Risk-adjusted intraventricular hemorrhage rates in very premature infants: towards quality assurance between neonatal units.

Background: The incidence of intraventricular hemorrhage (IVH) in very low birth weight infants can be used as an index of the quality of care in neonatal intensive care units as long as it is adjusted to reflect the infants' risk profiles on admission to the unit, which may vary systematically from one institution to another. Adjustment for gestational, birth-related, and neonatological risk factors enables a fair comparison of IVH rates across neonatal intensive care units.

Methods: Data on 1782 neonates born at less than 32 weeks of gestation or weighing less than 1500 g at birth were retrieved from the 26 744 anonymous data sets collected in the Peri- and Neonatal Survey of the German state of Saxony in the years 2001-2005.

[Risk-adjusted assessment of neonatology wards by the new quality indicator "transfer rate of mature newborns"].

Objective: 1. The transfer rate of mature newborns will be presented as a new quality indicator. 2.

[Risk-adjusted assessment: late-onset infection in neonates].

Objective: The weak point of the countrywide perinatal/neonatal quality surveillance is the ignorance of interhospital differences in the case mix of patients. As a result, this approach does not produce reliable benchmarking. The objective of this study was to adjust the result of the late-onset infection incidence of different hospitals according to their risk profile of patients by multivariate analysis.

[Risk adjusted assessment of quality of perinatal centers - results of perinatal/neonatal quality surveillance in Saxonia].

Background: The weak point of the country-wide perinatal/neonatal quality surveillance as a tool for evaluation of achievements of a distinct clinic, is the ignorance of interhospital differences in the case-mix of patients. Therefore, that approach can not result in a reliable bench marking.

Objective: To adjust the results of quality assessment of different hospitals according to their risk profile of patients by multivariate analysis.

[Determination of respiratory system compliance from resonance frequency--animal experiment].

10 anaesthetized and tracheotomized rabbits were used to test the possibility for calculation of total respiratory system compliance from resonance frequency (CR). Reference values were obtained by inflation method compliance (CI). A new servocontrolled infant ventilator was used with an integrated negative ventilator resistance mode for resistive unloading of combined resistances of lung, endotracheal tube and ventilator.

High frequency oscillatory ventilation near resonant frequency of the respiratory system in rabbits with normal and surfactant depleted lungs.

It has been suggested that high frequency oscillatory ventilation (HFV) might improve gas exchange and reduce the risk of pressure-related side-effects compared to conventional mechanical ventilation (CMV). Whereas most studies have used arbitrarily set frequencies for HFV, we evaluated the effects of HFV near resonant frequency (fr). Anaesthetised and tracheotomized adult rabbits (n = 10; 3.

A method of calculating total respiratory system compliance from resonant frequency: validity in a rabbit model.

Ten anesthetized, tracheotomized, adult rabbits were used to test the validity of a method for calculation of total respiratory system compliance from resonant frequency (Cr). Reference values were obtained during constant flow inflation of the relaxed respiratory system by dividing the volume gain by the related difference in pressure at the airway opening (inflation method compliance, Ci). The animals were connected to a new type of servo-controlled infant ventilator.

An infant ventilator technique for resistive unloading during spontaneous breathing. Results in a rabbit model of airway obstruction.

The combined system of ventilator circuit, endotracheal tube, and lung commonly imposes a resistive load on spontaneous breathing efforts. It is possible to compensate for this positive resistance by a device generating a "negative ventilator resistance" (NVR), i.e.

Titration of continuous positive airway pressure by the pattern of breathing: analysis of flow-volume-time relationships by a noninvasive computerized system.

Infants can defend or even dynamically elevate their functional residual capacity with additional respiratory muscle work by retarding early expiratory airflow (V) with postinspiration inspiratory muscle activity and/or laryngeal narrowing, or by starting inspiration before expiration to the relaxation volume has been completed. In order to study the effect of continuous positive airway pressure (CPAP) on both phenomena in 23 infants (birthweight 1,746 +/- 417 g), we elevated the airway pressure stepwise in 0.2 kPa increments.

[Neuropsychiatric disorders in very-low-birthweight newborn infants (VLBW-infants)--before and after the introduction of modern perinatal medicine. 3. Discussion of trends in quality of survival (CNS morbidity) and conclusions].

The reduction of both the severe CNS-disturbances (major CNS-handicaps) as a whole and the infantile cerebral palsies (ICP), epilepsies, and mental retardations (oligophrenias) especially, can be attributed to the comprehensively improved pre-, intra- and postnatal care since the 60/70-ies. The best indicator is the decreasing ICP, because 60% of this disturbance is caused perinatally. It is closely associated with cerebral hemorrhages.

[Neuropsychiatric disorders in newborn infants with very low birth weight (VLBW infants)--before and following introduction of modern perinatal medicine. 2. Infantile cerebral palsy, epilepsy and mental handicap (oligophrenia)].

Simultaneously with the introduction of modern perinatal intensive therapy the infantile cerebral palsies (ICP) of VLBW infants dropped on the average from 23 to 5.9 per cent. In Swedish and West-Australian ICP studies a considerable decrease in the ICP incidence was found in the 60's, but there was again a slight increase in the 70's.

[Neuropsychiatric disorders in newborn infants with very low birth weight (VLBW infants)--before and following introduction of modern perinatal medicine. 1. Overview of the problem, criteria for quality of survival, major CNS disorders (major handicap)].

The survival quality of very low birthweight infants (VLBW infants) is highly actual just even in the time of modern perinatal medicine. Through the development and permanent improvement of the perinatal intensive therapy the survival chances of VLBW infants could be improved significantly in the last 25 years. In the 70's survival rates of 60-84 per cent were achieved in VLBW infants, in the leading centers even rates of 86 and 90.

High frequency oscillatory and conventional mechanical ventilation in experimental surfactant deficiency: a study using a new infant ventilator technique.

The performance of a new infant ventilator system had to be evaluated. Technically it is characterized by flow (V)- and pressure (P)-transducers mounted immediately near the endotracheal tube. A microcomputer works as a function generator and governs servo-controllers for V and P thus offering a multiplicity of different modes both of the conventional (CMV) and high frequency oscillatory (HFO) type.

Pathogenetic significance of venous hyperoxaemia in retinopathy of prematurity.

Ten underweight newborns with severe retinopathy of prematurity (ROP) and 18 newborns with slight changes in the sense of ROP were compared with 66 healthy infants. The distribution of 13 possibly pathogenetically effective features in these 3 groups of patients was studied by means of variance analysis. The greatest significance resulted for multiple blood transfusions and exchange transfusions.

[Clinical and computed tomographic observations on newborn infants with generalized brain edema due to perinatal asphyxia].

We observed a sudden respiratory arrest in four term newborn infants after a clinically symptom-free period. There were no cardiac, pulmonary or metabolic changes responsible for these events. Signs of cerebral dysfunction existed (muscular hypotonia, jitterness, seizures).