BackgroundSince an objective description is essential to determine infant’s postnatal condition and efficacy of interventions, two scores were suggested in the past but weren’t tested yet: The Specified-Apgar uses the 5 items of the conventional Apgar score; however describes the condition regardless of gestational age (GA) or resuscitative interventions. The Expanded-Apgar measures interventions needed to achieve this condition. We hypothesized that the combination of both (Combined-Apgar) describes postnatal condition of preterm infants better than either of the scores alone.MethodsScores were assessed in preterm infants below 32 completed weeks of gestation. Data were prospectively collected in 20 NICU in 12 countries. Prediction of poor outcome (death, severe/moderate BPD, IVH, CPL and ROP) was used as a surrogate parameter to compare the scores. To compare predictive value the AUC for the ROC was calculated.ResultsOf 2150 eligible newborns, data on 1855 infants with a mean GA of 286/7 ± 23/7 weeks were analyzed. At 1 minute, the Combined-Apgar was significantly better in predicting poor outcome than the Specified- or Expanded-Apgar alone. Of infants with a very low score at 5 or 10 minutes 81% or 100% had a poor outcome, respectively. In these infants the relative risk (RR) for perinatal mortality was 24.93 (13.16-47.20) and 31.34 (15.91-61.71), respectively.ConclusionThe Combined-Apgar allows a more appropriate description of infant’s condition under conditions of modern neonatal care. It should be used as a tool for better comparison of group of infants and postnatal interventions.Trial registrationclinicaltrials.gov Protocol Registration System (NCT00623038). Registered 14 February 2008.Electronic supplementary materialThe online version of this article (doi:10.1186/s12887-015-0334-7) contains supplementary material, which is available to authorized users.

Infections caused by Panton-Valentine leukocidin-positive Staphylococcus aureus (PVL-SA) mostly present as recurrent skin abscesses and furunculosis. However, life-threatening infections (eg, necrotizing pneumonia, necrotizing fasciitis, and osteomyelitis) caused by PVL-SA have also been reported.We assessed the clinical phenotype, frequency, clinical implications (surgery, length of treatment in hospitals/intensive care units, and antibiotic treatments), and potential preventability of severe PVL-SA infections in children.Total, 75 children treated for PVL-SA infections in our in- and outpatient units from 2012 to 2017 were included in this retrospective study.Ten out of 75 children contracted severe infections (PVL-methicillin resistant S aureus n = 4) including necrotizing pneumonia (n = 4), necrotizing fasciitis (n = 2), pyomyositis (n = 2; including 1 patient who also had pneumonia), mastoiditis with cerebellitis (n = 1), preorbital cellulitis (n = 1), and recurrent deep furunculosis in an immunosuppressed patient (n = 1). Specific complications of PVL-SA infections were venous thrombosis (n = 2), sepsis (n = 5), respiratory failure (n = 5), and acute respiratory distress syndrome (n = 3). The median duration of hospital stay was 14 days (range 5–52 days). In 6 out of 10 patients a history suggestive for PVL-SA colonization in the patient or close family members before hospital admission was identified.PVL-SA causes severe to life-threatening infections requiring lengthy treatments in hospital in a substantial percentage of symptomatic PVL-SA colonized children. More than 50% of severe infections might be prevented by prompt testing for PVL-SA in individuals with a history of abscesses or furunculosis, followed by decolonization measures.

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End-of-life opioid administration to primary comfort care patients in the DR differs fundamentally from NICU or PICU handling of dying patients. Once patients are admitted to an intensive care unit, practice and attitudes towards end-of-life opioid administration are similar in NICUs and PICUs.

Hintergrund: Im deutschsprachigen Raum existieren bislang relativ wenige Studien, die sich mit den Veränderungen der weiblichen Sexualität nach einer Entbindung beschäftigen. Neben der Prävalenz postpartaler sexueller Dysfunktion sind insbesondere eventuelle Prädiktoren für ein verändertes Erleben bedeutsam. Diese Fragen wurden im Rahmen der vorgestellten Studie untersucht. Methoden: Untersucht wurden 236 Frauen, die in der Zeit zwischen November 2000 und Mai 2001 in der Universitätskli-nik Bonn entbunden haben. Ein erster Erhebungszeitpunkt war wenige Tage nach der Entbindung (Soziodemographie, Charakteristika von Schwangerschaft und Entbindung sowie Persönlich-keitsstruktur mittels NEO-FFI), ein zweiter 6,6 ± 0,8 Monate postpartal (BSPS = Bonner Skala zur Erfassung postpartaler Sexualität und Erfassung der psychischen Symptome mit der SCL-90-R). Ergebnisse: Ein halbes Jahr nach Entbindung erlebten 40,6% der Frauen ihre Sexualität im Vergleich zu der Zeit vor der Schwangerschaft als qualitativ verschlechtert; 23,2 % gaben eine Verschlechterung der Partnerschaft an. Als möglicherweise relevante Kovariablen der Veränderung der Sexualität wurden Alter, Stillen, Schwangerschaft nach Fertilitätsbehandlung, Art der Verhütungsmethode und psychische Symptombelastung identifiziert. Eine Veränderung in der Qualität der Partnerschaft korrelierte mit Familienstand und der psychischen SymptombelasAbstract Background: To date there is only a limited number of study data on the changes in the perceived quality of sexuality and relationships of women that occur with pregnancy and childbirth. Apart from prevalence issues predictors for those changes are important. These questions were addressed with this epidemiological follow-up study. Methods: The study sample consisted of 236 women who gave birth to a child between November 2000 and May 2001 at Bonn University Hospital in Germany. A first visit took place at the hospital a few days after childbirth. Data included sociodemographic data, medical and gynecological data as well as personality traits using the NEO-FFI. A second visit took place 6.6 ± 0.8 months after childbirth. It included the BSPS (Bonn Scale for Post-Partum Sexuality) and psychiatric symptoms using the SCL-90-R. Results: Approximately six months after childbirth 40.6 % of women perceived a diminished quality of sexual life compared to the time before pregnancy. 23.2 % indicated a diminished relationship quality. The potentially relevant co-variables regarding the changes in sexual quality were age, breast feeding, fertilization, use of contraceptives and presence of psychiatric symptoms. With the changes in relationship quality there were correlations with marital status, conscientiousness, and psychiatric symptom load. Discussion: The majority of women six months after childbirth did not return to Originalarbeit Heruntergeladen von: Karolinska Institutet. Urheberrechtlich geschützt. Key wordsChildbirth · puerperal · sexuality · sexual dysfunction · risk factors Berner MM et al. Erleben der Sexualität nach Schw...