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Rösch L, Hofstätter E, Krasnitzer-Leitner F, Wald M. Premature Babies Can Be Cared for in the Maternity Ward without an Increased Risk and Discharged with a Feeding Tube If Necessary. Children (Basel) 2024; 11:456. [PMID: 38671673 PMCID: PMC11049494 DOI: 10.3390/children11040456] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/05/2024] [Revised: 03/30/2024] [Accepted: 04/04/2024] [Indexed: 04/28/2024]
Abstract
In general, premature babies are discharged home when they reach full self-feeding. We established a discharge management protocol which allows for discharging late preterm babies with a feeding tube if necessary. This retrospective study included 108 preterm infants (34+ weeks) born in 2019 and 2020. The preterm infants discharged with a feeding tube (n = 32) were born at 35.23 weeks' gestation (±0.884), with a birth weight of 2423 g (±375.1), and were discharged at 7.22 days (±3.63) and had a weight of 3466 g (±591.3) at the first outpatient visit around the expected birth date. The preterm infants discharged without a feeding tube were born at 35.97 weeks' gestation (±0.702) with a birth weight of 2589 g (±424.84), discharged home at 6.82 days (±7.11) and a weight of 3784 g (±621.8) at the first outpatient visit. The gestational week and birth weight were statistically significantly different between the groups, with a p-value of <0.001 for each, and the length of hospital stay (p = 0.762) and weight at follow-up (p = 0.064) did not significantly differ. No infant required tube-feeding at the time of the first outpatient visit, i.e., the time of expected birth. Therefore, with well-thought-out management, it is possible and safe to discharge preterm infants home with a feeding tube.
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Affiliation(s)
| | | | | | - Martin Wald
- Division of Neonatology, Department of Pediatrics and Adolescent Medicine, Paracelsus Medical University, Salzburg 5020, Austria
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Brandstetter M, Neuner M, Dinges C, Hofstätter E, Wohlmuth C, Fazelnia C, Fischer T, Bogner G. Fetal Doppler monitoring during maternal open-heart surgery: Case report and key aspects of a multidisciplinary challenge. Eur J Obstet Gynecol Reprod Biol 2023; 287:63-66. [PMID: 37295346 DOI: 10.1016/j.ejogrb.2023.05.034] [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: 05/08/2023] [Accepted: 05/25/2023] [Indexed: 06/12/2023]
Abstract
CASE REPORT Herein we present the case of a 33-year nulliparous woman at 21 weeks of gestation with mitral valve vegetation resulting from infective endocarditis. Due to the mother's critical condition caused by consecutive thromboembolic events, surgery with cardiopulmonary bypass was indicated. During surgery the fetus was monitored by a specialized obstetrician who repetitively measured the Doppler indices of the umbilical artery, Ductus venosus and uterine artery. Right after CO2 was insufflated into the operating area, the Doppler monitoring showed an increased Pulsatility Index of the Umbilical artery right before fetal distress with bradycardia occurred. A subsequent maternal arterial blood gas analysis showed an acidosis with hypercapnia. Consequently, the CO2 insufflation was stopped and the gas flow on the Heart Lung Machine increased. After regaining homeostasis of acidosis, the Doppler Indices and fetal heart rate recovered. The remaining surgery and postoperative course were uneventful. At the 37 weeks of gestation a healthy boy was delivered by Cesarean section and at the age of two years, the neurodevelopment was assessed, which indicated normal development in mental cognition, language and motoric. This report presents a periodic Doppler examination of the maternal and fetal circulation during surgery on CPB while also discussing the possible impact of fetal monitoring in managing open cardiac surgery in pregnancy.
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Affiliation(s)
| | - Matthias Neuner
- Department of Anesthesiology, Paracelsus Medical University, Salzburg, Austria
| | - Christian Dinges
- Department of Heart Surgery, Paracelsus Medical University, Salzburg, Austria
| | - Edda Hofstätter
- Department of Neonatology, Paracelsus Medical University, Salzburg, Austria
| | - Christoph Wohlmuth
- Department of Obstetrics and Gynecology, Paracelsus Medical University, Salzburg, Austria
| | - Claudius Fazelnia
- Department of Obstetrics and Gynecology, Paracelsus Medical University, Salzburg, Austria
| | - Thorsten Fischer
- Department of Obstetrics and Gynecology, Paracelsus Medical University, Salzburg, Austria
| | - Gerhard Bogner
- Department of Obstetrics and Gynecology, Paracelsus Medical University, Salzburg, Austria.
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Auer-Hackenberg L, Stroicz P, Hofstätter E, Brandner J, Haselmann C, Wald M. Breath-dependent pressure fluctuations in various constant- and variable-flow neonatal CPAP devices. Pediatr Pulmonol 2022; 57:2411-2419. [PMID: 35774021 PMCID: PMC9796268 DOI: 10.1002/ppul.26050] [Citation(s) in RCA: 1] [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] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/23/2021] [Revised: 05/31/2022] [Accepted: 06/28/2022] [Indexed: 01/11/2023]
Abstract
OBJECTIVE In continuous positive airway pressure (CPAP) devices, pressure can be generated by two different mechanisms: either via an expiratory valve or by one or more jets. Valved CPAP devices are referred to as constant-flow devices, and jet devices are called variable-flow devices. Constant-flow CPAP devices are said to reduce the imposed work of breathing due to lower breath-dependent pressure fluctuations. The present study investigates the performance of various constant- and variable-flow CPAP devices in relation to breath-dependent pressure fluctuations. DESIGN Experimental study comparing the pressure fluctuations incurred by seven neonatal CPAP devices attached to an active neonatal lung model. METHODOLOGY Spontaneous breathing was simulated using a tidal volume of 6 ml at pressure levels of 5, 7, and 9 mbar. The main outcomes were respiratory pressure fluctuations, tidal volume, and end-expiratory pressure. RESULTS All CPAP devices tested showed respiratory pressure fluctuations, varying from 0.631 to 3.466 mbar. The generated tidal volume correlated significantly with the pressure fluctuations (r = -0.947; p = 0.001) and varied between 5.550 and 6.316 ml. CPAP devices with jets showed no advantage over CPAP devices with expiratory valves. End-expiratory pressure in the nose deviated from the set pressure between -1.305 and 0.644 mbar and varied depending on whether the pressure was measured in the device or in the tube extending to the nose. CONCLUSION During standard spontaneous breathing, breath-dependent pressure fluctuations in constant- and variable-flow devices are comparable. Pressure measurements taken in the tubing system can lead to a considerable deviation of the applied pressure.
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Affiliation(s)
- Lorenz Auer-Hackenberg
- Department of Neonatology, Division of Pediatrics and Adolescent Medicine, Paracelsus Medical Private University, Salzburg, Austria
| | - Patricia Stroicz
- Department of Neonatology, Division of Pediatrics and Adolescent Medicine, Paracelsus Medical Private University, Salzburg, Austria
| | - Edda Hofstätter
- Department of Neonatology, Division of Pediatrics and Adolescent Medicine, Paracelsus Medical Private University, Salzburg, Austria
| | - Johannes Brandner
- Department of Neonatology, Division of Pediatrics and Adolescent Medicine, Paracelsus Medical Private University, Salzburg, Austria
| | - Clemens Haselmann
- Department of Neonatology, Division of Pediatrics and Adolescent Medicine, Paracelsus Medical Private University, Salzburg, Austria
| | - Martin Wald
- Department of Neonatology, Division of Pediatrics and Adolescent Medicine, Paracelsus Medical Private University, Salzburg, Austria
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Hofstätter E, Köttstorfer V, Stroicz P, Schütz S, Auer-Hackenberg L, Brandner J, Wald M. Introduction and feeding practices of solid food in preterm infants born in Salzburg! BMC Pediatr 2021; 21:56. [PMID: 33499832 PMCID: PMC7839190 DOI: 10.1186/s12887-021-02505-6] [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] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/03/2020] [Accepted: 01/13/2021] [Indexed: 12/02/2022] Open
Abstract
Background It is shown that meeting the increased nutritional demand of preterm infants from birth is not only important for survival but essentially contributes to the infants` overall development and long-term health. While there are established guidelines for weaning term infants, evidence regarding preterm infants is scarce and less precise. The aim of this study was to identify the current practices on introducing solids to preterm infants amongst caregivers in Salzburg and determine potential reasons for early weaning. Methods Altogether 68 infants born between 24 0/7 and 36 6/7 weeks were recruited and detailed structured interviews with the caregivers were conducted at 17 weeks corrected age. Weight, height and head circumference were collected. Results 52% of the study group received solids before the recommended 17 weeks corrected age. For this group the mean age being 13.77 ± 1.11 weeks corrected age. Premature introduction of solids significantly correlates with exclusively and early formula-feeding. 34% were weaned due to recommendation by their paediatrician. 23% of the preterm infants even received solids before 12 weeks corrected age, putting them at risks for developing obesity, celiac disease and diabetes. Conclusions This study shows the necessity for clear guidelines regarding the introduction of complementary feeding in preterm infants as well as the importance of their implementation. Caregivers should receive information on this topic early enough and they should fully understand the difference between chronological and corrected age. Supplementary Information The online version contains supplementary material available at 10.1186/s12887-021-02505-6.
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Affiliation(s)
- Edda Hofstätter
- Division of Neonatology, Department of Paediatrics and Adolescent Medicine, Paracelsus Medical University, Salzburg, Austria
| | - Verena Köttstorfer
- Division of Neonatology, Department of Paediatrics and Adolescent Medicine, Paracelsus Medical University, Salzburg, Austria
| | - Patricia Stroicz
- Division of Neonatology, Department of Paediatrics and Adolescent Medicine, Paracelsus Medical University, Salzburg, Austria.
| | - Sebastian Schütz
- Department of Mathematics, Paris Lodron University, Salzburg, Austria
| | - Lorenz Auer-Hackenberg
- Division of Neonatology, Department of Paediatrics and Adolescent Medicine, Paracelsus Medical University, Salzburg, Austria
| | - Johannes Brandner
- Division of Neonatology, Department of Paediatrics and Adolescent Medicine, Paracelsus Medical University, Salzburg, Austria
| | - Martin Wald
- Division of Neonatology, Department of Paediatrics and Adolescent Medicine, Paracelsus Medical University, Salzburg, Austria
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Schneider A, Hofstätter E, Brandner J, Moder A, Häusler S, Wald M. Benchmarking of Four Near Infrared Spectroscopy Devices for Long Time Use in Neonates. Klin Padiatr 2018. [PMID: 29539643 DOI: 10.1055/s-0044-102256] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
BACKGROUND Using near-infrared spectroscopy (NIRS) mixed tissue saturation can be calculated by measuring the oxygen saturation of oxygenated and deoxygenated erythrocytes in the tissue. Quality of the calculated value is not only dependent on the exposure of the measured values in the calculation, but also on external factors such as artifacts. Main object of this study was to determine whether and how the measurement quality of different devices varies in their long-term use in premature infants. PATIENTS AND METHODS In 54 measurements, each lasting 2 hours, 4 NIRS devices were attached in pairs on the forehead of 9 cardio-respiratory stable, spontaneous breathing premature infants. Pooled meta-analysis was used to compare the correlation between regional tissue saturation to the pulse oximetry saturation per device. RESULTS The pooled random effect of all Pearson's correlation coefficients was 0.490 (CI95: 0.403-0.568) with the NIRO 200, 0.575 (CI95: 0.463-0.668) with the INVOS 5100c, 0.712 (CI95: 0.640-0.772) with the Fore-Sight and 0.638 (CI95: 0.554-0.709) with the SenSmart X- 100. CONCLUSION In this trial, a significant correlation between the tissue saturation and pulsoxymetry saturation was observed. The tremendous variation range among the measurements showed, however, that the measurement quality can be severely affected by unrecognized artifacts, after excluding other possible causes. None of the devices had reliable artifact detection for long-term measurements in very small premature infants. Key words: Near-Infrared-Spectroscopy, premature infants, Benchmark Test, Long-term measurements.
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Affiliation(s)
- Anna Schneider
- Division of Neonatology, Department of Pediatrics, Paracelsus Medical University, Salzburg, Austria
| | - Edda Hofstätter
- Division of Neonatology, Department of Pediatrics, Paracelsus Medical University, Salzburg, Austria
| | - Johannes Brandner
- Division of Neonatology, Department of Pediatrics, Paracelsus Medical University, Salzburg, Austria
| | - Angelika Moder
- Institute of Inborn Errors on Metabolism, Paracelsus Medical University, Salzburg, Austria
| | - Silke Häusler
- Division of Neonatology, Department of Pediatrics, Paracelsus Medical University, Salzburg, Austria
| | - Martin Wald
- Division of Neonatology, Department of Pediatrics, Paracelsus Medical University, Salzburg, Austria
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Matthäus V, Haiden N, Abou-Dakn M, Berns M, Eglin K, Flemmer A, Gebauer C, Glanzmann R, Graf-Rohrmeister K, Grunert J, Hattinger-Jürgenssen E, Herber-Jonat S, Hofstätter E, Klotz D, Kujawa M, Liegl Y, Malzacher A, Peter C, Radke M, Sams E, Mader S. Empfehlungen zur Förderung von Frauenmilchbanken in Deutschland, Österreich und der Schweiz (D-A-CH-Raum). Monatsschr Kinderheilkd 2018. [DOI: 10.1007/s00112-018-0447-9] [Citation(s) in RCA: 3] [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] [Indexed: 11/29/2022]
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Schneider A, Minnich B, Hofstätter E, Weisser C, Hattinger-Jürgenssen E, Wald M. Comparison of four near-infrared spectroscopy devices shows that they are only suitable for monitoring cerebral oxygenation trends in preterm infants. Acta Paediatr 2014; 103:934-8. [PMID: 24847771 DOI: 10.1111/apa.12698] [Citation(s) in RCA: 51] [Impact Index Per Article: 5.1] [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] [Received: 12/06/2013] [Revised: 03/18/2014] [Accepted: 05/16/2014] [Indexed: 11/29/2022]
Abstract
AIM Measuring cerebral oxygenation using near-infrared spectroscopy (NIRS) has taken on an increasingly important role in the field of neonatology. Several companies have already developed commercial devices, and more publications are reporting absolute boundary values or percentiles for neonates. We compared four commercially used devices to discover whether they provided consistent results in the same patients. METHODS We recruited nine preterm infants and tested them for 2 h, using sensors from two different devices. The measurements were carried out six times on each child, so that all four devices were compared with each other. A total of 54 measurements were conducted. The following devices were compared: the NIRO 200 (Hamamatsu Photonics K.K), the INVOS 5100c (Somanetics), the Fore-Sight (CAS Med.) and the SenSmart X-100 (NONIN). RESULTS The cerebral tissue oxygenation data yielded by the individual devices differed significantly from each other, ranging from a minimum difference of 2.93% to a maximum difference of 12.66%. CONCLUSION The commercially available NIRS devices showed highly significant differences in local cerebral tissue oxygenation levels, to the extent that the industry cannot agree on uniform and reproducible standards. Therefore, NIRS should only be used for trend measurements in preterm infants.
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Affiliation(s)
- Anna Schneider
- Division for Neonatology; University Hospital for Pediatrics; Paracelsus Medical University; Salzburg Austria
| | - Bernd Minnich
- Division of Animal Structure & Function; Department of Cell Biology; University of Salzburg; Salzburg Austria
| | - Edda Hofstätter
- Division for Neonatology; University Hospital for Pediatrics; Paracelsus Medical University; Salzburg Austria
| | - Christof Weisser
- Division for Neonatology; University Hospital for Pediatrics; Paracelsus Medical University; Salzburg Austria
| | - Erna Hattinger-Jürgenssen
- Division for Neonatology; University Hospital for Pediatrics; Paracelsus Medical University; Salzburg Austria
| | - Martin Wald
- Division for Neonatology; University Hospital for Pediatrics; Paracelsus Medical University; Salzburg Austria
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Javadi M, Hofstätter E, Stickle N, Beattie BK, Jaster R, Carter-Su C, Barber DL. The SH2B1 adaptor protein associates with a proximal region of the erythropoietin receptor. J Biol Chem 2012; 287:26223-34. [PMID: 22669948 DOI: 10.1074/jbc.m112.382721] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
Gene targeting experiments have shown that the cytokine erythropoietin (EPO), its cognate erythropoietin receptor (EPO-R), and associated Janus tyrosine kinase, JAK2, are all essential for erythropoiesis. Structural-functional and murine knock-in experiments have suggested that EPO-R Tyr-343 is important in EPO-mediated mitogenesis. Although Stat5 binds to EPO-R phosphotyrosine 343, the initial Stat5-deficient mice did not have profound erythroid abnormalities suggesting that additional Src homology 2 (SH2) domain-containing effectors may bind to EPO-R Tyr-343 and couple to downstream signaling pathways. We have utilized cloning of ligand target (COLT) screening to demonstrate that EPO-R Tyr(P)-343 and Tyr(P)-401 bind to the SH2 domain-containing adaptor protein SH2B1β. Immunoprecipitation and in vitro mixing experiments reveal that EPO-R binds to SH2B1 in an SH2 domain-dependent manner and that the sequence that confers SH2B1 binding to the EPO-R is pYXXL. Previous studies have shown that SH2B1 binds directly to JAK2, but we show that in hematopoietic cells, SH2B1β preferentially associates with the EPO-R. SH2B1 is capable of constitutive association with EPO-R, which is necessary for its optimal SH2-dependent recruitment to EPO-R-Tyr(P)-343/Tyr(P)-401. We also demonstrate that SH2B1 is responsive to EPO stimulation and becomes phosphorylated, most likely on serines/threonines, in an EPO dose- and time-dependent manner. In the absence of SH2B1, we observe enhanced activation of signaling pathways downstream of the EPO-R, indicating that SH2B1 is a negative regulator of EPO signaling.
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Affiliation(s)
- Mojib Javadi
- Ontario Cancer Institute, Campbell Family Cancer Research Institute, Toronto, Ontario M5G 2M9, Canada
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Muscará MN, Pedrazzoli J, Miranda EL, Ferraz JG, Hofstätter E, Leite G, Magalhães AF, Leonardi S, De Nucci G. Plasma hydroxy-metronidazole/metronidazole ratio in patients with liver disease and in healthy volunteers. Br J Clin Pharmacol 1995; 40:477-80. [PMID: 8703652 PMCID: PMC1365194 DOI: 10.1111/j.1365-2125.1995.tb05792.x] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023] Open
Abstract
Metronidazole pharmacokinetics were studied in patients with different degrees of liver cirrhosis, classified according to the Child-Pugh algorithm (A, B or C, as liver disease severity increases) and in schistosomic patients. Metronidazole (500 mg) was administered i.v. as a slow infusion over 20 min, and blood samples were collected at set intervals after the end of the infusion. The plasma concentrations of metronidazole and its main metabolite hydroxy-metronidazole were quantified by reversed-phase h.p.l.c. with u.v. detection. The metronidazole and hydroxy-metronidazole areas under the curve from 0 to 24 h (AUC0,24h), the metronidazole terminal elimination half-life (t1/2), the total clearance (CL), the metronidazole volume of distribution (V) values and the hydroxy-metronidazole/metronidazole concentration ratios as a function of time were calculated for each group. Comparison of the metronidazole AUC0,24h, t1/2 and CL values revealed that metronidazole metabolism is progressively impaired as the severity of liver disease increases. There were no variations in these parameters between the schistosomic and Child-Pugh A groups. In addition, there were no differences in the V and hydroxy-metronidazole AUC0,24h among the various groups studied. However, metronidazole metabolism was delayed in patients with hepatic disease, as illustrated by the hydroxy-metronidazole/metronidazole ratio 10 min after the end of metronidazole infusion. These results indicate that the clinical assessment of liver disease is paralleled by an impairment of metronidazole metabolism. Of the studied variables, we propose the hydroxy-metronidazole/metronidazole ratio 10 min after metronidazole infusion as a suitable and practical index for liver function evaluation.
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Affiliation(s)
- M N Muscará
- Department of Pharmacology, UNICAMP, Campinas, SP, Brazil
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