Postnataler Bilirubinanstieg bei Frühgeborenen < 1500 g Geburtsgewicht

Einleitung: In den ersten Lebenstagen kommt es bei Neugeborenen zu einem Anstieg des Gesamtserumbilirubins (GSB). Dies kann zu irreversiblen Schäden des zentralen Nervensystems führen. Frühgeborene gelten als besonders gefährdet, schwere neurologische Folgeschäden zu entwickeln. Über den postnatalen Bilirubinanstieg ist bei Frühgeborenen bisher wenig bekannt. Ziel der vorliegenden Forschungsarbeit ist es, den postnatalen Verlauf der GSB-Konzentration bei Frühgeborenen mit einem sehr niedrigen Geburtsgewicht 90. Perzentile zu identifizieren sowie die altersbezogenen GSB-Konzentrationen und den Anstieg des GSB zwischen der 12.–48. Lebensstunde mit publizierten Daten reifer Neugeborener aus der Literatur zu vergleichen. Insgesamt soll dies zu einem besseren Verständnis des postnatalen Bilirubinanstiegs bei VLBW Frühgeborenen beitragen. Methodik: In einer retrospektiven Studie wurden 2430 postnatale GSB-Messungen vor dem Beginn der Fototherapie bei 483 Frühgeborenen mit einem Geburtsgewicht 90. Perzentile (> 0,25 mg/dl/h) ist mit einem niedrigen Gestationsalter [27,2 (25,4–29,3) vs. 28,4 (26,4–30,4) Schwangerschaftswochen], einem niedrigen Geburtsgewicht [978,0 (665,0–1120,0) vs. 1045,0 (814,0–1300,0) g] und einem niedrigen 5-min in Apgar Score [7 (7–8) vs. 8 (7–9)] assoziiert. Die 50. Perzentile des GSB von VLBW Frühgeborenen verläuft zwischen der 12.–48. Lebensstunde unterhalb der 40. Perzentile publizierter GSB-Konzentrationen reifer Neugeborener aus der Literatur. Schlussfolgerung: Die Anstiegsgeschwindigkeit des GSB ist ein Indikator für einen frühzeitigen Beginn und eine lange Behandlungsdauer der Fototherapie. Ein niedriges Gestationsalter, ein niedriges Geburtsgewicht sowie ein niedriger 5-min Apgar Score sind mit einem steilen Anstieg des GSB > 90. Perzentile assoziiert. Zwischen der 12.–48. Lebensstunde weisen VLBW Frühgeborene im Vergleich zu reifen Neugeborenen sowohl eine niedrigere absolute GSB-Konzentration als auch einen niedrigeren Anstieg des GSB auf. Insgesamt trägt die Forschungsarbeit zu einem verbesserten Verständnis des postnatalen Bilirubinanstiegs bei Frühgeborenen mit einem sehr niedrigen Geburtsgewicht 90th percentile and comparing hour-specific TSB and TSB ROR at postnatal 12–48 hours with data of term infants retrieved from the literature, the present work aims to contribute to a better understanding of postnatal bilirubin increase in VLBW preterm infants. Methods: A retrospective analysis of 2430 routine capillary TSB measurements obtained between birth and initiation of phototherapy in 483 VLBW preterm infants was performed during a three-year study period. Results: In VLBW preterm infants postnatal TSB increases with an overall TSB ROR of 0.15 (0.11–0.19) mg/dL/h prior to the initiation of phototherapy. TSB ROR correlates with the age at initiation (RS = –0.687; p 90th percentile (> 0.25 mg/dL/h) is associated with low gestational age [27.2 (25.4–29.3) vs. 28.4 (26.4–30.4) weeks], low birth weight [978.0 (665.0–1120.0) vs. 1045.0 (814.0–1300.0) g] and low 5-min Apgar scores [7 (7–8) vs. 8 (7–9)]. At postnatal 12–48 hours, the 50th percentile of TSB of VLBW preterm infants is below the 40th percentile of term infants retrieved from the literature. Conclusion: TSB ROR is an indicator for early and prolonged phototherapy. A low gestational age, a low birth weight and a low 5-min Apgar score are associated with a rapid rise of TSB > 90th percentile. At 12–48 hours, hour-specific TSB and TSB ROR are lower in VLBW preterm infants compared to term infants. Overall, the present work contributes to a better understanding of postnatal bilirubin increase in VLBW preterm infants and provides important knowledge for future studies. Future studies should be dedicated to contribute to a better and more individualized management of hyperbilirubinemia in VLBW preterm infants

Trends in Nutritional Status and Dietary Behavior in School-Aged Children with Congenital Heart Defects

Background: Malnutrition and poor weight gain has been reported in infants with congenital heart defects (CHDs); however data in older children with CHDs are limited. In order to obtain representative data on the nutritional status, dietary behavior, and potential influencing factors in school-aged children with CHDs, we performed a nationwide online survey. Methods: Patients aged 6 to 17 years registered in the German National Register for CHDs were asked to participate in this study by completing the German Health Interview and Examination Survey for Children and Adolescents (KiGGS) eating study questionnaire in order to assess their self-reported dietary habits. The use of the same questionnaire enabled a comparison with a representative subset of 4569 participants of the KiGGS study. Results: A total of 894 patients (mean age 12.5 ± 3.0 years; 47.2% female) were enrolled. Patients were allocated according to anatomic complexity into simple (23.8%), moderate (37.8%), and complex CHDs (38.4%). The consumption of sugar-containing food (p < 0.001) and fast food (p < 0.05) was significantly lower among the CHD patients than in the healthy children. Children with CHDs showed significantly lower body mass index (BMI) percentiles (p < 0.001) compared with their healthy peers, while children with complex and moderate CHDs had the lowest BMI. While in CHD patients, the BMI percentiles were not related to unhealthy food, there was a strong correlation with the CHD severity and number of previous interventions (p < 0.01). Conclusions: According to this nationwide survey, school-aged children with complex CHD are at risk of undernutrition, which is not due to dietary habits but to CHD severity and repeated surgery

Open-Source Technology for Real-Time Continuous Glucose Monitoring in the Neonatal Intensive Care Unit: Case Study in a Neonate With Transient Congenital Hyperinsulinism

Background: Use of real-time continuous glucose monitoring (rtCGM) systems has been shown to be a low-pain, safe, and effective method of preventing hypoglycemia and hyperglycemia in people with diabetes of various age groups. Evidence on rtCGM use in infants and in patients with conditions other than diabetes remains limited. Objective: This case study describes the off-label use of rtCGM and the use of an open-source app for glucose monitoring in a newborn with prolonged hypoglycemia secondary to transient congenital hyperinsulinism during the perinatal period. Methods: The Dexcom G6 rtCGM system (Dexcom, Inc) was introduced at 39 hours of age. Capillary blood glucose checks were performed regularly. In order to benefit from customizable alert settings and detect hypoglycemic episodes, the open-source rtCGM app xDrip+ was introduced at 9 days of age. Results: Time in range (45-180 mg/dL) for interstitial glucose remained consistently above 90%, whereas time in hypoglycemia (<45 mg/dL) decreased. Mean glucose was maintained above 70 mg/dL at 72 hours of life and thereafter. Daily sensor glucose profiles showed cyclic fluctuations that were less pronounced over time. Conclusions: While off-label use of medication is both common practice and a necessity in newborn infants, there are few examples of off-label uses of medical devices, rtCGM being a notable exception. Real-time information allowed us to better understand glycemic patterns and to improve the quality of glycemic control accordingly. Severe hypoglycemia was prevented, and measurement of serum levels of insulin and further lab diagnostics were performed much faster, while the patient's individual burden caused by invasive procedures was reduced. Greater customizability of threshold and alert settings would be beneficial for user groups with glycemic instability other than people with diabetes, and for hospitalized newborn infants in particular. Further research in the field of personal and off-label rtCGM use, efficacy studies evaluating the accuracy of low glucose readings, and studies on the differences between algorithms in translating raw sensor data, as well as customization of commercially available rtCGM systems, is needed

Genetic variation in the transforming growth factor-β1 gene is associated with susceptibility to IgA nephropathy

Background. There is growing evidence of genetic risk for susceptibility to IgA nephropathy. Among several candidate genes related to immunological regulation in renal tissue, TGFB1 is known to be a contributor to proliferation and the development of fibrosis

The current state of hospital-based emergency medicine in Germany

Germany has a long tradition of having physicians, often anesthesiologists with additional training in emergency medicine, deliver prehospital emergency care. Hospital-based emergency medicine in Germany also differs significantly from the Anglo-American model, and until recently having separate emergency rooms for different departments was the norm. In the past decade, many hospitals have created “centralized emergency departments” [Zentrale Notaufnahme (ZNAs)]. There is ongoing debate about the training and certification of physicians working in the ZNAs and whether Germany will adopt a specialty board certification for emergency medicine

Beyond the Global Brain Differences:Intraindividual Variability Differences in 1q21.1 Distal and 15q11.2 BP1-BP2 Deletion Carriers

BACKGROUND: Carriers of the 1q21.1 distal and 15q11.2 BP1-BP2 copy number variants exhibit regional and globalbrain differences compared with noncarriers. However, interpreting regional differences is challenging if a globaldifference drives the regional brain differences. Intraindividual variability measures can be used to test for regionaldifferences beyond global differences in brain structure.METHODS: Magnetic resonance imaging data were used to obtain regional brain values for 1q21.1 distal deletion (n =30) and duplication (n = 27) and 15q11.2 BP1-BP2 deletion (n = 170) and duplication (n = 243) carriers and matchednoncarriers (n = 2350). Regional intra-deviation scores, i.e., the standardized difference between an individual’sregional difference and global difference, were used to test for regional differences that diverge from the globaldifference.RESULTS: For the 1q21.1 distal deletion carriers, cortical surface area for regions in the medial visual cortex, posterior cingulate, and temporal pole differed less and regions in the prefrontal and superior temporal cortex differedmore than the global difference in cortical surface area. For the 15q11.2 BP1-BP2 deletion carriers, cortical thicknessin regions in the medial visual cortex, auditory cortex, and temporal pole differed less and the prefrontal andsomatosensory cortex differed more than the global difference in cortical thickness.CONCLUSIONS: We find evidence for regional effects beyond differences in global brain measures in 1q21.1 distaland 15q11.2 BP1-BP2 copy number variants. The results provide new insight into brain profiling of the 1q21.1 distaland 15q11.2 BP1-BP2 copy number variants, with the potential to increase understanding of the mechanismsinvolved in altered neurodevelopment

Biografieforschung: theoretische Perspektiven und methodologische Konzepte für eine re-konstruktive Geschlechterforschung

Die Biografieforschung bezeichnet einen komplexen Forschungsansatz, der auf eine lange Geschichte des wissenschaftlichen Interesses an "persönlichen Dokumenten" verweisen kann. Sie ist eine voraussetzungsvolle Forschungsperspektive, die sich in zentralen Aspekten ihres Vorgehens auf Biografien als theoretisches Konzept, als historisch-empirischen Gegenstand und als komplexe methodologische Strategie bezieht. Andere Begriffe, welche oftmals synonym gebraucht, in der Biografieforschung aber systematisch unterschieden werden, sind "Lebensgeschichte" und "Lebenslauf". Die Autorin skizziert die Perspektiven einer rekonstruktiven Geschlechterforschung innerhalb der Biografieforschung, wozu sie auf die Differenzierungen empirischer Forschung, die methodologischen Prinzipien sowie auf Datenerhebung und Datenanalyse eingeht. Sie hebt insbesondere drei Kontextrelationen bei der Interpretation eines biografischen Textes hervor: Biografie, Interaktion, kulturelle Muster und soziale Regeln. Das skizzierte Konzept von Biografieforschung begreift sie als ein offenes Programm, das vielfältige Anknüpfungspunkte zu aktuellen theoretischen Diskussionen in der Geschlechterforschung aufweist. (ICI2

Beyond the global brain differences: Intra-individual variability differences in 1q21.1 distal and 15q11.2 BP1-BP2 deletion carriers

Background The 1q21.1 distal and 15q11.2 BP1-BP2 CNVs exhibit regional and global brain differences compared to non-carriers. However, interpreting regional differences is challenging if a global difference drives the regional brain differences. Intra-individual variability measures can be used to test for regional differences beyond global differences in brain structure. Methods Magnetic resonance imaging data were used to obtain regional brain values for 1q21.1 distal deletion (n=30) and duplication (n=27), and 15q11.2 BP1-BP2 deletion (n=170) and duplication (n=243) carriers and matched non-carriers (n=2,350). Regional intra-deviation (RID) scores i.e., the standardized difference between an individual’s regional difference and global difference, were used to test for regional differences that diverge from the global difference. Results For the 1q21.1 distal deletion carriers, cortical surface area for regions in the medial visual cortex, posterior cingulate and temporal pole differed less, and regions in the prefrontal and superior temporal cortex differed more than the global difference in cortical surface area. For the 15q11.2 BP1-BP2 deletion carriers, cortical thickness in regions in the medial visual cortex, auditory cortex and temporal pole differed less, and the prefrontal and somatosensory cortex differed more than the global difference in cortical thickness. Conclusion We find evidence for regional effects beyond differences in global brain measures in 1q21.1 distal and 15q11.2 BP1-BP2 CNVs. The results provide new insight into brain profiling of the 1q21.1 distal and 15q11.2 BP1-BP2 CNVs, with the potential to increase our understanding of mechanisms involved in altered neurodevelopment