Objective. The purpose of the study was to examine the possible age dependency of plasma N-terminal pro atrial natriuretic peptide (N-ANP) and N-terminal pro brain natriuretic peptide (N-BNP) levels in healthy term neonates to establish normal ranges for the neonatal period.Methods. N-ANP and N-BNP plasma concentrations were measured in peripheral venous (n = 116) and umbilical cord blood ( n = 37) in 153 healthy term neonates (mean: 5.1; range: 0 - 30 days) using an enzyme immunoassay. The neonates were classified into 8 groups according to their age ( day of delivery and 1, 2, 3, 4, 5 - 7, 8 - 14, and 14 - 30 days of age).Results. The plasma N-ANP and N-BNP concentration were the highest at the first day of age ( 96 700; 6912 - 436 000 and 641; 254-1272 fmol/mL) and were found significantly higher compared with the day of delivery ( 5680; 1005 - 16 900 and 221; 58 - 478 fmol/mL; P < 0,0001). After this marked increase, N-ANP and N-BNP levels decreased steadily and became stable at the fifth ( 5232; 2691 - 7353 fmol/mL) and third ( 246; 110 - 430 fmol/mL) day of life, respectively.Conclusions. The N-ANP and N-BNP plasma concentrations in healthy neonates showed a marked increase during the first days of age, suggesting that ANP and BNP have physiologic roles in the perinatal circulatory change from fetus to neonate.

A 17-year-old primigravida was referred at 31 + 6 weeks' gestation because of a supraumbilical fetal midline defect, thoracoabdominal ectopia cordis, and sternal aplasia. Fetal echocardiography showed a double-outlet right ventricle with pulmonary artery stenosis and a ventricular septal defect. Karyotyping was declined. After premature rupture of the membranes at 36+5 weeks' gestation a 3000-g male infant was delivered by cesarean section. The Apgar scores were 3/3 and the arterial cord blood pH was 7.26. Tissue coverage of the supraumbilical defect and the omphalocele was performed. Hemodynamic instability precluded primary replacement of the heart into the thorax. To relieve pressure a corset was fashioned for the thorax. The double-outlet right ventricle was corrected at 5 months. At 17 months the child is alive and stable. Replacement of the extrathoracic heart is planned at a later date.

To delineate the development of melatonin (MLT) production during childhood, we measured the excretion of MLT and 6-hydroxymelatonin sulfate (MLTS) in the urine of children (n = 134) from the 26th week of gestation until the age of 20 years. MLTS excretion showed a diphasic pattern with declining values in preterm babies with lowest values around term. After birth, the values remained low for the first 6 months of life. The highest values were reached between 4 and 7 years of age with a smooth but steady decline thereafter. A night-day difference was not detectable before the age of 6 months; the greatest night-day variations occurred at the time of the highest MLTS excretions. The MLT values showed an identical pattern but with amounts 1,000 times smaller; the ratio of MLTS to MLT increased from 40:1 in preterm babies to 900:1 in prepubertal children. In summary, the MLT/MLTS excretion exhibits the highest activity with respect to total secretory capacities as well as night-day differences at the time of gonadal quiescence during childhood. The strong inverse correlation of MLT and MLTS excretion with the hypothalamic-pituitary-gonadal activity points to a causal relationship between pineal gland activity and pubertal development.

The reunification in 1990 of the German Democratic Republic (GDR) and the Federal Republic of Germany (FRG) produced profound social transformations. Changes in the distribution of low birth-weight (LBW, < 2500 g) in the two parts of the country between 1990 and 1992 have been studied by analysing vital statistics for the period. In absolute numbers, livebirths in the former FRG remained stable, while those in the former GDR declined by 51%. Numbers of LBW livebirths increased slightly in the former FRG and decreased in the former GDR; those in the category between 500 and 999 g remained stable in the former GDR and increased in the former FRG. However in terms of proportion, livebirths in this category doubled in the former GDR. Migration rates for the same period showed a shifting population from East to West particularly of young people, and maternal age-specific numbers of livebirths decreased in both countries. Psychosocial stress may have contributed to the rise in ELBW, but it is also possible that the improvement and sharing of perinatal management strategies may have led to increased survival of babies < 1000 g. Most importantly, the observed rise in the proportion of ELBW births (except those < 500 g) could be a result of the introduction of the more comprehensive definition of livebirth into the former GDR.

We investigated the ontogeny of melatonin synthesis during fetal maturation by measuring the melatonin (MLT) and 6-hydroxymelatonin sulfate (MLTS) excretion in the urine of male infants aged 2-7 days and gestational age 26-42 weeks. We found a negative correlation between advancing gestational age and the MLT and MLTS excretion expressed as total 24-h amount, ratio of 24-h amount to creatinine and ratio of 24-h amount to body surface area, The ratio of MLT to MLTS was found to be about ten times higher in the study group than in prepubertal children, which might reflect the immaturity of hepatic sulfation capacities. The total amount of excreted MLT and MLTS was only one-tenth the prepubertal values. No day/night differences in MLT and MLTS excretion could be detected. We conclude that the fetal pineal gland is capable of a limited melatonin synthesis from the 26th week of gestation onwards, with decreasing values reaching its nadir around term. This indicates that the amount of fetal MLT excretion is not determined by synthesizing capacities of the pineal gland but by the development of neural connections to the pineal gland.

Obwohl seit fast 30 Jahren Methoden zur effektiven Prophylaxe der Rhesus- Erythroblastose eingesetzt werden — nämlich die Injektion von Anti D- Immunglobulin — kommen bis zum heutigen Tage fetale Erkrankungen durch blutgruppenspezifische Antikörper vor. Aus einer Umfrage unserer Arbeitsgruppe bei allen Universitätskliniken wissen wir, daß in der BRD bei einer Geburtenzahl von ca. 600 000 Geburten pro Jahr 300–450 Schwangerschaften mit leichten und mittelschweren sowie 50 mit schweren Erythroblastoseerkrankungen jährlich zu erwarten sind. Letztere benötigen eine pränatale Therapie. Von unserer Arbeitsgruppe wurden von 1966–1988 310 Schwangerschaften pränatal behandelt. Durch Optimierung des diagnostischen und therapeutischen Regimes konnten die Überlebensraten von 45% auf 83% im letzten Dreijahreszeitraum angehoben werden. Durch differenzierte serologische Untersuchungen (Spezifität, Titer und Reaktionsmerkmale der Antikörper) im mütterlichen und fetalen Serum sowie im Fruchtwasser, Einsatz der Sonographie und Kardiotokographie, ist es heute möglich, mit hoher Treffsicherheit zu entscheiden, ob, wann und wie oft pränatal transfundiert werden muß. In 96% der Fälle waren irreguläre Antikörper vom Typ Anti-D allein oder in Kombination mit Anti-c, Anti-E, Anti- Kidd oder Anti-Duffy die Ursache für die fetale Haemolyse. In 4% der Fälle führten seltene irreguläre Antikörper der Spezifität Anti-c, Anti-Kidd oder Anti- Duffy zu schweren pränatal transfusionsbedürftigen fetalen Erkrankungen. 49% aller Frauen hatten in früheren Schwangerschaften bereits ein Kind verloren, bei 28% wurde prä- und postnatal bei früheren Schwangerschaften behandelt und nur 23% der Patientinnen hatten keine belastete Anamnese. Die Sensibilisierung erfolgte in 64% durch frühere Schwangerschaften, am häufigsten durch einen Abort, eine Extrauteringravidität oder Blasenmole, bei der die Anti-D- Prophylaxe unterlassen worden war. Anti-D-Versager fanden wir in 23%, Fehltransfusionen in 7% als Ursache, während 6% nicht geklärt werden konnten. In der folgenden Abb. 1 sind unsere Ergebnisse jeweils in Dreijahreszeiträumen zusammengefaßt dargestellt. Die überlebenden Kinder sind schraffiert, die verstorbenen Kinder als leere Säulen markiert. Die Überlebensraten konnten von 45% auf 83% angehoben werden. Die Anzahl der Transfusionen pro Kind nahm von 1, 9 auf 3,6 zu. Die pränatale Therapie ist durch den Einsatz der Sonographie sowie zusätzliche direkte medikamentöse Behandlungen des Feten mit Cortison, Furosemid sicherer und erfolgreicher geworden.

Immunhämolytische Anämien des Feten können durch diaplazentar in die kindliche Zirkulation transferierte blutgruppenspezifische Antikörper der Mutter ab der 20. Schwangerschaftswoche (SSW) in 5 verschiedenen Schweregraden induziert werden (Tabelle 1).

We studied the role of AVP in the water metabolism of preterm infants with a sensitive urinary AVP RIA. Three groups were studie d.GroupA:16 orally fed infants from 32 to 38 weeks of gestation. Group8:16 infants with parenteral fluid administration from 32 to 36 weeks of gestation. GroupC:12 infants, ventilated for RDS from 28 to 36 weeks of gestation with parenteral fluid administration. Gr.A received 50±9 ml/kg on day 1 with daily increasing amounts up to 169±17 ml/kg on day 7 p.o. They had small urine volumes with high osmoTality and lost up to 9% weight. AVP was stimulated by this water loss from 15.3±4.3pg/ml on day 1 to 36.6±27.2pg/ml on day 3-5.GrB received initially greater fluid volumes i.v. (109±10 ml/kg on day D. They produced more urine with low osmolality and did not loose weight. AVP was suppressed from 13.1±11.4pg/ml on day 1 to 5.4±3.5pg/ml on day 2.GrC received on day 1 already 121±21ml/kg. The infants gained weight up to 107.5±6.3% on day 3while serum Na decreased to 133 mmol/l. Urine volume was inadequate low as was urine osmolality inadequate high. AVP was 21.0±18.7pg/ml on day 1 and was not suppressable until day 3. There was a significant (p=0.05)correlation between 1minApgar scores and AVP as well as FiO2 and AVP on day 1.No significant correlation was found between mean respiratory pressure and AVP. We conclude, that infants with RDS have a nonosmotic release of AVP and should receive smaller fluid volumes in the first three days of life.

Abstract. Stern, M., Hellwege, H. H., Grävinghoff, L. and Lambrecht, W. (Department of Paediatrics and Department of Surgery, University Hospital Eppendorf, Hamburg, Federal Republic of Germany). Total aganglionosis of the colon (Hirschsprung's disease) and congenital failure of automatic control of ventilation (Ondine's curse). Acta Paediatr Scand, 70:121, 1981.–Total aganglionosis of the colon presenting with small intestinal obstruction in the neonatal period was observed in combination with congenital alveolar hypoventilation requiring continuous mechanical ventilation in a boy. The patient died aged 15 months from acute dehydration due to enteritis, long after total resection of the aganglionic bowel had been performed. Pulmonary hypertension was found in the newborn period. There was progressive right ventricular myocardial hypertrophy. This is the fourth case reported with a combination of defects involving nerve cell function of the brain stem and gastrointestinal tract.