Publications by authors named "Roland R Wauer"

39 Publications

Ingeborg Syllm-Rapoport (1912-2017): An Exemplary Life for Children and Paediatrics.

Neonatology 2017 15;112(4):384-386. Epub 2017 Sep 15.

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

Ingeborg Syllm-Rapoport, the first Chair in neonatology in Europe, passed away on March 23. Her biography illustrates how medical and scientific work has been influenced by social, ideological, and economic frames and boundaries in the 20th century. Regarded as a "Half-Jew" by the Nazi racist laws, she was denied her medical doctorate. She went to the USA, where she trained in paediatrics and met her husband, the biochemist Samuel Mitja Rapoport. During the "McCarthy Era" both were persecuted as communists. They returned to Europe and became two of the most influential figures at the Charité Hospital in East Berlin. She had to wait until 2015 to finally undergo the doctoral examination at the age of 102 years, making her the oldest person in history to receive a doctorate. We describe Syllm-Rapoport's life and the challenges she had to face living in several countries under different political systems in the 20th century.
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http://dx.doi.org/10.1159/000479860DOI Listing
July 2018

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

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

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

Radiation exposure in 212 very low and extremely low birth weight infants.

Pediatrics 2009 Dec;124(6):1556-64

Clinic of Neonatology Charité Campus Mitte, Charité-Universitätsmedizin Berlin, Berlin, Germany .

Objective: We determined the frequency and estimated effective radiation dose (E) from conventional diagnostic radiographs for infants who had birth weight of
Methods: Entrance skin doses were experimentally measured for all standard weight-dependent exposure settings. For each radiograph in the radiologic file, the exposed area on the film was measured manually. Together with clinical data obtained from the Vermont Oxford Network, medical charts, and radiologic files, we estimated E. E values per radiograph and per child were compared with recommended reference values and annual natural background radiation (NBR). We used reference data to estimate the risk for radiation-induced cancers.

Results: Of 212 VLBW infants, 194 required at least 1 conventional radiograph. Measured entrance skin dose varied between 11.8 and 15.0 microGy. Calculated E received was 16 microsievert (microSv; median) per radiograph and 71.5 microSv (median) per infant for the whole stay. Infants with birth weight or=16 weeks, congenital malformations, or oxygen dependence for >or=36 weeks were at risk for high numbers of radiographs and high radiation dose. Compared with the annual NBR, the median of 4 radiographs per infant contributes 12 days of NBR. We estimated that only 1 of 60000 NICU-treated VLBW infants will develop a fatal malignancy up to 15 years of age.

Conclusions: We found that NICU-treated VLBW infants had low radiation exposure compared with the annual NBR.
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http://dx.doi.org/10.1542/peds.2008-1028DOI Listing
December 2009

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

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

Impaired somatic growth and delayed lung development in infants with congenital diaphragmatic hernia--evidence from a 10-year, single center prospective follow-up study.

J Pediatr Surg 2009 Jul;44(7):1309-14

Department of Neonatology, Charité Campus Mitte, Charité Universitätsmedizin Berlin, 10117 Berlin, Germany.

Purpose: In infants with congenital diaphragmatic hernia (CDH), somatic growth and pulmonary development are key issues beyond the time of intensive care treatment. The aim of the study was to investigate the somatic growth and pulmonary function after discharge and to compare CDH patients with a group of matched controls.

Methods: Anthropometric measurements and lung function tests were performed in 26 infants after surgical repair of CDH and 26 non-CDH intensive care patients, matched for gestational age and birth weight. Spontaneously breathing infants were tested at a mean of 44 weeks postconceptional age (range, 36-58 weeks). Body weight, body length, respiratory rate (RR), tidal volume (V(T)), functional residual capacity by body plethysmography (FRC(pleth)), respiratory compliance (C(rs)), and respiratory resistance (R(rs)) were measured.

Results: The mean (SD) weight gain per week in the CDH infants was significantly lower compared to non-CDH infants (89 [39] g vs 141 [49] g; P = .002). The breathing pattern between both groups differed considerably. In CDH infants, V(T) was significantly lower (P < .001) and RR significantly higher (P = .005). The respiratory compliance was also significantly (P < .001) reduced, whereas R(rs) did not differ significantly. No statistically significant differences were seen in FRC(pleth) related to the body weight between CDH and non-CDH infants (20.3 [4.4] mL/kg vs 21.5 [4.9] mL/kg).

Conclusion: Despite apparently well-inflated lungs after surgery, evidence of early and significantly reduced weight gain and impaired lung function in CHD patients should prompt careful dietary monitoring and regular lung function testing.
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http://dx.doi.org/10.1016/j.jpedsurg.2008.10.047DOI Listing
July 2009

Variations of Apgar score of very low birth weight infants in different neonatal intensive care units.

Acta Paediatr 2009 Sep 25;98(9):1433-6. Epub 2009 Jun 25.

Department of Neonatology and Pediatric Intensive Care, University Hospital Carl Gustav Carus Dresden, Dresden, Germany.

Objective: The Apgar score should be an objective method to assess the state of newborns; however, its applicability in preterm infants is hampered by large variations among different observers. The study tested whether physicians that give low scores to written case descriptions also apply lower scores to preterm infants.

Patients And Methods: Descriptions (BMJ 2004; 329: 143-4) were sent to 14 neonatal units. Physicians were asked to evaluate the Apgar (case score). From seven units Apgar scores of all very low birth weight infants (VLBW) born between January 2004 and December 2006 were obtained from charts (clinical score).

Results: In total, 121 physicians from 14 institutions (median 9, range 3-15) replied: 24 residents with <6-month and 28 with >6-month neonatal experience, and 69 consultants. The assessment of the case scores was very heterogeneous with large variations in respiration, muscle tone and reflexes. Clinical scores were obtained from 1000 VLBW infants. The score depended on the gestational age, with a median of 4 at 24 and 7 at 27 weeks. With one exception, centres that assigned low case scores had also low clinical scores.

Conclusion: There is considerable variation in assigning Apgar scores. Definitions are required to apply the Apgar score to infants under clinical conditions such as preterm delivery, resuscitation or artificial ventilation.
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http://dx.doi.org/10.1111/j.1651-2227.2009.01347.xDOI Listing
September 2009

Vascular endothelial growth factor as marker for tissue hypoxia and transfusion need in anemic infants: a prospective clinical study.

Pediatrics 2009 Mar;123(3):784-90

University Hospital Carl Gustav Carus Dresden, Department of Neonatology and Pediatric Intensive Care, Pediatrics, Fetscherstrasse 74, 01307 Dresden, Germany.

Objective: Oxygen-carrying capacity of blood is reduced in anemic infants because of low hemoglobin levels. Red blood cell transfusions become necessary if low hematocrit causes tissue hypoxia. No reliable parameters exist for detecting chronic tissue hypoxia. Vascular endothelial growth factor is upregulated by hypoxia; hence, elevated vascular endothelial growth factor levels may be a marker for tissue hypoxia and may indicate the need for red blood cell transfusions.

Methods: In a prospective study, plasma vascular endothelial growth factor levels were measured in 3 groups of infants suspected of requiring red blood cell transfusions to find a vascular endothelial growth factor cutoff value indicative of tissue hypoxia. The 3 groups were acute anemic (an episode of acute bleeding [hematocrit drop > 5%] per day); chronic anemic (hematocrit drop < 5% per day); and nontransfused (hematocrit drop < 5% per day) but not meeting clinical criteria for a transfusion. Blood was sampled before transfusion and again 48 hours after transfusion if required. Plasma vascular endothelial growth factor and erythropoietin concentrations were measured.

Results: Vascular endothelial growth factor concentrations were lower in acutely anemic compared with chronically anemic infants, whereas erythropoietin levels did not differ between these groups. The vascular endothelial growth factor concentration was <140 pg/mL in all acutely anemic infants, and this was deemed the threshold level indicating sufficient tissue oxygenation in subsequent analysis. We found that 30% of chronically anemic and 43% of nontransfused infants had vascular endothelial growth factor levels of >140 pg/mL. In transfused infants, with elevated vascular endothelial growth factor levels, red blood cell transfusion resulted in lowering of vascular endothelial growth factor concentrations.

Conclusions: Vascular endothelial growth factor concentrations of >140 pg/mL may indicate insufficient oxygen delivery to tissues and may serve as a marker of the need for transfusion or of tissue hypoxia in other diseases.
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http://dx.doi.org/10.1542/peds.2007-2304DOI Listing
March 2009

Comparison of 2-h versus 3-h enteral feeding in extremely low birth weight infants, commencing after birth.

Acta Paediatr 2008 Jun 16;97(6):764-9. Epub 2008 Apr 16.

Medical University Innsbruck, Department for Pediatrics, Pädiatrie IV-Neonatologie, Austria.

Aim: Immaturity is associated with problems in enteral nutrition of extremely low birth weight (ELBW) infants. Different time intervals between single feedings are used; however, no data are available to show a benefit of either regime.

Methods: In January 2001 enteral feeding regime was changed from 2-h to 3-h intervals. In a retrospective study charts were analysed for all ELBW infants during a period of 2 years prior (01/99-12/00) and after (08/01-07/03) changing the feeding regime.

Results: Forty-two in the 2-h group (gestational age 27 +/- 2.1, birth weight 797 +/-150) and 32 infants in 3-h (GA 26.9 +/- 1.8 weeks, BW 809 +/- 148 g) were included. Median (range) time until complete enteral feeding (26 (7 to 69) vs. 20 (12 to 58) days) was not statistical different. There were no differences with respect to enteral morbidity (NEC, abdominal surgery, feeding intolerance), length of stay (84 +/- 23 vs. 86 +/- 26 days), growth parameters or weight at discharge. Total duration of phototherapy and average length of continuous positive airway pressure (CPAP) support were significantly (p < 0.01) longer in the 3-h feeding group.

Conclusion: Weight gain and time until complete enteral nutrition are similar in 2-h and 3-h feeding regimes. Data suggest an advantage of 2-h feedings concerning the length of CPAP and phototherapy.
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http://dx.doi.org/10.1111/j.1651-2227.2008.00774.xDOI Listing
June 2008

Intratracheal perfluorocarbons diminish LPS-induced increase in systemic TNF-alpha.

Am J Physiol Lung Cell Mol Physiol 2008 Jun 21;294(6):L1043-8. Epub 2008 Mar 21.

Dept. for Neonatology and Pediatric Intensive Care Medicine, Klinik für Kinderheilkunde, Universitätsklinikum Carl Gustav Carus, Medizinische Fakultät der Technischen Universität Dresden, Fetscherstr. 74, 01307 Dresden, Germany.

Perfluorocarbons (PFC) reduce the production of various inflammatory cytokines, including TNF-alpha. The anti-inflammatory effect is not entirely understood. If anti-inflammatory properties are caused by a mechanical barrier, PFC in the alveoli should have no effect on the inflammatory response to intravenous LPS administration. To test that hypothesis, rats (n=31) were administered LPS intravenously and were either spontaneously breathing (Spont), conventionally ventilated (CMV), or receiving partial liquid ventilation (PLV). Serum concentration of TNF-alpha was measured. The pulmonary expressions of TNF-alpha and TNF-alpha receptor 1 protein and of TNF-alpha and ICAM-1 mRNA were determined. LPS caused a significant (P<0.001) increase in serum TNF-alpha. Serum TNF-alpha concentration was similar in LPS/Spont (525+/-180 pg/ml) and LPS/CMV (504+/-154 pg/ml) but was significantly (P<0.001) lower in animals of the LPS/PLV group (274+/-101 pg/ml). Immunohistochemical data on TNF-alpha protein expression showed a LPS-induced increase in TNF-alpha and TNF-alpha receptor 1 expression that was diminished by partial liquid ventilation. PCR measurements revealed a lower expression of TNF-alpha and ICAM-1 mRNA in LPS/PLV than in LPS/CMV or LPS/Spont animals. Semiquantitative histological evaluation revealed only minor alveolar inflammation with no significant differences between the groups. Low serum TNF-alpha concentration in PFC-treated animals is most likely explained by a decreased production of TNF-alpha in the lung.
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http://dx.doi.org/10.1152/ajplung.00125.2007DOI Listing
June 2008

Which information will be given to parents of preterm infants--a comparison of estimates and local data.

J Perinat Med 2007 ;35(5):436-42

Department for Pediatrics, Medical University Innsbruck, Pädiatrie IV-Neonatologie, Austria.

Objective: Parents of preterm infants require information on morbidity and duration of common interventions performed in the NICU. Since locally achieved data are often not available, information is mainly based on educated guesses of health care professionals. The present study compares estimates of neonatal nurses or medical doctors (MDs) in two separate NICUs with local data.

Methods: Health care professionals were asked to estimate morbidity and duration of medical interventions of two groups of very low birth weight infants. For comparison, local data were obtained from infant charts and the Vermont Oxford Neonatal Network data base.

Results: Incidence of BPD was underestimated by MDs and overestimated by nurses for low birth weight group (500-750 g) and overestimated by nurses for 1250- 1500 g infants. Incidence of IVH was significantly overestimated by nurses for both groups. Duration of ventilatory support was underestimated for infants of a gestational age of 24-27 weeks and overestimated for the age group of 31-32 weeks. Length of stay in NICU was underestimated for infants at gestational age of 24-27 weeks, but not for the 32-33 weeks group.

Conclusions: Information based on estimates made by health care professionals may be misleading. Data differ significantly among different NICUs, thus, local data should be obtained by each NICU and used to inform parents appropriately.
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http://dx.doi.org/10.1515/JPM.2007.074DOI Listing
December 2007

Alterations of alveolar type II cells and intraalveolar surfactant after bronchoalveolar lavage and perfluorocarbon ventilation. An electron microscopical and stereological study in the rat lung.

Respir Res 2007 Jun 5;8:40. Epub 2007 Jun 5.

Clinic for Neonatology, Charité Universitätsmedizin Berlin, Campus Mitte, Berlin, Germany.

Background: Repeated bronchoalveolar lavage (BAL) has been used in animals to induce surfactant depletion and to study therapeutical interventions of subsequent respiratory insufficiency. Intratracheal administration of surface active agents such as perfluorocarbons (PFC) can prevent the alveolar collapse in surfactant depleted lungs. However, it is not known how BAL or subsequent PFC administration affect the intracellular and intraalveolar surfactant pool.

Methods: Male wistar rats were surfactant depleted by BAL and treated for 1 hour by conventional mechanical ventilation (Lavaged-Gas, n = 5) or partial liquid ventilation with PF 5080 (Lavaged-PF5080, n = 5). For control, 10 healthy animals with gas (Healthy-Gas, n = 5) or PF5080 filled lungs (Healthy-PF5080, n = 5) were studied. A design-based stereological approach was used for quantification of lung parenchyma and the intracellular and intraalveolar surfactant pool at the light and electron microscopic level.

Results: Compared to Healthy-lungs, Lavaged-animals had more type II cells with lamellar bodies in the process of secretion and freshly secreted lamellar body-like surfactant forms in the alveoli. The fraction of alveolar epithelial surface area covered with surfactant and total intraalveolar surfactant content were significantly smaller in Lavaged-animals. Compared with Gas-filled lungs, both PF5080-groups had a significantly higher total lung volume, but no other differences.

Conclusion: After BAL-induced alveolar surfactant depletion the amount of intracellularly stored surfactant is about half as high as in healthy animals. In lavaged animals short time liquid ventilation with PF5080 did not alter intra- or extracellular surfactant content or subtype composition.
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http://dx.doi.org/10.1186/1465-9921-8-40DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1892019PMC
June 2007

The Apgar score.

Pediatrics 2006 Sep;118(3):1314-5; author reply 1315-6

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http://dx.doi.org/10.1542/peds.2006-1254DOI Listing
September 2006

Perfluorocarbons decrease Chlamydophila pneumoniae-mediated inflammatory responses of rat type II pneumocytes in vitro.

Pediatr Res 2006 Sep 20;60(3):264-9. Epub 2006 Jul 20.

Clinic for Neonatology, Campus Charité Mitte, D-10098 Berlin, Germany.

Chlamydophila pneumoniae alter the expression of Toll-like receptor (TLR) 4 in alveolar type II (ATII)-cells. Subsequently nuclear factor kappaB (NF-kappaB) is activated and tumor necrosis factor-alpha (TNF-alpha) and macrophage inflammatory protein 2 (MIP-2) are produced. Perfluorocarbons (PFC) are beneficial in animals with bacterial pneumonia and reduce production of TNF-alpha. Using isolated ATII-cells, it was studied whether PFC prevent C. pneumoniae-induced TNF-alpha and MIP-2 release and what the underlying pathway is. PF5080 preincubation prevented C. pneumoniae-induced secretion of TNF-alpha (43 +/- 10 versus 661 +/- 41 pg/mL) and MIP-2 (573 +/- 41 versus 4786 +/- 502 pg/mL). The C. pneumoniae-induced 2.2-fold increase of TNF-alpha Receptor 1 expression was reduced by PF5080. C. pneumoniae reduced cytoplasmatic IkappaBalpha (3.7 +/- 0.3 versus 14 +/- 1) and increased NF-kappaB p65 (31 +/- 7.5 versus 3.6 +/- 1.1) compared with control. PF5080 prevented NF-kappaB activation. TLR4 expression was 1.5-fold higher after C. pneumoniae incubation, but remained at control levels after PF5080 pretreatment. After 24 h of C. pneumoniae incubation, in 88 +/- 6% of cells bacteria were found in the perinuclear region and in 50% of these cells bacteria adhered to cellular surface. After PF5080 preincubation, C. pneumoniae were in 32 +/- 4% attached to and in 5 +/- 1% internalized in ATII-cells. Since PF5080 was found in ATII-cell membranes, PF5080 effect could be explained by an alteration of the cellular membrane, preventing activation of the inflammatory cascade.
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http://dx.doi.org/10.1203/01.pdr.0000233033.82664.91DOI Listing
September 2006

Observational study to compare the clinical efficacy of the natural surfactants Alveofact and Curosurf in the treatment of respiratory distress syndrome in premature infants.

Respir Med 2007 Jan 15;101(1):169-76. Epub 2006 May 15.

Clinic of Neonatology (Charité Campus Mitte), Humboldt-University Berlin, Berlin.

Introduction: Natural surfactants have been shown to be superior to synthetic surfactants in the treatment of neonatal respiratory distress syndrome (RDS). In Germany, Alveofact (A) and Curosurf (C) are the most frequently used natural surfactant preparations. The aim of this retrospective, observational study was to compare the effects of A and C on gas exchange and outcome in premature infants.

Methods: During a 5-year period in our neonatal intensive care unit (NICU), 187 premature infants were treated with surfactant, with 82 receiving A and 105 receiving C. We recorded F(I)O(2) and gas exchange (PaO(2)/F(I)O(2) ratio, PaCO(2), SaO(2)) during the first 72h after surfactant application and the incidence of outcome parameters at day 28 (bronchopulmonary dysplasia (BPD), intraventricular hemorrhage (IVH grade III or IV), patent ductus arteriosus (PDA), pneumothorax, necrotizing enterocolites (NEC) and death). The differences between the patient groups were assessed by ANOVA or the calculation of relative risks. Bonferroni correction was used for multiple comparisons.

Results: There were no statistically significant differences between infants treated with A and C in mean gestational age (28.4 vs. 28.4 weeks), birth weight (1210 vs.1258 g) and time of first surfactant application (60 vs. 90 min postnatal). We observed no significant between group differences in course of F(I)O(2) and blood gases, or in incidence at day 28 of BPD (41.7% vs. 42.8%), IVH III/IV (18.3% vs. 14.3%), pneumothorax (9.8% vs. 4.8%), PDA (23.2% vs. 21.9%), PVL (7.3% vs. 9.5%) and death (17% vs. 17.1%). There were also no statistically significant differences in the subgroup of infants <28 weeks. The lower incidence of NEC in A compared with C (1.2% vs. 10.5%, P=0.01) was not statistically significant after Bonferroni correction.

Conclusion: Independent of gestational age no significant difference in the clinical efficacy of A and C was observed.
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http://dx.doi.org/10.1016/j.rmed.2006.03.033DOI Listing
January 2007

Functional residual capacity measurement by heptafluoropropane in ventilated newborn lungs: in vitro and in vivo validation.

Crit Care Med 2006 Jun;34(6):1789-95

Clinic of Neonatology, Charité Campus Mitte, and Institute of Legal Medicine, Charité Universitätsmedizin, Berlin, Germany.

Objective: Heptafluoropropane is an inert gas commercially used as propellant for inhalers. Since heptafluoropropane can be detected in low concentrations, it could also be used as a tracer gas to measure functional residual capacity and ventilation homogeneity. The aim of the present study was to validate functional residual capacity measurements by heptafluoropropane wash-in/wash-out (0.8%) during mechanical ventilation in small, surfactant-depleted lungs using a newborn piglet model.

Design: Prospective laboratory and animal trial.

Setting: Animal laboratory in a university setting.

Subjects: Sixteen newborn piglets (age<12 hrs, median weight 1390 g [705-4200 g]) before and after surfactant depletion (Pao2<100 torr in Fio2=1.0) by lung lavage.

Interventions: Heptafluoropropane was measured with a new infrared mainstream sensor connected with the flow sensor of the Dräger Babylog 8000. Accuracy and precision of the measurement technique were tested in a mechanical lung model with a volume range from 11 to 35 mL. Reproducibility of the method and its sensitivity to detect changes of functional residual capacity were assessed in vivo by variation of ventilatory variables.

Measurements And Main Results: In vitro the absolute error of functional residual capacity was <1 mL (relative errors<3%) with a coefficient of variation<4%. The coefficient of variation of consecutive in vivo measurements was only slightly higher (<5.1%). Measurement of heptafluoropropane concentrations in blood showed no significant accumulation for repeated functional residual capacity measurements within short time periods. After lung lavage, the functional residual capacity decreased from 20.9 mL/kg to 14.5 mL/kg (p<.05) despite increased ventilatory pressures, and lung clearance index (p<.001) and moment ratios (p<.01) increased significantly due to uneven alveolar ventilation. In healthy lungs, the increase in peak inflation pressure and positive end-expiratory pressure by 3-4 cm H2O had only a moderate effect on functional residual capacity (20.9+/-8.6 vs. 26.0+/-11.9 mL/kg, p=.17) and no effect on ventilatory homogeneity, whereas in surfactant-depleted lungs the functional residual capacity increased from 14.5+/-6.7 mL/kg to 29.9+/-12.6 mL/kg (p<.001) and lung clearance index and moment ratios decreased significantly (p < .01).

Conclusions: Heptafluoropropane is a suitable tracer gas for precise functional residual capacity measurements tested in vitro and allows for reproducible measurements in ventilated small lungs without any adverse effects on mechanical ventilation. The sensitivity of the method is sufficiently high to demonstrate the effect of changes in ventilatory settings on the functional residual capacity and ventilation homogeneity.
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http://dx.doi.org/10.1097/01.CCM.0000220065.93507.ABDOI Listing
June 2006

Somatostatin or octreotide as treatment options for chylothorax in young children: a systematic review.

Intensive Care Med 2006 May 11;32(5):650-7. Epub 2006 Mar 11.

Department of Neonatology, Charité Campus Mitte, Universitätsmedizin Berlin, Schumannstrasse 20-21, 10098, Berlin, Germany, and John Radcliffe Hospital, Department of Paediatric Surgery, Oxford, UK.

Objective: Chylothorax is a rare but life-threatening condition in children. To date, there is no commonly accepted treatment protocol. Somatostatin and octreotide have recently been used for treating chylothorax in children. We set out to summarise the evidence on the efficacy and safety of somatostatin and octreotide in treating young children with chylothorax.

Design: Systematic review: literature search (Cochrane Library, EMBASE and PubMed databases) and literature hand search of peer reviewed articles on the use of somatostatin and octreotide in childhood chylothorax.

Patients: Thirty-five children treated for primary or secondary chylothorax (10/somatostatin, 25/octreotide) were found.

Results: Ten of the 35 children had been given somatostatin, as i.v. infusion at a median dose of 204 microg/kg/day, for a median duration of 9.5 days. The remaining 25 children had received octreotide, either as an i.v. infusion at a median dose of 68 microg/kg/day over a median 7 days, or s.c. at a median dose of 40 microg/kg/day and a median duration of 17 days. Side effects such as cutaneous flush, nausea, loose stools, transient hypothyroidism, elevated liver function tests and strangulation-ileus (in a child with asplenia syndrome) were reported for somatostatin; transient abdominal distension, temporary hyperglycaemia and necrotising enterocolitis (in a child with aortic coarctation) for octreotide.

Conclusions: A positive treatment effect was evident for both somatostatin and octreotide in the majority of reports. Minor side effects have been reported, however caution should be exercised in patients with an increased risk of vascular compromise as to avoid serious side effects. Systematic clinical research is needed to establish treatment efficacy and to develop a safe treatment protocol.
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http://dx.doi.org/10.1007/s00134-006-0114-9DOI Listing
May 2006

A survey of transcutaneous blood gas monitoring among European neonatal intensive care units.

BMC Pediatr 2005 Aug 10;5:30. Epub 2005 Aug 10.

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

Background: PCO2 and PO2 are important monitoring parameters in neonatal intensive care units (NICU). Compared to conventional blood gas measurements that cause significant blood loss in preterms, transcutaneous (tc) measurements allow continuous, non-invasive monitoring of blood gas levels. The aim of the study was to survey the usage and opinions among German speaking NICUs concerning tc blood gas monitoring.

Methods: A questionnaire was developed and sent to 56 head nurses of different NICUs in Germany, Switzerland and Austria.

Results: A completely answered questionnaire was obtained from 41 NICUs. In two of these units tc measurements are not performed. In most NICUs (77%), both PtcO2 and PtcCO2 are measured simultaneously. Most units change the sensors every 3 hours; however, the recommended temperature of 44 degrees C is used in only 15% of units. In only 8% of units are arterial blood gases obtained to validate tc values. Large variations were found concerning the targeted level of oxygen saturation [median upper limit: 95% (range 80-100%); median lower limit: 86% (range 75-93%)] and PO2 [median upper limit: 70 mmHg (range 45-90 mmHg); median lower limit: 44 mmHg (range 30-60 mmHg)].

Conclusion: Our survey shows that the use of tc monitors remains widespread among German speaking NICUs, despite earlier data suggesting that their use had been abandoned in many NICUs worldwide. In addition, we suggest that the current method of monitoring oxygenation may not prevent hyperoxemia in preterm infants.
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http://dx.doi.org/10.1186/1471-2431-5-30DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1192805PMC
August 2005

Inertance measurements by jet pulses in ventilated small lungs after perfluorochemical liquid (PFC) applications.

Physiol Meas 2005 Jun 4;26(3):239-49. Epub 2005 Mar 4.

Clinic of Neonatology (Charité), Humboldt-University of Berlin, Schumannstrasse 20/21, D-10098 Berlin, Germany.

Perfluorochemical liquid (PFC) liquids or aerosols are used for assisted ventilation, drug delivery, lung cancer hyperthermia and pulmonary imaging. The aim of this study was to investigate the effect of PFC liquid on the inertance (I) of the respiratory system in newborn piglets using partial liquid ventilation (PLV) with different volumes of liquid. End-inspiratory (I(in)) and end-expiratory (I(ex)) inertance were measured in 15 ventilated newborn piglets (age < 12 h, mean weight 724 +/- 93 g) by brief flow pulses before and 80 min after PLV using a PFC volume (PF5080, 3 M) of 10 ml kg(-1) (N = 5) or 30 ml kg(-1) (N = 10). I was calculated from the imaginary part of the measured respiratory input impedance by regression analysis. Straight tubes with 2-4 mm inner diameter were used to validate the equipment in vitro by comparison with the analytically calculated values. In vitro measurements showed that the measuring error of I was <5% and that the reproducibility was better than 1.5%. The correlation coefficient of the regression model to determine I was >0.988 in all piglets. During gas ventilation, I(in) and I(ex) (mean +/- SD) were 31.7 +/- 0.8 Pa l(-1) s(2) and 33.3 +/- 2.1 Pa l(-1) s(2) in the 10 ml group and 32.4 +/- 0.8 Pa l(-1) s(2) and 34.0 +/- 2.5 Pa l(-1) s(2) in the 30 ml group. However, I of the 3 mm endotracheal tube (ETT) used was already 26.4 Pa l(-1) s(2) (about 80% of measured I). During PLV, there was a minimal increase of I(in) to 33.1 +/- 2.5 Pa l(-1) s(2) in the 10 ml group and to 34.5 +/- 2.7 Pa l(-1) s(2) in the 30 ml group. In contrast, the increase of I(ex) was dramatically larger (p < 0.001) to 67.7 +/- 13.3 Pa l(-1) s(2) and to 74.8 +/- 9.3 Pa l(-1) s(2) in the 10 ml and 30 ml groups, respectively. Measurements of I by jet pulses in intubated small animals are reproducible. PFC increases the respiratory inertance, but the magnitude depends considerably on its spatial distribution which changes during the breathing cycle. Large differences between I(in) and I(ex) are an indicator for liquid in airways or the ETT.
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http://dx.doi.org/10.1088/0967-3334/26/3/009DOI Listing
June 2005

Contact of Chlamydophila pneumoniae with type II cell triggers activation of calcium-mediated NF-kappa B pathway.

Biochim Biophys Acta 2005 Mar;1743(1-2):37-48

Clinic of Neonatology, Campus Charité-Mitte, University Children's Hospital, University Medicine Berlin, Germany.

Nuclear factor-kappa B (NF-kappa B) plays an important role in inflammation, proliferation and regulation of apoptosis. The purpose of the present study on type II cells was to investigate whether Chlamydophila pneumoniae contact induces (I) a Ca2+ release, that (II) disrupts F-actin/beta-tubulin cytoskeletal association with NF-kappa B/I kappa B alpha, leading to (III) a subsequent NF-kappa B activation. Incubation of rat type II pneumocytes with C. pneumoniae caused an intracellular calcium release within seconds. Confocal laser scanning microscopy (CLSM) revealed that bacterial contact with cell surface leads to a disappearance of the microvilli and disturbs the co-localization between F-actin and NF-kappa B (p65). Using semi-quantitative CLSM, we show that at 10-30 min I kappa B alpha was decreased and p65 or p50 was simultaneously translocated from cytoplasm to the nucleus, resulting in a 19-fold and 17-fold increase versus control cells. During this time no bacteria were internalized into type II cells. The pre-treatment of cells with BAPTA-AM inhibited C. pneumoniae-mediated calcium release. BAPTA-AM or SN50 prevented the C. pneumoniae-induced changes in F-actin cytoskeleton and inhibited NF-kappa B activation. Paclitaxel reduced C. pneumoniae-mediated changes of beta-tubulin cytoskeleton and activation of NF-kappa B. These results suggest that calcium-mediated cytoskeleton reorganization is involved in C. pneumoniae-induced NF-kappa B activation in type II cells.
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http://dx.doi.org/10.1016/j.bbamcr.2004.08.009DOI Listing
March 2005

Human cytomegalovirus reactivation during lactation and mother-to-child transmission in preterm infants.

J Clin Microbiol 2005 Mar;43(3):1318-24

Humboldt University, Medical School (Charité), Institute of Virology, Schumannstrasse 20/21, D-10117 Berlin, Germany.

In a clinical trial, the incidence of cytomegalovirus reactivation in breastfeeding mothers and transmission to their preterm infants were studied. Breast milk from 73 mothers as well as urine and tracheal and pharyngeal aspirates from their 89 infants were screened weekly for human cytomegalovirus (HCMV) DNA during the first 2 months after delivery. Of the 73 mothers, 48 (66%) were positive for HCMV DNA in the lactating breast. HCMV reactivation could be confirmed for 19 of 20 (95%) immunoglobulin G-positive mothers. Of the eight immunoglobulin G-negative mothers one was positive for HCMV DNA in breast milk. In only 2 out of 13 seropositive mothers with HCMV DNA in breast milk could viral DNA be detected in the peripheral blood. HCMV mother-to-child transmission was concluded for 20 of the 48 (42%) mothers positive for DNA or 7 of 19 (37%) seropositive for HCMV and positive for HCMV DNA in breast milk and one of one mother seronegative for HCMV but positive for HCMV DNA in breast milk. One mother transmitted the virus to her twins. In addition, one infant acquired postnatal HCMV infection despite the mother's being negative for HCMV DNA in breast milk; altogether, we found 22 infants with HCMV infection. In 13 of these 22 infants, virus infection occurred definitively postnatally; two of them developed severe symptomatic HCMV infection. HCMV-infected infants demonstrated higher incidences of amniotic infection, respiratory distress syndrome, bronchopulmonary dysplasia, and retinopathia praenatalis than noninfected infants, however, the differences were not statistically significant. In summary, our study confirmed a very high incidence of HCMV reactivation in mothers during lactation and a significant risk of transmission to preterm infants with the possibility of severe disease in these babies.
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http://dx.doi.org/10.1128/JCM.43.3.1318-1324.2005DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1081237PMC
March 2005

Measurements of evaporated perfluorocarbon during partial liquid ventilation by a zeolite absorber.

Artif Cells Blood Substit Immobil Biotechnol 2004 ;32(3):375-86

Clinic of Neonatology (Charité Campus Mitte), Humboldt-University, Berlin, Germany.

Unlabelled: During partial liquid ventilation (PLV) the knowledge of the quantity of exhaled perfluorocarbon (PFC) allows a continuous substitution of the PFC loss to achieve a constant PFC level in the lungs. The aim of our in vitro study was to determine the PFC loss in the mixed expired gas by an absorber and to investigate the effect of the evaporated PFC on ventilatory measurements.

Method: To simulate the PFC loss during PLV, a heated flask was rinsed with a constant airflow of 4 L min(-1) and PFC was infused by different speeds (5, 10, 20 mL h(-1)). An absorber filled with PFC selective zeolites was connected with the flask to measure the PFC in the gas. The evaporated PFC volume and the PFC concentration were determined from the weight gain of the absorber measured by an electronic scale. The PFC-dependent volume error of the CO2SMO plus neonatal pneumotachograph was measured by manual movements of a syringe with volumes of 10 and 28 mL with a rate of 30 min(-1).

Results: Under steady state conditions there was a strong correlation (r2 = 0.999) between the infusion speed of PFC and the calculated PFC flow rate. The PFC flow rate was slightly underestimated by 4.3% (p < 0.01). However, this bias was independent from PFC infusion rate. The evaporated PFC volume was precisely measured with errors < 1%. The volume error of the CO2SMO-Plus pneumotachograph increased with increasing PFC content for both tidal volumes (p < 0.01). However for PFC flow rates up to 20 mL/h the error of the measured tidal volumes was < 5%.

Conclusions: PFC selective zeolites can be used to quantify accurately the evaporated PFC volume during PLV. With increasing PFC concentrations in the exhaled air the measurement errors of ventilatory parameters have to be taken into account.
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http://dx.doi.org/10.1081/bio-200027442DOI Listing
January 2005

Extrasystoles: side effect of kangaroo care?

Pediatr Crit Care Med 2004 Sep;5(5):455-6

Clinic for Neonatology, Otto Heubner Centre of Paediatrics, Charité-Campus Mitte, Berlin, Germany.

Objective: To present an unpublished reason for an arrhythmic electrocardiogram (ECG) recording during kangaroo care in a preterm infant.

Design: Case report.

Patient: Preterm infant.

Measurements And Main Results: A preterm infant exhibited cardiac arrhythmia on the ECG monitor during kangaroo care, leading to interruption of kangarooing. Arrhythmia disappeared after placing the baby back into the incubator. The most likely reasons for arrhythmia were excluded. However, arrhythmia reappeared upon continuation of kangaroo care. ECG monitoring revealed the reason for the monitoring error.

Conclusions: ECG monitoring during kangaroo care should cause error because of superimposed electric activity from the parent. Oxygen saturation represents a more reliable method of monitoring during kangaroo care.
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http://dx.doi.org/10.1097/01.pcc.0000137283.12685.7aDOI Listing
September 2004

Perfluorocarbon species and nebulizer type influence aerosolization rate and particle size of perfluorocarbon aerosol.

J Crit Care 2004 Mar;19(1):42-7

Clinic for neonatology, Charité Campus Mitte, Berlin, Germany.

Purpose: Aerosolization of perfluorocarbons (PFC) has been proven beneficial in vivo. The present in vitro study was performed to investigate, how PFC-aerosolization is affected by type of nebulizer and PFC properties.

Materials And Methods: Aerosolization rate was studied of 4 different PFC that were nebulized using 3 different jet nebulizers (operating at different flows: 4.1; 7.1; 13 l/min) and one ultrasonic nebulizer. Distribution of aerosol particle size was determined with a laser diffraction device.

Results: Between the studied nebulizers, considerable differences in the aerosolization rate were found. Aerosolization rate was significantly lower for PFOB (0.48-1.24 mL/min), when compared with PF 5080, RM 101 and FC 77 (1.33-4.75 mL/min). The ultrasonic nebulizer did not generate an aerosol but rather PFC vapor. Lowest mass median diameter (MMD) was found for PFOB and varied between the jet nebulizers from 2.2 and 3.7 microm, with a small range in particle size (maximum of 7.3 microm). FC 77 had highest MMD (3.5 to 9.2 microm) and greatest range of particle size of up to 13 microm.

Conclusions: Our in vitro data show that aerosolization rate depends mainly on density of PFC and the flow of nebulizer. Particle size distribution is affected by PFC properties. Our result may explain controversial results of published in vivo studies.
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http://dx.doi.org/10.1016/j.jcrc.2004.02.008DOI Listing
March 2004

Changes in FiO2 affect PaO2 with minor alterations in cerebral concentration of oxygenated hemoglobin during liquid ventilation in healthy piglets.

Intensive Care Med 2004 Feb 14;30(2):315-320. Epub 2004 Jan 14.

Clinic of Neonatology, Charité-Mitte, Schumannstrasse 20, 10098, Berlin, Germany.

Objective: To measure the impact of changes in the fraction of inspired oxygen (FiO2) on systemic and cerebral oxygen supply in gas and liquid ventilated healthy animals.

Design: Interventional prospective animal study.

Setting: University research laboratory.

Participants: Ten healthy, new-born piglets.

Interventions: Variations in FiO2 during conventional mechanical ventilation (CMV) followed by partial liquid ventilation (PLV) with two different filling volumes of PF 5080 (10 vs. 30 ml/kg).

Measurements And Results: Arterial blood gases were obtained 15 min after changing FiO2 and concentrations of cerebral oxygenated and total hemoglobin were determined with near infrared spectroscopy. During CMV an increase in FiO2 1.0 was associated with a constant rise in PaO2 but only a small increase in the cerebral concentration of oxygenated Hb. Initiation of PLV (at FiO2 of 1.0) caused a rapid drop in PaO2 towards values that were similar to CMV at FiO2 of 0.5. At FiO2 of 0.5 a reduction in oxygenated Hb was found in the 30 ml/kg filling group. Complete filling of the lungs with PFC caused a significant drop in total cerebral Hb concentration. CONCLUSIONS. According to our data, PLV in healthy lungs should be performed with a FiO2 of 1.0 and a small filling volume to avoid deterioration in cerebral oxygen supply.
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http://dx.doi.org/10.1007/s00134-003-2090-7DOI Listing
February 2004

Current limitations of volumetric capnography in surfactant-depleted small lungs.

Pediatr Crit Care Med 2004 Jan;5(1):75-80

Clinic of Neonatology (Charité Campus Mitte), Humboldt-University, Berlin, Germany.

Objective: To investigate the suitability of volumetric capnography for assessing alveolar gas exchange in very small, surfactant-depleted lungs.

Design: Prospective animal trial.

Settings: Animal laboratory in a university setting.

Subjects: Twenty-one ventilated newborn piglets (age <12 hrs; median weight, 890 g; range, 560-1435 g).

Interventions: Bronchoalveolar lavage with instillation of 30 mL/kg normal saline. Ventilatory, circulatory, and lung mechanic variables were measured before and 0, 30, and 60 mins after bronchoalveolar lavage.

Measurements And Main Results: The alveolar deadspace fraction calculated by the Bohr and the Bohr/Enghoff equations increased three-fold (p<.001) after bronchoalveolar lavage in capnograms with distinct alveolar plateau, whereas in capnograms without alveolar plateau no statistical significant difference was seen. The main problem of capnography in small and especially stiff lungs was the high number of discarded records exclusively caused by a missing alveolar plateau. Rates of discarded records of capnography were 9.5% before lavage and increased (p<.01) to 52.4%, 47.6%,42.8% after bronchoalveolar lavage (0, 30, and 60 mins). With decreasing exhalation time, the number of discarded records increased significantly. No plateau was seen in >75% of recorded files with exhalation times <200 msecs. The effect of bronchoalveolar lavage on all variables measured was quite different, with the highest impact on required ventilatory settings, calculated oxygenation variables, and compliance. The effect of bronchoalveolar lavage on arterio-alveolar CO2 difference, CO2 production, and alveolar deadspace was much lower and statistically significant only in capnograms with alveolar plateau.

Conclusions: Volumetric capnography is a useful tool to detect impaired alveolar gas exchange in surfactant-depleted small lungs. However, the method failed if there was no alveolar plateau in the volumetric capnogram especially in stiff lungs with short exhalation times.
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http://dx.doi.org/10.1097/01.PCC.0000102384.60676.E5DOI Listing
January 2004

In vitro validation of an ultrasonic flowmeter in order to measure the functional residual capacity in newborns.

Physiol Meas 2003 May;24(2):355-65

Clinic of Neonatology (Charité), Humboldt-University Berlin, Schumannstrasse 20/21, D-10098 Berlin, Germany.

Ultrasonic transit-time airflow meters (UFM) allow simultaneous measurements of volume flow V'(t) and molar mass MM(t) of the breathing gas in the mainstream. Consequently, by using a suitable tracer gas the functional residual capacity (FRC) of the lungs can be measured by a gas wash-in/wash-out technique. The aim of this study was to investigate the in vitro accuracy of a multiple-breath wash-in/wash-out technique for FRC measurements using 4% sulphur hexafluoride (SF6) in air. V'(t) and MM(t) were measured with a Spiroson SCIENTIFIC flowmeter (ECO Medics, CH) with 1.3 ml dead space. Linearity of airflow and MM were tested using different tidal volumes (V(T)) and breathing gases with different O2 and SF6 concentrations. To determine the accuracy of FRC measurements SF6 wash-in and wash-out curves from four mechanical lung models (FRC of 22, 53, 102 and 153 ml) were evaluated by the Spiroson. For each model five measurements were performed with a physiological V(T)/FRC ratio of 0.3 and constant respiratory rate of 30 min(-1). The error of measured V(T) (range 4-60 ml) was <2.5%. There was a strong correlation between the measured and calculated MM of different breathing gases (r = 0.989), and the measuring accuracy was better than 1%. The measured FRC of the four models were 20.3, 49.7, 104.3 and 153.4 ml with a coefficient of variation of 16.5%, 4.5%, 4.9% and 3%. Accordingly, for FRC <100 ml the in vitro accuracy was better than 8% and for FRC >100 ml better than 2.5%. The determination of FRC by MM measurements using the UFM is a simple and cost-effective alternative to conventionally used gas analysers with an acceptable accuracy for many clinical purposes.
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http://dx.doi.org/10.1088/0967-3334/24/2/311DOI Listing
May 2003