bluuebunny/crossref_metadata_2025 huggingface dataset:
Plasticizer, Di(2-ethylhexyl)Phthalate (DEHP), exposure in	neonatal ECMO vs. near-miss ECMO patients
Authors: Eig Matthew , Rais-Bahrami K. , Soldin Steven J. , McCarter Robert , Mendu Damodara R. , Short Billie L. , Luban Naomi L. C.
Published: December 2019

Objective: The plastic used in many medical devices is composed primarily of the plastic polyvinyl chloride (PVC). PVC is made flexible by treating it with chemical compounds called plasticizers. The most commonly used plasticizer is di(2-ethylhexyl) phthalate (DEHP). The general population is exposed daily to DEHP and one of its many metabolites, mono(2-ethylhexyl) phthalate (MEHP), primarily through food and aerosolization of environmental exposure. Exposure rises dramatically in premature or ill neonates, who are exposed to medical devices including enteral, blood and infusion bags, tubes and infusion devices. The rate of leaching of DEHP depends on many factors, including contact with lipophilic solutions and the amount of DEHP found in the product. Highly lipophilic substances readily extract plasticizers from PVC bags and tubes. Our objective was to determine the concentration of DEHP and MEHP in the urine of infants undergoing extracorporeal membrane oxygenation (ECMO) and near-miss ECMO to determine if ECMO results in increased concentrations of DEHP and MEHP in the urine.

Study design: Using an in vivo prospective comparative study design, we evaluated 12 term or near-term neonates requiring ECMO. Our control population included 17 neonates with similar underlying diagnoses, referred to our NICU for ECMO but who ultimately responded to maximal medical therapy without ECMO. Two baseline urine samples were collected on admission to the NICU for DEHP and MEHP analysis on both the ECMO and near-miss populations. Daily urine samples were collected sequentially for five days in both populations. Urine samples were collected prior to discharge/transfer for both populations. Urinary DEHP and MEHP analysis was performed using tandem mass spectroscopy. Demographic data was collected for each patient.

Results: We enrolled a total of twenty-nine patients in the study. All patients were transported to our NICU from outside birthing centers. Twelve neonates required ECMO support. The other seventeen patients responded to maximal medical therapy without ECMO. The mean DEHP for the ECMO group was 38.0 (95% CI=29.6, 47.5) compared to 33.0 (95% CI = 26.6, 40.1) in the near-miss group. The mean MEHP for the ECMO group was 29.8 (95% CI=22.4, 38.2) compared to 26.1 (95% CI=20.6, 32.3) for the near-miss group.

Conclusion: Even though urinary levels of DEHP and MEHP were slightly higher in the ECMO group compared to the near-miss group, these differences were not statistically significant.
Thermal responses of the newborn pig: In vivo	comparison of two prototype hybrid systems to standard care neonatal warming
Authors: Lindemann Rolf , Hubert Terrence L. , Wu Jichuan , Agnew Catherine , Shaffer  , Wolfson Marla R.
Published: December 2019

Objective: Underdeveloped thermoregulatory capability predisposes the preterm infant to metabolic instability. An ideal incubator environment should reduce thermal challenges of routine care. We compared the thermal responses of the newborn pig to clinical manipulations in 2 incubators and the impact of a heating blanket on these responses.

Design: Anesthetized, paralyzed, and ventilated newborn pigs were randomized to pre-warmed Caleo® or Giraffe® Omnibed®, with or without a heating blanket, and subjected to warmup and a series of open door perturbations. The temperature variation, time constant, and change in skin temperature were calculated and analyzed by 2-factor analysis of variance.

Results: There were no differences between the incubators during warm-up; incubator plus heating blanket decreased the time constant, independent of device. With the side access door open, the change in skin temperature was less in the Caleo®; the heating blanket attenuated the change in skin temperature in both devices.

Conclusion: These data demonstrate device and clinical manipulation-dependent differences in the thermal responses of the newborn pig.
A score predicting late-onset sepsis in very low birthweight	infants
Authors: Höpfl Anja , Willeitner Andrea , Arenz Tina , Jeremias Irmela , Geiger Ralf , Küster Helmut
Published: December 2019

Objective: To establish a score to predict late-onset sepsis in very low birth weight infants.

Study Design: Two successive prospective multi center studies in very low birth weight infants were used: infants in the first served as calculation cohort, those in the second as validation cohort. Infants were divided into a sepsis group, a non-sepsis group, and an undetermined group by predefined criteria partially based on the sepsis definition by the Robert Koch institute. In the first study 39 parameters recorded daily were compared in the sepsis and the non-sepsis group between Day -3 and Day 0 of sepsis. The score was created combining those parameters with the highest area under the ROC curve.

Results: A score was generated consisting of five clinical and laboratory categories: peripheral circulation, respiration, gastrointestinal tract, general laboratory findings and infection-specific laboratory findings. Sepsis was defined as pathological findings in at least 2 out of these 5 categories. This scoring system reached a sensitivity of 84.0% and a specificity of 91.7% (PPV 87.5% and NPV 89.2%) in discriminating the sepsis group from the non-sepsis group in the validation cohort.

Conclusion: We created a score for early diagnosis of late-onset sepsis in very low birth weight infants. The score may be of value when comparing infants with sepsis in multi center studies.
Severe, multiple congenital malformations after a short	carbimazole exposure
Authors: Lepeytre Caroline , Lacroze Valérie , Capelle Marianne , Nicollas Richard , Simeoni Umberto , Fayol Laurence
Published: December 2019

We studied the case of a newborn infant with severe congenital malformations following carbimazole exposure during the early weeks of pregnancy. The pattern of these malformations – choanal atresia, tetralogy of Fallot, duodenal atresia, dysmorphic features, and hypothelia – is unusual and is consistent with methimazole embryopathy.
Respiratory and cardiovascular morbidity in the first 48 hours post surgical ligation of the patent ductus arteriosus
Authors: Francis J.V. , Padmanabhan S. , Jaques L. , Courtot J. , Sehgal A.
Published: December 2019

Background: Ligation of a patent ductus arteriosus could be associated with severe cardiorespiratory compromise in preterm infants. There is limited data on the incidence, profile and temporal profile of post-operative morbidity. Objective: To assess the incidence, profile and temporal occurrence of cardiovascular and respiratory decompensation during the first 48 hours of postoperative period. Method: Retrospective analysis of the cohort over last seven years (2002–2008) was done and charts reviewed to record demographics and haemodynamic/ventilatory indices. Respiratory decompensation was defined a priori as increase in Fractional inspired oxygen by 0.2, Mean airway pressure by 2 cm H2O, increase in Respiratory Severity Score by 50% or increase in Ventilation Index by 50%. Cardiovascular decompensation was defined as systolic blood pressure <2 standard deviation, addition of inotrope, increase in dosage of previously started inotrope by 5 micrograms/kg/min or need for hydrocortisone. Data was plotted under 4 time epochs; 0–6, 6–12, 12–24 and 24–48 hours after surgical intervention. Results: Forty eight infants underwent duct ligation during the period. Mean gestational age and birthweight were 26.1 ± 1.3 weeks and 788 ± 181 g respectively. Respiratory decompensation was seen in 14 (29%) babies (increase in Mean airway pressure and Fractional inspired oxygen each) and 23 (48%) babies (increase in Respiratory Severity Score by 50%). Cardiovascular decompensation was seen in 14 (29%) babies (low systolic blood pressure), and 9 (19%) (addition or increased dosage of inotropes or hydrocortisone). Conclusions: Postoperative period after surgical duct ligation is oftentimes complicated by cardiorespiratory instability. Its knowledge could improve care in critically sick infants.
Staging the ductus arteriosus facilitates identification of neonates at increased risk of respiratory morbidity
Authors: Sehgal A. , McNamara P.J.
Published: December 2019

Background: None of the studies assessing effects of treatment of symptomatic duct on outcomes have considered heterogeneity of ductus arteriosus in terms of clinical and echocardiographic significance. Objectives: To characterize outcomes of neonates who received treatment for a haemodynamically significant ductus arteriosus and were classified according to the ductal staging system. Methods: Neonates were classified according to ductal disease severity score: clinical (C 1–4) and echocardiography (E 1–4) criteria (sum of C-score and E-score) as low-risk (composite score < 6), intermediate risk (composite score = 6) and high-risk (composite score > 6) groups. A comparative evaluation of neonatal demographics, respiratory outcomes and neonatal morbidities was made between low and high risk groups. Results: Data from 45 evaluations of the ductus arteriosus were analysed. Infants in high-risk group had significantly increased median transductal diameter [3.2 mm (2.7, 3.4) vs. 2.5 mm (2.4, 2.7), p = 0.02] and were more likely to require >1 course of indomethacin or surgical ligation. Infants with a high-risk stage were also more likely to require longer duration of oxygen support, home oxygen therapy and a higher, though statistically non-significant, trend for chronic lung disease. In the short term, at the end of the treatment course, no significant alteration in the ventilatory requirements was noted. Conclusions: Staging the ductus arteriosus may facilitate the identification of neonates at greatest risk of neonatal respiratory morbidity. It may also shed more light as to which babies, if any, benefit from therapeutic intervention. In this cohort, treatment with indomethacin did not reduce the morbidities assessed.
Whole body cooling for treatment of and antecedents of neonatal encephalopathy: The Children's National Medical Center's experience May 2006–August 2009, –95 infants
Authors: Baumgart S. , Massaro A.N. , Chang T. , Glass P. , Tsuchida T. , Short B.L.
Published: December 2019

Therapeutic hypothermia has prevented death and brain injury after asphyxiation in 5 randomized trials. Objective: Demonstrate our therapeutic hypothermia program, and compare our results with these randomized trials. Design/Methods: Whole body cooling was performed in 95 infants gestation 36 wks and < 6 hrs of age with severe acidosis, perinatal complications, and/or CPR at birth. Infants were cooled to an esophageal temperature of 33.5°C for 72 hours, then re-warmed slowly. Results of clinical studies, adverse events, and hospital outcomes are reported. Results: 95 neonates (mean weight 3.43 ± 0.68 SD kg, gestation 39 ± 2 wks) were admitted at ages 4:31 ± 1:10 hrs. Umbilical cord pH ranged 6.43–7.36 (median 6.87). Perinatal sentinel events occurred in 51 subjects. 33/95 infants (35%) presented with clinical seizures; 74/95 infants (78%) are surviving; most are now seizure-free having had improvement of EEG during hypothermia; 19/95 (20%) had normal brain MRI, 52 (55%) had ischemic injuries. 63/74 survivors (85%) are home; 44/74 (60%) are fed orally and passed hearing screens. 30/74 (40%) require tube feedings, and/or have uncertain hearing. 11/74 (15%) were discharged to rehabilitation hospitals. 21 deaths occurred (21/95, 22%): 2 died suddenly on life support while cooling, with no response to CPR. 83% of survivors have been seen in followup; 53% have been seen at ≥9 months. Fifty percent of all followups seen have had normal neurodevelopmental exams. Conclusions: Hypothermia can be instituted safely with mortality and short term morbidity commensurate with 5 previous studies published or otherwise reported. Neurodevelopmental follow up continues.
Fetal arrhythmia: An institutional experience
Authors: Sivanandam S. , Kebed K. , Dorostkar P.
Published: December 2019

Fetal arrhythmias occur commonly, but most are benign. Clinically significant arrhythmias should be distinguished and managed. Supraventricular tachycardia (SVT) and severe bradycardia from complete heart block (CHB) can progress to heart failure and hydrops fetalis. This retrospective review of 2042 fetal echocardiograms aims to characterize an institutional experience with fetal arrhythmias. 131 fetuses were referred for arrhythmia evaluation. Premature atrial contractions (PACs) were found in 67 (51%) of which a third had a prominent atrial septal aneurysm. 49 (37%) had sinus rhythm (no noted arrhythmia). 15 (11%) had hemodynamically significant arrhythmias, which included fetal tachycardias in 12 (9%) and CHB in 3 (2%). All fetuses with tachycardia had structurally normal hearts. 10 had fetal SVT (3 with hydrops and 7 without hydrops) and 2 had atrial flutter (1 with hydrops and 1 without hydrops). All fetuses in tachycardia were converted to sinus rhythm and 2 required antiarrhythmic treatment after birth. CHB was found in 3 fetuses. Major cardiac malformations and hydrops were noted in 2 of these fetuses, both resulting in fetal demise. The third fetus with CHB had a structurally normal heart, was associated with maternal systemic lupus erythematosus (positive SS-A, SS-B antibodies), and required a pacemaker after birth. PACs and sinus rhythm were the most common diagnosis in fetuses referred for arrhythmia evaluation. Despite the presence of hydrops, SVTs responded well to maternal administration of antiarrhythmic therapy and were successfully converted to sinus rhythm. CHB can be associated with maternal autoimmune disease and certain cardiac malformations. The prognosis of CHB in the presence of cardiac disease is poor.
Do neonatologists and parents share the same concerns about animal-derived pharmaceutical agents?
Authors: Sarkar S. , Donn S.M.
Published: December 2019

Objective: The purpose of the study was to explore and compare parents' and neonatologists' views regarding animal-derived versus synthetic medications. Methods: Questionnaires were distributed to the Directors of US neonatology divisions and to parents of the newborns admitted to a tertiary level neonatal intensive care unit (NICU). Results: Of the 98 neonatologists and 150 parents contacted, 66 (67%) neonatologists and all parents responded. The majority (92%) of neonatologists were concerned about exposure of newborns to animal products, and 54% of the parents preferred synthetic agents of comparable efficacy over an animal-derived agent for their infant. Safety was the prime concern in 58% of the parents for choosing a synthetic version, while another 27% expressed social or religious objections to the use of animal-derived agents. In all, 99 (67%) of the 150 parents want to be informed if an animal-derived agent is administered to their newborn. However, when prescribing medications, 97% of the neonatologists never or only occasionally discuss the source of the medications. Conclusion: Concerns about exposure of newborns to animal-derived agent do exist. However, the majority of responding neonatologists do not discuss the source of medications and/or concerns about administering animal-derived agents with parents.
Congenital lactic acidosis and mitochondrial disease – when to suspect and how to manage
Authors: Nesbitt V. , Bartlett K. , Taylor R.W. , McFarland R.
Published: December 2019

Congenital lactic acidosis presents in the newborn period, usually in a symptomatic infant (hypotonia, weakness, respiratory failure), and has a poor prognosis. The underlying aetiology may be an inborn error of metabolism, including Lethal Infantile Mitochondrial Disease (LIMD). In LIMD, lactic acidosis arises because poorly functioning mitochondria do not allow oxidation of pyruvate, which in turn leads to an accumulation of lactate as a by-product of anaerobic metabolism. Lactic acidosis may be the first clue to an underlying mitochondrial disease. In this article we will review the physiology of lactate metabolism, highlight clinical features associated with congenital lactic acidosis, and explore management options in order to make a diagnosis of mitochondrial disease.
Testing a new NIRS method to measure regional mesenteric tissue oxygen saturation in preterm infants that compensates for meconium and transitional stool interference
Authors: Said M.M. , Niforatos N. , Rais-Bahrami K.
Published: December 2019

Objective: Simultaneous monitoring of cerebral and mesenteric tissue saturations were recorded in preterm neonates using near infrared spectroscopy (NIRS) to evaluate if NIRS method can be improved to compensate for the optical absorption properties of stool interference, particularly meconium and transitional stools, in order to reliably measure gastrointestinal (GI) tissue oxygen saturation. Study design: With parental agreement, we used a 4-wavelength cerebral & tissue oximeter (FORE-SIGHT®, CAS Medical Systems, Branford, CT USA) to monitor premature neonates. The NIRS sensors were placed in the right lower quadrant of the abdomen and the forehead, with continuous data collection every 2 seconds for 72 hours. Simultaneously, continuous peripheral pulse oximetry (SpO2) was recorded. Feeding regimens, stooling patterns and clinical outcomes were recorded. Raw data from FORE-SIGHT were recorded and analyzed using a prototype neonatal stool compensation algorithm. Results: Twenty-three preterm neonates with adjusted gestational ages of 26–34 weeks, weighing 740–1930 grams were studied. NIRS stool interference level was determined for all subjects, and found to be extremely variable. High and Very High stool interference occurred for subjects passing meconium. Moderate and High stool interference resulted in erroneously computed very low GI StO2 using traditional NIRS methods. Stool compensated GI StO2 measurements showed a higher correlation to cerebral SctO2 and pulse oximetry SpO2 in subjects with healthy bowel. Conclusion: Measurement of mesenteric saturations via NIRS proves to be a useful tool in neonates. A NIRS algorithm that compensates for interference caused by meconium and transitional stools shows promising results to measure GI StO2 accurately.
Congenital depressed fracture of the skull in a neonate
Authors: Atay E. , Tokmak M. , Can E. , Ovali F.
Published: December 2019

Objective: Congenital depression of the skull is a rare event and the cause is not always clear. It may be complicated by brain injury, hematoma and epilepsy. This case is presented to draw attention to this rare congenital disorder which may raise suspicions in the family and discuss treatment options. Description: This baby boy was born at term by cesarean section and the depressed fracture of the right parietal bone, 5 cm × 4 cm, with a depth of 7.7 mm was noted at the first examination. Conventional and 3-dimentional computed tomography of the skull confirmed the diagnosis. The neurological examination was unremarkable. The depressed portion was elevated by surgery; the baby was growing well in the first month. Comments: Skull fracture is frequently assumed to have resulted from trauma, but it may occur prenatally.
Neurodevelopmental profile of children of a high-risk neonatal program: A follow-up study from Saudi Arabia
Authors: Alqahtani M.M.J. , Alaql F.
Published: December 2019

Introduction: Preterm infants are at increased risk for neurodevelopmental deficits. These deficits may be alleviated with early intervention. There has been no study to assess neurodevelopment of high risk neonates in Saudi Arabia. Objective: To assess the neurodevelopmental features of preterm (≤29 weeks or ≤1.25 kg) infants who were admitted over a two-year period following birth at a tertiary care neonatal intensive care unit (NICU). Methods: This study used a pool of standardized psychometric scales: Vineland Adaptive Behavior Scales, Bayley Scales of Infant Development, and Stanford-Binet Intelligence Test. Follow-up assessments were applied to examine 168 infants at 18 months; 96 of them were re-evaluated at 3 years. Results: Major neurodevelopmental abnormalities were present in 26 (15.50%) and 11 (11.46%) children, at 18 months and 3 years, respectively. The two scales: Bayley vs. Vineland at 18 months, and the two scales: Stanford-Binet vs. Vineland at 3 years were correlated significantly: χ2 (1, N = 168) = 58.07, P < 0.001; and χ2 (1, N = 96) = 49.45, P < 0.001, respectively. Nevertheless, Bayley scale and Stanford-Binet test were more likely to detect neurodevelopmental impairment among children at 18 months and 3 years, respectively. Conclusions: Infants born at the NICU at King Fahd Medical Center (KFMC), have rates of neurodevelopmental outcomes that are similar to those reported in other studies. This study confirms that need for developmental screening to detect preterm infants with special needs. Neurodevelopmental outcomes for the cohort managed at KFMC were similar to previously published data on preterm infants elsewhere.
Tracheal agenesis: Respiratory distress, aphonia and emergency airway management
Authors: Pun P. , Merritt T.A. , Zuppan C.
Published: December 2019

Tracheal agenesis is an extremely rare usually fatal congenital anomaly presenting with respiratory distress and aphonia. We present a case of tracheoesophageal fistula, in which an endotracheal tube failed to be placed; alternatively the infant was partially venitlated via an endoesophageal tube. A delayed transfer of the infant and inability to perform an urgent tracheostomy led to the infant's demise. Floyd described 3 different phenotypes of tracheal agenesis. The anomaly is thought to be due to errors in development occurring during the division of the foregut into the esophagus and the trachea. Affected neonates uniformly present in the immediate postnatal period with severe respiratory distress and aphonia. Endotracheal intubation is difficult, often with multiple failed attempts and inability to advance the tube below the vocal cords. Ventilation with a tube placed in the esophagus can temporarily sustain life in the presence of a fistula as in this case. The condition can occur in isolation or in association with malformations in organ systems other than the lungs, airway and esophagus. New approaches for reconstruction of the trachea have been reported and regenerative medicine may have a future role.
Late intraventricular hemorrhage in preterm infants
Authors: Vartanian R.J. , Attar M. , Donn S.M. , Sarkar S.
Published: December 2019

Objective: To determine the likelihood of intraventricular hemorrhage (IVH) occurring after the first three days of life and to develop a predictive model for late IVH in preterm infants. Methods: A retrospective study was conducted on very low birth weight infants with grades IVH II-IV. IVH was considered early if detected by ultrasound within the first three days of life and it was considered late if detected beyond this time. Infants with late IVH had at least one documented negative ultrasound scan on or after day of life three. Data were evaluated for associated risk factors using univariate and logistic regression analyses. Results: One-hundred thirty infants with IVH grades II-IV met the inclusion criteria. Early IVH occurred in 82 (63%) and late IVH occurred in 48 (37%). Infants with late IVH were more commonly exposed to prenatal steroids (OR 4.2, 95% CI 1.5–12.0), cesarean delivery (OR 2.8, 95% CI 1.1–7.0), or had symptomatic PDA requiring medical or surgical therapy prior to IVH detection (OR 12.0, 95% CI 3.8–37.7) compared to infants with early IVH. Conclusions: IVH after day of life three is not rare in VLBW infants. Further exploration of risk factors associated with late IVH compared to infants without IVH through interventional trials is warranted.
A novel mutation in surfactant protein-B gene resulting in fatal neonatal respiratory distress in an Indian family
Authors: Amin Z. , Lee J. , Nga M.E.
Published: December 2019

Hereditary surfactant deficiency remains elusive as a definitive diagnosis for full-term newborns presenting with intractable respiratory failure. We present a patient with a novel point mutation resulting in hereditary Surfactant Protein-B (SP-B) deficiency. A term female developed intractable respiratory failure soon after birth and died of respiratory failure at 2 months of age despite aggressive management. Genetic testing for the common mutation for SP-B (121ins2) and ABCA3 gene mutation was negative. Further genetic testing showed a novel mutation in the SP-B gene (c.1032insGCC). Both parents are heterozygous for the same gene mutation, thus confirming an autosomal recessive pattern of inheritance. This mutation has only been seen previously in 2 other infants, also of Indian subcontinent origin. We suggest heightened vigilance and consultation with a reference laboratory in detecting similar mutations in term newborns presenting with unexplained respiratory failure. This will primarily help in the counseling of future pregnancies for the affected families.
Perinatal common mental disorders and breastfeeding duration: A cohort study from Brazil
Authors: Faisal-Cury A. , Lauletta A.L. , Datti I. , Oliveira A.F. , Huang H. , Menezes P.R.
Published: December 2019

Objective: The aim of this study was to prospectively evaluate the relationship between common mental disorders (CMD) during the antenatal and the postpartum period and breastfeeding for less than four months (BF <4). Methods: A prospective cohort study conducted between May 2005 and March 2007 included 701 pregnant women recruited from primary care clinics of the public sector in São Paulo, Brazil. The followings instruments were in effect: antenatal and postnatal CMD were measured with the Self Report Questionnaire (SRQ-20); social support was assessed with a Brazilian version of the scale used in the Medical Outcomes Study, and questionnaires were employed to obtain socio-demographic, socioeconomic, obstetric, and breastfeeding information. The primary outcome was breastfeeding for BF <4. Crude and adjusted risk ratios (RR), with 95% confidence intervals (95% CI), were calculated using Poisson regression to examine the associations between BF <4 and CMD. Results: BF <4 occurred in 22.8% of the cohort. In the univariate analysis BF <4 was associated with lower maternal age, not having a partner, lower wealth score, having a previous miscarriage, newborn oral tracheal intubation, and CMD in the antenatal and postpartum period. In the multivariate analysis, the following variables were independently associated with BF <4: maternal age (RR: 0.62 (95% CI: 0.39–0.98), newborn oral tracheal intubation (RR: 1.85 (95% CI:1.28–2.65) and CMD during both the antenatal and postpartum (RR: 1.38 (95% CI: 0.98 : 1.95) periods. Conclusion: Among women who have a CMD both during the antenatal and postpartum period, there is a decreased likelihood for breastfeeding longer than 4 months.
Non anthrax bacillus species meningo-encephalitis with diabetes insipidus in a preterm infant
Authors: Hasan M.N. , Pourcyrous M. , Talati A.J.
Published: December 2019

Bacillus cereus, a Gram-positive, aerobic spore forming rod, is ubiquitous. Isolation of Bacillus cereus from a normally sterile site (i.e. blood or cerebrospinal fluid) is often disregarded by clinicians as a specimen contamination. We report a case of a 32-week small for gestational age twin preterm infant, of 839 grams birth weight, with non-anthrax bacillus species meningitis. There have been very few reports of meningitis and brain abscesses with these bacteria in low risk preterm infants. Our case was unusual with the development of central diabetes insipidus following bacillus meningoencephalitis and brain abscess. It draws attention to the severe morbidity caused by a relatively benign and usually ignored organism.
A preterm infant with early Bacteroides fragilis meningitis and bilateral subdural empyema: Literature review and treatment options
Authors: Goodwin A.J. , Reed-Day H. , Walle-Ramirez K. Vande , Boulden T.F. , Pourcyrous M.
Published: December 2019

We report a case on a low birth weight infant who developed early onset meningitis with bilateral occipital empyema. The pathogen isolated from the cerebral spinal fluid was Bacteroides fragilis, an anaerobic Gram negative bacillus of the gut, rarely reported as an etiology of neonatal meningitis.
Effects of the progressive walking-to-running technique on gait kinematics, ultrasound imaging, and motor function in spastic diplegic cerebral palsy – an experimenter-blind case study
Authors: Lee Nam Gi , Jeong Su Ji , You Joshua (Sung) Hyun , Cho Kang Hee , Lee Tae Heon
Published: December 2019

Purpose:

The purpose of this study was to investigate the effects of the progressive walking-to-running technique (PWRT) in a child with spastic diplegic cerebral palsy (CP).

Design:

A single case study with pre-/post-test.

Subject:

An 11-year-old male, diagnosed with spastic diplegic CP.

Methods:

The PWRT was provided for 60 minutes a day, 2 times a week for 12 weeks. Gross motor function tests, ultrasound imaging, hand-held dynamometer, and the Vicon motion capture system were used to determine motor function, muscle size and strength, and gait kinematics.

Results:

Gross motor function was improved after the intervention. The size of right and left rectus femoris and tibialis anterior muscles in their contracted states were enhanced by 1.36, 5.09, 83.74, and 54.37%, respectively. Associated muscle strength was also increased by 58.8, 30.8, 28.0, and 118.2% in both rectus femoris and tibialis anterior muscles. Left stride length, walking speed, maximal flexion-extension angular excursion of the hip joint were enhanced by 95.7, 87.8, and 100.4% after PWRT, respectively.

Conclusions:

Our novel walking-running training paradigm was effective for restoring gait and running ability in a child with spastic diplegic CP.
Recovery of an injured corticospinal tract during a critical period in a patient with intracerebral hemorrhage
Authors: Kwon Hyeok Gyu , Choi Byung Yeon , Chang Chul Hoon , Kim Seong Ho , Jung Young Jin , Jang Sung Ho
Published: December 2019

Most of the motor recovery in stroke occurs within 3 months after stroke onset and this period has been regarded as critical for motor recovery. Little is known about the motor recovery process during the critical period of stroke. We report on a patient with intracerebral hemorrhage (ICH) who showed recovery of an injured corticospinal tract (CST) during the critical period for motor recovery. A 43-year-old woman underwent conservative management for a spontaneous ICH in the right corona radiata and basal ganglia. She presented with complete left hemiplegia at the onset of ICH. She showed continuous and slow recovery, and consequently, she was able to flex her left fingers without gravity at 6 weeks after onset and extend the left fingers without gravity at 12 weeks. The 3- and 6-week DTTs showed that the right CST was discontinued around the hematoma. However, the 12-week DTT revealed that the right CST was originated from the right primary motor cortex and descended along the CST pathway. No motor evoked potential (MEP) was evoked from the right hemisphere on the 3- and 6-week TMS study. However, on the 12-week TMS study, an MEP which had the characteristics of the CST was evoked from the right hemisphere to the left abductor pollicis brevis muscle. Our results indicate that the injured right CST had been recovered between 6 weeks and 12 weeks after ICH onset. Consequently, we believe that this case demonstrated the recovery process of a severely injured CST during the critical period for motor recovery after ICH.
Effects of listening to pleasant music on chronic unilateral neglect: A single-subject study
Authors: Tsai Pei-Luen , Chen Mei-Ching , Huang Yu-Ting , Lin Keh-Chung
Published: December 2019

Recent studies suggest that the positive emotion induced by pleasant music may improve cognitive functions. We used the single-subject design to study whether listening to preferred music may reduce unilateral neglect in two participants with post-stroke neglect. These participants were instructed to listen to their preferred music every day for 5 weeks, followed by 2 weeks of follow-up assessment. Outcome measures involved the Star Cancellation Test, the Line Bisection Test, and the visual exploration task. A combination of visual analysis and the two-standard-deviation band method was used for data analysis. Both participants showed significant intervention-related improvements on all outcome measures except the Line Bisection Test, on which one participant showed no improvement. The therapeutic effects were maintained during the follow-up phase. The findings suggest that positive emotion, evoked by preferred music, may be used to ameliorate unilateral neglect. Further research using controlled trials is warranted to validate the findings.
Endurance exercise training protects against the upregulation of nitric oxide in the striatum of MPTP/probenecid mouse model of Parkinson's disease
Authors: Al-Jarrah Muhammed , Obaidat Heyam , Bataineh Ziad , Walton Lori , Al-Khateeb Ahed
Published: December 2019

Objectives:

Parkinson’s disease (PD) is a neurodegenerative disorder, caused by the gradual loss of cells in substantia nigra. Nitric oxide (NO) plays an important role in a variety of signal transduction pathways that are crucial for maintaining the physiologic functions of nervous system. The aims of this study are: 1) To investigate the expression of the inducible form of NO (iNOS), and compare it to neuronal nitric oxide (nNOS) in the brain of a chronic mouse model of PD and 2) To study the effect of endurance exercise training on the expression of these markers.

Method:

Mouse models of PD were obtained using 10 doses of 1-methyl-4-phenyl-1,2,3,6-tetrahydropyridine (MPTP) (25 mg/kg) and probenecid (250 mg/kg) over 5 weeks. Forty C57BL /6 albino mice were randomly divided into four groups: sedentary control (SC, N = 10), exercise control (EC, N = 10), sedentary PD (SPD, N = 10), exercise PD (EPD, N = 10). At the end of training program, nNOS and iNOS were evaluated in the striatum in all animal groups using immunohistochemistry.

Results:

nNOS showed significant increases in striatum (ST) of SPD mice compared to SC mice ( P > 0.03). There was also decreased expression of nNOS in EC group compared to SC mice, but this decrease was not significant ( P > 0.8). Exercise training significantly decreased the level of nNOS in the EPD compared to SPD, ( P > 0.04). Although, iNOS expression followed almost the same trend as nNOS, but exercise training did not significantly decrease the expression of iNOS in both EC and EPD groups, P > 0.2 and 0.3 respectively.

Discussion:

The data from this study suggests that 4 weeks of treadmill exercise has a positive impact on the expression of nNOS and iNOS in the striatum of a PD model. This might clear in part the pathogenicity of the diseases and the positive impact of training on PD.
Critical-Illness-Polyneuropathy as sequelae of severe neurological illness: Incidence and impact on ventilator therapy and rehabilitation
Authors: Schorl Martin , Valerius-Kukula Seung Ja , Kemmer Thomas P.
Published: December 2019

Introduction:

Critical-Illness-Polyneuropathy (CIP) is common in critically ill patients. In contrast to CIP arousing from primary non-neurological causes, studies dealing with CIP following a primary neurological illness are rare. This mono-center, retrospective study was performed to examine a) the incidence of CIP in patients after severe neurological illnesses and b) the impact on ventilator therapy.

Material and Methods:

Retrospective analysis of all patients, admitted for early (post-acute) neurological rehabilitation following severe neurological diseases between 01.01.2006 and 31.12.2010. Patients routinely underwent standard electrophysiological evaluation (nerve conduction studies of 8 motor and 6 sensory nerves; needle electromyography of 6 muscles). Diagnosis of CIP required a) pathological spontaneous activity in at least two muscles and b) reduced compound muscle activity potentials (CMAP) in at least two motor nerves of different extremities.

Results:

CIP was diagnosed in 430 of 623 patients (69.0%). Patients with proven CIP required significantly ( p < 0.001) longer ventilator therapy (33.1 days) in contrast to patients without CIP (21.5 days).

Conclusion:

CIP is common in patients suffering from primary severe neurological diseases. Due to CIP, duration of ventilator therapy is significantly prolonged. In patients with severe neurological diseases electrophysiology is crucial to establish the correct diagnosis.
Psychometric properties of the German version of the health-related quality of life in stroke patients (HRQOLISP) instrument
Authors: Owolabi Mayowa Ojo
Published: December 2019

Objective:

There is lack of a German-language holistic stroke-specific health-related quality of life (HRQOL) measure with therapeutically-oriented domains. The objective of this study was to investigate the psychometric properties of the HRQOL in stroke patients (HRQOLISP) questionnaire in German stroke survivors.

Methods:

Following standard procedure for cross-cultural validation, the HRQOLISP was translated into German. It was completed by 103 German stroke patients and 50 apparently healthy controls. Acceptance, ceiling and floor effects, reliability, as well as content, construct, factorial and known-group's validity were analysed. Stratification was according to modified Rankin, stroke levity and National Institute of Health stroke scales.

Results:

The HRQOLISP was acceptable and holistic with neither ceiling nor floor effect. One-factor solution explained >40% of the variance for most domains. Two-factor solution explained 82% of the variance for the global HRQOL consistent with the conceptual framework distributing the therapeutically-oriented domains into two spheres. Cronbach's α ranged from 0.77 to 0.92 for the domains. The HRQOLISP, though lengthy, covered the entire spectrum of stroke-related HRQOL with no additional item suggested by the German stroke patients. The HRQOLISP demonstrated good convergent and discriminant validity as well as excellent ‘known groups’ validity across disability and stroke severity strata.

Conclusions:

The German version of the HRQOLISP is the first holistic, stroke-specific HRQOLISP measures with therapeutically-oriented domains to be validated in Germany. It is acceptable, reliable and valid but needs to be validated in proxies to facilitate its utility among stroke patients with severe communication problems.
Social behaviour following severe traumatic brain injury: Contribution of emotion perception deficits
Authors: Saxton Melissa E. , Younan Shameran Slewa , Lah Suncica
Published: December 2019

Objective:

This theoretically driven study aimed to determine contribution of emotional perception impairments to social behaviour following traumatic brain injury (TBI).

Methods:

Adults with severe TBI (n = 24) participated. Emotion perception predictors included: (i) appraisal: Montreal Set of Facial Displays of Emotion, The Adapted Story Task, (ii) affective state: Depression, Anxiety and Stress Scale (DASS-21), Interpersonal Reactivity Index (IRI) and (iii) regulation: Delis Kaplan Executive Function System - Colour Word Interference and Word Fluency. Social behavioural outcomes were (i) interpersonal: Key Behaviors Change Inventory (KBCI) - Interpersonal Difficulties and (ii) communication: KBCI - Communication Problems.

Results:

Social behaviours correlated with affective state, but not appraisal or regulation. Simultaneous regression analyses revealed significant independent contributions of affective state: (i) the IRI Perspective Taking to the KBCI Interpersonal Difficulties and (ii) the DASS-21 (composite) and IRI Perspective Taking to the KBCI Communication Problems. The models explained 52% and 72% of the variance of the KBCI Interpersonal Difficulties and Communication Problems respectively.

Conclusions:

This study provides evidence that impairments in certain aspects of emotion perception: affective state [empathy (perspective taking) and mood], but not appraisal and regulation, contribute to social behaviour difficulties in patients with severe TBI, which has important implications for rehabilitation.
Benefits of inpatient multidisciplinary rehabilitation in multiple sclerosis
Authors: Salhofer-Polanyi Sabine , Windt Judith , Sumper Harald , Grill Hermine , Essmeister Maria , Diermayr Gudrun , Zebenholzer Karin , Leutmezer Fritz , Zulehner Gudrun , Vass Karl , Asenbaum-Nan Susanne
Published: December 2019

Background:

Rehabilitation is often recommended to MS-patients but data on its efficacy is limited.

Objective:

To evaluate the benefit of inpatient multidisciplinary rehabilitation.

Methods:

A rater-blinded, randomized, waiting list controlled exploratory study. 19 participants completed the study with ten allocated to the intervention and nine to the waiting list group. Assessment of outcome-parameters was done at baseline and after 3 months. Time Walking Tests (TWTs) and 9 Hole Peg Test were used to objectively assess the level of activity, Functional-Assessment-in-MS and MS-Self Efficacy-Scale to assess participation and quality of life and Expanded Disability Status Scale (EDSS) to assess bodily function. Additionally Rivermead Mobility Index, Berg Balance Scale, Tinetti-Test, MS-Functional Composite and a rater-blinded evaluation of a video-analysis on walking performance was done.

Results:

Mean change scores of Timed 50 meter Walk (p = 0.014), walking speed (p = 0.034), 2- (p = 0.204) and 6-Minute Walk (p = 0.027) indicated an improvement favoring inpatient multidisciplinary rehabilitation. We could not demonstrate a benefit for upper limb function and some improvement was seen in other outcome-parameters without reaching statistical significance. EDSS remained unchanged.

Conclusion:

Inpatient multidisciplinary rehabilitation is effective in MS patients with positive impact on the level of activity as measured by TWTs covering both short and long distance ambulation.
The effects of pilates on balance, mobility and strength in patients with multiple sclerosis
Authors: Guclu-Gunduz Arzu , Citaker Seyit , Irkec Ceyla , Nazliel Bijen , Batur-Caglayan Hale Zeynep
Published: December 2019

Background:

Although there are evidences as to Pilates developing dynamic balance, muscle strength and flexibility in healthy people, evidences related to its effects on Multiple Sclerosis patients are insufficient.

Objectives:

The aims of this study were to investigate the effects of Pilates on balance, mobility, and strength in ambulatory patients with Multiple Sclerosis.

Methods:

Twenty six patients were divided into two groups as experimental (n = 18) and control (n = 8) groups for an 8-week treatment program. The experimental group underwent Pilates and the control group did abdominal breathing and active extremity exercises at home. Balance and mobility were measured with Berg Balance Scale and Timed up and go test, upper and lower muscle strength with hand-held dynamometer. Confidence in balance skills while performing daily activities was evaluated with Activities Specific Balance Confidence Scale.

Results:

Improvements were observed in balance, mobility, and upper and lower extremity muscle strength in the Pilates group (p < 0.05). No significant differences in any outcome measures were observed in the control group (p > 0.05).

Conclusion:

Due to its structure which is made up of balance and strengthening exercises, Pilates training may develop balance, mobility and muscle strength of MS patients. For this reason, we think that, Pilates exercises which are appropriate for the disability level of the patient may be suggested.
Relationship between lower extremity isometric muscle strength and standing balance in patients with multiple sclerosis
Authors: Citaker Seyit , Guclu-Gunduz Arzu , Yazici Gokhan , Bayraktar Deniz , Nazliel Bijen , Irkec Ceyla
Published: December 2019

Background:

Muscle strength and standing balance decrease in patients with Multiple Sclerosis (MS).

Objective:

The aim of the present study was to investigate the relationship between the lower extremity isometric muscle strength and standing balance in patients with MS.

Methods:

Forty-seven patients with MS and 10 healthy volunteers were included. Neurological disability level was assessed using Expanded Disability Status Scale (EDSS). Isometric strength of seven lower extremity muscles (hip flexor-extensor-abductor-adductor, knee flexor-extensor, and ankle dorsal flexor) was assessed using hand-held dynamometer. Duration of static one-leg standing balance was measured using digital chronometer.

Results:

Hip flexor-extensor-abductor-adductor, knee flexor-extensor, and ankle dorsal flexor isometric muscle strength, and duration of one-leg standing balance were decreased in patients with MS when compared with controls (p < 0.05). All assessed lower extremity isometric muscle strength and EDSS level was related duration of one-leg standing balance in patients with MS. All assessed lower extremity isometric muscle strength (except ankle dorsal flexor) was related with EDSS.

Conclusions:

Hip flexor-extensor-abductor-adductor, knee flexor-extensor, and ankle dorsal flexor isometric muscle strength decreases in ambulatory MS patients. Lower extremity muscle weakness and neurological disability level are related with imbalance in MS population. Hip and knee region muscles weakness increases the neurological disability level. For the better balance and decrease neurological disability level whole lower extremity muscle strengthening should be included in rehabilitation programs.