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Background After enterostomy creation, the distal bowel to the ostomy is excluded from the physiologic passage of stool, nutrient uptake, and growth of this intestinal section. Those infants frequently require long-term parenteral nutrition, continued after enterostomy reversal due to the notable diameter discrepancy of the proximal and distal bowel. Previous studies have shown that mucous fistula refeeding (MFR) results in faster weight gain in infants. The aim of the randomized multicenter open-label controlled MUCous FIstula REfeeding (“MUC-FIRE”) trial is to demonstrate that MFR between enterostomy creation and reversal reduces the time to full enteral feeds after enterostomy closure compared to controls, resulting in shorter hospital stay and less adverse effects of parenteral nutrition. Methods/Design: A total of 120 infants will be included in the MUC-FIRE trial. Following enterostomy creation, infants will be randomized to either an intervention or a non-intervention group. In the intervention group, perioperative MFR between enterostomy creation and reversal will be performed. The control group receives standard care without MFR. The primary efficacy endpoint of the study is the time to full enteral feeds. Secondary endpoints include first postoperative bowel movement after stoma reversal, postoperative weight gain, and days of postoperative parenteral nutrition. In addition adverse events will be analyzed. Discussion The MUC-FIRE trial will be the first prospective randomized trial to investigate the benefits and disadvantages of MFR in infants. The results of the trial are expected to provide an evidence-based foundation for guidelines in pediatric surgical centers worldwide. Trial registration The trial has been registered at clinicaltrials.gov (number: NCT03469609, date of registration: March 19, 2018; last update: January 20, 2023, https://clinicaltrials.gov/ct2/show/NCT03469609?term=NCT03469609&draw=2&rank=1).

We measured free and proteinic concentrations of native and modified amino acids from post-translational modifications (PTMs) and correlated them with the activity of SIRT1 and SIRT3 in the pellet and aqueous phases of human breast milk samples of ten lactating women during the neonatal period. SIRT1 and SIRT3 correlated directly with citrullination, asymmetric dimethylation and glycation of L-arginine, hydroxylation and glycation of L-lysine. SIRT1 and SIRT3 correlated inversely with the hydroxylation of L-proline. SIRT1 and SITR3 tended to correlate inversely with oxidative stress measured as malondialdehyde. Our study suggests that SIRT1 and SIRT3 may modulate PTMs in human breast milk cells.

Breast feeding is regarded as the preferred nutrition modality for children during the first few months of life. It not only furthers growth and development but also is supposed to impact later life. The first 1000 days are regarded as a critical window for development, even beyond infancy. The physiological basis underlying this beneficial effect is not clear. Sirtuins are important regulatory proteins of metabolism and are supposed to play a critical role in ageing and longevity as well as in diseases. In the present study, we developed novel methods to assay sirtuin 1 and sirtuin 3 at enzyme activity (via fluorometry) and protein levels (by Western blot) in the aqueous phase and in the cell pellet of human breast milk and assessed the impact of ongoing lactation during the neonatal period. Sirtuin activities in the aqueous phase were negatively correlated with the duration of lactation in the neonatal period. There was no correlation of sirtuin activities in the cell pellet with the duration of lactation. The amounts of sirtuin 1 and sirtuin 3 measured by Western blot were negatively correlated with the lactation period.

Aim This study compiled percentiles for cardiorespiratory parameters in healthy term neonates during quiet sleep. Methods We enrolled 215 healthy term neonates born at Hannover Medical School, Germany, between October 2011 and March 2013. They were prospectively observed on the maternity ward at a median age of two days using six-hour recordings of pulse oximeter plethysmography, oxygen saturation, thoracic breathing movements and electrocardiogram during sleep in a supine position. We examined their heart rate, respiratory rate and oxygen saturation during quiet sleep, plus bradycardias, apnoeas lasting at least four-seconds and desaturations below 85%. Results The 3rd, 50th and 97th percentiles were calculated as follows: heart rate 87, 112 and 133 beats per minute, respiratory rate 32, 44 and 57 per minute and oxygen saturation 94, 98 and 100%. Desaturations, apnoeas and bradycardias below 80 beats per minute were common and recorded in 54%, 98% and 30% of participants. In contrast, only 7% experienced bradycardias of less than two-thirds of the baseline heart rate and 5% experienced apnoeas exceeding 15 seconds. Conclusion Our results will facilitate the evidence-based valuation of cardiorespiratory parameters in term neonates and help validate the significance of cardiorespiratory events in preterm infants at discharge.

Due to frequent cardiorespiratory events (CREs) in response to the first routine immunization (rIM), current guidelines recommend readmitting and monitoring extremely preterm infants after the second rIM, though evidence on CREs in response to the second rIM is weak. In a prospective observational study, preterm infants with an increase in CREs after the first rIM were monitored for CREs before and after the second rIM. Seventy-one infants with a median gestational age of 26.4 weeks and a median weight of 820 g at birth were investigated at a median postnatal age of 94 days. All but seven infants showed an increase in CREs after the second rIM. The frequency of hypoxemias (p &lt, 0.0001), apneas (p = 0.0003) and cardiorespiratory events requiring tactile stimulation (CRE-ts) (p = 0.0034) increased significantly. The 25 infants (35%) presenting with CRE-ts were significantly more likely to have been continuously hospitalized since birth (p = 0.001) and to receive analeptic therapy at the first rIM (p = 0.002) or some kind of respiratory support at the first (p = 0.005) and second rIM (p &lt, 0.0001). At a postmenstruational age of 43.5 weeks, CRE-ts ceased. Our data support the recommendation to monitor infants who fulfil the above-mentioned criteria during the second rIM up to a postmenstruational age of 44 weeks.

Home oxygen therapy is increasingly prescribed for various conditions in the neonatal period, particularly for infants with bronchopulmonary dysplasia. Due to limited evidence on indication, minimal target oxygen saturation, monitoring, application and discontinuation of home oxygen therapy clinical practice varies widely throughout the world. International guidelines provide recommendations mostly on the basis of nonsystematic clinical observations. Most relevant points for the clinical management of home oxygen therapy include a minimal target oxygen saturation of equal to or greater than 93%, the provision of a home monitoring of oxygen saturation ideally with a memory function, and the conduct of continuous overnight oximetry or polysomnography during weaning from supplemental oxygen. This review summarizes relevant literature as well as existing guidelines and recommendations on home oxygen therapy to aid clinicians in the management of these patients and identifies areas for future research.

Purpose: The purpose of this study was to investigate the impact of maternal, fetal and obstetric parameters in twin pregnancies due to chorionicity, perinatal morbidity and early neonatal mortality. Methods: Early neonatal outcome parameters were retrospectively analysed in 240 twin pregnancies (51 monochorionic [MC], 189 dichorionic [DC] twins) over a 7.5 years period. Beside chorionicity, we focused on risk factors affecting perinatal morbidity and early neonatal outcome in the overall study cohort and subgroups 1) late preterm and 2) pregnancies conceived by artificial fertilization (IVF/ICSI). Mixed effects logistic regression models were used for multivariate risk analyses. Results: MC vs DC pregnancies showed significantly lower birth weights (p 25% and amniotic inflammation (amniotic infection syndrome [AIS]). A gestational age >36 completed weeks was accompanied by a decrease of early neonatal complications (p

Background: Endotracheal suctioning, which is frequently necessary in mechanically ventilated patients, might cause complications, especially in patients with compromised lung function such as extremely low-birth-weight (ELBW) neonates. Objectives: To investigate whether closed endotracheal suctioning (CS) reduces the frequency of hypoxemia and bradycardia in ELBW neonates compared to open suctioning (OS). Methods: In a randomized, crossover trial, 15 ventilated ELBW neonates (mean birth weight 655 g) underwent suctioning with both techniques. Data on oxygen saturation (Spo2), heart rate (HR), arterial blood pressure, arterial blood gases, duration of the suctioning procedure and recovery time were collected. Statistical analysis was done using the SPSS t test for paired samples. Results: The mean frequency of hypoxemia o2 was significantly higher (p = 0.012) during CS (87%) compared to OS (84%), and a significantly less steep drop in mean Spo2 (p = 0.007) (CS: –5%, OS: –8%) was found. Mean arterial Po2 (p = 0.035; CS: 59 mm Hg, OS: 53 mm Hg) and mean oxygenation ratio (p = 0.016; CS: 197, OS: 171) were significantly higher after CS. No significant differences were found in HR, incidence or duration of bradycardia, recovery time, arterial blood pressure, duration of suctioning, number of complications, or duration of hypoxemia. Conclusion: CS was superior to OS on oxygenation values. To prove its overall superiority, further research is required. So, in this group of patients, CS should currently be administered on an individual basis.

Bernd Dewe und Corinna Peter pladieren in ihrem Beitrag fur eine neo-institutionalistische Perspektivenerweiterung des Verhaltnisses von Profession und Organisation. Das vermittelnde Glied zwischen Profession und professioneller Organisation sind Wissensstrukturen, die sich organisationsextern als Professionswissen und organisationsintern als Organisationswissen identifizieren lassen und denen theoretisch Isomorphie (Strukturahnlichkeit) unterstellt wird. Anhand einer empirischen Untersuchung einer sozialpadagogischen Familienhilfe (SPFH), als exemplarische sozialpadagogische Organisation, versuchen Dewe und Peters zu zeigen, ob und inwiefern sich „Strukturangleichungsprozesse“ zwischen beiden Wissensformen tatsachlich nachweisen lassen.

Objective: To determine diagnostic utility of Doppler measurements in fetal descending aorta and umbilical arteries in predicting intrauterine growth retarded (IUGR) fetuses at risk in pregnancies complicated by preeclampsia and/or HELLP syndrome. Methods: Doppler measurements were taken in fetal descending aorta and umbilical arteries of 53 patients with pre-eclampsia, 10 of whom had HELLP syndrome using fetometry (ACUSON 128XP/10, 3.5 MHz probe). These values were compared with those of 44 appropriate-for-gestational age singleton pregnancies (AGA). Doppler Indices (Resistance Index (RI), Systolic/Diastolic (S/D) ratio) and end-diastolic flows were related to fetal heart rate (FHR) during contraction stress test, to cord blood parameters (pH, Base Excess) and to Apgar Scores. Results: In contrast to AGA fetuses, IUGR fetuses had decreased end-diastolic flow and an increase of Doppler Indices significantly earlier in the descending aorta (p < 0.05), compared to umbilical artery. Increased RI’s, S/D ratios and a decrease of end-diastolic flow in fetal aorta were significantly correlated to frequency of FHR decelerations during contraction stress tests, pH, Base Excess (p < 0.01) and Apgar Scores in IUGR fetuses. Conclusion: A decrease in end-diastolic flow paralleled with an increase in Doppler indices in fetal descending aorta reflect oxygen deprivation in IUGR fetuses during pre-eclamptic pregnancies with or without HELLP syndrome. While ductus venosus and umbilical artery are more frequently used nowadays to determine fetal oxygen deprivation, Doppler measurements in fetal descending aorta provide additional information for early detection of fetuses at risk for IUGR in pregnancies complicated with pre-eclampsia and/or HELLP syndrome

Purpose: Antenatal diagnosis of congenital cystic adenomatoid lung malformation (CCAM) is vital for disease surveillance and postnatal care. Ultrasonography (US) has been the imaging gold standard for antenatal CCAM assessment. However, one of the limitations of US is the “vanishing phenomenon” caused by isoechogenicity of CCAM tissue and adjacent normal lung parenchyma. Methods: Antenatal serial US were concurrently used with magnetic resonance imaging (MRI) to monitor macro- and microcystic lesions. Results: In both pregnant women, antenatal US and MRI confirmed the presence, in the fetus, of cystic lesions and predicted disease regression/progression as well as the need for postnatal surgical intervention. Several advantages were detected by using both—serial US and MRI (over serial US alone)—including improved signal intensity, exact volume size measurements, precise CCAM location in particular for patients with adverse ultrasound conditions. Both neonates underwent surgical resection and had an uneventful post-operative course. Conclusions: Antenatal use of MRI as well as serial US improved information regarding tissue resolution and delineation of CCAM. The information from two imaging modalities was complementary. Our literature review confirmed the emerging role of prenatal MRI for postnatal monitoring and management of CCAM.

Objective: To determine the usefulness of sonographic screening of the newborn kidneys and urinary tract over a 10-year time period. Methods: Ultrasound screening of the kidneys and the urinary tract was performed between the third and tenth day after birth on 11.887 newborn infants. The classification of renal pyelectasis (RPE) according to the Society for Fetal Urology (SFU) was used. We evaluated infant renal pathologies and correlated them with the gestational age and weight at birth. Results: Renal pyelectasis (grades 1-4) was detected in 179 cases (1.5%); it was significantly more common in male (vs female) infants (p 4.000 g were the most significant risk factors (p < 0.01). Conclusions: Renal pyelectasis grades 1-4 was detected in only 1.5% of 11.887 consecutive infants subjected to sonographic screening of the kidneys and the urinary tract within the first 10 days after birth. Sonographic screening of the kidneys and the urinary tract is a non-invasive and effective screening method after birth. It allows planning for appropriate diagnostic tests and therapeutic procedures in a timely fashion.

Aim: To evaluate which clinical symptoms indicate proven neonatal bacterial infection (NBI) and whether measuring procalcitonin aside from C-reactive protein and interleukin 6 improves sensitivity and specificity in diagnosis. Methods: In a prospective observational study, clinical symptoms and procalcitonin, C-reactive protein and interleukin 6 were simultaneously determined from the 4th day of life in 170 preterm and term neonates at the first time of suspicion of NBI. Proven NBI was defined as a positive culture of otherwise sterile body fluids or radiologically verified pneumonia in combination with elevated inflammatory markers. Results: Fifty-eight (34%) patients were diagnosed with proven late-onset NBI. In case of proven NBI, odds ratio and 95% confidence intervals were 2.64 (1.06–6.54) for arterial hypotension, 5.16 (2.55–10.43) for feeding intolerance and 9.18 (4.10–20.59) for prolonged capillary refill. Sensitivity of combined determination of C-reactive protein (>10 mg/L) and interleukin 6 (>100 pg/mL) was 91.4%, specificity 80.4%, positive predictive value 70.7% and negative predictive value 94.7%. The additional determination of procalcitonin (>0.7 ng/mL) resulted in 98.3%, 65.2%, 58.8% and 98.6%, respectively. Conclusion: Arterial hypotension, feeding intolerance and especially prolonged capillary refill indicate proven neonatal late-onset bacterial infection, even at the time of first suspicion. Additional measurement of procalcitonin does indeed improve sensitivity to nearly 100%, but is linked to a decline in specificity. Nevertheless, in the high-risk neonatal population, additional procalcitonin measurement can be recommended because all infants with NBI have to be identified.

Vancomycin-resistant Enterococcus faecium (VRE) infection is a rare event in paediatric patients and often occurs under immunosuppression or after surgical intervention. We report what we believe to be the first paediatric case of ventriculitis due to VRE (in a 2-month-old infant) to be successfully treated with combined intravenous (i.v.) and intraventricular chloramphenicol after failure of i.v. linezolid and intraventricular gentamicin.

Background: Raised upper airway resistance may be involved in apnea of prematurity (AOP). Objectives: To determine the effects of an oral versus a nasal gastric tube on episodes of hypoxemia and bradycardia in infants with AOP. Methods: In a randomized controlled cross-over trial, 32 infants (median gestational age 29 (range 24–31) weeks, postmenstrual age at study 32 (range 30–35) weeks) with the need for tube feeding and symptoms of AOP underwent a 24-hour recording of breathing movements, nasal airflow, heart rate, pulse oximeter saturation and pulse waveforms. A 5-Fr feeding tube was placed orally or nasally for 12 h each, the position selected first was randomly assigned. When the feeding tube was placed nasally, always the smaller nostril was selected. Each infant acted as his/her own control. Recordings were analyzed for the summed rate of bradycardia and desaturation (heart rate Results: The route of placing the feeding tube had no significant effect on the summed rate of bradycardia and desaturation (nasal route: median 1.6, CI 0.8–1.9; oral route: median 1.0, CI 0.9–1.6, p = 0.25). Conclusion: We could not confirm an advantage of placing a feeding tube orally in these infants with AOP, as the oral route did not improve their symptoms of AOP. Possible explanations include: (i) the increase in nasal airway resistance by the 5-Fr nasogastric tube, inserted into the smaller nostril, is too small to have any effect on AOP; (ii) any benefit of the oral route is neutralized by the negative effects of an enhanced vagal stimulation, or (iii) study duration was too short to detect a difference in AOP.

Die Erkenntnisse der Kindheitsforschung zeigen sehr differenziert auf, wie sich Kindheit in Familie, insbesondere im Hinblick auf soziale Ungleichheit, gestaltet. Die Soziale Arbeit ist dabei gefordert, auf kindliche bzw. familiale prekare Lebenslagen zu reagieren. Hier agiert die Sozialpadagogische Familienhilfe (SPFH), die eine der intensivsten institutionellen Reaktionen im Kontext des prekaresn Aufwachsens von Kindern in Familien darstellt. Um das Verhaltnis von Kindheitsforschung und Sozialer Arbeit im Hinblick auf kognitive Vermittlungsprozesse – Wissen uber Kindheit – neu zu betrachten, wird Rekurs auf den soziologischen Neo-Institutionalismus genommen. Soziale Arbeit, beispielhaft dargestellt an der SPFH, ist in ihrer Praxis immer organisational gefasst und wird in ihrem Organisationswissen wesentlich durch kognitive Institutionen ihrer gesellschaftlichen Umwelt, insbesondere der Erkenntnisse der Kindheitsforschung, die uber das Professionswissen vermittelt werden, in ihrem Handeln bestimmt. Der neo-institutionalistische Ansatz bietet eine neue Perspektive zur Bestimmung des Verhaltnisses von Kindheitsforschung, Sozialer Arbeit und Kindheit in Familie.

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.

OBJECTIVES This article aims to investigate the impact of prenatal counseling on subsequent parents' experiences during in-patient care of their infant(s) and whether feelings of parents with deceased infants are different in principle. STUDY DESIGN A questionnaire was sent to 99 families with a child born less than 26 weeks' gestational age at Medical School Hanover 2000-2008. Statistical analysis was performed using Fisher exact t test and chi-square tests in IBM SPSS Statistics for Windows, Version 20.0. RESULTS Response rate was 73%. Parents with solely surviving children significantly more often answered the questionnaire (p

Objective. There is no consensus on prescription of home oxygen therapy to infants in Germany. We hypothesized that this causes considerable variability in prescribing home oxygen to infants. Study Design. A structured questionnaire involving management of home oxygen therapy was sent to all German pediatric departments (n = 293). Results. Response rate was 84% (247/293). SpO2cutoff values below which oxygen therapy was considered indicated showed a wide range (80% to 94%, mean 90%). Respondents admitting >50 very low birth weight infants annually significantly more frequently prescribed home oxygen ( P < .001) and aimed for SpO2levels closer to the physiological range than those admitting less very low birth weight infants ( P = .046). Conclusion. Management of pediatric home oxygen therapy is diverse in Germany. Optimal SpO2targets have to be further investigated by controlled studies and German guidelines should be established. Until then practice should abide by existing foreign guidelines.

Eine Anmerkung der Autorin und des Autors dieses Beitrages sei vorweg erlaubt: Bei den nachfolgenden Ausfuhrungen handelt es sich primar um kritische Reflektionen und fachliche Uberlegungen, die im Diskurs der AutorInnen mit Studierenden im Kontext eines Seminars und im Rahmen eines ExpertInnengespraches mit Fachleuten aus den Bereichen der Kinder- und Jugendhilfe sowie der rechtlichen Betreuung entstanden sind.

To evaluate which clinical symptoms indicate proven neonatal bacterial infection (NBI) and whether measuring procalcitonin aside from C-reactive protein and interleukin 6 improves sensitivity and specificity in diagnosis.In a prospective observational study, clinical symptoms and procalcitonin, C-reactive protein and interleukin 6 were simultaneously determined from the 4th day of life in 170 preterm and term neonates at the first time of suspicion of NBI. Proven NBI was defined as a positive culture of otherwise sterile body fluids or radiologically verified pneumonia in combination with elevated inflammatory markers.Fifty-eight (34%) patients were diagnosed with proven late-onset NBI. In case of proven NBI, odds ratio and 95% confidence intervals were 2.64 (1.06-6.54) for arterial hypotension, 5.16 (2.55-10.43) for feeding intolerance and 9.18 (4.10-20.59) for prolonged capillary refill. Sensitivity of combined determination of C-reactive protein (10 mg/L) and interleukin 6 (100 pg/mL) was 91.4%, specificity 80.4%, positive predictive value 70.7% and negative predictive value 94.7%. The additional determination of procalcitonin (0.7 ng/mL) resulted in 98.3%, 65.2%, 58.8% and 98.6%, respectively.Arterial hypotension, feeding intolerance and especially prolonged capillary refill indicate proven neonatal late-onset bacterial infection, even at the time of first suspicion. Additional measurement of procalcitonin does indeed improve sensitivity to nearly 100%, but is linked to a decline in specificity. Nevertheless, in the high-risk neonatal population, additional procalcitonin measurement can be recommended because all infants with NBI have to be identified.

In the recent pandemic influenza A-(H1N1) v-2009 vaccination campaign, adjuvanted vaccines have been used because of their antigen-sparing effect. According to available reports, the rate of severe vaccination reactions has not increased, as compared with previous seasonal influenza vaccinations. Here we describe an adult female patient who was vaccinated with an AS03 adjuvanted split-virus vaccine injected into the left arm. She experienced a prolonged and painful local reaction for 4 weeks. During this time, persistent incapacitating pain shifted into the left shoulder. Magnetic resonance imaging (MRI) at the injection site detected atraumatic humeral head osteonecrosis in conjunction with bursitis of the rotator cuff region. Clinical and laboratory examination revealed no other underlying disease. Using analgetic medication and physical therapy, resting pain completely remitted within the following 14 weeks. Pain on exertion declined within the following 6 months. Atraumatic osteonecrosis, a relatively rare disorder which initially presents non-specific clinical symptoms, has never been associated with parenteral influenza vaccination. Although the available data cannot establish a causal relationship, our patient's clinical course - with a continuous transition from increased local post-vaccination reactions to symptoms of a severe shoulder lesion with osteonecrosis - raises the question of a pathogenetic link. Considering the vascular pathogenesis of osteonecrosis, we hypothesize that our patient's enhanced local immunologic reaction may have led to regional vasculitis as the cause of bone destruction. As mild forms of osteonecrosis may have escaped previous clinical attention, it is the purpose of our report to increase awareness of this exceptional event as a possible side effect of parenteral adjuvanted vaccination.

Ausgangspunkt dieses Beitrages ist die Frage nach dem Einfluss des familialen Wandels, der sich seit Ende der 1960er, Anfang der 1970er Jahre in Deutschland vollzogen hat, auf Angebote der Kinder- und Jugendhilfe. Wie spiegeln sich familiale Transformationsprozesse in der professionellen Praxis der Kinder- und Jugendhilfe wider? In diesem Beitrag soll es darum gehen, eine neue Perspektive darzulegen, auf deren Grundlage diese Frage tiefergehend erforscht werden kann. Im Kontext dieses Artikels kann dabei lediglich die Grundidee dieser Forschungsperspektive skizziert und vorgestellt werden. Um der Frage mit einer im sozialpadagogischen Forschungsbereich innovativen theoretischen Hintergrundfolie zu begegnen, bietet sich der soziologische Neo-Institutionalismus an. Dieser organisationstheoretische Ansatz prasentiert die Moglichkeit eines neuartigen Blickwinkels auf die Erforschung der sozialpadagogischen Praxis sowie den Einfluss gesellschaftlich-kultureller Elemente und Regeln auf diese. Beispielhaft fur die Kinder- und Jugendhilfe wird in diesem Beitrag der Blick auf die Sozialpadagogische Familienhilfe (SPFH) als familienunterstutzende Hilfe zur Erziehung gerichtet, da aufgrund ihrer intensiven Familienorientierung von der Annahme ausgegangen wird, dass familiale Veranderungsprozesse hier moglicherweise deutlich zum Ausdruck kommen und die Arbeit in diesem Hilfesetting entsprechend beeinflussen. Die SPFH kann aus Sicht des Neo-Institutionalismus als eine Organisation Sozialer Arbeit aufgefasst werden bzw. es ist mit der Einnahme einer organisationstheoretischen Perspektive zu berucksichtigen, dass die SPFH immer auch in organisationale Strukturen eingebunden ist, die je nach Trager- und Einrichtungsform erheblich variieren konnen.

To report our experience with an early initiation of enteral feedings after necrotizing enterocolitis (NEC).Over a 4-year period, all inborn infants with NEC Bell stage II or greater received enteral feedings, increased by 20 mL/kg/d, once no portal vein gas had been detected on ultrasound for 3 consecutive days (group 1). Infants were compared with a historic comparison group (group 2).Necrotizing enterocolitis rates were 5% (26/523) in the early feeding group and 4% (18/436) in the comparison group. One early feeding infant and two comparison group infants died of NEC, whereas two and one, respectively, had recurrent NEC. Enteral feedings were restarted at a median of 4 days (range, 3-14) versus 10 days (range, 8-22) after onset of NEC. Early feeding was associated with shorter time to reach full enteral feedings (10 days [range, 7-31] vs 19 days [range, 9-76], P.001), a reduced duration of central venous access (13.5 days [range, 8-24] vs 26.0 days [range, 8-39], P.01), less catheter-related septicemia (18% vs 29%, P.01), and a shorter duration of hospital stay (63 days [range, 28-133] vs 69 days [range, 36-150], P.05).Early enteral feeding after NEC was associated with significant benefits and no apparent adverse effects. This study was underpowered, however, to exclude a higher NEC recurrence risk potentially associated with this change in practice.

Background: Multiple intraluminal impedance (MII) is a new technique that allows detection of reflux and swallows via changes in impedance caused by a liquid bolus inside the esophagus. The method is independent of pH. The authors studied the ability of this technique to detect the small bolus volumes potentially occurring in young infants. Methods: Ten preterm infants (median gestational age at birth, 33 weeks; range, 25-36 weeks; age at study, 9 days; range, 2-39 days) underwent 10 instillations each of 0.1 mL to 0.5 mL saline while MII was recorded via a 2.4-mm nasogastric catheter. MII signals were analyzed for swallows, defined as a decrease in impedance starting within I minute. From the liquid instillation in the most proximal channel and extending downward, impedance changes during these induced swallows were compared with those occurring during spontaneous swallows. Results: All 100 liquid instillations resulted in a typical impedance pattern, occurring after a median interval of 4.4 seconds (range, 1.8-8.9 seconds). The decrease in impedance was more pronounced than after spontaneous swallows (30% vs. 24%, P < 0.03) and extended downward more rapidly (12.3 cm/s vs. 5.8 cm/s, P < 0.01). Conclusion: Bolus transport of small liquid volumes can be detected via MII.

Aim: To determine the sensitivity and specificity of three newly developed pulse oximeters in the detection of hyperoxaemia, defined as an arterial partial pressure of oxygen (PaO2) of > 80 mm Hg. Methods: SpO2 readings from three oximeters (Agilent Viridia (AgV), Masimo SET (MaS), Nellcor Oxismart (NeO)) were documented in 56 infants (median gestational age at birth 35.5 weeks, range 24–41) whenever an arterial blood gas was taken for clinical purposes. Blood samples were analysed within one minute in a Radiometer ABL 505 blood gas analyser and OSM3 co-oximeter. Results: Between 280 and 291 blood gases were analysed for each instrument; 105–112 showed a PaO2 > 80 mm Hg. At an upper alarm limit of 95%, the three instruments detected hyperoxaemia with 93–95% sensitivity. Specificity at this alarm level ranged from 26 to 45%. The mean (SD) difference between arterial oxygen saturation and SpO2 (bias) was -0.25 (2.5)% for AgV, -0.06 (2.5)% for MaS, and -0.91 (2.6)% for NeO (p < 0.01, NeO v AgV and MaS). Conclusion: These instruments detected hyperoxaemia with sufficient sensitivity at an upper alarm limit of 95%, but showed differences in their specificity, which was probably related to differences in measurement bias.

The multiple intraluminal impedance (MII) technique is a new method that allows pH-independent gastroesophageal reflux detection via changes in impedance caused by a liquid bolus inside the esophagus. We wanted to know whether this technique yields objective and reproducible results. Twenty 3- to 6-hour recordings of MII from 19 preterm infants (median gestational age at birth 30 weeks, range 24–34 weeks; age at study 26 days, range 13–93 days) were divided into 23-second segments and analyzed for reflux episodes by three investigators; one investigator analyzed the data set twice. Observer agreement was assessed using kappa statistics. Each investigator analyzed 16,627 23-second segments, with a median of 854 (range 486–979) segments per recording. Median kappa values for the 20 recordings were 0.79, 0.83, and 0.83 for the three pairs of investigators and 0.84 for the repeated scoring procedure. MII recordings could be analyzed with a high level of inter- and intraobserver agreement.

To investigate whether a nasogastric tube predisposes to gastroesophageal reflux, 16 preterm infants underwent 48-hour recordings of multiple intraluminal impedance with the catheter tip in the lower esophagus or stomach for 24 hours each. There were 72 (range, 40-145) reflux episodes with the esophageal placement and 122 (range, 60-147) during the gastric position (P

Objective. A relationship between gas- troesophageal reflux (GER) and apnea of prematurity (AOP) has long been suspected but is difficult to prove because most GER in this age group is nonacidic and thus undetectable by pH monitoring, the current stan- dard for GER detection. The new multiple intraluminal impedance (MII) technique allows pH-independent re- flux detection via changes in impedance caused by a liquid bolus inside the esophagus. We used this tech- nique to investigate whether there is a temporal relation- ship between GER and AOP and whether GER occurs predominantly before a cardiorespiratory (CR) event. Methods. Nineteen infants with AOP (median gesta- tional age at birth: 30 weeks; range: 24 -34; age at study: 26 days (13-93)) underwent 20 6-hour recordings of MII, breathing movements, nasal airflow, electrocardiogram, pulse oximeter saturation, and pulse waveforms. MII signals were analyzed, independent of CR signals, for reflux episodes (RE), defined as a fall in impedance in at least the 2 most distal channels. CR signals were ana- lyzed for CR events, ie, apneas of >4-second duration, desaturations to

To demonstrate that skin-to-skin care (SSC) has no detrimental effects on the frequency of episodes of bradycardia and/or hypoxemia.Twenty-two spontaneously breathing preterm infants (median gestational age at birth, 29 weeks [range, 24-31 weeks]; age at study, 26 days [range, 7-72 days]; weight at study, 1310 g [range, 725-1890 g]) had three 2-hour recordings of breathing movements, nasal airflow, heart rate, and oxygen saturation as measured by pulse oximetry (SpO(2)) before, during, and after SSC. Rectal temperature was obtained every 2 hours. Recordings were analyzed for baseline heart and respiratory rates, bradycardia (heart ratetwo thirds of baseline), and hypoxemia (SpO(2)or =80%), as well as for breathing pattern (regular vs non-regular).Baseline heart rate and respiratory rate increased during SSC (P.01), as did the combined frequency of bradycardia and hypoxemia (from 1.5/h [0-8] before to 2.8/h [0-15] during SSC; P.05). Rectal temperature increased from 36.9 degrees C (36.2 degrees -37.4 degrees C) to 37.3 degrees C (36.6 degrees -38.6 degrees C; P.01). The proportion of regular breathing pattern decreased from 14% (2%-28%) to 7% (3%-26%) with SSC (P.01).SSC was associated with a significant increase in the combined frequency of bradycardia and hypoxemia and with less regular breathing. These changes were unexpected and may have been related to heat stress. Body temperature, heart rate, and oxygenation should be monitored during SSC.

Pulse oximeters are increasingly used for patient monitoring; however, they are traditionally very prone to motion artifact. Newly developed instruments have lower false alarm rates. We wanted to know whether this is achieved at the expense of an increased proportion of false negative alarms such as missed or delayed identification of hypoxemia and/or bradycardia.Observational study.Neonatal intensive care unit.A total of 17 unsedated preterm infants (median gestational age at birth, 25 wks; range, 24-30 wks).Long-term recordings of transcutaneous partial pressure of oxygen (P(Tc)O2), heart rate, pulse oximeter saturation (SpO2), and pulse rate from a conventional oximeter and two new generation oximeters.Recordings were analyzed for episodes with P(Tc)O240 torr or with heart rate80 beats/min for5 secs. Hypoxemia was considered identified if SpO2 had fallen to85% within 2 mins of P(Tc)O2 reaching 40 torr, and bradycardia was considered identified if pulse rate had fallen to80 beats/min within 2 mins of the heart rate reaching this threshold.A total of 202 falls in P(Tc)O2 to40 torr occurred; 174 (86%) were identified by all three oximeters. Of the remaining episodes, manual analysis of red and infrared absorption signals confirmed that SpO2 had indeed been85% foror =10 secs in 11 episodes; therefore, these episodes should have been identified by all three oximeters. None of these had been missed by the conventional oximeter, but 10 (5.4% of the total) were missed by one of the new generation instruments (Nellcor), and one (0.5%) was missed by the other (Masimo). Of 54 bradycardias, only 14 were identified by all three oximeters; 17 (32%) were missed by the conventional, 37 (69%) by the Nellcor, and 4 (7%) by the Masimo instrument.One of the two new generation instruments investigated in this study missed 5.4% of hypoxemic episodes and 69% of bradycardias. It thus appears that this instrument's reduced false alarm rate is achieved at the expense of an unreliable and/or delayed identification of hypoxemia and bradycardia. The other instrument identified both conditions equally as or more reliably than a conventional pulse oximeter.

Pulse Oximeters Reliability for Home Monitoring: Comparison Between Nellcor N-200, N-3000 and Masimo Set

There is no consensus on home oxygen therapy in infancy. We hypothesised that this might lead to considerable variability in the practice of prescribing home oxygen to infants. To assess this variability, a structured questionnaire was sent to all departments of Paediatrics in Germany (n = 380). Response rate was 92% (n = 349). Indications were mostly (86%) based on long-term recordings of pulse oximeter saturation (SPO2). There was, however, a wide range (85–94%, mean 90%) of SPO2-values below which oxygen therapy was considered indicated. Hospitals more experienced with this therapy tended to prescribe oxygen at SPO2 values closer to the physiological range. Similarly, SPO2 values aimed for during therapy ranged from 86 to 100%, with hospitals prescribing home oxygen more frequently aiming for higher values. These differences would argue for concentrating home oxygen therapy to centers with the largest experience.