[Show abstract][Hide abstract] ABSTRACT: Subcutaneous microdialysis is a sampling method that permits continuous analysing a patients extracellular tissue chemistry without draining blood.
Applications and side effects of subcutaneous microdialysis used in children are demonstrated. The present study contains application of the method for up to 16 days in 42 pediatric patients, including preterm infants as well as adolescents, and proves long-term subcutaneous microdialysis to be suitable and safe for biochemical tissue monitoring. Using a special insertion technique, it can be applied to children of all ages without causing discomfort or severe side effects. As it permits frequent sampling it allows evaluating and optimizing therapy and means a substantial progress for pediatric observation. Apart from clinical biochemical monitoring of patients at risk microdialysis can also contribute to basic research.
[Show abstract][Hide abstract] ABSTRACT: The ketogenic diet (KD) provides ketones from the degradation of free fatty acids for energy metabolism. It is a therapeutic option for pharmacoresistant epilepsies. Carnitine is the carrier molecule that transports fatty acids across the mitochondrial membrane for degradation into ketones. The integrity of this transport system is a prerequisite for an adequate ketogenic response. For monitoring of tissue metabolism with KD, we used the sampling method of s.c. microdialysis (MD), which permits minimally invasive, frequent, and extensive metabolic monitoring independent of blood tests. By using this new method, we monitored changes in carnitine metabolism induced by KD, particularly in free carnitine (C0), acetylcarnitine (C2), and hydroxybutyrylcarnitine (C4OH). Correlation of microdialysate and tissue concentrations for carnitines in vitro was about 85%. Carnitine metabolism was monitored in seven children started on a KD for pharmacoresistant epilepsy after a conventional initial fasting period. Detected metabolic changes consisted of a slight decrease in s.c. C0 and a marked increase in C2/CO and C4OH/CO levels. The levels of s.c. C4OH strongly correlate with beta-hydroxybutyrate (beta-OHB) levels in plasma providing an additional parameter for the carnitine reserve of the body and reflect an optimal ketogenic energy supply. Subcutaneous MD allows close and extensive monitoring of metabolism with a KD.
Pediatric Research 08/2006; 60(1):93-6. DOI:10.1203/01.pdr.0000219479.95410.79 · 2.31 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Neonatal diabetes mellitus can be extremely brittle. In this situation close glucose monitoring is essential for adequate insulin treatment. Continuous subcutaneous microdialysis is a promising approach for the babies to reduce the painful stress caused by diagnostic blood sampling. The goal of this study was to evaluate the feasibility of continuous subcutaneous microdialysis for glucose monitoring in a baby with neonatal diabetes and to assess the correlation between the blood and the subcutaneous glucose profile.
During a period of seven days glucose monitoring was performed on a six month old infant with neonatal diabetes mellitus. In addition to frequent capillary blood glucose determinations, a continuous subcutaneous microdialysis device was used for the detection of the subcutaneous interstitial glucose concentration.
Subcutaneous tissue glucose concentrations were measured in a wide range from 1.7 to 23.8 mM. Variations in the adipose tissue glucose concentration closely paralleled changes in the capillary blood glucose. Based on 104 reference pairs there was a high overall correlation (r = 0.89) between the subcutaneous interstitial tissue (X) and the blood (Y) glucose concentration (Y = 1.1 X + 0.29). However the glucose profiles demonstrated a considerable variation of the time lag, up to one hour, between blood and subcutaneous interstitial glucose concentration.
Continuous subcutaneous microdialysis helps the glucose monitoring of infants with diabetes mellitus by providing additional informations about the rise and fall of the glucose concentration. Further studies should focus on how to get a tighter link between blood glucose and the subcutaneous interstitial glucose concentration in the area around the microdialysis probe. Thus monitoring the subcutaneous interstitial glucose concentration will become a reliable procedure for real-time glucose monitoring.
[Show abstract][Hide abstract] ABSTRACT: Microdialysis (MD) enables analysis of extracellular metabolites without performing blood tests. Changes in the concentration of various metabolites can be monitored frequently on almost every type of human tissue. Microdialysis of subcutaneous tissue (sc MD) is of particular significance in the case of pediatric patients because diurnal profiles can be generated without repeated blood sampling. There are only a few scientific articles that describe the application of sc MD on neonates, infants, or children. So far, side effects have not been investigated comprehensively. This prospective study scrutinizes side effects of sc MD in pediatric patients, focusing on a Minimal Traumatizing Insertion Technique of the MD catheter.
42 pediatric patients within four age categories participated in the study which involved bedside monitoring using sc MD, including 5 extremely low birth weight (ELBW) infants with a body weight <1000g. A total of 48 sc MD catheters were inserted. Selection criteria were risk of hypoglycaemia (n = 29), elevated lactate levels (n = 16), or aminoacidopathies (n = 3). Duration of sc MD ranged from 1 to 16 days. We used a Minimal Traumatizing Insertion Technique to safely insert the MD catheter into the subcutaneous tissue, characterized by blunt dissection of the tissue and by the use of a plastic cannula guidance to avoid desterilisation of the catheter. Complications and side effects related to sc MD were documented in standardized forms.
The MD probe was easily placed even in the scanty adipose tissue of ELBW infants. During insertion of sc MD catheters accidental venous puncture occurred to 8%, and minor bleeding to 27%. Even with local anaesthesia insertion was painful for 40%. During the course of sc MD complications were rare: disturbance of perfusion flow 4%, catheter dislocation 4%, local bleeding 4%. No signs of systemic or local infection were observed, there were no cases of local incompatibility. All catheters were withdrawn completely without leaving a scar. Repeated measurements allowed the generation of diurnal metabolic profiles. In some cases (respiratory chain complex I deficiency, PDH-deficiency) significant therapeutical effects on the patients' metabolism were demonstrated.
The present study proves long-term sc MD to be suitable and safe for biochemical tissue monitoring. Using our insertion technique, it can be applied to children of all ages without causing discomfort or severe side effects. As it permits frequent sampling it allows evaluating and optimizing therapy and means a substantial progress for pediatric observation.
European journal of medical research 10/2005; 10(10):419-25. · 1.50 Impact Factor