Klinische Padiatrie 

About: Klinische Padiatrie is an academic journal published by Thieme Medical Publishers (Germany). The journal publishes majorly in the area(s): Medicine & Internal medicine. It has an ISSN identifier of 0300-8630. Over the lifetime, 3564 publications have been published receiving 26788 citations. The journal is also known as: Klinische Pädiatrie (Print).

[Corticosteroid-dependent reduction of leukocyte count in blood as a prognostic factor in acute lymphoblastic leukemia in childhood (therapy study ALL-BFM 83)].

Abstract: In therapy study ALL-BFM 83 a total of 630 patients with acute lymphoblastic leukemia (ALL) have prospectively been evaluated for initial response on therapy with corticosteroids. It was the aim to qualify the in vivo cytoreduction as a new predictor for therapy failure. All patients were exposed for 7 days to prednisone before combination chemotherapy at day 8 has been started. At day 0 one additional dose of Methotrexate was given intrathecally. Therapy for all patients with non-B-ALL has been stratified according to initial tumor burden (risk factor) providing four therapy branches: standard risk low (SR-L), standard risk high (SR-H), medium risk (MR), high risk (HR). After a median duration of study of 21 months, event-free survival (EFS) is for all 630 patients 73%, 81% for SR-L, 76% for SR-H, 69% for MR, and 35% for HR patients (date of evaluation Jan. 1, 1987). In this prospective study, a small subgroup of patients (n = 48; 7.6% of total group) is characterized by greater than 1000 leukemic blasts/mm3 peripheral blood at day 8 after exposure to prednisone. In this subgroup the EFS is only 43% in contrast to 76% in the complementary group of 582 patients with less than 1000 leukemic blasts/mm3 peripheral blood at day 8. Patients of that risk group are derived from therapy branches SR-H, M and HR, the latter contributing relatively most patients. In this negatively selected group all patients with an initial high white blood count, CNS disease at diagnosis, immune subtypes as prae-T-ALL (n = 6), T-ALL (n = 18), null-ALL (n = 5), and males clearly dominate. Of 48 patients with greater than 1000 blasts/mm3 at day 8 4 subsequently failed to enter remission and 8 were qualified as lateresponders. 18 patients relapsed, most of them earlier compared to those of the complementary group. The initial in vivo response on corticosteroid therapy is considered a supplementary prognostic predictor for early failure. It will be utilized in trial ALL/NHL-BFM 86 to qualify patients at the highest risk for relapse. This group of patients is supplemented in addition by non- and lateresponders and children with acute undifferentiated leukemia (AUL). The in vivo corticosteroid test is simple, generates early and reliable results and can be obtained almost always. Thus it may be recommended for use in a multicenter trial.

Obesity after childhood craniopharyngioma--German multicenter study on pre-operative risk factors and quality of life.

Abstract: BACKGROUND Craniopharyngiomas are tumorous embryogenic malformations As the survival rate after craniopharyngioma is high (92 %), prognosis and quality of life (QoL) in survivors mainly depend on adverse late effects such as obesity PATIENTS AND METHODS We analyzed 214 children and adolescents with craniopharyngioma The records of 185 patients (86 %) were available for retrospective analysis of weight profiles and risk factors for obesity Quality of life (QoL) was measured in 145 patients by the Fertigkeitenskala Munster/Heidelberg score (FMH) and in 77 patients by PEDQOL questionnaire RESULTS Eighty-two of 185 patients (44 %) developed severe obesity (body mass index [BMI] > 3 SD) Obese patients were compared with 79 patients (43 %) who kept normal weight (BMI 2 SD at diagnosis (p 25 kg/m(2) (p < 005; odds ratio: 46) Significant increases in BMI (p < 0001) occurred during the early post-operative period especially during the first three years after diagnosis FMH percentiles correlated negatively with BMI SDS (Spearman r: - 037; p < 0001) Children with craniopharyngioma rated their QoL more negative (p < 005) in regard to physical abilities, cognitive functioning and social functioning when compared with healthy children of the same age group Severely obese patients with craniopharyngioma estimated their QoL lower (p < 005) for all domains except for autonomy, cognition and familial integration in comparison with non-obese patients CONCLUSION Hypothalamic tumor involvement and familial disposition for obesity are risk factors for the development of severe obesity in patients with craniopharyngioma As weight gain starts early after diagnosis and severe obesity causes a reduction in QoL, early therapeutic efforts should be considered in patients at risk To confirm our results the prospective multicenter study Kraniopharyngeom 2000 on children and adolescents with craniopharyngioma was initiated (wwwkraniopharyngeomcom)

Prevalence of congenital heart defects in newborns in Germany: Results of the first registration year of the PAN Study (July 2006 to June 2007).

Abstract: OBJECTIVE: To investigate the current prevalence of congenital heart defects (CHD) in live births in Germany and to assess its relation to demographic and gestational parameters. DESIGN: Nation-wide study (PAN: Praevalenz angeborener Herzfehler bei Neugeborenen) with passive registration of infants born between 1 st July 2006 and 30 th June 2007 in Germany diagnosed with CHD. RESULTS: Data were provided by 260 participating institutions. 7 245 infants with CHD were registered to give a total CHD prevalence of 1.08%. The most common lesions were: ventricular septal defect (all types) (48.9%), atrial septal defect (17.0%), valvular pulmonary stenosis (6.1%), persistent arterial duct (4.3%) and aortic coarctation (3.6%). The most common cyanotic lesions were tetralogy of Fallot (2.5%) and complete transposition of the great arteries (2.2%). A single ventricle (all types) was identified in 2.8%, half of them being a hypoplastic left heart syndrome. Female gender was more common among mild CHD (57.3%) while there was a striking predominance of male infants among severe lesions (58.4%). Prematurity (18.7% vs. 9.1%), a birth weight below 2 500 g (17.5% vs. 6.8%) and multiple births (6.2% vs. 3.3%) were more frequent in infants with CHD than in all live births. More than 80% of the CHD diagnoses were made within three months after birth. CONCLUSIONS: The PAN study recorded an overall CHD prevalence of 1.08% in Germany. The proportion of mild CHD may indicate a high diagnostic level, the prevalence of severe lesions is concordant with ranges reported by others. CHD is associated with prematurity, low birth weight and multiple births.

Parents' perspective on symptoms, quality of life, characteristics of death and end-of-life decisions for children dying from cancer.

Abstract: Background In the present study, we investigated the situation of children who had succumbed to their malignancy in Germany as perceived by their parents. Specifically, we were interested in bereaved parents' perspective on five essential areas: 1) symptoms and quality of life, 2) characteristics of the child's death, 3) anticipation of their child's death and care delivery, 4) end-of-life decisions and 5) impact of the child's death on the parents and perceived social support by the health care team. Materials and methods We contacted all existing departments for paediatric oncology in the German federal state of Nordrhein Westfalen and asked them to contact all parents for participation in our study who had lost their child to cancer in 1999 and 2000. Upon agreement, we interviewed the parents utilising a validated semi-structured interview on distressing symptoms and quality of life of their children during the end-of-life care period. Results Six of the 19 departments agreed to participate. Parents of 48 children (31 boys, 17 girls) were interviewed. The main distressing symptoms were fatigue, pain, loss of appetite, and dyspnoea according to the parents. While parents perceived pain and constipation to have been treated successfully, loss of appetite and anxiety were not treated effectively. 75% of the children died due to a progression of their malignancy. Of these, 50% obtained cancer-directed therapy at the end of life, which was negatively rated by the parents in hindsight. 48% of the children died at home even though 88% of the parents chose 'at home' as the most appropriate locale of death in hindsight. Parents anticipated their child's death on average 9 weeks prior to the child's death. 41% of the parents provided palliative home care for their child and the majority (88%) rated the quality of care as good or very good. 64% discussed end-of-life decisions with the health care team, 36% did not have a discussion. Parents were clearly affected by their child's death. However, 15% of the parents were not contacted by the health care team following the child's death. Conclusions The present study demonstrated that psychological symptoms (e.g. anxiety) are frequent symptoms in the end-of-life care period and cause severe suffering in the children. Questions in terms of benefits and costs of cancer-directed therapy in the end-of-life care period need to be addressed in future prospective studies. Parents' perspective on their child's death and related end-of-life decisions highlighted the importance of communication between parents and the health care team. Future studies need to investigate potential barriers in the communication between parents and the team to optimise end-of-life decisions and hence, reduce parents' long-term distress. In line with the previous, the present data demonstrated that there is still a lack of routine contact from the health care team following the child's death despite existing guidelines. Research is therefore needed into the implementation of guidelines for routine contact into clinical practice following a child's death.

Longitudinale Körperentwicklung gesunder Kinder von 0 bis 18 Jahren

Abstract: In addition to the Dortmunder longitudinal growth study we investigated development of height, weight and height velocity in 213 healthy boys and girls 15-18 years old. Number of children decreased in the age group of 17 and 18 years old to 143. The study was performed in a longitudinal way, the measurements were taken in an one year distance. The median height gain in boys between 15 and 18 years amounted to 9.3 cm, in girls to 2.1 cm, respectively. 18 years old boys are 180.1 cm tall, girls 167.9 cm. The median increment of body weight in boys from 15-18 years amounted to 7.3 kg, in girls 4.4 kg, respectively. Median weight in 18 years old boys amounted to 65.2 kg, in girls to 58.0 kg. International comparison with other longitudinal growth studies shows a trend of somewhat higher weight, height and height velocity of the children from our study.