Aim
This study compared the management and outcomes of early‐onset neonatal sepsis (EONS) in two tertiary neonatal units in Denmark and Norway.
Methods
We retrospectively studied all infants ...diagnosed with EONS between April 2010 and March 2013 and managed at Odense University Hospital, Denmark, and the University Hospital of North Norway, Norway. Clinical and laboratory data were collected from patient records.
Results
We identified 137 EONS cases in Denmark and 101 in Norway. There were 35 culture‐confirmed EONS cases: 16% of the Danish cases and 13% of the Norwegian cases. Staphylococcus aureus was the most frequently detected pathogen in 11 cases (31%), followed by Group B streptococci in nine (26%) and Escherichia coli in six (17%). In 85% of the 238 cases, the empiric therapy comprised gentamicin and a beta‐lactam, namely ampicillin in Denmark and benzylpenicillin in Norway. Patients with positive blood cultures had higher C‐reactive protein levels than patients with negative blood cultures and higher sepsis‐attributable mortality. Lumbar punctures were performed more frequently in Denmark.
Conclusion
There were marginal differences in the management of EONS between units in Denmark and Norway, mainly in their choice of antibiotics and the use of lumbar punctures. Staphylococcus aureus was the most common pathogen.
To determine if the addition of a multinutrient human milk fortifier to mother's milk while breastfeeding very preterm infants after hospital discharge is possible and whether it influences ...first-year growth.
Of a cohort of 320 infants (gestational age: 24-32 weeks; birth weight: 535-2255 g), breastfed infants (65% n = 207) were randomly assigned shortly before hospital discharge to receive either unfortified (n = 102, group A) or fortified (n = 105, group B) mother's milk until 4 months' corrected age (CA). The remaining infants were bottle-fed with a preterm formula (group C). Follow-up was performed at term and at 2, 4, 6, and 12 months' CA.
Mean duration of breastfeeding after term was not significantly different between groups A and B (11.8 and 10.6 weeks, respectively). Weight, length, and head circumference were not significantly different between groups A and B at 12 months' CA. Compared with groups A and B, infants in group C had a higher increase in weight z score until term and in length z score until 6 months' CA. At 12 months' CA, boys in group C were significantly longer and heavier compared with those in groups A and B, whereas girls in group C were longer and heavier compared with those in group A only. A higher protein intake was related to a higher serum urea nitrogen level and growth.
Fortification of mother's milk after hospital discharge while breastfeeding very preterm infants was possible without influencing breastfeeding duration but did not significantly influence growth parameters at 1 year of age compared with unfortified mother's milk.
Pre-analytical errors account for the majority of laboratory-associated errors. In a 5 months old infant hospitalised with lung dysfunction due to prematurity, a routine measurement of zinc revealed ...an unexpected elevated concentration of 20.2 µmol/L (reference interval 10.0 - 19.0 µmol/L) compared to 11.6 µmol/L five days earlier. Zinc measurement was repeated two days later and had further increased to 42.4 µmol/L. Of note, there were no clinical signs of the increased zinc concentrations. Performance data for the zinc analysis (performed by inductively coupled plasma mass spectrometry) was found satisfactory. A thorough review of the patient´s medication and nutrition supplements revealed no relevant zinc content. The blood was obtained through capillary blood sampling, and anything at the skin puncture site containing zinc could therefore potentially contribute to the elevated zinc results. It was investigated if any ointment containing zinc had been applied at the puncture site, which revealed that the mother had applied vitamin E ointment containing zinc-oxide at the infant's heel. A capillary sample obtained from the opposite heel, where no vitamin E ointment had been applied, revealed a zinc concentration of 14.3 µmol/L. In conclusion, pre-analytical contamination with ointments must be considered in case of unexpected measurements from capillary blood.
To cite this article: Zachariassen G, Faerk J, Esberg BH, Fenger‐Gron J, Mortensen S, Christesen HT, Halken S. Allergic diseases among very preterm infants according to nutrition after hospital ...discharge. Pediatr Allergy Immunol 2011; 22: 515–520.
To determine whether a cow’s milk‐based human milk fortifier (HMF) added to mother’s milk while breastfeeding or a cow’s milk‐based preterm formula compared to exclusively mother’s milk after hospital discharge, increases the incidence of developing allergic diseases among very preterm infants (VPI) during the first year of life.
Of a cohort of 324 VPI (gestational age 24–32 wk), the exclusively breastfed VPI were shortly before discharge randomized to breastfeeding without fortification or supplementing with a fortifier. Those not breastfed were fed a preterm formula. The intervention period was from discharge until 4 months corrected age (CA). Follow‐up was performed at 4 and 12 months CA including specific IgE to a panel of allergens at 4 months CA.
The incidence during and prevalence at 12 months CA of recurrent wheezing (RW) was 39.2% and 32.7%, while atopic dermatitis (AD) was 18.0% and 12.1%, respectively. Predisposition to allergic disease increased the risk of developing AD (p = 0.04) OR 2.6 (95% CI 1.0–6.4) and the risk of developing RW (p = 0.02) OR 2.7 (95% CI 1.2–6.3). Boys had an increased risk of developing RW (p = 0.003) OR 3.1 (95% CI 1.5–6.5). No difference was found between nutrition groups. None developed food allergy.
Compared to exclusively breastfed, VPI supplemented with HMF or fed exclusively a preterm formula for 4 months did not have an increased risk of developing allergic diseases during the first year of life.
The aim of this study was to compare the allergy‐preventive effect of a partially hydrolyzed formula with two extensively hydrolyzed formulas, in infants with a high risk for development of allergic ...disease. High‐risk infants from four Danish centres were included in the period from June 1994 to July 1995. Five‐hundred and ninety‐five high‐risk infants were identified. High‐risk infants were defined as having bi‐parental atopy, or a single atopic first‐degree relative combined with cord blood immunoglobulin E (IgE) ≥ 0.3 kU/l. At birth all infants were randomized to one of three different blinded formulas. All mothers had unrestricted diets during pregnancy and lactation and were encouraged to breast‐feed exclusively. If breast‐feeding was insufficient, one of the three formulas, according to randomization, was given during the first 4 months. It was recommended not to introduce cow's milk, cow's milk products, and solid foods until the age of 4 months. After the age of 4 months a normal unrestricted diet and conventional cow's milk‐based formula were given when needed. All infants were followed‐up prospectively with interview and physical examination at the age of 6, 12, and 18 months, and if any possible atopic symptoms were reported. If food allergy was suspected, controlled elimination/challenge procedures were performed in a hospital setting. Of 550 infants included in the study, 514 were seen at all visits and 36 were excluded owing to non‐compliance. Of 478 infants who completed the study, 232 were exclusively breast‐fed, 79 received an extensively hydrolyzed casein formula (Nutramigen), 82 an extensively hydrolyzed whey formula (Profylac), and 85 a partially hydrolyzed whey formula (Nan HA), during the first 4 months of life. These four groups were identical in regard to atopic predisposition, cord blood IgE, birthplace, and gender. Exclusively breast‐fed children were exposed less to tobacco smoke and pets at home and belonged to higher social classes, whereas the three formula groups were identical concerning environmental factors. The frequency of breast‐feeding was high; only eight (2%) children were not breast‐fed at all. The three formula groups were identical in regard to duration of breast‐feeding and age at introduction of formula and solid foods. No significant differences were found in the three groups of infants receiving formula milk regarding the cumulative incidence of atopic dermatitis or respiratory symptoms. The cumulative incidence of parental‐reported cow's milk allergy was significantly higher in children fed partially hydrolyzed formula (Nan HA) compared with extensively hydrolyzed formula (Nutramigen or Profylac) at 12 and 18 months (NanHA, 7.1%; Nutramigen, 2.5%; Profylac, 0%; p = 0.033). The cumulative incidence of confirmed cow's milk allergy was 1.3% (three of 232) in exclusively breast‐fed infants, 0.6% (one of 161) in infants fed extensively hydrolyzed formula (Nutramigen or Profylac), and 4.7% (four of 85) in infants fed partially hydrolyzed formula (Nan HA). Partially hydrolyzed formula was found to be less effective than extensively hydrolyzed formula in preventing cow's milk allergy, 0.6% vs. 4.7% (p = 0.05), but because of the small number of cases the results should be interpreted with caution. Compared with other similar studies the frequency of atopic symptoms was low, even though the dietetic intervention did not include either maternal diet during lactation or dietary restrictions to the children after the age of 4 months.
The natural product royal jelly (trade name Bidro) is widely used for the treatment and prevention of allergic symptoms. Several case reports suggest marked clinical benefits. Our aim was to assess ...whether treatment with royal jelly modifies the development of allergic hay fever symptoms in children with pollen allergy.
Eighty children aged 5-16 years with hay fever symptoms due to birch, grass and/or mugwort participated in a placebo-controlled, double-blind, randomized, controlled trial. Treatment with royal jelly or placebo was administered three to six months before and throughout the pollen season.
The primary outcome was the occurrence of symptoms of rhinitis and conjunctivitis in the pollen season. A secondary outcome was symptom severity, as measured by symptom score, by visual analog scale (VAS) and by the need for additional hay fever treatment. Sixty-four children completed the study; 34 of them had been treated with royal jelly and 30 with placebo. All of the patients in both groups developed hay fever symptoms during in the pollen season. The severity of hay fever symptoms was similar in the two groups (VAS = 1.6 in the placebo group and 1.4 in the royal jelly group; the mean number of combined daily nasal symptoms was 2.83 in the placebo group and 2.82 in the royal jelly group). The need for additional hay fever treatment was similar in the two groups.
We conclude that royal jelly has no effect on the occurrence of hay fever in the pollen season, nor does it modify the severity of hay fever symptoms.
Medical treatment of depression during pregnancy and breastfeeding often involves concern by both the patient and the doctor because of the fear of adverse reactions or malformations of the child. ...This article gives an updated review on how antidepressants, lithium, antipsychotics and ECT can be used during pregnancy and breastfeeding, and presents a treatment algorithm which is used at Odense University Hospital.
Many studies in which patient's inhaler use technique has been studied have shown that one of the major problems patients have, in using an inhaler correctly, is that of poor coordination of inhaler ...actuation with inspiration. We have studied a new breath-actuated inhaler ("Autohaler" 3M Riker) which is designed to ensure correct coordination automatically. This study involves 100 children (aged 3-10 years) and includes both normal children and asthmatic patients. None of these children have previous experience using any type of inhaler. Each child is taught to use the "Autohaler" containing a placebo only. A video film is employed in order to standardize the teaching technique. Once the child is able to operate the new inhaler correctly, he or she inspires through an "Autohaler" unit specially modified so that the inspiratory flow rate and the volume of air inhaled is measured by a pneumotachograph in series with the inhaler. The time point, within the inspiratory cycle, at which the inhaler is triggered is also recorded. The majority of children older than 7 years were able to use the "Autohaler" after a few minutes instruction. Therefore, this is a valuable alternative in this age group.
This review article presents a description of contemporary developments and findings related to the different elements needed in future 4th generation district heating systems (4GDH). Unlike the ...first three generations of district heating, the development of 4GDH involves meeting the challenge of more energy efficient buildings as well as the integration of district heating into a future smart energy system based on renewable energy sources. Following a review of recent 4GDH research, the article quantifies the costs and benefits of 4GDH in future sustainable energy systems. Costs involve an upgrade of heating systems and of the operation of the distribution grids, while benefits are lower grid losses, a better utilization of low-temperature heat sources and improved efficiency in the production compared to previous district heating systems. It is quantified how benefits exceed costs by a safe margin with the benefits of systems integration being the most important.
•Provides a review of 4th Generation District Heating (4GDH) in scientific papers.•Shows how 4GDH is an important integrated part of future sustainable energy systems.•Quantifies costs and benefits of 4GDH in a future sustainable energy system.•Shows how benefits exceed costs by a safe margin.•Shows the significant benefits of systems integration.
Future spacecraft communication subsystems will potentially benefit from software-defined radios controlled by artificial intelligence algorithms. In this paper, we propose a novel radio resource ...allocation algorithm leveraging multiobjective reinforcement learning and artificial neural network ensembles able to manage available resources and conflicting mission-based goals. The uncertainty in the performance of thousands of possible radio parameter combinations and the dynamic behavior of the radio channel over time producing a continuous multidimensional state-action space requires a fixed-size memory continuous state-action mapping instead of the traditional discrete mapping. In addition, actions need to be decoupled from states in order to allow for online learning, performance monitoring, and resource allocation prediction. The proposed approach leverages the authors' previous research on constraining decisions predicted to have poor performance through "virtual environment exploration." The simulation results show the performance for different communication mission profiles, and accuracy benchmarks are provided for the future research reference. The proposed approach constitutes part of the core cognitive engine proof-of-concept delivered to the NASA John H. Glenn Research Center's SCaN Testbed radios on-board the International Space Station.
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