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Biomedical subjects

K Riegel

Publications and source records attributed to K Riegel.

At least 19 recordsLinked to original sources
PubMed2000

Effects of gestation and birth weight on the growth and development of very low birthweight small for gestational age infants: a matched group comparison.

AIMS: To investigate the effects of small for gestational age (SGA) in very low birthweight (VLBW) infants on growth and development until the fifth year of life. METHODS: VLBW (< 1500 g) infants, selected from a prospective study, were classified as SGA (n = 115) on the basis of birth weight below the 10th percentile for gestational age and were compared with two groups of appropriate for gestational age (AGA) infants matched according to birth weight (AGA-BW; n = 115) or gestation at birth (AGA-GA; n = 115). Prenatal, perinatal, and postnatal risk factors were recorded, and duration and intensity of treatment were computed from daily assessments. Body weight, length, and head circumference were measured at birth, five and 20 months (corrected for prematurity), and at 56 months. General development was assessed at five and 20 months with the Griffiths scale of babies abilities, and cognitive development at 56 months with the Columbia mental maturity scales, a vocabulary (AWST) and language comprehension test (LSVTA). RESULTS: Significant group differences were found in complications (pregnancy, birth, and neonatal), parity, and multiple birth rate. The AGA-GA group showed most satisfactory growth up to 56 months, with both the AGA-BW and SGA groups lagging behind. The AGA-GA group also scored significantly more highly on all developmental and cognitive tests than the other groups. Developmental test results were similar for the SGA and AGA-BW groups at five and 20 months, but AGA-BW infants (lowest gestation) had lower scores on performance intelligence quotient and language comprehension at 56 months than the SGA group. When prenatal and neonatal complications, parity, and multiple birth were accounted for, group differences in growth remained, but differences in cognitive outcome disappeared after five months. CONCLUSIONS: Being underweight and with a short gestation (SGA and VLBW) leads to poor weight gain and head growth in infancy but does not result in poorer growth than in infants of the same birth weight but shorter gestation (AGA-BW) in the long term. SGA is related to early developmental delay and later language problems; however, neonatal complications may have a larger detrimental effect on long term cognitive development of VLBW infants than whether they are born SGA or AGA.

Birth Weight↗
PubMed1998

An epidemiologic longitudinal study of sleeping problems and feeding experience of preterm and term children in southern Finland: comparison with a southern German population sample.

OBJECTIVE: To determine the influence of breast-feeding on the prevalence and persistence of sleeping problems in southern Finland (SF) and southern Germany (SG). DESIGN: Prospective binational population study of infants admitted to special care units (SCUs) in geographically defined areas in SF and SG. SUBJECTS: In SF, the number of SCU infants was 1057 (very preterm, 47; preterm, 258; term, 752); 485 term infants were control subjects. In SG, the number of SCU infants was 4427 (very preterm, 284; preterm, 1419; term, 2724). MAIN OUTCOME MEASURE: Parent reports of child sleeping problems at 5, 20, and 56 months of age. RESULTS: Night waking at 5 months of age was less frequent for SCU very preterm (25.5%), preterm (40.6%), and term infants (48%) than for term control subjects (56.7% to 59.9%) in SF. No differences in sleeping behavior according to gestation were found at 20 and 56 months. Sleeping problems were greater in SF infants (25.5% to 48%) than in SG infants (15.1% to 19.1%) at 5 months of age and were explained by a higher rate of breast-feeding in SF. Breast-feeding had no long-term effects on night waking or on co-sleeping in SF. In contrast, breast-fed infants continued to wake more often in SG. CONCLUSIONS: Breast-feeding rather than gestational age is strongly related to night waking. More support for dealing with night waking might prevent early termination of breast-feeding.

Breast Feeding↗
PubMed1995

The incidence of sleeping problems in preterm and fullterm infants discharged from neonatal special care units: an epidemiological longitudinal study.

Anecdotal reports have suggested that sleeping problems are a frequent complaint from parents of preterm infants. This prospective epidemiological study examined the incidence and stability of sleeping problems of very preterm (< 32 weeks gestation at birth), preterm (32-36 weeks gestation) and fullterm infants, all admitted to special care baby units (SCBU) after birth, in comparison to healthy term infants over the first 5 years of life. Preterm infants were found to have fewer and shorter night-wakings at 5 months. No differences in sleeping behaviour compared with healthy term children were found at 20 and 56 months of age. Similar significant, and moderate, stability of nightwaking from one age to the next were found for exSCBU-graduates and healthy fullterm infants. Parental interventions such as staying with the child until sleep and taking the infant into bed af night were related to nightwaking problems and increased parental distress. It is concluded that prematurity, and thus neurological immaturity and special care experience are less important than caretaking behaviour in the development of sleeping problems in both preterm and fullterm infants.

Birth Weight↗
PubMed1994

The cognitive outcome of very preterm infants may be poorer than often reported: an empirical investigation of how methodological issues make a big difference.

The effects of relying on outmoded IQ-test norms and the use of arbitrary classifications of developmental delay on estimates of cognitive impairment of very preterm infants (VPI) was evaluated in a prospective population study. Cognitive assessments included the Griffiths test at 5 and 20 months and the Columbia Mental Maturity Scales (CMM) and a vocabulary test (Aktiver Wortschatz Test, AWST) at 56 months of age. Rates of cognitive impairment of 321 very preterm infants (VPI; < 32 weeks gestation or < 1500 g birth weight) were determined according to the published test norms, to scores of a full-term control group (FC n = 321), and to scores from a representative sample of children (NC n = 431) of the same birth cohort. IQ-scores were higher in the FC and NC children than in the original standardisation sample (SS). Using the concurrent test norms (FC, NC) up to 2.4 times more VPI were identified as seriously impaired (<-2 SD) than if the published (outdated) norms were used. Serious developmental delay was underestimated when arbitrary (e.g. DQ < 70) rather than across age comparable definitions (DQ <-2 SD) were used. VPI study drop-outs had mothers with lower educational qualifications and poorer cognitive developmental scores at 5 or 20 months of age. In conclusion, a lack of appropriate control groups and use of arbitrary criteria for judging serious delay leads to large underestimations of cognitive impairment in VPI. Findings from previous uncontrolled studies of VPI need re-interpretation.

Child Development↗
PubMed1994

[Incidence and persistence of problems at sleep onset and sleep continuation in the preschool period: results of a prospective study of a representative sample in Bavaria].

The prevalence and persistence of sleeping problems was studied in a prospective investigation of a representative sample of 432 German children at the ages of 5, 20 and 56 months. 21.5% of children had night waking problems at 5 months, 21.8% at 20 months and 13.3% at 56 months. Falling asleep difficulties were diagnosed in 12.1% of 4-5 year olds. One in four of five year-olds slept regularly in the bed with the parents (co-sleeping). Children with night waking problems had a 2.2 to 2.5 fold increased risk to remain nightwakers from one assessment point to the next compared with non-wakers. 7 to 14% of parents were distressed by their children's sleeping behaviour. Parental behaviour often contributed to continued sleeping problems because the children were not supported in acquiring appropriate skills to settle to sleep unaided. A developmental model for the treatment of sleeping problems is discussed.

Child, Preschool↗
PubMed1987

Effectiveness of neonatal transport systems.

In order to assess the effectiveness of neonatal transport systems, morbidity on admission and early neonatal mortality of low birth weight infants below 2000 gm were studied. All infants referred to a neonatal department in Munich or Southern Bavaria from 1979 to 1981 were included. The data of infants born in Munich perinatal centers were compared to those of infants delivered in hospitals in the Munich area (radius 30 km) and in other hospitals in Southern Bavaria. Ninety-four percent of 248 LBW neonates born in the Munich perinatal centers, 87.5% of 736 infants and 84.4% of 681 LBW infants from the Munich area and Southern Bavaria respectively survived the first week of life although the morbidity risks of inborn infants were higher than those of the outborn. The presence of a pediatrician at birth and during neonatal transport to an NICU did not improve survival rates of infants delivered outside the perinatal centers. The effectiveness of neonatal transport systems is limited. They should be complemented by a maternal transport system, i.e., an infant transport in utero for cases in which the necessity for intensive neonatal care is expected.

Germany, West↗
PubMed1983

[Infant mortality- course, causes, improvement possibilities].

According to national mortality statistics and to epidemiologic surveys main causes of infant mortality are congenital malformations, prematurity with its immaturity related morbidity, asphyxia, and, more recently, the sudden infant death syndrome. In all these situations the full scale of possible preventive measures has not been exhausted. This applies, in particular, to disorders in the perinatal period. What is needed is a greater awareness of risks, more gynecological interest in the baby and better teamwork between gynecologist and pediatrician; this also means a more effective use of available resources. Infant mortality rate still could be reduced by 50 percent.

Asphyxia Neonatorum↗
PubMed1980

[Sudden child death].

There is evidence that in a majority of SIDS cases, which cannot be uncovered by autopsy, an acute minor event (like common cold; separation) causes an abnormal respiratory control to decompensate. Preventive measures are conceivable.

Airway Obstruction↗
PubMed1980

[Time sequence of risks. a new approach to weighting perinatal perils (author's transl)].

In the Munich area from 1975 to 1977 37.3% of 55089 women came to birth without any risk, 7.4% with anamnestic risks (i.e. existing before pregnancy), 12.1% with gestational risks acquired during pregnancy, 4,0% with anamnestic and gestational risks. In 17,0% risks were developed at first during delivery. 4.0% of the pregnant women had anamnestic and birth risks, 12.6% gestational and birth risks, and 5.5% anamnestic and gestational and birth risks. There were remarkable interrelationships between the combination of risks, obstetrical management and outcome (perinatal mortality and infant transferral rate as a crude measure of neonatal morbidity). Anamnestic risks are followed by gestational risks with a chance of 50%. If pregnancy began without risks the probability of gestational risks is approximately 33%. Some distinct anamnestic risks considerably contribute to cesarean section rate. Risks solely occurring during pregnancy have a rather low perinatal mortality (6%o compared to 2%o of riskfree pregnancies). The combination of gestational and birth risks increases perinatal mortality and neonatal morbidity by a factor of 10. This increase is due to some "mortgage-risks", i.e. impairments which are still present at birth. Among those risks conditions most often associated with threatening preterm delivery predominate. Pregnant women who develop such persisting risks should be transferred to a perinatal center.

Cesarean Section↗
PubMed1980

[Cardiovascular adaptation of the newborn to stress situations: effects of hypoxia on newborn and 14-day-old piglets (author's transl)].

-Newborn and 14-day-old piglets (in a developmental stage equivalent to that of a 3-month-old infant) compensate sustained hypoxemia by increasing cardiac performance. -This compensation can be maintained for only roughly 30 min. -Newborn piglets free from hypoxemia are able to tolerate the stress of anesthesia, artificial respiration, and operation significantly longer than those with additional hypoxemia. -14 day-old piglets without hypoxemia are not able to tolerate the stress of anesthesia, artificial respiration, and operation longer than those with additional hypoxemia. -The reactions of the cardiovascular system to anesthesia, artificial respiration, and operation in present or absent additional hypoxemia are qualitatively identical and are also identical in time in the newborn hypoxic, the 14-day-old hypoxic, and normoxic animals, whereas they appear significantly later in newborn control piglets.

Animals↗
PubMed1979

[Maturity determination of the newborn infant].

Uncertain dating of pregnancy and the relative independency of fetal maturation of time require judgement of the maturity state of every newborn infant for obvious practical reasons. Such scoring can be easily performed using external-superficial criteria with acceptable accuracy.

Female↗