Hannover, Germany


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Kaiser P.,Prof. Hess Kinderklinik | Borte M.,Kinderklinik | Zimmer K.-P.,Universitatskinderklinik Giessen | Huppertz H.-I.,Prof. Hess Kinderklinik
European Journal of Pediatrics | Year: 2012

Acute gastroenteritis (AGE) caused by rotavirus (RV) is a common disease among infants and toddlers, often leading to hospitalization and, in resource-poor countries, to death. However, little is known on specific complications of severe RV-positive (RV+) AGE and on the clinical course in chronically ill children. This was a retrospective analysis of data for children <5 years of age hospitalized due to AGE during six rotavirus seasons in three large German pediatric hospitals. The primary study end point was the incidence and type of complications in RV+ versus RV-negative (RV-) cases. A total of 6,884 episodes of AGE in hospitalized children aged <5 years were included in this analysis. Of the 4,880 stools tested for RV, 2,118 (43.4%) were RV+. Hypernatremia was significantly more common in RV+ AGE (P < 0.001) and was associated with severe disease, need for intensive care treatment, and longer duration of hospitalization. Metabolic disorders, particularly hypoglycemia, were more common in RV+ AGE. In contrast, symptoms such as respiratory infections, neurological, and abdominal symptoms were more common in children with RV- AGE. Conclusions: hypernatremia is a specific complication of RV+ AGE. RV would therefore appear to be the cause of infant toxicosis, the traditional descriptive term for severe dehydration and clinical deterioration following AGE. © 2011 Springer-Verlag.

Novoa E.,Klinik fur Hals Nasen Ohrenkrankheiten | Podvinec M.,Klinik fur Hals Nasen Ohrenkrankheiten | Podvinec M.,University of Basel | Angst R.,Kinderklinik | And 2 more authors.
International Journal of Pediatric Otorhinolaryngology | Year: 2013

Objective: Otogenic lateral sinus thrombosis (LST) in children represents a serious condition with potential long-lasting morbidity. The role of adjunct anticoagulation therapy and the benefit of an analysis of prothrombotic factors are unclear. The aim of the study was to report therapeutic management and outcome, analyze prothrombotic factors in children with otogenic LST treated with mastoidectomy/antibiotics/anticoagulation and to evaluate the results with a review of the literature. Methods: Retrospective chart review of 9 children with otogenic LST (2000-2009) and literature search in PubMed. Results: The most frequent sign was fever in 88%, while neurologic findings were seen in 55%. Streptococci was the most common bacteria (55%). Prothrombotic factors were normal in all children. All patients received therapeutic anticoagulation, without experiencing bleeding complications. Eight children made a full recovery, neurologic sequelae persisted in one. The literature review of 115 children identified fever as the most prominent sign, reported the absence of neurologic findings in almost 50% of cases and confirmed the major role of streptococci. Anticoagulation, as adjunct therapy, was given to 38% of patients in the therapeutic range with a trend towards better neurologic outcome. A prothrombotic analysis was reported in 5 studies with positive results in 2. Conclusions: Surgery and antibiotics represent the mainstay of the therapy. Anticoagulation can be safely added in view of the high potential for morbidity and might reduce neurologic sequelae. Bacteria with thrombotic activity seem to be an important aetiology. In contrast, a prothrombotic disposition seems to play a minor role in the development of otogenic LST. © 2013 Elsevier Ireland Ltd.

Hofmann S.R.,TU Dresden | Morbach H.,University of Würzburg | Schwarz T.,University of Würzburg | Rosen-Wolff A.,TU Dresden | And 3 more authors.
Clinical Immunology | Year: 2012

Chronic recurrent multifocal osteomyelitis (CRMO) is an autoinflammatory bone disorder of unknown origin. We previously demonstrated that monocytes from CRMO patients fail to express the immune-modulatory cytokine interleukin10 (IL10) in a chromatin dependent manner. Here, we demonstrate that attenuated extracellular-signal regulated kinase (ERK)1 and 2 signaling in response to TLR4 activation results in failure to induce IL-10 expression in monocytes from CRMO patients. Attenuated ERK1/2 activation results in 1) reduced levels of Sp-1, a transcription factor that induces IL-10 expression in monocytes, and 2) impaired H3S10 phosphorylation of the IL10 promoter, an activating epigenetic mark. The pro-inflammatory cytokines tumor necrosis factor (TNF)α and IL-6 are not negatively affected, resulting in an imbalance towards pro-inflammatory cytokines. Thus, impaired ERK1/2 signaling with subsequently reduced Sp-1 expression and H3S10 phosphorylation of the IL10 promoter may centrally contribute to the pathophysiology of CRMO. © 2012 Elsevier Inc.

Mihatsch W.,Kinderklinik | Trotter A.,Hegau Bodensee Hochrhein Kliniken GmbH | Pohlandt F.,University of Ulm
Klinische Padiatrie | Year: 2012

Aim of the present study was to test whether six-hour (6 h) urine specimens predict the 24-hour (24 h) mineral homeostasis in individual infants born preterm. Urinary Calcium (Ca) and Phosphate (P) concentrations were studied in 60 stable infants; gestational age 34 (25-42) weeks. In 58 infants four 6 h urine specimens and in 2 infants all spot urine specimens obtained within 24 h were analyzed. In 39 infants born preterm coefficients of variation were 0.42 (SD 0.26) and 0.41 (SD 0.26) for Ca and P measurements in the four 6 h urine specimens obtained within 24 h, respectively, The mineral homeostasis of the infants was defined as Ca or P surplus homeostasis if the 24 h urinary concentrations were 1 mmol/l. The sensitivity, specificity, and PPV of a 6 h urinary specimen to predict Ca deficiency homeostasis (24 h urinary Ca <1 mmol/l) were 0.93 (0.77-0.98; 95%CI), 0.72 (0.43-0.90) and 0.90 (0.74-0.96). The sensitivity, specificity and PPV for urinary P were 0.8 (0.38-0.96), 0.97 (0.85-0.995), and 0.8 (0.38-0.96). In conclusion, in infants born preterm on regular 3 or 4 h feedings, 6 h urine sampling is sufficiently precise for prediction of Ca and P mineral deficiency homeostasis (PPV 0.92 and 0.83). However, measurements at regular intervals (twice weekly) are recommended not to miss any infant in mineral deficiency homeostasis. © Georg Thieme Verlag KG Stuttgart · New York.

Scholle S.,Robert Koch Krankenhaus Apolda GmbH | Wiater A.,Kinderklinik | Scholle H.C.,Universitatsklinikum Jena
Sleep Medicine | Year: 2012

Objective: This study focused on differences in arousals during sleep, using the arousal rules of the American Academy of Sleep Medicine, by gender, age, and maturity in healthy children. Methods: One-night polysomnography was performed on 209 healthy German children (age 1-18. years) at their habitual bedtimes in 16 laboratories. Subjects were grouped by gender (112 females, 97 males), age, and Tanner stage. Results: Normative values of arousal events in sleep are presented, including indexes of spontaneous and respiratory arousals, total electroencephalogram (EEG) arousals, phasic increase in submental electromyogram (EMG) in stage R, and leg movements. With increasing age, a decrease was seen in: EEG arousal index ≥1-2.9. s, EEG arousal index ≥3. s, index of total EEG arousals, index of respiratory arousals, chin EMG enhancement in stage R ≥1-2.9 and ≥3. s, index of total leg movements, and leg movements with EEG arousals (p< 0.05). Only spontaneous arousals showed no association with age. There was a significant negative correlation between Tanner stage and arousals ≥1-2.9. s, respiratory arousals, leg movements, and leg movements with arousals (p< 0.05). Only arousals ≥3. s and total leg movements showed gender differences (p< 0.05). Conclusions: For the diagnosis of pediatric sleep disturbances, the given arousal data enable estimation of the degree of deviation from normal findings for age and maturity. There is need for further research on, and further discussion of, the arousal rules of the American Academy of Sleep Medicine. © 2011 Elsevier B.V.

Scholle S.,Robert Koch Krankenhaus Apolda GmbH | Wiater A.,Kinderklinik | Scholle H.C.,Universitatsklinikum Jena
Sleep Medicine | Year: 2011

Objective: To provide normative values for pediatric sleep cardiorespiratory parameters following AASM rules, assessing effects of gender, age, and Tanner stage. Methods: One-night polysomnograhy was performed at subjects' habitual bedtimes in 16 laboratories on 209 healthy German children, 1-18. years old. Results: Normative values of cardiorespiratory parameters in pediatric sleep are presented. No obstructive and mixed apneas occurred. Hypopneas were seldom. Respiratory frequency and apnea-hypopnea-index decreased with age (p<. 0.001). In all groups central apneas ≥20. s were present but uncommon. Oxygen desaturations or respiratory arousals following central apnea were rare. Heart rate showed an inverse correlation to age (p<. 0.001). Heart rate was lower in sleep, lowest in stage N. The mean heart rate of females was higher than males (p<. 0.05). Neither Tanner stage nor corresponding age (p<. 0.05) influenced: mean apnea duration, central apnea index ≥20. s, hypopnea index, index of periodic breathing, or oxygen saturation nadir. All other parameters except maximal apnea duration and central apnea index after movements with oxygen desaturation show dependency on both Tanner stage and corresponding age (p<. 0.05). Conclusions: Using AASM rules, the development of cardiorespiratory parameters in healthy children, ages 1-18 is shown. Age-related norms may improve sleep pathology identification. © 2011 Elsevier B.V..

Schoffl V.,Sektion Sportorthopadie | Schoffl I.,Kinderklinik
Sport-Orthopadie - Sport-Traumatologie | Year: 2012

Competition climbing has become ever more popular over the last few years. Next to regional and national climbing events, World Cups, World and Continental Championships take place regularly. Three different disciplines are performed: "Lead", "Boulder" and "Speed" Performance limiting in "Lead" is the forearm finger strength endurance, in "Boulder" the finger power and in "Speed" power as well as coordination. The injury risk in competition climbing is of minor importance. Mainly the upper extremity is injured. In "Lead" most injuries are overstrains of the fingers, in "Boulder" additional ankle injuries from falls can occur. "Speed", as it is climbed in "top-rope", has only very little injuries and then only skin bruises. © 2011.

Wiater A.,Kinderklinik
Monatsschrift fur Kinderheilkunde | Year: 2016

Development, control and regulation of sleep are described on the basis of physiological processes. The chronobiological correlations are discussed, in particular the circadian sleep-wake cycle, as well as the cyclic patterns of parameters influencing sleep, such as temperature, neurotransmitters and hormones. Sleep development begins with the appearance of synchronized electrocortical activity. During the phase of development the sleep-wake behavior is profoundly influenced by stable rhythms. In addition to the endogenous rhythms, sleeping is also influenced by exogenous factors and light is the most important zeitgeber. In addition, social factors also play an important role in early infancy, particularly food intake. During sleep somatic processes take place as well as emotional memory generation and cognitive processes related to learning and memory consolidation. Sleep disorders can be favored by the lack of coordination of external factors with the endogenous rhythms. The assessment of sleep disorders is facilitated by knowledge of the physiological basis and pathophysiological changes. Sleep problems in children lead to organic disorders, mental impairment and cognitive limitations corresponding to the functions of sleep. Preventive measures as well as early diagnosis and treatment of sleep disorders in children and adolescents should be encouraged with respect to the context described. © 2016 Springer-Verlag Berlin Heidelberg

Hofmann S.R.,TU Dresden | Schwarz T.,University of Würzburg | Moller J.C.,TU Dresden | Morbach H.,University of Würzburg | And 4 more authors.
Clinical Immunology | Year: 2011

Chronic non-bacterial osteomyelitis (CNO) is an auto-inflammatory disorder that affects the skeletal system. Interleukin (IL-)10 is an immune-modulatory cytokine that controls inflammation, and limits inflammatory cytokine responses. Dysregulation of IL-10 expression has been shown to result in autoimmune and infectious diseases.We investigated IL-10 expression by monocytic cells from CNO patients and controls. In response to stimulation with LPS, IL-10 expression from CNO monocytes was reduced (p< 0.001). This was independent of IL10 promoter polymorphisms. Thus, we investigated Sp1 recruitment to the IL10 promoter and saw markedly reduced binding in CNO monocytes. This was accompanied with reduced phosphorylation of histone H3 serine 10 (H3S10), an activating epigenetic mark.Impaired recruitment of Sp1 to the IL10 promoter, and reduced H3S10 phosphorylation, may be a reflection of deficient MAPK signaling in CNO monocytes in response to LPS stimulation. Thus, we have discovered a mechanism that may be central in the pathophysiology of CNO. © 2011 Elsevier Inc.

The FoNTAN-circulation ist the only palliative therapeutic option - except heart transplantation - that is available for a patient with a functional univentricular heart. The short and midterm results in patients with FoNTAN-circulation are almost good when using appropriate selection criteria and the new surgical modifications of the FONTAN-procedure. Long-term outcome in patients with FoNTAN-circulation is fair but not good. However, the long-term prognosis is based on historical facts and does necessarily not represent the nowadays Fontan-population. Nevertheless morbidity and mortality is still high. The main causes of death are heart failure, sudden cardiac death, and protein loosing enteropathy and thromboembolic events. The re-intervention-rate is high (>50%). Re-interventions are necessary because of stenosis in the tunnel or in the pulmonary arteries. Interventional closure of venous-venous collaterals and fenestrations, electrophysiological procedures and pacemaker implantation has to be taken into account. Heart transplantation is indicated in severe cardiac failure. A lifelong cardiac of antithrombotic medication is necessary beside the recommendation of endocarditis prophylaxis. The life expectancy is due to the fact that the first FoNTAN-operations were performed in 1968 not known. However life expectancy is not normal. Mental, neurological and motor development may be not normal. Reasons for this may be cyanosis and the fact of several operations using heart-lung-machine. Neurological development in children with hypoplastic left heart seems to be unfavourable because of the abnormal prenatal perfusion conditions. Cardiopulmonary capacity is reduced and in adulthood the patients will be in NYHA class ll-lll. The overall quality of life is reduced, but is also influenced by the patients own perception.

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