[Trendsetting Ideas of the Children's Hospital "Kinderklinik Glanzing" Since 1915]. / Richtungsweisende Ideen der "Kinderklinik Glanzing" seit 1915: Quo vadis Kinderheilkunde.

Since its foundation in 1915, the Children's Hospital Glanzing has had many innovative medical directors, whose careers and scientific activities are described here in chronological order. Leopold Moll established substantial socio-pediatric initiatives such as "Kriegspatenschaften" ("war sponsorship organizations") and vacations for poor children, as well as counseling centers for mothers in Vienna. August Reuss founded baby care wards and pediatrics departments. He established his own training for pediatricians. Alfred Rosenkranz established in 1974 the first Neonatal Intensive Care Unit in Austria.In 1992, Andreas Lischka successfully introduced quality management (QM) to the Children's Hospital Glanzing, one of the first hospitals in Europe, involving all hospital staff. The Children's Hospital Glanzing was the second European center to participate in the Vermont Oxford Neonatal Network (VONN) for the quality assurance of neonatal care. In 2000 in Wilhelminen Hospital, the first "baby hatch" was established for the anonymous abandonment of newborns without legal prosecution in order to give these unwanted babies a chance of survival (in addition to the possibility of an anonymous birth).Since 1999, music therapy has been offered at the neonatal intensive care unit in cooperation with the University of Music and Performing Arts, Vienna (mdw).Publications on the toxicity of the plasticizer diethylhexyl phthalate (DEHP) in polyvinyl chloride (PVC)-containing medical products constituted the opportunity to establish a PVC-free neonatal intensive care unit. Promotion of breast-feeding especially for premature born babies has always been a particular concern of the Children's Hospital Glanzing. Pollution with polychlorinated biphenyls (PCBs), dioxins, and furan in breast milk cannot be avoided; only a legal ban would lead to a reduction in these pollutants.To reduce the fear of hospitals in children, in 1994 the Children's Hospital Glanzing established a yearly summer children's festival before the end of the school term, with more than 2,500 parents and children attending in 2007. Great importance was attached to the comprehensive education of prospective pediatricians in all areas of our specialty, which could be taught by rotation in our own department with many focal points.The current situation of the Covid-19 pandemic indicates the great importance not only of intensive care beds but also the training of sufficient medical and supporting staff.

Breech presentation: a retrospective analysis of 12-years' experience at a single center.

OBJECTIVE: To investigate neonatal outcome after breech presentation in term pregnancies. STUDY DESIGN: Data from 1345 term breech deliveries over a 12-year study period were retrospectively reviewed. Neonatal morbidity and mortality were compared by route of delivery. RESULTS: We investigated 1345 term breech deliveries. A total of 1041 patients (77.4%) attempted a vaginal delivery; of these, 808 (60.1%) were delivered vaginally and 233 patients (17.3%) who failed at vaginal birth underwent cesarean section. The other 304 women (22.6%) were delivered by a planned cesarean section. No statistical differences were found in the incidence of low 5-minute Apgar scores and arterial cord blood pH values

Smoking, cereal consumption, and supplementation affect cadmium content in breast milk.

Breast milk might be a source of potentially toxic metals such as cadmium (Cd). The purpose of the present study is to provide data pertaining to the influence of maternal lifestyles on Cd concentrations in breast milk in the Austrian setting. Breast milk was obtained from 124 Austrian women. Each participant provided 10 ml of milk. A second group of eight mothers were recruited to investigate changes in their milk cadmium levels at 1, 3, 5, 7 and 9 weeks post partum. The study participants filled a questionnaire concerning nutrition, supplementation, and smoking habits. The samples were analyzed using GF-Atomic Absorption Spectrophotometer (AAS). The mean Cd content in breast milk was among the lowest in Europe (0.086 +/- 0.085 microg/l, 95% CI: 0.07-0.10; n = 124). Increased Cd levels in breast milk were found to be significantly associated with frequent cereal consumption and smoking. Smokers had a two-fold higher concentration than did non-smokers (0.15 versus 0.07 microg/l; P = 0.000). In contrast, low Cd levels in breast milk were associated with the intake of supplements containing trace elements or vitamins and trace elements (P < 0.05). This protective effect of supplements on Cd levels was only observed in non-smokers. The Cd levels registered in the present investigation were far below critical levels. We conclude that the current maternal Cd levels in Austria signify no risk for the breastfed infant of a healthy mother. Further research will have to focus on the specific effects of supplementation and smoking on Cd concentrations.

Increased risk of mother-to-infant transmission of hepatitis C virus by intrapartum infantile exposure to maternal blood.

Virological and clinical data from 73 hepatitis C virus (HCV)-infected pregnant women who gave birth to 75 children were merged retrospectively, by logistic regression analysis, to investigate risk factors for vertical transmission of HCV. Eighty-two percent of the HCV-infected mothers were HCV-RNA-positive during pregnancy, and 10% were coinfected with human immunodeficiency virus (HIV). Nine children were HCV infected, 1 was HIV infected, but none was HIV-HCV coinfected. Among vaginal deliveries, the mean HCV load of mothers who transmitted HCV to their infants was higher than that of those who did not (8.1 x 10(5) vs. 1.4 x 10(4) copies/mL; P=.056). A reduction in umbilical cord-blood pH (relative risk, 3.9; P=.04) or the occurrence of perineal or vaginal laceration (relative risk, 6.4; P=.028) during vaginal delivery significantly increased the risk of vertical HCV transmission. In conclusion, high maternal viremia, infantile hypoxia, and intrapartum exposure to virus-contaminated maternal blood increased the risk of HCV transmission during vaginal deliveries. Consequently, cesarean section may reduce the risk of vertical HCV transmission in selected cases.

Lead and mercury in breast milk.

OBJECTIVE: Heavy metals are potentially toxic substances, especially for the susceptible infant. Exposure to mercury (Hg) and lead (Pb) may result in neurotoxic and nephrotoxic impairment and in anemia. Previous data on breast milk Pb and Hg contents are sparse or missing for the Austrian population. No evaluations of the influence of mothers' lifestyles on Pb and Hg levels in breast milk are available. METHODS: Five- to 10-mL individual samples of breast milk were provided from healthy mothers in Vienna (urban; n = 59), Linz (industrial; n = 47), and Tulln (rural; n = 59). A questionnaire about area of residence, maternal nutrition, smoking habits, and dental fillings was filled out by the lactating mothers. Milk samples and infant formulas were lyophilized, wet-ashed with nitric acid (65%), and analyzed with atomic absorption spectrophotometry. Spiked skim milk powder was used as reference material. Statistical analysis included the Kruskal-Wallis test and multiple robust regression analysis. RESULTS: Breast milk showed low Hg and Pb concentrations (Hg: 1.59 +/- 1.21 1g/l, n = 116; Pb: 1.63 +/- 1.66 6g/l, n = 138). Eight percent of the breast milk samples marginally exceeded the screening level of 3.5 micro g/L for Hg. Austrian Pb values declined strongly during the last 20 years. Bivariate comparison revealed that the factors significantly related to metal levels in breast milk were area of residence (Hg, Pb), prematurity (Hg), consumption of fish (Pb) and cereals (Hg), vitamin supplementation (Hg), and smoking (Pb). The Hg and Pb contents of cow milk and infant formulas were far below respective guideline values. CONCLUSIONS: Neither Hg nor Pb concentrations exceeded critical levels. There are no reports on infants harmed by the intake of milk from unexposed mothers. We conclude that even theoretical risks from current Hg or Pb levels for the breastfed infant of a healthy mother can be ruled out.