Publications (20)47.92 Total impact
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Article: Inspiratory capacity at inflation hold in ventilated newborns: A surrogate measure for static compliance of the respiratory system.
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ABSTRACT: : To study appropriateness of respiratory system compliance calculation using an inflation hold and compare it with ventilator readouts of pressure and tidal volume as well as with measurement of compliance of the respiratory system with the single-breath-single-occlusion technique gained with a standard lung function measurement. : Prospective clinical trial. : Level III neonatal unit of a university hospital. : Sixty-seven newborns, born prematurely or at term, ventilated for a variety of pathologic conditions. : A standardized sigh maneuver with a predefined peak inspiratory pressure of 30 cm H2O, termed inspiratory capacity at inflation hold, was applied. Using tidal volume, exhaled from inspiratory pause down to ambient pressure, as displayed by the ventilator, and predefined peak inspiratory pressure, compliance at inspiratory capacity at inflation hold conditions could be calculated as well as ratio of tidal volume and ventilator pressure using tidal volume and differential pressure at baseline ventilator settings: peak inspiratory pressure minus positive end-expiratory pressure. : For the whole cohort, the equation for the regression between tidal volume at inspiratory capacity at inflation hold and compliance of the respiratory system was: compliance of the respiratory system = 0.052 * tidal volume at inspiratory capacity at inflation hold - 0.113, and compliance at inspiratory capacity at inflation hold conditions was closely related to the standard lung function measurement method of compliance of the respiratory system (R = 0.958). In contrast, ratio of tidal volume and ventilator pressure per kilogram calculated from the ventilator readouts and displayed against compliance of the respiratory system per kilogram yielded a broad scatter throughout the whole range of compliance; both were only weakly correlated (R = 0.309) and also the regression line was significantly different from the line of identity (p < .05). Peak inspiratory pressure at study entry did not affect the correlation between compliance at inspiratory capacity at inflation hold conditions and compliance of the respiratory system. : After a standard sigh maneuver, inspiratory capacity at inflation hold and the derived quantity compliance at inspiratory capacity at inflation hold conditions can be regarded as a valid, accurate, and reliable surrogate measure for standard compliance of the respiratory system in contrast to ratio of tidal volume and ventilator pressure calculated from the ventilator readouts during ongoing mechanical ventilation at respective ventilator settings.Pediatric Critical Care Medicine 03/2012; 13(5):560-7. · 3.13 Impact Factor -
Article: Endotracheal tube resistance and inertance in a model of mechanical ventilation of newborns and small infants-the impact of ventilator settings on tracheal pressure swings.
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ABSTRACT: Resistive properties of endotracheal tubes (ETTs) are particularly relevant in newborns and small infants who are generally ventilated through ETTs with a small inner diameter. The ventilation rate is also high and the inspiratory time (ti) is short. These conditions effectuate high airway flows with excessive flow acceleration, so airway resistance and inertance play an important role. We carried out a model study to investigate the impact of varying ETT size, lung compliance and ventilator settings, such as peak inspiratory pressure (PIP), positive end expiratory pressure (PEEP) and inspiratory time (ti) on the pressure-flow characteristics with respect to the resistive and inertive properties of the ETT. Pressure at the Y piece was compared to direct measurement of intratracheal pressure (P(trach)) at the tip of the ETT, and pressure drop (ΔP(ETT)) was calculated. Applying published tube coefficients (Rohrer's constants and inertance), P(trach) was calculated from ventilator readings and compared to measured P(trach) using the root-mean-square error. The most relevant for ΔP(ETT) was the ETT size, followed by (in descending order) PIP, compliance, ti and PEEP, with gas flow velocity being the principle in common for all these parameters. Depending on the ventilator settings ΔP(ETT) exceeded 8 mbar in the smallest 2.0 mm ETT. Consideration of inertance as an additional effect in this setting yielded a better agreement of calculated versus measured P(trach) than Rohrer's constants alone. We speculate that exact tracheal pressure tracings calculated from ventilator readings by applying Rohrer's equation and the inertance determination to small size ETTs would be helpful. As an integral part of ventilator software this would (1) allow an estimate of work of breathing and implementation of an automatic tube compensation, and (2) be important for gentle ventilation in respiratory care, especially of small infants, since it enables the physician to estimate consequences of altered ventilator settings at the tracheal level.Physiological Measurement 09/2011; 32(9):1439-51. · 1.68 Impact Factor -
Article: Colonization, serotypes and transmission rates of group B streptococci in pregnant women and their infants born at a single University Center in Germany.
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ABSTRACT: To evaluate colonization, transmission rate and serotype distribution of group B streptococci (GBS) in pregnant women and infants born in a single University Center in Germany. In a prospective study we collected cultures from pregnant women and ear cultures from newborns. We performed serotyping and susceptibility testing. Obstetrical factors associated with mother to infant transmission were analyzed using logistic regression. We evaluated cultures of 869 pregnant women and 845 neonates including 657 paired maternal-neonatal cultures. Maternal colonization occurred in 21.1% (183/869), transmission from mother to newborn in 11.2% (17/152). Intrapartum antimicrobial prophylaxis (IAP) and cesarean delivery were associated with reduction of transmission rate (P=0.014 and 0.019, respectively). The incidence for early-onset disease (EOD) was 1.71 per 1000 live births. Of GBS positive women IAP was administered in only 39% (59/152). Serotype III was the most prevalent isolate (28% maternal; 52% neonatal) and transmission occurred more frequently compared to other serotypes. The incidence of EOD and distribution of serotypes in Germany are similar to published data from the USA prior to 1996. Despite national guidelines with universal GBS screening, our study demonstrated a lack of adherence to this recommendation. There is a need for enhanced compliance.Journal of Perinatal Medicine 05/2011; 39(4):417-22. · 1.70 Impact Factor -
Chapter: Inkubatoren
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ABSTRACT: Inkubatoren werden zur Stabilisierung und Aufrechterhaltung des thermischen Gleichgewichts bei Früh- und Neugeborenen eingesetzt.12/2010: pages 933-937; -
Article: D-lactic acidosis: "right-left disorientation" in laboratory testing: acute encephalopathy in a child with carbohydrate malabsorption syndrome.
Journal of pediatric gastroenterology and nutrition 01/2010; 50(1):106-7. · 2.18 Impact Factor -
Article: Fatal and severe codeine intoxication in 3-year-old twins--interpretation of drug and metabolite concentrations.
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ABSTRACT: This work presents two cases of codeine intoxication in 3-year-old monozygotic twin brothers while treated with a codeine slow-release formulation. One child had to be admitted to the hospital, whereas the other one died at home after aspiration of gastric content. The concentrations of codeine and major metabolites including morphine and corresponding glucuronide conjugates were measured by liquid chromatography-tandem mass spectrometry in serum, urine, cerebrospinal fluid, and brain tissue, respectively. A genetic polymorphism study was carried out in order to determine the ability of the children to metabolize codeine by O-demethylation. A pharmacokinetic calculation was also performed to estimate the administered dose of codeine in question. High concentrations of all substances were found in samples of both children. The pharmacokinetic estimate suggests an overdose of codeine, and the possible reasons for the high opiate concentrations are discussed. Furthermore, the postmortem distribution--during and after resuscitation--might play a major role in the interpretation of postmortem concentration levels.Deutsche Zeitschrift für die Gesamte Gerichtliche Medizin 05/2009; 123(5):387-94. · 2.59 Impact Factor -
Article: Drug dosing error with drops: severe clinical course of codeine intoxication in twins.
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ABSTRACT: In spite of the lack of evidence for its efficacy, and of sporadic reports of severe adverse events, codeine is still widely used as an antitussive agent in children. A 3-year-old boy (twin 1) was found lying in vomit and apnoeic at night; he was resuscitated and immediately transferred to our paediatric intensive care unit (PICU). Two and a half hours later, his twin brother (twin 2) was found dead in his bed at home. Twin 1 required mechanical ventilation for 3 days, but he eventually made a full recovery; autopsy in twin 2 showed massive aspiration of gastric content. History revealed that the monozygotic twins had an upper respiratory tract infection for several days and had both been given codeine at a dose of "10 drops per day" by their mother. The blood of both twins was found to contain high levels of codeine and its metabolites. The weight of "10 drops" was determined experimentally and was found to range from 494 to 940 mg. Thus, the highest possible dose given by mother was 23.5 mg of codeine instead of the recommended 10 mg. The twins had identical CYP2D6 gene polymorphisms corresponding to the "extensive metaboliser" type. Conclusions: Because of the variability of drop size drug dosage, dosage "by drops" is unprecise and may result in accidental overdose. The combination of repeated overdosing and extensive metabolism to morphine is likely to have caused apnoea in these twins. These cases illustrate the danger of codeine as an antitussive in young children.European Journal of Pediatrics 11/2008; 168(7):819-24. · 1.88 Impact Factor -
Article: Bronchopulmonary dysplasia and early prophylactic inhaled nitric oxide in preterm infants: current concepts and future research strategies in animal models.
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ABSTRACT: We reviewed the literature on the use of inhaled nitric oxide and the influence of supplemental oxygen on bronchopulmonary dysplasia (BPD), and the role of endogenous nitric oxide-synthase, vascular endothelial growth factor, the interplay of nitric oxide and superoxide, protein nitration and the nuclear factor kappa B-pathway. BPD is a major cause of neonatal mortality and morbidity leading to arrested lung development in newborns. Several studies indicate that inhaled nitric oxide (iNO) improves pulmonary angiogenesis, lung alveolarization, distal lung growth and pulmonary function in preterm infants. Given the inconclusive results of clinical studies, however, it is unclear which subpopulations of infants might benefit. Moreover, data on iNO are conflicting whether exogenous nitric oxide is protective or damaging in the presence of hyperoxia. The toxicology of iNO is poorly understood and its potential interaction with oxygen has to be considered given that infants treated with iNO are also supplemented with oxygen. The underlying mechanisms of the effects of iNO in the newborn lung need further analysis. New data clarifying the role of endogenous nitric oxide-synthases, vascular endothelial growth factor (VEGF), the interplay of nitric oxide and superoxide, and protein nitration with concurrent iNO-therapy might answer some of these questions.Journal of Perinatal Medicine 07/2008; 36(5):442-7. · 1.70 Impact Factor -
Article: Pressure loss caused by pediatric endotracheal tubes during high-frequency-oscillation-ventilation.
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ABSTRACT: In a physical model of a pediatric respiratory system we measured the pressure drop across ETTs of 3 and 4mm inner diameter (ID) when we varied frequency, mean airway pressure and pressure amplitude of high-frequency-oscillation-ventilation (HFOV). Depending on ventilator settings the relative loss of mean pressure amplitude caused by the ETT ranged from 3.3% to 24.7% for ETT 4mm ID, respectively, from 23.8% to 51.8% for 3mm ID. In addition to the well-described flow dependency, ventilation frequency affected ETT resistance. Due to this frequency dependence, calculation of the pressure drop across the ETT using Rohrer's or Blasius-Itos' approach underestimated the true pressure drop significantly (p<0.001). Based on the experimental results, nomograms for graphical determination of the pressure drop across the ETT during HFOV were developed. We conclude that the pressure drop across the ETT during HFOV is dependent on ETT size, pressure amplitude and ventilation frequency. Calculation of this pressure drop with conventional methods is inaccurate. The high-frequency-resistance of the ETT might protect the lungs from excessive pressure amplitudes during HFOV.Respiratory Physiology & Neurobiology 06/2008; 162(2):132-7. · 2.24 Impact Factor -
Article: Treatment of preterm infants at the lower margin of viability--a comparison of guidelines in German speaking countries.
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ABSTRACT: The treatment of preterm infants at the lower margin of viability is carried out amid growing tension between increasing survival rates, uncertain clinical outcomes, and financial and ethical considerations. The three German speaking countries have released guidelines on this issue, based on a previous common guideline. That is why the differences in national guidelines between the three countries is of peculiar interest in respect of medical ethics. Current guidelines from Germany, Switzerland, and Austria were compared and similarities and differences discussed. The three countries' guidelines follow broadly similar principles, with almost identical intellectual underpinnings and formulations. Some national differences are apparent, nevertheless. All three guidelines call for a pragmatic approach. National guidelines can only predetermine the framework, with long-term collection of sound local data on morbidity and mortality forming a prerequisite for decision-making, and also in discussions with parents.02/2008; 105(3):47-52. · 2.92 Impact Factor -
Article: Restriction of ongoing intensive care in neonates: a prospective study.
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ABSTRACT: The purpose of this work was to record the current practice of restricting ongoing intensive care in severely ill newborns. This was a prospective observational study over a 30-month period of consecutive newborns for whom restriction of ongoing intensive care was taken into consideration, discussed, or decided on. A standardized form recorded patients' medical condition, the type of restriction decided on, parents' wishes, and their information level. The research was conducted in a neonatal unit of a level III university children's hospital, with no interventions. Forty patients were enrolled, 25 were preterm, 21 had either a genetic defect or an inborn malformation. Restriction of ongoing intensive care was decided on for 32 patients with a great variety of specified recommendations. Thirty-six patients died during the observation period. In general, parents were well informed; however, their wishes concerning restriction of ongoing intensive care were unknown in approximately 25% of cases. The decision-making process for restriction of ongoing intensive care is well established, but the role of parents needs to be defined.PEDIATRICS 09/2006; 118(2):563-9. · 4.47 Impact Factor -
Article: Pressure support ventilation combined with volume guarantee versus synchronized intermittent mandatory ventilation: a pilot crossover trial in premature infants in their weaning phase.
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ABSTRACT: To compare pressure support ventilation combined with volume guarantee (PSV-VG) to synchronized intermittent mandatory ventilation (SIMV) regarding safety, course of blood gases, and infant-ventilator interaction in premature infants. Prospective, two-treatment, crossover pilot study. Tertiary care neonatal unit. Twenty-five ventilated premature infants: median (range) gestational age 26.1 wks (23.1-35.7), birth weight 765 g (450-3170), age at study 5 days (2-27), in their weaning phase. Infants were studied for three 30-min periods, starting from SIMV, followed by PSV-VG, and back again to SIMV. After concluding the last period, all infants were switched back to PSV-VG. On the next day, infants were studied in the opposite direction. During each period, vital parameters, ventilation parameters, degree of physical activity, duration of rhythmic breathing, and the number of vital signs monitor alarms were recorded. Nineteen infants (84%) could be successfully ventilated with PSV-VG till the next day. PSV-VG achieved a similar oxygenation level as SIMV but with significantly lower ventilation pressures. Comparable ventilation was achieved, but infants with strong respiratory drive were more liable to hyperventilation episodes during PSV-VG. Although infants breathed more rhythmically during PSV-VG, suggesting better infant-ventilator synchrony, the infants' behavioral state and the fluctuations in blood gases did not differ. The potentials of PSV-VG to improve infant-ventilator synchrony and to decrease pressure needed to ventilate premature lungs are promising, even though the changes were small. However, its benefits during acute illness and on the final outcome remain to be proven.Pediatric Critical Care Medicine 06/2005; 6(3):286-92. · 3.13 Impact Factor -
Article: [General nursing practice in treating neonatal jaundice].
Kinderkrankenschwester: Organ der Sektion Kinderkrankenpflege / Deutsche Gesellschaft fur Sozialpadiatrie und Deutsche Gesellschaft fur Kinderheilkunde 08/2004; 23(7):268-70. -
Article: Life-threatening complications of transient abnormal myelopoiesis in neonates with Down syndrome.
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ABSTRACT: Neonates with Down syndrome can present with a haematological disorder called transient abnormal myelopoiesis (TAM). While TAM is usually a self-limiting disease, patients with severe complications such as hydrops fetalis, cardiorespiratory failure and liver fibrosis have been described. Here, we present five consecutive neonates with trisomy 21 and TAM, four of whom were critically ill and were therefore treated with cytosine-arabinoside. All five patients survived. CONCLUSION: severely affected neonates with Down syndrome and transient abnormal myelopoiesis might benefit from early cytostatic treatment with cytosine-arabinoside.European Journal of Pediatrics 08/2004; 163(7):374-7. · 1.88 Impact Factor -
Article: Efficacy, recovery, and safety of RBCs from autologous placental blood: clinical experience in 52 newborns.
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ABSTRACT: In the present study, the efficacy, recovery, and safety of RBCs from autologous placental blood (PB-RBCs) were investigated. A total of 52 newborns received transfusion with PB-RBCs. The number of newborns requiring no additional allogeneic RBCs was calculated. In 22 of these 52 neonates with a birth weight of 1000 to 2500 g, vital measures were performed during transfusion, and serum potassium levels were measured up to 3 days after transfusion. The results were compared with those of a matched control group given allogeneic RBC transfusions. All neonates of the study group with a birth weight of less than 1000 g, but only 59 percent those with a birth weight of 1000 to 2500 g and 58 percent of those requiring surgery directly after delivery needed allogeneic transfusions in addition to PB-RBCs. The mean Hb increase after RBC transfusion of 10 mL per kg of body weight was 3 g per dL per kg of body weight in both groups; the Hb decrease was accelerated in the placental blood group (0.32 vs. 0.24 g/dL/day; p < 0.05). There were no intergroup differences in the vital parameters. Our results show no difference in efficacy and safety between PB-RBC transfusion and allogeneic RBC transfusion. According to well-defined criteria, 40 percent of anemic neonates can be supported by autologous placental blood transfusions alone.Transfusion 09/2003; 43(9):1210-6. · 3.22 Impact Factor -
Article: Treatment with bovine surfactant in severe acute respiratory distress syndrome in children: a randomized multicenter study.
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ABSTRACT: To determine whether bovine surfactant given in cases of severe pediatric acute respiratory distress syndrome (ARDS) improves oxygenation. Single-center study with 19 patients, followed by a multicenter randomized comparison of surfactant with a standardized treatment algorithm. Primary endpoint PaO(2)/FIO(2) at 48 h, secondary endpoints: PaO(2)/FIO(2) at 2, 4, 12, and 24 h, survival, survival without rescue, days on ventilator, subgroups analyzed by analysis of variance to identify patients who might benefit from surfactant. Multicenter study in 19 reference centers for ARDS. Children after the 44th postconceptional week and under 14 years old, admitted for at least 4 h, ventilated for 12-120 h, and without heart failure or chronic lung disease. In the multicenter study 35 patients were recruited; 20 were randomized to the surfactant group and 15 to the nonsurfactant group. Decreasing recruitment of patients led to a preliminary end of this study. Administration of 100 mg/kg bovine surfactant intratracheally under continuous ventilation and PEEP, as soon as the PaO(2)/FIO(2) ratio dropped to less than 100 for 2 h (in the pilot study increments of 50 mg/kg as long as the PaO(2)/FIO(2) did not increase by 20%). A second equivalent dose within 48 h was permitted. In the pilot study the PaO(2)/FIO(2) increased by a mean of 100 at 48 h (n=19). A higher PaO(2)/FIO(2) ratio was observed in the surfactant group 2 h after the first dose (58 from baseline vs. 9), at 48 h there was a trend towards a higher ratio (38 from baseline vs. 22). The rate of rescue therapy was significantly lower in the surfactant group. Outcome criteria were not affected by a second surfactant dose (n=11). A significant difference in PaO(2)/FIO(2) in favor of surfactant at 48 h was found in the subgroup with an initial PaO(2)/FIO(2) ratio higher than 65 and in patients without pneumonia. CONCLUSIONS. Surfactant therapy in severe ARDS improves oxygenation immediately after administration. This improvement is sustained only in the subgroup of patients without pneumonia and that with an initial PaO(2)/FIO(2) ratio higher than 65Intensive Care Medicine 04/2003; 29(3):437-46. · 5.40 Impact Factor -
Article: Effect of sepsis syndrome on neonatal oxygen consumption and energy expenditure.
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ABSTRACT: To evaluate oxygen consumption (VO2), carbon dioxide production, and energy expenditure (EE) in full-term neonates with early-onset neonatal septicemia daily for 7 days beginning at the day of clinical diagnosis of sepsis. A total of 17 spontaneously breathing full-term neonates, 10 with clinical signs of sepsis and 7 healthy neonates (control group), were enrolled in the study. Age at first study day was 3 +/- 0.9 days in both groups. Sepsis syndrome was defined as a systemic response to a bacterial infection with clinical signs of infection, elevated values of interleukins 6 and 8 and C-reactive protein, and abnormal white blood cell count and positive blood cultures (9 group B streptococci, 1 Escherichia coli). Measurements of VO2 and carbon dioxide production were performed daily for 7 days by means of indirect calorimetry. In the septic infants, VO2 and EE were increased by about 20% at days 1 to 3 and by 15% at day 4 when compared with the controls. From days 1 to 3, EE averaged 57 +/- 3 kcal/kg/d in the septic neonates and 47 +/- 2 kcal/kg/d in the controls. At day 4, EE was 55 +/- 2 and 47 +/- 2 kcal/kg/d, respectively. Energy intake was about the same in both groups, whereas weight gain during the 7 study days was significantly lower in the sick patients than in the control group (19 +/- 2 g/d vs 33 +/- 9 g/d and 5.4 +/- 0.5 g/kg/d vs 9.4 +/- 2.6 g/kg/d, respectively). Increased EE was associated with increased heart rate (126 +/- 4 vs 112 +/- 4 min(-1) at day 1) and respiratory rate (56 +/- 6 vs 40 +/- 4 min(-1) at day 1). There were no differences in rectal temperature (37.3 +/- 0.4 degrees C vs 37.4 +/- 0.2 degrees C), skin temperature (36.5 +/- 0.4 degrees C vs 36.6 +/- 0.3 degrees C), and oxygen saturation (96 +/- 3% vs 96 +/- 3%) between the 2 groups. Neonates with sepsis syndrome have elevated VO2 and EE values that could explain impaired growth during the illness period and may make the infants vulnerable to insufficient calorie supply during the acute phase of septic disease.PEDIATRICS 01/2003; 110(6):e69. · 4.47 Impact Factor -
Article: Acute side effects of surfactant treatment.
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ABSTRACT: There is increasing evidence from studies on animals and humans that surfactant administration may have a great impact on cerebral perfusion. These effects may result from direct pulmonary or hemodynamic changes (or a combination of both), but may also be due to rapid alterations of blood gases. Type of surfactant and mode of administration seem to play an important role. Results from the pertinent literature are summarised with a special emphasis on how to avoid potentially harmful side effects of surfactant therapy in preterm infants.Journal of Perinatal Medicine 02/2002; 30(2):143-8. · 1.70 Impact Factor -
Article: Enterococcus casseliflavus septicaemia in a preterm neonate.
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ABSTRACT: Enterococcus casseliflavus is a yellow-pigmented, motile, Gram-positive coccus that is only rarely isolated from clinical specimens. We report the first case of neonatal sepsis due to E. casseliflavus in a premature neonate. Precise identification of Enterococcus species is difficult but is of significant clinical interest because of the intrinsic low-level resistance to vancomycin of species such as E. casseliflavus and E. gallinarum.Scandinavian Journal of Infectious Diseases 02/2002; 34(6):471-2. · 1.72 Impact Factor -
Article: Infants of mothers with HELLP syndrome compensate intrauterine growth retardation faster than unaffected premature infants: does HELLP change fetal programming?
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ABSTRACT: To investigate the influence of HELLP (hemolysis, elevated liver enzymes and low platelet count) pregnancies on the postpartal course and further development of the neonate. The postnatal course and further development up to 4 years of age of 43 infants after pregnancies complicated by HELLP syndrome were evaluated. 43 unexposed infants matched for gestational age and gender served as controls. Small-for-gestational age (SGA) neonates exhibiting hypoglycemia and hypoproteinemia during the first 4 weeks after birth were significantly more commonly observed in the HELLP group (p < 0.5). No other differences in the postpartal course or clinical outcome were detected. At the age of 4 years the gains in weight and length were significantly increased in the HELLP group (p < 0.01). The postnatal course of newborns after HELLP pregnancies is influenced by low energy stores. Fetal programming toward a more efficacious GH-IGF-1 pathway may explain the faster postnatal catch-up growth of premature SGA infants born to mothers with HELLP syndrome.Biology of the Neonate 02/2002; 82(3):174-80. · 1.90 Impact Factor
Top co-authors
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Institutions
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2008–2012
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Universitätsklinikum Freiburg
Freiburg, Lower Saxony, Germany
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2005–2008
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Universität Freiburg
Freiburg, Lower Saxony, Germany
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