Annette Schulz‐Baldes

Corticosteroid hormone induced factor (CHIF) is a small epithelial-specific protein regulated by aldosterone and K+ intake. It is a member of the FXYD family of single span transmembrane proteins involved in the regulation of ion transport. Recent data have suggested that CHIF interacts with the a subunit of the Na+-K+-ATPase and increases the pump's affinity to cell Na+. CHIF knockout (KO) mice have mild renal phenotype under low Na+ or high K+ diets. The present study further characterizes kidney electrolyte metabolism in CHIF KO mice and describes abnormalities in the colonic ion transport function. Kidney: KO mice were not compromised in salt and water balance under resting conditions. Fractional excretions (FE) of Na+ and K+ were normal and the animals had no deficit in the adaptation to low Na+ or high K+ intake. Glucocorticoid treatment did not unmask any difference. The effects of amiloride on Na+ absorption were not different at any treatment protocol. In contrast, FEK+ was reduced by 35% in KO mice under low Na+ intake. COLON: Amiloride inhibitable Na+ absorption was reduced in distal colon by 42%, 54% and 58% under control conditions, glucocorticoid treatment and low Na+ intake, respectively. Also, the cAMP dependent ion transport was significantly diminished. Forskolin induced equivalent short circuit current (I'SC) was reduced by 41%, 32% and 58%, under control conditions, high K+, and low Na+ intake, respectively. The present findings support a role of CHIF as an indirect modulator of several different ion transport mechanisms and are consistent with regulation of the Na+-K+-ATPase as the common denominator.

AIM: To investigate the end-of-life practice in a large perinatal centre in Germany. METHODS: Retrospective chart review was performed in all neonates deceased in the delivery room (n = 31) and the neonatal intensive care unit (n = 47) between 2002 and 2004. RESULTS: Neonatal death was preceded by an end-of-life decision (EOLD) in 81% of cases in the delivery room and 83% in the neonatal intensive care unit. The majority of deceased neonates were born prematurely or with congenital malformation. Life-sustaining treatment was not initiated in 74% of the infants deceased in the delivery room. In the unit, 52% died after withdrawal of therapy. Mechanical ventilation was withdrawn most frequently (79% of cases). Futility and immediate death were common considerations in EOLD, but the infant's suffering and future quality of life also played a role. Parents were involved in EOLD-making in all but emergency cases. No active termination of life was performed. CONCLUSION: In our perinatal centre, the majority of neonatal deaths occurred after limitation of therapy. Treatment was actively withdrawn in half of the infants in the neonatal intensive care unit. Actual end-of-life practice in a large perinatal centre differs from the restrictive attitude towards EOLD reported for German neonatologists in previous surveys.