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Er zijn nieuwe inzichten in de pathogenese van wiegendood. Op grond daarvan is door de Nederlandse Vereniging voor Kindergeneeskunde en de Artsen Jeugdgezondheidszorg Nederland een nieuwe richtlijn ‘Preventie wiegendood’ opgesteld; deze vervangt de consensustekst uit 1996.

Bij 117 te vroeg geboren kinderen werden op de gecorrigeerde leeftijd van 2 jaar de uitkomsten van het Van Wiechen-onderzoek vergeleken met de uitkomsten van ontwikkelingsonderzoek volgens de Bayley-ontwikkelings schalen. De Spearman-correlatiecoefficient tussen de beide uitkomsten op de leeftijd van 2 jaar bedroeg 0,64. De relatie met handicap of beperking op 5-jarige leeftijd was voor het Bayley-onderzoek sterker dan voor bet Van Wiechen-onderzoek. Bij beide onderzoeken was er een goede specificiteit, met weinig overdiagnostiek, maar de sensitiviteit van beide was laag. Voor kinderen met een goed resultaat bij bet Van Wiechen-onderzoek leverde bet uitvoeren van een Bayley-test geen nieuwe gegevens. Voor kinderen met een slecht resultaat was uitgebreider onderzoek waaronder ontwikkelingspsychologisch onderzoek ook buiten de onderzoeksopzet om geindiceerd. Bij kinderen met een negatief gescoord item bij bet Van Wiechen onderzoek kon bet Bayley-onderzoek een goed onderscheid maken tussen kinderen met een hoog, respectievelijk met een laag risico op een handicap of beperking op de leeftijd van 5 jaar. Aanwijzingen voor lichte stoornissen op de leeftijd van 5 jaar, zoals lichte algemene retardatie, achterstand in spraak-taalontwikkeling, lichte neurologische dysfunctie of visusstoornissen, bleken op 2-jarige leeftijd vaak nog niet aantoonbaar ongeacht welk onderzoek werd gebruikt. Bij jonge kinderen is het Van Wie­chen-onderzoek een goed hulpmiddel om te onderscheiden bij welke kinderen nader onderzoek noodzakelijk is. Om lichte ontwikkelingsstoornissen, die bij te vroeg geborenen vaak voorkomen en die een belangrijke invloed hebben op bet later functioneren op school te onderkennen is follow up zeker tot de kleuterleeftijd noodzakelijk.

Objective. Assessment of the prevalence of convulsion-like symptoms in 1854 children of Dutch-speaking mothers of a population-based birth cohort. Method. At each child health clinic (CHC) visit mothers were asked whether they had noted any of the following signs: loss of consciousness, involuntary movements, eye rotation movements and apnoea, and if so, whether these appeared to be related to feeding. Registration was done by the CHC physician during eight consultations. Results. Convulsion-like symptoms occurred in a quarter of the children: in 8% exclusively in relation to feeding, almost without exception in the first three months of life, in 19% also without relation to feeding, continuing until the second birthday. The latter children were more frequently admitted into hospital, even for non-neurological problems, than the former or than children without any such signs. They also have more disabilities at the age of two years. No connection with epilepsy in the family or with congenital anomalies could be demonstrated. Conclusion. Convulsion-like symptoms were observed in a quarter of children up to the age of two years. Special attention should be paid by the CHC team to children with signs not connected with feeding.

Objective. To assess consumption of medical care for infants and toddlers provided by general practitioners and specialists, and of hospital admissions for young children. Design. Descriptive. Setting. Dutch Child Health Clinics (CHC). Method. An aselect cohort of newborns of 1988/89 of the Social Medical Survey of children attending Child Health Clinics (SMOCC) were followed for two years; at maximally 8 CHC visits data were collected on the preceding interval. Results. Health problems as observed in the CHCs like hearing disorders, strabismus, congenital hip dysplasia and growth disturbances were present as a cause for consultation of a GP or specialist in one out of six. Over 95% of the children went to consult their GP, 30% to a paediatrician, 20% to another specialist. Twelve per cent of the children was admitted to hospital, 10% of these more than once. Accidents caused 10% of all visits to a doctor in primary or secondary health care. Children with any form of disability at the age of two (6%) made use of the health care system as indicated in this study about three times more frequently than the non-disabled children. Conclusion. Nearly every child under two visited a GP, many a specialist. Timely recognition of specific health problems at the CHC prevents delay in treatment, and limits the harm in development as well as the costs.

Doel. Onderzoeken of de geboortegewichtscurven (‘Amsterdamse groeicurven’) van Kloosterman, gebaseerd op gegevens uit 1931-1965, voor vroeggeborenen nog steeds van toepassing zijn. Opzet. Inventariserend onderzoek. Plaats. Nederland. Methode. De gegevens werden ontleend aan het ‘project onderzoek praematuritas en small for gestational age’ (POPS), verricht in 1983. De onderzoeksgroep bestond uit 855 blanke kinderen met een zwangerschapsduur van 24-31 weken. Resultaten. De percentages kinderen ‘small for gestational age’ (SGA) waren bij vrijwel iedere zwangerschapsduur hoger dan 10, terwijl ze per definitie 10 zouden moeten bedragen; de percentages kinderen ‘large for gestational age’ (LGA) waren veel lager dan 10. Ook na uitsluiting van electieve geboorten bleven de percentages afwijkend. Conclusie. Deze verschuivingen in de verdeling van geboortegewichten zijn waarschijnlijk vooral het gevolg van veranderingen in de hedendaagse verloskunde. De geboortegewichtspercentielgrenzen zullen voor vroeggeborenen opnieuw vastgesteld moeten worden.

To predict height at five years in a cohort of 565 very preterm and/or very low-birth-weight children, hypothesized growth determinants were subjected to discriminant analysis. Many neonatal parameters were not significantly associated with short stature at five years of age. A correct classification of stature (smaller/larger than the 10th percentile at five years of age) could be obtained in 85% of children, using the following variables: height at two years of age; total (or mid) parental height; parental level of education; length at one year of age; hypertension during pregnancy; sex; weight at two years of age; length percentile at one year of age. However, when compared to actual longitudinal data, the false-positive rate was 37%. The survey also demonstrated the continuing catch-up growth in very preterm and very low-birth-weight infants after two years of age. Chemicals/CAS: Thyrotropin, 9002-71-5; Thyroxine, 7488-70-2

Beschrijving van verschillen in gebruik van zorg vóór, tijdens en na de bevalling in relatie tot sociaal-economische status (SES).

In a prospective collaborative survey on very preterm (less than 32 weeks) and/or very low birthweight (VLBW) infants (less than 1500 g) in The Netherlands, the use of health services was studied by examining the incidence of and reasons for rehospitalisation and the use of out-patient care, i.e. visits to medical specialists and physical therapists. Out of 1338 liveborn infants originally enrolled in the survey, 998 survived the initial hospital stay. Their use of health services was studied during four period: discharge-3 months, 3-6, 6-12 and 12-24 months corrected for expected date of delivery. A total of 320 infants (34%) was readmitted on 481 occasions. The main reasons for rehospitalisation were surgical procedures, of which inguinal herniorrhaphy was the most prominent, and respiratory tract disorders: 149 admissions (31%) and 147 (31%) admissions respectively. The remaining reasons for rehospitalisation occurred less frequently. In a multivariate analysis, both sex and the length of the initial hospital stay were shown to be significantly associated with an increased risk of rehospitalisation. During the study period, 671 children (67%) attended a medical specialist other than their paediatrician, and 313 children (31%) attended a physical therapist. The use of out-patient services was higher in the first than in the second year of follow-up. The use of health services depended very much on the neurodevelopmental status of the child. In the second year of life, a similar rehospitalisation rate and use of out-patient services was found in the non-impaired children as in children from the general Dutch population.

As part of a collaborative project in the Netherlands in 1983, for which data were collected on 1,338 newborn infants (less than 32 weeks' gestation and/or less than 1,500 g birth weight), all infants were assigned to one of three levels of care according to hospital of birth. Considerable centralization was achieved by antenatal and neonatal transport. Although the uncorrected mortality rates were similar, the mortality odds (adjusted for four and 22 potential confounding perinatal factors, respectively) were significantly higher in level 1 and level 2 hospitals compared with level 3 hospitals (tertiary perinatal care centers). By extending the facilities for full perinatal intensive care in level 3 centers and thus providing optimal care for all such infants, the overall mortality rate is expected to decrease further.

In a cohort of 1338 very preterm and/or very-low-birthweight infants, representing 94% of all infants born alive after less than 32 weeks' gestation or weighing less than 1500 g in the Netherlands in 1983, the neonatal mortality rate was 233 per 1000. In these infants, the best obstetric estimate of gestational age was a better predictor of neonatal mortality than birthweight. In such pregnancies, careful obstetric assessment of gestational age seems to be a more accurate basis for clinical decisions and management than the expected birthweight.