Vastasyntyneen keltaisuus ei ole aina harmitonta

Vasta­syn­tyneen kel­taisuus on yleistä ensim­mäi­sinä elin­vuo­ro­kau­sina, ja hyper­bi­li­ru­bi­nemiaan liit­tyvän ­aivo­sai­rauden estä­mi­seksi sen hoi­tona käy­tetään sini­valoa. Keltai­suuden pitkit­ty­minen yli kah­den vii­kon, konju­goi­tuneen bili­ru­biinin yli 20 %:n osuus koko­nais­bi­li­ru­bii­nista tai vaa­leat ulosteet voi­vat vii­tata koles­taasiin. Vasta­syn­tyneen koles­taasi edel­lyttää ri­peää diagnos­tiikkaa ja hoi­toa. Sappi­tieat­resia on yleisin ime­väisen koles­taasin aiheut­taja, ja sen hoi­to on mahdol­li­simman varhai­sessa vai­heessa suori­tettu leik­kaus. Suo­messa leikkaus­hoito on keski­tetty HYKS:n Lastenk­li­ni­kalle. Koles­taat­tisen ime­väisen ravit­se­mus­hoito aloi­tetaan viivy­tyk­settä seu­raten myös mak­san toi­mintaa ja luus­ton aineen­vaih­duntaa.Peer reviewe

Infection Prevention and Management in Pediatric Short Bowel Syndrome

Short bowel syndrome (SBS) is a rare disease with potentially life-threatening consequences. In addition to intestinal failure-associated liver disease, infections and other complications related to central venous catheters (CVCs) cause a significant burden to patients with SBS and may even necessitate an intestinal transplant eventually. The need for long-term central venous access and the intestinal dysfunction associated with SBS drive the need for intestinal failure-specific approach to prevent and treat infections in patients with SBS. In bacterial infections, the line can often be salvaged with proficient antibiotic therapy. Repeated catheter replacements are predisposed to recurrent infections and thrombotic complications, which may limit the long-term survival of patients with SBS. Protocol-based CVC access procedures and daily care including taurolidine and ethanol catheter locks have been shown to reduce infection rates substantially. Compromised intestinal function in SBS predisposes to small bowel bacterial overgrowth, mucosal injury, and increased permeability. These pathophysiological changes are concentrated in a subset of patients with excessive bowel dilatation and frequent bowel-derived infections. In such patients, reconstructive intestinal surgery may be indicated. Probiotics have not been effective in infection prevention in SBS and carry a significant risk of complications. While more studies focusing on the prevention of infections and their complications are needed, protocol-based approach and multidisciplinary teams in the care of patients with SBS have been shown to reduce complications and improve outcomes.Peer reviewe

How to digitally enhance bioeconomy collaboration:multidisciplinary research teamideation for technology innovation

Publisher Copyright: © 2020 OSA - The Optical Society. All rights reserved.In this paper we examine the potential of digital platforms for managing multidisciplinary collaboration and particularly the ideation processes of multidisciplinary research and development in the case of technology-supported vertical farming. The article draws on research data from semi-structured interviews and a collaborative workshop that was conducted with researchers representing biological, digital, and technological domains. The results of this research indicate that digital platforms may offer impactful, processaccelerating support during the kick-off phase of multidisciplinary technological innovations. A digital platform can support ideation and the prioritisation of ideas and can be especially fruitful when paired with face to face discussion and non-digital interaction.Peer reviewe

Intestinal failure as a significant risk factor for renal impairment in children

Objective: Although impaired renal function has been a frequent finding among adults with intestinal failure (IF), the data on children is scarce. The aim of this study was to assess renal function in pediatric-onset IF. Methods: Medical records of 70 patients (38 boys) with pediatric-onset IF due to either short bowel syndrome (n = 59) or primary motility disorder (n = 11) and a history of parenteral nutrition (PN) dependency for >= 1 mo were evaluated. Renal function at the most recent follow-up was studied using plasma creatinine, cystatin C, and urea concentrations and estimated glomerular filtration rate (eGFR). Results: At a median age of 5.7 y and after PN duration of 3.2 y, 20 patients (29%) had decreased eGFR and higher cystatin C and urea concentrations. Patients with decreased renal function had significantly longer duration of PN (3.2 versus 0.9 y; P = 0.030) and shorter percentage of age adjusted small bowel length remaining (22 versus 32%; P = 0.041) compared with patients with preserved renal function. No other predisposing factors for decreased eGFR were identified. Conclusions: Patients with pediatric-onset IF are at significant risk for impaired renal function, which is associated with the duration of PN and the length of the remaining small bowel. In the present study, no other predisposing factors for decreased eGFR were found. Further studies using measured GFR are needed. (C) 2017 Elsevier Inc. All rights reserved.Peer reviewe

Small Bowel Dilatation Predicts Prolonged Parenteral Nutrition and Decreased Survival in Pediatric Short Bowel Syndrome

Objective: To analyze risk factors and prognostic significance of small bowel (SB) dilatation in children with short bowel syndrome (SBS). Background: In SBS, the remaining SB may dilate as part of intestinal adaptation. The impact of dilatation on parenteral nutrition (PN) dependence and survival has not been studied systematically. Methods: SB diameter of SBS children (n = 61) was measured in contrast SB series (n = 169, median age 0.94, range 0.32-2.7 years) during 2002 to 2015, and expressed as millimeters (SB width) and as ratio to L5 vertebra height (SB diameter ratio). Linear regression was used to examine risk factors for dilatation. PN weaning and survival were analyzed with Cox proportional hazards regression. Results: Maximal SB diameter ratio during follow-up was predicted by PN dependence and SB atresia, while maximal absolute SB width by birth weight, age, PN duration, and remaining bowel length. Weaning off PN was 14-fold more likely in patients with maximal SB diameter ratio 3.00 (P = 0.005), and 5.4-fold more likely when maximal SB width was 30mm (P = 0.023). After adjustment for age, remaining SB length, and the presence of ileocecal valve, both estimates of maximal SB dilatation remained significant independent predictors for weaning off PN. When all measurements were included, the cumulative survival was worse if SB diameter ratio exceeded 2.00 (P = 0.002-0.042). Conclusions: SB dilatation predicts prolonged PN duration and decreased survival in SBS children. Measurement of maximal SB diameter standardized to L5 vertebra height may be a valuable objective tool for patient follow-up and assessment of prognosis.Peer reviewe

Efficient achievement of enteral autonomy facilitates resolution of liver injury in necrotizing enterocolitis induced short bowel syndrome

Peer reviewe

Clinical and microbiological characterization of Aerococcus urinae bacteraemias at Helsinki metropolitan area, Finland

Our objective was to assess the incidence of bacteraemic Aerococcus urinae cases at Helsinki metropolitan area, Finland, from a 6-year study period (2013 to 2018) and to further characterize available cases. The study evaluates the outcome of commonly used cefuroxime treatment and determinate a set of A. urinae in vitro antimicrobial susceptibilities for benzylpenicillin, cefuroxime, and ceftriaxone. Clinical records of A. urinae bacteraemic patients were reviewed retrospectively. Antimicrobial susceptibility testing was performed by disk diffusion, gradient test, and broth microdilution for 139-141 clinical A. urinae isolates. Clinical data of 72/77 patients were combined with the in vitro susceptibilities. We found an increasing number of bacteraemic A. urinae cases within 6-year study period (p = 0.01). The patients were mainly elderly males, and all suffered from underlying conditions. A total of 27.3% of cases (21/77) showed polymicrobial blood cultures. Thirty-day mortality was 22.1%. Cefuroxime was the initial empiric antimicrobial agent given for 66/76 of the patients and treatment outcome was favorable for 20/22 patients who received cefuroxime at least up to day 5. All isolates were susceptible to benzylpenicillin and cefuroxime interpreted by EUCAST breakpoints for Aerococci and PK-PD breakpoints, respectively. MIC determinations gave variable results for ceftriaxone, 2.1-2.9% of the isolates were resistant. To conclude, it seems that the number of bacteraemic Aerococcus urinae cases is increasing at Helsinki metropolitan area, Finland, reflecting the growing blood culture sampling. Clinical A. urinae isolates were susceptible to cefuroxime in vitro. Treatment data indicate that empirical cefuroxime started for possibly urinary tract -derived community-acquired bacteraemia covers A. urinae.Peer reviewe

Mobiiliavusteinen ja ammatillisesti ohjattu uusperheinterventio - Intervention soveltuvuus uusperheiden ja sote-ammattilaisten näkökulmasta

Tutkimuksen tarkoituksena oli kuvata uusperheiden hyvinvoinnin edistämiseen kehitetyn mobiiliavusteisen, ammatillisesti ohjatun intervention soveltuvuutta uusperheiden ja ammattilaisten näkökulmasta. Soveltuvuuden arviointi kohdistui intervention hyväksyttävyyteen, hyödyllisyyteen ja jatkokehittämistarpeisiin sekä mobiilisovelluksen käytettävyyteen ja jatkokehittämistarpeisiin. Interventio sisältää viisi sote-ammattilaisten ohjaamaa ryhmätapaamista uusperheiden aikuisille sekä StepApp-mobiilisovelluksen uusperheille. Tutkittavat rekrytoitiin tarkoituksenmukaisella otannalla ja aineisto kerättiin sähköisellä tai paperisella kyselylomakkeella intervention jälkeen. Intervention soveltuvuutta arvioitiin puolistrukturoiduilla kyselyillä ja mobiilisovelluksen käytettävyyttä arvioitiin SUS(System Usability Scale) -kyselyllä. Aineisto analysoitiin temaattisella analyysilla ja kvantifioimalla. Uusperheiden aikuisten (n=35) ja ammattilaisten (n=9) näkemysten mukaan interventio näyttäisi soveltuvan hyvin sote-alan perhepalveluihin. Suurin osa uusperheiden aikuisista ja kaikki sote-ammattilaiset kokivat intervention hyödyllisenä. Uusperheiden aikuisten kuvaamat hyödyt liittyivät interventiosta saatuun vertaistukeen, tietoon, ymmärrykseen sekä käytännön vinkkeihin, ideoihin ja työkaluihin. Lapset ja nuoret (n=5) pitivät osasta sovelluksen pelillisistä ominaisuuksista, mutta esittivät sovellukseen myös kehittämiskohteita. Perheet ja ammattilaiset arvioivat mobiilisovelluksen käytettävyyden hyväksi (SUS-arvo=75). Tutkimuksen tuottamaa tietoa voidaan hyödyntää sote-alalla uusien digitaalisten menetelmien kehittämissä ja käyttöönoton tukena.&nbsp