Search

ZusammenfassungIn Deutschland kommen rund 1,4 % aller Neugeborenen mit einem Gewicht unter 1500 g zur Welt. Im Jahr 2015 waren das 9484 Kinder, von denen 87 % lebend nach Hause entlassen werden konnten. Seit 2006 schreibt der Gemeinsame Bundesausschuss eine Nachuntersuchung dieser Kinder im Alter von 2 Jahren vor, etwa mit den Bayley Scales of Infant Development. In diesem Alter lassen sich Zerebralparesen relativ sicher diagnostizieren, Aussagen zur kognitiven Entwicklung sind aber erst mit etwa 4–5 Jahren einigermaßen verlässlich. Längsschnittdaten aus Niedersachsen der Jahrgänge 2004–2008 weisen nur in 73 % eine übereinstimmende Klassifizierung der gleichen Frühgeborenen (FG) im Alter von 2 und 5 Jahren auf. Die landesweiten Berliner Einschulungsuntersuchungen im Alter von 5–6 Jahren weisen bei 36 % der Kinder unter 750 g Geburtsgewicht und bei 22 % der Kinder zwischen 750 und 1500 g Geburtsgewicht auf einen sonderpädagogischen Förderbedarf hin (gegenüber 5 % bei normalgewichtigen Neugeborenen). Im Alter von 26 Jahren hatten ehemalige Frühgeborene der Bayerischen Entwicklungsstudie (Jahrgänge 1985/86) einen um 7–15 Punkte verringerten Intelligenzquotienten gegenüber Reifgeborenen (RG), sie neigten mehr zu sozialen Ängsten, hatten Schwierigkeiten, einen Partner bzw. eine Part-nerin zu finden und waren häufiger von ihren Eltern abhängig als Kontrollpersonen.

ZusammenfassungWährend effektive Präventionsstrategien zu einem deutlichen Rückgang der meisten vertikalen Infektionen geführt haben (Röteln, HIV, Hepatitis B, Lues, B-Streptokokken), dürften jedes Jahr in Deutschland mehrere Tau-send Kinder mit einer konnatalen Zytomegalie-Virus (CMV)-Infektion auf die Welt kommen, von denen schätzungsweise 90 % jedoch nicht diagnostiziert werden. Während in Mitteleuropa jeweils rund die Hälfte der konnatalen CMV-Infektionen Kinder betrifft, deren Mütter ihre CMV-Erstinfektion entweder in der Schwangerschaft oder bereits vor der Schwangerschaft durchgemacht haben, erreicht der Anteil fetaler CMV-Infektionen bei prägravider mütterliche CMV-Infektion in Ländern mit höheren durchschnittlichen Familiengrößen über 90 %. Die Transmissions-rate steigt mit der Schwangerschaftsdauer an, während die fetale Erkrankungsschwere abnimmt. Bei Erkrankungen vor allem im ersten und zweiten Trimenon kann es zu Hydrops fetalis, hämolytischer Anämie und Gehirnfehlbildungen kommen. Ist die Erkrankung bei Geburt noch in einem floriden Stadium, bietet sich das Bild eines „blueberry muffin“-Babys mit extramedullären Hämatopoiese-Herden in der Haut. Auch bei Geburt asymptomatisch erscheinende Kinder mit konnataler CMV-Infektion können im Laufe des ersten Lebensjahres einen sensorineuralen Hörverlust erleiden (zweithäufigste Ursache nicht syndromalen Hörverlustes nach Connexin-26-Mutationen). Der hypothetische Wert einer pränatalen spezifischen ImmunglobulinGabe wird gegenwärtig in zwei randomisierten Multicenterstudien geprüft, die Behandlung wird dennoch vielerorts von den Krankenkassen übernommen. Bei Neugeborenen mit symptomatischer CMV-Infektion lässt sich ein konsekutiver Hörverlust durch Behandlung mit Ganciclovir bzw. dem oral applizierbaren Valganciclovir in vielen Fällen verhindern, Aussagen zu Neugeborenen mit asymptomatischer konnataler CMV-Infektion sind mangels Screenings derzeit nicht möglich.

While infants with trisomy 13 (T13) and trisomy 18 (T18) are known to die early, parents want to know more about life expectancy and quality of life.30-year single-center retrospective chart analysis (1980-2010) of cytogenetically confirmed T13 and T18 cases. Mothers of infants who had lived 3 months or longer were approached to judge their infant's quality of life and talk about their experiences with medical staff.Data of 18/20 T13 infants and 18/21 T18 infants could be retrieved. Median survival times were 5 d for T13 and 19 d for T18. One T13 and 2T18 children survived past 1 year. Out of 5 mothers whose infants had survived at least 3 months, 4 described their infant as friendly, happy and peaceful. They observed some degree of psychomotor development and were in favour of the numerous medical and surgical interventions performed. They wished to have had a doctor coordinating these interventions and missed an active offer for psychological help.While most infants with T13 or T18 die as neonates, mothers of infants surviving longer periods of time have positive memories about their infants' quality of life.

Transverse-field measurements of the muon-spin precession frequency and relaxation rate in liquid supercooled and solid Co 1−x Pd x (0.1⩽x⩽0.3) show the characteristic behaviour of a ferromagnet. On decreasing the sample temperature from above its Curie-temperature TC, the precession frequency decreases, while the relaxation rate increases and diverges on approaching TC. Close to TC the temperature dependence of the inverse frequency shift is in good agreement with susceptibility measurements. In the solid phase, the magnetic field at the muon strongly decreases with the addition of palladium; for x=0.2 it is only 10% of the field in pure cobalt.

By means of a new electromagnetic levitation apparatus the magnetization of solid cobalt, Co80Pd20 and liquid undercooled Co80Pd20 was measured in an external field of up to 60 mT close to the critical temperature. From this the ferromagnetic Curie temperature of the liquid phase TC(l)=1251 K could be determined. Following the extrapolation method of Arrott–Belov–Kouvel and using a modified Arrott plot the zero field susceptibility was computed yielding the effective exponent γ(T). Extrapolation of T→TC resulted in a critical exponent of γ=1.42±0.05 for the liquid ferromagnet in accordance with the Heisenberg model. While the temperature-dependent behavior at T>TC for crystalline cobalt results in a monotonic decrease to the molecular-field value 1, the chemically disordered alloy Co80Pd20 shows a distinct, sharp maximum in γ(T). In comparison, liquid Co80Pd20 has a broad maximum well above TC as already known for amorphous ferromagnets.

Records of the only children's hospital equipped to perform exchange transfusions in West Berlin were used to identify all 29 non-hemolytic healthy term newborns with total serum bilirubin between 20 and 30 mg/dL, 16 of whom were available for follow-up neurological examination according to Touwen. Compared to 18 case controls with bilirubin

Liquid samples of Co80Pd20 were cooled below their liquidus temperature Tl and supercooled towards the paramagnetic-ferromagnetic transition temperature TC(l) by means of the Electromagnetic Levitation (EML) technique. Muon-Spin Rotation (μSR) measurements were used to determine the spin precession frequency f and the transverse muon-spin relaxation rate Γ in the liquid supercooled sample at temperatures T > TC(l). Γ increases by a factor of 5 when T approaches TC(l), indicating large spin fluctuations caused by the onset of spontaneous magnetization. The temperature dependence of the inverse frequency shift Δf−1 reflects a Curie-Weiss behaviour of the paramagnetic susceptibility. The experiments strongly suggest the existence of ferromagnetic ordering in a liquid metal.

Patienten mit einem unkorrigiertem zyanotischen Vitium konnen eine eingeschrankte Nierenfunktion entwickeln und tragen ein erhohtes Risiko fur die Entwicklung eines akuten Nierenversagens nach Operation am offenen Herzen. In einer prospektiven Studie untersuchten wir uber einen Zeitraum von pra- bis 3 Tage postoperativ 6 adolezente oder adulte Patienten nach Operation eines zyanotischen Vitium cordis. Als Kontrollgruppe dienten adulte Patienten mit einem azyanotischen Vitium. 3 der 6 zyanotischen Patienten hatten praoperativ Zeichen einer renalen Glomerulopathie mit erhohter Albuminkonzentration im Urin und in 2 Fallen auch mit erhohten Urinkonzentrationen von Transferrin und Immunoglobulin G. Diese 3 Patienten entwickelten postoperativ ein akutes Nierenversagen mit Dialysepflichtigkeit am 1. und 4. Tag nach der Operation. Die ubrigen 3 Patienten hatten praoperativ normale Urineiweiskonzentrationen und entwickelten postoperativ kein akutes Nierenversagen. Die Urinkonzentrationen von Albumin, L-Selectin (sCD62L), Transferrin, Immunoglobulin G (IgG), α1-Mikroglobulin (α1-M) und die Aktivitat der β-N-Acetyl-Glukosaminidase (NAG) blieben in der postoperativen Periode bei den Patienten mit azyanotischen Vitien im Normbereich und waren bei den 3 zyanotischen Patienten ohne akutes Nierenversagen gering erhoht. Bei den 3 zyanotischen Patienten mit akutem Nierenversagen stiegen als Zeichen der vermehrten glomerularen Schadigung die postoperativen Urinkonzentrationen nach 24 Stunden auf uber 1000 mg Albumin/gKrea, uber 150 mg Transferrin/gKrea und uber 200 mg IgG/gKrea. Als Zeichen zusatzlicher tubularer Nierenschadigung war der Anstieg der β1-M-Urinkonzentration auf uber 1000 mg/gKrea und der NAG-Aktivitat im Urin auf uber 100 U/gKrea zu werten. Patienten mit unkorrigiertem zyanotischen Vitium cordis und Proteinurie als Ausdruck eines “zyanotischen” glomerularen Nierenschadens haben ein hohes Risiko fur die Entwicklung eines postoperativen akuten Nierenversagens in den ersten Tagen postoperativ. Diese Entwicklung kann fruh postoperativ an einer exzessiven Proteinurie erkannt werden.

Miniaturized electromagnetic levitation has been used to undercool a liquid Co 80 Pd 20 alloy below the Curie temperature T C (l) = 1257 K of the liquid state. The magnetization of the undercooled liquid sample has been measured as a function of temperature using a modified Faraday balance. Below T C (l), the magnetization of the liquid metal shows a plateau in the weak external field of μ 0 H z = 5.6 mT. The effect is comparable to the behaviour of the corresponding solid phase, indicating the onset of spontaneous magnetization with ferromagnetic domains. T C (l) is about 20 K lower than the Curie temperature of the solid phase T C (s).

Language barriers hinder the interaction with patients and relatives. The use of language services increases knowledge, satisfaction and the use of medical care and thus improves patient's clinical outcome. The recommended use of professional interpreters (PI) is not always feasible. We tested an online translation tool as an alternative for PI for the transla-tion of standardized sentences from a neonatal doctor-/nurse-relative-interview.Translation of 20 sentences from a German neonatal intensive care unit parent information brochure to English, Portuguese and Arabic, using Google Translate (GT). Assessment of accuracy concerning grammar and content, in a second step simplification of all incorrect sentences, translation by GT and critical re-assessment and evaluation.An average of 42% of the sentences was correctly translated concerning grammar and content. The proportion of incorrectly translated sentences varied between 45-70%. By simpli-fication another 23% were translated correctly.Translations by GT were often incorrect in content and grammar. We suppose that the design of GT, which is a statistical translation engine, might be an explanation for this phenomenon. Presently, GT cannot guarantee unambiguous translations and cannot substitute PIs, only in particular circumstances, the use of GT or similar engines may be justified. For future use of electronic translation services, we suggest to compile a catalogue of sentences containing central information, which can be translated into defined foreign languages without misinterpretation or loss of information.

Neonatal end-of-life care and family-centred bereavement support in perinatal medicine are a multiprofessional challenge directed to the dying newborn and the parents as well as to the care-givers. Clinical experience shows that many aspects of individual neonatal end-of-life care and family-centred bereavement support are not well known to the health-care providers. This is especially true for a standardised quality management and the components of bereavement support offered to parents. An interdisciplinary concept for an individual neonatal end-of-life care and famlily-centred bereavement support has been developed at the Center of Perinatal Medicine at the Charité, Berlin. The concept aims for two main aspects: (1) meeting the individual medical, psychological, emotional and spiritual needs of the dying newborn, the parents and family, and (2) facilitating standardised and process-orientated preparation, evaluation and reflexion of every case of end-of-life care. In this article some recommendations for implementing a basic care concept for families and their dying newborns are presented.

Positron annihilation measurements have been performed in solid, liquid and undercooled Co80Pd20 alloy using electromagnetic levitation as containerless processing method. The formation enthalpy for a single vacancy is H1v = (1.7 ± 0.1) eV. In the melt, the thermal expansion continues linear in the undercooled phase and is larger than that of the solid alloy. The mean free volume in the liquid phase is slightly larger than the volume of a single vacancy. At the Curie temperatures of both solid and liquid phase, the S-parameter indicates no effect on the atomic structure. Different H2 concentrations in the processing gas atmosphere have no detectable influence on the data.

Protocols recommended in the USA and Germany for the postnatal treatment of congenital toxoplasmosis are mainly based on the National Collaborative Chicago-based Congenital Toxoplasmosis Study that calls for daily administration of pyrimethamine in combination with sulfadiazine for several months, then 3 times a week. The recommended total duration of treatment is 12 months. This scheme necessitates frequent white blood cell counts that often result in the discontinuation of treatment because of severe neutropenia even with the concomitant administration of folinic acid. In contrast, the administration of pyrimethamine with sulfadoxine every 2 weeks for 2 years, as used by a referral centre in Toulouse, France, is associated with less toxicity. The efficacy may even be improved, as judged by the rate of new chorioretinal lesions. In the absence of larger randomised studies the Toulouse protocol appears to have several advantages when a decision has to be made to treat infants with congenital toxoplasmosis.

L-selectin, a cell surface glycoprotein expressed on lymphocytes, granulocytes, and monocytes, has been implicated in lymphocyte homing and extravasation of phagocytic leukocytes into areas of inflammation. Considerable differences of L-selectin expression among various individuals has been reported, with clinical correlations to perinatal events, maturation, and circadian rhythm. In this study, L-selectin expression of various white blood cells was found to be differentially sensitive to ficoll-hypaque or percoll density gradient centrifugation. After density gradient centrifugation, a significant loss of median monocyte L-selectin expression was observed when compared to time and temperature-matched controls or results obtained by whole blood incubation with anti-L-selectin monoclonal antibodies followed by simultaneous leukocyte fixation and red cell lysis. Mock treatment itself was associated with a variable L-selectin loss of monocytes but not lymphocytes or granulocytes. Ficoll-hypaque or percoll density gradient centrifugation resulted in significant L-selectin down-regulation of lymphocytes while granulocytes separated from lymphocytes and monocytes by ficoll-hypaque or percoll retained full L-selectin surface reactivity. L-selectin downregulation was seen also after colloid sedimentation with hydroxy-ethyl starch. It is concluded that unseparated blood should be used for measuring L-selectin expression.

Methylnaltrexone, a peripherally acting µ-opioid receptor antagonist, has been studied in adults for the treatment of opioid-induced constipation in advanced illness. Here, the authors document the first neonate to receive methylnaltrexone in an attempt to resolve morphine-induced urinary retention. An asphyxiated term newborn infant underwent induced hypothermia and received morphine by continuous intravenous infusion. After 36 h, the patient developed progressive urinary retention (calculated bladder volume 63 ml), followed by venous congestion of the lower extremities. Attempted bladder catheterisation was unsuccessful. Voiding occurred within 20 min after intravenous administration of methylnaltrexone (0.15 mg/kg body weight). A relapse of urinary retention 24 h later responded well to a second dose of methylnaltrexone. There were no adverse effects and no opioid withdrawal symptoms. The neonate had normal findings in cranial MRI that was performed after elective cessation of induced hypothermia.

Directed migration of lymphocytes from blood into lymph nodes and gut-associated lymphatic tissue, also referred to as homing, is subject to change following activation. Lymphocyte migration into lymphoid organs in vivo and binding to high endothelial venules in vitro is largely suppressed after short-term stimulation with phorbol esters. The observed functional alterations were correlated with changes in the expression of three putative homing receptors, LECAM-1 (MEL-14 antigen), LPAM-1/2 (alpha 4-integrin) and the murine CD44 (Pgp-1, H-CAM, Hermes-antigen equivalent) upon different modes of cellular activation. Expression of LECAM-1 (gp90 MEL-14), a lymphocyte adhesion molecule implicated in targeting extravasation into lymph nodes, was found to be lost almost completely within minutes after protein kinase C activation. LECAM-1 re-expression occurred within less than 24 h. Rapid loss of LECAM-1 was also observed after calcium ionophores whereas anti-CD3 or concanavalin A elicited a gradual and heterogeneous loss of LECAM-1 becoming detectable after several hours only. A number of cytokines tested were not able to induce alterations in LECAM-1 expression. In contrast, expression of LPAM-1/2 (alpha 4-integrin) and CD44 (Pgp-1, H-CAM), two adhesion molecules supposed to direct extravasation into Peyer's patches, remained stable for hours after every stimulus tested; CD44 expression gradually increased 24 h after mitogenic activation, whereas a small reduction only was observed for the expression of the alpha 4-chain under certain conditions. Thus, reduced extravasation of lymphocytes into Peyer's patches after activation is not due to a decline in the surface density of LPAM-1/2 alpha-chain or CD44 whereas alterations in migration into lymph nodes parallel the expression of LECAM-1.

Animal models for morphological investigations of anorectal malformations are barely known to pediatric surgeons. In this study the morphological characteristics of a spontaneous mutation of the house mouse, the so-called SD-mouse, are described. The semidominant gene SD exerts its influence on the anorectum, the urogenital system and the axial skeleton. Many heterozygous (SD/+) and all homozygous (SD/SD) animals die shortly after birth due to their malformations. Surviving heterozygotes, identified by their short and deformed tails, may be used for breeding purposes. According to Mendel's laws, mating of such heterozygous yields 75% more or less malformed animals which may be used for morphological investigations. The morphological features of these animals were investigated in 61 neonatal SD-mice (33 SD/SD, 28 SD/+) and in 10 normal controls by microdissection and in 49 animals (25 SD/SD, 20 SD/+ and four normal controls) by serial sections. Of these, all homozygous and 10 heterozygous SD mice had anorectal malformations. The spectrum of these malformations is wide: very complex malformations in SD/SD mice and high anorectal malformations in SD/+ mice. These are comparable to morphological features found in humans and piglets. Hence the SD mouse represents an animal model for morphologic and embryonic investigations of complex anorectal malformations.

Recommendations of the International Liaison Committee on Resuscitation (ILCOR) become updated every five years with changing evidence resulting in revised recommendations for clinical practice. New data exist concerning the adequate oxygen concentration to be used in the delivery room, the management of imminent meconium aspiration, ventilation strategies and the role of body temperature during and after resuscitation of preterm and term newborn infants. Only in some cases new evidence has led to clear-cut recommendations for or against specific interventions. Therefore the present publication cites the original ILCOR-recommendations and discusses these with regard to their practical implementation. The authors of the present work suggest to commence resuscitation independendly of gestational age with room air and adjust the inspiratory oxygen concentration thereafter on clinical grounds. The authors also advocate the retention of the presently performed intranatal suction procedure in cases of meconium-stained amniotic fluid and the use of therapeutic hypothermia following perinatal asphyxia in term newborns according to the protocol of one of the published randomized, controlled trials. Standard equipment for neonatal resuscitation should include pressure gauge for monitoring of inspiratory pressures, oxygen blender, and pulse oxymeter. The predominant majority of ILCOR-recommendations have only been cited and have been commented with respect to their practical implementation within the clinical context.

The high mortality of newborn infants with congenital diaphragmatic hernia (CDH) can be partly attributed to pulmonary hypertension causing extrapulmonary right-to-left shunting with subsequent severe hypoxemia. Inhaled nitric oxide (NO) may reduce elevated pulmonary artery pressure and has been successfully improve arterial oxygenation in some newborns with CDH. However, it is not clear whether inhaled NO will actually improve survival of newborns with CDH. We therefore investigated the effect of inhaled NO on the survival rate of newborn rats with CDH following intrauterine exposure to nitrofen. A total of 151 newborn rats (9 litters) were exposed to nitrofen on day 11 of pregnancy, After spontaneous delivery, 63 newborn rats (4 litters) were allowed to spontaneously breathe air containing NO (80 parts per million), while 88 newborn rats (5 litters) were given air without NO. Survival was checked 15 min after birth and then hourly until the animals were sacrificed at 24 h of age to verify the absence or presence of CDH. The 2 groups of newborn rats breathing air with or without NO did not differ significantly with respect to the presence or size of CDH. Twenty-four of 63 (38%) newborn rats breathing air with NO survived for 24 h, compared to 12 of 88 (14%) rats breathing air alone (p < 0.01). Of newborn rats that were actually found to have CDH (n = 113), 8 of 42 (19%) animals breathing air with NO survived for 24 h, compared to 2 of 71 (2.8%) animals breathing air alone (p < 0.01). In animals with CDH confirmed by autopsy, the median survival time was significantly longer with NO (p < 0.001) ( 2 h, interquartile range 2h-15h), than those breathing or without NO (median/interquartile range 15 min). We conclude that in the nitrofen rat CDH model, significantly improved survival rates occur with inhaled NO as a sole intervention. The combined impact of inhaled NO and mechanical ventilation remains to be determined.