Respiratory syncytial virus associated hospitalizations in preterm infants of 29 to 32 weeks gestational age using a risk score tool for palivizumab prophylaxis.

To evaluate the efficacy of palivizumab in infants of 29 to 32 weeks of gestational age (GA) based on a risk score tool developed for Austria. Retrospective single-center cohort study including all preterm infants of 29 (+0) to 32 (+6) weeks of GA born between 2004 and 2012 at a tertiary care university hospital. Data on RSV-related hospitalizations over the first 2 years of life were analyzed and compared between those having received palivizumab and those without. The study population was comprised of 789 of 816 screened infants, of whom 262 (33%) had received palivizumab and 527 (67%) had not. Nine of 107 rehospitalizations (8.4%) in the palivizumab group compared to 32 of 156 rehospitalizations (20.5%) in the group without prophylaxis were tested RSV-positive (p = 0.004; OR 0.356 [CI 90% 0.184-0.689]). Proven and calculated RSV hospitalization rate was 3.1% (8/262) in the palivizumab group and 5.9% (31/527) in the group without (p = 0.042; OR 0.504 [CI 90% 0.259-0.981]). Increasing number of risk factors (up to three) increased the RSV hospitalization rate in infants with (6.1%) and without (9.0%) prophylaxis. RSV-associated hospitalizations did not differ between groups with regard to length of stay, severity of infection, age at hospitalization, demand of supplemental oxygen, need for mechanical ventilation, and admission rate to the ICU. A risk score tool developed for infants of 29 to 32 weeks of gestational age led to a reduction of RSV-associated hospitalizations without influencing the severity of disease.

Lung-protective ventilatory strategies in intubated preterm neonates with RDS.

This article provides a narrative review of lung-protective ventilatory strategies (LPVS) in intubated preterm infants with RDS. A description of strategies is followed by results on short-and long-term respiratory and neurodevelopmental outcomes. Strategies will include patient-triggered or synchronized ventilation, volume targeted ventilation, the technique of intubation, surfactant administration and rapid extubation to NCPAP (INSURE), the open lung concept, strategies of high-frequency ventilation, and permissive hypercapnia. Based on this review single recommendations on optimal LPVS cannot be made. Combinations of several strategies, individually applied, most probably minimize or avoid potential serious respiratory and cerebral complications like bronchopulmonary dysplasia and cerebral palsy.

Preterm twin and triplet pregnancies are at increased risk for the development of cystic periventricular leukomalacia.

BACKGROUND: An increased risk of cerebral palsy in multiples has been reported. AIMS: To determine the risk for the development of periventricular leukomalacia (PVL) of twin and triplet pregnancy. STUDY DESIGN: Retrospective single-centre study at a tertiary care university hospital. SUBJECTS: Infants ≤ 35 weeks gestational age born between 1988 and 2008. OUTCOME MEASURES: Risk of twin and triplet compared to singleton pregnancy regarding development of PVL in one offspring. RESULTS: Of 6195 infants 117 singletons and 39 multiples were diagnosed as having cystic PVL. Perinatal data did not differ as did not ultrasonographic findings and neurologic outcome. The relative risk (RR) of a twin pregnancy resulting in at least one infant with PVL when born prior to 36 weeks was 2.181 (CI 95% 1.474-3.228, p < .0001), and 6.793 (CI 95% 2.470-13.108, p < .0001) of a triplet pregnancy. In-vitro fertilisation was present in 3% of affected twins compared to 100% in triplets (p < .001). CONCLUSION: We found an increased risk for PVL in preterm twin and triplet pregnancies.

Focal nodular hyperplasia in children following treatment of hemato-oncologic diseases.

BACKGROUND: Focal nodular hyperplasia (FNH) is a benign hepatic lesion of unknown etiology. Although uncommon in children, a cumulative incidence is reported in oncologic patients after ending their therapy. Differential diagnosis to other focal liver lesions especially to metastases is often difficult. PATIENTS AND METHODS: We report on four children (female n=2, male n=2; age at initial diagnosis: 9 months, 20 months, 11.5 and 14 years) with different non-hepatic primary tumors (gastrointestinal stroma-tumor, neuroblastoma (n=2) and nephroblastoma) who developed focal liver lesions 2, 2.5, 3 and 8 years after successful treatment of their primary malignancy, respectively. RESULTS: Diagnosis of focal nodular hyperplasia was established by sonography, computed tomography and magnetic resonance imaging. In addition percutaneous needle biopsy was performed in two patients. Median interval from the end of chemotherapy to the onset of FNH was 3.9 years (range 2-8 years). CONCLUSION: Diagnosis of FNH has to be included in the differential diagnosis of uncertain liver lesions. Biopsy might be avoided by using special imaging techniques like MRI, CT and ultrasound. A wait and see strategy is recommended, specific treatment is not necessary.

Long term survival in two children with rhabdomyosarcoma of the biliary tract.

BACKGROUND: Due to low incidence, rhabdomyosarcoma (RMS) of the biliary tract poses numerous complex management problems especially in diagnosis and local therapy. PATIENTS: The two presented patients were diagnosed by biopsy, performed by laparotomy and endoscopic retrograde cholangiopancreatography (ERCP) respectively. Nearly complete tumor regression was achieved by chemotherapy and irradiation according to the CWS-protocol. Subsequent radical resection followed directly in one patient and after local relapse in the other. Both patients are in remission 13 resp. 4 years after diagnosis with a good quality of life. CONCLUSIONS: Even in well responding biliary rhabdomyosarcomas, surgery after chemotherapy and radiotherapy seems to be necessary. Adjuvant chemotherapy should be continued after hepatic lobectomy.