Placebo Controlled Introduction of Prophylactic Supplementation of Probiotics to Decrease the Incidence of Necrotizing Enterocolitis at Dhulikhel Hospital in Nepal.

Background Although recent reports suggest that the use of probiotics may enhance intestinal functions in premature infants, the mechanisms are unclear, and open questions remain regarding the safety and its efficacy. Objective The objective of this study is to evaluate the efficacy of probiotics on prevention of necrotizing enterocolitis in preterm infants in Nepal. Method We conducted a randomized, double blind, placebo controlled study of 72 hospitalized preterm infants. They were randomly allocated to receive probiotics (lactobacillus rhamnosus 35) at a dose of 0.8 mg in infants >1500 gms and 0.4 mg in infants <1500 gms in 2 ml of expressed breast milk two times daily or the same amount of expressed breast milk as placebo (without probiotics). Result Seventy-two patients were studied. The probiotics group (n=37) and placebo group (n=35) showed similar clinical characteristics. The incidence of necrotizing enterocolitis was found less frequently in the probiotic group (6/37, 16.2%) compared to the control group (10/35, 28.6%), this difference was not significant (p=0.16). This is 12.35% reduction in the incidence of necrotizing enterocolitis. Among the risk factors for necrotizing enterocolitis, pregnancy risk factors and perinatal risk factors were not significant. However neonatal risk factors were more frequent in the probiotic group (59.3%, n=32) than in the placebo group (40.7%, n=22), the difference was significant (p=0.02). Conclusion In the western world probiotics have been shown to be preventive in regard to necrotizing enterocolitis incidence. The present randomized trial showed a trend towards necrotizing enterocolitis minimal reduction in Nepal too. Further studies in a larger cohort are warranted to prove this effect for preterm infants.

The burden of pneumococcal meningitis in Austrian children between 2001 and 2008.

UNLABELLED: The present study was conducted to evaluate the burden of pneumococcal meningitis in Austrian children between 2001 and 2008. Clinical outcome was retrospectively analyzed both on discharge and on follow-up investigations. This study was based on a prospective multicentre surveillance study on hospitalized invasive pneumococcal infections in Austrian children with a total annual "study population" of about 399,000 children aged below 5 years per year. Between 2001 and 2008, 74 cases of pneumococcal meningitis were identified in children aged below 5 years. The mean annual incidence rate for pneumococcal meningitis was 2.3 per 100,000 children in this age group. In 57/74 children (mean age on admission 14.5 ± 13.3 months), outcome data on hospital discharge were available: 5 deaths (8.8%), 20 children (35.1%) with sequelae and 32 children (56.1%) without sequelae were observed. Sequelae on discharge included motor impairment in 8 children (14.0%), hearing impairment in 9 children (15.8%) and/or other complications in 14 children (24.6%). In 7/8 children with motor deficits, matching cerebral lesions were identified by neuroimaging: cerebral infarction in five children, cerebral vasculitis and cerebral abscess in one child each. In 40/57 children, long-term outcome (18.9 ± 20.2 months after discharge) could be assessed: 1 child (2.5%) died 9 months after hospital discharge, 11 children (27.5%) had one or two long-term sequelae and 28 children (70.0%) had no sequelae. Long-term sequelae included motor impairment in three children (7.5%), hearing impairment in nine children (22.5%) and other deficits in two children (5.0%). CONCLUSION: Our study confirms that pneumococcal meningitis causes high mortality and severe long-term sequelae. On long-term follow-up, we observed improvements of motor impairment, but not of hearing impairment.

The auditory p300-based SSBCI: a door to minimally conscious patients?

In this study we report on the evaluation of a novel auditory single-switch BCI in nine patients diagnosed with MCS. The task included a simple and a complex oddball paradigm, the latter uses the tone stream segregation phenomenon. In all patients a significant difference between deviant and frequent tones could be observed in EEG. However, in some cases the deviant tones produce a significant negative peak and in some a very late positive peak. These preliminary findings are relevant in order to address future customization of this auditory ssBCI-based paradigm for unresponsive patients.

Toward a high-throughput auditory P300-based brain-computer interface.

OBJECTIVE: Brain-computer interface (BCI) technology can provide severely disabled people with non-muscular communication. For those most severely disabled, limitations in eye mobility or visual acuity may necessitate auditory BCI systems. The present study investigates the efficacy of the use of six environmental sounds to operate a 6x6 P300 Speller. METHODS: A two-group design was used to ascertain whether participants benefited from visual cues early in training. Group A (N=5) received only auditory stimuli during all 11 sessions, whereas Group AV (N=5) received simultaneous auditory and visual stimuli in initial sessions after which the visual stimuli were systematically removed. Stepwise linear discriminant analysis determined the matrix item that elicited the largest P300 response and thereby identified the desired choice. RESULTS: Online results and offline analyses showed that the two groups achieved equivalent accuracy. In the last session, eight of 10 participants achieved 50% or more, and four of these achieved 75% or more, online accuracy (2.8% accuracy expected by chance). Mean bit rates averaged about 2 bits/min, and maximum bit rates reached 5.6 bits/min. CONCLUSIONS: This study indicates that an auditory P300 BCI is feasible, that reasonable classification accuracy and rate of communication are achievable, and that the paradigm should be further evaluated with a group of severely disabled participants who have limited visual mobility. SIGNIFICANCE: With further development, this auditory P300 BCI could be of substantial value to severely disabled people who cannot use a visual BCI.