Increased risk for bronchitis after discharge in non-vaccinated very low birth weight infants.

BACKGROUND: In very low birth weight (VLBW) infants, obstructive bronchitis is a frequent cause of hospital re-admission. For VLBW infants, early vaccinations starting at 2 months after birth have been recommended. OBJECTIVE: To analyze risk factors for bronchitis during the first year after discharge and the effects of in-hospital standard vaccination (hexavalent/pneumococci) and/or RSV immunoprophylaxis with palivizumab. METHODS: A standardized questionnaire was sent to the parents of VLBW infants 7 month after discharge. The reported episodes of bronchitis were correlated with clinically recorded parameters including risk factors for pulmonary morbidity. The effects of in-hospital vaccination were assessed in a subgroup discharged after day 60. RESULTS: A sample of 1 967 responses of infants born 2009-2011 was analyzed. Risk factors for bronchitis were male gender and older siblings. 24% of the population had episodes of bronchitis. In the subgroup discharged after day 60, episodes of bronchitis were reported for 31% of infants who were not vaccinated in-hospital. A significant reduction of the bronchitis rate was found in infants who received palivizumab±standard vaccination (17% bronchitis, p=0.003). Interestingly, in-hospital standard vaccination without RSV immunoprophylaxis was protective (20% bronchitis; p=0.037) as well. CONCLUSIONS: Non-vaccinated male VLBW infants with older siblings are at increased risk for bronchitis during the first year after discharge. Vaccination according to schedule seems to have protective effects, while underlying mechanisms are unknown. The rate of timely vaccination in preterm infants should be increased.

Therapeutic management of evans syndrome in a pregnancy with maternal systemic lupus erythematosus.

A 31-year-old 2 G 1 P was referred to our unit of prenatal medicine at 35+3 weeks of gestation with a spontaneously conceived singleton pregnancy of a female fetus without detectable anomalies. Maternal hematological evaluation revealed an Evans-syndrome-related thrombocytopenia based on a lupus erythematosus. The former delivery was aggravated by a severe hemorrhage several years before. Anti-autoimmunologic therapy was started and maternal platelets count increased to physiological values. Uneventful ceasarean section was performed at 37 weeks of gestation with favourable outcome for mother and child. This case is the first report of a successful therapy in maternal Evans syndrome in pregnancy combined with a lupus erythematosus.

Influence of smoking and alcohol during pregnancy on outcome of VLBW infants.

BACKGROUND: Nicotine and alcohol consumption have been associated with premature delivery and adverse neonatal outcome. We wanted to analyze the influence of self-reported nicotine and alcohol consumption on outcome of VLBW infants. MATERIAL AND METHODS: In an ongoing multicenter study 2475 parents of former very low birth weight (VLBW) infants born between January 2009 and December 2011 answered questionnaires about maternal smoking habits and alcohol consumption during pregnancy. 2463 (99.5%) completed questions on alcohol consumption and 2462 (99.5%) on smoking habits. These infants were stratified to reported maternal smoking and alcohol consumption during pregnancy. We compared the reasons for premature delivery, neonatal outcome and parental reports on bronchitis during the first year of life, as well as growth and development at age 2 years to pregnancy exposure. RESULTS: In nicotine exposed infants intrauterine growth restriction (31 vs. 21%, p<0.01), a birth weight below the 10th percentile (26 vs. 17%, p<0.01) and placenta abruption (9.2 vs. 5.8%, p<0.05) was seen more often. Premature rupture of membranes (24 vs. 30%, p<0.05) or HELLP syndrome (6 vs. 11%, p<0.01) was less frequent. A birth weight below the 3rd percentile was seen more frequently in mothers with reported alcohol consumption (13 vs. 6%, p<0.05). We noted an increased rate of BPD and ROP if mothers reported smoking during pregnancy (p<0.05). Growth parameters and scores on Bayley Sscales of infant development at age 2 years did not differ. CONCLUSION: Smoking during pregnancy results in a high rate of growth restricted VLBW infants. Prenatal exposition to nicotine seems to increase postnatal complications such as BPD und ROP.

Bowel obstruction in patients with Alpers-Huttenlocher syndrome.

Alpers-Huttenlocher syndrome (AHS) is a very rare autosomal recessive disorder. AHS is caused by homozygous or compound heterozygous mutations in the nuclear gene encoding mitochondrial DNA polymerase gamma (POLG, chromosome 15q25). Most patients become symptomatic before the age of 2 years. We report 3 patients who were treated in our clinic between 2007 and 2010. All patients suffered from myoclonic seizures and had at least one refractory convulsive status which led to the diagnosis. All of them had varying degrees of developmental delay, 2 of them additionally ataxia. Gastrointestinal motility problems were severe in all patients despite only mildly deranged liver function. While in most aspects our patients present with typical AHS features, they also share intestinal problems, a feature that has not been recognized as typical for AHS before. AHS is a multisystem disorder that does affect all cell systems. Liver and brain are organs with the highest energy demand and are therefore usually affected early in the disease course of AHS. However, constipation and bowel obstruction should be regarded as typical complications in AHS and patients should be monitored and treated to improve quality of life. Regarding treatment options for epilepsy in AHS ketogenic diet as well as lacosamide might be considered.

Frequency of participation and association with functioning in adolescents born extremely preterm - Findings from a population-based cohort in northern Germany.

BACKGROUND: Outcomes after extremely preterm birth (<28 weeks gestation) have been studied intensely, and follow-up into adulthood is well-established. Following the introduction of the International Classification of Functioning, Disability and Health, participation has been recognized to be a relevant outcome in rehabilitation research. During adolescence, participation is crucial to adapting to new social roles. The aim of our study was to investigate participation in the domains Autonomy, Relationships and Community Recreation. METHODS: Participation was assessed as part of a cross-sectional, population-based study in a German federal state examining all adolescents born between January 1997 and December 1999 at under 27 weeks gestation. Of the surviving 90 adolescents, 72 (80%) were followed-up at age 14 to 17. Frequency of participation was assessed using the short form of the Questionnaire of Young People's Participation and compared to matched peers. Associations with physical, cognitive, and psychological functioning and contextual factors were examined using multivariate regression. RESULTS: Frequency of participation in Autonomy, Relationships, and Community Recreation in adolescents born extremely preterm was significantly lower than that of matched peers from the general population (p < 0,001). Lower frequency of participation in Autonomy and Relationships was associated with severe physical and cognitive impairment, and psychological problems. Fifty-seven percent of the adjusted variance in Autonomy and 31% of the adjusted variance in Relationships was explained by our regression models. CONCLUSION: Further research is warranted to investigate additional factors associated with the restricted frequency of participation of adolescents born preterm to design suitable interventions for improving participation.

Independence of location of light absorption and discrete wave latency distribution in Limulus ventral nerve photoreceptors.

Discrete waves of depolarization evoked by dim pulses of light in dark-adapted ventral nerve photoreceptors in Limulus show fluctuation in their latency. To a resolution of 5-10 microm the latency distribution function appears to be independent of where in the receptor light is absorbed. Also, there is apparent local adaptation to bright light pulses.

Light-evoked and spontaneous discrete waves in the ventral nerve photoreceptor of Limulus.

Discrete waves, recorded from the ventral nerve photoreceptor, occur in the light and in the dark. Spontaneous waves, on the average, are smaller than light-evoked waves. This suggests that not all spontaneous waves can arise from spontaneous changes in the visual pigment molecule identical to changes induced by photon absorption. Spontaneous and light-evoked waves are statistically independent of each other. This is shown by determination of frequency of response as a function of pulse energy for short pulses and determination of the distribution of intervals between waves evoked by steady lights. The available data can be explained by two models. In the first each photon produces a time-dependent excitation that goes to zero the instant the wave occurs so that the number of effective absorptions from a short light pulse equals the number of waves produced by the light pulse. In the second the excitation produced by photon absorption is unaffected by the occurrence of the waves so that the number of waves produced from a short light pulse may be different from the number of effective absorptions. Present results do not allow a choice between the two models.

Length and weight of very low birth weight infants in Germany at 2 years of age: does it matter at what age they start complementary food?

BACKGROUND/OBJECTIVES: We analysed at what age parents start complementary food in very low birth weight infants, determined risk factors for early introduction of complementary food (post-term age) and analysed whether the age at introduction of complementary food influences height or weight at 2 years of age. SUBJECTS/METHODS: Parents of premature infants born in 2009-2011 answered questionnaires regarding introduction of complementary food in the first year of life (N=2262) and were followed up at a post-term age of 2 years (N=981). Length and weight were compared with full-term infants from the KiGGs study. Logistic and linear regression analyses were conducted to study predictors for early introduction of complementary food and the influence of age at introduction of complementary food on later height and weight. RESULTS: Average age at introduction of complementary food was 3.5 months post-term age. The lower the gestational age at birth, the earlier (post-term age) vegetables and meat were introduced. Age at introduction of complementary food was influenced by intrauterine growth restriction, gestational age at birth, maternal education and a developmental delay perceived by the parents. Length and weight at a post-term age of 2 years was not negatively influenced by early introduction of complementary food. CONCLUSIONS: VLBW infants are introduced to complementary food on average before a post-term age of 4 months. There was no negative effect of early introduction of complementary food on height and weight at 2 years of age.

Patient characteristics and lifestyle recommendations in the treatment of gastroesophageal reflux disease.

BACKGROUND: The objectives of this study were to describe the patient-reported frequency with which health care providers recommend lifestyle changes to patients with GERD (gastroesophageal reflux disease) with respect to patient characteristics, eg, sex, age, body mass index, tobacco use, alcohol use, type of health insurance, and clinic location (rural vs urban). METHODS: The study was conducted in a five-center, university-based family practice in southeastern West Virginia. The first 50 patients enrolled in a prospective quality-of-life study of patients with GERD were used as the sample population. Telephone surveys administered immediately following the diagnosis of GERD included seven specific questions on lifestyle modification that may have been recommended by primary health care providers during the clinic visit. Patient-reported data were obtained from baseline surveys. RESULTS: Five of seven (71%) lifestyle modification recommendations were reported by less than 50% of patients as being received from health care providers. Patients aged 60 years or older were less likely to report receiving recommendations than those younger than 60 years (P = .0002), and patients with a body mass index greater than 30 were more likely to report receiving eating-related recommendations (P = .047). Heavier smokers were more likely to report receiving recommendations than lighter smokers (P = .0001). CONCLUSIONS: Based on patient report, health care providers recommended lifestyle modifications to a modest percentage of patients with GERD and modified counseling for specific patient characteristics, such as age, body mass index, smoking, and alcohol consumption. Additional prospective research using physician report and observation as well as patient report, and more numerous patient cohorts, is needed.

Polymorphisms in the Renin-Angiotensin system and outcome of very-low-birthweight infants.

BACKGROUND: The insertion/deletion polymorphism of the angiotensin-converting enzyme (ACE-ins/del) and the angiotensin II type 1 receptor 1166A/C polymorphism (ATR1166A/C) were reported to be associated with several unfavorable outcome parameters in preterm infants like bronchopulmonary dysplasia, persistent ductus arteriosus and impaired insulin sensitivity. OBJECTIVE: To confirm the above-mentioned associations in a large cohort of very-low-birthweight (VLBW) infants. METHOD: Clinical data of VLBW infants were prospectively recorded. The ACE-ins/del polymorphism and the ATR1166A/C polymorphism were determined by polymerase chain reaction in 1,209 and 1,168 infants, respectively. RESULTS: There was no significant association between ACE-ins/del or ATR1166A/C genotype and outcome parameters (death, intraventricular hemorrhage, sepsis, bronchopulmonary dysplasia, ventilation, supplemental oxygen at discharge, postnatal treatment with insulin, surgery for intestinal perforation/necrotizing enterocolitis/retinopathy of prematurity/persistent ductus arteriosus. CONCLUSION: Both known functional polymorphisms of the renin-angiotensin system do not seem to be associated with the outcome of VLBW infants.

Apparent path of a Pulfrich target as a function of the slope of its plane of motion: a theoretical note.

A theoretical equation is derived to predict the apparent path of a Pulfrich target moving with constant velocity in a plane that intersects the pupillary plane of an observer. Generally, the predicted apparent path is a hyperbola. However, if the angle between the two planes is zero, or they intersect at a pupillary center, then the predicted apparent path is a line. Other theoretical equations are derived that describe the apparent size and orientation of a line target that is parallel to the pupillary plane and receding from the observer.

The observed image velocity of a stationary target reflected by a rotating plane mirror.

An equation is presented describing the angular velocity of an image, viewed by an observer when a plane mirror is undergoing angular velocity. The image velocity is determined at the observer's entrance pupil. An expression to determine the size of the mirror aperture for a given exposure time is also presented. The results indicate that, in general, the image velocity is not constant nor twice the mirror velocity, as is usually assumed. Also, if the mirror extends to an equal length on each side of its axis of rotation, then the time in which the image appears to travel from the mirror's edge to the axis of rotation does not equal the time in which it appears to travel from the axis to the other edge.

Lens weight as a function of density, shape, and power.

An equation to determine the weight of a spherical lens as a function of its density, shape, and power is presented. I found that if center thickness and size are held constant, lens weight increases as the lens power increases in minus or decreases in plus. A way to calculate the power at which two lenses are equal in weight when they differ only in density is also presented. This power is the endpoint of a range of powers above which one of the two lenses is heavier, whereas below this power it is lighter than the other lens. A way to reduce the weight of a lens by altering the surface powers is also suggested.

Matrix techniques in colorimetry.

The usual (geometric) procedure to determine the chromaticity coordinates of a color that results from the additive mixture of colored stimuli is to plot the coordinates of these stimuli on the CIE chromaticity diagram and apply the center-of-gravity rule. This procedure, however, may become inaccurate and cumbersome if more than just a few colored stimuli are mixed in various proportions. An alternate method is presented that uses matrix techniques to solve problems related to colorimetry simply and accurately.