[Music therapy for prematures]. / Musiktherapie bei Frühgeborenen. Praktische Durchführung und mögliche Auswirkungen anhand eines Fallbeispiels.

BACKGROUND: More than ever before the neonatal care besides the medical and nursing work has to been balanced between protecting the child against over extension due to the concept of "minimal handling" and on the other hand the necessary fostering of the young patients psychic and sensomotor development during the long stationary treatment. In addition to known approaches of auditive stimulation as receptive music therapy a concept of active music therapy methods based on the Nordoff/Robbins creative music-therapy (University Witten/Herdecke) is presented in a case-report. PATIENT AND METHODS: The report describes in a single case-report the music-therapeutic work with a premature of the 23 + 3 (th) week of pregnancy at the neonatological unit of the Vestische Kinder- und Jugendklinik Datteln, Universität Witten/Herdecke. The main focus was the observation of the prematures reactions on specific synchronisation of motoric, sensor and acoustical stimulation. RESULTS: Positive reactions allow to presume the effectiveness of music therapy with early born children as they are already shown in clinical studies about receptive music therapy. On the level of involuntary motional actions in the area of head-, face- and hand movements increased directly reactions of awareness on the coordination of sensomotor and acoustical stimulation have been observed. Temporary increase of oxygen partial pressure and reduction of heart/pulse rate seem to cause positive physiological effects. CONCLUSIONS: Active music therapeutic treatment does not seem to be an other risk of over-tension for prematures, but offers through the coordination of different levels of perception an adequate development fostering stimulation.

Treatment of neonatal thrombus formation with recombinant tissue plasminogen activator: six years experience and review of the literature.

BACKGROUND: Thrombosis is a relatively rare event in children. However, many conditions in the neonatal period result in an increased risk of thrombus formation. The major risk factor is the indwelling intravascular catheter. Numerous small studies have reported experience of thrombolytic treatment for neonatal thrombotic disease with a wide range of different thrombolytic agents in various forms of administration, dosage, and duration, but no conclusions on the most effective treatment for neonates has been reached. OBJECTIVE: To assess the efficacy and safety of thrombolytic treatment of neonatal catheter related thrombus (CRT) formation with recombinant tissue plasminogen activator (rt-PA). METHOD: Over a six year period, 14 neonates with CRT were treated with the same rt-PA protocol (an initial bolus of 0.7 mg/kg over 30-60 minutes followed by infusion of 0.2 mg/kg/h). RESULTS: Complete clot dissolution was documented in 11 patients, and partial clot lysis in two patients, leading to a patency rate of 94%. In two cases, local bleeding occurred, resulting in treatment failure in one case. Finally, antithrombin III substitution was required in one case. No other complications such as severe bleeding were recognised. CONCLUSION: With the use of close clinical and haematological monitoring on a neonatal intensive care unit combined with serial two dimensional colour echocardiography, the present rt-PA protocol was shown to be a safe and effective method of clot dissolution in neonates.

Neonatal screening for hearing disorders in infants at risk: incidence, risk factors, and follow-up.

OBJECTIVE: To determine the incidence and risk factors for hearing disorders in a selected group of neonates and the feasibility of selective hearing screening. SETTINGS: Multicenter prospective trial at five centers in Germany. METHODS: Enrollment criteria: in addition to previously defined risk factors by the Joint Committee on Infant Hearing (family history of hearing loss, in utero infections, craniofacial anomalies, birth weight <1500 g, critical hyperbilirubinemia, ototoxic medications, bacterial meningitis, postnatal asphyxia, mechanical ventilation >5 days, stigmata, or syndromes associated with hearing loss), the impact of maternal drug abuse, birth weight <10th percentile, persistent pulmonary hypertension, and intracranial hemorrhage more than or equal to grade III or periventricular leukomalacia on infant hearing were evaluated. The screening procedure was performed by automated auditory brainstem response (A-ABR; ALGO 1-plus; Natus Med Inc, San Carlos, CA). STATISTICS: univariate analyses of risk factors versus A-ABR results and a multivariate regression analysis were used; additionally, the total test time was recorded. RESULTS: Seven hundred seventy recordings from 777 infants enrolled consecutively constitute the basis of this analysis. Mean gestational age was 33.8 +/- 4.3 weeks, birth weight 2141 +/- 968 g; 431 infants being male and 339 female; 41 (5.3%) infants exhibited pathologic A-ABR results (16 bilateral and 25 unilateral). Meningitis or sepsis, craniofacial malformations, and familial hearing loss were independent significant risk factors. Median total test time was 25 minutes. Follow-up examinations in 31 infants revealed persistent hearing loss in 18 infants (13 infants sensorineural, 5 from mixed disorders), 7 requiring amplification. CONCLUSION: Hearing screening in high-risk neonates revealed a total of 5% of infants with pathologic A-ABR (bilateral 2%). Significant risk factors were familial hearing loss, bacterial infections, and craniofacial abnormalities. Other perinatal complications did not significantly influence screening results indicating improved perinatal handling in a neonatal population at risk for hearing disorders.

Predicting length-of-stay in preterm neonates.

UNLABELLED: In neonatology, the early prediction of length-of-stay (LOS) may help in decision making. We retrospectively studied the accuracy of two LOS prediction models, namely a multiple linear regression model (MR) and an artificial neural network (ANN). Preterm neonates (n = 2144) were randomly assigned to a training-and-test (75%), or validation patient set (25%). A total of 40 first-day-of-life items (input data) and the date of discharge (output data) were routinely available. Training-and-test set data were used to identify input items with impact on LOS (input variables) using MR analysis to establish a MR prediction model and to train and test an ANN on those selected variables. Fed with validation set data, predicted LOS obtained from MR and ANN was compared individually with actual LOS. Predicted and actual LOS were highly correlated (for MR, r = 0.85 to 0.90; for ANN, r = 0.87 to 0.92). CONCLUSION: Even first-day-of-life data may contain substantial information with which to predict individual length-of-stay.

Artificial neural network for risk assessment in preterm neonates.

AIM: To predict the individual neonatal mortality risk of preterm infants using an artificial neural network "trained" on admission data. METHODS: A total of 890 preterm neonates (< 32 weeks gestational age and/or < 1500 g birthweight) were enrolled in our retrospective study. The neural network trained on infants born between 1990 and 1993. The predictive value was tested on infants born in the successive three years. RESULTS: The artificial neural network performed significantly better than a logistic regression model (area under the receiver operator curve 0.95 vs 0.92). Survival was associated with high morbidity if the predicted mortality risk was greater than 0.50. There were no preterm infants with a predicted mortality risk of greater than 0.80. The mortality risks of two non-survivors with birthweights > 2000 g and severe congenital disease had largely been underestimated. CONCLUSION: An artificial neural network trained on admission data can accurately predict the mortality risk for most preterm infants. However, the significant number of prediction failures renders it unsuitable for individual treatment decisions.

Artificial neural network for predicting intracranial haemorrhage in preterm neonates.

Intraventricular haemorrhage (IVH) incidence is used to assess peri-/neonatal therapy, and to make intra- and inter-hospital quality assessments. Unbiased assessment is complicated by the amount of confounding factors. Is an artificial neural network (ANN) able to early and accurately forecast the occurrence of severe IVH in an individual patient? Is it superior to classic multiple logistic regression? We conducted an observational study on pre-existing routine data. Admission data were available from 890 preterm neonates (gestational age < 32 weeks, birthweight < 1500 g). Patients were randomly assigned to either a training, or a validation set (50%/50%). Using the training set data an ANN was trained. A second predictive model was developed by stepwise multiple logistic regression analysis. Using the validation set input data both models delivered estimates of the probability for severe IVH to occur in each individual patient. Receiver operating characteristic (ROC) curves were used to compare prognostic performance. The optimal ANN processed 13 input variables, whereas stepwise logistic regression analysis only identified five independent predictor variables. The area under the ROC curve was 0.935 for the ANN and 0.884 for the logistic regression model (p = 0.001). Adjusted for 95%, 90%, 85%, 80% and 75% specificity, the sensitivity of the ANN was significantly superior to that of the logistic regression model. Due to its ability to give an accurate prognosis based solely on admission data, a trained ANN qualifies as a tool for local quality control.

[Primary lymphatic dysplasia in a newborn infant]. / Primäre lymphatische Dysplasie des Neugeborenen.

We describe a case of primary lymphatic dysplasia in a newborn, presenting with lymphedema, chylothorax, and chylous ascites. Malfunction of the lymphatic system, which is supposed to cause this rare disorder, could also be responsible for a number of cases of non-immunologic hydrops fetalis.

[Causes of neonatal mortality 1981-1983: a regional analysis]. / Ursachen neonataler Letalität 1981-1983: Eine regionale Analyse.

We studied perinatal care and causes of death in 182 newborn infants who died during the first 28 days of life in the children's hospitals of Bochum, Datteln, and Essen in 1981-1983. Birth weight was below 2 500 g in 73%, cerebral hemorrhage was found in 15% of the infants. Most common causes of death were cardiorespiratory maladaptation (60%), congenital malformation (27%), and severe infection (12%). 90 infants died on the first day, 138 within the first week of life. A matched pair analysis comparing 153 deaths above 750 g with survivors of similar birth weight demonstrated preventable factors in half of the neonatal deaths: hypothermia, acidosis, blindbuffer and volume therapy, and hyperglycemia. More infants survived when born during the daylight hours and when a pediatrician was present at birth. Mortality and incidence of hypothermia were higher in small maternity units. In order to reduce neonatal mortality further, regional perinatal centres for high risk deliveries should be developed in Nordrhein-Westfalen.