Less invasive ventilation in extremely low birth weight infants from 1997 to 2011: survey versus evidence.

Evidence for target values of arterial oxygen saturation (SaO2), CO2, and pH has changed substantially over the last 20 years. A representative survey concerning treatment strategies in extremely low-birth-weight infants (ELBW) was sent to all German neonatal intensive care units (NICUs) treating ELBW infants in 1997. A follow-up survey was conducted in 2011 and sent to all NICUs in Germany, Austria, and Switzerland. During the observation period, NICUs targeting SaO2 of 80, 85, and 90 % have increased, while units aiming for 94 and 96 % decreased (all p < 0.001). Similarly, NICUs aiming for pH 7.25 or lower increased, while 7.35 or higher decreased (both p < 0.001). Furthermore, more units targeted a CO2 of 50 mmHg (7.3 kPa) or higher (p < 0.001), while fewer targeted 40 or 35 mmHg (p < 0.001). Non-invasive ventilation (NIV) was used in 80.2 % of NICUs in 2011. The most frequently used ventilation modes were synchronized intermittent mandatory ventilation (SIMV) (67.5 %) and intermittent positive pressure ventilation (IPPV) (59.7 %) in 1997 and SIMV (77.2 %) and synchronized intermittent positive pressure ventilation (SIPPV) (26.8 %) in 2011. NICUs reporting frequent or always use of IPPV decreased to 11.0 % (p < 0.001). SIMV (77.2 %) and SIPPV (26.8 %) did not change from 1997 to 2011, while high-frequency oscillation (HFO) increased from 9.1 to 19.7 % (p = 0.018). Differences between countries, level of care, and size of the NICU were minimal. CONCLUSIONS: Target values for SaO2 decreased, while CO2 and pH increased significantly during the observation period. Current values largely reflect available evidence at time of the surveys. WHAT IS KNOWN: • Evidence concerning target values of oxygen saturation, CO 2 , and pH in extremely low-birth-weight infants has grown substantially. • It is not known to which extent this knowledge is transferred into clinical practice and if treatment strategies have changed. WHAT IS NEW: • Target values for oxygen saturation in ELBW infants decreased between 1997 and 2011 while target values for CO 2 and pH increased. • Similar treatment strategies existed in different countries, hospitals of different size, or university versus nonuniversity hospitals in 2011.

Increase of caffeine and decrease of corticosteroids for extremely low-birthweight infants with respiratory failure from 1997 to 2011.

AIM: To compare treatment strategies for respiratory failure in extremely low-birthweight (ELBW) infants in Germany in 1997 to Germany, Austria and Switzerland in 2011. METHODS: A detailed questionnaire about treatment strategies for ELBW infants was sent to all German centres treating ELBW infants in 1997. A follow-up survey was conducted in 2011 in Germany, Austria and Switzerland. RESULTS: In 1997 and 2011, 63.6% and 66.2% of the hospitals responded. In 2011, the response rate was higher in Switzerland than in Germany, and in university hospitals versus nonuniversity hospitals. Treatment strategies did not differ between university and nonuniversity hospitals as well as NICUs of different sizes in 2011. Differences between Germany, Austria and Switzerland were minimal. Administration of caffeine increased significantly, whereas theophylline and doxapram declined (all p < 0.001). While the use of dexamethasone decreased and the use of hydrocortisone increased, the overall use of corticosteroids declined (all p < 0.001). Between 1997 and 2011, therapy with inhalations and mucolytics decreased (both p < 0.001), whereas the use application of diuretics did not change significantly. In mechanically ventilated infants, the application of muscle relaxants and sedation declined significantly (p = 0.009 and p < 0.001), whereas analgesia use did not change. CONCLUSION: Treatment strategies for respiratory failure in ELBW infants have changed significantly between 1997 and 2011.

Influence of age and genetic risk on anti-tissue transglutaminase IgA titers.

OBJECTIVES: False-positive results of anti-tissue-transglutaminase (tTG) IgA autoantibodies have been reported in subjects with a genetic risk for celiac disease (CD). The aims of this retrospective study were to assess the prevalence of false-positive tTG titers in patients at risk of CD compared with symptomatic children and to evaluate the influence of age and indication for testing on tTG titers. PATIENTS AND METHODS: All tTG results measured in our institution during a 33-month period were evaluated. Patients with known CD were excluded. Indications for testing were either symptoms suggestive of CD (group 1) or history of being at risk for CD (group 2). Duodenal biopsies were recommended if titers were positive (> or =10 U/mL) and offered if borderline (> or =4 to <10 U/mL). RESULTS: The final analysis included 2056 patients, 1707 belonged to group 1, and 349 to group 2. All 65 patients with positive tTG results underwent biopsy (group 1: 57, group 2: 8). Celiac disease was confirmed in 61 subjects (median titer: 107.8 U/mL, range 12.0-1748 mL, NS between group 1 and 2), whereas 4 had normal histology (10.2-25.2 U/mL). Three out of 16 patients with borderline results underwent biopsy and had normal histology. Borderline titers were more common in group 2 patients (2.6% vs 0.4%, P<0.001). Multiple regression analysis in patients with negative tTG results (n=1975) revealed that titers were independently related to age (P<0.05) and indication for testing (P<0.001). CONCLUSIONS: The influence of age and genetic predisposition/risk has to be taken into account when interpreting tTG results.

Organizing human functioning and rehabilitation research into distinct scientific fields. Part III: Scientific journals.

OBJECTIVE: The variety of human functioning and rehabilitation research makes it difficult to overview the whole area with respect to journals, societies and conferences of potential relevance to a research question in focus. The objective of this paper is thus to provide an outline of scientific journals, societies and conferences of major relevance to human functioning and rehabilitation research. METHODS: A systematic search for journals relevant to human functioning and rehabilitation research was performed. The resulting journal list was used to identify affiliated societies and conferences. In addition, an informal expert survey was conducted for the identification of further relevant societies, conferences and additional journals. RESULTS: A total of 6416 journal articles referring to human functioning and rehabilitation research were identified and analysed. A total of 231 journals, 153 societies and 115 conferences relevant to human functioning and rehabilitation research were selected from the systematic search and the informal expert survey. The societies and conferences are published via the website of this journal. CONCLUSION: The list of journals presented will be of use to scientists entering human functioning and rehabilitation research or engaging in an interdisciplinary perspective. It may serve as an initial guide for identifying possibilities for the submission of publications, sources of scientific information and platforms for the scientific exchange and discourse.

Effectiveness of measles vaccination after household exposure during a measles outbreak: a household contact study in Coburg, Bavaria.

BACKGROUND: A measles outbreak was recently observed in Coburg, Bavaria, in a population with vaccination rates of 76.5% in 5- to 6-year-old children in the years preceding the outbreak. Only a small proportion of children had received 2 vaccinations against measles. Vaccine effectiveness is estimated in a household contact study and also by a screening method. METHODS: A household contact study was conducted in families with at least 1 measles case by standardized computer-assisted telephone interviews to assess secondary attack rate and to estimate vaccine effectiveness. Vaccine effectiveness was also estimated with Farrington's screening method with information from school entry examinations and from questionnaires of confirmed measles cases in the Coburg outbreak. RESULTS: Thirty-eight children were primary cases. Of their contacts, 20 children were included in the study as secondary cases (1 vaccinated), and 23 children were contacts who did not develop measles (12 vaccinated once and 4 vaccinated twice), resulting in a vaccine effectiveness of 90% (95% confidence interval, 35-97%) for one vaccine dose. The proportion of the population vaccinated reached 81.5% during the outbreak and the proportion of the cases vaccinated was 10.9%, resulting in a vaccine effectiveness estimated using the screening method of 97.2% (95% confidence interval, 95.7-98.3%). CONCLUSIONS: With the use of 2 approaches to estimate the effectiveness of measles vaccination, a consistently high vaccine effectiveness of 90% or above was shown during a measles outbreak in Western Europe.

Intracellular T-cell cytokine levels are age-dependent in healthy children and adults.

Intracellular detection of cytokines via fluorescent antibody staining and flow cytometry has quickly become a standard method in experimental immunology. However, in pediatrics most studies have been hampered by the exclusion of healthy control individuals or have been skewed by neglecting to observe age-dependent differences in cytokine production. We therefore intended to establish normal values for different age groups and to describe the age-dependent development of cytokine profiles. Whole blood from 46 healthy children and 33 adults was analyzed by flow cytometry after stimulation with PMA, ionomycin and Mmonensin, and staining with anti-cytokine and surface antibodies. In the pediatric population, we found a significant positive correlation between age and intracellular cytokine levels of IFN-gamma, IL-2, IL-4 and TNF-alpha in CD4+ cells, as well as for IFN-gamma and TNF-alpha in CD8+ cells. In adulthood, no such striking trend could be detected, but significant correlation was found for IL-10 in CD4+ cells and IFN-gamma in CD8+ cells as well as for TNF-alpha in both cell subgroups. We present here the first systematic analysis of intracellular cytokine production in normal, healthy children between the ages of 0 to 18 years compared to results in adults. These data may provide a reference basis for the study of cytokine secretion patterns, and they also demonstrate a significant maturation of the T-cell cytokine production capacity from birth to adulthood.

Protective effect of breastfeeding against obesity in childhood. Can a meta-analysis of observational studies help to validate the hypothesis?

The relationship between breast-feeding and childhood obesity is of great interest. Since 2000, sixteen studies have been published with conflicting data regarding the potential protective effect of breast-feeding on childhood obesity. A narrative review of Dewey in 2003 suggested a protective effect of breast-feeding, but an editorial in the British Medical Journal later that year cited two more recent studies without such an effect and stated there was inconclusive evidence A recent meta-analysis, however, has suggested a small, but significant, protective effect of breast-feeding. This paper summarizes this meta-analysis and discusses the strengths and limitations of the meta-analysis approach.

[Inoculation rates of children starting school in Bavaria]. / Durchimpfungsraten bei der Einschulung. Noch deutliche Defizite bei Mumps, Masern, Röteln und Hepatitis B.

The recording of vaccination rates is indispensable for recognizing and closing regional immunization gaps, and for the planning, implementation and evaluation of vaccination schedules. Within the framework of school-entry examinations in Bavaria, the immunization status of every child examined is recorded, and evaluated by the Bavarian Health and Food Safety Authority. With regard to the vaccinations recommended by the STIKO, the overall immunization rate is satisfactory, although there are deficits for some types of vaccination, e. g. the second inoculation against measles, mumps and rubella. Thanks to improved vaccination documentation, the basis for a differentiated recording of vaccination rates during the school-entry examination has been created. All physicians in private practice should therefore take every opportunity to check and document vaccination status, and, where necessary, update it.

Measles outbreak in Germany: clinical presentation and outcome of children hospitalized for measles in 2006.

In 2006, 115 children hospitalized with measles in Germany were reported. Detailed information could be obtained for 96 cases from a pediatric hospital surveillance system. The most frequent symptoms and complications were pneumonia, respiratory insufficiency, other respiratory disorders, otitis media, feeding problems, and other gastrointestinal symptoms. Two children died of measles inclusion body encephalitis.

No temporal association between influenza outbreaks and invasive pneumococcal infections.

OBJECTIVE: To assess whether the influenza peak in populations precedes the annual peak for invasive pneumococcal infections (IPI) in winter. DESIGN: Ecological study. Active surveillance data on influenza A and IPI in children up to 16 years of age collected from 1997 to 2003 were analysed. SETTING: Paediatric hospitals in Germany. PATIENTS: Children under 16 years of age. RESULTS: In all years under study, the influenza A season did not appear to affect the IPI season (p = 0.49). Specifically, the influenza peak never preceded the IPI peak. CONCLUSION: On a population level there was no indication that the annual influenza epidemic triggered the winter increase in the IPI rate or the peak of the IPI distribution in children.

Intellectual outcome, motor skills and BMI of children with congenital hypothyroidism: a population-based study.

AIM: To evaluate intellectual outcome, motor skills and anthropometric data of children with congenital hypothyroidism (CH). METHODS: Children with permanent CH who were born in 1999 in Bavaria were eligible for this prospective, population-based study. Cognitive performance was evaluated by the Kaufman Assessment Battery for Children and motor skills were assessed by the motor test, Motoriktest für vier-bis sechsjahrige Kinder (MOT) 4-6. RESULTS: Eighteen of 21 eligible children participated (86%). Median age of the children was 5.5 years (range 4.9-5.8). Treatment with levothyroxine was started after a median of 7.2 days (range 4-15) with a median dose of 12.0 microg/kg (range 7.2-17.0). Mean intelligence quotient (IQ) of the children was 100.4 (standard deviation [SD] 10.1): no children had IQ values below the normal range. Reactivity and speed of movement were significantly reduced in children with CH. Children with an initial thyroid-stimulating hormone (TSH) value of >200 mU/L performed significantly worse than children with TSH value of

Reduced incidence of severe metabolic crisis or death in children with medium chain acyl-CoA dehydrogenase deficiency homozygous for c.985A>G identified by neonatal screening.

The incidence of severe metabolic crises in medium chain acyl-CoA dehydrogenase deficiency (MCADD) patients homozygous for the common c.985A>G mutation, who had been identified by neonatal screening, was assessed prospectively and compared to retrospective cohort data in unscreened patients with identical genotypes. Logrank test showed a significant reduction of severe metabolic crises in the screened cohort (p<0.01). Neonatal screening appears to reduce the rate of severe metabolic crisis or death in the most prevalent subset of MCADD.