Screening for complications and associated conditions in children, adolescents and young adults with Type 1 diabetes mellitus in the Netherlands: Big differences in a small country.

INTRODUCTION: Children, adolescents and young adults with Type 1 diabetes mellitus need to be screened for chronic complications and associated (autoimmune) diseases. There are no Dutch national guidelines for screening available but the International Society for Pediatric and Adolescent Diabetes (ISPAD) gives recommendations in its guidelines. The ISPAD guidelines from 2014 were updated in 2018. OBJECTIVES: The adherence of the Dutch pediatric diabetes clinics to the international guidelines as stated by the ISPAD. METHODS: A questionnaire about screening method and frequency was send to all members of the Dutch national committee for pediatric diabetes. The screening policies of the pediatric diabetes clinics were compared to the ISPAD guidelines of 2014 and 2018. RESULTS: Sixty-two percent of all diabetes clinics filled out the questionnaire. None of the diabetes clinics followed all recommendations of the ISPAD. The majority of the clinics had a higher frequency of screening, performed extra blood tests and did not personalize their policy to the individual patient. Approximately one third of the diabetes clinics still commenced screening for chronic complications at the age of 10 years, as recommended in the previous version of the ISPAD guideline. CONCLUSIONS: Dutch pediatric diabetes clinics screen their patients on chronic complications and associated conditions very differently and not according to the international (and most recent) guidelines. A more individualized approach with respect to the newest ISPAD guidelines will diminish the burden for the patient and medical costs as well.

[A neonate with a vaginal cyst]. / Een neonaat met een vaginale cyste.

During the physical examination of a full-term neonate we noticed a stalked, fluid-filled appendix, attached to the posterior vagina wall. A 'hymenal tag' was diagnosed: an innocent, self-limiting phenomenon caused by maternal oestrogens.

Limitations and opportunities of transcutaneous bilirubin measurements.

OBJECTIVE: Although transcutaneous bilirubinometers have existed for over 30 years, the clinical utility of the technique is limited to a screening method for hyperbilirubinemia, rather than a replacement for invasive blood sampling. In this study, we investigate the reason for this limited clinical value and address possibilities for improvement. METHODS: To obtain better insight into the physiology of bilirubin measurements, we evaluated a transcutaneous bilirubinometer that determines not only the cutaneous bilirubin concentration (TcB) but also the blood volume fraction (BVF) in the investigated skin volume. For 49 neonates (gestational age 30 ± 3.1 weeks, postnatal age 6 [4-10] days) at our NICU, we performed 124 TcB and 55 BVF measurements. RESULTS: The TcB correlated well with the total serum bilirubin concentration (TSB) (r = 0.88) with an uncertainty of 55 µmol/L. The BVF in the measured skin volume ranged between 0.1% and 0.75%. CONCLUSIONS: The performance of our bilirubinometer is comparable to existing transcutaneous devices. The limited clinical value of current bilirubinometers can be explained by the low BVF in the skin volume that is probed by these devices. Because the TcB depends for over 99% on the contribution of extravascular bilirubin, it is a physiologically different parameter from the TSB. Hence, the standard method of evaluation that compares the TcB to the TSB is insufficient to fully investigate the clinical value of transcutaneous bilirubinometers, ie, their predictive value for kernicterus. We suggest that the clinical value may be improved considerably by changing either the method of evaluation or the technological design of transcutaneous bilirubinometers.

Optical properties of neonatal skin measured in vivo as a function of age and skin pigmentation.

Knowledge of the optical properties of neonatal skin is invaluable when developing new, or improving existing optical techniques for use at the neonatal intensive care. In this article, we present in vivo measurements of the absorption µ(a) and reduced scattering coefficient µ(s) (') of neonatal skin between 450 and 600 nm and assess the influence of age and skin pigmentation on the optical properties. The optical properties were measured using a spatially resolved, steady state diffuse reflectance spectroscopy setup, combined with a modified spatially resolved diffusion model. The method was validated on phantoms with known values for the absorption and reduced scattering coefficient. Values of µ(a) and µ(s) (') were obtained from the skin at four different body locations (forehead, sternum, hand, and foot) of 60 neonates with varying gestational age, postnatal age, and skin pigmentation. We found that µ(a) ranged from 0.02 to 1.25 mm(-1) and µ(s) (') was in the range of 1 to 2.8 mm(-1) (5th to 95th percentile of the patient population), independent of body location. In contrast to previous studies, no to very weak correlation was observed between the optical properties and gestational maturity, but a strong dependency of the absorption coefficient on postnatal age was found for dark skinned patients.