Characteristics and special challenges of neonatal emergency transports.

BACKGROUND: As a rule, newborns do not require special medical care. If unexpected complications occur peripartum or postpartum, support from and transport to specialised neonatal hospitals might be needed. METHODS: In a retrospective study, all transport protocols of a supraregional paediatric­neonatological maximum care hospital in northwestern Germany from 01.10.2018 through 30.09.2021 were analysed. The particular focus was on transports of newborns (<7 days) and the leading symptoms that led to contact. RESULTS: A total of 299 patients were included (average age of 15.4 h, 61.6 % males). The average complete transport time was approximately 2 h. Five leading neonatal diseases (respiratory, infectious, asphyxia, cardiac, haematological) were found to represent the causes of >80 % of transfers. Respiratory adaptation disorders are the main reason for transferring a newborn to a centre, whereas asphyxia is the most severe condition. The various symptoms differ in their time of onset, a factor which must be taken into account in practice. Differences were also found between different types of hospitals: while a large proportion of transports were carried out from maternity hospitals (80.6 %), children transported from children's hospitals were generally more severely ill. DISCUSSION: Transfers of neonates, especially from maternity hospitals to neonatal intensive care units due to special neonatal diseases, are not rare. In times of increasingly scarce resources, the effective care of sick or at-risk neonates is essential. For low-population regions, this means professional cooperation between maximum care providers and smaller children's hospitals and maternity-only hospitals.

[Prioritization in the healthcare system: options and limits]. / Priorisierung im Gesundheitswesen : Möglichkeiten und Grenzen.

The public discussion on the future of the healthcare system has recognized that the gap between needs and financial possibilities for coverage is becoming increasingly larger due to increasing needs and reduced financial support. It can be assumed that due to reduced financial means and increasing demands on provision of service in healthcare and nursing, the time will come when prioritization will be necessary. The medical profession should prepare itself for this situation because prioritization is a long process.

[Disease numbers in pneumology - a projection to 2060]. / Erkrankungszahlen in der Pneumologie - eine Projektion bis 2060.

BACKGROUND: The demographic change leads to a change in the age-composition of the population. We have calculated a status quo projection of the absolute numbers for five diagnoses of the lung (COPD, CAP, lung cancer, bronchial asthma and tuberculosis) for Germany up to 2060. MATERIAL AND METHODS: Based on the 12 (th) coordinated population prediction of the Federal Statistics Office, we transferred age- and sex-specific incidence and prevalence rates, respectively, to the expected population. All described developments are based solely on demographic changes. RESULTS: The absolute numbers of bronchial asthma and tuberculosis will experience a minor decrease. We expect at first increasing and later decreasing case numbers for COPD and lung cancer. A major increase of the case numbers for CAP will be probable. By reason of a decreasing population, the rates (burden of disease for the population) will increase considerably. DISCUSSION: The demographic change is mainly caused by increasing life expectancy, constantly low birth rates, and the entry of the baby-boom generation into the age of higher disease risks. A discussion about prioritisation of health care is needed because of the rising burdens for the health system, including diseases of the lung.

[Demographic change and disease rates: a projection until 2050]. / Demografischer Wandel und Krankheitshäufigkeiten: Eine Projektion bis 2050.

Demographic change and its impact on the German healthcare system is a subject of great debate. The purpose of this paper is to make projections on disease rates based on the 11th coordinated demographic prediction and population-based data which take into consideration demographic developments. The German population will decrease by approximately 16% until 2050, while at the same time the number of persons aged over 65 years will increase by 38% and the number of individuals aged over 80 years will increase by 156%. Baby boomers cause a vertical wave in the population pyramid. The population pyramid itself will lead to an overproportional increase in the number of elderly persons. Assuming that disease probability stays the same, the incidence of diseases due to advanced age will rise dramatically. Especially diseases, such as community-acquired pneumonia, age-related macula degeneration, dementia, fracture of the femur neck, and myocardial infarction, will by then occur more often. By 2050, some of the most frequent diseases will be hypertension and arthrosis. Thus, the continuous cutting of resources seems rather short minded. It is highly recommended to reconsider the long-run effects before setting a health policy course. A proper social discourse about primary care and prioritization appears to be urgently needed.

Treatment of neonatal abstinence syndrome with clonidine and chloral hydrate.

AIM: The objective of this retrospective study is to compare the medical treatment of neonatal narcotic abstinence syndrome with clonidine and chloral hydrate with the commonly used combination therapy of morphine and phenobarbital. METHODS: From 1998 to 2008, a total of 133 newborns suffering from neonatal narcotic abstinence syndrome were treated at our clinic. All of these patients were born to mothers who had received methadone substitution for drug addiction during the course of pregnancy. RESULTS: Twenty-nine patients received clonidine and chloral hydrate, and 64 patients were treated with morphine and phenobarbital for abstinence syndrome. The duration of treatment was significantly shorter in the clonidine/chloral hydrate group (median: 14 days vs. 35 days). Correspondingly, the period of hospitalization was also considerably shorter in the clonidine/chloral hydrate group (median: 32 days vs. 44 days). In addition, patients in the clonidine/chloral hydrate group exhibited markedly reduced withdrawal symptoms. CONCLUSION: This study suggests that a treatment of neonatal abstinence syndrome with clonidine in omission of opiates is possible without causing short-term adverse cardiovascular effects. Considering the retrospective design of the study, controlled and prospective trials are needed.

[Home care: responsibilities and importance, present situation and future prospects]. / Häusliche Pflege: Aufgaben und Bedeutung, gegenwärtiger Stand und zukünftige Perspektiven.

Home care enables those in need of care to be looked after in their home environment for as long as is in their interest. This is not necessarily always more economical than inpatient care. Regardless of this, it may be in the interest of those in need of care or their relatives that they be looked after in a nursing home. The need for care is defined differently in various laws. When the need for care is established, certain services including financial support are granted. Approximately 80 per cent of those in need of care are looked after at home by their relatives, often supported by neighbours and home help services. The older those in need become, the more care is necessary and therefore more are admitted into nursing homes. The future perspectives of home care are determined by four factors. (i) Demographic developments are such that there is an increase in the number of people in need of care, whereas the size of the working population is on the decrease. (ii) The changing family structure means a possible reduction in the ability and even willingness to care for those in need in the family environment. (iii) A drop in nursing staff potential. (iv) Financing nursing care so that it can support home care. All in all, the looking after of those in need of care in the future brings with it problems for society, the solutions for which have not yet been found. The socio-political and humanitarian aim of looking after those in need of care in their home environment whenever possible still remains.

Health policy in a changing world.

Perhaps never has the world changed--politically, economically and socially--as much as it is at present. With this in mind, Dr Beske asks how can adequate healthcare provision be guaranteed world-wide, and how can intensive co-operation to combat the inequity of health care be achieved? It is well known that the level of health care differs greatly throughout the world, but the author draws the conclusion that 'The organization of the health service is one of the tasks of each country. But just as solidarity is demanded on a national level, international solidarity is also required'.