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Nagel B.,Universitatsklinik For Kinder Und Jugendheilkunde | Maier R.,Universitatsklinik For Innere Medizin Und Der | Gasser S.,Universitatsklinik For Innere Medizin Und Der | Mair J.,Universitatsklinik For Innere Medizin Iii
Journal fur Kardiologie | Year: 2015

The advances in pediatric cardiology and pediatric cardiac surgery have led to a long term survival of children with congenital heart defects of > 90[%]. A new patient population has developed, the adults with congenital heart defects (ACHD). Due to the mostly reparative and not corrective surgery of patients with complex congenital heart defects long term complications often occur. These complications have to be recognized in time and treated correctly. Thus the knowledge of the heterogenous anatomy, pathophysiology and hemodynamics of these heart defects are necessary. The optimal care of ACHD should be multidisciplinary and take place in special ACHD-centers in cooperation with the treating specialist in internal medicine or cardiologist. The whole spectrum of diagnostic modalities has to be provided in these centers. Exemplarily the most frequent cyanotic heart defect, tetralogy of Fallot, the different forms of transposition of the great arteries as well as the features of the univentricular circulation are presented with special emphasis on the anatomy, pathophysiology and diagnostic options for longterm followup. Source

Rietschel E.,Universitatsklinik Cologne | Huttegger I.,Universitatsklinik For Kinder Und Jugendheilkunde | Lange L.,Klinik fur Kinder und Jugendmedizin | Urbanek R.,Zentrum fur Kinder und Jugendmedizin
Monatsschrift fur Kinderheilkunde | Year: 2012

Anaphylaxis is a severe, potentially life-threatening, systemic allergic reaction, which generally happens unexpectedly in healthy individuals. Among children, the most common elicitors are food, insect stings, and drugs. Currently, the incidence of anaphylaxis is increasing. Risk factors are asthma, infections as well as previous, sudden respiratory and cardiovascular symptoms after exposure to a specific antigen. If cutaneous, respiratory, gastrointestinal, cardiovascular and neurologic symptoms involving ≥2 organ systems occur, adrenaline/epinephrine, preferably intramuscularly, should be administered. Although allergen skin testing and serological estimation of specific IgE antibodies do not predict who will develop anaphylaxis, they help to identify sensitized individuals at risk. Patients with a history of anaphylaxis need training on how to use the emergency medication and how to recognize and prevent the anaphylactic symptoms. © Springer-Verlag 2012. Source

Urlesberger B.,Medical University of Graz | Urlesberger B.,Universitatsklinik For Kinder Und Jugendheilkunde | Brandner A.,Medical University of Graz | Pocivalnik M.,Medical University of Graz | And 3 more authors.
Neonatology | Year: 2013

Background: Oxygen delivery to the brain is dependent on cardiac output and arterial oxygen content. Objectives: The study was designed to investigate the influence of a left-to-right shunt via the ductus arteriosus (DA) on regional oxygen saturation (rSO2) of the brain and peripheral tissue during postnatal transition. Methods: Nested case-control study. In term neonates after elective cesarian section, rSO2 of the brain and pre-and postductal peripheral tissue were measured 15 min after uncomplicated postnatal transition. Two groups were formed according to shunt flow characteristics via the DA: shunt group (with a left-to-right shunt), and nonshunt group (no shunt). Results: Of 80 infants, in 58 (72%) a left-to-right shunt was identified, and in 22 (28%) no flow was seen via the DA. The 22 infants formed the nonshunt group. They were matched with 22 newborn infants with a left-to-right shunt via the DA (shunt group). Infants in the nonshunt group had significantly lower cerebral rSO2 values and higher fractional tissue oxygen extraction and heart rate values. There were no significant differences in regard to peripheral rSO2 values. Conclusion: During postnatal transition, term infants with a left-to-right shunt via the DA have significantly higher cerebral rSO2 values compared to infants without shunt flow. Copyright © 2013 S. Karger AG, Basel. Source

Cesarean sections are potentially life-saving for neonates with certain congenital anomalies and maternal infections, fetal malpresentation, cephalopelvic disproportion, multiple pregnancies and failure of labor progression. Additionally, there seems to be a significant survival advantage associated with cesarean delivery in extremely preterm infants of less than 25 weeks gestation. The main risk for neonates after cesarean section is the increased respiratory morbidity often requiring admission to an intensive care unit. Consequently, elective cesarean sections without medical indications should not be performed prior to 39 + 0 weeks of gestation. Other risks for the neonate include a delayed initiation of breastfeeding as well as a potentially increased risk for allergic conditions, such as asthma, allergic rhinitis and type 1 diabetes mellitus. The possible impact of increasing numbers of cesarean deliveries on the overall burden of allergic diseases is, however, small at the population level and causality has never been proven. However, it has to be assured that parents are counseled on the short-term and long-term consequences of a cesarean section particularly when performed electively at term on maternal request. © 2013 Springer-Verlag Berlin Heidelberg. Source

Haiden N.,Universitatsklinik For Kinder Und Jugendheilkunde
Monatsschrift fur Kinderheilkunde | Year: 2014

Background: A targeted nutritional management plays a key role in the health and growth of the preterm infant.Material and methods: This review article provides well-known and recent data on the topics of parenteral and enteral nutrition of very low birth weight preterm infants with a birth weight below 1500 g and late preterm infants. New concepts of individually adjusted enrichment of breast milk or human milk-based fortifiers are presented as well as recent data on probiotics and lactoferrin. In addition, relevant aspects of discharge management are discussed.Results: In parenteral nutrition an early onset and “aggressive” continuation are important issues to avoid growth restriction. New generations of lipid emulsions administered i.v. are available providing optimized immunomodulatory properties due to the favorable fatty acid profile. Standardized enteral feeding regimens including breast milk as the primary feeding source contribute to the prevention of necrotizing enterocolitis (NEC) and improve feeding tolerance.Conclusion: Adequate nutrition of preterm infants is of great importance because it helps to prevent morbidities, such as NEC and osteopenia of prematurity. There is convincing evidence that optimizing nutrition in the early postnatal life of a premature infant also has an impact on better long-term neurodevelopmental outcome later in life. © 2014, Springer-Verlag Berlin Heidelberg. Source

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