[Necrotizing enterocolitis in the newborn infant. Pathogenetic risk factors in a 3 year analysis]. / Die nekrotisierende Enterokolitis des Neugeborenen. Pathogenetische Risikofaktoren in einer 3-Jahres-Analyse.

In a clinical study possible risk factors causing necrotizing enterocolitis (NEC) were studied in 17 preterm infants with NEC and compared with a control group of 17 healthy preterm infants. We found a more frequent rate of blood exchange transfusions and a lower rate of breast milk feeding in patients who later developed NEC than in the control group. But there were no differences between both groups concerning factors promoting hypoxia of the gut, the number of infections, antibiotic treatment, or hyperosmolar enteral feeding. The preterm infants with NEC did not show any characteristics in history, physical examination and clinical course. These children could not be distinguished as a risk group for this illness from the newborn infant control group. Therefore, with the exception of breast milk feeding, no special prevention of the necrotizing enterocolitis can be recommended.

[Intracerebral hemorrhage and neuron-specific enolase in premature and full-term infants--a clinical study]. / Intrazerebrale Blutungen und neuronenspezifische Enolase bei Früh- und Termingeborenen--Eine klinische Studie.

In a prospective study 199 risk newborn infants were examined by means of cerebral ultrasound scanning and after this the influence of diagnosed intracerebral events on the concentration of neuron-specific enolase (NSE) was determined. The NSE may be valid as an indicator of intracerebral damage. A significant relationship between increased concentration of NSE and intracerebral haemorrhage of type II could be found only for the NSE-1 (determination from cordblood or from blood of the first or second day of life). The same relationship results for intracranial cystic rebuildings, destructions and enlargements of ventricles. The diagnostic tests of NSE-1 for intracerebral haemorrhages don't prove with a validity of 57.4% high prognostic value. Not until a NSE-1-level of 16.0 micrograms/l a predictive value of the positive test of 100% was calculated.

[The status of biological risk factors and the optimality concept in diagnosis of early childhood developmental disorders]. / Die Stellung biologischer Risikofaktoren und des Optimalitätskonzeptes in der Diagnostik frühkindlicher Entwicklungsstörungen.

In a prospective study the psychomotor development up to the end of the second year of life of 409 preterm and term newborn infants was examined in order to identify which optimality score might be associated with disturbances of normal childlike development. Significant connections between 24 and 55 risk factors and the mortality could be demonstrated, but only 3 factors (sex, apgar, acidosis) exert influence on psychomotor development. The risk loading of the collective was high, not one of the children showed an optimal score. Decreased patients possessed a stronger reduced optimality than survivors. The optimality concept is not suitable for the prediction of later disturbed development of children, because the items are unspecific. The marker of hypoxia, the erythrocytic-density-test, as well as the neuron-specific enolase showed better diagnostic values than the optimality concept.

[Intracerebral hemorrhage and its sequelae in high risk newborn infants in relation to oxygen deficiency status]. / Intrazerebrale Blutungen und ihre Folgezustände bei Risikoneugeborenen in Abhängigkeit von Sauerstoffmangelzuständen.

In a prospective study 325 risk newborn infants were examined by means of ultrasound scanning. Children with and without intracerebral haemorrhages were classified, according to pre-, intra-, and postnatal periods of oxygen privation. For the characterization of short-term hypoxia the blood-gas analysis was used for the ascertainment of longtime hypoxia the erythrocytic-density-test (EDT). In dependence on PO2-values less than or equal to 5 kPa intracerebral haemorrhages of variable states increased significantly (p = 0.01). Evaluating the results of erythrocytic-density-test it may be concluded that the prenatal hypoxia has the greatest influence on the rate of intracerebral bleedings. Thus only 37.5% of our patients with prenatal hypoxia remained free of haemorrhages, in contrast of 70.2% of children without deficiency of oxygen.

[Psychomotor development of newborn infants at risk with reference to the neuron-specific enolase]. / Psychomotorische Entwicklung von Risikoneugeborenen unter Berücksichtigung der Konzentration der neuronenspezifischen Enolase.

In a prospective study the psychomotor development of an unselected collective of risk newborn infants up to the end of the second year of life was examined. 199 children have developed normal, 21 showed developmental abnormalities, 84 light to moderate disturbances, and 30 severe disabilities. Already in the newborn period the concentration of neuron-specific enolase in the serum was evaluated. The NSE could be an indicator of brain damage. The determined values of NSE showed a log-normal-distribution at the three times (cord-blood, first or second day of life, third or fourth day of life, and ninth to eleventh day of life). Significant relationship between the psychomotor development during the first two years of life and of NSE-concentration was not found. Nevertheless the diagnostic value of the NSE is better with a specificity of 47.7% and a sensitivity of 80.0% than those of the results of intracranial ultrasound examination or of the erythrocytic-density-test. In contrast to these results the use of the neuron-specific enolase alone for the prediction of individual prognosis of children is not be recommended.

[Psychomotor development of children at risk with special reference to prenatal, intrapartum and postnatal hypoxia]. / Psychomotorische Entwicklung von Risikokindern unter Berücksichtigung prä-, intra- und postnataler Hypoxien.

In a prospective study the psychomotor development of an unselected collective of high risk newborn infants up to the end of the second year of life was examined. The proof of hypoxia was performed with the erythrocytic density test (EDT). The value of EDT showed a decline with the age of life, and it was independent of gestational age or of birthweight only at the first point of determination (cord blood, first or second day of life). Significant connections between the level of light red blood cells and the children's development could not be demonstrated, although the probability to develop psychomotor disabilities increased in the newborn with a positive value of EDT. The diagnostic value of EDT showed the best results for intrapartum and postnatal hypoxia. The highest specificity was calculated with 38.0%, if the sensitivity is 80.0%. In conclusion of these results it's not to be recommended to use the EDT alone for the prediction of individual prognosis of children.

[Intracranial hemorrhage in preterm- and full-term newborn infants. Frequency and prognosis for development]. / Intrakranielle Blutungen bei Früh- und Termingeborenen. Häufigkeit und Entwicklungsprognose.

In a prospective study 306 high-risk infants with a birth-weight between 890 to 4900 gm were examined by means of cerebral ultrasound scanning and about a time of two years the psychomotor development was evaluated. 145 patients (47.4%) were classified as intracerebral haemorrhages. The strongest relation with the event of bleeding was found for the high level of PCO2. With increased severity of the intracranial haemorrhage was associated a worse prognosis of development in the first two years of life. The type I-haemorrhage showed in 72.2%, the types III/IV in yet only 42.9% a development without psychomotor disorders.