Den neonatale forskning

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1 Den neonatale forskning
under professoratet i neonatologi i Region Sjælland Hovedvægten har været lagt på: Metodeudvikling - behandling og perinatal diagnosticering af RDS Multicenterstudier – behandling af RDS Ph.d. studerende og ”prægraduat forskningsårsstuderende” Landssymposiet i Neonatologi september HV 1

2 Premature infants with severe RDS before the introduction of nasal CPAP and mechanical ventilation
From Rudolph AJ et al. Pediatr Clin North Am 1966; 13:669-92

3 Introduction of CPAP (Gregory 1971) more than halved
The Mortality of RDS before and after introduction of CPAP and surfactant Introduction of CPAP (Gregory 1971) more than halved the mortality from 55 to 20% and surfactant treatment halved the mortality from 20 to 10% 3

4 Den neonatale mortalitet 1981-1992
Den neonatale mortalitet Danske børn med fødselsvægt <1500 g 1.000 Ugeskr Læger 1995;157:

5 The Scandinavian Method
INSURE (Verder H et al.) Ventilation with small volumina at birth (Björklund et al.) Minimal oxygen at birth (Saugstad O) Minimal handling (Jacobsen T et al.) NIDCAP (Westrup B et al.) Breastfeeding, skin to skin, kangaroo method 5

6 SURFACTANTBEHANDLING AF NYFØDTE MED RESPIRATORISK DISTRESS-SYNDROM PRIMÆRT BEHANDLET MED NASALT KONTINUERLIGT POSITIVT LUFTVEJSTRYK En pilotundersøgelse Ugeskr Læger 1992;154:2136-9 Verder H, Agertoft L, Albertsen P, Christensen NC, Curstedt T, Ebbesen F, Greisen G, Hobolt N, Holm V, Jacobsen T, Johansen KAH, Kamper J, Laange A, Mølgaard C, Nathan E, Nielsen F, Pedersen-Bjergaard, Peitersen B, Robertson B, Skov L, Svenningsen N, Tegllund L 6

7 RESPIRATORY DISTRESS SYNDROME
SURFACTANT THERAPY AND NASALCONTINUOUS POSITIVE AIRWAY PRESSURE FOR NEWBORNS WITH RESPIRATORY DISTRESS SYNDROME NEJMed 1994;331:1051-5 Verder H, Robertson B, Greisen G, Ebbesen F, Albertsen P, Lundstrøm K, Jacobsen T for the Danish-Swedish Multicenter Study Group 7

8 NASAL CONTINUOUS POSITIVE AIRWAY PRESSURE AND EARLY SURFACTANT FOR RESPIRATORY DISTRESS SYNDROME IN NEWBORN LESS THAN 30 WEEKS’ GESTATION Pediatrics 1999;103:e24 Verder H, Albertsen P, Ebbesen F, Greisen G, Robertson B, Bertelsen A, Agertoft L, Djernes B, Nathan E, Reinholdt J for the Danish-Swedish Multicenter Study Group 8

9 PREDICTION OF RESPIRATORY DISTRESS SYNDROME BY THE MICROBUBBLE STABILITY TEST ON GASTRIC ASPIRATES IN NEWBORNS OF LESS THAN 32 WEEKS’ GESTATION Acta paediatr 2003;92:728-33 Verder H, Ebbesen F, Linderholm B, Robertson B, Eschen C, Arrøe M, Lange A, Grytter C, Bohlin K, Bertelsen for the Danish-Swedish Multicenter Study Group 9

10 Different bubble sizes in vortexed gastric secretion

11 Shake test a.m. Clements on amniotic fluid

12 PROPHYLACTICOR EARLY SURFACTANT COMBINED WITH NCPAP IN VERY PRETERM INFANTS
Pediatrics 2010;125:e1402 Sandri F, Plavka R, Ancora G, Simeoni U, Stranak Z, Martinelli S, Mosca F, Nona J, Thomson M, Verder H, Fabbri L, Halliday; CURPAP Study Group 12

13 LAMELLAR BODY COUNTS ON GASTRIC ASPIRATES FOR PREDICTION OF RESPIRATORY DISTRESS SYNDROME
Acta Paediatr 2011;100:175-80 Verder H, Ebbesen F, Brandt J, Dahl M, Esberg G, Eschen C, Grytter C, Kroner J, Nørgaard M, Reinholdt J, Stanchev H for the Danish-Swedish Multicenter Study Group for Surfactant Replacement 13

14 Selective treatment of RDS
Diagnosing of surfactant deficiency Lamellar body county (LBC) on gastric aspirate at birth

15 Early surfactant Guided by Lamellar Body Counts on Gastric Aspirate
in Very preterm Infants Verder H, Ebbesen F, Fenger-Grøn J, Henriksen TB for the Danish-Swedish Multicenter Study Group of Surfactant Replacement University of Copenhagen, University of South Denmark, University of Aarhus, Denmark and University of Skåne, Sweden Sponsored by Chiesi Farmaceutici, Takeda-Nycomed and Region Zealand 27th International Workshop on Surfactant Replacement. Lisbon, June 1-2, 2012. Submitted to Pediatrics August 2, 2012 15

16 Early selective surfactant for RDS
Henrik Verder, Finn Ebbesen, Jesper Fenger-Grøn, Tine Brink Henriksen, Bengt Andreasson, Lars Bender, Aksel Bertelsen, Lars Bjørklund, Marianne Dahl, Gitte Esberg, Christian Eschen, Marie Høvring, Andreas Kreft, Jørn Kroner, Fredrik Lundberg, Pernille Pedersen, Jes Reinholdt, and Hristo Stanchev.

17 L/S ratio on amniotic fluid for RDS Thin-layer chromatography

18 KEMOMETRISK FORSKNINGSENHED
Spektroskopi, Computerteknik, specielle Algoritmer Alle legemlige væsker, Små mængder (50 µL), Webbaseret, Svar på få min Anvendelse i neonatologien L/S ratio på ventrikelaspirat 2. Koncentrationsbestemmelse af multiple molekuler/biomarkører 3. Mønstergenkendelse af diverse sygdomme (syge/raske) 18

19 BESTEMMELSE AF LUNGEMATURITETEN PÅ Fødselstidspunktet
Fra protokollen til pilotprojektet. Juni 2011 BESTEMMELSE AF LUNGEMATURITETEN PÅ Fødselstidspunktet Kemometrisk hurtigmetode til bestemmelse af Lecithin-sphingomyelin ratio i ventrikelsekretet Deltagere: Maria Jensen, Holbæk børneafd. og KU Henrik Verder, Holbæk børneafd. og KU Christian Eschen, Holbæk børneafd. Agnar Höskuldsson, Holbæk børneafd. Torben Ehlern Jessen, Holbæk Klin. Biokem. Afd. Poul Bjerrum, Holbæk Klin. Biokem. Afd. Jes Reinholdt, GN, RH 19

20 The technology is based on spectroscopy & mathematics and is used to determine chemical components in liquids 1 Liquid Sample Sample placed on instrument Multi frequency infrared (IR) light beam passing through sample Measures molecular light absorbance in the infrared light frequency Raw absorbance spectrum data passed to PC FT/IR Spectrometer 2 Raw data processed by Fourier Transform (FT) algorithm to produce light absorption wavelength Wavelength Fourier Transform 3 Spectrum Chemical information extracted from spectral signatures through chemometrics algorithm (multivariate data analysis) Chemical Parameters Chemometrics Reference data 4 Detailed Liquid Analysis 5

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22 Den neonatale forskning
under professoratet i neonatologi i Region Sjælland Ph.d. studerende: Mette Louise Gyhrs – ”Probiotikas effekt på infektioner hos småbørn” Stine Brøndum Andersen – ” Neonutri - ernæringens betydning for det for tidligt fødte barns vækst og udvikling” Heike Weyhreter – ”Neonatal asphyxi og inflammatoriske biomarkører: Har analyse af cytokiner, neuroprotektorer og de respektive gener fra PKU-kort en prognostisk værdi?” Landssymposiet i Neonatologi september HV 22

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