The effect of less invasive surfactant administration on cerebral oxygenation in preterm infants.

AIM: To determine the regional cerebral tissue oxygenation saturation (rcSO2 ) in a group of infants requiring less invasive surfactant administration (LISA) as compared to infants with continuous positive airway pressure (CPAP) only. METHODS: In preterm infants with a gestational age 26 0/7-31 6/7 weeks, we conducted an observational study using near-infrared spectroscopy (NIRS) in the first 120 hours of life. RESULTS: We analysed the data of 22 infants who never received surfactant (CPAP), 22 infants had LISA and CPAP (LISA) and 6 infants received surfactant via endotracheal tube (ETT). Four infants had both surfactant application modes including six LISA applications. In total, there were 32 successful LISA applications but 44 attempts; 13/44 (30%) of LISA attempts resulted in a 20% decrease of rcSO2 . During the first 120 hours of life, rcSO2 values of CPAP were similar to those of infants in the LISA group, that is median rcSO2 values 90% vs 85%, respectively (P = .126). Episodes with rcSO2 values <65% were 0.4% in the CPAP group as compared to 4.8% in the LISA group (P < .001). CONCLUSION: Our observational data indicate that rcSO2 values of infants in the LISA group were similar to the CPAP group.

The modulatory effect of lipids and glucose on the neonatal immune response induced by Staphylococcus epidermidis.

BACKGROUND: Parenteral nutrition is an important risk factor for late onset sepsis in neonates. This may be caused by the long-term need of central venous access but also through a potentially modulating effect of lipids and glucose on the immune function. OBJECTIVE: It was the aim of this study to characterize the effect of lipids and glucose on the neonatal immune response in an in vitro Staphylococcus epidermidis sepsis model using whole cord blood of healthy term infants and preterm infants. RESULTS: At the single cell level, IL-6, IL-8 and TNF-α expression of CD14+ cells was significantly increased upon addition of 1% lipids, while the addition of clinically meaningful lipid concentrations had no remarkable effect. When glucose was added to whole cord blood cultures, a dose-dependent effect was demonstrated for IL-8 expression but not for other cytokines. CONCLUSIONS: These in vitro data suggest that the proinflammatory cytokine response to S. epidermidis may be modulated by lipids and glucose. Further studies are needed to investigate whether these findings are applicable to clinical settings and to evaluate the role of cytokine monitoring in infants receiving long-term parenteral nutrition.

Individual versus group oral hygiene instruction for adults.

PURPOSE: The objective of this study was to assess the practicability and effectiveness of group oral hygiene instruction for adults in comparison with individual oral hygiene instruction. MATERIALS AND METHODS: A total of 104 male subjects aged 18 to 54 (mean age: 29.7) years were randomly assigned to one of four groups: group A was given individual oral hygiene instruction; group B was given group oral hygiene instruction; group C was given a combination of individual and group oral hygiene instructions; and group D received no oral hygiene instruction (the control group). The success of each form of instruction was evaluated on the basis of four parameters: (1) the Quigley-Hein plaque index (QHI), (2) the approximal plaque index (API), (3) a modified sulcus bleeding index (SBI) and (4) the community periodontal index of treatment needs (CPITN). All participants had professional tooth cleaning at the end of the baseline examination. The final examinations were conducted 13 weeks later. RESULTS: All subjects showed a poor oral health status at the beginning of the study, and the mean QHI score was 2.2. In addition, 92% of all subjects had an API score of more than 70%. Moderate-to-severe gingival inflammation (modified SBI) was observed in 67.3% of the subjects. CPITN scores of 2 or 3 were calculated for 82% of all sextants. At the end of the study, all groups showed a significant improvement in their oral health status and periodontal parameters (P < 0.0001). The majority of the subjects achieved an API score between 25% and 70%, and they had a mean QHI score of 1.2. A CPITN score of 0 or 1 was recorded for most sextants (62%). There was no significant difference between the various groups. CONCLUSIONS: This study demonstrated that group oral hygiene instruction and conventional individual instruction have similar beneficial effects in adults.

Lyme disease with lymphocytic meningitis, trigeminal palsy and silent thalamic lesion.

We describe a follow-up in a 15-year-old boy with neuroborreliosis diagnosed by clinical symptoms, CSF and serum analysis. MRI revealed a thalamic lesion and an enhancement of the right trigeminal nerve clinically associated with mild hypasthesia in the right maxillary region. Both, clinical symptoms and radiological findings disappeared within 2 months after treatment. Borrelia burgdorferi specific IgM and IgG in CSF and IgG in serum became negative between 6 and 12 months after diagnosis. We show that neuroborreliosis at an early stage may present only with moderate neurological deficits and that at this stage MRI reveals distinct cerebral lesions which might even precede clinical manifestation. Thus, early diagnosis and treatment of neuroborreliosis may prevent persistent neurologic lesions.