1
|
Woodford S, Parmar T, Leong E, Zhong J, Oei JL, Suzuki K, Kumar K, Yeo KT, Ma L, De Luca D, Hummler H, Schmölzer G, Vento M, Schindler T. International Online Survey on the Management of Patent Ductus Arteriosus. Neonatology 2024:1-7. [PMID: 38211569 DOI: 10.1159/000535121] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/26/2023] [Accepted: 10/31/2023] [Indexed: 01/13/2024]
Abstract
INTRODUCTION There is uncertainty and lack of consensus regarding optimal management of patent ductus arteriosus (PDA). We aimed to determine current clinical practice in PDA management across a range of different regions internationally. MATERIALS AND METHODS We surveyed PDA management practices in neonatal intensive care units using a pre-piloted web-based survey, which was distributed to perinatal societies in 31 countries. The survey was available online from March 2018 to March 2019. RESULTS There were 812 responses. The majority of clinicians (54%) did not have institutional protocols for PDA treatment, and 42% reported variable management within their own unit. Among infants <28 weeks (or <1,000 g), most clinicians (60%) treat symptomatically. Respondents in Australasia were more likely to treat PDA pre-symptomatically (44% vs. 18% all countries [OR 4.1; 95% CI 2.6-6.5; p < 0.001]), and respondents from North America were more likely to treat symptomatic PDA (67% vs. 60% all countries [OR 2.0; 95% CI 1.5-2.6; p < 0.001]). In infants ≥28 weeks (or ≥1,000 g), most clinicians (54%) treat symptomatically. Respondents in North America were more likely to treat PDAs in this group of infants conservatively (47% vs. 38% all countries [OR 2.3; 95% CI 1.7-3.2; p < 0.001]), and respondents from Asia were more likely to treat the PDA pre-symptomatically (21% vs. 7% all countries [OR 5.5; 95% CI 3.2-9.8; p < 0.001]). DISCUSSION/CONCLUSION There were marked international differences in clinical practice, highlighting ongoing uncertainty and a lack of consensus regarding PDA management. An international conglomeration to coordinate research that prioritises and addresses these areas of contention is indicated.
Collapse
Affiliation(s)
- Sarah Woodford
- School of Clinical Medicine, University of New South Wales, Sydney, New South Wales, Australia
| | - Trisha Parmar
- Department of Newborn Care, Royal Hospital for Women, Randwick, New South Wales, Australia
| | - Emily Leong
- School of Clinical Medicine, University of New South Wales, Sydney, New South Wales, Australia
| | - Jiayue Zhong
- School of Clinical Medicine, University of New South Wales, Sydney, New South Wales, Australia
| | - Ju Lee Oei
- Department of Newborn Care, Royal Hospital for Women, Randwick, New South Wales, Australia
| | - Keiji Suzuki
- Department of Pediatrics, Nagoya City University West Medical Center, Nagoya, Japan
| | - Kishore Kumar
- Department of Neonatology and Pediatrics, Cloudnine Hospitals, Bangalore, India
| | - Kee Thai Yeo
- Department of Neonatology, KK Women's and Children's Hospital, Singapore, Singapore
| | - Li Ma
- Hebei Provincial Children's Hospital, Shijiazhuang, China
| | - Daniele De Luca
- Division of Paediatrics and Neonatal Critical Care, South "A. Beclere" Medical Center, South Paris University Hospitals, Paris, France
| | - Helmut Hummler
- Section Neonatology, Pediatric Intensive Care, Ulm University Children's Hospital, Ulm, Germany
| | - Georg Schmölzer
- Department of Pediatrics, University of Alberta, Edmonton, Alberta, Canada
| | - Maximo Vento
- Spanish Neonatal Network, Health Research Institute La Fe, Valencia, Spain
| | - Timothy Schindler
- Department of Newborn Care, Royal Hospital for Women, Randwick, New South Wales, Australia
| |
Collapse
|
2
|
Nasrah S, Radi A, Daberkow JK, Hummler H, Weber S, Seaayfan E, Kömhoff M. MAGED2 Depletion Promotes Stress-Induced Autophagy by Impairing the cAMP/PKA Pathway. Int J Mol Sci 2023; 24:13433. [PMID: 37686237 PMCID: PMC10488052 DOI: 10.3390/ijms241713433] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2023] [Revised: 08/22/2023] [Accepted: 08/28/2023] [Indexed: 09/10/2023] Open
Abstract
Melanoma-associated antigen D2 (MAGED2) plays an essential role in activating the cAMP/PKA pathway under hypoxic conditions, which is crucial for stimulating renal salt reabsorption and thus explaining the transient variant of Bartter's syndrome. The cAMP/PKA pathway is also known to regulate autophagy, a lysosomal degradation process induced by cellular stress. Previous studies showed that two members of the melanoma-associated antigens MAGE-family inhibit autophagy. To explore the potential role of MAGED2 in stress-induced autophagy, specific MAGED2-siRNA were used in HEK293 cells under physical hypoxia and oxidative stress (cobalt chloride, hypoxia mimetic). Depletion of MAGED2 resulted in reduced p62 levels and upregulation of both the autophagy-related genes (ATG5 and ATG12) as well as the autophagosome marker LC3II compared to control siRNA. The increase in the autophagy markers in MAGED2-depleted cells was further confirmed by leupeptin-based assay which concurred with the highest LC3II accumulation. Likewise, under hypoxia, immunofluorescence in HEK293, HeLa and U2OS cell lines demonstrated a pronounced accumulation of LC3B puncta upon MAGED2 depletion. Moreover, LC3B puncta were absent in human fetal control kidneys but markedly expressed in a fetal kidney from a MAGED2-deficient subject. Induction of autophagy with both physical hypoxia and oxidative stress suggests a potentially general role of MAGED2 under stress conditions. Various other cellular stressors (brefeldin A, tunicamycin, 2-deoxy-D-glucose, and camptothecin) were analyzed, which all induced autophagy in the absence of MAGED2. Forskolin (FSK) inhibited, whereas GNAS Knockdown induced autophagy under hypoxia. In contrast to other MAGE proteins, MAGED2 has an inhibitory role on autophagy only under stress conditions. Hence, a prominent role of MAGED2 in the regulation of autophagy under stress conditions is evident, which may also contribute to impaired fetal renal salt reabsorption by promoting autophagy of salt-transporters in patients with MAGED2 mutation.
Collapse
Affiliation(s)
- Sadiq Nasrah
- Department of Pediatrics, University Hospital Giessen and Marburg, Philipps University Marburg, 35043 Marburg, Germany; (S.N.); (A.R.); (H.H.); (S.W.)
| | - Aline Radi
- Department of Pediatrics, University Hospital Giessen and Marburg, Philipps University Marburg, 35043 Marburg, Germany; (S.N.); (A.R.); (H.H.); (S.W.)
| | - Johanna K. Daberkow
- Faculty of Medicine, Justus Liebig University Giessen, 35392 Giessen, Germany;
| | - Helmut Hummler
- Department of Pediatrics, University Hospital Giessen and Marburg, Philipps University Marburg, 35043 Marburg, Germany; (S.N.); (A.R.); (H.H.); (S.W.)
| | - Stefanie Weber
- Department of Pediatrics, University Hospital Giessen and Marburg, Philipps University Marburg, 35043 Marburg, Germany; (S.N.); (A.R.); (H.H.); (S.W.)
| | - Elie Seaayfan
- Department of Pediatrics, University Hospital Giessen and Marburg, Philipps University Marburg, 35043 Marburg, Germany; (S.N.); (A.R.); (H.H.); (S.W.)
| | - Martin Kömhoff
- Department of Pediatrics, University Hospital Giessen and Marburg, Philipps University Marburg, 35043 Marburg, Germany; (S.N.); (A.R.); (H.H.); (S.W.)
| |
Collapse
|
3
|
Keil C, Köhler S, Sass B, Schulze M, Kalmus G, Belfort M, Schmitt N, Diehl D, King A, Groß S, Sutton CD, Joyeux L, Wege M, Nimsky C, Whitehead WE, Uhl E, Huisman TAGM, Neubauer BA, Weber S, Hummler H, Axt-Fliedner R, Bedei I. Implementation and Assessment of a Laparotomy-Assisted Three-Port Fetoscopic Spina Bifida Repair Program. J Clin Med 2023; 12:5151. [PMID: 37568553 PMCID: PMC10419476 DOI: 10.3390/jcm12155151] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2023] [Revised: 07/24/2023] [Accepted: 08/03/2023] [Indexed: 08/13/2023] Open
Abstract
Open spina bifida (OSB) is a congenital, non-lethal malformation with multifactorial etiology. Fetal therapy can be offered under certain conditions to parents after accurate prenatal diagnostic and interdisciplinary counseling. Since the advent of prenatal OSB surgery, various modifications of the original surgical techniques have evolved, including laparotomy-assisted fetoscopic repair. After a two-year preparation time, the team at the University of Giessen and Marburg (UKGM) became the first center to provide a three-port, three-layer fetoscopic repair of OSB via a laparotomy-assisted approach in the German-speaking area. We point out that under the guidance of experienced centers and by intensive multidisciplinary preparation and training, a previously described and applied technique could be transferred to a different setting.
Collapse
Affiliation(s)
- Corinna Keil
- Department of Prenatal Medicine and Fetal Therapy, Philipps University, 35043 Marburg, Germany
| | - Siegmund Köhler
- Department of Prenatal Medicine and Fetal Therapy, Philipps University, 35043 Marburg, Germany
| | - Benjamin Sass
- Department of Neurosurgery, Philipps University, 35043 Marburg, Germany
| | - Maximilian Schulze
- Department of Neuroradiology, Philipps University, 35043 Marburg, Germany
| | - Gerald Kalmus
- Department of Anesthesiology and Intensive Care Medicine, Philipps University, 35043 Marburg, Germany
| | - Michael Belfort
- Department of Obstetrics and Gynecology, Texas Children’s Hospital, Baylor College of Medicine, Houston, TX 77030, USA
- Texas Children’s Fetal Center, Texas Children’s Hospital, Baylor College of Medicine, Houston, TX 77030, USA
| | - Nicolas Schmitt
- Department of Anesthesiology and Intensive Care Medicine, Philipps University, 35043 Marburg, Germany
| | - Daniele Diehl
- Department of Pediatric Neurology, Justus-Liebig University Giessen, 35392 Giessen, Germany
| | - Alice King
- Texas Children’s Fetal Center, Texas Children’s Hospital, Baylor College of Medicine, Houston, TX 77030, USA
- Division of Pediatric Surgery, Department of Surgery, Texas Children’s Hospital, Baylor College of Medicine, Houston, TX 77030, USA
| | - Stefanie Groß
- Department of Pediatric Neurology, Justus-Liebig University Giessen, 35392 Giessen, Germany
| | - Caitlin D. Sutton
- Department of Pediatric Anesthesiology, Perioperative, and Pain Medicine, Texas Children’s Hospital, Baylor College of Medicine, Houston, TX 77030, USA
| | - Luc Joyeux
- Texas Children’s Fetal Center, Texas Children’s Hospital, Baylor College of Medicine, Houston, TX 77030, USA
- Division of Pediatric Surgery, Department of Surgery, Texas Children’s Hospital, Baylor College of Medicine, Houston, TX 77030, USA
| | - Mirjam Wege
- Division of Neonatology, University Children’s Hospital Marburg, 35043 Marburg, Germany
| | | | - Wiliam E. Whitehead
- Texas Children’s Fetal Center, Texas Children’s Hospital, Baylor College of Medicine, Houston, TX 77030, USA
- Department of Neurosurgery, Texas Children’s Hospital, Baylor College of Medicine, Houston, TX 77030, USA
| | - Eberhard Uhl
- Department of Neurosurgery, Justus-Liebig University, 35390 Giessen, Germany
| | - Thierry A. G. M. Huisman
- Edward B. Singleton Department of Radiology, Texas Children’s Hospital, Baylor College of Medicine, Houston, TX 77030, USA
| | - Bernd A. Neubauer
- Department of Pediatric Neurology, Justus-Liebig University Giessen, 35392 Giessen, Germany
| | - Stefanie Weber
- Division of Pediatric Nephrology and Transplantation, University Children’s Hospital Marburg, 35043 Marburg, Germany
| | - Helmut Hummler
- Division of Neonatology, University Children’s Hospital Marburg, 35043 Marburg, Germany
| | - Roland Axt-Fliedner
- Department of Prenatal Medicine and Fetal Therapy, Justus-Liebig University Giessen, 35390 Giessen, Germany
| | - Ivonne Bedei
- Department of Prenatal Medicine and Fetal Therapy, Justus-Liebig University Giessen, 35390 Giessen, Germany
| |
Collapse
|
4
|
Gross M, Hummler H, Haase B, Quante M, Wiechers C, Poets CF. Interventions for Promoting Meconium Passage in Very Preterm Infants—A Survey of Current Practice at Tertiary Neonatal Centers in Germany. Children 2022; 9:children9081122. [PMID: 36010013 PMCID: PMC9406488 DOI: 10.3390/children9081122] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/01/2022] [Revised: 07/19/2022] [Accepted: 07/26/2022] [Indexed: 11/16/2022]
Abstract
Meconium passage is often delayed in preterm infants. Faster meconium passage appears to shorten the time to full enteral feeds, while severely delayed meconium passage may indicate meconium obstruction. Neonatologists often intervene to promote meconium passage, assuming that benefits outweigh potential risks such as necrotizing enterocolitis (NEC). We performed an anonymous online survey on different approaches to facilitate meconium passage among tertiary neonatal intensive care units (NICUs) in Germany between February 2022 and April 2022. We collected information on enteral nutrition, gastrointestinal complications, and interventions to promote meconium passage. We received 102 completed questionnaires (response rate 64.6%). All responders used interventions to promote meconium passage, including enemas (92.0%), orally applied contrast agents (61.8%), polyethylene glycol (PEG) (46.1%), acetylcysteine (19.6%), glycerin suppositories (11.0%), and maltodextrin (8.8%). There was substantial heterogeneity among NICUs regarding frequency, composition, and mode of administration. We found no differences in NEC incidence between users and nonusers of glycerin enemas, high or low osmolar contrast agents, or PEG. There is wide variability in interventions used to promote meconium passage in German NICUs, with little or no evidence for their efficacy and safety. Within this study design, we could not identify an increased risk of NEC with any intervention reported.
Collapse
|
5
|
V Salis-Soglio N, Hummler H, Schwarz S, Mendler MR. Success rate and duration of orotracheal intubation of premature infants by healthcare providers with different levels of experience using a video laryngoscope as compared to direct laryngoscopy in a simulation-based setting. Front Pediatr 2022; 10:1031847. [PMID: 36507131 PMCID: PMC9731376 DOI: 10.3389/fped.2022.1031847] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/30/2022] [Accepted: 11/07/2022] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND Endotracheal intubation of very low birth weight infants (VLBWI) is an essential procedure in NICUs, but intubation experience is often limited. Video laryngoscopy (VL) has been described as a tool to improve intubation skills, but studies in high-risk neonatal populations are limited. OBJECTIVE The aim of this study was to investigate whether VL is a useful tool to support airway management in high-risk premature infants with inexperienced operators. METHODS In this crossover study predominantly inexperienced participants were exposed in random sequence to VL and conventional direct laryngoscopy (DL) for endotracheal intubation of a VLBWI simulation manikin to measure total time, number of attempts, success rate on first attempt, view of the vocal cords and perceived subjective safety until successful intubation. RESULTS In our study group of 94 participants there was no significant difference in the total time (mean VL: 34 s (±24 s); DL: 37 s (±28 s), p = 0.246), while the number of intubation attempts using VL was significantly lower (mean VL: 1.22 (±0.53); DL: 1.37 (±0.60), p = 0.023). Success rate of VL during the first attempt was significantly higher (VL: 84%; DL 69%, p = 0.016), view of the vocal cords was significantly better and perceived subjective safety was increased using VL. CONCLUSIONS Our study results suggest that with rather inexperienced operators, VL can be a useful tool to increase rate of successful endotracheal intubation of VLBWI and to improve their perceived safety during the procedure, which may have an impact on mortality and/or morbidity.
Collapse
Affiliation(s)
| | - Helmut Hummler
- Divison of Neonatology, Department of Pediatrics, University of Ulm, Ulm, Germany.,Divison of Neonatology, Department of Pediatrics, University of Tübingen, Tübingen, Germany
| | - Stephan Schwarz
- Divison of Neonatology, Department of Pediatrics, University of Ulm, Ulm, Germany
| | - Marc R Mendler
- Divison of Neonatology, Department of Pediatrics, University of Ulm, Ulm, Germany
| |
Collapse
|
6
|
Kröger J, Günster C, Heller G, Jeschke E, Malzahn J, Grab D, Vetter K, Abou-Dakn M, Hummler H, Bührer C. Prevalence and Infant Mortality of Major Congenital Malformations Stratified by Birthweight. Neonatology 2022; 119:41-59. [PMID: 34852351 DOI: 10.1159/000520113] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/18/2021] [Accepted: 10/06/2021] [Indexed: 11/19/2022]
Abstract
BACKGROUND Low birthweight and major congenital malformations (MCMs) are key causes of infant mortality. OBJECTIVES The aim of this study was to explore the prevalence of MCMs in infants with low and very low birthweight and analyze the impact of MCMs and birthweight on infant mortality. METHODS We determined prevalence and infant mortality of 28 life-threatening MCMs in very-low-birthweight (<1,500 g, VLBW), low-birthweight (1,500-2,499 g, LBW), or normal-birthweight (≥2,500 g, NBW) infants in a cohort of 2,727,002 infants born in Germany in 2006-2017, using de-identified administrative data of the largest statutory public health insurance system in Germany. RESULTS The rates of VLBW, LBW, and NBW infants studied were 1.3% (34,401), 4.0% (109,558), and 94.7% (2,583,043). MCMs affected 0.5% (13,563) infants, of whom >75% (10,316) had severe congenital heart disease. The prevalence (per 10,000) of any/cardiac MCM was increased in VLBW (286/176) and LBW (244/143), as compared to NBW infants (38/32). Infant mortality rates were significantly higher in infants with an MCM, as opposed to infants without an MCM, in each birthweight group (VLBW 28.5% vs. 11.5%, LBW 16.7% vs. 0.9%, and NBW 8.6% vs. 0.1%). For most MCMs, observed survival rates in VLBW and LBW infants were lower than expected, as calculated from survival rates of VLBW or LBW infants without an MCM, and NBW infants with an MCM. CONCLUSIONS Infants with an MCM are more often born with LBW or VLBW, as opposed to infants without an MCM. Many MCMs carry significant excess mortality when occurring in VLBW or LBW infants.
Collapse
Affiliation(s)
| | | | - Günther Heller
- Institut für Qualität und Transparenz im Gesundheitswesen, Berlin, Germany
| | | | | | | | | | | | | | | |
Collapse
|
7
|
Foglia EE, Kirpalani H, Ratcliffe SJ, Davis PG, Thio M, Hummler H, Lista G, Cavigioli F, Schmölzer GM, Keszler M, Te Pas AB. Sustained Inflation Versus Intermittent Positive Pressure Ventilation for Preterm Infants at Birth: Respiratory Function and Vital Sign Measurements. J Pediatr 2021; 239:150-154.e1. [PMID: 34453917 PMCID: PMC8604776 DOI: 10.1016/j.jpeds.2021.08.038] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/30/2021] [Revised: 07/30/2021] [Accepted: 08/19/2021] [Indexed: 11/18/2022]
Abstract
OBJECTIVE To characterize respiratory function monitor (RFM) measurements of sustained inflations and intermittent positive pressure ventilation (IPPV) delivered noninvasively to infants in the Sustained Aeration of Infant Lungs (SAIL) trial and to compare vital sign measurements between treatment arms. STUDY DESIGN We analyzed RFM data from SAIL participants at 5 trial sites. We assessed tidal volumes, rates of airway obstruction, and mask leak among infants allocated to sustained inflations and IPPV, and we compared pulse rate and oxygen saturation measurements between treatment groups. RESULTS Among 70 SAIL participants (36 sustained inflations, 34 IPPV) with RFM measurements, 40 (57%) were spontaneously breathing prior to the randomized intervention. The median expiratory tidal volume of sustained inflations administered was 5.3 mL/kg (IQR 1.1-9.2). Significant mask leak occurred in 15% and airway obstruction occurred during 17% of sustained inflations. Among 34 control infants, the median expiratory tidal volume of IPPV inflations was 4.3 mL/kg (IQR 1.3-6.6). Mask leak was present in 3%, and airway obstruction was present in 17% of IPPV inflations. There were no significant differences in pulse rate or oxygen saturation measurements between groups at any point during resuscitation. CONCLUSION Expiratory tidal volumes of sustained inflations and IPPV inflations administered in the SAIL trial were highly variable in both treatment arms. Vital sign values were similar between groups throughout resuscitation. Sustained inflation as operationalized in the SAIL trial was not superior to IPPV to promote lung aeration after birth in this study subgroup. TRIAL REGISTRATION Clinicaltrials.gov: NCT02139800.
Collapse
Affiliation(s)
- Elizabeth E Foglia
- Division of Neonatology, Department of Pediatrics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA.
| | - Haresh Kirpalani
- Division of Neonatology, Department of Pediatrics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - Sarah J Ratcliffe
- Division of Biostatistics, Department of Public Health Sciences, University of Virginia, Charlottesville, VA
| | - Peter G Davis
- Newborn Research Center, The Royal Women's Hospital and The University of Melbourne, Victoria, Australia
| | - Marta Thio
- Newborn Research Center, The Royal Women's Hospital and The University of Melbourne, Victoria, Australia
| | | | - Gianluca Lista
- Department of Pediatrics, NICU, Ospedale dei Bambini V.Buzzi ASST-FBF-Sacco, Milan, Italy
| | - Francesco Cavigioli
- Department of Pediatrics, NICU, Ospedale dei Bambini V.Buzzi ASST-FBF-Sacco, Milan, Italy
| | - Georg M Schmölzer
- Department of Pediatrics, University of Alberta, Edmonton, Alberta, Canada
| | - Martin Keszler
- Department of Pediatrics, Alpert Medical School of Brown University, Women and Infants Hospital of Rhode Island, Providence, RI
| | - Arjan B Te Pas
- Department of Pediatrics, Leiden University Medical Center, Leiden, The Netherlands
| |
Collapse
|
8
|
Khalil BA, Zarroug AE, Elawad A, Moussa S, Donnelly C, Mammoo S, Brisseau G, Bedford Russell A, Hummler H. Outcomes following the establishment of Qatar’s quaternary neonatal general surgical service in a hospital with a “Tabula Rasa” for service development. J Neonatal Surg 2021. [DOI: 10.47338/jns.v10.975] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
Abstract
Background: Sidra Medicine is the first dedicated Children and Maternity hospital in the State of Qatar. This paper describes the preparations for and results of activating quaternary neonatal surgical services in a brand new, "greenfield" hospital. We believe that these are the first published national results of neonatal general surgical services from the Gulf region.
Methods: A review of surgical babies below four weeks corrected age from 1st of April 2018 – 31st of March 2020 was undertaken. Patient demographics, primary diagnosis, surgical procedures, 30-day postoperative mortality, overall mortality, and cause of death were recorded.
Results: One hundred and sixty-nine babies (169) were identified (44.4% term and 55.6% preterm). Major surgery included laparotomy (76), congenital diaphragmatic hernia repair (20), surgery for anorectal malformations (25), and esophageal atresia (13). One set of conjoined twins were also separated successfully. Fourteen babies died, resulting in overall mortality of 8.3 %. Excluding babies who died of life-limiting conditions, two babies died within 30 days of surgery, resulting in 30 days postoperative mortality rate of 1.2 %.
Conclusions: The neonatal surgical mortality rate is comparable with those from top international centers. This low rate could be attributed to the high level of expertise preceded by months of preparations.
Collapse
|
9
|
Maier RF, Hummler H, Kellner U, Krohne TU, Lawrenz B, Lorenz B, Mitschdörfer B, Roll C, Stahl A. Erratum: Augenärztliche Screening-Untersuchung bei Frühgeborenen (S2k-Level, AWMF-Leitlinien-Register-Nr. 024/010, März 2020). Z Geburtshilfe Neonatol 2021; 225:e1. [PMID: 33465780 DOI: 10.1055/a-1361-4844] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Affiliation(s)
- Rolf F Maier
- Zentrum für Kinder- und Jugendmedizin Marburg, Universitätsklinikum Gießen und Marburg GmbH, Standort Marburg, Philipps-Universität Marburg
| | | | - Ulrich Kellner
- Augenzentrum Siegburg, MVZ Augenärztliches Diagnostik- und Therapiecentrum Siegburg GmbH
| | | | - Burkhard Lawrenz
- Privatpraxis für Kinder- und Jugendmedizin Dr. med. Burkhard Lawrenz, Arnsberg
| | - Birgit Lorenz
- Klinik und Poliklinik für Augenheilkunde, Universitätsklinikum Gießen und Marburg GmbH, Standort Gießen, Justus-Liebig-Universität Gießen
| | | | - Claudia Roll
- Abteilung für Neonatologie, Pädiatrische Intensivmedizin, Schlafmedizin, Vestische Kinder- und Jugendklinik Datteln, Universität Witten/Herdecke
| | - Andreas Stahl
- Klinik und Poliklinik für Augenheilkunde, Universitätsmedizin Greifswald
| |
Collapse
|
10
|
Maier RF, Hummler H, Kellner U, Krohne TU, Lawrenz B, Lorenz B, Mitschdörfer B, Roll C, Stahl A. Augenärztliche Screening-Untersuchung bei Frühgeborenen (S2k-Level, AWMF-Leitlinien-Register-Nr. 024/010, März 2020). Z Geburtshilfe Neonatol 2021; 225:19-33. [PMID: 33450782 DOI: 10.1055/a-1248-0649] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Affiliation(s)
- Rolf F Maier
- Zentrum für Kinder- und Jugendmedizin Marburg, Universitätsklinikum Gießen und Marburg GmbH, Standort Marburg, Philipps-Universität Marburg
| | | | - Ulrich Kellner
- Augenzentrum Siegburg, MVZ Augenärztliches Diagnostik- und Therapiecentrum Siegburg GmbH
| | | | - Burkhard Lawrenz
- Privatpraxis für Kinder- und Jugendmedizin Dr. med. Burkhard Lawrenz, Arnsberg
| | - Birgit Lorenz
- Klinik und Poliklinik für Augenheilkunde, Universitätsklinikum Gießen und Marburg GmbH, Standort Gießen, Justus-Liebig-Universität Gießen
| | | | - Claudia Roll
- Abteilung für Neonatologie, Pädiatrische Intensivmedizin, Schlafmedizin, Vestische Kinder- und Jugendklinik Datteln, Universität Witten/Herdecke
| | - Andreas Stahl
- Klinik und Poliklinik für Augenheilkunde, Universitätsmedizin Greifswald
| |
Collapse
|
11
|
Abstract
Bronchopulmonary dysplasia (BPD) remains a significant clinical challenge in neonatal medicine. BPD is clearly a multifactorial disease with numerous antenatal and postnatal components influencing lung development. Extremely immature infants are born in the late canalicular or early saccular stage and usually receive intensive care until the early alveolar stage of lung development, resulting in varying magnitudes of impairment of alveolar septation, lung fibrosis, and abnormal vascular development. The interactions between T lymphocytes, the genome and the epigenome, the microbiome and the metabolome, as well as nutrition and therapeutic interventions such as the exposure to oxygen, volutrauma, antibiotics, corticosteroids, caffeine and omeprazole, play an important role in pathogenesis and disease progression. While our general understanding of these interactions thanks to basic research is improving, this knowledge is yet to be translated into comprehensive prevention and clinical management strategies for the benefit of preterm infants developing BPD and later during infancy and childhood suffering from the disease itself and its sequelae. In this review, we summarise existing evidence on the interplay between T lymphocytes, lung multi-omics and currently used therapeutic interventions in BPD, and highlight avenues for potential future immunology related research in the field.
Collapse
Affiliation(s)
- Gergely Toldi
- Institute of Immunology and Immunotherapy, University of Birmingham, Birmingham, United Kingdom.,Liggins Institute, University of Auckland, Auckland, New Zealand
| | - Helmut Hummler
- Department of Neonatology, University of Tuebingen, Tuebingen, Germany
| | - Thillagavathie Pillay
- Faculty of Science and Engineering, University of Wolverhampton, Wolverhampton, United Kingdom.,Department of Neonatology, University Hospitals Leicester NHS Foundation Trust, Leicester, United Kingdom.,College of Life Sciences, University of Leicester, Leicester, United Kingdom
| |
Collapse
|
12
|
Hummler H. Near-Infrared spectroscopy for perfusion assessment and neonatal management. Semin Fetal Neonatal Med 2020; 25:101145. [PMID: 32830077 DOI: 10.1016/j.siny.2020.101145] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
Term and preterm infants often present with adverse conditions after birth resulting in abnormal vital functions and severe organ failure, which are associated or sometimes caused by low oxygen and/or blood supply. Brain injury may lead to substantial mortality and morbidity often affecting long-term outcome. Standard monitoring techniques in the NICU focus on arterial oxygen supply and hemodynamics and include respiratory rate, heart rate, blood pressure and arterial oxygen saturation as measured by pulse oximetry but provide only limited information on end organ oxygen delivery. Near-Infrared Spectroscopy can bridge this gap by displaying continuous measurements of tissue oxygen saturation, providing information on the balance of oxygen delivery and consumption in organs of interest. Future techniques using multi-wavelength devices may provide additional information on oxidative metabolism in real time adding important information.
Collapse
Affiliation(s)
- Helmut Hummler
- Chief Division of Neonatology, Department of Pediatrics, Sidra Medicine, Al Gharrafa Street, Ar-Rayyan, PO Box 26999, Doha, Qatar; Professor of Pediatrics, Weill Cornell Medicine Qatar, Professor of Pediatrics adj. Ulm University, Germany.
| |
Collapse
|
13
|
Foglia EE, te Pas AB, Kirpalani H, Davis PG, Owen LS, van Kaam AH, Onland W, Keszler M, Schmölzer GM, Hummler H, Lista G, Dani C, Bastrenta P, Localio R, Ratcliffe SJ. Sustained Inflation vs Standard Resuscitation for Preterm Infants: A Systematic Review and Meta-analysis. JAMA Pediatr 2020; 174:e195897. [PMID: 32011661 PMCID: PMC7042947 DOI: 10.1001/jamapediatrics.2019.5897] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
IMPORTANCE Most preterm infants require respiratory support to establish lung aeration after birth. Intermittent positive pressure ventilation and continuous positive airway pressure are standard therapies. An initial sustained inflation (inflation time >5 seconds) is a widely practiced alternative strategy. OBJECTIVE To conduct a systematic review and meta-analysis of sustained inflation vs intermittent positive pressure ventilation and continuous positive airway pressure for the prevention of hospital mortality and morbidity for preterm infants. DATA SOURCES MEDLINE (through PubMed), Embase, the Cumulative Index of Nursing and Allied Health Literature, and the Cochrane Central Register of Controlled Trials were searched through June 24, 2019. STUDY SELECTION Randomized clinical trials of preterm infants born at less than 37 weeks' gestation that compared sustained inflation (inflation time >5 seconds) vs standard resuscitation with either intermittent positive pressure ventilation or continuous positive airway pressure were included. Studies including other cointerventions were excluded. DATA EXTRACTION AND SYNTHESIS Two reviewers assessed the risk of bias of included studies. Meta-analysis of pooled outcome data used a fixed-effects model specific to rarer events. Subgroups were based on gestational age and study design (rescue vs prophylactic sustained inflation). MAIN OUTCOMES AND MEASURES Death before hospital discharge. RESULTS Nine studies recruiting 1406 infants met inclusion criteria. Death before hospital discharge occurred in 85 of 736 infants (11.5%) treated with sustained inflation and 62 of 670 infants (9.3%) who received standard therapy for a risk difference of 3.6% (95% CI, -0.7% to 7.9%). Although analysis of the primary outcome identified important heterogeneity based on gestational age subgroups, the 95% CI for the risk difference included 0 for each individual gestational age subgroup. There was no difference in the primary outcome between subgroups based on study design. Sustained inflation was associated with increased risk of death in the first 2 days after birth (risk difference, 3.1%; 95% CI, 0.9%-5.3%). No differences in the risk of other secondary outcomes were identified. The quality-of-evidence assessment was low owing to risk of bias and imprecision. CONCLUSIONS AND RELEVANCE There was no difference in the risk of the primary outcome of death before hospital discharge, and there was no evidence of efficacy for sustained inflation to prevent secondary outcomes. These findings do not support the routine use of sustained inflation for preterm infants after birth.
Collapse
Affiliation(s)
- Elizabeth E. Foglia
- Division of Neonatology, Department of Pediatrics, Perelman School of Medicine, University of Pennsylvania, Philadelphia
| | - Arjan B. te Pas
- Division of Neonatology, Department of Pediatrics, Leiden University, Leiden, the Netherlands
| | - Haresh Kirpalani
- Division of Neonatology, Department of Pediatrics, Perelman School of Medicine, University of Pennsylvania, Philadelphia
| | - Peter G. Davis
- Newborn Research Center, The Royal Women’s Hospital, Melbourne, Victoria, Australia
| | - Louise S. Owen
- Newborn Research Center, The Royal Women’s Hospital, Melbourne, Victoria, Australia
| | - Anton H. van Kaam
- Emma Children’s Hospital, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, the Netherlands
| | - Wes Onland
- Emma Children’s Hospital, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, the Netherlands
| | - Martin Keszler
- Department of Pediatrics, Women and Infants Hospital of Rhode Island, Alpert Medical School of Brown University, Providence
| | - Georg M. Schmölzer
- Department of Pediatrics, University of Alberta, Edmonton, Alberta, Canada
| | | | - Gianluca Lista
- Department of Pediatrics, Neonatal Intensive Care Unit, Ospedale dei Bambini V.Buzzi ASST-FBF-Sacco, Milan, Italy
| | - Carlo Dani
- Department of Neuroscience, Psychology, Pharmacology and Child Health, University of Florence, Florence, Italy
| | - Petrina Bastrenta
- Department of Pediatrics, Neonatal Intensive Care Unit, Ospedale dei Bambini V.Buzzi ASST-FBF-Sacco, Milan, Italy
| | - Russell Localio
- Department of Biostatistics and Epidemiology, Perelman School of Medicine, University of Pennsylvania, Philadelphia
| | - Sarah J. Ratcliffe
- Division of Biostatistics, Department of Public Health Sciences, University of Virginia, Charlottesville
| |
Collapse
|
14
|
Katheria A, Reister F, Essers J, Mendler M, Hummler H, Subramaniam A, Carlo W, Tita A, Truong G, Davis-Nelson S, Schmölzer G, Chari R, Kaempf J, Tomlinson M, Yanowitz T, Beck S, Simhan H, Dempsey E, O’Donoghue K, Bhat S, Hoffman M, Faksh A, Arnell K, Rich W, Finer N, Vaucher Y, Khanna P, Meyers M, Varner M, Allman P, Szychowski J, Cutter G. Association of Umbilical Cord Milking vs Delayed Umbilical Cord Clamping With Death or Severe Intraventricular Hemorrhage Among Preterm Infants. JAMA 2019; 322:1877-1886. [PMID: 31742630 PMCID: PMC6865839 DOI: 10.1001/jama.2019.16004] [Citation(s) in RCA: 149] [Impact Index Per Article: 29.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
IMPORTANCE Umbilical cord milking as an alternative to delayed umbilical cord clamping may provide equivalent benefits to preterm infants, but without delaying resuscitation. OBJECTIVE To determine whether the rates of death or severe intraventricular hemorrhage differ among preterm infants receiving placental transfusion with umbilical cord milking vs delayed umbilical cord clamping. DESIGN, SETTING, AND PARTICIPANTS Noninferiority randomized clinical trial of preterm infants (born at 23-31 weeks' gestation) from 9 university and private medical centers in 4 countries were recruited and enrolled between June 2017 and September 2018. Planned enrollment was 750 per group. However, a safety signal comprising an imbalance in the number of severe intraventricular hemorrhage events by study group was observed at the first interim analysis; enrollment was stopped based on recommendations from the data and safety monitoring board. The planned noninferiority analysis could not be conducted and a post hoc comparison was performed instead. Final date of follow-up was December 2018. INTERVENTIONS Participants were randomized to umbilical cord milking (n = 236) or delayed umbilical cord clamping (n = 238). MAIN OUTCOMES AND MEASURES The primary outcome was a composite of death or severe intraventricular hemorrhage to determine noninferiority of umbilical cord milking with a 1% noninferiority margin. RESULTS Among 540 infants randomized, 474 (88%) were enrolled and completed the trial (mean gestational age of 28 weeks; 46% female). Twelve percent (29/236) of the umbilical cord milking group died or developed severe intraventricular hemorrhage compared with 8% (20/238) of the delayed umbilical cord clamping group (risk difference, 4% [95% CI, -2% to 9%]; P = .16). Although there was no statistically significant difference in death, severe intraventricular hemorrhage was statistically significantly higher in the umbilical cord milking group than in the delayed umbilical cord clamping group (8% [20/236] vs 3% [8/238], respectively; risk difference, 5% [95% CI, 1% to 9%]; P = .02). The test for interaction between gestational age strata and treatment group was significant for severe intraventricular hemorrhage only (P = .003); among infants born at 23 to 27 weeks' gestation, severe intraventricular hemorrhage was statistically significantly higher with umbilical cord milking than with delayed umbilical cord clamping (22% [20/93] vs 6% [5/89], respectively; risk difference, 16% [95% CI, 6% to 26%]; P = .002). CONCLUSIONS AND RELEVANCE In this post hoc analysis of a prematurely terminated randomized clinical trial of umbilical cord milking vs delayed umbilical cord clamping among preterm infants born at less than 32 weeks' gestation, there was no statistically significant difference in the rate of a composite outcome of death or severe intraventricular hemorrhage, but there was a statistically significantly higher rate of severe intraventricular hemorrhage in the umbilical cord milking group. The early study termination and resulting post hoc nature of the analyses preclude definitive conclusions. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT03019367.
Collapse
Affiliation(s)
- Anup Katheria
- Neonatal Research Institute, Sharp Mary Birch Hospital for Women & Newborns, San Diego, California
| | - Frank Reister
- Department of Obstetrics, University of Ulm, Ulm, Germany
| | - Jochen Essers
- Department of Pediatrics, University of Ulm, Ulm, Germany
| | - Marc Mendler
- Department of Pediatrics, University of Ulm, Ulm, Germany
| | - Helmut Hummler
- Division of Neonatology, Department of Pediatrics, Sidra Medicine, Doha, Qatar
| | | | - Waldemar Carlo
- Department of Pediatrics, University of Alabama at Birmingham
| | - Alan Tita
- Department of Obstetrics, University of Alabama at Birmingham
| | - Giang Truong
- Department of Pediatrics, Loma Linda University, Loma Linda, California
| | | | - Georg Schmölzer
- Department of Pediatrics, University of Alberta, Edmonton, Canada
| | - Radha Chari
- Department of Obstetrics, University of Alberta, Edmonton, Canada
| | - Joseph Kaempf
- Women and Children’s Services, Providence St Vincent Medical Center, Portland, Oregon
| | - Mark Tomlinson
- Women and Children’s Services, Providence St Vincent Medical Center, Portland, Oregon
| | - Toby Yanowitz
- Department of Pediatrics, Magee Women’s Hospital of UPMC, Pittsburgh, Pennsylvania
| | - Stacy Beck
- Department of Obstetrics, Magee Women’s Hospital of UPMC, Pittsburgh, Pennsylvania
| | - Hyagriv Simhan
- Department of Obstetrics, Magee Women’s Hospital of UPMC, Pittsburgh, Pennsylvania
| | - Eugene Dempsey
- Department of Paediatrics and Child Health, University College Cork, Cork, Ireland
- INFANT Research Centre, University College Cork, Cork, Ireland
| | | | - Shazia Bhat
- Department of Pediatrics, Christiana Care Health System, Newark, Delaware
| | - Matthew Hoffman
- Department of Obstetrics, Christiana Care Health System, Newark, Delaware
| | - Arij Faksh
- Neonatal Research Institute, Sharp Mary Birch Hospital for Women & Newborns, San Diego, California
| | - Kathy Arnell
- Neonatal Research Institute, Sharp Mary Birch Hospital for Women & Newborns, San Diego, California
| | - Wade Rich
- Neonatal Research Institute, Sharp Mary Birch Hospital for Women & Newborns, San Diego, California
| | - Neil Finer
- Neonatal Research Institute, Sharp Mary Birch Hospital for Women & Newborns, San Diego, California
| | - Yvonne Vaucher
- Department of Radiology, Children’s Hospital Colorado, University of Colorado School of Medicine, Denver
| | - Paritosh Khanna
- Department of Radiology, Rady Children’s Hospital, San Diego, California
| | - Mariana Meyers
- Department of Radiology, Children’s Hospital Colorado, University of Colorado School of Medicine, Denver
| | - Michael Varner
- Department of Obstetrics and Gynecology, University of Utah, Salt Lake City
| | - Phillip Allman
- Department of Biostatistics, University of Alabama at Birmingham
| | - Jeff Szychowski
- Department of Biostatistics, University of Alabama at Birmingham
| | - Gary Cutter
- Department of Biostatistics, University of Alabama at Birmingham
| |
Collapse
|
15
|
Maiwald CA, Niemarkt HJ, Poets CF, Urschitz MS, König J, Hummler H, Bassler D, Engel C, Franz AR. Effects of closed-loop automatic control of the inspiratory fraction of oxygen (FiO 2-C) on outcome of extremely preterm infants - study protocol of a randomized controlled parallel group multicenter trial for safety and efficacy. BMC Pediatr 2019; 19:363. [PMID: 31630690 PMCID: PMC6802113 DOI: 10.1186/s12887-019-1735-9] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/31/2019] [Accepted: 09/20/2019] [Indexed: 01/08/2023] Open
Abstract
Background Most extremely low gestational age neonates (ELGANS, postmenstrual age at birth (PMA) < 28 completed weeks) require supplemental oxygen and experience frequent intermittent hypoxemic and hyperoxemic episodes. Hypoxemic episodes and exposure to inadequately high concentrations of oxygen are associated with an increased risk of retinopathy of prematurity (ROP), chronic lung disease of prematurity (BPD), necrotizing enterocolitis (NEC), neurodevelopmental impairment (NDI), and death beyond 36 weeks PMA. Closed-loop automated control of the inspiratory fraction of oxygen (FiO2-C) reduces time outside the hemoglobin oxygen saturation (SpO2) target range, number and duration of hypo- and hyperoxemic episodes and caregivers’ workload. Effects on clinically important outcomes in ELGANs such as ROP, BPD, NEC, NDI and mortality have not yet been studied. Methods An outcome-assessor-blinded, randomized controlled, parallel-group trial was designed and powered to study the effect of FiO2-C (in addition to routine manual control (RMC) of FiO2), compared to RMC only, on death and severe complications related to hypoxemia and/or hyperoxemia. 2340 ELGANS with a GA of 23 + 0/7 to 27 + 6/7 weeks will be recruited in approximately 75 European tertiary care neonatal centers. Study participants are randomly assigned to RMC (control-group) or FiO2-C in addition to RMC (intervention-group). Central randomization is stratified for center, gender and PMA at birth (< 26 weeks and ≥ 26 weeks). FiO2-C is provided by commercially available and CE-marked ventilators with an FiO2-C algorithm intended for use in newborn infants. The primary outcome variable (composite of death, severe ROP, BPD or NEC) is assessed at 36 weeks PMA (or, in case of ROP, until complete vascularization of the retina, respectively). The co-primary outcome variable (composite outcome of death, language/cognitive delay, motor impairment, severe visual impairment or hearing impairment) is assessed at 24 months corrected age. Discussion Short-term studies on FiO2-C showed improved time ELGANs spent within their assigned SpO2 target range, but effects of FiO2-C on clinical outcomes are yet unknown and will be addressed in the FiO2-C trial. This will ensure an appropriate assessment of safety and efficacy before FiO2-C may be implemented as standard therapy. Trial registration The study is registered at www.ClinicalTrials.gov: NCT03168516, May 30, 2017.
Collapse
Affiliation(s)
- Christian A Maiwald
- Department of Neonatology, University Children's Hospital Tübingen, Calwerstr. 7, 72076, Tübingen, Germany.,Center for Pediatric Clinical Studies (CPCS), University Children's Hospital Tübingen, Calwerstr. 7, 72076, Tübingen, Germany
| | | | - Christian F Poets
- Department of Neonatology, University Children's Hospital Tübingen, Calwerstr. 7, 72076, Tübingen, Germany
| | - Michael S Urschitz
- Institute of Medical Biostatistics, Epidemiology and Informatics, Medical Center of the Johannes Gutenberg-University Mainz, Mainz, Germany
| | - Jochem König
- Institute of Medical Biostatistics, Epidemiology and Informatics, Medical Center of the Johannes Gutenberg-University Mainz, Mainz, Germany
| | | | | | - Corinna Engel
- Center for Pediatric Clinical Studies (CPCS), University Children's Hospital Tübingen, Calwerstr. 7, 72076, Tübingen, Germany
| | - Axel R Franz
- Department of Neonatology, University Children's Hospital Tübingen, Calwerstr. 7, 72076, Tübingen, Germany. .,Center for Pediatric Clinical Studies (CPCS), University Children's Hospital Tübingen, Calwerstr. 7, 72076, Tübingen, Germany.
| | | |
Collapse
|
16
|
Weber B, Mendler MR, Lackner I, von Zelewski A, Höfler S, Baur M, Braun CK, Hummler H, Schwarz S, Pressmar J, Kalbitz M. Lung injury after asphyxia and hemorrhagic shock in newborn piglets: Analysis of structural and inflammatory changes. PLoS One 2019; 14:e0219211. [PMID: 31276543 PMCID: PMC6611609 DOI: 10.1371/journal.pone.0219211] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2019] [Accepted: 06/18/2019] [Indexed: 11/18/2022] Open
Abstract
OBJECTIVE Asphyxia of newborns is a severe and frequent challenge of the peri- and postnatal period. The purpose of this study was to study early morphological, immunological and structural alterations in lung tissue after asphyxia and hemorrhage (AH). METHODS 44 neonatal piglets (age 32 hrs) underwent asphyxia and hemorrhage (AH) and were treated according to the international liaison committee of resuscitation (ILCOR) guidelines. For this study, 15 piglets (blood transfusion (RBC) n = 9; NaCl n = 6, mean age 31 hrs) were randomly picked. 4 hours after ROSC (return of spontaneous circulation), lung tissue and blood samples were collected. RESULTS An elevation of myeloperoxidase (MPO) activity was observed 4 hrs after AH accompanied by an increase of surfactant D after RBC treatment. After AH tight junction proteins Claudin 18 and junctional adhesion molecule 1 (JAM1) were down-regulated, whereas Occludin was increased. Furthermore, after AH and RBC treatment dephosphorylated active form of Connexin 43 was increased. CONCLUSIONS AH in neonatal pigs is associated with early lung injury, inflammation and alterations of tight junctions (Claudin, Occludin, JAM-1) and gap junctions (Connexin 43) in lung tissue, which contributes to the development of lung edema and impaired function.
Collapse
Affiliation(s)
- Birte Weber
- Department of Traumatology, Hand-, Plastic-, and Reconstructive Surgery, Center of Surgery, University of Ulm, Ulm, Baden-Württemberg, Germany
| | - Marc Robin Mendler
- Division of Neonatology and Pediatric Critical Care, Department of Pediatrics and Adolescent Medicine, University of Ulm, Ulm, Baden-Württemberg, Germany
| | - Ina Lackner
- Department of Traumatology, Hand-, Plastic-, and Reconstructive Surgery, Center of Surgery, University of Ulm, Ulm, Baden-Württemberg, Germany
| | - Alexander von Zelewski
- Department of Traumatology, Hand-, Plastic-, and Reconstructive Surgery, Center of Surgery, University of Ulm, Ulm, Baden-Württemberg, Germany
| | - Severin Höfler
- Department of Traumatology, Hand-, Plastic-, and Reconstructive Surgery, Center of Surgery, University of Ulm, Ulm, Baden-Württemberg, Germany
| | - Meike Baur
- Department of Traumatology, Hand-, Plastic-, and Reconstructive Surgery, Center of Surgery, University of Ulm, Ulm, Baden-Württemberg, Germany
| | - Christian Karl Braun
- Institute of Clinical and Experimental Trauma-Immunology, University Hospital of Ulm, Ulm, Baden-Württemberg, Germany
| | - Helmut Hummler
- Division of Neonatology and Pediatric Critical Care, Department of Pediatrics and Adolescent Medicine, University of Ulm, Ulm, Baden-Württemberg, Germany
- Division of Neonatology, Department of Pediatrics, Sidra Medicine, Doha, Qatar
| | - Stephan Schwarz
- Division of Neonatology and Pediatric Critical Care, Department of Pediatrics and Adolescent Medicine, University of Ulm, Ulm, Baden-Württemberg, Germany
| | - Jochen Pressmar
- Department of Traumatology, Hand-, Plastic-, and Reconstructive Surgery, Center of Surgery, University of Ulm, Ulm, Baden-Württemberg, Germany
| | - Miriam Kalbitz
- Department of Traumatology, Hand-, Plastic-, and Reconstructive Surgery, Center of Surgery, University of Ulm, Ulm, Baden-Württemberg, Germany
- * E-mail:
| |
Collapse
|
17
|
Gajdos M, Waitz M, Mendler MR, Braun W, Hummler H. Effects of a new device for automated closed loop control of inspired oxygen concentration on fluctuations of arterial and different regional organ tissue oxygen saturations in preterm infants. Arch Dis Child Fetal Neonatal Ed 2019; 104:F360-F365. [PMID: 30154236 DOI: 10.1136/archdischild-2018-314769] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/08/2018] [Revised: 06/27/2018] [Accepted: 06/29/2018] [Indexed: 11/03/2022]
Abstract
OBJECTIVE To assess the efficacy of a newly developed system for closed loop control of the fraction of inspired oxygen (FiO2) on variation of arterial (SpO2) and on regional tissue oxygen saturation (StO2) in preterm infants with fluctuations in SpO2. DESIGN Randomised crossover trial comparing automated (auto) to manual FiO2 adjustment (manual) during two consecutive 24 hours periods using a Sophie infant ventilator (SPO2C). SETTING Tertiary university medical centre. PATIENTS Twelve very low birthweight infant (VLBWI) (gestational age (median; IQR): (25; 23-26 weeks); birth weight (mean±SD): (667±134 g); postnatal age (mean±SD): (31.5±14 days)). MAIN OUTCOME MEASURE Time within SpO2 target range. RESULTS There was an increase in time within the intended SpO2 target range (88%-96%) during auto as compared with manual mode (77.8%±7.1% vs 68.5%±7.7% (mean±SD), p<0.001) and a decrease in time below the SpO2 target during the auto period (18.1%±6.4% vs 25.6%±7.6%; p<0.01). There was a dramatic reduction in events with an SpO2 <88% with >180 s duration: (2 (0-10) vs 10 (0-37) events, p<0.001) and the need for manual adjustments. The time the infants spent above the intended arterial oxygen range (4.1%±3.8% vs 5.9%±3.6%), median FiO2, mean SpO2 over time and StO2 in the brain, liver and kidney did not differ significantly between the two periods. CONCLUSIONS Closed-loop FiO2 using SPO2C significantly increased time of arterial SpO2 within the intended range in VLBWI and decreased the need for manual adjustments when compared with the routine adjustment by staff members. StO2 was not significantly affected by the mode of oxygen control.
Collapse
Affiliation(s)
- Marek Gajdos
- Divison of Neonatology and Pediatric Intensive Care, Department of Pediatrics, University of Ulm, Ulm, Germany
| | - Markus Waitz
- Divison of Neonatology and Pediatric Intensive Care, Department of Pediatrics, University of Ulm, Ulm, Germany.,Division of Neonatology, Department of Pediatrics, University of Giessen, Giessen, Germany
| | - Marc Robin Mendler
- Divison of Neonatology and Pediatric Intensive Care, Department of Pediatrics, University of Ulm, Ulm, Germany
| | | | - Helmut Hummler
- Divison of Neonatology and Pediatric Intensive Care, Department of Pediatrics, University of Ulm, Ulm, Germany.,Division of Neonatology, Department of Pediatrics, Sidra Medical and Research Center, Sidra, Qatar
| |
Collapse
|
18
|
Kirpalani H, Ratcliffe SJ, Keszler M, Davis PG, Foglia EE, te Pas A, Fernando M, Chaudhary A, Localio R, van Kaam AH, Onland W, Owen LS, Schmölzer GM, Katheria A, Hummler H, Lista G, Abbasi S, Klotz D, Simma B, Nadkarni V, Poulain FR, Donn SM, Kim HS, Park WS, Cadet C, Kong JY, Smith A, Guillen U, Liley HG, Hopper AO, Tamura M. Effect of Sustained Inflations vs Intermittent Positive Pressure Ventilation on Bronchopulmonary Dysplasia or Death Among Extremely Preterm Infants: The SAIL Randomized Clinical Trial. JAMA 2019; 321:1165-1175. [PMID: 30912836 PMCID: PMC6439695 DOI: 10.1001/jama.2019.1660] [Citation(s) in RCA: 101] [Impact Index Per Article: 20.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
IMPORTANCE Preterm infants must establish regular respirations at delivery. Sustained inflations may establish lung volume faster than short inflations. OBJECTIVE To determine whether a ventilation strategy including sustained inflations, compared with standard intermittent positive pressure ventilation, reduces bronchopulmonary dysplasia (BPD) or death at 36 weeks' postmenstrual age without harm in extremely preterm infants. DESIGN, SETTING, AND PARTICIPANTS Unmasked, randomized clinical trial (August 2014 to September 2017, with follow-up to February 15, 2018) conducted in 18 neonatal intensive care units in 9 countries. Preterm infants 23 to 26 weeks' gestational age requiring resuscitation with inadequate respiratory effort or bradycardia were enrolled. Planned enrollment was 600 infants. The trial was stopped after enrolling 426 infants, following a prespecified review of adverse outcomes. INTERVENTIONS The experimental intervention was up to 2 sustained inflations at maximal peak pressure of 25 cm H2O for 15 seconds using a T-piece and mask (n = 215); standard resuscitation was intermittent positive pressure ventilation (n = 211). MAIN OUTCOME AND MEASURES The primary outcome was the rate of BPD or death at 36 weeks' postmenstrual age. There were 27 prespecified secondary efficacy outcomes and 7 safety outcomes, including death at less than 48 hours. RESULTS Among 460 infants randomized (mean [SD] gestational age, 25.30 [0.97] weeks; 50.2% female), 426 infants (92.6%) completed the trial. In the sustained inflation group, 137 infants (63.7%) died or survived with BPD vs 125 infants (59.2%) in the standard resuscitation group (adjusted risk difference [aRD], 4.7% [95% CI, -3.8% to 13.1%]; P = .29). Death at less than 48 hours of age occurred in 16 infants (7.4%) in the sustained inflation group vs 3 infants (1.4%) in the standard resuscitation group (aRD, 5.6% [95% CI, 2.1% to 9.1%]; P = .002). Blinded adjudication detected an imbalance of rates of early death possibly attributable to resuscitation (sustained inflation: 11/16; standard resuscitation: 1/3). Of 27 secondary efficacy outcomes assessed by 36 weeks' postmenstrual age, 26 showed no significant difference between groups. CONCLUSIONS AND RELEVANCE Among extremely preterm infants requiring resuscitation at birth, a ventilation strategy involving 2 sustained inflations, compared with standard intermittent positive pressure ventilation, did not reduce the risk of BPD or death at 36 weeks' postmenstrual age. These findings do not support the use of ventilation with sustained inflations among extremely preterm infants, although early termination of the trial limits definitive conclusions. TRIAL REGISTRATION clinicaltrials.gov Identifier: NCT02139800.
Collapse
Affiliation(s)
- Haresh Kirpalani
- Division of Neonatology, Children’s Hospital of Philadelphia, University of Pennsylvania, Philadelphia
| | - Sarah J. Ratcliffe
- Division of Biostatistics, Department of Public Health Sciences, University of Virginia, Charlottesville
| | - Martin Keszler
- Warren Alpert Medical School, Department of Pediatrics, Brown University Women and Infants Hospital of Rhode Island, Providence
| | - Peter G. Davis
- Newborn Research Centre, The Royal Women’s Hospital, Melbourne, Victoria, Australia
| | - Elizabeth E. Foglia
- Division of Neonatology, Department of Pediatrics, Children’s Hospital of Philadelphia, University of Pennsylvania Perelman School of Medicine, Philadelphia
| | - Arjan te Pas
- Division of Neonatology, Department of Pediatrics, Leiden University Medical Center, Leiden, the Netherlands
| | - Melissa Fernando
- Department of Biostatistics and Epidemiology, Perelman School of Medicine, University of Pennsylvania, Philadelphia
| | - Aasma Chaudhary
- Division of Neonatology, Department of Pediatrics, Children’s Hospital of Philadelphia, Hospital of the University of Pennsylvania, Philadelphia
| | - Russell Localio
- Department of Biostatistics and Epidemiology, Perelman School of Medicine, University of Pennsylvania, Philadelphia
| | - Anton H. van Kaam
- Department of Neonatology, Emma Children’s Hospital, Academic Medical Center, Amsterdam, the Netherlands
| | - Wes Onland
- Department of Neonatology, Emma Children’s Hospital, Academic Medical Center, Amsterdam, the Netherlands
| | - Louise S. Owen
- Newborn Research Center and Neonatal Services, The Royal Women’s Hospital, Melbourne, Victoria, Australia
- Department of Obstetrics and Gynecology, The University of Melbourne, Melbourne, Victoria, Australia
- Murdoch Children’s Research Institute, Melbourne, Victoria, Australia
| | - Georg M. Schmölzer
- Department of Pediatrics, University of Alberta, Edmonton, Alberta, Canada
| | - Anup Katheria
- Department of Neonatology, Sharp Mary Birch Hospital for Women and Newborns, San Diego, California
| | - Helmut Hummler
- Division of Neonatology, Department of Pediatrics, Sidra Medicine, Doha, Qatar
- Division of Neonatology and Pediatric Critical Care, Department of Pediatrics and Adolescent Medicine, Ulm University, Ulm, Germany
| | - Gianluca Lista
- Department of Pediatrics, NICU, Ospedale dei Bambini V. Buzzi, ASST-FBF-Sacco, Milan, Italy
| | - Soraya Abbasi
- Division of Newborn Pediatrics, Pennsylvania Hospital, Philadelphia
| | - Daniel Klotz
- Center for Pediatrics, Medical Center–University of Freiburg, Faculty of Medicine, Freiburg, Germany
| | - Burkhard Simma
- Department of Pediatrics, Academic Teaching Hospital, Landeskrankenhaus Feldkirch, Feldkirch, Austria
| | - Vinay Nadkarni
- Department of Anesthesiology and Critical Care Medicine, Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Francis R. Poulain
- Division of Neonatology, Department of Pediatrics, University of California, Davis, Sacramento
| | - Steven M. Donn
- Division of Neonatal-Perinatal Medicine, Department of Pediatrics, C.S. Mott Children’s Hospital, Michigan Medicine, University of Michigan, Ann Arbor
| | - Han-Suk Kim
- Division of Neonatology, Department of Pediatrics, Seoul National University Children’s Hospital, Seoul, Republic of Korea
| | - Won Soon Park
- Department of Pediatrics, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | - Claudia Cadet
- Department of Neonatology, WakeMed Health and Hospitals, Raleigh, North Carolina
| | - Juin Yee Kong
- Department of Neonatology, KK Women’s and Children’s Hospital, Singapore
| | - Alexandra Smith
- Department of Pediatrics, Tufts Clinical and Translational Research Institute, The Floating Hospital for Children at Tufts Medical Center, Boston, Massachusetts
| | | | - Helen G. Liley
- Newborn Services, Mater Mothers’ Hospital and Mater Research, South Brisbane, Queensland, Australia
| | - Andrew O. Hopper
- Division of Neonatology, Department of Pediatrics, Loma Linda University, Loma Linda, California
| | - Masanori Tamura
- Department of Pediatrics, Saitama Medical Center, Saitama Medical University, Kawagoe, Saitama, Japan
| |
Collapse
|
19
|
Katheria AC, Reister F, Hummler H, Essers J, Mendler M, Truong G, Davis-Nelson S, Subramaniam A, Carlo W, Yankowitz TD, Simhan H, Beck S, Kaempf J, Tomlinson M, Schmolzer G, Chari R, Dempsey E, O’Donoghue K, Bhat S, Hoffman M, Faksh A, Vaucher Y, Szychowski J, Cutter G, Varner M, Finer N. LB 1: Premature Infants Receiving Cord Milking or Delayed Cord Clamping: A Randomized Controlled Non-inferiority Trial. Am J Obstet Gynecol 2019. [DOI: 10.1016/j.ajog.2018.12.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
|
20
|
Cipowicz C, Schmid M, Hummler H, Thome U. [Correction: IVH Prevention for ELBW Preterm Babies in Two Different Perinatal Centers]. Z Geburtshilfe Neonatol 2018; 222:e2. [PMID: 30566962 DOI: 10.1055/a-0818-7142] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Affiliation(s)
- Clara Cipowicz
- Abteilung für Neonatologie, Universitätsklinikum Leipzig.,Klinik für Gynäkologie und Geburtshilfe, Ernst von Bergmann Klinikum, Potsdam
| | - Manuel Schmid
- Sektion Neonatologie und pädiatrische Intensivmedizin, Klinik für Kinder- und Jugendmedizin, Universitätsklinikum Ulm.,Klinik für Neonatologie, Universitätsspital Zürich, Schweiz
| | - Helmut Hummler
- Sektion Neonatologie und pädiatrische Intensivmedizin, Klinik für Kinder- und Jugendmedizin, Universitätsklinikum Ulm.,Division of Neonatology, Sidra Medicine, Doha, Qatar
| | - Ulrich Thome
- Abteilung für Neonatologie, Universitätsklinikum Leipzig
| |
Collapse
|
21
|
Abstract
Zusammenfassung
Hintergrund Im Rahmen eines Projekts zur konsequenten Vermeidung zahlreicher bekannter Risikoindikatoren sank die Inzidenz von intraventrikulären Hämorrhagien (IVH) am Ulmer Perinatalzentrum. Ein Vergleich mit dem Leipziger Zentrum sollte Hinweise liefern, an welchen Stellen es an beiden Zentren noch Verbesserungsmöglichkeiten gibt.
Methoden Eine retrospektive Datenerhebung wurde für 189 Leipziger und 89 Ulmer Frühgeborene mit einem Geburtsgewicht von unter 1000 g durchgeführt. Für diese Daten wurde ein Vergleich zwischen den beiden Zentren durchgeführt.
Ergebnisse Eine IVH aller Schweregrade wurde in Leipzig (56/197, 28,4%) häufiger (p=0,01) als in Ulm (13/89, 14,6%) gefunden. Der Unterschied betraf nur die leichten IVH Grade 1–2; die Inzidenz der schweren IVH (Grad 3–4) unterschied sich nicht zwischen den beiden Zentren (p=0,59, Leipzig 12/197, 6,1%; Ulm 4/89, 4,5%). Weiterhin zeigte sich bei einzelnen IVH-Risikoindikatoren eine unterschiedliche Verteilung zwischen den beiden Zentren. So trat eine postnatale Hypokapnie in Leipzig (42/197, 21,3%) häufiger auf (p<0,01) als in Ulm (3/86, 3,5%). Auch eine postnatale Hypothermie ereignete sich häufiger (p<0,01) in Leipzig (53/197, 26,9%) als in Ulm (10/89, 11,2%). In Ulm wurde hingegen eine rasche postnatale Surfactantapplikation seltener (p<0,01) durchgeführt (32/60, 53,3%) als in Leipzig (136/158, 86,1%) und Bikarbonat wurde in Ulm häufiger gegeben (48/89, 46,1% gegenüber 183/197, 7,1%, p<0,01).
Schlussfolgerung Potenziell vermeidbare Risikofaktoren traten in beiden Zentren in unterschiedlicher Häufigkeit auf. Diese Ergebnisse ermöglichen es beiden Zentren, die jeweils mit erhöhte Häufigkeit aufgetretenen Risikofaktoren gezielt zu vermeiden und so die IVH-Rate weiter abzusenken.
Collapse
Affiliation(s)
- Clara Cipowicz
- Abteilung für Neonatologie, Universitätsklinikum Leipzig
- Klinik für Gynäkologie und Geburtshilfe, Ernst von Bergmann Klinikum, Potsdam
| | - Manuel Schmid
- Sektion Neonatologie und pädiatrische Intensivmedizin, Klinik für Kinder- und Jugendmedizin, Universitätsklinikum
Ulm
- Klinik für Neonatologie, Universitätsspital Zürich, Schweiz
| | - Helmut Hummler
- Sektion Neonatologie und pädiatrische Intensivmedizin, Klinik für Kinder- und Jugendmedizin, Universitätsklinikum
Ulm
- Division of Neonatology, Sidra Medicine, Doha, Qatar
| | - Ulrich Thome
- Abteilung für Neonatologie, Universitätsklinikum Leipzig
| |
Collapse
|
22
|
Kalbitz M, Schwarz S, Weber B, Bosch B, Pressmar J, Hoenes FM, Braun CK, Horst K, Simon TP, Pfeifer R, Störmann P, Hummler H, Gebhard F, Pape HC, Huber-Lang M, Hildebrand F. Cardiac Depression in Pigs after Multiple Trauma - Characterization of Posttraumatic Structural and Functional Alterations. Sci Rep 2017; 7:17861. [PMID: 29259232 PMCID: PMC5736586 DOI: 10.1038/s41598-017-18088-1] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2017] [Accepted: 12/06/2017] [Indexed: 12/17/2022] Open
Abstract
The purpose of this study was to define the relationship between cardiac depression and morphological and immunological alterations in cardiac tissue after multiple trauma. However, the mechanistic basis of depressed cardiac function after trauma is still elusive. In a porcine polytrauma model including blunt chest trauma, liver laceration, femur fracture and haemorrhage serial trans-thoracic echocardiography was performed and correlated with cellular cardiac injury as well as with the occurrence of extracellular histones in serum. Postmortem analysis of heart tissue was performed 72 h after trauma. Ejection fraction and shortening fraction of the left ventricle were significantly impaired between 4 and 27 h after trauma. H-FABP, troponin I and extracellular histones were elevated early after trauma and returned to baseline after 24 and 48 h, respectively. Furthermore, increased nitrotyrosine and Il-1β generation and apoptosis were identified in cardiac tissue after trauma. Main structural findings revealed alteration of connexin 43 (Cx43) and co-translocation of Cx43 and zonula occludens 1 to the cytosol, reduction of α-actinin and increase of desmin in cardiomyocytes after trauma. The cellular and subcellular events demonstrated in this report may for the first time explain molecular mechanisms associated with cardiac dysfunction after multiple trauma.
Collapse
Affiliation(s)
- M Kalbitz
- Department of Traumatology, Hand-, Plastic-, and Reconstructive Surgery, Center of Surgery, University of Ulm, Ulm, Germany.
| | - S Schwarz
- Division of Neonatology and Pediatric Critical Care, University of Ulm, Ulm, Germany
| | - B Weber
- Department of Traumatology, Hand-, Plastic-, and Reconstructive Surgery, Center of Surgery, University of Ulm, Ulm, Germany
| | - B Bosch
- Department of Traumatology, Hand-, Plastic-, and Reconstructive Surgery, Center of Surgery, University of Ulm, Ulm, Germany
| | - J Pressmar
- Department of Traumatology, Hand-, Plastic-, and Reconstructive Surgery, Center of Surgery, University of Ulm, Ulm, Germany
| | - F M Hoenes
- Department of Traumatology, Hand-, Plastic-, and Reconstructive Surgery, Center of Surgery, University of Ulm, Ulm, Germany
| | - C K Braun
- Institute of Clinical and Experimental Trauma-Immunology, University of Ulm, Ulm, Germany
| | - K Horst
- Department of Orthopaedic Trauma, RWTH Aachen University, Aachen, Germany
| | - T P Simon
- Department of Intensive Care and Intermediate Care, RWTH Aachen University, Aachen, Germany
| | - R Pfeifer
- Department of Trauma Surgery, University Hospital Zurich, Zurich, Switzerland
| | - P Störmann
- Department of Trauma-, Hand- and Reconstructive Surgery, University Hospital Frankfurt, Goethe University, Frankfurt/Main, Germany
| | - H Hummler
- Division of Neonatology and Pediatric Critical Care, University of Ulm, Ulm, Germany
| | - F Gebhard
- Department of Traumatology, Hand-, Plastic-, and Reconstructive Surgery, Center of Surgery, University of Ulm, Ulm, Germany
| | - H C Pape
- Department of Trauma Surgery, University Hospital Zurich, Zurich, Switzerland
| | - M Huber-Lang
- Institute of Clinical and Experimental Trauma-Immunology, University of Ulm, Ulm, Germany
| | - F Hildebrand
- Department of Orthopaedic Trauma, RWTH Aachen University, Aachen, Germany
| | | |
Collapse
|
23
|
Koch S, Essers J, Beringer O, Reister F, Hummler H, Moewes A. [EXIT - A Possible Intervention for New- and Earlyborn Babies with Severe Hydrops Fetalis and Hydrothoraces on Both Sides]. Z Geburtshilfe Neonatol 2017; 221:286-290. [PMID: 28915526 DOI: 10.1055/s-0043-117419] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
The EXIT (ex utero intrapartum treatment) procedure is an established method of respiratory protection, originally used in the delivery of fetuses with congenital obstructive airway diseases (tumors in the throat area, hygromas, so-called congenital high airway obstruction syndrome (CHAOS)). Meanwhile, the procedure is also carried out in large perinatal centers for pronounced diaphragmatic hernia or other special indications (EXIT to ECMO, congenital lung airway malformations (CCAM), pulmonary atresia). We present our experience with adapted EXIT procedures in 5 preterm infants with secondary generalized hydrops fetalis and pronounced bilateral hydrothoraces.
Collapse
Affiliation(s)
- Sandra Koch
- Sektion Neonatologie und Pädiatrische Intensivmedizin, Klinik für Kinder- und Jugendmedizin, Ulm
| | - Jochen Essers
- Sektion Neonatologie und Pädiatrische Intensivmedizin, Klinik für Kinder- und Jugendmedizin, Ulm
| | - Ortraud Beringer
- Sektion Neonatologie und Pädiatrische Intensivmedizin, Klinik für Kinder- und Jugendmedizin, Ulm
| | - Frank Reister
- Klinik für Frauenheilkunde und Geburtshilfe, Universitätsklinikum Ulm, Ulm
| | - Helmut Hummler
- Klinik für Kinder- und Jugendmedizin, Universitätsklinikum Ulm, Ulm
| | - Anja Moewes
- Department of Neonatology, St. Christopher's Hospital for Children, Philadelphia, United States
| |
Collapse
|
24
|
Affiliation(s)
- Helmut Hummler
- Division of Neonatology; Department of Pediatrics; Sidra Medical and Research Center; Doha Qatar
| |
Collapse
|
25
|
Abstract
Wolf-Hirschhorn syndrome (WHS) represents a complex developmental disorder characterized by craniofacial dysmorphism, short stature, hypotonia, psychomotor retardation and seizures caused by a terminal deletion of the short arm of chromosome 4. Depending on the extent of the deletion, variable midline defects, abnormalities of the skeletal or urogenital system as well as the central nervous system are observed. Approximately 1/3 of the infants will die in the first year of life even though survival for more than 30 years has been reported. Due to current high quality standards of ultrasonography, WHS can often be diagnosed prenatally. We present a clinical case and provide an overview of the current literature.
Collapse
Affiliation(s)
- U Friebe-Hoffmann
- Klinik für Frauenheilkunde und Geburtshilfe, Universitätsklinikum Ulm, Ulm
| | - F Reister
- Klinik für Frauenheilkunde und Geburtshilfe, Universitätsklinikum Ulm, Ulm
| | - H Gaspar
- Institut für Humangenetik, Universitätsklinikum Ulm, Ulm
| | - H Hummler
- Klinik für Kinder- und Jugendmedizin, Universitätsklinikum Ulm, Ulm
| | - W Lindner
- Klinik für Kinder- und Jugendmedizin, Universitätsklinikum Ulm, Ulm
| | - K Lato
- Klinik für Frauenheilkunde und Geburtshilfe, Universitätsklinikum Ulm, Ulm
| |
Collapse
|
26
|
Lato K, Friebe-Hoffmann U, Borck G, Barbi G, Lindner W, Hummler H, Reister F, Janni W, Gaspar H. Spontane Chromosomeninstabilität im Rahmen einer Amniozentese. Geburtshilfe Frauenheilkd 2016. [DOI: 10.1055/s-0036-1593208] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
|
27
|
Friebe-Hoffmann U, Reister F, Gaspar H, Hummler H, Lindner W, Lato K. Das Wolf-Hirschhorn-Syndrom. Geburtshilfe Frauenheilkd 2016. [DOI: 10.1055/s-0036-1592865] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
|
28
|
Waitz M, Nusser S, Schmid MB, Dreyhaupt J, Reister F, Hummler H. Risk Factors Associated with Intraventricular Hemorrhage in Preterm Infants with ≤28 Weeks Gestational Age. Klin Padiatr 2016; 228:245-50. [PMID: 27617760 DOI: 10.1055/s-0042-111689] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
OBJECTIVE To identify obstetric and neonatal risk factors associated with the development of germinal matrix-intraventricular hemorrhage (GM-IVH) in high-risk preterm neonates. METHODS AND PATIENTS Data from 279 preterm infants (246 mothers) with a gestational age≤28+0 weeks admitted to our NICU between January 2004 and December 2009 were analyzed retrospectively. Occurrence of (GM-IVH) was diagnosed by using ultrasound and important clinical variables were extracted from the patient charts. Infants were divided into 2 groups: GM-IVH and non-GM-IVH. To account for multiple gestation, generalized estimation equations (GEE) were used for univariate analysis and for the evaluation of independent risk factors. RESULTS A low 5-min APGAR-Score, multiple birth, low arterial blood pressure at NICU admission, hypercapnia during the first 72 h of life in life and absence of any antenatal corticosteroids were found to be significant independent risk factors in the development of GM-IVH. CONCLUSION Preterm infants with low arterial blood pressure, absence of antenatal corticosteroids, low 5-min APGAR-Score, higher paCO2 within the first 3 days of life and multiple gestation were at higher risk to develop GM-IVH. Avoiding these risk factors may help to decrease the rate of GM-IVH.
Collapse
Affiliation(s)
- M Waitz
- Division of Neonatology, Department of Pediatrics and Adolescent Medicine, University Gießen, Germany
| | - S Nusser
- Division of Neonatology and Pediatric Critical Care, Department of Pediatrics and Adolescent Medicine, University Ulm, Germany
| | - M B Schmid
- Division of Neonatology and Pediatric Critical Care, Department of Pediatrics and Adolescent Medicine, University Ulm, Germany
| | - J Dreyhaupt
- Institute of Epidemiology and Medical Biometry, Universitat Ulm, Ulm, Germany
| | - F Reister
- Department of Obstetrics and Gynecology, Universitat Ulm, Ulm, Germany
| | - H Hummler
- Division of Neonatology and Pediatric Critical Care, Department of Pediatrics and Adolescent Medicine, University Ulm, Germany
| |
Collapse
|
29
|
Kribs A, Hummler H. Ancillary therapies to enhance success of non-invasive modes of respiratory support - Approaches to delivery room use of surfactant and caffeine? Semin Fetal Neonatal Med 2016; 21:212-8. [PMID: 26936187 DOI: 10.1016/j.siny.2016.02.011] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
During recent decades, non-invasive respiratory support has become popular for treating neonates with respiratory failure. Several prospective randomized controlled trials have been performed to compare use of continuous positive airway pressure (CPAP) as primary respiratory support in preterm infants with respiratory distress syndrome (RDS) to endotracheal intubation, mechanical ventilation and surfactant therapy. Systematic reviews of these studies suggest that routine CPAP at delivery is efficacious in decreasing bronchopulmonary dysplasia (BPD), death, or both. This led to the recommendation to consider CPAP to avoid endotracheal intubation. As surfactant therapy is known to reduce BPD and death, several ways to combine CPAP with surfactant have been described. With the increasing use of CPAP immediately after birth, the early use of caffeine to stimulate respiration has become a point of discussion. This review focuses on different modes of surfactant application during CPAP and on the early use of caffeine as ancillary therapies to enhance CPAP success.
Collapse
Affiliation(s)
- Angela Kribs
- Department of Neonatology and Pediatric Critical Care, Children's Hospital University of Cologne, Germany.
| | - Helmut Hummler
- Division of Neonatology and Pediatric Critical Care, Children's Hospital, University of Ulm, Germany
| |
Collapse
|
30
|
Friebe-Hoffmann U, Lato K, Reister F, Wolf E, Hummler H, Lindner W. Das Wolf-Hirschhorn-Syndrom (WHS) – eine interdisziplinäre Herausforderung. Z Geburtshilfe Neonatol 2015. [DOI: 10.1055/s-0035-1566661] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
|
31
|
Kennerknecht L, Dold S, Hummler H, Reister F. Massive fetomaternale Transfusion nach äußerer Wendung – a case report. Z Geburtshilfe Neonatol 2015. [DOI: 10.1055/s-0035-1566493] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
|
32
|
Gajdos M, Gaspar H, Friebe-Hoffmann U, Lato K, Beer M, Gems R, Hummler H. Zwerchfellhernie bei beiden Zwillingen – eine interdisziplinäre Herausforderung. Z Geburtshilfe Neonatol 2015. [DOI: 10.1055/s-0035-1566596] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
|
33
|
Foglia EE, Owen LS, Thio M, Ratcliffe SJ, Lista G, Te Pas A, Hummler H, Nadkarni V, Ades A, Posencheg M, Keszler M, Davis P, Kirpalani H. Sustained Aeration of Infant Lungs (SAIL) trial: study protocol for a randomized controlled trial. Trials 2015; 16:95. [PMID: 25872563 PMCID: PMC4372179 DOI: 10.1186/s13063-015-0601-9] [Citation(s) in RCA: 42] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2014] [Accepted: 02/11/2015] [Indexed: 11/12/2022] Open
Abstract
Background Extremely preterm infants require assistance recruiting the lung to establish a functional residual capacity after birth. Sustained inflation (SI) combined with positive end expiratory pressure (PEEP) may be a superior method of aerating the lung compared with intermittent positive pressure ventilation (IPPV) with PEEP in extremely preterm infants. The Sustained Aeration of Infant Lungs (SAIL) trial was designed to study this question. Methods/Design This multisite prospective randomized controlled unblinded trial will recruit 600 infants of 23 to 26 weeks gestational age who require respiratory support at birth. Infants in both arms will be treated with PEEP 5 to 7 cm H2O throughout the resuscitation. The study intervention consists of performing an initial SI (20 cm H20 for 15 seconds) followed by a second SI (25 cm H2O for 15 seconds), and then PEEP with or without IPPV, as needed. The control group will be treated with initial IPPV with PEEP. The primary outcome is the combined endpoint of bronchopulmonary dysplasia or death at 36 weeks post-menstrual age. Trial Registration www.clinicaltrials.gov, Trial identifier NCT02139800, Registered 13 May 2014 Electronic supplementary material The online version of this article (doi:10.1186/s13063-015-0601-9) contains supplementary material, which is available to authorized users.
Collapse
Affiliation(s)
- Elizabeth E Foglia
- Division of Neonatology, The Children's Hospital of Philadelphia, 34th and Civic Center Blvd., 2nd Floor Main Building, Philadelphia, PA, 19104, USA. .,Department of Pediatrics, University of Pennsylvania Perelman School of Medicine, 34th and Civic Center Blvd, Philadelphia, PA, 19104, USA.
| | - Louise S Owen
- Department of Newborn Research, Royal Women's Hospital, 20 Flemington Road, Parkville, VIC, 3052, Australia. .,University of Melbourne, Grattan Street, Parkville, VIC, 3010, Australia. .,Murdoch Children's Research Institute, Royal Children's Hospital, 50 Flemington Road, 9th Floor, Parkville, VIC, 3052, Australia.
| | - Marta Thio
- Department of Newborn Research, Royal Women's Hospital, 20 Flemington Road, Parkville, VIC, 3052, Australia. .,University of Melbourne, Grattan Street, Parkville, VIC, 3010, Australia. .,Murdoch Children's Research Institute, Royal Children's Hospital, 50 Flemington Road, 9th Floor, Parkville, VIC, 3052, Australia.
| | - Sarah J Ratcliffe
- Department of Biostatistics and Epidemiology, University of Pennsylvania Perelman School of Medicine, Blockley Hall, 423 Guardian Dr., Philadelphia, PA, 19104, USA.
| | - Gianluca Lista
- Division of Neonatology, 'VBuzzi' Children's Hospital, Via Castelvetro 32, 20154, Milan, Italy.
| | - Arjan Te Pas
- Division of Neonatology, Department of Pediatrics, Leiden University Medical Center, Albinusdreef 2, 2333, ZA, Leiden, Netherlands.
| | - Helmut Hummler
- Division of Neonatology and Pediatric Critical Care, Department of Pediatrics, Children's Hospital University of Ulm, Eythstrasse 24, Ulm, 89081, Germany.
| | - Vinay Nadkarni
- Department of Anesthesiology and Critical Care Medicine, The Children's Hospital of Philadelphia, 34th and Civic Center Blvd, 8th Floor Main Building, Philadelphia, PA, 19104, USA.
| | - Anne Ades
- Division of Neonatology, The Children's Hospital of Philadelphia, 34th and Civic Center Blvd., 2nd Floor Main Building, Philadelphia, PA, 19104, USA. .,Department of Pediatrics, University of Pennsylvania Perelman School of Medicine, 34th and Civic Center Blvd, Philadelphia, PA, 19104, USA.
| | - Michael Posencheg
- Division of Neonatology, The Children's Hospital of Philadelphia, 34th and Civic Center Blvd., 2nd Floor Main Building, Philadelphia, PA, 19104, USA. .,Department of Pediatrics, University of Pennsylvania Perelman School of Medicine, 34th and Civic Center Blvd, Philadelphia, PA, 19104, USA.
| | - Martin Keszler
- Alpert Medical School of Brown University, 222 Richmond St, Providence, RI, 02903, USA. .,Division of Neonatology, Women and Infants Hospital of Rhode Island, 101 Dudley Street, Providence, RI, 02905, USA.
| | - Peter Davis
- Department of Newborn Research, Royal Women's Hospital, 20 Flemington Road, Parkville, VIC, 3052, Australia. .,University of Melbourne, Grattan Street, Parkville, VIC, 3010, Australia. .,Murdoch Children's Research Institute, Royal Children's Hospital, 50 Flemington Road, 9th Floor, Parkville, VIC, 3052, Australia.
| | - Haresh Kirpalani
- Division of Neonatology, The Children's Hospital of Philadelphia, 34th and Civic Center Blvd., 2nd Floor Main Building, Philadelphia, PA, 19104, USA. .,Department of Pediatrics, University of Pennsylvania Perelman School of Medicine, 34th and Civic Center Blvd, Philadelphia, PA, 19104, USA.
| |
Collapse
|
34
|
Hummler H, Fuchs H, Schmid M. Automated adjustments of inspired fraction of oxygen to avoid hypoxemia and hyperoxemia in neonates - a systematic review on clinical studies. Klin Padiatr 2014; 226:204-10. [PMID: 25010125 DOI: 10.1055/s-0034-1375617] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Supplemental oxygen is commonly provided during transition of neonates immediately after birth. Whereas an initial FiO2 of 0.21 is now recommended to stabilize full-term infants in the delivery room, the best FiO2 to start resuscitation of the very low birth weight infant (VLBWI) immediately after delivery is currently not known. Recent recommendations include the use of pulse oximetry to titrate the use of supplemental oxygen. As reference values for pulse oximetry during the first minutes of life have become available, automated FiO2-adjustments are feasible and may be very useful for delivery room care to limit oxygen exposure. Beyond neonatal transition, preterm infants in the neonatal intensive care unit (NICU) commonly require supplemental oxygen to avoid hypoxemia, especially VLBWI receiving respiratory support because of poor respiratory drive and/or lung disease. For respiratory care of newborn infants in the NICU automated FiO2-adjustment systems have been developed and have been studied in preterm infants for limited time frames using short-term physiological outcomes. These studies could demonstrate short-term benefits such as more stable arterial oxygen saturation. Recent clinical trials have shown that oxygen targeting may significantly affect mortality and morbidity. Therefore, randomized controlled trials are needed to study the effects of automated FiO2-adjustment on long-term outcomes to prove possible benefits on survival, the rate of retino-pathy of prematurity and on neuro-development-al outcome.
Collapse
Affiliation(s)
- H Hummler
- Department of Pediatrics and Adolescent Medicine, Division of Neonatology and Pediatric Critical Care, Ulm University Medical Center, Ulm, Germany
| | - H Fuchs
- Department of Pediatrics, Children's Hospital of Freiburg, Freiburg, Germany
| | - M Schmid
- Department of Pediatrics and Adolescent Medicine, Division of Neonatology and Pediatric Critical Care, Ulm University Medical Center, Ulm, Germany
| |
Collapse
|
35
|
Baranowski ST, Hummler H, Hopfner RJ. Unusual malposition of a peripherally inserted central catheter (PICC) in a very low birth weight infant (VLBW Infant). Klin Padiatr 2014; 226:248-9. [PMID: 25010131 DOI: 10.1055/s-0034-1376948] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Affiliation(s)
- S T Baranowski
- Department of Pediatrics and Adolescent Medicine, Division of Neonatology and Pediatric Critical Care, Ulm University, Ulm, Germany
| | - H Hummler
- Department of Pediatrics and Adolescent Medicine, Division of Neonatology and Pediatric Critical Care, Ulm University, Ulm, Germany
| | - R J Hopfner
- Department of Pediatrics and Adolescent Medicine, Division of Neonatology and Pediatric Critical Care, Ulm University, Ulm, Germany
| |
Collapse
|
36
|
Flemmer A, Maier R, Hummler H. Behandlung der neonatalen Asphyxie unter besonderer Berücksichtigung der therapeutischen Hypothermie. Klin Padiatr 2014; 226:29-37. [DOI: 10.1055/s-0033-1361104] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Affiliation(s)
- A. Flemmer
- Neonatologie der Kinderklinik am Perinatalzentrum der Ludwig-Maximilians-Universität München
| | - R. Maier
- Klinik für Kinder- und Jugendmedizin Marburg, Universitätsklinikum Gießen und Marburg
| | - H. Hummler
- Sektion Neonatologie und Pädiatrische Intensivmedizin, Universitätsklinikum Ulm
| |
Collapse
|
37
|
Vento M, Hummler H, Dawson J, Escobar J, Kuligowski J. Use of Oxygen in the Resuscitation of Neonates. Oxidative Stress in Applied Basic Research and Clinical Practice 2014. [DOI: 10.1007/978-1-4939-1405-0_11] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
|
38
|
Durrmeyer X, Hummler H, Sanchez-Luna M, Carnielli VP, Field D, Greenough A, Van Overmeire B, Jonsson B, Hallman M, Mercier JC, Marlow N, Johnson S, Baldassarre J. Two-year outcomes of a randomized controlled trial of inhaled nitric oxide in premature infants. Pediatrics 2013; 132:e695-703. [PMID: 23940237 DOI: 10.1542/peds.2013-0007] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND AND OBJECTIVES The European Union Nitric Oxide trial was designed to assess the potential benefits of inhaled nitric oxide (iNO) compared with placebo in infants with respiratory failure. This follow-up study evaluated respiratory, neurodevelopmental, and other outcomes for infants entered into the European Union Nitric Oxide trial to age 2 years. METHODS In a multicenter, randomized, double-blind study, preterm infants born at <29 weeks' gestation with moderate respiratory failure were allocated to receive iNO (5 ppm) or placebo for 7 to 21 days. Subjects underwent assessments at 1 and 2 years corrected for prematurity. RESULTS At 36 weeks' postmenstrual age, 696 of 792 infants were alive; 4 in the iNO arm subsequently died before age 2 years compared with 7 in the control arm. We evaluated 95% of the survivors at 12 months and 90% at 2 years. In the iNO arm, 244 of 363 (67.2%) infants had survived without disability at age 2 years compared with 270 of 374 (72.2%) who received placebo (P = .094). Mean (SD) cognitive composite scores (Bayley Scales of Infant and Toddler Development, third edition) were 94 (13) in the iNO group and 95 (14) in the placebo group; in the iNO group, 19% scored <85 and 9.5% developed cerebral palsy compared with 13.3% and 9%, respectively. There were no significant differences in hospitalizations overall or due to respiratory illness in use of home oxygen therapy or respiratory medications, in growth, or in other health outcomes. CONCLUSIONS At 2 years of age, low-dose (5 ppm) iNO started early (<24 hours after birth) for a median of 20 days did not affect neurodevelopmental or other health outcomes.
Collapse
Affiliation(s)
- Xavier Durrmeyer
- Department of Neonatology, CRC, Centre Hospitalier Intercommunal de Créteil, Créteil, France.
| | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
39
|
Bode H, Galm C, Hummler H, Teller C, Haas D, Gencik M. Non-lethal non-mosaic male with Conradi-Hunermann syndrome caused by a novel EBP c.356T>G mutation. Am J Med Genet A 2013; 161A:2385-8. [PMID: 23852825 DOI: 10.1002/ajmg.a.35985] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2012] [Accepted: 03/13/2013] [Indexed: 11/08/2022]
Affiliation(s)
- Harald Bode
- Division of Social Pediatrics and Child Neurology, University Childrens's Hospital, Frauensteige 10, D-89077 Ulm, Germany.
| | | | | | | | | | | |
Collapse
|
40
|
Tsikas D, Sutmöller K, Maassen M, Nacke M, Böhmer A, Mitschke A, Konrad H, Starke H, Hummler H, Maassen N. Even and carbon dioxide independent distribution of nitrite between plasma and erythrocytes of healthy humans at rest. Nitric Oxide 2013; 31:31-7. [DOI: 10.1016/j.niox.2013.03.002] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2012] [Revised: 02/15/2013] [Accepted: 03/08/2013] [Indexed: 12/21/2022]
|
41
|
Struck A, Almaazmi M, Bode H, Sander S, Hay B, Schmid M, Hummler H. [Neurodevelopmental outcome of very low birth weight infants born at the Perinatal Centre in Ulm, Germany]. Z Geburtshilfe Neonatol 2013; 217:65-71. [PMID: 23625768 DOI: 10.1055/s-0033-1341503] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
BACKGROUND Since 2006 an assessment of the neurodevelopmental outcome of very low birth weight infants (VLBWI) at a corrected age of 2 years is mandatory for every perinatal centre in Germany. The aim of our study was to check how complete these assessments were performed in our population of infants born at our perinatal centre and receiving treatment within our local neonatal network. Furthermore, the data obtained will be used for prenatal consultations. Another objective was to identify risk factors for adverse neurodevelopmental outcomes. METHODS All VLBWI were invited for a follow-up exam using the Bayley Scales of Infant Development II (BSID-II) or III (BSID-III), or Griffiths Mental Developmental Scales) at 2 years corrected age. The results of children assessed by other institutions were collected. RESULTS 142 (69.3%) of the 205 VLBWI, born and finally discharged alive at the perinatal centre in Ulm were assessed at a median (minimum - maximum) corrected age of 23 (18-27) months. The BSID-II Psychomotor Development Index (PDI) 91 was (< 50-128) (n=115), the BSID-II Mental Development Index (MDI) was 87 (< 50-134) (n=96), BSID-III MDI 95 (60-112) (n=29) and the Griffiths Score was 93 (67-140) (n=17). Severe disability was diagnosed in 36 (25.4%) of the children studied. Gestational age and higher grade intraventricular haemorrhage were associated independently with severe disability. CONCLUSIONS It is very difficult to achieve a high rate of follow-up examinations in preterm infants <1,500 g in a neonatal network. Severe impairment in VLBWI is not rare. Improving neurodevelopmental outcome remains a challenge.
Collapse
Affiliation(s)
- A Struck
- Sektion Sozialpädiatrisches Zentrum und Kinderneurologie, Klinik für Kinder- und Jugendmedizin, Universitätsklinikum, Ulm
| | | | | | | | | | | | | |
Collapse
|
42
|
Hummler H. Benchmarking in neonatal intensive care: obstetrical and neonatal practices and registration policies may influence outcome data. Arch Dis Child Fetal Neonatal Ed 2013; 98:F96-7. [PMID: 23144008 DOI: 10.1136/archdischild-2012-301880] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
|
43
|
Hummler H. Quality analysis is overdue. Dtsch Arztebl Int 2013; 110:117-8. [PMID: 23468824 DOI: 10.3238/arztebl.2013.0117b] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
|
44
|
Kittel J, Galm C, Hummler H, Eicken A, Puig S, Beringer O. Massive Aortenstenose trotz Angioplastie - Komplizierter Verlauf eines Mid aortic syndrome. Klin Padiatr 2011. [DOI: 10.1055/s-0031-1273888] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
|
45
|
Beringer O, Kittel J, Pauli S, Hönig M, Fuchs H, Amann K, Hummler H, Schulz A. Hyperkalzämische Krise Komplikation bei Osteopetrose nach Stammzelltransplantation. Klin Padiatr 2011. [DOI: 10.1055/s-0031-1273883] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
|
46
|
Roehr CC, Gröbe S, Rüdiger M, Hummler H, Nelle M, Proquitté H, Hammer H, Schmalisch G. Delivery room management of very low birth weight infants in Germany, Austria and Switzerland--a comparison of protocols. Eur J Med Res 2010; 15:493-503. [PMID: 21159574 PMCID: PMC3352658 DOI: 10.1186/2047-783x-15-11-493] [Citation(s) in RCA: 39] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2010] [Accepted: 10/26/2010] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND Surveys from the USA, Australia and Spain have shown significant inter-institutional variation in delivery room (DR) management of very low birth weight infants (VLBWI, <1500g) at birth, despite regularly updated international guidelines. OBJECTIVE To investigate protocols for DR management of VLBWI in Germany, Austria and Switzerland and to compare these with the 2005 ILCOR guidelines. METHODS DR management protocols were surveyed in a prospective, questionnaire-based survey in 2008. Results were compared between countries and between academic and non-academic units. Protocols were compared to the 2005 ILCOR guidelines. RESULTS In total, 190/249 units (76%) replied. Protocols for DR management existed in 94% of units. Statistically significant differences between countries were found regarding provision of 24 hr in house neonatal service; presence of a designated resuscitation area; devices for respiratory support; use of pressure-controlled manual ventilation devices; volume control by respirator; and dosage of Surfactant. There were no statistically significant differences regarding application and monitoring of supplementary oxygen, or targeted saturation levels, or for the use of sustained inflations. Comparison of academic and non-academic hospitals showed no significant differences, apart from the targeted saturation levels (SpO2) at 10 min. of life. Comparison with ILCOR guidelines showed good adherence to the 2005 recommendations. SUMMARY Delivery room management in German, Austrian and Swiss neonatal units was commonly based on written protocols. Only minor differences were found regarding the DR setup, devices used and the targeted ranges for SpO2 and FiO2. DR management was in good accordance with 2005 ILCOR guidelines, some units already incorporated evidence beyond the ILCOR statement into their routine practice.
Collapse
Affiliation(s)
- C C Roehr
- Department of Neonatology, Charité Universitätsmedizin Berlin, Chariteplatz 1, 10117 Berlin, Germany.
| | | | | | | | | | | | | | | |
Collapse
|
47
|
Mercier JC, Hummler H, Durrmeyer X, Sanchez-Luna M, Carnielli V, Field D, Greenough A, Van Overmeire B, Jonsson B, Hallman M, Baldassarre J. Inhaled nitric oxide for prevention of bronchopulmonary dysplasia in premature babies (EUNO): a randomised controlled trial. Lancet 2010; 376:346-54. [PMID: 20655106 DOI: 10.1016/s0140-6736(10)60664-2] [Citation(s) in RCA: 126] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
BACKGROUND In animal models, inhaled nitric oxide improved gas exchange and lung structural development, but its use in premature infants at risk of developing bronchopulmonary dysplasia remains controversial. We therefore tested the hypothesis that inhaled nitric oxide at a low concentration, started early and maintained for an extended period in babies with mild respiratory failure, might reduce the incidence of bronchopulmonary dysplasia. METHODS 800 preterm infants with a gestational age at birth of between 24 weeks and 28 weeks plus 6 days (inclusive), weighing at least 500 g, requiring surfactant or continuous positive airway pressure for respiratory distress syndrome within 24 h of birth were randomly assigned in a one-to-one ratio to inhaled nitric oxide (5 parts per million) or placebo gas (nitrogen gas) for a minimum of 7 days and a maximum of 21 days in a double-blind study done at 36 centres in nine countries in the European Union. Care providers and investigators were masked to the computer-generated treatment assignment. The primary outcome was survival without development of bronchopulmonary dysplasia at postmenstrual age 36 weeks. Analysis was by intention to treat. This study is registered with ClinicalTrials.gov, number NCT00551642. FINDINGS 399 infants were assigned to inhaled nitric oxide, and 401 to placebo. 395 and 400, respectively, were analysed. Treatment with inhaled nitric oxide and placebo did not result in significant differences in survival of infants without development of bronchopulmonary dysplasia (258 [65%] of 395 vs 262 [66%] of 400, respectively; relative risk 1.05, 95% CI 0.78-1.43); in survival at 36 weeks' postmenstrual age (343 [86%) of 399 vs 359 [90%] of 401, respectively; 0.74, 0.48-1.15); and in development of bronchopulmonary dysplasia (81 [24%] of 339 vs 96 [27%] of 358, respectively; 0.83, 0.58-1.17). INTERPRETATION Early use of low-dose inhaled nitric oxide in very premature babies did not improve survival without bronchopulmonary dysplasia or brain injury, suggesting that such a preventive treatment strategy is unsuccessful. FUNDING INO Therapeutics.
Collapse
Affiliation(s)
- Jean-Christophe Mercier
- Assistance Publique-Hôpitaux de Paris, Université Paris-7 Denis Diderot, Hôpital Robert Debré, Paris, France.
| | | | | | | | | | | | | | | | | | | | | |
Collapse
|
48
|
Hummler H. [Current outcome quality in the care of preterm infants with birth weight less than 1500 grams as a basis for regionalization of risk pregnancies]. Z Geburtshilfe Neonatol 2010; 214:126-7. [PMID: 20577959 DOI: 10.1055/s-0030-1255068] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
|
49
|
Hummler H, Rauh N, Fuchs H, Lindner W, Beringer O, Reister F. Verlauf der Hospitalisationen von Schwangeren mit drohender Frühgeburt im Perinatalzentrum des Universitätsklinikums Ulm. Klin Padiatr 2010. [DOI: 10.1055/s-0030-1261571] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
|
50
|
Hummler H. Stickstoffmonoxid (NO) bei RDS und BPD des Frühgeborenen. Klin Padiatr 2010. [DOI: 10.1055/s-0030-1261349] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
|