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Hintergrund: Wenn ein Kind infolge einer schweren Erkrankung intensive Pflege und medizinische Versorgung braucht, ist das für Eltern traumatisch. Dies wird für sie noch herausfordernder, wenn eine technisch hochspezialisierte Therapie, wie die extrakorporale Membranoxygenierung (ECMO) auf der pädiatrischen Intensivstation nötig ist. Ziel: Das Ziel der Studie ist, aus den Erfahrungen betroffener Eltern typische Muster für deren Bedürfnisse sowie entsprechende Handlungsoptionen von Gesundheitsfachpersonen abzuleiten. Methode: Die qualitativ-explorative Studie untersuchte mit narrativen Paarinterviews die Erfahrungen von sechs Elternpaaren, deren Kind eine ECMO erhält oder im vergangenen Jahr erhalten hat. Die Transkripte wurden mithilfe intensiven Paraphrasierens und induktiven Kodierens analysiert. Ergebnisse: Die Situation der Eltern ist geprägt durch das Phänomen der Ambivalenz mit den gleichzeitigen Gefühlen von Hoffnung und Angst. Sie erkennen die Lebensgefahr ihres Kindes, was zu einer großen Hilflosigkeit mit starken emotionalen Reaktionen führt. Es zeigt sich, dass es zu wenig Passung zwischen der Gefühlswelt der Eltern und den Handlungsmustern der Gesundheitsfachpersonen gibt. Schlussfolgerungen: Die Denklogik der Gesundheitsfachpersonen baut auf professionellen Kriterien, wie der Lebensbedrohung und den Risiken der ECMO auf, welche die emotionalen Bedürfnisse der Eltern außer Acht lässt. Aus dem Grund ist es wichtig, sensibler auf die Eltern zu zugehen und auch positive kleine Zeichen zum Gesundheitszustand und der Leidensfähigkeit ihres Kindes mit ihnen zu teilen. Schlüsselwörter: Qualitative Forschung, Eltern, pädiatrische Intensivstation, ECMO, Erfahrung, Background: It is a traumatic experience for parents when their child's severe illness necessitates a period of intensive care. This situation becomes even more challenging for parents if a highly technical therapy such as extracorporeal membrane oxygenation (ECMO) in the Pediatric Intensive Care Unit is required. Aim: The study explores the experiences of parents of critically ill children undergoing ECMO therapy with the aim of better understanding their needs and identifying courses of action for healthcare professionals. Method: The qualitative-explorative study was based on interviews with six couples whose critically ill child is or has been receiving ECMO during the last year, which were used to examine their experiences. The analysis of six such interviews was performed using intensive paraphrasing and inductive coding. Results: The parents' situation can be best characterised as ambivalent with simultaneous feelings of hope and fear. They recognize the danger to their child's life, leading to intense feelings of helplessness with strong emotional reactions. It becomes apparent that there is too little fit between the emotional world of the parents and the action patterns of the health care professionals. Conclusions: The health care professionals thinking logic is based on professional criteria, such as the life threat and risks of ECMO, which ignores the emotional needs of the parents. For this reason, it is important to be more sensitive to the parents and to share positive little signs about their child' s state of health and ability to suffer with them. Keywords: Qualitative research, parents, pediatric intensive care unit (PICU), ECMO, experience

Recently, there is a growing scarcity of qualified personnel in German healthcare system. This can lead to problems especially in the highly specialized neonatal and pediatric intensive care.We conducted a survey to evaluate the staffing situation at 583 European neonatal and pediatric intensive care units (ICU).Response rate was 48.5%. As a main result our evaluation demonstrated a significant lower nurse-staffing in Germany compared to the other countries (90.4 vs. 95.8%, p0.001). In addition, the average nurse-to-patient ratio was worse in German neonatal ICUs (3.0 vs. 2.3, p0.001). The presence of senior doctors is also lower in German neonatal and pediatric ICUs compared to the other countries (on weekdays: 12.0 vs. 14.6 h, p=0.04; on weekends: 8.9 vs. 13.2 h, p=0.003).Our survey demonstrates that the nurse-staffing at neonatal and ICUs in Germany is worse than in other European countries. The resulting potential loss of quality is worsened due to lower presence of senior doctors at the ICUs. Possible consequences include increase of complications, impairment of treatment success, closure of intensive care beds, and mental and physical illness of the staff.Compared to other European countries, there is a lack of nurses at neonatal and pediatric ICUs in Germany. This study underlines the importance to take measures to counteract nursing crisis.In den vergangenen Jahren zeichnet sich ein zunehmender Fachkräfte- und Pflegemangel im Gesundheitswesen der Bundesrepublik Deutschland ab. Insbesondere im hochspezialisierten Bereich der neonatologischen und pädiatrischen Intensivmedizin kann dies zu Versorgungsengpässen führen.Wir führten eine Umfrage zur Erfassung der Personalsituation auf 583 neonatologischen und pädiatrischen Intensivstationen in Europa durch.Die Rücklaufquote betrug 48,5%. Als wesentliches Ergebnis zeigte sich in Deutschland eine geringere Stellenbesetzung im pflegerischen Bereich im Vergleich zu den anderen teilnehmenden Ländern (90,4% gegenüber 95,8%, p0,001). Zudem werden in Deutschland durchschnittlich mehr neonatologische Patienten pro Pflegekraft versorgt (3,0 gegenüber 2,3, p0,001). Die Anwesenheit von Fach- und Oberärzten ist auf deutschen Intensivstationen werktags (12,0 h gegenüber 14,6 h, p=0,04) und am Wochenende (8,9 h gegenüber 13,2 h, p=0,003) geringer als in den anderen Ländern, wobei länderübergreifend der Wunsch nach einer längeren Facharztanwesenheit besteht.Unsere Ergebnisse zeigen eine im internationalen Vergleich schlechtere Besetzung von Pflegestellen auf neonatologischen und pädiatrischen Intensivstationen in Deutschland. Der dadurch drohende Qualitätsverlust in der Patientenversorgung wird dadurch verstärkt, dass im Vergleich in Deutschland vergleichsweise weniger Zeit durch fach- und oberärztliche Anwesenheit abgedeckt wird. Mögliche Folgen sind Zunahme von Komplikationen mit Gefährdung des Behandlungserfolgs, Versorgungsengpässen und psychischen sowie physischen Erkrankungen der Mitarbeiter führen.Im internationalen Vergleich zeigt sich ein Fachkräftemangel auf neonatologischen und pädiatrischen Intensivstationen in Deutschland. Dies unterstreicht die Notwendigkeit von energischen Maßnahmen zur Beseitigung des Pflegenotstands und Prävention eines drohenden Ärztemangel.

As an alternative to ambulatory 24-h blood pressure monitors, the continuous, non-invasive blood pressure recording using pulse transit time (PTT) was compared with both oscillometric and intra-arterial measurement.In 144 pediatric patients (9.4±5.2 years) acute blood pressure was determined using three different methods of measurement. In 57 patients (11.4±4.9 years) of the pediatric normal ward, the blood pressure was simultaneously determined continuously by means of PTT compared to the intermittent oscillometric long-term measurement. In 9 patients (9.8±6.8 years) of the pediatric intensive care unit with continuous intra-arterial blood pressure measurement, the blood pressure was measured in parallel by means of PTT.Compared to the gold standard sphygmomanometry, mean systolic blood pressure values were comparable to 2 different oscillometric devices, but in the case of diastolic pressure measurement the pressure values were significantly lower or higher than with sphygmomanometry and auscultation. The results of the non-invasive comparative long-term measurements showed better correlations for systolic rather than diastolic pressure. Similar results were obtained comparing the direct intra-arterial blood pressure measurement with the SOMNOtouch™ NIBP device which measures blood pressure using the PTT.Continuous, indirect blood pressure recording using pulse transit time provides good correlations to the reference measurements for long-term measurement of blood pressure in children and adolescents and appears to be a usable method to measure the blood pressure of children especially at rest.Alternativ zu ambulanten 24h-Blutdruckmessgeräten wurde die kontinuierliche, nicht-invasive Blutdruckaufzeichnung mittels Pulswellenlaufzeit bzw. Puls -Transit-Zeit (PTZ) sowohl mit oszillometrischen als auch intraarteriellen Messmethoden verglichen.An 144 pädiatrischen Patienten (9,4±5,2 Jahre) wurde der akute Blutdruck mithilfe von 3 verschiedenen Messmethoden ermittelt. An 57 Patienten (11,4±4,9 Jahre) der pädiatrischen Normalstation wurde simultan der Blutdruck kontinuierlich mittels PTZ im Vergleich zur intermittierenden oszillometrischen Langzeitmessung bestimmt. Bei 9 Patienten (9,8±6,8 Jahre) der pädiatrischen Intensivstation mit kontinuierlicher intraarterieller Blutdruckmessung wurde der Blutdruck parallel mittels PTZ gemessen.Verglichen mit dem Goldstandard der Sphygmomanometrie, waren die mittleren systolischen Blutdruckwerte mit 2 verschiedenen oszillometrischen Messgeräten vergleichbar, aber bei der diastolischen Druckmessung waren die Druckwerte signifikant niedriger bzw. höher als mit der Sphygmomanometrie und Auskultation. Die Ergebnisse der nicht-invasiven vergleichenden Langzeitmessungen zeigten insgesamt bessere Korrelationen für den systolischen als für den diastolischen Druck. Ähnliche Ergebnisse ergab der Vergleich der direkten intraarteriellen Blutdruckmessung mit dem SOMNOtouch™ NIBP -Messgerät, das den Blutdruck mittels PTZ misst.Die kontinuierliche, indirekte Blutdruckaufzeichnung mittels PTZ liefert im Vergleich zur Langzeitmessung des Blutdrucks bei Kindern und Jugendlichen gute Korrelationen zu den Referenzmessungen und scheint eine brauchbare Methode, v. a. in Ruhe den Blutdruck bei Kindern zu messen.

According to the current update of the German guideline on brain death (BD), participation of paediatricians is now mandatory for the examination of BD in patients younger than 14 years. The present analysis focuses on the previous practice and highlights the challenges that arise from the current update.Retrospective evaluation of the patient registry of the German organ procurement organisation (north-eastern bureau) between January, 2001 and December, 2010 with specified paediatric age groups according to the 4th update of the German guideline on BD from the 1st of July 2015.133 patients (0-17 years) received at least one BD examination. Secondary brain damage was most frequent within the first 6 months of life whereas traumatic and other causes of primary brain damage were predominantly observed thereafter. The number of patients who received BD examination by paediatricians or were treated on neonatal/paediatric intensive care units declined with increasing age. In more than two-third of all paediatric patients, no paediatrician was involved in BD diagnostics.After enforcement of the 4th update of the German guideline on BD, the participation of qualified paediatric physicians must be increased significantly compared to previous practice. Advancements in the specialist training of paediatric physicians, adjustments in patient-centered paediatric care and interdisciplinary diagnostic teams may be solutions to meet this demand.Gemäß der 4. Fortschreibung der Richtlinie zur Feststellung des irreversiblen Ausfalls der Gesamtfunktion des Großhirns, des Kleinhirns und des Hirnstamms muss bis zum vollendeten 14. Lebensjahr ein Facharzt für Kinder- und Jugendmedizin mit entsprechender Zusatzqualifikation an der Diagnostik mitwirken. In dieser retrospektiven Analyse soll untersucht werden, wer die Diagnostik bislang durchführte und welche Herausforderungen sich aus der aktuellen Richtlinie ergeben.Retrospektive Auswertung des Patientenregisters der Deutschen Stiftung Organtransplantation (Organisationszentrale Nordost) aus den Jahren 2001–2010 unter Berücksichtigung der Vorgaben der 4. Fortschreibung vom 01. Juli 2015.133 Patienten im Alter von 0–17 Jahren erhielten Diagnostik zur Feststellung des irreversiblen Ausfalls der Hirnfunktion. Ätiologisch dominierten in den ersten 6 Lebensmonaten sekundäre Hirnschädigungen, während danach traumatische und andere primäre Hirnschäden überwogen. Mit zunehmendem Alter sank der Anteil der Patienten, die auf neonatologischen/pädiatrischen Intensivstationen behandelt wurden bzw. Diagnostik durch Fachärzte für Kinder- und Jugendmedizin erhielten, kontinuierlich ab. Diese Fachärzte waren bei mehr als zwei Dritteln der pädiatrischen Patienten nicht an der abschließenden Feststellung des irreversiblen Hirnfunktionsausfalls beteiligt.Seit Inkrafttreten der 4. Fortschreibung müssen intensivmedizinisch ausgebildete und mit dem diagnostischen Vorgehen vertraute Fachärzte für Kinder- und Jugendmedizin wesentlich häufiger an der Feststellung des irreversiblen Ausfalls der Hirnfunktion mitwirken. Diesbezüglich sollten die ärztlichen Weiterbildungsordnungen weiterentwickelt, die Versorgungsstrukturen angepasst und Konsiliardienste etabliert werden.

Many publications, mainly from other countries, suggest that the treatment of seriously injured children might be better in specialised paediatric trauma centres than in general trauma centres. Data from Germany are not available yet, but those from abroad were used for the recommendations made by the German Association for Trauma Surgery (DGU) on the topic of paediatric trauma in the "White Paper on Trauma Care". The goal of this study was to analyse whether the outcome of severely injured children is dependent on treatment level and on the availability of a paediatric surgeon based on the given data.Data from the "TraumaRegister DGU" between 2002 and 2012 were used. Children aged 1-15 years treated during the period 2002-2012 were included. Severity had to reach a minimum Injury Severity Score (ISS) of 9 and the treatment had to involve a stay at an Intensive Care Unit. Patients with an ISS ≥9 who died were also included to take into consideration children with particularly severe injuries.Hospitals without a paediatric surgeon transferred the patients significantly more frequently (p 0.001). Mean hospital stay was shorter in centres with a paediatric surgeon, with slightly longer median stays at an Intensive Care Unit. Hospitals without a paediatric surgeon performed slightly more frequent surgical interventions on injured children (barely significant at p = 0.045). The death rate and the calculated Revised Injury Severity Classification (RISC) II prognosis were the same with or without the presence of a paediatric surgeon. No difference was found in the Glasgow Outcome Score (GOS) between the group with and the group without involvement of a paediatric surgeon.Overall, the medical care of seriously injured and polytraumatised children in Germany is good at all levels of treatment whether a paediatric surgeon is involved or not.

The development of the Glamorgan Paediatric Pressure Ulcer Risk Assessment Scale was based on empirical data. This instrument was translated into German for application in a hospital in Berlin. Psychometric properties of scale scores of the German version in a paediatric intensive care setting are unknown. In the current study, 24 nurses rated the pressure ulcer risk of 20 children based on the Glamorgan Scale and on a visual analogue scale (VAS) independently from each other. Interrater reliability was assessed using kappa and intraclass correlation (ICC) coefficients. The kappa values for item scores ranged from 0.21 to 0.69. Interrater reliability of the Devices item score was zero. The ICC of the Glamorgan scale sum score was 0.43 (95%-CI: 0.16 - 0.69) and 0.34 (95%-CI: 0.01 - 0.67) for the VAS score. The correlation between Glamorgan Scale sum scores and VAS scores was 0.78. Results indicate high relative errors in sum and item scores in this paediatric intensive care setting. Glamorgan scale sum and item score seem to be of minor value in supporting individual clinical decision making. It is highly probable that this was caused by the homogeneity of the investigated sample of children.

As immunization coverage of varicella vaccination is low, the disease is still very frequent in Austria. Albeit the prognosis in general is good, the incidence of varicella-related hospitalization is about 6 per 100,000 in all children between 0-15 years of age, affecting mainly previously healthy children. Especially young children under the age of 5 are at risk with highest rates among children younger than one year. The most common complications are secondary bacterial infections, neurological and respiratory complications. Two cases of life threatening secondary bacterial infection are presented. One child suffered from a Toxic Shock Syndrome caused by group A streptococcus along with large necrotizing skin lesions. The second child nearly lost her left eye due to a deep orbital abscess. Both children survived without severe sequelae but had to undergo several procedures of plastic surgery. Implementation of the varicella vaccination program in the USA has shown a near elimination of deaths due to severe varicella complications. The initiation of the varicella vaccination program for children until the age of 2 in Austria should be considered to prevent complications and deaths caused by varicella.

The role of diagnostic imaging in pediatric intensive care units (PICU) includes primary diagnosis, monitoring of the patient's progress, and the assessment of interventional procedures. Images should be acquired in the PICU, not only to minimize the time interval between image acquisition and image interpretation but also in order to avoid unnecessary and maybe harmful transportation of the patient. Portable, optimized equipment is warranted. Most images are acquired as conventional X-ray examinations. Thorough consideration of radiation protection based on optimized equipment also includes the protection of relatives and other children in the PICU room. Ultrasound is an expanding imaging modality adjunct or as alternative to conventional X-ray examinations, which allows the generation of functional information (color-coded duplex, elastography). Fluoroscopy, computed tomography, and magnetic resonance imaging are available as advanced diagnostic modalities in special circumstances, but require transportation of the patient.

Having an ill child that is being treated in a pediatric intensive care unit (PICU) is tremendously stressful for the parents, both physically and emotionally. To help them cope with the circumstances they find themselves in, parents often develop expectations which are addressed to the team of the PICU, and which they find important to be fulfilled. Many of these expectations are culturally shaped. At present, there exist no data from German speaking area. Thus, this qualitative study was undertaken to fill this gap. Episodic interviews were conducted with five mothers and two fathers. Using the content analysis technique described by Mayring, one main category and six subcategories emerged from the data. "Concering about the sick child" was of particular importance for the parents. Their own expectations were reflected in the six subcategories: "Knowing that the child is receiving good care", "Being with the child", "Being involved", "Experiencing care for oneself and one's child", "Being informed" and "Experiencing continuity". These results are congruent with prior research reported in the international literature. Having a desire for a continuous medical support and the clear separation of roles between physicians and nurses are new findings from this investigation which have not been described previously.

Important prerequisites to adequately treat pediatric patients with multiple trauma are a profound knowledge of the underlying mechanisms of injury, common injury patterns and the associated mortality. The younger the child the more injury patterns as well as organ-specific injury severity differ in comparison to adult trauma patients. Traumatic brain and thorax injuries are the key to the prognosis of the injured child. Abdominal injuries rarely require surgery in contrast to adults. Spine and pelvic injuries as well as injuries of the extremities make age-adapted surgical procedures mandatory. The present article describes the established primary diagnostic evaluation after admittance to the emergency room as well as specific treatment options for particular organ systems with respect to age-specific anatomical characteristics and pitfalls in children.

In the last time the alcohol consumption among children and adolescents is a big theme in all kind of media. The ethanol consumption among children and adolescents has risen during the last years, but also new hazardous drinking patterns like "binge-drinking" are increasing. These drinking episodes are responsible for many hospital presentations of children and adolescents with acute ethanol intoxication.This study is a retrospective analysis of 173 patients admitted to the university children hospital of Leipzig due to acute ethanol intoxication during the period 1998-2004. Investigated parameters were: socio-demographic factors, clinical presentation and management as well as quantity and type of alcohol.During the years 1998-2004 the rate of alcohol intoxicated patients in this study increased, from 1998-2003 at about 171.4%. Totally 173 patients with an average age of 14.5 years were admitted to the university children hospital. There were significantly more boys than girls. The mean blood alcohol concentration of these patients was 1.77%. Some of the patients had severe symptoms. 62 were unconscious, 2 were in coma and at least 3 patients had to be ventilated. A difference between socioeconomic groups could be observed by comparing the different school types. 44.8% of the patients went to the middle school. Furthermore 17 patients of this study had mental disorders or psychosocial problems and were therefore in psychological or psychiatric treatment.In this study a significant influence of social classes or psychosocial problems on alcohol consumption such as binge-drinking leading to acute ethanol intoxication could not be found. Alarming is the increasing number of ethanol intoxicated patients, the young age, the high measured blood ethanol concentrations and the severe symptoms of these patients. This is the reason why early and intensive prevention strategies are required.