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Eine wichtige Voraussetzung fur das Wachstum sowie die korperliche Entwicklung von Fruhgeborenen ist eine adaquate Nahrungszufuhr. Basierend auf den Ergebnissen zahlreicher Studien werden sowohl die Geschwindigkeit des Nahrungsaufbaus als auch die parenteral zugefuhrten Substratmengen z. T. kontrovers diskutiert. Ziel dieser Arbeit war es, das parenterale Ernahrungsregime bei sehr und extrem unreifen Fruhgeborenen („Very-low-birth-weight“(VLBW)-Neonaten: Geburtsgewicht

Intraventricular hemorrhage (IVH) is a major complication in preterm neonates with significant long-term morbidity and an increased mortality rate. The role of the immature coagulation system in the pathogenesis of IVH in these infants is still under debate. The aim of this study was to provide reference values for coagulation studies within the first 24h of life, and to relate these findings to the incidence of IVH.In this retrospective study, a total of 250 (male: 123/female: 127; VLBW: 150 and ELBW: 100) infants were included over a 4-year-period. Coagulation studies were performed within the first 24h of life in all infants. Multiple regression analysis was employed to demonstrate a potential association between IVH and a number of known risk and protective factors for IVH (antenatal steroids, birth weight, gender, IUGR, APGAR score at 10minutes, platelet count, INR, PTT, fibrinogen).Mean birth weight was 1047.9±305.6 (range: 320-1490g). Both cellular (platelets, nucleated red blood cells) and plasmatic coagulation parameters (INR, fibrinogen and antithrombin III) were dependent on birth weight. Moreover, INR levels (p0.05) were significantly increased in neonates with IVH of any grade. Also, INR was positively correlated with the severity of IVH (Spearman's correlation coefficient: 0.193; p=0.003). While overall fibrinogen levels were not associated with IVH, a fibrinogen level100mg/dL significantly increased the risk for IVH (p0.01).Our data provide a robust set of reference values for both cellular and humoral coagulation studies in VLBW and ELBW infants for the first 24h of life. The results of our study indicate that abnormal INR levels and fibrinogen levels100mg/dL are significantly associated with the occurrence of IVH in this susceptible cohort.

To assess the incidence of cardiac and metabolic adverse events in very low birth weight (VLBW) infants receiving systematic steroids.Prospective single centre audit in VLBW infants (1,500 g) at the neonatal intensive care unit at the University Children's Hospital of Saarland, Germany.A total of 72 VLBW infants (38 female) were included in this report (mean birth weight: 967 ± 338 g; range: 320-1490 g). Birth weight, gestational age and Apgar scores were significantly lower in the steroid group (p0.01). Mortality rate was 8/72 (7/34 in the steroid treated vs nontreated 1/38; odds ratio [OR]: 9.6; 95% confidence interval [CI]: 1.1-82.6 p = 0.02). In 34/72 infants, steroids were given (22 hydrocortisone alone; 12 combination of hydrocortisone and dexamethasone). The most common indication for use of steroids was respiratory distress syndrome (RDS) and respiratory insufficiency (30/34). Adverse events that occurred more often in the steroid group included hypertrophic cardiomyopathy (14/34 vs 0/38; p0.001); thrombus formation (8/34 vs 1/38; OR: 11.4; 95% CI: 1.3-96.6; p0.05), hyperglycaemia (27/34 vs 3/38; OR: 45.0; 95% CI: 10.6-190.4; p0.01), hypernatraemia (15/34 vs 7/38; OR: 3.5; 95% CI: 1.2-10.1; p0.05), and sepsis/infections (8/34 vs 1/38; OR: 11.4; 95% CI: 1.3-96.6; p0.05). No significant differences were seen between hydrocortisone alone and the combination of hydrocortisone with dexamethasone. Birth weight and severity of RDS were predictors of steroid use (p0.01).The use of steroids was significantly associated with severe short-term adverse events - most importantly hypertrophic cardiomyopathy and thrombus formation. These complications must be taken into consideration when administering steroids to VLBW infants.

Children suffering from cancer may experience short episodes of respiratory distress and/or chronic impairment in pulmonary function. Pulmonary dysfunction may be primarily disease-related, but it may also result secondarily from treatment. Emergencies with critical respiratory dysfunction in childhood cancer include mechanical obstruction of vital anatomical structures and hyperleukocytosis syndrome. This paper focuses on the most relevant causes of respiratory distress and lung injury in pediatric oncology patients and bone marrow transplant patients. Infectious causes, lung disease resulting from anti-neoplastic agents, and bone marrow transplant-related pulmonary dysfunction are emphasized. A review of the literature pertinent to this subject is given.