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Grassi M, Laubscher B, Pandey AV, Tschumi S, Graber F, Schaller A, Janner M, Aeberli D, Hewer E, Nuoffer JM, Gautschi M. Expanding the p.(Arg85Trp) Variant-Specific Phenotype of HNF4A: Features of Glycogen Storage Disease, Liver Cirrhosis, Impaired Mitochondrial Function, and Glomerular Changes. Mol Syndromol 2023; 14:347-361. [PMID: 37766831 PMCID: PMC10521240 DOI: 10.1159/000529306] [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: 06/29/2022] [Accepted: 01/22/2023] [Indexed: 09/29/2023] Open
Abstract
Introduction The p.(Arg85Trp) variant-specific phenotype of hepatocyte nuclear factor 4 alpha shows a complex clinical picture affecting three different organ systems and their corresponding metabolisms. Little is known about the molecular mechanisms involved and their relationship with the diverse symptoms seen in the context of this specific variant. Here, we present data of a new patient that expand the clinical phenotype, suggesting possible disease mechanisms. Case Presentation Clinical data were extracted from the patient's charts. The liver, kidney, and muscle were analyzed with routine histology and electron microscopy. Mitochondrial function was assessed by respirometric analyses and enzymatic activity assays. Structure and sequence analyses of this specific variant were investigated by in silico analyses. Our patient showed the known features of the variant-specific phenotype, including macrosomia, congenital hyperinsulinism, transient hepatomegaly, and renal Fanconi syndrome. In addition to that, she showed liver cirrhosis, chronic kidney failure, and altered mitochondrial morphology and function. The clinical and biochemical phenotype had features of a new type of glycogen storage disease. Discussion This case expands the p.(Arg85Trp) variant-specific phenotype. Possible pathomechanistic explanations for the documented multiorgan involvement and changes of symptoms and signs during development of this ultra-rare but instructive disorder are discussed.
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Affiliation(s)
- Mara Grassi
- Pediatric Endocrinology, Diabetology and Metabolism, Department of Pediatrics, Inselspital, University Hospital Bern, University of Bern, Bern, Switzerland
| | - Bernard Laubscher
- Department of Pediatrics, Réseau hospitalier neuchâtelois, Neuchâtel, Switzerland
- Department of Pediatrics, Lausanne University Hospital, University of Lausanne, Lausanne, Switzerland
| | - Amit V. Pandey
- Pediatric Endocrinology, Diabetology and Metabolism, Department of Pediatrics, Inselspital, University Hospital Bern, University of Bern, Bern, Switzerland
- Department of Biomedical Research, University of Bern, Bern, Switzerland
| | - Sibylle Tschumi
- Pediatric Nephrology, Inselspital, University Hospital Bern, Bern, Switzerland
| | | | - André Schaller
- Department of Human Genetics, Inselspital, University Hospital Bern, University of Bern, Bern, Switzerland
| | - Marco Janner
- Pediatric Endocrinology, Diabetology and Metabolism, Department of Pediatrics, Inselspital, University Hospital Bern, University of Bern, Bern, Switzerland
| | - Daniel Aeberli
- Department of Rheumatology and Immunology, Inselspital, University Hospital Bern, Bern, Switzerland
| | - Ekkehard Hewer
- Institute of Pathology, University of Bern, Bern, Switzerland
- Institute of Pathology, Lausanne, University Hospital and University of Lausanne, Lausanne, Switzerland
| | - Jean-Marc Nuoffer
- Pediatric Endocrinology, Diabetology and Metabolism, Department of Pediatrics, Inselspital, University Hospital Bern, University of Bern, Bern, Switzerland
- Institute of Clinical Chemistry, Inselspital, University Hospital Bern, University of Bern, Bern, Switzerland
| | - Matthias Gautschi
- Pediatric Endocrinology, Diabetology and Metabolism, Department of Pediatrics, Inselspital, University Hospital Bern, University of Bern, Bern, Switzerland
- Institute of Clinical Chemistry, Inselspital, University Hospital Bern, University of Bern, Bern, Switzerland
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Progin C, Pauchard JY, Amiguet M, Laubscher B. Urine collection techniques in non-toilet trained children: Switzerland's paediatric office practices in 2022. Acta Paediatr 2023. [PMID: 36932711 DOI: 10.1111/apa.16758] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/15/2023] [Revised: 03/14/2023] [Accepted: 03/15/2023] [Indexed: 03/19/2023]
Affiliation(s)
- Chloé Progin
- Faculty of Biology and Medicine, University of Lausanne, Lausanne, Switzerland
| | - Jean-Yves Pauchard
- Women-Mother-Child Department, Lausanne University Hospital, Lausanne, Switzerland
| | - Michael Amiguet
- Division of Biostatistics, Center for Primary Care and Public Health (Unisanté), University of Lausanne, Switzerland
| | - Bernard Laubscher
- Faculty of Biology and Medicine, University of Lausanne, Lausanne, Switzerland.,Women-Mother-Child Department, Lausanne University Hospital, Lausanne, Switzerland.,Department of Pediatrics, Réseau Hospitalier Neuchâtelois, Neuchâtel, Switzerland
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Laubscher B, Diezi M, Renella R, Mitchell EAD, Aebi A, Mulot M, Glauser G. Multiple neonicotinoids in children's cerebro-spinal fluid, plasma, and urine. Environ Health 2022; 21:10. [PMID: 35016674 PMCID: PMC8750865 DOI: 10.1186/s12940-021-00821-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [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: 07/27/2021] [Accepted: 12/20/2021] [Indexed: 05/05/2023]
Abstract
BACKGROUND Neonicotinoids (NN) are selective neurotoxic pesticides that bind to insect but also mammal nicotinic acetycholine receptors (nAChRs). As the most widely used class of insecticides worldwide, they are ubiquitously found in the environment, wildlife, and foods, and thus of special concern for their impacts on the environment and human health. nAChRs are vital to proper brain organization during the prenatal period and play important roles in various motor, emotional, and cognitive functions. Little is known on children's contamination by NN. In a pilot study we tested the hypothesis that children's cerebro-spinal fluid (CSF) can be contaminated by NN. METHODS NN were analysed in leftover CSF, blood, and urine samples from children treated for leukaemias and lymphomas and undergoing therapeutic lumbar punctions. We monitored all neonicotinoids approved on the global market and some of their most common metabolites by ultra-high performance liquid chromatography-tandem mass spectrometry. RESULTS From August to December 2020, 14 children were consecutively included in the study. Median age was 8 years (range 3-18). All CSF and plasma samples were positive for at least one NN. Nine (64%) CSF samples and 13 (93%) plasma samples contained more than one NN. Thirteen (93%) CSF samples had N-desmethyl-acetamiprid (median concentration 0.0123, range 0.0024-0.1068 ng/mL), the major metabolite of acetamiprid. All but one urine samples were positive for ≥ one NN. A statistically significant linear relationship was found between plasma/urine and CSF N-desmethyl-acetamiprid concentrations. CONCLUSIONS We have developed a reliable analytical method that revealed multiple NN and/or their metabolites in children's CSF, plasma, and urine. Our data suggest that contamination by multiple NN is not only an environmental hazard for non-target insects such as bees but also potentially for children.
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Affiliation(s)
- Bernard Laubscher
- Departments of Paediatrics, Réseau Hospitalier Neuchâtelois, Neuchâtel, and Lausanne University Hospital and Lausanne University, Lausanne, Switzerland.
| | - Manuel Diezi
- Department of Paediatrics, Lausanne University Hospital and Lausanne University, Lausanne, Switzerland
| | - Raffaele Renella
- Department of Paediatrics, Lausanne University Hospital and Lausanne University, Lausanne, Switzerland
| | | | - Alexandre Aebi
- Institutes of Biology and Anthropology, University of Neuchâtel, Neuchâtel, Switzerland
| | - Matthieu Mulot
- Institute of Biology, University of Neuchâtel, Neuchâtel, Switzerland
| | - Gaëtan Glauser
- Neuchâtel Platform of Analytical Chemistry, University of Neuchâtel, Neuchâtel, Switzerland
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Favre G, Mazzetti S, Gengler C, Bertelli C, Schneider J, Laubscher B, Capoccia R, Pakniyat F, Ben Jazia I, Eggel-Hort B, de Leval L, Pomar L, Greub G, Baud D, Giannoni E. Decreased Fetal Movements: A Sign of Placental SARS-CoV-2 Infection with Perinatal Brain Injury. Viruses 2021; 13:v13122517. [PMID: 34960786 PMCID: PMC8706116 DOI: 10.3390/v13122517] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [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: 11/24/2021] [Revised: 12/07/2021] [Accepted: 12/10/2021] [Indexed: 01/23/2023] Open
Abstract
Neonatal COVID-19 is rare and mainly results from postnatal transmission. Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), however, can infect the placenta and compromise its function. We present two cases of decreased fetal movements and abnormal fetal heart rhythm 5 days after mild maternal COVID-19, requiring emergency caesarean section at 29 + 3 and 32 + 1 weeks of gestation, and leading to brain injury. Placental examination revealed extensive and multifocal chronic intervillositis, with intense cytoplasmic positivity for SARS-CoV-2 spike antibody and SARS-CoV-2 detection by RT-qPCR. Vertical transmission was confirmed in one case, and both neonates developed extensive cystic peri-ventricular leukomalacia.
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Affiliation(s)
- Guillaume Favre
- Materno-Fetal and Obstetrics Research Unit, Department Woman-Mother-Child, Lausanne University Hospital, University of Lausanne, 1011 Lausanne, Switzerland; (G.F.); (L.P.)
| | - Sara Mazzetti
- Clinic of Pediatrics, Department Mother-Woman-Child, Lausanne University Hospital, University of Lausanne, 1011 Lausanne, Switzerland; (S.M.); (B.L.)
| | - Carole Gengler
- Department of Laboratory Medicine and Pathology, Institute of Pathology, Lausanne University Hospital, University of Lausanne, 1011 Lausanne, Switzerland; (C.G.); (L.d.L.)
| | - Claire Bertelli
- Institute of Microbiology, Lausanne University Hospital, University of Lausanne, 1011 Lausanne, Switzerland; (C.B.); (G.G.)
| | - Juliane Schneider
- Clinic of Neonatology, Department Mother-Woman-Child, Lausanne University Hospital, University of Lausanne, 1011 Lausanne, Switzerland; (J.S.); (E.G.)
| | - Bernard Laubscher
- Clinic of Pediatrics, Department Mother-Woman-Child, Lausanne University Hospital, University of Lausanne, 1011 Lausanne, Switzerland; (S.M.); (B.L.)
- Department of Pediatrics, Réseau Hospitalier Neuchâtelois, 2000 Neuchâtel, Switzerland
| | - Romina Capoccia
- Department of Obstetrics and Gynecology, Réseau Hospitalier Neuchâtelois, 2000 Neuchatel, Switzerland; (R.C.); (F.P.); (I.B.J.)
| | - Fatemeh Pakniyat
- Department of Obstetrics and Gynecology, Réseau Hospitalier Neuchâtelois, 2000 Neuchatel, Switzerland; (R.C.); (F.P.); (I.B.J.)
| | - Inès Ben Jazia
- Department of Obstetrics and Gynecology, Réseau Hospitalier Neuchâtelois, 2000 Neuchatel, Switzerland; (R.C.); (F.P.); (I.B.J.)
| | - Béatrice Eggel-Hort
- Department of Obstetrics and Gynecology, Hôpital du Valais—Centre Hospitalier du Valais Romand—Site de Sion, 1951 Sion, Switzerland;
| | - Laurence de Leval
- Department of Laboratory Medicine and Pathology, Institute of Pathology, Lausanne University Hospital, University of Lausanne, 1011 Lausanne, Switzerland; (C.G.); (L.d.L.)
| | - Léo Pomar
- Materno-Fetal and Obstetrics Research Unit, Department Woman-Mother-Child, Lausanne University Hospital, University of Lausanne, 1011 Lausanne, Switzerland; (G.F.); (L.P.)
- Midwifery Department, School of Health Sciences (HESAV), University of Applied Sciences and Arts Western Switzerland, 1011 Lausanne, Switzerland
| | - Gilbert Greub
- Institute of Microbiology, Lausanne University Hospital, University of Lausanne, 1011 Lausanne, Switzerland; (C.B.); (G.G.)
- Infectious Diseases Service, Department of Internal Medicine, Lausanne University Hospital, University of Lausanne, 1011 Lausanne, Switzerland
| | - David Baud
- Materno-Fetal and Obstetrics Research Unit, Department Woman-Mother-Child, Lausanne University Hospital, University of Lausanne, 1011 Lausanne, Switzerland; (G.F.); (L.P.)
- Correspondence: ; Tel.: +41-79-556-13-51
| | - Eric Giannoni
- Clinic of Neonatology, Department Mother-Woman-Child, Lausanne University Hospital, University of Lausanne, 1011 Lausanne, Switzerland; (J.S.); (E.G.)
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5
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Knüsli J, Desseauve D, Laubscher B. Parental resistance to oral vitamin K prophylaxis was much more common in Swiss birthing centres than private or public hospitals. Acta Paediatr 2021; 110:3365-3366. [PMID: 34329534 PMCID: PMC9292146 DOI: 10.1111/apa.16052] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/10/2021] [Revised: 07/27/2021] [Accepted: 07/29/2021] [Indexed: 11/27/2022]
Affiliation(s)
- José Knüsli
- Faculty of Biology and Medicine University of Lausanne Lausanne Switzerland
| | - David Desseauve
- Faculty of Biology and Medicine University of Lausanne Lausanne Switzerland
- Women‐Mother‐Child Department Lausanne University Hospital Lausanne Switzerland
| | - Bernard Laubscher
- Faculty of Biology and Medicine University of Lausanne Lausanne Switzerland
- Women‐Mother‐Child Department Lausanne University Hospital Lausanne Switzerland
- Department of Pediatrics Réseau Hospitalier Neuchâtelois Neuchâtel Switzerland
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6
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Carlhan-Ledermann A, Laubscher B, Steinlin M, Ulrich CT, Verma RK, Rizzi M, Maduri R, Grunt S. Spinal epidural hematoma without significant trauma in children: two case reports and review of the literature. BMC Pediatr 2020; 20:77. [PMID: 32075604 PMCID: PMC7029477 DOI: 10.1186/s12887-020-1957-x] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/16/2019] [Accepted: 02/04/2020] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND Spinal epidural hematoma without significant trauma is a rare condition with potentially severe outcome. This case report and systematic review of the literature illustrates the clinical presentation, risk factors, evaluation, treatment and outcomes of spinal epidural hematoma without significant trauma in children. CASE PRESENTATION We report one case of a 7-year-old girl who developed a neck pain after minor cervical sprain. MRI showed a right posterior epidural hematoma extending from C2/3 to T1. The hematoma was surgically evacuated, and the histopathology showed an arteriovenous malformation. Postoperative MRI showed complete evacuation of the hematoma and no residual vascular malformation. We report a second ASE with idiopathic spinal epidural hematoma of a 4½-year-old boy presenting with neck pain. MRI showed a right-sided latero-posterior subacute spinal epidural hematoma at C3-C5. Owing to the absence of any neurological deficit, the patient was treated conservatively. MRI at 3 months showed complete resolution of the hematoma. CONCLUSIONS Spinal epidural hematoma without significant trauma in children is a rare condition. It may present with unspecific symptoms. Screening for bleeding diathesis is warranted and neuroradiologic follow-up is essential to rule out vascular malformation. Whereas most children have a favorable outcome, some do not recover, and neurological follow-up is required.
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Affiliation(s)
| | - Bernard Laubscher
- Department of Pediatrics, Hospital of Neuchâtel, Neuchâtel, Switzerland.,Department Woman-Mother-Child, Division of Pediatrics, University Hospital of Lausanne, Lausanne, Switzerland
| | - Maja Steinlin
- Division of Neuropediatrics, Development and Rehabilitation, University Children's Hospital, Bern University Hospital, Inselspital, CH 3010, Bern, Switzerland
| | - Christian T Ulrich
- Department of Neurosurgery, University of Bern, Inselspital, Bern, Switzerland
| | - Rajeev Kumar Verma
- Institute of Diagnostic and Interventional Neuroradiology, University of Bern, Inselspital, Bern, Switzerland
| | - Mattia Rizzi
- Department Woman-Mother-Child, Division of Pediatrics, Oncology/Hematology Unit, University Hospital of Lausanne, Lausanne, Switzerland
| | - Rodolfo Maduri
- Department of Neurological Sciences, Service of Neurosurgery, University Hospital of Lausanne, Lausanne, Switzerland
| | - Sebastian Grunt
- Division of Neuropediatrics, Development and Rehabilitation, University Children's Hospital, Bern University Hospital, Inselspital, CH 3010, Bern, Switzerland.
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7
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Jacquier D, Good J, Laubscher B, Mercati D, Roulet-Perez E, Kuntzer T, Royer-Bertrand B, Mittaz-Crettol L, Fostad H, Superti-Furga A, Klein A. P.378A complex movement disorder associated with myasthenic features: a novel phenotype caused by a homozygous NGLY1 mutation. Neuromuscul Disord 2019. [DOI: 10.1016/j.nmd.2019.06.540] [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: 11/16/2022]
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8
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Gerull R, Brauer V, Bassler D, Laubscher B, Pfister RE, Nelle M, Müller B, Roth-Kleiner M, Gerth-Kahlert C, Adams M. Prediction of ROP Treatment and Evaluation of Screening Criteria in VLBW Infants-a Population Based Analysis. Pediatr Res 2018; 84:632-638. [PMID: 30188497 DOI: 10.1038/s41390-018-0128-3] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [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: 12/24/2017] [Revised: 06/28/2018] [Accepted: 07/03/2018] [Indexed: 12/30/2022]
Abstract
BACKGROUND The incidence of retinopathy of prematurity (ROP) and ROP screening criteria differ between countries. We assessed whether ROP screening could be reduced based on the local ROP incidence. METHODS Observational cohort study of infants born in Switzerland between 2006 and 2015 <32 0/7 weeks. Chronological and postmenstrual ages at ROP treatment were analyzed. A model to identify ROP treatment on patients born between 2006 and 2012 (training set) was developed and tested on patients born between 2013 and 2015 (validation set). RESULTS Of 7817 live-born infants, 1098 died within the first 5 weeks of life. The remaining 6719 infants were included into analysis. All patients requiring ROP treatment would have been identified if screening had been performed before reaching 60 days of life or 37 3/7 weeks postmenstrual age, whichever came first. The training and validation sets included 4522 and 2197 preterm infants encompassing 56 and 20 patients receiving ROP treatment, respectively. All patients would have required screening to reach 100% sensitivity. To reach a sensitivity of 95.0% and a specificity of 87.6%, we predicted a reduction in 13.2% of patients requiring screening (c-statistic = 0.916). CONCLUSIONS A substantial reduction of infants requiring screening seems possible, but necessitates prospective testing of new screening criteria.
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Affiliation(s)
- Roland Gerull
- Department of Neonatology, University of Basel, Children's Hospital UKBB, 4056, Basel, Switzerland.
| | - Viviane Brauer
- Department of Neonatology, University of Basel, Children's Hospital UKBB, 4056, Basel, Switzerland
| | - Dirk Bassler
- Department of Neonatology, University Hospital Zurich, 8091, Zurich, Switzerland
| | | | | | - Mathias Nelle
- Inselspital Bern, Neonatology, University of Berne, 3008, Berne, Switzerland
| | - Beatrice Müller
- Ostschweizer Kinderspital St. Gallen, Intensive Care and Neonatology, 9006, St. Gallen, Switzerland
| | - Matthias Roth-Kleiner
- University Hospital and University of Lausanne, Clinic of Neonatology, 1011, Lausanne, Switzerland
| | | | - Mark Adams
- Hôpital Neuchâtelois, Pediatrics, 2000, Neuchâtel, Switzerland
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Gerull R, Brauer V, Bassler D, Laubscher B, Pfister RE, Nelle M, Müller B, Gerth-Kahlert C, Adams M. Incidence of retinopathy of prematurity (ROP) and ROP treatment in Switzerland 2006-2015: a population-based analysis. Arch Dis Child Fetal Neonatal Ed 2018; 103:F337-F342. [PMID: 28916563 DOI: 10.1136/archdischild-2017-313574] [Citation(s) in RCA: 31] [Impact Index Per Article: 5.2] [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: 06/19/2017] [Revised: 08/08/2017] [Accepted: 08/17/2017] [Indexed: 11/04/2022]
Abstract
BACKGROUND Retinopathy of prematurity (ROP) is a severe complication of preterm birth and can lead to severe visual impairment or even blindness if untreated. The incidence of ROP requiring treatment is increasing in some developed countries in conjunction with higher survival rates at the lower end of gestational age (GA). MATERIAL AND METHODS The incidence of ROP and severe ROP (sROP) requiring treatment in Switzerland was analysed using the SwissNeoNet registry. We conducted a retrospective cohort analysis of very preterm infants with a GA below 32 weeks who were born between 2006 and 2015 in Switzerland. Patient characteristics were stratified according to GA. RESULTS 9.3% and 1.8% of very preterm infants in Switzerland developed ROP of any stage and sROP, respectively. The incidence of ROP treatment was 1.2%. Patients with 24 and 25 weeks GA had the highest proportion of ROP treatment at 14.5% and 7.3%, respectively, whereas the proportion of treated infants at or above a GA of 29 weeks was 0.06%. Similarly, the risk of sROP declined strongly with increasing GA. During the observation period of 10 years, the incidence of ROP treatment ranged between 0.8% and 2.0%. Incidences of sROP or ROP treatment did not increase over time. CONCLUSION The incidence of ROP treatment in Switzerland is low and was stable over the analysed period. The low incidence of sROP in patients with a GA of 29 weeks or more leaves room for a redefinition of ROP screening criteria.
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Affiliation(s)
- Roland Gerull
- Department of Neonatology, Inselspital Bern, Bern, Switzerland.,Department of Neonatology, University Children's Hospital UKBB, Basel, BS, Switzerland
| | - Viviane Brauer
- Department of Neonatology, Inselspital Bern, Bern, Switzerland
| | - Dirk Bassler
- Department of Neonatology, University Hospital Zurich, Zurich, Switzerland
| | - Bernard Laubscher
- Department of Pediatrics, Hôpital Neuchâtelois, Neuchâtel, Switzerland
| | - Riccardo E Pfister
- Department of Neonatology, University Hospital Geneva, Geneva, Switzerland
| | - Mathias Nelle
- Department of Neonatology, Inselspital Bern, Bern, Switzerland
| | - Béatrice Müller
- Department of Intensive Care and Neonatology, Ostschweizer Kinderspital St. Gallen, Gallen, Switzerland
| | | | - Mark Adams
- Department of Neonatology, University Hospital Zurich, Zurich, Switzerland
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Zimmermann K, Cignacco E, Engberg S, Ramelet AS, von der Weid N, Eskola K, Bergstraesser E, Ansari M, Aebi C, Baer R, Popovic MB, Bernet V, Brazzola P, Bucher HU, Buder R, Cagnazzo S, Dinten B, Dorsaz A, Elmer F, Enriquez R, Fahrni-Nater P, Finkbeiner G, Frey B, Frey U, Greiner J, Hassink RI, Keller S, Kretschmar O, Kroell J, Laubscher B, Leibundgut K, Malaer R, Meyer A, Stuessi C, Nelle M, Neuhaus T, Niggli F, Perrenoud G, Pfammatter JP, Plecko B, Rupf D, Sennhauser F, Stade C, Steinlin M, Stoffel L, Thomas K, Vonarburg C, von Vigier R, Wagner B, Wieland J, Wernz B. Patterns of paediatric end-of-life care: a chart review across different care settings in Switzerland. BMC Pediatr 2018; 18:67. [PMID: 29452600 PMCID: PMC5816353 DOI: 10.1186/s12887-018-1021-2] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [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: 10/19/2016] [Accepted: 01/29/2018] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Paediatric end-of-life care is challenging and requires a high level of professional expertise. It is important that healthcare teams have a thorough understanding of paediatric subspecialties and related knowledge of disease-specific aspects of paediatric end-of-life care. The aim of this study was to comprehensively describe, explore and compare current practices in paediatric end-of-life care in four distinct diagnostic groups across healthcare settings including all relevant levels of healthcare providers in Switzerland. METHODS In this nationwide retrospective chart review study, data from paediatric patients who died in the years 2011 or 2012 due to a cardiac, neurological or oncological condition, or during the neonatal period were collected in 13 hospitals, two long-term institutions and 10 community-based healthcare service providers throughout Switzerland. RESULTS Ninety-three (62%) of the 149 reviewed patients died in intensive care units, 78 (84%) of them following withdrawal of life-sustaining treatment. Reliance on invasive medical interventions was prevalent, and the use of medication was high, with a median count of 12 different drugs during the last week of life. Patients experienced an average number of 6.42 symptoms. The prevalence of various types of symptoms differed significantly among the four diagnostic groups. Overall, our study patients stayed in the hospital for a median of six days during their last four weeks of life. Seventy-two patients (48%) stayed at home for at least one day and only half of those received community-based healthcare. CONCLUSIONS The study provides a wide-ranging overview of current end-of-life care practices in a real-life setting of different healthcare providers. The inclusion of patients with all major diagnoses leading to disease- and prematurity-related childhood deaths, as well as comparisons across the diagnostic groups, provides additional insight and understanding for healthcare professionals. The provision of specialised palliative and end-of-life care services in Switzerland, including the capacity of community healthcare services, need to be expanded to meet the specific needs of seriously ill children and their families.
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Affiliation(s)
- Karin Zimmermann
- Department Public Health (DPH), Nursing Science, University of Basel, Bernoullistrasse 28, 4056, Basel, Switzerland. .,Paediatric Palliative Care, University Children's Hospital Zurich, Children's Research Center CRC, Steinwiesstrasse 75, 8032, Zurich, Switzerland. .,Department of Pediatrics, Inselspital Bern University Hospital, Bern, Switzerland.
| | - Eva Cignacco
- Department Public Health (DPH), Nursing Science, University of Basel, Bernoullistrasse 28, 4056, Basel, Switzerland.,Health Division, University of Applied Sciences Bern, Bern, Switzerland
| | - Sandra Engberg
- School of Nursing, University of Pittsburgh, 3500 Victoria Street, Pittsburgh, PA, 15261, USA
| | - Anne-Sylvie Ramelet
- Institute of Higher Education and Research in Healthcare - IUFRS, University of Lausanne, Route de la Corniche 10, 1010, Lausanne, Switzerland.,Nurse Research Consultant, Department of Woman-Mother-Child, Lausanne University Hospital CHUV, Lausanne, Switzerland
| | - Nicolas von der Weid
- Paediatric Haematology-Oncology, University Children's Hospital UKBB, Spitalstrasse 33, 4056, Basel, Switzerland
| | - Katri Eskola
- Department Public Health (DPH), Nursing Science, University of Basel, Bernoullistrasse 28, 4056, Basel, Switzerland.,Triemli Hospital Zurich, Zurich, Switzerland
| | - Eva Bergstraesser
- Department of Pediatrics, Inselspital Bern University Hospital, Bern, Switzerland
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Laubscher B. The "squeeze and wheeze" sign: a useful clinical sign in lung sounds analysis of children with acute cough. Clin Pediatr (Phila) 2014; 53:794-6. [PMID: 23859886 DOI: 10.1177/0009922813494471] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Affiliation(s)
- Bernard Laubscher
- Hôpital Neuchâtelois, Neuchâtel, Switzerland Lausanne University Hospital (CHUV), Lausanne, Switzerland
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12
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Dix L, Mégevand C, Laubscher B. Happy cord. Arch Dis Child Fetal Neonatal Ed 2013; 98:F278. [PMID: 23077107 DOI: 10.1136/fetalneonatal-2012-302496] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Affiliation(s)
- Laure Dix
- Hôpital Neuchâtelois, Department of Paediatrics, Maladière 45, 2000 Neuchâtel, Switzerland
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13
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Laubscher B, Bänziger O, Schubiger G. Prevention of vitamin K deficiency bleeding with three oral mixed micellar phylloquinone doses: results of a 6-year (2005-2011) surveillance in Switzerland. Eur J Pediatr 2013. [PMID: 23192459 DOI: 10.1007/s00431-012-1895-1] [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] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
UNLABELLED In 2003, the Swiss guidelines to prevent vitamin K deficiency bleeding (VKDB) were adapted. As two oral doses (2 mg, hour/day 4) of mixed micellar VK preparation had failed to abolish late VKDB, a third dose (week 4) was introduced. This report summarizes the new guidelines acceptance by Swiss pediatricians and the results of a prospective 6-year surveillance to study their influence on the incidence of VKDB. The new guidelines acceptance by Swiss pediatricians was evaluated by a questionnaire sent to all pediatricians of the Swiss Society of Paediatrics. With the help of the Swiss Paediatric Surveillance Unit, the incidence of VKDB was monitored prospectively from July 1, 2005 until June 30, 2011. Over a 6-year period (458,184 live births), there was one case of early and four cases of late VKDB. Overall incidence was 1.09/10(5) (95 % confidence intervals (CI) 0.4-2.6). Late VKDB incidence was 0.87/10(5) (95 % CI 0.24-2.24). All four infants with late VKDB had an undiagnosed cholestasis at the time of bleeding; parents of 3/4 had refused VK prophylaxis, and in 1/4, the third VK dose had been forgotten. Compared with historical control who had received only two oral doses of mixed micellar VK (18 cases for 475,372 live births), the incidence of late VKDB was significantly lower with three oral doses (Chi(2),Yates correction, P = 0.007). CONCLUSION VKDB prophylaxis with 3 × 2 mg oral doses of mixed micellar VK seems to prevent adequately infants from VKDB. The main risk factors for VKDB in breast-fed infants are parental VK prophylaxis refusal or an unknown cholestasis.
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Affiliation(s)
- Bernard Laubscher
- Department of Pediatrics, Hôpital Neuchâtelois, Maladière 45, 2000, Neuchâtel, Switzerland.
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14
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Manzano S, Guggisberg D, Hammann C, Laubscher B. Pustulose exanthématique aiguë généralisée : premier cas décrit en relation avec une infection à Chlamydia pneumoniae. Arch Pediatr 2006; 13:1230-2. [PMID: 16919427 DOI: 10.1016/j.arcped.2006.06.004] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2005] [Accepted: 05/22/2006] [Indexed: 11/20/2022]
Abstract
UNLABELLED Skin reactions to drugs or infections can be very important. CASE REPORT A 14-year-old boy developed fever, a diffuse pustular rash and a respiratory distress. Chest X-rays and serology were consistent with an acute Chlamydia pneumoniae infection. A skin biopsy revealed an acute generalized exanthematous pustulosis. CONCLUSION Acute generalized exanthematous pustulosis (AGEP) is a disease manifested by a diffuse eruption of follicular sterile pustules. Most of the cases are drug induced, but they may be secondary to viral or bacterial infections. We report the first case of AGEP in a child with an acute C. pneumoniae infection.
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Affiliation(s)
- S Manzano
- Département de pédiatrie, hôpital Pourtalès, Maladière 45, 2000 Neuchâtel, Suisse.
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15
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Ecoffey M, Merz A, Egli D, Panchard MA, Laubscher B. Rôle du médecin traitant dans les convulsions hyponatrémiques chez l'enfant énurétique traité par desmopressine. Arch Pediatr 2006; 13:262-5. [PMID: 16443352 DOI: 10.1016/j.arcped.2005.11.020] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2005] [Accepted: 11/22/2005] [Indexed: 11/23/2022]
Abstract
UNLABELLED Enuresis nocturna is regularly treated by desmopressin, a vasopressin analog. Its side effects, notably neurological, are fortunately rare. We comment on 5 enuretic children on desmopressin who suffered from hyponatremic encephalopathy (natremia 115-127, median 117 mmol/l). RESULTS Side effects appeared at therapeutic doses (10-40 mg/d intranasal). An excessive fluid intake at night was often noted, leading to a dilutional hyponatremia. This may be due to a lack of correct information to the parents. These children presented after a period of warning symptoms, such as headache, vomiting and altered consciousness. Parents could have sought earlier medical attention if they had been informed about these symptoms. CONCLUSION In the absence of fluid restriction, severe hyponatremia can occur in enuretic children on desmopressin. It is therefore mandatory for the prescribing doctor to adequately inform patients and parents to limit fluids at night when desmopressin is used, and seek medical help quickly if any sign of intracranial hypertension appears.
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Affiliation(s)
- M Ecoffey
- Hôpital Pourtalès, 45, rue de la Maladière, 2000 Neuchâtel, Suisse.
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16
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Bolli S, Melle GV, Laubscher B. After-hours paediatric telephone triage and advice: the Neuchâtel experience. Eur J Pediatr 2005; 164:568-72. [PMID: 15906091 DOI: 10.1007/s00431-005-1687-y] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [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: 02/01/2005] [Revised: 04/04/2005] [Accepted: 04/05/2005] [Indexed: 12/01/2022]
Abstract
UNLABELLED Delivery of paediatric primary care by call centres has emerged as a satisfactory system. It has been reported in the literature in the United States and Australia. European public-funded paediatric emergency departments (ED) have little epidemiological data to rely on to match the demand in care. Since 1996, we have run a free nurse-led after-hours paediatric telephone triage and advice (TTA) system. To determine whether other Swiss public paediatric departments practiced formal TTA, we conducted a nation-wide postal survey. To delineate who used our call centre and for what reasons, we embarked on a retrospective study of all the 1997/2000 calls. Most of the units run a TTA (27/35) but few specifically train their staff (14/27). A 43% increase in call numbers was seen between 1997 (3242) and 2000 (4628). During week-days, most of the calls were between 6 and 11 pm and at weekends, a mid morning activity peak was seen. Some 75% of calls were for children aged 5 years or less. Fever, earache and cough accounted for 42% of the main complaints. Of all calls, 27% were dealt by nurses' advice only. About 15% of the calls were transferred to the on-call resident. About 50% led to a same day ED appointment. CONCLUSION Nurse-led paediatric telephone triage and advice is common in Switzerland where training seems to be irregular. Our data can help units to better plan an eventual paediatric telephone triage and advice service.
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Affiliation(s)
- Sybil Bolli
- Département de pédiatrie, Hôpital Pourtalès, 2000 Neuchâtel, Switzerland
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17
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Affiliation(s)
- B Laubscher
- Department of Paediatrics, Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland.
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18
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Affiliation(s)
- B Laubscher
- Hôpital Pourtalès, Neuchâtel 2000, Switzerland.
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Schubiger G, Berger TM, Weber R, Bänziger O, Laubscher B. Prevention of vitamin K deficiency bleeding with oral mixed micellar phylloquinone: results of a 6-year surveillance in Switzerland. Eur J Pediatr 2003; 162:885-8. [PMID: 14576936 DOI: 10.1007/s00431-003-1327-3] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.7] [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: 06/14/2003] [Revised: 09/03/2003] [Accepted: 09/05/2003] [Indexed: 11/30/2022]
Abstract
UNLABELLED In 1995, a new form of vitamin K prophylaxis with two oral doses of 2 mg mixed micellar phylloquinone (Konakion MM) on the 1st and 4th day of life was introduced in Switzerland. It was hoped that this new galenic preparation of phylloquinone would protect infants with insufficient or absent bile acid excretion from late vitamin K deficiency bleeding (VKDB). Subsequently, the occurrence of VKDB was monitored prospectively between July 1, 1995 and June 30, 2001 with the help of the Swiss Paediatric Surveillance Unit (SPSU). Over a period of 6 years (475,000 deliveries), there were no cases of early (<24 h of age), one case of classical (2-7 days of life), and 18 cases of late (1-12 weeks) VKDB fulfilling standard case definitions. In 13/18 patients with late VKDB there was pre-existing liver disease and in 4/18 patients, parents had refused prophylaxis. The incidence of late VKDB for infants with completed Konakion MM prophylaxis was 2.31/100,000 (95% CI: 1.16-4.14) and for the entire population 3.79/100,000 (95% CI: 2.24-5.98). There was only one case of late VKDB after complete prophylaxis in an infant without underlying liver disease. CONCLUSION two oral doses of 2 mg of a mixed micellar vitamin K preparation failed to abolish VKDB. The recommendations for vitamin K prophylaxis in Switzerland have therefore been changed to include a third dose at 4 weeks of age. Starting on January 1, 2004, the incidence of vitamin K deficiency bleeding will again be monitored prospectively by the Swiss Paediatric Surveillance Unit.
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Affiliation(s)
- Gregor Schubiger
- Department of Paediatrics, Children's Hospital of Lucerne, 6000, Lucerne 16, Switzerland.
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20
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Krähenbühl JD, Laubscher B, Gehri M, Masserey E. [Ambulatory parenteral antibiotics in the treatment of severe pediatric infections]. Rev Med Suisse Romande 2002; 122:606-11. [PMID: 12611186] [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: 03/01/2023]
Abstract
The indications to parenteral antibiotic treatment in paediatrics are frequent. Antibiotic agents with antimicrobial spectrums and pharmacodynamic properties allowing effective and secure outpatient parenteral therapy are now widely available. Outpatient treatment has a number of advantages including important economic benefits. The physician responsible for conducting such treatment should select patients according to strict criteria and never neglect security and quality issues. In this article, the authors discuss different aspects (general, medical, psychosocial, economic and practical) related to outpatient parenteral antibiotic treatment of severe paediatric infections.
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Affiliation(s)
- Jean-Daniel Krähenbühl
- Département médico-chirurgical de pédiatrie, CHUV, Hôpital de l'Enfance de Lausanne, Lausanne.
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21
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Laubscher B, Donatiello C. Use of Swiss paediatric emergency department has grown. BMJ 2002; 325:389. [PMID: 12183317 PMCID: PMC1123896] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/26/2023]
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23
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Diana A, Arni P, Honegger R, Laubscher B. An eight-year-old girl with a painful neck mass. Pediatr Infect Dis J 2001; 20:1006, 1013-4. [PMID: 11642618 DOI: 10.1097/00006454-200110000-00018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Affiliation(s)
- A Diana
- Department of Pediatrics, Hĵpital Pourtalès, Institut für Pflanzenbiologie, Universität Zürich, Switzerland
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24
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Donatiello C, Laubscher B. ["Urgent" pediatric consultations constantly increasing: a problem that affects all of French-speaking Switzerland]. Rev Med Suisse Romande 2001; 121:305-7. [PMID: 11400403] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/20/2023]
Affiliation(s)
- C Donatiello
- Service de pédiatrie, Hôpital Pourtalès, Neuchâtel.
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25
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Kavvadia V, Greenough A, Boylan G, Dimitriou G, Laubscher B, Panerai RB, Rennie JM. Effect of a high volume strategy high frequency oscillation on cerebral haemodynamics. Eur J Pediatr 2001; 160:140-1. [PMID: 11271389 DOI: 10.1007/s004310000655] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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Rafferty GF, Greenough A, Dimitriou G, Kavadia V, Laubscher B, Polkey MI, Harris ML, Moxham J. Assessment of neonatal diaphragm function using magnetic stimulation of the phrenic nerves. Am J Respir Crit Care Med 2000; 162:2337-40. [PMID: 11112160 DOI: 10.1164/ajrccm.162.6.2004019] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.3] [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: 11/16/2022] Open
Abstract
A nonvolitional test to assess diaphragm strength in neonates has not been previously described. Our aim was to assess the feasibility of cervical (CMS) and anterior (AMS) magnetic stimulation of the phrenic nerves in neonates. Double circular stimulating coils (90-mm) were used. For CMS, one coil was placed over the cervical spine to bilaterally stimulate the phrenic nerve roots, whereas for AMS the coils were placed on the anterolateral aspect of the neck to allow unilateral and bilateral stimulation. Diaphragm contractility was assessed as transdiaphragmatic pressure (Pdi) measured with balloon catheters positioned in the midesophagus and stomach. Stimulus supramaximality was assessed by examining diaphragm twitch Pdi (TwPdi) across a range of stimulator outputs; 85, 90, 95, and 100% of maximum. Pressure signals were measured by differential pressure transducer and displayed in real time on a computer. Patients were studied supine during sleep. CMS was performed on seven neonates (mean gestational age [GA] 38 wk, range 33 to 40 wk) and AMS on 18 neonates (mean GA 37 wk, range 32 to 41 wk). The mean (SD) TwPdi with CMS was 2.5 (0.8) cm H(2)O. CMS was not supramaximal; reducing the stimulator output below 100% caused marked reductions in TwPdi, also the shape of the pressure waveforms suggested that CMS may not have activated the diaphragm alone. Mean (SD) TwPdi with AMS was 4.5 (1.3) cm H(2)O on the left, 4.1 (0.9) cm H(2)O on the right, and 8.7 (3.9) cm H(2)O for bilateral stimulation. The shape of the pressure waveforms suggested that AMS was more specific and a plateau in TwPdi at higher stimulator outputs indicated supramaximality. We conclude that AMS may provide a useful technique to assess diaphragm function in the neonate.
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Affiliation(s)
- G F Rafferty
- Department of Child Health, Guy's, King's and St Thomas' School of Medicine, King's College Hospital, London, United Kingdom
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Abstract
The authors report a case of thrombosis of the spermatic veins associated with Henoch-Schönlein purpura mimicking an acute scrotum, which responded to a low-molecular-weight heparin treatment.
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Affiliation(s)
- A Diana
- Hôpital Pourtalès, Neuchâtel, Switzerland
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28
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Laubscher B, Van Melle G. [How to administer suppositories in children: good parental sense and good sense in introduction?]. Arch Pediatr 2000; 7:899. [PMID: 10985198 DOI: 10.1016/s0929-693x(00)80209-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Dimitriou G, Greenough A, Kavvadia V, Laubscher B, Alexiou C, Pavlou V, Mantagos S. Elective use of nasal continuous positive airways pressure following extubation of preterm infants. Eur J Pediatr 2000; 159:434-9. [PMID: 10867849 DOI: 10.1007/s004310051302] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.3] [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] [Indexed: 10/28/2022]
Abstract
UNLABELLED The aim of this study was to determine whether elective use of nasal continuous positive airways pressure (CPAP) following extubation of preterm infants was well tolerated and improved short- and long-term outcomes. A randomized comparison of nasal CPAP to headbox oxygen was undertaken and a meta-analysis performed including similar randomized trials involving premature infants less than 28 days of age. A total of 150 infants (median gestational age 30 weeks, range 24-34 weeks) were randomized in two centres. Fifteen nasal CPAP infants and 25 headbox infants required increased respiratory support post-extubation and 15 nasal CPAP infants and nine headbox infants required reintubation (non significant). Eight infants became intolerant of CPAP and were changed to headbox oxygen within 48 h of extubation; 19 headbox infants developed apnoeas and respiratory acidosis requiring rescue nasal CPAP, 3 ultimately were re-intubated. Seven other trials were identified, giving a total number of 569 infants. Overall, nasal CPAP significantly reduced the need for increased respiratory support (relative risk, 0.57, 95% CI 0.43-0.73), but not for re-intubation (relative risk 0.89, 95% CI 0.68-1.17). Nasal CPAP neither influenced significantly the intraventricular haemorrhage rate reported in four studies (relative risk 1.0, 95% CI 0.55, 1.82) nor that of oxygen dependency at 28 days reported in six studies (relative risk 1.0, 95% CI 0.8, 1.25). In two studies nasal CPAP had to be discontinued in 10% of infants either because of intolerance or hyperoxia. CONCLUSION Elective use of nasal continuous positive airways pressure post-extubation is not universally tolerated, but does reduce the need for additional support.
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Affiliation(s)
- G Dimitriou
- Children Nationwide Regional Neonatal Intensive Care Centre, King's College Hospital, London, UK
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30
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Kavvadia V, Greenough A, Lilley J, Laubscher B, Dimitriou G, Boa F, Poyser K. Plasma arginine levels and the response to inhaled nitric oxide in neonates. Biol Neonate 1999; 76:340-7. [PMID: 10567762 DOI: 10.1159/000014177] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
Inhaled nitric oxide (iNO) can be an effective vasodilator in pulmonary hypertension of the newborn (PHN). The aim of this study was to determine whether differences in arginine levels, from which endogenous NO is produced, explain the variability in response to NO and whether the arginine levels were lower in term and preterm infants with PHN than in infants without PHN (controls). We prospectively studied 30 infants (17 born preterm) with clinically diagnosed PHN and treated with iNO and 22 controls (14 born preterm). Three NO levels (10, 20, 40 ppm) were administered to the PHN infants to identify that associated with maximum oxygenation. Twenty-seven infants with PHN improved following iNO and had lower arginine levels than those infants who did not respond to iNO (p < 0. 05). No significant relationship, however, was noted between the arginine levels and either the magnitude of change in the oxygenation index in response to iNO or the NO level associated with maximum oxygenation. The median plasma arginine level prior to iNO of the PHN infants was 12.5 (range 2-53) mu mol/l, but not significantly lower than that of the controls (median 24, range 3-82 mu mol/l). We conclude that differences in plasma arginine levels are unlikely to explain the variation in response to iNO and that, although arginine levels tended to be lower in infants with PHN, this is not a consistent finding in either the term or preterm infants.
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Affiliation(s)
- V Kavvadia
- Department of Child Health, King's College Hospital, London, UK
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31
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Abstract
UNLABELLED Positive end expiratory pressure (PEEP) is routinely used when ventilating preterm infants, and high levels are recommended in those with severe respiratory distress syndrome (RDS). Elevation of PEEP increases lung volume, as does surfactant administration. We postulated that in surfactant-treated infants even modest PEEP levels could result in overdistension and (CO(2)) retention. To test that hypothesis, lung volume, compliance and arterial blood gases were measured in eight preterm infants (median gestational age 28 weeks, range 26-35 weeks) at three PEEP levels. The infants, all with RDS, were studied at a median time of 18 h, (range 12-68 h) after their last dose of surfactant. Infants were routinely nursed at 3 cmH(2)O of PEEP, the PEEP level was then raised to 6 cmH(2)O or lowered to 0 cmH(2)O in random order. The new setting was maintained for 20 min; the PEEP level was then changed to the third level (0 or 6 cmH(2)O) again for 20 min. At the end of each 20-min period, lung volume, compliance and blood gases were measured. Lung volume was assessed by measuring functional residual capacity (FRC) using a helium dilution technique. Compliance was measured by relating the volume change from a positive pressure inflation maintained until no further volume change occurred to the pressure drop (peak inflating pressure PEEP). Increasing PEEP from 0 to 3 cmH(2)O and particularly to 6 cmH(2)O resulted in increases in FRC (P < 0.05), oxygenation (ns) and paCO(2) (P < 0.02). Specific compliance (compliance/FRC) (P < 0.05) and pH (P < 0.02) fell. CONCLUSION Following surfactant treatment, relatively low levels of positive end expiratory pressure (</=3 cmH(2)O) may be appropriate.
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Affiliation(s)
- G Dimitriou
- Children Nationwide Regional Neonatal Intensive Care Centre, 4th floor, Ruskin Wing, King's College Hospital, London SE5 9RS UK
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32
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Schubiger G, Stocker C, Bänziger O, Laubscher B, Zimmermann H. Oral vitamin K1 prophylaxis for newborns with a new mixed-micellar preparation of phylloquinone: 3 years experience in Switzerland. Eur J Pediatr 1999; 158:599-602. [PMID: 10412823 DOI: 10.1007/s004310051155] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.6] [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] [Indexed: 10/28/2022]
Abstract
UNLABELLED In 1995, a new water-soluble mixed-micellar analogue of vitamin K1 (Konakion MM paediatric) was introduced in Switzerland to replace the formerly used fat-soluble Konakion drops for the prevention of vitamin K1-deficiency-bleeding (VKDB) in infants. According to the new guidelines, an oral dose of 2 mg is given after birth and again on the 4th day of life. We examined the compliance with these guidelines and the impact on the incidence of VKDB. To assess compliance, questionnaires were sent to all hospitals with delivery services 6 months after the introduction of the new guidelines. Using the database of the Swiss Paediatric Surveillance Unit (SPSU) which records rare paediatric diseases, we assessed the incidence of VKDB in Switzerland between July 1995 and June 1998. In addition, we determined the precise circumstances under which the episodes of VKDB occurred. More than 99% of infants received vitamin K1 prophylaxis. Since July 1995, 93% of newborns have received prophylaxis according to the new guidelines; the remaining infants were given fat-soluble Konakion drops or parenteral vitamin K1. Within 3 years, one case of classical and 12 cases of late-onset VKDB (11 confirmed, 1 probable) were reported to the SPSU. Of the 11 confirmed late-onset cases, 7 received the recommended prophylaxis, whereas 3 had not and 1 had been given fat-soluble Konakion drops. All confirmed cases of late-onset VKDB occurred in fully breast-fed infants and 8 of 11 had hepatobiliary disease. CONCLUSION With the introduction of two oral doses of a mixed-micellar vitamin K1 preparation administered in the 1st week of life, the incidence of late vitamin K1-deficiency-bleeding has decreased from 7.2:100,000 between 1986-1987 to 2.8:100,000 between 1995 and 1998. This regimen may be suitable for prophylaxis of vitamin K1-deficiency-bleeding, however, it does not fully protect infants with cholestatic disease from late-onset bleeding. If oral prophylaxis is considered for these infants, vitamin K1 has to be administered repeatedly to all infants during the breast feeding period.
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Affiliation(s)
- G Schubiger
- Department of Paediatrics, Kinderspital, Luzern, Switzerland.
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33
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Doering C, Pilloud J, de Meuron G, Gaze H, Laubscher B. Collaboration Prive-Public Pour Une Gestion Plus Performante Des Urgences Pediatriques. Arch Pediatr 1999. [DOI: 10.1016/s0929-693x(99)81592-9] [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: 11/30/2022]
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34
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Dimitriou G, Greenough A, Laubscher B, Yamaguchi N. Comparison of airway pressure-triggered and airflow-triggered ventilation in very immature infants. Acta Paediatr 1998; 87:1256-60. [PMID: 9894826 DOI: 10.1080/080352598750030942] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 09/30/2022]
Abstract
Failure of patient-triggered ventilation in very immature infants may be due to the use of inappropriate triggering systems. Two types of airflow trigger were therefore compared consecutively to an airway pressure (SLE) triggering system. Each comparison was made in 10 infants, < or =28 weeks of gestation. Comparison was made of the delivered volume, trigger performance and blood gases using each system for 1 h. Both comparisons showed that the airflow triggering systems performed better: one (Draeger Babylog 8000) had a higher sensitivity (p < 0.01) and the other (Bird VIP airflow trigger), in which inflation was terminated by sensing a reduction in inspiratory flow, had a lower degree of asynchrony (p < 0.01) and a tendency to deliver higher volumes. These results suggest that triggering systems sensing airflow changes may be superior to those sensing airway pressure changes in very immature infants. The use of a mechanism to synchronize the termination of inflation to the end of the patient's inspiration may offer further advantages.
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Affiliation(s)
- G Dimitriou
- Children Nationwide Regional Neonatal Intensive Care Centre, King's College Hospital, London, UK
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Abstract
AIM To examine the delivered volume during "high volume strategy" high frequency oscillation, used as rescue treatment in preterm infants; and to identify factors, other than frequency and oscillatory amplitude, influencing the magnitude of volume delivery. METHOD Twenty infants (median gestational age 29 weeks) were studied on 45 occasions. Two oscillator types were used (SensorMedics and SLE). Delivered volume was measured under clinical conditions with the arterial blood gases within a predetermined range. A specially calibrated pneumotachograph system was used. RESULTS Overall, the median delivered volume was 2.4 ml/kg (range 1.0 to 3.6 ml/kg); on 32 occasions the delivered volume was greater than 2.0 ml/kg and on seven greater than 3.0 ml/kg. The delivered volume related significantly to disease severity; there was an inverse correlaton between delivered volume and both the oxygenation index (OI) (r = -0.51) and AaDO2 (r = -0.54). CONCLUSION Delivered volume during HFO may, in certain infants, exceed the anatomical dead space, permitting some direct alveolar ventilation.
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Affiliation(s)
- G Dimitriou
- Children Nationwide Regional Neonatal Intensive Care Centre, King's College Hospital, London
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Laubscher B, Greenough A, Dimitriou G, Davenport M, Nicolaides KH. Serial lung volume measurements during the perinatal period in infants with abdominal wall defects. J Pediatr Surg 1998; 33:497-9. [PMID: 9537565 DOI: 10.1016/s0022-3468(98)90096-3] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.3] [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] [Indexed: 02/07/2023]
Abstract
METHODS Daily measurements of lung volume (functional residual capacity, FRC) were made during the perinatal period in eight infants (median gestational age, 37 weeks; range, 34 to 38 weeks) with abdominal wall defects. RESULTS On the first day of life and before surgical intervention, four infants had FRCs below the reference range; the occurrence of low lung volumes was not significantly related to gestational age or diagnosis. Lung volume was further, but only temporarily, impaired by surgical closure of the abdominal wall defect, with a reduction in the median FRC from 25 mL/kg (range, 18 to 36) preoperatively to 12 mL/kg (range, 5 to 19) on the first postoperative day (P < .02). CONCLUSION These data are consistent with abnormal antenatal lung growth in certain infants with abdominal wall defects.
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Affiliation(s)
- B Laubscher
- Department of Child Health, Harris Birthright Research Centre for Fetal Medicine, King's College Hospital, London, England
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Abstract
The aim of this study was to determine the relative effects of theophylline and caffeine on neonatal respiratory function. Fifty-three preterm infants (45 infants with a median gestational age of 28 weeks, range 24-34 weeks completed the protocol) were randomized to receive either theophylline (loading dose 4 mg/kg followed by 4 mg/kg/day) or caffeine (loading dose 10 mg/kg followed by 5 mg/kg/day). Compliance of the respiratory system (CRS), strength of Hering Breuer reflex and the inspired oxygen concentration requirement were measured immediately prior to, 24 h and 7 days after commencing therapy. There was no statistically significant difference in the patient characteristics of the two groups, but only the theophylline group contained immature infants (i.e. < 26 weeks gestational age (n = 7)). At 24 h, there was a significant improvement in CRS and reduction in supplementary oxygen requirements in the caffeine group (p < 0.01), in the theophylline group no such significant effects were seen. In the study population overall, after 7 days of treatment in both the theophylline and caffeine groups there was an improvement in CRS (p < 0.05 and p < 0.01 respectively) and a reduction in the inspired oxygen concentration (p < 0.05 and p < 0.01 respectively). There was, however, a significant reduction in the strength of the Hering Breuer reflex only in the caffeine group (p < 0.05) and this was a decrease which related to the change in CRS (p < 0.05). The only statistically significant difference in the magnitude of change in CRS, reflex strength or supplementary oxygen requirements between the two groups was that the reduction in inspired oxygen requirement in the caffeine group was greater than that in the theophylline treated infants at 24 h (p < 0.05). We conclude theophylline and caffeine have similar effects on neonatal respiratory function, but our results suggest caffeine administration may be associated with an earlier onset of action.
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Affiliation(s)
- B Laubscher
- Dept of Child Health, King's College Hospital, London, UK
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Kavvadia V, Greenough A, Laubscher B, Dimitriou G, Davenport M, Nicolaides KH. Perioperative assessment of respiratory compliance and lung volume in infants with congenital diaphragmatic hernia: prediction of outcome. J Pediatr Surg 1997; 32:1665-9. [PMID: 9433995 DOI: 10.1016/s0022-3468(97)90502-9] [Citation(s) in RCA: 22] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
BACKGROUND/PURPOSE Infants who have congenital diaphragmatic hernia (CDH) have high mortality and morbidity. The aim of this study was to determine the relative ability of the results of serial measurements of compliance of the respiratory system (CRS) and lung volume (functional residual capacity (FRC)) to predict poor outcome: death or oxygen dependency at 28 days. In addition, the authors wished to document the evolution of any lung function abnormalities during the perioperative period. METHODS Daily measurements of CRS and FRC were made in the first week of life and subsequently during week 2 in 16 infants who had a median gestational age of 38 weeks and birth weight of 3.2 kg. RESULTS Seven infants had a poor outcome: five died and two others remained oxygen dependent beyond 28 days. The infants who had a poor outcome were characterized on day 1 by a significantly lower CRS, but not FRC (P < .05). In comparison with results from day 1, the median CRS of the infants overall had significantly improved only by week 2 (P < .05), there was no such significant change in FRC with increasing postnatal age. At week 2, only the CRS results differed significantly between those infants who had and who did not have poor outcome (P < .05). CONCLUSION The results of serial measurements of CRS, rather than FRC are the more useful predictor of outcome in infants who have CDH.
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Affiliation(s)
- V Kavvadia
- Department of Child Health, and Harris Birthright Research Centre for Fetal Medicine, King's College Hospital, London, England
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Abstract
We describe a neonate with hypotonia, weakness, early death owing to respiratory failure, and a severe form of arthrogryposis multiplex congenita. Postmortem studies revealed numerous ragged-red fibers and central nervous system abnormalities consistent with a mitochondrial disease. No NADH:ubiquinone-1 oxidoreductase (complex I) activity could be detected in skeletal muscle. These findings suggest that mitochondrial cytopathies can be associated with arthrogryposis multiplex congenita and should therefore be sought in neonates presenting with severe arthrogryposis.
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Affiliation(s)
- B Laubscher
- Department of Pediatrics, Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland
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Abstract
The response to three levels (10 ppm, 20 ppm and 40 ppm) of nitric oxide (NO) was assessed in 30 infants, median gestational age 30 (range 24-42) weeks. All the infants required an inspired oxygen concentration of more than 0.5, despite receiving surfactant where appropriate. All but one infant had a positive response to NO (median reduction in the oxygenation index (OI) was 33%, range -9%-90%), but only 20 infants showed a greater than 20% reduction in the OI. There was no obvious relationship of the optimum NO level (i.e. that associated with the maximum reduction in OI) and either diagnosis (congenital diaphragmatic hernia, meconium aspiration syndrome, respiratory distress syndrome, pulmonary interstitial emphysema (PIE), hydrops and sepsis) or maturity, except that five of six infants with PIE responded best to 40 ppm, as did eight of nine infants less than 28 weeks gestational age. We conclude NO dosage should be individualized and NO levels up to 40 ppm should be considered in very immature infants.
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Affiliation(s)
- B Laubscher
- Department of Child Health, King's College Hospital, London, UK
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Abstract
Failure of patient triggered ventilation in very premature infants may reflect the use of inappropriate triggering systems. We have therefore compared the performance of an airway and a body surface trigger in 12 infants of median gestational age 26 weeks (range 24-27). Airway flow and oesophageal and ventilator pressure changes were recorded during two periods of patient triggered ventilation. From the traces, the degree of asynchrony (inflation extending beyond inspiration), triggering rate, sensitivity (proportion of the infant's breaths detected) and trigger delay (response time) were calculated. Although with both triggering systems there was a high rate of asynchrony, the triggering rate (p < 0.05), sensitivity (p < 0.05) and trigger delay (p < 0.01) were all better with the body surface trigger. These results suggest that the body surface trigger is the more appropriate system for very immature infants.
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Affiliation(s)
- B Laubscher
- Department of Child Health, King's College Hospital, London, UK
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Laubscher B. [High frequency oscillatory ventilation in pediatrics]. Rev Med Suisse Romande 1996; 116:975-8. [PMID: 9026887] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
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Laubscher B, van Melle G, Fawer CL, Sekarski N, Calame A. Haemodynamic changes during high frequency oscillation for respiratory distress syndrome. Arch Dis Child Fetal Neonatal Ed 1996; 74:F172-6. [PMID: 8777679 PMCID: PMC2528354 DOI: 10.1136/fn.74.3.f172] [Citation(s) in RCA: 33] [Impact Index Per Article: 1.2] [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] [Indexed: 02/02/2023]
Abstract
In a crossover trial left ventricular output (LVO), cerebral blood flow velocity (CBFV), and resistance index (RI) of the anterior cerebral artery were compared using Doppler ultrasonography, in eight preterm infants with respiratory distress syndrome (RDS) during conventional mechanical ventilation and high frequency oscillation. LVO was 14% to 18% lower with high frequency oscillation. There were no significant changes in CBFV. On the first day of life there was a trend towards lower RI on high frequency oscillation; the fall in LVO on high frequency oscillation was not related to lung hyperinflation. Changes in ventilation type (from conventional mechanical ventilation to high frequency oscillation, or vice versa) can induce significant LVO changes in preterm infants with RDS.
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Affiliation(s)
- B Laubscher
- Département de Pédiatrie, Universitaire, Lausanne, Switzerland
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Abstract
To test the hypothesis that premature infants in whom extubation fails in the first 10 days of life have low volume lungs, functional residual capacity (FRC) was measured in the first hour after extubation. Once extubated, infants received the appropriate level of inspired oxygen necessary to maintain acceptable arterial oxygen saturation. After humidification, oxygen was bled into a headbox, and FRC was assessed using a helium gas dilution technique and a specially designed infant circuit. The results were related to extubation failure, which was diagnosed when the infant required nasal continuous positive airway pressure or re-intubation and ventilation within 48 hours. The latter two forms of respiratory support were instituted by the clinical team, whenever the infant developed recurrent or severe apnea or respiratory acidosis. Infants were eligible for entry into the study when born prematurely and extubated within the first 10 days of life. Twenty infants initially ventilated for respiratory distress syndrome at a median gestational age of 29 weeks (range, 26-36 weeks) were studied at a median postnatal age of 3 days (range, 1-7 days). All were receiving theophylline. Extubation failed in seven infants, who did not differ significantly from the rest of the cohort regarding gestational age, birthweight, postnatal age, or inspired oxygen concentration (F(I)O2) at extubation, but their maximum F(I)O2 during ventilation was higher than in those infants who did not require reintubation (P < 0.05). In the infants who failed extubation, the median FRC was 19 ml/kg (range, 12-27 ml/kg), which was lower than that of the infants in whom extubation was successfully accomplished (median, 28 ml/kg; range, 19-37 ml/kg; P < 0.01). An FRC of less than 26 ml/kg had a sensitivity of 71% and specificity of 77% in predicting extubation failure. These results support the hypothesis that a very low lung volume relates to extubation failure in the first 10 days of life.
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Affiliation(s)
- G Dimitriou
- Department of Child Health, King's College Hospital, London, United Kingdom
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Laubscher B, van Melle G, Dreyfuss N, de Crousaz H. Evaluation of a new immunologic test kit for rapid detection of group A streptococci, the Abbott Testpack Strep A plus. J Clin Microbiol 1995; 33:260-1. [PMID: 7699057 PMCID: PMC227926 DOI: 10.1128/jcm.33.1.260-261.1995] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.3] [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: 01/26/2023] Open
Abstract
We compared the Testpack Strep A plus (TPSAP) enzyme-linked immunosorbent assay test for group A beta-hemolytic streptococcal (GAS) antigen rapid detection with blood agar culture in 454 pediatric patients with clinical pharyngitis. Of the 454 patients, 118 (25.9%) had positive oropharyngeal cultures for GAS. TPSAP sensitivity was 89.9% (106 of 118) and specificity was 95.8% (322 of 336). We conclude that the TPSAP is specific enough to indicate treatment for a patient with a positive test but that a negative test should be confirmed by culture.
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Micheli JL, Pfister R, Junod S, Laubscher B, Tolsa JF, Schutz Y, Calame A. Water, energy and early postnatal growth in preterm infants. Acta Paediatr Suppl 1994; 405:35-42. [PMID: 7734789 DOI: 10.1111/j.1651-2227.1994.tb13396.x] [Citation(s) in RCA: 21] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
Non-invasive methods, including stable isotope techniques, indirect calorimetry, nutritional balance and skinfold thickness, have given a new insight into early postnatal growth in neonates. Neonates and premature infants in particular, create an unusual opportunity to study the fluid and metabolic adaptation to extrauterine life because their physical environment can be controlled, fluid and energy balance can be measured and the link between metabolism and the energetics of their postnatal growth can be assessed accurately. Thus the postnatal time course of total body water, heat production, energy cost of growth and composition of weight gain have been quantified in a series of "healthy" low-birth-weight premature infants. These results show that total body water is remarkably stable between postnatal days 3-21. Energy expenditure and heat production rates increase postnatally from mean values of 40 kcal/kg/day during the first week to 60 kcal/kg/day in the third week. An apparent energy balance deficit of 180 kcal/kg can be ascribed to premature delivery. The cost of protein metabolism is the highest energy demanding process related to growth. The fact that nitrogen balance becomes positive within 72 h after birth places the newborn in a transitional situation of dissociated balance between energy and protein metabolism during early postnatal growth: skinfold thickness, dry body mass and fat decrease, while there is a gain in protein and increase in supine length. This particular situation ends during the second postnatal week and soon thereafter the rate of weight gain matches statural growth. The goals of the following review are to summarize data on total body water and energy metabolism in premature infants and to discuss how they correlate with physiological aspects of early postnatal growth.
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Affiliation(s)
- J L Micheli
- Department of Neonatology, University Hospital, Lausanne, Switzerland
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Laubscher B. [Streptococcal sore throat: the role of rapid diagnostic tests in the doctor's office]. Rev Med Suisse Romande 1994; 114:873-7. [PMID: 7973300] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
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Laubscher B, Deonna T, Uske A, van Melle G. Primitive megalencephaly in children: natural history, medium term prognosis with special reference to external hydrocephalus. Eur J Pediatr 1990; 149:502-7. [PMID: 2347345 DOI: 10.1007/bf01959405] [Citation(s) in RCA: 43] [Impact Index Per Article: 1.3] [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] [Indexed: 12/31/2022]
Abstract
We studied 74 children with primitive megalencephaly retrospectively with attention directed to familial megalencephaly, birth history, enlarged pericerebral subarachnoid space (SAS) (idiopathic external hydrocephalus), head and statural growth dynamics, developmental and school prognosis, morphological findings and development of subdural haematoma. In the megalencephalic children, no significant differences were found between those with normal or those with enlarged pericerebral SAS. Out of 62, 31 children (50%) were already megalencephalic at birth. Of 74, 37 children (50%) showed variable degrees of developmental delay which in 18 was transient. Eight out of 74 were mentally retarded. Of 52 children at school age, 42 attend normal schools and 10, of whom 7 are mentally retarded, attend special schools. Three children showed subdural haematoma resulting from apparently minor trauma or occurring spontaneously. We suggest that idiopathic external hydrocephalus represents a variant of primitive megalencephaly with transient increase of intracranial pressure and that it could predispose to the development of idiopathic (spontaneous or non-traumatic) subdural haematoma.
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Affiliation(s)
- B Laubscher
- Department of Paediatrics (Neuropaediatric Unit), Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland
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Tintinalli J, Freeman S, Kalia S, Laubscher B. Advanced cardiac life-support training for medical students and house officers. J Med Educ 1984; 59:200-202. [PMID: 6699895 DOI: 10.1097/00001888-198403000-00008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/21/2023]
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