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Greve S, Bruns N, Dathe AK, Schuendeln MM, Felderhoff-Mueser U, Stein A. Effects of an early transfer from incubator to a warming crib in very low birthweight preterm infants. BMC Pediatr 2024; 24:319. [PMID: 38724933 PMCID: PMC11080167 DOI: 10.1186/s12887-024-04795-y] [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] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/26/2023] [Accepted: 04/26/2024] [Indexed: 05/13/2024] Open
Abstract
PURPOSE Very low birth weight infants are cared for postnatally in the incubator because of adverse consequences of hypothermia. Data on the optimal weight of transfer to a warming crib are rare. The aim of this study was to determine the course of temperature and body weight during a standardized transfer to a warming crib at a set weight. METHODS Prospective intervention study in very low birthweight infants who were transferred from the incubator to a warming crib at a current weight between 1500 g and 1650 g. RESULTS No infant had to be transferred back to an incubator. Length of hospital stay was equal compared to a historical cohort from the two years directly before the intervention. The intervention group showed an increase in the volume fed orally on the day after transfer to the warming crib, although this did not translate into an earlier discontinuation of gavage feedings. Compared to the historical group, infants in the intervention group could be transferred to an unheated crib at an earlier postmenstrual age and weight. CONCLUSIONS Early transfer from the incubator to a warming crib between 1500 g and 1650 g is feasible and not associated with adverse short-term events or outcomes. TRIAL REGISTRATION DRKS-IDDRKS00031832.
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Affiliation(s)
- Sandra Greve
- Department of Paediatrics I, Neonatology, Paediatric Intensive Care and Paediatric Neurology, Universitätsmedizin Essen, University of Duisburg-Essen, North-Rhine Westphalia, 45122, Essen, Germany.
| | - Nora Bruns
- Department of Paediatrics I, Neonatology, Paediatric Intensive Care and Paediatric Neurology, Universitätsmedizin Essen, University of Duisburg-Essen, North-Rhine Westphalia, 45122, Essen, Germany
| | - Anne-Kathrin Dathe
- Department of Paediatrics I, Neonatology, Paediatric Intensive Care and Paediatric Neurology, Universitätsmedizin Essen, University of Duisburg-Essen, North-Rhine Westphalia, 45122, Essen, Germany
- Department of Health and Nursing, Occupational Therapy, Ernst-Abbe-University of Applied Sciences, Jena, Germany
| | - Michael M Schuendeln
- Department of Paediatrics III, Department of Pediatric Hematology and Oncology, Universitätsmedizin Essen, University of Duisburg-Essen, North-Rhine Westphalia, 45122, Essen, Germany
| | - Ursula Felderhoff-Mueser
- Department of Paediatrics I, Neonatology, Paediatric Intensive Care and Paediatric Neurology, Universitätsmedizin Essen, University of Duisburg-Essen, North-Rhine Westphalia, 45122, Essen, Germany
| | - Anja Stein
- Department of Paediatrics I, Neonatology, Paediatric Intensive Care and Paediatric Neurology, Universitätsmedizin Essen, University of Duisburg-Essen, North-Rhine Westphalia, 45122, Essen, Germany
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Kobus S, Kleinbeck T, Ader M, Dewan MV, Dathe AK, Feddahi N, Felderhoff-Mueser U, Bruns N. COMFORTneo scale in preterm infants during live performed music therapy-Difference between close physical contact and hand touch contact. Front Neurosci 2024; 18:1359769. [PMID: 38606306 PMCID: PMC11008230 DOI: 10.3389/fnins.2024.1359769] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2023] [Accepted: 03/14/2024] [Indexed: 04/13/2024] Open
Abstract
There is evidence that music therapy combined with physical contact to parents stabilizes the vital signs of hospitalized preterm infants. Yet, there is no evidence for the difference between simple contact by touching the infant in the incubator or cod, or close physical contact during music therapy sessions (MT). Behavioral effects of the various forms of attention toward the infant during therapy need to be elucidated. Our study aimed to quantify the effects of hand touch contact (HTC) and close physical contact (CPC) during live performed MT in preterm infants regardless of gestational age on behavioral state (assessed via COMFORTneo scale) and vital signs. A maximum of ten live music therapy sessions were delivered three to four times a week until hospital discharge to 50 stable infants. Pre-, during- and post-therapy heart rates, respiratory rates, oxygen saturations and COMFORTneo scores were recorded for each session. A total of 486 sessions was performed with 243 sessions using HTC and CPC each. The mean gestational age was 33 + 3 weeks, with 27 (54%) infants being male. We observed lower COMFORTneo scores, heart and respiratory rates and higher oxygen saturation during and after live performed music therapy independent of the kind of physical contact than before therapy. While pre-therapy values were better in the CPC group for all four variables, a higher mean response on COMFORTneo scale and vital signs was observed for HTC (COMFORTneo score -5.5, heart rate -12.4 beats per min., respiratory rate -8.9 breaths per min, oxygen saturation + 1.5%) compared to CPC (COMFORTneo score -4.6, heart rate -9.6 beats per min., respiratory rate -7.0 breaths per min, oxygen saturation + 1.1%). Nonetheless, post-therapy values were better for all four measures in the CPC group. Regression modeling with correction for individual responses within each patient also yielded attenuated effects of MT in the CPC group compared to HTC, likely caused by the improved pre-therapy values. Live performed music therapy benefits preterm infants' vital signs and behavioral state. During CPC with a parent, the absolute therapeutic effect is attenuated but resulting post-therapy values are nonetheless better for both the COMFORTneo scale and vital signs.
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Affiliation(s)
- Susann Kobus
- Department of Paediatrics I, University Hospital, University of Duisburg-Essen, Essen, Germany
- Centre for Translational Neuro- and Behavioural Sciences, C-TNBS, Faculty of Medicine, University Duisburg-Essen, Essen, Germany
- Center of Artistic Therapy, University Medicine Essen, Essen, Germany
| | - Tim Kleinbeck
- Department of Paediatrics I, University Hospital, University of Duisburg-Essen, Essen, Germany
- Centre for Translational Neuro- and Behavioural Sciences, C-TNBS, Faculty of Medicine, University Duisburg-Essen, Essen, Germany
| | - Miriam Ader
- Department of Paediatrics I, University Hospital, University of Duisburg-Essen, Essen, Germany
- Centre for Translational Neuro- and Behavioural Sciences, C-TNBS, Faculty of Medicine, University Duisburg-Essen, Essen, Germany
| | - Monia Vanessa Dewan
- Department of Paediatrics I, University Hospital, University of Duisburg-Essen, Essen, Germany
- Centre for Translational Neuro- and Behavioural Sciences, C-TNBS, Faculty of Medicine, University Duisburg-Essen, Essen, Germany
| | - Anne-Kathrin Dathe
- Department of Paediatrics I, University Hospital, University of Duisburg-Essen, Essen, Germany
- Centre for Translational Neuro- and Behavioural Sciences, C-TNBS, Faculty of Medicine, University Duisburg-Essen, Essen, Germany
- Department of Health and Nursing, Occupational Therapy, Ernst-Abbe-University of Applied Sciences, Jena, Germany
| | - Nadia Feddahi
- Department of Paediatrics I, University Hospital, University of Duisburg-Essen, Essen, Germany
- Centre for Translational Neuro- and Behavioural Sciences, C-TNBS, Faculty of Medicine, University Duisburg-Essen, Essen, Germany
| | - Ursula Felderhoff-Mueser
- Department of Paediatrics I, University Hospital, University of Duisburg-Essen, Essen, Germany
- Centre for Translational Neuro- and Behavioural Sciences, C-TNBS, Faculty of Medicine, University Duisburg-Essen, Essen, Germany
| | - Nora Bruns
- Department of Paediatrics I, University Hospital, University of Duisburg-Essen, Essen, Germany
- Centre for Translational Neuro- and Behavioural Sciences, C-TNBS, Faculty of Medicine, University Duisburg-Essen, Essen, Germany
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Dathe AK, Greve S, Teschler U, Heuser-Spura KM, Cordier L, Albayrak B, Felderhoff-Mueser U, Huening BM. Adaption of Follow-Up Visits for Preterm and High-Risk Children for Video Consultations. Telemed J E Health 2024. [PMID: 38466975 DOI: 10.1089/tmj.2023.0594] [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: 03/13/2024] Open
Abstract
Introduction: Structured and standardized follow-up care for preterm and high-risk infants enables an early detection of developmental deficits. The aim is to adapt the in-person follow-up to video consultation. Developmental delays can thus be identified at an early stage, independently of in-person contact. Methods: The adaptation of these follow-up to video consultation is presented descriptively, compared with the in-person consultation (similarities, differences, challenges, and limitations). Professionals's experiences with the adaption are described. Results: The experience of n = 267 video consultations for follow-up of children up to 6 years shows that an adaptation of the in-person consultation is necessary and possible. Prerequisite is a digital medium with a stable internet connection on both sides: the professional and the family, as well as a portal for video consultations with certified, encrypted data transmission. Among infants, testing is almost entirely parent guided. For older children, testing procedures have been adapted. A neurological examination is largely possible, while a general pediatric examination is omitted. A survey on professionals' (n = 7) experiences with video- and in-person consultations found that the rate of complete follow-up visits and the resources required for taking medical histories, personnel, and time remained constant for both approaches. All reported that the video consultation is generally suitable for identifying developmental delays in children up to an age of 6 years comparable with in-person consultations. One professional stated that the physical examination of children aged ≥1 year is impossible. Discussion: Video consultation is an alternative despite some limitations when an in-person consultation is impossible. Developmental delays can be identified, and therapies recommended.
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Affiliation(s)
- Anne-Kathrin Dathe
- Department of Paediatrics I, Neonatology, Paediatric Intensive Care and Paediatric Neurology, University Hospital Essen, University of Duisburg-Essen, Essen, Germany
- Centre for Translational Neuro- and Behavioural Sciences, C-TNBS, Faculty of Medicine, University Duisburg-Essen, Essen, Germany
- Department of Health and Nursing, Occupational Therapy, Ernst-Abbe-University of Applied Sciences, Jena, Germany
| | - Sandra Greve
- Department of Paediatrics I, Neonatology, Paediatric Intensive Care and Paediatric Neurology, University Hospital Essen, University of Duisburg-Essen, Essen, Germany
- Centre for Translational Neuro- and Behavioural Sciences, C-TNBS, Faculty of Medicine, University Duisburg-Essen, Essen, Germany
| | - Uta Teschler
- Department of Paediatrics I, Neonatology, Paediatric Intensive Care and Paediatric Neurology, University Hospital Essen, University of Duisburg-Essen, Essen, Germany
- Centre for Translational Neuro- and Behavioural Sciences, C-TNBS, Faculty of Medicine, University Duisburg-Essen, Essen, Germany
| | - Katharina M Heuser-Spura
- Department of Paediatrics I, Neonatology, Paediatric Intensive Care and Paediatric Neurology, University Hospital Essen, University of Duisburg-Essen, Essen, Germany
- Centre for Translational Neuro- and Behavioural Sciences, C-TNBS, Faculty of Medicine, University Duisburg-Essen, Essen, Germany
| | - Larissa Cordier
- Department of Paediatrics I, Neonatology, Paediatric Intensive Care and Paediatric Neurology, University Hospital Essen, University of Duisburg-Essen, Essen, Germany
- Centre for Translational Neuro- and Behavioural Sciences, C-TNBS, Faculty of Medicine, University Duisburg-Essen, Essen, Germany
| | - Bilge Albayrak
- Department of Paediatrics I, Neonatology, Paediatric Intensive Care and Paediatric Neurology, University Hospital Essen, University of Duisburg-Essen, Essen, Germany
- Centre for Translational Neuro- and Behavioural Sciences, C-TNBS, Faculty of Medicine, University Duisburg-Essen, Essen, Germany
| | - Ursula Felderhoff-Mueser
- Department of Paediatrics I, Neonatology, Paediatric Intensive Care and Paediatric Neurology, University Hospital Essen, University of Duisburg-Essen, Essen, Germany
- Centre for Translational Neuro- and Behavioural Sciences, C-TNBS, Faculty of Medicine, University Duisburg-Essen, Essen, Germany
| | - Britta M Huening
- Department of Paediatrics I, Neonatology, Paediatric Intensive Care and Paediatric Neurology, University Hospital Essen, University of Duisburg-Essen, Essen, Germany
- Centre for Translational Neuro- and Behavioural Sciences, C-TNBS, Faculty of Medicine, University Duisburg-Essen, Essen, Germany
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Kobus S, Felderhoff-Mueser U, Lainka E, Fandrey J, Benson S. Music Therapy as a Topic in Medical Education: Course Concept and Student Evaluation of an Elective Course for Medical Students. J Med Educ Curric Dev 2024; 11:23821205241234537. [PMID: 38405366 PMCID: PMC10894546 DOI: 10.1177/23821205241234537] [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] [Figures] [Subscribe] [Scholar Register] [Received: 08/30/2023] [Accepted: 01/31/2024] [Indexed: 02/27/2024]
Abstract
OBJECTIVES Music therapy has been proven as a safe and well-established intervention in healthcare to relieve symptoms and improve quality of life. While music therapy is already established in several settings to supplement medical care, there is a lack of integration in the field of medical education. METHODS We report on the implementation and evaluation of a teaching concept for a five-day-intensive-course on music therapy. The course was offered as an elective course for medical students at the University Duisburg-Essen. At the end of the course, students filled out a free text questionnaire to assess the students' perception of the course, and additionally answered standardized questions by the structured EVALuna online evaluation tool of the University of Duisburg-Essen. RESULTS All students (N = 35) who participated in the music therapy course between September 2019 and March 2023 completed the questionnaires and N = 21 students filled out the EVALuna. Most students (89%) chose the course because of their interest in alternative and supportive therapy options to improve patients' well-being. About 46% had previous musical experience and passion and fun with music and 37% of the students were interested in the interdisciplinary academic subject that combined music and medicine. EVALuna online evaluation reflected high satisfaction with the course. CONCLUSION Due to the well-proven effectiveness and evidence of music therapy as well as the positive perception of medical students, music therapy should be further established in medical care and medical education.
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Affiliation(s)
- Susann Kobus
- Department of Paediatrics I, University Hospital, University of Duisburg-Essen, Essen, Germany
- Center of Artistic Therapy, University Medicine Essen, Essen, Germany
| | - Ursula Felderhoff-Mueser
- Department of Paediatrics I, University Hospital, University of Duisburg-Essen, Essen, Germany
- Center for Translational Neuro- and Behavioural Sciences, C-TNBS, Faculty of Medicine, University Duisburg-Essen, Essen, Germany
| | - Elke Lainka
- Clinic for Pediatrics II, University Children's Hospital Essen, University of Duisburg-Essen, Essen, Germany
| | - Joachim Fandrey
- Institute of Physiology, University Hospital Essen, University of Duisburg-Essen, Essen, Germany
| | - Sven Benson
- Center for Translational Neuro- and Behavioural Sciences, C-TNBS, Faculty of Medicine, University Duisburg-Essen, Essen, Germany
- Institute for Medical Education, University Hospital Essen, University of Duisburg-Essen, Essen, Germany
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Teschler U, Dathe AK, Heuser-Spura KM, Bialas J, Cordier LJ, Albayrak B, Felderhoff-Mueser U, Huening BM. General Movements trajectories and outcome at 12 months in very preterm infants: An analysis of tendencies and pathological persistence. Sci Rep 2023; 13:21825. [PMID: 38071260 PMCID: PMC10710415 DOI: 10.1038/s41598-023-49037-w] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2023] [Accepted: 12/03/2023] [Indexed: 12/18/2023] Open
Abstract
Very preterm infants (VPI) < 32 weeks are at increased risk of developmental disorders detectable using the Prechtl General Movements Assessment (GMA) and the Bayley Scales of Infant and Toddler Development-Third Edition (BSID-III). The aim of this study was to investigate General Movements (GMs) trajectories from preterm to fidgety age including GMs tendencies and their association with cognitive and motor outcome. Retrospective analysis of VPI with GMA at preterm (35 ± 2 weeks postmenstrual age (PMA), T1) and fidgety age (12 ± 3 weeks corrected age CA), T2), and BSID-III (12 ± 3 months CA, T3) is performed. Data are analysed using Pearson χ2-test, Fisher-Freeman-Halton Exact test, and residual analyses. This study found significant associations between (a) GMs (T1) and (b) persistent pathological GMs (T1 + T2) with cognitive outcomes at 12 months (T3) considering the tendencies of GMs in addition to the global character (p = 0.007, p = 0.022, respectively), representing medium-sized effects. There were no significant associations between GMs or persistence of pathological GMs and gross and fine motor outcomes, regardless of GMs tendencies. Findings indicate that considering tendencies of GMs and the persistence of pathological GMs may be important in identifying children at risk of cognitive impairments early. This additional assessment parameter may have the potential for early identification of infants with milder motor and/or cognitive impairments. However, more research is needed using larger sample cohorts to generalise the results and to be able to recommend sequential GMA for clinical routine.
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Affiliation(s)
- Uta Teschler
- Department of Paediatrics I, Neonatology, Paediatric Intensive Care and Paediatric Neurology, University Hospital Essen, University of Duisburg-Essen, Essen, Germany.
- Center for Translational Neuro- and Behavioral Sciences, University Hospital Essen, University of Duisburg-Essen, Essen, Germany.
| | - Anne-Kathrin Dathe
- Department of Paediatrics I, Neonatology, Paediatric Intensive Care and Paediatric Neurology, University Hospital Essen, University of Duisburg-Essen, Essen, Germany
- Center for Translational Neuro- and Behavioral Sciences, University Hospital Essen, University of Duisburg-Essen, Essen, Germany
- Department of Health and Nursing, Occupational Therapy, Ernst-Abbe-University of Applied Sciences, Jena, Germany
| | - Katharina Maria Heuser-Spura
- Department of Paediatrics I, Neonatology, Paediatric Intensive Care and Paediatric Neurology, University Hospital Essen, University of Duisburg-Essen, Essen, Germany
- Center for Translational Neuro- and Behavioral Sciences, University Hospital Essen, University of Duisburg-Essen, Essen, Germany
| | - Johanna Bialas
- Department of Paediatrics I, Neonatology, Paediatric Intensive Care and Paediatric Neurology, University Hospital Essen, University of Duisburg-Essen, Essen, Germany
- Center for Translational Neuro- and Behavioral Sciences, University Hospital Essen, University of Duisburg-Essen, Essen, Germany
| | - Larissa Jane Cordier
- Department of Paediatrics I, Neonatology, Paediatric Intensive Care and Paediatric Neurology, University Hospital Essen, University of Duisburg-Essen, Essen, Germany
- Center for Translational Neuro- and Behavioral Sciences, University Hospital Essen, University of Duisburg-Essen, Essen, Germany
| | - Bilge Albayrak
- Department of Paediatrics I, Neonatology, Paediatric Intensive Care and Paediatric Neurology, University Hospital Essen, University of Duisburg-Essen, Essen, Germany
- Center for Translational Neuro- and Behavioral Sciences, University Hospital Essen, University of Duisburg-Essen, Essen, Germany
| | - Ursula Felderhoff-Mueser
- Department of Paediatrics I, Neonatology, Paediatric Intensive Care and Paediatric Neurology, University Hospital Essen, University of Duisburg-Essen, Essen, Germany
- Center for Translational Neuro- and Behavioral Sciences, University Hospital Essen, University of Duisburg-Essen, Essen, Germany
| | - Britta Maria Huening
- Department of Paediatrics I, Neonatology, Paediatric Intensive Care and Paediatric Neurology, University Hospital Essen, University of Duisburg-Essen, Essen, Germany
- Center for Translational Neuro- and Behavioral Sciences, University Hospital Essen, University of Duisburg-Essen, Essen, Germany
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Paniskaki K, Goretzki S, Anft M, Konik MJ, Meister TL, Pfaender S, Lechtenberg K, Vogl M, Dogan B, Dolff S, Westhoff TH, Rohn H, Felderhoff-Mueser U, Stervbo U, Witzke O, Dohna-Schwake C, Babel N. Increased SARS-CoV-2 reactive low avidity T cells producing inflammatory cytokines in pediatric post-acute COVID-19 sequelae (PASC). Pediatr Allergy Immunol 2023; 34:e14060. [PMID: 38146118 DOI: 10.1111/pai.14060] [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] [Received: 07/22/2023] [Revised: 11/13/2023] [Accepted: 11/29/2023] [Indexed: 12/27/2023]
Abstract
BACKGROUND A proportion of the convalescent SARS-CoV-2 pediatric population presents nonspecific symptoms, mental health problems, and a reduction in quality of life similar to myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS) and long COVID-19 symptomatic. However, data regarding its clinical manifestation and immune mechanisms are currently scarce. METHODS In this study, we perform a comprehensive clinical and immunological profiling of 17 convalescent COVID-19 children with post-acute COVID-19 sequelae (PASC) manifestation and 13 convalescent children without PASC manifestation. A detailed medical history, blood and instrumental tests, and physical examination were obtained from all patients. SARS-CoV-2 reactive T-cell response was analyzed via multiparametric flow cytometry and the humoral immunity was addressed via pseudovirus neutralization and ELISA assay. RESULTS The most common PASC symptoms were shortness of breath/exercise intolerance, paresthesia, smell/taste disturbance, chest pain, dyspnea, headache, and lack of concentration. Blood count and clinical chemistry showed no statistical differences among the study groups. We detected higher frequencies of spike (S) reactive CD4+ and CD8+ T cells among the PASC study group, characterized by TNFα and IFNγ production and low functional avidity. CRP levels are positively correlated with IFNγ producing reactive CD8+ T cells. CONCLUSIONS Our data might indicate a possible involvement of a persistent cellular inflammatory response triggered by SARS-CoV-2 in the development of the observed sequelae in pediatric PASC. These results may have implications on future therapeutic and prevention strategies.
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Affiliation(s)
- Krystallenia Paniskaki
- Department of Infectious Diseases, West German Centre of Infectious Diseases, University Hospital Essen, University of Duisburg-Essen, Essen, Germany
- Center for Translational Medicine and Immune Diagnostics Laboratory, Medical Department I, Marien Hospital Herne, University Hospital of the Ruhr-University Bochum, Bochum, Germany
| | - Sarah Goretzki
- Department of Infectious Diseases, West German Centre of Infectious Diseases, University Hospital Essen, University of Duisburg-Essen, Essen, Germany
- Department of Pediatrics I, Children's Hospital Essen, University of Duisburg-Essen, Essen, Germany
| | - Moritz Anft
- Center for Translational Medicine and Immune Diagnostics Laboratory, Medical Department I, Marien Hospital Herne, University Hospital of the Ruhr-University Bochum, Bochum, Germany
| | - Margarethe J Konik
- Department of Infectious Diseases, West German Centre of Infectious Diseases, University Hospital Essen, University of Duisburg-Essen, Essen, Germany
| | - Toni L Meister
- Department of Molecular and Medical Virology, Ruhr-University Bochum, Bochum, Germany
| | - Stephanie Pfaender
- Department of Molecular and Medical Virology, Ruhr-University Bochum, Bochum, Germany
| | - Klara Lechtenberg
- Department of Pediatrics I, Children's Hospital Essen, University of Duisburg-Essen, Essen, Germany
| | - Melanie Vogl
- Department of Pediatrics III, Pediatric Pulmonology and Sleep Medicine, Children's Hospital Essen, University of Duisburg-Essen, Essen, Germany
| | - Burcin Dogan
- Department of Pediatrics I, Children's Hospital Essen, University of Duisburg-Essen, Essen, Germany
| | - Sebastian Dolff
- Department of Infectious Diseases, West German Centre of Infectious Diseases, University Hospital Essen, University of Duisburg-Essen, Essen, Germany
| | - Timm H Westhoff
- Medical Department I, Marien Hospital Herne, University Hospital of the Ruhr-University Bochum, Herne, Germany
| | - Hana Rohn
- Department of Infectious Diseases, West German Centre of Infectious Diseases, University Hospital Essen, University of Duisburg-Essen, Essen, Germany
| | - Ursula Felderhoff-Mueser
- Department of Pediatrics I, Children's Hospital Essen, University of Duisburg-Essen, Essen, Germany
- Center for Translational Neuro- and Behavioral Sciences C-TNBS, University of Duisburg-Essen, Essen, Germany
| | - Ulrik Stervbo
- Center for Translational Medicine and Immune Diagnostics Laboratory, Medical Department I, Marien Hospital Herne, University Hospital of the Ruhr-University Bochum, Bochum, Germany
| | - Oliver Witzke
- Department of Infectious Diseases, West German Centre of Infectious Diseases, University Hospital Essen, University of Duisburg-Essen, Essen, Germany
| | - Christian Dohna-Schwake
- Department of Infectious Diseases, West German Centre of Infectious Diseases, University Hospital Essen, University of Duisburg-Essen, Essen, Germany
- Department of Pediatrics I, Children's Hospital Essen, University of Duisburg-Essen, Essen, Germany
- Center for Translational Neuro- and Behavioral Sciences C-TNBS, University of Duisburg-Essen, Essen, Germany
| | - Nina Babel
- Center for Translational Medicine and Immune Diagnostics Laboratory, Medical Department I, Marien Hospital Herne, University Hospital of the Ruhr-University Bochum, Bochum, Germany
- Berlin Institute of Health at Charité - University Clinic Berlin, BIH Center for Regenerative Therapies (BCRT) Berlin, Berlin, Germany
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Paniskaki K, Goretzki S, Anft M, Konik MJ, Lechtenberg K, Vogl M, Meister TL, Pfaender S, Zettler M, Jäger J, Dolff S, Westhoff TH, Rohn H, Felderhoff-Mueser U, Stervbo U, Witzke O, Dohna-Schwake C, Babel N. Fading SARS-CoV-2 humoral VOC cross-reactivity and sustained cellular immunity in convalescent children and adolescents. BMC Infect Dis 2023; 23:818. [PMID: 37993788 PMCID: PMC10664582 DOI: 10.1186/s12879-023-08805-9] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2023] [Accepted: 11/08/2023] [Indexed: 11/24/2023] Open
Abstract
Cross-reactive cellular and humoral immunity can substantially contribute to antiviral defense against SARS-CoV-2 variants of concern (VOC). While the adult SARS-CoV-2 cellular and humoral immunity and its cross-recognition potential against VOC is broadly analyzed, similar data regarding the pediatric population are missing. In this study, we perform an analysis of the humoral and cellular SARS-CoV-2 response immune of 32 convalescent COVID-19 children (children), 27 convalescent vaccinated adults(C + V+) and 7 unvaccinated convalescent adults (C + V-). Similarly to adults, a significant reduction of cross-reactive neutralizing capacity against delta and omicron VOC was observed 6 months after SARS-CoV-2 infection. While SAR-CoV-2 neutralizing capacity was comparable among children and C + V- against all VOC, children demonstrated as expected an inferior humoral response when compared to C + V+. Nevertheless, children generated SARS-CoV-2 reactive T cells with broad cross-recognition potential. When compared to V + C+, children presented even comparable frequencies of WT-reactive CD4 + and CD8 + T cells with high avidity and functionality. Taking into consideration the limitations of study - unknown disease onset for 53% of the asymptomatic pediatric subjects, serological detection of SARS-CoV-2 infection-, our results suggest that following SARS-CoV-2 infection children generate a humoral SARS-CoV-2 response with neutralizing potential comparable to unvaccinated COVID-19 convalescent adults as well a sustained SARS-CoV-2 cellular response cross-reactive to VOC.
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Affiliation(s)
- Krystallenia Paniskaki
- Department of Infectious Diseases, West German Centre of Infectious Diseases, University Hospital Essen, University Duisburg-Essen, Essen, Germany.
- Center for Translational Medicine and Immune Diagnostics Laboratory, Medical Department I, Marien Hospital Herne, University Hospital of the Ruhr-University Bochum, Bochum, Germany.
| | - Sarah Goretzki
- Department of Pediatrics I, University Hospital Essen, University Duisburg-Essen, Essen, Germany
| | - Moritz Anft
- Center for Translational Medicine and Immune Diagnostics Laboratory, Medical Department I, Marien Hospital Herne, University Hospital of the Ruhr-University Bochum, Bochum, Germany
| | - Margarethe J Konik
- Department of Infectious Diseases, West German Centre of Infectious Diseases, University Hospital Essen, University Duisburg-Essen, Essen, Germany
| | - Klara Lechtenberg
- Department of Pediatrics I, University Hospital Essen, University Duisburg-Essen, Essen, Germany
| | - Melanie Vogl
- Department of Pediatrics III, University Hospital Essen, University Duisburg-Essen, Essen, Germany
| | - Toni L Meister
- Department of Molecular and Medical Virology, Ruhr-University Bochum, Bochum, Germany
| | - Stephanie Pfaender
- Department of Molecular and Medical Virology, Ruhr-University Bochum, Bochum, Germany
| | - Markus Zettler
- Department of Infectious Diseases, West German Centre of Infectious Diseases, University Hospital Essen, University Duisburg-Essen, Essen, Germany
| | - Jasmin Jäger
- Department of Infectious Diseases, West German Centre of Infectious Diseases, University Hospital Essen, University Duisburg-Essen, Essen, Germany
- Center for Translational Medicine and Immune Diagnostics Laboratory, Medical Department I, Marien Hospital Herne, University Hospital of the Ruhr-University Bochum, Bochum, Germany
| | - Sebastian Dolff
- Department of Infectious Diseases, West German Centre of Infectious Diseases, University Hospital Essen, University Duisburg-Essen, Essen, Germany
| | - Timm H Westhoff
- Medical Department I, Marien Hospital Herne, University Hospital of the Ruhr-University Bochum, Herne, Germany
| | - Hana Rohn
- Department of Infectious Diseases, West German Centre of Infectious Diseases, University Hospital Essen, University Duisburg-Essen, Essen, Germany
| | - Ursula Felderhoff-Mueser
- Department of Pediatrics I, University Hospital Essen, University Duisburg-Essen, Essen, Germany
| | - Ulrik Stervbo
- Center for Translational Medicine and Immune Diagnostics Laboratory, Medical Department I, Marien Hospital Herne, University Hospital of the Ruhr-University Bochum, Bochum, Germany
| | - Oliver Witzke
- Department of Infectious Diseases, West German Centre of Infectious Diseases, University Hospital Essen, University Duisburg-Essen, Essen, Germany
| | - Christian Dohna-Schwake
- Department of Pediatrics I, University Hospital Essen, University Duisburg-Essen, Essen, Germany
| | - Nina Babel
- Center for Translational Medicine and Immune Diagnostics Laboratory, Medical Department I, Marien Hospital Herne, University Hospital of the Ruhr-University Bochum, Bochum, Germany
- Berlin Institute of Health at Charité - University Clinic Berlin, BIH Center for Regenerative Therapies (BCRT) Berlin, Berlin, Germany
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8
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Kobus S, Diezel M, Dewan MV, Huening B, Dathe AK, Marschik PB, Felderhoff-Mueser U, Bruns N. Music therapy modulates mothers' perception of their preterm infants. Front Psychol 2023; 14:1231741. [PMID: 37928582 PMCID: PMC10620800 DOI: 10.3389/fpsyg.2023.1231741] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2023] [Accepted: 10/06/2023] [Indexed: 11/07/2023] Open
Abstract
Premature birth imposes considerable challenges on the preterm infant, but also challenges the mother, who may not yet be prepared for motherhood and encounter psychological stress during the post-partum period. This secondary analysis of a prospective randomized controlled trial (RCT) aimed to investigate how mothers perceive their preterm infants. We surveyed 33 mothers of preterm infants born before 32 weeks of gestation, who were participating in an RCT on music therapy. We employed the neonatal perception inventory (NPI), an instrument designed to assess the mother's perception and expectations regarding her infant immediately after birth. Infants were randomly assigned to either standard care (control group) or standard care plus music therapy (intervention group). Eighteen mothers from the intervention group participated in the survey (mean age 34.1 ± 4.6 years) and 15 mothers from the control group (mean age 29.6 ± 4.2 years). At the time of the infant's hospital discharge, mothers rated their expectations of how they felt a baby should behave (NPI I) and how they perceived their own infant (NPI II). The NPI score difference was calculated by subtracting the NPI II from the NPI I. Mean NPI I scores were comparable between both groups, but NPI II scores in the intervention group were better [18.0, 95% confidence interval (CI) 16.6-19.4] than in the control group (19.1, 95% CI 18.0-20.3). The relative probability of mothers rating their own baby as better than average was 1.94 (95% CI 1.00-3.79) for mothers whose infants received music therapy. These findings suggest that music therapy in the neonatal intensive care unit can positively influence mothers' perception of their hospitalized preterm infant.
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Affiliation(s)
- Susann Kobus
- Department of Paediatrics I, University Hospital, University of Duisburg-Essen, Essen, Germany
- Faculty of Medicine, Centre for Translational Neuro- and Behavioural Sciences (C-TNBS), University Duisburg-Essen, Essen, Germany
- Center of Artistic Therapy, University Medicine Essen, Essen, Germany
| | - Marlis Diezel
- Department of Paediatrics I, University Hospital, University of Duisburg-Essen, Essen, Germany
- Faculty of Medicine, Centre for Translational Neuro- and Behavioural Sciences (C-TNBS), University Duisburg-Essen, Essen, Germany
| | - Monia Vanessa Dewan
- Department of Paediatrics I, University Hospital, University of Duisburg-Essen, Essen, Germany
- Faculty of Medicine, Centre for Translational Neuro- and Behavioural Sciences (C-TNBS), University Duisburg-Essen, Essen, Germany
| | - Britta Huening
- Department of Paediatrics I, University Hospital, University of Duisburg-Essen, Essen, Germany
- Faculty of Medicine, Centre for Translational Neuro- and Behavioural Sciences (C-TNBS), University Duisburg-Essen, Essen, Germany
| | - Anne-Kathrin Dathe
- Department of Paediatrics I, University Hospital, University of Duisburg-Essen, Essen, Germany
- Faculty of Medicine, Centre for Translational Neuro- and Behavioural Sciences (C-TNBS), University Duisburg-Essen, Essen, Germany
- Department of Health and Nursing, Occupational Therapy, Ernst-Abbe-University of Applied Sciences, Jena, Germany
| | - Peter B. Marschik
- Child and Adolescent Psychiatry and Psychotherapy, Systemic Ethology and Developmental Science, University Medical Center Göttingen and Leibniz ScienceCampus Primate Cognition, Göttingen, Germany
- iDN - Interdisciplinary Developmental Neuroscience, Division of Phoniatrics, Medical University of Graz, Graz, Austria
- Center of Neurodevelopmental Disorders (KIND), Center for Psychiatry Research, Department of Women’s and Children’s Health, Karolinska Institutet, Stockholm, Sweden
| | - Ursula Felderhoff-Mueser
- Department of Paediatrics I, University Hospital, University of Duisburg-Essen, Essen, Germany
- Faculty of Medicine, Centre for Translational Neuro- and Behavioural Sciences (C-TNBS), University Duisburg-Essen, Essen, Germany
| | - Nora Bruns
- Department of Paediatrics I, University Hospital, University of Duisburg-Essen, Essen, Germany
- Faculty of Medicine, Centre for Translational Neuro- and Behavioural Sciences (C-TNBS), University Duisburg-Essen, Essen, Germany
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9
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Albayrak B, Dathe AK, Heuser-Spura KM, Felderhoff-Mueser U, Timmann D, Huening BM. Ataxia Rating Scales Reveal Increased Scores in Very Preterm Born 5-6-Year-Old Preschool Children and Young Adults. Cerebellum 2023; 22:877-887. [PMID: 36018542 PMCID: PMC10485085 DOI: 10.1007/s12311-022-01463-8] [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] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 08/18/2022] [Indexed: 06/15/2023]
Abstract
The aim of this study is to investigate whether scores in ataxia rating scales (ARS) are different in very preterm (VP) preschool and adult participants compared to term controls. This is a case-control study. Sixty VP children (years: 5.5-6.5; gestational age: 23.9-31.7 weeks) and 56 VP adults (years: 17.8-27.9; gestational age: 23.3-32.0 weeks) without major cerebral lesions participated in the study; 60-age and sex-matched term children and 64 term adults for comparison were used in the study intervened with the assessment with International Cooperative Ataxia Rating Scale (ICARS) and Scale for Assessment and Rating of Ataxia (SARA). Main outcome measures are primary outcome: total icars and sara scores in preterm (vp) participants versus controls. Results showed that VP children showed significantly higher total ICARS (M 15.98, SD 6.29, range 4.0-32.0; p < .001) and SARA scores (M 6.5, SD 2.53, range 1.0-15.0; p < .001) than controls (ICARS: M 9.17, SD 3.88, range 2.0-20.0; SARA: M 3.51, SD 1.54, range 1.0-8.0). VP adults also showed significantly higher total ICARS (M 1.0, SD 1.99, range 0.0-11.0; p < .001) and SARA scores (M 0.54, SD 1.08, range 0.0-6.0; p < .001) than controls (ICARS: M 0.11, SD 0.44, range 0.0-2.0; SARA: M 0.04, SD 0.18, range 0.0-1.0). In conclusion, VP children showed significantly higher scores in ARS than controls. These differences were also present in VP adults, suggesting that deficits likely prevail until adulthood. ARS are a time and cost-effective method to screen for difficulties in coordination and balance in a patient group at risk.
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Affiliation(s)
- Bilge Albayrak
- Department of Pediatrics I, Neonatology, Pediatric Intensive Care and Pediatric Neurology, University Hospital Essen, University of Duisburg-Essen, Essen, Germany.
- Center for Translational Neuro- and Behavioral Sciences, University Hospital Essen, University of Duisburg-Essen, Hufelandstraße 55, 45147, Essen, Germany.
| | - Anne-Kathrin Dathe
- Department of Pediatrics I, Neonatology, Pediatric Intensive Care and Pediatric Neurology, University Hospital Essen, University of Duisburg-Essen, Essen, Germany
- Center for Translational Neuro- and Behavioral Sciences, University Hospital Essen, University of Duisburg-Essen, Hufelandstraße 55, 45147, Essen, Germany
| | - Katharina Maria Heuser-Spura
- Department of Pediatrics I, Neonatology, Pediatric Intensive Care and Pediatric Neurology, University Hospital Essen, University of Duisburg-Essen, Essen, Germany
- Center for Translational Neuro- and Behavioral Sciences, University Hospital Essen, University of Duisburg-Essen, Hufelandstraße 55, 45147, Essen, Germany
| | - Ursula Felderhoff-Mueser
- Department of Pediatrics I, Neonatology, Pediatric Intensive Care and Pediatric Neurology, University Hospital Essen, University of Duisburg-Essen, Essen, Germany
- Center for Translational Neuro- and Behavioral Sciences, University Hospital Essen, University of Duisburg-Essen, Hufelandstraße 55, 45147, Essen, Germany
| | - Dagmar Timmann
- Center for Translational Neuro- and Behavioral Sciences, University Hospital Essen, University of Duisburg-Essen, Hufelandstraße 55, 45147, Essen, Germany
- Department of Neurology, University Hospital Essen, University of Duisburg-Essen, Essen, Germany
| | - Britta Maria Huening
- Department of Pediatrics I, Neonatology, Pediatric Intensive Care and Pediatric Neurology, University Hospital Essen, University of Duisburg-Essen, Essen, Germany
- Center for Translational Neuro- and Behavioral Sciences, University Hospital Essen, University of Duisburg-Essen, Hufelandstraße 55, 45147, Essen, Germany
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10
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Albayrak B, Jablonski L, Felderhoff-Mueser U, Huening BM, Ernst TM, Timmann D, Batsikadze G. Author Correction: Fear conditioning is preserved in very preterm-born young adults despite increased anxiety levels. Sci Rep 2023; 13:12667. [PMID: 37542194 PMCID: PMC10403610 DOI: 10.1038/s41598-023-39891-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/06/2023] Open
Affiliation(s)
- Bilge Albayrak
- Department of Pediatrics I and C-TNBS, Pediatric and Developmental Neurology and Center for Translational Neuro- and Behavioral Sciences, University Hospital Essen, University of Duisburg-Essen, Hufelandstrasse 55, 45147, Essen, Germany.
| | - Lara Jablonski
- Department of Pediatrics I and C-TNBS, Pediatric and Developmental Neurology and Center for Translational Neuro- and Behavioral Sciences, University Hospital Essen, University of Duisburg-Essen, Hufelandstrasse 55, 45147, Essen, Germany
| | - Ursula Felderhoff-Mueser
- Department of Pediatrics I and C-TNBS, Pediatric and Developmental Neurology and Center for Translational Neuro- and Behavioral Sciences, University Hospital Essen, University of Duisburg-Essen, Hufelandstrasse 55, 45147, Essen, Germany
| | - Britta M Huening
- Department of Pediatrics I and C-TNBS, Pediatric and Developmental Neurology and Center for Translational Neuro- and Behavioral Sciences, University Hospital Essen, University of Duisburg-Essen, Hufelandstrasse 55, 45147, Essen, Germany
| | - Thomas M Ernst
- Department of Neurology and C-TNBS, Essen University Hospital, University of Duisburg Essen, Hufelandstrasse 55, 45147, Essen, Germany
| | - Dagmar Timmann
- Department of Neurology and C-TNBS, Essen University Hospital, University of Duisburg Essen, Hufelandstrasse 55, 45147, Essen, Germany
| | - Giorgi Batsikadze
- Department of Neurology and C-TNBS, Essen University Hospital, University of Duisburg Essen, Hufelandstrasse 55, 45147, Essen, Germany
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11
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Albayrak B, Jablonski L, Felderhoff-Mueser U, Huening BM, Ernst TM, Timmann D, Batsikadze G. Fear conditioning is preserved in very preterm-born young adults despite increased anxiety levels. Sci Rep 2023; 13:11319. [PMID: 37443342 PMCID: PMC10344879 DOI: 10.1038/s41598-023-38391-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2023] [Accepted: 07/07/2023] [Indexed: 07/15/2023] Open
Abstract
Very preterm birth is associated with an increased risk for anxiety disorders. Abnormal brain development may result in disordered fear learning processes, which may be exacerbated by environmental risk factors and persist in adulthood. We tested the hypotheses that very preterm-born young adults displayed higher levels of fear conditioning, less differentiation between threat (CS+) and safety (CS-) signals, and stronger resistance to extinction relative to term-born controls. A group of 37 very preterm-born young adults and 31 age- and sex-matched term-born controls performed a differential fear conditioning paradigm on two consecutive days. Acquisition and extinction training were performed on day 1. Recall and reinstatement were tested on day 2. Preterm-born participants showed significantly higher levels of anxiety in the Depression-Anxiety-Stress-Scale-21 questionnaire. The fear conditioning outcome measures, skin conductance response amplitudes and anxiety ratings, were overall higher in the preterm-born group compared to controls. Awareness of CS-US contingencies was mildly reduced in preterms. Acquisition, extinction, recall and reinstatement of differential conditioned fear responses (CS+ > CS-), however, were not significantly different between the groups. There were no significant group by stimulus type interactions. The finding of largely preserved associative fear learning in very preterm-born young adults was unexpected and needs to be confirmed in future studies.
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Affiliation(s)
- Bilge Albayrak
- Department of Pediatrics I and C-TNBS, Pediatric and Developmental Neurology and Center for Translational Neuro- and Behavioral Sciences, University Hospital Essen, University of Duisburg-Essen, Hufelandstrasse 55, 45147, Essen, Germany.
| | - Lara Jablonski
- Department of Pediatrics I and C-TNBS, Pediatric and Developmental Neurology and Center for Translational Neuro- and Behavioral Sciences, University Hospital Essen, University of Duisburg-Essen, Hufelandstrasse 55, 45147, Essen, Germany
| | - Ursula Felderhoff-Mueser
- Department of Pediatrics I and C-TNBS, Pediatric and Developmental Neurology and Center for Translational Neuro- and Behavioral Sciences, University Hospital Essen, University of Duisburg-Essen, Hufelandstrasse 55, 45147, Essen, Germany
| | - Britta M Huening
- Department of Pediatrics I and C-TNBS, Pediatric and Developmental Neurology and Center for Translational Neuro- and Behavioral Sciences, University Hospital Essen, University of Duisburg-Essen, Hufelandstrasse 55, 45147, Essen, Germany
| | - Thomas M Ernst
- Department of Neurology and C-TNBS, Essen University Hospital, University of Duisburg Essen, Hufelandstrasse 55, 45147, Essen, Germany
| | - Dagmar Timmann
- Department of Neurology and C-TNBS, Essen University Hospital, University of Duisburg Essen, Hufelandstrasse 55, 45147, Essen, Germany
| | - Giorgi Batsikadze
- Department of Neurology and C-TNBS, Essen University Hospital, University of Duisburg Essen, Hufelandstrasse 55, 45147, Essen, Germany
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12
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Dathe AK, Stein A, Bruns N, Craciun ED, Tuda L, Bialas J, Brasseler M, Felderhoff-Mueser U, Huening BM. Early Prediction of Mortality after Birth Asphyxia with the nSOFA. J Clin Med 2023; 12:4322. [PMID: 37445355 DOI: 10.3390/jcm12134322] [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] [Received: 04/26/2023] [Revised: 06/11/2023] [Accepted: 06/25/2023] [Indexed: 07/15/2023] Open
Abstract
(1) Birth asphyxia is a major cause of delivery room resuscitation. Subsequent organ failure and hypoxic-ischemic encephalopathy (HIE) account for 25% of all early postnatal deaths. The neonatal sequential organ failure assessment (nSOFA) considers platelet count and respiratory and cardiovascular dysfunction in neonates with sepsis. To evaluate whether nSOFA is also a useful predictor for in-hospital mortality in neonates (≥36 + 0 weeks of gestation (GA)) following asphyxia with HIE and therapeutic hypothermia (TH), (2) nSOFA was documented at ≤6 h of life. (3) A total of 65 infants fulfilled inclusion criteria for TH. All but one infant received cardiopulmonary resuscitation and/or respiratory support at birth. nSOFA was lower in survivors (median 0 [IQR 0-2]; n = 56, median GA 39 + 3, female n = 28 (50%)) than in non-survivors (median 10 [4-12], p < 0.001; n = 9, median GA 38 + 6, n = 4 (44.4%)). This was also observed for the respiratory (p < 0.001), cardiovascular (p < 0.001), and hematologic sub-scores (p = 0.003). The odds ratio for mortality was 1.6 [95% CI = 1.2-2.1] per one-point increase in nSOFA. The optimal cut-off value of nSOFA to predict mortality was 3.5 (sensitivity 100.0%, specificity 83.9%). (4) Since early accurate prognosis following asphyxia with HIE and TH is essential to guide decision making, nSOFA (≤6 h of life) offers the possibility of identifying infants at risk of mortality.
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Affiliation(s)
- Anne-Kathrin Dathe
- Neonatology, Paediatric Intensive Care and Paediatric Neurology, Department of Paediatrics I, University Hospital Essen, University of Duisburg-Essen, 45122 Essen, Germany
- Centre for Translational Neuro- and Behavioural Sciences, C-TNBS, Faculty of Medicine, University of Duisburg-Essen, 45122 Essen, Germany
- Department of Health and Nursing, Occupational Therapy, Ernst-Abbe-University of Applied Sciences, 07745 Jena, Germany
| | - Anja Stein
- Neonatology, Paediatric Intensive Care and Paediatric Neurology, Department of Paediatrics I, University Hospital Essen, University of Duisburg-Essen, 45122 Essen, Germany
- Centre for Translational Neuro- and Behavioural Sciences, C-TNBS, Faculty of Medicine, University of Duisburg-Essen, 45122 Essen, Germany
| | - Nora Bruns
- Neonatology, Paediatric Intensive Care and Paediatric Neurology, Department of Paediatrics I, University Hospital Essen, University of Duisburg-Essen, 45122 Essen, Germany
- Centre for Translational Neuro- and Behavioural Sciences, C-TNBS, Faculty of Medicine, University of Duisburg-Essen, 45122 Essen, Germany
| | - Elena-Diana Craciun
- Neonatology, Paediatric Intensive Care and Paediatric Neurology, Department of Paediatrics I, University Hospital Essen, University of Duisburg-Essen, 45122 Essen, Germany
- Centre for Translational Neuro- and Behavioural Sciences, C-TNBS, Faculty of Medicine, University of Duisburg-Essen, 45122 Essen, Germany
| | - Laura Tuda
- Neonatology, Paediatric Intensive Care and Paediatric Neurology, Department of Paediatrics I, University Hospital Essen, University of Duisburg-Essen, 45122 Essen, Germany
- Centre for Translational Neuro- and Behavioural Sciences, C-TNBS, Faculty of Medicine, University of Duisburg-Essen, 45122 Essen, Germany
| | - Johanna Bialas
- Neonatology, Paediatric Intensive Care and Paediatric Neurology, Department of Paediatrics I, University Hospital Essen, University of Duisburg-Essen, 45122 Essen, Germany
- Centre for Translational Neuro- and Behavioural Sciences, C-TNBS, Faculty of Medicine, University of Duisburg-Essen, 45122 Essen, Germany
| | - Maire Brasseler
- Neonatology, Paediatric Intensive Care and Paediatric Neurology, Department of Paediatrics I, University Hospital Essen, University of Duisburg-Essen, 45122 Essen, Germany
- Centre for Translational Neuro- and Behavioural Sciences, C-TNBS, Faculty of Medicine, University of Duisburg-Essen, 45122 Essen, Germany
| | - Ursula Felderhoff-Mueser
- Neonatology, Paediatric Intensive Care and Paediatric Neurology, Department of Paediatrics I, University Hospital Essen, University of Duisburg-Essen, 45122 Essen, Germany
- Centre for Translational Neuro- and Behavioural Sciences, C-TNBS, Faculty of Medicine, University of Duisburg-Essen, 45122 Essen, Germany
| | - Britta M Huening
- Neonatology, Paediatric Intensive Care and Paediatric Neurology, Department of Paediatrics I, University Hospital Essen, University of Duisburg-Essen, 45122 Essen, Germany
- Centre for Translational Neuro- and Behavioural Sciences, C-TNBS, Faculty of Medicine, University of Duisburg-Essen, 45122 Essen, Germany
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13
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Kobus S, Diezel M, Dewan MV, Huening B, Dathe AK, Marschik PB, Felderhoff-Mueser U, Bruns N. Music Therapy in Preterm Infants Reduces Maternal Distress. Int J Environ Res Public Health 2022; 20:731. [PMID: 36613052 PMCID: PMC9819311 DOI: 10.3390/ijerph20010731] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 11/24/2022] [Revised: 12/27/2022] [Accepted: 12/28/2022] [Indexed: 06/17/2023]
Abstract
Preterm delivery is a stressful event for mothers, posing them at risk for post-traumatic stress reactions. This study examined the degree of depressive symptoms and post-traumatic stress in mothers of preterm infants born before 32 gestational weeks depending on whether the infant received music therapy in the neonatal intensive care unit (NICU) or not. We included 33 mothers of preterm infants enrolled in a previously described prospective randomized controlled trial, of whom 18 received music therapy (mean mothers' age 34.1 ± 4.6 years) and 15 did not (mean mothers' age 29.6 ± 4.2). The degree of depressive symptoms, anxiety and acute stress reactions of these mothers were measured by using the German version of the Center for Epidemiologic Studies Depression Scale (CES-D) and Impact of Events Scale-Revised (IES-R) one week after birth (T1) and at infants' hospital discharge (T2). 605 music therapy sessions with a mean duration of 24.2 ± 8.6 min (range 10 to 50 min) were conducted two times a week from the second week of life (T1) until discharge (T2) to the infants from the intervention group. The infants from the control group received standard medical care without music therapy. The mean total CES-D score decreased from T1 (mean 34.7, 95% Confidence Interval (CI) 31.1-38.1) until T2 in all mothers (mean 16.3, 95% CI 12.6-20.1). Mothers whose infants received music therapy showed stronger declines of depressive and stress symptoms (with music therapy: CES-D mean difference of total score 25.7, 95% CI 20.0-31.3, IES-R mean difference of total score 1.7, 95% CI 0.9-2.5, IES-R mean difference of subcategory hyperarousal 10.2, 95% CI 6.2-14.3; without music therapy: CES-D mean difference of total score 9.5, 95% CI 3.8-15.3, IES-R mean difference of total score 0.1, 95% CI -1.0-1.2, IES-R mean difference of subcategory hyperarousal 1.6, 95% CI -4.7-7.9). Effect sizes were strong for CES-D, IES-R, and the hyperarousal subcategory, moderate for intrusion, and low for avoidance. These findings show that mothers of preterm infants are highly susceptible to supportive non-medical interventions such as music therapy to reduce psychological symptoms and distress during their infants' NICU stay.
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Affiliation(s)
- Susann Kobus
- Department of Paediatrics I, University Hospital Essen, University of Duisburg-Essen, 45147 Essen, Germany
- Centre for Translational Neuro- and Behavioural Sciences (C-TNBS), Faculty of Medicine, University Duisburg-Essen, 45147 Essen, Germany
- Center of Artistic Therapy, University Medicine Essen, 45147 Essen, Germany
| | - Marlis Diezel
- Department of Paediatrics I, University Hospital Essen, University of Duisburg-Essen, 45147 Essen, Germany
- Centre for Translational Neuro- and Behavioural Sciences (C-TNBS), Faculty of Medicine, University Duisburg-Essen, 45147 Essen, Germany
| | - Monia Vanessa Dewan
- Department of Paediatrics I, University Hospital Essen, University of Duisburg-Essen, 45147 Essen, Germany
- Centre for Translational Neuro- and Behavioural Sciences (C-TNBS), Faculty of Medicine, University Duisburg-Essen, 45147 Essen, Germany
| | - Britta Huening
- Department of Paediatrics I, University Hospital Essen, University of Duisburg-Essen, 45147 Essen, Germany
- Centre for Translational Neuro- and Behavioural Sciences (C-TNBS), Faculty of Medicine, University Duisburg-Essen, 45147 Essen, Germany
| | - Anne-Kathrin Dathe
- Department of Paediatrics I, University Hospital Essen, University of Duisburg-Essen, 45147 Essen, Germany
- Centre for Translational Neuro- and Behavioural Sciences (C-TNBS), Faculty of Medicine, University Duisburg-Essen, 45147 Essen, Germany
- Department of Health and Nursing, Occupational Therapy, Ernst-Abbe-University of Applied Sciences Jena, 07745 Jena, Germany
| | - Peter B. Marschik
- Child and Adolescent Psychiatry and Psychotherapy, University Medical Center Göttingen, 37075 Göttingen, Germany
- Leibniz ScienceCampus Primate Cognition, 37075 Göttingen, Germany
- iDN—Interdisciplinary Developmental Neuroscience, Division of Phoniatrics, Medical University of Graz, 8036 Graz, Austria
- Center of Neurodevelopmental Disorders (KIND), Center for Psychiatry Research, Department of Women’s and Children’s Health, Karolinska Institutet, 11330 Stockholm, Sweden
| | - Ursula Felderhoff-Mueser
- Department of Paediatrics I, University Hospital Essen, University of Duisburg-Essen, 45147 Essen, Germany
- Centre for Translational Neuro- and Behavioural Sciences (C-TNBS), Faculty of Medicine, University Duisburg-Essen, 45147 Essen, Germany
| | - Nora Bruns
- Department of Paediatrics I, University Hospital Essen, University of Duisburg-Essen, 45147 Essen, Germany
- Centre for Translational Neuro- and Behavioural Sciences (C-TNBS), Faculty of Medicine, University Duisburg-Essen, 45147 Essen, Germany
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14
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Kobus S, Diezel M, Dewan MV, Huening B, Dathe AK, Felderhoff-Mueser U, Bruns N. Impact of Physical Contact on Preterm Infants' Vital Sign Response to Live Music Therapy. Int J Environ Res Public Health 2022; 19:ijerph19159524. [PMID: 35954880 PMCID: PMC9368366 DOI: 10.3390/ijerph19159524] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/22/2022] [Revised: 07/28/2022] [Accepted: 08/01/2022] [Indexed: 11/17/2022]
Abstract
Evidence that music therapy stabilises vital parameters in preterm infants is growing, but the optimal setting for therapy is still under investigation. Our study aimed to quantify the effect of physical contact during live music therapy in preterm infants born < 32 weeks’ gestational age (GA) on post-therapy vital sign values. Live music therapy was delivered twice-weekly until discharge from hospital to 40 stable infants < 32 weeks’ GA. Baseline and post-therapy heart rate, respiratory rate, oxygen saturation and physical contact during each session were recorded. 159 sessions were performed with, and 444 sessions without, physical contact. Descriptive and multivariable regression analyses based on directed acyclic graphs were performed. The mean GA was 28.6 ± 2.6 weeks, and 26 (65%) infants were male. Mean absolute values for heart and respiratory rates lowered during music therapy regardless of physical contact. The mean post-therapy SaO2 was higher compared to baseline values regardless of physical contact (mean differences −8.6 beats/min; −13.3 breaths/min and +2.0%). There were no clinically relevant changes in vital sign responses between therapy sessions, with or without physical contact, or adjusted post-therapy values for any of the studied vital signs. Physical contact caused better baseline and post-therapy vital sign values but did not enhance the vital sign response to music therapy. Thus, the effect of music therapy on preterm infants’ vital signs is independent of physical contact and parents’ presence during music therapy in the neonatal intensive care unit.
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Affiliation(s)
- Susann Kobus
- Department of Paediatrics I, University Hospital, University of Duisburg-Essen, 45147 Essen, Germany; (M.D.); (M.V.D.); (B.H.); (A.-K.D.); (U.F.-M.); (N.B.)
- Centre for Translational Neuro- and Behavioural Sciences (C-TNBS), Faculty of Medicine, University of Duisburg-Essen, 45147 Essen, Germany
- Correspondence:
| | - Marlis Diezel
- Department of Paediatrics I, University Hospital, University of Duisburg-Essen, 45147 Essen, Germany; (M.D.); (M.V.D.); (B.H.); (A.-K.D.); (U.F.-M.); (N.B.)
- Centre for Translational Neuro- and Behavioural Sciences (C-TNBS), Faculty of Medicine, University of Duisburg-Essen, 45147 Essen, Germany
| | - Monia Vanessa Dewan
- Department of Paediatrics I, University Hospital, University of Duisburg-Essen, 45147 Essen, Germany; (M.D.); (M.V.D.); (B.H.); (A.-K.D.); (U.F.-M.); (N.B.)
- Centre for Translational Neuro- and Behavioural Sciences (C-TNBS), Faculty of Medicine, University of Duisburg-Essen, 45147 Essen, Germany
| | - Britta Huening
- Department of Paediatrics I, University Hospital, University of Duisburg-Essen, 45147 Essen, Germany; (M.D.); (M.V.D.); (B.H.); (A.-K.D.); (U.F.-M.); (N.B.)
- Centre for Translational Neuro- and Behavioural Sciences (C-TNBS), Faculty of Medicine, University of Duisburg-Essen, 45147 Essen, Germany
| | - Anne-Kathrin Dathe
- Department of Paediatrics I, University Hospital, University of Duisburg-Essen, 45147 Essen, Germany; (M.D.); (M.V.D.); (B.H.); (A.-K.D.); (U.F.-M.); (N.B.)
- Centre for Translational Neuro- and Behavioural Sciences (C-TNBS), Faculty of Medicine, University of Duisburg-Essen, 45147 Essen, Germany
- Department of Health and Nursing, Occupational Therapy, Ernst-Abbe-University of Applied Sciences Jena, 07745 Jena, Germany
| | - Ursula Felderhoff-Mueser
- Department of Paediatrics I, University Hospital, University of Duisburg-Essen, 45147 Essen, Germany; (M.D.); (M.V.D.); (B.H.); (A.-K.D.); (U.F.-M.); (N.B.)
- Centre for Translational Neuro- and Behavioural Sciences (C-TNBS), Faculty of Medicine, University of Duisburg-Essen, 45147 Essen, Germany
| | - Nora Bruns
- Department of Paediatrics I, University Hospital, University of Duisburg-Essen, 45147 Essen, Germany; (M.D.); (M.V.D.); (B.H.); (A.-K.D.); (U.F.-M.); (N.B.)
- Centre for Translational Neuro- and Behavioural Sciences (C-TNBS), Faculty of Medicine, University of Duisburg-Essen, 45147 Essen, Germany
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Middendorf L, Gellhaus A, Iannaccone A, Köninger A, Dathe AK, Bendix I, Reisch B, Felderhoff-Mueser U, Huening B. The Impact of Increased Maternal sFlt-1/PlGF Ratio on Motor Outcome of Preterm Infants. Front Endocrinol (Lausanne) 2022; 13:913514. [PMID: 35846340 PMCID: PMC9279729 DOI: 10.3389/fendo.2022.913514] [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] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/05/2022] [Accepted: 06/02/2022] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND The sFlt-1 (soluble fms-like tyrosine kinase-1)/PlGF (placental growth factor) ratio serves as a clinical biomarker to predict the hypertensive, placenta-derived pregnancy disorder pre-eclampsia which is often associated with placental dysfunction and fetal growth restriction. Additionally elevated levels also indicate an increased risk for prematurity. However, its predictive value for subsequent neonatal neurological outcome has not been studied. OBJECTIVE This study aimed to evaluate the correlation of maternal sFlt-1/PlGF ratio with early motor outcome of preterm infants. Design/Methods: 88 preterm infants (gestational age ≤ 34 + 0) born between February 2017 and August 2020 at the Department of Obstetrics and Gynecology, University Hospital Essen in Germany, were included, when the following variables were available: maternal sFlt-1/PlGF levels at parturition and general movement assessment of the infant at the corrected age of 3 to 5 months. The infants were stratified into high and low ratio groups according to maternal sFlt-1/PlGF cut-off values of 85. To investigate the early motor repertoire and quality of spontaneous movements of the infant, the Motor Optimality Score (MOS-R) based on antigravity movements and posture patterns, was applied. In the given age, special attention was paid to the presence of fidgety movements. Linear regressions were run to test differences in infants motor repertoire according to the maternal sFlt-1/PIGF ratio. RESULTS Linear regression analysis showed that the sFlt-1/PlGF ratio does not predict the MOS-R score (β=≤0.001; p=0.282). However, children with birth weight below the 10th percentile scored significantly lower (mean 20.7 vs 22.7; p=0.035). These children were 91% in the group with an increased ratio, which in turn is a known predictor of low birth weight (β= -0.315; p <0.001). In the group with a high sFlt-1/PLGF ratio above 85 the mothers of female infants had a lower average sFlt-1/PlGF ratio compared to a male infant (median: 438 in female vs. 603 in male infant, p=0.145). CONCLUSIONS In our cohort, especially low birth weight, which correlated with an elevated sFlt-1/PlGF ratio, had a negative effect on the outcome in the MOS-R. A direct correlation between an increased ratio and a worse motor outcome was not demonstrated.
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Affiliation(s)
- Lisa Middendorf
- Department of Pediatrics I, Neonatology, Pediatric Intensive Care and Pediatric Neurology, University Hospital Essen, University of Duisburg-Essen, Essen, Germany
| | - Alexandra Gellhaus
- Department of Obstetrics and Gynecology, University Hospital Essen, Essen, Germany
| | - Antonella Iannaccone
- Department of Obstetrics and Gynecology, University Hospital Essen, Essen, Germany
| | - Angela Köninger
- Department of Obstetrics and Gynecology, University Hospital Essen, Essen, Germany
- Department of Obstetrics and Gynecology, University of Regensburg, Clinic St Hedwig of the Order of St. John, Regensburg, Germany
| | - Anne-Kathrin Dathe
- Department of Pediatrics I, Neonatology, Pediatric Intensive Care and Pediatric Neurology, University Hospital Essen, University of Duisburg-Essen, Essen, Germany
- Centre for Translational Neuro- and Behavioural Sciences, C-TNBS, Faculty of Medicine, University Duisburg-Essen, Essen, Germany
- Department of Health and Nursing, Occupational Therapy, Ernst-Abbe-University of Applied Sciences, Jena, Germany
| | - Ivo Bendix
- Centre for Translational Neuro- and Behavioural Sciences, C-TNBS, Faculty of Medicine, University Duisburg-Essen, Essen, Germany
- Department of Pediatrics I, Neonatology and Experimental Perinatal Neurosciences, University Hospital Essen, University Duisburg-Essen, Essen, Germany
| | - Beatrix Reisch
- Department of Obstetrics and Gynecology, University Hospital Essen, Essen, Germany
| | - Ursula Felderhoff-Mueser
- Department of Pediatrics I, Neonatology, Pediatric Intensive Care and Pediatric Neurology, University Hospital Essen, University of Duisburg-Essen, Essen, Germany
- Centre for Translational Neuro- and Behavioural Sciences, C-TNBS, Faculty of Medicine, University Duisburg-Essen, Essen, Germany
| | - Britta Huening
- Department of Pediatrics I, Neonatology, Pediatric Intensive Care and Pediatric Neurology, University Hospital Essen, University of Duisburg-Essen, Essen, Germany
- Centre for Translational Neuro- and Behavioural Sciences, C-TNBS, Faculty of Medicine, University Duisburg-Essen, Essen, Germany
- *Correspondence: Britta Huening,
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Markus M, Giannakis S, Ruhfus M, Stein A, Heep A, Plagemann T, Jahn P, Hoehn T, Felderhoff-Mueser U, Sabir H. Fluid Supply and Feeding Practices in Cooled Asphyxiated Newborns. Children (Basel) 2021; 8:children8100899. [PMID: 34682164 PMCID: PMC8534831 DOI: 10.3390/children8100899] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/13/2021] [Revised: 09/30/2021] [Accepted: 10/06/2021] [Indexed: 11/16/2022]
Abstract
Therapeutic hypothermia (TH) for 72 h is the standard treatment to reduce neurological deficits in term newborns with hypoxic-ischemic encephalopathy. There is a large variability regarding nutritional supply during TH treatment in asphyxiated newborns. We performed a retrospective multicentre study in four level I (highest level of care in Germany) NICUs, including 135 asphyxiated term newborns undergoing TH. We analyzed enteral and parenteral nutritional supply during and after TH. We correlated nutritional supply with risk factors for encephalopathy, pH, Sarnat score, mechanical ventilation, seizures, and sedation. A total of 120 of 135 neonates received enteral nutritional supply within the first 24 h, and the majority of children were fully enterally fed within the first 10 days. The grade of encephalopathy and mechanical ventilation had a significant influence on the amount of enteral fluids (p = 0.01), whereas the pH and appearance of seizures did not affect the amount of nutritional supply significantly. Furthermore, we did not observe any correlation between enteral intake and abdominal complications such as necrotizing enterocolitis. We observed a large variability of feeding regimes in the four participating NICUs. Early enteral feeding among newborns undergoing TH was performed in each NICU and was well tolerated without increased rates of complications.
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Affiliation(s)
- Mona Markus
- Department of General Pediatrics, Neonatology and Pediatric Cardiology, Medical Faculty and University Hospital Duesseldorf, Heinrich-Heine-University Duesseldorf, 40225 Duesseldorf, Germany; (M.M.); (S.G.); (T.H.)
| | - Stamatios Giannakis
- Department of General Pediatrics, Neonatology and Pediatric Cardiology, Medical Faculty and University Hospital Duesseldorf, Heinrich-Heine-University Duesseldorf, 40225 Duesseldorf, Germany; (M.M.); (S.G.); (T.H.)
| | - Maria Ruhfus
- Department of Pediatrics I/Neonatology, University Hospital Essen, University Duisburg-Essen, 45147 Essen, Germany; (M.R.); (A.S.); (U.F.-M.)
| | - Anja Stein
- Department of Pediatrics I/Neonatology, University Hospital Essen, University Duisburg-Essen, 45147 Essen, Germany; (M.R.); (A.S.); (U.F.-M.)
| | - Axel Heep
- Department of Paediatrics, Elisabeth Children’s Hospital, University of Oldenburg, 26133 Oldenburg, Germany; (A.H.); (T.P.)
| | - Thorsten Plagemann
- Department of Paediatrics, Elisabeth Children’s Hospital, University of Oldenburg, 26133 Oldenburg, Germany; (A.H.); (T.P.)
| | - Peter Jahn
- Department of Neonatology, Children’s Hospital Leverkusen, 51375 Leverkusen, Germany;
| | - Thomas Hoehn
- Department of General Pediatrics, Neonatology and Pediatric Cardiology, Medical Faculty and University Hospital Duesseldorf, Heinrich-Heine-University Duesseldorf, 40225 Duesseldorf, Germany; (M.M.); (S.G.); (T.H.)
| | - Ursula Felderhoff-Mueser
- Department of Pediatrics I/Neonatology, University Hospital Essen, University Duisburg-Essen, 45147 Essen, Germany; (M.R.); (A.S.); (U.F.-M.)
| | - Hemmen Sabir
- Department of Neonatology and Pediatric Intensive Care, Children’s Hospital University of Bonn, 53127 Bonn, Germany
- German Centre for Neurodegenerative Diseases (DZNE), 53175 Bonn, Germany
- Correspondence:
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Kobus S, Diezel M, Dewan MV, Huening B, Dathe AK, Felderhoff-Mueser U, Bruns N. Music Therapy Is Effective during Sleep in Preterm Infants. Int J Environ Res Public Health 2021; 18:ijerph18168245. [PMID: 34443994 PMCID: PMC8391215 DOI: 10.3390/ijerph18168245] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/27/2021] [Revised: 07/29/2021] [Accepted: 07/30/2021] [Indexed: 11/16/2022]
Abstract
Recent research found evidence supporting music therapy for preterm infants to stabilize vital signs and possibly promote neurodevelopment. Even though preterm infants spend a considerable amount of time sleeping, the effectiveness of music therapy during sleep has not been studied. The aim of this study was to investigate the effect of music therapy on preterm infants' vital signs with respect to the state of wakefulness. The first 20 consecutive infants born with <32 weeks' gestational age (GA) from the intervention group of an ongoing randomized controlled trial received live music therapy twice a week until hospital discharge. The heart rate, respiratory rate, oxygen saturation, and state of wakefulness were recorded before and after therapy. We observed significantly lower heart and respiratory rates and higher oxygen saturation after live music therapy sessions in general (mean differences -4.9 beats per min; -7.0 breaths per min and +1.5%, respectively). When music therapy was applied during sleep, respiratory rates significantly lowered by 8.8 breaths per min and oxygen saturation increased by 1.6%, whereas in the awake state the vital parameters did not significantly change (heart rate -5.2 beats per min; respiratory rate +0.6 breaths per min and oxygen saturation +1.0%). Music therapy stabilized the respiratory rates and oxygen saturations in sleeping preterm infants.
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18
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Giannakis S, Ruhfus M, Markus M, Stein A, Hoehn T, Felderhoff-Mueser U, Sabir H. Mechanical Ventilation, Partial Pressure of Carbon Dioxide, Increased Fraction of Inspired Oxygen and the Increased Risk for Adverse Short-Term Outcomes in Cooled Asphyxiated Newborns. Children (Basel) 2021; 8:children8060430. [PMID: 34063852 PMCID: PMC8224013 DOI: 10.3390/children8060430] [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] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/05/2021] [Revised: 05/04/2021] [Accepted: 05/18/2021] [Indexed: 11/26/2022]
Abstract
Neonates treated with therapeutic hypothermia (TH) following perinatal asphyxia (PA) suffer a considerable rate of disability and mortality. Several risk factors associated with adverse outcomes have been identified. Mechanical ventilation might increase the risk for hyperoxia and hypocapnia in cooled newborns. We carried out a retrospective study in 71 asphyxiated cooled newborns. We analyzed the association of ventilation status and adverse short-term outcomes and investigated the effect of the former on pCO2 and oxygen delivery before, during and after TH. Death, abnormal findings on magnetic resonance imaging, and pathological amplitude-integrated electroencephalography traces were used to define short-term outcomes. The need for mechanical ventilation was significantly higher in the newborns with adverse outcomes (38% vs. 5.6%, p = 0.001). Compared to spontaneously breathing neonates, intubated newborns suffered from significantly more severe asphyxia, had significantly lower levels of mean minimum pCO2 over the first 6 and 72 h of life (HOL) (p = 0.03 and p = 0.01, respectively) and increased supply of inspired oxygen, which was, in turn, significantly higher in the newborns with adverse outcomes (p < 0.01). Intubated newborns with adverse short-term outcomes had lower levels of pCO2 over the first 36 HOL. In conclusion, need for mechanical ventilation was significantly higher in newborns with more severe asphyxia. In ventilated newborns, level of encephalopathy, lower pCO2 levels, and increased oxygen supplementation were significantly higher in the adverse short-term outcomes group. Ventilatory parameters need to be carefully monitored in cooled asphyxiated newborns.
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Affiliation(s)
- Stamatios Giannakis
- Department of General Pediatrics, Neonatology and Pediatric Cardiology, Faculty of Medicine, University Children’s Hospital, Heinrich-Heine-University Duesseldorf, 40225 Düsseldorf, Germany; (S.G.); (M.M.); (T.H.)
| | - Maria Ruhfus
- Department of Pediatrics I/Neonatology, University Hospital Essen, University Duisburg Essen, 45147 Essen, Germany; (M.R.); (A.S.); (U.F.-M.)
| | - Mona Markus
- Department of General Pediatrics, Neonatology and Pediatric Cardiology, Faculty of Medicine, University Children’s Hospital, Heinrich-Heine-University Duesseldorf, 40225 Düsseldorf, Germany; (S.G.); (M.M.); (T.H.)
| | - Anja Stein
- Department of Pediatrics I/Neonatology, University Hospital Essen, University Duisburg Essen, 45147 Essen, Germany; (M.R.); (A.S.); (U.F.-M.)
| | - Thomas Hoehn
- Department of General Pediatrics, Neonatology and Pediatric Cardiology, Faculty of Medicine, University Children’s Hospital, Heinrich-Heine-University Duesseldorf, 40225 Düsseldorf, Germany; (S.G.); (M.M.); (T.H.)
| | - Ursula Felderhoff-Mueser
- Department of Pediatrics I/Neonatology, University Hospital Essen, University Duisburg Essen, 45147 Essen, Germany; (M.R.); (A.S.); (U.F.-M.)
| | - Hemmen Sabir
- Department of Pediatrics I/Neonatology, University Hospital Essen, University Duisburg Essen, 45147 Essen, Germany; (M.R.); (A.S.); (U.F.-M.)
- Department of Neonatology and Pediatric Intensive Care, Children’s Hospital University of Bonn, 53127 Bonn, Germany
- German Centre for Neurodegenerative Diseases (DZNE), 53127 Bonn, Germany
- Correspondence:
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19
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Tschiedel E, Eckerland M, Felderhoff-Mueser U, Dohna-Schwake C, Stehling F. Sedation for bronchoscopy in children: A prospective randomized double-blinded trial. Pediatr Pulmonol 2021; 56:1221-1229. [PMID: 33336889 DOI: 10.1002/ppul.25235] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [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: 07/22/2020] [Revised: 12/03/2020] [Accepted: 12/15/2020] [Indexed: 01/06/2023]
Abstract
INTRODUCTION In pediatric patients, flexible bronchoscopy requires deep sedation. Different sedation regimes are common, but only some of them include opioids. Due to their antitussive effect, the use of short-acting opioids may be beneficial for this particular indication, but additional respiratory depression may lead to an increase in adverse events. Here, we systematically compared sedation regimes in children undergoing flexible bronchoscopy with either propofol alone, or a combination of propofol and remifentanil. The primary outcome parameter was the frequency of coughing episodes during the intervention. Secondary outcome parameters were frequency and types of complications, patient satisfaction, examiner satisfaction, and recovery time after finishing the sedation. METHODS Fifty children aged 1-17 years undergoing flexible bronchoscopy under deep sedation with propofol were randomly assigned to two groups: PR receiving propofol and remifentanil and PP receiving propofol only. Sedation depth was predefined as Comfort Score 10-13. RESULTS We found significantly less coughing episodes ([med (IQR)] PR: 0.73 (0.28-2.45)/min; PP: 1.98 (1.26-3.12)/min; p = .010) and shorter recovery time in Group PR (PR: 13.5 (8-17.5) min; PP: 21.0 (14-27) min; p = .011). Examiner's satisfaction was higher in Group PR (PR: 10 (8-10); PP: 9 (7-9); p = .012). The number of adverse events, patient satisfaction, and required propofol dose during the intervention did not differ between groups. CONCLUSION We suggest the combination of propofol with remifentanil instead of using propofol alone in pediatric procedural sedation for flexible bronchoscopy.
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Affiliation(s)
- Eva Tschiedel
- Department of Pediatrics I, University Hospital Essen, University of Duisburg-Essen, Essen, Germany
| | - Maximilian Eckerland
- Department of Pediatrics III, University Hospital Essen, University of Duisburg-Essen, Essen, Germany
| | - Ursula Felderhoff-Mueser
- Department of Pediatrics I, University Hospital Essen, University of Duisburg-Essen, Essen, Germany
| | - Christian Dohna-Schwake
- Department of Pediatrics I, University Hospital Essen, University of Duisburg-Essen, Essen, Germany
| | - Florian Stehling
- Department of Pediatrics III, University Hospital Essen, University of Duisburg-Essen, Essen, Germany
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Jaekel J, Heuser KM, Zapf A, Roll C, Nuñez FB, Bartmann P, Wolke D, Felderhoff-Mueser U, Huening B. Preterm children's long-term academic performance after adaptive computerized training: an efficacy and process analysis of a randomized controlled trial. Pediatr Res 2021; 89:1492-1499. [PMID: 32919388 PMCID: PMC7588952 DOI: 10.1038/s41390-020-01114-w] [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] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/07/2020] [Revised: 06/04/2020] [Accepted: 07/16/2020] [Indexed: 11/09/2022]
Abstract
BACKGROUND Adaptive computerized interventions may help improve preterm children's academic success, but randomized trials are rare. We tested whether a math training (XtraMath®) versus an active control condition (Cogmed®; working memory) improved school performance. Training feasibility was also evaluated. METHODS Preterm born first graders, N = 65 (28-35 + 6 weeks gestation) were recruited into a prospective randomized controlled multicenter trial and received one of two computerized trainings at home for 5 weeks. Teachers rated academic performance in math, reading/writing, and attention compared to classmates before (baseline), directly after (post), and 12 months after the intervention (follow-up). Total academic performance growth was calculated as change from baseline (hierarchically ordered-post test first, follow-up second). RESULTS Bootstrapped linear regressions showed that academic growth to post test was significantly higher in the math intervention group (B = 0.25 [95% confidence interval: 0.04-0.50], p = 0.039), but this difference was not sustained at the 12-month follow-up (B = 0.00 [-0.31 to 0.34], p = 0.996). Parents in the XtraMath group reported higher acceptance compared with the Cogmed group (mean difference: -0.49, [-0.90 to -0.08], p = 0.037). CONCLUSIONS Our findings do not show a sustained difference in efficacy between both trainings. Studies of math intervention effectiveness for preterm school-aged children are warranted. IMPACT Adaptive computerized math training may help improve preterm children's short-term school performance. Computerized math training provides a novel avenue towards intervention after preterm birth. Well-powered randomized controlled studies of math intervention effectiveness for preterm school-aged children are warranted.
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Affiliation(s)
- Julia Jaekel
- Child and Family Studies
- Psychology, University of Tennessee Knoxville, Knoxville, TN, USA. .,Psychology, University of Warwick, Coventry, UK.
| | - Katharina M. Heuser
- grid.410718.b0000 0001 0262 7331Pediatrics I, Neonatology, Pediatric Intensive Care, Pediatric Neurology, University Hospital Essen, Essen, Germany ,grid.5570.70000 0004 0490 981XPsychology, Ruhr-University Bochum, Bochum, Germany
| | - Antonia Zapf
- grid.13648.380000 0001 2180 3484Medical Biometry and Epidemiology, Universitätsklinikum Hamburg-Eppendorf, Hamburg, Germany
| | - Claudia Roll
- grid.412581.b0000 0000 9024 6397Vest Children’s Hospital Datteln, University Witten-Herdecke, Datteln, Germany
| | | | - Peter Bartmann
- grid.15090.3d0000 0000 8786 803XChildren’s Hospital, University Hospital Bonn, Bonn, Germany
| | - Dieter Wolke
- grid.7372.10000 0000 8809 1613Psychology, University of Warwick, Coventry, UK
| | - Ursula Felderhoff-Mueser
- grid.410718.b0000 0001 0262 7331Pediatrics I, Neonatology, Pediatric Intensive Care, Pediatric Neurology, University Hospital Essen, Essen, Germany
| | - Britta Huening
- grid.410718.b0000 0001 0262 7331Pediatrics I, Neonatology, Pediatric Intensive Care, Pediatric Neurology, University Hospital Essen, Essen, Germany
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Ruhfus M, Giannakis S, Markus M, Stein A, Hoehn T, Felderhoff-Mueser U, Sabir H. Association of Routinely Measured Proinflammatory Biomarkers With Abnormal MRI Findings in Asphyxiated Neonates Undergoing Therapeutic Hypothermia. Front Pediatr 2021; 9:624652. [PMID: 33855004 PMCID: PMC8039151 DOI: 10.3389/fped.2021.624652] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [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: 10/31/2020] [Accepted: 03/01/2021] [Indexed: 01/16/2023] Open
Abstract
Background: The neuroprotective treatment effect of therapeutic hypothermia (TH) following perinatal asphyxia may be negatively influenced by neonatal sepsis and concomitant inflammation. We aimed to correlate routinely used blood biomarkers for perinatal sepsis in cooled asphyxiated newborns with MRI findings. Methods: Perinatal data was retrospectively collected from 67 cooled asphyxiated newborns. Levels of C-reactive protein (CRP), white blood cells and platelets were analyzed before, during and after TH. Interleukin-6 blood levels were analyzed before initiation of TH. Magnetic resonance imaging (MRI) on postnatal day 5-7 was used defining short-term outcome. Adverse outcome was defined as death or adverse MRI findings. Amplitude-integrated electroencephalography (aEEG) was additionally analyzed and correlated with short-term MRI outcome. Results: Forty-nine newborns had favorable short-term MRI outcome. Perinatal data referring to perinatal sepsis did not differ significantly between groups. IL-6 levels before initiation of TH and CRP levels on day three and after TH were significantly higher in newborns with adverse short-term MRI outcome. Males with adverse short-term MRI outcome had significantly increased CRP values at the end of the cooling phase. aEEG strongly correlated with short-term MRI outcome. Conclusion: Routinely used blood biomarkers may be helpful early identifying newborns at high risk of unfavorable outcome and in need of close neurodevelopmental follow-up.
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Affiliation(s)
- Maria Ruhfus
- Department of Pediatrics I/Neonatology, University Hospital Essen, University Duisburg-Essen, Essen, Germany
| | - Stamatios Giannakis
- Department of General Pediatrics, Neonatology and Pediatric Cardiology, Medical Faculty, University Children's Hospital Duesseldorf, Heinrich Heine University, Duesseldorf, Germany
| | - Mona Markus
- Department of General Pediatrics, Neonatology and Pediatric Cardiology, Medical Faculty, University Children's Hospital Duesseldorf, Heinrich Heine University, Duesseldorf, Germany
| | - Anja Stein
- Department of Pediatrics I/Neonatology, University Hospital Essen, University Duisburg-Essen, Essen, Germany
| | - Thomas Hoehn
- Department of General Pediatrics, Neonatology and Pediatric Cardiology, Medical Faculty, University Children's Hospital Duesseldorf, Heinrich Heine University, Duesseldorf, Germany
| | - Ursula Felderhoff-Mueser
- Department of Pediatrics I/Neonatology, University Hospital Essen, University Duisburg-Essen, Essen, Germany
| | - Hemmen Sabir
- Department of Pediatrics I/Neonatology, University Hospital Essen, University Duisburg-Essen, Essen, Germany.,Department of Neonatology and Pediatric Intensive Care, Children's Hospital University of Bonn, Bonn, Germany.,German Centre for Neurodegenerative Diseases (DZNE), Bonn, Germany
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22
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Dathe AK, Jaekel J, Franzel J, Hoehn T, Felderhoff-Mueser U, Huening BM. Visual Perception, Fine Motor, and Visual-Motor Skills in Very Preterm and Term-Born Children before School Entry-Observational Cohort Study. Children (Basel) 2020; 7:E276. [PMID: 33291494 PMCID: PMC7762188 DOI: 10.3390/children7120276] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/29/2020] [Revised: 11/29/2020] [Accepted: 12/01/2020] [Indexed: 12/03/2022]
Abstract
Very preterm children (<32 weeks gestation at birth; VP) are at risk of developmental difficulties. Specific functional difficulties and delays in visual perception, fine motor, and visual-motor skills have received little research attention, although they are critical for daily life and school readiness. Our aim was to assess these skills in a contemporary cohort of 60 VP and 60 matched term-born children before school entry. We administered the Movement Assessment Battery for Children (M-ABC-2) and the Developmental Test of Visual Perception (DTVP-2). Linear and logistic regressions were run to test group differences in performance and rates of developmental delay in visual perception, fine motor, and visual-motor skills. Very preterm children had lower scores than term-born children in visual perception (β = -0.25; p = 0.006), fine motor (β = -0.44; p < 0.001), and visual-motor tasks (β = -0.46; p < 0.001). The rate of developmental delay (<-1 SD) was higher among VP in visual perception (odds ratio (OR) = 3.4; 95% confidence interval (CI 1.1-10.6)), fine motor (OR = 6.2 (2.4-16.0)), and visual-motor skills (OR = 13.4 (4.1-43.9)) than in term-born controls. VP children are at increased risk for clinically relevant developmental delays in visual perception, fine motor, and visual-motor skills. Following up VP children until preschool age may facilitate early identification and timely intervention.
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Affiliation(s)
- Anne-Kathrin Dathe
- Department of Paediatrics I, Neonatology, Paediatric Intensive Care and Paediatric Neurology, University Hospital Essen, University of Duisburg-Essen, 45122 Essen, North-Rhine Westphalia, Germany; (U.F.-M.); (B.M.H.)
| | - Julia Jaekel
- Department of Child and Family Studies and Department of Psychology, University of Tennessee, Knoxville, TN 37996, USA;
| | - Julia Franzel
- Department of General Paediatrics, Neonatology and Paediatric Cardiology, University Hospital Duesseldorf, 40225 Duesseldorf, North-Rhine Westphalia, Germany; (J.F.); (T.H.)
| | - Thomas Hoehn
- Department of General Paediatrics, Neonatology and Paediatric Cardiology, University Hospital Duesseldorf, 40225 Duesseldorf, North-Rhine Westphalia, Germany; (J.F.); (T.H.)
| | - Ursula Felderhoff-Mueser
- Department of Paediatrics I, Neonatology, Paediatric Intensive Care and Paediatric Neurology, University Hospital Essen, University of Duisburg-Essen, 45122 Essen, North-Rhine Westphalia, Germany; (U.F.-M.); (B.M.H.)
| | - Britta M. Huening
- Department of Paediatrics I, Neonatology, Paediatric Intensive Care and Paediatric Neurology, University Hospital Essen, University of Duisburg-Essen, 45122 Essen, North-Rhine Westphalia, Germany; (U.F.-M.); (B.M.H.)
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23
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Jungner Å, Vallius Kvist S, Romantsik O, Bruschettini M, Ekström C, Bendix I, Herz J, Felderhoff-Mueser U, Bibic A, In Apos T Zandt R, Gram M, Ley D. White Matter Brain Development after Exposure to Circulating Cell-Free Hemoglobin and Hyperoxia in a Rat Pup Model. Dev Neurosci 2020; 41:234-246. [PMID: 31991415 DOI: 10.1159/000505206] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2019] [Accepted: 12/03/2019] [Indexed: 12/19/2022] Open
Abstract
Neonates born with critical congenital heart defects are at risk of diffuse white matter injuries and neurodevelopmental impairments. This study aimed to determine the impact of circulating cell-free hemoglobin and hyperoxia, both present during cardiopulmonary bypass circulation, on white matter brain development. Postnatal day 6 rat pups were injected intraperitoneally with cell-free Hb or vehicle and exposed to hyperoxia (fiO2 = 0.8) or normoxia (fiO2 = 0.21) for 24 h. We evaluated apoptosis, myelination, and oligodendrocyte maturation with immunohistochemistry, gene and protein analyses, and in vivo diffusion tensor magnetic resonance imaging (MRI). Consistent with previous studies, we found an increase in apoptosis of oligodendrocytes as determined by TUNEL+ staining in Olig2+ cells in white matter, cortex, thalamus, and hippocampus following exposure to hyperoxia with no additional effect of cell-free Hb. A transient increase in the mRNA expression of intercellular adhesion molecule 1 at 6 h was observed following combined exposure to cell-free Hb and hyperoxia. No indications of oligodendrocyte maturational delay or hypomyelination were observed after either insult, delivered separately or combined, as determined by immunohistochemistry, Western blot, and diffusion tensor MRI. In our model, exposure to circulatory cell-free Hb, with or without concomitant hyperoxia, did not significantly alter brain white matter development.
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Affiliation(s)
- Åsa Jungner
- Department of Clinical Sciences Lund, Pediatric Surgery and Neonatal Care, Skane University Hospital, Lund University, Lund, Sweden,
| | - Suvi Vallius Kvist
- Department of Clinical Sciences Lund, Pediatrics, Lund University, Lund, Sweden
| | - Olga Romantsik
- Department of Clinical Sciences Lund, Pediatric Surgery and Neonatal Care, Skane University Hospital, Lund University, Lund, Sweden
| | - Matteo Bruschettini
- Department of Clinical Sciences Lund, Pediatrics, Lund University, Lund, Sweden
| | - Claes Ekström
- Department of Clinical Sciences Lund, Pediatrics, Lund University, Lund, Sweden
| | - Ivo Bendix
- Department of Pediatrics I, Neonatology and Experimental Perinatal Neuroscience, University Hospital Essen, University Duisburg-Essen, Essen, Germany
| | - Josephine Herz
- Department of Pediatrics I, Neonatology and Experimental Perinatal Neuroscience, University Hospital Essen, University Duisburg-Essen, Essen, Germany
| | - Ursula Felderhoff-Mueser
- Department of Pediatrics I, Neonatology and Experimental Perinatal Neuroscience, University Hospital Essen, University Duisburg-Essen, Essen, Germany
| | - Adnan Bibic
- Lund University Bioimaging Center, Lund University, Lund, Sweden
| | | | - Magnus Gram
- Department of Clinical Sciences Lund, Pediatrics, Lund University, Lund, Sweden
| | - David Ley
- Department of Clinical Sciences Lund, Pediatric Surgery and Neonatal Care, Skane University Hospital, Lund University, Lund, Sweden
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24
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Dzietko M, Schulz S, Preuss M, Haertel C, Stein A, Felderhoff-Mueser U, Goepel W. Apolipoprotein E gene polymorphisms and intraventricular haemorrhage in infants born preterm: a large prospective multicentre cohort study. Dev Med Child Neurol 2019; 61:337-342. [PMID: 30084487 DOI: 10.1111/dmcn.13987] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [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] [Accepted: 06/18/2018] [Indexed: 11/28/2022]
Abstract
AIM Infants born preterm are at risk of intraventricular haemorrhage (IVH) but individual susceptibility related to genes is not well defined in this vulnerable population. Apolipoprotein genotypes APOE2 and APOE4 increase the hazard of cerebral haemorrhages in adults. We investigated whether APOE is associated with prevalence of IVH and is likely to have a particular genotype. METHOD In this prospective study, 5075 infants born preterm with genotype APOE3 were compared to 965 (APOE2) and 1912 (APOE4) individuals, to analyse the association between APOE genotype and grade III and IV IVH. We used a logistic regression model including gestational age, antenatal steroid treatment, 5-minute Apgar scores less than 3, intubation, pneumothorax, small for gestational age, multiple birth, sex, and maternal descent as independent factors. RESULTS The APOE2 (20.1%) and APOE4 (19.8%) genotypes were significantly more prevalent in infants with IVH than in those with the APOE3 haplotype (17.4%) (APOE2: odds ratio [OR] 1.33, 95% confidence interval [CI] 1.00-1.76; APOE4: OR 1.39, 95% CI 1.12-1.74). Infants with two polymorphisms had the highest risk of IVH (8.7%; OR 1.63, 95% CI 1.09-2.45). INTERPRETATION APOE2 and APOE4 genotypes are relevant risk factors for IVH in infants born preterm. Our findings improve our understanding of the genetic contributions to IVH.
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Affiliation(s)
- Mark Dzietko
- Department of Pediatrics I, University Duisburg-Essen, Essen, Germany
| | - Soeren Schulz
- Department of Pediatrics, University of Lübeck, Lübeck, Germany
| | - Michael Preuss
- Department of Pediatrics, University of Lübeck, Lübeck, Germany
| | | | - Anja Stein
- Department of Pediatrics I, University Duisburg-Essen, Essen, Germany
| | | | - Wolfgang Goepel
- Department of Pediatrics, University of Lübeck, Lübeck, Germany
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25
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Looney AM, O'Sullivan MP, Ahearne CE, Finder M, Felderhoff-Mueser U, Boylan GB, Hallberg B, Murray DM. Altered Expression of Umbilical Cord Blood Levels of miR-181b and Its Downstream Target mUCH-L1 in Infants with Moderate and Severe Neonatal Hypoxic-Ischaemic Encephalopathy. Mol Neurobiol 2018; 56:3657-3663. [PMID: 30178296 DOI: 10.1007/s12035-018-1321-4] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2018] [Accepted: 08/15/2018] [Indexed: 01/22/2023]
Abstract
Hypoxic-ischaemic encephalopathy (HIE) remains one of the leading causes of neurological disability worldwide. No blood biomarker capable of early detection and classification of injury severity in HIE has been identified. This study aimed to investigate the potential of miRNA-181b (miR-181b) and its downstream target, ubiquitin C-terminal hydrolase-L1 (UCH-L1), to predict the severity of HIE. Full-term infants with perinatal asphyxia were recruited at birth and observed for the development of HIE, along with healthy controls. Levels of miR-181b and messenger UCH-L1 (mUCH-L1) in umbilical cord blood were determined using qRT-PCR. In total, 131 infants; 40 control, 50 perinatal asphyxia without HIE (PA) and 41 HIE, recruited across two separate cohorts (discovery and validation) were included in this study. Significant and consistent downregulation of miR-181b was observed in infants with moderate/severe HIE compared to all other groups in both cohorts: discovery 0.25 (0.16-0.32) vs 0.61 (0.26-1.39), p = 0.027 and validation 0.33 (0.15-1.78) vs 1.2 (0.071-2.09), p = 0.035. mUCH-L1 showed increased expression in infants with HIE in both cohorts. The expression ratio of miR-181b to mUCH-L1 was reduced in those infants with moderate/severe HIE in both cohorts: discovery cohort 0.23 (0.06-0.44) vs 1.59 (0.46-2.54), p = 0.01 and validation cohort 0.41 (0.10-0.81) vs 1.38 (0.59-2.56) in all other infants, p = 0.009. We have validated consistent patterns of altered expression in miR-181b/mUCH-L1 in moderate/severe neonatal HIE which may have the potential to guide therapeutic intervention in HIE.
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Affiliation(s)
- A M Looney
- Department of Paediatrics and Child Health, University College Cork, Cork, Ireland.,INFANT Centre, University College Cork, Cork, Ireland
| | - M P O'Sullivan
- Department of Paediatrics and Child Health, University College Cork, Cork, Ireland.,INFANT Centre, University College Cork, Cork, Ireland
| | - C E Ahearne
- Department of Paediatrics and Child Health, University College Cork, Cork, Ireland.,INFANT Centre, University College Cork, Cork, Ireland
| | - M Finder
- Pediatric Department, CLINTEC, Karolinska Institutet and Neonatal Department, Karolinska University Hospital, Stockholm, Sweden
| | - U Felderhoff-Mueser
- Department of Pediatrics/Neonatology, University Hospital Essen, University Duisburg-Essen, Essen, Germany
| | - G B Boylan
- Department of Paediatrics and Child Health, University College Cork, Cork, Ireland.,INFANT Centre, University College Cork, Cork, Ireland
| | - B Hallberg
- Pediatric Department, CLINTEC, Karolinska Institutet and Neonatal Department, Karolinska University Hospital, Stockholm, Sweden
| | - Deirdre M Murray
- Department of Paediatrics and Child Health, University College Cork, Cork, Ireland. .,INFANT Centre, University College Cork, Cork, Ireland.
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26
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Tschiedel E, Heck V, Felderhoff-Mueser U, Dohna-Schwake C. The influence of parents' voice on the consumption of propofol for pediatric procedural sedation-a randomized controlled trial. Paediatr Anaesth 2017; 27:394-398. [PMID: 28177568 DOI: 10.1111/pan.13078] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [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] [Accepted: 11/17/2016] [Indexed: 11/30/2022]
Abstract
BACKGROUND In pediatric patients, invasive procedures such as the insertion of a central venous catheter or gastroscopy require deep sedation. It is unknown whether listening to parental voice during deep sedation in children can reduce sedative doses. AIM The aim of this prospective study was to determine the effect of listening to a parent's voice during deep sedation on consumption of sedatives in children. METHODS Fifty children aged 2-14 years undergoing central line placement or gastroscopy under deep sedation with propofol were randomly assigned to two groups: (A) listening or (B) not listening their parents' recorded voice reading a standardized text by the use of earphones. Depth of sedation was monitored by Comfort Score and by Bispectral Index. RESULTS Mean sedative dose of propofol in both groups was equal (A 0.25 mg·kg-1 ·min-1 ; B 0.28 mg·kg-1 ·min-1 ; Δ -0.03 mg·kg-1 ·min-1 (CI 95% -0.08 to 0.01); P = 0.089). Furthermore, complication rate (P = 1.0) and recovery time (A 14.5 min; B 16.1 min; Δ = -1.6 min (CI 95% -6.98 to 3.81); P = 0.60) did not differ between the intervention and the control group. CONCLUSION Listening to parental voice during deep sedation does not result in a reduction of sedative dose in children undergoing short medical procedures.
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Affiliation(s)
- Eva Tschiedel
- Department of Pediatrics 1, University Hospital Essen, Essen, Germany
| | - Victoria Heck
- Department of Pediatrics 1, University Hospital Essen, Essen, Germany
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27
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Reich B, Hoeber D, Bendix I, Felderhoff-Mueser U. Hyperoxia and the Immature Brain. Dev Neurosci 2017; 38:311-330. [PMID: 28152539 DOI: 10.1159/000454917] [Citation(s) in RCA: 51] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2016] [Accepted: 12/02/2016] [Indexed: 12/24/2022] Open
Abstract
Despite major advances in obstetrics and neonatal intensive care, preterm infants frequently suffer from neurological impairments in later life. Preterm and also full-term neonates are generally susceptible to injury caused by reactive oxygen species due to the immaturity of endogenous radical scavenging systems. It is well known that high oxygen levels experienced during the critical phase of maturation can profoundly influence developmental processes. Supraphysiological oxygen concentrations used for resuscitation or in the care of critically ill infants are known to have deleterious effects on the developing lung and retina, contributing to the pathophysiology of neonatal diseases like bronchopulmonary dysplasia and retinopathy of prematurity. Moreover, experimental work from the last decade suggests that hyperoxia also leads to neuronal and glial cell death, contributing to the injury of white and grey matter observed in preterm infants. During the critical phase of brain maturation, hyperoxia can alter developmental processes, resulting in the disruption of neural plasticity and myelination. However, oxygen therapy can often not be avoided in neonatal intensive care. Therefore, in situations requiring oxygen supplementation, in addition to the development of appropriate monitoring systems, protective and/or regenerative strategies are highly warranted. Here, we summarise the clinical and experimental evidence as well as potential therapeutic strategies, providing an overview of the pathophysiology of oxygen exposure on the developing central nervous system and its impact on neonatal brain injury.
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Affiliation(s)
- Bettina Reich
- Department of Paediatric Cardiology, Paediatric Heart Center, Justus Liebig University, Giessen, Germany
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28
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Bertling F, Bendix I, Drommelschmidt K, Wisniewski HG, Felderhoff-Mueser U, Keller M, Prager S. Tumor necrosis factor-inducible gene 6 protein: A novel neuroprotective factor against inflammation-induced developmental brain injury. Exp Neurol 2016; 279:283-289. [PMID: 26953231 DOI: 10.1016/j.expneurol.2016.03.005] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [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: 09/14/2015] [Revised: 02/20/2016] [Accepted: 03/02/2016] [Indexed: 11/18/2022]
Abstract
Inflammation is an important factor contributing to developmental brain injury in preterm infants. Although tumor necrosis factor-inducible gene 6 protein (TSG-6) has immunomodulatory effects in several inflammatory conditions of adult animals, nothing is currently known about the role of TSG-6 in the developing brain, its impact on perinatal inflammation and its therapeutic potential. The aim of the current work was 1) to characterize the developmental expression of TSG-6 in the newborn rat brain, 2) to evaluate the impact of LPS exposure on TSG-6 expression and 3) to assess the therapeutic potential of exogenous TSG-6 administration. Brain hemispheres of healthy Wistar rats (postnatal day 1-postnatal day 15 (P1-P15)) were evaluated with regard to the physiological expression of TSG-6. LPS-treated rats (0.25mg/kg LPS i.p. on P3) were analyzed for inflammation-induced changes in TSG-6 and cytokine expression. To evaluate whether exogenous recombinant human (rh)TSG-6 affects inflammation-induced brain injury, newborn Wistar rats, exposed to LPS on P3, were treated with rhTSG-6 i.p. (four repetitive doses of 2.25mg/kg every 12h, first dose 3h before LPS injection). PCR, Western blotting and multiplex ELISA were performed according to standard protocols. TSG-6 is physiologically expressed in the developing brain with a linear increase in expression from P1 to P15 at the mRNA level. At P6, regional differences in TSG-6 expression in the cortex, thalamus and striatum were detected at mRNA and protein level. Furthermore, TSG-6 gene expression was significantly increased by inflammation (induced by LPS treatment). Combined treatment with LPS and TSG-6 vs. LPS exposure alone, resulted in significant down-regulation of cleaved caspase-3, a marker of apoptosis and neuronal plasticity. In addition, several inflammatory serum markers were decreased after TSG-6 treatment. Finally, TSG-6 is physiologically expressed in the developing brain. Changes of TSG-6 expression associated with inflammation suggest a role of TSG-6 in neuroinflammation. Reduction of cleaved caspase-3 by TSG-6 treatment demonstrates the putative neuroprotective potential of exogenous TSG-6 administration in inflammation-induced developmental brain injury.
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Affiliation(s)
- F Bertling
- Dept. of Pediatrics I-Neonatology, University Hospital Essen, University Duisburg-Essen, Germany
| | - I Bendix
- Dept. of Pediatrics I-Neonatology, University Hospital Essen, University Duisburg-Essen, Germany
| | - K Drommelschmidt
- Dept. of Pediatrics I-Neonatology, University Hospital Essen, University Duisburg-Essen, Germany
| | - H G Wisniewski
- Dept. of Microbiology, New York University School of Medicine, New York, USA
| | - U Felderhoff-Mueser
- Dept. of Pediatrics I-Neonatology, University Hospital Essen, University Duisburg-Essen, Germany
| | - M Keller
- Dept. of Pediatrics I-Neonatology, University Hospital Essen, University Duisburg-Essen, Germany; Technical University Munich, Germany; Children's Hospital Passau, Germany
| | - S Prager
- Dept. of Pediatrics I-Neonatology, University Hospital Essen, University Duisburg-Essen, Germany
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29
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Lener T, Gimona M, Aigner L, Börger V, Buzas E, Camussi G, Chaput N, Chatterjee D, Court FA, Del Portillo HA, O'Driscoll L, Fais S, Falcon-Perez JM, Felderhoff-Mueser U, Fraile L, Gho YS, Görgens A, Gupta RC, Hendrix A, Hermann DM, Hill AF, Hochberg F, Horn PA, de Kleijn D, Kordelas L, Kramer BW, Krämer-Albers EM, Laner-Plamberger S, Laitinen S, Leonardi T, Lorenowicz MJ, Lim SK, Lötvall J, Maguire CA, Marcilla A, Nazarenko I, Ochiya T, Patel T, Pedersen S, Pocsfalvi G, Pluchino S, Quesenberry P, Reischl IG, Rivera FJ, Sanzenbacher R, Schallmoser K, Slaper-Cortenbach I, Strunk D, Tonn T, Vader P, van Balkom BWM, Wauben M, Andaloussi SE, Théry C, Rohde E, Giebel B. Applying extracellular vesicles based therapeutics in clinical trials - an ISEV position paper. J Extracell Vesicles 2015; 4:30087. [PMID: 26725829 PMCID: PMC4698466 DOI: 10.3402/jev.v4.30087] [Citation(s) in RCA: 919] [Impact Index Per Article: 102.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2015] [Revised: 12/11/2015] [Accepted: 12/13/2015] [Indexed: 02/06/2023] Open
Abstract
Extracellular vesicles (EVs), such as exosomes and microvesicles, are released by different cell types and participate in physiological and pathophysiological processes. EVs mediate intercellular communication as cell-derived extracellular signalling organelles that transmit specific information from their cell of origin to their target cells. As a result of these properties, EVs of defined cell types may serve as novel tools for various therapeutic approaches, including (a) anti-tumour therapy, (b) pathogen vaccination, (c) immune-modulatory and regenerative therapies and (d) drug delivery. The translation of EVs into clinical therapies requires the categorization of EV-based therapeutics in compliance with existing regulatory frameworks. As the classification defines subsequent requirements for manufacturing, quality control and clinical investigation, it is of major importance to define whether EVs are considered the active drug components or primarily serve as drug delivery vehicles. For an effective and particularly safe translation of EV-based therapies into clinical practice, a high level of cooperation between researchers, clinicians and competent authorities is essential. In this position statement, basic and clinical scientists, as members of the International Society for Extracellular Vesicles (ISEV) and of the European Cooperation in Science and Technology (COST) program of the European Union, namely European Network on Microvesicles and Exosomes in Health and Disease (ME-HaD), summarize recent developments and the current knowledge of EV-based therapies. Aspects of safety and regulatory requirements that must be considered for pharmaceutical manufacturing and clinical application are highlighted. Production and quality control processes are discussed. Strategies to promote the therapeutic application of EVs in future clinical studies are addressed.
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Affiliation(s)
- Thomas Lener
- Spinal Cord Injury & Tissue Regeneration Center Salzburg (SCI-TReCS), Paracelsus Medical University (PMU), Salzburg, Austria
- Department of Blood Group Serology and Transfusion Medicine, University Hospital, Salzburger Landeskliniken GesmbH (SALK), Salzburg, Austria
| | - Mario Gimona
- Spinal Cord Injury & Tissue Regeneration Center Salzburg (SCI-TReCS), Paracelsus Medical University (PMU), Salzburg, Austria
- Department of Blood Group Serology and Transfusion Medicine, University Hospital, Salzburger Landeskliniken GesmbH (SALK), Salzburg, Austria
| | - Ludwig Aigner
- Spinal Cord Injury & Tissue Regeneration Center Salzburg (SCI-TReCS), Paracelsus Medical University (PMU), Salzburg, Austria
| | - Verena Börger
- Institute for Transfusion Medicine, University Hospital Essen, University of Duisburg-Essen, Essen, Germany
| | - Edit Buzas
- Department of Genetics, Cell- and Immunobiology, Semmelweis University, Budapest, Hungary
| | - Giovanni Camussi
- Molecular Biotechnology Center, Department of Medical Sciences, University of Turin, Turin, Italy
| | - Nathalie Chaput
- Laboratory of Immunomonitoring in Oncology, UMS 3655 CNRS/US23 Inserm, Villejuif, France
- Centre of Clinical Investigation in Biotherapy CICBT 1248, Institut Gustave Roussy, Villejuif, France
| | - Devasis Chatterjee
- Division of Hematology & Oncology, Rhode Island Hospital, Providence, RI, USA
- The Alpert Medical School of Brown University, Providence, RI, USA
| | - Felipe A Court
- Department of Physiology, Faculty of Biology, Pontificia-Universidad Católica de Chile, Santiago, Chile
| | - Hernando A Del Portillo
- ICREA at Barcelona Centre for International Health Research (CRESIB), Hospital Clínic - Universitat de Barcelona, Barcelona, Spain
- Institut d'Investigació Germans Trias i Pujol (IGTP), Badalona, Spain
| | - Lorraine O'Driscoll
- School of Pharmacy and Pharmaceutical Sciences, Trinity College Dublin, Dublin 2, Ireland
- Trinity Biomedical Sciences Institute, Trinity College Dublin, Dublin 2, Ireland
| | - Stefano Fais
- Anti-Tumor Drugs Section, Department of Therapeutic Research and Medicines Evaluation, National Institute of Health (ISS), Rome, Italy
| | - Juan M Falcon-Perez
- Metabolomics Unit, CIC bioGUNE, CIBERehd, Bizkaia Technology Park, Derio, Spain
- IKERBASQUE, Basque Foundation for Science, Bilbao, Spain
| | - Ursula Felderhoff-Mueser
- Department of Paediatrics I, Neonatology, University Hospital Essen, University Duisburg-Essen, Essen, Germany
| | - Lorenzo Fraile
- Departament de Producció Animal, ETSEA, Universitat de Lleida, Lleida, Spain
| | - Yong Song Gho
- Department of Life Sciences, Pohang University of Science and Technology, Pohang, Republic of Korea
| | - André Görgens
- Institute for Transfusion Medicine, University Hospital Essen, University of Duisburg-Essen, Essen, Germany
| | - Ramesh C Gupta
- Department of Pharmacology and Toxicology, University of Louisville, Louisville, KY, USA
- James Graham Brown Cancer Center, University of Louisville, Louisville, KY, USA
| | - An Hendrix
- Laboratory of Experimental Cancer Research, Department of Radiation Oncology and Experimental Cancer Research, Ghent University Hospital, Ghent, Belgium
| | - Dirk M Hermann
- Department of Neurology, University Hospital Essen, University of Duisburg-Essen, Essen, Germany
| | - Andrew F Hill
- Department of Biochemistry and Genetics, La Trobe Institute for Molecular Science, La Trobe University, Melbourne, Australia
| | | | - Peter A Horn
- Institute for Transfusion Medicine, University Hospital Essen, University of Duisburg-Essen, Essen, Germany
| | | | - Lambros Kordelas
- Department of Bone Marrow Transplantation, University Hospital Essen, University of Duisburg-Essen, Essen, Germany
| | - Boris W Kramer
- Experimental Perinatology/Neonatology, School of Mental Health and Neuroscience, School of Oncology and Developmental Biology, Maastricht University Medical Center, Maastricht, The Netherlands
| | - Eva-Maria Krämer-Albers
- Molecular Cell Biology and Focus Program Translational Neurosciences, University of Mainz, Mainz, Germany
| | - Sandra Laner-Plamberger
- Spinal Cord Injury & Tissue Regeneration Center Salzburg (SCI-TReCS), Paracelsus Medical University (PMU), Salzburg, Austria
- Department of Blood Group Serology and Transfusion Medicine, University Hospital, Salzburger Landeskliniken GesmbH (SALK), Salzburg, Austria
| | - Saara Laitinen
- Research and Cell Services, Finnish Red Cross Blood Service, Helsinki, Finland
| | - Tommaso Leonardi
- Division of Stem Cell Neurobiology, Department of Clinical Neurosciences, Wellcome Trust-Medical Research Council Stem Cell Institute, University of Cambridge, Cambridge, UK
- European Molecular Biology Laboratory, European Bioinformatics Institute (EMBL-EBI), Cambridge, UK
| | - Magdalena J Lorenowicz
- Department of Cell Biology, Center for Molecular Medicine, University Medical Center, Utrecht, The Netherlands
| | - Sai Kiang Lim
- Institute of Medical Biology, Agency for Science Technology and Research (A*STAR), Singapore, Singapore
| | - Jan Lötvall
- Krefting Research Centre, Institute of Medicine, the Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Casey A Maguire
- Harvard Medical School, Massachusetts General Hospital, Boston, MA, USA
| | - Antonio Marcilla
- Dpto. Biología Celular y Parasitologia, Facultat de Farmacia, Universitat de Valencia, Valencia, Spain
- Joint Research Unit on Endocrinology, Nutrition and Clinical Dietetics, Universitat de València-Health Research Institute La Fe, Valencia, Spain
| | - Irina Nazarenko
- Institute for Environmental Health Sciences and Hospital Infection Control Medical Center, University of Freiburg, Freiburg im Breisgau, Germany
| | - Takahiro Ochiya
- Division of Molecular and Cellular Medicine, National Cancer Center Research Institute, Tokyo, Japan
| | - Tushar Patel
- Departments of Transplantation and Cancer Biology, Mayo Clinic, Jacksonville, FL, USA
| | - Shona Pedersen
- Centre for Cardiovascular Research, Department of Clinical Biochemistry, Aalborg University Hospital, Aalborg University, Aalborg, Denmark
| | - Gabriella Pocsfalvi
- Mass Spectrometry and Proteomics, Institute of Biosciences and BioResources, National Research Council of Italy, Naples, Italy
| | - Stefano Pluchino
- Division of Stem Cell Neurobiology, Department of Clinical Neurosciences, Wellcome Trust-Medical Research Council Stem Cell Institute, University of Cambridge, Cambridge, UK
| | - Peter Quesenberry
- Division of Hematology & Oncology, Rhode Island Hospital, Providence, RI, USA
- The Alpert Medical School of Brown University, Providence, RI, USA
| | - Ilona G Reischl
- BASG - Bundesamt für Sicherheit im Gesundheitswesen - Federal Office for Safety in Health Care, AGES - Agentur für Gesundheit und Ernährungssicherheit - Austrian Agency for Health and Food Safety, Institut Überwachung - Institute Surveillance, Wien, Austria
| | - Francisco J Rivera
- Institute of Molecular Regenerative Medicine, Spinal Cord Injury & Tissue Regeneration Center Salzburg (SCI-TReCS), Paracelsus Medical University (PMU), Salzburg, Austria
| | - Ralf Sanzenbacher
- Ralf Sanzenbacher, Paul-Ehrlich-Institut, Bundesinstitut für Impfstoffe und biomedizinische Arzneimittel, Federal Institute for Vaccines and Biomedicines, Langen, Germany
| | - Katharina Schallmoser
- Spinal Cord Injury & Tissue Regeneration Center Salzburg (SCI-TReCS), Paracelsus Medical University (PMU), Salzburg, Austria
- Department of Blood Group Serology and Transfusion Medicine, University Hospital, Salzburger Landeskliniken GesmbH (SALK), Salzburg, Austria
| | - Ineke Slaper-Cortenbach
- Cell Therapy Facility, Department of Clinical Pharmacy, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Dirk Strunk
- Experimental & Clinical Cell Therapy Institute, Spinal Cord Injury & Tissue Regeneration Center Salzburg (SCI-TReCS), Paracelsus Medical University, Salzburg, Austria
| | - Torsten Tonn
- Institute for Transfusion Medicine Dresden, German Red Cross Blood Donation Service North-East, Dresden, Germany
| | - Pieter Vader
- Laboratory of Clinical Chemistry and Hematology, University Medical Center Utrecht, Utrecht, The Netherlands
- Department of Physiology, Anatomy and Genetics, University of Oxford, Oxford, UK
| | - Bas W M van Balkom
- Department of Nephrology and Hypertension, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Marca Wauben
- Department of Biochemistry and Cell Biology, Faculty of Veterinary Medicine, Utrecht University, Utrecht, The Netherlands
| | - Samir El Andaloussi
- Department of Physiology, Anatomy and Genetics, University of Oxford, Oxford, UK
- Department of Laboratory Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Clotilde Théry
- Centre of Clinical Investigation in Biotherapy CICBT 1248, Institut Gustave Roussy, Villejuif, France
- INSERM U932, Institut Curie, Paris, France
| | - Eva Rohde
- Spinal Cord Injury & Tissue Regeneration Center Salzburg (SCI-TReCS), Paracelsus Medical University (PMU), Salzburg, Austria
- Department of Blood Group Serology and Transfusion Medicine, University Hospital, Salzburger Landeskliniken GesmbH (SALK), Salzburg, Austria;
| | - Bernd Giebel
- Institute for Transfusion Medicine, University Hospital Essen, University of Duisburg-Essen, Essen, Germany;
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Bendix I, Serdar M, Herz J, von Haefen C, Nasser F, Rohrer B, Endesfelder S, Felderhoff-Mueser U, Spies CD, Sifringer M. Inhibition of acetylcholinesterase modulates NMDA receptor antagonist mediated alterations in the developing brain. Int J Mol Sci 2014; 15:3784-98. [PMID: 24595240 PMCID: PMC3975367 DOI: 10.3390/ijms15033784] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2013] [Revised: 02/20/2014] [Accepted: 02/21/2014] [Indexed: 01/05/2023] Open
Abstract
Exposure to N-methyl-d-aspartate (NMDA) receptor antagonists has been demonstrated to induce neurodegeneration in newborn rats. However, in clinical practice the use of NMDA receptor antagonists as anesthetics and sedatives cannot always be avoided. The present study investigated the effect of the indirect cholinergic agonist physostigmine on neurotrophin expression and the extracellular matrix during NMDA receptor antagonist induced injury to the immature rat brain. The aim was to investigate matrix metalloproteinase (MMP)-2 activity, as well as expression of tissue inhibitor of metalloproteinase (TIMP)-2 and brain-derived neurotrophic factor (BDNF) after co-administration of the non-competitive NMDA receptor antagonist MK801 (dizocilpine) and the acetylcholinesterase (AChE) inhibitor physostigmine. The AChE inhibitor physostigmine ameliorated the MK801-induced reduction of BDNF mRNA and protein levels, reduced MK801-triggered MMP-2 activity and prevented decreased TIMP-2 mRNA expression. Our results indicate that AChE inhibition may prevent newborn rats from MK801-mediated brain damage by enhancing neurotrophin-associated signaling pathways and by modulating the extracellular matrix.
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Affiliation(s)
- Ivo Bendix
- Department of Pediatrics I, Neonatology, University Hospital Essen, Essen 45122, Germany.
| | - Meray Serdar
- Department of Pediatrics I, Neonatology, University Hospital Essen, Essen 45122, Germany.
| | - Josephine Herz
- Department of Pediatrics I, Neonatology, University Hospital Essen, Essen 45122, Germany.
| | - Clarissa von Haefen
- Department of Anesthesiology and Intensive Care Medicine, Charité-Universitätsmedizin Berlin, Campus Virchow-Klinikum, Berlin 13353, Germany.
| | - Fatme Nasser
- Department of Anesthesiology and Intensive Care Medicine, Charité-Universitätsmedizin Berlin, Campus Virchow-Klinikum, Berlin 13353, Germany.
| | - Benjamin Rohrer
- Department of Anesthesiology and Intensive Care Medicine, Charité-Universitätsmedizin Berlin, Campus Virchow-Klinikum, Berlin 13353, Germany.
| | - Stefanie Endesfelder
- Department of Neonatology, Charité-Universitätsmedizin Berlin, Campus Virchow-Klinikum, Berlin 13353, Germany.
| | | | - Claudia D Spies
- Department of Anesthesiology and Intensive Care Medicine, Charité-Universitätsmedizin Berlin, Campus Virchow-Klinikum, Berlin 13353, Germany.
| | - Marco Sifringer
- Department of Anesthesiology and Intensive Care Medicine, Charité-Universitätsmedizin Berlin, Campus Virchow-Klinikum, Berlin 13353, Germany.
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Karen T, Schlager GW, Bendix I, Sifringer M, Herrmann R, Pantazis C, Enot D, Keller M, Kerner T, Felderhoff-Mueser U. Effect of propofol in the immature rat brain on short- and long-term neurodevelopmental outcome. PLoS One 2013; 8:e64480. [PMID: 23737984 PMCID: PMC3667818 DOI: 10.1371/journal.pone.0064480] [Citation(s) in RCA: 46] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2012] [Accepted: 04/16/2013] [Indexed: 02/06/2023] Open
Abstract
Background Propofol is commonly used as sedative in newborns and children. Recent experimental studies led to contradictory results, revealing neurodegenerative or neuroprotective properties of propofol on the developing brain. We investigated neurodevelopmental short- and long-term effects of neonatal propofol treatment. Methods 6-day-old Wistar rats (P6), randomised in two groups, received repeated intraperitoneal injections (0, 90, 180 min) of 30 mg/kg propofol or normal saline and sacrificed 6, 12 and 24 hrs following the first injection. Cortical and thalamic areas were analysed by Western blot and quantitative real-time PCR (qRT-PCR) for expression of apoptotic and neurotrophin-dependent signalling pathways. Long-term effects were assessed by Open-field and Novel-Object-Recognition at P30 and P120. Results Western blot analyses revealed a transient increase of activated caspase-3 in cortical, and a reduction of active mitogen-activated protein kinases (ERK1/2, AKT) in cortical and thalamic areas. qRT-PCR analyses showed a down-regulation of neurotrophic factors (BDNF, NGF, NT-3) in cortical and thalamic regions. Minor impairment in locomotive activity was observed in propofol treated adolescent animals at P30. Memory or anxiety were not impaired at any time point. Conclusion Exposing the neonatal rat brain to propofol induces acute neurotrophic imbalance and neuroapoptosis in a region- and time-specific manner and minor behavioural changes in adolescent animals.
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Affiliation(s)
- Tanja Karen
- Department of Paediatrics I, Neonatology, University Hospital Essen, University Duisburg-Essen, Essen, Germany.
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Prager S, Singer BB, Bendix I, Schlager GW, Bertling F, Ceylan B, Keller M, Felderhoff-Mueser U, Ergün S. CEACAM1 expression in oligodendrocytes of the developing rat brain shows a spatiotemporal relation to myelination and is altered in a model of encephalopathy of prematurity. Dev Neurosci 2013; 35:226-40. [PMID: 23651919 DOI: 10.1159/000348436] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2012] [Accepted: 01/28/2013] [Indexed: 11/19/2022] Open
Abstract
CEACAM1 is the founder molecule of the family of 'carcinoembryonic antigen-related cell adhesion molecules' and part of the immunoglobulin superfamily. Due to its role as a coreceptor to many other receptors (e.g. Toll-like receptor 2, Toll-like receptor 4, T-cell receptor, B-cell receptor, epidermal growth factor receptor and vascular endothelial growth factor receptor) and its different isoforms, CEACAM1 is a multifunctional protein with an impact on proliferation and differentiation of multiple cell types. Although different modes of action in other tissues are described, the role of CEACAM1 in the developing brain remains elusive. Here we report for the first time that CEACAM1 is expressed ontogenetically in oligodendrocytes of the developing rat brain, and that CEACAM1 expression has a spatiotemporal relation to myelination. In addition, CEACAM1 expression is altered in a model of hyperoxia- and inflammation-induced encephalopathy of prematurity, a myelination disorder of children born preterm. Furthermore, primary oligodendrocytes stimulated with CEACAM1 show increased myelination. Therefore, we postulate that CEACAM1 is, at least in part, involved in hyperoxia- and inflammation-induced disruption of myelination, but may also play a role in intact myelination as it is ontogenetically expressed in myelinating oligodendrocytes.
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Affiliation(s)
- Sebastian Prager
- Department of Pediatrics 1, Neonatology, University Hospital Essen, Essen, Germany.
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Sifringer M, Bendix I, von Haefen C, Endesfelder S, Kalb A, Bührer C, Felderhoff-Mueser U, Spies CD. Oxygen toxicity is reduced by acetylcholinesterase inhibition in the developing rat brain. Dev Neurosci 2013; 35:255-64. [PMID: 23445753 DOI: 10.1159/000346723] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2012] [Accepted: 12/27/2012] [Indexed: 11/19/2022] Open
Abstract
The cholinergic anti-inflammatory pathway is a neural mechanism that suppresses the innate inflammatory response and controls inflammation employing acetylcholine as the key endogenous mediator. In this study, we investigated the effects of the cholinergic agonists, physostigmine and donepezil, on neurodegeneration, inflammation and oxidative stress during oxygen toxicity in the developing rat brain. The aim of this study was to investigate the level of neurodegeneration, expression of proinflammatory cytokines, glutathione and lipid peroxidation after hyperoxia and treatment with the acetylcholinesterase (AChE) inhibitors, physostigmine and donepezil in the brain of neonatal rats. Six-day-old Wistar rats were exposed to 80% oxygen for 12-24 h and received 100 μg/kg physostigmine or 200 μg/kg donepezil intraperitoneally. Sex-matched littermates kept in room air and injected with normal saline, physostigmine or donepezil served as controls. Treatment with both inhibitors significantly reduced hyperoxia-triggered activity of AChE, neural cell death and the upregulation of the proinflammatory cytokines IL-1β and TNF-α in the immature rat brain on the mRNA and protein level. In parallel, hyperoxia-induced oxidative stress was reduced by concomitant physostigmine and donepezil administration, as shown by an increased reduced/oxidized glutathione ratio and attenuated malondialdehyde levels, as a sign of lipid peroxidation. Our results suggest that a single treatment with AChE inhibitors at the beginning of hyperoxia attenuated the detrimental effects of oxygen toxicity in the developing brain and may pave the way for AChE inhibitors, which are currently used for the treatment of Alzheimer's disease, as potential candidates for adjunctive neuroprotective therapies to the immature brain.
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Affiliation(s)
- Marco Sifringer
- Department of Anesthesiology and Intensive Care Medicine, Campus Charité Mitte and Campus Virchow-Klinikum, Charité-Universitätsmedizin Berlin, Berlin, Germany.
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Dührsen L, Simons SHP, Dzietko M, Genz K, Bendix I, Boos V, Sifringer M, Tibboel D, Felderhoff-Mueser U. Effects of repetitive exposure to pain and morphine treatment on the neonatal rat brain. Neonatology 2013; 103:35-43. [PMID: 23037996 DOI: 10.1159/000341769] [Citation(s) in RCA: 72] [Impact Index Per Article: 6.5] [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: 01/26/2012] [Accepted: 07/10/2012] [Indexed: 12/11/2022]
Abstract
BACKGROUND Untreated exposure to pain in preterm neonates might damage the vulnerable premature brain and alter development. Pain treatment is limited because analgesic agents may also have adverse neurodevelopmental consequences in newborns. OBJECTIVE To study the effects of neonatal pain and morphine treatment on the developing brain in a neonatal rat model. METHODS Newborn rats were randomly assigned to: treatment with formalin injections (group 1), saline injections (group 2) and controls receiving no injections (group 3). Treatment was given on postnatal days 1-3 (model A), 1-5 (model B) and 10-12 (model C). Brains were studied histologically and protein expression was evaluated (protein kinase C epsilon and doublecortin). Effects of preemptive morphine treatment were studied in the same models (models A+M and B+M). RESULTS Formalin injections resulted in increased apoptotic scores in models A and B. Saline injections increased the number of degenerative cells only in model B. Morphine showed protective effects in formalin-treated animals of model A+M and saline-treated animals of model B+M only. In model C, no neurodegenerative effects were detected. The protein expression of doublecortin showed a pain-related upregulation in the thalamus region, whereas protein kinase C epsilon expression was upregulated in the cortex. CONCLUSIONS Severe inflammatory pain and pain caused by repetitive injections in neonatal rats may cause major changes in the developing brain during the first week of life. Morphine may only protect the newborn brain against these changes in specific situations.
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Affiliation(s)
- Lasse Dührsen
- Department of Neonatology, Charité-Universitätsmedizin Berlin, Berlin, Germany
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35
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Brehmer F, Bendix I, Prager S, van de Looij Y, Reinboth BS, Zimmermanns J, Schlager GW, Brait D, Sifringer M, Endesfelder S, Sizonenko S, Mallard C, Bührer C, Felderhoff-Mueser U, Gerstner B. Interaction of inflammation and hyperoxia in a rat model of neonatal white matter damage. PLoS One 2012; 7:e49023. [PMID: 23155446 PMCID: PMC3498343 DOI: 10.1371/journal.pone.0049023] [Citation(s) in RCA: 67] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2012] [Accepted: 10/03/2012] [Indexed: 12/27/2022] Open
Abstract
Intrauterine infection and inflammation are major reasons for preterm birth. The switch from placenta-mediated to lung-mediated oxygen supply during birth is associated with a sudden rise of tissue oxygen tension that amounts to relative hyperoxia in preterm infants. Both infection/inflammation and hyperoxia have been shown to be involved in brain injury of preterm infants. Hypothesizing that they might be additive or synergistic, we investigated the influence of a systemic lipopolysaccharide (LPS) application on hyperoxia-induced white matter damage (WMD) in newborn rats. Three-day-old Wistar rat pups received 0.25 mg/kg LPS i.p. and were subjected to 80% oxygen on P6 for 24 h. The extent of WMD was assessed by immunohistochemistry, western blots, and diffusion tensor (DT) magnetic resonance imaging (MRI). In addition, the effects of LPS and hyperoxia were studied in an in vitro co-culture system of primary rat oligodendrocytes and microglia cells. Both noxious stimuli, hyperoxia, and LPS caused hypomyelination as revealed by western blot, immunohistochemistry, and altered WM microstructure on DT-MRI. Even so, cellular changes resulting in hypomyelination seem to be different. While hyperoxia induces cell death, LPS induces oligodendrocyte maturity arrest without cell death as revealed by TUNEL-staining and immunohistological maturation analysis. In the two-hit scenario cell death is reduced compared with hyperoxia treated animals, nevertheless white matter alterations persist. Concordantly with these in vivo findings we demonstrate that LPS pre-incubation reduced premyelinating-oligodendrocyte susceptibility towards hyperoxia in vitro. This protective effect might be caused by upregulation of interleukin-10 and superoxide dismutase expression after LPS stimulation. Reduced expression of transcription factors controlling oligodendrocyte development and maturation further indicates oligodendrocyte maturity arrest. The knowledge about mechanisms that triggered hypomyelination contributes to a better understanding of WMD in premature born infants.
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Affiliation(s)
- Felix Brehmer
- Department of Neonatology, Charité University Medical Center, Berlin, Germany.
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Bendix I, Schulze C, von Haefen C, Gellhaus A, Endesfelder S, Heumann R, Felderhoff-Mueser U, Sifringer M. Erythropoietin modulates autophagy signaling in the developing rat brain in an in vivo model of oxygen-toxicity. Int J Mol Sci 2012. [PMID: 23202931 PMCID: PMC3497305 DOI: 10.3390/ijms131012939] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023] Open
Abstract
Autophagy is a self-degradative process that involves turnover and recycling of cytoplasmic components in healthy and diseased tissue. Autophagy has been shown to be protective at the early stages of programmed cell death but it can also promote apoptosis under certain conditions. Earlier we demonstrated that oxygen contributes to the pathogenesis of neonatal brain damage, which can be ameliorated by intervention with recombinant human erythropoietin (rhEpo). Extrinsic- and intrinsic apoptotic pathways are involved in oxygen induced neurotoxicity but the role of autophagy in this model is unclear. We analyzed the expression of autophagy activity markers in the immature rodent brain after exposure to elevated oxygen concentrations. We observed a hyperoxia-exposure dependent regulation of autophagy-related gene (Atg) proteins Atg3, 5, 12, Beclin-1, microtubule-associated protein 1 light chain 3 (LC3), LC3A-II, and LC3B-II which are all key autophagy activity proteins. Interestingly, a single injection with rhEpo at the onset of hyperoxia counteracted these oxygen-mediated effects. Our results indicate that rhEpo generates its protective effect by modifying the key autophagy activity proteins.
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Affiliation(s)
- Ivo Bendix
- Department of Pediatrics I, Neonatology, University Hospital Essen, 45122 Essen, Germany; E-Mail:
- Author to whom correspondence should be addressed; E-Mail: ; Tel.: +49-201-723-2114; Fax: +49-201-723-5727
| | - Corina Schulze
- Department of Anaesthesiology and Intensive Care Medicine, Charité-Universitätsmedizin Berlin, Campus Virchow-Klinikum, 13353 Berlin, Germany; E-Mails: (C.S.); (C.H.); (M.S.)
| | - Clarissa von Haefen
- Department of Anaesthesiology and Intensive Care Medicine, Charité-Universitätsmedizin Berlin, Campus Virchow-Klinikum, 13353 Berlin, Germany; E-Mails: (C.S.); (C.H.); (M.S.)
| | - Alexandra Gellhaus
- Institute of Molecular Biology, University of Duisburg-Essen, 45122 Essen, Germany; E-Mail:
| | - Stefanie Endesfelder
- Department of Neonatology, Charité-Universitätsmedizin Berlin, Campus Virchow-Klinikum, 13353 Berlin, Germany; E-Mail:
| | - Rolf Heumann
- Department of Molecular Neurobiochemistry, Ruhr-University Bochum, 44780 Bochum, Germany; E-Mail:
| | - Ursula Felderhoff-Mueser
- Department of Pediatrics I, Neonatology, University Hospital Essen, 45122 Essen, Germany; E-Mail:
| | - Marco Sifringer
- Department of Anaesthesiology and Intensive Care Medicine, Charité-Universitätsmedizin Berlin, Campus Virchow-Klinikum, 13353 Berlin, Germany; E-Mails: (C.S.); (C.H.); (M.S.)
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Sirin S, Huening B, Stein A, Göricke SL, Krasny A, Felderhoff-Mueser U, Schweiger B. Detektion von intrakraniellen Blutungen bei früh- und reifgeborenen Säuglingen mittels suszeptibilitätsgewichteter Bildgebung. ROFO-FORTSCHR RONTG 2012. [DOI: 10.1055/s-0032-1326818] [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: 10/27/2022]
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Harzer K, Blech-Hermoni Y, Goldin E, Felderhoff-Mueser U, Igney C, Sidransky E, Yildiz Y. Beta-glucosidase 1 (GBA1) is a second bile acid β-glucosidase in addition to β-glucosidase 2 (GBA2). Study in β-glucosidase deficient mice and humans. Biochem Biophys Res Commun 2012; 423:308-12. [PMID: 22659419 DOI: 10.1016/j.bbrc.2012.05.117] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2012] [Accepted: 05/18/2012] [Indexed: 10/28/2022]
Abstract
Beta-glucosidase 1 (GBA1; lysosomal glucocerebrosidase) and β-glucosidase 2 (GBA2, non-lysosomal glucocerebrosidase) both have glucosylceramide as a main natural substrate. The enzyme-deficient conditions with glucosylceramide accumulation are Gaucher disease (GBA-/- in humans), modelled by the Gba-/- mouse, and the syndrome with male infertility in the Gba2-/- mouse, respectively. Before the leading role of glucosylceramide was recognised for both deficient conditions, bile acid-3-O-β-glucoside (BG), another natural substrate, was viewed as the main substrate of GBA2. Given that GBA2 hydrolyses both BG and glucosylceramide, it was asked whether vice versa GBA1 hydrolyses both glucosylceramide and BG. Here we show that GBA1 also hydrolyses BG. We compared the residual BG hydrolysing activities in the GBA1-/-, Gba1-/- conditions (where GBA2 is the almost only active β-glucosidase) and those in the Gba2-/- condition (GBA1 active), with wild-type activities, but we used also the GBA1 inhibitor isofagomine. GBA1 and GBA2 activities had characteristic differences between the studied fibroblast, liver and brain samples. Independently, the hydrolysis of BG by pure recombinant GBA1 was shown. The fact that both GBA1 and GBA2 are glucocerebrosidases as well as bile acid β-glucosidases raises the question, why lysosomal accumulation of glucosylceramide in GBA1 deficiency, and extra-lysosomal accumulation in GBA2 deficiency, are not associated with an accumulation of BG in either condition.
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Affiliation(s)
- Klaus Harzer
- Neurometabolic Laboratory, Klinik für Kinder- und Jugendmedizin, University of Tübingen, Tübingen, Germany
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Chip S, Zelmer A, Ogunshola OO, Felderhoff-Mueser U, Nitsch C, Bührer C, Wellmann S. The RNA-binding protein RBM3 is involved in hypothermia induced neuroprotection. Neurobiol Dis 2011; 43:388-96. [PMID: 21527344 DOI: 10.1016/j.nbd.2011.04.010] [Citation(s) in RCA: 84] [Impact Index Per Article: 6.5] [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: 08/26/2010] [Revised: 04/07/2011] [Accepted: 04/11/2011] [Indexed: 02/07/2023] Open
Abstract
Induced hypothermia is the only therapy with proven efficacy to reduce brain damage after perinatal asphyxia. While hypothermia down-regulates global protein synthesis and cell metabolism, low temperature induces a small subset of proteins that includes the RNA-binding protein RBM3 (RNA-binding motif protein 3), which has recently been implicated in cell survival. Here, immunohistochemistry of the developing postnatal murine brain revealed a spatio-temporal neuronal RBM3 expression pattern very similar to that of doublecortin, a marker of neuronal precursor cells. Mild hypothermia (32°C) profoundly promoted RBM3 expression and rescued neuronal cells from forced apoptosis as studied in primary neurons, PC12 cells, and cortical organotypic slice cultures. Blocking RBM3 expression in neuronal cells by specific siRNAs significantly diminished the neuroprotective effect of hypothermia while vector-driven RBM3 over-expression reduced cleavage of PARP, prevented internucleosomal DNA fragmentation, and LDH release also in the absence of hypothermia. Together, neuronal RBM3 up-regulation in response to hypothermia apparently accounts for a substantial proportion of hypothermia-induced neuroprotection.
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Affiliation(s)
- Sophorn Chip
- Children's University Hospital Basel, Spitalstrasse 33, 4031 Basel, Switzerland.
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40
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Schmitz T, Felderhoff-Mueser U, Sifringer M, Groenendaal F, Kampmann S, Heep A. Expression of soluble Fas in the cerebrospinal fluid of preterm infants with posthemorrhagic hydrocephalus and cystic white matter damage. J Perinat Med 2011; 39:83-8. [PMID: 20954855 DOI: 10.1515/jpm.2010.125] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [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] [Indexed: 11/15/2022]
Abstract
Perinatal brain damage may result in impaired neurological development in extremely preterm infants. The underlying pathophysiological mechanisms are complex, and biomarkers of prognostic value are not available. The aim of this study was to analyze soluble Fas (sFas) concentrations in the cerebrospinal fluid (CSF) representative for involvement of apoptotic processes in preterm infants developing posthemorrhagic hydrocephalus (PHHC) and to link them to white matter damage (WMD) diagnosed by cranial ultrasound. A total of 29 preterm infants with PHHC were included in the study; 17 of them had signs of cystic WMD (cWMD) on ultrasound examinations. CSF samples were obtained at first ventriculostomy, and results were compared to those of a reference group of 24 preterm and term infants without neurologic diseases. sFas concentrations were elevated in CSF samples of PHHC patients compared to the reference group. In patients with cWMD, sFas concentrations were significantly higher than in patients without cWMD. These results indicate that apoptosis via the Fas pathway is involved in the pathogenesis of cWMD in the context of PHHC, and that sFas in the CSF may serve as a marker of cWMD development.
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Affiliation(s)
- Thomas Schmitz
- Department of Neonatology, Charité Universitätsmedizin Berlin, Campus Virchow Klinikum, Berlin D-13353, Germany.
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Schlager GW, Griesmaier E, Wegleiter K, Neubauer V, Urbanek M, Kiechl-Kohlendorfer U, Felderhoff-Mueser U, Keller M. Systemic G-CSF treatment does not improve long-term outcomes after neonatal hypoxic-ischaemic brain injury. Exp Neurol 2010; 230:67-74. [PMID: 21145889 DOI: 10.1016/j.expneurol.2010.11.021] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2009] [Revised: 11/15/2010] [Accepted: 11/29/2010] [Indexed: 11/25/2022]
Abstract
Hypoxia-ischaemia (HI) is a major factor in the pathogenesis of developmental brain injury, leading to cognitive deficits and motor disabilities in preterm infants. The haematopoietic growth factor granulocyte colony-stimulating factor (G-CSF) has been shown to exert a neuroprotective activity in rodent models of ischaemic stroke and is currently subject to phase I/II clinical trials in adults. Results of studies examining the effect of G-CSF in perinatal brain damage have been contradictory. We have previously shown that G-CSF increases NMDAR-mediated excitotoxic brain injury in the neonatal mouse brain. In this study, we evaluated the effect of G-CSF on long-term outcomes after HI. On postnatal day 5, mice pubs were first randomly assigned to a sham operation or HI and then divided into four treatment groups: i) G-CSF; ii) phosphate buffered saline (PBS) 1h after injury; iii) G-CSF and iv) PBS 60 h after injury. G-CSF (200 μg/kg BW) was administered five times within a 24h interval. Neuromotor and cognitive outcomes were assessed by open-field, novel object recognition tests and rotarod tests starting on P90, with subsequent histological analyses of brain injury. G-CSF treatment did not improve either neurobehavioural outcomes or brain injuries. Interestingly, the application of PBS and G-CSF in the acute phase increased brain damage in the hippocampus. We could not confirm the neuroprotective properties of G-CSF in neonatal HI brain damage. The exacerbation of injury by the administration of substances in the acute phase might indicate a heightened state of neurological sensitivity that is specific to mechanisms of secondary neurodegeneration and influenced by unidentified external factors possibly associated with the treatment protocol during the acute phase. This article is part of a Special Issue entitled "Interaction between repair, disease, & inflammation."
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Affiliation(s)
- G W Schlager
- Department of Paediatrics I, University Hospital Essen, Germany
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Keller M, Felderhoff-Mueser U, Lagercrantz H, Dammann O, Marlow N, Hüppi P, Buonocore G, Poets C, Simbruner G, Guimaraes H, Mader S, Merialdi M, Saugstad OD. Policy benchmarking report on neonatal health and social policies in 13 European countries. Acta Paediatr 2010; 99:1624-9. [PMID: 20500729 DOI: 10.1111/j.1651-2227.2010.01894.x] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.6] [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: 11/30/2022]
Abstract
BACKGROUND AND AIM Preterm birth is the major cause of infant mortality and morbidity in both developed and developing countries. In Europe, the prevalence rate of premature birth ranges from 5.5 to 11.4% - an average of 7.1% of all live births. In this report, we aim to compare the current health and social policies, as well as practices in 13 EU member states. MATERIALS AND METHODS Using desk research, relevant information was gathered from each of the 13 European countries with regard to the prevalence of preterm birth, the cost of preterm birth to healthcare budgets, and the relevant policies, guidelines and practices in place at the national and, in some cases, regional level. The information comes from a range of sources, including government and parent association websites, published scientific literature and media reports. RESULTS Despite the growing prevalence and increasing costs, neonatal and preterm infant health rank low on the policy agendas of EU member states. CONCLUSION Based on the findings, there are a number of recommendations that should be considered. The European Union should (i) recognize the growing challenge of prematurity in Europe and its significant impact on infant morbidity and mortality, (ii) improve neonatal health through the development and implementation of coordinated EU health and social policies, (iii) address the lack of comparable European data on prematurity, including prevalence, mortality, acute morbidity and long-term impairment, (iv) also increase the standard of neonatal care across Europe by supporting the development and implementation of European medical guidelines and quality standards, (v) support the development of European postgraduate training programmes in Peri- and Neonatology in order to increase the quality and availability of trained healthcare professionals.
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Affiliation(s)
- Matthias Keller
- Department of Pediatrics, Neonatology, University Hospital Essen, Germany.
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Adén U, Favrais G, Plaisant F, Winerdal M, Felderhoff-Mueser U, Lampa J, Lelièvre V, Gressens P. Systemic inflammation sensitizes the neonatal brain to excitotoxicity through a pro-/anti-inflammatory imbalance: key role of TNFalpha pathway and protection by etanercept. Brain Behav Immun 2010; 24:747-58. [PMID: 19861157 DOI: 10.1016/j.bbi.2009.10.010] [Citation(s) in RCA: 68] [Impact Index Per Article: 4.9] [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: 08/21/2009] [Revised: 10/21/2009] [Accepted: 10/22/2009] [Indexed: 10/20/2022] Open
Abstract
Systemic inflammation sensitizes the perinatal brain to an ischemic/excitotoxic insult but the mechanisms are poorly understood. We hypothesized that the mechanisms involve an imbalance between pro- and anti-inflammatory factors. A well characterized mouse model where a systemic injection of IL-1beta during the first five postnatal days (inflammatory insult) is combined with an intracerebral injection of the glutamatergic analogue ibotenate (excitotoxic insult) at postnatal day 5 was used. Following the inflammatory insult alone, there was a transient induction of IL-1beta and TNFalpha, compared with controls measured by quantitative PCR, ELISA, and Western blot. Following the combined inflammatory and excitotoxic insult, there was an induction of IL-1beta, TNFalpha, and IL-6 but not of IL-10 and TNFR1, indicating an altered pro-/anti-inflammatory balance after IL-1beta sensitized lesion. We then tested the hypothesis that the TNFalpha pathway plays a key role in the sensitization and insult using TNFalpha blockade (etanercept) and TNFalpha(-/-) mice. Etanercept given before the insult did not affect brain damage, but genetic deletion of TNFalpha or TNFalpha blockade by etanercept given after the combined inflammatory and excitotoxic insult reduced brain damage by 50%. We suggest this protective effect was centrally mediated, since systemic TNFalpha administration in the presence of an intact blood-brain barrier did not aggravate the damage and etanercept almost abolished cerebral TNFalpha production. In summary, sensitization was, at least partly, mediated by an imbalance between pro- and anti-inflammatory cytokines. Cerebral TNFalpha played a key role in mediating brain damage after the combined inflammatory and excitatory insult.
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Dzietko M, Sifringer M, Klaus J, Endesfelder S, Brait D, Hansen H, Bendix I, Felderhoff-Mueser U. Neurotoxic Effects of MDMA (Ecstasy) on the Developing Rodent Brain. Dev Neurosci 2010; 32:197-207. [DOI: 10.1159/000313473] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2010] [Accepted: 04/06/2010] [Indexed: 11/19/2022] Open
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Sifringer M, Genz K, Brait D, Brehmer F, Löber R, Weichelt U, Kaindl AM, Gerstner B, Felderhoff-Mueser U. Erythropoietin attenuates hyperoxia-induced cell death by modulation of inflammatory mediators and matrix metalloproteinases. Dev Neurosci 2009; 31:394-402. [PMID: 19672068 DOI: 10.1159/000232557] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2008] [Accepted: 12/02/2008] [Indexed: 11/19/2022] Open
Abstract
Oxygen toxicity appears to contribute to the pathogenesis of adverse neurological outcome in survivors of preterm birth. In infant rodent brains, hyperoxia triggers widespread apoptotic neurodegeneration, induces proinflammatory cytokines and inhibits growth factor signaling cascades. Since a tissue-protective effect has been observed for recombinant erythropoietin (rEpo), we hypothesized that rEpo would influence the expression of proinflammatory cytokines and matrix metalloproteinase (MMP)-2 and MMP-9. Six-day-old Wistar rats were exposed to 80% oxygen for 2-48 h and received 20,000 IU rEpo i.p. Sex-matched littermates kept in room air and injected with normal saline or rEpo served as controls. Treatment with rEpo significantly reduced hyperoxia-induced upregulation of the proinflammatory cytokines IL-1beta and IL-18 in infant rodent brains on the mRNA and protein levels. In parallel, gelatin zymography in hyperoxia-treated immature rat brains revealed an upregulation of active MMP-2 which was reduced by concomitant rEpo treatment. Furthermore, hyperoxia induced upregulation of MMP-9 following 12 h of oxygen exposure and this was attenuated by rEpo treatment. Our results suggest that rEpo generates its protective effect against oxygen toxicity through a reduction of proinflammatory mediator levels.
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Affiliation(s)
- Marco Sifringer
- Department of Neonatology, Campus Virchow-Klinikum, Charité-Universitätsmedizin Berlin, Berlin, Germany
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Dzietko M, Boos V, Sifringer M, Polley O, Gerstner B, Genz K, Endesfelder S, Börner C, Jacotot E, Chauvier D, Obladen M, Bührer C, Felderhoff-Mueser U. A critical role for Fas/CD-95 dependent signaling pathways in the pathogenesis of hyperoxia-induced brain injury. Ann Neurol 2009; 64:664-73. [PMID: 19107989 DOI: 10.1002/ana.21516] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
OBJECTIVE Prematurely born infants are at risk for development of neurocognitive impairment in later life. Oxygen treatment has been recently identified as a trigger of neuronal and oligodendrocyte apoptosis in the developing rodent brain. We investigated the role of the Fas death receptor pathway in oxygen-triggered developmental brain injury. METHODS Six-day-old Wistar rats were exposed to 80% oxygen for various periods (2, 6, 12, 24, 48, and 72 hours), and mice deficient in either Fas (B6.MRL-Tnfrsf6(lpr)) or Fas ligand (B6Smn.C3-Fasl(gld)) and control mice (C57BL/6J) were exposed to 80% oxygen for 24 hours. Polymerase chain reaction, Western blotting, and caspase activity assays of thalamus and cortex tissue were performed. RESULTS Fas and Fas ligand messenger RNA and protein were upregulated. Furthermore, hyperoxia resulted in induction of downstream signaling events of Fas, such as Fas-associated death domain (FADD), the long and short form of FADD-like interleukin-1beta-converting enzyme (FLICE) inhibitory protein (FLIP-L, FLIP-S), and cleavage of caspase-8 and caspase-3. Injection of a selective caspase-8 inhibitor (TRP801, 1mg/kg) at the beginning of hyperoxia blocked subsequent caspase-3 cleavage in this model. B6.MRL-Tnfrsf6(lpr) mice were protected against oxygen-mediated injury, confirming Fas involvement in hyperoxia-induced cell death. Mice deficient in Fas ligand did not differ from control animals in the amount of cell death. INTERPRETATION We conclude that neonatal hyperoxia triggers Fas receptor and its downstream signaling events in a Fas ligand-independent fashion. Lack of functional Fas receptors and selective pharmacological inhibition of caspase-8 prevents activation of caspase-3 and provides significant neuroprotection.
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Affiliation(s)
- Mark Dzietko
- Department of Neonatology, Charité, Universitätsmedizin-Berlin, Campus Virchow Klinikum, Berlin, Germany.
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Kaindl AM, Sifringer M, Koppelstaetter A, Genz K, Loeber R, Boerner C, Stuwe J, Klose J, Felderhoff-Mueser U. Erythropoietin protects the developing brain from hyperoxia-induced cell death and proteome changes. Ann Neurol 2009; 64:523-34. [PMID: 19067366 DOI: 10.1002/ana.21471] [Citation(s) in RCA: 55] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
OBJECTIVE Oxygen toxicity has been identified as a risk factor for adverse neurological outcome in survivors of preterm birth. In infant rodent brains, hyperoxia induces disseminated apoptotic neurodegeneration. Because a tissue-protective effect has been observed for recombinant erythropoietin (rEpo), widely used in neonatal medicine for its hematopoietic effect, we examined the effect of rEpo on hyperoxia-induced brain damage. METHODS Six-day-old C57Bl/6 mice or Wistar rats were exposed to hyperoxia (80% O(2)) or normoxia for 24 hours and received rEpo or normal saline injections intraperitoneally. The amount of degenerating cells in their brains was determined by DeOlmos cupric silver staining. Changes of their brain proteome were determined through two-dimensional electrophoresis and mass spectrometry. Western blot, enzyme activity assays and real-time polymerase chain reaction were performed for further analysis of candidate proteins. RESULTS Systemic treatment with 20,000 IE/kg rEpo significantly reduced hyperoxia-induced apoptosis and caspase-2, -3, and -8 activity in the brains of infant rodents. In parallel, rEpo inhibited most brain proteome changes observed in infant mice when hyperoxia was applied exclusively. Furthermore, brain proteome changes after a single systemic rEpo treatment point toward a number of mechanisms through which rEpo may generate its protective effect against oxygen toxicity. These include reduction of oxidative stress and restoration of hyperoxia-induced increased levels of proapoptotic factors, as well as decreased levels of neurotrophins. INTERPRETATION These findings are highly relevant from a clinical perspective because oxygen administration to neonates is often inevitable, and rEpo may serve as an adjunctive neuroprotective therapy.
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Affiliation(s)
- Angela M Kaindl
- Department of Pediatric Neurology, Charité-Universitätsmedizin Berlin, Campus Virchow-Klinikum, Berlin, Germany.
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Nagl B, Loui A, Raila J, Felderhoff-Mueser U, Obladen M, Schweigert FJ. Urinary vitamin A excretion in very low birth weight infants. Pediatr Nephrol 2009; 24:61-6. [PMID: 18751734 DOI: 10.1007/s00467-008-0965-0] [Citation(s) in RCA: 5] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/26/2008] [Revised: 07/17/2008] [Accepted: 07/17/2008] [Indexed: 10/21/2022]
Abstract
Vitamin A (VA) deficiency in very low birth weight (VLBW) infants is associated with an increased risk for disorders related to kidney and lung maturation and function. VA losses through increased urinary retinol (ROH) excretion might contribute to this deficiency risk. The mechanism accounting for ROH loss in the urine has not yet been clarified. The aim of this study was to assess the excretion of ROH, retinol-binding protein 4 (RBP4) and transthyretin (TTR) in urine from VLBW infants in comparison with that in term infants in relation to kidney function. Urine specimens were collected from 15 VLBW infants (birth weight < 1,500 g) as well as from 20 term infants during the first 2 days after birth. ROH in urine was detectable in 14 of the 15 VLBW infants at a median concentration of 234 nmol/g creatinine. In the group of term infants, 17 of the 20 excreted ROH, but at an approximately five-times lower concentration (P < 0.001). Excretion of RBP4 and TTR was also much higher in VLBW infants (both P< 0.001). The urinary ROH excretion in VLBW infants may be related to the impaired tubular handling of its carrier proteins RBP4 and TTR. Thus, ROH excretion might contribute to an increased risk of VA deficiency, especially in VLBW infants.
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Affiliation(s)
- Britta Nagl
- Department of Physiology and Pathophysiology, Institute of Nutritional Science, University of Potsdam, Potsdam, Germany.
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Stark S, Schuller A, Sifringer M, Gerstner B, Brehmer F, Weber S, Altmann R, Obladen M, Buhrer C, Felderhoff-Mueser U. Suramin induces and enhances apoptosis in a model of hyperoxia-induced oligodendrocyte injury. Neurotox Res 2008; 13:197-207. [PMID: 18522899 DOI: 10.1007/bf03033503] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
Recent evidence suggests oxygen as a powerful trigger for cell death in the immature white matter, leading to periventricular leukomalacia (PVL) as a cause of adverse neurological outcome in survivors of preterm birth. This oligodendrocyte (OL) death is associated with oxidative stress, upregulation of apoptotic signaling factors (i.e., Fas, caspase-3) and decreased amounts of neurotrophins. In search of neuroprotective strategies we investigated whether the polysulfonated urea derivative suramin, recently identified as a potent inhibitor of Fas signaling, affords neuroprotection in an in vitro model of hyperoxia-induced injury to immature oligodendrocytes. Immature OLs (OLN-93) were subjected to 80% hyperoxia (48 h) in the presence or absence of suramin (0, 30, 60, 120 microM). Cell death was assessed by flow cytometry (Annexin V, caspase-3 activity assay) and immunohistochemistry for activated caspase-3. Immunoblotting for the death receptor Fas, cleaved caspase-8 and the phosphorylated isoform of the serine-threonin kinase Akt (pAkt) was performed. Suramin lead to OL apoptosis and potentiated hyperoxia-induced injury in a dose-dependent manner. Immunoblotting revealed increased Fas and caspase-8 expression by suramin treatment. This effect was significantly enhanced when suramin was combined with hyperoxia. Furthermore, pAkt levels decreased following suramin exposure, indicating interference with neurotrophin-dependent growth factor signaling. These data indicate that suramin causes apoptotic cell death and aggravates hyperoxia-induced cell death in immature OLs. Its mechanism of action includes an increase of previously described hyperoxia-induced expression of pro-apoptotic factors and deprivation of growth factor dependent signaling components.
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Affiliation(s)
- Simone Stark
- Department of Neonatology, Campus Virchow-Klinikum, Charité, Universitätsmedizin Berlin, D-13353 Berlin, Germany
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Abstract
A 25-day-old boy was admitted to hospital because of pneumonia and additionally developed symptoms of encephalitis. The immune fluorescence test for Chlamydia trachomatis in tracheal fluids was positive. Furthermore, ligase chain reaction for C trachomatis was positive in the cerebrospinal fluid. The antibiotic regimen was changed to erythromycin intravenously. C trachomatis encephalitis is rare in neonates and may result from a defect in the alternative pathway of complement activation which was the case in this patient.
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Affiliation(s)
- Astrid Bertsche
- Department of Neonatology Campus Virchow-Klinikum, Charité Universitätsmedizin, University Children's Hospital, Heidelberg, Germany.
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