Publications by authors named "Martin Wald"

38 Publications

Development and validation of a self-reported questionnaire to assess occupational balance in parents of preterm infants.

PLoS One 2021 15;16(11):e0259648. Epub 2021 Nov 15.

Department of Pediatrics and Adolescent Medicine, Division of Neonatology, Pediatric Intensive Care and Neuropediatrics, Comprehensive Center for Pediatrics, Medical University of Vienna, Vienna, Austria.

Background: Parents' meaningful activities (occupations) and occupational balance are relevant to neonatal care. Valid and reliable self-reported measurement instruments are needed to assess parents' occupational balance and to evaluate occupational balance interventions in neonatal care. The aims of this study were to develop a self-reported questionnaire on occupational balance in informal caregivers (OBI-Care) and to examine its measurement properties including construct validity and internal consistency.

Methods And Findings: A mixed method multicenter study design was employed. Items of the OBI-Care were created with parents of preterm infants based on qualitative research methods. Measurement properties were analyzed with quantitative data of parents of preterm infants. Construct validity was assessed by determining dimensionality, overall and item fit to a Rasch model, differential item functioning and threshold ordering. Internal consistency was examined by determining inter-item and item-total correlations, Cronbach's alpha and Rasch's person separation index. Fourteen parents participated in item creation. Measurement properties were explored in data of 304 parents. Twenty-two items, summarized in three subscales were compiled to the OBI-Care. Items showed an overall fit and except one item, an item fit to the Rasch model. There was no evidence of differential item functioning and all items displayed ordered thresholds. Each subscale had good values of person separation indices and Cronbach's alpha.

Conclusions: The OBI-Care demonstrates construct validity and internal consistency and is thus a suitable measurement instrument to assess occupational balance of parents of preterm infants in neonatal care. OBI-Care is generic and can be applied in various health care settings.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0259648PLOS
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8592439PMC
November 2021

When synchronized isn't synchronous- an experimental benchmarking study on the efficiency of SIMV in very-low-birth weight premature infants.

Minerva Pediatr (Torino) 2021 Nov 10. Epub 2021 Nov 10.

Division of Neonatology, Department of Pediatrics and Adolescent Medicine, Paracelsus Medical University, Salzburg, Austria.

Background: Synchronized ventilation promotes a patient's ability to breathe spontaneously by providing intermittent, mechanical-controlled respiration that is synchronized with the patient's own efforts. In "synchronized-intermittent-mandatory-ventilation" SIMV, assisted ventilation is regulated by frequency settings which dictate the interval at which the ventilator becomes sensitive to respiratory efforts and responds with an assisted breath. SIMV has become one of the most widely used modes of ventilation in neonates. Using a neonatal-active-lung-model (NALM), this in-vitro benchmark study investigated how well synchronization works in SIMV with several ventilators.

Methods: The competence of eight ventilators was tested using a NALM simulator representing a preterm infant weighing approximately 1500 grams. Two conditions were explored: first, the ventilators were set to a constant ventilation rate, while the NALM was adjusted to frequencies equal to and below this ventilation rate. The second condition varied the ventilators' rates while the NALM frequency was held constant. Correctly triggered breaths were counted and displayed as a percentage (%) of the total potential triggerable breaths.

Results: Performance among devices significantly differed, ranging from a low 38.9% competency to a max of 71.7% under the first condition, and 70.7% to 100% under the second condition.

Conclusions: At high SIMV frequencies, synchronization between the patient and ventilator becomes increasingly limited. Despite their identical ventilator functions, SIMV algorithms of the various manufacturers and models tested, deliver ventilation rates with significantly different degrees of synchronization; not only in comparison to each other, but also in their own ability to continuously and effectively synchronize breaths under variable conditions, typical of preterm lungs.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.23736/S2724-5276.21.06538-1DOI Listing
November 2021

Effects of an exclusive human-milk diet in preterm neonates on early vascular aging risk factors (NEOVASC): study protocol for a multicentric, prospective, randomized, controlled, open, and parallel group clinical trial.

Trials 2021 Jul 31;22(1):509. Epub 2021 Jul 31.

Department of Pediatrics II (Neonatology), Medical University of Innsbruck, Anichstraße 35, 6020, Innsbruck, Austria.

Background: Preterm birth accounts for approximately 11% of all livebirths globally. Due to improvements in perinatal care, more than 95% of these infants now survive into adulthood. Research has indicated a robust association between prematurity and increased cardiovascular risk factors and cardiovascular mortality. While the innate adverse effects of prematurity on these outcomes have been demonstrated, therapeutic strategies on the mitigation of these concerning developments are lacking. The primary objective of the NEOVASC clinical trial is therefore to investigate whether the administration of a prolonged exclusive human-milk diet in preterm infants is capable of alleviating the harmful effects of preterm birth on the early development of cardiovascular risk factors.

Methods: The NEOVASC study is a multicentric, prospective, randomized, controlled, open, and parallel group clinical trial conducted in four Austrian tertiary neonatal care facilities. The purpose of the present trial is to investigate the effects of a prolonged exclusive human-milk-diet devoid of bovine-milk-based food components on cardiovascular and metabolic risk factors at 1, 2, and 5 years of corrected age. Primary outcomes include assessments of fasting blood glucose levels, blood pressure levels, and the distensibility of the descending aorta using validated echocardiographic protocols at 5 years of corrected age. The test group, which consists of 200 preterm infants, will therefore be compared to a control group of 100 term-born infants and a historical control group recruited previously.

Discussion: Given the emerging implications of an increased cardiovascular risk profile in the potentially growing population of preterm infants, further research on the mitigation of long-term morbidities in formerly preterm infants is urgently warranted. Further optimizing preterm infants' nutrition by removing bovine-milk-based food components may therefore be an interesting approach worth pursuing.

Trial Registration: ClinicalTrials.gov NCT04413994 . Registered on 4 June 2020.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1186/s13063-021-05445-9DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8325296PMC
July 2021

Lymphedema alters lipolytic, lipogenic, immune and angiogenic properties of adipose tissue: a hypothesis-generating study in breast cancer survivors.

Sci Rep 2021 04 14;11(1):8171. Epub 2021 Apr 14.

Department of Pathophysiology, Centre for Research On Nutrition, Metabolism and Diabetes, Third Faculty of Medicine, Charles University, Ruská 87, 100 00, Prague 10, Czech Republic.

Later stages of secondary lymphedema are associated with the massive deposition of adipose tissue (AT). The factors driving lymphedema-associated AT (LAT) expansion in humans remain rather elusive. We hypothesized that LAT expansion could be based on alterations of metabolic, adipogenic, immune and/or angiogenic qualities of AT. AT samples were acquired from upper limbs of 11 women with unilateral breast cancer-related lymphedema and 11 healthy women without lymphedema. Additional control group of 11 female breast cancer survivors without lymphedema was used to assess systemic effects of lymphedema. AT was analysed for adipocyte size, lipolysis, angiogenesis, secretion of cytokines, immune and stem cell content and mRNA gene expression. Further, adipose precursors were isolated and tested for their proliferative and adipogenic capacity. The effect of undrained LAT- derived fluid on adipogenesis was also examined. Lymphedema did not have apparent systemic effect on metabolism and cytokine levels, but it was linked with higher lymphocyte numbers and altered levels of several miRNAs in blood. LAT showed higher basal lipolysis, (lymph)angiogenic capacity and secretion of inflammatory cytokines when compared to healthy AT. LAT contained more activated CD4+ T lymphocytes than healthy AT. mRNA levels of (lymph)angiogenic markers were deregulated in LAT and correlated with markers of lipolysis. In vitro, adipose cells derived from LAT did not differ in their proliferative, adipogenic, lipogenic and lipolytic potential from cells derived from healthy AT. Nevertheless, exposition of preadipocytes to LAT-derived fluid improved their adipogenic conversion when compared with the effect of serum. This study presents results of first complex analysis of LAT from upper limb of breast cancer survivors. Identified LAT alterations indicate a possible link between (lymph)angiogenesis and lipolysis. In addition, our in vitro results imply that AT expansion in lymphedema could be driven partially by exposition of adipose precursors to undrained LAT-derived fluid.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1038/s41598-021-87494-3DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8046998PMC
April 2021

Introduction and feeding practices of solid food in preterm infants born in Salzburg!

BMC Pediatr 2021 01 27;21(1):56. Epub 2021 Jan 27.

Division of Neonatology, Department of Paediatrics and Adolescent Medicine, Paracelsus Medical University, Salzburg, Austria.

Background: It is shown that meeting the increased nutritional demand of preterm infants from birth is not only important for survival but essentially contributes to the infants` overall development and long-term health. While there are established guidelines for weaning term infants, evidence regarding preterm infants is scarce and less precise. The aim of this study was to identify the current practices on introducing solids to preterm infants amongst caregivers in Salzburg and determine potential reasons for early weaning.

Methods: Altogether 68 infants born between 24 0/7 and 36 6/7 weeks were recruited and detailed structured interviews with the caregivers were conducted at 17 weeks corrected age. Weight, height and head circumference were collected.

Results: 52% of the study group received solids before the recommended 17 weeks corrected age. For this group the mean age being 13.77 ± 1.11 weeks corrected age. Premature introduction of solids significantly correlates with exclusively and early formula-feeding. 34% were weaned due to recommendation by their paediatrician. 23% of the preterm infants even received solids before 12 weeks corrected age, putting them at risks for developing obesity, celiac disease and diabetes.

Conclusions: This study shows the necessity for clear guidelines regarding the introduction of complementary feeding in preterm infants as well as the importance of their implementation. Caregivers should receive information on this topic early enough and they should fully understand the difference between chronological and corrected age.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1186/s12887-021-02505-6DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7839190PMC
January 2021

Growth, Feeding Tolerance and Metabolism in Extreme Preterm Infants under an Exclusive Human Milk Diet.

Nutrients 2019 Jun 26;11(7). Epub 2019 Jun 26.

Department of Clinical Pharmacology, Medical University of Vienna, 1090 Vienna, Austria.

Background: For preterm infants, human milk (HM) has to be fortified to cover their enhanced nutritional requirements and establish adequate growth. Most HM fortifiers are based on bovine protein sources (BMF). An HM fortifier based on human protein sources (HMF) has become available in the last few years. The aim of this study is to investigate the impact of an HMF versus BMF on growth in extremely low birth weight (ELBW, <1000 g) infants.

Methods: This was a retrospective, controlled, multicenter cohort study in infants with a birthweight below 1000 g. The HMF group received an exclusive HM diet up to 32+0 weeks of gestation and was changed to BMF afterwards. The BMF group received HM+BMF from fortifier introduction up to 37+0 weeks.

Results: 192 extremely low birth weight (ELBW)-infants were included (HMF = 96, BMF = 96) in the study. After the introduction of fortification, growth velocity up to 32+0 weeks was significantly lower in the HMF group (16.5 g/kg/day) in comparison to the BMF group (18.9 g/kg/day, = 0.009) whereas all other growth parameters did not differ from birth up to 37+0 weeks. Necrotizing enterocolitis (NEC) incidence was 10% in the HMF and 8% in the BMF group.

Conclusion: Results from this study do not support the superiority of HFM over BMF in ELBW infants.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.3390/nu11071443DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6683272PMC
June 2019

Benchmarking of Four Near Infrared Spectroscopy Devices for Long Time Use in Neonates.

Klin Padiatr 2018 Sep 14;230(5):240-244. Epub 2018 Mar 14.

Division of Neonatology, Department of Pediatrics, Paracelsus Medical University, Salzburg, Austria.

Background: Using near-infrared spectroscopy (NIRS) mixed tissue saturation can be calculated by measuring the oxygen saturation of oxygenated and deoxygenated erythrocytes in the tissue. Quality of the calculated value is not only dependent on the exposure of the measured values in the calculation, but also on external factors such as artifacts. Main object of this study was to determine whether and how the measurement quality of different devices varies in their long-term use in premature infants.

Patients And Methods: In 54 measurements, each lasting 2 hours, 4 NIRS devices were attached in pairs on the forehead of 9 cardio-respiratory stable, spontaneous breathing premature infants. Pooled meta-analysis was used to compare the correlation between regional tissue saturation to the pulse oximetry saturation per device.

Results: The pooled random effect of all Pearson's correlation coefficients was 0.490 (CI95: 0.403-0.568) with the NIRO 200, 0.575 (CI95: 0.463-0.668) with the INVOS 5100c, 0.712 (CI95: 0.640-0.772) with the Fore-Sight and 0.638 (CI95: 0.554-0.709) with the SenSmart X- 100.

Conclusion: In this trial, a significant correlation between the tissue saturation and pulsoxymetry saturation was observed. The tremendous variation range among the measurements showed, however, that the measurement quality can be severely affected by unrecognized artifacts, after excluding other possible causes. None of the devices had reliable artifact detection for long-term measurements in very small premature infants. Key words: Near-Infrared-Spectroscopy, premature infants, Benchmark Test, Long-term measurements.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1055/s-0044-102256DOI Listing
September 2018

Left ventricular pumping during the transition-adaptation sequence in preterm infants: impact of the patent ductus arteriosus.

Pediatr Res 2018 05 11;83(5):1016-1023. Epub 2018 Apr 11.

Department of Pediatrics and Adolescent Medicine, Division of Pediatric Cardiology, Medical University of Vienna, Vienna, Austria.

BackgroundPostnatally, the immature left ventricle (LV) is subjected to high systemic afterload. Hypothesizing that LV pumping would change during transition-adaptation, we analyzed the LV in preterm infants (GA≤32+6), clinically stable or with a hemodynamically significant patent ductus arteriosus (hPDA) by applying a pump model.MethodsPumping was characterized by E (effective arterial elastance, reflecting afterload), E (end-systolic LV elastance, reflecting contractility), E/E coupling ratios, descriptive E:E relations, and E/E graphs. Data calculated from echocardiography and blood pressure were analyzed by diagnosis (S group: clinically stable, no hPDA, n=122; hPDA group, n=53) and by periods (early transition: days of life 1-3; late transition: 4-7; and adaptation: 8-30).ResultsS group: LV pumping was characterized by an increased E/E coupling ratio of 0.65 secondary to low E in early transition, a tandem rise of both E and E in late transition, and an E/E coupling ratio of 0.45 secondary to high E in adaptation; hPDA group: time-trend analyses showed significantly lower E (P<0.0001) and E (P=0.006). Therefore, LV pumping was characterized by a lower E/E coupling ratio (P=0.088) throughout transition-adaptation.ConclusionsIn stable infants, facing high afterload, the immature LV, enhanced by the physiological PDA, increases its contractility. In hPDA, facing low afterload, the overloaded immature LV exhibits a consistently lower contractility.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1038/pr.2018.22DOI Listing
May 2018

Heart rate variability can't be used to evaluate acute distress in preterm infants.

Acta Paediatr 2017 Aug 25;106(8):1359. Epub 2017 Apr 25.

Division for Neonatology, University Hospital for Pediatrics, Paracelsus Medical University, Salzburg, Austria.

View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1111/apa.13843DOI Listing
August 2017

Volume-Targeted Ventilation in the Neonate: Benchmarking Ventilators on an Active Lung Model.

Pediatr Crit Care Med 2017 Mar;18(3):241-248

All authors: Division of Neonatology, Department of Pediatrics and Adolescent Medicine, Paracelsus Medical University, Salzburg, Austria.

Objective: Mechanically ventilated neonates have been observed to receive substantially different ventilation after switching ventilator models, despite identical ventilator settings. This study aims at establishing the range of output variability among 10 neonatal ventilators under various breathing conditions.

Design: Relative benchmarking test of 10 neonatal ventilators on an active neonatal lung model.

Setting: Neonatal ICU.

Subjects: Ten current neonatal ventilators.

Interventions: Ventilators were set identically to flow-triggered, synchronized, volume-targeted, pressure-controlled, continuous mandatory ventilation and connected to a neonatal lung model. The latter was configured to simulate three patients (500, 1,500, and 3,500 g) in three breathing modes each (passive breathing, constant active breathing, and variable active breathing).

Measurements And Main Results: Averaged across all weight conditions, the included ventilators delivered between 86% and 110% of the target tidal volume in the passive mode, between 88% and 126% during constant active breathing, and between 86% and 120% under variable active breathing. The largest relative deviation occurred during the 500 g constant active condition, where the highest output machine produced 147% of the tidal volume of the lowest output machine.

Conclusions: All machines deviate significantly in volume output and ventilation regulation. These differences depend on ventilation type, respiratory force, and patient behavior, preventing the creation of a simple conversion table between ventilator models. Universal neonatal tidal volume targets for mechanical ventilation cannot be transferred from one ventilator to another without considering necessary adjustments.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1097/PCC.0000000000001088DOI Listing
March 2017

Comparison of four near-infrared spectroscopy devices shows that they are only suitable for monitoring cerebral oxygenation trends in preterm infants.

Acta Paediatr 2014 Sep 10;103(9):934-8. Epub 2014 Jun 10.

Division for Neonatology, University Hospital for Pediatrics, Paracelsus Medical University, Salzburg, Austria.

Aim: Measuring cerebral oxygenation using near-infrared spectroscopy (NIRS) has taken on an increasingly important role in the field of neonatology. Several companies have already developed commercial devices, and more publications are reporting absolute boundary values or percentiles for neonates. We compared four commercially used devices to discover whether they provided consistent results in the same patients.

Methods: We recruited nine preterm infants and tested them for 2 h, using sensors from two different devices. The measurements were carried out six times on each child, so that all four devices were compared with each other. A total of 54 measurements were conducted. The following devices were compared: the NIRO 200 (Hamamatsu Photonics K.K), the INVOS 5100c (Somanetics), the Fore-Sight (CAS Med.) and the SenSmart X-100 (NONIN).

Results: The cerebral tissue oxygenation data yielded by the individual devices differed significantly from each other, ranging from a minimum difference of 2.93% to a maximum difference of 12.66%.

Conclusion: The commercially available NIRS devices showed highly significant differences in local cerebral tissue oxygenation levels, to the extent that the industry cannot agree on uniform and reproducible standards. Therefore, NIRS should only be used for trend measurements in preterm infants.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1111/apa.12698DOI Listing
September 2014

Importance of transcript levels of caspase-2 isoforms S and L for breast carcinoma progression.

Future Oncol 2013 Mar;9(3):427-38

Toxicogenomics Unit, Department of Toxicology & Safety, National Institute of Public Health, Srobarova 48, 100 42, Prague 10, Czech Republic.

Aim: A role of caspase-2 in chemotherapy-induced apoptosis has been suggested. Our study aimed to evaluate the prognostic and predictive importance of caspase-2 isoforms in breast cancer patients.

Materials & Methods: Caspase-2L and -2S transcript levels were determined in paired tumor and non-malignant control tissues from 64 patients after neoadjuvant chemotherapy and 100 pretreatment patients (general set) by real-time PCR with absolute quantification.

Results: Low but statistically significant upregulation of caspase-2L in tumor versus control tissues was observed in both sets. Significant associations of the levels of caspase-2L, -2S or S/L ratio with clinical prognostic factors were observed. However, none of these associations were confirmed in both sets. Levels of caspase-2 isoforms or the S/L ratio did not significantly associate with progression-free survival in the general set or with chemotherapy response in the neoadjuvant set.

Conclusion: Our results suggest that the role of caspase-2 isoforms in the progression of breast cancer may considerably differ between pre- and post-chemotherapy patients.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.2217/fon.12.200DOI Listing
March 2013

Less invasive surfactant administration in extremely preterm infants: impact on mortality and morbidity.

Neonatology 2013 22;103(4):252-8. Epub 2013 Feb 22.

Division of Neonatology, Pediatric Intensive Care and Neuropediatrics, Department of Pediatrics and Adolescent Medicine, Medical University of Vienna, Vienna, Austria.

Background: A new mode of surfactant administration without intubation - less invasive surfactant administration (LISA) - has recently been described for premature infants.

Objective: We report single-center outcome data of extremely premature infants who have been managed by LISA in our department. Mortality and morbidity rates of the cohort were compared to historical controls from our own center and to data of the Vermont-Oxford Neonatal Network (VONN).

Patients And Methods: All infants born at 23-27 weeks' gestational age during 01/2009 and 06/2011 (n = 224) were managed by LISA and included in the study group.

Results: LISA was tolerated by 94% of all infants. 68% of infants stayed on continuous positive airway pressure on day 3. The rate of mechanical ventilation was 35% within the first week and 59% during the entire hospital stay. Compared to historical controls, we found significantly higher survival rates (75.8 vs. 64.1%) and significantly less intraventricular hemorrhage (IVH) (28.1 vs. 45.9%), severe IVH (13.1 vs. 23.9%) and cystic periventricular leukomalacia (1.2 vs. 5.6%); only persistent ductus arteriousus (PDA) (74.7 vs. 52.6%) and retinopathy of prematurity (ROP) (40.5 vs. 21.1%) occurred significantly more often. Compared to VONN data, we found significantly less chronic lung disease (20.6 vs. 46.4%), severe cerebral lesions (IVH 3/4 + cystic PVL; 9.4 vs. 16.1%) and ROP (all grades) (40.5 vs. 56.5%); only PDA (74.7 vs. 63.1%) and severe ROP (> grade 2) (24.1 vs. 14.1%) occurred significantly more often in our cohort.

Conclusion: Surfactant can be effectively and safely delivered via LISA and this is associated with low rates of mechanical ventilation and various adverse outcomes in extremely premature infants.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1159/000346521DOI Listing
January 2014

Recombinant allergens for SIT of mite allergy.

Arb Paul Ehrlich Inst Bundesinstitut Impfstoffe Biomed Arzneim Langen Hess 2013 ;97:140-7

View Article and Find Full Text PDF

Download full-text PDF

Source
September 2014

Hypoallergenic mutants of the Timothy grass pollen allergen Phl p 5 generated by proline mutations.

Int Arch Allergy Immunol 2012 30;159(2):130-42. Epub 2012 May 30.

Research and Development Division, Allergopharma Joachim Ganzer KG, Reinbek, Germany.

Background: Phl p 5 is a major allergen of Timothy grass (Phleum pratense). A recombinant native Phl p 5 has already been used in clinical trials of allergen-specific immunotherapy as a component of a cocktail of allergens. Recombinant hypoallergenic allergens should further improve the treatment by reducing the risk of anaphylactic reactions at an increased therapeutic dosage. Native Phl p 5 is formed by α-helical regions separated by regions containing prolines. In order to generate hypoallergenic mutants, we studied the effect of proline mutations in single and multiple regions.

Methods: All mutants were analyzed by IgE inhibition assays and size exclusion chromatography with on-line mass determination. Selected mutants were additionally analyzed by field-flow fractionation, dynamic light scattering, circular dichroism spectroscopy, basophil activation and T-cell proliferation assays.

Results: Variants lacking prolines in a single region were obtained as soluble monomers. Six of eight molecules showed a slightly reduced IgE-binding capacity. Mutants carrying proline deletions in multiple regions formed monomers, dimers or insoluble aggregates. The mutant MPV.7 with five proline deletions and a substitution of proline 211 to leucine is monomeric, shows a strongly diminished IgE binding and maintains T-cell reactivity. The hydrodynamic radius and the content of the α-helical structure of MPV.7 are well comparable with the wild-type allergen.

Conclusions: The hypoallergenic Phl p 5 variant MPV.7 combines multiple proline deletions with a substitution of proline 211 to leucine and meets basic demands for a pharmaceutical application. MPV.7 is a promising candidate for grass pollen immunotherapy with a cocktail of recombinant hypoallergens.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1159/000336651DOI Listing
December 2012

In vitro comparison of noise levels produced by different CPAP generators.

Neonatology 2012 17;101(2):95-100. Epub 2011 Sep 17.

Division of Neonatology, Pediatric Intensive Care and Neuropediatrics, Department of General Pediatrics and Adolescent Medicine, Medical University of Vienna, Vienna, Austria.

Introduction: Minimization of noise exposure is an important aim of modern neonatal intensive care medicine. Binasal continuous positive airway pressure (CPAP) generators are among the most important sources of continuous noise in neonatal wards. The aim of this study was to find out which CPAP generator creates the least noise.

Method: In an experimental setup, two jet CPAP generators (Infant Flow® generator and MediJet®) and two conventional CPAP generators (Bubble CPAP® and Baby Flow®) were compared. Noise production was measured in decibels in an A-weighted scale [dB(A)] in a closed incubator at 2 mm lateral distance from the end of the nasal prongs. Reproduction of constant airway pressure and air leak was achieved by closure of the nasal prongs with a type of adhesive tape that is semipermeable to air.

Results: The noise levels produced by the four generators were significantly different (p < 0.001). Values measured at a continuous constant flow rate of 8 l/min averaged 83 dB(A) for the Infant Flow® generator with or without sound absorber, 72 dB(A) for the MediJet®, 62 dB(A) for the Bubble CPAP® and 55 dB(A) for the Baby Flow®.

Conclusion: Conventional CPAP generators work more quietly than the currently available jet CPAP generators.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1159/000329558DOI Listing
June 2012

Variety of expiratory resistance between different continuous positive airway pressure devices for preterm infants.

Artif Organs 2011 Jan;35(1):22-8

Department of Pediatrics and Adolescent Medicine, Division of General Pediatrics and Neonatology, Medical University of Vienna, Vienna, Austria.

Continuous positive airway pressure (CPAP) systems for preterm infants work with conventional ventilators or use a jet ventilation system. It is assumed that the most important advantage of jet-CPAP systems is a lower expiratory resistance (R(E) ). We investigated the R(E) of seven different CPAP systems. We studied two primary-care CPAP systems, three jet-CPAP generators, and two conventional CPAP devices. All devices were adjusted at 6 mbar and connected with a test lung simulating a standardized expiration volume. Maximum pressure increase during expiration was measured and maximum R(E) was calculated. In primary-care CPAP devices, the maximum R(E) of the Benveniste valve was 9.7 mbar/L/s (SD 1.2) while that of the Neopuff was 102.8 mbar/L/s (SD 7.9) (P < 0.01). In jet-CPAP devices, the R(E) of the Infant Flow was 6.8 mbar/L/s (SD 1.7), the one of the Medijet REF 1000 was 43.5 mbar/L/s (SD 1.5), and that of the Medijet REF 1010 was 36.7 mbar/L/s (SD 0.3) (P < 0.01). In conventional CPAP systems, the R(E) of the Baby Flow was 29.7 mbar/L/s (SD 1.1) and that of the Bubble CPAP was 37.1 mbar/L/s (SD 4.3) (P < 0.01). All CPAP devices created an R(E). Jet-CPAP devices did not produce lower R(E) than conventional CPAP devices.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1111/j.1525-1594.2010.01020.xDOI Listing
January 2011

Danger of low pressure alarm failure in preterm infants on continuous positive airway pressure.

Eur J Pediatr 2010 May 17;169(5):585-9. Epub 2009 Oct 17.

Division of General Pediatrics and Neonatology, Department of Pediatrics and Adolescent Medicine, Medical University of Vienna, Waehringer Guertel 18-20, Vienna, Austria.

In certain settings of conventional continuous positive airway pressure (CPAP) application, the ventilator may not be able to detect dislodgement of the prongs. This occurs especially in settings with high flow and small prongs. We investigated the relation between ventilator flows, size of the nasal prongs, and pressure generated within the ventilator circuit due to the flow resistance of the prongs. We studied a Baby-flow CPAP connected to a Babylog 8000plus ventilator. Five prongs of increasing size (x-small, small, medium, large, x-large) and one nose mask were connected to the CPAP in turn. Starting at 30 lpm, the flow was reduced in 2 lpm steps. The dynamic pressure caused by the flow resistance of the prongs within the ventilator circuit was recorded. For all devices, we observed a correlation between the reduction of the flow and the reduction in pressure within the ventilator circuit. However, the flow resistance of the x-small prongs generated the highest dynamic pressure (30 mbar at 22 lpm) within the ventilator circuit while the mask gave rise to the lowest pressure (9 mbar at 30 lpm). The pressure value generated with x-small prongs at low flow rate was observed at high flow rate with x-large prongs or with a mask. We conclude that in settings with high flow rates, low CPAP levels, and small prongs, the resistance of the prongs will create enough dynamic pressure within the ventilator circuit to permit the ventilator to compensate a large leakage flow by closing the expiratory valve. Thus, in case of dislodgement of the prongs, the pressure within the ventilator circuit will not decrease below the alarm level, and the machine will not be able to generate an alarm.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1007/s00431-009-1078-xDOI Listing
May 2010

Long hospitalization is the most important risk factor for early weaning from breast milk in premature babies.

Acta Paediatr 2009 Jun 6;98(6):981-4. Epub 2009 Mar 6.

Division of General Pediatrics and Neonatology, Department of Pediatrics, Medical University of Vienna, Währinger Gürtel 18-20, Vienna, Austria.

Aim: To identify certain variables related to the infants' course that might have an impact on the mothers' decision to breastfeed.

Patients And Method: Retrospective survey including all patients <1500 g birth weight (BW) treated between January 1, 2000 and December 31, 2005 at the Neonatal Intensive Care Unit of the Medical University of Vienna who were not transferred to another hospital. Multiple regression analysis of the following variables was carried out: gestational age (GA), BW, length of stay (LOS), parity, singleton or multiple gestation, sex and severe morbidity.

Results: Of the 239 patients included, 142 (60%) were fed breast milk at the time of final discharge, 97 (40%) were fed formula. LOS was significantly correlated with the probability of being breastfed: the shorter it was, the higher was the probability of being breastfed at the time of final discharge (p = 0.0064 for singletons, p = 0.001 for multiples). Lower GA also increased the probability of being breastfed, but this was only statistically significant for multiples (p = 0.001).

Conclusion: This study shows clearly that the most important influencing factor on the mothers' decision to continue breastfeeding is the LOS. Thus more emphasis should be put on encouraging mothers to continue lactation throughout their babies' hospital stay.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1111/j.1651-2227.2009.01248.xDOI Listing
June 2009

Must screening examinations for retinopathy of prematurity necessarily be painful?

Retina 2009 May;29(5):586-91

Division of General Pediatrics and Neonatology, Medical University of Vienna, Vienna, Austria.

Purpose: This study investigates the impact of the length of the examination, the insertion of eyelid specula, and the indentation of the globe on the pain and stress sensation of premature infants.

Methods: Ninety-two premature infants in three neonatal wards were included. In two wards, the patients were examined using eyelid specula and scleral indentation as recommended in the official guidelines. In the third ward, the investigation time was minimized and ophthalmoscopy was performed without eyelid specula and scleral indentation. Physical and mental disturbance of the patients was assessed by the Neonatal Infant Pain Score and by monitoring the heart rate. The results were divided into two groups: in the one, eyelid specula and scleral indentation were used, whereas in the other one, they were not used. An independent-samples t-test was performed, which allowed us to calculate the correlation between the way the examination was executed and the condition of the patients.

Results: Demographic data and baseline values of heart rate and pain score did not differ between the two groups. Heart rate and pain score during and after the investigation were significantly higher and increased significantly with the duration of the examination for the patients who were investigated using lid specula and scleral indentation.

Conclusion: Our study shows that indirect ophthalmoscopy without specula causes significantly less stress to infants than screening with lid specula and scleral indentation.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1097/IAE.0b013e31819a5fb1DOI Listing
May 2009

Exogenous proteases confer a significant chemopreventive effect in experimental tumor models.

Authors:
Martin Wald

Integr Cancer Ther 2008 Dec;7(4):295-310

Department of Surgery, 2nd Faculty of Medicine, Charles University, Prague, Czech Republic.

In this monograph, the chemopreventive effects of enterally administered proteases (trypsin, chymotrypsin, and papain) have been documented in a series of animal experimental tumor models. The experimental evidence demonstrates a significant inhibition of growth of both the primary tumor and the metastatic disseminations. Survival in animals treated with proteases is significantly longer than in untreated animals. The results confirm the fundamental correlation between early initiation of therapy and consequent growth of the tumorous disease. Comparable results have been shown in solid tumors in animal models (melanoma and Lewis lung carcinoma) and in human tumors (pancreatic and breast cancers). In this article, details of the known mechanisms of systemic actions of enterally administered proteases are documented and their relationship with cancerogenesis is discussed.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1177/1534735408327036DOI Listing
December 2008

Staging of upper limb lymphedema from routine lymphoscintigraphic examinations.

Comput Biol Med 2009 Jan 29;39(1):1-7. Epub 2008 Nov 29.

Department of Adaptive Systems, Institute of Information Theory and Automation, Academy of Sciences of the Czech Republic, P.O. Box 18, 182 08 Prague 8, Czech Republic.

Secondary lymphedema of upper limbs, a frequent complication after a breast cancer therapy, can be successfully treated only when diagnosed at an early, ideally latent, stage. Lymphoscintigraphy is a promising candidate to this purpose. A slow lymphatic dynamics of upper limbs allows, however, a routine collection at most three images reflecting it. This makes an exploitation of lymphoscintigraphy to early-stage diagnosis a complex task. Recently, a Bayesian methodology extracting diagnostic information from the available sparse data has been developed. It properly detects lymphedema occurrence but not a desirable disease staging. The present paper proposes Bayesian diagnostic processing of lymphoscintigraphic and routine clinical data. Its staging ability was tested on diagnostic data of 88 women at the age of 39-84 years (60.2+/-10.4) with a suspicion of unilateral secondary lymphedema of upper limbs caused by a breast cancer treatment. Less than 20 of them had simply detectable disease stages. Information about accumulation dynamics of the lymphatic system contained in lymphoscintigraphic images was quantified via estimation of a simplified accumulation model [P. Gebouský, M. Kárný, A. Quinn, Lymphoscintigraphy of upper limbs: a Bayesian framework, in: J.M. Bernardo, M.J. Bayarri, J.O. Berger (Eds.), Bayesian Statistics, vol. 7, University Press, Oxford, 2003, pp. 543-552]. The sole use of this approach, referred as "Bayesian quantitative lymphoscintigraphy", was found insufficient for a finer staging of the disease to typical categories (healthy, latent, reversible, spontaneously irreversible, elephantiasis). For this reason, the results of Bayesian quantitative lymphoscintigraphy were attached to routinely available qualitative lymphoscintigraphic inspection and clinical data. These combined data were modelled by normal probabilistic mixtures. Their Bayesian estimates were used for a computerized disease staging. The resulting model predicts expert's conclusions on the presence of a lymphedema in 95% cases. A finer staging is successful in 85% cases of suspicious limbs. Model cross-validation and a closer look on patients' data indicate that the combined data are still insufficiently informative. It calls for the further improvements of the inspection methods. Even under the current inspection conditions, the proposed processing provides clinicians a reliable quantitative "second" opinion on the disease staging.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.compbiomed.2008.10.003DOI Listing
January 2009

Caffeine monitoring in infants: comparison of automated (VITROS 5, 1 FS) chemistry system versus HPLC analysis.

Clin Lab 2008 ;54(3-4):89-94

Medical University Vienna, Department of Pediatrics, Division of Neonatology and Intensive Care Medicine, Vienna, Austria.

This is the first study comparing the caffeine testing by HPLC to the MicroTip Technology patented by Ortho-Clinical Diagnostics. For the determination of the precision for intra-run and day to day variances, control materials with concentration ranges between 2.3 microg/mL and 23.3 microg/mL were used. Test evaluation was done using plasma samples. The coefficient of variation for intra-run precision was calculated to range from 4.3% to 2.1%. The coefficients of variation for the day-to-day precision were between 4.9% and 2.3%. A coefficient of correlation of 0.99% was calculated for the comparison of the two methods. In the statistical analysis of the comparison of the methods. Differences between + 4.5% and - 0.92% could be found. The HPLC system must be ready for use at any time necessitating maintenance and increased costs. This, in addition to the low sample throughput for caffeine analysis and the findings of this study favour the use of an automated clinical chemistry system.
View Article and Find Full Text PDF

Download full-text PDF

Source
August 2008

Analysis of the spatial distribution of infant mortality by cause of death in Austria in 1984 to 2006.

Int J Health Geogr 2008 May 21;7:21. Epub 2008 May 21.

Center of Public Health, Department of Epidemiology, Medical University of Vienna, Borschkegasse 8a, 1090 Vienna, Austria.

Background: In Austria, over the last 20 years infant mortality declined from 11.2 per 1,000 life births (1985) to 4.7 per 1,000 in1997 but remained rather constant since then. In addition to this time trend we already reported a non-random spatial distribution of infant mortality rates in a recent study covering the time period 1984 to 2002. This present study includes four additional years and now covers about 1.9 million individual birth certificates. It aimes to elucidate the observed non-random spatial distribution in more detail. We split up infant mortality into six groups according to the underlying cause of death. The underlying spatial distribution of standardized mortality ratios (SMR) is estimated by univariate models as well as by two models incorporating all six groups simultaneously.

Results: We observe strong correlations between the individual spatial patterns of SMR's except for "Sudden Infant Death Syndrome" and to some extent for "Peripartal Problems". The spatial distribution of SMR's is non-random with an area of decreased risk in the South-East of Austria. The group "Sudden Infant Death Syndrome" clearly and the group "Peripartal Problems" slightly show deviations from the common pattern. When comparing univariate and multivariate SMR estimates we observe that the resulting spatial distributions are very similar.

Conclusion: We observe different non-random spatial distributions of infant mortality rates when grouped by cause of death. The models applied were based on individual data thereby avoiding ecological regression bias. The estimated spatial distributions do not substantially depend on the employed estimation method. The observed non-random spatial patterns of Austrian infant mortality remain to appear ambiguous.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1186/1476-072X-7-21DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2432051PMC
May 2008

A new modified Seldinger technique for 2- and 3-French peripherally inserted central venous catheters.

Eur J Pediatr 2008 Nov 4;167(11):1327-9. Epub 2008 Jan 4.

Paediatric Cardiology and Internal Medicine, Centre of Paediatrics and Adolescent Medicine, Medical University Hannover, Hannover, Germany.

This study describes a modified Seldinger technique for 2- and 3-French peripherally inserted central venous catheters: A device similar to that used in heart catherisation with a standard micro-introducer serving as sheath and an arterial catheter serving as inner dilator was pushed forward over a wire guide that had before been inserted via a peripheral venous catheter. With this method 2-and 3-French catheters could be safely inserted into peripheral veins of 14 paediatric patients. In conclusion successful insertion of a small peripheral venous catheter offers in most cases a possibility for the placement of a central venous line.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1007/s00431-007-0656-zDOI Listing
November 2008

Test procedures for allergoids and hypoallergenic recombinant allergens: immunological characterization.

Arb Paul Ehrlich Inst Bundesamt Sera Impfstoffe Frankf A M 2006 (95):135-46; discussion147-8, 155

Allergopharma Joachim Ganzer KG, Reinbek.

View Article and Find Full Text PDF

Download full-text PDF

Source
April 2007

Amnionitis with Ureaplasma urealyticum or other microbes leads to increased morbidity and prolonged hospitalization in very low birth weight infants.

Eur J Obstet Gynecol Reprod Biol 2007 Sep 13;134(1):44-50. Epub 2006 Nov 13.

Department of Neonatology and Intensive Care, University Hospital of Pediatrics, Waehringer Guertel 18-20, 1090 Vienna, Austria.

Objective: To investigate the influence of culture proven intrauterine infection on preterm morbidity and to test the effect of antimicrobial treatment.

Methods: Retrospective cohort study conducted between October 1997 and February 2001 in patients with preterm premature rupture of membranes or preterm labor. Vaginal swabs were sampled and amniocentesis for microbiologic culture of the amniotic fluid was performed. Patients with Ureaplasma urealyticum in the amniotic fluid were treated with josamycin. Infants were followed post partum according to birth weight, gestational age, APGAR score and infant morbidity.

Results: In 49 eligible patients, 40% of cultures were positive, 22% for Ureaplasma urealyticum, 12% for other bacteria and 6% for candida. Children of mothers with positive amniotic fluid cultures had significantly lower gestational ages (26+4 weeks for Ureaplasma urealyticum [p=0.04] and 25+5 weeks for other microorganisms [p=0.0017] versus 28+6 weeks for mothers with negative amniotic fluid cultures) and lower birth weights (975 g [n.s.] and 828 g [p=0.0072] versus 1,041 g) but were appropriate for their gestational ages. 33.3% and 66.7% versus 24% of the children were mechanically ventilated [n.s.], duration of mechanical ventilation was 5.3 [p=0.02] and 10.1 days [p=0.04] versus 1.4 days, and prevalence of chronic lung disease was 38% and 33% versus 11% [n.s.]. Prevalence of severe intraventricular hemorrhage (12.5% [n.s.] and 33% [p=0.04] versus 3.4%) and nosocomial infections (50% for both groups of positive cultures versus 10.3% for negative cultures, p=0.02 and 0.03, respectively) was higher and median length of stay was significantly longer (121 [p=0.02] and 107 days [p=0.03] versus 60 days) in these patients. Maternal positive vaginal swab cultures were not associated with any of the above-mentioned factors. In none of the patients treated with macrolids for proven Ureaplasma urealyticum amnionitis could the microbes be eradicated.

Conclusion: Maternal positive amniotic fluid cultures have been associated with lower gestational age and lower birth weight. Rate of infant morbidity was higher and length of stay was significantly longer in this group. Positive vaginal swabs were not predictive for infant morbidity. Treatment of mothers showing positive amniotic fluid cultures with macrolids was not effective.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.ejogrb.2006.09.013DOI Listing
September 2007

Effects of a combined therapy of erythropoietin, iron, folate, and vitamin B12 on the transfusion requirements of extremely low birth weight infants.

Pediatrics 2006 Nov;118(5):2004-13

Department of Pediatrics, Division of Neonatology and Intensive Care, Medical University of Vienna, Währinger Gürtel 18-20, 1090 Vienna, Austria.

Objectives: Erythropoietin is frequently administered to premature infants to stimulate erythropoiesis. The primary goal of erythropoietin therapy is to reduce transfusions, but the efficacy of erythropoietin has not been convincingly demonstrated in this regard. The aim of this trial was to investigate whether combined administration of vitamin B12, folic acid, iron, and erythropoietin could decrease transfusion requirements in extremely low birth weight infants.

Patients And Methods: In a randomized, controlled trial, extremely low birth weight infants with a birth weight < or = 800 g and a gestational age < or = 32 weeks were randomly assigned to a group receiving combination treatment or a control arm.

Results: The treatment increased levels of folate in red blood cells, vitamin B12, ferritin, transferrin receptor levels in plasma, and reticulocyte counts. The proportion of infants requiring no transfusions was lower in the treatment group (38%) as compared with controls (5%). The treatment group and the need for mechanical ventilation were independent predictors of the number of transfusions in multiple regression analysis. Cox regression analysis indicated that combined therapy resulted in a 79% risk reduction for any transfusion.

Conclusion: Combined treatment with erythropoietin, intravenous iron, folate, and vitamin B12 during the first weeks reduces the need for transfusion in extremely low birth weight infants.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1542/peds.2006-1113DOI Listing
November 2006

A flow sensor suitable for use with split-flow ventilation--first preclinical data.

Artif Organs 2006 Nov;30(11):888-91

Division of Neonatology and Intensive Care, Department of Pediatrics, Medical University of Vienna, Austria.

Volutrauma caused by artificial ventilation represents a major morbidity risk for premature infants. Our working group has recently developed an innovative "split-flow ventilation" system aiming at the reduction of tidal volumes (TVs). The main problem for the practical use of this system is the fact that conventional measurements of commercially available flow sensors are distorted by the split flow. In this study, we present the first preclinical data from testing an adapted flow sensor combination recognizing the split flow. A preterm infant test lung was conventionally ventilated, modified by insertion of a split-flow line. In addition to the customary flow sensor (FS-1), a second flow sensor (FS-2) was integrated into the split-flow line, and a third (FS-3) was placed at the exit of the test lung for reference measurements. The signals of all three flow sensors were read and processed by a computer. The program was set to graphically add up flow curves 1, 2, and 3 during one ventilation loop. After 10 runs, a mean curve of FS-1+2 was calculated and compared to the mean curve of FS-3. Furthermore, the mean TV of 10 runs measured by FS-1+2 was calculated and compared with the mean TV calculated by FS-3. The summation curve FS-1+2 proved identical to the reference curve FS-3. FS-1+2 yielded a TV of 6.6 +/- 0.01 mL (inspiratory) and 6.7 +/- 0.02 mL (expiratory). The corresponding values of FS-3 were 6.5 +/- 0.20 mL and 6.6 +/- 0.09 mL, respectively. According to our results, the presented flow sensor constellation allows exact flow measurements in the experimental setting and appears suitable for usage in a split-flow ventilation circuit under clinical conditions.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1111/j.1525-1594.2006.00317.xDOI Listing
November 2006

Non-random geographical distribution of infant mortality in Austria 1984-2002.

Wien Klin Wochenschr 2006 Jun;118(11-12):341-7

Department of Epidemiology, Center of Public Health, Medical University of Vienna, Vienna, Austria.

Over the last 20 years in Austria infant mortality has declined from 11.2/1,000 life births (1985) to 4.7/100,000 (1997) but has remained constant since then. This stagnation is in contrast to the trend in Finland, where the infant mortality rate is both lower than in Austria and continues to decline. In attempting to understand this difference we concentrated on the spatial distribution of infant mortality in Austria in addition to the trend over time. We describe the regional distribution of infant mortality adjusted by risk factors over the period from 1984 to 2002 based on data from 1.6 million birth certificates. All variables we examined were significant due to the large number of observations. We calculated an R-squared measure to assess the ability of our regression model to predict the survival status of newborns. Only the variables birth weight, gestational age, infant's length at birth and to a lesser extent year of birth had relevant impacts in terms of predictive ability. All remaining variables did not notably contribute to the prediction of survival status of the newborn despite their significance. In the greater area of Styria, infant mortality is significantly lower than in the rest of Austria even when the mortality rates are adjusted for variables such as birth weight, gestational age, sex of the newborn and sociodemographic status of the mother. In the period from 1984 to 2002 about 1500 more infants would have survived the first year of life if the mortality rate in the rest of Austria had been the same as in this area. In our regression model many important risk factors were included. Nevertheless, we can not explain the observed spatial pattern in infant morality. Further analytic studies are needed to explore the impact of variables other than those contained in the birth certificates.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1007/s00508-006-0610-5DOI Listing
June 2006
-->