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ZUSAMMENFASSUNG Einleitung Das Geburtsgewicht ist u. a. durch die mütterliche Größe beeinflusst. Die SGA-Rate Neugeborener relativ kleiner und leichter Mütter ( 177 cm,>79 kg) werden überschätzt. Die LGA-Rate Neugeborener relativ kleiner und leichter Mütter und die SGA-Rate relativ großer und schwerer Mütter wird unterschätzt. Individualisierte Geburtsgewichtsperzentilen (IGGP) basierend auf 18 Müttergruppen (6 Körperhöhengruppen mit jeweils 3 Gewichtsgruppen), Geschlecht und Schwangerschaftswochen wurden publiziert. Das Ziel dieser Studie ist die Validierung der IGGP durch Evaluierung der SGA-, AGA- und LGA-Raten an einem unabhängigen Perinataldatensatz. Methoden Die Validierungsstudie vergleicht IGGP (1995 bis 2000, n=2,2 Mio Einlingsschwangerschaften) mit Perzentilwerten aus zwei gesamtdeutschen Kohorten (i: 1995 bis 2000; n=2,3 Mio und ii: 2007 bis 2011, n=3,2 Mio) anhand von Neugeborenen der niedersächsischen Perinatalerhebung (n=0,56 Mio Einlingsschwangerschaften von 2001 bis 2009). SGA-, AGA- und LGA-Raten werden berechnet mit dem Statistikprogramm R. Ergebnisse Die Perzentilwerte der Gesamtpopulation 1995–2000 bzw. 2007–2011 ergaben SGA-Raten bei relativ kleinen und leichten Müttern von 21,1 bis 21,6% und LGA-Raten von 2,0 bis 3,1%. Bei relativ großen und schweren Müttern waren die SGA-Raten von 3,3 bis 3,5% und die LGA-Raten von 26,6 bis 27,1%. Die IGGP erreichten SGA-Raten von 9,0% und LGA-Raten von 11,4 bis 11,6% bei relativ kleinen und leichten Müttern sowie SGA- und LGA-Raten von annähernd 10% bei relativ großen und schweren Müttern. Diskussion IGGP berücksichtigen das Wachstumspotential von Feten entsprechend der mütterlichen Größe und erreichen die erwarteten SGA- und LGA-Raten von 10%. Die Berücksichtigung des individuellen Wachstumspotential vermeidet ein Unter- und Überschätzen von SGA- und LGA-Raten. IT-unterstützte Analysen des Geburtsgewichtes mit IGGP vereinfachen die Anwendung.

Probiotics are often viewed as an immunity enhancing agent. The objective of this study was to investigate whether oral administration of Escherichia coli Nissle 1917 reduces the number of infections, their duration, and severity in the first 24 months after parturition in healthy neonates. This prospective, confirmatory, randomised, double-blind, placebo-controlled study enrolled 567 healthy neonates from four German and two Polish sites. Neonates received 10e8 viable E. coli Nissle (n=283) or placebo (n=284) daily in the first week and every second day in week 2 and 3. After 6 and 12 months, the subjects received additional instillations on ten subsequent days. The overall efficacy was assessed by the number of infections per observation period. Incidence rates of infection, infection duration and severity showed no statistically significant difference between groups after 24 months. Post-hoc analyses, however, revealed a short-term benefit of E. coli Nissle four weeks after treatment start which became less pronounced after eight weeks. E. coli Nissle was safe and well tolerated. A long-term effect after colonising the healthy neonate´s gut with E. coli Nissle to protect against infections could not be shown. Additional studies are needed to confirm a transitory, yet clinically significant role of probiotics in the first four weeks after parturition. Probiotika werden oftmals als Immunstimulans gewertet. In dieser Studie wurde untersucht, ob sich für reife Neugeborene durch die perorale Verabreichung von Escherichia coli Nissle 1917 die Zahl der Infektionen, ihre Dauer und Schwere in den ersten 24 Monaten nach Geburt verringert. 567 gesunde Neugeborene aus vier deutschen und zwei polnischen Studienzentren wurden in diese prospektive, konfirmatorische, randomisierte, doppelblinde und Plazebo-kontrollierte Studie eingeschlossen. Neugeborene erhielten 10e8 lebende E. coli Nissle (n=283) oder Plazebo (n=284) täglich in der ersten Woche und jeden zweiten Tag in Woche 2 und 3. Nach 6 und 12 Monaten fanden zusätzliche Verabreichungen an zehn aufeinanderfolgenden Tagen statt. Die Wirksamkeit insgesamt wurde anhand der Zahl der Infektionen im Beobachtungszeitraum beurteilt. Nach 24 Monaten bestand zwischen den Gruppen kein statistisch signifikanter Unterschied in den Inzidenzraten der Infektionen, Dauer oder Schwere der Infektionen. Post-hoc Analysen ergaben allerdings einen kurzfristigen Nutzen von E. coli Nissle vier Wochen nach Beginn der Therapie, der nach acht Wochen nachgelassen hatte. E. coli Nissle war sicher und wurde gut toleriert. Es konnte kein gegen Infektionen schützender Langzeiteffekt nach intestinaler Besiedlung mit E. coli Nissle für den gesundenen Neugeborenen gezeigt werden. Zusätzliche Studien sind nötig, um die vorübergehende, jedoch klinisch signifikante Rolle des Probiotikums in den ersten vier Wochen nach Entbindung zu bestätigen.

Background Probiotics are often viewed as an immunity enhancing agent. The objective of this study was to investigate whether oral administration of Escherichia coli Nissle 1917 reduces the number of infections, their duration, and severity in the first 24 months after parturition in healthy neonates. Subjects and methods This prospective, confirmatory, randomised, double-blind, placebo-controlled study enrolled 567 healthy neonates from four German and two Polish sites. Neonates received 10e8 viable E. coli Nissle (n=283) or placebo (n=284) daily in the first week and every second day in week 2 and 3. After 6 and 12 months, the subjects received additional instillations on ten subsequent days. The overall efficacy was assessed by the number of infections per observation period. Results Incidence rates of infection, infection duration and severity showed no statistically significant difference between groups after 24 months. Post-hoc analyses, however, revealed a short-term benefit of E. coli Nissle four weeks after treatment start which became less pronounced after eight weeks. E. coli Nissle was safe and well tolerated. Conclusions A long-term effect after colonising the healthy neonate´s gut with E. coli Nissle to protect against infections could not be shown. Additional studies are needed to confirm a transitory, yet clinically significant role of probiotics in the first four weeks after parturition.

Zusammenfassung Ziel Offizielle Leitlinie der Deutschen Gesellschaft für Gynäkologie und Geburtshilfe (DGGG), der Österreichischen Gesellschaft für Gynäkologie und Geburtshilfe (ÖGGG) und der Schweizerischen Gesellschaft für Gynäkologie und Geburtshilfe (SGGG). Ziel der Leitlinie ist es, die Prädiktion, die Prävention und das Management der Frühgeburt anhand der aktuellen Literatur, der Erfahrung der Mitglieder der Leitlinienkommission einschließlich der Sicht der Selbsthilfe evidenzbasiert zu verbessern. Methoden Anhand der internationalen Literatur entwickelten die Mitglieder der beteiligten Fachgesellschaften und Organisationen Empfehlungen und Statements. Diese wurden in einem formalen Prozess (strukturierte Konsensuskonferenzen mit neutraler Moderation, schriftliche Delphi-Abstimmung) verabschiedet. Empfehlungen Der Teil 2 dieser Kurzversion der Leitlinie zeigt Statements und Empfehlungen zur tertiären Prävention der Frühgeburt sowie zum Management des frühen vorzeitigen Blasensprungs.

Zusammenfassung Ziel Offizielle Leitlinie der Deutschen Gesellschaft für Gynäkologie und Geburtshilfe (DGGG), der Österreichischen Gesellschaft für Gynäkologie und Geburtshilfe (ÖGGG) und der Schweizerischen Gesellschaft für Gynäkologie und Geburtshilfe (SGGG). Ziel der Leitlinie ist es, die Prädiktion, die Prävention und das Management der Frühgeburt anhand der aktuellen Literatur, der Erfahrung der Mitglieder der Leitlinienkommission einschließlich der Sicht der Selbsthilfe evidenzbasiert zu verbessern. Methoden Anhand der internationalen Literatur entwickelten die Mitglieder der beteiligten Fachgesellschaften und Organisationen Empfehlungen und Statements. Diese wurden in einem formalen Prozess (strukturierte Konsensuskonferenzen mit neutraler Moderation, schriftliche Delphi-Abstimmung) verabschiedet. Empfehlungen Der Teil I dieser Kurzversion der Leitlinie zeigt Statements und Empfehlungen zur Epidemiologie, Ätiologie, der Prädiktion sowie der primären und sekundären Prävention der Frühgeburt.

ZusammenfassungZur Bestimmung des quantitativen Einflusses der Körpermesswerte von Mutter und Vater auf das Geburtsgewicht Neugeborener wurden im Rahmen einer Multizenterstudie an 10 deutschen Geburtskliniken das Geburtsgewicht von 1312 eutrophen Termingeborenen sowie die Körperhöhe und das Körpergewicht ihrer Eltern erfasst. Auch wenn man die Körperhöhe der Väter von 176–184 cm mit einem Körpergewicht von 76–84 kg relativ konstant hält, liegen die Geburtsgewichte bei größeren Müttern höher als bei kleineren. Hinsichtlich Körpergewicht der Mutter und Geburtsgewicht zeigt sich ebenfalls ein deutlicher Anstieg des Geburtsgewichtes bei steigendem Körpergewicht der Mutter. Hält man hier Körperhöhe (164–172 cm) und Körpergewicht (56–64 kg) der Mutter konstant, so steigen auch hier die Geburtsgewichte deutlich mit der Körperhöhe des Vaters an. Ein signifikanter Beitrag des Körpergewichtes des Vaters zum Geburtsgewicht ist nicht zu erkennen. Aus der multivariablen Regressionsanalyse wurde folgende Rangfolge für die Einflussfaktoren Körperhöhe und Körpergewicht der Eltern auf das Geburtsgewicht ihrer Neugeborenen ermittelt: 1.: Körperhöhe der Mutter, 2.: Körpergewicht der Mutter, 3.: Körperhöhe des Vaters. Bei der Beurteilung des somatischen Entwicklungsstandes der Neugeborenen, sollten neben der Körperhöhe und Körpergewicht der Mutter auch die Körperhöhe des Vaters herangezogen werden.

Objective To investigate the variability in the prevalences of selected birth risks in women of different heights and weights. Methods Data from the German Perinatal Survey of 1998–2000 were analyzed: 503,468 cases contributed to our analysis of the prevalences of selected birth risks specified according to maternal weight groups, 502,562 cases contributed to our analysis according to maternal height groups and 43,928 cases contributed to our analysis of birth risks in women with a body mass index (BMI) of 21–23 kg/m2 but different heights and weights. Data analysis was performed using SPSS version 22. Results Some birth risks varied substantially by maternal height in women with a “normal” BMI of 21–23 kg/m2: the prevalence of post-term birth increased from 8.7% in women with a height of 150 cm to 13.5% in 185 cm tall women, the prevalence of preterm birth decreased from 5.9% (150 cm tall women) to 3.1% (185 cm tall women), a pathologic cardiotocography (CTG) or poor fetal heart sounds on auscultation occurred in 19.4% of the 150 cm tall women but only in 9.2% of 185 cm tall women and cephalopelvic disproportion decreased from 12.3% (150 cm tall women) to 1.2% (185 cm tall women). Analyses of women in different body height and weight groups (without restriction of BMI) likewise showed differences in the prevalences of some birth risks. Conclusion Birth risks may vary by height and weight in women with the same, “normal” BMI. BMI should not be the only way by which the impact of maternal height and weight is assessed with regard to perinatal outcomes such as birth risks.

Objectives The maternal body size affects birth weight. The impact on birth weight percentiles is unknown. The objective of the study was to develop birth weight percentiles based on maternal height and weight. Methods This observational study analyzed 2.2 million singletons from the German Perinatal Survey. Data were stratified into 18 maternal height and weight groups. Sex-specific birth weight percentiles were calculated from 31 to 42 weeks and compared to percentiles from the complete dataset using the GAMLSS package for R statistics. Results Birth weight percentiles not considering maternal size showed 22% incidence of small for gestational age (SGA) and 2% incidence of large for gestational age (LGA) for the subgroup of newborns from petite mothers, compared to a 4% SGA and 26% LGA newborns from big mothers. The novel percentiles based on 18 groups stratified by maternal height and weight for both sexes showed significant differences between identical original percentiles. The differences were up to almost 800 g between identical percentiles for petite and big mothers. The 97th and 50th percentile from the group of petite mothers almost overlap with the 50th and 3rd percentile from the group of big mothers. Conclusions There is a clinically significant difference in birth weight percentiles when stratified by maternal height and weight. It could be hypothesized that birth weight charts stratified by maternal anthropometry could provide higher specificity and more individual prediction of perinatal risks. The new percentiles may be used to evaluate estimated fetal as well as birth weight.

Background Anthropometric parameters such as birth weight (BW) and adult body height vary between ethnic groups. Ethnic-specific percentile charts are currently being used for the assessment of newborns. However, due to globalization and interethnic families, it is unclear which charts should be used. A correlation between a mother’s height and her child’s BW (1 cm accounts for a 17 g increase in BW) has been observed. The study aims to test differences in small for gestational age (SGA) and large for gestational age (LGA) rates, employing BW percentile charts based on maternal height between ethnic groups. Methods This retrospective study of 2.3 million mother/newborn pairs analyzed BW, gestational age, sex, maternal height and ethnicity from the German perinatal survey (1995–2000). These data were stratified for maternal height (≤157, 158–163, 164–169, 170–175, ≥176 cm) and region of origin (Germany, Central and Northern Europe, North America, Mediterranean region, Eastern Europe, Middle East and North Africa, and Asia excluding Middle East). Percentile charts were calculated for each maternal height group. Results The average BW and maternal height differ significantly between ethnic groups. On current percentile charts, newborns of taller mothers (≥176 cm) have a low rate of SGA and a high rate of LGA, whereas newborns of shorter mothers (≤157 cm) have a high rate of SGA and a low rate of LGA. When the BW data are stratified based on the maternal height, mothers of similar height from different ethnic groups show similar average BWs, SGA and LGA rates. Conclusion Maternal body height has a greater influence on BW than maternal ethnicity. The use of BW percentile charts for maternal height should be considered.

ObjectiveTo determine if survival rates of preterm infants receiving active perinatal care improve over time.DesignThe German Neonatal Network is a cohort study of preterm infants with birth weight Setting43 German level III neonatal intensive care units (NICUs).Patients8222 preterm infants with a gestational age between 22/0 and 28/6 weeks who received active perinatal care.InterventionsParticipating NICUs were grouped according to their specific survival rate from 2011 to 2013 to high (percentile >P75), intermediate (P25–P75) and low (Main outcome measuresDeath by any cause before discharge.ResultsTotal survival increased from 85.8% in 2011–2013 to 87.4% in 2014–2016. This increase was due to reduced mortality of NICUs with low survival rates in 2011–2013. Survival increased in these centres from 53% to 64% in the 22–24 weeks strata and from 73% to 84% in the 25–26 weeks strata.ConclusionsOur data support previous reports that active perinatal care of very immature infants improves outcomes at the border of viability and survival rates at higher gestational ages. The high total number of surviving infants below 24 weeks of gestation challenges national recommendations exclusively referring to gestational age as the single criterion for providing active care. However, more data are needed before recommendations for parental counselling should be reconsidered.Trial registrationApproval by the local institutional review board for research in human subjects of the University of Lübeck (file number 08–022) and by the local ethic committees of all participating centres has been given.

Zielstellung: Ziel dieser Arbeit war die Berechnung und Darstellung von Referenzwerten fur Drillingsgeborene fur Geburtsgewicht, -lange, -kopfumfang und langenbezogenes Geburtsgewicht. Grundlage dafur bildeten die Daten der deutschen Perinatalerhebung der Jahre 2007–2011. Material und Methoden: Daten von 3 690 Drillingsgeborenen aus allen Bundeslandern Deutschlands, die im Rahmen der deutschen Perinatalerhebung erfasst worden waren, wurden uns freundlicherweise vom AQUA-Institut in Gottingen zur Verfugung gestellt. Daten von 3 567 Fallen wurden in die Auswertungen einbezogen. Geschlechtsspezifische Perzentilwerte wurden uber die kumulativen Haufigkeiten fur die 3., 10., 25., 50., 75., 90. und 97. Perzentile fur 21–36 vollendete Schwangerschaftswochen berechnet. Ergebnisse und Schlussfolgerungen: Es werden erstmalig fur die Bundesrepublik Deutschland Normwerte (Tabellen und zugehorige Kurven) fur die Korpermase von Drillingskindern vorgestellt und ausgewahlte Geburtsgewichts- und Geburtslangenperzentilwerte (nach 32 und 34 vollendeten Schwangerschaftswochen) von Drillingen mit denen von Einlingen und Zwillingen verglichen. Die Differenzen in der 50. Geburtsgewichtsperzentile zwischen Einlingen und Drillingen nach 32 vollendeten Schwangerschaftswochen betrugen bei den Madchen 180 g und bei den Knaben 210 g; nach 34 Wochen waren 320 bzw. 325 g. Die Differenzen zwischen Zwillingen und Drillingen betrugen bei den Madchen nach 32 Schwangerschaftswochen 100 g und bei den Knaben 120 g, nach 34 Wochen waren es 130 bzw. 135 g. Durch die hier vorgestellten Daten gibt es jetzt auch fur Drillingskinder die Moglichkeit, sie unter Bezugnahme auf das deutsche Geburtengut nach somatischen Parametern zu klassifizieren.

Background A legitimate indication for growth hormone (GH) therapy in children born too light or short at birth [small-for-gestational age (SGA)] exists in Germany and the European Union only if special criteria are met. Methods We conducted a longitudinal, multi-centered study on full-term appropriate-for-gestational age (AGA, n=1496) and pre-term born SGA (n=173) and full-term SGA children (n=891) in Germany from 2006 to 2010. We analyzed height, weight, body mass index (BMI) and head circumference. Results Pre-term or full-term born SGA children were shorter, lighter and had a lower BMI from birth until 3 years of age than full-term AGA children. The growth velocity of the analyzed anthropometric measurements was significantly higher in pre-term and full-term SGA children exclusively in the first 2 years of life than in AGA children. The criteria for GH treatment were fulfilled by 12.1% of pre-term SGA children compared to only 1.3% of full-term SGA children. Conclusion For children that do not catch up growth within the first 2 years of life, an earlier start of GH treatment should be considered, because a catch-up growth later than 2 years of life does not exist. Pre-term SGA-born children more frequently fulfill the criteria for GH treatment than full-term SGA children.

Aim Providing less invasive surfactant administration (LISA) to spontaneously breathing preterm infants has been reported to reduce mechanical ventilation and bronchopulmonary dysplasia (BPD) in randomised controlled trials. This large cohort study compared these outcome measures between LISA-treated infants and controls. Methods Infants receiving LISA, who were born before 32 gestational weeks and enrolled in the German Neonatal Network, were matched to control infants by gestational age, umbilical cord pH, Apgar-score at 5 min, small for gestational age status, antenatal treatment with steroids, gender and highest supplemental oxygen during the first 12 h of life. Outcome data were compared with chi-square and Mann–Whitney U-tests and adjusted for multiple comparisons. Results Between 2009 and 2012, 1103 infants were treated with LISA at 37 centres. LISA infants had lower rates of mechanical ventilation (41% versus 62%, p

The aim of this study was to derive percentile values for birth weight, length, head circumference, and weight for length for singleton neonates based on the German perinatal survey of 2007-2011 (using data from all 16 states of Germany). We also compared these new percentile values with the percentile values of 1995-2000 that so far have been considered standard values.Data of 3 187 920 singleton neonates from the German perinatal survey of the years 2007-2011 were kindly provided to us by the AQUA Institute in Gottingen, Germany. Sex specific percentile values were calculated using cumulative frequencies. Percentile values at birth were computed for the 3(rd), 10(th), 25(th), 50(th), 75(th), 90(th), and 97(th) percentiles for 21-43 completed weeks of gestation. Percentile curves and tabulated values for the years 2007-2011 were compared with the published values of 1995-2000.Overall the new percentile curves closely resemble the previous ones. Minimal differences can be found for the 10(th) percentile andgenerally for early weeks of gestation. Values for the 10(th) percentile in the 2007-2011 dataset are somewhat higher than values of 1995-2000 for birth weight, length, and weight for length.We recommend the use of these new percentile values instead of the old ones.

We investigated the effects of maternal age, body weight, body height, weight gain during pregnancy, smoking during pregnancy, previous live births and being a single mother on somatic development at birth. We analysed data from the German Perinatal Survey for the years 1998–2000 from eight German federal states. We had available data on 508,926 singleton pregnancies and neonates in total; for 508,893 of which we could classify the neonates as small, appropriate or large for gestational age (SGA, AGA or LGA) based on the 10th and 90th birth weight percentiles. Multivariable regression analyses found statistically significant effects of a clinically relevant magnitude for smoking during pregnancy [odds ratio (OR) 2.9 for SGA births for women smoking >10 cigarettes per day], maternal height (OR 1.4 for SGA births for women 172 cm), maternal weight (OR 1.5 for SGA births for women 69 kg), weight gain during pregnancy (OR 1.9 for SGA births for women with a weight gain 18 kg) and previous live births (OR 2.1 for LGA births for women with one or more previous live births). Maternal age and being a single mother also had significant effects but their magnitude was small. Our analysis confirms the clinically relevant effects of smoking, maternal anthropometric measures and weight gain during pregnancy on neonatal somatic development.

BACKGROUND We have previously described the prevalence in pregnancy of hypertension, proteinuria, oedema and preeclampsia/eclampsia according to maternal body mass index (BMI) and smoking status. We found that these disorders were less frequent among smoking women. To investigate whether this relationship is causal or a chance finding, we here present an analysis according to BMI and smoking specified according to the number of cigarettes consumed per day. MATERIALS AND METHODS Data were from the German Perinatal Survey of 1998-2000. We classified women by BMI as underweight (BMI

Very premature delivery is a major cause of infant morbidity and mortality. Obesity, diabetes and pregnancy hypertension are known risk factors for pregnancy complications. The study aimed to scrutinize differences of pregnancy complications in a cohort of very premature deliveries compared to a national group. In a multicenter study performed between January 2009 and December 2010 including 1,577 very low birth weight (VLBW) infants, we compared parental reported pregnancy problems of VLBW infants with a national cohort (KIGGS). We compared reported pregnancy complications to reasons for premature delivery and neonatal outcome within the group of VLBW infants. While parents of the national cohort reported pregnancy-induced hypertension in 8 %, parents of VLBW infants reported this complication more frequently (27 %). Mothers of the national cohort were significantly younger (1 year), suffered less from obesity, anaemia, diabetes. Regression analysis showed that hypertension (OR = 5.11) and advanced maternal age (OR = 1.03) increased the risk for premature birth. Women with hypertension were likely to experience a clinically indicated premature delivery, had more VLBW infants with a moderate growth restriction, but less multiples and their infants had less intraventricular haemorrhages grade 3 or 4. Otherwise, neonatal outcome was correlated with gestational age but not with the pregnancy complications diabetes, hypertension or obesity. Premature birth seems to be correlated to gestational hypertension and associated problems in about ¼ of VLBW infants. Further studies should focus on preventing and treating gestational hypertension to avoid premature delivery and associated neonatal morbidity.

Schlaf stabilisiert und verbessert das Gedächtnis sowohl bei Erwachsenen als auch bei Kindern. Es kann im Schlaf zur Einsicht in logische Probleme kommen. Dies ist bei Kindern besonders ausgeprägt. Die Besserung des Gedächtnisses ist selektiv und betrifft vor allem emotional relevante und individuell bedeutungsvolle Informationen. Störungen des Schlafes können zu Gedächtnisproblemen führen. Ausreichend ungestörter erholsamer Schlaf ist für die Entwicklung der Kinder und deren kognitive Leistungsfähigkeit wichtig.

Trotz der Senkung der Morbiditat und Mortalitat von Fruhgeborenen durch Schwangerenvorsorge und einer verbesserten neonatologischen Intensivtherapie sind die Fruhgeburtsraten unverandert hoch. International schwanken die Haufigkeitsangaben zwischen 5–10 %. In Deutschland lag die Rate in den Jahren 1998–2000 bei 6,5 % ( 22 ). In einer grosen Datenanalyse wurde deshalb der Einfluss einzelner mutterlicher Faktoren auf die Fruhgeburtlichkeit untersucht, um eine differenzierte Beratung der schwangeren Frauen zu ermoglichen.

Abduction splints for the treatment of hip dysplasia normally operate on curbing the legs at the hip flexion and abduction. The forces are absorbed in different designs of shoulder straps and thus diverted to the shoulder and the spine. The present study is the first comparing these undesired forces of two spread orthoses and subsequently the transmitted forces to the infant's spine.Between March 2009 and October 2009 the hips of 290 infants were investigated by ultrasound within the first 3 days after birth. Thereof 20 infants with a hip dysplasia Graf type IIc, D or IIIa met our inclusion criteria and were investigated with a Tübinger and a Superior abduction splint. Biomechanical evaluation was performed by using a high-sensitive strain gauge sensor applied to the infant's orthoses between pelvic harness and shoulder straps.The transmitted forces to the infant's shoulders correlated significantly with their body mass (P0.05). Maximal forces on the shoulder of the infants and subsequently transmitted forces on the spine were significantly higher (P0.05) with the Tübinger splint (range 7.6N to 32.3N; arithmetic mean M: 13.7N) in comparison to the Superior orthosis (range 0.0N to 3.5N; M: 0.7N).The Superior orthosis works with primary load transmission to the pelvic bone. Using the Tübinger splint the shoulders of the newborn infants are loaded with a maximum of 93.9% of their body mass. This may influence the development of the growing infant's spine.

Sehr fruh geborene Kinder leiden mit sehr hoher Wahrscheinlichkeit unter Behinderungen und haben nur geringe Uberlebenschancen. Der Umgang mit ihnen muss deshalb zwischen Eltern und Arzten einvernehmlich und gemas rechtlichen und ethischen Vorgaben geregelt werden. Bei drohender Fruhgeburt werden Lungenreifeinduktion, Antibiotikatherapie und Tokolyse standardmasig eingesetzt. Es gibt dabei jedoch einige rechtlich relevante Faktoren (z.B. Off-Label-Use, Aufklarungspflicht), die berucksichtigt werden sollten.

Aim We aimed to set-up a passive malformations registry for 2002-2004 for the German Federal State of Mecklenburg-Western Pomerania in order to estimate the prevalence of congenital malformations among live births, stillbirths, miscarriages, and induced abortions. POPULATION AND STUDY DESIGN: Under the guidance of the working group "Neonatology Mecklenburg-Vorpommern" a standardised malformations record form modelled after the Mainz registry was developed and used to record malformations among live births, stillbirths, miscarriages, and induced abortions in all 21 obstetric departments in Mecklenburg-Western Pomerania between 2002 and 2004. We compared the population of neonates with malformations with a general population sample from the German Perinatal Survey of 1995-1997. Results There were 768 neonates with at least one major malformation among a total of 37 634 neonates in Mecklenburg-Western Pomerania; this means that the prevalence of major malformations was 203.53 per 10 000 neonates. The prevalence of major malformations in liveborn infants was 178.61 per 10 000. The most common malformations in the total study population were ventricular septal defect (prevalence: 37.2 per 10 000), hydronephrosis (16.7 per 10 000), hypospadias (14.8 per 10 000), Down syndrome (10.1 per 10 000), and cleft lip and palate (9.0 per 10 000). Among the induced abortions the most common diagnoses were Down syndrome, anencephalus, Edwards syndrome, and congenital hydrocephalus. The preterm birth rate among the 637 liveborn and stillborn infants with malformations was 19.6%; 5.6% were born before 32 completed weeks of gestation. The small for gestational age rate for infants with malformations was 14.2% for girls and 14.5% for boys, thus increased compared with the general population sample (9.7%). Conclusions Congenital malformations are important determinants of childhood morbidity and mortality. Malformation prevalence and types of malformations, along with morbidity and mortality, are important parameters in perinatal medicine. The establishment of active malformation registries is therefore an important task.

AIM: We aimed to examine the impact of duration of pregnancy, birth weight, and the somatic classification of neonates - small for gestational age (SGA), appropriate for gestational age (AGA), or large for gestational age (LGA) - on rates of neonatal depression, as demonstrated by low Apgar scores (0-3). METHODS: We analysed data from 508 926 singleton births in the years 1998-2000 from the perinatal statistics of eight German federal states (Bavaria, Brandenburg, Hamburg, Mecklenburg-West Pomerania, Lower Saxony, Saxony, Saxony-Anhalt, and Thuringia). For the somatic classification of neonates the 10th and 90th birth weight percentiles calculated from our dataset were used. We defined neonates with a birth weight under the 10th percentile as SGA, those between the 10th and 90th birth weight percentiles as AGA, and those above the 90th percentile as LGA. RESULTS: A low Apgar score (0-3) was observed in 37.3 % of very early preterm infants (< 27 weeks' gestation) at 5 minutes and in 34.4 % at 10 minutes. For term neonates, such low Apgar-scores were seen in only 0.2 % (5-minute Apgar) and 0.1 % (10-minute Apgar). An Apgar score of 0-3 was noted for 31.8 % (5 minutes) and 29.2 % (10 minutes) of extremely small neonates (< 999 g). Only 0.1 % of neonates with a birth weight of 3500-3999 g or 4000-4499 g had a low Apgar score (0-3) (after both 5 and 10 minutes). Very early preterm infants classified as SGA or AGA were equally affected by low Apgar scores: 37.2 % for both categories at 5 minutes, and 32.7 % (SGA) and 34.3 % (AGA) at 10 minutes. In very early preterm LGA infants the rates with low Apgar scores were somewhat smaller: 31.3 % (5 minutes) and 27.0 % (10 minutes). The figures for early preterm (27-31 weeks' gestation) infants were: a low 5-minute Apgar score in 25.5 % of cases (SGA), in 9.1 % (AGA), and in 7.8 % (LGA) and a low 10-minute Apgar score in 24.4 % (SGA), 7.7 % (AGA), and 7.0 % (LGA). CONCLUSIONS: We confirm the association of low Apgar scores with preterm birth and low birth weight. SGA preterm infants are more commonly affected by low Apgar scores compared to AGA and especially LGA preterm infants.

AIM: The influence of previous interruptions, miscarriages and IUFD on the IUGR and preterm rate as well as on the somatic staging (gestational age and birth weight) of the new born is a subject of controversial discussion in the literature. The present paper attempts to quantify these risks of the medical history. 2 282 412 singleton pregnancies of the period 1995 to 2000 were evaluated from the German Perinatal Database. For the analysis 1 065 202 pregnancies (46.7 %) of those mothers without any live birth in the medical history were assessed. To exclude any influence from previous abortions patients with previous miscarriages and IUFDs were excluded. The control collective were new borns whose mothers had suffered neither from miscarriages nor from abortions or IUFD. RESULTS: Previous interruptions, miscarriages and IUFD influence the rate of new borns with low birth weight and increase the rate of prematurity. With increasing numbers of isolated or combined risks in the medical history, the rate of newborns with a low birth weight or with prematurity is increased. The lowest risk was found after one interruption, the highest rate with two or more IUFDs. Interruptions, miscarriages or IUFD are not risk factors for IUGR or SGA. CONCLUSION: Previous interruptions, miscarriages and IUFD are relevant risk factors for prematurity and are related with low birth weight of the new borns. Pregnant women with such risk factors have to been considered as risk pregnancies and need intensive surveillance.

BACKGROUND: As about 20 % of pregnant women smoke, 137,000 of the 685,795 neonates delivered in Germany in 2005 have been affected by smoking during pregnancy. Caring for neonates born prematurely because of smoking results in additional costs. We have attempted to estimate these costs. MATERIAL AND METHODS: Data of 1,815,318 pregnancies were collected from the German perinatal statistics of 1995-1997. In 876,645 cases there was information regarding smoking. Of these, 699,134 pregnant women were non-smokers and 177,511 were smokers. To determine the number of preterm births due to smoking, we compared the distribution of the duration of pregnancy of the non-smoking cohort to that of the smoking cohort. From the difference between this and the actual distribution of the duration of pregnancy among smokers we determined the number of additional preterm births caused by smoking. For the analysis of the associated costs we used the actual costs of care and daily rates used in neonatology. RESULTS: For 2002 we estimate 43 million Euros of additional costs due to neonates born prematurely because of smoking. CONCLUSIONS: We present a rough estimate of the additional health care costs for neonates because of smoking. Costs were estimated only with regard to premature deliveries. Other effects of smoking during pregnancy on neonatal health were not considered. More detailed cost analyses will likely reveal even higher costs.

BACKGROUND: The weight gain during pregnancy is influenced by maternal body weight and height. With this study we want to illustrate the relationship between weight, height, body mass index (BMI) and the weight gain in pregnancy. MATERIALS AND METHODS: Data of about 2.3 million singleton pregnancies were taken from the German perinatal statistics of 1995-2000. Weight gain was calculated as the difference between the weight at the end of the pregnancy and the weight at the first consultation. RESULTS: The distribution of the weight gain resembles a normal distribution. Overall mean weight gain is 12.8 kg. For women weighing< 63 kg, there is a rise in weight gain with increasing body weight at the first consultation. Beyond 63 kg the amount of weight gain falls with increasing body weight at the first consultation. Weight gain increases with increasing height. Overall there is a negative correlation between BMI and weight gain. However, women with the same BMI but different body weights and heights can differ significantly with regard to their weight gain. CONCLUSIONS: Height and body weight at the beginning of pregnancy are important determinants of the weight gain. They should therefore be used when assessing the weight gain in clinical practice. Use of the BMI, however, is not appropriate. We are investigating other ways of combining body weight and height. This will be discussed in a later publication.

In a retrospective analysis, data from the perinatal survey of the years 1995-1997 were examined to determine the influence of mothers' previous stillbirths on the average birthweight, the rate of premature births, and the somatic classification of newborns. Mothers with previous live births, miscarriages or abortions were excluded from the 1.8 million perinatal data, which means that only cases with a history of stillbirths were considered in the analysis (exposed group: n = 2649). The comparison group consisted of all newborns of mothers without previous live births, stillbirths, miscarriages or abortions (n = 674 814). The high number of cases made it possible to analyse specific age groups of the mothers. The average birthweight is reduced in the case of previous stillbirths. The reduction in birthweight amounts to 69 to 168 grams in the various age groups. In the case of 20-year-old mothers with previous stillbirths, the rate of premature births increased 2.8-fold (from 7.8 to 21.6%) in comparison to newborns of mothers without a history of stillbirths, and for 30-year-old mothers with a history of stillbirths the increase was 2.3-fold (from 8 to 18.3%). The increase in the percentage of hypotrophic, eutrophic and hypertrophic premature births in the case of previous stillbirths occurs at the expense of the percentage of term newborns (-10.3%). On the basis of these results, we conclude that pregnant women with a history of stillbirths should be viewed as a risk group and as such should be closely monitored. The increased rate of hypertrophic newborns in the group of mothers with previous stillbirths makes a careful exclusion of gestational diabetes advisable.

Based on the perinatal data from 1995-2000, the 1st, 2nd, 3rd, 4th, 5th, 10th, 25th 50th, 75th, 90th, 95th, 96th, 97th, 98th, 99th percentile values for birth weight, size (length), head circumference, and for length-related birth weight are presented for girls and boys. These data represent more precise percentile values, particularly for the early gestational weeks compared to the currently used German standard data from 1992 [1,2]. The following updates and modifications were made to the values from 1992: 1. Due to the large number of probands, we were able to establish percentile values already from the 20th completed week of gestation. 2. The calculation of the percentile values was made by means of the arithmetic mean (X) and the standard deviation (s), provided that the individual somatic measures were normally distributed. With this method, strongly differentiated percentile values could also be calculated. 3. In order to meet international standards, the values x - 2 s and x + 2 s are stated as well. We hope that the published percentile values will be applied soon for the somatic classification of newborns and that the data from 1992 will be replaced. For easier use a software programme will be available in the near future.

This study examines the quantitative changes in the somatic classification according to birth weight and duration of pregnancy of German neonates when maternal height is considered (5 maternal height groups). Our calculations were performed using data of 319 884 girls born in 2010. Overall, about 6% (18 792 girls) are classified differently (more appropriately) when group-specific norm values were used.

Pregnancy and postpartum adaptation cause an increased formation of free radicals. This is associated with various perinatological diseases, e.g. necrotising enterocolitis. The human body has developed a protective system in the form of the antioxidative potential. The present study was the first to investigate the kinetics of the cutaneous antioxidative status in pregnant women and newborns using a non-invasive spectroscopic method. Eighteen pregnant women and their babies took part in the study. A light-emitting diode-based compact scanner system was used for quick non-invasive measurements of carotenoid antioxidants in human skin based on reflection spectroscopy. It could be shown that the antioxidative status of the expectant mothers significantly declined during labour (p < 0.001) and on day 1 after delivery (p < 0.01). Compared to the mothers, the newborns exhibited a significantly higher cutaneous carotenoid concentration on both day 1 (p < 0.01) and 5 (p < 0.01) after delivery. These results suggest that the oxidative stress due to postpartum adaptation is counteracted by an enhanced reservoir of carotenoid antioxidants in the subcutaneous fatty tissue. The peripartum cutaneous carotenoid level of mothers declines continuously, whereas term newborns show very high cutaneous antioxidant values.

We have previously analysed neonatal characteristics and duration of pregnancy in Germany based on data from the German Perinatal Survey of 1995–1997. Here we describe neonatal characteristics and duration of pregnancy based on the German Perinatal Survey of 2007–2011. We had been provided with data from the German Perinatal Survey of 1995–1997 by the chambers of physicians of all the states of Germany except Baden-Wurttemberg (1 815 318 singleton neonates). We were also provided with access to the perinatal survey data of 2007–2011 by the AQUA Institute in Gottingen, Germany (3 187 920 singleton neonates). We investigated regional differences within Germany and also compared the 2 periods of time. We used the computer programme SPSS for data analysis and performed plausibility checks on the survey data. Comparing the states of Germany, we found that birth weight was largest for neonates born in Schleswig-Holstein (3 407 g) and Mecklenburg-Western Pomerania (3 392 g); the lowest mean birth weight was observed in the Saarland (3 283 g). Preterm birth rate varied between 6.3% (Saxony) and 8.1% (Bremen, Saarland). Comparing 1995–1997 vs. 2007–2011, deliveries after 37 and 38 weeks of gestation were more common and deliveries after 39 and more weeks of gestation were less common in the later period of time. Regional differences in the anthropometric characteristics of neonates exist between the states of Germany. The proportion of deliveries after 39 and more weeks of gestation has decreased.

OBJECTIVE Birth weight percentiles based on weekly measurements are used to assess the nutritional status of preterm infants. However, as preterm infants exhibit a rapid growth rate (up to 20 g/kg/day), their body weight can increase by 15% per week. We calculated birth weight percentiles based on daily measurements, to more precisely classify very preterm infants (gestational age of 154-223 days). METHODS Data of 23,864 (10,720 females and 13,144 males) very preterm singleton infants with a gestational age of 154-223 days (22-31 completed weeks) were retrieved from the German perinatal statistics of 1995-2000. Percentile curves based on the empirical birth weight data were subjected to three statistical smoothing procedures: cubic regression, local regression (LOESS smoothing), and the LMS method. RESULTS Smoothing of the birth weight percentiles using cubic regression produced the smallest residual variance. CONCLUSION Birth weight percentiles based on daily averages allow a more precise assessment of the somatic development of preterm infants.

Einleitung: Wochengenaue Geburtsgewichtsperzentilwerte werden zur Einschatzung des Ernahrungszustandes von Fruhgeborenen verwendet. Da Fruhgeborene ein hohes Wachstum (bis zu 20g/kg/d) haben, nimmt das Korpergewicht um 15% in einer Woche zu. Das Ziel der Studie war die Berechnung von tagesgenauen Geburtsgewichtsperzentilwerten, auf deren Basis fruhe Fruhgeborene (154–223 Tage) zeitgenauer klassifiziert werden konnen. Methoden: Das Datenmaterial entstammt der deutschen Geburtenpopulation der Jahre 1995–2000 mit 24.399 fruhen Fruhgeborenen (Einlinge) mit einer Schwangerschaftsdauer von 154–223 Tagen (22 bis 31 vollendete Wochen). Die empirischen Geburtsgewichtsperzentilkurven wurden mit folgenden 3 Glattungsverfahren statistisch bearbeitet: kubische Regression, Loess-Verfahren und LMS-Methode. Ergebnisse: Die Glattung der empirischen Geburtsgewichtsperzentilwerte mit kubischer Regression zeigte die kleinsten Residuen. Schlussfolgerung: Tagesgenaue Geburtsgewichtsperzentilwerte erlauben prazise Aussagen zum somatischen Entwicklungsstand von Neugeborenen.