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The authors of this publication have developed a new screening method to evaluate the physical development of infants, which identifies growth and developmental restrictions based on their gestational age, gender, weight and length standard positions and nourishment status. This so-called MDN-method (MDN = Maturity, Development, Nourishment) offers several benefits: 1. It enables the expansion of the scope and definition of intrauterine growth restriction (IUGR) and the establishment of five separate condition subtypes. 2. It facilitates the study of the risk of mortality of infants based on their development and nourishment status. 3. The method is suitable for the screening of high-risk IUGR infants and neonates. 4. The MDN method allowed for the development of a new ultrasound screening methodology for high-risk IUGR infants and neonates, based on abdominal circumference (AC) and femur length (FL) standards, which correlate the most with the weight and length of the fetus. The data of 1,244,918 Hungarian live and stillbirths recorded during 2000-2012 were used for these studies. It is believed that these new screening methods may have a significant impact on reducing the frequency of IUGR-related stillbirth and infant mortality cases.

It is a regrettable deficiency in the Hungarian healthcare that the culture and the system of quality control of cure have not been formed (except for a few subspecialties, units or wards). If hospital wards do not have a national, professionally unified and modern information system presenting the most important quantity and quality indicators of their medicinal activity annually, a stable basis for definition of future tasks is absent. The author puts forward a proposal for the establishment of the information systems for different professional fields. On the basis of experience of perinatological information system operating for over 3 decades in Borsod-Abaúj-Zemplén county, he also proposes introduction of a nationally unified, Europeristat-compatible information system following Tauffer-statistics which may serve as a uniform quality control of obstetrics and perinatological care, as well as introduction of its base, the dataform "TePERA" (Form of Obstetrics and Perinatological Care Risk).

To study the influence of bodily development and nutritional status on perinatal mortality.The authors developed a new method, the MDN system (MDN: Maturity, Development, Nutritional Status), to determine the development and nutritional status of newborns based on their weight and length standard positions. Using data of 680,947 neonates born in the 7 years from 1997 to 2003 in Hungary, they computed the perinatal mortality (PM) rate of each developmental groups of neonates.PM in the group of neonates of absolute average development was 7 per thousand, 30 per thousand in the proportionally retarded group and it was 90 per thousand in the extremely overnourished group. The PM rate was the highest (191 per thousand) in the extremely undernourished group.Both bodily development and nourishment have a major impact on PM. The MDN system is a suitable method to differentiate the most endangered groups of neonates based on their development and nutritional status.

The most common method is still in use: by measuring the bodyweights of neonates, one can immediately differentiate those whose weights are below 2,500 grams, and who are regarded as being the most endangered newborns. Recently, however, specialists normally differentiate between neonates of body weight below 1,500 grams, those less than 1,000 grams and those who weigh less than 500 grams at birth. At the same time, we have learned that body weight alone is not a reliable parameter to estimate the life chances of a neonate (Macferlene et al., 1980, WHO, 1961, 1970, Wilcox & Russel, 1983, 1990). This is true for a series of reasons: (1) body weight depends on many factors; (2) each weight group is extremely heterogeneous when gestational age, body length and nutritional status (nourishment) are considered (Berkő, 1992, Berkő & Joubert, 2006, 2009, Zadik et al., 2003), however, scientific research needs homogeneous groups to study; (3) since the average birth weights of neonate populations differ greatly by country and race (Meredith, 1970), there is no practical chance to develop uniform weight criteria to be applicable in each country.

Reference databases play a key role in the management of osteoporosis. The aim of this preliminary study was to compare the diagnostic consequences of using either an international or a local reference database in peripheral densitometry. For this purpose, standard curves for bone mineral density (measured by dual-energy X-ray absorptiometry at the distal and proximal forearm) were generated for healthy Hungarian men and women. In total, 303 healthy volunteers of both sexes (age range: 20-94 yr) were recruited from four osteoporosis centers. Subjects with medical conditions or taking medication affecting the bone metabolism were excluded. Bone densitometry was performed with pDEXA (Norland-Stratec, Fort Atkinson, WI) devices in each center after cross-calibration of the machines. The precision error of the forearm measurement was also determined (1% in vitro, and 1.2-2.5% in vivo). In females, the peak forearm density was detected in the 30-39-yr group. The density decreased by 8% per 5 yr in early postmenopausal females, and by 10% per 10 yr in late postmenopausal females. In males, the highest bone mineral density was found in the 30-39-yr group for the distal forearm, but 1 decade later for the proximal site. Subsequently, a 5% decrease in density occurred per 10 yr, except in the 8th decade, in which a 20% decrease was demonstrated. One thousand four hundred thirty-four patients with suspected osteoporosis were classified according to the forearm density T-scores using both the new Hungarian reference database and the international database provided by the manufacturer. Comparison of the results measured at the distal forearm with the two different databases led to similar outcomes. However, at the proximal site, one fifth of the female patients were reclassified from the low-density group to the normal group using the domestic normative database. An opposite difference was observed for the males: use of the Hungarian reference data resulted in 40% more men being categorized in the low-density group than when the international normal database was applied. Our results suggest that not only geographic differences, but also the reference database used, can influence the prevalence of the diagnosis of osteoporosis. Further data are currently being collected to increase the statistical power of the study.

The author’s aim was to study 1./ the effect of intrauterine weight and length development and nutritional status on the later height development of children, - 2./ how can we use the MDN system to identify and distinguish neonates who are likely to need growth hormone treatment in the future. The authors examined the height of 6335 Hungarian 18 years old young men, whose intrauterine weight and length development was known after birth. They have used a new diagnostic method, so called MDN (Maturity, Development and Nutritional status) system which is suitable to determine the body development and nutritional status of a neonate on the basis of its gestational age, length and weight development considered simultaneously (Berkő P., Joubert K. J Maternal Fetal Neonatal Med, 2009; 22/7, pp.552). Relying on the birth data and the MDN matrix position of 6335 young men, the authors have established, the height of the 18 years old men became smallest who were proportionally retarded neonates at birth time. Their average height was 170.8cm comparing to the young men who were absolutely averages at birth time (176.1). The difference is strongly significant. The MDN system is a suitable method for the differentiation the mostly endangered neonate groups, based on their body development and nourishment. The development and the nutritional status have a major impact on the neonatal mortality. The MDN system has another important area of application. It allows the prompt and accurate identification of those newborns for whom systematic follow-up measurements and growth hormone therapy treatment is likely to be necessary in the future.