N(1520) 3/2(-) helicity amplitudes from an energy-independent multipole analysis based on new polarization data on photoproduction of neutral pions

New data on the polarization observables T, P, and H for the reaction γp→pπ(0) are reported. The results are extracted from azimuthal asymmetries when a transversely polarized butanol target and a linearly polarized photon beam are used. The data were taken at the Bonn electron stretcher accelerator ELSA using the CBELSA/TAPS detector. These and earlier data are used to perform a truncated energy-independent partial wave analysis in sliced-energy bins. This energy-independent analysis is compared to the results from energy-dependent partial wave analyses.

Decrease of the incidence of renin-angiotensin-system inhibitor induced oligohydramnios-sequence in Germany in 2011

AIM

to assess whether the incidence of angiotensin II-receptor type 1 antagonist (AT1-antagonist)– or ACE-inhibitor induced cases of oligohydramnios sequence (OHS) in 2011 was reduced after intensive alerts as to the causal association between AT1-antagonist /ACE-inhibitor and OHS in the German medical literature.

METHOD

3 sources of information were used: A nationwide active surveillance of OHS in German paediatric hospitals (ESPED); Embryotox, (Berlin Institute for Clinical Teratology and Drug Risk Assessment in Pregnancy) and screening of pubmed (AT1-antagonist/ACE-inhibitor induced OHS).

RESULTS

45 cases of OHS were identified, no case due to maternal AT1-antagonist/ACE-inhibitor treatment. Causes for OHS were: premature rupture of membranes (PPROM) (n = 28), congenital anomalies of fetal kidneys and urinary tract(CAKUT (n = 15), placental insufficiency (n = 1),unknown cause (n = 1). Mortality until discharge was 37.8 % (32.1 % PPROM, 57.1 % CAKUT). Embryotox identified 3 exposures to AT1-antagonists in pregnancy, no case was associated with OHS. The pubmed search did not identify any case of OHS related to AT1-antagonist/ACE-inhibitor in pregnancy in Germany in 2011.

CONCLUSION

Treatment of pregnant women with ACE inhibitors or AT1-antagonists still occurs but no cases of AT1-antagonist- or ACE-inhibitor induced OHS were reported in 2011 in Germany most likely due to repeated published alerts underlining the importance of consequent education. OHS remains a serious condition with high mortality despite modern intensive care.

Transiente neonatale Myasthenia gravis

Ten to twenty percent of the offspring of mothers suffering from myasthenia gravis (MG) also develop transient neonatal MG, since maternal antibodies are able to cross the placenta. We report the course of two newborns of a mother with MG and a healthy father. The first pregnancy was complicated during the 3rd trimester by a hydramnion. The newborn presented with generalized muscle weakness, respiratory distress, weak sounding, anaemia, and poor sucking. Mechanical ventilation was necessary. Confirmation of the diagnosis was achieved by the result of repetitive muscle stimulation, showing a typical decrement in the EMG, and measurement of serum antiacetylcholin receptor antibodies. For 3 months, the infant was treated with neostigmin (cholinesterase inhibitor). After 26 days of hospitalization, the patient was released and followed up regularly. Myasthenic symptoms completely resolved. Side effects of the treatment were not observed. The course of the second pregnancy was normal. This second newborn was healthy. Our case report is remarkable for the very different presentation of two children of the same mother with MG during pregnancy and after delivery, with one child developing severe transient neonatal MG, initially requiring intensive care unit (ICU) treatment followed by quick recovery, and one child being healthy. We also present a score for monitoring the clinical course and adjusting anticholinesterase therapy accordingly.

Disposition of midazolam in asphyxiated neonates receiving therapeutic hypothermia--a pilot study

Moderate hypothermia has become an established therapy for asphyxiated neonates. Midazolam is a frequently used sedative for this indication, although it has never been investigated how therapeutic hypothermia and asphyxia influence midazolam metabolism in neonates.9 asphyxiated newborns were treated with whole body hypothermia of 32-34°C for 72 h and all of them received continuous midazolam infusion for sedation. Serum concentrations of midazolam and its metabolites 1-hydroxy-midazolam and 4-hydroxy-midazolam were measured during hypothermia and the rewarming period. Renal and hepatic parameters were assessed to take into account the influence of asphyxia related renal or hepatic impairment.We found a high interindividual variability of serum midazolam concentrations in asphyxiated neonates with therapeutic hypothermia; median midazolam concentration was 369.3 ng/ml (minimum 36.6; maximum 3 218.6 ng/ml). The population pharmacokinetic model revealed a midazolam clearance of 2.57 ml/kg/min, comparable to midazolam clearances observed in normothermic critically ill neonates. However, midazolam clearance was significantly decreased in patients with asphyxia related renal and hepatic impairment.It seems that isolated hypothermia does not significantly influence midazolam metabolism. However, neonates with asphyxia related hepatic and renal impairment are at risk of generating unexpectedly high serum midazolam concentrations. In addition pronounced interindividual variability of midazolam metabolism may contribute to dangerously high midazolam concentrations.

Neonatal opiate withdrawal and rooming-in: a retrospective analysis of a single center experience

AIM

To evaluate our treatment of neonatal abstinence syndrome (NAS), our experience with rooming-in of opiate-dependent mothers and to examine the influence of rooming-in on short term outcome of infants exposed to opiates in utero.

METHOD

Retrospective analysis of maternal and perinatal data of newborn infants with NAS treated between 2004 and 2011 in a level 3 academic children's hospital in a German metropolis. Therapy of NAS and duration of therapy, length of hospital stay and costs were considered in particular.

FINDINGS

Data of 77 newborns with NAS were analysed. 84.6% of infants were treated with tincture of opium (79.2% rooming-in, 88.7% no rooming-in). Infants with rooming-in (n=24) had a 17% shorter median duration of therapy [27.0 d (IQR 24.0-38.5), no rooming-in (n=53) 32.5 d (IQR 25.0-54.5)] and shorter median length of hospital stay [33.0 d (IQR 28.0-48.0), no rooming-in 41.5 d (IQR 30.3-54.5)]. Demographic data was comparable between newborns and mothers with or without rooming-in. Costs were median 13 457 € (IQR 8 967-17 494)/patient [rooming-in: 9 547 € (IQR 7 024-16 135), no rooming-in: 14 486 € (IQR 9 479-19 352)].

CONCLUSIONS

Rooming-in in NAS should be encouraged to shorten duration of therapy and length of hospital stay and thereby reduce costs. No major problems arose in the care of the infants with NAS when parents stayed with their infants but close monitoring of the newborn and strict instruction of parents are required.

Observations on the effects of inhaled isoflurane in long-term sedation of critically Ill children using a modified AnaConDa©-system

Long-term intravenous sedation may present problems due to dependence and side effects. Medical records of children who were administered isoflurane were reviewed. 15 patients (9 boys, 6 girls) with a mean age of 11.8 month (+2.4) were analysed.Analgesia and sedation was given in mean 9.7+1.1 days before commencing inhalation using a modified application device (AnaConDa©). Administration was given over a period of 7.2+1.4 days. Depth of sedation was monitored by using Comfort- and Hartwig-scores. Observations included continuous monitoring of heart-rate, pulse oxymetry, blood pressure and cerebral tissue oxygenation.Within 4 h post administration of isoflurane a satisfactory increase in the depth of sedation was seen and kept till extubation. 6/15 patients received tracheostomies during the observation period. None of the patients observed suffered life-critical events of the modified application of isoflurane proceeded without complications. Ketamine and clonidine infusion rates were significantly reduced (p<0.005) as well as the use and overall infusion rate of midazolam, γ-hydroxy butyrate, fentanyl and morphine (p<0.05).Isoflurane inhalation may provide an additional option for long-term sedation in a specific group of critically ill infants but neurodegenerative toxic effects will have to be taken into account when using volatile anesthetics at any time during infancy.

New method for density determination of nanoparticles using a CPS disc centrifuge™

A model has been developed for the determination of the correct absolute size of nanoparticles using a disc centrifuge; the method does not require externally measured or literature derived particle densities. The principle of this method is the altered settling velocity of particles in fluids with different viscosities and/or densities, with the use of a linear regression analysis for the calculation of particle densities. This allows a fast particle density determination with at least two measurements using a disc centrifuge and a small subset of easily measurable parameters. Furthermore, correctness of the model is evaluated using viruses and nonbiological particles of known densities.

The flexion withdrawal reflex reveals an increasing threshold during the first year of life and is influenced by the infant's state of consciousness

BACKGROUND

The idea that preterm and term infants are capable of experiencing pain is now widely accepted. However, there is still insufficient knowledge how pain perception develops throughout infancy. A promising approach to quantify the level of spinal excitability in infants is to measure cutaneous sensitivity by the flexion withdrawal reflex (WR). In our study we wanted to test how the threshold of the WR develops in healthy infants during the first year of life. Furthermore, we aimed to analyse the impact of the state of consciousness on the reflex threshold.

PATIENTS AND METHOD

In 44 healthy infants we tested the threshold of the WR with calibrated von-Frey-Filaments at the age of 3 days as well as with 4, 12, 26 and 52 weeks. To analyse the influence of the state of consciousness on the reflex threshold, we documented at 12, 26 and 52 weeks whether the infants were quietly awake or lightly asleep during testing.

RESULTS

The median threshold of the WR increased during the first year of life from 1.2 g up to 4.6 g at the age of 1 year. At 12, 26 and 52 weeks we found significantly lower thresholds in sleeping infants compared to infants being awake (p=0.004, p<0.001 and p=0.086, respectively).

CONCLUSION

The threshold of the flexion withdrawal reflex increases during infancy, probably reflecting neuronal maturation processes in the first year of life. Besides postnatal age, the threshold of the WR also depends on the state of consciousness. Therefore, future studies about the WR should consider postnatal age as well as the state of consciousness.

Live chilling of Atlantic salmon: physiological response to handling and temperature decrease on welfare

Investigation of the physiological effects of live chilling in Atlantic salmon, Salmo salar, has been performed in two experiments. In the first, fish (mean weight 840 g) acclimatized to either 16, 8, or 4°C were directly transferred horizontally or vertically (9 combinations) to water temperatures of 16, 8, 4, or 0°C using a dip net. Blood samples were collected at 1 and 6 h (h) post-transfer. In the second experiment, fish (mean weight 916 g) acclimatized to 16°C were exposed to four temperature-drop regimes (no physical handling): 16-4°C (over 5 h), 16-4°C (over 1 h), 16-0°C (over 5 h), and 16-0°C (over 1 h). Blood samples were collected 1 h post-temperature drop. Physical transfers in the first trial, i.e., temperature drops, resulted in immediate (1 h) increases in blood lactate concentrations at all three temperatures, but levels were significantly reduced and close to pre-transfer levels after 6 h. Horizontal transfers, i.e., 16-16°C, 8-8°C, and 4-4°C, resulted in similar increases and were not significantly different from the groups exposed to temperature drops. The most severe vertical transfer (16-0) resulted in a swift loss of equilibrium and eventually death. In experiment 2, temperature drops from 16 to 4°C and from 16 to 0°C over a period of one or 5 h, without physically handling the fish, resulted in no significant increases in any of the measured parameters 1 h post-transfer, except in the 16-0 (1 h) group. The latter experienced a significant increase in blood sodium, glucose, lactate, and cortisol levels compared to all other groups. The results suggest that salmon are capable of tolerating relatively steep temperature drops without any significant negative effects on blood stress parameters and that physical stress from handling overrides the effect of thermal insults.

Comparison of the novel ResPlex III assay and existing techniques for the detection and subtyping of influenza virus during the influenza season 2006-2007

Influenza virus is a major cause of disease worldwide. The accurate detection and further subtyping of influenza A viruses are important for epidemiologic surveillance, and subsequent comprehensive characterization of circulating influenza viruses is essential for the selection of an optimal vaccine composition. ResPlex III is a new multiplex reverse transcriptase polymerase chain reaction (RT-PCR)-based method for detecting, typing, and subtyping influenza virus in clinical specimens. The ResPlex III assay was compared with other methods with respect to sensitivity and accuracy, using 450 clinical specimens obtained from subjects throughout Germany during the 2006–2007 influenza season. Samples were analyzed for the presence of influenza virus in Madin-Darby canine kidney (MDCK) cells by rapid cell culture using peroxidase staining and conventional cell culture confirmed by hemagglutination inhibition assay, a rapid diagnostic assay (Directigen Flu A+B test; BD Diagnostic Systems, Heidelberg, Germany), in-house real-time RT-PCR (RRT-PCR), and ResPlex III (Qiagen, Hilden, Germany). ResPlex III had the highest sensitivity for detecting influenza virus in clinical specimens, followed by in-house RRT-PCR (96% compared with ResPlex III). Conventional cell culture in MDCK cells, rapid culture, and quick test assays were substantially less sensitive (55%, 72%, and 39%, respectively). Virus subtyping results were identical using ResPlex III and the standard virological subtyping method, hemagglutination inhibition. ResPlex III is a quick, accurate, and sensitive assay for detecting and typing influenza A and B viruses and subtyping influenza A viruses in clinical specimens, and might be considered for a supplemental role in worldwide seasonal and pandemic influenza surveillance.

Mothers seeing their VLBW infants within 3 h after birth are more likely to establish a secure attachment behavior: evidence of a sensitive period with preterm infants?

OBJECTIVE

Close contact of mother and child in the first hours after birth is essential for the establishment of a secure attachment behavior in term infants. To date, studies investigating whether a 'sensitive period' also exists for very low birth weight (VLBW) preterm infants are lacking.

STUDY DESIGN

Attachment patterns of 62 VLBW infants were assessed using the 'strange situation' setting and correlated with the time mothers saw their child for the first time. Furthermore, maternal and infant covariates possibly influencing the attachment behavior were analyzed. As maternal factors the mother's age, social status and pregnancy history were recorded and at three time points (time 1, 2 and 3 (t-1, t-2 and t-3)), a semi-structured interview, a depression and a social support questionnaire were performed. As infant factors neonatal basic data, ventilation time and length of hospital stay were recorded. Disease severity was scored using the clinical risk index for babies, score for neonatal acute physiology (SNAP), SNAP perinatal extension and nursery neurobiological risk score. At time points t-2 and t-3, the infants were examined using the second edition of Bayley scales of infant development.

RESULTS

In all, 53.2% of the children showed a secure, 33.9% an insecure-avoidant, 3.2% an insecure-ambivalent and 9.7% an insecure-disorganized attachment behavior. Preterm infants whose mothers had seen them within 3 h after birth had a higher rate of secure attachment than preterm infants with no early contact (76 versus 41%, P=0.009). Firstborns showed a significantly higher rate of insecure attachment behavior (93 versus 67%, P=0.01). No influence on attachment behavior was shown for any other maternal or infant factor.

CONCLUSIONS

Our results support the hypothesis that the first hours after birth are a 'sensitive period' for the development of attachment behavior in VLBW infants. When a mother is enabled to see her infant shortly after birth, the 'sensitive period' right after birth may be used to help forming an important basis for the secure attachment of the preterm infant.

[Recommendations for the use of polyhexanide-containing products for the treatment of wounds]

Polihexanide-containing wound products are often used for the treatment of acute and chronic wounds. Although information pertaining to the use of polihexanide can be found in the literature, the appropriate use of these products in clinical practice is not always clear. The goal of this short review is to provide clinically relevant recommendations to physicians and nurses treating patients with acute and chronic wounds. This review describes the clinically relevant characteristics of polihexanide and gives recommendations for the prophylaxis and treatment of wound infections.

Surfactant in spontaneous breathing with nCPAP: neurodevelopmental outcome at early school age of infants ≤ 27 weeks

AIM

In 2001, we implemented the 'surfactant without intubation' (SWI) method to administer surfactant during spontaneous breathing with nasal continuous positive airway pressure in preterm infants. To determine whether application of the SWI method in infants born at ≤ 27 weeks gestational age influences early school age outcome.

METHODS

A historical control cohort was compared to an interventional cohort, when the SWI method had become part of primary respiratory support. According to the overall results of psychometric and neurological examinations, children were classified as showing no functional impairment, minor or major impairments.

RESULTS

Out of 79 surviving children, 54 (68%, two children not completely classifiable) were assessed at a median age of 6 5/12 years [25 (32%) lost to follow-up]. Thirteen of 31 (42%, interventional cohort) vs. 8 of 21 (38%, control cohort) children had no functional impairment, 16 (52%) vs. 9 (43%) showed minor, and 2 (7%) vs. 4 (19%) major impairments.

CONCLUSION

There was no statistically significant difference regarding neurodevelopmental school age outcome in children treated after implementing the SWI procedure, even though surviving infants had been more immature and survival rates had increased.

Angiotensin II receptor blocker induced fetopathy: 7 cases

BACKGROUND

During a period of 12 months 7 newborns with a partially severe fetopathy caused most probably by maternal sartan-intake in pregnancy were treated in 5 German teaching hospitals. Sartans antagonize the effect of angiotensin II at the AT1-receptor and are used to treat arterial hypertension.

METHOD

We presented 2 cases at the yearly GNPI meeting 2010 and we were informed about similar cases in other German teaching hospitals which we brought together in this publication.

RESULTS

In the presented cases, maternal sartan intake was noticed at different times in pregnancy and was in part discontinued some weeks before delivery. In all pregnancies oligohydramnios was present and fetal kidneys displayed a hyperechogenic structure on ultrasound. The newborns' postnatal course varied: oligohydramnios sequence with lung hypoplasia, arterial hypotension and renal insufficiency were the predominant problems of the first days of life. The majority (4/7) of infants did not survive this period, in other cases there was a complete (1/7) recovery of renal function whereas others survived with renal impairment (2/7), in part requiring chronic dialysis. Further distinctive features seen frequently were disturbances of cranial ossification and flaccid paralysis of hands and feet with deviations as well as sensorineural hearing loss.

CONCLUSION

These case reports again underline the hazardousness of maternal sartan intake with potential fatal outcome for the newborn. Though the use of sartans in pregnancy is contraindicated and several case reports of sartan induced fetopathies exist, the risk of sartan treatment generally seems to be underestimated.

Life-threatening hypernatremic dehydration in a 7-week-old exclusively breastfed infant as a cause of a decline in breastmilk volume and parental language barriers in a North African family

Breast-feeding is regarded as the most appropriate source of nutrition for healthy, full-term newborns and infants. Here, we present the case of a full-term, seven week old male infant who was exclusively breast-fed but who developed severe hypernatremic dehydration as a result of declined breast milk volume that was not recognized by the parents. In order to prevent serious therapy-associated side effects due to rapid rehydration, we performed a rehydration regime providing a slow decrease of serum sodium levels by carefully infusing hypertonic saline solution. Following this approach, the patient could be discharged without any noticeable disorder. As the incidence of breast-feeding associated hypernatremic dehydration in the developed countries is increasing, strategies of prevention are discussed.