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Problem: Inflammatory breast diseases during lactation are major reasons for early weaning., Method of Study: A prospective cohort study was performed to examine the association between stress and inflammatory breast diseases. Psychometric data, cytokine levels in breast milk and blood samples were analysed postpartum (T1). Psychometric data and course of breast feeding were evaluated twelve weeks later (T2). Patients were divided into case- and control-groups (according to the presence of breast diseases)., Results: Mothers of the case group (n = 23) were significantly older and showed significantly increased stress levels between T1 and T2 compared with the control group (n = 43). Leucocytes in the postpartum blood count were significantly decreased in the case group. There were no significant differences between groups in the concentrations of Th-1- and Th-2-cytokines in breast milk postpartum., Conclusion: Higher maternal age, postpartum increase in stress perception and low number of leucocytes are associated with a higher incidence of inflammatory breast diseases. Further studies must examine the causality of this effect.

Aim: To investigate the relationship between breastfeeding and infant health and to describe growth in the first 9 months., Methods: Mothers delivering a baby in April 2005 were recruited throughout Bavaria, Germany, for a prospective birth cohort study. These mothers reported breastfeeding data, health and growth data of 1901 infants assessed by a physician in questionnaires on day 2-6, and in months 2, 4, 6 and 9. Subjects were healthy term infants with a birth weight > or =2500 g. We compared 475 infants breastfed exclusively for > or =6 months (group A), 870 infants breastfed fully/exclusively > or =4 months, but not exclusively > or =6 months (group B) and 619 infants not breastfed/breastfed <4 months (group C)., Results: In multivariate analysis > or =6 months of exclusive breastfeeding reduced significantly the risk for > or =1 episode of gastrointestinal infection(s) during months 1-9 compared to no/<4 months breastfeeding (adjusted odds ratio [OR]: 0.60; 95% confidence interval [CI]: 0.44-0.82). The application of the World Health Organization (WHO)-child growth standards showed lower weight-for-length z-scores in first days of life in group C versus groups A and B, whereas in months 6/7 group C showed the highest scores., Conclusion: Differences in child growth depending on breastfeeding duration should be investigated further. Concerning health outcomes our findings support the recommendation for > or =6 months of exclusive breastfeeding.

Background: Recent studies from predominantly rural areas in Germany show that neonatal outcome of very low birth weight (VLBW) neonates is (on average) inferior with lower NICU (neonatal intensive care unit) volume. However, there are no data available which show that study results of one specific region can be transferred to other areas with possibly different medical infrastructure and needs., Aim: It was investigated whether a systematic difference of treatment quality between smaller (1000-2000 births/year; < or =20 neonatal beds) vs. larger neonatal centres in Berlin (>3000 births/year; >20 neonatal beds) exists. Furthermore, the results are compared to data from a rural region in order to discuss transferability between regions., Methods: Retrospectively, completely, and for the first time, the data of all centres which treat VLBW neonates (< or =1500 g birth weight) in the city-state of Berlin, Germany, from the years 2003/2004 were reviewed., Results: Our study showed no difference in the treatment quality of smaller vs. larger neonatal units in Berlin. This result differs from those of a study in Baden-Württemberg, a predominantly rural state, with different medical infrastructure than Berlin., Conclusion: The present study suggests that regional investigations on the infrastructure vs. treatment outcome are not transferable between areas. Patient volume/unit appears inadequate for predicting the future treatment quality of neonatal departments. Direct quality indicators are stable for the assessed departments and should be preferably used to organize medical infrastructure.