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Kurz H, Sever-Yildiz G, Kocsisek CV, Resch E, Großschädl C, Totschnig L, Resch B. Respiratory Syncytial Virus and Influenza During the COVID-19 Pandemic: A Two-center Experience. Pediatr Infect Dis J 2024; 43:410-414. [PMID: 38266234 PMCID: PMC11003405 DOI: 10.1097/inf.0000000000004260] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 12/18/2023] [Indexed: 01/26/2024]
Abstract
BACKGROUND The aim of the study was to determine the burden of respiratory syncytial virus (RSV) and influenza disease during the COVID-19 pandemic at 2 Austrian urban pediatric centers between October 1, 2019 and April 30, 2022. METHODS We performed a retrospective observational 2-center study on RSV- and influenza virus-associated hospitalizations in infants and children up to 18 years at the University Hospital of Graz and the Clinic Donaustadt of Vienna from October 1, 2019 to April 30, 2022. Hospitalization had to be associated with the infectious disease, proven by polymerase chain reaction, including presence of respiratory symptoms. Demographic data including underlying diseases and treatment strategies were compared between centers and diseases, respectively. RESULTS There were 826 cases in Graz and 379 in Vienna with significant more RSV cases in Graz and more influenza cases in Vienna (RSV: 76% vs. 59%, influenza: 24% vs. 41%; both P < 0.001). One death occurred in Graz due to RSV and another due to influenza in Vienna. Seasonality only slightly differed between centers and severity of diseases was not aggravated when measured by pediatric intensive care unit admission rates, need for supplemental oxygen and respiratory support between first and last seasons. Treatment regimen differed regarding higher use of antibiotics and rates of intravenous fluids in Vienna compared to higher rates of bronchodilators, corticosteroids and nose drops in Graz. CONCLUSIONS We observed higher numbers of hospitalizations due to both viruses after the lockdown but not increased severity of the diseases; and mortality remained extremely low. Preventive measures should be implemented with high priority especially focused on infants with underlying diseases.
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Affiliation(s)
- Herbert Kurz
- From the Department of Pediatrics and Adolescents, Clinic Donaustadt, Vienna, Austria
| | - Gulsen Sever-Yildiz
- Research Unit for Neonatal Infectious Diseases and Epidemiology, Medical University of Graz
| | - Corinna V. Kocsisek
- From the Department of Pediatrics and Adolescents, Clinic Donaustadt, Vienna, Austria
| | - Elisabeth Resch
- Research Unit for Neonatal Infectious Diseases and Epidemiology, Medical University of Graz
| | - Clara Großschädl
- Research Unit for Neonatal Infectious Diseases and Epidemiology, Medical University of Graz
| | - Leonie Totschnig
- Research Unit for Neonatal Infectious Diseases and Epidemiology, Medical University of Graz
| | - Bernhard Resch
- Research Unit for Neonatal Infectious Diseases and Epidemiology, Medical University of Graz
- Division of Neonatology, Department of Pediatrics and Adolescent Medicine, Medical University of Graz, Graz, Austria
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Eichberger J, Resch E, Resch B. Reliability of IL-6 Alone and in Combination for Diagnosis of Late Onset Sepsis: A Systematic Review. Children (Basel) 2024; 11:486. [PMID: 38671704 PMCID: PMC11049321 DOI: 10.3390/children11040486] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/20/2024] [Revised: 04/13/2024] [Accepted: 04/16/2024] [Indexed: 04/28/2024]
Abstract
Diagnosis of neonatal sepsis is difficult due to nonspecific signs and symptoms. Interleukin-6 (IL-6) is a promising marker for neonatal sepsis. We aimed to test the accuracy of IL-6 in neonates after 72 h of life in case of late onset sepsis (LOS). We searched for studies regarding IL-6 accuracy for the diagnosis of LOS between 1990 and 2020 using the PubMed database. Following study selection, the reported IL-6 sensitivities and specificities ranged between 68% and 100% and 28% and 100%, with median values of 85.7% and 82% and pooled values of 88% and 78% (respectively) in the 15 studies including 1306 infants. Subgroup analysis revealed a better sensitivity (87% vs. 82%), but not specificity (both 86%), in preterm infants compared to term infants or mixed populations. Early sample collection revealed the highest sensitivity (84%), but had the lowest specificity (86%). To assess quality, we used a STARD checklist adapted for septic neonates and the QUADAS criteria. Limitations of this review include the heterogeneous group of studies on the one side and the small number of studies on the other side that analyzed different combinations of biomarkers. We concluded that IL-6 demonstrated good performance especially in the preterm infant population and the best results were achieved by measurements at the time of LOS suspicion.
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Affiliation(s)
- Julia Eichberger
- Research Unit for Neonatal Infectious Diseases and Epidemiology, Medical University of Graz, Auenbruggerplatz 34/2, 8036 Graz, Austria; (J.E.); (E.R.)
| | - Elisabeth Resch
- Research Unit for Neonatal Infectious Diseases and Epidemiology, Medical University of Graz, Auenbruggerplatz 34/2, 8036 Graz, Austria; (J.E.); (E.R.)
- Division of Neonatology, Department of Pediatrics and Adolescent Medicine, Medical University of Graz, Auenbruggerplatz 34/2, 8036 Graz, Austria
| | - Bernhard Resch
- Research Unit for Neonatal Infectious Diseases and Epidemiology, Medical University of Graz, Auenbruggerplatz 34/2, 8036 Graz, Austria; (J.E.); (E.R.)
- Division of Neonatology, Department of Pediatrics and Adolescent Medicine, Medical University of Graz, Auenbruggerplatz 34/2, 8036 Graz, Austria
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Abstract
This is a narrative review on the role of biomarkers in the diagnosis of neonatal sepsis. We describe the difficulties to obtain standardized definitions in neonatal sepsis and discuss the limitations of published evidence of cut-off values and their sensitivities and specificities. Maternal risk factors influence the results of inflammatory markers as do gestational age, the time of sampling, the use of either cord blood or neonatal peripheral blood, and some non-infectious causes. Current evidence suggests that the use of promising diagnostic markers such as CD11b, CD64, IL-6, IL-8, PCT, and CRP, either alone or in combination, might enable clinicians discontinuing antibiotics confidently within 24-48 h. However, none of the current diagnostic markers is sensitive and specific enough to support the decision of withholding antibiotic treatment without considering clinical findings. It therefore seems to be justified that antibiotics are often initiated in ill term and especially preterm infants. Early markers like IL-6 and later markers like CRP are helpful in the diagnosis of neonatal sepsis considering the clinical aspect of the neonate, the gestational age, maternal risk factors and the time (age of the neonate regarding early-onset sepsis) of blood sampling.
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Affiliation(s)
- Julia Eichberger
- Research Unit for Neonatal Infectious Diseases and Epidemiology, Medical University of Graz, Graz, Austria
| | - Elisabeth Resch
- Research Unit for Neonatal Infectious Diseases and Epidemiology, Medical University of Graz, Graz, Austria
| | - Bernhard Resch
- Research Unit for Neonatal Infectious Diseases and Epidemiology, Medical University of Graz, Graz, Austria.,Division of Neonatology, Department of Pediatrics and Adolescent Medicine, Medical University of Graz, Graz, Austria
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Eberhart M, Grisold A, Lavorato M, Resch E, Trobisch A, Resch B. Extended-spectrum beta-lactamase (ESBL) producing Enterobacterales in stool surveillance cultures of preterm infants are no risk factor for necrotizing enterocolitis: a retrospective case-control study over 12 years. Infection 2020; 48:853-860. [PMID: 32462287 PMCID: PMC7674344 DOI: 10.1007/s15010-020-01453-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2020] [Accepted: 05/22/2020] [Indexed: 12/17/2022]
Abstract
Purpose Microbial dysbiosis has been found preceding necrotizing enterocolitis (NEC) in preterm infants; thus, we aimed to investigate whether there is evidence that neonates with extended-spectrum beta-lactamase-producing Enterobacterales (ESBL-E) positive stool cultures are at higher risk for NEC at the NICU. Methods We included very preterm inborn infants of ≤ 32 weeks of gestational age being fecal carriers of ESBL-E and compared them with 1:1 matched (gestational age, birth weight, gender and year) controls tested negative for ESBL-E in the stool between 2005 and 2016. An association with NEC was defined as the first detection of ESBL-E before or at the time of definite diagnosis of NEC. Results During the study period, we diagnosed 217 infants with a total of 270 ESBL-E. We identified ten different species with ESBL-producing Klebsiella oxytoca being the most common one (46%) followed by Klebsiella pneumoniae (19%), and Citrobacter freundii (17%). Ten out of 217 infants had any kind of NEC in the case group compared to two of the controls (p < 0.01), but only four cases with predefined criteria were associated with NEC ≥ stage IIa (1.8 vs. 0.5%, p = 0.089, OR 4.1, CI95% 0.45–36.6). NEC mortality rate was 2/8 (25%). Conclusions We observed a threefold increase of ESBL-E in stool surveillance cultures during study time and germs were dominated by ESBL-producing Klebsiella spp. There was no evidence that preterm infants colonized with ESBL-E in the stool were at higher risk for definite NEC.
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Affiliation(s)
- Martin Eberhart
- Research Unit for Neonatal Infectious Diseases and Epidemiology, Medical University of Graz, Graz, Austria
| | - Andrea Grisold
- D&R Institute of Hygiene Microbiology and Environmental Medicine, Medical University of Graz, Graz, Austria
| | - Michela Lavorato
- Research Unit for Neonatal Infectious Diseases and Epidemiology, Medical University of Graz, Graz, Austria
- Policlinico Umberto I Hospital, Sapienza University of Rome, Rome, Italy
| | - Elisabeth Resch
- Research Unit for Neonatal Infectious Diseases and Epidemiology, Medical University of Graz, Graz, Austria
- Division of Neonatology, Department of Paediatrics and Adolescent Medicine, Medical University of Graz, Auenbruggerplatz 34/2, 8036, Graz, Austria
| | - Andreas Trobisch
- Research Unit for Neonatal Infectious Diseases and Epidemiology, Medical University of Graz, Graz, Austria
- Division of Neonatology, Department of Paediatrics and Adolescent Medicine, Medical University of Graz, Auenbruggerplatz 34/2, 8036, Graz, Austria
| | - Bernhard Resch
- Research Unit for Neonatal Infectious Diseases and Epidemiology, Medical University of Graz, Graz, Austria.
- Division of Neonatology, Department of Paediatrics and Adolescent Medicine, Medical University of Graz, Auenbruggerplatz 34/2, 8036, Graz, Austria.
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Garrigue D, Godier A, Glacet A, Labreuche J, Kipnis E, Paris C, Duhamel A, Resch E, Bauters A, Machuron F, Renom P, Goldstein P, Tavernier B, Sailliol A, Susen S. French lyophilized plasma versus fresh frozen plasma for the initial management of trauma-induced coagulopathy: a randomized open-label trial. J Thromb Haemost 2018; 16:481-489. [PMID: 29274254 DOI: 10.1111/jth.13929] [Citation(s) in RCA: 54] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2017] [Indexed: 01/08/2023]
Abstract
Essentials An immediate supply of plasma in case of trauma-induced coagulopathy is required. The Traucc trial compared French Lyophilised Plasma (FLyP) and Fresh Frozen Plasma (FFP). FLyP achieved higher fibrinogen concentrations compared with FFP. FLyP led to a more rapid coagulopathy improvement than FFP. SUMMARY Background Guidelines recommend beginning hemostatic resuscitation immediately in trauma patients. We aimed to investigate if French lyophilized plasma (FLyP) was more effective than fresh frozen plasma (FFP) for the initial management of trauma-induced coagulopathy. Methods In an open-label, phase 3, randomized trial (NCT02750150), we enrolled adult trauma patients requiring an emergency pack of 4 plasma units within 6 h of injury. We randomly assigned patients to receive 4-FLyP units or 4-FFP units. The primary endpoint was fibrinogen concentration at 45 min after randomization. Secondary outcomes included time to transfusion, changes in hemostatic parameters at different time-points, blood product requirements and 30-day in-hospital mortality. Results Forty-eight patients were randomized (FLyP, n = 24; FFP, n = 24). FLyP reduced the time from randomization to transfusion of first plasma unit compared with FFP (median[IQR],14[5-30] vs. 77[64-90] min). FLyP achieved a higher fibrinogen concentration 45 min after randomization compared with FFP (baseline-adjusted mean difference, 0.29 g L-1 ; 95% confidence interval [CI], 0.08-0.49) and a greater improvement in prothrombin time ratio, factor V and factor II. The between-group differences in coagulation parameters remained significant at 6 h. FLyP reduced fibrinogen concentrate requirements. Thirty-day in-hospital mortality rate was 22% with FLyP and 29% with FFP. Conclusion FLyP led to a more rapid, pronounced and extended increase in fibrinogen concentrations and coagulopathy improvement compared with FFP in the initial management of trauma patients. FLyP represents an attractive option for trauma management, especially when facing logistical issues such as combat casualties or mass casualties related to terror attacks or disasters.
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Affiliation(s)
- D Garrigue
- CHU de Lille, Pôle d'Anesthésie-Réanimation, Lille, France
- CHU Lille, Pôle de l'Urgence, Lille, France
| | - A Godier
- Service d'Anesthésie-Réanimation, Fondation Ophtalmologique Adolphe de Rothschild, Paris, France
- NSERM, UMR-S1140, Université Paris Descartes, Sorbonne Paris Cité, Paris, France
| | - A Glacet
- CHU de Lille, Pôle d'Anesthésie-Réanimation, Lille, France
- CHU Lille, Pôle de l'Urgence, Lille, France
| | - J Labreuche
- Université Lille, CHU Lille, EA 2694 - Santé Publique: Épidémiologie et Qualité des Soins, Lille, France
| | - E Kipnis
- CHU de Lille, Pôle d'Anesthésie-Réanimation, Lille, France
- Université Lille, EA 7366, Lille, France
| | - C Paris
- CHU de Lille, Institut d'Hématologie-Transfusion, Lille, France
| | - A Duhamel
- Université Lille, CHU Lille, EA 2694 - Santé Publique: Épidémiologie et Qualité des Soins, Lille, France
| | - E Resch
- EFS Hauts de France, Lille, France
| | - A Bauters
- CHU de Lille, Institut d'Hématologie-Transfusion, Lille, France
| | - F Machuron
- Université Lille, CHU Lille, EA 2694 - Santé Publique: Épidémiologie et Qualité des Soins, Lille, France
| | - P Renom
- CHU de Lille, Institut d'Hématologie-Transfusion, Lille, France
| | - P Goldstein
- CHU de Lille, Pôle d'Anesthésie-Réanimation, Lille, France
- CHU Lille, Pôle de l'Urgence, Lille, France
| | - B Tavernier
- CHU de Lille, Pôle d'Anesthésie-Réanimation, Lille, France
| | - A Sailliol
- Centre de Transfusion Sanguine des Armées, Clamart, France
| | - S Susen
- CHU de Lille, Institut d'Hématologie-Transfusion, Lille, France
- Université Lille, Inserm, CHU Lille, U1011 - EGID, Lille, France
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Reiterer F, Resch E, Haim M, Maurer-Fellbaum U, Riccabona M, Zobel G, Urlesberger B, Resch B. Neonatal Extracorporeal Membrane Oxygenation Due to Respiratory Failure: A Single Center Experience Over 28 Years. Front Pediatr 2018; 6:263. [PMID: 30320047 PMCID: PMC6167543 DOI: 10.3389/fped.2018.00263] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/07/2018] [Accepted: 09/03/2018] [Indexed: 11/19/2022] Open
Abstract
Background: ECMO therapy is worldwide declining in the neonatal population; hence, its therapeutic value is sometimes questioned. Objectives: To report our experience with neonatal ECMO due to respiratory failure over a 28 year time period. Methods: Retrospective single center observational study including all neonates admitted to ECMO due to respiratory failure between 1989 and 2016 at Graz, Austria. Data were collected regarding survival rate, duration of ECMO, complications, length of hospital stay, changes over time, and follow-up. Results: Sixty-seven neonates were admitted and 43 (64%) needed ECMO-median birth weight 3390 grams (range 1810-4150) and gestational age 39 weeks (32-43). Survival rate was 65% (28/43); with higher rates in meconium aspiration syndrome (MAS) 89% vs. congenital diaphragmatic hernia (CDH) 46% and septic shock 44% (p = 0.005 and p = 0.006, respectively). ECMO duration was median 5 days (1-30) and veno-arterial ECMO (52%) dominated. Need for ECMO therapy decreased over time (p < 0.001). Complications occurred in 31 (72%) neonates. Five neonates had cerebral hemorrhages (11.4%) and four had cerebral infarction (9.1%). Of 26 survivors 17 (65%) showed normal neurodevelopmental outcome at median follow-up of 73 months. Motor deficits were present in one case, cognitive deficits in 9 (35%). Median length of hospital stay was 78 days in those with deficits and 29 in those with normal neurodevelopmental outcome (p < 0.001). Conclusions: Survival rate did not change over the study time but indications for ECMO did. Cognitive impairment was the major long-term deficit following neonatal ECMO being associated with longer hospital stay.
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Affiliation(s)
- Friedrich Reiterer
- Division of Neonatology, Department of Pediatrics and Adolescent Medicine, Medical University of Graz, Graz, Austria
| | - Elisabeth Resch
- Research Unit for Neonatal Infectious Diseases and Epidemiology, Medical University of Graz, Graz, Austria
| | - Michaela Haim
- Division of Neonatology, Department of Pediatrics and Adolescent Medicine, Medical University of Graz, Graz, Austria
| | - Ute Maurer-Fellbaum
- Division of Neonatology, Department of Pediatrics and Adolescent Medicine, Medical University of Graz, Graz, Austria.,Outpatient Clinic of Neurodevelopmental Follow-Up, Division of Neonatology, Department of Pediatrics and Adolescent Medicine, Medical University of Graz, Graz, Austria
| | - Michael Riccabona
- Division of Pediatric Radiology, Department of Radiology, Medical University of Graz, Graz, Austria
| | - Gerfried Zobel
- Pediatric Intensive Care Unit, Department of Pediatrics and Adolescent Medicine, Medical University of Graz, Graz, Austria
| | - Berndt Urlesberger
- Division of Neonatology, Department of Pediatrics and Adolescent Medicine, Medical University of Graz, Graz, Austria
| | - Bernhard Resch
- Division of Neonatology, Department of Pediatrics and Adolescent Medicine, Medical University of Graz, Graz, Austria.,Research Unit for Neonatal Infectious Diseases and Epidemiology, Medical University of Graz, Graz, Austria
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Kringel D, Ultsch A, Zimmermann M, Jansen JP, Ilias W, Freynhagen R, Griessinger N, Kopf A, Stein C, Doehring A, Resch E, Lötsch J. Emergent biomarker derived from next-generation sequencing to identify pain patients requiring uncommonly high opioid doses. Pharmacogenomics J 2017; 17:419-426. [PMID: 27139154 PMCID: PMC5637232 DOI: 10.1038/tpj.2016.28] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/26/2015] [Revised: 11/05/2015] [Accepted: 11/13/2015] [Indexed: 12/14/2022]
Abstract
Next-generation sequencing (NGS) provides unrestricted access to the genome, but it produces 'big data' exceeding in amount and complexity the classical analytical approaches. We introduce a bioinformatics-based classifying biomarker that uses emergent properties in genetics to separate pain patients requiring extremely high opioid doses from controls. Following precisely calculated selection of the 34 most informative markers in the OPRM1, OPRK1, OPRD1 and SIGMAR1 genes, pattern of genotypes belonging to either patient group could be derived using a k-nearest neighbor (kNN) classifier that provided a diagnostic accuracy of 80.6±4%. This outperformed alternative classifiers such as reportedly functional opioid receptor gene variants or complex biomarkers obtained via multiple regression or decision tree analysis. The accumulation of several genetic variants with only minor functional influences may result in a qualitative consequence affecting complex phenotypes, pointing at emergent properties in genetics.
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MESH Headings
- Analgesics, Opioid/administration & dosage
- Analgesics, Opioid/therapeutic use
- Biomarkers, Pharmacological/analysis
- Chronic Pain/drug therapy
- Chronic Pain/genetics
- Dose-Response Relationship, Drug
- Genotype
- High-Throughput Nucleotide Sequencing
- Humans
- Pharmacogenomic Testing
- Pharmacogenomic Variants
- Receptors, Opioid/genetics
- Receptors, Opioid, delta/genetics
- Receptors, Opioid, kappa/genetics
- Receptors, Opioid, mu/genetics
- Receptors, sigma/genetics
- Sigma-1 Receptor
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Affiliation(s)
- D Kringel
- Institute of Clinical Pharmacology, Goethe-University, Frankfurt am Main, Germany
| | - A Ultsch
- DataBionics Research Group, University of Marburg, Marburg, Germany
| | - M Zimmermann
- Department of Anesthesiology, Intensive Care Medicine and Pain Therapy, University Hospital Frankfurt, Frankfurt am Main, Germany
| | | | - W Ilias
- Department of Anaesthesiology and Intensive Care Medicine, Vienna, Austria
| | - R Freynhagen
- Zentrum für Anästhesiologie, Intensivmedizin, Schmerztherapie & Palliativmedizin, Benedictus Krankenhaus Tutzing, Tutzing, Germany
- Klinik für Anästhesiologie, Technische Universität München, München, Germany
| | - N Griessinger
- Department of Anesthesiology, University Hospital Erlangen, Erlangen, Germany
| | - A Kopf
- Department of Anesthesiology and Critical Care Medicine, Freie Universität Berlin–Charité, Berlin, Germany
| | - C Stein
- Department of Anesthesiology and Critical Care Medicine, Freie Universität Berlin–Charité, Berlin, Germany
| | - A Doehring
- Institute of Clinical Pharmacology, Goethe-University, Frankfurt am Main, Germany
| | - E Resch
- Fraunhofer Institute for Molecular Biology and Applied Ecology IME, Project Group Translational Medicine and Pharmacology TMP, Frankfurt am Main, Germany
| | - J Lötsch
- Institute of Clinical Pharmacology, Goethe-University, Frankfurt am Main, Germany
- Fraunhofer Institute for Molecular Biology and Applied Ecology IME, Project Group Translational Medicine and Pharmacology TMP, Frankfurt am Main, Germany
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Resch E, Kreth U, Boesing T, Hamelmann E, Teig N. Evaluation of the effect of the Newborn Life Support (NLS)-course in Germany on resuscitation skills and the participants’ perceived benefit. Resuscitation 2016. [DOI: 10.1016/j.resuscitation.2016.07.147] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Eibisberger M, Resch E, Resch B. Surfactant replacement therapy in extremely low gestational age newborns. Indian Pediatr 2016; 52:227-30. [PMID: 25849000 DOI: 10.1007/s13312-015-0612-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
There is a growing body of evidence over the last years suggesting continuous positive airway pressure (CPAP) ventilation being the first choice of ventilatory support in newborns with extremely low gestational age, and early rescue surfactant treatment being as effective as prophylactic therapy. The Intubation Surfactant Extubation procedure is discussed as an alternative procedure that may have the potential to combine the positive effects of surfactant and early CPAP. A further mode of surfactant administration, administration via a thin endotracheal catheter during spontaneous breathing with CPAP, has recently come into clinical use. This less invasive surfactant administration technique shows some short-term benefits but still cannot be recommended for general use in this vulnerable population. Long-term follow-up studies are needed to allow new recommendations on surfactant therapy in this high-risk population.
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Affiliation(s)
- M Eibisberger
- Research Unit for Neonatal Infectious Diseases and Epidemiology, Division of Neonatology, Department of Paediatrics, Medical University of Graz, Austria. Correspondence to: Prof. Dr. Bernhard Resch, Division of Neonatology, Department of Paediatrics, Medical University of Graz, Auenbruggerplatz 34/2, 8036 Graz, Austria.
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Resch B, Mühlanger A, Maurer-Fellbaum U, Pichler-Stachl E, Resch E, Urlesberger B. Quality of Life of Children with Cystic Periventricular Leukomalacia - A Prospective Analysis with the Child Health Questionnaire-Parent Form 50. Front Pediatr 2016; 4:50. [PMID: 27242979 PMCID: PMC4869559 DOI: 10.3389/fped.2016.00050] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/01/2016] [Accepted: 05/02/2016] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVE Cystic periventricular leukomalacia (PVL) is associated with moderate to severe physical and mental handicaps in preterm infants. We hypothesized whether or not those handicaps were associated with a poorer quality of life (QOL) of affected children and their families compared to matched controls. PATIENTS AND METHODS All children with the diagnosis PVL collected from a local database of the Division of Neonatology of the Medical University of Graz, Austria, and born between 1997 and 2008 were included in the study group. Preterm infants matched for gestational age, birth weight, year of birth, and gender without PVL served as controls. Selected perinatal data and neurological outcome were documented. The interview of the parents was conducted using the Child Health Questionnaire-Parent Form 50 (CHQ-PF50), German version. The CHQ-PF50 consists of 50 items divided over 11 multi-item scales and 2 single-item questions. RESULTS The CHQ-PF50 was answered by 21 parents of the study (26%) and 44 of the control (39%) group. Cases were diagnosed as having developmental delay, dystonia, strabismus, central visual impairment, seizures, and cerebral palsy (81 vs. 7%, p < 0.001) more common than controls. Analysis of the CHQ-PF 50 revealed significantly poorer results for cases regarding physical health (physical functioning: p < 0.001, physical social limitations: p < 0.001, and physical summary score: p < 0.001). Several psychosocial categories (behavior, mental health, and self-esteem) and the psychosocial summary score did not differ between groups. Only two categories (parental impact concerning time p = 0.004 and family activities: p = 0.026) revealed significantly poorer results in the cases as it was for the global category for health (p = 0.009). CONCLUSION Children with PVL had an overall poorer QOL regarding physical aspects. However, PVL was not generally associated with a poorer QOL regarding psychosocial aspects.
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Affiliation(s)
- Bernhard Resch
- Research Unit for Neonatal Infectious Diseases and Epidemiology, Medical University of Graz, Graz, Austria; Division of Neonatology, Department of Pediatrics, Medical University of Graz, Graz, Austria
| | - Anja Mühlanger
- Research Unit for Neonatal Infectious Diseases and Epidemiology, Medical University of Graz , Graz , Austria
| | - Ute Maurer-Fellbaum
- Division of Neonatology, Department of Pediatrics, Medical University of Graz, Graz, Austria; Outpatient Department of Developmental Follow-Up, Department of Pediatrics and Adolescent Medicine, Medical University of Graz, Graz, Austria
| | - Elisabeth Pichler-Stachl
- Division of Neonatology, Department of Pediatrics, Medical University of Graz, Graz, Austria; Outpatient Department of Developmental Follow-Up, Department of Pediatrics and Adolescent Medicine, Medical University of Graz, Graz, Austria
| | - Elisabeth Resch
- Research Unit for Neonatal Infectious Diseases and Epidemiology, Medical University of Graz , Graz , Austria
| | - Berndt Urlesberger
- Division of Neonatology, Department of Pediatrics, Medical University of Graz , Graz , Austria
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Hofer N, Jank K, Resch E, Urlesberger B, Reiterer F, Resch B. Meconium Aspiration Syndrome – a 21-years’ Experience from a Tertiary Care Center and Analysis of Risk Factors for Predicting Disease Severity. Klin Padiatr 2013; 225:383-8. [DOI: 10.1055/s-0033-1361105] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Affiliation(s)
- N. Hofer
- Department of Pediatrics and Adolescent Medicine, Research Unit for Neonatal Infectious Diseases and Epidemiology, Medical University of Graz, Graz, Austria
| | - K. Jank
- Department of Pediatrics and Adolescent Medicine, Research Unit for Neonatal Infectious Diseases and Epidemiology, Medical University of Graz, Graz, Austria
| | - E. Resch
- Department of Pediatrics and Adolescent Medicine, Research Unit for Neonatal Infectious Diseases and Epidemiology, Medical University of Graz, Graz, Austria
| | - B. Urlesberger
- Department of Pediatrics and Adolescent Medicine, Division of Neonatology, Medical University of Graz, Austria
| | - F. Reiterer
- Department of Pediatrics and Adolescent Medicine, Division of Neonatology, Medical University of Graz, Austria
| | - B. Resch
- Department of Pediatrics and Adolescent Medicine, Research Unit for Neonatal Infectious Diseases and Epidemiology, Medical University of Graz, Graz, Austria
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Maire F, Resch E, Gallian P, Corbi C, Ribon N, Jbilou S, Narbey D, Courbil R. À propos d’un cas de paludisme post-transfusionnel. Transfus Clin Biol 2013. [DOI: 10.1016/j.tracli.2013.03.220] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Resch B, Kaltenberger Z, Resch E, Müller W, Berghold A, Riccabona M. Interobserver reliability of neonatal cranial ultrasound scanning regarding white matter disease. Pediatr Neonatol 2013; 54:214-5. [PMID: 23602383 DOI: 10.1016/j.pedneo.2013.01.020] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/13/2012] [Accepted: 01/09/2013] [Indexed: 10/26/2022] Open
Affiliation(s)
- Bernhard Resch
- Research Unit for Neonatal Infectious Diseases and Epidemiology, Medical University of Graz, Auenbruggerplatz 30, Graz, Austria.
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Resch B, Resch E, Freidl T, Maurer U, Haas J, Müller W. Preterm twin and triplet pregnancies are at increased risk for the development of cystic periventricular leukomalacia. Eur J Paediatr Neurol 2013; 17:148-52. [PMID: 22795624 DOI: 10.1016/j.ejpn.2012.06.010] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/09/2011] [Revised: 05/16/2012] [Accepted: 06/19/2012] [Indexed: 11/26/2022]
Abstract
BACKGROUND An increased risk of cerebral palsy in multiples has been reported. AIMS To determine the risk for the development of periventricular leukomalacia (PVL) of twin and triplet pregnancy. STUDY DESIGN Retrospective single-centre study at a tertiary care university hospital. SUBJECTS Infants ≤ 35 weeks gestational age born between 1988 and 2008. OUTCOME MEASURES Risk of twin and triplet compared to singleton pregnancy regarding development of PVL in one offspring. RESULTS Of 6195 infants 117 singletons and 39 multiples were diagnosed as having cystic PVL. Perinatal data did not differ as did not ultrasonographic findings and neurologic outcome. The relative risk (RR) of a twin pregnancy resulting in at least one infant with PVL when born prior to 36 weeks was 2.181 (CI 95% 1.474-3.228, p < .0001), and 6.793 (CI 95% 2.470-13.108, p < .0001) of a triplet pregnancy. In-vitro fertilisation was present in 3% of affected twins compared to 100% in triplets (p < .001). CONCLUSION We found an increased risk for PVL in preterm twin and triplet pregnancies.
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Affiliation(s)
- B Resch
- Research Unit for Neonatal Infectious Diseases and Epidemiology, Medical University of Graz, Austria.
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Sandlarz M, Cabre P, Billaut C, Resch E. Jeux olympiques de Londres 2012 : organiser une réponse transfusionnelle rapide à un éventuel besoin massif de produits sanguins. Transfus Clin Biol 2012. [DOI: 10.1016/j.tracli.2012.08.087] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Resch E, Ihm U, Haslinger V, Wagner T, Kurz H. [Life threatening secondary bacterial infection of varicella skin lesions]. Wien Med Wochenschr 2012; 162:164-7. [PMID: 22614542 DOI: 10.1007/s10354-012-0076-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2012] [Accepted: 03/06/2012] [Indexed: 12/01/2022]
Abstract
As immunization coverage of varicella vaccination is low, the disease is still very frequent in Austria. Albeit the prognosis in general is good, the incidence of varicella-related hospitalization is about 6 per 100,000 in all children between 0-15 years of age, affecting mainly previously healthy children. Especially young children under the age of 5 are at risk with highest rates among children younger than one year. The most common complications are secondary bacterial infections, neurological and respiratory complications. Two cases of life threatening secondary bacterial infection are presented. One child suffered from a Toxic Shock Syndrome caused by group A streptococcus along with large necrotizing skin lesions. The second child nearly lost her left eye due to a deep orbital abscess. Both children survived without severe sequelae but had to undergo several procedures of plastic surgery. Implementation of the varicella vaccination program in the USA has shown a near elimination of deaths due to severe varicella complications. The initiation of the varicella vaccination program for children until the age of 2 in Austria should be considered to prevent complications and deaths caused by varicella.
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Affiliation(s)
- Elisabeth Resch
- Abteilung für Kinder- und Jugendheilkunde, Sozialmedizinisches Zentrum Ost, Donauspital, Wien, Austria.
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Resch B, Neubauer K, Hofer N, Resch E, Maurer U, Haas J, Müller W. Episodes of hypocarbia and early-onset sepsis are risk factors for cystic periventricular leukomalacia in the preterm infant. Early Hum Dev 2012; 88:27-31. [PMID: 21752559 DOI: 10.1016/j.earlhumdev.2011.06.011] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/25/2011] [Revised: 06/18/2011] [Accepted: 06/21/2011] [Indexed: 11/26/2022]
Abstract
BACKGROUND Septic episodes in preterm infants recently have been reported to be associated with periventricular leukomalacia (PVL). The role of hypocarbia as an independent risk factor for PVL in clinical studies raises many questions without conclusive answers. AIMS To evaluate risk factors for cystic PVL focussing on the influence of hypocarbia. STUDY DESIGN Retrospective single centre case-control study. SUBJECTS Preterm infants 24 to 35 weeks of gestational age and matched (1:2 for gender, birth year, gestational age and birth weight) controls. OUTCOME MEASURES Multivariate analysis of perinatal factors being associated with cystic PVL diagnosed by serial ultrasound examinations. RESULTS Univariate analysis of risk factors revealed lower 5 and 10 min Apgar scores, and higher rates of neonatal seizures, early-onset sepsis, neonatal steroids, respiratory distress syndrome with surfactant replacement therapy, and episodes of hypocarbia significantly being associated with PVL. Multivariate analysis using a logistic regression model revealed early-onset sepsis and hypocarbia being significantly associated with PVL (p=.022 and .024, respectively). Lowest PaCO(2) values did not differ as did not the duration of hypocarbia, but the onset of hypocarbia was significantly later in PVL cases compared to controls (mean 26 vs. 15 h, p=.033). Neurodevelopmental follow-up at a median time of 46 months was poor showing 88% of the cases having an adverse neurological outcome. CONCLUSION We found early-onset sepsis and episodes of hypocarbia within the first days of life being independently associated with PVL.
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Affiliation(s)
- B Resch
- Research Unit for Neonatal Infectious Diseases and Epidemiology, Medical University of Graz, Austria.
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Resch B, Resch E, Maurer U, Mueller W. Periventricular leukomalacia and neurodevelopmental outcome. J Pediatr 2011; 159:1049; author reply 1049-50. [PMID: 21962604 DOI: 10.1016/j.jpeds.2011.08.025] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/01/2011] [Accepted: 08/10/2011] [Indexed: 10/17/2022]
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Resch B, Resch E, Maurer U, Müller W. Die zystische periventrikuläre Leukencephalomalazie: eine rückläufige Ursache schwerer Entwicklungsdefizite bei Frühgeborenen? Klin Padiatr 2010. [DOI: 10.1055/s-0030-1261584] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Resch E. Cognitive therapy helps break the prison bars of obesity. J Am Diet Assoc 1992; 92:425. [PMID: 1556339] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
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Resch E, Müller H, Glatz W, Schönberner H. [Correlation of parameters in cholestasis]. Z Med Lab Diagn 1979; 20:202-7. [PMID: 41373] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
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