[Ear acupuncture points in neonates with neonatal abstinence syndrome due to maternal substitution therapy]. / Akupunkturpunkte am Ohr bei Neugeborenen mit Neonatalem Abstinenzsyndrom (NAS) aufgrund mütterlicher Substitutionstherapie.

BACKGROUND: This is a prospective observational study performed at a university teaching hospital. The aim of the study was to determine the presence and absence of acupuncture ear points in neonates with neonatal abstinence syndrome (NAS). PATIENTS AND METHOD: The patients are neonates with neonatal abstinence syndrome. The examination took place on the third day (mean value: 72.3 h) after delivery and was performed by a neuronal pen (PS 3 Silberbauer, Vienna, Austria). A integrated optical and sound signal detects the ear points that were assigned to the ear map. RESULTS: We investigate 5 neonates (3 males, 2 females, mean gestational age: 37+3, mean birth weight: 2,655 g). All investigated neonates showed the presence of active ear acupuncture points. The psychovegetative rim was the most common point in 100% of the children. In all neonates we found the presence of psychic ear points. The detectable psychic ear points are frustration point, R point and the psychotropic field nasal from the incisura intertragica. CONCLUSION: Ear points are detectable in neonates with NAS and do not depend on the side of the ear lobe. The most important point is the psychovegetative rim and, in all neonates with NAS, psychic ear points were detectable. So for the first time it is possible to identify psychic ear acupuncture points in neonates. In the future it could be possible to use active ear points in neonates for diagnostic and therapeutic options.

Forearm and calf tissue oxygenation in term neonates measured with near-infrared spectroscopy.

Peripheral tissue oxygenation has been studied with near-infrared spectroscopy (NIRS) on either the forearm or calf with questionable comparability. The aim was to compare forearm and calf tissue oxygenation in healthy term neonates measured with NIRS. Fractional oxygen extraction, tissue oxygenation index, and mixed venous oxygenation were similar in both extremities, whereas oxygen delivery and oxygen consumption of calf tissue were higher.

Neurodevelopmental outcome at 2 years in 23 to 26 weeks old gestation infants.

BACKGROUND: Assessment of neurologic and developmental outcome at 2 years age of infants with gestational age (GA)<27 weeks, born between 1996-2001. PATIENTS: A total of 110 live-born preterm infants with GA<27 weeks. METHODS: Main outcome criterions: Neurologic examination (according to Touwen) and classification of cerebral palsy by using the Gross Motor Function Classification System (GMFCS) at the corrected age of 1 and 2 years; assessment of mental and psychomotor development by using the Griffith Mental Development scales at the corrected age of 2 years; growth assessment at birth, 1 and 2 years. RESULTS: Mortality was 52%. Regular follow up was performed in 48 (91%) of the 53 surviving infants. Neurologic outcome: at 1 year age: 2% nonambulant cerebral palsy, 25% mild neurologic signs and 73% normal; at 2 years age: 4% nonambulant cerebral palsy, 2% ambulant cerebral palsy, 4% mild neurologic signs and 90% normal neurology. Developmental outcome at 2 years age: 40% DQ>-1 SD, 6% DQ between -1 SD and -2 SD (mild delay), 35% DQ between -2 SD and -3 SD (moderate delay) and 19% DQ<-3 SD (severe delay). Overall disability was found in 64%, severe disability in 27% of the infants. Profound growth failure in weight and head circumference<3rd centile at 2 years age was recorded in 39 and 19% of the infants, respectively. CONCLUSION: Developmental delay is very common in preterm infants<27 GA and exceeds the number of neurological disabilities (including cerebral palsy).

Peripheral oxygenation in term neonates.

The aim of this study was to analyse changes in peripheral oxygenation in healthy term neonates within the first week of life with near-infrared spectroscopy and venous occlusion. Oxygen delivery did not change with increasing age. Oxygen consumption and fractional oxygen extraction increased, whereas tissue oxygenation index decreased with increasing age.

Multi-modal approach to prophylaxis of necrotizing enterocolitis: clinical report and review of literature.

For the first time a multimodal approach to NEC prophylaxis is reported, consisting of early trophic feeding with human breast milk, and enteral administration of an antibiotic, an antifungal agent, and probiotics. A retrospective analysis of local protocol of NEC prophylaxis is presented. Included were all VLBWI admitted to the NICU, including transfers within the first 28 days of life. These infants were divided into two groups, an "inborn group" (infants admitted within the first 24 h of life) and an "outborn group" (infants admitted after the onset of their second day of life). Prophylaxis of NEC according to protocol was started at the day of admission, and was continued until discharge. Between 1998 and 2004, 405 VLBWI were admitted, including all transfers within the first 28 days of life. A total of 334 (82%) infants were admitted within the first 24 h of life (inborn group), and 71 (18%) were admitted after 24 h of life (outborn group). Five infants developed clinical features of necrotizing enterocolitis. The inborn group showed a NEC incidence of 0.7% (two infants), whereas the outborn group showed a NEC incidence of 4.5% (three infants), respectively. This difference was significant (P=0.049, Fisher's exact test). A surgical treatment with bowel resection was performed in two infants (both from the outborn group). The present study used a combination of different strategies, all having shown to have some beneficial effect, but not having brought a clinical breakthrough in single administration studies. Combinated were the beneficial effects of human breast milk feeding, oral antiobiotics, oral antifungal agents, and the administration of probiotics. In a homogenous group of preterm infants, using this protocol of multimodal NEC prophylaxis, there was a very low incidence of NEC, when started within the first 24 h of life.

Minor neurological dysfunction, cognitive development, and somatic development at the age of 3 to 7 years after dexamethasone treatment in very-low birth-weight infants.

The objective of this study was to assess minor neurological dysfunction, cognitive development, and somatic development after dexamethasone therapy in very-low-birthweight infants. Thirty-three children after dexamethasone treatment were matched to 33 children without dexamethasone treatment. Data were assessed at the age of 3-7 years. Dexamethasone was started between the 7th and the 28th day of life over 7 days with a total dose of 2.35 mg/kg/day. Exclusion criteria were asphyxia, malformations, major surgical interventions, small for gestational age, intraventricular haemorrhage grades III and IV, periventricular leukomalacia, and severe psychomotor retardation. Each child was examined by a neuropediatrician for minor neurological dysfunctions and tested by a psychologist for cognitive development with a Kaufman Assessment Battery for Children and a Draw-a-Man Test. There were no differences in demographic data, growth, and socio-economic status between the two groups. Fine motor skills and gross motor function were significantly better in the control group (p<0.01). In the Draw-a-Man Test, the control group showed better results (p<0.001). There were no differences in development of speech, social development, and the Kaufman Assessment Battery for Children. After dexamethasone treatment, children showed a higher rate of minor neurological dysfunctions. Neurological development was affected even without neurological diagnosis. Further long-term follow-up studies will be necessary to fully evaluate the impact of dexamethasone on neurological and cognitive development.

[Inhalation therapy with nitric oxide in pulmonary hypertension: Comparison of preterm infants versus newborn infants]. / Inhalative Therapie mit Stickstoffmonoxid bei pulmonaler Hypertension: Vergleich des Effektes bei Früh- und Neugeborenen.

BACKGROUND: Inhaled nitric oxide (iNO) is used as a vasodilator in pulmonary hypertension (PH) of the newborn infant. PATIENTS AND METHODS: Retrospective analysis of patients, who were treated at our department with iNO in the period from 1994-2001. Response was defined as an increase of the paO (2)/FiO (2) Ratio > or = 20 % and/or a decrease of the oxygenation index (OI) >/= 20 % after 2 h (early response), and consecutively after 24 h (late response). The patients were divided into a) primary persistent pulmonary hypertension of the newbom (PPHN), or b) pulmonary hypertension secondary to meconium aspiration syndrome (MAS), sepsis or congenital diaphragmatic hernia (CDH). RESULTS: Between 1994 and 2001 we treated 47 patients with iNO at our neonatal intensive care unit. We included 16 (35 %) preterm infants (GA 34,5 [25 - 37] weeks, GG 2061 [680 - 3410] g) (Median/Range) and 31 (65 %) newbom (GA 40 [38 - 42] weeks, GG 3510 [2550 - 4560] g). 18 (38 %) patients suffered from primary PPHN, 29 (62 %) from secondary PPHN (14 MAS [30 %], 8 sepsis [17 %], 4 CDH [8 %]). 8 (50 %) preterm and 20 (64 %) term infants showed a positive iNO response after 2 h, again 8 (50 %) preterm and 20 (64%) term infants showed a positive iNO response after 24 h. There was neither a significant difference between term and preterm infants at 2 h, nor at 24 h. Between 2 h and 24 h 10 patients changed in their response to iNO. 5 (18 %) patients with early response showed a significant degradation after 24 h, whereas 5 (26 %) of the patients without early response showed a significant improvement of the oxygenation alter 24 h. Alltogether 13 (72 %) patients with PPHN, 8 (57 %) with MAS, 2 (50 %) with CDH, 4 (50 %) with sepsis showed a positive iNO response after 24 h. In regard to the oxygenation parameters at start of iNO-therapy, the patients with early response did not differ from the patient without response (median OI: 20,0 versus 21,8, median paO (2)/FiO (2) Ratio: 59,3 versus 55,0 mmHg at the start of the iNO therapy). CONCLUSION: In regard to iNO response, there was no significant difference between term and preterm infants. Due to the changing response, a positive iNO-response after 2 h had no predictive value for the further prognosis of the oxygenation situation under iNO therapy.

Absent or reversed end-diastolic blood flow in the umbilical artery and abnormal Doppler cerebroplacental ratio--cognitive, neurological and somatic development at 3 to 6 years.

UNLABELLED: The objective of this study was to examine the cognitive, neurological and somatic developments of children who had in utero an absent or reversed end-diastolic blood flow (ARED) in the umbilical artery or an abnormal cerebroplacental ratio (ABF). METHODS: 16 children with ARED blood flow and 15 children with ABF were each matched to children with the same gestational age, appropriate for gestational age, the same sex and born within 4 months. Data were assessed at the age of 3-6 years. Children with asphyxia, neonatal infection, malformation or major surgical interventions in the neonatal period were excluded. Each child underwent a neuropediatrical examination; furthermore, a Kaufman Assessment Battery for Children, a Snijders-Oomen Intelligence Scale for Children and a Man-Drawing Test were used to evaluate cognitive development. The socioeconomic status was also assessed. RESULTS: Children in the ARED group remained lighter and had a higher frequency of microcephaly. In the Kaufman Assessment Battery for Children and the Snijders-Oomen Intelligence Scale for Young Children, cognitive development was impaired in the ARED and the ABF groups compared to the control group. The ARED and the ABF groups, however, showed no differences. The Man-Drawing Test and the Denver Development Test did not show any differences. DISCUSSION: ARED blood flow and ABF showed impaired cognitive development. The degree of impairment was the same in the ARED and the ABF groups. Long-term follow-up studies until adulthood are necessary to see if impaired cognitive development remains significant in these groups of patients.

[Small for gestational age - Somatic, neurological and cognitive development until adulthood]. / Small for Gestational Age - Körperliche, neurologische und kognitive Entwicklung bis ins Erwachsenenalter.

BACKGROUND: The somatic, neurological and cognitive development of children born small for gestational age (SGA) until adulthood was assessed in recent studies. Studies that assessed mortality, morbidity, somatic, neurological and cognitive development of SGA children were compared. MATERIALS AND METHODS: In the studies very low birth weight SGA children were compared to very low birth weight appropriate for age children (AGA, birth weight below 1500 g or 1250 g). Full-term SGA children were compared to full-term appropriate for age children. Growth of SGA children remained under the 10th percentile, if catch up growth did not occur until the end of the second year. Cerebral palsy appeared more often in VLBW-AGA than in VLBW-SGA children. Cognitive development problems appeared in VLBW-SGA and FT-SGA children more often than in VLBW-AGA and FT-AGA children. These cognitive development problems were observed mainly as poor school performance. When reaching adulthood, the differences in cognitive function seem to be less significant. Low socioeconomic status and persistence of microcephaly were associated with problems in neurological and cognitive development. CONCLUSIONS AND DISCUSSION: Growth and cognitive development problems appeared more often in SGA children. More longterm studies are necessary to show, if these cognitive development problems remain significant until adulthood.

[Changes in breast feeding behavior in Styria 1994 and 2000]. / Anderungen des Stillverhaltens in der Steiermark in den Jahren 1994 und 2000.

Aim of this study was to examine breast feeding behaviour in Styria, Austria in the years 1994 and 2000. Differences were documented and possibilities for better support were outlined. 1994 106 and 2000 60 mothers were questioned about breast feeding behaviour of the last child after delivery of a newborn in our hospital. The social status of the parents, breast feeding duration and frequency, problems while breast feeding and contraception were documented. The mothers were also asked about the breast feeding behaviour they planed for the newborn. 1994 83% and 2000 88% of the mothers breast fed their babies for at least 1 month. The average breast feeding duration increased from 4.8 months in 1994 to 5.3 months in 2000. The frequency of breast feeding also increased. Low social status was correlated with shorter breast feeding duration. Support for breast feeding was used by 53% of the mothers in 1994 and by only 28% of the mothers in 2000. 27% of the mothers wish to breast-feed the newborn longer than the last child in 2000. Breast feeding duration has increased in Styria, Austria from 1994 to 2000. Since mothers want to breast feed even longer, support to breast feeding mothers should be offered as often as possible.

Polypharmacy among patients admitted to hospital with rheumatic diseases.

AIM: This study describes polypharmacy among patients admitted to hospital with rheumatic diseases. METHODS: The study was performed in departments of rheumatology at nine Norwegian hospitals during five weeks in 1998. Pharmacists recorded all drugs on admittance among patients 18 years or older with rheumatic diseases. RESULTS: Sixty percent of 313 patients had polypharmacy defined as the concurrent use of five or more drugs, and this was most frequent among the older patients. However, they used fewer antirheumatic drugs compared to the younger patients. With regard to the three most common drug groups, older patients used more corticosteroids, and less nonsteroidal antiinflammatory drugs (NSAIDs) and disease modifying antirheumatic drugs (DMARDs), compared to the younger. Eighty-four percent of patients on methotrexate used folic acid, but only 52% of the patients who used corticosteroids used calcium supplements. CONCLUSION: Polypharmacy among patients with rheumatic diseases is common, and the present description could be useful for drug-related interventions.

Blood pH in the umbilical artery at birth: an analysis of data from patients delivered in Hesse between 1986 and 1989.

OBJECTIVE: Measuring blood pH in the umbilical artery at birth is an important means of maintaining obstetrical quality. Consideration of the interrelations between low umbilical blood pH and perinatal risk factors may enable obstetricians to provide better care of the mother and child during pregnancy and delivery. We therefore studied the incidence of measuring blood pH at birth, the distribution and normal range of umbilical blood pH at birth, and the correlation between umbilical blood pH and pre-, sub-, and postnatal risk factors in patients delivered in Hesse between 1986 and 1989. SUBJECTS: Over this period 2053 women were delivered between 30 and 32 weeks and 128,654 between 39 and 41 weeks of gestation. Each of these two groups was further subdivided according to the mode of delivery (spontaneous vaginal delivery; operative vaginal delivery; Cesarean section). Of the patients delivered between 39 and 41 weeks of gestation, 24,315 had exhibited no risk factors during pregnancy or delivery. RESULTS: The overall incidence of measuring umbilical blood pH at birth was about 70%, whereas pH measurements were taken in only 60% of preterm babies delivered vaginally. The percentage of preterm neonates with an umbilical blood pH < 7.10 was considerably higher than that of term fetuses (5.0% vs. 1.3%). Of the neonates born of women displaying no risk factors during pregnancy and delivery, 22.4% had an umbilical blood pH < or = 7.25. In patients delivered at term hardly any correlation was found between prenatal risk factors and umbilical blood pH. This contrasted to the situation in patients delivered between 30 and 32 weeks of gestation. In most subgroups a close correlation could be demonstrated between umbilical blood pH and both sub- and postnatal risk factors. No correlation was detected between umbilical blood pH and perinatal mortality. CONCLUSION: In view of the aim of maintaining and improving obstetrical quality in Hesse, the incidence of measuring umbilical blood pH at birth should be increased, especially in preterm fetuses. Since 22.4% of all babies from patients exhibiting no risk factors during pregnancy and delivery had an umbilical blood pH < or = 7.25, we have to reflect once again on the range of 'normal' umbilical blood pH at birth. Consideration of the various interrelations between umbilical blood pH and pre-, sub-, and postnatal risk factors demonstrated in this study may enable obstetricians to reduce the incidence of severely compromised fetuses at birth.

[Digestion of fat and protein and its relation to the activity of faecal enzymes in mucoviscidosis infants under substitution therapy with pancreatic enzymes (author's transl)]. / Fett- und Eiweissverdauung und ihre Beziehung zur Aktivität von Stuhlenzymen bei Mucoviscidosis-kranken Kindern unter Substitutionstherapie mit Pankreasenzymen.

The article reports on a study to determine the influence of different dosage schedules of a pancreas enzyme preparation on the digestion of fat and protein and on the lipolytic, tryptic and chymotryptic activity of the faeces in children suffering from mucoviscidose. After administration of the pancreatin preparation at the low dose level, the quantity of faeces, the excretion of fatty acids and of nitrogen are reduced and the absorption coefficient is improved. The faecal tryptic and chymotryptic activity increases, whereas the lipase activity in the faeces merely shows a tendency to rise. Increasing the pancreatin dose up to a still tolerable value by doubling the dosage does not result in further reduction of the excretion of fat and nitrogen although it enhances the proteolytic activity of the faeces while the lipase activity remains unaffected. Determination of the lipolytic, tryptic or chymotryptic activity is, therefore, unsuitable for assessing the fat and protein digestion and for estimating the required dose of pancreatic enzyme. No increase in uric acid excretion was seen in the urine collected for 24 hours after administration of both enzyme doses.