[No increase of incidence of retinopathy of prematurity and improvement of its outcome in a university perinatal centre level III - a prospective observational study from 1978 to 2007]. / Kein Anstieg von Inzidenz, Therapie- und Erblindungsrate der Retinopathia praematurorum in einem universitären Perinatalzentrum Level 1 - eine prospektive Beobachtungsstudie von 1978 - 2007.

BACKGROUND: There is a controversy over whether the improved survival rate of extremely low birth weight (ELBW; birth weight < 1000 g) and of extremely low gestational age (ELGA; gestational age < 28 weeks) infants has resulted in a higher incidence of severe retinopathy of prematurity (ROP) and induced blindness. We studied the incidence, treatment and the structural outcome of ROP in a Perinatal Centre Level III over a 30-year period in infants < 1500 g birth weight (VLBW = very low birth weight). PATIENTS AND METHODS: 1473 VLBW infants, who survived the first 28 days, had ocular examinations from 1978 to 2007. Neonatal and ROP data were collected prospectively. Proliferative ROP, threshold disease and high-risk prethreshold ROP indicated treatment for peripheral retinal ablation in respect to the CRYO-ROP and ETROP studies. Incidence, treatment and structural outcome of ROP were analysed for the periods 1978 - 1992 (P1) and 1993 - 2007 (P2) and for children with BW < 1000 g and > 1000 g. RESULTS: In P 1 43.1 % (n = 87) ELBW infants survived and 82.3 % (n = 372) in P 2, whereas the survival rates of the infants with a BW of 1000 - 1499 g were 74.6 % (n = 453) and 95.1 % (561), respectively. The ROP incidence was decreased from 27.6 % (n = 149) in P 1 to 15.1 % (n = 141) in P 2 significantly (p < 0.003) as well the mean BW 1136.6 ± 211.3 g to a mean BW 822.3 ± 215.3 g and the mean gestational age (GA) 29.3 ± 2.2 weeks and to a mean GA 26.4 ± 2 weeks, respectively (both differences p < 0.001). Also the coagulation rate was significantly decreased from 13 % (n = 70) in P 1 to 6.8 % (n = 63) in P 2 (p = 0.043). The blindness rates (structurally unfavourable outcome of both eyes) of 1.5 % in P 1 and 1.0 % in P 2 were not significantly reduced (p = 0.543). Among the ELBW the number of ROP infants was increased from 39 in P 1 to 117 in P 2 while the ROP incidence decreased from 44.8 % to 31.5 % (p = 0.053) and the ROP-OP rate from 19.5 % to 14.8 % (p = 0.029). Also among the ELGA the number ROP infants was increased from 66 in P 1 to 121 in P 2 but the ROP incidence was reduced from 70.2 % to 27.6 % and the ROP-OP rate from 30.9 % to 13.2 % (both p < 0.001). CONCLUSIONS: Inspite of an increase of the number of ELBW/ELGA infants and their survival rate in 1978 - 2007 there is no increase in the incidence of ROP, operations and blindness among the VLBW and VLGA infants.

Management of spontaneous congenital chylothorax: oral medium-chain triglycerides versus total parenteral nutrition.

The aim of this article is to compare total parenteral nutrition (TPN) with oral medium-chain triglycerides-diets (MCT) in the management of spontaneous congenital chylothorax. We analyzed retrospectively the charts of 6 patients seen in our tertiary care center and of 11 comparable patients from the literature. All neonates were symptomatic at birth; 15 had bilateral chylothorax. In the neonates who received mainly TPN (n = 9), the chylothorax resolved significantly (p < 0.05) earlier (mean 10 days, SE 1) than in the others, who received mainly MCT (n = 8) (mean 23 days, SE 4). The mean chyle loss was not significantly different between the 2 groups. Our results suggest that TPN is more effective than oral MCT in the treatment of spontaneous congenital chylothorax. These results support the data of Peitersen et al, who reported that most of the positive results with MCT were achieved in postoperative chylothorax of the newborn.

High-versus low-dose erythropoietin in extremely low birth weight infants. The European Multicenter rhEPO Study Group.

OBJECTIVE: To investigate whether a weekly 1500 IU/kg dose of recombinant human erythropoietin (rhEPO) is more effective than a dose of 750 IU/kg/week in preventing anemia and reducing the transfusion need in infants with birth weights less than 1000 gm. STUDY DESIGN: In a randomized, double-blind, multicenter trial, 184 infants with birth weights between 500 and 999 gm were treated with either rhEPO 750 (low-dose group) or 1500 IU/kg/week (high-dose group) from day 3 of life until 37 weeks' corrected age. RESULTS: Thirty-two percent of the infants in each group did not receive any transfusion during the treatment period. The total volume of erythrocytes received was similar in each group. The success rate, defined as no transfusion needed and hematocrit value 0.30 L/L or greater, was 27.6% in the low-dose and 29.5% in the high-dose group (p = 0.96). CONCLUSION: Doubling the rhEPO dose of 750 IU/kg/week is not indicated in infants with birth weights less than 1000 gm.

Concentration of purine compounds in the cerebrospinal fluid of infants suffering from sepsis, convulsions and hydrocephalus.

Catabolites of purine nucleotides were measured in the cerebrospinal fluid (CSF) of newborn infants with sepsis, seizures and hydrocephalus using isocratic reversed-phase HPLC. The inosine levels in the CSF of the infants with any of the illnesses were significantly higher when compared with the controls. There was a tendency for hypoxanthine levels to be higher in the group of children with hydrocephalus. No significant differences in the concentrations of xanthine, adenine and uric acid were found. The inosine concentration in the CSF is proposed to be a more sensitive indicator of brain injury than the levels of other CSF purines. The levels of all purine metabolites measured in the CSF showed large individual variations. The ratio between hypoxanthine (as an indicator of ATP breakdown) and uric acid (as a scavenger of oxygen free radicals) concentration is proposed as a new criterion to be used in the evaluation of brain injury.

[Clinical significance and fetal outcome in end-diastolic decreased flow in the umbilical artery and/or fetal aorta: analysis of 51 cases]. / Klinische Bedeutung und fetal outcome beim enddiastolischen Flowverlust in der A. umbilicalis und/oder fetalen Aorta: Analyse von 51 Fällen.

The AEDV in the umbilical artery or the foetal aorta is considered to be the most severe waveform abnormality. Using pulsed Doppler, we found such a waveform in 51 foetuses out of 954 high-risk pregnancies (33/51 in both vessels, 17/51 aorta only and 1/51 umbilical artery only). A reverse flow was registered in 24 foetuses. The outcome was compared with that of a control group (n = 72) showing normal Doppler findings. The following parameters were highly significant (p less than 0.001): Rate of Caesarean section owing to foetal distress (85.3% to 4.8%), of growth retardation (IUGR) (66.7% to 6.0%), of premature delivery (73.5% to 7.5%), of low postnatal pH- and Apgar score (73.5 to 12.1%), of admission to the neonatal intensive care unit (94.1% to 8.6%), of morbidity (35.3% to 2.3%) and of mortality (41.1% to 0%). We observed 17/51 intrauterine and 4/51 postnatal deaths. The rate of malformations was 35.3% with 4 cases of aneuploidy. Considering the malformations, the rate of corrected mortality was 23%. We found, that the association of an AEDV and the absence of severe IUGR is highly suspicious of malformation. We also observed, that congenital heart diseases (CHD) could lead to an AEDV too. An AEDV precedes a pathological cardiotocogram (CTG) with a latency of 0 to 35 days (mean 9.5 days). This latency is not predictable, but we think, that a reliable assessment of jeopardy is possible by analysing further vessels (Aa. arcuatae, A. renalis, A. carotis interna): 72.5% of the foetuses with AEDV had high indices in the carotid artery and 93.1% among these showed a pathological CTG pattern.(ABSTRACT TRUNCATED AT 250 WORDS)

[Caroli syndrome in childhood. Review and report of a patient with an unbalanced karyotype]. / Das Caroli'Syndrom im Kindesalter. Ubersicht und Bericht über einen Patienten mit unbalanciertem Karyotyp.

This paper describes the clinical symptomatology, the pathogenesis, diagnosis and therapy of the Caroli'Syndrome with a special reference to differences to other congenital hepatic diseases with similar manifestations. We report on a male infant with a Caroli'Syndrome, which is associated with a chromosomal imbalance and other malformations and discuss the genetical background.

[Candida parapsilosis infection as a complication of long-term parenteral nutrition]. / Candida parapsilosis-Sepsis als Komplikation der langfristigen parenteralen Ernährung.

In case of short bowel syndrome in infancy the total parenteral nutrition was complicated by catheter-associated Candida parapsilosis septicemia based on generalized enterococci infection. Specific problems in antifungal treatment are discussed.

[Enterococci as pathogens of severe infections in newborn infants and young infants]. / Enterokokken als Erreger schwerer Infektionen bei Neugeborenen und jungen Säuglingen.

We report about severe perinatal infections caused by enterococci during a 5 year-period. Between January 1983 and December 1987 8 infants were treated in the Department of Neonatology of the Charité-Hospital, 5 of them died. In 4 of the infants this infection was of the early onset type and in 4 infants the infection had a late onset. The clinical course of the four infants with early onset type was very similar to that of infants with group-B-streptococcus disease. The increase of severe infections caused by enterococci in 1987 (7 cases) is unclear. One cause of the increase could be, that the chemotherapy of septicemia and meningitis in the Department of Neonatology of the Charité is the combination cefotiam and gentamicin or cefotaxime and gentamicin. Enterococci are resistant to all cephalosporins and a selection of these pathogens after this therapy is possible. In vitro and clinical experience has demonstrated, that a ampicillin-gentamicin combination constitutes effective therapy for enterococcal infection.

[Neonatal percentile values for the GDR--1985. Correlation of body weight and length in newborn infants (calculation of birth weight/body length in cm. with reference to gestational age)]. / Neugeborenenperzentilwerte für die DDR--1985. Zur Korrelation von Gewicht und Länge bei Neugeborenen (Berechnung des Geburtsgewichtes/cm Körperlänge unter Berücksichtigung des Gestationsalters).

Taking account of the gestational age (28th to 42nd completed week of pregnancy) the sex-related ratio of birth weight to length (g/cm) for newborn infants is reported. This shows that observation of the correlation between birth weight and length with reference to gestational age makes a more accurate classification of newborn infants possible, rather than using a two dimensional classification (birth weight week of gestation).

[Perinatal imaging diagnosis in twin pregnancies with humanus amorphus]. / Perinatale bildgebende Diagnostik bei Geminischwangerschaften mit Humanus amorphus.

The humanus amorphus or acardiac twin is a very rare anomaly found only in monocygotic multiple pregnancies. In 8 twin pregnancies observed from 1977 to 1988 at the Charité-Hospital the findings of perinatal imaging diagnostics (sonography, amniofetrography, postnatal radiography) have been presented. For the prenatal diagnosis, especially for continuous prenatal control in these high-risk pregnancies, sonography seems to be the suitable method. However, an exact classification and morphological description of such monstrosities will be possible only by postnatal radiography (eventually in combination with a transumbilical angiography). Six ouf of eight cases were classified as an acephalous type, and two as an acardius anceps fetus.

Development of enolase isoenzymes in various regions of the human brain.

Various brain regions from 4 fetuses (21st to 28th gestational week) and from a 3-month-old infant were investigated for the total enolase activity and their isoenzyme distribution. In the brain tissue from a 3-month-old infant, the activity of the so-called neuron-specific enolase amounted to about 50% of the total enolase activity. In various brain regions different developmental patterns emerged for nonneuronal (NNE) and neuron-specific enolase (NSE). By the 21st gestational week the medulla, pons and thalamus had already reached a relatively high NSE activity (about 60-90% of that of the 3-month values), whereas the cortex regions had 10-30% only. It is concluded that in phylogenetically old regions, the switch from NNE to NSE-subunits appears before the 21st gestational week, in the phylogenetically young regions between the 21st and 28th gestational week.

Nosocomial infections due to Serratia marcescens--clinical findings, antibiotic susceptibility patterns and fine typing.

We report on nosocomial infections caused by Serratia marcescens occurring in a neonatal intensive care unit and a children's ward for cardiac intensive care. According to the plasmid pattern analysis, all isolated epidemic strains belonged to one clone. Multi-drug resistance, even to cephalosporins of the third generation and amikacin, was characteristic for all strains. Certain markers of S. marcescens (haemolysin, proteases, siderophores) which are thought to be related to virulence were studied but will require further investigation.

Neonatal septicaemia--incidence, etiology and outcome. A 6-year analysis.

Between 1983 and 1988 we observed altogether 222 cases of neonatal septicemia and/or meningitis in our Department of Neonatology. The incidence was 8.46 per 1,000 liveborn infants. The case fatality rate amounted to 45.9%. The most frequently isolated causative agents were Escherichia coli (23.4%) followed by group B Streptococci (16.7%), Staphylococcus aureus (9.9%), Klebsiella pneumoniae species (8.8%), Serratia marcescens (7.9%), Pseudomonas aeruginosa and coagulase-negative Staphylococci each 5.9%. The report includes information about serotypes of Escherichia coli, group B Streptococci and plasmid patterns of Serratia marcescens. The latter was responsible for an outbreak of septicemia and meningitis with high mortality. The changing infection pattern reflects changes in the newborn population, especially in the patient structure of the neonatal intensive care unit, changes in the antibiotic policy and organizational problems.

[Neonatal percentile values for East Germany--1985. 3. On the correlation of body height and weight of the mother in a two-dimensional classification of newborn infants according to birth weight and gestational age]. / Neugeborenen-Perzentilwerte für die DDR--1985. 3. Mitteilung: Zur Berücksichtigung von Körperlänge und -gewicht der Mutter bei der zweidimensionalen Klassifikation der Neugeborenen nach Geburtsgewicht und Schwangerschaftsdauer.

There were published percentiles of birthweight in relation to bodyheight of the mother as well as in relation to bodyweight and parity, bodyheight and bodyweight of the mother for term range 37th to 41st week of pregnancy. They were calculated through median quantities. The dates again derive from the investigation of 51,570 single births in elected regions of GDR in 1984 and 1985. The length of pregnancy was stated in full weeks. It was determined on the base of three parameters (by Naegele method, by sonography, and by neonatal maturity judgment). Selected percentiles of birthweight regarding the above influencing factors, distributed into sex, were summarized for use in practice.

[Nosocomial infections caused by multi-resistant Serratia marcescens at a university clinic--clinical aspects and drug resistance]. / Nosokomiale Infektionen durch multiresistente Serratin marcescens in einem Universitätsklinikum--Aspekte der Klinik und Chemotherapeutikaresistenz.

Serratia marcescens (S.m.) has become increasingly important as a nosocomial pathogen and displayed an increasing resistance to antimicrobial agents in the past decade. We recently studied in 1985 and 1986 an epidemic caused by multi resistant S.m. strains that involved 27 infants and 1 adult patient. 14 neonates (in most cases very low birth weight infants) in a neonatal intensive care unit developed a S.m.-septicemia and/or meningitis, 11 of them died. In a ward for young infants with congenital heart diseases 13 patients suffered a S.m. infection and one patient died in the adult intensive care unit in consequence of a S.m. septicemia.

[East German percentile values for newborn infants--1985 relation of age, parity, body weight and height of the mother and the birth weight of newborn infants]. / Neugeborenen-Perzentilwerte für die DDR - 1985 Beziehungen zwischen Alter, Parität, Körpergewicht und -länge der Mutter und dem Geburtsgewicht der Neugeborenen.

Based on an analysis of very comprehensive data material multidimensional investigations on connections between age, parity, weight and height of mothers and birth weight of infants have been made. Maternal height as well as maternal weight have a considerable influence on birth weight of infants. At the same maternal height infant birth weight will rise in connection with the rise of maternal weight. Maternal age, parity and weight are correlated variables. The older a woman, the higher on average is not only her parity but at the same her weight, too. The rise of maternal weight per year in the statistic mean amounts to 401 g. Moreover, at the same age like primiparae second and subsequent parae are of higher weights so that partly maternal weight contains indirectly not only maternal age but also maternal parity. The following range of the influencing factors maternal height, weight, parity and age on birth weight can be given: 1. Height and weight as relatively equivalent factors, 2. parity and 3. age.