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Sozialpädiatrie beschäftigt sich mit sozialen Determinanten für Erkrankungen. Diese können die Inzidenz bzw. Prävalenz von Morbidität und Mortalität verändern. Epidemiologie beschreibt zeitliche Trends in Populationen und untersucht deren Ursachen. Durch Prävention sollen Erkrankungsraten reduziert bzw. deren Prognose verbessert werden. Psychische Störungen sind häufige Phänomene und betreffen bis zu 20% der Kinder und Jugendlichen bis zum Erreichen des Erwachsenenalters. Die Besonderheit der Phänomenologie psychischer Störungen im Kindes- und Jugendalters ist ihre enge Verbindung zur Entwicklung des Individuums und ihre häufig starke Wechselwirkung mit körperlichen Funktionen und dem Auftreten somatischer Symptome. Aus diesem Grund bewährt sich für das Verständnis und die Versorgung zahlreicher psychischer Störungen ein biopsychosomatischer Ansatz im Kindes- und Jugendalter. Dieser Ansatz kann als Wechsel der Perspektive von einer primär auf das Organ zu einer mehr psychisch zentrierten Betrachtung in der Diagnostik und Behandlung von Störungen mit einer primär körperlichen Symptomatik verstanden werden. Dieser Vorstellung liegt zugrunde, dass keine somatische Symptomatik isoliert aufritt, ohne dass ein psychisches Korrelat besteht, was dann als somato-psychisches Phänomen beschrieben werden kann. Psychosomatische Erkrankungen sind z. B. die Essstörungen, die dissoziativen und die somatoformen Störungen.

Additional file 1: Table S1. Frequencies and relative risk of comorbidities by chapters of ICD-10-GM in the control and the migraine group.

Additional file 3: Table S3. Comparison of primary care physician and specialist raw costs in 2017 for control group and migraine group.

Additional file 4: Table S4. Excess costs of specific diseases and disease related difference in migraine and control group. * G Diagnosis without ICD G43 and G44,** R diagnosis without ICD R51.

Additional file 2: Table S2. Costs of painkillers and other possibly headache-related drugs.

Metabolic factors acting during limited and sensitive time periods of pre- and postnatal development can induce lasting effects on health and disease risk in later life up to old age, including later obesity risk, which is referred to as early metabolic programming of long-term health. Three meta-analyses of observational studies found that obesity risk at school age was reduced with early breastfeeding compared to formula feeding. We assumed that breastfeeding protects against later obesity by reducing the occurrence of high weight gain in infancy and that one causative factor is the lower protein content of human milk compared to usual infant formulas (the "early protein hypothesis"). We are testing this hypothesis in the European Childhood Obesity Project, a double-blind, randomized clinical trial enrolling 1,678 infants in five countries (Belgium, Germany, Italy, Poland, Spain). We have randomized healthy infants born at term to receive for the first year infant formula and follow-on formula with higher or lower protein contents, respectively. The follow-up data obtained at age 2 years indicates that feeding formula with reduced protein content normalizes early growth relative to a breastfed reference group and the current WHO growth standard, which may furnish a significant long-term protection against later obesity. We conclude that infant feeding practice has a high potential for long-term health effects. The results obtained should stimulate the review of recommendations and policies for infant formula composition.

For the first time in the German speaking area 8 cases of neonatal immunothrombocytopenia caused by platelet-specific P1A1 antibodies could be ascertained. The disease is caused by fetomaternal incompatibility against platelet antigens. All mothers were healthy. The children showed a postnatal tendency for petechial haemorrhages. Cerebral haemorrhages occurred in two cases. Optimal treatment consists of administration of P1A1-negative platelets (perhaps of the mother). Demonstration of platelet antibodies is possible nowadays by adequate serological methods.

Hintergrund: Der populationsbezogene Einsatz von Physiotherapie bei Kindern und Jugendlichen wurde bisher ausschließlich anhand von Krankenkassendaten analysiert, die weder anamnestische noch soziale Faktoren berücksichtigen können. Mit Hilfe der KiGGS-Basisdaten ist es möglich die[zum vollständigen Text gelangen Sie über die oben angegebene URL], 14. Deutscher Kongress für Versorgungsforschung

Objectives: Health economic evaluations (HEEs) of vaccines are commonly considered during immunization introduction decision-making processes in most industrialized countries. Despite the availability of guidelines advocating more standardization for such HEEs, there are still several infection/immunization-specific particularities that are debated in the scientific community. An international expert-workshop was convened to identify good practices for (i) how to conduct HEEs of vaccines and (ii) how to consider results of HEE in vaccine introduction decision-making. Methods: A systematic literature search was conducted to identify prevailing opinions and remaining issues of HEE in vaccination. Twentytwo experts in the field of health economics and immunization decision-making were invited to a workshop and were asked to answer a survey-questionnaire based on the systematic literature search beforehand to inform the preparation of group work sessions (GWS). In GWS, issues focusing on 'mathematical modeling', 'health economics', and 'decision-making' were discussed and summarized. Results: The GWS (based on systematic literature search) included topics such as cost-components, quality of life (QoL), discounting, and perspectives leading to suggestions such as including caregiver QoL impact and applying decreasing time-related discount rates. Since vaccination often causes indirect effects, the use of dynamic models is required and exceptions should be justified. In order to facilitate transparent decision-making, the results of HEE should present parameter and methodological uncertainty as well as cumulative and time-specific figures. The majority of countries in Europe use results from HEEs in an informal judgment-process without willingness to pay (WTP) threshold. The expert-group emphasized that transparency should be maximized in decisionmaking process. Conclusions: The deliberations led to suggestions on several HEE issues. However, vaccines not always need to be considered differently in HEE since other interventions might share similar characteristics. Transparency in the conduct and presentation of HEE, and subsequent decision-making is essential, especially in the absence of explicit WTP thresholds.

Hintergrund und Fragestellung: Vor dem Hintergrund des Risikos der Chronifizierung von Kopfschmerzen sind präventive Strategien von besonderer Bedeutung. Die Herausforderung bei der Kopfschmerzprävention: Identifikation von präventablen Risikofaktoren, Bestimmung von deren attributablem[for full text, please go to the a.m. URL], Prävention zwischen Evidenz und Eminenz; 15. Jahrestagung des Deutschen Netzwerks Evidenzbasierte Medizin

OBJECTIVE: Whether specific combinations of risk factors in very early life might allow identification of high-risk target groups for overweight prevention programs was examined. DESIGN AND METHODS: Data of n = 8981 children from the German KiGGS study were analyzed. Using a classification tree approach, predictive risk factor combinations were assessed for overweight in 3-6, 7-10, and 11-17-year-old children. RESULTS: In preschool children, the subgroup with the highest overweight risk were migrant children with at least one obese parent, with a prevalence of 36.6 (95% confidence interval or CI: 22.9, 50.4)%, compared to an overall prevalence of 10.0 (8.9, 11.2)%. The prevalence of overweight increased from 18.3 (16.8, 19.8)% to 57.9 (46.6, 69.3)% in 7-10-year-old children, if at least one parent was obese and the child had been born large-for-gestational-age. In 11-17-year-olds, the overweight risk increased from 20.1 (18.9, 21.3)% to 63.0 (46.4, 79.7)% in the highest risk group. However, high prevalence ratios were found only in small subgroups, containing

Streptokokken der Serogruppe B (GBS) sind die häufigsten Erreger der neonatalen Sepsis und verursachen eine signifikante Morbidität und Mortalität. Zwischen 2001 und 2003 wurde in Deutschland eine erste ESPED-Studie zur Erfassung von Inzidenz und klinischen Eigenschaften neonataler GBS-Infektionen[for full text, please go to the a.m. URL], 21. Jahrestagung der Deutschen Gesellschaft für Pädiatrische Infektiologie (DGPI)

Objective: To evaluate if percentile-specific effects of genetic, environmental and lifestyle obesity risk factors on body mass index (BMI) might reflect gene-environment interactions with respect to the development of overweight. Design and Methods: Retrospective study with data of 2,346 children from the Avon Longitudinal Study of Parents and Children (ALSPAC), using quantile regression with body fat mass index (FMI) for children at the age of 9 years as outcome variable. We assessed interactions of an “obesity-risk-allele-score” with environmental and nutritional factors. Results: There was no evidence of interactions between the obesity-risk-allele score and the environmental variables except for maternal overweight. However, we found a significant interaction with respect to intake of mono- and polyunsaturated fatty acids at the age of 7. In children with low intake, genetic risk was associated with increasing effect sizes by FMI percentile. Conclusions: Our results suggest an interaction between a low dietary content of unsaturated fatty acids and genetic risk factors for overweight on FMI. This effect is likely to be stronger in children with higher FMI. &nbsp

Noise can affect well-being and performance of individuals and might be associated with an increased risk of cardiovascular events. To date most epidemiological studies considered exposure from a single source of noise. The EU Environmental Noise Directive (2002/49/EC) requires a summative measurement of ambient noise. This study aimed to capture the participants' exposure to environmental noise by means of personal noise dosimetry.Children (n=628, participation=61%, age 8-12 years), adolescents (n=632, participation=58%, age 13-17 years) and adults (n=482, participation=40%, age 18-65 years) were selected randomly from the population registry of 4 Bavarian towns and were invited to participate in a 24-h measurement using noise dosimetry. Noise exposures during day and night were analyzed separately. In addition, predictors of noise exposure were assessed.For daytime noise exposure mean±standard deviation were in children 80.0±5.8dB(A), in adolescents 76.0±6.2dB(A), in adults 72.1±6.1dB(A) (pANOVA

This study aimed to (i) gain insight in the prevalence of overweight indices in European preschoolers (4-7 years); (ii) identify energy balance-related behaviours associated with overweight/obesity; and (iii) identify children at risk for overweight/obesity. Secondary analyses of six European data sets were conducted according to standardized protocols. Based on objectively measured height and weight, prevalence of overweight and obesity across the countries ranged from 8% to 30% and 1% to 13%, respectively, with highest rates in Southern European countries (i.e. Spain and Greece). Positive associations between sedentary behaviours and overweight indices were found. Physical activity and dietary behaviours were not associated, possibly because of methodological limitations. Children of parents with high body mass index or low socioeconomic status were at increased risk of overweight/obesity. In conclusion, large differences in prevalence of overweight and obesity among preschoolers across Europe were observed. Future obesity prevention interventions in preschoolers should target screen time giving specific attention to children from overweight and/or low socioeconomic status parents. There is a need for high methodological quality studies, preferably with a long-term prospective design using sensitive, valid and reliable measures of behaviours, assessing whether and which physical activity and dietary behaviours are associated with overweight in preschoolers. © 2012 The Authors. obesity reviews © 2012 International Association for the Study of Obesity.

Fragestellung: Die Hüftlateralisation bei Kindern mit Cerebralparese hängt von der schwere der motorischen Beeinträchtigung ab und kann zu einer milden Beeinträchtigung, bis hin zu starken Schmerzen führen. Über den Zusammenhang zwischen der Lateralisation der Hüfte[for full text, please go to the a.m. URL], Süddeutsche Tage der Kinder- und Jugendmedizin; 61. Jahrestagung der Süddeutschen Gesellschaft für Kinder- und Jugendmedizin und der Süddeutschen Gesellschaft für Kinderchirurgie und dem Berufsverband für Kinder- und Jugendärzte – Landesverband Bayern

Hintergrund: GBS sind weltweit die häufigsten Erreger der neonatalen Sepsis. Über die Rolle als Erreger invasiver Infektionen jenseits der Neugeborenenperiode ist relativ wenig bekannt. Wir stellen Zwischenergebnisse einer laufenden, bundesweit altersübergreifend durchgeführten Studie[for full text, please go to the a.m. URL], 10. Kongress für Infektionskrankheiten und Tropenmedizin (KIT 2010)

SummaryAssessments of the vitamin K status in newborns and their mothers by means of des-γ-carboxy-prothrombin (PIVKA II) measurement have given equivocal results. Part of the variability could be attributed to differences in sensitivity (i.e. the ability to detect small concentrations) and validity (i.e. ability to detect vitamin K deficiency) of the methods applied. None of these methods have yet been validated with respect to plasma vitamin K1. In 22 healthy mother/infant pairs PIVKA II was determined using three different assays including ratio Xa/ecarin (Xa/ec), crossed immunoelectrophoresis (CIE), and an ELISA with a monoclonal antibody (MAB). The results were compared with conventional clotting tests and plasma vitamin K1. The following results were obtained:Cord blood: Clotting tests within age-related normal ranges; PIVKA II detection rates: 0/22 (Xa/ec), 1/22 (CIE), 4/22 (MAB); plasma vitamin K1: undetectable in 20/22.Mothers: Clotting tests all within normal range; PIVKA II detection rates: 1/22 (Xa/ec), 0/22 (CIE), 5/22 (MAB); plasma vitamin K1 (pg/ml) for all mothers (median; range): 186; 55–833; for PIVKA II positive mothers: 213; 59–699.PIVKA II detectability in newborns and mothers was not correlated. The results show an increase in sensitivity for PIVKA II detection in the order of MAB ≫CIE >Xa/ec. Due to the very low plasma vitamin K1 at birth, no correlation was possible between cord PIVKA II detectability and plasma vitamin K1. However, in mothers at term PIVKA II MAB appears to be unrelated to the vitamin K status.

Von einer angeborenen beidseitigen therapiebedürftigen Hörstörung ist etwa 1 von 1000 Neugeborenen betroffen. Ein universelles Neugeborenen-Hörscreeningprogramm soll sicherstellen, dass alle Neugeborenen mit geeigneten Testmethoden gescreent und alle Befunde abgeklärt werden (Tracking), um so eine vollständige und frühzeitige Erkennung der Hörstörungen und einen adäquaten Therapiebeginn möglichst im ersten Lebenshalbjahr zu gewährleisten. Ein Modellprojekt mit geeigneten logistischen Strukturen wurde in der Oberpfalz 2003 etabliert und 2006 auf Oberfranken ausgeweitet. In allen Geburts-und Kinderklinken in der Modellregion wird ein dreistufiges OAE- und BERA-Screening durchgeführt. Ein Screeningzentrum am Landesamt für Gesundheit und Lebensmittelsicherheit (LGL) in Oberschleißheim übernimmt die Koordination des Screeningprozesses, die Sicherstellung der Vollständigkeit, das Tracking der auffälligen Befunde und die Qualitätssicherung. Insgesamt wurden 56.554 Neugeborene (etwa 95%) gescreent. Die Referrate bei Entlassung lag bei 2,0% (0,6% beidseitig). Über 97% der auffälligen Befunde wurden abgeklärt, 48% erst nach Intervention durch das Screeningzentrum. 38 Kinder (0,7(PER MILLE)) mit einer hochgradigen beidseitigen Hörstörung wurden in einem Durchschnittsalter von 5,5 Monaten diagnostiziert und die Therapie mit 5,9 Monaten begonnen. Die in dem Modellprojekt etablierten logistischen Strukturen ermöglichen ein effektives universelles Neugeborenen-Hörscreening.

Seit 2003 wird in 2 Regionen Bayerns ein universelles Neugeborenenhörscreenings (NHS) als Modellprojekt durchgeführt, um eine frühere Diagnosestellung und Therapieeinleitung und damit eine bessere Sprachentwicklung und schulische Bildung der betroffenen Kinder zu ermöglichen. Um das Langzeitoutcome der im Modellprojekt entdeckten Kinder evaluieren zu können, wurden bei der Schuleingangsuntersuchung Eltern von Kindern mit beidseits angeborenen Hörstörungen der Geburtsjahrgänge 1999-2001 als Kontrollgruppe befragt. Dabei konnten bislang auch unter Einbeziehung der Kinder aus Förderschulen nur ca. ein Drittel der erwarteten Fälle erreicht werden. Die Verteilung der Schweregrade der Hörstörung (15% leichte, 40% mittelgradige, 45% hochgradige), der Geschwisterzahl, der Ethnizität ist trotz der niedrigen Teilnahmerate repräsentativ. Das Alter bei Diagnosestellung (Median 29/30 Monate) und Therapiebeginn (Median 29,5/30 Monate) wurde weder durch das NHS (ohne systematisches Programm) noch das Vorliegen einer positiven Familienanamnese oder anderer Risikofaktoren vorverlegt. Im Modellprojekt liegt der Median für Diagnosealter und Therapiebeginn bei 4,6 bzw. 5 Monaten. Dies zeigt, dass ein positiver Effekt auf das Alter bei Therapiebeginn nur durch ein Hörscreening im Rahmen eines Programms mit einem Tracking der kontrollbedürftigen Befunde erzielt werden kann. Insgesamt besuchen aus der Studienpopulation ca. 35% der Kinder eine Regelschule.

Einleitung: Bei SSES ist bislang offen, ob Unterschiede im Kurzzeitgedächtnis (KG) zwischen expressiver (ESES) und rezeptiver SES (RSES) bestehen. Methode: 21 Kinder mit ESES und 21 mit RSES wurden untereinander nach Alter und nonverbalem IQ sowie mit 21 Kontrollkindern (KO) gematched. Untersucht wurden zum einen auditiv Sinnlossilbenfolgen (SSF) und Zahlenfolgen (ZF) sowie zum anderen visuell Handbewegungsfolgen (HF) und Symbolfolgen (SYF). Analysen erfolgten über einfaktorielle ANOVA, Korrelationen (Pearson) und lineare Regression mit backward selection. Ergebnisse: ESES und RSES unterschieden sich in den ZF und SSF von den KO, jedoch ohne Differenzen zwischen ESES und RSES. SYF waren bei RSES signifikant schlechter gegenüber den KO (Gesamt-ANOVA p=.016, Tukey-HSD p

Einleitung: Bei SES ist bislang offen, ob Unterschiede im KG zwischen expressiver (ESES) und rezeptiver SES (RSES) bestehen. Methode: 21 Kinder mit ESES und 21 mit RSES wurden untereinander nach Alter und nonverbalem IQ sowie auch mit 21 sprachunauffälligen Kindern (KO) gematched. Die Gruppeneinteilung in ESES und RSES erfolgte über 5 Subtests aus dem Heidelberger Sprachentwicklungstest, die auch bei allen KO vorgenommen wurden. Mittelwerte (M) und 95%-Konfidenzintervalle (95KI) wurden berechnet. Ergebnisse: ESES und RSES unterschieden sich im auditiv-verbalen KG (Zahlen- und Sinnlossilbenfolgen) von den KO, jedoch ohne Differenzen zwischen ESES und RSES. Dagegen war das rein visuelle KG (Symbolfolgen) bei RSES (M=43.2; 95KI=39.3-47.0) signifikant schlechter (ANOVA-p=.022; posthoc Student-Newan-Keuls-Test p

BACKGROUND: In May 2003, a newborn auditory screening program was initiated in the Upper Palatinate. METHODS: Sequential OAE- and BERA-screening was conducted in all hospitals with obstetric facilities. The Screening Center at the Public Health Authority was responsible for the coordination of the screening process, completeness of participation, the follow-up of all subjects with a positive screening test and the quality of instrumental screening. RESULTS: A total of 96% of 17,469 newborns were screened. The referral rate at discharge was 1.6% (0.4% for bilateral positive findings). For 97% of the positive screening results, a definite diagnosis to confirm or exclude hearing loss was achieved; for 43% only after intervention by the Screening Center. Fifteen children with profound bilateral hearing impairment were identified of whom eight were only detected by the intervention of the Screening Center. CONCLUSION: The effective structures established in the Upper Palatinate provide a standard for the quality of neonatal auditory screening achievable in Germany.

OBJECTIVE. Streptococcus agalactiae (group B Streptococcus) is an important cause of morbidity and mortality in newborn infants. So far, there have been no published data on the incidence, morbidity, and mortality of invasive neonatal group B Streptococcus infections in Germany.METHODS. A prospective active surveillance study involving all of the pediatric hospitals, which reported their cases to the German Pediatric Surveillance Unit, and all of the microbiological laboratories serving pediatric hospitals, which reported their cases to the Laboratory Sentinel Group at Robert Koch Institute Berlin, was conducted between 2001 and 2003. Capture-recapture analysis was used to evaluate the completeness of reported neonatal invasive group B Streptococcus infections.RESULTS. We collected and analyzed data from 347 and 360 infants with invasive group B Streptococcus infection during the first 3 months of life, as reported by pediatricians to the German Pediatric Surveillance Unit and microbiologists to the Robert Koch Institute Berlin, respectively. Using capture-recapture analysis, we calculated an incidence of 0.47 per 1000 live births. Nearly 60% of the infants suffered from early-onset disease, and 16% of these presented with meningitis. In contrast, 61.8% of infants with late-onset disease presented with meningitis. Prematurity was present in 22.4% of early-onset disease and 39.7% of late-onset disease cases, respectively. A high proportion of infants suffered from sequelae because of group B Streptococcus infection at the time of discharge from the hospital. Most common sequelae were hydrocephalus and cerebral seizure. Case fatality rate was 4.3%.CONCLUSIONS. This study, which is the first to provide information on the current national incidence and morbidity of invasive group B Streptococcus infection in Germany, demonstrates remarkable country-specific variation in comparison with other European countries, which gather data in a similar fashion. Therefore, the importance of country-specific prevention guidelines has to be stressed.

Using a sensitive electrochemical assay for vitamin K1 and standardized techniques for breast-milk collection, we studied the vitamin K1 content of human milk during the first 5 wk of lactation with respect to 1) individual and interindividual differences, 2) the relationship of vitamin K1 to other lipids, and 3) the influence of oral supplements of vitamin K1 on breast milk concentrations. Comparison of fore and hind milk from the mothers revealed higher vitamin K1 concentrations in hindmilks, suggesting that the lipid content influences the vitamin K1 concentration in maternal milk. Samples of maternal milk from nine mothers collected from day 1 to day 36 of lactation showed significantly higher vitamin K1 concentrations in colostral milk than in mature milk. For colostral milk there was a significant correlation of vitamin K1 to cholesterol (r = 0.62) but not to total lipid or phospholipid suggesting a role for cholesterol in the secretion of vitamin K1 into colostral milk. For mature milk correlation coefficients of vitamin K1 with all lipids were low (r = 0.29-0.37) suggesting that at later stages of lactation dietary fluctuations of vitamin K1 may be a more important determinant of the vitamin K1 content of breast milk than the lipid composition. To test the influence of diet, mothers were given oral supplements of vitamin K1.(ABSTRACT TRUNCATED AT 250 WORDS)

Higher levels of factor VIII: C and factor VIII R: Ag were found in healthy newborns (n = 60) as compared to adults. This could be explained as a stress reaction due to birth and the adaptation to extrauterine life. A further stress factor is disease. The highest values for factor VIII R: Ag were found in ill (n = 32) and in severely ill newborns (n = 21). The large ranges of factor VIII: C and of the ratio of factor VIII: C/VIII R: Ag in healthy newborns can be explained by an increased turnover of coagulation factors. Diseases in the newborn period lead to an increase of this process, resulting in even larger ranges of factor VIII: C and of the ratio of factor VIII: C/VIII R: Ag in ill and extremely ill newborns. Consumption of factor VIII: C with a low ratio of factor VIII: C/VIII R: Ag predominates in extremely ill newborns. The ratio of factor VIII: C/VIII R: Ag is more valuable than factor VIII: C for diagnosis of DIC in newborns. A diagnosis of hemophilia and von Willebrand's disease cannot be established with certainty in severely ill newborns. Stress and DIC may influence the characteristic changes of laboratory parameters.

Bleeding symptoms complicating HDMTX and CFR therapy have been reported, Thrombocytopenia and disturbed plasmatic coagulation could not explain all bleeding episodes. Platelet function had not been investigated in HDMTX and CFR treatment so far. In vitro tests showed a dose-dependent inhibition of platelet aggregation post incubation with MTX. Platelet factor 3 availability was decreased as well. Ex vivo investigations in 10 children undergoing HDMTX and CFR treatment (6 or 12 g/m2) showed impaired platelet factor 3 release whereas aggregation tests were normal. No severe platelet function disturbances could be seen under HDMTX with CFR treatment. However, platelet function should be tested in cases of unexplained bleeding tendency under HDMTX/CFR treatment, since the impairment of platelet function observed in vitro might become relevant in the individual condition.

The incidence of hemorrhagic disease of the newborn (HDNB) can be expected to increase in Canada as breast-feeding becomes more popular. There are three clinical patterns of hemorrhagic disease: early HDNB (usually related to maternal drug ingestion), classic HDNB (related to breast-feeding) and late hemorrhagic disease of infancy (related to the combination of breast-feeding and diseases that cause fat malabsorption). Despite the knowledge that the disease can virtually be prevented by the administration of vitamin K, not all newborns are being routinely considered for such treatment. The Canadian Paediatric Society has made several recommendations: (a) women who take drugs that interfere with vitamin K1 metabolism should receive oral doses of vitamin K1 daily for a minimum of 2 weeks before expected delivery; (b) all healthy term infants should receive a single dose of vitamin K1, orally or intramuscularly, within 6 hours after birth; (c) all other newborns, including preterm, low-birthweight and sick infants, should receive a single intramuscular dose of vitamin K1 within 6 hours after birth; and (d) infants at high risk for secondary late-onset hemorrhagic disease due to fat malabsorption should receive vitamin K1 orally every day or intramuscularly once a month.

SummaryBleeding after ear-nose-and throat surgery in children is a serious complication. With the help of the German Surveillance Unit for Rare Paediatric Disorders (Erhebungseinheit für seltene pädiatrische Erkrankungen in Deutschland; ESPED) a two year survey was performed to record the incidence, severity, reasons and treatment of haemorrhages. During the study period, 1069 bleeds were reported from 720 paediatric hospitals and departments of otorhinolaryngology after adenoidectomy and tonsillectomy. 713 reports could be analyzed. Two deaths occurred after adenoidectomy. Although laboratory screening was performed in more than 70% of all cases, bleeding complications were neither foreseeable nor preventable. Inherited coagulopathies were rare and in most cases not detected, neither by laboratory screening nor by taking a history. Since preoperative measures cannot help much to improve the situation, all efforts have to be taken to improve the postoperative period, especially since more than 20% of the hemorrhages occurred during weekends. Guidelines on postoperative care and behaviour should therefore be implemented and parents and patients must be informed on bleeding risks and on what to do in case of emergency. If bleeding occurs, extensive coagulation testing is mandatory.

227-240 BACKGROUND: Incremental cost-effectiveness and cost-utility analyses [health economic evaluations (HEEs)] of vaccines are routinely considered in decision making on immunization in various industrialized countries. While guidelines advocating more standardization of such HEEs (mainly for curative drugs) exist, several immunization-specific aspects (e.g. indirect effects or discounting approach) are still a subject of debate within the scientific community. OBJECTIVE: The objective of this study was to develop a consensus framework for HEEs of vaccines to support the development of national guidelines in Europe. METHODS: A systematic literature review was conducted to identify prevailing issues related to HEEs of vaccines. Furthermore, European experts in the field of health economics and immunization decision making were nominated and asked to select relevant aspects for discussion. Based on this, a workshop was held with these experts. Aspects on 'mathematical modelling', 'health economics' and 'decision making' were debated in group-work sessions (GWS) to formulate recommendations and/or-if applicable-to state 'pros' and 'contras'. RESULTS: A total of 13 different aspects were identified for modelling and HEE: model selection, time horizon of models, natural disease history, measures of vaccine-induced protection, duration of vaccine-induced protection, indirect effects apart from herd protection, target population, model calibration and validation, handling uncertainty, discounting, health-related quality of life, cost components, and perspectives. For decision making, there were four aspects regarding the purpose and the integration of HEEs of vaccines in decision making as well as the variation of parameters within uncertainty analyses and the reporting of results from HEEs. For each aspect, background information and an expert consensus were formulated. CONCLUSIONS: There was consensus that when HEEs are used to prioritize healthcare funding, this should be done in a consistent way across all interventions, including vaccines. However, proper evaluation of vaccines implies using tools that are not commonly used for therapeutic drugs. Due to the complexity of and uncertainties around vaccination, transparency in the documentation of HEEs and during subsequent decision making is essential.