Stephan Arenz

Breast-feeding and childhood obesity—a systematic review

OBJECTIVE: To investigate the relationship between breast-feeding and obesity in childhood.DESIGN: Systematic review and meta-analysis of published epidemiological studies (cohort, case–control or cross-sectional studies) comparing early feeding-mode and adjusting for potential confounding factors. Electronic databases were searched and reference lists of relevant articles were checked. Calculations of pooled estimates were conducted in fixed- and random-effects models. Heterogeneity was tested by Q-test. Publication bias was assessed from funnel plots and by a linear regression method.OUTCOME MEASURES: Odds ratio (OR) for obesity in childhood defined as body mass index (BMI) percentiles.RESULTS: Nine studies with more than 69 000 participants met the inclusion criteria. The meta-analysis showed that breast-feeding reduced the risk of obesity in childhood significantly. The adjusted odds ratio was 0.78, 95% CI (0.71, 0.85) in the fixed model. The assumption of homogeneity of results of the included studies could not be refuted (Q-test for heterogeneity, P>0.3), stratified analyses showed no differences regarding different study types, age groups, definition of breast-feeding or obesity and number of confounding factors adjusted for. A dose-dependent effect of breast-feeding duration on the prevalence of obesity was reported in four studies. Funnel plot regression gave no indication of publication bias.CONCLUSION: Breast-feeding seems to have a small but consistent protective effect against obesity in children.

No temporal association between influenza outbreaks and invasive pneumococcal infections

Objective: To assess whether the influenza peak in populations precedes the annual peak for invasive pneumococcal infections (IPI) in winter. Design: Ecological study. Active surveillance data on influenza A and IPI in children up to 16 years of age collected from 1997 to 2003 were analysed. Setting: Paediatric hospitals in Germany. Patients: Children under 16 years of age. Results: In all years under study, the influenza A season did not appear to affect the IPI season (p = 0.49). Specifically, the influenza peak never preceded the IPI peak. Conclusion: On a population level there was no indication that the annual influenza epidemic triggered the winter increase in the IPI rate or the peak of the IPI distribution in children.

[The model project "newborn auditory screening" in the Upper Palatinate: high process and result quality of an interdisciplinary concept].

ZusammenfassungHintergrundIm Mai 2003 wurde in der Oberpfalz ein Modellprojekt gestartet, um ein interdisziplinäres Neugeborenen-Hörscreeningprogramm zu etablieren.MethodikIn allen Geburts- und Kinderklinken wird ein sequenzielles Screening mittels otoakustischer Emissionen (OAE) und Hirnstammaudiometrie („brainstem electric response audiometry“, BERA) durchgeführt. Das Screeningzentrum des öffentlichen Gesundheitsdienstes (ÖGD) übernimmt die Koordination des Screeningprozesses, die Sicherstellung der Vollständigkeit, das Tracking der auffälligen Befunde und die Qualitätssicherung.ErgebnisseVon 17.469 Neugeborenen wurden 96% gescreent. Die Referrate bei Entlassung lag bei 1,6% (0,4% beidseitig). 97% der auffälligen Befunde wurden abgeklärt, 43% erst nach Intervention durch das Screeningzentrum. 15 Kinder mit einer hochgradigen beidseitigen Hörstörung wurden diagnostiziert, davon 8 frühzeitig durch das Tracking.FazitDie in der Oberpfalz etablierten, effektiven Strukturen sind ein geeigneter Standard für in Deutschland erreichbare Prozess- und Ergebnisqualität eines universellen Hörscreenings in der Neugeborenenperiode.AbstractBackgroundIn May 2003, a newborn auditory screening program was initiated in the Upper Palatinate.MethodsSequential OAE- and BERA-screening was conducted in all hospitals with obstetric facilities. The Screening Center at the Public Health Authority was responsible for the coordination of the screening process, completeness of participation, the follow-up of all subjects with a positive screening test and the quality of instrumental screening.ResultsA total of 96% of 17,469 newborns were screened. The referral rate at discharge was 1.6% (0.4% for bilateral positive findings). For 97% of the positive screening results, a definite diagnosis to confirm or exclude hearing loss was achieved; for 43% only after intervention by the Screening Center. Fifteen children with profound bilateral hearing impairment were identified of whom eight were only detected by the intervention of the Screening Center.ConclusionThe effective structures established in the Upper Palatinate provide a standard for the quality of neonatal auditory screening achievable in Germany.

Modellprojekt Neugeborenen-Hörscreening in der Oberpfalz

ZusammenfassungHintergrundIm Mai 2003 wurde in der Oberpfalz ein Modellprojekt gestartet, um ein interdisziplinäres Neugeborenen-Hörscreeningprogramm zu etablieren.MethodikIn allen Geburts- und Kinderklinken wird ein sequenzielles Screening mittels otoakustischer Emissionen (OAE) und Hirnstammaudiometrie („brainstem electric response audiometry“, BERA) durchgeführt. Das Screeningzentrum des öffentlichen Gesundheitsdienstes (ÖGD) übernimmt die Koordination des Screeningprozesses, die Sicherstellung der Vollständigkeit, das Tracking der auffälligen Befunde und die Qualitätssicherung.ErgebnisseVon 17.469 Neugeborenen wurden 96% gescreent. Die Referrate bei Entlassung lag bei 1,6% (0,4% beidseitig). 97% der auffälligen Befunde wurden abgeklärt, 43% erst nach Intervention durch das Screeningzentrum. 15 Kinder mit einer hochgradigen beidseitigen Hörstörung wurden diagnostiziert, davon 8 frühzeitig durch das Tracking.FazitDie in der Oberpfalz etablierten, effektiven Strukturen sind ein geeigneter Standard für in Deutschland erreichbare Prozess- und Ergebnisqualität eines universellen Hörscreenings in der Neugeborenenperiode.AbstractBackgroundIn May 2003, a newborn auditory screening program was initiated in the Upper Palatinate.MethodsSequential OAE- and BERA-screening was conducted in all hospitals with obstetric facilities. The Screening Center at the Public Health Authority was responsible for the coordination of the screening process, completeness of participation, the follow-up of all subjects with a positive screening test and the quality of instrumental screening.ResultsA total of 96% of 17,469 newborns were screened. The referral rate at discharge was 1.6% (0.4% for bilateral positive findings). For 97% of the positive screening results, a definite diagnosis to confirm or exclude hearing loss was achieved; for 43% only after intervention by the Screening Center. Fifteen children with profound bilateral hearing impairment were identified of whom eight were only detected by the intervention of the Screening Center.ConclusionThe effective structures established in the Upper Palatinate provide a standard for the quality of neonatal auditory screening achievable in Germany.

Comparison of treatment strategies for anaemia of prematurity in extremely low birthweight infants between 1997 and 2011

Anaemia of prematurity (AOP) is a common sequela of preterm birth.1 It remains largely unknown how individual neonatal intensive care units (NICUs) manage AOP and whether treatment strategies have changed over time. We present the results of a standardised multicentre survey to assess the alterations in the treatment of AOP in NICUs caring for extremely low birthweight (ELBW) infants comparing Germany in 1997 (n=125 NICUs) to German-speaking countries in 2011 (n=129): Germany (n=110), Austria (n=10) and Switzerland (n=9).2 Preparation strategies for red blood cells (RBCs), transfusion volume, and rate and protocols for erythropoietin administration were analysed. High response rates (63.6%, 1997; 66.2%, 2011) make our results representative for German-speaking countries: Treatment strategies for AOP …