OBJECTIVES: To present our experience in an interdisciplinary and interprofessional morbidity and mortality conference, with special emphasis on its usefulness in improving patient safety. DESIGN: Retrospective analysis. SETTING: Tertiary interdisciplinary neonatal PICU. PATIENTS: Morbidity and mortality conference minutes on 48 patients (newborns to 17 yr), January 2009 to June 2014. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: The authors' PICU implemented a morbidity and mortality conference guideline in 2009 using a system-based approach to identify medical errors, their contributing factors, and possible solutions. In the subsequent 5.5 years, there were 44 mortality conferences (of 181 deaths [27%] over the same period) and four morbidity conferences. The median death/morbidity event-morbidity and mortality conference interval was 90 days (range, 7 d to 1.5 yr). The median age of patients was 4 months (range, newborn to 17 years). In six cases, the primary reason for PICU admission was a treatment complication. Unsafe processes/medical errors were identified and discussed in 37 morbidity and mortality conferences (77%). In seven cases, new autopsy findings prompted the discussion of a possible error. The 48 morbidity and mortality conferences identified 50 errors, including 30 in which an interface problem was a contributing factor. Fifty-four improvements were identified in 34 morbidity and mortality conferences. Four morbidity and mortality conferences discussed specific ethical issues. CONCLUSIONS: From our experience, we have found that the interdisciplinary and interprofessional morbidity and mortality conference has the potential to reveal unsafe processes/medical errors, in particular, diagnostic and communication errors and interface problems. When formatted as a nonhierarchical tool inviting contributions from all staff levels, the morbidity and mortality conference plays a key role in the system approach to medical errors. Originally published at: Frey, Bernhard; Doell, Carsten; Klauwer, Dietrich; Cannizzaro, Vincenzo; Bernet, Vera; Maguire, Christine; Brotschi, Barbara (2016). The morbidity and mortality conference in pediatric intensive care as a means for improving patient safety. Pediatric Critical Care Medicine, 17(1):67-72.

The insulin‐like growth factors (IGF‐I and IGF‐II) and their binding proteins (IGFBPs) have been implicated in regulating fetal growth and development. The aim of this study was to determine whether fetal IGFs correlate with auxologic data at birth and/or gestational age. Venous cord blood was obtained from 138 healthy newborns immediately after birth and clinical data were recorded using a standardized data sheet. For the determination of IGF‐I and IGF‐II, IGFBP‐blocked radioimmunoassays were used. A coated‐tube immunoradiometric assay was applied for the measurement of free IGF‐I. IGFBP‐1, ‐2, and ‐3 were measured using specific radioimmunoassays. IGF‐I levels were 61 ± 21 ng ml‐1, median 61 ng ml‐1, range 19‐114ng ml‐1: IGF‐II levels were 466 ± 80ng ml‐1, median 457 ng ml‐1, range 311–701 ng ml‐1; free IGF‐I levels were 2.4 ± 1.8ng ml‐1, median 1.8 ng ml‐1, range 0.4–7.8ng ml‐1. The concentration of IGFBP‐1 was 144± 110 ng ml‐1, median 113 ng ml‐1, range 20–626 ng ml‐1; that of IGFBP‐2 was 1165 ± 455ng ml‐1, median 1119ng ml‐1, range 440–3466 ng ml‐1. IGFBP‐3 levels were 1272 ± 280 ng ml‐1, median 1272ng ml‐1, range 600–1966 ng ml‐1. IGF‐I levels correlated significantly with IGFBP‐3 levels (r= 0.71). birthweight (r= 0.48) and birth length (r= 0.37). There were significant inverse correlations between IGF‐I and both IGFBP‐I (r= ‐ 0.45) and IGFBP‐2 (r= ‐ 0.62). Although free IGF‐I levels correlated (r= 0.71) with total IGF‐I, only marginally significant correlations were found between free IGF‐I and birthweight (r= 0.25). According to multiple regression analysis free IGF‐I levels were only dependent upon total IGF‐I, IGFBP‐2 and IGFBP‐1, whereas IGFBP‐3 levels did not contribute to the variance of free IGF‐1 concentrations in venous cord blood. There was no significant correlation between IGF‐II and auxologic data at birth. When IGF‐I and IGFBP‐3 levels were analysed with respect to gestational age a biphasic pattern with maxima at 270 d was observed. IGFBP‐2 exhibited a reversed pattern with a minimum at 265 d of gestation. In conclusion, these data suggest that IGF‐I and the IGFBPs, but not IGF‐II, play a role in the regulation of late fetal growth and development.

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The primarily anuric very low birth weight infant (VLBWI) is an ethical challenge for the attending doctor as well as for the parents. Long term peritoneal dialysis (PD) might provide an acceptable way in treating a primarily anuric VLBWI prior to kidney transplantation without endangering the child's neurologic development. We report a case of a VLBWI born at 30 weeks gestational age after anhydramnion for 5 weeks. Postnatally the neonate had persisting anuria and was successfully treated with peritonealdialysis for 31 months followed by hemodialysis for 12 months and eventually received a renal transplantion at the age of 43 months.

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The connection between Pediatric Inflammatory Multisystem Syndrome (PIMS) and Kawasaki Disease (KD) is not yet fully understood. Using the same national registry, clinical features and outcome of children hospitalized in Germany, and Innsbruck (Austria) were compared. Reported to the registry were 395 PIMS and 69 KD hospitalized patients. Patient age in PIMS cases was higher than in KD cases (median 7 [IQR 4–11] vs. 3 [IQR 1–4] years). A majority of both PIMS and KD patients were male and without comorbidities. PIMS patients more frequently presented with organ dysfunction, with the gastrointestinal (80%), cardiovascular (74%), and respiratory (52%) systems being most commonly affected. By contrast, KD patients more often displayed dermatological (99% vs. 68%) and mucosal changes (94% vs. 64%), plus cervical lymph node swelling (51% vs. 34%). Intensive care admission (48% vs. 19%), pulmonary support (32% vs. 10%), and use of inotropes/vasodilators (28% vs. 3%) were higher among PIMS cases. No patients died. Upon patient discharge, potentially irreversible sequelae—mainly cardiovascular—were reported (7% PIMS vs. 12% KD). Despite differences in age distribution and disease severity, PIMS and KD cases shared many common clinical and prognostic characteristics. This supports the hypothesis that the two entities represent a syndrome continuum.

In the differential diagnosis of acute renal failure in Newborns prerenal, renal and postrenal causes must be considered. Additionally, in twin-to-twin transfusion syndrome especially the donor can suffer from acute renal failure caused by longterm intrauterine hypoperfusion of the kidneys resulting in severe retardation of renal development.

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