Non-neurological, steroid-related adverse events in very low birth weight infants: a prospective audit.

BACKGROUND AND STUDY PURPOSE: To assess the incidence of cardiac and metabolic adverse events in very low birth weight (VLBW) infants receiving systematic steroids. PATIENTS AND METHODS: Prospective single centre audit in VLBW infants (<1,500 g) at the neonatal intensive care unit at the University Children's Hospital of Saarland, Germany. RESULTS: A total of 72 VLBW infants (38 female) were included in this report (mean birth weight: 967 ± 338 g; range: 320-1490 g). Birth weight, gestational age and Apgar scores were significantly lower in the steroid group (p <0.01). Mortality rate was 8/72 (7/34 in the steroid treated vs nontreated 1/38; odds ratio [OR]: 9.6; 95% confidence interval [CI]: 1.1-82.6 p = 0.02). In 34/72 infants, steroids were given (22 hydrocortisone alone; 12 combination of hydrocortisone and dexamethasone). The most common indication for use of steroids was respiratory distress syndrome (RDS) and respiratory insufficiency (30/34). Adverse events that occurred more often in the steroid group included hypertrophic cardiomyopathy (14/34 vs 0/38; p <0.001); thrombus formation (8/34 vs 1/38; OR: 11.4; 95% CI: 1.3-96.6; p <0.05), hyperglycaemia (27/34 vs 3/38; OR: 45.0; 95% CI: 10.6-190.4; p <0.01), hypernatraemia (15/34 vs 7/38; OR: 3.5; 95% CI: 1.2-10.1; p <0.05), and sepsis/infections (8/34 vs 1/38; OR: 11.4; 95% CI: 1.3-96.6; p <0.05). No significant differences were seen between hydrocortisone alone and the combination of hydrocortisone with dexamethasone. Birth weight and severity of RDS were predictors of steroid use (p <0.01). CONCLUSIONS: The use of steroids was significantly associated with severe short-term adverse events - most importantly hypertrophic cardiomyopathy and thrombus formation. These complications must be taken into consideration when administering steroids to VLBW infants.

Recent trends in the burden of alcohol intoxication on pediatric in-patient services in Germany.

AIMS: To elicit data on alcohol intoxications requiring in-patient treatment in children and adolescents in Germany between 2000 and 2002. DESIGN AND PARTICIPANTS: An ex-post analysis was performed to assess the number of children and adolescents (age 10-17 years) with acute alcohol intoxications requiring in-patient hospital treatment (> or =24 hours). SETTING: 22 major children hospitals in Germany. FINDINGS: The number of acute alcohol intoxications requiring in-patient treatment increased from 227 in 2000 to 313 in 2001 (+37.9%; p*<.01) and 350 in 2002 (+10.6%; p*<.05). 10-12 year-old children comprised 2.2%, adolescents aged 13-14 years 28.6%, and adolescents aged 15-17 years 69.2% of the study population. The most significant increase was seen in adolescents aged 13-14 years (2001: +35.9%, and 2002: +19.3%; p*<.05), and 15-17 years (2001: +59.1%, and 2002: +10.1%; p*<.05). The percentage of female patients increased from 34.1% in 2000 to 41.9% in 2001 and 49.8% in 2002 (p*<.05). Mean time spent in the hospital was 1.7 days (range: 1 day-->4 days). DISCUSSION AND CONCLUSIONS: This is one of the very few studies that provide epidemiological data on the specific issue of alcohol intoxications in children and adolescents that require in-patient treatment. Apparently, gender differences seem to play a minor role in alcohol-related hospital admissions. Our data demonstrate that excessive alcohol consumption remains an issue of concern in this age cohort.