Publications by authors named "Hendrik S Fischer"

17 Publications

  • Page 1 of 1

Interventional creation of an endogenous reverse Potts shunt in an infant with pulmonary hypertension and genetic surfactant disorder-a case report.

Cardiovasc Diagn Ther 2020 Oct;10(5):1696-1700

Department of Pediatric Cardiology, Charité-Universitätsmedizin Berlin, Berlin, Germany.

Reverse Potts shunt is a palliative procedure aimed at decompressing the pressure-overloaded right ventricle in severe pulmonary hypertension (PH). We, herein, report the first case of an interventional creation of an "endogenous" reverse Potts shunt by stenting a pre-existing small but patent ductus arteriosus (PDA) in a 2 months old female infant with severe, supra-systemic PH, associated with a novel combination of a compound heterozygous mutation and additional heterozygous genetic variants of surfactant protein B () and C (). The aforementioned combination of human genetic mutations has not been described before in viable infants, children or adults. The catheter intervention was performed via percutaneous femoral arterial access and was well-tolerated. Subsequently, the infant improved by means of clinical status, echocardiographic systolic right ventricular (RV) function, and serum NT-proBNP levels as biomarker of right atrial and RV pressure load. In conclusion, this single case report suggests that interventional stenting of a pre-existing PDA to create an "endogenous" reverse Potts shunt is feasible and efficacious in infants less than 3 months old with severe PH and impending RV failure associated with developmental lung disease.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.21037/cdt.2020.03.11DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7666916PMC
October 2020

Early Exchange Transfusion to Treat Neonates With Gestational Alloimmune Liver Disease: An 11-Year Cohort Study.

J Pediatr Gastroenterol Nutr 2020 04;70(4):444-449

Department of Neonatology, Charité - Universitätsmedizin Berlin, Berlin.

Objectives: Exchange transfusion (ET) and intravenous immunoglobulin are potentially life-saving treatment options in newborns with gestational alloimmune liver disease (GALD). Since 2008, early ET has been the standard of care for symptomatic neonates with suspected GALD in our unit. The present study's aim was to investigate the outcomes of this approach.

Methods: From 2008 to 2018, all neonates who received ET for suspected GALD were identified, and their clinical course and outcomes were analyzed in a descriptive cohort study. In survivors, liver function parameters before ET and maximum values after ET and at discharge were compared.

Results: During the 11-year period, 12 infants received ET for suspected GALD at a median (range) chronological age of 11 (1-23) days and gestational age of 38 (32-40) weeks. Signs of impaired liver function, most frequently postnatal hypoglycemia, hyperferritinemia, direct hyperbilirubinemia, and coagulopathy, were present in all infants. Survival without a liver transplant in the overall cohort was 10 of 12 (83.3%) and 7 of 9 (78%) in those fulfilling the criteria of acute liver failure. Two patients died, one of them after liver transplantation. Direct bilirubin typically increased after ET, even in survivors. All survivors recovered and were discharged from the pediatric hepatology outpatient clinic after 8 (3-11) months of follow-up.

Conclusions: In newborns with suspected GALD, a limited diagnostic work-up followed by early ET may lead to favorable outcomes. More data are required to develop an evidence-based clinical approach to GALD.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1097/MPG.0000000000002593DOI Listing
April 2020

Nutritional interventions to reduce rates of infection, necrotizing enterocolitis and mortality in very preterm infants.

Pediatr Res 2020 01 23;87(2):371-377. Epub 2019 Oct 23.

Division of Neonatology, University Children's Hospital Regensburg (KUNO), University of Regensburg, Regensburg, Germany.

Observational studies demonstrating reduced rates of infections, necrotizing enterocolitis (NEC), and mortality in preterm infants fed their own mother's milk, as opposed to formula, have prompted endeavors to achieve similar effects with the right choice of food and food additives. In a systematic review of meta-analyses and randomized controlled trials (RCTs), we considered nutritional interventions aimed at reducing the rates of infections, NEC, or mortality in very preterm infants. The overall effects of particular interventions were presented as risk ratios with 95% confidence intervals. In RCTs, pasteurized human donor milk, as opposed to formula, reduced NEC but not infections or mortality. No differences emerged between infants receiving human or bovine milk-based fortifiers. Pooled data of small trials and a recent large RCT suggested that bovine lactoferrin reduced rates of fungal sepsis without impact on other infections, NEC, or mortality. Pooled data of RCTs assessing the use of prebiotic oligosaccharides found reduced infection but not mortality. Enteral L-glutamine (six RCTs) lowered infection rates, and enteral L-arginine (three RCTs) reduced NEC. A meta-analysis sensitivity approach found multiple-strain (but not single-strain) probiotics to be highly effective in reducing NEC and mortality. Thus, selected food components may help to improve outcomes in preterm infants.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1038/s41390-019-0630-2DOI Listing
January 2020

Hazards to avoid in future neonatal studies of nasal high-frequency oscillatory ventilation: lessons from an early terminated trial.

BMC Res Notes 2019 Apr 25;12(1):237. Epub 2019 Apr 25.

Department of Neonatology, Charité - Universitätsmedizin Berlin, Augustenburger Platz 1, 13353, Berlin, Germany.

Objective: To investigate whether nasal high-frequency oscillatory ventilation (nHFOV) started immediately after extubation of mechanically ventilated very low birth weight infants reduces the partial pressure of carbon dioxide at 72 h after extubation in comparison with nasal continuous positive airway pressure. This randomised controlled single-centre trial aimed to include 68 preterm infants at high risk of extubation failure.

Results: Implementation of the study protocol was feasible. However, from 2015 to 2017, only six patients could be recruited, leading to early termination of the trial. The slow recruitment was due to the introduction of new strategies to avoid endotracheal mechanical ventilation, which reduced the number of eligible infants. Moreover, the included infants failed their extubation more often than anticipated, thereby increasing the required sample size. Based on our single-centre experience, we provide information for study planning and discuss the specific requirements for future trial protocols on nHFOV. The extubation of high-risk infants into nHFOV could well be beneficial, but a multicentric approach is necessary to investigate this hypothesis. Trial Registration Clinicaltrials.gov NCT02340299, on 16 January 2015.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1186/s13104-019-4268-2DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6482494PMC
April 2019

Sustained inflations and avoiding mechanical ventilation to prevent death or bronchopulmonary dysplasia: a meta-analysis.

Eur Respir Rev 2018 Dec 28;27(150). Epub 2018 Nov 28.

Dept of Neonatology, Charité University Medical Centre, Berlin, Germany.

Sustained inflations and avoidance of endotracheal mechanical ventilation (eMV) are delivery room interventions aimed at preventing bronchopulmonary dysplasia (BPD). Their effectiveness is the subject of the present meta-analysis.The databases MEDLINE, EMBASE and CENTRAL were searched for randomised controlled trials (RCTs) of preterm infants that compared: 1) sustained inflations with intermittent positive-pressure ventilation; and 2) a non-intubated strategy of respiratory support with one that prescribed eMV at an earlier stage. Data extraction and analysis followed the standard methods of the Cochrane Collaboration. The primary outcome was death or BPD, defined as need for oxygen or positive pressure treatment at 36 weeks' postmenstrual age.Avoiding eMV (nine RCTs, 3486 infants) reduced the risk of death or BPD, with a risk ratio of 0.90 (95% CI 0.84-0.97) and a number needed to treat of 35. After sustained inflations (six RCTs, 854 infants), the risk ratio was 0.85 (95% CI 0.65-1.12). A current multicentre RCT of sustained inflations in very preterm infants was halted for increased early mortality in the sustained inflations arm.While strategies aimed at avoiding eMV had a small but significant impact on preventing BPD, sustained inflations had no effect and may even increase mortality in very preterm infants.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1183/16000617.0083-2018DOI Listing
December 2018

Early noninvasive high-frequency oscillatory ventilation in the primary treatment of respiratory distress syndrome.

Pediatr Pulmonol 2018 02 21;53(2):126-127. Epub 2017 Dec 21.

Service of Neonatology and Pediatric Intensive Care, University Hospital of Geneva, Geneva, Switzerland.

View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1002/ppul.23883DOI Listing
February 2018

Nasal high-frequency oscillatory ventilation impairs heated humidification: A neonatal bench study.

Pediatr Pulmonol 2017 Nov 7;52(11):1455-1460. Epub 2017 Sep 7.

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

Objective: Nasal high-frequency oscillatory ventilation (nHFOV) is a novel mode of non-invasive ventilation used in neonates. However, upper airway obstructions due to viscous secretions have been described as specific adverse effects. We hypothesized that high-frequency oscillations reduce air humidity in the oropharynx, resulting in upper airway desiccation. Therefore, we aimed to investigate the effects of nHFOV ventilatory settings on oropharyngeal gas conditions.

Methods: NHFOV or nasal continuous positive airway pressure (nCPAP) was applied, along with heated humidification, to a previously established neonatal bench model that simulates oropharyngeal gas conditions during spontaneous breathing through an open mouth. A digital thermo-hygro sensor measured oropharyngeal temperature (T) and humidity at various nHFOV frequencies (7, 10, 13 Hz), amplitudes (10, 20, 30 cmH O), and inspiratory-to-expiratory (I:E) ratios (25:75, 33:66, 50:50), and also during nCPAP.

Results: Relative humidity was always >99%, but nHFOV resulted in lower mean T and absolute humidity (AH) in comparison to nCPAP (P < 0.001). Specifically, decreasing the nHFOV frequency and increasing nHFOV amplitude caused a decline in T and AH (P < 0.001). Mean T and AH were highest during nCPAP (T 34.8 ± 0.6°C, AH 39.3 ± 1.3 g · m ) and lowest during nHFOV at a frequency of 7 Hz and an amplitude of 30 cmH O (T 32.4 ± 0.3°C, AH 34.7 ± 0.5 g · m ). Increasing the I:E ratio also reduced T and AH (P = 0.03).

Conclusion: Intensified nHFOV settings with low frequencies, high amplitudes, and high I:E ratios may place infants at an increased risk of upper airway desiccation. Future studies should investigate strategies to optimize heated humidification during nHFOV.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1002/ppul.23824DOI Listing
November 2017

Prophylactic Early Erythropoietin for Neuroprotection in Preterm Infants: A Meta-analysis.

Pediatrics 2017 May 7;139(5). Epub 2017 Apr 7.

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

Context: Recombinant human erythropoietin (rhEPO) is a promising pharmacological agent for neuroprotection in neonates.

Objective: To investigate whether prophylactic rhEPO administration in very preterm infants improves neurodevelopmental outcomes in a meta-analysis of randomized controlled trials (RCTs).

Data Sources: Medline, Embase, and the Cochrane Central Register of Controlled Trials were searched in December 2016 and complemented by other sources.

Study Selection: RCTs investigating the use of rhEPO in preterm infants versus a control group were selected if they were published in a peer-reviewed journal and reported neurodevelopmental outcomes at 18 to 24 months' corrected age.

Data Extraction: Data extraction and analysis followed the standard methods of the Cochrane Neonatal Review Group. The primary outcome was the number of infants with a Mental Developmental Index (MDI) <70 on the Bayley Scales of Infant Development. Secondary outcomes included a Psychomotor Development Index <70, cerebral palsy, visual impairment, and hearing impairment.

Results: Four RCTs, comprising 1133 infants, were included in the meta-analysis. Prophylactic rhEPO administration reduced the incidence of children with an MDI <70, with an odds ratio (95% confidence interval) of 0.51 (0.31-0.81), < .005. The number needed to treat was 14. There was no statistically significant effect on any secondary outcome.

Conclusions: Prophylactic rhEPO improved the cognitive development of very preterm infants, as assessed by the MDI at a corrected age of 18 to 24 months, without affecting other neurodevelopmental outcomes. Current and future RCTs should investigate optimal dosing and timing of prophylactic rhEPO and plan for long-term neurodevelopmental follow-up.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1542/peds.2016-4317DOI Listing
May 2017

Abstracts of the 52nd Workshop for Pediatric Research : Frankfurt, Germany. 27-28 October 2016.

Authors:
Rhea van den Bruck Patrick P Weil Thomas Ziegenhals Philipp Schreiner Stefan Juranek Daniel Gödde Silvia Vogel Frauke Schuster Valerie Orth Johannes Dörner Daniel Pembaur Meike Röper Stefan Störkel Hubert Zirngibl Stefan Wirth Andreas C W Jenke Jan Postberg Nikolas Boy Jana Heringer Gisela Haege Esther M Glahn Georg F Hoffmann Sven F Garbade Peter Burgard Stefan Kölker Cho-Ming Chao Faady Yahya Alena Moiseenko Amit Shrestha Negah Ahmadvand Jennifer Quantius Jochen Wilhelm Elie El-Agha Klaus-Peter Zimmer Saverio Bellusci Christian Staufner Stefan Kölker Holger Prokisch Georg F Hoffmann Stephan Seeliger Matthias Müller Andreas Hippe Henrik Steinkraus Roland Wauer Burkhard Lachmann Sigrun R Hofmann Christian M Hedrich Jakob Zierk Farhad Arzideh Rainer Haeckel Wolfgang Rascher Manfred Rauh Markus Metzler Sebastian Thieme Joanna Bandoła Cornelia Richter Martin Ryser Arshad Jamal Michelle P Ashton Malte von Bonin Matthias Kuhn Christian M Hedrich Ezio Bonifacio Reinhard Berner Sebastian Brenner Johanna Hammersen Cristina Has Nora Naumann-Bartsch Daniel Stachel Dimitra Kiritsi Stephan Söder Mathilde Tardieu Markus Metzler Leena Bruckner-Tuderman Holm Schneider F Bohne D Langer R Cencic T Eggermann U Zechner J Pelletier F Zepp T Enklaar D Prawitt Martin Pech Markus Weckmann Femke-Anouska Heinsen Andre Franke Christine Happle Anna-Maria Dittrich Gesine Hansen Oliver Fuchs Erika von Mutius Brian G Oliver Matthias V Kopp Claudia Paret Alexandra Russo Johanna Theruvath Bettina Keller Khalifa El Malki Nadine Lehmann Arthur Wingerter Marie A Neu Gerhold-Ay Aslihan Wolfgang Wagner Clemens Sommer Torsten Pietsch Larissa Seidmann Jörg Faber Felix Schreiner Merle Ackermann Michael Michalik Eva Rother Andras Bilkei-Gorzo Ildiko Racz Laura Bindila Beat Lutz Jörg Dötsch Andreas Zimmer Joachim Woelfle Hendrik S Fischer Tim L Ullrich Christoph Bührer Christoph Czernik Gerd Schmalisch Robert Stein Sigrun R Hofmann Judith Hagenbuchner Ursula Kiechl-Kohlendorfer Petra Obexer Michael J Ausserlechner Niki T Loges Adrien Tobias Frommer Julia Wallmeier Heymut Omran Soner Öner-Sieben Martina Gimpfl Jan Rozman Martin Irmler Johannes Beckers Martin Hrabe De Angelis Adelbert Roscher Eckhard Wolf Regina Ensenauer Karolina Nemes Michael Frühwald Martin Hasselblatt Reiner Siebert Uwe Kordes Marcel Kool Haicui Wang Holly Hardy Osama Refai Katy E S Barwick Holly H Zimmerman Joachim Weis Emma L Baple Andrew H Crosby Sebahattin Cirak C Hellmuth O Uhl M Standl J Heinrich E Thiering B Koletzko Lena Blümel Kornelius Kerl Daniel Picard Michael C Frühwald Max C Liebau Guido Reifenberger Arndt Borkhardt Martin Hasselblatt Marc Remke D Tews M Wabitsch P Fischer-Posovszky Mike-Andrew Westhoff Lisa Nonnenmacher Julia Langhans Lukas Schneele Nancy Trenkler Klaus-Michael Debatin

Mol Cell Pediatr 2017 May;4(Suppl 1)

Department of Pediatrics and Adolescent Medicine, University Medical Center Ulm, Ulm, Germany.

View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1186/s40348-017-0071-0DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5435609PMC
May 2017

Influence of mouth opening on oropharyngeal humidification and temperature in a bench model of neonatal continuous positive airway pressure.

Med Eng Phys 2017 02 30;40:87-94. Epub 2016 Dec 30.

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

Clinical studies show that non-invasive respiratory support by continuous positive airway pressure (CPAP) affects gas conditioning in the upper airways, especially in the presence of mouth leaks. Using a new bench model of neonatal CPAP, we investigated the influence of mouth opening on oropharyngeal temperature and humidity. The model features the insertion of a heated humidifier between an active model lung and an oropharyngeal head model to simulate the recurrent expiration of heated, humidified air. During unsupported breathing, physiological temperature and humidity were attained inside the model oropharynx, and mouth opening had no significant effect on oropharyngeal temperature and humidity. During binasal CPAP, the impact of mouth opening was investigated using three different scenarios: no conditioning in the CPAP circuit, heating only, and heated humidification. Mouth opening had a strong negative impact on oropharyngeal humidification in all tested scenarios, but heated humidification in the CPAP circuit maintained clinically acceptable humidity levels regardless of closed or open mouths. The model can be used to test new equipment for use with CPAP, and to investigate the effects of other methods of non-invasive respiratory support on gas conditioning in the presence of leaks.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.medengphy.2016.12.005DOI Listing
February 2017

Computerized wheeze detection in young infants: comparison of signals from tracheal and chest wall sensors.

Physiol Meas 2016 12 21;37(12):2170-2180. Epub 2016 Nov 21.

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

Computerized wheeze detection is an established method for objective assessment of respiratory sounds. In infants, this method has been used to detect subclinical airway obstruction and to monitor treatment effects. The optimal location for the acoustic sensors, however, is unknown. The aim of this study was to evaluate the quality of respiratory sound recordings in young infants, and to determine whether the position of the sensor affected computerized wheeze detection. Respiratory sounds were recorded over the left lateral chest wall and the trachea in 112 sleeping infants (median postmenstrual age: 49 weeks) on 129 test occasions using an automatic wheeze detection device (PulmoTrack). Each recording lasted 10 min and the recordings were stored. A trained clinician retrospectively evaluated the recordings to determine sound quality and disturbances. The wheeze rates of all undisturbed tracheal and chest wall signals were compared using Bland-Altman plots. Comparison of wheeze rates measured over the trachea and the chest wall indicated strong correlation (r  ⩾  0.93, p  <  0.001), with a bias of 1% or less and limits of agreement of within 3% for the inspiratory wheeze rate and within 6% for the expiratory wheeze rate. However, sounds from the chest wall were more often affected by disturbances than sounds from the trachea (23% versus 6%, p  <  0.001). The study suggests that in young infants, a better quality of lung sound recordings can be obtained with the tracheal sensor.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1088/0967-3334/37/12/2170DOI Listing
December 2016

The lung clearance index in young infants: impact of tidal volume and dead space.

Physiol Meas 2015 Jul 18;36(7):1601-13. Epub 2015 Jun 18.

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

Lung clearance index (LCI), measured by multiple breath washout (MBW), is one of the most frequently used measures of ventilation inhomogeneity. This study was designed to investigate the effect of lung volumes on LCI in young infants. The dependence of LCI on dead space volume (VD), tidal volume (VT) and functional residual capacity (FRC) was investigated by mathematical modeling and by MBW measurements using sulfur hexafluoride (SF6) as a tracer gas. MBW was performed in 150 infants, of median postmenstrual age 46.7 weeks, followed up after neonatal intensive care. Wheezing was assessed in 90 of these infants by computerized respiratory sound analysis during quiet sleep. The strongest correlation was observed between LCI and the volume ratios VT/FRC (Spearman rank order correlation coefficient Rs = 0.688, p < 0.001), VD/VT (Rs = 0.733, p < 0.001) and VD/FRC (Rs = 0.854, p < 0.001). LCI calculated from VD, VT, and FRC was linearly related to measured LCI with a coefficient of determination of 75%. There were no significant differences between wheezers and non-wheezers in postmenstrual age and body weight, but FRC was significantly increased (p < 0.001) and median (interquartile range) LCI significantly decreased (5.83 (5.45-6.51) versus (6.54 (6.03-7.22), p < 0.001) in wheezing compared to non-wheezing infants. Model calculations also showed that LCI was significantly reduced in wheezing infants (5.09 (4.79-5.62) versus 5.43 (5.08-5.82), p < 0.018), indicating that the reduction can be explained by differences in the lung volumes, not by improved ventilation homogeneity. In conclusion, the strong dependence of LCI on lung volumes in young infants can lead to misinterpretations regarding the homogeneity of alveolar ventilation.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1088/0967-3334/36/7/1601DOI Listing
July 2015

Validation of computerized wheeze detection in young infants during the first months of life.

BMC Pediatr 2014 Oct 9;14:257. Epub 2014 Oct 9.

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

Background: Several respiratory diseases are associated with specific respiratory sounds. In contrast to auscultation, computerized lung sound analysis is objective and can be performed continuously over an extended period. Moreover, audio recordings can be stored. Computerized lung sounds have rarely been assessed in neonates during the first year of life. This study was designed to determine and validate optimal cut-off values for computerized wheeze detection, based on the assessment by trained clinicians of stored records of lung sounds, in infants aged <1 year.

Methods: Lung sounds in 120 sleeping infants, of median (interquartile range) postmenstrual age of 51 (44.5-67.5) weeks, were recorded on 144 test occasions by an automatic wheeze detection device (PulmoTrack®). The records were retrospectively evaluated by three trained clinicians blinded to the results. Optimal cut-off values for the automatically determined relative durations of inspiratory and expiratory wheezing were determined by receiver operating curve analysis, and sensitivity and specificity were calculated.

Results: The optimal cut-off values for the automatically detected durations of inspiratory and expiratory wheezing were 2% and 3%, respectively. These cutoffs had a sensitivity and specificity of 85.7% and 80.7%, respectively, for inspiratory wheezing and 84.6% and 82.5%, respectively, for expiratory wheezing. Inter-observer reliability among the experts was moderate, with a Fleiss' Kappa (95% confidence interval) of 0.59 (0.57-0.62) for inspiratory and 0.54 (0.52 - 0.57) for expiratory wheezing.

Conclusion: Computerized wheeze detection is feasible during the first year of life. This method is more objective and can be more readily standardized than subjective auscultation, providing quantitative and noninvasive information about the extent of wheezing.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1186/1471-2431-14-257DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4287542PMC
October 2014

Effect of intubation and mechanical ventilation on exhaled nitric oxide in preterm infants with and without bronchopulmonary dysplasia measured at a median postmenstrual age of 49 weeks.

BMC Res Notes 2014 Jun 24;7:389. Epub 2014 Jun 24.

Department of Neonatology, Charité University Medicine, Charitéplatz 1, D - 10117 Berlin, Germany.

Background: Exhaled nitric oxide (eNO) is a marker of established airway inflammation in adults and children, but conflicting results have been reported in preterm infants when postnatal eNO is measured during tidal breathing. This study investigated the extent to which intubation and mechanical ventilation (MV) affect eNO and NO production (V'NO) in preterm infants with and without bronchopulmonary dysplasia (BPD).

Patients And Methods: A total of 176 very low birth weight (VLBW) infants (birth weight <1500 g), including 74 (42%) with and 102 (58%) without BPD, were examined at a median postmenstrual age of 49 weeks. Of the 176 infants, 84 (48%) did not require MV, 47 (27%) required MV for <7 days and 45 (26%) required MV for ≥7 days. Exhaled NO and tidal breathing parameters were measured in sleeping infants during tidal breathing, respiratory mechanics were assessed by occlusion tests, and arterialized capillary blood gas was analyzed.

Results: eNO was significantly correlated with tidal breathing parameters, while V'NO was correlated with growth parameters, including age and body length (p < 0.001 each). Infants who were intubated and received MV for <7 days had significantly lower eNO (p < 0.01) and V'NO (p < 0.01) than non-ventilated infants. In contrast, eNO and V'NO did not differ significantly in non-ventilated infants and those receiving MV for ≥7 days. Multivariate analysis showed that independent on the duration of MV eNO (p = 0.003) and V'NO (p = 0.018) were significantly increased in BPD infants comparable with the effects of intubation and MV on eNO (p = 0.002) and V'NO (p = 0.017).

Conclusions: Preterm infants with BPD show only weak postnatal increases in eNO and V'NO, but these changes may be obscured by the distinct influences of breathing pattern and invasive respiratory support. This limits the diagnostic value of postnatal eNO measurements in the follow-up of BPD infants.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1186/1756-0500-7-389DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4102333PMC
June 2014

Avoiding endotracheal ventilation to prevent bronchopulmonary dysplasia: a meta-analysis.

Pediatrics 2013 Nov 21;132(5):e1351-60. Epub 2013 Oct 21.

Klinik für Neonatologie, Charité Universitätsmedizin Berlin, Augustenburger Platz 1, 13353 Berlin, Germany.

Background And Objective: Mechanical ventilation via an endotracheal tube is a risk factor for bronchopulmonary dysplasia (BPD), one of the most common morbidities of very preterm infants. Our objective was to investigate the effect that strategies to avoid endotracheal mechanical ventilation (eMV) have on the incidence of BPD in preterm infants <30 weeks' gestational age (GA).

Methods: In February 2013, we searched the databases Medline, Embase, and the Cochrane Central Register of Controlled Trials. Study selection criteria included randomized controlled trials published in peer-reviewed journals since the year 2000 that compared preterm infants <30 weeks' GA treated by using a strategy aimed at avoiding eMV with a control group in which mechanical ventilation via an endotracheal tube was performed at an earlier stage. Data were extracted and analyzed by using the standard methods of the Cochrane Neonatal Review Group. The authors independently assessed study eligibility and risk of bias, extracted data and calculated odds ratios and 95% confidence intervals, employing RevMan version 5.1.6.

Results: We identified 7 trials that included a total of 3289 infants. The combined odds ratio (95% confidence interval) of death or BPD was 0.83 (0.71-0.96). The number needed to treat was 35. The study results were remarkably homogeneous. Avoiding eMV had no influence on the incidence of severe intraventricular hemorrhage.

Conclusions: Strategies aimed at avoiding eMV in infants <30 weeks' GA have a small but significant beneficial impact on preventing BPD.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1542/peds.2013-1880DOI Listing
November 2013

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.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.resuscitation.2009.10.008DOI Listing
February 2010

Is volume and leak monitoring feasible during nasopharyngeal continuous positive airway pressure in neonates?

Intensive Care Med 2009 Nov;35(11):1934-41

Clinic of Neonatology CCM, Charité University Medicine Berlin, Charité platz 1, 10117 Berlin, Germany.

Objective: To investigate tidal volume (VT) and leak measurements during continuous positive airway pressure (CPAP) in neonates using a commercial ventilatory device equipped with a flow sensor at the Y-piece.

Design: Randomized cross-over trial.

Setting: Neonatal intensive care unit level III.

Patients: Thirty-two infants, median (range) birth weight 1,435 (710-2,730) g, gestational age 30 (24-38) weeks.

Interventions: During nasopharyngeal CPAP, leak and VT were measured with and without occlusion of the contralateral nostril using the Leoni ventilator (Heinen & Löwenstein, Germany) and a recently developed algorithm to correct measured VT in the presence of leaks. The measuring range of the Leoni is limited to leaks <90%.

Main Results: Analyzable measurements with leaks <90% could be obtained in 12.5% of the patients with open nostril, and in 65.6% with occluded nostril. Calculated leak flow after nostril occlusion was 23 (3-77) ml min(-1) with closed mouth. Leak flow increased significantly if mouth was opened (548 (0-1,394) ml min(-1), p<0.001), but was probably even higher where leaks exceeded 90%. Mean expiratory volume +/- SD was 5.8 +/- 1.3 ml kg(-1) (corrected VT 5.9 +/-1.2 ml kg(-1)) for leaks <20%, and 3.7 +/-1.4 ml kg(-1) (corrected VT 5.8 +/- 2.2 ml kg(-1)) for leaks between 20 and 69%.

Conclusions: Leak and corrected VT could be determined in the presence of leaks of up to 69%, but leaks during CPAP often exceeded the measuring range. Reliable volume and leak monitoring was not possible with the tested equipment during nasopharyngeal CPAP. Advanced equipment is necessary to further investigate the effects of leaks on neonatal CPAP therapy.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1007/s00134-009-1651-9DOI Listing
November 2009