[Bone Analysis in the Newborn - Quantitative Ultrasound of the Peripheral Skeleton]. / Alternative Knochenanalyse bei Neugeborenen ­ Quantitativer Ultraschall des peripheren Skeletts.

PURPOSE: The aim was to determine whether the quantitative ultrasound (QUS) parameter speed of sound (SOS) is sufficient for evaluation of reference data in the newborn and how they are influenced. MATERIALS AND METHODS: 219 full-term and 14 preterm infants (gestational age 28-41 weeks (GA), birth weight 590-4,930 g) were evaluated by Omnisense 7000 P on their tibia. Reference values were sampled in 178 eutrophic infants. RESULTS: SOS reference values at the tibia were 3028 m/s for GA<40 and 3057 m/s for ≥ 40 weeks. There was a significant correlation between SOS and gestational age. SOS was significantly higher in male (3058.3±93.3 vs. 3022.8±93.4 m/s; p 0.012) infants. If birth weight was below 3,800 g, there was a correlation between SOS and weight (p<0.05). Preterm infants showed lower SOS than term babies (p<0.05). CONCLUSION: Speed of sound can be evaluated sufficiently in preterm and term infants on the tibia. The estimated reference data can be used to identify osteopenia in the preterm infant with low birth weight.

A Complex Intervention to Prevent Medication-Related Hospital Admissions.

BACKGROUND: Children are often treated off-label and are at a disadvantage in pharmacotherapy. The aim of this study was to implement and evaluate a quality assurance measure (PaedPharm) for pediatric pharmacotherapy whose purpose is to reduce medication-related hospitalizations among children and adolescents. METHODS: PaedPharm consisted of the digital pediatric drug information system PaedAMIS, pediatric pharmaceutical quality circles (PaedZirk), and an adverse drug event (ADE) reporting system (PaedReport). The intervention was implemented in a cluster-randomized trial (DRKS 00013924) in 12 regions, with a pediatric and adolescent medicine clinic in each and a total of 152 surrounding private practitioners, in 6 sequences over 8 quarters. In addition to the proportion of ADE-related hospital admissions (primary endpoint), comprehensive process evaluation included other endpoints such as coverage, user acceptance, and relevance to practice. RESULTS: 41 829 inpatient admissions were recorded, of which 5101 were patients of physicians who participated in our study. 4.1% of admissions were ADE-related under control conditions, and 3.1% under intervention conditions (95% CI: [2.3; 5.9] and [1.8; 4.5], respectively). A model-based comparison yielded an intervention effect of 0.73 (population-based odds ratio; [0.39; 1.37]; p = 0.33). PaedAMIS achieved moderate user acceptance and PaedZirk achieved high user acceptance. CONCLUSION: The introduction of PaedPharm was associated with a decrease in medication-related hospitalizations that did not reach statistical significance. The process evaluation revealed broad acceptance of the intervention in outpatient pediatrics and adolescent medicine.

Placental 11beta-HSD2 gene expression at birth is inversely correlated with growth velocity in the first year of life after intrauterine growth restriction.

Intrauterine growth restriction (IUGR) is associated with an increased risk for short stature and diseases in adulthood thought to be inflicted by fetal programming. We hypothesized that placental endocrine systems involved in perinatal growth might also play a role in postnatal growth after IUGR. In a prospective controlled multicenter study, placental gene expression of IGF-binding protein-1 (IGFBP-1), leptin and 11beta-hydroxysteroid dehydrogenase type 2 (11beta-HSD2) were measured in 14 IUGR infants and 15 children born appropriate for gestational age (AGA) proven by serial ultrasound examinations. Postnatally, IUGR infants experienced a significantly higher growth velocity than AGA neonates (at 1 y: p = 0.001). Gene expression of 11beta-HSD2 at birth correlated positively with birth length (r = 0.55, p = 0.04) and inversely with growth velocity in the first year of life (r = -0.69, p = 0.01) in the IUGR, but not in the AGA group. There was no correlation between gene expression of placental IGFBP-1, leptin and birth weight, length and growth velocity during the first year of life. AGA infants showed significantly higher concentrations of cortisone in venous cord blood after birth (p = 0.02) as a surrogate of a higher 11beta-HSD2 activity in the fetoplacental unit. In conclusion, placental 11beta-HSD2 gene expression might predict postnatal growth in IUGR.

Successful treatment of a huge congenital cervical teratoma.

Congenital cervical teratomas are extremely rare tumors with high perinatal mortality and morbidity rates particularly due to compression and distortion of the infant's airway. Hence, these mostly benign malformations require immediate excision, whereas surgery of these tumors is challenging for a multidisciplinary team. We report on a recent case of congenital cervical mature teratoma with total excision and cure. The aim of this case study is to report the authors' experience in managing a case of congenital cervical teratoma to provide a structured approach and help in decision making, once prenatal diagnosis is made.

Associations of the IGF/IGFBP axis and respiratory diseases in neonatal patients during the first 6 months of life.

OBJECTIVES: To analyse IGFs in respect to somatic growth and neonatal diseases during the first 6 months of life. METHODS: IGF-I, IGF-II and IGF binding proteins (IGFBP-1, -2, -3) were determined by immunoassays in neonatal patients after birth (n = 67) and at 3 (3 mo; n = 75) and 6 months (6 mo; n = 47) of corrected postnatal age. Data on growth were tested for associations to the gestational age, birth weight (bw) SDS (/-2 SDS), neonatal morbidity and therapeutic strategies. RESULTS: All IGFs and IGFBPs changed significantly between birth and 3 mo of corrected age (p < 0.05). Perinatal respiratory diseases influenced IGF-II at 3 mo, and bronchopulmonary dysplasia IGF-II at 3 and 6 mo (all p < 0.05). IGF-I differed between the subgroups bw /-2 SDS (p < 0.05). At 3 mo, IGFBP-1 was significantly increased in infants with glucocorticoid administration during the first four weeks of life. CONCLUSION: The first months of life are characterised by a pole reversal of the somatotropic axis: IGFBP-1 and -2 decrease and IGFBP-3 increases. Respiratory diseases with an origin in the neonatal period, glucocorticoid therapy and low birth weight have an impact on the IGF pattern up to 6 mo. Prospective studies are necessary to investigate, whether the described link between the IGF/IGFBP axis and respiratory morbidity in neonatal patients has an impact on development in later infancy.

Oligohydramnios associated with sonographically normal kidneys.

We report a male newborn presenting with sonographically normal kidneys, oligohydramnios during late pregnancy, and persisting anuric renal failure. Despite intensive treatment, the patient suffered from severe hypotension and died at the age of 4 weeks. At autopsy, kidneys were found to be normal; on histology, deranged renal structures, in particular proximal tubuli and vessels, were noted, leading to the diagnosis of renal tubular dysgenesis (RTD). The diagnosis was confirmed by 2 heterozygous nonsense mutations of the ACE gene. Because the recurrence rate of RTD is 25% for the autosomal recessive trait, knowledge and genetic diagnosis of the disease is important for the parents.

Effect of dexamethasone on the IGFBP-1 regulation in premature infants during the first weeks of life.

BACKGROUND: Early glucosteroid treatment in preterm infants has a negative impact on physical growth and development. So far, data on dexamethasone effect on the GH/IGF axis and the clinical outcome are conflicting. OBJECTIVE: Therefore, we studied the effect of dexamethasone treatment on parameters of somatic growth and on the secretion of insulin like growth factors (IGFs) and insulin like growth factors binding proteins (IGFBPs) in preterm infants. METHODS: In 75 preterm infants somatic development was assessed at birth and after 3 months of corrected age. IGF-I/II and IGFBP-1-3 were measured at the same time. According to their treatment regime the infants were assigned to the dexamethasone treated or the non-treated group. RESULTS: At 3 months the 13 infants with dexamethasone had a lower body weight, slightly lower body length and a lower head circumference. IGF-II (464.4 +/- 97.4 vs 638 +/- 201.4 mug/l, p = 0.001) and IGFBP-3 (1800 +/- 426 vs 2105 +/- 547 mug/l, p = 0.045) were significantly reduced under the influence of glucocorticoids, whereas IGFBP-1 was elevated (59.6 +/- 61.0 vs 21.1 +/- 21.7 mug/l, p = 0.002). The ratio IGFBP-3/(IGFBP-1 + 2) was reduced in the dexamethasone group (1.827 +/- 0.868 vs 3.098 +/- 1.898 mug/l, p = 0.016), implying a significant retardation in the somatic development. CONCLUSION: Dexamethasone impairs IGF and IGFBP secretion and stimulates IGFBP-1, an inhibitor of IGF-I. These pathways might contribute to alterations of the GH/IGF axis, particularly the ratio IGFBP-3/(IGFBP-1 + 2).

Does insulin-like growth factor 1 contribute in red blood cell transfusions to the pathogenesis of retinopathy of prematurity during retinal neovascularization?

BACKGROUND: Red blood cell (RBC) transfusions are associated with the development of retinopathy of prematurity (ROP). During the period of retinal neovascularization a rise of insulin-like growth factor 1 (IGF-1) may trigger rapid growth of new blood vessels. OBJECTIVES: To study endocrine factors in RBC transfusions that might be of importance for ROP. METHODS: IGF-1, IGF-2 and their binding proteins 1-3 (IGFBP-1-3) were determined by radioimmunoassays in 7 very-low-birthweight (VLBW) infants with ROP >or= stage 2 receiving a RBC transfusion, in 10 controls (VLBW infants with ROP

Associations between ghrelin levels in serum of preterm infants and enteral nutritional state during the first 6 months after birth.

BACKGROUND: Previous studies have suggested a possible influence of ghrelin on foetal growth. After birth, the regulation of this newly discovered orexigenic peptide is largely unknown. OBJECTIVE: To study the relationship between circulating levels of ghrelin and enteral nutritional state in preterm infants during the first months of life. METHODS: Ghrelin levels were measured in a cross-sectional study by radioimmunoassay on the second day after birth (n = 51), at 3 months (n = 63) and at 6 months (n = 53) of corrected postnatal age. Complete data sets of auxological parameters, biochemical values, perinatal diseases, nutritional management and therapy were determined. RESULTS: All infants showed levels of ghrelin in postnatal serum. In correlation analyses and multivariable linear regression models, ghrelin was strongly related to enteral caloric intake on the second day after birth (all P < 0.01). At 6 months of corrected postnatal age, infants who were exclusively breastfed/formula fed had significantly lower ghrelin levels than infants with solid foods (Mann-Whitney U-test: P = 0.027). CONCLUSION: Ghrelin levels were positively correlated with the enteral nutritional state in preterm infants on the second day after birth. The introduction of solid foods increased the ghrelin levels in a group of preterm infants at 6 months of corrected postnatal age.