Morbidity in Newborns Readmitted Into a Hospital After Discharge From a Maternity Unit During the First 28 Days of Their Lives - Results From the Rhine-Main Area, Germany.

BACKGROUND: The neonatal period can be associated with a multitude of medical and social problems. Little is known about the reasons that lead to neonatal readmissions in a pediatric hospital and their individual outcomes. OBJECTIVE: To record the diagnosis of neonatal admissions in a pediatric hospital after discharge from a maternity unit. Predictive parameters are to be identified and a possible trend over the years is to be examined. METHODS: The medical history of newborns admitted to a pediatric hospital in the Rhine-Main area from 01/01/2004 to 31/12/2013 was retrospectively analyzed based on provided medical files. RESULTS: The data of 2851 newborns was recorded. 72% of the patients were delivered by vaginal birth. During the period under examination, there was a certain fluctuation although no significant trend in the number of admissions per year (p=0.062). The most frequent primary diagnoses were jaundice (27%), newborn infection (12.4%), and feeding problems (12.3%). Exclusively breastfed newborns had fewer feeding problems than newborns with a mixed or purely formula diets (p < 0.001). CONCLUSIONS: The results of this study showed that the hospital readmissions of newborns throughout the years did not increase. Unfortunately, owing to the retrospective character of the study, it is not possible to make a clear statement as to whether hospitalization can be prevented with more intensive preventative measures. A prospective study on this matter is being planned.

[Critical Outcome and Hypoxic Ischemic Encephalopathy - A quality Assurance Issue]. / Kritisches Outcome und Hypoxisch-Ischämische Enzephalopathie (HIE) ­ Ein Thema der Qualitätssicherung.

The study evaluates the predictive value of the critical status of a newborn as to the risk of developing hypoxic ischemic encephalopathy (HIE). METHODS: On the basis of the data set from the perinatal survey in Hesse, Germany, in the year 2016, including 52,122 live births (singleton, 37+0 GA), cases of critical newborns were identified. A conjoined analysis with the data set of the neonatal survey from the identical period provided the basis to evaluate the relationship to cases compromised by HIE. RESULTS: The incidence of cases with a critical outcome (n=11) and those with HIE (n=29) was low. The sensitivity of the status of the newborn for detecting a risk of HIE was 10.34%. The specificity was 99.98%. The positive predictive value was 27.35%. The negative predictive value was 99.95%. The detailed, confidential single-case analysis indicated the ability to avoid negative outcomes in about one third of cases with a critical status of the newborn (4/11) and HIE (9/29). DISCUSSION AND CONCLUSION: The likelihood of developing encephalopathy (HIE) increases after a critical outcome after birth. Intensified monitoring of these newborns is justified. A single-case analysis identifies the potential ways to improve perinatal outcomes. Measures of external quality assurance should integrate the analysis of both perinatal and neonatal surveys as a basis for quality management (QM).

Mucormycosis in paediatric patients: demographics, risk factors and outcome of 12 contemporary cases.

Mucormycosis is associated with high morbidity and mortality and is perceived as an emerging fungal infection. However, contemporary paediatric data are limited. We present a series of paediatric cases of mucormycosis reported from Germany and Austria collected within a voluntary epidemiological survey through standardised, anonymized case report forms. Twelve cases were reported between January 2004 and December 2008 (six men; mean age: 12.6 years, range: 0.1-17 years). Mucormycosis was proven in nine, and probable in three cases. Isolates included Lichtheimia (syn. Absidia pro parte, Mycocladus) (five), Rhizopus (three) and Mucor (one) species. Infection was limited to soft tissue in three cases, the lung in two cases, and an infected thrombus in one case; rhinocerebral disease was found in three cases, and pulmonary-mediastinal, pulmonary-cerebral and soft tissue-cerebral involvement in one case each. All three patients with isolated soft tissue infection were cured, whereas seven of the remaining patients died (one patient without follow-up). The overall mortality rate was 67%. While these data cannot provide conclusive data on incidence and disease burden of mucormycosis in paediatric patients, they reflect the continuing threat of these infections to immunocompromised patients and the need for improved diagnosis and management.

A new type of transfusion-dependent congenital dyserythropoietic anemia.

Cases of congenital dyserythropoietic anemia (CDA) that do not conform to any of the three classical types often present diagnostic difficulties and are at risk of developing secondary hemochromatosis. Here, we report a case of a six year old boy with transfusion dependency and gross abnormalities of the erythroblasts.

Treatment with bovine surfactant in severe acute respiratory distress syndrome in children: a randomized multicenter study.

OBJECTIVE: To determine whether bovine surfactant given in cases of severe pediatric acute respiratory distress syndrome (ARDS) improves oxygenation. DESIGN: Single-center study with 19 patients, followed by a multicenter randomized comparison of surfactant with a standardized treatment algorithm. Primary endpoint PaO(2)/FIO(2) at 48 h, secondary endpoints: PaO(2)/FIO(2) at 2, 4, 12, and 24 h, survival, survival without rescue, days on ventilator, subgroups analyzed by analysis of variance to identify patients who might benefit from surfactant. SETTING: Multicenter study in 19 reference centers for ARDS. PATIENTS: Children after the 44th postconceptional week and under 14 years old, admitted for at least 4 h, ventilated for 12-120 h, and without heart failure or chronic lung disease. In the multicenter study 35 patients were recruited; 20 were randomized to the surfactant group and 15 to the nonsurfactant group. Decreasing recruitment of patients led to a preliminary end of this study. INTERVENTIONS: Administration of 100 mg/kg bovine surfactant intratracheally under continuous ventilation and PEEP, as soon as the PaO(2)/FIO(2) ratio dropped to less than 100 for 2 h (in the pilot study increments of 50 mg/kg as long as the PaO(2)/FIO(2) did not increase by 20%). A second equivalent dose within 48 h was permitted. RESULTS: In the pilot study the PaO(2)/FIO(2) increased by a mean of 100 at 48 h (n=19). A higher PaO(2)/FIO(2) ratio was observed in the surfactant group 2 h after the first dose (58 from baseline vs. 9), at 48 h there was a trend towards a higher ratio (38 from baseline vs. 22). The rate of rescue therapy was significantly lower in the surfactant group. Outcome criteria were not affected by a second surfactant dose (n=11). A significant difference in PaO(2)/FIO(2) in favor of surfactant at 48 h was found in the subgroup with an initial PaO(2)/FIO(2) ratio higher than 65 and in patients without pneumonia. CONCLUSIONS. Surfactant therapy in severe ARDS improves oxygenation immediately after administration. This improvement is sustained only in the subgroup of patients without pneumonia and that with an initial PaO(2)/FIO(2) ratio higher than 65

Head size and motor performance in children born prematurely.

PURPOSE: The objective of this study was to determine the relationship between head circumference (HC) and motor performance in 6- to 12-yr-old children born prematurely (PRE: birthweight < or = 1500 g, gestational age < or = 32 wk) and in children born at term (CON). METHODS: Thirty-three PRE and 21 CON without an apparent neurological deficit participated in this study. HC was measured on the day of testing and was rated as small HC (SHC, HC more than 1 SD below the 50th percentile of reference data) or as normal HC (NHC). Subjects were examined by an experienced neuropediatrician, and whole-body coordination was assessed by the Körper-Koordinationstest für Kinder (KTK). Peak exercise performance was determined by a Wingate test and an incremental cycling test to volitional fatigue. Net oxygen cost of cycling was measured during four different tasks lasting 5-7 min each. Subjects pedaled at an intensity corresponding to 30% and 60% of peak oxygen uptake ([OV0312]O(2peak)) at a cadence of 36 and 76 rpm, respectively. RESULTS: Prematures with SHC showed no statistically significant difference in their neurological examination and whole-body coordination compared with prematures with NHC. Wingate test performance and [OV0312]O(2peak) relative to body mass were similar among SHC, NHC, and CON. In SHC, but not in NHC and CON, net oxygen cost of cycling increased significantly (P < 0.05) when cadence was increased from 36 to 76 rpm. CONCLUSION: At the age of 6-12 yr, SHC have a higher oxygen cost of cycling in exercise tasks requiring high velocity, which might be explained-at least in part-by an impaired neural control of intra- and intermuscular coordination.

Effect of head-up body tilt position on autonomic function and cerebral oxygenation in preterm infants.

Skin-to-skin care (kangaroo) of premature infants causes orthostatic stress. Therefore, the effect of head elevated body tilt position (HETP) of 30 degrees and supine repositioning on systemic and cerebral oxygenation, circulation and sympathetic-vagal balance was investigated in 36 pre-term infants (25-36 weeks), from day 2 to 12 of life. Continuous polygraphic recordings revealed initial maximal fluctuations of total cerebral hemoglobin content (tHb) up to 42% following HETP determined by near infrared spectroscopy. After stabilization within several minutes, prolonged tilting did not result in any further significant changes of tHb, heart rate, mean arterial pressure and oxygen saturation measured by pulseoxymetry. Respiratory frequency was reduced by 6-12%. Spectral analysis of heart rate variability revealed a greater increase in low frequency than high frequency activity following HETP reflecting a relative increase in sympathetic versus vagal activation. Only preterm infants < or =1,500 g showed a significant decrease of regional cerebral oxygen saturation (rSO(2)) of about 2-5% from day 2 to 8. As this mild decrease in rSO(2) is clinically insignificant, there were no severe side effects of prolonged tilting in stable preterm infants even during the first days of life. However, the initial decline of tHb might be critical in very immature infants and needs further investigations.