Potential Benefit of Probiotic E. Coli Nissle in Term Neonates.

BACKGROUND: Probiotics are often viewed as an immunity enhancing agent. The objective of this study was to investigate whether oral administration of Escherichia coli Nissle 1917 reduces the number of infections, their duration, and severity in the first 24 months after parturition in healthy neonates. SUBJECTS AND METHODS: This prospective, confirmatory, randomised, double-blind, placebo-controlled study enrolled 567 healthy neonates from four German and two Polish sites. Neonates received 10e8 viable E. coli Nissle (n=283) or placebo (n=284) daily in the first week and every second day in week 2 and 3. After 6 and 12 months, the subjects received additional instillations on ten subsequent days. The overall efficacy was assessed by the number of infections per observation period. RESULTS: Incidence rates of infection, infection duration and severity showed no statistically significant difference between groups after 24 months. Post-hoc analyses, however, revealed a short-term benefit of E. coli Nissle four weeks after treatment start which became less pronounced after eight weeks. E. coli Nissle was safe and well tolerated. CONCLUSIONS: A long-term effect after colonising the healthy neonate´s gut with E. coli Nissle to protect against infections could not be shown. Additional studies are needed to confirm a transitory, yet clinically significant role of probiotics in the first four weeks after parturition.

A novel MECP2 mutation in a boy with neonatal encephalopathy and facial dysmorphism.

Methly-CpG-binding protein 2 (MECP2) mutations cause Rett syndrome in females. Here we report on a male infant with neonatal encephalopathy, myoclonic jerks, and irregular breathing patterns caused by a novel frameshift mutation in the MECP2 gene. In addition he has facial dysmorphisms previously not described in these patients.

[Aspiration of milk in healthy infant--cause of acute respiratory arrest?]. / Atemstillstand bei einem gesunden Säugling durch Aspiration?

We present the case of 4month old female infant, who obviously suffered from a respiratory arrest during bottle-feed ing. After primary successful resuscitation the baby died after 49 days due to large intracranial hemorrages. The diagnosis of shaking trauma was based on the detailed medical examinations and on the case history taken from the police file. The life-threatening shaking trauma is rare as an emergency. Therefore every doctor should be aware of a potential victim in cases of infants who are normal developed without signs of injuries, have no history of a severe disease and show life-threatening symptomes.

Intrauterine torsion of a testicular teratoma: a case report.

Neonatal testicular tumors and intrauterine testicular torsions are very rare. The presented case is the first describing intrauterine torsion of a descended testis with a teratomatous tumor. Immediately after birth, right hemiscrotal swelling was seen in a preterm male newborn. Surgical intervention showed extravaginal testicular torsion and a highly differentiated testicular teratoma with haemorrhagic infarction. The testis was removed (orchiectomy). Over a period of twelve months no signs of tumor recurrence were found. While being extremely rare, testicular tumors should be included in the differential diagnosis of neonatal scrotal swelling.

Obstructive sleep apnea syndrome in children: a state-of-the-art review.

Snoring and obstructive sleep apnea are a frequent problem not only in adults, but also in children and adolescents, as can be seen from current epidemiological data. The epidemiology, etiology, diagnosis, and management of obstructive sleep apnea syndrome (OSAS) in adults have been adequately established on the basis of evidential data. As a result of this, both physicians and the public are increasingly aware of OSAS in adults. Although there are numerous parallels between pediatric and adult OSAS, the situation in children differs that in adults. There is a greater variety of symptoms in children with OSAS, diagnosis is often more difficult with serious consequences for growth and development of children. Treatment of OSAS in children is also different from that of the adult patient. There are many possible causes for the development of obstructive sleep apnea in children. These include hypertrophy of the tonsils and syndromes such as Down syndrome, Pickwickian syndrome, Prader-Willi syndrome or Marfan syndrome. OSAS can, however, also be the result of obesity, midfacial dysplasia, retro- or micrognathia, allergic rhinitis or muscular dystrophy. Epidemiological data presented in the literature concerning the incidence of OSAS in children is extremely varied. This wide range is probably due to the fact that snoring may be misdiagnosed as OSAS. The diagnosis of OSAS in children may only be made by considering clinical history (such as rate of growth, tendency to fall asleep during the day, sleep disturbances, susceptibility to infection, etc.), polysomnography (if possible during several nights) and accompanying instrumental diagnosis including cephalometry or laryngoscopy. One of the problems of polysomnography in childhood is that performance and interpretation of the results have not yet been standardized or evaluated for different age groups. Treatment depends on the cause of OSAS and require multidisciplinary management involving the pediatrician, pediatric or adolescent psychiatrist, ear, nose, and throat specialist, maxillofacial surgeons, and neurosurgeons. Adenotonsillectomy (ATE) is the therapy generally chosen if the child has adenoidal vegetations and/or tonsillar hypertrophy. Corrective surgery is possible for rare malformation syndromes. Nocturnal masks for continuous positive airway nasal pressure or procedures for mask respiration are effective in children, but are only used in exceptional cases, such as when ATE is contraindicated or when symptoms of OSAS remain after surgery. The success of pharmacological treatment of OSAS in children has not been evaluated in controlled clinical trials.

Longevity of Masimo and Nellcor pulse oximeter sensors in the care of infants.

OBJECTIVE: Pulse oximetry is a standard of care for monitoring oxygenation in neonates. Associated with the use of pulse oximetry is the cost of patient sensors, especially if the sensor is designed for single-patient use. Pulse oximetry monitoring of sick newborns is routine and often lengthy and, if the pulse oximeter sensor is short-lived, can result in a significant portion in the cost of intensive care. METHODS: We evaluated, in the NICUs of two hospitals and one step-down nursery, the useful life of disposable neonatal pulse oximeter sensors from two manufacturers: Masimo and Nellcor. The only requisites were ethics committee approval and need for monitoring. The timed of PO sensor placement and replacement were noted along with the reason for changing the sensor. The standard care practices for PO and sensor use in the respective institutions were followed. RESULTS: A total of 835.5 patient days of monitoring were accumulated with 65 infants in the Masimo group and 56 using Nellcor. The Masimo Neo sensors had over twice (2.33) the useful life of the Nellcor N-25 (9.05+/-4.4 versus 3.9+/-2.3 days (range of 7.2-11.8 and 2.5-5.8 days, respectively, p<0.05)). The magnitude of useful life between the two institutions was not significantly different in the Masimo group (2.35- versus 2.22-fold). PO sensors were replaced due to impaired adhesion (38 Masimo and 32 Nellcor) and no signal (six Masimo and four Nellcor). CONCLUSIONS: We found a more than two-fold increase in the life of Masimo versus Nellcor sensors. This difference was consistent between various caregivers in multiple settings and corroborates the experience of another, more limited study. A cost savings should result from the use of Masimo versus Nellcor disposable pulse oximeter sensors in neonatal routine care

[Reliability of home monitoring with event-recording compared with polysomnography in infants]. / Zuverlässigkeit eines Heimmonitors mit Event-Recording im Vergleich zur kontinuierlichen Polysomnographie im Säuglingsalter.

AIM OF THE STUDY: Although reliable recognition of hypoxemia, apnea, bradycardia and tachycardia is absolutely necessary for home monitoring, many commercially available home monitors have not been sufficiently tested for their sensitivity. The purpose of this study was to determine the reliability of the home monitor VitaGuard 3000 by comparing it with the manual evaluation of full polysomnography (polysomnographic system Alice 3). PATIENT AND METHODS: 20 infants (11 males; 9 females) aged between 5 and 40 weeks (12.2 +/- 3.5 weeks, median 10.5) and with a gestational age between 29 and 41 weeks (37.7 +/- 6.1 weeks, median 39.0) were tested using both full polysomnography and, simultaneously, the home monitor VitaGuard 3000. The results were evaluated manually and compared. RESULTS: The monitor system detected 7/51 central apneas, 6/260 desaturations and 7/18 tachycardias. The sensitivity was 13.72% for apnea, 4.23% for desaturation and 38.80% for tachycardia. The reliability of the home monitor for detecting apnea, desaturation and tachycardia was therefore insufficient. CONCLUSION: A polysomnographic reliability test should be mandatory for all home monitoring systems prior to commercial introduction.

Swaddling: a traditional care method rediscovered.

BACKGROUND: This study was undertaken to compare the sleep profiles of healthy infants in swaddling and sleeping bag conditions. METHODS: Polysomnographs of 85 healthy infants (40 in the study group, 45 in the control group) with a mean age of 7.5 weeks were recorded in the sleeping laboratory. A positive decision from the local Ethics Committee and the written consent of the parents were obtained for the study. RESULTS: Swaddling significantly reduces the rate of spontaneous waking (events/h: 1.39 [0.85-2.77] vs. 2.81 [1.49-4.53], P=0.020) and the number of sleep stage changes (events/h: 3.82 [2.97-5.16] vs. 5.37 [3.58-6.67], P=0.015). Swaddling promotes quiet sleep (36.37% [29%-40.31%] vs. 30.2% [24.45%-36.78%], P=0.032), the time spent awake was decreased (8.98% [4.62%-14.25%] vs. 14.17% [9.2%-18.94%], P=0.001) and sleep efficiency was increased (91.02% [85.75%-95.38%] vs. 85.83% [81.06%-90.8%], P=0.001). CONCLUSION: Swaddling promotes a more quiet sleep in infants.

Normative values of polysomnographic parameters in childhood and adolescence: quantitative sleep parameters.

OBJECTIVE: To provide normative values for sleep macroarchitecture of healthy children aged 1-18 years using the AASM sleep scoring criteria, assessing the effects of gender, age, and Tanner pubertal stage. METHODS: One-night polysomnography was performed at subjects' habitual bedtimes in 16 laboratories on 209 healthy German children. RESULTS: Normal values of sleep macrostructure show significant age dependencies (p<0.05). Increasing with age: awakening index, R latency (RL), sleep efficiency (SE) (total sleep time (TST)/sleep period time (SPT)) and SE (TST/time in bed), stage N2, mean sleep cycle duration, number of stage shifts. Decreasing with age: TST, SPT, wake after sleep onset, stage N3, stage R, movement time (MT), number of sleep cycles. The following sleep parameters show a dependency on Tanner stages as well as corresponding age (p<0.05):TST, SPT, awakening index, R latency, stage N2, stage N3, MT, number of sleep cycles, mean sleep cycle duration. No gender dependencies were found. CONCLUSION: The given study, considering AASM rules, shows the development of sleep in normal children ages 1-18. Subject selection criteria and other factors influencing sleep as well AASM guideline modifications including scoring arousals in N2 and scoring MT as a measure of sleep fragmentation are discussed.