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Wu YH, Hsiao CH, Chen YL, Tsai LY, Mu SC. Rare type of tracheal agenesis: Unexpected presentation and immediate consideration of emergent esophageal intubation in neonatal resuscitation program. Case reports and review of the literature. Pediatr Pulmonol 2024; 59:1757-1764. [PMID: 38695627 DOI: 10.1002/ppul.26990] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/24/2023] [Revised: 01/25/2024] [Accepted: 03/15/2024] [Indexed: 05/28/2024]
Abstract
BACKGROUND Tracheal agenesis, or tracheal atresia, is a rare congenital anomaly. The presence of a tracheoesophageal fistula (TEF) can help with breathing for newborns with tracheal agenesis. In this article, we presented three unique cases and outcomes of neonates with tracheal agenesis along with a review of the literature. METHODS This study consisted of a single center case series followed by a review of literature. Case reports were generated using both written and electronic medical records from a single hospital. We summarized three unique cases and outcomes of neonates with tracheal agenesis and performed a review of the literature. RESULTS We identified three cases of tracheal agenesis presented with severe cyanosis without spontaneous crying upon birth. Experienced pediatricians attempted to intubate the babies but were unsuccessful. Endotracheal tubes were subsequently either accidentally or purposely placed into the esophagus, and oxygen saturation levels improved. This suggested tracheal agenesis with TEF. Two cases underwent surgical intervention after resuscitation with esophageal intubation. CONCLUSION Esophageal intubation may be a life-sustaining ventilation support for patients with tracheal agenesis and TEF at initial resuscitation. Clinicians should suspect tracheal agenesis when a newborn presents with severe cyanosis and voiceless crying upon birth, and esophageal intubation should be immediately attempted.
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Affiliation(s)
- Yi-Hsin Wu
- Department of Pediatrics, Shin-Kong Wu Ho-Su Memorial Hospital, Taipei, Taiwan
| | - Ching-Heng Hsiao
- Department of Medical Education, Taichung Veterans General Hospital, Taichung, Taiwan
- School of Medicine, College of Medicine, Taipei Medical University, Taipei City, Taiwan
| | - Yi-Ling Chen
- Department of Pediatrics, Shin-Kong Wu Ho-Su Memorial Hospital, Taipei, Taiwan
| | - Li-Yi Tsai
- Department of Pediatrics, Shin-Kong Wu Ho-Su Memorial Hospital, Taipei, Taiwan
| | - Shu-Chi Mu
- Department of Pediatrics, Shin-Kong Wu Ho-Su Memorial Hospital, Taipei, Taiwan
- School of Medicine, College of Medicine, Fu Jen Catholic University, New Taipei City, Taiwan
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2
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Pfeifer M, Rehder H, Gerykova Bujalkova M, Bartsch C, Fritz B, Knopp C, Beckers B, Dohle F, Meyer-Wittkopf M, Axt-Fliedner R, Beribisky AV, Hofer M, Laccone F, Schoner K. Tracheal agenesis versus tracheal atresia: anatomical conditions, pathomechanisms and causes with a possible link to a novel MAPK11 variant in one case. Orphanet J Rare Dis 2024; 19:114. [PMID: 38475835 DOI: 10.1186/s13023-024-03106-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2023] [Accepted: 02/23/2024] [Indexed: 03/14/2024] Open
Abstract
BACKGROUND In this study we aimed to describe the morphological and pathogenetic differences between tracheal agenesis and tracheal atresia, which are not clearly distinguished from each other in the literature, and to contribute thereby to the understanding and management of these conditions. Both tracheal agenesis and tracheal atresia represent rare disorders of still unknown aetiology that cannot be detected by prenatal ultrasound. If the affected foetuses survive until birth these conditions result in respiratory failure and in futile attempts to rescue the infant's life. RESULTS Autopsies and genetic analyses, including singleton or trio exome sequencing, were performed on five neonates/foetuses with tracheal agenesis and three foetuses with tracheal atresia. Tracheal agenesis was characterized by absence of the sublaryngeal trachea and presence of a bronchooesophageal fistula and by pulmonary isomerism and occurred as an isolated malformation complex or as part of a VACTERL association. Special findings were an additional so-called 'pig bronchus' and a first case of tracheal agenesis with sirenomelia. Tracheal atresia presenting with partial obliteration of its lumen and persistence of a fibromuscular streak resulted in CHAOS. This condition was associated with normal lung lobulation and single, non-VACTERL type malformations. Trio ES revealed a novel variant of MAPK11 in one tracheal agenesis case. Its involvement in tracheooesophageal malformation is herein discussed, but remains hypothetical. CONCLUSION Tracheal agenesis and tracheal atresia represent different disease entities in terms of morphology, pathogenesis and accompanying anomalies due to a primary developmental and secondary disruptive possibly vascular disturbance, respectively.
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Affiliation(s)
- Mateja Pfeifer
- Institute of Medical Genetics, Medical University of Vienna, Waehringer Strasse 10, 1090, Vienna, Austria
| | - Helga Rehder
- Institute of Medical Genetics, Medical University of Vienna, Waehringer Strasse 10, 1090, Vienna, Austria.
- Institute of Pathology, Fetal Pathology, Philipps-University of Marburg, Marburg, Germany.
| | - Maria Gerykova Bujalkova
- Institute of Medical Genetics, Medical University of Vienna, Waehringer Strasse 10, 1090, Vienna, Austria
| | - Christine Bartsch
- Institute of Forensic Medicine, University of Zürich, Zurich, Switzerland
- Berlin School of Economics and Law (HWR), Berlin, Germany
| | - Barbara Fritz
- Institute of Human Genetics, Philipps-University of Marburg, Marburg, Germany
| | | | | | - Frank Dohle
- Department of Pediatrics, Children's Center Bethel, University Bielefeld, Bielefeld, Germany
| | | | - Roland Axt-Fliedner
- Division of Prenatal Medicine and Fetal Therapy, University Hospital Giessen, Giessen, Germany
| | - Alexander V Beribisky
- Institute of Medical Genetics, Medical University of Vienna, Waehringer Strasse 10, 1090, Vienna, Austria
| | - Manuel Hofer
- Institute of Medical Genetics, Medical University of Vienna, Waehringer Strasse 10, 1090, Vienna, Austria
| | - Franco Laccone
- Institute of Medical Genetics, Medical University of Vienna, Waehringer Strasse 10, 1090, Vienna, Austria
| | - Katharina Schoner
- Institute of Pathology, Fetal Pathology, Philipps-University of Marburg, Marburg, Germany
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3
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Hino Y, Hayashida M, Kitadai Y, Kan N, Tsukimori K. A case of tracheal agenesis: Prenatal imaging resembles esophageal atresia. Pediatr Int 2022; 64:e14753. [PMID: 34761853 DOI: 10.1111/ped.14753] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/23/2020] [Revised: 04/12/2021] [Accepted: 04/21/2021] [Indexed: 11/26/2022]
Affiliation(s)
- Yuko Hino
- Department of Pediatric Surgery, Fukuoka Children's Hospital, Fukuoka, Japan
| | - Makoto Hayashida
- Department of Pediatric Surgery, Fukuoka Children's Hospital, Fukuoka, Japan
| | - Yuzo Kitadai
- Department of Obstetrics, Fukuoka Children's Hospital, Fukuoka, Japan
| | - Nobuhiko Kan
- Department of Neonatal Cardiology, Fukuoka Children's Hospital, Fukuoka, Japan
| | - Kiyomi Tsukimori
- Department of Obstetrics, Fukuoka Children's Hospital, Fukuoka, Japan
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4
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Akhter AP, Donn SM. The challenging airway: Tracheal agenesis in the newborn. J Neonatal Perinatal Med 2021; 15:663-665. [PMID: 34974441 DOI: 10.3233/npm-210846] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
A preterm female presented with severe respiratory distress in the delivery room and was found to have tracheal agenesis with a tracheoesophageal fistula and a congenital heart defect. Tracheal agenesis is uncommon and is often associated with other congenital abnormalities. Although there are surgical options for repair, mortality remains high.
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Affiliation(s)
- A P Akhter
- Department of Pediatrics, Division of Neonatal-Perinatal Medicine, C.S. Mott Children's Hospital, Michigan Medicine, University of Michigan, Ann Arbor, Michigan USA
| | - S M Donn
- Department of Pediatrics, Division of Neonatal-Perinatal Medicine, C.S. Mott Children's Hospital, Michigan Medicine, University of Michigan, Ann Arbor, Michigan USA
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5
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Lupariello F, Di Vella G, Botta G. Death Shortly after Delivery Caused by Congenital High Airway Obstruction Syndrome. Fetal Pediatr Pathol 2020; 39:179-183. [PMID: 31342827 DOI: 10.1080/15513815.2019.1644688] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Background: Congenital High Airway Obstruction Syndrome (CHAOS) is an uncommon anomaly. Prenatal ultrasonography allows a prenatal diagnosis to prepare for immediate surgical correction at birth. If the obstruction is severe and a correct therapeutic approach is not planned, CHAOS can cause neonatal death shortly after delivery from a potentially surgically correctable lesion.Case report: This neonate died unexpectedly shortly after delivery due to CHAOS. Ultrasonographic findings of enlarged echogenic lungs, dilated airways distal to the obstruction, flattened or inverted diaphragms, or ascites were absent. This was due to a type-II laryngeal-atresia and a type-C esophageal-atresia, with a resultant distal fistula that allowed intrauterine decompression of the fluid in the lungs.Conclusions: The absence of prenatal ultrasonographic findings of CHAOS may be due to a lower fistula between respiratory and gastrointestinal tracts. This set of associations may not be a surgically correctable cause of CHAOS.
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Fishel-Bartal M, Watad H, Hoffmann C, Achiron R, Barzilay E, Katorza E. Fetal brain MRI in polyhydramnios: is it justified? J Matern Fetal Neonatal Med 2018; 32:3986-3992. [PMID: 29865922 DOI: 10.1080/14767058.2018.1480605] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Introduction: Despite meticulous investigation of polyhydramnios cases, in many of these cases, congenital anomalies are detected only after birth. The aim of our study was to explore the contribution of fetal brain MRI to the detection of CNS anomalies in cases of polyhydramnios. Materials and methods: This was retrospective cohort study on fetuses referred for the investigation of polyhydramnios at a single tertiary center. All fetuses underwent a detailed sonographic anatomical scan and a fetal brain MRI. Isolated and nonisolated polyhydramnios were differentiated according to associated anomalies. MRI findings were compared between the groups. Results: A total of 46 fetuses were included in the study. Brain anomalies were detected in ultrasound in 12 (26%) cases while MRI detected brain anomalies in 23 (50%) cases. MRI detected more anomalies in fetuses with nonisolated compared to isolated polyhydramnios (62.9% and 31.6%, respectively, p = .019). Conclusions: Fetal brain MRI may contribute to the evaluation of fetuses with polyhydramnios. The clinical value and cost-effectiveness of MRI use in the routine work-up of polyhydramnios should be assessed in future studies.
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Affiliation(s)
- Michal Fishel-Bartal
- Antenatal Diagnostic Unit, Department of Obstetrics and Gynecology, Chaim Sheba Medical Center, Tel Hashomer, Sackler School of Medicine, Tel Aviv University , Tel Aviv , Israel
| | - Hadel Watad
- Antenatal Diagnostic Unit, Department of Obstetrics and Gynecology, Chaim Sheba Medical Center, Tel Hashomer, Sackler School of Medicine, Tel Aviv University , Tel Aviv , Israel
| | - Chen Hoffmann
- Diagnostic Radiology, Chaim Sheba Medical Center, Tel Hashomer, Sackler School of Medicine, Tel Aviv University , Tel Aviv , Israel
| | - Reuven Achiron
- Antenatal Diagnostic Unit, Department of Obstetrics and Gynecology, Chaim Sheba Medical Center, Tel Hashomer, Sackler School of Medicine, Tel Aviv University , Tel Aviv , Israel
| | - Eran Barzilay
- Antenatal Diagnostic Unit, Department of Obstetrics and Gynecology, Chaim Sheba Medical Center, Tel Hashomer, Sackler School of Medicine, Tel Aviv University , Tel Aviv , Israel
| | - Eldad Katorza
- Antenatal Diagnostic Unit, Department of Obstetrics and Gynecology, Chaim Sheba Medical Center, Tel Hashomer, Sackler School of Medicine, Tel Aviv University , Tel Aviv , Israel
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Dethe V, Lamghare P, Bagale S, Agarwal V. Creating Order Out of Chaos - Role of Antenatal Ultrasound in Diagnosis. Pol J Radiol 2018; 82:463-465. [PMID: 29662573 PMCID: PMC5894023 DOI: 10.12659/pjr.901757] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2016] [Accepted: 11/25/2016] [Indexed: 11/09/2022] Open
Abstract
Background Congenital high airway obstruction syndrome (CHAOS) is a rare fetal anomaly characterized by obstruction of the higher fetal airway. This could be either complete or incomplete and is more commonly seen at the subglottic level, resulting in a spectrum of characteristic secondary features. Case Report In this case study, we report two cases of CHAOS with one showing laryngeal atresia and the other, tracheal atresia. Both these cases showed characteristic findings on a detailed, meticulous USG examination which led to this diagnosis. Conclusions Early and accurate diagnosis offers a window of opportunity for parental counseling and management using procedures such as EXIT (ex-utero intrapartum procedure). Earlier, CHAOS was thought to be incompatible with life; however, with the advent of ex-utero intrapartum procedure, a few cases of post-natal survival have been noted in the literature. In this article, we emphasize the sonographic findings found in CHAOS. Early diagnosis offers an opportunity for a intrauterine fetal intervention in potentially lethal cases.
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Affiliation(s)
- Vaibhav Dethe
- Department of Radiology, Byramjee Jeejeebhoy Medical College and Sassoon General Hospital, Pune, Maharashtra, India
| | - Purnachandra Lamghare
- Department of Radiology, Byramjee Jeejeebhoy Medical College and Sassoon General Hospital, Pune, Maharashtra, India
| | - Sachin Bagale
- Department of Radiology, Byramjee Jeejeebhoy Medical College and Sassoon General Hospital, Pune, Maharashtra, India
| | - Vasudha Agarwal
- Department of Radiology, Byramjee Jeejeebhoy Medical College and Sassoon General Hospital, Pune, Maharashtra, India
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Agarwal A, Nakao M, Rajadurai VS, Chandran S. Neonatal airway: challenging endotracheal intubation in infants with tracheal malformations at birth. BMJ Case Rep 2017; 2017:bcr-2016-218818. [PMID: 28408368 DOI: 10.1136/bcr-2016-218818] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
Intubating newborn infants can be exacting. We describe two cases of endotracheal intubations in infants born with tracheal malformations. A male infant aged 30 weeks required intubation at birth for respiratory distress. Repeated attempts at intubation failed to achieve an optimal endotracheal tube position as the tube could not advance beyond the vocal cords. Hence ventilation continued with suboptimal air entry in the lungs. Bronchoscopy and CT scan confirmed tracheal stenosis. Slide tracheoplasty was successfully executed on day 78 of life. A female infant aged 33 weeks was intubated at birth for perinatal depression. Attempts at intubation were unsuccessful due to non-visualisation of the laryngeal inlet. Oesophagus was intubated and attempts to inflate showed air entry in the lungs, suggesting a fistulous communication between oesophagus and airway. A contrast oesophagogram showed a fistula connecting oesophagus and carina. With airway patency in question and associated major anomalies, parents were counselled and support was withdrawn.
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Affiliation(s)
- Arpan Agarwal
- Department of Neonatology, KK Women's and Children's Hospital, Singapore
| | - Masakazu Nakao
- Department of Cardiothoracic Surgery, KK Women's and Children's Hospital, Singapore
| | - Victor Samuel Rajadurai
- Department of Neonatology, KK Women's and Children's Hospital, Singapore.,Yong Loo Lin School of Medicine, Singapore.,Lee Kong Chian School of Medicine, Singapore.,Duke-NUS Medical School, Singapore
| | - Suresh Chandran
- Department of Neonatology, KK Women's and Children's Hospital, Singapore .,Yong Loo Lin School of Medicine, Singapore.,Lee Kong Chian School of Medicine, Singapore.,Duke-NUS Medical School, Singapore
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9
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Jansen G, Schmidt B, Mertzlufft F, Boesing T, Barthel M. [CHAOS in neonatal emergency care? : Tracheal agenesis in the obstetric theatre]. Anaesthesist 2017; 65:763-767. [PMID: 27612864 DOI: 10.1007/s00101-016-0220-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Tracheal agenesis (TA) is a very rare congenital malformation of unknown aetiology. It is often associated with polymalformative syndromes; the neonates commonly present a critical condition during post-natal treatment. Pathology revolves around the triad of aphonia, respiratory distress syndrome and impossibility of endotracheal intubation. In contrast to the most important differential diagnosis, i. e., congenital high airway obstruction syndrome (CHAOS), surgical airway management is also impossible due to the absence of tracheal structures. In most cases, prognosis is very poor. The case report at hand portrays the treatment of a neonate suffering from tracheal agenesis.
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Affiliation(s)
- G Jansen
- Klinik für Anästhesiologie, Intensiv-, Notfall-, Transfusionsmedizin und Schmerztherapie, Evangelisches Krankenhaus Bielefeld gGmbH, Burgsteig 13, 33617, Bielefeld, Deutschland.
| | - B Schmidt
- Klinik für Anästhesiologie, Intensiv-, Notfall-, Transfusionsmedizin und Schmerztherapie, Evangelisches Krankenhaus Bielefeld gGmbH, Burgsteig 13, 33617, Bielefeld, Deutschland
| | - F Mertzlufft
- Klinik für Anästhesiologie, Intensiv-, Notfall-, Transfusionsmedizin und Schmerztherapie, Evangelisches Krankenhaus Bielefeld gGmbH, Burgsteig 13, 33617, Bielefeld, Deutschland
| | - T Boesing
- Klinik für Kinder- und Jugendmedizin, Evangelisches Krankenhaus Bielefeld gGmbH, Bielefeld, Deutschland
| | - M Barthel
- Klinik für Kinderchirurgie, Evangelisches Krankenhaus Bielefeld gGmbH, Bielefeld, Deutschland
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Grass B, Simma L, Reinehr M, Zimmermann U, Gysin C, Henze G, Cannizzaro V. Two case reports of unexpected tracheal agenesis in the neonate: 3 C's beyond algorithms for difficult airway management. BMC Pediatr 2017; 17:49. [PMID: 28178944 PMCID: PMC5299661 DOI: 10.1186/s12887-017-0806-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/22/2016] [Accepted: 02/06/2017] [Indexed: 11/30/2022] Open
Abstract
Background Handling neonates with postnatal respiratory failure due to congenital airway malformations implies knowledge about emergency management of unexpected difficult airway. In these stressful situations both technical and communication skills of the caretakers are essential. Case presentation Two cases with prenatally unknown tracheal agenesis are reported. Conclusion In the presented cases, airway malformation and subsequent difficulties upon endotracheal intubation were not adequately communicated between caretakers. We discuss the aspects of culture, communication, and capnography.
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Affiliation(s)
- Beate Grass
- Department of Intensive Care Medicine and Neonatology, University Children's Hospital Zurich, Steinwiesstrasse 75, 8032, Zurich, Switzerland. .,Children's Research Center, University Children's Hospital Zurich, Steinwiesstrasse 75, 8032, Zurich, Switzerland.
| | - Leopold Simma
- Department of Intensive Care Medicine and Neonatology, University Children's Hospital Zurich, Steinwiesstrasse 75, 8032, Zurich, Switzerland.,Children's Research Center, University Children's Hospital Zurich, Steinwiesstrasse 75, 8032, Zurich, Switzerland
| | - Michael Reinehr
- Department of Pathology, University Hospital Zurich, Raemistrasse 100, 8091, Zurich, Switzerland
| | - Urs Zimmermann
- Department of Neonatology, Hospital Buelach, Spitalstrasse 24, 8180, Buelach, Switzerland
| | - Claudine Gysin
- Department of Otorhinolaryngology, University Children's Hospital Zurich, Steinwiesstrasse 75, 8032, Zurich, Switzerland.,Children's Research Center, University Children's Hospital Zurich, Steinwiesstrasse 75, 8032, Zurich, Switzerland
| | - Georg Henze
- Department of Anesthesia, University Children's Hospital Zurich, Steinwiesstrasse 75, 8032, Zurich, Switzerland.,Children's Research Center, University Children's Hospital Zurich, Steinwiesstrasse 75, 8032, Zurich, Switzerland
| | - Vincenzo Cannizzaro
- Department of Intensive Care Medicine and Neonatology, University Children's Hospital Zurich, Steinwiesstrasse 75, 8032, Zurich, Switzerland.,Children's Research Center, University Children's Hospital Zurich, Steinwiesstrasse 75, 8032, Zurich, Switzerland
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