ORCID Profile
0000-0003-0021-0262
Current Organisation
University Children's Hospital Basel
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Publisher: American Academy of Pediatrics (AAP)
Date: 2021
Abstract: Evidence suggests that intramuscular vitamin A reduces the risk of bronchopulmonary dysplasia (BPD) in preterm infants. Our objective was to compare enteral water-soluble vitamin A with placebo supplementation to reduce the severity of BPD in extremely preterm infants. We conducted a double-blind randomized controlled trial in infants & weeks’ gestation who were to receive either enteral water-soluble vitamin A (5000 IU per day) or a placebo. Supplementation was started within 24 hours of introduction of feeds and continued until 34 weeks’ postmenstrual age (PMA). The primary outcome was the severity of BPD, assessed by using the right shift of the pulse oximeter saturation versus the inspired oxygen pressure curve. A total of 188 infants were randomly assigned. The mean ± SD birth weight (852 ± 201 vs 852 ± 211 g) and gestation (25.8 ± 1.49 vs 26.0 ± 1.39 weeks) were comparable between the vitamin A and placebo groups. There was no difference in the right shift (median [25th–75th percentiles]) of the pulse oximeter saturation versus inspired oxygen pressure curve (in kilopascals) between the vitamin A (11.1 [9.5–13.7]) and placebo groups (10.7 [9.5–13.1]) (P = .73). Enteral vitamin A did not affect diagnosis of BPD or other clinical outcomes. Plasma retinol levels were significantly higher in the vitamin A group versus the placebo group on day 28 and at 34 weeks’ PMA. Enteral water-soluble vitamin A supplementation improves plasma retinol levels in extremely preterm infants but does not reduce the severity of BPD.
Publisher: Wiley
Date: 15-12-2021
DOI: 10.1111/PAN.14369
Abstract: Extremely preterm infants commonly suffer from respiratory distress syndrome. Ventilatory management of these infants starts from birth and includes decisions such as timing of respiratory support in relation to umbilical cord management, oxygenation targets, and options of positive pressure support. The approach of early intubation and surfactant administration through an endotracheal tube has been challenged in recent years by primary noninvasive respiratory support and newer methods of surfactant administration via thin catheters. Available data comparing the thin catheter method to endotracheal tube and delayed extubation in extremely preterm infants born before 28 weeks of gestation did not show differences in survival free of bronchopulmonary dysplasia. Data from numerous randomized trials comparing conventional ventilation with high‐frequency oscillatory ventilation did not show differences in meaningful outcomes. Among conventional modes of ventilation, there is good evidence to favor volume‐targeted ventilation over pressure‐limited ventilation. The former reduces the combined risk of bronchopulmonary dysplasia or death and several important secondary outcomes without an increase in adverse events. There are no evidence‐based guidelines to set positive end‐expiratory pressure in ventilated preterm infants. Recent research suggests that the forced oscillation technique may help to find the lowest positive end‐expiratory pressure at which lung recruitment is optimal. Benefits and risks of the various modes of noninvasive ventilation depend on the clinical setting, degree of prematurity, severity of lung disease, and competency of staff in treating associated complications. Respiratory care after discharge includes home oxygen therapy, lung function monitoring, weaning from medication started in the neonatal unit, and treatment of asthma‐like symptoms.
Publisher: American Thoracic Society
Date: 15-08-2019
Publisher: Public Library of Science (PLoS)
Date: 20-04-2015
Publisher: Elsevier BV
Date: 09-2010
DOI: 10.1016/J.SEIZURE.2010.06.006
Abstract: To evaluate the long-term efficacy/tolerability of the ketogenic diet (KD) in paediatric drug-resistant epilepsies. Data from children who were treated between 1999 and 2008 and had continuous follow-up of at least 6 months after initiation of the KD were analysed retrospectively. Response was defined as > or = 50% seizure reduction. Treatment effects on EEG, developmental outcome and the "outcome-predictive" value of various clinical factors were also assessed. 50 children (22 boys mean age 4.5 years+/-3.55) were included. Mean follow-up was 3.93+/-2.95. 50% of the patients were responders, 48% of them became seizure free. 50% were non-responders, 20% of them deteriorated. In responders, EEG background activity improved significantly (p=0.014) and a significantly lower rate of epileptic discharges (p=0.009) was seen after 6 months. In addition, neurological examination findings demonstrated significant developmental progress (p=0.038). Favourable treatment outcome was associated with a shorter disease duration (p=0.025) and generalised tonic clonic seizures (p=0.059). No further significant outcome predictors were detected. However, response was 44% in patients with infantile spasms, 62.5% in those with Dravet syndrome and 50% in Lennox-Gastaut-syndrome. Side effects occurred in 28%, but discontinuation of the KD was not required in any case. They most often observed with concomitant topiramate (p=0.001) and valproate (p=0.046). Despite the retrospective nature of the study and the inhomogeneous patient s le, we found good long-term effects of the KD on seizure frequency, EEG and neurological development.
Publisher: S. Karger AG
Date: 2021
DOI: 10.1159/000513357
Abstract: b i Background: /i /b Right shift of the peripheral oxyhaemoglobin saturation (SpO sub /sub ) versus inspired oxygen pressure (P sub I /sub O sub /sub ) curve is a sensitive marker of pulmonary gas exchange. b i Objectives: /i /b The aim of this study was to assess the impact of prematurity and bronchopulmonary dysplasia (BPD) on gas exchange and right-to-left shunt in the neonatal period, and its evolution over the first year of life. b i Method: /i /b We assessed shift and shunt in extremely preterm (EP) and very preterm (VP) infants at 36 and 44 weeks’ postmenstrual age (PMA), and at 1-year corrected postnatal age (cPNA). P sub I /sub O sub /sub was decreased stepwise to achieve SpO sub /sub between 85 and 98%. Shift and shunt were calculated from paired SpO sub /sub /P sub I /sub O sub /sub measurements using customized software. Results were examined cross-sectionally at each time point, and longitudinally using generalized linear regression. Term infants were assessed at 44 wk PMA as a comparative reference. b i Results: /i /b Longitudinal modelling showed continuous decline in shift in EP and VP infants during the first year of life. There was no difference in shift compared to term infants at 44 wk PMA ( i /i = 0.094). EP infants with BPD had higher shift than infants without BPD at 36 wk PMA ( i /i & #x3c 0.001) and 44 wk PMA ( i /i = 0.005) but not at 1-year cPNA. b i Conclusions: /i /b In the absence of lung disease, prematurity per se did not result in reduced gas exchange at 1-year cPNA. We report ongoing, significant improvements in pulmonary gas exchange in all preterm infants during the first year of life, despite evidence of early deficits in gas exchange in EP infants with BPD.
Publisher: Wiley
Date: 06-06-2017
DOI: 10.1002/PPUL.23499
Abstract: A refined software algorithm was recently proposed for the analysis of infant multiple breath washout (MBW) measurements. The proposed algorithm uses the change in end-inspiratory molar mass between the wash-in and wash-out curves (EIMM-step) to define the required step response correction of the MM signal and is assumed to provide an accurate evaluation of complete washout of the tracer gas, in comparison to the current software algorithm which applies the change in end-expiratory molar mass (EEMM)-step. We aimed to evaluate the use of the EIMM-step method in a broad range of infants. We performed retrospective analyses comparing the EIMM- and EEMM-step change methods in MBW data collected from infants with cystic fibrosis (CF), infants born preterm, and healthy infants using an ultrasonic flowmeter. We found that the EIMM-step correction significantly increased LCI and functional residual capacity (FRC) in infants with CF, preterm infants, and healthy infants compared with the EEMM-step method. In addition, more than half the measurements that were technically acceptable and repeatable using the EEMM-step correction in healthy infants were excluded after using the EIMM-step correction. We found a large difference between the EIMM- and EEMM-steps in healthy infants indicating incomplete washout, suggesting the need for a longer washout time with using the EIMM-step analysis method. The data indicates that the EIMM-step analysis method may have the potential to generate false abnormal LCI values in in iduals without lung disease. Revised normative data may be required if this method is universally adopted. Pediatr Pulmonol. 2017 :10-13. © 2016 Wiley Periodicals, Inc.
Publisher: BMJ
Date: 11-02-2021
DOI: 10.1136/THORAXJNL-2020-214659
Abstract: We aimed to develop and validate a prediction table for a simplified measure of rightward shift of the fetal oxyhaemoglobin saturation (SpO 2 ) versus inspired oxygen pressure ( P I O 2 ) curve as an objective marker of lung disease severity in very preterm infants, independent of unit altitude or oxygen prescribing policies. Very preterm infants (n=219) had an oxygen reduction test at median (IQR) test age of 35 4 (34 5 –36 0 ) weeks’ postmenstrual age (PMA). Shift was derived from at least three paired SpO 2 versus P I O 2 measurements using a computer algorithm, using the fetal oxyhaemoglobin dissociation curve as the reference. Linear regression of resultant shift values enabled construction of a table to predict shift using a single paired SpO 2 versus P I O 2 measurement, validated subsequently in a separate infant cohort using Bland-Altman analysis. Receiver operating curve analysis provided threshold values equating to a clinical diagnosis of mild bronchopulmonary dysplasia (BPD) or moderate to severe BPD. The median (IQR) age of 63 infants in the validation cohort was 36 0 (35 6 –36 2 ) weeks’ PMA. Mean difference (95% CI) between predicted and measured shift was 2.1 (−0.8% to 4.9%) with wide limits of agreement (−20.7% to 24.8%). Predicted shift .1 kPa identified mild BPD with 71% sensitivity and 88% specificity while values .0 kPa identified moderate to severe BPD with 81% sensitivity and 100% specificity. Shift predicted from a single paired SpO 2 versus P I O 2 measurement using our validated table enables objective bedside screening of lung disease severity in very preterm infant cohorts at 36 weeks’ PMA.
Publisher: Public Library of Science (PLoS)
Date: 03-01-2019
Publisher: Wiley
Date: 13-02-2023
DOI: 10.1002/PPUL.26343
Abstract: Preterm infants have immature control of breathing and impaired pulmonary gas exchange. We hypothesized that infants with bronchopulmonary dysplasia (BPD) have a blunted ventilatory response and peripheral oxygen saturation (SpO 2 ) instability during a hypoxic challenge. We evaluated the response to hypoxia in 57 very preterm infants (38 no BPD, 10 mild BPD, 9 moderate‐to‐severe BPD) at 36 weeks' postmenstrual age. The fraction of inspired oxygen (F I O 2 ) was reduced stepwise at 5‐min intervals to achieve peripheral SpO 2 between 86% and 95%. The lowest permissible F I O 2 and SpO 2 were 0.14% and 86%. We recorded SpO 2 , F I O 2 , and the respiratory signal (respiratory inductive plethysmography). We calculated respiratory rate (RR), tidal volume ( V T ), minute ventilation ( V E ), and respiratory drive (ratio between V T and inspiratory time, V T / T I ). SpO 2 variability was expressed as the interquartile range (IQR). F I O 2 was reduced from a median (Q1, Q3) of 0.21 (0.21, 0.21) to 0.17 (0.17, 0.18). We observed a marked in idual variability in the ventilatory response to the hypoxic challenge, regardless of BPD severity. At the lowest permissible F I O 2 , 37 (65%) infants reduced their V E , and 20 (35%) increased minute ventilation 20 infants (35%) developed periodic breathing associated with increased SpO 2 IQR and lower SpO 2 minima, and 16 (28%) exhibited an oscillatory pattern in V E and SpO 2 without end‐expiratory pauses, regardless of BPD severity. In very preterm infants, a mild hypoxic challenge reduced ventilation, increased SpO 2 variability and periodic breathing regardless of BPD severity.
Publisher: Elsevier BV
Date: 11-2019
DOI: 10.1016/J.PRRV.2018.12.002
Abstract: Bronchopulmonary dysplasia (BPD), also known as Chronic Lung Disease (CLD), is a chronic respiratory condition of prematurity with potential life-long consequences for respiratory well-being. BPD was first described by Northway in 1967, when the mean gestation of preterm infants with BPD was 34 weeks' postmenstrual age (PMA). Survival of preterm infants at lower gestational ages has increased steadily since 1967 associated with marked improvements in respiratory management of respiratory distress syndrome. Currently, BPD develops in approximately 45 % of all infants born extremely preterm (Stoll et al., 2015). These smaller and more immature babies are born during the late canalicular or early saccular period of lung development. Not surprisingly, the pathophysiology of BPD also evolved since classical BPD was described. As the nature and our understanding of BPD evolved, so too the definitions and classification of BPD changed over time. These differing and ever-changing definitions h er clinical benchmarking as they are interpreted and applied inconsistently, and define BPD and its severity by non-standardised treatments rather than independent evaluations of structure or function. A standardised, unambiguous definition and classification of BPD is essential for evaluation and improvement in clinical practice, both within an in idual unit, as well as across and between neonatal networks. The determination and implementation of diagnostic criteria and severity classification that is standardised, globally applicable, and that has prognostic utility for clinical outcomes and guidance of ongoing respiratory management remain of utmost importance. This review describes the evolution of BPD definitions, evaluates the benefits and limitations of each approach, and discusses alternative approaches that may improve the functional assessment of BPD severity.
No related grants have been discovered for Benjamin Stoecklin.