Our data show that infants with sonographic signs of brain atrophy at discharge achieve lower scores in neurodevelopmental testing at 3 y.

Background: Intraventricular haemorrhage and periventricular leukomalacia are associated with poor outcome of very preterm infants, while the role of more subtle cerebral alterations, as detected by cranial ultrasound, is less clear. Aim: In this study, we related periventricular echodensities and signs of brain atrophy to neurodevelopmental outcome at 3 y of age. Patients and methods: All preterm infants born in 1997 in our institution with a gestational age <32 wk or birthweight <1500 g were subjected to repeated standardized cranial ultrasound examinations until discharge. Survivors were examined at 3 y of age employing the Bayley Scales of Infant Development II. Results: Eighty‐seven infants were enrolled (birthweight 430–2500 g (median 1200 g), gestational age 24–34 wk (median 29 wk)). Periventricular echodensities were detected in 42 infants (48%); in 12 cases persisting <7 d, in 30 cases >7 d. At discharge, 18 infants (22%) had signs of brain atrophy. Neurodevelopmental outcome was assessed in 64 infants. Infants with signs of brain atrophy scored significantly lower on MDI (atrophy 91.8, no atrophy 101.9; p=0.02), PDI (atrophy 91.4, no atrophy 106.5; p=0.001) and Behaviour Rating Scale (atrophy 41.1, no atrophy 66.4; p=0.01) than infants without atrophy. Periventricular echodensities were not related to outcome. Conclusion: Our data show that infants with sonographic signs of brain atrophy at discharge achieve lower scores in neurodevelopmental testing at 3 y.

Background Antimicrobial therapy is recommended to eradicate Helicobacter (H.) pylori in infected individuals. As first‐line treatments are empiric, knowledge of antimicrobial resistance is key to successful eradication. Aims We investigated primary resistance in an eastern German region to derive recommendations for eradication treatment. Methods We used molecular genetic methods to examine Helicobacter rapid urease test (RUT) positive gastric specimens of 533 patients from Berlin and the federal state of Brandenburg with allegedly no prior eradication treatment. Tissue samples were removed from RUT and screened by real‐time PCR for mutations conferring resistance to clarithromycin. In addition, 182 samples out of 533 were tested for resistance to levofloxacin and tetracycline. Results Primary resistances were 10.9% (58 out of 533) to clarithromycin; 13.7% (25/182) to levofloxacin; and 2.2% to tetracycline (4/182). Combined resistance to clarithromycin/levofloxacin was low (2.2%, 4/182). Female sex was significantly associated with clarithromycin resistance. Conclusion Clarithromycin may be a suitable first‐line antibiotic for about 90% of outpatients. A simple molecular test may help physicians avoid prescription of an ineffective first‐line regimen.

Background: The outcome of premature infants is mainly determined by lung function in the first days of life. The pulmonary surfactant (SF) system plays a major role in maintaining lung function and is strongly impaired in the premature lung. We aimed to investigate surfactant protein (SP) levels in tracheal aspirates (TA) of preterm infants and their relation to perinatal complications. Methods: 45 intubated and mechanically ventilated preterm infants (median 27, range 23-31 weeks gestational age; GA), all suffering from respiratory distress syndrome (RDS), were prospectively included in the study. TA were obtained in the first 12 hours of life before SF treatment following a standardized study protocol, SPA , B, C and D concentrations were determined by means of ELISA techniques and normalized to the phospholipid (PL) concentration of each sample. Clinical variables were monitored. 12 pulmonary healthy infants (0-4 months of age), intubated before elective surgery, served as control group. Mann-Whitney U test was performed for statistical analysis. Results: Levels of SP-C (0.53; 0.11-5.82 % (w/w) SP-C/PL) and SP-D (0.0011; 0.0002-0.0207 % (w/w) SP-D/PL) were significantly reduced in preterm infants Ͻ32 weeks GA compared to controls (1.80; 0.38-6.06 % SP-C/PL, pϽ0.01; 0.0118; 0.0029-0.0233 % SP-D/PL, pϽ0.005; median and range each). In contrast, SP-B concentrations were significantly elevated in preterms (0.41; 0.14-1.74 % (w/w) SP-B/PL) compared to controls (0.20; 0.15-0.45 % (w/w) SP-B/PL, pϽ0.005), whereas SPA was not significantly different between the groups. SP-C concentrations were significantly elevated in the group of preterms delivered by c-section with contractions (0.62; 0.47-0.86 vs 0.46; 0.11-2.18 % (w/w) SPC/PL; pϽ0.04). Furthermore, SP-B and-D levels were significantly increased in preterm infants when clinically relevant haemorrhage was apparent under birth (pϽ0.002). Conclusion: This is the first report describing levels of all four SP in tracheal aspirates in a well defined group of preterm infants. It was shown that SP are differentially regulated in preterm infants and are depending on perinatal complications.