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Aim We assessed the risk factors for transient acute kidney injury in very low birth weight (VLBW) infants treated for patent ductus arteriosus (PDA) using the serum creatinine-based criteria in Kidney Disease: Improving Global Outcomes. Method This retrospective study of infants requiring ibuprofen and, or, surgery for haemodynamic relevant PDAs was performed at the University Children's Hospital of Saarland, Homburg, Germany, from January 2009 to December 2015. Results We studied 422 infants with a mean birth weight of 1059 ± 308.2 g. Acute kidney injuries developed in 150/295 infants (50.9%) with spontaneous PDA closure, in 46/82 (56.1%) who received intravenous ibuprofen treatment, in 18/24 (75.0%) who had surgery and in 15/21 infants (71.4%) who received both medical and surgical treatment. Acute kidney injuries were associated with birth weight and gestational age, Apgar scores at 10 minutes, the PDA size corrected for birth weight, a PDA with three affected circulatory territories, PDA surgery and gentamicin. Multiple logistic regression analysis showed particular associations between acute kidney injury and birth weight (p = 0.001), the 10-minute Apgar score (p = 0.02) and gentamicin (p = 0.043). Conclusion Birth weight, the 10-minute Apgar score and gentamicin were particularly associated with acute kidney injuries in our cohort.

Surfactant treatment of neonatal respiratory distress syndrome (RDS) was introduced in Europe during the 1990s. Meta-analyses have indicated that using less invasive surfactant administration techniques on preterm neonates receiving continuous positive airway pressure (CPAP) results in improved survival rates without bronchopulmonary dysplasia. Surfactant should be administered early and ventilator settings adapted to changing oxygen requirements and lung mechanics. Side effects including initial bradycardia, oxygen desaturation, tube obstruction and isolated cases of pulmonary haemorrhage have been reported. Conclusion Less invasive surfactant therapy improves pulmonary outcomes in preterm neonates with RDS and should ideally be administered in combination with CPAP.

ZusammenfassungObschon die intrauterine Exposition gegenüber Drogen vom Typ Opioide, Cannabinoide sowie Kokain eine nicht ganz seltene Entität ist, liegen nur wenige systematische Arbeiten zu deren langfristigen Konsequenzen für die Entwicklung Betroffener vor. Wesentliche Konsequenzen der Exposition gegenüber Opioiden sind innerhalb der ersten 2 Lebensjahre eine Reduktion der motorischen Entwicklungs-Scores, die sich bis zum Schulkindesalter und Adoleszenz verbessern. In diesen Altersabschnitten finden sich für kognitive und Verhaltensuntersuchungen in Metaanalysen deutliche, allerdings nicht signifikante Trends zu verminderten Leistungen nach Exposition. Die Nachuntersuchungen nach intrauteriner Exposition gegenüber Cannabinoiden zeigen in einem Teil der Studien verminderte kognitive Leistungen und eine verschlechterte Lesefunktion sowie Störungen der Exekutivfunktionen der komplexen Planung. Bei Jungen zeigen sich in der Verhaltensanalyse vermehrt externalisierende Störungen. Die pränatale Kokainexposition führt hinsichtlich der Variablen Kognition, Sprache sowie Verhalten zu einer schwach signifikanten Verminderung der Leistungen Betroffener bis zur Adoleszenz. Insgesamt ist bei der Interpretation der Nachsorgedaten zu beachten, dass widersprüchliche Resultate publiziert wurden, die zumindest partiell durch differente Umgebungsbedingungen während der Kindheit zu erklären sind. Die aufgeführten Daten sollten ein Grund mehr sein, primäre und sekundäre Präventivbemühungen zu intensivieren.

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

Background Infections and autoimmune disorders are more frequent in Down syndrome, suggesting abnormality of adaptive immunity. Although the role of B cells and antibodies is well characterized, knowledge regarding T cells is limited. Methods Lymphocyte subpopulations of 40 children and adolescents with Down syndrome and 51 controls were quantified, and phenotype and functionality of antigen-specific effector T cells were analyzed with flow cytometry after polyclonal and pathogen-specific stimulation (with varicella-zoster virus [VZV] and cytomegalovirus [CMV]). Results were correlated with immunoglobulin (Ig) G responses. Results Apart from general alterations in the percentage of lymphocytes, regulatory T cells, and T-helper 1 and 17 cells, all major T-cell subpopulations showed higher expression of the inhibitory receptor PD-1. Polyclonally stimulated effector CD4+ T-cell frequencies were significantly higher in subjects with Down syndrome, whereas their inhibitory receptor expression (programmed cell death 1 [PD-1] and cytotoxic T-lymphocyte antigen 4 [CTLA-4]) was similar to that of controls and cytokine expression profiles were only marginally altered. Pathogen-specific immunity showed age-appropriate levels of endemic infection, with correlation of CMV-specific cellular and humoral immunity in all subjects. Among VZV IgG-positive individuals, a higher percentage of VZV-specific T-cell-positive subjects was seen in those with Down syndrome. Conclusions Despite alterations in lymphocyte subpopulations, individuals with Down syndrome can mount effector T-cell responses with similar phenotype and functionality as controls but may require higher effector T-cell frequencies to ensure pathogen control.

Background: Spontaneous closure of patent ductus arteriosus (PDA) occurs frequently in very preterm infants and despite the lack of evidence for treatment benefits, treatment for PDA is common in neonatal medicine. Objectives: The aim of this work was to study regional variations in PDA treatment in very preterm infants (≤31 weeks of gestation), its relation to differences in perinatal characteristics, and associations with bronchopulmonary dysplasia (BPD) and survival without major neonatal morbidity. Methods: This was a population-based cohort study in 19 regions in 11 European countries conducted during 2011 and 2012. A total of 6,896 infants with data on PDA treatment were included. The differences in infant characteristics were studied across regions using a propensity score derived from perinatal risk factors for PDA treatment. The primary outcomes were a composite of BPD or death before 36 weeks postmenstrual age, or survival without major neonatal morbidity. Results: The proportion of PDA treatment varied from 10 to 39% between regions (p < 0.001), and this difference could not be explained by differences in perinatal characteristics. The regions were categorized according to a low (n = 6), medium (15-25%, n = 9), or high (>25%, n = 4) proportion of PDA treatment. Infants treated for PDA, compared to those not treated, were at higher risk of BPD or death in all regions, with an overall propensity score adjusted risk ratio of 1.33 (95% confidence interval 1.18-1.51). Survival without major neonatal morbidity was not related to PDA treatment. Conclusions: PDA treatment varies largely across Europe without associated variations in perinatal characteristics or neonatal outcomes. This finding calls for more uniform guidance for PDA diagnosis and treatment in very preterm infants.

Background This study investigates plasma cytokine levels in neonates with the more common left-sided congenital diaphragmatic hernia (CDH) and correlates them with severity of disease indicated by position of the liver. An intrathoracic part of liver is associated with higher need for extracorporeal membrane oxygenation (ECMO) and higher risk for chronic lung disease (CLD). Methods A total of 28 newborns with CDH were subdivided by their liver position in partially intrathoracic (n = 16) and only abdominal (n = 12) position. Only liver-up patients went on ECMO (n = 9) and developed severe/moderate CLD (n = 5). Controls consisted of 19 healthy matched-term neonates. Laboratory samples were extracted from umbilical cord blood and during the neonatal period. Results In umbilical cord blood, CDH patients showed decreased IL-8 values while MIP-1a (macrophage inflammatory protein-1) values were increased. Concerning the severity of CDH, we measured significantly higher levels of TGFb2 in CDH patients with liver-up than in liver-down cases and controls (p Conclusion In neonates with CDH, plasma cytokine levels are already altered in utero. TGFb2 may work as an early predictor for severity of disease. VEGF and IL-10 could serve as potential biomarkers predicting the course of disease in CDH.

Grundlagen Bei der Tuberosen Sklerose Complex-Erkrankung (TSC) handelt sich um eine seltene, genetisch bedingte Multisystemerkrankung, die charakterisiert ist durch das Auftreten von Hamartomen.

The aim of the NeoVitaA Trial is to assess the role of postnatal additional high-dose oral vitamin A supplementation for 28 days in reducing Bronchopulmonary dysplasia (BPD) or death in extremely low birth weight (ELBW) infants at 36 weeks postmenstrual age (PMA). All infants (both intervention and control group) will be provided with basic vitamin A (1000 IU/kg/day) in addition to trial intervention. In this short communication, we will give an up-date on obstacles, challenges as well as perspectives and potential solutions when putting into place a multicenter, double-blind, randomized trial in this cohort of extremely susceptible infants.

Early onset infection (EOI) in preterm infants

Summary Background The aim of this study was to assess multiplex PCR analysis in detecting causative viruses in children with febrile seizures. Methods The study was a retrospective analysis comparing data from a pre-multiplex era (2009) with a period after the introduction of routine respiratory multiplex analysis (2010–2013) in children with febrile seizures. Results We included 200 children with febrile seizures (mean age: 29.5 ± 1.4.months; 104 male) in the study. In 2009, in 10 out of 49 (20 %) children, microbiology testing (bacterial/fungal) was positive compared with a rate of 74 out of 151 (49 %) children during 2010–2013 (p < 0.01). The rate of positive virological studies increased from 10 (20 %) in 2009 to 73 (48.3 %) in the period 2010–2013 (p < 0.01). Multiplex PCR analysis confirmed viral infections in 52 of 73 cases (71.2 %). Conclusion Routine multiplex PCR analysis fosters the detection of respiratory viruses in children with febrile seizure. The precise role of multiplex analysis in the management of these children awaits further clarification.

BACKGROUNDBetween 2010 and 2012, 3 outbreaks of nosocomial infections in German neonatal intensive care units (NICUs) attracted considerable public interest. Headlines on national television channels and in newspapers had important consequences for the involved institutions and a negative impact on the relationship between families and staff in many German NICUs.OBJECTIVETo determine whether NICU outbreaks reported in the media influenced provider behavior in the community of neonatal care and led to more third-line antibiotic prescribing.DESIGNObservational cohort study.METHODSTo investigate secular trends, we evaluated data for very-low-birth-weight infants (VLBWIs, birth weight RESULTSThe exposure of all VLBWIs to third-line antibiotics increased after outbreaks (19.4% before vs 22.5% after; P=.007). This trend particularly affected male infants (4.6% increase; P=.005) and infants with a birth weight between 1,000 and 1,499 g (3.5% increase; P=.001)In a logistic regression analysis, month of discharge as linear variable of time was associated with increased exposure to third-line antibiotics (odds ratio [OR], 1.01; 95% confidence interval [CI], 1.009–1.014; PP=.024).CONCLUSIONSMedia reports directly affect medical practice, eg, overuse of third-line antibiotics. Future communication and management strategies must be based on objective dialogues between the scientific community and investigative journalists.Infect Control Hosp Epidemiol 2016;37:924–930

Key Clinical Message Dravet syndrome is often caused by SCN1A mutations and has a wide variation in clinical appearance. Indication for genetic analysis should be an epileptic encephalopathy or severe clinical course of seizures in infants with episodes of fever before the first year of life., Dravet syndrome is often caused by SCN1A mutations and has a wide variation in clinical appearance. Indication for genetic analysis should be an epileptic encephalopathy or severe clinical course of seizures in infants with episodes of fever before the first year of life.

Background Controversy exists regarding the impact of small for gestational age (SGA = birth weight Aim To assess the effects of SGA on mortality and major morbidities in ≤750 gram (g) neonates. Study design Retrospective (01/2005–12/2017), single center study at a tertiary NICU. Subjects SGA neonates ≤ 750 g. Outcome Effect of SGA status on mortality and major morbidities. Results 183 infants were enrolled. 103 (56.3%) were non-SGA (mean gestational age 25 + 1 weeks ± 9.9 days, mean birth weight 662.6 ± 75.2 g), and 80 (43.7%) SGA (mean gestational age 26 + 6 weeks ± 14.0 days, mean birth weight 543.9 ± 114.7 g). Mortality was 24.1% (non-SGA: 30/103 (29.1%), SGA: 14/80 (17.5%); p = 0.08). Univariable logistic regression analysis revealed a significant protective effect of SGA status on pneumothoraces (OR 0.28, 95%-CI [0.11–0.69]), IVH (≥3) (OR 0.38; 95%-CI [0.15–0.67]), and seizures (OR 0.09, 95%-CI [0.01–0.76]), but NEC (≥2a) occurred more frequently in SGA neonates (p = 0.024). Multiple logistic regression analysis found SGA status to negatively influence ROP (≥3) (OR 2.87, 95%-CI [1.14–7.23]) and need for home monitoring (OR 2.38, 95%-CI [1.05–5.41]). Other major morbidities (IVH, PVL, RDS, BPD, NEC, FIP, sepsis, hearing impairment) and mortality rates were not significantly affected, but distinct organ-specific patterns were seen. Conclusion SGA had negative effects on the rate of severe ROP and the need for home monitoring, but other major morbidities as well as mortality rates were not significantly affected. In the future, it will be important to delineate underlying pathophysiological mechanisms that contribute to this pattern.

Tuberous sclerosis complex (TSC) is a genetic disease with a significant morbidity and mortality. We conducted a retrospective analysis of two cohorts (Vall d'Hebron University Hospital [HVH], Barcelona, Spain, 1982–2015, and at Saarland University Medical Center [UKS], Homburg, Germany, 1998–2015) to assess prevalence and treatment of TSC associated manifestations and to evaluate if the follow-up was in line with published recommendations. This was considered if more than 15% of patients did not receive adequate examination with regard to potential organ involvement. A definite diagnosis was made in 52 patients (96%), and a possible diagnosis was made in 2 patients (4%). Thirty-four (63%) patients were from HVH and 20 (37%) from UKS. Median age at first presentation was 6 months (interquartile range: 0–38 months), and median time of follow-up was 6 years (interquartile range: 2–13 years). Clinical symptoms that led to a diagnosis of TSC were cardiac rhabdomyoma (22/54), epilepsy (20/54), and cutaneous manifestations (4/54). Assessment of neuropsychiatric, renal, and ocular manifestations was inadequate in both hospitals, whereas cutaneous manifestation was inadequate at UKS only. Our data demonstrate insufficient examinations in a substantial number of TSC patients with regard to neuropsychiatric, renal, ocular, and cutaneous manifestations. The recently published guidelines may prove valuable in establishing a more comprehensive approach.

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.

Neurological dysfunction may occur after corrective cardiac surgery using cardio-pulmonary bypass (CPB) with or without circulatory arrest. Different neurophysiological monitoring systems have been employed to detect neurological complications and possible brain injury in infants and children during and after cardiac surgery. The value of EEG in infants and children at risk for neurological sequelae has not been systematically studied. Sequential performance of 2 EEGs before and after cardiac surgery at a tertiary University Hospital to screen for possible brain injury after cardiac surgery. In addition, a complete neurological examination was performed. In 313 patients (age: 54.2±55.7 months; normal initial EEG) after cardiac surgery CPB (duration of surgery: 146.0±58.9 minutes; aortic cross clamp time: 34.1±19.1 minutes) a 19-channel EEG recording was performed 2.4±1.8 days prior and 11.6±5.3 days after cardiac surgery. An abnormal EEG was detected in only 8 of 313 patients (2.5%; focal slowing(1), generalised slowing (5), epiletiform discharges(2)) after cardiac surgery, while the EEG was normal in the remaining 305 patients (97.5%). In one patient, an intra-cerebral pathology was seen on MRI (ischemic); in 5 patients follow-up EEGs were performed, which revealed normalised findings. None of the 8 patients demonstrated new focal neurological deficits on physical examination, but 33 (9.7%) children demonstrated minor abnormalities (eg, subtle motor asymmetry, increase in muscle tone, etc.), which were unrelated to abnormal EEG findings. According to the used protocol pathological EEG findings were very infrequent in our study cohort. The routine and indiscriminative recording of EEGs in children before and after corrective or palliative cardiac surgery for congenital heart disease using CPB is not recommended. Further intra-operative neuromonitoring methods with immediate intervention should be evaluated.

In this study we investigated changes of serum leptin in 74 newborn lambs and associations with environmental temperature (from - 8°C to + 25°C), body temperature, and concentrations of plasma lipids, 3-beta-hydroxybutyric acid and blood glucose. A leptin radioimmunoassay was established, using an antiserum (rabbit) produced against a partial sequence of ovine leptin (31-44). Before measurement, serum samples were denatured. The sensitivity of the assay was 0.4 µg l(-1) and intra- and interassay coefficients of variation were 5.1% and 2.5%, respectively. Blood samples were collected immediately after birth up to 24 h postnatally (pn). Median leptin concentrations at birth and 24 h pn were 20.9 and 52.7 µg l(-1), respectively. Because of non-normal distribution, leptin concentrations were converted to log(leptin) before further statistical processing. The change in log(leptin) during the first 24 h was highly significant (p0.0001). Correlation analysis showed significant associations between serum leptin and the following variables: environmental temperature 24 h pn (r=0.34, p0.005), log(plasma triglycerides) 24 h pn (r=0.50, p0.001), log(plasma 3-beta-hydroxybutyric acid) 24 h pn (r=-0.50, p0.001), blood glucose 6 h pn (r=0.43, p0.001) and plasma cholesterol 12 h pn (r=0.38, p=0.001). We conclude that this radioimmunoassay is suited to measure total serum ovine leptin and that total leptin is already regulated in the very early postnatal phase. Leptin is increased at higher environmental temperatures, consistent with leptin's suppressive effect on energy expenditure and appetite. Furthermore, leptin levels are associated with plasma concentrations of lipids and lipid metabolites.

BACKGROUND AND PURPOSE: Germinal matrix hemorrhage is a frequent complication of prematurity and can be associated with adverse neurodevelopmental outcome, depending on its severity. In addition to parenchymal damage, intraventricular residues of hemorrhage and hydrocephalus MR imaging findings include superficial siderosis. The purpose of this study was to investigate the prevalence and location of superficial siderosis in patients with a history of germinal matrix hemorrhage. MATERIALS AND METHODS: We retrospectively identified patients with a history of germinal matrix hemorrhage who underwent MR imaging in our institution between 2008 and 2016. Imaging was evaluated for the presence and location of superficial siderosis. The presence of subependymal siderosis and evidence of hydrocephalus were assessed. RESULTS: Thirty-seven patients with a history of germinal matrix hemorrhage were included; 86.5% had preterm births. The mean age at the first MR imaging was 386 days (range 2–5140 days). The prevalence of superficial siderosis was 67.6%. Superficial siderosis was detected significantly more often when MR imaging was performed within the first year of life (82.8% versus 12.5%, P < .000). When present, superficial siderosis was located infratentorially in all cases, while additional supratentorial superficial siderosis was detectable in 27%. CONCLUSIONS: Here we report that superficial siderosis is a common MR imaging finding in the first year of life of patients with a history of germinal matrix hemorrhage, but it dissolves and has a low prevalence thereafter. A prospective analysis of its initial severity and speed of dissolution during this first year might add to our understanding of the pathophysiology of neurodevelopmental impairment after germinal matrix hemorrhages.

Although prenatal exposure to opioids, cannabinoids and cocaine is a frequent problem, only scarce data have been published on the long-term outcome in affected children and adolescents. While opioid-exposed children up to the age of 2 years show a reduced motor developmental pattern, data from meta-analyses up to adolescence show a strong trend for reduced performance with regard to cognitive function and behavior. Follow-up data after intrauterine cannabinoid exposure indicate reduced cognitive and reading abilities as well as abnormal findings in complex planning tests. Externalizing pathologies have been observed more frequently in boys. Prenatal cocaine exposure results in reduced cognitive and verbal development up to adolescence; however, differences are small but significant in meta-analyses. Interpretation of follow-up data with partially contradictory results may reflect methodological differences and a number of modifying co-factors, e.g., social conditions during the childhood period. These data should encourage further primary and secondary preventive attempts.Obschon die intrauterine Exposition gegenüber Drogen vom Typ Opioide, Cannabinoide sowie Kokain eine nicht ganz seltene Entität ist, liegen nur wenige systematische Arbeiten zu deren langfristigen Konsequenzen für die Entwicklung Betroffener vor. Wesentliche Konsequenzen der Exposition gegenüber Opioiden sind innerhalb der ersten 2 Lebensjahre eine Reduktion der motorischen Entwicklungs-Scores, die sich bis zum Schulkindesalter und Adoleszenz verbessern. In diesen Altersabschnitten finden sich für kognitive und Verhaltensuntersuchungen in Metaanalysen deutliche, allerdings nicht signifikante Trends zu verminderten Leistungen nach Exposition. Die Nachuntersuchungen nach intrauteriner Exposition gegenüber Cannabinoiden zeigen in einem Teil der Studien verminderte kognitive Leistungen und eine verschlechterte Lesefunktion sowie Störungen der Exekutivfunktionen der komplexen Planung. Bei Jungen zeigen sich in der Verhaltensanalyse vermehrt externalisierende Störungen. Die pränatale Kokainexposition führt hinsichtlich der Variablen Kognition, Sprache sowie Verhalten zu einer schwach signifikanten Verminderung der Leistungen Betroffener bis zur Adoleszenz. Insgesamt ist bei der Interpretation der Nachsorgedaten zu beachten, dass widersprüchliche Resultate publiziert wurden, die zumindest partiell durch differente Umgebungsbedingungen während der Kindheit zu erklären sind. Die aufgeführten Daten sollten ein Grund mehr sein, primäre und sekundäre Präventivbemühungen zu intensivieren.

Neurological dysfunction may occur after corrective cardiac surgery using cardio-pulmonary bypass (CPB) with or without circulatory arrest. Different neurophysiological monitoring systems have been employed to detect neurological complications and possible brain injury in infants and children during and after cardiac surgery. The value of Elecetroencephalogram (EEG) in infants and children at risk for neurological sequelae has not been systematically studied. Sequential performance of two EEGs before and after cardiac surgery at a tertiary University Hospital to screen for possible brain injury after cardiac surgery in neonates and children undergoing CPB surgery. In addition, a complete neurological examination and assessment by a physiotherapist was performed. Over a 4-year period, in 313 patients (age: 54.2 ± 55.7 months; normal initial EEG) after cardiac surgery CPB (duration of surgery: 146.0 ± 58.9 min; aortic cross clamp time: 34.1 ± 19.1 min), a 19-channel EEG recording was performed 2.4 ± 1.8 days prior to and 11.6 ± 5.3 days after cardiac surgery. An abnormal EEG was detected in only 8 of 313 patients (2.5%; focal slowing: 1, generalised slowing: 5, epiletiform discharges: 2) after cardiac surgery, while the EEG was normal in the remaining 305 patients (97.5%). In 1 patient, an intra-cerebral pathology was seen on MRI (ischemic); in 5 patients, follow-up EEGs were performed, which revealed normalized findings. None of the 8 patients demonstrated new focal neurological deficits on physical examination, but 33 (9.7%) children demonstrated minor abnormalities (e.g., subtle motor asymmetry, increase in muscle tone, etc.), which were unrelated to abnormal EEG findings. According to the used protocol, pathological EEG findings were very infrequent in our study cohort. The routine and indiscriminative recording of EEGs in children before and after corrective or palliative cardiac surgery for congenital heart disease using CPB is not recommended. Further intra-operative neuromonitoring methods with immediate intervention should be evaluated.

The use of complementary and alternative medicine (CAM) is widespread in children with cancer and is poorly regulated. Case report. We describe a case of severe cyanide poisoning arising from CAM use. A severely agitated, encephalopathic, unresponsive 4-year-old boy (initial Glasgow Coma Scale of 3) with a history of metastatic ependymoma was brought to our emergency department by ambulance services. Initial blood gas analysis demonstrated severe metabolic/lactic acidosis. On detailed questioning of the parents, the use of CAM including intravenous and oral “vitamin B 17” (amygdalin) and oral apricot kernel was reported. After administering sodium thiosulfate, rapid improvement in his medical condition with complete recovery without need for further intensive care treatment was seen. Serum cyanide level was markedly elevated. Cyanide poisoning can be the cause of severe encephalopathy in children receiving CAM treatment with substances containing cyanogenic glycosides.

Intraventricular hemorrhage (IVH) is one of the most serious complications in preterm infants and is associated with neurological sequelae and mortality. Over the past few decades, the rate of IVH has decreased due to improved neonatal intensive care. However, up to 15-25% of very and extremely premature infants (32 and28weeks of pregnancy (WOP) respectively) still suffer from IVH.The aim of this study was to perform an updated, multicenter analysis to identify ante-, peri, and postnatal factors other than gestational age/birth weight associated with IVH of any grade in a large cohort of very and extremely premature infants.We performed a retrospective analysis in a prospectively conducted multicenter cohort study between 01/01/1998-31/12/2012 at 5 level 3 perinatal centers. All relevant ante-, peri- and neonatal data were collected and univariate as well as multivariate logistic regression analysis was performed.765 inborn infants with a gestational age32 WOP were enrolled into this study (369 (48.2%) female; 396 (51.8%) male). Birth weight ranged from 315g to 2200g (mean 1149.7g, SD 371.9g); 279 (36.5%) were born ≤27+6 WOP and 486 (63.5%)≥28+0 WOP. IVH was seen in 177 (23.1%) patients. Multivariate analysis revealed that in addition to higher gestational age (OR 0.7, CI [0.6-0.8]), antenatal steroid treatment (OR 0.3, CI [0.2-0.6]) and caesarian section without uterine contraction (OR 0.6, CI [0.4-0.9]) were associated with a lower rate of IVH while RDS (OR 5.6, CI [1.3-24.2]), pneumothorax (OR 2.8, CI [1.4-5.5]) and use of catecholamines (OR 2.7, CI [1.7-4.5]) were associated with an increased risk of IVH. After exclusion of gestational age and birth weight from multivariate analysis, early onset sepsis (OR 1.6, CI [1.01-2.7]) and patent ductus arteriosus (OR 1.9, CI [1.1-3.1]) were associated with a higher rate of IVH. In addition, univariate analysis revealed that Apgar scores at 5min (p0.001), BDP/ROP/NEC (p0.001), mechanical ventilation (p0.001) and inhalative nitric oxide (p0.001) were significantly associated with IVH.Our comprehensive analysis demonstrated that the occurrence of IVH in very premature infants is significantly associated with ante-, peri- and postnatal factors being either related to the degree of immaturity or indicating a critical clinical course after birth. The analysis reiterates the necessity for a very close cooperation between obstetricians and neonatologists to reduce the incidence of IVH in this susceptible cohort.

Background Oxygen supply as a lifesaving intervention is frequently used to treat preterm infants suffering additionally from possible prenatal or perinatal pathogen features. The impact of oxygen and/or physical lung injury may influence the morphological lung development, leading to a chronic postnatal lung disease called bronchopulmonary dysplasia (BPD). At present different experimental BPD models are used. However, there are no systematic comparative studies regarding different influences of oxygen on morphological lung maturation. Objective We investigated the influence of prenatal hypoxia and/or postnatal hyperoxia on morphological lung maturation based on stereological parameters, to find out which model best reflects morphological changes in lung development comparable with alterations found in BPD. Methods Pregnant mice were exposed to normoxia, the offspring to normoxia (No/No) or to hyperoxia (No/Hyper). Furthermore, pregnant mice were exposed to hypoxia and the offspring to normoxia (Hypo/No) or to hyperoxia (Hypo/Hyper). Stereological investigations were performed on all pups at 14 days after birth. Results Compared to controls (No/No) 1) the lung volume was significantly reduced in the No/Hyper and Hypo/Hyper groups, 2) the volume weighted mean volume of the parenchymal airspaces was significantly higher in the Hypo/Hyper group, 3) the total air space volume was significantly lower in the No/Hyper and Hypo/Hyper groups, 4) the total septal surface showed significantly lower values in the No/Hyper and Hypo/Hyper groups, 5) the wall thickness of septa showed the highest values in the Hypo/Hyper group without reaching significance, 6) the volume density and the volume weighted mean volume of lamellar bodies in alveolar epithelial cells type II (AEII) were significantly lower in the Hypo/Hyper group. Conclusion Prenatal hypoxia and postnatal hyperoxia differentially influence the maturation of lung parenchyma. In 14 day old mice a significant retardation of morphological lung development leading to BPD-like alterations indicated by different parameters was only seen after hypoxia and hyperoxia.

Parenteral and enteral nutrition are essential for both growth and development of preterm infants. Based on the results of many studies, the rate of nutritional growth and the amount of substrate delivered parenterally are under debate.The main aim of this study was to assess parenteral nutrition in very and extremely immature preterm infants, i.e. very low birth weight (VLBW, birth weight1500g) and extremely low birth weight (ELBW, birth weight1000g) neonates, and to compare the amount of parenterally delivered substrate in our neonatal intensive care unit (NICU) to current German guidelines.Retrospective audit at our tertiary NICU at the University Children's Hospital of Saarland, Homburg, Germany between 1 January 2009 and 31 December 2010.In total, 100 premature neonates were included. The mean gestational age was 29.6 weeks (range 24.4-34.1 weeks) and the mean birth weight was 1119 g ± 260 g (range 570 g-1490 g). Comparing the amount of fluids, glucose, amino acids, lipids and kcals with the current guidelines of the German Society for Nutritional Medicine in preterm infants, only glucose was adequately given; however, a substantial number of weight-dependent (more often in ELBW neonates) episodes of hyperglycemia requiring insulin treatment were also seen. During the first 3 weeks of life a substantial drop in body weight, length and head circumference occurred in our study cohort. In contrast, at 2 years corrected age, catch-up growth was seen in our cohort with anthropometric data now comparable to healthy term infants. Using the Bayley II test for developmental outcome assessment, at 2 years corrected age 78.6% (33/42) of infants demonstrated normal development.This retrospective data analysis demonstrated inadequate provision of parenteral nutrition in our NICU, which was often not in line with current German guidelines. This was associated with inadequate growth in our cohort, most notably during the first 3 weeks of life; however, implementation of current guidelines is impeded by metabolic disturbances in this cohort, most notably in ELBW neonates. Whether adherence to published guidelines will result in better early ex utero growth, and whether this normalized growth pattern will translate into better long-term outcome on a metabolic and neurological level, remains unclear.

Background Systematic and up-to-date Cochrane reviews in pediatrics in general and in pediatric gastroenterology in particular are important tools in disseminating the best available evidence to the medical community, thus providing the physician at the bedside with invaluable information and recommendations with regard to specific clinical questions. Methods A systematic literature review was conducted, including all Cochrane reviews published by the Cochrane Review Group in the field of pediatric gastroenterology between 1993 and 2012, with regard to the percentage of reviews that concluded that a certain intervention provided a benefit, percentage of reviews that concluded that a certain intervention should not be performed, and percentage of studies that concluded that the current level of evidence was inconclusive. Results In total, 86 reviews in the field of pediatric gastroenterology were included. The majority of reviews assessed pharmacological interventions (46/86); other important fields included prevention (15/86) and nutrition (9/86). A total of 33/86 reviews issued definite recommendations (positive, 19/86; negative, 14/86). The remaining 53/86 reviews were either inconclusive (24/86) or only of limited conclusiveness (29/86). The percentage of inconclusive reviews increased from 9% (1998–2002) to 19% (2003–2007; P < 0.05) to finally 24% (2008–2012) (P < 0.05). The three most common reasons for the need for further research were heterogeneity of studies (26/86), small number of patients (18/86), and insufficient data (16/86). Conclusions Further high-quality research is necessary to increase the proportion of reviews with clear recommendations. Funding and research agencies are key to selecting the most appropriate research programs.

Hintergrund In rezenten Veroffentlichungen wurde die Stammzelltherapie bei Fruhgeborenen mit drohender bronchopulmonaler Dysplasie (BPD) und bei reifen Neugeborenen mit schwerer hypoxisch-ischamischer Enzephalopathie (HIE) beschrieben.

Key Clinical Message Muscular hypotonia in infants may be associated with several conditions, such as spinal muscular atrophy (SMA). We report on an infant with tongue fasciculations and a rare mutation of the SMN1 gene. The presence of tongue fasciculations in combination with a thorough history may be suggestive of SMA.

Very premature delivery is a major cause of infant morbidity and mortality. Obesity, diabetes and pregnancy hypertension are known risk factors for pregnancy complications. The study aimed to scrutinize differences of pregnancy complications in a cohort of very premature deliveries compared to a national group. In a multicenter study performed between January 2009 and December 2010 including 1,577 very low birth weight (VLBW) infants, we compared parental reported pregnancy problems of VLBW infants with a national cohort (KIGGS). We compared reported pregnancy complications to reasons for premature delivery and neonatal outcome within the group of VLBW infants. While parents of the national cohort reported pregnancy-induced hypertension in 8 %, parents of VLBW infants reported this complication more frequently (27 %). Mothers of the national cohort were significantly younger (1 year), suffered less from obesity, anaemia, diabetes. Regression analysis showed that hypertension (OR = 5.11) and advanced maternal age (OR = 1.03) increased the risk for premature birth. Women with hypertension were likely to experience a clinically indicated premature delivery, had more VLBW infants with a moderate growth restriction, but less multiples and their infants had less intraventricular haemorrhages grade 3 or 4. Otherwise, neonatal outcome was correlated with gestational age but not with the pregnancy complications diabetes, hypertension or obesity. Premature birth seems to be correlated to gestational hypertension and associated problems in about ¼ of VLBW infants. Further studies should focus on preventing and treating gestational hypertension to avoid premature delivery and associated neonatal morbidity.