Postnatal maturation of skin barrier function in premature infants

BACKGROUND

In preterm infants, skin barrier maturation entails regional variability.

OBJECTIVES

To characterize postnatal skin barrier development in covered, uncovered and diapered regions in healthy premature infants over a longitudinal observation period.

METHODS

Transepidermal water loss (TEWL), stratum corneum hydration (SCH), pH and sebum were measured at postnatal ages of 1-7 days and 2-7 weeks on the forehead, abdomen, thigh and buttock of preterm infants (gestational age 30-37 weeks; n = 48) under monitored ambient conditions. A standard minimal skin care regimen was practised.

RESULTS

TEWL increased significantly on the buttock (p = 0.007), while remaining stable on the forehead, abdomen and thigh. SCH and sebum remained stable in all studied body regions with increasing age. On the buttock, pH increased (p = 0.049), while other body regions exhibited a significant decrease (p ≤ 0.019). TEWL (p < 0.001) and SCH (p ≤ 0.002) revealed significantly higher values on the buttock, compared to other body regions.

CONCLUSIONS

Stable TEWL, SCH and sebum values may indicate a lack of skin barrier maturation. Postnatal decrease in skin pH suggests an adaptation process with acid mantle formation. Differences in skin barrier development were observed between anatomical regions. SCH, TEWL and pH values demonstrated a distinct course in the diaper area, indicating an impaired skin barrier function in this region.

[Google translate is not sufficient to overcome language barriers in neonatal medicine]

Language barriers hinder the interaction with patients and relatives. The use of language services increases knowledge, satisfaction and the use of medical care and thus improves patient's clinical outcome. The recommended use of professional interpreters (PI) is not always feasible. We tested an online translation tool as an alternative for PI for the transla-tion of standardized sentences from a neonatal doctor-/nurse-relative-interview.Translation of 20 sentences from a German neonatal intensive care unit parent information brochure to English, Portuguese and Arabic, using Google Translate (GT). Assessment of accuracy concerning grammar and content, in a second step simplification of all incorrect sentences, translation by GT and critical re-assessment and evaluation.An average of 42% of the sentences was correctly translated concerning grammar and content. The proportion of incorrectly translated sentences varied between 45-70%. By simpli-fication another 23% were translated correctly.Translations by GT were often incorrect in content and grammar. We suppose that the design of GT, which is a statistical translation engine, might be an explanation for this phenomenon. Presently, GT cannot guarantee unambiguous translations and cannot substitute PIs, only in particular circumstances, the use of GT or similar engines may be justified. For future use of electronic translation services, we suggest to compile a catalogue of sentences containing central information, which can be translated into defined foreign languages without misinterpretation or loss of information.

Pilot study of experiences and needs of 111 fathers of very low birth weight infants in a neonatal intensive care unit

OBJECTIVE

To study the experiences and needs of the fathers of very low birth weight (VLBW, <1500 g) infants in a neonatal intensive care unit (NICU).

STUDY DESIGN

An anonymous self-report questionnaire was administered to fathers of VLBW infants born between Jan 1, 2008 and December 31, 2009 at two tertiary NICUs.

RESULT

A total of 111 of 273 fathers responded to the questionnaire. Responses to a variety of items, including self-perception, parenting attitudes, confidence, emotional pressure to satisfaction and self-efficacy as a parent were similar for the fathers of this survey and previous results for mothers of VLBW infants. Fathers judged direct bedside support by the NICU team as sufficient. However, 54.4% of fathers reported missing nonbedside interventions such as VLBW father-specific baby care courses, seminars or workshops, and platforms or chatrooms on the internet.

CONCLUSION

Bedside support of fathers, accomplished by the NICU team, could be complemented by additional father-specific non-bedside support, such as peer-education measures or interactive mass media.

[Postnatal therapy for congenital toxoplasmosis: a comparison of 2 different treatment approaches]

Protocols recommended in the USA and Germany for the postnatal treatment of congenital toxoplasmosis are mainly based on the National Collaborative Chicago-based Congenital Toxoplasmosis Study that calls for daily administration of pyrimethamine in combination with sulfadiazine for several months, then 3 times a week. The recommended total duration of treatment is 12 months. This scheme necessitates frequent white blood cell counts that often result in the discontinuation of treatment because of severe neutropenia even with the concomitant administration of folinic acid. In contrast, the administration of pyrimethamine with sulfadoxine every 2 weeks for 2 years, as used by a referral centre in Toulouse, France, is associated with less toxicity. The efficacy may even be improved, as judged by the rate of new chorioretinal lesions. In the absence of larger randomised studies the Toulouse protocol appears to have several advantages when a decision has to be made to treat infants with congenital toxoplasmosis.

Reversal of morphine-induced urinary retention after methylnaltrexone

Methylnaltrexone, a peripherally acting µ-opioid receptor antagonist, has been studied in adults for the treatment of opioid-induced constipation in advanced illness. Here, the authors document the first neonate to receive methylnaltrexone in an attempt to resolve morphine-induced urinary retention. An asphyxiated term newborn infant underwent induced hypothermia and received morphine by continuous intravenous infusion. After 36 h, the patient developed progressive urinary retention (calculated bladder volume 63 ml), followed by venous congestion of the lower extremities. Attempted bladder catheterisation was unsuccessful. Voiding occurred within 20 min after intravenous administration of methylnaltrexone (0.15 mg/kg body weight). A relapse of urinary retention 24 h later responded well to a second dose of methylnaltrexone. There were no adverse effects and no opioid withdrawal symptoms. The neonate had normal findings in cranial MRI that was performed after elective cessation of induced hypothermia.