14 of the 16 German Federal "Lands" ("Bundesländer") participated in the first assessment in perinatal medicine in reunited Germany. A total of stored data representing 563,480 single births were used to calculate percentile values for birth weight, size (length) at birth and circumference of the head from the 23rd week of pregnancy, presented in tabulated and graphic form. Only data of German Population were evaluated; no other selective criteria were applied. The percentile values were calculated via the cumulative frequencies. Besides the conventional somatic data, the length-related birth weight percentile values were also stated, since these enable a classification more in accordance with the fetal development of the newborn. A cursory comparison with other German standard value determinations and with Lubchenco's curve is carried out.
Neonatal anthropometric data reflect intrauterine development and correlate with postnatal outcome. Therefore, classification of neonates by body dimensions, using gestational age-adjusted population percentiles, is clinically practiced. However, neonatal anthropometric variables are also influenced by maternal constitution and the extent of this influence is currently unknown. We analyzed small for gestational age (SGA) and large for gestational age (LGA) rates according to maternal height and weight. We used data of about 2.3 million singleton pregnancies from the German Perinatal Survey of 1995-2000. A close correlation between maternal and neonatal anthropometric data was found; SGA rates were inversely proportional and LGA rates were directly proportional to maternal height, weight, and body mass index. Neonates of small and light mothers (<155 cm, <50 kg) had, according to the presently used classification scheme, an SGA rate of 25.3% and an LGA rate of 1.7%, respectively. Newborns to tall and heavy women (>179 cm, >89 kg) had a much lower SGA rate (3.1%) and a much higher LGA rate (30.6%). Neonatal body length and head circumference depended on maternal stature in a similar way. Some neonates who are "appropriate" for their gestational age in that they achieve their genetically determined growth potential are therefore apparently misclassified as SGA or LGA.
407 newborns with idiopathic transitory hyperbilirubinaemia were examined with regard to the decrease in serum bilirubin levels during 24 hours of intermittent phototherapy (12 hours of light exposure). The photoeffect (i.e. decrease of serum bilirubin concentration after 24 hours of therapy) showed a unique and predictable nonlinear correlation with the plasma bilirubin concentration before treatment. This relationship can be used for individualizing the duration of phototherapy and the dose of light. The apparent effect of birth weight, gestational age, and postnatal age on the efficiency of phototreatment is only due to differing initial levels of bilirubin concentration. Intermittent illumination seemed to be more efficient than continuous.
and the 'Gerhard Katsch' Central Research Institute for Diabetes, Karlsburg, G.D.R.). Neonatal jaundice in infants of diabetic mothers. Acta Paediatr Scand Suppl360: 101, 1989. 357 IDMs and 20 healthy newborns of non-diabetic mothers were examined at term for body measurements, red blood cell count, serum bilirubin, cord blood insulin and blood glucose during the first postnatal week. The stage of maternal diabetes did not influence the course of neonatal bilirubin levels, but the IDMs had prolonged and higher bilirubinaemia compared with the controls. Hyperbilirubinaemia was found to be most prominent in newborns with an increased birthweightllength ratio and was not simply related to macrosomia (LGA). These infants had significantly lower blood glucose concentrations immediately after birth, whereas cord blood insulin was found to be identical between the I D M sub-groups. Bilirubinaemia in heavy for length infants was slightly correlated to haematocrit. For the pathogenesis of hyperbilirubinaemia in IDMs induction of heme oxygenase (due to a lack of energy provision following a phosphorylation disorder) is discussed. Nutritional support (early feeding, glucose infusions) does not affect the course of bilirubinaemia. Key words: infants of diabetic mothers, bilirubin metabolism, hyperbilirubinaemia.In spite of remarkably reduced mortality and lower malformation rates in infants of diabetic mothers (IDMs), due to modern strategies in the management of diabetes during pregnancy, the incidence of macrosomia and hyperbilirubinaemia in these newborns has remained relatively high.Opinions concerning the pathogenesis of these phenomena differ to some extent (1-3), but most of them are based on the classical theory of Pedersen (4): maternal hyperglycaemia leads to fetal hyperglycaemia and subsequently to hyperplasia of the fetal pancreatic islets. This basic disorder is thought to be responsible for most of the clinical signs and symptoms which can be observed in IDMs, including hyperbilirubinaemia.But, since the IDMs form a heterogeneous group we speculated that the problem of hyperbilirubinaemia was not identical for all of them. Therefore, the aim of our study was to look for different types of IDMs with reference to their somatic development and metabolic condition and the degree of hyperbilirubinaemia in the first week after birth. MATERIALS AND METHODSFrom January 1984 until December 1987 a total of 382 diabetic women gave birth in the Obstetric Department of the Karlsburg Central Institute. The main principles of management were: ( a ) insulin treatment to keep blood sugar in or near the normal range (if possible already praeconceptionally); (b) hospitalization of pregnant women in the 32nd week of gestation for early treatment of complications related to pregnancy as well as to diabetes; (c) delivery near
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