[High-Flow Nasal Cannulae (HFNC) in Neonates: A Survey of Current Practice in Level 1 Perinatal Centres in the German State of North Rhine-Westphalia]. / High-flow nasal cannulae (HFNC) in der Neonatologie: Umfrage über Einsatz und Erfahrungen in den nordrheinwestfälischen Level 1 Perinatalzentren.

INTRODUCTION: High-flow nasal cannulae (HFNC) is a kind of non-invasive respiratory support. In recent years, its application has gained increasing popularity for treating neonates with respiratory failure. Within this study, neonatologists employed at high level perinatal centres within the region of North Rhine-Westphalia, Germany were interviewed. We evaluated their personal experience as well as the underlying indication for using HFNC. METHOD: We undertook an online survey. RESULTS: 93% of the interviewed participants use HFNC systems in their NICU. The most prominent indications were CPAP-weaning, nasal trauma, and apnoea of prematurity. Both initial flow and maximum and minimum flow rates varied widely. The primary benefit of HFNC vs. conventional CPAP was the improved neonate tolerance, less nasal traumata and ease of application and care. A common disadvantage was the inability to conduct PEEP measurements. DISCUSSION: The application of the HFNC system is increasing for specific neonatal indications, thereby increasing the data for the evaluation of effectivity and safety. Nevertheless, detailed investigations of the appropriate flow rate settings are still lacking.

Successful treatment of neonatal respiratory failure caused by a novel surfactant protein C p.Cys121Gly mutation with hydroxychloroquine.

SFTPC (surfactant protein C) mutations resulting in SP-C deficiency causing ongoing respiratory failure in the neonatal period represent a rare entity. We report a full-term female infant who developed respiratory distress and respiratory failure shortly after birth. From the first day of life the infant was mechanically ventilated. Application of exogenous surfactant or cortisone did not lead to any clinical improvement. Genetic analysis identified a novel SFTPC mutation as the cause of her lung disease. The patient was diagnosed as heterozygous for a p.Cys121Gly/C121G substitution encoded by exon 4, which could not be detected in both parents. Experimental therapy with hydroxychloroquine resulted in a significant clinical improvement within 2 weeks time. Mechanical ventilation was no longer needed, and the patient was discharged without additional oxygen demand. The patient remained well under therapy till the age of 6 months. After that time, the therapy was successfully discontinued.

C/EBPbeta enhances IL-4 but impairs IL-2 and IFN-gamma induction in T cells.

C/EBP transcription factors have been described to control the activity of the human IL-4 promoter. The C/EBP binding sites within the IL-4 promoter overlap with composite NF-AT and AP-1 binding motifs. We show here that similar binding sites are part of the murine IL-4 promoter. Retroviral overexpression of C/EBPbeta in murine EL-4 thymoma cells led to a strong induction of endogenous IL-4 and a reduction in IL-2 and IFN-gamma expression. Similarily, in primary murine T cells C/EBPbeta induction resulted in an increase in IL-4 levels, whereas in human Jurkat T cells a decrease in IL-2 RNA was detected. Like AP-1, C/EBP factors belong to the large class of basic leucine zipper proteins. However, unlike AP-1, C/EBPbeta does not act in synergy with NF-AT in the induction of the murine IL-4 promoter. Instead, both factors compete in their binding to the P4/Pu-bD site, one of the most important sequence elements of the IL-4 promoter. Whereas NF-AT factors require high levels of free Ca2+ and calcineurin activity for induction, C/EBP induction in T cells is Ca2+/calcineurin independent. These observations suggest that various induction conditions lead to the activation of transcription factors, inducing IL-4 promoter activity at specific developmental stages of T cells.