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Background: The German Neonatal Census provides epidemiological data in the field of perinatology particularly concerning the rates of preterm birth and the mortality and morbidity of preterm infants., Materials: All but two inquiries in Germany in 2001 were analyzed, covering 87% of all live births., Results: The transfer rate from obstetric departments to children's hospitals/neonatological wards was 14.6% of which 87.4% were singletons, 11.5% were twins and 1.1% were triplets or higher order births. 1.3% of all admitted patients were born before 32 weeks gestational age and the mortality rate was 9.1%. After 28 weeks gestational age the mortality rate was lower for twins than for singletons, after 32 weeks gestational age it was lower for triplets as well. In 17.4% of all patients born before 28 weeks gestational age a high grade intracranial hemorrhage (B III and IV) was found and in 6.2% a periventricular leukomalacia was seen. 15.8% of all surviving preterm infants before 28 weeks developed ROP 3 + >., Conclusions: A synopsis of all neonatal censuses is an appropriate tool to study morbidity and mortality in preterm infants. Comparing the results with published data of large cohorts make the presented results reasonable although documentation seems to need some improvement in several fields.

A change of Federal Law in Germany in 1994 required the registration of premature infants with birthweights between 500 and 1000 g the previous limit being 1000 g. The data of the National Bureau of Statistics (Statistisches Bundesamt) indicate that as a consequence overall perinatal mortality increased slightly with a clear increase in premature infants with a birthweight of less than 2500 g. In all other birthweight-specific subgroups, a further decrease in perinatal mortality was observed. Overall perinatal mortality in 1996 was 0.68%.

In 58 premature infants with a birthweight < 1500 g High-Frequency-Oscillating-Ventilation (HFOV) was initiated within the first 48 hours of life. Indications for HFOV were: no response to surfactant application (N = 41), respiratory distress syndrome without surfactant application (N = 9), pulmonary interstitial emphysema (N = 8). Mean gestational age of the enrolled patients was 27.6 weeks (24-32) and mean birthweight was 964 g (490-1450). 23 infants died, 5 from non-pulmonary causes. Of the remainder 2 had B-Strept.-septicemia, 1 lunghypoplasia, and 1 patient died on the 70th day of life from chronic lung disease. There were no statistical differences between survivors and nonsurvivors in gestational age, birthweight, umbilical pH, 1 min APGAR score or time on conventional ventilation prior to HFOV. Alveolar-arterial-O2-difference dropped in the group of surviving patients from x487 mm Hg (sd +/- 60) to 252 mm Hg (sd +/- 89) after 6 hours (p < 0.0001) and in the nonsurvivors from x517 mm Hg (sd +/- 74) to x373 mm Hg (sd +/- 106) (p = 0.002). Oxygenationindex fell from x25 (sd +/- 10) to x5 (sd +/- 1.5) in the survivors and from 25 (sd +/- 11) to x9 (sd +/- 5.5) in the nonsurvivors within 6 hours (p < 0.0001). Mean airway pressure could be lowered in survivors from x7.6 cm H2O (sd +/- 0.6) to 5.3 cm H2O (sd +/- 0.8) and in nonsurvivors from x8.6 cm H2O (sd +/- 0.6) to 5.7 cm H2O (sd +/- 0.9) (p = 0.0002). The promising results of HFOV as a rescue therapy require a controlled study for its use as a primary mode of ventilation in premature infants.

To study the effects of high frequency oscillating ventilation (HFOV) on cerebral and abdominal circulation we measured blood flow velocities in three cerebral arteries and in the A. mesenterica superior by pulsed doppler ultrasound in 13 preterm (mean gestational age 28 weeks [25-31]) and 3 term infants during conventional ventilation (intermitted positive pressure ventilation, IPPV) and HFOV. In the preterm infants systolic blood flow velocities decreased under HFOV in all cerebral arteries. Statistically significant differences were found in the A. cerebri anterior (45.8 cm/s [sd +/- 20.6] versus 34.3 [sd +/- 10.8]; p < 0.02) and in the A. basilaris (52.8 cm/s [sd +/- 26.4] versus 44.1 [sd +/- 18.7]; p < 0.05). There was also a distinct decrease of systolic blood flow velocity in the A. mesenterica (111 cm/s [ +/- 31.3] versus 61.8 cm/s [sd +/- 18.6]; p < 0.002). The enddiastolic blood flow velocity and the Resistance Index of Pourcelot did not change significantly. The systemic blood pressure did not change during conventional ventilation or HFOV. Mean airway pressure and pCO2 were lower during HFOV, but there was not strong correlation with the reduction of flow velocities in the studied arteries (r = 0.48). In the three term infants presenting with a persistent pulmonary hypertension of the newborn, there was an increase in systolic and enddiastolic flow velocities in all studied arteries under HFOV.

A male full-term neonate is described in whom cardiac insufficiency developed within 24 hours post partum. Ultrasound revealed an arterio-venous fistula of the vein of Galen. The patient's condition did not allow surgical correction and he died on the 22nd day of life. Persistent pulmonary hypertension was an important accompanying feature. The literature is reviewed with respect to the prognosis and the up to now seldom reported complication of persistent pulmonary hypertension of the newborn (PPHN).

38 psychiatric inpatients with various degrees of sleeping disorders were given L-tryptophane plus oxprenolol or placebo, each for two nights. Self-rating, rating of the nursing staff, tests of attention level and motor performance were the variables of the investigation. The statistical evaluation of the double-blind study shows no significant difference under these specific experimental conditions.

13 psychotic patients developing various degrees of postural hypotension during neuroleptic or antidepressant treatment were additionally given either placebo or a mineralocorticoid or a sympathomimetic drug. As shown by Schellong tests during therapy the best effect on postural hypotension was achieved by the mineralocorticoid. The statistical evaluation of the randomised study was significant.