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Storm Van's Gravesande K, Calabrese P, Blaschek A, Rostásy K, Huppke P, Rothe L, Mall V, Kessler J, Kalbe E, Dornfeld E, Elpers C, Lohmann H, Weddige A, Hagspiel S, Kirschner J, Brehm M, Blank C, Schubert J, Schimmel M, Pacheè S, Mohrbach M, Karenfort M, Kamp G, Lücke T, Neumann H, Lutz S, Gierse A, Sievers S, Schiffmann H, de Soye I, Trollmann R, Candova A, Rosner M, Neu A, Romer G, Seidel U, John R, Hofmann C, Schulz, Kinder S, Bertolatus A, Scheidtmann K, Lasogga R, Leiz S, Alber M, Kranz J, Bajer-Kornek B, Seidl R, Novak A. The Multiple Sclerosis Inventory of Cognition for Adolescents (MUSICADO): A brief screening instrument to assess cognitive dysfunction, fatigue and loss of health-related quality of life in pediatric-onset multiple sclerosis. Eur J Paediatr Neurol 2019; 23:792-800. [PMID: 31551133 DOI: 10.1016/j.ejpn.2019.08.006] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/09/2019] [Revised: 07/23/2019] [Accepted: 08/22/2019] [Indexed: 10/26/2022]
Abstract
OBJECTIVE Screening for cognitive impairment (CI), fatigue and also Health-related quality of life (HRQoL) in patients with pediatric-onset multiple sclerosis (POMS) is of utmost importance in clinical practice. The aim of this study was to establish a new and validated pediatric screening tool "MUSICADO" that is easy to use and time economical. METHODS 106 patients with POMS aged 12-18 years and 210 healthy controls (HCs) stratified for age and education underwent neuropsychological testing including a screening test "Multiple Sclerosis Inventory of Cognition" for adults and 8 standardized cognitive tests and established scales to assess fatigue and HRQoL. RESULTS The phonemic verbal fluency task (RWT "s-words"), the Trail Making Test A (TMT-A), and the Digit Span Forward discriminated significantly between patients and HCs (p = 0.000, respectively) and showed the highest proportion of test failure in patients (24.5%, 17.9%; 15.1%, respectively). Therefore, they were put together to form the cognitive part of the "MUSICADO". After applying a scoring algorithm with balanced weighting of the subtests and age and education correction and a cut-off score for impairment, 35.8% of patients were categorized to be cognitively impaired (specificity: 88.6%). Fatigue was detected in 37.1% of the patients (specificity: 94.0%) and loss of HRQoL in 41.8% (specificity 95.7%) with the screening version, respectively. CONCLUSION The MUSICADO is a newly designed brief and easy to use screening test to help to early identify CI, fatigue, and loss of HRQoL in patients with POMS as cut scores are provided for all three items. Further studies will have to show its usability in independent samples of patients with POMS.
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Affiliation(s)
- K Storm Van's Gravesande
- Department of Pediatrics, Child and Adolescent Psychosomatics, Technische Universität München, Munich, Heigelhofstr. 63, 81377 München, Germany.
| | - P Calabrese
- Neuropsychology and Behavioral Neurology Unit, Division of Molecular and Cognitive Neuroscience, Department of Psychology, University of Basel, Birmannsgasse 8, 4055 Basel, Switzerland
| | - A Blaschek
- Department of Pediatric Neurology and Developmental Medicine, Dr. von Hauner Children's Hospital, Ludwig-Maximilians-University, Lindwurmstrasse 4, 80337 Munich, Germany
| | - K Rostásy
- Pediatric Neurology, Witten/Herdecke University, Children's Hospital Datteln, Dr. Friedrich Steiner Str. 5, 5711 Datteln, Germany
| | - P Huppke
- Department of Pediatrics and Adolescent Medicine, Division of Pediatric Neurology, University Medical Center Göttingen, Robert-Koch Strasse 40, 37075 Göttingen, Germany
| | - L Rothe
- Department of Neurology, University Hospital Cologne, Kerpenerstr. 62, 50937 Cologne, Germany
| | - V Mall
- Department of Pediatrics, Child and Adolescent Psychosomatics, Technische Universität München, Munich, Heigelhofstr. 63, 81377 München, Germany
| | - J Kessler
- Department of Neurology, University Hospital Cologne, Kerpenerstr. 62, 50937 Cologne, Germany
| | - E Kalbe
- Department of Medical Psychology ǀ, Neuropsychology and Gender Studies & Center for Neuropsychological Diagnostics and Intervention (CeNDI), University Hospital Cologne, Kerpenerstr. 62, 50937 Cologne, Germany
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Franke I, Pingen A, Schiffmann H, Vogel M, Vlajnic D, Ganschow R, Born M. Cardiopulmonary resuscitation (CPR)-related posterior rib fractures in neonates and infants following recommended changes in CPR techniques. Child Abuse Negl 2014; 38:1267-1274. [PMID: 24636360 DOI: 10.1016/j.chiabu.2014.01.021] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/09/2013] [Revised: 01/16/2014] [Accepted: 01/27/2014] [Indexed: 06/03/2023]
Abstract
Posterior rib fractures are highly indicative of non-accidental trauma (NAT) in infants. Since 2000, the "two-thumbs" technique for cardiopulmonary resuscitation (CPR) of newborns and infants has been recommended by the American Heart Association (AHA). This technique is similar to the grip on an infant's thorax while shaking. Is it possible that posterior rib fractures in newborns and infants could be caused by the "two-thumbs" technique? Using computerized databases from three German children's hospitals, we identified all infants less than 12 months old who underwent professional CPR within a 10-year period. We included all infants with anterior-posterior chest radiographs taken after CPR. Exclusion criteria were sternotomy, osteopenia, various other bone diseases and NAT. The radiographs were independently reviewed by the Chief of Pediatric Radiology (MB) and a Senior Pediatrician, Head of the local Child Protection Team (IF). Eighty infants with 546 chest radiographs were identified, and 50 of those infants underwent CPR immediately after birth. Data concerning the length of CPR was available for 41 infants. The mean length of CPR was 11min (range: 1-180min, median: 3min). On average, there were seven radiographs per infant. A total of 39 infants had a follow-up radiograph after at least 10 days. No rib fracture was visible on any chest X-ray. The results of this study suggest rib fracture after the use of the "two-thumbs" CPR technique is uncommon. Thus, there should be careful consideration of abuse when these fractures are identified, regardless of whether CPR was performed and what technique used. The discovery of rib fractures in an infant who has undergone CPR without underlying bone disease or major trauma warrants a full child protection investigation.
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Affiliation(s)
- I Franke
- Department of Pediatrics, Medical Center, University of Bonn, Adenauerallee 119, 53113 Bonn, Germany
| | - A Pingen
- Department of Pediatrics, Medical Center, University of Bonn, Adenauerallee 119, 53113 Bonn, Germany
| | - H Schiffmann
- Department of Pediatrics, Clinical Center, Nuremburg, Germany
| | - M Vogel
- Department of General Pediatrics, University Children's Hospital, Düsseldorf, Germany
| | - D Vlajnic
- Department of Pediatrics, Medical Center, University of Bonn, Adenauerallee 119, 53113 Bonn, Germany
| | - R Ganschow
- Department of Pediatrics, Medical Center, University of Bonn, Adenauerallee 119, 53113 Bonn, Germany
| | - M Born
- Department of Radiology, Medical Center, University of Bonn, Germany
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Stichtenoth G, Demmert M, Bohnhorst B, Stein A, Ehlers S, Heitmann F, Rieger-Fackeldey E, Olbertz D, Roll C, Emeis M, Mögel M, Schiffmann H, Wieg C, Wintgens J, Herting E, Göpel W, Härtel C. Major Contributors to Hospital Mortality in Very-Low-Birth-Weight Infants: Data of the Birth Year 2010 Cohort of the German Neonatal Network. Klin Padiatr 2012; 224:276-81. [DOI: 10.1055/s-0032-1306344] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
AbstractThe German Neonatal Network (GNN) is a prospective cohort study with the focus on long term development of very-low-birth-weight infants. It was the aim of this study to determine detailed information on causes of mortality in the GNN birth cohort 2010.Major contributors to hospital mortality were recorded by the attending neonatologists for the cohort of very-low-birth-weight (VLBW) infants born in centres of the German Neonatal Network (GNN) in 2010. The data quality was approved by on-site monitoring.2 221 VLBW infants were born in GNN centres in 2010, and death occurred in 221 infants. Male infants carried a higher risk than females (58.8% males among non-survivors vs. 51.7% among survivors, p=0.047). In 11 infants, the major contributor to death was not determined by the attending neonatologist. In 25 infants born at the limit of viability, comfort palliative care was primarily initiated and 14 infants had lethal malformations. The majority of non-survivors suffered from inflammatory diseases including sepsis- or necrotizing enterocolitis (NEC)-associated death (n=56). Respiratory pathology was a major contributor to death in 65 infants including 11 infants who died from pulmonary haemorrhage.Potentially preventable complications of preterm birth such as sepsis, NEC and pulmonary haemorrhage predominate the major contributors to mortality in the GNN 2010 cohort. In order to decrease the rate of these associated deaths, future trials should focus on prophylaxis and therapy optimization strategies for these outcomes.
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Affiliation(s)
| | - M. Demmert
- Children’s Hospital, University of Lübeck, Germany
| | | | - A. Stein
- Neonatology, Children’s Hospital I, University of Essen, Germany
| | - S. Ehlers
- Neonatology, Burgerhospital Frankfurt, Germany
| | - F. Heitmann
- Department of Pediatrics, Community Hospital Dortmund, Germany
| | | | - D. Olbertz
- Neonatology, Klinikum Rostock Süd, Rostock, Germany
| | - C. Roll
- Department of Neonatology and Pediatric Intensive Care, Vest Children’s Hospital, Datteln, Germany
| | - M. Emeis
- Neonatology, Vivates Klinikum Berlin, Germany
| | - M. Mögel
- Neonatology, University of Dresden, Germany
| | | | - C. Wieg
- Neonatologie, Klinikum Aschaffenburg, Germany
| | - J. Wintgens
- Neonatology, Klinikum Mönchengladbach, Germany
| | - E. Herting
- Children’s Hospital, University of Lübeck, Germany
| | - W. Göpel
- Children’s Hospital, University of Lübeck, Germany
| | - C. Härtel
- Children’s Hospital, University of Lübeck, Germany
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Leu TK, Rompel O, Fingerhut M, Karsten S, Schiffmann H. Mittelhirn-Hirnstamm-Diskonnektion bei Ponsagenesie als seltene Kombination mit einer VACTERL-Assoziation. Klin Padiatr 2011. [DOI: 10.1055/s-0031-1273905] [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: 10/18/2022]
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Fahr A, Anani D, Rompel O, Schiefer A, Köhler W, Wutz B, Schiffmann H. Erfreulicher Verlauf bei primärer pulmonaler Lymphangiektasie. Klin Padiatr 2009. [DOI: 10.1055/s-0029-1214277] [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: 10/21/2022]
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Frenzel I, Quentin T, Schiffmann H. Vergleich aktiver und passiver Atemgasklimatisierung von Neugeborenen und Säuglingen anhand der Zytokinkonzentration im Trachealsekret. Z Geburtshilfe Neonatol 2006. [DOI: 10.1055/s-2006-946274] [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: 10/19/2022]
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Frenzel I, Quentin T, Schiffmann H. Vergleich aktiver und passiver Atemgasklimatisierung von Neugeborenen und Säuglingen anhand der Zytokinkonzentration im Trachealsekret. Z Geburtshilfe Neonatol 2006. [DOI: 10.1055/s-2006-943359] [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: 10/19/2022]
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Möller O, Schiffmann H, Jux C, Paul T. Stentimplantation in die Atemwege von Frühgeborenen und Säuglingen. Pneumologie 2005. [DOI: 10.1055/s-2005-864539] [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: 10/19/2022]
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Schiffmann H, Block C, Züchner K. Atemgasklimatisierung in einem künstlichen neonatalen Lungenmodell – Vergleich von „Heat and Moisture Exchanger“ (HME) und „Heated Humidifier“ (HH). Z Geburtshilfe Neonatol 2004. [DOI: 10.1055/s-2004-829300] [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: 10/20/2022]
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Schiffmann H, Gleiss J, von Hirscheydt A, Schröder T, Kahles H, Hellige G. Effects of epinephrine on the myocardial performance and haemodynamics of the isolated rat heart during moderate hypothermia--importance of calcium homeostasis. Resuscitation 2001; 50:309-17. [PMID: 11719161 DOI: 10.1016/s0300-9572(01)00357-4] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
Controversies exist concerning myocardial performance in hypothermia. We have studied the effects of epinephrine on myocardial function at various calcium concentrations in moderate hypothermia (28 degrees C) and normothermia (37 degrees C) using an isolated antegrade perfused rat heart. The maximum pressure velocity (dP/dt(max)) developed was significantly higher in normothermia compared with hypothermia and was improved by the addition of calcium in both circumstances. Peak negative pressure velocity (dP/dt(min)) was significantly higher at 37 degrees C compared with 28 degrees C, and was increased by the addition of calcium in normothermia; in contrast to hypothermia, in which no change of dP/dt(min) was observed. A reduction in cardiac output and stroke volume by hypercalcaemia was observed in hypothermia. The addition of epinephrine improved dP/dt(max) and dP/dt(min), but had a depressive effect on stroke volume and cardiac output at normal and elevated calcium concentrations. Myocardial efficiency was significantly higher during hypothermia compared with normothermia, but was impaired by epinephrine during hypothermia. The variable or even paradoxical effects of epinephrine suggest the need for careful haemodynamic monitoring and determination of calcium levels in hypothermia. The impairment of myocardial performance may be explained by impaired diastolic relaxation and calcium overload.
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Affiliation(s)
- H Schiffmann
- Department of Paediatrics, University of Göttingen, Robert-Koch-Strasse 40, 37075 Göttingen, Germany.
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Frerichs I, Schiffmann H, Hahn G, Hellige G. Non-invasive radiation-free monitoring of regional lung ventilation in critically ill infants. Intensive Care Med 2001; 27:1385-94. [PMID: 11511953 DOI: 10.1007/s001340101021] [Citation(s) in RCA: 73] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2001] [Accepted: 05/30/2001] [Indexed: 10/27/2022]
Abstract
OBJECTIVE Established techniques used to examine lung function in critically ill infants cannot continuously follow regional aspects of lung ventilation although this information would be beneficial for proper therapy planning. We have studied the applicability and clinical relevance of a relatively new non-invasive radiation-free imaging method, electrical impedance tomography (EIT), in monitoring regional lung function in paediatric intensive care patients. DESIGN Prospective study. SETTING Neonatal and paediatric intensive care unit (ICU) at a university hospital. PATIENTS Eight infants (1 day-7 years old) suffering from miscellaneous diseases requiring intensive care therapy. INTERVENTIONS Adjustment of ventilator settings, surfactant administration, and postural changes. MEASUREMENTS AND RESULTS Repeated EIT measurements were performed with the intention to monitor regional lung ventilation in mechanically ventilated and spontaneously breathing infants. The follow-up time ranged between 1 and 11 days. During individual EIT measurements of 100-s duration electrical voltages resulting from repetitive injection of small electrical currents were continuously measured on the thoracic circumference using conventional surface electrodes. Acquired data were used to generate functional cross-sectional thoracic images of regional lung ventilation. A total of 638 EIT measurements were performed. The redistribution of lung ventilation and changes in regional ventilation magnitude resulting from adjusted positive end-expiratory pressure, peak inspiratory pressure, inspiration-expiration ratio, surfactant instillation, and prone or supine positioning were identified. CONCLUSIONS Provided that EIT hardware and software are further developed to guarantee stable and undisturbed measurements in the ICU and that practical handling is improved, this non-invasive method may become a useful bedside monitoring tool of regional lung ventilation in critically ill infants.
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Affiliation(s)
- I Frerichs
- Department of Anaesthesiological Research, Centre of Anaesthesiology, Emergency and Intensive Care Medicine, TL 195, University of Göttingen, Robert-Koch-Strasse 40, 37075 Göttingen, Germany.
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Schiffmann H, Singer S, Singer D, von Richthofen E, Rathgeber J, Züchner K. Determination of airway humidification in high-frequency oscillatory ventilation using an artificial neonatal lung model. Comparison of a heated humidifier and a heat and moisture exchanger. Intensive Care Med 1999; 25:997-1002. [PMID: 10501758 DOI: 10.1007/s001340050995] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
OBJECTIVE Thus far only few data are available on airway humidification during high-frequency oscillatory ventilation (HFOV). Therefore, we studied the performance and efficiency of a heated humidifier (HH) and a heat and moisture exchanger (HME) in HFOV using an artificial lung model. METHODS Experiments were performed with a pediatric high-frequency oscillatory ventilator. The artificial lung contained a sponge saturated with water to simulate evaporation and was placed in an incubator heated to 37 degrees C to prevent condensation. The airway humidity was measured using a capacitive humidity sensor. The water loss of the lung model was determined gravimetrically. RESULTS The water loss of the lung model varied between 2.14 and 3.1 g/h during active humidification; it was 2.85 g/h with passive humidification and 7.56 g/h without humidification. The humidity at the tube connector varied between 34. 2 and 42.5 mg/l, depending on the temperature of the HH and the ventilator setting during active humidification, and between 37 and 39.9 mg/l with passive humidification. CONCLUSION In general, HH and HME are suitable devices for airway humidification in HFOV. The performance of the ventilator was not significantly influenced by the mode of humidification. However, the adequacy of humidification and safety of the HME remains to be demonstrated in clinical practice.
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Affiliation(s)
- H Schiffmann
- Department of Pediatrics, University of Göttingen, Robert-Koch-Strasse 40, D-37 073 Göttingen, Germany. - goettingen.de
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Frerichs I, Hahn G, Schiffmann H, Berger C, Hellige G. Monitoring regional lung ventilation by functional electrical impedance tomography during assisted ventilation. Ann N Y Acad Sci 1999; 873:493-505. [PMID: 10372185 DOI: 10.1111/j.1749-6632.1999.tb09498.x] [Citation(s) in RCA: 46] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
A new approach in discriminating the regional air volume changes in the lungs associated with either spontaneous or mechanical ventilation during assisted ventilation is presented. Impedance data are obtained by conventional electrical impedance tomography (EIT). The data are filtered in the range of either the spontaneous or the ventilator rate and processed by the functional EIT (f-EIT) evaluation technique, whereby the variation of the respective EIT data with time is determined and imaged. EIT measurements performed in an infant during synchronized intermittent mandatory ventilation were evaluated with this method and indicated that the specific local lung volume swings related to spontaneous and mechanical inhalations can be separated and imaged as tomograms. This noninvasive approach may become useful in optimizing the ventilatory pattern during advanced forms of artificial ventilation and may help the clinician in the therapy management of individual patients.
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Affiliation(s)
- I Frerichs
- Department of Anesthesiological Research, University of Göttingen, Germany
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Harms K, Herting E, Kron M, Schill M, Schiffmann H. [Importance of pre- and perinatal risk factors in respiratory distress syndrome of premature infants. A logical regression analysis of 1100 cases]. Z Geburtshilfe Neonatol 1997; 201:258-62. [PMID: 9491546] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
BACKGROUND Respiratory distress syndrome (RDS) due to surfactant deficiency remains a cause of considerable mortality in the neonatal period. METHODS In a retrospective study we analysed the records of 1109 premature newborns with a birth weight below 1500 g that were treated on our unit. RDS was assumed if the infants needed mechanical ventilation with oxygen supplementation and the typical radiological signs were present on chest x-ray. RESULTS No changes in the incidence of RDS were found during the period of observation. Below 29 weeks gestational age 90% of infants suffered from RDS (55% severe RDS grade III or IV). The incidence was 75% (grade III or IV: 32%) for infants born at 29 and 30 weeks, 48% (grade III or IV: 15%) at 31 and 32 weeks and 33% (grade III or IV: 6%) for neonates born at 33 weeks of gestation. Using a logistic regression analysis model the following parameters were found to increase the risk for RDS significantly (p < 0.05): no prenatal steroid treatment, Cesarean section, male gender, APGAR at 5 min < 7, metabolic acidosis (base excess < or = -6 mval) and rectal temperature < 36 degrees C on admission. Following gestosis, insufficiency of the placenta and premature rupture of membranes a decrease in the incidence of RDS was observed. CONCLUSION We conclude that although some risk factors for RDS will be difficult to exclude (e.g. maternal disease, gender) the incidence and severity of RDS can be reduced by measures like maternal antenatal steroid treatment. Perinatal asphyxia (low APGAR values and/or acidosis) and hypothermia should be avoided, as these conditions increase the relative risk for developing RDS.
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Affiliation(s)
- K Harms
- Kinderklinik, Universität Göttingen
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Schiffmann H, Rathgeber J, Singer D, Harms K, Bolli A, Züchner K. Airway humidification in mechanically ventilated neonates and infants: a comparative study of a heat and moisture exchanger vs. a heated humidifier using a new fast-response capacitive humidity sensor. Crit Care Med 1997; 25:1755-60. [PMID: 9377894 DOI: 10.1097/00003246-199710000-00029] [Citation(s) in RCA: 23] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
OBJECTIVE To study the efficiency of a heated humidifier and a heat and moisture exchanger in mechanically ventilated neonates and infants. DESIGN Prospective, controlled, clinical study. SETTING University pediatric intensive care unit. PATIENTS Forty neonates and infants who needed mechanical ventilation were enrolled in the study. INTERVENTIONS None. MEASUREMENTS AND MAIN RESULTS A heat and moisture exchanger and active airway humidification were alternately used in the same patients to exclude interindividual differences in airway humidification. Airway humidity was measured by a new fast-response capacitive humidity sensor which measures airway humidity with an acquisition rate of 20 Hz throughout the respiratory cycle. The humidity sensor was placed at the endotracheal tube adapter. Measurements were done at the beginning and at the end of three consecutive sessions of passive, active, and again passive airway humidification, each session lasting 6 hrs. There was no significant difference between mean inspiratory airway humidity with the heated humidifier (33.8 +/- 2.9 mg/L) and with the heat and moisture exchanger (34.0 +/- 2.6 mg/L). Moreover, the mode of airway humidification did not significantly influence body temperature or PCO2. No serious side effects such as endotracheal tube occlusion were observed. CONCLUSIONS Passive airway humidification by a heat and moisture exchanger is effective in mechanically ventilated neonates and infants over a 6-hr period. However, the performance and safety of a heat and moisture exchanger in prolonged mechanical ventilation remain to be proven.
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Affiliation(s)
- H Schiffmann
- Department of Pediatrics, University of Göttingen, Germany
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Wilichowski E, Christen HJ, Schiffmann H, Schulz-Schaeffer W, Behrens-Baumann W. Fatal Pseudallescheria boydii panencephalitis in a child after near-drowning. Pediatr Infect Dis J 1996; 15:365-70. [PMID: 8866809 DOI: 10.1097/00006454-199604000-00016] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Affiliation(s)
- E Wilichowski
- Department of Pediatrics/Neuropediatrics, Universitäts-Kinderklinik, Göttingen, Germany
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Bouillon T, Schiffmann H, Bartmus D, Gundert-Remy U. Amiodarone in a newborn with ventricular tachycardia and an intracardiac tumor: adjusting the dose according to an individualized dosing regimen. Pediatr Cardiol 1996; 17:112-4. [PMID: 8833497 DOI: 10.1007/bf02505094] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
We report the successful management of recurrent ventricular tachycardias in a newborn suffering from an intracardiac tumor. Amiodarone was the only agent able to control the tachycardias and did so as long as an individually titrated plasma concentration above 0.8 mu mol/L was maintained. Because no therapeutic plasma concentration has been defined in children and no kinetic studies are available in this population, we optimized the dosing regimen based on a computer simulation, taking into account the pharmacokinetic parameters of the patient and the individual concentration-effect relation.
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Affiliation(s)
- T Bouillon
- Department of Clinical Pharmacology, Medical School, University of Gottingen, Germany
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Harms K, Herting E, Kron M, Schiffmann H, Schulz-Ehlbeck H. Randomized, controlled trial of amoxicillin prophylaxis for prevention of catheter-related infections in newborn infants with central venous silicone elastomer catheters. J Pediatr 1995; 127:615-9. [PMID: 7562288 DOI: 10.1016/s0022-3476(95)70126-5] [Citation(s) in RCA: 22] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
OBJECTIVE To clarify the effectiveness of amoxicillin prophylaxis in the prevention of catheter-related infections. METHOD We performed a randomized, controlled, sequential, prospective trial in newborn infants undergoing percutaneous central venous catheterization. RESULTS Seventy-five infants (median birth weight, 1240 gm; median age at catheter insertion, 3 days) received prophylactic amoxicillin (100 mg/kg per day); 73 infants in the control group (median birth weight, 1170 gm; median age, 2 days) received no routine prophylactic antibiotic treatment. No infant receiving amoxicillin had septicemia, whereas two infants (2.7%) in the control group did; suspected septicemia (positive clinical and laboratory findings but negative blood culture results) was found in 3 infants in the amoxicillin group and in 6 of the control group (not significantly). Bacterial contamination of the catheter tip at removal was significantly reduced in the amoxicillin group (13.3% vs 28.8% in control subjects; p < 0.05). Negligible differences were found in duration of catheterization (median, 15 days in both groups), or the number of thrombotic (9.3% vs 2.7% in control subjects) and other catheter-related complications between the groups. CONCLUSION A low incidence of catheter-related infections can be achieved in neonates with central venous catheters without using prophylaxis with an antibiotic.
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Affiliation(s)
- K Harms
- Department of Pediatrics, University of Göttingen, Germany
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Pekrun A, Schiffmann H, Lakomek M. [Lysis of cytostatic drug-associated axillary vein thrombosis]. Klin Padiatr 1994; 206:346-8. [PMID: 7967437 DOI: 10.1055/s-2008-1046628] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
A 3 years old patient receiving chemotherapy for acute-lymphoblastic leukemia according to the ALL-BFM 90-treatment protocol developed thrombosis of the vena axillaris. Without removing the central venous catheter located at the site of thrombosis it was possible to lyse the thrombus by the systemic application of recombinant human tissue-type plasminogen activator (rt-PA). The method is recommended for the treatment of thrombotic occlusions in children.
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Affiliation(s)
- A Pekrun
- Universitäts-Kinderklinik Göttingen
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Schiffmann H, Eidelstein E, Wisliczki L. Visual endotracheal intubation without laryngoscope. Isr J Med Sci 1969; 5:1266-7. [PMID: 5365613] [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: 01/14/2023]
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Schiffmann H. [Occupational vocal cord carcinoma caused by inhalation of carcinogenic substances]. HNO 1966; 14:82-7. [PMID: 5997627] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
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