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Background: Since 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., Methods: Scores 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., Results: Of 2150 eligible newborns, data on 1855 infants with a mean GA of 28(6/7) ± 2(3/7) 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., Conclusion: The 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 Registration: clinicaltrials.gov Protocol Registration System (NCT00623038). Registered 14 February 2008.

Objective: Delayed passage of stool is a result of both gestational immaturity and illness severity. Small for gestational age (SGA) preterm infants are at high risk of gastrointestinal (GI) complications. We aimed to analyse the effects of a strict nutrition and stool protocol on GI problems in SGA compared to appropriate for gestational age (AGA) preterm infants., Methods: Retrospective cohort analysis including all preterm infants with delayed meconium passage hospitalized at the Neonatal Intensive Care Unit of the Medical University of Graz, Austria. Infants were identified by a local data system and by the use of a strict feeding and stool protocol between 2001 and 2009. Main outcome parameters included neonatal morbidity, surgical intervention and mortality., Findings: Twenty-six SGA (median GA 28.6 weeks, birth weight 825 grams, 46% males) were compared to 101 AGA (median GA 28.4 weeks, birth weight 1168 grams, 55% males) preterm infants. Clinical signs of delayed meconium passage did not differ significantly between groups. Differences regarding percentage of necrotizing enterocolitis, ileus, spontaneous intestinal perforation, and surgical intervention did not differ between groups. Mortality rate was significantly higher in SGA (11.5%) compared to AGA (2.9%) infants (P=0.03)., Conclusion: Despite similar morbidity SGA infants exhibited higher lethal complication rates following delayed meconium passage compared to AGA infants.

Unlabelled: Comparability and reproducibility of different near-infrared spectroscopy devices measuring regional tissue oxygen saturation remain poor. Aim of the present study was to compare values and reproducibility of cerebral∕peripheral "tissue-oxygenation-index" (TOI; NIRO 300, Hamamatsu(®), Japan) with cerebral∕peripheral "regional-oxygen-saturation" (rSO; INVOS5100, Somanetics(®), USA), and to analyze the influence of quality criteria., Methods: cTOI and crSO2 were measured on the left forehead, pTOI and prSO2 were measured on the left calf. To analyse reproducibility, optodes were reapplied five times. A quality criterion was introduced for cTOI, crSO2 and prSO2. For pTOI quality criteria were introduced in combination with a venous occlusion technique., Results: Cerebral measurements were performed in 37 neonates. cTOI (72.7+∕-6.2%) was lower than crSO2 (83.3+∕-5.8%) (p < 0.001). The mean difference between cTOI and crSO2 was 10%. Mean standard deviations of cTOI and crSO2 were similar (cTOI: 4.9+∕-3.6; crSO2: 4.5+∕-2.6). Peripheral measurements were performed in 39 neonates. pTOI (66.0+∕-7.9%) was lower than prSO2 (82.0+∕-7.0%)(p < 0.001). The mean difference between pTOI and prSO2 was 15%. Mean standard deviations of pTOI (3.7+∕-2.6%) were lower than of prSO2 (5.0+∕-3.0%) (p = 0.047)., Conclusion: TOI values were significantly lower than rSO2 values, in cerebral and peripheral measurements. Reproducibility was higher for pTOI than for prSO2.

One of the problems of near-infrared-spectroscopy (NIRS) measurements is low reproducibility. The aim of the present study was to introduce quality criteria to increase reproducibility of peripheral NIRS measurements. In a prospective cohort study in 40 neonates, repeated NIRS measurements were performed on the calf. During five "reapplication" periods (of NIRS optodes), five "measurements" (venous occlusions) were performed. Tissue oxygenation index (TOI), mixed venous oxygenation (SvO2), fractional oxygen extraction (FOE), hemoglobin flow (Hbflow), oxygen delivery (DO2), and oxygen consumption (VO2) were assessed. Measurements with linear changes during venous occlusions were included for further analysis (first quality criterion: R(2)>0.95). The second quality criterion was the equation 0 < or = TOI-SvO2 < or = (SaO2-SvO2)x0.2. Variance components and mean standard deviations were analyzed after introduction of the quality criteria. Variance components of reapplication and measurement decreased after introduction of the second quality criterion (TOI: 46.6-35.0%, SvO2: 76.8-38.2%, FOE: 73.1-37.5%, Hbflow: 70.3-51.9%, DO2: 71.5-52.7%, and VO2: 70.9-63.8%). Mean standard deviations of TOI (6.6+/-3.0 to 4.7+/-3.2%), SvO2 (11.1+/-4.8 to 5.7+/-3.9%), FOE (11.3+/-4.8 to 5.9+/-4.0%), Hbflow (4.3+/-2.0 to 2.9+/-1.6 micromol100 mLmin), and DO2 (17.8+/-7.6 to 11.4+/-6.2 micromol100 mLmin) decreased significantly, too. Only 12% of measurements fulfilled both quality criteria. With the introduction of two quality criteria, test-retest variability of peripheral NIRS measurements decreased significantly and reproducibility increased significantly.

Objective: The aim of this study was to measure forearm blood flow (FBF) to detect any possible changes that might indicate vascular disorders in children and adolescents with type 1 diabetes., Research Design and Methods: FBF was measured by near-infrared spectroscopy (NIRS), venous occlusion at rest, and after handgrip exercise. A total of 40 children and adolescents with type 1 diabetes and 40 healthy children and adolescents (6-18 years) were matched for age and sex for comparison., Results: In the diabetic group (age 12.79 +/- 2.9 years, duration of diabetes 51.5 +/- 36 months), FBF at rest was significantly lower (1.39 +/- 0.76 ml x 100 g muscle(-1) x min(-1)) than in control subjects (age 12.66 +/- 2.9 years, FBF at rest 1.90 +/- 1.19 ml x 100 g muscle(-1) x min(-1)). After exercise, FBF increased significantly less in the diabetic group (0.70 +/- 0.82 ml. 100 g muscle(-1) x min(-1)) compared with the control subjects (1.15 +/- 1.05 ml. 100 g muscle(-1) x min(-1)). FBF at rest decreased with increasing age in both groups. The change in FBF after exercise was independent of age in the diabetic group and increased with increasing age in control subjects. FBF is reduced with impaired hyperemic response after exercise in children and adolescents with type 1 diabetes., Conclusions: These data suggest that vascular disorders in childhood are detectable noninvasively by NIRS.