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Köstlin-Gille N, Serna-Higuita LM, Bubser C, Arand J, Haag L, Schwarz CE, Heideking M, Poets CF, Gille C. Early initiation of antibiotic therapy and short-term outcomes in preterm infants: a single-centre retrospective cohort analysis. Arch Dis Child Fetal Neonatal Ed 2023; 108:623-630. [PMID: 37137680 PMCID: PMC10646875 DOI: 10.1136/archdischild-2022-325113] [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] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/09/2022] [Accepted: 04/19/2023] [Indexed: 05/05/2023]
Abstract
BACKGROUND Sepsis is one of the most important complications in preterm infants. For this reason, many such infants receive antibiotics during their hospital stay. However, early antibiotic therapy has also been associated with adverse outcome. It is yet largely unclear if the time of onset of antibiotic therapy influences the outcome. We here investigated whether the timing of initiation of antibiotic therapy plays a role in the association between antibiotic exposure and short-term outcome. METHODS Retrospective analysis of data from 1762 very low birthweight infants born in a German neonatal intensive care unit (NICU) between January 2004 and December 2021. RESULTS Antibiotics were administered to 1214 of the 1762 (68.9%) infants. In 973 (55.2%) of the 1762 of infants, antibiotic therapy was initiated within the first two postnatal days. Only 548 (31.1%) infants did not have any antibiotic prescription during their stay in the NICU. Antibiotic exposure at every timepoint was associated with an increased risk of all short-term outcomes analysed in univariable analyses. In multivariable analyses, initiation of antibiotic therapy within the first two postnatal days and initiation between postnatal days 3 and 6 was independently associated with an increased risk of developing bronchopulmonary dysplasia (BPD) (OR 3.1 and 2.8), while later initiation of antibiotic therapy was not. CONCLUSION Very early initiation of antibiotic therapy was associated with an increased risk of BPD. Due to the study design, no conclusions on causality can be drawn. If confirmed, our data suggest that an improved identification of infants at low risk of early-onset sepsis is needed to reduce antibiotic exposure.
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Affiliation(s)
| | - Lina Maria Serna-Higuita
- Department of Clinical Epidemiology and Applied Biostatistics, Eberhard Karls University, Tübingen, Germany
| | - Caren Bubser
- Department of Neonatology, University of Tuebingen, Tubingen, Germany
| | - Joerg Arand
- Department of Neonatology, University of Tuebingen, Tubingen, Germany
| | - Laura Haag
- Department of Neonatology, University of Tuebingen, Tubingen, Germany
| | | | - Martin Heideking
- Department of Neonatology, University of Tuebingen, Tubingen, Germany
| | - Christian F Poets
- Department of Neonatology, University of Tuebingen, Tubingen, Germany
| | - Christian Gille
- Department of Neonatology, University of Tuebingen, Tubingen, Germany
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Kastner U, Javaheripour N, Arand J, Schönherr D, Sobanski T, Fehler S, Walter M, Wagner G. Effects of the COVID-19 pandemic on suicide attempts in a rural region in Germany, a 5-year observational study. J Affect Disord 2022; 318:393-399. [PMID: 36113687 PMCID: PMC9472680 DOI: 10.1016/j.jad.2022.09.022] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [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: 04/28/2022] [Revised: 08/05/2022] [Accepted: 09/11/2022] [Indexed: 10/26/2022]
Abstract
BACKGROUND The COVID-19 pandemic and public life restrictions may have a negative impact on people's mental health. Therefore, we analyzed whether this condition affected the occurrence of suicide attempts (SA) over 20 months during the pandemic period. METHODS We included patient records according to DSM-5 criteria for suicidal behavior disorders (n = 825) between Jan 1, 2017, and Dec 31, 2021. We applied interrupted time-series Poisson regression models to investigate the effect of the pandemic on SA occurrence, time trends, and seasonal patterns in the whole group of patients as well as stratified by age and gender. RESULTS There was no significant effect of the pandemic on the occurrence of SA in the overall group. However, we observed a significant impact of the pandemic on the seasonal pattern of SA, also the variance differed significantly (pre-pandemic mean ± variance: 13.33 ± 15.75, pandemic: mean ± variance: 13.86 ± 7.26), indicating less periodic variation in SA during the pandemic. Male patients and young adults mainly contributed to this overall effect. Subgroup analysis revealed a significant difference in SA trends during the pandemic in older adults (>55 years) compared with younger adults (18-35 years); SA numbers increased in older adults and decreased in younger adults as the pandemic progressed. LIMITATIONS A few patients may have received initial care in an emergency department after SA without being referred to psychiatry. CONCLUSIONS In general, the COVID-19 pandemic and related measures did not significantly affect the occurrence of SA but did significantly affect the dynamics. In addition, the pandemic appeared to affect suicidal behavior differently across age groups as it progressed. Particularly for the older adult group, negative long-term effects of the pandemic on suicidal behavior can be derived from the present results, indicating the need to strengthen suicide prevention for the elderly.
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Affiliation(s)
- U.W. Kastner
- Department of Psychiatry and Psychotherapy, Helios Fachkliniken Hildburghausen, Eisfelder Str.41, 98646 Hildburghausen, Germany,Correspondence to: U.W. Kastner, Helios Fachkliniken Hildburghausen, Eisfelder Str.41, 98646 Hildburghausen, Germany
| | - N. Javaheripour
- Department of Psychiatry and Psychotherapy, Jena University Hospital, Jena, Germany
| | - J. Arand
- Department of Psychiatry and Psychotherapy, Helios Fachkliniken Hildburghausen, Eisfelder Str.41, 98646 Hildburghausen, Germany
| | - D. Schönherr
- Department of Psychiatry and Psychotherapy, Helios Fachkliniken Hildburghausen, Eisfelder Str.41, 98646 Hildburghausen, Germany
| | - T. Sobanski
- Department of Psychiatry, Psychotherapy, and Psychosomatic Medicine, Thueringen-Kliniken GmbH, 07318 Saalfeld, Germany
| | - S.W. Fehler
- Department of Psychiatry and Psychotherapy, Helios Fachkliniken Hildburghausen, Eisfelder Str.41, 98646 Hildburghausen, Germany
| | - M. Walter
- Department of Psychiatry and Psychotherapy, Jena University Hospital, Jena, Germany
| | - G. Wagner
- Department of Psychiatry and Psychotherapy, Jena University Hospital, Jena, Germany,Correspondence to: G. Wagner, Department of Psychiatry and Psychotherapy, Jena University Hospital, Philosophenweg 3, 07743 Jena, Germany
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Xepapadeas AB, Weise C, Frank K, Spintzyk S, Poets CF, Wiechers C, Arand J, Koos B. Technical note on introducing a digital workflow for newborns with craniofacial anomalies based on intraoral scans - part II: 3D printed Tübingen palatal plate prototype for newborns with Robin sequence. BMC Oral Health 2020; 20:171. [PMID: 32546229 PMCID: PMC7298740 DOI: 10.1186/s12903-020-01159-7] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2019] [Accepted: 06/04/2020] [Indexed: 11/28/2022] Open
Abstract
Background Orthodontic treatment of newborns and infants with Robin-Sequence using the Tübingen Palatal Plate (TPP) is a complex procedure that could benefit from simplification through digitalization. The design of the velar extension (spur) and the palatal base determines the success of the treatment. Therefore, a prototype must be produced and inserted under endoscopic supervision in order to determine the appropriate shape, length and position of the spur. This technical note demonstrates a fully digital workflow for the design and manufacturing of a functional TPP prototype, based on an intraoral scan. This prototype can be altered and individualized digitally for each patient. After the shape and position of the spur have been optimized, the prototype is duplicated using a silicone mold. Then the definitive TPP is manufactured and inserted. We aim to present a workflow which facilitates the fitting procedure and does not require a conventional impression or a physical model to create the appliance. Methods As described in part I of this series, the intraoral scan is performed using the 3Shape TRIOS3 scanner and its corresponding acquisition software. The virtual model is rendered in the 3Shape ortho appliance designer and the base of the palatal plate is designed in the 3Shape dental designer. The palatal plate and the virtual model are then imported into Autodesk Meshmixer and a standardized spur is positioned and merged with the base. The TPP is exported in Standard Tessellation Language (STL) format and manufactured on a W2P Solflex 170 DLP printer using VOCO VPrint Splint material (MDR Class IIa). Results Based on an intraoral scan, the TPP prototype could be successfully manufactured and proved suitable for the patients’ treatment. Conclusion The new digital workflow for the design of the TPP can been successfully implemented into daily clinical routine in our facility. Patients could be alleviated from having to undergo conventional impression procedures and fitting of the TPP could be facilitated by producing multiple functional prototypes for endoscopic evaluation. Through rapid prototyping, the expenditure of the fitting process was reduced, which makes the TPP therapy more efficient and accessible to a wider range of clinicians.
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Affiliation(s)
- A B Xepapadeas
- Department of Orthodontics, University Hospital Tuebingen, Osianderstr. 2-8, 72076, Tuebingen, Germany. .,Section "Medical Materials Science & Technology" University Hospital Tuebingen, Osianderstr. 2-8, 72076, Tuebingen, Germany.
| | - C Weise
- Department of Orthodontics, University Hospital Tuebingen, Osianderstr. 2-8, 72076, Tuebingen, Germany
| | - K Frank
- Department of Orthodontics, University Hospital Tuebingen, Osianderstr. 2-8, 72076, Tuebingen, Germany
| | - S Spintzyk
- Section "Medical Materials Science & Technology" University Hospital Tuebingen, Osianderstr. 2-8, 72076, Tuebingen, Germany
| | - C F Poets
- Department of Neonatology, University Hospital Tuebingen, Calwerstr. 7, 72076, Tuebingen, Germany
| | - C Wiechers
- Department of Neonatology, University Hospital Tuebingen, Calwerstr. 7, 72076, Tuebingen, Germany
| | - J Arand
- Department of Neonatology, University Hospital Tuebingen, Calwerstr. 7, 72076, Tuebingen, Germany
| | - B Koos
- Department of Orthodontics, University Hospital Tuebingen, Osianderstr. 2-8, 72076, Tuebingen, Germany
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Xepapadeas AB, Weise C, Frank K, Spintzyk S, Poets CF, Wiechers C, Arand J, Koos B. Technical note on introducing a digital workflow for newborns with craniofacial anomalies based on intraoral scans - part I: 3D printed and milled palatal stimulation plate for trisomy 21. BMC Oral Health 2020; 20:20. [PMID: 31973720 PMCID: PMC6979345 DOI: 10.1186/s12903-020-1001-4] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2019] [Accepted: 01/10/2020] [Indexed: 11/27/2022] Open
Abstract
Background Advanced digital workflows in orthodontics and dentistry often require a combination of different software solutions to create patient appliances, which may be a complex and time-consuming process. The main objective of this technical note is to discuss treatment of craniofacial anomalies using digital technologies. We present a fully digital, linear workflow for manufacturing palatal plates for infants with craniofacial anomalies based on intraoral scanning. Switching to intraoral scanning in infant care is advantageous as taking conventional impressions carries the risk of impression material aspiration and/or infections caused by material remaining in the oronasal cavity. Material and methods The fully digital linear workflow presented in this technical note can be used to design and manufacture palatal plates for cleft palate patients as well as infants with functional disorders. We describe the workflow implemented in an infant with trisomy 21. The maxilla was registered using a digital scanner and a stimulation plate was created using dental CAD software and an individual impression tray module on a virtual model. Plates were manufactured using both additive and subtractive methods. Methacrylate based light curing resin and Poly-Ether-Ether-Ketone were the materials used. Results The palatal area was successfully scanned to create a virtual model. The plates fitted well onto the palatal area. Manual post-processing was necessary to optimize a functional ridge along the vestibular fold and remove support structures from the additively manufactured plate as well as the milled plate produced from a blank. The additively manufactured plate fitted better than the milled one. Conclusion Implementing a fully digital linear workflow into clinical routine for treatment of neonates and infants with craniofacial disorders is feasible. The software solution presented here is suitable for this purpose and does not require additional software for the design. This is the key advantage of this workflow, which makes digital treatment accessible to all clinicians who want to deal with digital technology. Whether additive or subtractive manufacturing is preferred depends on the appliance material of choice and influences the fit of the appliance.
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Affiliation(s)
- Alexander B Xepapadeas
- Department of Orthodontics, University Hospital Tuebingen, Osianderstr, 2-8, 72076, Tuebingen, Germany.,Section "Medical Materials Science & Technology", University Hospital Tuebingen, Osianderstr, 2-8, 72076, Tuebingen, Germany
| | - Christina Weise
- Department of Orthodontics, University Hospital Tuebingen, Osianderstr, 2-8, 72076, Tuebingen, Germany.
| | - K Frank
- Department of Orthodontics, University Hospital Tuebingen, Osianderstr, 2-8, 72076, Tuebingen, Germany
| | - S Spintzyk
- Section "Medical Materials Science & Technology", University Hospital Tuebingen, Osianderstr, 2-8, 72076, Tuebingen, Germany
| | - C F Poets
- Department of Neonatology, University Hospital Tübingen, Calwerstr, 7, 72076, Tuebingen, Germany
| | - C Wiechers
- Department of Neonatology, University Hospital Tübingen, Calwerstr, 7, 72076, Tuebingen, Germany
| | - J Arand
- Department of Neonatology, University Hospital Tübingen, Calwerstr, 7, 72076, Tuebingen, Germany
| | - B Koos
- Department of Orthodontics, University Hospital Tuebingen, Osianderstr, 2-8, 72076, Tuebingen, Germany
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Mueller-Hagedorn S, Wiechers C, Arand J, Buchenau W, Bacher M, Krimmel M, Reinert S, Poets C. Less invasive treatment of sleep-disordered breathing in children with syndromic craniosynostosis. Int J Oral Maxillofac Surg 2019. [DOI: 10.1016/j.ijom.2019.03.056] [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: 10/26/2022]
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Ziegler JO, Maas C, Bernhard W, Arand J, Poets CF, Franz AR. Retrospective cohort analysis on pancreatic enzyme substitution in very low birthweight infants with postnatal growth failure. Arch Dis Child Fetal Neonatal Ed 2018; 103:F485-F489. [PMID: 29122829 DOI: 10.1136/archdischild-2017-313278] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [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: 05/01/2017] [Revised: 10/03/2017] [Accepted: 10/17/2017] [Indexed: 01/29/2023]
Abstract
OBJECTIVE To evaluate the effects of pancreatic enzyme substitution (PES) in selected very low birthweight (VLBW) infants with poor postnatal growth despite intensified nutritional support. DESIGN Retrospective historic cohort study with matched controls. SETTING Single level III neonatal intensive care unit. PATIENTS Infants with a gestational age at birth <32 weeks and birth weight <1500 g born between 1 January 2005 and 31 December 2014 (n=26) who received PES for restricted postnatal growth despite intensified enteral nutritional support in comparison with infants matched for birth weight, birth year, gestational and postnatal age (n=52). INTERVENTIONS PES 15-93 mg/g fat with enteral feeds. MAIN OUTCOME MEASURES The difference in SD score (SDS) differences for weight during the 7 days before and after onset of PES and weight gain in g/kg/d. Data are presented as median (P10-P90). RESULTS Gestational age was 26.6 (24.4-29.9) weeks in enzyme substituted versus 26.4 (24.7-29.9) weeks in matched controls, and birth weight was 648(420-950)g versus 685(453-949)g. SDS differences for weight improved after onset of PES by 0.18(-0.12 to 0.53) in PES infants versus -0.04(-0.31 to 0.44) in controls. Weight gain increased in the PES group from 13.6 (4.2-22.9) g/kg/day in the week before to 19.0 (10.9-29.1) g/kg/day in the week after the onset of PES. There was no difference in weight gain in substituted subgroups receiving formula/pasteurised human milk versus unpasteurised human breast milk or who had pancreatic-specific elastase-1 concentrations in stool >200 µg/g versus≤200 µg/g. No adverse effects were noted. CONCLUSIONS PES in selected VLBW infants with growth failure despite intensified enteral nutritional support was associated with a significant increase in weight gain in the first 7 days of PES.k.
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Affiliation(s)
- Julian O Ziegler
- Department of Neonatology, Center for Pediatric Clinical Studies, University Children's Hospital, Tuebingen, Germany
| | - Christoph Maas
- Department of Neonatology, Center for Pediatric Clinical Studies, University Children's Hospital, Tuebingen, Germany
| | - Wolfgang Bernhard
- Department of Neonatology, Center for Pediatric Clinical Studies, University Children's Hospital, Tuebingen, Germany
| | - Joerg Arand
- Department of Neonatology, Center for Pediatric Clinical Studies, University Children's Hospital, Tuebingen, Germany
| | - Christian F Poets
- Department of Neonatology, Center for Pediatric Clinical Studies, University Children's Hospital, Tuebingen, Germany
| | - Axel R Franz
- Department of Neonatology, Center for Pediatric Clinical Studies, University Children's Hospital, Tuebingen, Germany
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Kort J, Garbuzov A, Arand J, Behr B, Artandi S. Oocyte telomerase levels correlate with blastocyst development. Fertil Steril 2017. [DOI: 10.1016/j.fertnstert.2017.07.461] [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: 11/15/2022]
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8
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Poets CF, Maas C, Buchenau W, Arand J, Vierzig A, Braumann B, Müller-Hagedorn S. Multicenter study on the effectiveness of the pre-epiglottic baton plate for airway obstruction and feeding problems in Robin sequence. Orphanet J Rare Dis 2017; 12:46. [PMID: 28274235 PMCID: PMC5343539 DOI: 10.1186/s13023-017-0602-8] [Citation(s) in RCA: 31] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2016] [Accepted: 02/27/2017] [Indexed: 12/03/2022] Open
Abstract
Background Treatment of Robin sequence is often either invasive or of unproven effectiveness. The pre-epiglottic baton plate (PEBP) is a well-studied alternative, yet is not widely applied internationally. We report on a prospective 3-center cohort study investigating this treatment. Based on an agreed protocol, parents of infants with Robin sequence referred to participating centers were offered enrollment, which involved taking a maxillary cast followed by endoscopy to fit the plate and sleep studies to monitor its effectiveness. Recordings were centrally analyzed by sleep specialists blinded to timing and center. Primary outcome was the mixed-obstructive apnea index, defined as the number of such apneas/h of sleep; secondary outcomes included the desaturation index to <80% pulse oximeter saturation and weight gain. Results Of 75 infants referred, 49 could be included; 1 center failed to perform appropriate sleep studies. Within a mean hospitalization of 3 weeks, the mixed-obstructive apnea index decreased (median; interquartile range) from 15.9 (6.3–31.5) to 2.3 (1.2–5.4); it decreased further to 0.7 (0.1–2.4) in the 32 infants who had a successful 3-month follow-up sleep study performed. The desaturation index normalized (from 0.38 (0–2.7) to 0.0 (0–0.1)). Mean standard deviation score for weight remained unchanged between admission and follow-up, while the proportion of tube-fed infants decreased from 74 to 14%. Conclusions This prospective multi-center cohort study confirms retrospective audits on the effectiveness of PEBP treatment in improving upper airway obstruction and feeding problems, the main clinical problems of infants with Robin sequence. International collaboration is required to compare this with other treatment approaches. Trial registration Number NCT02266043, Registered 30/09/2014; registered partially retrospectively.
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Affiliation(s)
- Christian F Poets
- Interdisciplinary Center for Craniofacial Malformations, Tuebingen University Hospital, Tuebingen, Germany. .,Department of Neonatology, Tuebingen University Hospital, Calwerstrasse 7, Tuebingen, 72076, Germany.
| | - Christoph Maas
- Interdisciplinary Center for Craniofacial Malformations, Tuebingen University Hospital, Tuebingen, Germany.,Department of Neonatology, Tuebingen University Hospital, Calwerstrasse 7, Tuebingen, 72076, Germany
| | - Wolfgang Buchenau
- Interdisciplinary Center for Craniofacial Malformations, Tuebingen University Hospital, Tuebingen, Germany.,Department of Neonatology, Tuebingen University Hospital, Calwerstrasse 7, Tuebingen, 72076, Germany
| | - Joerg Arand
- Interdisciplinary Center for Craniofacial Malformations, Tuebingen University Hospital, Tuebingen, Germany
| | - Anne Vierzig
- Department of Pediatrics, Cologne University Hospital, Cologne, Germany
| | - Bert Braumann
- Department of Orthodontics, Cologne University Hospital, Cologne, Germany
| | - Silvia Müller-Hagedorn
- Interdisciplinary Center for Craniofacial Malformations, Tuebingen University Hospital, Tuebingen, Germany.,Department of Orthodontics, Tuebingen University Hospital, Tuebingen, Germany
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9
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Buchenau W, Wenzel S, Bacher M, Müller-Hagedorn S, Arand J, Poets CF. Functional treatment of airway obstruction and feeding problems in infants with Robin sequence. Arch Dis Child Fetal Neonatal Ed 2017; 102:F142-F146. [PMID: 27435577 DOI: 10.1136/archdischild-2016-311407] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.7] [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: 02/16/2016] [Revised: 06/18/2016] [Accepted: 06/28/2016] [Indexed: 11/04/2022]
Abstract
BACKGROUND Robin sequence (RS), characterised by micrognathia/retrognathia and glossoptosis with or without cleft palate, presents with intermittent upper airway obstruction and feeding difficulties. Active intervention is required to reduce the risk of brain damage or sudden death. Most treatment options are poorly studied and/or invasive. Our group developed a functional approach including early feeding training and the pre-epiglottic baton plate (PEBP), an orthodontic appliance with a velar extension shifting the base of the tongue forward. PATIENTS AND METHODS We evaluated the effect of this approach on sleep study results and early weight gain by searching our electronic patient database for infants with isolated RS, born at or referred to our department between 1 January 2003 and 31 December 2012 and treated with the PEBP. RESULTS Of 122 patients identified, 360 overnight sleep study results, obtained at admission, prior to hospital discharge and 3 months postdischarge, were available (117 infants had complete data). These showed a decrease in the mixed-obstructive apnoea index from (median; IQR) 8.8 (2.1-19.7) to 1.8 (0.6-5.4); p<0.001 and 0.2 (0-1.3); p<0.001, respectively. Z-scores for weight improved from -0.7 (-1.39 to -0.24) upon admission to -0.5 (-0.90 to +0.02) at follow-up (p=0.02), accompanied by a decrease in the proportion of infants requiring nasogastric tube feeding from 66% to 8%. No infant required craniofacial surgery or tracheostomy. CONCLUSIONS These longitudinal cohort data suggest that this functional approach may be an option to treat both, upper airway obstruction and feeding problems, in infants with isolated RS.
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Affiliation(s)
- Wolfgang Buchenau
- Department of Neonatology, Tübingen University Hospital, Tübingen, Germany
| | - Sarah Wenzel
- Department of Neonatology, Tübingen University Hospital, Tübingen, Germany
| | | | - Silvia Müller-Hagedorn
- Interdisciplinary Center for Craniofacial Malformations, Tübingen University Hospital, Tübingen, Germany
| | - Joerg Arand
- Department of Neonatology, Tübingen University Hospital, Tübingen, Germany
| | - Christian F Poets
- Department of Neonatology, Tübingen University Hospital, Tübingen, Germany.,Interdisciplinary Center for Craniofacial Malformations, Tübingen University Hospital, Tübingen, Germany
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10
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Bagci S, Brosens E, Tibboel D, De Klein A, Ijsselstijn H, Wijers CHW, Roeleveld N, de Blaauw I, Broens PM, van Rooij IALM, Hölscher A, Boemers TM, Pauly M, Münsterer OJ, Schmiedeke E, Schäfer M, Ure BE, Lacher M, Choinitzki V, Schumacher J, Zwink N, Jenetzky E, Katzer D, Arand J, Bartmann P, Reutter HM. More than fetal urine: enteral uptake of amniotic fluid as a major predictor for fetal growth during late gestation. Eur J Pediatr 2016; 175:825-31. [PMID: 26979529 DOI: 10.1007/s00431-016-2713-y] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/17/2015] [Revised: 02/25/2016] [Accepted: 03/03/2016] [Indexed: 11/26/2022]
Abstract
UNLABELLED The purpose of our study was to investigate the importance of amniotic fluid (AF) for fetal growth during late gestation using esophageal atresia (EA) patients as a model. In this retrospective cohort study, we compared the z-scores adapted for birth weights (BW z-scores) for each of 517 European newborns with congenital pre-gastric intestinal atresia, i.e., EA, to a European reference population. To account for the influence of the intestinal atresia on fetal growth per se, we compared adapted birth weights for each of 504 European newborns with post colonic intestinal atresia (anorectal malformation (ARM) with atresia of the anus) to the same European reference population. Analysis of the complete cohort showed (i) a significantly higher rate of small for gestational age newborns among EA compared to ARM newborns (p < 0.001) and (ii) significantly lower BW z-scores among EA compared to ARM newborns (p < 0.001). BW z-scores of EA newborns were significantly lower in term compared to preterm newborns with an inverse correlation with gestational age (GA) (Spearman correlation coefficient, r = -0.185, p < 0.001). CONCLUSIONS Enteral uptake of AF seems to play a pivotal role in fetal growth during late gestation. WHAT IS KNOWN • Peak velocity of fetal weight gain occurs at 33 weeks of gestation and continues until birth. During this period, fetal growth is mainly characterized by cellular hypertrophy. • Amniotic fluid (AF) comprises large amounts of hormones and growth regulators. What is New: • A significantly higher rate of small for gestational age and lower birth weights and z-scores are observed among newborn infants with congenital pre-gastric intestinal atresia. • These findings suggest that enteral uptake of AF is a major predictor for fetal growth during late gestation.
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Affiliation(s)
- Soyhan Bagci
- Department of Neonatology and Pediatric Intensive Care, Children's Hospital, University of Bonn, Adenauerallee 119, 53113, Bonn, Germany.
| | - Erwin Brosens
- Department of Clinical Genetics, Erasmus Medical Centre, Rotterdam, The Netherlands
| | - Dick Tibboel
- Department of Pediatric Surgery and Intensive Care, Erasmus Medical Centre-Sophia Children's Hospital, Rotterdam, The Netherlands
| | - Annelies De Klein
- Department of Clinical Genetics, Erasmus Medical Centre, Rotterdam, The Netherlands
| | - Hanneke Ijsselstijn
- Department of Pediatric Surgery and Intensive Care, Erasmus Medical Centre-Sophia Children's Hospital, Rotterdam, The Netherlands
| | - Charlotte H W Wijers
- Department for Health Evidence, Radboud Institute for Health Sciences, Radboudumc, Nijmegen, The Netherlands
| | - Nel Roeleveld
- Department for Health Evidence, Radboud Institute for Health Sciences, Radboudumc, Nijmegen, The Netherlands
| | - Ivo de Blaauw
- Department of Surgery-Pediatric Surgery, Radboudumc Amalia Children's Hospital, Nijmegen, The Netherlands
| | - Paul M Broens
- Department of Surgery, Anorectal Physiology Laboratory, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
- Department of Surgery, Division of Pediatric Surgery, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Iris A L M van Rooij
- Department for Health Evidence, Radboud Institute for Health Sciences, Radboudumc, Nijmegen, The Netherlands
| | - Alice Hölscher
- Department of Pediatric Surgery and Urology, University Hospital Cologne, Cologne, Germany
| | - Thomas M Boemers
- Department of Pediatric Surgery and Urology, University Hospital Cologne, Cologne, Germany
| | - Marcus Pauly
- Department of Pediatric Surgery, Asklepios Children's Hospital St. Augustin, St. Augustin, Germany
| | - Oliver J Münsterer
- Department of Pediatric Surgery, University Medicine of Mainz, Mainz, Germany
| | - Eberhard Schmiedeke
- Department of Pediatric Surgery and Urology, Center for Child and Youth Health, Klinikum Bremen-Mitte, Bremen, Germany
| | - Mattias Schäfer
- Department of Pediatric Surgery and Urology, Cnopf'sche Kinderklinik, Nürnberg, Germany
| | - Benno E Ure
- Center of Pediatric Surgery Hannover, Hannover Medical School and Bult Children's Hospital, Hannover, Germany
| | - Martin Lacher
- Center of Pediatric Surgery Hannover, Hannover Medical School and Bult Children's Hospital, Hannover, Germany
| | - Vera Choinitzki
- Institute of Human Genetics, University of Bonn, Bonn, Germany
| | | | - Nadine Zwink
- Division of Clinical Epidemiology and Aging Research, German Cancer Research Center, Heidelberg, Germany
| | - Ekkehart Jenetzky
- Division of Clinical Epidemiology and Aging Research, German Cancer Research Center, Heidelberg, Germany
- Department of Child and Adolescent Psychiatry and Psychotherapy, Johannes-Gutenberg University, Mainz, Germany
| | - David Katzer
- Department of Neonatology and Pediatric Intensive Care, Children's Hospital, University of Bonn, Adenauerallee 119, 53113, Bonn, Germany
| | - Joerg Arand
- Department of Neonatology, University Children's Hospital of Tübingen, University of Tübingen, Tübingen, Germany
| | - Peter Bartmann
- Department of Neonatology and Pediatric Intensive Care, Children's Hospital, University of Bonn, Adenauerallee 119, 53113, Bonn, Germany
| | - Heiko M Reutter
- Department of Neonatology and Pediatric Intensive Care, Children's Hospital, University of Bonn, Adenauerallee 119, 53113, Bonn, Germany
- Institute of Human Genetics, University of Bonn, Bonn, Germany
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Hoopmann M, Kagan KO, Borgmeier F, Seitz G, Arand J, Wagner P. Measurement of Gastric Circumference in Foetuses with Oesophageal Atresia. Geburtshilfe Frauenheilkd 2015; 75:1148-1152. [PMID: 26719598 DOI: 10.1055/s-0035-1558172] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [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: 01/30/2023] Open
Abstract
Background: The specific recognition of oesophageal atresia (OA) with or without a tracheal fistula in a foetus is a diagnostic challenge for prenatal medicine. The aim of the present work is to analyse the value of the measurement of gastric size in the diagnosis of this significant malformation. Materials and Methods: Altogether, the examinations of 433 pregnancies between the 18.4 and 39.1 weeks of gestation were retrospectively analysed. 59 of these foetuses exhibited an OA. By means of a linear regression analysis with normal foetuses, significant parameters influencing gastric size were examined. Subsequently the gastric sizes were transformed into z values and a comparison was made between OA with and without fistulae with the help of t tests. Results: In the normal foetuses there was a significant association between the gastric circumference and the abdominal circumference (circumference = 6.809 + 0.179 × abdominal circumference, r = 0.686, p < 0.0001). In the normal group the average was 43.0 (standard deviation [SD] 13.7) mm and those in foetuses with and without fistuale were 33.8 (SD 22.7) and 0.9 (SD 3.7) mm. In 34 (57.6 %) foetuses with an OA, the gastric circumference was below the 5th percentile. In detail, there were 13 (34.2 %) foetuses with a fistula and 21 (100 %) without a fistula. The average z values in the normal group and in the groups of OA with fistula and without fistula amounted to 0.0 (SD 1.0), -1.3 (SD 2.2) and -4.5 (SD 1.0). Conclusion: Measurements of the gastric circumference below the 5th percentile should lead to further diagnostic measures, especially when associated with polyhydramnios. Although OA without a fistula is always conspicuous, only about one in three OAs with fistula are associated with a significantly smaller stomach.
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Affiliation(s)
- M Hoopmann
- Department of Obstetrics and Gynecology, University of Tübingen, Tübingen
| | - K O Kagan
- Department of Obstetrics and Gynecology, University of Tübingen, Tübingen
| | - F Borgmeier
- Department of Obstetrics and Gynecology, University of Tübingen, Tübingen
| | - G Seitz
- Department of Pediatric Surgery and Urology, University Children's Hospital, Tübingen
| | - J Arand
- Department of Neonatology, University Children's Hospital, Tübingen
| | - P Wagner
- Department of Obstetrics and Gynecology, University of Tübingen, Tübingen
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Vatlach S, Arand J, Engel C, Poets CF. Safety profile comparison between extemporaneous and a licensed preparation of caffeine citrate in preterm infants with apnea of prematurity. Neonatology 2014; 105:108-11. [PMID: 24335098 DOI: 10.1159/000355715] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [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] [Received: 07/23/2013] [Accepted: 09/12/2013] [Indexed: 11/19/2022]
Abstract
BACKGROUND Given the lack of a licensed product (LP), extemporaneous caffeine citrate (ECC) has been used by many hospital pharmacies. OBJECTIVES Since July 2011, an LP has been available in Germany. We prospectively compared the safety profile of ECC and LP in preterm infants with apnea of prematurity. METHODS Between April 2010 and April 2013, selected side effects occurring with ECC or LP were documented in 6 German NICUs for infants ≤34 weeks' gestation using a longitudinal study design. The software developed for daily prescriptions in NICU residents requires entries if any of the following symptoms occurred during the last 24 h: tachycardia (resting heart rate >200/min), clinical or encephalographic seizures, gastric residuals, vomiting, or necrotizing enterocolitis (NEC). ECC and LP were administered at identical doses (20 mg/kg/day loading, 5-10 mg/kg/day maintenance) and in similar formulations either orally or intravenously. RESULTS 562 infants with 14,590 treatment days on ECC and 538 infants with 12,813 treatment days on LP were evaluated. The mean gestational age was similar (29.20 weeks for ECC vs. 29.14 weeks for LP). No relevant differences were seen concerning tachycardia, gastric residuals, or vomiting, but ECC was associated with a higher risk of NEC (risk ratio: 2.68, 95% CI: 1.01-7.23, p = 0.047) and, albeit not significantly so, seizures (risk ratio: 1.91, 95% CI: 0.53-6.96, p = 0.35). CONCLUSION This survey demonstrates a similar safety profile for both forms of caffeine citrate. The lower NEC and seizure rate seen with the LP is intriguing, but requires confirmation in a controlled study design.
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Affiliation(s)
- Scarlet Vatlach
- Department of Neonatology, University Children's Hospital, Tuebingen, Germany
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Maas C, Mitt S, Full A, Arand J, Bernhard W, Poets CF, Franz AR. A historic cohort study on accelerated advancement of enteral feeding volumes in very premature infants. Neonatology 2013; 103:67-73. [PMID: 23095283 DOI: 10.1159/000342223] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.3] [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] [Received: 03/15/2012] [Accepted: 07/23/2012] [Indexed: 01/24/2023]
Abstract
BACKGROUND The optimal rate of enteral feeding (EF) advancement in very low birth weight infants is under debate. OBJECTIVES To evaluate the effects of accelerated EF advancement on the time to full enteral feeds, on early postnatal growth as well as on the frequency of necrotizing enterocolitis (NEC) and focal intestinal perforation (FIP) in very premature infants. METHODS In a retrospective single-center historic cohort study, infants with a gestational age <32 weeks at birth and birth weight <1,500 g, born between January 1, 2006, and December 31, 2007 (n = 136), were compared with infants born between January 1, 2010, and December 31, 2010 (n = 88). In 2006/2007, enteral feeds were initiated on day 1 with 10-15 ml/kg/day and advanced by 15-20 ml/kg/day. In 2010, enteral feeds were initiated with 20 ml/kg/day on day 1 and advanced by 25-30 ml/kg/day. Full enteral feeds were defined as ≥ 140 ml/kg/day. Data are presented as median (P25-P75). RESULTS The time to establish full enteral feeds was shorter in 2010: 8 (7-11) days in 2006/2007 versus 6 (5-9) days in 2010. The incidences of NEC and FIP were 2.7 and 4.1% in 2006/2007 and 3.3 and 2.2% in 2010, respectively. Weight gain was not affected by the rate of EF advancement. Higher parenteral protein intake during week 1 in 2006/2007 was associated with better head circumference growth. CONCLUSIONS The new approach was associated with a significantly shorter period to establish full enteral feeds. No difference in the incidence of FIP or NEC was observed; however, the study was underpowered to detect small but possibly important differences.
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Affiliation(s)
- C Maas
- Department of Neonatology, University Children's Hospital Tübingen, Tübingen, Germany
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Eicher C, Seitz G, Bevot A, Moll M, Goelz R, Arand J, Poets C, Fuchs J. Surgical management of extremely low birth weight infants with neonatal bowel perforation: a single-center experience and a review of the literature. Neonatology 2012; 101:285-92. [PMID: 22286302 DOI: 10.1159/000335325] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.0] [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] [Received: 03/25/2011] [Accepted: 11/19/2011] [Indexed: 12/15/2022]
Abstract
BACKGROUND Necrotizing enterocolitis (NEC) and focal intestinal perforation (FIP) are major causes of morbidity in infants with extremely low birth weight (ELBW). OBJECTIVE To evaluate the surgical procedures applied, and the survival and long-term outcome of ELBW infants with NEC and FIP in a single-center study. METHODS Inborn and outborn ELBW infants (<1000 g) with NEC and FIP were analyzed retrospectively from 2002 to 2007. Data collected include surgical procedures, survival as well as complications, length of partial parenteral nutrition and hospital stay. The short-term and long-term outcomes after 2-7 years were assessed and compared with a matched control group. RESULTS Out of 280 ELBW infants, 28 underwent surgery, 19 because of FIP and 9 for NEC. Fourteen infants in the FIP group were treated with primary laparotomy and 5 with peritoneal drainage (PD). In the NEC group, only 1 infant was treated with PD. PD was used for unstable patients and was always followed by secondary laparotomy after stabilization. Five of 28 (18%) surgically treated ELBW infants and 4 (14%) matched controls died. The following complications occurred in the surgical group: complete (n = 1) or minor wound dehiscence (n = 4), stoma prolapse (n = 5), parastomal hernia (n = 2), stoma fistula (n = 1), and wound infection (n = 2). Dependency on parenteral nutrition was significantly shorter in infants with FIP, while there were no differences in time to stoma closure and length of hospital stay between those with FIP and those with NEC. Eleven of 23 (47.8%) surviving patients with FIP or NEC showed developmental delay, compared with 9 of 24 (37.5%) in the controls. CONCLUSIONS The management of EBLW infants with NEC and FIP remains challenging. Our treatment approach was associated with low mortality. Developmental delay seems to be caused by extreme prematurity rather than NEC- or FIP-related bowel perforation.
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Affiliation(s)
- Carmen Eicher
- Department of Pediatric Surgery and Urology, University Children's Hospital, Tübingen, Germany.
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Linz A, Bacher M, Urschitz M, Buchenau W, Arand J, Poets C. Diagnostik und Therapie der Pierre-Robin-Sequenz. Monatsschr Kinderheilkd 2011. [DOI: 10.1007/s00112-011-2458-7] [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: 10/16/2022]
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Lutz UC, Hiemke C, Wiatr G, Farger G, Arand J, Wildgruber D. Aripiprazole use during pregnancy and lactation. Pharmacopsychiatry 2011. [DOI: 10.1055/s-0031-1292300] [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: 10/17/2022]
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Linz A, Bacher M, Kagan KO, Buchenau W, Arand J, Poets CF. Pierre Robin Sequenz: Pränatale Diagnostik und interdisziplinäre Therapie. Z Geburtshilfe Neonatol 2011; 215:105-8. [DOI: 10.1055/s-0031-1273718] [Citation(s) in RCA: 3] [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: 10/18/2022]
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Moll M, Schöning M, Gölz R, Döbler-Neumann M, Arand J, Krägeloh-Mann I, Poets C. 2-Jahres-Nachuntersuchung (Bayley) sehr kleiner Frühgeborener der Jahrgänge 2004–2007: Ergebnisse und Vollständigkeitsanalyse eines Perinatalzentrums. Klin Padiatr 2011; 223:251-4. [DOI: 10.1055/s-0031-1275679] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Bacher M, Sautermeister J, Urschitz MS, Buchenau W, Arand J, Poets CF. An Oral Appliance with Velar Extension for Treatment of Obstructive Sleep Apnea in Infants with Pierre Robin Sequence. Cleft Palate Craniofac J 2011; 48:331-6. [DOI: 10.1597/09-091] [Citation(s) in RCA: 49] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023] Open
Abstract
Objective A new oral appliance to treat obstructive sleep apnea in infants with Pierre Robin sequence has recently been shown to be superior to a sham procedure. We now investigate safety and long-term effects of this appliance on obstructive sleep apnea in infants with Pierre Robin sequence. Design Case series with repetitive follow-up examinations. Setting Tertiary neonatal intensive care unit at the University Children's Hospital Tuebingen, Germany. Patients Fifteen infants (11 girls and four boys; median age, 5 days) with Pierre Robin sequence and obstructive sleep apnea (i.e., mixed-obstructive-apnea index > 3). Intervention A custom-made intraoral appliance with velar extension was used continuously in situ from admission until 3 months after hospital discharge. Main Outcome Measure The mixed-obstructive-apnea index was determined prior to the intervention at admission, at discharge, and 3 months later using polygraphic sleep studies. The geometric mean of the mixed-obstructive-apnea index and its 95% confidence interval were calculated. Results Compared with admission (mean, 17.2; 95% confidence interval, 11.1–26.7), there was a significant decrease in the mixed-obstructive-apnea index to discharge (mean, 3.8; 95% confidence interval, 2.2–6.6) and 3 months later (mean, 1.2; 95% confidence interval, 0.7–2.2; p value < .001). No severe adverse events occurred. Conclusions This oral appliance was safe and appears to treat obstructive sleep apnea effectively in infants with Pierre Robin sequence.
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Affiliation(s)
- Margit Bacher
- Interdisciplinary Center for Craniofacial Malformations, Tübingen, Germany
| | | | | | - Wolfgang Buchenau
- Interdisciplinary Center for Craniofacial Malformations and Department of Neonatology, Tübingen, Germany
| | - Joerg Arand
- Department of Neonatology, Tübingen, Germany
| | - Christian F. Poets
- Interdisciplinary Center for Craniofacial Malformations and Department of Neonatology, University Children's Hospital, Tübingen, Germany
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Full A, Franz A, Arand J, Poets CF, Bernhard W. Tatsächliche Zufuhr von Cholin und Folsäure bei Frühgeborenen mit <1000g Geburtsgewicht oder <28 SSW Gestationsalter. Klin Padiatr 2010. [DOI: 10.1055/s-0030-1261570] [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]
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Moll M, Schöning M, Goelz R, Arand J, Poets C. 2-Jahres-Nachuntersuchung (Bayley) sehr kleiner Frühgeborener der Jahrgänge 2004–2007 – Ergebnisse und Vollständigkeitsanalyse eines Perinatalzentrums (PNZ). Klin Padiatr 2010. [DOI: 10.1055/s-0030-1261376] [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]
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Ziegler J, Arand J, Bassler D, Goelz R, Poets CF, Franz A. Substitution von Pankreaslipase bei Frühgeborenen mit ausgeprägter Gedeihstörung. Klin Padiatr 2010. [DOI: 10.1055/s-0030-1261544] [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]
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Bacher M, Buchenau W, Arand J, Linz A, Urschitz MS, Krimmel M, Göz G, Reinert S, Poets CF. Schwere obstruktive Atmungsstörungen bei kraniofazialen Dysmorhpiesyndromen. Klin Padiatr 2010. [DOI: 10.1055/s-0030-1261632] [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]
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Yarkin Y, Goelz R, Arand J, Müller-Hansen I, Bassler D, Poets CF, Franz A. Magensonden-Fehllage im Hauptbronchus. Nur Röntgenbild oder Aspiration von Magensekret beweisen die korrekte Lage der Magensonde und verhindern iatrogene Nahrungsaspiration. Klin Padiatr 2010. [DOI: 10.1055/s-0030-1261605] [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]
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Hallenberger A, Arand J, Müller-Hansen I, Poets CF, Bassler D. Milrinon bei persistierender pulmonaler Hypertonie des Neugeborenen (PPHN): Zwei Fallberichte. Z Geburtshilfe Neonatol 2009. [DOI: 10.1055/s-0029-1223080] [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]
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Müller-Hansen I, Arand J, Poets CF. Wie gelb ist gelb? – Weiterhin große Abweichungen zwischen verschiedenen Bilirubin-Bestimmungsmethoden und kein Ende absehbar? Z Geburtshilfe Neonatol 2009. [DOI: 10.1055/s-0029-1223136] [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]
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Reinert S, Bacher M, Buchenau W, Arand J, Poets C, Göz G. O.086 Treatment of severe Pierre Robin Sequence – state of the art. J Craniomaxillofac Surg 2008. [DOI: 10.1016/s1010-5182(08)71210-1] [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: 10/21/2022] Open
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Eicher C, Luithle T, Goelz R, Kirschner HJ, Arand J, Poets C, Fuchs J. Die Bedeutung frühzeitiger Intervention bei Frühgeborenen mit Darmperforation. Z Geburtshilfe Neonatol 2008. [DOI: 10.1055/s-2008-1078894] [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: 10/21/2022]
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Buchenau W, Urschitz MS, Sautermeister J, Bacher M, Herberts T, Arand J, Poets CF. A randomized clinical trial of a new orthodontic appliance to improve upper airway obstruction in infants with Pierre Robin sequence. J Pediatr 2007; 151:145-9. [PMID: 17643765 DOI: 10.1016/j.jpeds.2007.02.063] [Citation(s) in RCA: 81] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/19/2006] [Revised: 02/05/2007] [Accepted: 02/27/2007] [Indexed: 01/10/2023]
Abstract
OBJECTIVE To test the hypothesis that a new orthodontic appliance with a velar extension that shifts the tongue anteriorly would reduce upper airway obstruction in infants with Pierre Robin sequence (PRS). STUDY DESIGN Eleven infants with PRS (median age, 3 days) and an apnea index (AI) >3 were studied. The effect of the new appliance on the AI was compared with that of a conventional appliance without a velar extension by using a crossover study design with random allocation. RESULTS Compared with baseline (mean AI, 13.8), there was a significant decrease in the AI with the new appliance (3.9; P value <.001), but no change with the conventional appliance (14.8; P = .842). Thus, the relative change in AI was -71% (95% CI, -84--49) for the new appliance and +8% (95% CI, -52-142) for the conventional appliance, which was significantly different (P = .004). No severe adverse effects were observed. CONCLUSION This new orthodontic appliance appears to be safe and effective in reducing upper airway obstruction in infants with PRS.
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Affiliation(s)
- Wolfgang Buchenau
- Department of Neonatology, University Hospital Tuebingen, Tuebingen, Germany
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Moll M, Arand J, Goelz R, Poets C. Entwicklung der somatischen Parameter sehr kleiner Frühgeborener 1995–2006 in den Monaten nach Entlassung – kein Aufholwachstum trotz besserer Supplementierung? Z Geburtshilfe Neonatol 2007. [DOI: 10.1055/s-2007-983202] [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: 10/21/2022]
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Roth A, Buck P, Zieger B, Buchenau W, Arand J, Holland-Cunz S, Bender C, Henschen M. Fallbericht: Interstitielles Emphysem mit ausgeprägter Pseudozystenbildung bei einem Frühgeborenen trotz milder Beatmung. Z Geburtshilfe Neonatol 2007. [DOI: 10.1055/s-2007-983244] [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: 10/21/2022]
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Arand J. Körperliche Entwicklung von VLBI bis zur Entlassung nach Hause – können wir zufrieden sein? Z Geburtshilfe Neonatol 2006. [DOI: 10.1055/s-2006-946034] [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]
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Pantalitschka T, Sievers J, Arand J, Baden W, Poets C. Vergleichende Untersuchung verschiedener nasaler Atemhilfen zur Behandlung von Frühgeborenen mit Atemregulationsstörungen. Z Geburtshilfe Neonatol 2006. [DOI: 10.1055/s-2006-946154] [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]
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Buchenau W, Urschitz M, Sautermeister J, Bacher M, Arand J, Poets C. Die Behandlung von Atemwegsobstruktionen bei Pierre-Robin-Sequenz mit Gaumenplatte. Z Geburtshilfe Neonatol 2006. [DOI: 10.1055/s-2006-946273] [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]
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Arand J. Körperliche Entwicklung von VLBI bis zur Entlassung nach Hause – können wir zufrieden sein? Z Geburtshilfe Neonatol 2006. [DOI: 10.1055/s-2006-943119] [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]
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Buchenau W, Urschitz M, Sautermeister J, Bacher M, Arand J, Poets C. Die Behandlung von Atemwegsobstruktionen bei Pierre-Robin-Sequenz mit Gaumenplatte. Z Geburtshilfe Neonatol 2006. [DOI: 10.1055/s-2006-943358] [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]
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Pantalitschka T, Sievers J, Arand J, Baden W, Poets C. Vergleichende Untersuchung verschiedener nasaler Atemhilfen zur Behandlung von Frühgeborenen mit Atemregulationsstörungen. Z Geburtshilfe Neonatol 2006. [DOI: 10.1055/s-2006-943239] [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]
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Buchenau W, Sautermeister J, Bacher M, Arand J, Urschitz MS, Poets CF. Die Tübinger Gaumenplatte – Ein innovatives Therapiekonzept bei Pierre-Robin-Sequenz. Einfluss auf die schlafbezogene Atmungsstörung. Z Geburtshilfe Neonatol 2004. [DOI: 10.1055/s-2004-829212] [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]
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Abstract
Associated malformations and symptoms may be decisive in the differential diagnosis of neonatal phocomelia. We report on a neonate with phocomelia, petechiae and thrombocytopenia. This constellation is typical for the phocomelia-thrombocytopenia-syndrome, a variant of the thrombocytopenia-absent radius-(TAR) syndrome. During the neonatal period platelet transfusions were necessary. Relevant bleeding and development delays were not evident until the age of seven months. Cardinal symptoms of the TAR syndrome are bilaterally absent radius and neonatal thrombocytopenia. The patient presented with phocomelia of the upper extremities which occurs in only 5 - 10 % of the patients with TAR syndrome. Further abnormalities include additional bone and joint disorders and haematopoietic problems, such as thrombocytopenia. Bleeding episodes mainly occur in the first year of life, hence platelet transfusions may be necessary during this period. A new experimental approach is the Interleukin-6-mediated stimulation of thrombopoiesis. Usually platelet counts reach normal values in adults. The main problem remains a satisfactory management of various limb defects.
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Affiliation(s)
- C Maas
- Universitätsklinikum Tübingen, Klinik für Kinderheilkunde und Jugendmedizin, Abteilung IV, Neonatologie, Germany
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41
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Bacher M, Bacher U, Göz G, Pham T, Cornelius CP, Speer CP, Goelz R, Arand J, Wendling F, Buchner P, Bacher A. Three-dimensional computer morphometry of the maxilla and face in infants with Pierre Robin sequence--a comparative study. Cleft Palate Craniofac J 2000; 37:292-302. [PMID: 10830810 DOI: 10.1597/1545-1569_2000_037_0292_tdcmot_2.3.co_2] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVE To analyze the morphology of the maxillary crest in infants with Pierre Robin sequence using an anthropometric coordinate system and to compare the data with those of healthy infants. SETTING The study was performed at a craniofacial center servicing a large geographic area. PARTICIPANTS The study involved eight infants aged 1-28 days (average, 7 days) with an established diagnosis of Pierre Robin sequence and six healthy infants aged 1-43 days (average, 22 days). MAIN OUTCOME MEASURES Physical models of the maxilla and face obtained by alginate replication were analyzed by computer morphometry yielding the three-dimensional topology of the maxillary crest. RESULTS The maxillary crest of children with Pierre Robin sequence shows an increased inclination relative to the transverse plane (30 +/- 3.9 degrees) as compared with that of healthy infants (20 +/- 2.9 degrees). The maxillary crest of the patients is shortened in the sagittal direction by comparison with healthy controls. CONCLUSIONS The increased inclination of the maxilla in infants with Pierre Robin sequence may aggravate the retroposition of the mandible and may thus be a pathogenetic factor contributing to the severe respiratory problems.
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Affiliation(s)
- M Bacher
- Department of Orthodontics, School of Dentistry, Center of Craniofacial Disorders at the University of Tübingen, Federal Republic of Germany
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42
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Abstract
In order to test the ability of Ambroxol to improve the clinical course of respiratory distress syndrome and to reduce the incidence of complications a multicentre, randomized, placebo-controlled double-blind trial was conducted. Entry was limited to infants with a birth weight below 1500 g. A total of 179 neonates were enrolled, but 31 were later excluded because they had other diseases. Of the remaining 148 babies, 74 received Ambroxol (birth weight 1190 +/- 216 g; gestational age 29.1 +/- 1.9 weeks) and 74 placebo (birth weight 1168 +/- 216 g; gestational age 28.9 +/- 1.9 weeks). In the Ambroxol group 23 (31%) and in the placebo group 27 (37%) infants died during the first 5 months of life. In 28 day-survivors Ambroxol was able to significantly improve the PaO2/FiO2 ratio, mean airway pressure, phospholipid profile of tracheal effluent and pulmonary mechanics of spontaneously breathing infants. In addition, the incidences of bronchopulmonary dysplasia (29% vs 54%), intraventricular haemorrhage (25% vs 44%) and postnatally acquired pneumonia (15% vs 36%) were significantly reduced in the Ambroxol group as compared to the control group. No adverse events attributed to the Ambroxol treatment were reported.
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Affiliation(s)
- R R Wauer
- Department of Neonatology, Charité, Humboldt-University Berlin, Federal Republic of Germany
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43
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Wehner J, Arand J, Todt H, Richter K. [Phenobarbital poisoning in a eutrophic term newborn infant. A case report]. Kinderarztl Prax 1991; 59:31-4. [PMID: 2056659] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
An iatrogenic intoxication with 300 mg phenobarbital (Lepinal) in a newborn is reported. Description is given about clinical course, blood levels of phenobarbital (maximum 507 mumols/l) and the therapy. The most important therapeutic interventions like alkalinization of urine, haemoperfusion or blood exchange are directed towards increase of elimination of phenobarbital. The phenobarbital blood level decreased from 349 mumols/l before to 242 mumols/l after the blood exchange transfusion in our case. The transfer to a pediatric intensive care unit should be made as early as possible because of the risk of respiratory failure.
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Affiliation(s)
- J Wehner
- Klinik für Kinderheilkunde, Medizinischen Akademie, Carl Gustav Carus, Dresden
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44
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Sharida HA, Holohan M, Hogan M, Mathias P, Griffin E, Deasy P, Tempany E, Lambert I, Matthews TG, Clarke TA, Wauer RR, Schmalsisch G, Boye H, Rüstow B, Gaughan B, O’Connor R, Bonnar C, Dalrymple I, Wingfield M, Rasmussen MJ, Turner MJ, Stonge JM, McDonnell M, Burke AG, Murphy JFA, Wauer R, Schmalisch G, Böhme B, Arand J, Moeller C, Jenkins D, Boylan P, McCarthy C, Roberts RN, Quinn AJ, Thompson W, Han KT, Halliday HL, McClure G, Reid MM, McDonald D, Hepper PG, White R, Shahidullah S, Tubman TRJ, Halliday HL, Normand C, Hamilton RA, Dornan JC. Irish perinatal society. Ir J Med Sci 1990. [DOI: 10.1007/bf02937384] [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: 10/21/2022]
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45
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Kabus M, Rupprecht E, Köhler K, Schaps P, Arand J. [Vein of Galen malformation in a newborn infant with clinical symptoms of a cardiologic emergency]. Kinderarztl Prax 1990; 58:247-53. [PMID: 2376939] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
We report on the management of one term newborn infant with a malformation of the Vena Galeni. The baby suffered from cyanosis and intractable congestive heart failure without evidence of congenital heart malformation at his second day of life. The diagnosis was established by two-dimensional sonography and Doppler examination. However, we thought it necessary additionally to perform an angiography of the intracerebral vessels before surgical intervention. We conclude that a real time two-dimensional imaging system and a range-gated pulsed Doppler velocimeter should be available in newborn intensive care units. Otherwise neonatologists are forced to transport these infants to pediatric heart centers because of inability to detect such an extracardiac origin of heart and circulatory failure.
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Affiliation(s)
- M Kabus
- Abteilung für Neonatologie der Klinik für Kinderheilkunde, Medizinischen Akademie Carl Gustav Carus, Dresden
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