective study included MRI brain examinations conducted at patients' corrected age ≤6 months and presence of four standard sequences (PD TSE transversal, T2 TSE transversal, T2 TSE sagittal and T1 SE transversal). Signal-to-Noise Ratio (SNR) and Contrast-to-Noise Ratio (CNR) was calculated. Subjective image quality was estimated using a 5-point Likert scale. Findings of MRI were compared with those of previous transfontanellar ultrasound because of additional diagnostic information. Severe brain abnormality scaled by score of Kidokoro was related to results of Munich Functional Developmental Diagnostics (MFDD) within first year. Results One hundred MRI brain examinations (76 with MRcI, 24 without MRcI) were performed in 79 patients. Using the MRcI SNR and CNR were significantly higher in PD- and in T2-weighted sequences (p<0.05). TSE PD transversal demonstrated a higher risk of non-diagnostic quality using MRcI (OR 5.23; 95%-CI 1.86-14.72). MRcI revealed additional diagnostic information (OR 5.69; 95%-CI 1.15-28.24). Severe brain abnormality was associated with walking deficits (r=0.570; p=0.021). Conclusions The MRcI increased objective image quality and revealed additional diagnostic information to transfontanellar ultrasound. Nevertheless, prediction of infants' future development remains limited.
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http://dx.doi.org/10.1515/jpm-2020-0051DOI Listing
September 2020

[Intrauterine Growth Restriction: Transsectoral, Interdisciplinary and Multiprofessional Care for Pregnant Women and Newborns in a Feto-neonatal Pathway: A Project of the Innovationsfonds].

Z Geburtshilfe Neonatol 2020 Feb 11;224(1):15-21. Epub 2019 Sep 11.

Zentrum für Feto-Neonatale Gesundheit an der TU Dresden, TU Dresden, Dresden.

Intrauterine growth restriction (IUGR) is present in fetuses that do not achieve their full in-utero growth potential. IUGR needs to be discriminated from small for gestational age (SGA) because IUGR newborns in particular experience long-term side effects from their small growth. IUGR fetuses have a significantly increased risk of prematurity and a distinct risk profile compared to adequate-for-gestational-age preterm newborns. Complications of prematurity are more frequent, including bronchopulmonary dysplasia, intraventricular hemorrhage, and meconium ileus. IUGR newborns are at risk of long-term health issues like cerebral palsy, impaired lung function, and delayed speech development. Interdisciplinary and interprofessional care of IUGR pregnancies in the context of a standardized health care research project is feasible: Pregnant women at risk are identified, early therapy with acetylsalicylic acid is started as indicated, risk-adapted care at level III centers is organized including psychosocial interventions and neonatal consultations. Postnatally, integrated neonatal care focusing on parent-child interaction and optimized nutrition is a hallmark. Afterwards, in-depth pediatric follow-up visits with local pediatricians help to identify growth and neurodevelopment problems early. The effects, acceptance. and cost efficiency of this approach are evaluated prospectively as part of an Innovationsfonds project.
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http://dx.doi.org/10.1055/a-0998-4532DOI Listing
February 2020

[Bone Analysis in the Newborn - Quantitative Ultrasound of the Peripheral Skeleton].

Z Geburtshilfe Neonatol 2020 Apr 24;224(2):79-85. Epub 2019 Jun 24.

Section of Pediatric Radiology, Jena University Hospital, Jena.

Purpose: The aim was to determine whether the quantitative ultrasound (QUS) parameter speed of sound (SOS) is sufficient for evaluation of reference data in the newborn and how they are influenced.

Materials And Methods: 219 full-term and 14 preterm infants (gestational age 28-41 weeks (GA), birth weight 590-4,930 g) were evaluated by Omnisense 7000 P on their tibia. Reference values were sampled in 178 eutrophic infants.

Results: SOS reference values at the tibia were 3028 m/s for GA<40 and 3057 m/s for ≥ 40 weeks. There was a significant correlation between SOS and gestational age. SOS was significantly higher in male (3058.3±93.3 vs. 3022.8±93.4 m/s; p 0.012) infants. If birth weight was below 3,800 g, there was a correlation between SOS and weight (p<0.05). Preterm infants showed lower SOS than term babies (p<0.05).

Conclusion: Speed of sound can be evaluated sufficiently in preterm and term infants on the tibia. The estimated reference data can be used to identify osteopenia in the preterm infant with low birth weight.
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http://dx.doi.org/10.1055/a-0915-9828DOI Listing
April 2020

Antifungal Treatment and Outcome in Very Low Birth Weight Infants: A Population-based Observational Study of the German Neonatal Network.

Pediatr Infect Dis J 2018 11;37(11):1165-1171

From the Department of Pediatrics, University of Lübeck, Germany.

Background: The diagnostic proof of fungal infection in preterm infants is difficult. Antifungal treatment (AFT) is often initiated empirically when infants with suspected infection do not improve despite broad-spectrum antibiotic therapy. It was the aim of our study to determine the rate of exposure to empirical AFT in a large cohort of very low birth weight infants (VLBWI) of the German Neonatal Network and to address associated risks and outcomes.

Methods: The epidemiologic database consisted of n = 13,343 VLBWI born in 54 German Neonatal Network centers between 2009 and 2015. AFT was defined as number of neonates who got any dose of at least one of the following antifungal drugs: fluconazole, amphotericin B, voriconazole and caspofungin (denominator: number of infants enrolled in German Neonatal Network) for treatment (not prophylaxis) of (suspected) fungal infection. Univariate and logistic regression analyses were used to identify risk factors for exposure to AFT and associated short-term morbidities and long-term outcomes at 5-year follow-up.

Results: In our cohort, 724 out of 13,343 (5.4%) VLBWI were exposed to empiric AFT and had a mean gestational age of 25.7 (±2.1) weeks. Forty-four out of 13,343 (0.3%) had proven bloodstream infection with Candida spp. The main risk factors for exposure to AFT were gestational age, postnatal steroid treatment, need for abdominal surgery and use of carbapenems. Notably, AFT was associated with adverse outcomes such as bronchopulmonary dysplasia [adjusted odds ratio (OR): 1.9; 95% confidence interval (CI): 1.6-2.3; P < 0.001) and retinopathy of prematurity requiring intervention (adjusted OR: 1.69; 95% CI: 1.3-2.3; P <0.001) but not mortality. In the subgroup of infants available for 5-year follow-up (n = 895), exposure to AFT was associated with a risk for cerebral palsy (adjusted OR: 2.79; 95% CI: 1.11-7.04; P = 0.04) and intelligence quotient < 85 (adjusted OR: 2.07; 95% CI: 1.01-4.28; P = 0.049).

Conclusions: A significant proportion of VLBWI is exposed to AFT, specifically those born <26 weeks. Exposed infants were found to have a higher risk for adverse outcomes, which may reflect their significant vulnerability in general. Given the observational design of our study, it remains unclear whether potential side effects of empirical or target AFT itself contribute to adverse outcome. Future studies need to include risk-based strategies and stewardship programs to restrict the use of antifungal management in VLBWI.
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http://dx.doi.org/10.1097/INF.0000000000002001DOI Listing
November 2018

Pontine Tegmental Cap Dysplasia in an Extremely Preterm Infant and Review of the Literature.

J Child Neurol 2017 03 20;32(3):334-340. Epub 2016 Dec 20.

2 Institute of Cell Biology and Neurobiology, Charité-Universitätsmedizin Berlin, Berlin, Germany.

Pontine tegmental cap dysplasia is a rare hindbrain malformation syndrome with a hypoplastic pons, a tissue protrusion into the fourth ventricle, and cranial nerve dysfunction. We here report clinical, imaging, and genetic findings of the first extremely low-birth-weight preterm infant with pontine tegmental cap dysplasia born at 25 weeks of gestation and provide an overview of 29 sporadic cases. A prenatally diagnosed hypoplastic and rostrally shifted cerebellum was indicative of a hindbrain defect and later identified as an early sign of pontine tegmental cap dysplasia in our patient. The neonate exhibited severe muscle hypotonia, persistent thermolability, and clinical signs of an involvement of facial, cochlear, and hypoglossal nerves. Furthermore, paroxysmal episodes of agonizing pain with facial tics, tonic and clonic muscle contractions, blepharospasm, and singultus are highlighted as new phenotypic features of pontine tegmental cap dysplasia. With our report, we present a severe case of pontine tegmental cap dysplasia and provide a brief overview of current knowledge on this rare disease.
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http://dx.doi.org/10.1177/0883073816680748DOI Listing
March 2017

[Infection Prevention in Premature Infants and Newborns in Thuringia: Implementation of Recommendation of the Commission for Hospital Hygiene and Infection Prevention (KRINKO)].

Z Geburtshilfe Neonatol 2017 Feb 10;221(1):30-38. Epub 2016 Nov 10.

Klinik für Kinder-und Jugendmedizin Jena, Sektion Neonatologie / Päd. Intensivmedizin, Universitätsklinikum Jena.

Systematic recording of practical implementation of current recommendations of KRINKO for the prevention of nosocomial infections in premature and newborn infants in children's hospitals in Thuringia. All neonatal treatment centers in Thuringia (n=18) were included in this survey. Answer were received from 83% (15/18). Degree of compliance was 100% in level-1 (3/3) and level-2 centers (5/5), and 70% in level-3 centers (7/10). The aim of the questionnaire was to evaluate infection prevention measures as well as structural/organizational parameters in neonatal centers in Thuringia. Preventive measures as well as weekly screening for colonization was fully performed in patients with a birth weight <1 500 g (n=205) at all centers. Additionally, prolonged screening and colonization surveillance measures were performed in 60% of all units until discharge from the hospital. Results related to structural/organizational parameters and especially structural conditions in neonatal centers in Thuringia pointed up challenges (2 m minimum distance between incubators in 27% (n=4/15), isolation in single room in 53% (n=8/15)). Insufficient number of staff also hamper the complete implementation of KRINKO recommendations (intensive care unit: patient/staff ratio (MW±SD) 2.5±1.1; newborn area 4.3±0.9). Analysis shows actual rate of implementation of KRINKO recommendations as well as structural/organizational parameters in neonatal treatment centers in Thuringia. It provides important points for discussion regarding necessary staff numbers and structural conditions. Analysis could also be used for future surveys in other regions in Germany.
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http://dx.doi.org/10.1055/s-0042-112372DOI Listing
February 2017

Intensified colonisation screening according to the recommendations of the German Commission for Hospital Hygiene and Infectious Diseases Prevention (KRINKO): identification and containment of a Serratia marcescens outbreak in the neonatal intensive care unit, Jena, Germany, 2013-2014.

Infection 2016 Dec 11;44(6):739-746. Epub 2016 Jul 11.

Center for Infectious Diseases and Infection Control, Jena University Hospital, Erlanger Allee 101, 07740, Jena, Germany.

Purpose: In 2013, the German Commission for Hospital Hygiene and Infectious Disease Prevention (KRINKO) stated that extending weekly colonisation screening from very low birth weight (VLBW) infants (<1500 g) to all patients in the Neonatal Intensive Care Unit (NICU) might be useful.

Methods: After implementing this recommendation, we detected a previously unnoticed cluster of Serratia marcescens. Strains were typed by Pulsed Field Gel Electrophoresis (PFGE).

Results: Over 6 months, 19 out of 159 infants acquired S. marcescens. Twelve of the nineteen patients with S. marcescens were non-VLBW infants, and they were colonised significantly earlier than were VLBW infants (median 17 vs. 28 days; p < 0.01). Molecular typing revealed a polyclonal outbreak with multiple strain types leading to one or two transmissions each and a dominating outbreak strains being involved in an explosive outbreak involving eight neonates.

Conclusion: The revised KRINKO recommendation may help identify unnoticed outbreaks. Colonised non-VLBW patients may be an underestimated source of S. marcescens.
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http://dx.doi.org/10.1007/s15010-016-0922-yDOI Listing
December 2016

Birth weight-related percentiles of brain ventricular system as a tool for assessment of posthemorrhagic hydrocephalus and ventricular enlargement.

J Perinat Med 2016 Mar;44(2):179-85

Besides remarkable improvements of neonatal medical therapy, neurological morbidity remains a major concern in preterm infants. In particular, intracranial hemorrhage is a severe complication strongly correlated to poor neurological outcome. For early clinical assessment of intracranial hemorrhage and its impact on the ventricular system, cranial sonography is an important bedside diagnostic tool. Reference values of ventricular sizes are available in relation to gestational age (GA). So far, it has not been demonstrated that ventricular size values are also reliable in relation to birth weight (BW). In this study, we performed cranial ultrasonography in 250 preterm and term newborn infants. Measurements of the intracranial ventricular system by cranial ultrasound examination were performed within 72 h after birth. We determined ventricular index, anterior horn width, width of the third ventricle, width and length of the fourth ventricle for statistical analysis in relation to BW and GA. GA ranged from 23 weeks, 3 days to 42 weeks, 1 day (mean: 33 weeks), BW ranged from 345 to 5620 g (mean: 2146 g). Ventricular index and fourth ventricle width revealed a significant correlation to birth weight with r=0.75, each. A significant correlation to birth weight was also obtained for width and length of the third ventricle (r=0.55 and 0.47, respectively). Correlations obtained for ventricular measures in relation to GA were similar to those referring to BW. In preterm and term infants, ventricular sizes in relation to BW seem reliable for assessment and monitoring of ventricular pathologies, i.e. after intracranial hemorrhage.
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http://dx.doi.org/10.1515/jpm-2015-0085DOI Listing
March 2016

Molecular typing of toxic shock syndrome toxin-1- and Enterotoxin A-producing methicillin-sensitive Staphylococcus aureus isolates from an outbreak in a neonatal intensive care unit.

Int J Med Microbiol 2015 Oct 22;305(7):790-8. Epub 2015 Aug 22.

National Reference Centre for Staphylococci and Enterococci, Division Nosocomial Pathogens and Antibiotic Resistances, Department of Infectious Diseases, Robert Koch Institute, Burgstraße 37, 38855 Wernigerode, Germany.

Outbreaks of Staphylococcus aureus are common in neonatal intensive care units (NICUs). Usually they are documented for methicillin-resistant strains, while reports involving methicillin-susceptible S. aureus (MSSA) strains are rare. In this study we report the epidemiological and molecular investigation of an MSSA outbreak in a NICU among preterm neonates. Infection control measures and interventions were commissioned by the Local Public Health Authority and supported by the Robert Koch Institute. To support epidemiological investigations molecular typing was done by spa-typing and Multilocus sequence typing; the relatedness of collected isolates was further elucidated by DNA SmaI-macrorestriction, microarray analysis and bacterial whole genome sequencing. A total of 213 neonates, 123 healthcare workers and 205 neonate parents were analyzed in the period November 2011 to November 2012. The outbreak strain was characterized as a MSSA spa-type t021, able to produce toxic shock syndrome toxin-1 and Enterotoxin A. We identified seventeen neonates (of which two died from toxic shock syndrome), four healthcare workers and three parents putatively involved in the outbreak. Whole-genome sequencing permitted to exclude unrelated cases from the outbreak and to discuss the role of healthcare workers as a reservoir of S. aureus on the NICU. Genome comparisons also indicated the presence of the respective clone on the ward months before the first colonized/infected neonates were detected.
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http://dx.doi.org/10.1016/j.ijmm.2015.08.033DOI Listing
October 2015

Dead space reduction by Kolobow's endotracheal tube does not justify the waiving of volume monitoring in small, ventilated lungs.

J Clin Monit Comput 2014 Dec 28;28(6):605-11. Epub 2014 Jan 28.

Department of Neonatology, Charité University Medical Center, Charitéplatz 1, 10117, Berlin, Germany.

In ventilated preterm infants the flow sensor contributes significantly to the total apparatus dead space, which may impair gas exchange. The aim of the study was to quantify to which extent a dead space reduced Kolobow tube (KB) without flow sensor improves the gas exchange compared with a conventional ventilator circuit with flow sensor [Babylog 8000 (BL)]. In a cross-over trial in 14 tracheotomized, surfactant-depleted (saline lavage) and mechanically ventilated newborn piglets (age <12 h; body weight 705-1200 g) BL and KB was applied alternately for 15 min and blood gases were recorded. The inner diameter of the endotracheal tube was 3.6 mm and the apparatus dead space of BL and KB including the endotracheal tube were 3.0 and 1.34 mL. Despite a 50 % apparatus dead space reduction with KB compared to BL statistically significant improvements were only observed for body weights <900 g. In this weight group median paCO2 was decreased by 5 mmHg (p < 0.01), whereas the improvement decreased with decreasing baseline paCO2. Furthermore, median paO2 was increased by 4 mmHg (p < 0.05) and O2 saturation was increased by 2.5 % (p < 0.05). No significant changes were seen in the circulatory parameters. In very small, ventilated lungs the use of KB improved the gas exchange; however, the improvement was moderate and does not justify the waiving of volume monitoring.
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http://dx.doi.org/10.1007/s10877-014-9559-5DOI Listing
December 2014

Adiponectin serum concentrations in newborn at delivery appear to be of fetal origin.

J Pediatr Endocrinol Metab 2014 Mar;27(3-4):273-8

Objective: Adiponectin (APN) may play a role in adapting energy metabolism at the maternal-fetal unit. The aim of the study was to investigate the relationship between placental APN mRNA expression, maternal serum APN concentration and umbilical cord serum APN concentration in full-term healthy newborns.

Methods: Serum APN levels were compared in 46 samples (23 from healthy newborns; gestational age 37.0 to 41.5 weeks) and their mothers (n=23). The APN concentration was measured using enzyme linked immunosorbent assay (ELISA). We analyzed the mRNA expression profile of APN in 22 placenta tissue samples using real time polymerase chain reaction (RT-PCR).

Results: The highest APN serum concentrations were found in umbilical cord blood, these were significantly higher than maternal APN levels (mean concentration±SD; 38.48±12.8 vs. 6.6±2.3 μg/mL, p<0.001). Otherwise, there were no significant correlation between maternal APN and umbilical cord APN concentration. APN gene expression was very low and only found in 8 out of 22 placentas. There were no significant correlation between placental APN mRNA and umbilical cord serum APN or maternal serum APN concentration. Umbilical cord APN concentrations were positively associated with birth weight (r=0.535; p=0.012) and gestational age (r=0.559; p=0.013). Maternal APN concentration revealed a negative correlation between maternal body weight (r=-0.623; p=0.009) and body mass index (BMI) (r=-0.634; p=0.008) at delivery. Additionally, no significant correlation was found between newborn birth weight and maternal weight.

Conclusions: This study suggests that high serum APN concentrations in umbilical cord blood are not regulated by placental APN mRNA gene expression. The high concentration of APN in cord blood is independent from maternal APN concentration, suggesting an important physiological role of APN and implicating that umbilical APN concentration reflects its exclusive production by fetal tissues.
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http://dx.doi.org/10.1515/jpem-2013-0218DOI Listing
March 2014

Influence of nose and mouth leaks on peripheral oxygen saturation during continuous positive airway pressure in neonates.

World J Pediatr 2013 Nov 21;9(4):318-22. Epub 2013 Oct 21.

Department of Neonatology, Charité University Medicine Berlin, Berlin, Germany,

Background: Nose and mouth leaks impair effective pressure transmission during neonatal continuous positive airway pressure (CPAP), but little is known about how these leaks affect physiological parameters. This study investigated the influence of nose leaks and spontaneous mouth opening on peripheral oxygen saturation (SpO₂) and respiratory rate (RR) using nasopharyngeal CPAP.

Methods: In 32 neonates with a gestational age of 30 (24-38) weeks and a birth weight of 1435 (710-2730) g, SpO₂ and RR measurements were taken with and without occlusion of the contralateral nostril in a randomized cross-over trial in 1-minute intervals over a 10-minute period during each condition. Mouth opening and newborn activity were documented.

Results: SpO₂ with open nostril was comparable to that with occluded nostril [93 (78.5-99.5)% vs. 94 (80-100)%, P=0.20]. RR decreased from 51 (26-82)/min to 48 (32-85)/min (P=0.027). In infants with an SpO₂ ≤ 93% during open nostril (n=17), SpO₂ increased after nostril occlusion [91 (80-96)% vs. 89.5 (78.5-93)%, P=0.036]. The mouth was open in 78.5% of measurements with open nostril, and in 87.4% of measurements after nostril occlusion (P=0.005). No significant influence of mouth opening or closure on SpO₂ or RR was detected.

Conclusions: In neonates on unilateral nasopharyngeal CPAP with an SpO₂ ≤ 93%, occlusion of the contralateral nostril significantly increased SpO₂ and reduced RR. The beneficial physiological effects further support using binasal prongs to minimize nose leaks in this population. Future studies should investigate the beneficial effects of reducing mouth leaks when applying CPAP to these infants.
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http://dx.doi.org/10.1007/s12519-013-0435-zDOI Listing
November 2013

Fetal and neonatal samples of a precursor surfactant protein B inversely related to gestational age.

BMC Pediatr 2013 Oct 10;13:164. Epub 2013 Oct 10.

Department of Neonatology, Charité University Medical Center, Berlin, Germany.

Background: Alveolar-capillary membrane leaks can increase the amount of surfactant protein B (SP-B) in the bloodstream. The purpose of this study was to measure the concentration of C-proSP-B, a SP-B precursor that includes C-terminal domains, in various body fluids of newborn infants and determine its dependence on gestational age.

Methods: C-pro-SPB was measured in amniotic fluid and umbilical cord blood at birth, and in peripheral blood and urine on postnatal day 3 in 137 newborn infants with a median birth weight of 2015 g (range, 550-4475 g) and gestational age of 34 weeks (range, 23-42 weeks).

Results: C-proSP-B levels differed more than 100-fold among samples. The levels (median; interquartile range) were highest in peripheral blood (655.6 ng/mL; 419.0-1467.0 ng/mL) and lowest in urine (3.08 ng/mL; 2.96-3.35 ng/mL). C-proSP-B levels in amniotic fluid (314.9 ng/mL; 192.7-603.6 ng/mL) were approximately half of those in peripheral blood. In cord blood C-proSP-B was slightly lower (589.1 ng/mL; 181.2-1129.0 ng/mL) compared with peripheral blood. C-proSP-B levels significantly increased in all the fluids sampled except urine with decreasing gestational age (p < 0.001).

Conclusions: This novel assay allows for the quantitative measurement of C-proSP-B in blood and amniotic fluid. The dependence of C-proSP-B on gestational age may hamper its use for the detection of alveolar leaks in preterm newborns.
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http://dx.doi.org/10.1186/1471-2431-13-164DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3852371PMC
October 2013

A comparison of conventional surfactant treatment and partial liquid ventilation on the lung volume of injured ventilated small lungs.

Physiol Meas 2013 Aug 26;34(8):915-24. Epub 2013 Jul 26.

Clinic of Neonatology, Charité University Medicine, Berlin, Germany.

As an alternative to surfactant therapy (ST), partial liquid ventilation (PLV) with perfluorocarbons (PFC) has been considered as a treatment for acute lung injury (ALI) in newborns. The instilled PFC is much heavier than the instilled surfactant and the aim of this study was to investigate whether PLV, compared to ST, increases the end-expiratory volume of the lung (VL). Fifteen newborn piglets (age <12 h, mean weight 678 g) underwent saline lung lavage to achieve a surfactant depletion. Thereafter animals were randomized to PLV (n = 8), receiving PFC PF5080 (3M, Germany) at 30 mL kg(-1), and ST (n = 7) receiving 120 mg Curosurf®. Blood gases, hemodynamics and static compliance were measured initially (baseline), immediately after ALI, and after 240 min mechanical ventilation with either technique. Subsequently all piglets were killed; the lungs were removed in toto and frozen in liquid N2. After freeze-drying the lungs were cut into lung cubes (LCs) with edge lengths of 0.7 cm, to calculate VL. All LCs were weighed and the density of the dried lung tissue was calculated. No statistically significant differences between treatment groups PLV and ST (means ± SD) were noted in body weight (676 ± 16 g versus 679 ± 17 g; P = 0.974) or lung dry weight (1.64 ± 0.29 g versus 1.79 ± 0.48 g; P = 0.48). Oxygenation index and ventilatory efficacy index did not differ significantly between both groups at any time. VL (34.28 ± 6.13 mL versus 26.22 ± 8.1 mL; P < 0.05) and the density of the dried lung tissue (48.07 ± 5.02 mg mL(-1) versus 69.07 ± 5.30 mg mL(-1); P < 0.001), however, differed significantly between the PLV and ST groups. A 4 h PLV treatment of injured ventilated small lungs increased VL by 30% and decreased lung density by 31% compared to ST treatment, indicating greater lung distension after PLV compared to ST.
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http://dx.doi.org/10.1088/0967-3334/34/8/915DOI Listing
August 2013

Differential effects of immaturity and neonatal lung disease on the lung function of very low birth weight infants at 48-52 postconceptional weeks.

Pediatr Pulmonol 2013 Dec 8;48(12):1214-23. Epub 2013 Feb 8.

Department of Neonatology, Charité University Medical Center, Berlin, Germany.

Background: The pathogenesis of chronic lung disease of prematurity involves maturational arrest and neonatal lung disease (NLD) followed by mechanical ventilation (MV). However, the effect of these factors on postnatal lung function is not well established. Therefore, the aim of this study was to examine the differential effects of immaturity and NLD requiring MV on lung function test (LFT) parameters within 4 months after discharge.

Patients And Methods: A total of 386 very low birth weight (VLBW) infants (birth weight <1,500 g) were examined at a median postmenstrual age of 49 weeks. Two hundred twenty-six infants (59%) were born before the 28th week of gestation, and 247 infants (64%) had NLD requiring invasive MV. LFTs included tidal breathing measurements, measurement of respiratory mechanics assessed by occlusion test, body plethysmography, SF6 multiple breath washout, forced expiratory flow (VmaxFRC') by rapid thoraco-abdominal compression technique, end-expiratory CO2 (Pet CO2 ), exhaled NO (FeNO), and arterialized capillary blood gas analysis.

Main Results: Multivariate analysis indicated that severe immaturity was mainly associated with changes in the breathing pattern (reduced tidal volume (P = 0.003) and increased respiratory rate (P = 0.03)), a reduced VmaxFRC' (P = 0.004) and lower respiratory compliance (P < 0.001). NLD requiring MV, but not immaturity, was significantly and independently associated with increased respiratory and airway resistances (both P = 0.003), reduced FRCSF6 (P = 0.03), increased Pet CO2 (P = 0.019) and lower FeNO (P < 0.001). Both immaturity and NLD requiring MV caused a lower paO2 (P < 0.001) and higher a paCO2 .

Conclusions: Lung function after discharge of VLBW infants is differentially affected by both immaturity and NLD requiring MV. With increasing prematurity, intubated and mechanically ventilated infants are at increased risk of developing impaired lung function which can be detected by LFT.
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http://dx.doi.org/10.1002/ppul.22770DOI Listing
December 2013

Value of Doppler sonography near term: can umbilical and uterine artery indices in low-risk pregnancies predict perinatal outcome?

J Perinat Med 2013 Mar;41(2):165-70

Department of Obstetrics, Charité University Medical Center, Berlin, Germany.

Aim: The goal of this study was to evaluate the umbilical and uterine Doppler velocimetry waveforms for predicting the perinatal outcome of low-risk pregnancies at term.

Methods: We prospectively recruited 514 women with low risk pregnancies and performed umbilical and uterine artery Doppler assessments between 37 and 41 weeks of gestation. Ultrasound measurements (completed in 365 patients) were correlated with the perinatal outcome.

Results: The velocimetry waveforms of the umbilical artery were significantly associated with birthweight, placental weight, and postpartal umbilical artery pH. Low pH, placental weight, and birthweight were correlated with increasing pulsatility index (PI) and resistance index (RI). An umbilical artery PI > 1.2 and a uterine artery RI > 0.5 were associated with statistically higher rates of infants that were small for gestational age (SGA). Also, high cesarean delivery rates were correlated with an umbilical artery PI > 1.2.

Conclusions: In our low-risk pregnancies population, the elevated umbilical artery indices at term appeared to be associated with the higher rates of infants that were SGA and cesarean deliveries. The Doppler waveforms at term had low prognostic value for predicting neonatal acidosis or decreased Apgar scores.
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http://dx.doi.org/10.1515/jpm-2012-0042DOI Listing
March 2013

Persurf, a new method to improve surfactant delivery: a study in surfactant depleted rats.

PLoS One 2012 17;7(10):e47923. Epub 2012 Oct 17.

Department for Neonatology and Pediatric Intensive Care Medicine, Klinik für Kinderheilkunde, Universitätsklinikum Carl Gustav Carus, Medizinische Fakultät der Technischen Universität Dresden, Dresden, Germany.

Purpose: Exogenous surfactant is not very effective in adults with ARDS, since surfactant does not reach atelectatic alveoli. Perfluorocarbons (PFC) can recruit atelectatic areas but do not replace impaired endogenous surfactant. A surfactant-PFC-mixture could combine benefits of both therapies. The aim of the proof-of-principal-study was to produce a PFC-in-surfactant emulsion (Persurf) and to test in surfactant depleted Wistar rats whether Persurf achieves I.) a more homogenous pulmonary distribution and II.) a more homogenous recruitment of alveoli when compared with surfactant or PFC alone.

Methods: Three different PFC were mixed with surfactant and phospholipid concentration in the emulsion was measured. After surfactant depletion, animals either received 30 ml/kg of PF5080, 100 mg/kg of stained (green dye) Curosurf™ or 30 ml/kg of Persurf. Lungs were fixated after 1 hour of ventilation and alveolar aeration and surfactant distribution was estimated by a stereological approach.

Results: Persurf contained 3 mg/ml phospholipids and was stable for more than 48 hours. Persurf-administration improved oxygenation. Histological evaluation revealed a more homogenous surfactant distribution and alveolar inflation when compared with surfactant treated animals.

Conclusions: In surfactant depleted rats administration of PFC-in-surfactant emulsion leads to a more homogenous distribution and aeration of the lung than surfactant alone.
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http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0047923PLOS
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3474734PMC
April 2013

Effect of endotracheal tube leakage on respiratory function monitoring: Comparison of three neonatal ventilators.

J Pediatr Intensive Care 2012 Jun;1(2):61-69

Department of Neonatology, Charité University Medical Center, Berlin, Germany.

In preterm infants, lung function monitoring is important for lung-protective mechanical ventilation. In this study, we used a neonatal lung model to investigate the effect of endotracheal tube (ETT) leakage on the monitoring of tidal volume (V) and lung mechanics using different ventilators. A neonatal lung model was ventilated via a 3 mm ETT using three ventilators, Babylog 8000, Leoni, and Stephanie. ETT leakage was simulated by open silicone tubes with different lengths. The volume delivered to the lung model was measured and compared with the displayed expiratory V of the three ventilators. The effect of ETT leakage on lung mechanical parameters displayed by the ventilators was investigated for respiratory rates from 20 min to 70 min and a constant inspiratory time: expiratory time ratio of 1:1. The displayed ETT leakage depended on the size of the leak, ventilator settings, and the ventilator used. In the presence of ETT leakages, for all three ventilators, the displayed V underestimated the true volume delivered to the lung. With increasing ETT leakage, displayed compliance was overestimated by Babylog 8000 and Stephanie, whereas Leoni underestimated compliance. The displayed resistance increased with increasing ETT leakage for the three ventilators, but quite different. The effect of ETT leakage on displayed V and lung mechanical parameters is ventilator-dependent. ETT leakage can lead to incorrect measurements that indicate reduced V, improvement of lung compliance, or ETT obstruction.
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http://dx.doi.org/10.3233/PIC-2012-012DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6530677PMC
June 2012

Maternal characteristics and twin gestation outcomes over 10 years: impact of conception methods.

Fertil Steril 2012 Jul 17;98(1):95-101. Epub 2012 May 17.

Department of Obstetrics, Charité University Medical Center, Berlin, Germany.

Objective: To compare maternal characteristics and obstetric outcomes of spontaneously conceived (SC) and after-fertility treatment (FT) twins.

Design: Retrospective study.

Setting: Single tertiary center (university hospital).

Patient(s): All twin pregnancies (n = 1,239) delivered ≥ 24 weeks of gestation and classified by the mode of conception.

Intervention(s): None.

Main Outcome Measure(s): Maternal age, prematurity, preterm rupture of membranes (PROM), delivery mode, cervical insufficiency, preeclampsia/HELLP (hemolysis, elevated liver enzymes, low platelet count) syndrome, gestational diabetes, and postpartum hemorrhage.

Result(s): Of 1,239 mothers evaluated, 34.4% received FT. We observed a continuous 3.2-year mean increase in maternal age over time in the FT population. The FT group had statistically significantly higher rates of women ≥ 35 years of age versus the SC group (37.6% vs. 22.9%). Mean maternal age (32.5 vs. 30.1 years) and the rates of cesarean delivery (72.3% vs. 63.9%), dichorionic twin prematurity (67.7% vs. 59.6%), postpartum hemorrhage (9.9% vs. 6%), PROM (2.3% vs. 0.6%), and cervical insufficiency (17.6% vs. 10%) were statistically significantly higher in the FT group. Preeclampsia/HELLP syndrome and gestational diabetes showed no significantly significant difference.

Conclusion(s): Mothers of twins after FT were statistically significantly older and had higher rates of prematurity, cesarean delivery, and obstetric morbidity.
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http://dx.doi.org/10.1016/j.fertnstert.2012.04.009DOI Listing
July 2012

Development of lung function in very low birth weight infants with or without bronchopulmonary dysplasia: longitudinal assessment during the first 15 months of corrected age.

BMC Pediatr 2012 Mar 23;12:37. Epub 2012 Mar 23.

Department of Neonatology, Charité University Medicine, Berlin, Germany.

Background: Very low birth weight (VLBW) infants (< 1,500 g) with bronchopulmonary dysplasia (BPD) develop lung damage caused by mechanical ventilation and maturational arrest. We compared functional lung development after discharge from hospital between VLBW infants with and without BPD.

Methods: Comprehensive lung function assessment was performed at about 50, 70, and 100 weeks of postmenstrual age in 55 sedated VLBW infants (29 with former BPD [O2 supplementation was given at 36 weeks of gestational age] and 26 VLBW infants without BPD [controls]). Mean gestational age (26 vs. 29 weeks), birth weight (815 g vs. 1,125 g), and the proportion of infants requiring mechanical ventilation for ≥7 d (55% vs. 8%), differed significantly between BPD infants and controls.

Results: Both body weight and length, determined over time, were persistently lower in former BPD infants compared to controls, but no significant between-group differences were noted in respiratory rate, respiratory or airway resistance, functional residual capacity as determined by body plethysmography (FRC(pleth)), maximal expiratory flow at the FRC (V'max (FRC)), or blood gas (pO2, pCO2) levels. Tidal volume, minute ventilation, respiratory compliance, and FRC determined by SF6 multiple breath washout (representing the lung volume in actual communication with the airways) were significantly lower in former BPD infants compared to controls. However, these differences became non-significant after normalization to body weight.

Conclusions: Although somatic growth and the development of some lung functional parameters lag in former BPD infants, the lung function of such infants appears to develop in line with that of non-BPD infants when a body weight correction is applied. Longitudinal lung function testing of preterm infants after discharge from hospital may help to identify former BPD infants at risk of incomplete recovery of respiratory function; such infants are at risk of later respiratory problems.
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http://dx.doi.org/10.1186/1471-2431-12-37DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3362756PMC
March 2012

Standardized diaper care regimen: a prospective, randomized pilot study on skin barrier function and epidermal IL-1α in newborns.

Pediatr Dermatol 2012 May-Jun;29(3):270-6. Epub 2012 Jan 20.

Department of Dermatology and Allergy, Clinical Research Center for Hair and Skin Science, Charité Campus Mitte, Charité-Universitätsmedizin Berlin, Berlin, Germany.

Adaptation of skin barrier function and interleukin-1α (IL-1α) content in diapered and nondiapered skin are poorly characterized in newborns receiving standard skin care. In a monocentric, prospective pilot study 44 healthy, full-term neonates were randomly assigned to skin care with baby wipes (n = 21) or water-moistened washcloth (n = 23) at each diaper change. Transepidermal water loss (TEWL), skin hydration, skin-pH, IL-1α, and epidermal desquamation were measured on days 2, 14, and 28 postpartum. Microbiological colonization was evaluated at baseline and on day 28. Significantly lower TEWL was found on the buttock in the group using baby wipes compared to water. IL-1α and skin hydration significantly increased and pH decreased independent of skin care regimen. IL-1α was significantly higher in diapered skin compared to nondiapered skin. Although skin care with wipes seems to stabilize TEWL better than using water, the skin condition and microbiological colonization were comparable using both cleansing procedures. Increase of epidermal IL-1α may reflect postnatal skin barrier maturation. These data suggest that neither of the two cleansing procedures harms skin barrier maturation within the first four weeks postpartum. Longer observations on larger populations could provide more insight into postnatal skin barrier maturation.
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http://dx.doi.org/10.1111/j.1525-1470.2011.01590.xDOI Listing
September 2012

Early lung function testing in infants with aortic arch anomalies identifies patients at risk for airway obstruction.

PLoS One 2011 23;6(9):e24903. Epub 2011 Sep 23.

Department of Neonatology, Charité Universitätsmedizin Berlin, Berlin, Germany.

Background: Aortic arch anomalies (AAA) are rare cardio-vascular anomalies. Right-sided and double-sided aortic arch anomalies (RAAA, DAAA) are distinguished, both may cause airway obstructions. We studied the degree of airway obstruction in infants with AAA by neonatal lung function testing (LFT).

Patients And Methods: 17 patients (10 RAAA and 7 DAAA) with prenatal diagnosis of AAA were investigated. The median (range) post conception age at LFT was 40.3 (36.6-44.1) weeks, median body weight 3400 (2320-4665) g. Measurements included tidal breathing flow-volume loops (TBFVL), airway resistance (R(aw)) by bodyplethysmography and the maximal expiratory flow at functional residual capacity (V'(max)FRC) by rapid thoracic-abdominal compression (RTC) technique. V'(max)FRC was also expressed in Z-scores, based on published gender-, age and height-specific reference values.

Results: Abnormal lung function tests were seen in both RAAA and DAAA infants. Compared to RAAA infants, infants with DAAA had significantly more expiratory flow limitations in the TBFVL, (86% vs. 30%, p<0.05) and a significantly increased R(aw) (p = 0.015). Despite a significant correlation between R(aw) and the Z-score of V'(max)FRC (r = 0.740, p<0.001), there were no statistically significant differences in V'(max)FRC and it's Z-scores between RAAA and DAAA infants. 4 (24%) infants (2 RAAA, 2 DAAA) were near or below the 10(th) percentile of V'(max)FRC, indicating a high risk for airway obstruction.

Conclusion: Both, infants with RAAA and DAAA, are at risk for airway obstruction and early LFT helps to identify and to monitor these infants. This may support the decision for therapeutic interventions before clinical symptoms arise.
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http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0024903PLOS
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3179483PMC
March 2012

Weaning of neonates from mechanical ventilation by use of nasopharyngeal high-frequency oscillatory ventilation: a preliminary study.

J Matern Fetal Neonatal Med 2012 Apr 26;25(4):374-8. Epub 2011 May 26.

Department of Neonatology, Charité University Medical Center, Berlin, Germany.

Objective: To investigate the feasibility of nasopharyngeal high-frequency oscillatory ventilation (nHFOV) immediately after extubation in difficult-to-wean preterm infants.

Study Design: This was an observational study of 20 mechanically ventilated neonates [median (range) birth weight 635 (382-1020)g, median gestational age 25.3 (23.7-27.6) weeks] at high risk for extubation failure. Nine infants had failed at least one previous extubation. Fourteen infants were given hydrocortisone. All 20 infants were extubated into nHFOV, with a mean airway pressure of 8 cmH(2)O, an amplitude of 20 cmH(2)O, and a frequency of 10 Hz.

Results:  Infants remained on nHFOV for a median duration of 136.5 (7.0-456.0) h until further weaning to continuous positive airway pressure (n =14) or reintubation (n = 6). Reintubation was performed in 1 of 11 infants who had not experienced any previous extubation, and in five of nine infants who had experienced at least one previous extubation (P < 0.05). PaCO(2) was virtually unchanged from preextubation levels 2 h after extubation, but declined significantly at 32 h from 59.8 (45.0-92.3) mmHg to 50.7 (39.8-74.4) mmHg (P < 0.01). PaCO(2) returned to preextubation levels upon discontinuation of nHFOV.

Conclusion: This small observational study demonstrates that nHFOV can be successfully applied to wean premature infants from ventilator support.
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http://dx.doi.org/10.3109/14767058.2011.580401DOI Listing
April 2012

Tracheal tube airleak in clinical practice and impact on tidal volume measurement in ventilated neonates.

Pediatr Crit Care Med 2011 Mar;12(2):197-202

Department of Neonatology, Charité University Medical Center, Berlin, Germany.

Objective: To determine the prevalence, size, and factors affecting tracheal tube (TT) leak in clinical practice and their influence on the displayed tidal volume (Vt) in ventilated newborn infants using uncuffed TTs. Monitoring of Vt is important for implementation of lung-protective ventilation strategies but becomes meaningless in the presence of large TT airleaks.

Design: Retrospective clinical study.

Setting: Neonatal intensive care unit.

Patients: Patient records of 163 neonates ventilated with Babylog 8000 for ≥ 5 hrs with a median (range) gestation age of 31.1 wks (23.3-41.9 wks) and a median birth weight of 1470 g (410-4475 g) were evaluated.

Interventions: : Ventilatory settings, TT leak, and Vt were recorded every 3 hrs. The lowest, median, and highest TT leaks were noted on the day the first TT leak (>5%) occurred, the day on which TT leak peaked, and the day of extubation.

Measurements And Main Results: A TT leak of >5% was seen in 122 (75%) infants. Neonates with TT leak, compared with those without TT leak, had a longer duration of mechanical ventilation (p < .001), a lower gestational age (p = .004), a reduced birth weight (p = .005), and a higher prevalence of reintubation (p = .003). The greatest TT leak was seen in infants ventilated with a TT of <3-mm diameter. During the entire duration of mechanical ventilation, 42.3% of all neonates experienced at least one TT leak of >40% commonly seen on the third day of mechanical ventilation. Regression analysis showed that a TT leak of 40% indicated that the displayed Vt was underestimated by 1.2 mL/kg (about 24% of target Vt).

Conclusions: TT leak is highly variable, and TT leak of >40% with clinically relevant Vt errors occurred in nearly half of all ventilated neonates. Preterm infants of low birth weight and with small-diameter TTs ventilated for a long period were at greater risk of TT leak.
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http://dx.doi.org/10.1097/PCC.0b013e3181e89834DOI Listing
March 2011

Equipment and operator training denote manual ventilation performance in neonatal resuscitation.

Am J Perinatol 2010 Oct 10;27(9):753-8. Epub 2010 May 10.

Clinic of Neonatology, Charité Universitätsmedizin Berlin, Berlin, Germany.

High peak inspiratory pressure (PIP) and tidal volume (V(T)) from manual ventilation are hazardous to the neonatal lung. We investigated the influence of operator training on the extent of applied PIP and V(T) between two manual ventilation devices. We performed a prospective, crossover study of 84 medical professionals using a neonatal mannequin. Participants were classified into four groups, according to experience in neonatal resuscitation and previous training in manual ventilation. Provision of PIP, V(T), and inspiratory time (Ti) were compared between groups and equipment used, either a self-inflating bag (SI-bag) or a T-piece resuscitator (Neopuff). Using SI-bags, operator training significantly affected provision of PIP ( P < 0.001), V(T) ( P < 0.001), and Ti ( P = 0.048). Using a T-piece device, PIP and V(T) provision was independent of operator training ( P = 0.55 and P = 0.66, respectively). Twenty-five participants (30%) had previous experience with T-piece devices; this correlated significantly with lower PIP and lower V(T) provision ( P > 0.001 for PIP and V(T)). Operator training level and device-specific experience had a significant impact on PIP and V(T) provision when using SI-bags for manual ventilation. For operators with no specific training in manual ventilation, use of T-piece devices is advised to control for excessive PIP and V(T) application.
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http://dx.doi.org/10.1055/s-0030-1254236DOI Listing
October 2010

Hydrops fetalis--has there been a change in diagnostic spectrum and mortality?

J Matern Fetal Neonatal Med 2011 Feb 7;24(2):258-63. Epub 2010 May 7.

Department of Neonatology, Charité University Medical Center, Berlin, Germany.

Objective: To investigate the impact of medical progress on the diagnostic spectrum and outcome of infants with hydrops fetalis (HF).

Study Design: We reviewed the charts of all live-born HF infants (n = 70) over a 16-year period (1993-2009). Data were compared to two published case series (Wafelman LS, Pollock BH, Kreutzer J, Richards DS, Hutchison AA. Biol Neonate 1999;75:73-81, Gainesville, Florida 1983-1992, n = 62; Simpson JH, McDevitt H, Young D, Cameron AD. Fetal Diagn Ther 2006;21:380-382, Glasgow, UK 1990-2004, n = 30).

Results: Only two cases were immune HF. The proportion of infants with unexplained HF (30%), lymphatic (24%), cardiac (17%), hematological (6%) or chromosomal anomalies (6%) did not differ from the published case series. There was also no difference in overall mortality (57% vs. 55% or 67%, respectively). Low gestational age (<34 weeks), low 5-min Apgar scores (<4), and heart failure were independently associated with fatality.

Conclusion: The diagnostic spectrum and mortality of HF has changed little over the last 25 years. In the future, new techniques in mutational analysis will be needed to reduce the high rate of unexplained cases of HF.
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http://dx.doi.org/10.3109/14767058.2010.483522DOI Listing
February 2011

Effect of standardized skin care regimens on neonatal skin barrier function in different body areas.

Pediatr Dermatol 2010 Jan-Feb;27(1):1-8

Department of Dermatology and Allergy, Clinical Research Center for Hair and Skin Science, Charité-Universitätsmedizin Berlin, Berlin, Germany.

The effect of topical skin care products on neonatal skin barrier during first 8 weeks of life has not been scientifically evaluated. In a prospective, randomized clinical study, we compared the influence of three skin care regimens to bathing with water on skin barrier function in newborns at four anatomic sites. A total of 64 healthy, full-term neonates (32 boys and 32 girls) aged <48 hours were randomly assigned to four groups receiving twice-weekly: WG, bathing with wash gel (n = 16); C, bathing and cream (n = 16); WG + C, bathing with wash gel plus cream (n = 16); and B, bathing with water (n = 16). Transepidermal water loss, stratum corneum hydration, skin pH, sebum were measured on day 2, week 2, 4, 8 of life on front, abdomen, upper leg, and buttock. Skin condition was scored and microbiologic colonization was documented. After 8 weeks, group WG + C showed significantly lower transepidermal water loss on front, abdomen, and upper leg as well as higher stratum corneum hydration on front and abdomen compared with group B. Similarly, group C showed lower transepidermal water loss and higher stratum corneum hydration on these body regions. Group WG revealed significantly lower pH on all sites compared with group B at week 8. No differences in sebum level, microbiologic colonization and skin condition score were found. Skin care regimens did not harm physiologic neonatal skin barrier adaptation within the first 8 weeks of life. However, significant influence of skin care on barrier function was found in a regional specific fashion.
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http://dx.doi.org/10.1111/j.1525-1470.2009.01068.xDOI Listing
June 2010

Manual ventilation devices in neonatal resuscitation: tidal volume and positive pressure-provision.

Resuscitation 2010 Feb 17;81(2):202-5. Epub 2009 Nov 17.

Clinic of Neonatology, Charité Universitätsmedizin Berlin, Charitéplatz 1, 10117 Berlin, Germany.

Background: Excessive peak inspiratory pressures (PIP) and high tidal volumes (Vt) during manual ventilation can be detrimental to the neonatal lung. We compared the influence of different manual ventilation devices and individual professional experience on the extent of applied Vt and PIP in simulated neonatal resuscitation.

Material And Methods: One hundred and twenty medical professionals were studied. An intubated mannequin (equivalent to 1.0 kg neonate) was ventilated using two different devices: a self-inflating bag and a T-piece resuscitator. Target value was a PIP of 20 cm H(2)O. Applied PIP and the resulting Vt were recorded continuously using a respiratory function monitor (CO(2)SMO(+), Novametrix, USA).

Results: Vt and PIP provision was significantly higher in SI-bags, compared to T-piece devices: median (interquartile range) PIP 25.6 (18.2) cm H(2)O vs 19.7 (3.2) cm H(2)O (p<0.0005), and Vt 5.1(3.2) ml vs Vt 3.6 (0.8) ml (p<0.0005) respectively. The intersubject variability of Vt and PIP provision was distinctly higher in SI-bags, compared to T-piece devices. Professional experience had no significant impact on the level and the variability of Vt or PIP provided.

Conclusion: Use of T-piece devices guarantees reliable and constant Vt and PIP provision, irrespective of individual, operator dependent variables. Methods to measure and to avoid excessive tidal volumes in neonatal resuscitation need to be developed.
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http://dx.doi.org/10.1016/j.resuscitation.2009.10.008DOI Listing
February 2010

Comparison of lung volume measurements by multiple-breath heptafluoropropane washout and computed tomography in small ventilated piglets.

Med Sci Monit 2009 Oct;15(10):BR275-280

Clinic of Neonatology (Charité Campus Mitte), Charité Universitätsmedizin, Berlin, Germany.

Background: Knowledge of lung volume is essential for monitoring and optimizing mechanical ventilation. The aim of this study was to compare lung volume measurements by multiple-breath heptafluoropropane (HFP) washout (MBW) and by respiratory gated computed tomography (CT) in ventilated newborn piglets.

Material/methods: In 6 ventilated piglets (age: <12 h, median weight: 945 g) blood gases, respiratory mechanics, and lung volumes were measured in both the supine and prone positions. The measurements were performed in random order. Functional residual capacity (FRC) was measured simultaneously by HFP MBW (FRC(HFP)) using a new infrared mainstream sensor and by CT (FRC(CT)) at the end of inspiration and expiration (multi-slice Toshiba Aquilon 16, Otawara, Japan). Tidal volume (V(T)) was measured both by the Dräger Babylog 8000 ventilator (V(T BL)) and the volume difference of the CT scans (V(T CT)).

Results: FRC(HFP) (25.2+/-8.5 ml) and FRC(CT) (24.9+/-7.6 ml) correlated strongly (r=0.97) without significant bias. Bland-Altman limits of agreement showed differences between the two methods that ranged from -19.7 to +19.5%. A similar strong correlation without statistically significant bias was found between V(T BL) (8.5+/-2.0 ml) and V(T CT) (9.0+/-2.4 ml) with r=0.91. The limits of agreement were -24.4 and +14.0%. Body position (prone vs. supine) had no significant effect on blood gases, respiratory mechanics, or lung volumes.

Conclusions: Lung volumes measured in small ventilated lungs by HFP washout and CT are highly correlated and independent of body position. However, the relatively large limits of agreement indicate differences in the two techniques.
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October 2009