Effects of paediatric intensive care due to congenital heart defects on maternal mental health.

AIM: Successful mother-child-bonding is a fundamental step for a healthy development of the child. Different factors like postpartum depression can hinder the bonding process. This study aimed to investigate how intensive care treatment due to congenital heart diseases of the infant alters bonding and how mothers cope with the situation. METHODS: Validated questionnaires were used to analyse postpartum depression, mother-child bonding, stress factors and coping strategies for mothers at a paediatric intensive care unit (PICU; n = 38) and a group of mothers without known psychiatric disorders attending a babywell visit with their child (n = 91). Descriptive statistics and interaction models were calculated. RESULTS: The PICU group showed on average higher total scores on the postpartum bonding questionnaire indicating mother-child bonding impairment and a higher proportion of mothers with depression was observed (76% vs 11%). The model showed a significant interaction between effective coping strategies and mother infant bonding (p = 0.04). Ineffective coping had no effect on bonding or depression in the PICU group. CONCLUSION: Mothers of children treated at an ICU due a congenital heart disease are at increased risk for the development of depression and difficulties in different aspects of postpartum bonding. Our results show that coping mechanisms might significantly influence postpartum bonding. Implementation of tailored support is needed to optimise maternal outcomes.

A cross-sectional, exploratory survey on health-relevant free-time activities and body mass index in preschool children in urban and rural settings of Austria.

BACKGROUND: The increasing prevalence of obesity is among the most relevant healthcare issues in Europe. The number of overweight people rises due to lifestyle changes, increased sitting activities, and less physical activity. Prevention in early childhood is paramount to stop this alarming trend. AIM: This study primarily aimed to evaluate the average time children (3-5 years) from rural and urban Austrian regions spent engaging in physical activity and sedentary behaviors in their free-time. Additionally, we investigated the potential correlation between duration and habits of free-time activity or place of residence and age- and sex-specific body mass index (BMI). The potential impact of socio-economic factors on BMI was examined. METHODS: Urban (Vienna) and rural (Carinthia) regions of Austria were chosen for this observational cross-sectional study. Preschool children (n=130) attending nurseries in these regions were included. Weight and height were measured and BMI calculated. Free-time activity and socio-economic data were asked using a self-administered questionnaire. Data on sedentary behavior time (sedentary activity and media consumption) and physical activity time (defined as organized or spontaneous exercise) were analyzed using non-parametric tests. RESULTS: Preschool children spent approximately as many hours of their free-time engaged in physical activity as in sedentary behaviors. Time trend in media consumption amounts to one-third of the cumulative time spent engaging in sedentary behaviors. Preschoolers from the urban area spent fewer hours practicing organized exercise and more in sedentary behaviors than peers in the rural area. In the selected areas, 7 % of preschoolers were overweight, 3.9 % were obese. BMI was not associated with free-time activities but showed a trendwise negative correlation with organized exercise. A positive correlation of age and organized exercise was observed but not with physical activity per se. CONCLUSIONS: Our results confirm the necessity of preventive interventions among Austrian preschoolers and lead to a better understanding of their free-time activities. Further investigations with larger study populations are needed to promote effective childhood obesity prevention and examine the differences regarding obesity prevalence and leisure-time activity between rural and urban areas.

Incidence of previously unknown cardiac malformations in asymptomatic children after prenatal obstetric ultrasound screening.

BACKGROUND: Cardiac murmurs may be frequently found in otherwise asymptomatic children. Obstetric ultrasound screening for congenital heart disease is increasingly used to provide an antenatal diagnosis and an early treatment; thus, the incidence of cardiac anomalies in children has changed. We evaluated cardiac murmurs in otherwise healthy children referred to a level I pediatric cardiology institution. METHODS: Echocardiography data from a cohort of 2045 patients from 2000 to 2009 were evaluated and the incidence and type of a newly diagnosed congenital heart disease have been determined. RESULTS: The majority of the children with a cardiac murmur were found to have an innocent murmur, chordae tendinae, or a minor lesion. Children born after obstetric screening are nevertheless associated with a small risk of severe congenital heart disease. We found 14.9% with a previously unknown congenital cardiac malformation; 1.4% required medical treatment and 0.6% of the patients had either a catheter or a surgical intervention. CONCLUSIONS: This study provides evidence that the use of obstetric screening for congenital heart disease reduces the occurrence of severe heart disease. Otherwise healthy children with murmurs still bear a small risk of having a cardiac defect, even if a prenatal study was negative. Therefore, the evaluation of children with a murmur by a pediatric cardiologist is recommended in an antenatally-screened population.

Renal pyelectasis in fetuses and neonates: diagnostic value of renal pelvis diameter in pre- and postnatal sonographic screening.

OBJECTIVE: Pre- and postnatal pyelectasis detected by sonographic screening is of questionable pathologic importance. Therefore, we defined the natural course and diagnostic value of renal pelvis diameter (RPD) during fetal life and the neonatal period as such dilatation was revealed on routine sonography. MATERIALS AND METHODS: Routine sonography in pregnant women was obtained between gestational weeks 22 and 30. Sonograms were obtained for 1021 fetuses, of which 15 could not be followed up as neonates. The remaining 1006 fetuses also underwent neonatal sonography. All neonates with an RPD larger than 5 mm were followed up sonographically. Neonates with an RPD larger than 9 mm or persistent widening (> 5-9 mm) were examined by voiding cystourethrogram, radionuclide renogram, or both. RESULTS: Thirty fetuses (3%) had an RPD larger than 5 mm. Nine of these fetuses also had an RPD larger than 5 mm as neonates. Of these nine neonates, one had bilateral grade II vesicoureteric reflux (VUR) and two had urinary tract obstructions (one posterior urethral valve and one ureteropelvic junction obstruction). Forty-nine neonates whose results on fetal sonograms had been normal showed an RPD larger than 5 mm on neonatal sonograms. Grade III VUR was found in one boy, and ureteropelvic junction obstruction was found in two boys. The kidneys of 54 neonates who showed an RPD larger than 5 mm without urinary tract obstruction were followed up until an RPD of 0-5 mm was evident. RPD normalized within 1 year of birth, whether VUR was present or not. Symptomatic urinary tract infection was diagnosed in 17 infants who had no renal pelvis dilatation seen on pre-or postnatal screening during the observation period. Seven of the 17 neonates had VUR. Conversely, none of the infants with pre- postnatal dilatation presented with symptomatic urinary tract infection. However, in one neonate an asymptomatic urinary tract infection without VUR was diagnosed by routine urinalysis. CONCLUSION: In our study, we linked renal pelvis dilatation on pre- and postnatal sonograms to obstructive uropathies rather than to vesicoureteric reflux. Prenatal sonography proved less sensitive than postnatal sonography in revealing obstructive uropathies. An RPD smaller than 10 mm on neonatal sonography was of no pathologic significance because renal collecting systems normalized spontaneously in all infants within 1 year of birth. These neonates and infants had no significant risk for urinary tract infection and did not need further evaluation.

Special compression sutures: a new surgical technique to achieve a quick decrease in shunt volume caused by diffuse hemangiomatosis of the liver.

A new surgical technique for the management of shunting liver hemangiomas that otherwise would rapidly lead to intractable cardiac failure is presented. Rapid, significant reduction of shunt volume was achieved surgically by transhepatic compression sutures using PTFE pledgets and selective ligation of a large feeding vessel from the right hepatic artery.