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The number of cases of diabetes worldwide has increased significantly in the last decade. Characteristically, the incidence of gestational diabetes (GDM) reflects the incidence of type 2 diabetes mellitus (T2DM) in the background population, which is a warning that a rapid increase in the incidence is to be expected concomitant with the already observed increase in the incidence of T2DM. Although the majority of all deliveries worldwide take place in the so-called developing world, little is known about the prevalence of diabetes in pregnancy in rural areas of East Africa. Diabetes in pregnancy has effects on prospects for marriage, motherhood, and the role of women in East African society. Furthermore, intrauterine exposure to the metabolic environment of maternal diabetes, or GDM, is associated with increased risk of altered glucose homeostasis in the offspring, beginning in childhood and producing a higher prevalence of GDM in the next generation with all burdens and complications being associated with this disease. It is reasonable to conclude that more newborn infants each year are being exposed to the metabolic environment of diabetes during intrauterine development as a result of changing incidence and demographics of diabetes and pregnancy. We believe that programs and policies have to be established, including organization of the health system to provide care, medicines, and other tools necessary for diabetes in pregnancy management, consideration of accessibility and affordability of care, education for healthcare workers, and education of pregnant and nonpregnant women of reproductive age.

Aims: The aim of the present evaluation is to describe the frequency of breast-feeding as well as breast-feeding problems of mothers in Bavaria and to derive practical measures to promote breast-feeding., Methods: The study "Breast-Feeding Behaviour in Bavaria" is a prospective cohort study that was carried out from April 2005 to January 2006. 3 822 mothers who had given birth in April 2005 from all of Bavaria participated in the study. The methods and preliminary results have already been described. The participants of the study were questioned about their breast-feeding habits in 4 follow-ups. The follow-up quota was 82%., Results: The frequency of breast-feeding exclusively according to needs at 2-6 days following delivery was about 62%. At the end of the infants' second month of life only 46.7% of the infants were breast-fed at least 7 times. In the first 2 months the prevalence of breast-feeding problems in mothers who still breast-feed and those who had stopped was about the same. In mother-infant pairs who no longer breast-feed, the concerns about too little milk, sore nipples and drinking or sucking problems of the infant predominated., Conclusions: Breast-feeding problems that lead to termination of nursing are often due to a lack of milk or, respectively, a mother's concern about giving too little milk. Prospective, quality-assured counselling should focus on increasing the frequency of breast-feeding and on an improvement of suckling techniques in the first weeks of life. The medical necessity to supplementary feeding should be critically assessed and clearly explained to the mother in order to avoid giving her the feeling that she is unable to adequately feed her own child.

Aim: With the intention to create a basis for interventions on the promotion of breast-feeding, the public opinion on breast-feeding and infant nutrition in NRW was assessed., Methods: A two-stage random sample of interviewees was drawn for a computer-assisted telephone survey (CATI). Methods applied on the selection of: 1. Households: 1.1. Gabler-Häder (n=1 811); 1.2. Onomastik (n=200); participants with a Turkish background of migration interviewed in German or Turkish language, alternatively: 2. Interviewees: Last Birthday method (n=2 011), age > or =18 years., Results: Breast milk is the nutrition preferably recommended in the first six months, the knowledge of adjacent issues of infant nutrition has to be improved. The majority accepts supportive measures for breast-feeding. Different sources of information were assessed in Turkish and German participants., Conclusion: The survey supplies the background for the development of target group-specific information strategies which take specifically into account of issues attributable to ethnic differences and to reach the relatives and friends of young families, too.

The present analyses were undertaken to understand the role of workplace characteristics in the breastfeeding practices of working women. The effects of the perception of the availability of employer-sponsored child care, the perception of the availability of a flexible schedule, hours worked at home, and worked a fixed schedule on breastfeeding outcomes were estimated using a sample of 1,506 births from the National Longitudinal Survey of Youth 1979 and the Children of the National Longitudinal Survey of Youth 1979. The availability of employer-sponsored child care increased the likelihood of breastfeeding six months after birth by 47 percent. In addition, working an additional eight hours at home per week, at the mean, increased the probability of breastfeeding initiation by 8 percent and breastfeeding six months after birth by 16.8 percent. Workplace characteristics show promise as an effective way to increase breastfeeding rates among working women.

The article presents comparative study of the incidence of adverse effects following vaccinations with whole cell and acellular pertussis vaccines, based on data collected in obligatory routine surveillance of AEFI in the period of 2001-2005 in Poland. Comparisons done in children less then 2-years-old show in general about twice as high incidence of adverse effects following the whole-cell than the acellular vaccine. The biggest rate of proportions (RR = 4,75) was observed for high pitch cry. There was no significant difference in incidence of the most severe reactions, including encephalopathy and nonfebrile seizures, and there was no significant difference in allergic reactions.

This study aimed to identify risk factors associated with very low birth weight in a general hospital in Caxias do Sul, Rio Grande do Sul State, Brazil. This was a case-control study of 200 newborns with birth weight from 500 to 1,499 g (cases) and 400 with birth weight from 3,000 to 3,999 g (controls). Infants were from singleton pregnancies, and their mother had received prenatal care at public health services. The dependent variable was birth weight, and independent variables included socioeconomic status, schooling, and gestational and birth status. Univariate and multivariate analyses were performed with a 5% level of significance. Mortality in very low birth weight newborns was 32.5%. The limits of viability were 600 g for birth weight and 26 weeks for gestational age. Variables related to very low birth weight were: maternal age > 35 years (p = 0.01), lack of prenatal care (p < 0.0001), illness during the index pregnancy (p = 0.03), maternal hypertension (p = 0.007), hospitalization during pregnancy (p < 0.0001), and prior history of low birth weight (p < 0.0001). Many premature births were due to avertable factors.

Background: Low birth weight is associated with an increased risk of neonatal and infant mortality and morbidity, as well as with other adverse conditions later in life. Since the birth weight-specific mortality of a second child depends on the birth weight of an older sibling, a failure to achieve the biologically intended size appears to increase the risk of adverse outcome even in babies who are not classified as small for gestation. In this study, we aimed at quantifying the risk of neonatal death as a function of a baby's failure to fulfil its biologic growth potential across the whole distribution of birth weight., Methods: We predicted the birth weight of 411,957 second babies born in Denmark (1979-2002), given the birth weight of the first, and examined how the ratio of achieved birth weight to predicted birth weight performed in predicting neonatal mortality., Results: For any achieved birth weight category, the risk of neonatal death increased with decreasing birth weight ratio. However, the risk of neonatal death increased with decreasing birth weight, even among babies who achieved their predicted birth weight., Conclusion: While a low achieved birth weight was a stronger predictor of mortality, a failure to achieve the predicted birth weight was associated with increased mortality at virtually all birth weights. Use of family data may allow identification of children at risk of adverse health outcomes, especially among babies with apparently "normal" growth.

Research shows that mothers who are obese (with a BMI >30) are less likely to initiate lactation, have delayed lactogenesis II, and are prone to early cessation of breastfeeding. Black women, with the highest rates of American obesity, have the lowest rates and shortest duration of breastfeeding compared to Hispanic and white women. Women who are overweight and obese have lowered prolactin responses to suckling. Women who are obese are at risk for prolonged labors, excessive labor stress, and cesarean birth, all of which delay lactogenesis II. Lactation has a small but significant role in preventing future obesity in the mother and child. Midwifery management of obesity-related lactation problems begins with education about optimal prenatal weight gain and regular weight assessment to avoid excessive gain. Support of physiologic birth processes to avoid stress, prolonged labor, and surgical birth and limit maternal-newborn separation enhances the onset of lactogenesis II. Massage or pumping may soften and extend the obese nipple for easier latch. Infants of lactating women with prior bariatric surgery are at risk for B12 deficiency and require regular nutrition and growth assessment. Five hundred calorie per day restriction paired with aerobic exercise for intentional postpartum weight loss does not affect milk quality or infant growth.

Estimates of intimate partner violence (IPV) during pregnancy vary by population being studied, measures, and other methodological limitations, hindering the ability to gauge the relationship between IPV and negative birth outcomes. The authors report aggregated data from a subsample (n = 148) of the first three waves of the Women's Employment Study. The authors compared groups of women who did and did not give birth to low birth weight infants on demographic, material deprivation, risk behavior, mental health, and IPV factors. The prevalence of domestic violence was more than twice as high for women with low birth weight infants as those women who had a normal weight infant. When considering additional risk factors, including food insufficiency, substance dependence, and depression and/or posttraumatic stress disorder, IPV remained a significant indicator, but it was most strongly associated with low birth weight among women also experiencing depression and/or posttraumatic stress disorder.

Background: The objective of this cohort study was to examine the effect on birth weight of living in a disadvantaged neighbourhood in a Nordic welfare state. Birth weight is a health indicator known to be sensitive to political and welfare state conditions. No former studies on urban neighbourhood differences regarding mean birth weight have been carried out in a Nordic country., Methods: A register based on individual data on children's birth weight and maternal risk factors was used. A neighbourhood characteristic, i.e. an aggregated measure on income was also included. Connections between individual- and neighbourhood-level determinants and the outcome were analysed using multi-level regression technique. The study covered six hundred and ninety-six neighbourhoods in the three major cities of Sweden, Stockholm, Göteborg and Malmö, during 1992-2001. The majority of neighbourhoods had a population of 4 000-10 000 inhabitants. An average of 500 births per neighbourhood were analysed in this study., Results: Differences in mean birth weight in Swedish urban neighbourhoods were minor. However, gestational length, parity and maternal smoking acted as modifiers of the neighbourhood effects. Most of the observed variation in mean birth weight was explained by individual risk factors., Conclusion: Welfare institutions and benefits in Sweden might buffer against negative infant outcomes due to adverse structural organisation of urban neighbourhoods.

The prevalence of overweight has risen to 19% in children aged 6 to 11 years and 17% in adolescents aged 12 to 19 years. This paper examines gestational and infancy factors that influence the risk of overweight in childhood. Important factors to eliminate the infancy connection to childhood obesity include the following: (a) maternal lifestyle patterns, (b) infant feeding transitions, and (c) environmental factors. Prevention efforts need to focus on practice, research, and public policy.

Background: Around 80% of intrauterine growth restricted (IUGR) infants are born at term. They have an increase in perinatal mortality and morbidity including behavioral problems, minor developmental delay and spastic cerebral palsy. Management is controversial, in particular the decision whether to induce labour or await spontaneous delivery with strict fetal and maternal surveillance. We propose a randomised trial to compare effectiveness, costs and maternal quality of life for induction of labour versus expectant management in women with a suspected IUGR fetus at term., Methods/design: The proposed trial is a multi-centre randomised study in pregnant women who are suspected on clinical grounds of having an IUGR child at a gestational age between 36+0 and 41+0 weeks. After informed consent women will be randomly allocated to either induction of labour or expectant management with maternal and fetal monitoring. Randomisation will be web-based. The primary outcome measure will be a composite neonatal morbidity and mortality. Secondary outcomes will be severe maternal morbidity, maternal quality of life and costs. Moreover, we aim to assess neurodevelopmental and neurobehavioral outcome at two years as assessed by a postal enquiry (Child Behavioral Check List-CBCL and Ages and Stages Questionnaire-ASQ). Analysis will be by intention to treat. Quality of life analysis and a preference study will also be performed in the same study population. Health technology assessment with an economic analysis is part of this so called Digitat trial (Disproportionate Intrauterine Growth Intervention Trial At Term). The study aims to include 325 patients per arm., Discussion: This trial will provide evidence for which strategy is superior in terms of neonatal and maternal morbidity and mortality, costs and maternal quality of life aspects. This will be the first randomised trial for IUGR at term., Trial Registration: Dutch Trial Register and ISRCTN-Register: ISRCTN10363217.

Background: Taiwan has a high rate of cesarean section, approximately 33 percent in the past decade. This study investigates and discusses 2 possible factors that may encourage the practice, one of which is fetal gender difference and the other is Taiwan's recently implemented National Health Insurance (NHI)., Methods: A logistic regression model was used with the 1989 and 1996 National Maternal and Infant Health Survey and with the 2001 to 2003 NHI Research Databases., Results: Using survey data, we found a statistically significant 0.3 percent gender difference in parental choice for cesarean section. However, no statistically significant difference was found in the rate of cesarean section before and after NHI implementation., Conclusions: Taiwan's high cesarean section rate is not directly related to financial incentives under NHI, indicating that adjusting policy to lower financial incentives from NHI would have only limited effect. Likewise, focusing effort on the small gender difference is unlikely to have much impact. Effective campaigns by health authorities might be conducted to educate the general population about risks associated with cesarean section and the benefits of vaginal birth to the child, mother, and society.

Objective: To determine whether remoteness category of residence of Indigenous women affects the perinatal outcomes of their newborn infants., Design and Participants: A population-based study of 35 240 mothers identified as Indigenous and their 35 658 babies included in the National Perinatal Data Collection in 2001-2004., Main Outcome Measures: Australian Standard Geographical Classification remoteness category, birthweight, Apgar score at 5 minutes, stillbirth, gestational age and a constructed measure of perinatal outcomes of babies called "healthy baby" (live birth, singleton, 37-41 completed weeks' gestation, 2500-4499 g birthweight, and an Apgar score at 5 minutes >or= 7)., Results: The proportion of healthy babies in remote, regional and city areas was 74.9%, 77.7% and 77.6%, respectively. After adjusting for age, parity, smoking and diabetes or hypertension, babies born to mothers in remote areas were less likely to satisfy the study criteria of being a healthy baby (adjusted odds ratio [AOR], 0.87; 95% CI, 0.81-0.93) compared with those born in cities. Babies born to mothers living in remote areas had higher odds of being of low birthweight (AOR, 1.09; 95% CI, 1.01-1.19) and being born with an Apgar score < 7 at 5 minutes (AOR, 1.63; 95% CI, 1.39-1.92)., Conclusions: Only three in four babies born to Indigenous mothers fell into the "healthy baby" category, and those born in more remote areas were particularly disadvantaged. These findings demonstrate the continuing need for urgent and concerted action to address the persistent perinatal inequity in the Indigenous population.

Background: Modern obstetrics is faced with a serious paradox. Obstetric practice is becoming increasingly interventionist based on empirical evidence but without a theoretical basis for such intervention. Whereas obstetric models of perinatal death show that mortality declines exponentially with increasing gestational duration, temporal increases in medically indicated labour induction and cesarean delivery have resulted in rising rates of preterm birth and declining rates of postterm birth. Other problems include a disconnection between patterns of gestational age-specific growth restriction (constant across gestation) and gestational age-specific perinatal mortality (exponential decline with increasing duration) and the paradox of intersecting perinatal mortality curves (low birth weight infants of smokers have lower neonatal mortality rates than the low birth weight infants of non-smokers)., Discussion: The fetuses at risk approach is a causal model that brings coherence to the various perinatal phenomena. Under this formulation, pregnancy complications (such as preeclampsia), labour induction/cesarean delivery, birth, revealed small-for-gestational age and death show coherent patterns of incidence. The fetuses at risk formulation also provides a theoretical justification for medically indicated early delivery, the cornerstone of modern obstetrics. It permits a conceptualization of the number needed to treat (e.g., as low as 2 for emergency cesarean delivery in preventing perinatal death given placental abruption and fetal bradycardia) and a calculation of the marginal number needed to treat (i.e., the number of additional medically indicated labour inductions/cesarean deliveries required to prevent one perinatal death). Data from the United States showed that between 1995-96 and 1999-2000 rates of labour induction/cesarean delivery increased by 45.1 per 1,000 and perinatal mortality decreased by 0.31 per 1,000 total births among singleton pregnancies at > or = 28 weeks of gestation. The marginal number needed to treat was 145 (45.1/0.31), showing that 145 excess labour inductions/cesarean deliveries in 1999-2000 (relative to 1995-96) were responsible for preventing 1 perinatal death among singleton pregnancies at > or = 28 weeks gestation., Summary: The fetuses at risk approach, with its focus on incidence measures, provides a coherent view of perinatal phenomena. It also provides a theoretical justification for medically indicated early delivery and reconciles the contemporary divide between obstetric theory and obstetric practice.

Vaccines against rotaviruses infections are the first vaccines used against gastro-enterity among young children. There are two actual used oral vaccines: Rotarix (GSK) and RotaTeq (MSD/Sanofi Pasteur). Both vaccines are live with atenuated strains of viruses. Vaccination should be performed between 6 and 24 weeks of life, most often between 6 and 6 weeks. Two doses of Rotarix, three doses of RotaTeq with 4 weeks distances of time between vactination are used as immunization. No booster doses are recommended. Vaccines used actually are succesful and safety, especially according intussusception after vaccination.

Each year an estimated 328,500 infants age 0-12 months are treated for unintentional injuries in emergency departments (EDs): one infant every minute and a half. The leading cause, overall and by month of age, was fall-related injury. The second leading cause was 'struck by or against.' The majority of patients were injured at home. Younger infants were more likely to be hospitalized than older ones and more males than females were injured. Gender differences suggest that parenting practices may play a role, but ecological approaches should be considered in an effort to understand the connection between injuries and an infant's developmental stage.

Objectives: Assessment of the literature on the length of maternity leaves and health of mothers and children; evaluation of the Swiss situation in view of the maternity leave policy implemented in 2005., Methods: Review of thirteen original studies identified by PubMed using topic-related terms., Results: A positive association was shown between the length of maternity leave and mother's mental health and duration of breastfeeding. Extended maternity leaves were also associated with lower perinatal, neonatal and post-neonatal mortality rates as well as lower child mortality; however, results are obtained in ecological studies. There is less evidence regarding other health outcomes. The new policy in Switzerland extends maternity leave for a considerable number of women to 14 weeks. With this prolongation, fewer depressive symptoms and longer breastfeeding duration can be expected, while benefits regarding other health outcomes would warrant longer leaves., Conclusions: Longer maternity leaves are likely to produce health benefits. The new policy in Switzerland will probably improve the situation of those women, who previously were granted only minimal leave and/or mothers with additional social risk factors.

Objectives: The aim of the study was to analyze the course of labor of grand multiparas (4 deliveries and more) in comparison to multiparas (2 or 3 deliveries)., Materials and Methods: A group of 400 grand multiparas were included in the study and compared with a group of 393 multiparas. All the deliveries took place in the City Hospital in Puck in the years 1998-2002. The age of parturients, duration of pregnancy, pregnancy accompanying pathologies, course and way of delivery, indications for cesarean section, complications of labor and newborns' condition were taken into account and analyzed statistically., Results: It occurred that grand multiparas were significantly more often countryside dwellers, experienced preterm deliveries, gained less weight during pregnancy and amniorrhexis took place in a more advanced 1st stage of labor. Perineal ruptures and episiotomies were significantly less frequent in the study group. Moreover, grand multiparas preferred traditional form of labor, more rarely deciding on water labor, despite its common access. There were no differences as to the duration of labor stages, accompanying pathologies, the use of oxytocin, postpartum curettage and newborns' condition., Conclusions: Grand multiparity seems not to be an independent risk factor of obstetrical complications and should not be considered dangerous in centers with well organized modern perinatal care.

Objective: The aim of the study was an evaluation of the frequency and distribution of congenital malformations in infants born at the Obstetrics and Gynecology Department of Wołomin District Hospital in the years 1991-95 and 2000-2004 and a comparison of occurrence frequency of defects' types in the analyzed periods., Methods: The study comprises an evaluation of documentations of 5649 infants born in the years 1991-1995 and 6049 infants born in the years 200-2004, 11698 infants in total. In the study groups of infants, the frequency of congenital malformation occurrence was analyzed., Results: The majority of congenital malformation diagnosis in the years 1991-1995 were CNS defects with 21% and the second most frequent group were facial skeleton defects with 16% The majority of congenital malformation diagnosis in the years 2000-2004 were osteoarticular system defects (25%) and the second most frequent group were organic heart diseases with 14%., Conclusions: The frequency and distribution of congenital defects was comparable with data provided by other authors. The most frequent defects were osteoarticular system defects, congenital hart dsefects and CNS. An increase in number of defects of the osteoarticular system was observed.

Vital statistics documents for the United States have been revised approximately decennially throughout the past century. In this commentary we review the contents of the 2003 revision of the national standard certificate of live birth, focusing on changes from the certificates in use nationally since 1989, and identifying strengths and weaknesses of key data elements. Additional federal-state partnership funding is imperative to support the transition to the new standard certificates, and to ensure a focus on data quality at the state and national levels.

Background: In the United States, more new mothers are part of the work force than ever before. This trend has implications for many child-rearing practices, including breastfeeding., Methods: Based on a national sample of new mothers (n = 228,000), this study considered the prevalence of the initiation and duration of breastfeeding to 6 months after delivery in 2003 among women who were employed full time, who worked part time, or who were not employed outside the home. Breastfeeding trends since 1984 were also considered., Results: In 2003, at the national level, the prevalence of the initiation of breastfeeding and breastfeeding to 6 months after delivery were 66.0% and 32.8%, respectively. In the hospital, mothers who worked part time had a significantly (p <0.05) higher rate of breastfeeding (68.8%) than those who were employed full time (65.5%), or who were not employed (64.8%). Working full time had a (p <0.05) negative effect on breastfeeding duration. By 6 months after delivery, 26.1% of mothers employed full time, 36.6% of mothers working part time, and 35.0% of nonworking mothers breastfed their infant. Mothers who were not employed were more than twice as likely to breastfeed at 6 months than mothers who worked full time. Breastfeeding trends since 1984 indicated a large increase in the rate of breastfeeding at 6 months after delivery among full-time working mothers (204.5%). However, rates for these women have not yet reached those of mothers who worked part time or were not employed., Conclusions: To ensure that the Healthy People 2010 goals for breastfeeding are achieved (75% in the hospital and 50% at 6 months), programs designed to support working mothers who choose to breastfeed must be continued and strengthened.

The potential diagnostic significance of prior family referral to Child Protective Services (CPS) in cases of sudden infant death is unknown. Therefore, the authors retrospectively searched for CPS data for the 5-year referral history on all 533 families whose infants died suddenly from Sudden Infant Death Syndrome (SIDS), other natural diseases, accidents, or inflicted injuries and underwent postmortem examination by the medical examiner during a 10-year period. No family had more than one infant death. At least 27% of the families in each group had at least one CPS referral. The data suggest that a family's referral to CPS prior to their sudden death of their infant does not increase the likelihood that it was caused by inflicted injuries, and prior referral should not preclude a diagnosis of SIDS. The authors recommend future prospective studies that include refined exposure histories and that are large enough to have sufficient statistical power to compare family CPS referrals and outcomes in groups of infants who died suddenly with a matched group of living infants.

Introduction: Newborns and infants up to three months of life are a specific group of population in paediatric oncology due to immaturity of tissues and organs and rarity of neoplastic diseases in this group of patients (pts). There are no strict therapeutic procedures established for these children. THE AIM of our study was to examine distribution of tumours in newborns and infants up to 3 months of age treated in our institution and to present our own experience in the treatment of these patients., Material and Methods: Medical records of 71 pts (37 boys and 34 girls) treated from 1996 to 2004 were reviewed. Distribution of tumour types in newborns and babies from 1 to 3 months of age was analyzed separately. Due to similar growth pattern, response to treatment and it's side effects in newborns and small infants, treatment results were evaluated for the whole group., Results: there were 50 newborns. The most common diagnosis in this group was germ cell tumours (GCT) which constituted 60% of all tumours, amongst them 52% were mature teratomas (MT). The second most common was neuroblastoma (NBL) 22%. There were also 3 cases of soft tissue sarcomas (STS), 2 central nervous system tumours (CNS), 2 retinoblastoma (RB), 2 hepatoblastoma (HB). In the group of 21 babies aged 1-3 months NBL was the commonest (37%) followed by RB, CNS tumours (14% of each) HB and MT (10% of each) and Wilms tumour (WT) and immature teratoma (IT) each 5%. Surgery alone was performed in 48 pts. It concerned pts with MT--28, IT--3 pts, yolk sac tumour (YST)--1 pt and malignant tumours (stage I and II): 8-NBL, 2-CNS tumours, 2 STS, 3-HB, 1-WT. Forty two pts from this group are alive. Six pts died: 2 from surgical complications, 1 from sepsis, 1 of congenital heart defect and 1 from unknown reason at the age of 18 months. It was a patient with severe infantile cerebral palsy. One pt died of disease--relapse of yolk sac tumour, 2 years 4 months after surgery of MT. Eleven pts underwent combined treatment of chemotherapy and surgery: 5 with stage III and IV NBL, 6 with other tumours. One pt with STS at the age of 1 yr 6 months was the tumour bed irradiated after surgery for microscopic tumour residual. Four pts are alive, 4 with NBL and 5 with other tumours. Two pts died from disease: one with NBL and one with IT. Chemotherapy alone was administered to 7 pts in whom local advancement of disease enabled surgery and to pts with RBL. Three out of 7 pts are alive all with RBL. Four pts died: 3 from disease, 1 from infectious complications. Four pts with NBL (2 stage IV and 2 stage IVS) were treated with irradiation to the liver only. Two pts (st. IV) died and 2 (st. IVS) pts are alive. One pt relapsed at age of 2 yrs 3 mths, probably at the primary site which was not visualized at primary diagnosis. One pt, critically ill, died before any treatment. Fifty six out of 70 pts (80%) are alive with a follow up from 1 year to 9 yrs 11 months (median- 4 yrs 4 months). Fourteen pts died (20%), 8 from disease and 6 of other reasons., Conclusions: 1. GCT and neuroblastoma are the most common tumours in newborns and infants up to 3 months of age. 2. Newborns and small infants with advanced neoplastic disease, similarly to older children can be cured with chemotherapy. 3. Individual approach is warranted in newborns and small infants and treatment should be carried out in specialized centres. 4. All patients who completed treatment of any tumour type should be followed up by a pediatric oncologist.

Unlabelled: Hepatitis type C (HCV) infection is one of the most serious health problems in the child population. Due to the clinical course of infection the diagnosis is often incidentally diagnosed in infants. Prevalence of HCV infection in the infant population is not well reported., The Aim: of the study was to estimate the prevalence of HCV infection in infants., Patients and Methods: retrospective analysis of medical records of 278 infants (138 girls and 140 boys) aged from 3 weeks to 12 months (medium age 7.6 months) hospitalized in our department between 2002 and 2005, was performed. Serum anti-HCV antibodies using the third generation ELISA test (ARCHITEKT Anti-HCV) were examined in all of the children. The majority of children (54%) have been hospitalized at least one time. 85 infants (30.6%) have been hospitalized once and 128 infants (46%) haven not been previously hospitalized., Results: among 278 children we found HCV antibodies only in one 6-months old infant, who was previously hospitalized twice. After 6 weeks a control study was done and no anti-HCV antibodies were detected., Conclusion: 1. In spite of a continuously increasing number of HCV infections in general population in Poland during the last few years, infection among infants is rather rare. 2. Epidemiological studies of prevalence of HCV infection in infants should be carried out.

The Aim of This Study: was to estimate what kind of milk is administrated to children between 7-23 months of age in Poland., Material and Methods: the study included 1390 children 13-36 months of age, from 4 different regions in Poland. Data were obtained on the basis of questionnaires filled in by mothers visiting the outpatient clinic., Results: 16.7% of studied population were fed with human milk (9.l% only with human milk, 7.6% received both human milk and formula); 0.03% were fed with cow milk. Regional differences were observed. In the second year of life, 11.44% children were still given human milk, 60.3% -formula and 28.6% - cow milk., Conclusions: in Poland, only small percentage of children, older than 6 months, are still breastfed. Considering WHO recommendations, that children should be given human milk till 2nd year of age, breastfeeding recommendations are still to be promoted in our country.

Objectives: The personal child health record (PCHR) is a record of a child's growth, development, and uptake of preventive health services, designed to enhance communication between parents and health professionals. We examined its use throughout the United Kingdom with respect to recording children's weight and measures of social disadvantage and infant health., Design: Cross sectional survey within a cohort study., Setting: UK., Participants: Mothers of 18,503 children born between 2000 and 2002, living in the UK at 9 months of age., Main Outcome Measures: Proportion of mothers able to produce their child's PCHR; proportion of PCHRs consulted containing record of child's last weight; effective use of the PCHR (defined as production, consultation, and child's last weight recorded)., Results: In all, 16,917 (93%) mothers produced their child's PCHR and 15,138 (85%) mothers showed effective use of their child's PCHR. Last weight was recorded in 97% of PCHRs consulted. Effective use was less in children previously admitted to hospital, and, in association with factors reflecting social disadvantage, including residence in disadvantaged communities, young maternal age, large family size (four or more children; incidence rate ratio 0.87; 95% confidence interval 0.83 to 0.91), and lone parent status (0.88; 0.86 to 0.91)., Conclusions: Use of the PCHR is lower by women living in disadvantaged circumstances, but overall the record is retained and used by a high proportion of all mothers throughout the UK in their child's first year of life. PCHR use is endorsed in the National Service Framework for Children and has potential benefits which extend beyond the direct care of individual children.

Background: The purpose of this paper is to describe maternal reports of various health problems experienced by their Pacific infants in the first six weeks of their lives and to examine the infant, maternal and socio-demographic factors associated with infant health problems., Material/methods: The data were gathered as part of the Pacific Islands Families: First Two Years of Life (PIF) Study in which mothers in the cohort (n=1376) were interviewed about the health problems experienced by their infants (n=1398) in the first six weeks of life., Results: Fifty-five percent of mothers reported that their infant had experienced minor health problems, and 15.6% reported moderate to severe infant health problems. Most mothers (98%) reported that they had a regular family doctor or health clinic to go to if their infant had a health problem. We found no meaningful associations between infant, maternal, or socio-demograhic variables and general infant health problems, possibly because of the wide range of infant illnesses reported. Since 43% of the infant health problems reported were related to breathing difficulties we carried out univariate and multivariate analyses on this specific health problem. Factors significantly associated (p<0.05) with infant breathing problems were maternal cigarette smoking during the last trimester, cold housing, and residing in New Zealand for over 10 years., Conclusions: The high rate of infant health problems, in particular infant breathing problems, among Pacific infants in this cohort and the significant links with modifiable factors warrant priority action by housing and health agencies to minimise the consequences of these risk factors.

The aim of the study was to evaluate the knowledge of mothers and grandmothers regarding breastfeeding and health-seeking behavior for neonatal sickness in a rural community. A cross-sectional survey, using a triangulation of qualitative (focus group discussion) and quantitative (structured questionnaire) methods was carried out. Although most of the grandmothers and mothers believed in early feeding within 2 h of delivery, they often administered prelacteal feeds such as ghutti and honey. Colostrum was considered beneficial. Most respondents believed that ghutti, water, or both should be given along with breastmilk. Diluted buffalo milk was the preferred choice if supplementation was required. It was thought that weaning should be introduced after 6 months of life. Mothers preferred to give dalia and khichri as the initial weaning food compared to roti and dal water by grandmothers. Both grandmothers and mothers felt that a baby who was playful and not crying excessively was usually healthy. Most of the respondents described the normal pattern of breathing, feeding, urination, and defecation adequately. Most of the grandmothers and mother's felt that by touching forehead and limbs of baby could reliably assess temperature. Refusal to feed was considered as a marker of a sickness by most grandmothers and mothers. However, they also believed that health-seeking for poor feeding could be delayed for 1 day. Respiratory distress was described by the presence of fast respiration, chest retractions, or noisy breathing. Most respondents did not know how to assess cyanosis or seizures. Jaundice was descried as yellowish discoloration of skin, eyes, and urine. Failure to pass urine for 4-6 h bothered most of the respondents. The first response to illness was home remedies. The choice of healthcare was unqualified village practitioners followed by government hospital. Knowledge regarding desirable breastfeeding practices was inadequate and quite a few inappropriate beliefs were widely prevalent. Although knowledge regarding sickness was present, health-seeking from qualified providers was considerably delayed with most respondents preferring village practitioners to government hospitals.

Background: Postpartum depression (PPD) is a disorder with broad public health implications and consequences that impact almost every aspect of child development., Methods: In this pilot study, study participants were 96 women who brought their babies to the University of Arizona Pediatrics Clinic for their 8-week well-baby visit. Participants completed a packet that consisted of questions about demographics, potential correlates of PPD, and the Edinburgh Postpartum Depression Scale (EPDS). English and Spanish versions were available., Results: Of a total of 172 women who brought their babies in for their 8-week well-baby visit, 96 women completed the packets, for an overall response rate of 56.9%. Observed EPDS scores ranged from 0 to 18, with a mean of 5.44 and a standard deviation (SD) of 4.83. Using the cutoff of EPDS > or = 12, 14.6% of participants were likely suffering from clinically significant depression. Higher EPDS scores and also categorical depression classification were statistically associated with reported smoking and a family history of mental health problems., Conclusions: We conclude that screening for mothers at well-baby visits is feasible and that the data collected are of sufficient quality to identify reliable predictors even with small sample sizes.

Shaken baby syndrome (SBS) is a violent act of abuse that can cause myriad neurologic, cognitive, and other functional deficits. In the most serious cases, death can result. Health care practitioners, child care providers, and parents must be educated on the signs of SBS. Cases should be thoroughly reviewed and prevention strategies developed to prevent future incidents.

In this article, we examine the National Breastfeeding Policy in Nigeria, the extent to which the law guarantees and protects the maternity rights of the working mother, and the interplay between the law and the National Breastfeeding Policy. Our aim is to make people aware of this interplay to lead to some positive efforts to sanitize the workplace and shield women from some of the practices against them in employment relations in Nigeria as well as encourage exclusive breastfeeding by employed mothers.We conclude that the provisions of the law in this regard are not in accord with the contemporary international standards for the protection of pregnancy and maternity. It does not guarantee and protect the freedom of the nursing mother to exclusively breastfeed the child for at least the 6 months as propagated by Baby Friendly Hospital Initiative (BFHI) and the National Breastfeeding Policy. Moreover, there is no enabling law to back up the National Policy Initiative as it affects employer and employee relations. We, therefore, suggest a legal framework for effective implementation of the National Breastfeeding Policy for women in dependent labour relations. It is hoped that such laws will not only limit some of the practices against women in employment but also will encourage and promote exclusive breastfeeding behaviour by employed mothers.

Syphilis is a persistent cause of perinatal mortality in Rio de Janeiro, Brazil, where this study was performed using data from the mortality data system and investigational reports for fetal and neonatal deaths, mandatory in municipal maternity hospitals. From 1996 to 1998, 13.1% of fetal deaths and 6.5% of neonatal deaths in municipal maternity hospitals were due to congenital syphilis. From 1999 to 2002, the proportions were 16.2% and 7.9%, respectively. For the city of Rio de Janeiro as a whole from 1999 and 2002, the proportions were 5.4% of fetal deaths and 2.2% of neonatal deaths. The perinatal mortality rate due to congenital syphilis remains stable in Rio de Janeiro, despite efforts initiated with congenital syphilis elimination campaigns in 1999 and 2000. We propose that the perinatal mortality rate due to congenital syphilis be used as an impact indicator for activities to control and eliminate congenital syphilis, based on the investigational reports for fetal and neonatal deaths. Such reports could be extended to the surveillance of other avoidable perinatal disease outcomes.

Objective: To evaluate the outcome after early, primary repair of Tetralogy of Fallot (TOF) in children under 6 months of age., Methods: 74 infants, who underwent repair of TOF between 1992 and 2003, aged from 1.5 to 6 months, were investigated. 32 (43%) patients were cyanotic, 14 (18%) had anoxemic spells. Most of them were qualified for surgical procedure by echocardiographic study only, 26 patients required cardiac catheterisation. Two had balloon angioplasty prior to primary repair. None of them underwent initial palliation. Mean follow-up was 4.9 years (1 -9.5 years)., Results: 71 children survived and they were in good condition. 3 patients died (mortality 3.6%). One child required reoperation. Transannular patch (TAP) was inserted in 66% of patients. Right ventricular outflow tract obstruction (RVOTO) more than 40 mmHg occurred in 2 infants. Moderate pulmonary insufficiency was present in 38 infants (25%). None of the patients had QRS complex longer than 140 msec., Conclusions: Early one-stage repair of TOF was achieved with low mortality rate and low risk for reoperation (1.5%). It eliminates initial palliation and drug therapy.