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Klemme M, Staffler A, De Maio N, Lauseker M, Schubert S, Innocenti P, Wurster TM, Foerster K, Herber-Jonat S, Mittal R, Messner H, Flemmer AW. Use of impregnated catheters to decrease colonization rates in neonates - A randomized controlled pilot trial. J Neonatal Perinatal Med 2021; 13:231-237. [PMID: 31609709 DOI: 10.3233/npm-190273] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVE Nosocomial infections increase mortality and morbidity in preterm infants. Central venous line colonization is a major risk factor for the development of such infections. In adults and children, antibiotic and antimycotic impregnated catheters have been demonstrated to reduce colonization. However, recently published data showed no significant difference in bloodstream infection in neonates when an impregnated catheter was used. We investigated the effect of impregnation of percutaneously inserted micro-catheters (PICC) on colonization in preterm and sick term infants in our unit. METHODS Neonates were randomly assigned to receive either a standard (S-PICC; n = 34) or antibiotic and antimycotic impregnated (IP-PICC; n = 37) PICC. Catheters were placed and removed according to a standard procedure and subsequently examined by roll-out culture. The primary outcome was the rate of colonization defined as >15 colony-forming-units/ml. Additional outcomes were catheter associated or systemic infections. RESULTS The rate of colonization was lower in neonates who received an IP-PICC as compared to S-PICC (5.6% vs. 12.1% respectively; p = 0.42). However, the difference was not significant. In IP-PICC vs S-PICC, catheter related local infection (CRI) although lower was not statistically significant (2.9% vs. 6.1%; p = 0.60). We observed no difference in catheter related systemic infection (CR-SI) (0% vs. 3.1%, p = 0.48). The neonates whose catheters were colonized were predominantly of a lower gestational age (median 254/7, p = 0.05) and males (100%, p = 0.01). In addition, the median colony count in the colonized IP-PICC catheters was lower as compared to S- PICC group (53 vs 250, p = 0.06). CONCLUSIONS The use of antibiotic and antimycotic impregnated PICC-lines in neonates tended to decrease colonization rates in neonates in our centers but this difference was not significant. Lower gestational age and male sex are risk factors for catheter colonization.
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Affiliation(s)
- M Klemme
- Division of Neonatology, Dr. v. Hauner Children's Hospital and Perinatal Center Munich - Grosshadern, LMU Munich, Germany
| | - A Staffler
- Division of Neonatology, Central Teaching Hospital of Bolzano/Bozen, Bolzano, Italy
| | - N De Maio
- Division of Neonatology, Dr. v. Hauner Children's Hospital and Perinatal Center Munich - Grosshadern, LMU Munich, Germany
| | - M Lauseker
- Institute for Medical Information Processing, Biometry, and Epidemiology, Ludwig Maximilians University, Munich, Germany
| | - S Schubert
- Max von Pettenkofer Institute of Hygiene and Medical Microbiology, Faculty of Medicine, LMU Munich, Germany
| | - P Innocenti
- Laboratory of Microbiology and Virology, Bolzano Health District, Bolzano, Italy
| | - T M Wurster
- Division of Neonatology, Central Teaching Hospital of Bolzano/Bozen, Bolzano, Italy
| | - K Foerster
- Division of Neonatology, Dr. v. Hauner Children's Hospital and Perinatal Center Munich - Grosshadern, LMU Munich, Germany
| | - S Herber-Jonat
- Division of Neonatology, Dr. v. Hauner Children's Hospital and Perinatal Center Munich - Grosshadern, LMU Munich, Germany
| | - R Mittal
- Division of Neonatology, Dr. v. Hauner Children's Hospital and Perinatal Center Munich - Grosshadern, LMU Munich, Germany
| | - H Messner
- Division of Neonatology, Central Teaching Hospital of Bolzano/Bozen, Bolzano, Italy
| | - A W Flemmer
- Division of Neonatology, Dr. v. Hauner Children's Hospital and Perinatal Center Munich - Grosshadern, LMU Munich, Germany
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Burgmann DM, Foerster K, Klemme M, Delius M, Hübener C, Wisskott R, Boulesteix AL, Flemmer AW. Delivery room desaturations and bradycardia in the early postnatal period of healthy term neonates - a prospective observational study. J Matern Fetal Neonatal Med 2020; 35:1457-1461. [PMID: 32375581 DOI: 10.1080/14767058.2020.1757064] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
OBJECTIVE It has been suggested that desaturations and bradycardia precede acute life-threatening events (ALTE) and that ALTE is more common in the delivery room than later in life. However, frequency, duration and severity of desaturations in the first hours of life and additional risk factors have not readily been studied. METHODS Term neonates (n = 100) were monitored for the first two hours after birth by pulse oximetry. The impact of maternal and perinatal factors on the frequency and severity of desaturations (<85%) and bradycardia (<80/min) was evaluated. RESULTS Desaturations were detected in 30%, prolonged desaturations in 25% of infants. Desaturations were observed significantly more often in infants born by planned Cesarean section (pCs) compared to other modes of delivery (pCs 20/49; others 10/51; p = .029). Desaturations were also more frequent in infants diagnosed with neonatal infection (NI) or infants born to a mother with gestational diabetes (GDM), although not significantly. No bradycardia <80/min was detected. CONCLUSIONS In our collective 4% of healthy term neonates had prolonged, clinically relevant desaturations in the first hours after birth. The mode of delivery and maternal risk factors may increase the risk for these events. However, our cohort was too small to detect any ALTE or SIDS and determine potential risk factors for these events. Our data lay ground for a large-scale prospective trial to investigate whether the mode of delivery could be an indication for general pulse oximetry monitoring of newborn in the delivery room.
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Affiliation(s)
- D-M Burgmann
- Department of Obstetrics and Gynecology, Perinatal Center, University Hospital, Campus Grosshadern, LMU Munich, Munich, Germany
| | - K Foerster
- Division of Neonatology, University Children's Hospital and Perinatal Center, University Hospital, Campus Grosshadern, LMU Munich, Munich, Germany
| | - M Klemme
- Division of Neonatology, University Children's Hospital and Perinatal Center, University Hospital, Campus Grosshadern, LMU Munich, Munich, Germany
| | - M Delius
- Department of Obstetrics and Gynecology, Perinatal Center, University Hospital, Campus Grosshadern, LMU Munich, Munich, Germany
| | - C Hübener
- Department of Obstetrics and Gynecology, Perinatal Center, University Hospital, Campus Grosshadern, LMU Munich, Munich, Germany
| | - R Wisskott
- Department of Medical Information Processing, Biometry and Epidemiology, University Hospital, LMU Munich, Munich, Germany
| | - A L Boulesteix
- Department of Medical Information Processing, Biometry and Epidemiology, University Hospital, LMU Munich, Munich, Germany
| | - A W Flemmer
- Division of Neonatology, University Children's Hospital and Perinatal Center, University Hospital, Campus Grosshadern, LMU Munich, Munich, Germany
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Mola-Schenzle E, Staffler A, Klemme M, Pellegrini F, Molinaro G, Parhofer KG, Messner H, Schulze A, Flemmer AW. Clinically stable very low birthweight infants are at risk for recurrent tissue glucose fluctuations even after fully established enteral nutrition. Arch Dis Child Fetal Neonatal Ed 2015; 100:F126-31. [PMID: 25381093 DOI: 10.1136/archdischild-2014-306168] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [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] [Indexed: 11/04/2022]
Abstract
OBJECTIVE In previous cases, we have observed occasional hypoglycaemic episodes in preterm infants after initial intensive care. In this prospective study, we determined the frequency and severity of abnormal tissue glucose (TG) in clinically stable preterm infants on full enteral nutrition. METHODS Preterm infants born at <1000 g (n=23; G1) and birth weight 1000-1500 g (n=18; G2) were studied at a postmenstrual age of 32±2 weeks (G1) and 33±2 weeks (G2). Infants were fed two or three hourly, according to a standard bolus-nutrition protocol, and continuous subcutaneous glucose measurements were performed for 72 h. Normal glucose values were assumed at ≥2.5 mmol/L (45 mg/dL) and ≤8.3 mmol/L (150 mg/dL). Frequency, severity and duration of glucose values beyond normal values were determined. RESULTS We observed asymptomatic low TG values in 39% of infants in G1 and in 44% in G2. High TG values were detected in 83% in G1 and 61% in G2. Infants in G1 experienced prolonged and more severe low TG episodes, and also more frequent and severe high TG episodes. In G1 and G2, 87% and 67% of the infants, respectively, showed glucose fluctuations characterised by rapid glucose increase followed by a rapid glucose drop after feeds. In more mature infants, glucose fluctuations were less pronounced and less dependent on enteral feeds. CONCLUSIONS Clinically stable well-developing preterm infants beyond their initial period of intensive care show interstitial glucose instabilities exceeding values as low as 2.5 mmol/L and as high as 8.3 mmol/L. This novel observation may play an important role for the susceptibility of these high-risk infants for the development of the metabolic syndrome. TRIAL REGISTRATION NUMBER German trial registration number DRKS00004590.
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Affiliation(s)
- E Mola-Schenzle
- Division of Neonatology, Dr von Hauner Children's Hospital and Perinatal Center, Ludwig Maximilian University Munich-Grosshadern, Munich, Germany
| | - A Staffler
- Division of Neonatology, Regional Hospital Bolzano, Bolzano, Italy
| | - M Klemme
- Division of Neonatology, Dr von Hauner Children's Hospital and Perinatal Center, Ludwig Maximilian University Munich-Grosshadern, Munich, Germany
| | - F Pellegrini
- Division of Neonatology, Regional Hospital Bolzano, Bolzano, Italy
| | - G Molinaro
- Division of Neonatology, Regional Hospital Bolzano, Bolzano, Italy
| | - K G Parhofer
- Department of Internal Medicine, Ludwig-Maximilian-University Munich-Grosshadern, Munich, Germany
| | - H Messner
- Division of Neonatology, Regional Hospital Bolzano, Bolzano, Italy
| | - A Schulze
- Division of Neonatology, Dr von Hauner Children's Hospital and Perinatal Center, Ludwig Maximilian University Munich-Grosshadern, Munich, Germany
| | - A W Flemmer
- Division of Neonatology, Dr von Hauner Children's Hospital and Perinatal Center, Ludwig Maximilian University Munich-Grosshadern, Munich, Germany
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Mola-Schenzle E, Staffler A, Klemme M, Schulze A, Parhofer KG, Flemmer AW. Kontinuierliche Glukose Messung in enteral ernährten Frühgeborenen. DIABETOL STOFFWECHS 2013. [DOI: 10.1055/s-0033-1341851] [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: 10/26/2022]
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Schneider C, Balzer C, Buttstädt M, Eßer K, Ginski S, Hahmann J, Ketzler G, Klemme M, Kröpelin A, Merbitz H, Michael S, Sachsen T, Siuda A, Weishoff-Houben M, Brunk MF, Dott W, Hofmeister H, Pfaffenbach C, Roll C, Selle K. "CITY 2020+": assessing climate change impacts for the city of Aachen related to demographic change and health – a progress report. Adv Sci Res 2011. [DOI: 10.5194/asr-6-261-2011] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Abstract
Abstract. The research initiative CITY 2020+ assesses the risks and opportunities for residents in urban built environments under projected demographic and climate change for the year 2020 and beyond, using the city of Aachen as a case study. CITY 2020+ develops strategies, options and tools for planning and developing sustainable future city structures. The investigation focuses on how urban environment, political structure and residential behaviour can best be adapted, with attention to the interactions among structural, political, and sociological configurations and their impacts on human health. The interdisciplinary research is organized in three clusters. Within the first cluster, strategies of older people exposed to heat stress, and their networks as well as environmental health risks according to atmospheric conditions are examined. The second cluster addresses governance questions, urban planning and building technologies as well as spatial patterns of the urban heat island. The third cluster includes studies on air quality related to particulate matter and a historical perspective of city development concerning environmental issues and climate variability. However, it turns out that research topics that require an interdisciplinary approach are best addressed not by pre-structuring the work into related sub-projects but through combining them according to shared methodological approaches. Examples illustrating this rather practical approach within ongoing research are presented in this paper.
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Staffler A, Klemme M, Hilgendorff A, Schulze A, Flemmer AW. Hypoglykämien bei hyperalimentatierten extrem unreifen Frühgeborenen. Z Geburtshilfe Neonatol 2008. [DOI: 10.1055/s-2008-1078815] [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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Kuscha M, Raithel E, Klemme M, Schulze A, Thome U, Flemmer AW. Der Effekt von Salbutamol auf die elektrische Impedanz der Lunge extrem Frühgeborener. Z Geburtshilfe Neonatol 2007. [DOI: 10.1055/s-2007-983141] [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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Flemmer AW, Raithel E, Kuscha M, Klemme M, Schulze A, Thome U. Intravenöses Salbutamol bei Frühgeborenen unter 1000g, Ergebnisse einer Pilotstudie. Z Geburtshilfe Neonatol 2007. [DOI: 10.1055/s-2007-983142] [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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Schmidt S, Klemme M, Heer I, Hasbargen U, Rückert S, Schulze A. Bedeutung der Differenzialdiagnose bei erstmaliger Feststellung einer fetalen Bradykardie. Z Geburtshilfe Neonatol 2007. [DOI: 10.1055/s-2007-983272] [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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Raithel E, Kuscha M, Klemme M, Schulze A, Thome U, Flemmer AW. Der Effekt von intravenös appliziertem Salbutamol auf die Aktivität des epithalialen Natriumkanals, gemessen als amiloridabhängiges Nasenpotential. Z Geburtshilfe Neonatol 2007. [DOI: 10.1055/s-2007-983120] [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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