Klinische Pädiatrie
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Klinische Pädiatrie · Mar 2007
Practice Guideline[ILCOR's new resuscitation guidelines in preterm and term infants: critical discussion and suggestions for implementation].
Recommendations of the International Liaison Committee on Resuscitation (ILCOR) become updated every five years with changing evidence resulting in revised recommendations for clinical practice. New data exist concerning the adequate oxygen concentration to be used in the delivery room, the management of imminent meconium aspiration, ventilation strategies and the role of body temperature during and after resuscitation of preterm and term newborn infants. Only in some cases new evidence has led to clear-cut recommendations for or against specific interventions. ⋯ The authors also advocate the retention of the presently performed intranatal suction procedure in cases of meconium-stained amniotic fluid and the use of therapeutic hypothermia following perinatal asphyxia in term newborns according to the protocol of one of the published randomized, controlled trials. Standard equipment for neonatal resuscitation should include pressure gauge for monitoring of inspiratory pressures, oxygen blender, and pulse oxymeter. The predominant majority of ILCOR-recommendations have only been cited and have been commented with respect to their practical implementation within the clinical context.
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Klinische Pädiatrie · Jan 2007
Neurodevelopmental outcome at 2 years in 23 to 26 weeks old gestation infants.
Assessment of neurologic and developmental outcome at 2 years age of infants with gestational age (GA)<27 weeks, born between 1996-2001. ⋯ Developmental delay is very common in preterm infants<27 GA and exceeds the number of neurological disabilities (including cerebral palsy).
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Klinische Pädiatrie · Nov 2006
Review Comparative StudyAntiepileptic treatment in paediatric oncology--an interdisciplinary challenge.
Epileptic seizures are a common and clinically relevant problem in paediatric oncology. Attributable to the heterogeneity of this group of patients and a number of possible comorbidities antiepileptic treatment in paediatric oncology poses a number of diagnostic and therapeutic challenges. This requires a close interdisciplinary approach to the seizing child or adolescent. ⋯ Preliminary studies indicate that gabapentin and levetiracetam may provide good options in terms of efficacy and safety. However, more properly designed clinical studies are warranted to raise the level of evidence for robust clinical recommendations. Until that time, clinicians will need to continue to question current policies and adapt their daily practice to evolving scientific data.
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Klinische Pädiatrie · Nov 2006
Comparative Study[Effects of self-adapting G-DRG system 2004 to 2006 on in-patient services payment in pediatric hematology and oncology patients of a university hospital].
Reimbursement of inpatient treatment by daily constant charges is replaced by diagnosis- and procedure-related group system (G-DRG) in German acute care hospitals excerpt for psychiatry since 2004. Re-designs of G-DRG system were undertaken in 2005 and 2006. Parallel to implementation requirement- and resource-based self-adjustment of this new reimbursement system has been established by law. Adjustments performed in 2005 and 2006 are examined with respect to their effect on reimbursements in treatments of children with oncological, hematological, and immunological diseases. ⋯ The G-DRG system in its versions 2005 and 2006 results in lowering overall reimbursements of a pediatric hematology, oncology, and immunology department compared to initial status in 2004. The growing chargeability of additional payments ameliorate this effect.
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Klinische Pädiatrie · Jul 2006
Baroreflex sensitivity in children, adolescents, and young adults with essential and white-coat hypertension.
Hypertension, which is a common cardiovascular disease in adults, could originate in childhood. The aim of the study was to show differences in baroreflex sensitivity and short-term blood-pressure variability between healthy and hypertensive children, adolescents and young adults, and those with white-coat effect with respect to obesity. We examined 54 subjects (11-21 years) who had repeatedly high causal blood pressure. Basing on 24-hour blood pressure monitoring, the subjects were divided into groups: 24 subjects with hypertension (Hy) and 30 subjects with white-coat effect (WhC). Hy and WhC subjects were compared with age-matched healthy controls in a ratio of 1 : 2 for both groups: 48 controls for hypertensive subjects (CoHy) and 60 for subjects with white-coat effect (CoWhC). Totally, 162 subjects were studied. Systolic blood pressure (SBP) and inter-beat intervals (IBI) were recorded in all subjects for 5 min (Finapres, metronome controlled breathing at a frequency of 0.33 Hz). The power spectra of SBP and IBI were calculated. Indices of baroreflex sensitivity (BRS [ms/mmHg] and BRSf [mHz/mmHg]) were determined by the cross-spectral method. The SBP variability was determined as SBP spectral power in the range of 10-second rhythm (SBP (0.1Hz)). The body mass index (BMI) was significantly higher in both Hy and WhC compared with their controls (Hy vs. CoHy; WhC vs. CoWhC: 24.6 +/- 6.0 kg/m (2) vs. 20.4 +/- 2.8 kg/m (2), p < 0.001; 23.2 +/- 5.9 kg/m (2) vs. 20.3 +/- 2.6 kg/m (2), p < 0.05). BRS was significantly decreased in both groups (Hy vs. CoHy; WhC vs. CoWhC: 6.0 +/- 2.7 ms/mmHg vs. 9.5 +/- 3.9 ms/mmHg, p < 0.001; 7.2 +/- 3.1 ms/mmHg vs. 10.9 +/- 6.2 ms/mmHg, p < 0.01), and BRSf as well (Hy vs. CoHy; WhC vs. CoWhC: 10.8 +/- 4.6 mHz/mmHg vs. 16.2 +/- 6.1 mHz/mmHg, p < 0.001; 13.0 +/- 4.9 mHz/mmHg vs. 18.3 +/- 8.7 mHz/mmHg, p < 0.01). The decrease of baroreflex sensitivity was linked with the increase in the variability of SBP (0.1Hz), which was significant in hypertensives only (Hy vs. CoHy; WhC vs. CoWhC: 142 +/- 96 mmHg (2)/Hz vs. 94 +/- 83 mmHg (2)/Hz, p < 0.01; 121 +/- 131 mmHg (2)/Hz vs. 107 +/- 98 mmHg (2)/Hz). ⋯ The mild increase of BMI was associated with white-coat effect and a BRS and BRSf decrease. The greater increase of BMI was associated with hypertension and a deeper BRS and BRSf decrease. This greater decrease of BRS and BRSf in hypertensives was linked with the increased SBP-variability.