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Copyright of Monatsschrift Kinderheilkunde is the property of Springer Nature and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Background: Arachidonic (ARA) and docosahexaenoic acid (DHA) are constitutive to membrane phospholipids, and essential for brain and overall development. ARA/DHA pools in term infants (TI) are built during the third trimester, stored as adipose tissue triglycerides and predominantly distributed via plasma phosphatidylcholine (PC). In preterm infants (PTI), placental ARA/DHA supply is replaced by linoleic-acid (LA)-enriched nutrition. This study aimed to investigate the impact of PTI nutrition, compared to placental supply, on fatty acid composition in adipose tissue and blood. Methods: Prospective observational study (4/2017–3/2019) in 12 PTI and 3 PTI with enterostomy (PTI/E) (gestational age (GA) < 32 weeks) with surgical intervention at term (± 6 weeks) and 14 TI (GA ≥ 34 weeks, surgical intervention < 2 weeks postnatally). PTI/E were analyzed descriptively only. PC and triglyceride fatty acids were analyzed with tandem mass spectrometry and gas chromatography, respectively. Results were compared between TI and PTI with Wilcoxon Test and shown as median [25th percentile–75th percentile] mol%. Results: PTI had less ARA in adipose tissue TG (0.77[0.67–0.87]% vs. 1.04[0.95–1.14]%, p = 0.0003) and plasma PC (20.7[18.7–22.8]% vs. 28.3[22.7–33.5]%, p = 0.011) than TI. PTI also had less DHA in adipose tissue TG (0.6[0.4–0.8]% vs. 1.1[0.8–1.4]%, p = 0.006) and plasma PC (6.4[5.6–7.1]% vs. 8.4[7.8–13.1]%, p = 0.002). LA was increased in PTI's adipose tissue TG (10.0[8.8–12.3]% vs. 3.0[2.5–3.6]%, p < 0.0001) and plasma PC (48.4[44.6–49.6]% vs. 30.6[24.9–35.6]%, p = 0.0002). Similar differences were observed in erythrocyte PC. Conclusion: In PTI, LA is increased and ARA/DHA decreased in adipose tissue, plasma and erythrocyte lipids as proxies for other tissues, likely caused by PTI nutrition. This may contribute to impaired PTI development. [ABSTRACT FROM AUTHOR]

Background: Orthodontic treatment of newborns and infants with Robin-Sequence using the Tübingen Palatal Plate (TPP) is a complex procedure that could benefit from simplification through digitalization. The design of the velar extension (spur) and the palatal base determines the success of the treatment. Therefore, a prototype must be produced and inserted under endoscopic supervision in order to determine the appropriate shape, length and position of the spur. This technical note demonstrates a fully digital workflow for the design and manufacturing of a functional TPP prototype, based on an intraoral scan. This prototype can be altered and individualized digitally for each patient. After the shape and position of the spur have been optimized, the prototype is duplicated using a silicone mold. Then the definitive TPP is manufactured and inserted. We aim to present a workflow which facilitates the fitting procedure and does not require a conventional impression or a physical model to create the appliance. Methods: As described in part I of this series, the intraoral scan is performed using the 3Shape TRIOS3 scanner and its corresponding acquisition software. The virtual model is rendered in the 3Shape ortho appliance designer and the base of the palatal plate is designed in the 3Shape dental designer. The palatal plate and the virtual model are then imported into Autodesk Meshmixer and a standardized spur is positioned and merged with the base. The TPP is exported in Standard Tessellation Language (STL) format and manufactured on a W2P Solflex 170 DLP printer using VOCO VPrint Splint material (MDR Class IIa). Results: Based on an intraoral scan, the TPP prototype could be successfully manufactured and proved suitable for the patients' treatment. Conclusion: The new digital workflow for the design of the TPP can been successfully implemented into daily clinical routine in our facility. Patients could be alleviated from having to undergo conventional impression procedures and fitting of the TPP could be facilitated by producing multiple functional prototypes for endoscopic evaluation. Through rapid prototyping, the expenditure of the fitting process was reduced, which makes the TPP therapy more efficient and accessible to a wider range of clinicians. [ABSTRACT FROM AUTHOR]

Background: Advanced digital workflows in orthodontics and dentistry often require a combination of different software solutions to create patient appliances, which may be a complex and time-consuming process. The main objective of this technical note is to discuss treatment of craniofacial anomalies using digital technologies. We present a fully digital, linear workflow for manufacturing palatal plates for infants with craniofacial anomalies based on intraoral scanning. Switching to intraoral scanning in infant care is advantageous as taking conventional impressions carries the risk of impression material aspiration and/or infections caused by material remaining in the oronasal cavity. Material and methods: The fully digital linear workflow presented in this technical note can be used to design and manufacture palatal plates for cleft palate patients as well as infants with functional disorders. We describe the workflow implemented in an infant with trisomy 21. The maxilla was registered using a digital scanner and a stimulation plate was created using dental CAD software and an individual impression tray module on a virtual model. Plates were manufactured using both additive and subtractive methods. Methacrylate based light curing resin and Poly-Ether-Ether-Ketone were the materials used. Results: The palatal area was successfully scanned to create a virtual model. The plates fitted well onto the palatal area. Manual post-processing was necessary to optimize a functional ridge along the vestibular fold and remove support structures from the additively manufactured plate as well as the milled plate produced from a blank. The additively manufactured plate fitted better than the milled one. Conclusion: Implementing a fully digital linear workflow into clinical routine for treatment of neonates and infants with craniofacial disorders is feasible. The software solution presented here is suitable for this purpose and does not require additional software for the design. This is the key advantage of this workflow, which makes digital treatment accessible to all clinicians who want to deal with digital technology. Whether additive or subtractive manufacturing is preferred depends on the appliance material of choice and influences the fit of the appliance. [ABSTRACT FROM AUTHOR]

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Copyright of Monatsschrift Kinderheilkunde is the property of Springer Nature and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Summary: Preterm delivery is the leading cause of perinatal morbidity and mortality. Among the most important complications in preterm infants are peri‐ or postnatal infections. Myeloid‐derived suppressor cells (MDSC) are myeloid cells with suppressive activity on other immune cells. Emerging evidence suggests that granulocytic MDSC (GR‐MDSC) play a pivotal role in mediating maternal–fetal tolerance. The role of MDSC for postnatal immune‐regulation in neonates is incompletely understood. Until the present time, nothing was known about expression of MDSC in preterm infants. In the present pilot study, we quantified GR‐MDSC counts in cord blood and peripheral blood of preterm infants born between 23 + 0 and 36 + 6 weeks of gestation (WOG) during the first 3 months of life and analysed the effect of perinatal infections. We show that GR‐MDSC are increased in cord blood independent of gestational age and remain elevated in peripheral blood of preterm infants during the neonatal period. After day 28 they drop to nearly adult levels. In case of perinatal or postnatal infection, GR‐MDSC accumulate further and correlate with inflammatory markers C‐reactive protein (CRP) and white blood cell counts (WBC). Our results point towards a role of GR‐MDSC for immune‐regulation in preterm infants and render them as a potential target for cell‐based therapy of infections in these patients. [ABSTRACT FROM AUTHOR]

Copyright of Monatsschrift Kinderheilkunde is the property of Springer Nature and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Unlabelled: Our objective was to determine arterial oxygen saturation as measured by pulse oximetry (SpO2) in healthy term neonates during their first 4 weeks of life. Overnight recordings of SpO2 (Nellcor N200), photoplethysmographic (pulse) waveforms from the oximeter and breathing movements were performed in 60 term infants. They were studied initially during their 1st week of life (median age 4 days, range 1-7) and then again during their 2nd-4th week (median age 17 days, range 8-27). Median baseline SpO2, measured during regular breathing, was 97.6% (range 92-100) during week 1 versus 98.0% (86.6-100) during week 2-4 (P > 0.05). Episodes of desaturation, defined as a fall in SpO2 to < or = 80% for > or = 4 s, were found in 35% of recordings obtained in week 1 compared to 60% of those obtained in week 2-4 (P < 0.01). Their frequency increased from a median of (0-41) per 12 h of recording at the initial recording to 1 (0-165) at follow up (P < 0.01). Analysis of the data by week of life showed a peak in desaturation frequency in the 2nd week of life. The infants with extreme values at follow-up (e.g. a baseline SpO2 of 86.6%, 5th percentile 91.9%, or a desaturation frequency of 165 per 12 h of recording, 95th percentile 32) had had values well within the normal range during their initial recording (a baseline SpO2 of 94.4%, or a desaturation frequency of 4). Most of the desaturations in the infants with extreme values were associated with periodic apnoea. These results demonstrate only relatively minor developmental changes in oxygenation in term neonates during the first 4 weeks of life. The clinical significance of outlying values, i.e. a low baseline SpO2 or a high number of episodic desaturations, remains to be determined.Conclusion: These healthy term neonates had values for baseline oxygen saturation and desaturation frequency that were not substantially different from those observed in older infants. [ABSTRACT FROM AUTHOR]

Copyright of Monatsschrift Kinderheilkunde is the property of Springer Nature and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Neonates show an impaired anti-microbial host defence, but the underlying immune mechanisms are not understood fully. Myeloid-derived suppressor cells ( MDSCs) represent an innate immune cell subset characterized by their capacity to suppress T cell immunity. In this study we demonstrate that a distinct MDSC subset with a neutrophilic/granulocytic phenotype ( Gr- MDSCs) is highly increased in cord blood compared to peripheral blood of children and adults. Functionally, cord blood isolated Gr- MDSCs suppressed T cell proliferation efficiently as well as T helper type 1 ( Th1), Th2 and Th17 cytokine secretion. Beyond T cells, cord blood Gr- MDSCs controlled natural killer ( NK) cell cytotoxicity in a cell contact-dependent manner. These studies establish neutrophilic Gr- MDSCs as a novel immunosuppressive cell subset that controls innate ( NK) and adaptive ( T cell) immune responses in neonates. Increased MDSC activity in cord blood might serve as key fetomaternal immunosuppressive mechanism impairing neonatal host defence. Gr- MDSCs in cord blood might therefore represent a therapeutic target in neonatal infections. [ABSTRACT FROM AUTHOR]

Two extremely low birth weight (ELBW) infants developed characteristic signs of kernicterus at 4 and 8 months corrected age despite only moderate neonatal hyperbilirubinemia (peak serum bilirubin <10 g/dl) and phototherapy being applied according to current guidelines. Both girls were from twin pregnancies and had fetal complications (donor in a twin-twin transfusion syndrome and acardius-acranius malformation in the second twin, respectively), connatal anemia (initial hematocrit 30%), and mild acidosis after birth. They had been neurologically normal at discharge except for abnormal otoacustic emissions (OAE). At the time kernicterus was diagnosed, both infants were nearly deaf, showed severe psychomotor retardation with dystonic features and had marked bilateral hyperintensities in the globus pallidum on MRI. Based on these and similar cases from the literature, we question whether current phototherapy guidelines are appropriate for high-risk ELBW infants. Lower thresholds may be preferable, at least if additional risk factors, such as anemia, are present. Copyright © 2010 S. Karger AG, Basel [ABSTRACT FROM AUTHOR]

Objective:Monthly audits for the multicenter Canadian Oxygen Trial have shown that our neonatal team has consistently maintained study participants within the intended pulse oximetry alarm limits between 68 and 79% of the time during the first 3 days of life while infants were receiving supplemental oxygen. This good performance prompted us to explore our nurses’ perceptions of what makes them compliant with alarm limits for pulse oximetry in preterm infants.Study Design:The local neonatal research nurse interviewed all 41 staff nurses in the neonatal intensive care unit at the University Children's Hospital in Tuebingen, Germany, for this qualitative study.Result:Nurses identified education (22/41), prompt response to alarms (22/41), a favorable patient-to-staff ratio (18/41), root cause analysis at the bedside (15/41), and the high priority given to control of oxygen therapy in the department (14/41) as the five most important determinants of their good compliance.Conclusion:These findings may be useful for other neonatal teams who struggle to improve their compliance with alarm limits for pulse oximetry. [ABSTRACT FROM AUTHOR]

Aim: To review treatments for apnoea of prematurity (AOP). Methods: Literature Review and description of personal practice. Results: Provided that symptomatic apnoea has been ruled out, interventions to improve AOP can be viewed as directed at one of three underlying mechanisms: (i) a reduced work of breathing [e.g. prone positioning, nasal continuous positive airway pressure (CPAP)], (ii) an increased respiratory drive (e.g. caffeine), and (iii) an improved diaphragmatic function (e.g. branched-chain amino acids). Most options currently applied, however, have not yet been shown to be effective and/or safe, except for prone, head-elevated positioning, synchronized nasal ventilation/CPAP, and caffeine. Conclusion: Treatment usually follows an incremental approach, starting with positioning, followed by caffeine (which should be started early, at least in infants <1250 g), and nasal ventilation or CPAP via variable flow systems that reduce work of breathing. From a research point of view, we most urgently need data on the frequency and severity of bradycardia and intermittent hypoxia that can yet be tolerated without putting an infant at risk of impaired development or retinopathy of prematurity. [ABSTRACT FROM AUTHOR]

Copyright of Somnologie is the property of Springer Nature and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Background: Apnoea of prematurity (AOP) is a common problem in preterm infants which can be treated with various modes of nasal continuous positive airway pressure (NCPAP) or nasal intermittent positive pressure ventilation (NIPPV). It is not known which mode of NCPAP or NIPPV is most effective for AOP. Objective: To assess the effect of four NCPAP/NIPPV systems on the rate of bradycardias and desaturation events in very low birthweight infants. Methods: Sixteen infants (mean gestational age at time of study 31 weeks, 10 males) with AOP were enrolled in a randomised controlled trial with a crossover design. The infants were allocated to receive nasal pressure support using four different modes for 6 h each: NIPPV via a conventional ventilator, NIPPV and NCPAP via a variable flow device, and NCPAP delivered via a constant flow underwater bubble system. The primary outcome was the cumulative event rate of bradycardias (≤ 80 beats per minute) and desaturation events (≤ 80% arterial oxygen saturation), which was obtained from cardio-respiratory recordings. Results: The median event rate was 6.7 per hour with the conventional ventilator in NIPPV mode, and 2.8 and 4.4 per hour with the variable flow device in NCPAP and NIPPV mode, respectively (p value<0.03 for both compared to NIPPV/conventional ventilator). There was no significant difference between the NIPPV/conventional ventilator and the underwater bubble system. Conclusion: A variable flow NCPAP device may be more effective in treating AOP in preterm infants than a conventional ventilator in NIPPV mode. It remains unclear whether synchronised NIPPV would be even more effective. [ABSTRACT FROM AUTHOR]

The authors investigated whether there was a decline in infants sleeping prone and other modifiable risk factors for sudden infant death syndrome (SIDS) in Germany, where, as in some other countries, no nationwide intervention campaign against the prone sleeping position had been initiated. Data were obtained from parents by mailed questionnaires in two cross-sectional studies in 1991 (n = 3,330) and 1995 (n = 3,124). Prevalence of prone sleeping decreased from 37.6% to 8.7% (p < 0.05) in the German population and from 44.1% to 32.0% (p < 0.05) in the Turkish immigrant population. Parents who laid their infants prone in 1995 were less likely to follow advice from physicians, public media, and other parents (relative risks < 0.5, p < 0.05) and were more likely to have a low educational level, to be <20 years old, to be single parents, to have two or more children, to be raised in West Germany, or to be of Turkish ethnicity. Although the information on prone sleeping being a risk factor for SIDS became known among the population, these data suggest that subgroup-specific public intervention campaigns may be needed to reduce the prevalence of prone sleeping even further in those countries where no nationwide campaign has been initiated. Am J Epidemiol 1999;150:51–7. [ABSTRACT FROM PUBLISHER]

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Objectives: To report on a case of fetal varicella infection following the diagnosis of maternal infection at 16 weeks of gestation. Methods: Diagnosis was based on serology testing and prenatal ultrasound, confirmed by DNA detection in amniotic fluid (Lightcycler-PCR). Serial ultrasound examinations were performed. Results: Sonographic anomalies included borderline ventriculomegaly, intracerebral, intrahepatic and myocardial calcifications, limb deformities, articular effusions, and intrauterine growth retardation (confirmed postpartally). The newborn showed a severe encephalopathy and could not be stabilized sufficiently. The child died 23 days after birth. Conclusion: The outcome of an affected fetus may be very serious and prenatal ultrasound is a helpful tool to recognize the severity of the infection. [ABSTRACT FROM AUTHOR]

Objective: We report the case of a female fetus with a single spherical anechoic cyst on the right side of the lower abdomen first diagnosed at 22 weeks of pregnancy. Methods: Serial ultrasound monitoring and needle aspiration of the cyst were performed. Results: The cyst grew during pregnancy up to 8 cm diameter. Needle aspiration was performed at 33 and 36 weeks. At 38 weeks labor was induced and a girl was delivered spontaneously. Postnatally the child showed abdominal distention, vomiting, and an obstruction of venous return of the right leg. To improve venous circulation, another needle aspiration of the cyst was performed. Laparoscopy revealed cystic colon duplication. Conclusions: Prenatal differentiation of a single round anechoic cyst in the pelvis of a female fetus can be difficult. As a rare abnormality cystic colon duplication has to be considered. [ABSTRACT FROM AUTHOR]

Objectives:To investigate postnatal lipopolysaccharide-binding protein (LBP) kinetics in term neonates and to test its diagnostic accuracy for early-onset bacterial infection (EOBI).Study design:A total of 99 neonates with clinical and serological signs of EOBI comprised the study group; 198 neonates with risk factors, but without EOBI, served as controls. LBP, C-reactive protein (CRP) and interleukin-8 (IL-8) were determined.Results:LBP in the noninfected group increased until 24 h after birth (P<0.05 vs 6 h). LBP and CRP correlated strongly in neonates with suspected EOBI (r=0.63). Although LBP reached a higher sensitivity than CRP 6 and 12 h after clinical suspicion (45 (24–68) and 79% (54–94) vs 9 (0–24) and 39% (17–64); P<0.05)), EOBI was most reliably detected by IL-8.Conclusion:LBP kinetics were age-dependent. LBP was not sufficiently sensitive in the prediction of EOBI.Journal of Perinatology (2006) 26, 115–119. doi:10.1038/sj.jp.7211422; published online 12 January 2006 [ABSTRACT FROM AUTHOR]

Copyright of Notfall & Rettungsmedizin is the property of Springer Nature and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Copyright of Monatsschrift Kinderheilkunde is the property of Springer Nature and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Objective: To explore whether and how population based data from a regional quality control programme can be used to investigate the hypothesis that small for gestational age (SGA) very low birthweight infants (VLBW, <1500 g) are at increased risk of death, severe intraventricular haemorrhage (IVH), and periventricular leucomalacia (PVL), but at decreased risk of respiratory distress syndrome (RDS). Methods: Analyses of population based perinatal/neonatal data (1991-96) from a quality control programme in Lower Saxony, Germany. After assessment of data validity and representativeness, exclusion criteria were defined: birth weight >90th centile, severe malformations, siblings of multiple births, and gestational age (GA) <25 or >29 weeks. Outcomes of interest were death, severe IVH, PVL, and RDS. Multivariable analyses were performed by Cox proportional hazard and logistic regression models. Results: Within the data validation procedure, an increase in proportions of both VLBW (from 0.95% in 1991 to 1.11% in 1996; +17%) and SGA (from 22.7% to 27.4%; +21%) infants became apparent (p<0.05). The study population consisted of 1623 infants (173 SGA). Mortality was 12.1 % (n = 196), with an adjusted hazard ratio for SGA infants of 2.54, 95% confidence interval (CI) 1.70 to 3.79. Both groups were at similar risk of severe IYN (adjusted odds ratio 0.93, 95% Cl 0.5 to 1.65) and PVL (1.54, 95% Cl 0.78 to 2.87), but SGA infants had less RDS (0.57, 95% CI 0.35 to 0.93). Male sex, multiple birth, hypothermia (<35.5°C), and sepsis were associated with IVH and RDS. Infants admitted to hospitals with <36 VLBW admissions/year had increased mortality (adjusted hazard ratio 1.56, 95% CI 1.12 to 2.18). Conclusions: SGA VLBW infants are at increased risk of death, but not of IVH and PVL, and at decreased risk of RDS. That mortality is higher in smaller hospitals needs further investigation. [ABSTRACT FROM AUTHOR]

Copyright of Monatsschrift Kinderheilkunde is the property of Springer Nature and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Unlabelled: Monitor alarms are a major burden on both patients and staff in intensive care units. We compared alarm rates from three different monitor systems (Hewlett Packard (HP), Kontron Instruments (KI), Marquette-Hellige (MH)) in a tertiary neonatal intensive care unit. Monitors were used in random order on three consecutive days over 8 h each in 16 preterm infants (median gestational age at birth 29 wk (range 24-34), age at study 18 d (8-53), weight at study 1,160g (595-1,430)). Alarms were classified as true or false using flow sheets based on continuous observation of both the patient and related parameters. There was one alarm every 9 min of monitoring. The median number of true alarms did not differ significantly between systems, being 28 per 8 h (range 9-87) for HP, 26 (3-81) for KI, and 30 (5-135) for MH. The median number of false alarms differed widely, with the HP system generating 32 (7-77) such alarms per 8 h, compared to 8 (0-19) for KI and 15 (2-32) for MH (p < 0.01 HP vs KI and MH, p < 0.05 KI vs MH). These differences between systems were mainly due to differences in pulse oximeter and transcutaneous PO2 monitor alarm rates.Conclusions: In conclusion, this study shows marked differences between both parameters and manufacturers in the frequency with which false alarms occur. It may provide a basis from which reductions in alarm rates can be sought. [ABSTRACT FROM AUTHOR]

Aims: To examine the haemodynamic effects of brief alteration in arterial oxygenation in preterm infants with respiratory failure.Methods: Eighteen preterm infants with respiratory failure, aged 9-76 hours, underwent detailed Doppler echocardiographic assessment at 86%, 96%, and 100% SaO2, achieved by altering the FIO2. Sixteen were receiving intermittent positive pressure ventilation, median FIO2 0.45 (0.20-0.65), median mean airway pressure 12 cm H2O (0-20). SaO2 was stable for 15 minutes at each stage. Four parameters of pulmonary arterial pressure were measured: peak velocity of tricuspid regurgitation and peak velocity of left to right ductal flow, TPV:RVET ratio and PEP:RVET ratio, measured at the pulmonary valve, along with flow velocity integrals at the aortic and pulmonary valves, and systemic arterial pressure. Ductal size was graded into closed, small, moderate, large with imaging, pulsed and continuous wave Doppler.Results: Between 86% and 96% SaO2, there were no consistent changes, but in three of the 12 with a patent ductus arteriosus (PDA) there was ductal constriction, with complete closure in one. Between 96% and 100% SaO2, peak ductal flow velocity rose significantly in four of eight with a PDA. Ductal constriction occurred in four infants; in three this was associated with a significant fall in aortic flow integral and a rise in aortic pressure (4-6 mm Hg). Overall, 11 infants went from 86% to 100% SaO2 and pulmonary arterial pressure fell significantly in seven.Conclusion: A brief rise in SaO2 within the range maintained by most neonatal units can cause significant ductal constriction. The fall in pulmonary arterial pressure with 100% SaO2 seen in most infants was associated with a fall in pulmonary blood flow (or no change), rather than a rise, indicating that the dominant haemodynamic effect was ductal constriction rather than pulmonary vasodilation. [ABSTRACT FROM AUTHOR]

Schlaud M (Department of Epidemiology and Social Medicine, Hannover Medical School, OE 5410, 30623 Hannover, Germany), Kleeman W J, Poets C F and Sens B. Smoking during pergnancy and poor antenatal care; two major preventable risk factors for sudden infant death synfroms. Itemational Journal of Epidemiology 1996; 25: 959–965.Background In this case-control study on sudden infant death syndrome (SIDS), the magnitude of the risk factors ‘mataernal smoking during pergnancy’ and ‘poor anteratal care’ was assessed and the attributable proportions of SIDS incidence estimated. Methods Perinatal data from 190 SIDS cases, who died between 1986 and 1990 at age >7 days and had a diagnosis of SIDS confirmed by autopsy, were compared to 5920 controls. Adjusted odds ratios (OR) and 95% confidence intervals (CI) were computed by unconditional logistlc regression. The attributable risk per cent among the exposed AR%) and the population attributable risk per cent (PAR%) were calculated. Results Maternal smoking during pregnancy was associated with a more than twofold risk of SIDS (OR = 2.4; 95% CI; 1.7–3.4) and showed significant does-response. Low numbers of antenatal care visits were also associated with an increased risk of SIDS; OR = 1.6 (95% CI: 1.1–2.3) for 4–8 consultations and 2.9 (95% CI: 1.4–5.8) for 0–3 consultations; reference: >8 consultations Maternal smoking during pregnancy yielded an AR% of 58% (95% CI:42–70) and a PAR% OF 28% (95% CI:16–40). The AR% for ≤8 antenatal care visits versus >8 consultations was 41% (95% CI: 16–59); the PAR% 10% (95% CI; 3–17). Conclusions Assuming causality, our data suggest that a reduction of the prevalence of elther risk factor by population-based interventions may yield a worthwhile public health impact in terms of a substantially lower SIDS incidence. [ABSTRACT FROM PUBLISHER]

To determine whether preterminal hyperthermia is significantly associated with sudden infant death (SID), 140 structured interviews with parents of SID victims were compared with questionnaires filled in by a control group of parents living in the same area. All SID autopsies were performed between 1986 and 1992 at the Institute of Legal Medicine of Hannover Medical School according to the same protocol. Signs of profuse sweating (i.e. moist head, damp clothing or bedding) were present at the scene of death in 35.7% of cases. SID victims with signs of profuse sweating were more frequently found under their bedding (p < 0.001), were older (178 vs. 130 days) and the time period between when they were last seen alive and when they were found dead was longer (6.5 vs. 4.5 hours p < 0.01) compared to cases without sweating. Sweat on the head [odds ratio (OR) = 1.9; 95% confidence interval (CI) = 1.0, 3.6], and sweaty clothing and bedding (OR = 17.9; 95% CI = 8.7; 37.1) showed a significant association with the risk for SID. The pathophysiological basis for hyperthermia in SID remains to be determined. Hyperthermia could result from infection, overinsulation from excessive clothing with high environmental temperatures, covering of the infant's head or immature central thermoregulatory centres. The influence on the fatal outcome and the role in the pathogenesis of these deaths requires further research. [ABSTRACT FROM AUTHOR]

Imposed upper airway obstruction was diagnosed as the cause of recurrent and severe cyanotic episodes in 14 patients. Episodes started between 0.8 and 33 months of age (median 1.4) and occurred over a period of 0.8 to 20 months (median 3.5). Diagnosis was made by covert video surveillance, instituted after either (a) the observation that episodes began only in the presence of one person, or (b) characteristic findings on physiological recordings, lasting between 12 hours and three weeks, performed in hospital or at home. Surveillance was undertaken for between 15 minutes and 12 days (median 24 hours) and resulted in safety for the patient and psychiatric assessment of the parent: mother (n = 12), father (n = 1), and grandmother (n = 1). These revealed histories of sexual, physical, or emotional abuse (n = 11), self harm (n = 9), factitious illness (n = 7), eating disorder (n = 10), and previous involvement with a psychiatrist (n = 7). Management of the abusing parents is complex, but recognition of their psychosocial characteristics may allow earlier diagnosis. Imposed upper airway obstruction should be considered and excluded by physiological recordings in any infant or young child with recurrent cyanotic episodes. If physiological recordings fail to substantiate a natural cause for episodes, covert video surveillance may be essential to protect the child from further injury or death. [ABSTRACT FROM AUTHOR]

Twenty three patients (age range 0.5-40 months) with recurrent cyanotic episodes underwent physiological recordings, including transcutaneous oxygen tension (TcPO2) from a monitor modified for use at home (Kontron 821S). Of 69 episodes in which the arterial oxygen saturation (SaO2, Nellcor N200) was less than or equal to 80% for greater than or equal to 20 seconds and/or central cyanosis was present, the TcPO2 monitor alarmed (less than or equal to 20 mmHg or 2.67 kPa) in every episode. The pulse oximeter identified hypoxaemia in 62 out of 69 episodes, failing in seven episodes due to signal loss from movement artefact. In only seven of 69 episodes was there an accompanying apnoeic pause (greater than or equal to 20 seconds), and heart rate fell to less than or equal to 80 beats/minute in only five of 28 episodes in which an electrocardiogram was recorded. In 32 episodes in which SaO2 fell to less than or equal to 60%, the TcPO2 monitor alarmed after a median time interval of 16 seconds (maximum time interval 30 seconds). The TcPO2 monitor was then used in an uncontrolled trial at home in 350 patients at increased risk of sudden death and/or hypoxaemia. Indications for monitoring included apparent life threatening events or cyanotic episodes (n = 163), prematurity and prematurity related disorders (n = 86), and sudden unexpected death in one or more siblings (n = 122). The TcPO2 monitor detected cyanotic episodes at home in 81 patients, 52 of whom received vigorous stimulation and/or mouth to mouth resuscitation. Twenty one of these 52 patients had further hypoxaemic episodes documented in hospital with pulse oximetry. In 30 patients, the TcPo2 monitor also identified the gradual development of hypoxaemia, as confirmed by pulse oximetry. Twenty of these needed additional inspired oxygen and six subsequently needed ventilatory support in hospital. This TcPo2 monitor is a reliable detector of both sudden and gradual onset hypoxaemia and is able to be used by parents in the home. [ABSTRACT FROM AUTHOR]