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Purpose This guideline aims to summarize the current state of knowledge about vaginal birth at term. The guideline focuses on definitions of the physiological stages of labor as well as differentiating between various pathological developments and conditions. It also assesses the need for intervention and the options to avoid interventions. The second part of this guideline presents recommendations and statements on care during the dilation and expulsion stages as well as during the placental/postnatal stage. Methods The German recommendations largely reproduce the recommendations of the National Institute for Health and Care Excellence (NICE) CG190 guideline “Intrapartum care for healthy women and babies”. Other international guidelines were also consulted in individual cases when compiling this guideline. In addition, a systematic search and analysis of the literature was carried out using PICO questions where necessary, and other systematic reviews and individual studies were taken into account. For easier comprehension, the assessment tools of the Scottish Intercollegiate Guidelines Network (SIGN) were used to evaluate the quality of additionally consulted studies. Otherwise, the GRADE system was used for the NICE guideline, and the evidence reports of the IQWiG were used to evaluate the quality of the evidence. Recommendations Recommendations and statements were formulated based on identified evidence and/or a structured consensus.

Purpose This guideline aims to summarize the current state of knowledge about vaginal birth at term. The guideline focuses on definitions of the physiological stages of labor as well as differentiating between various pathological developments and conditions. It also assesses the need for intervention and the options to avoid interventions. This first part presents recommendations and statements about patient information and counselling, general patient care, monitoring of patients, pain management and quality control measures for vaginal birth. Methods The German recommendations largely reproduce the recommendations of the National Institute for Health and Care Excellence (NICE) CG 190 guideline “Intrapartum care for healthy women and babies”. Other international guidelines were also consulted in specific cases when compiling this guideline. In addition, a systematic search and analysis of the literature was carried out using PICO questions, if this was considered necessary, and other systematic reviews and individual studies were taken into account. For easier comprehension, the assessment tools of the Scottish Intercollegiate Guidelines Network (SIGN) were used to evaluate the quality of the additionally consulted studies. Otherwise, the GRADE system was used for the NICE guideline and the evidence reports of the IQWiG were used to evaluate the quality of the evidence. Recommendations Recommendations and statements were formulated based on identified evidence and/or a structured consensus.

In der Vergangenheit gab es in Deutschland unterschiedliche Empfehlungen zur Kariespravention durch Fluoridanwendung im Sauglings- und fruhen Kindesalter (0 bis 6 Jahre). Parallel existierende, unterschiedliche Empfehlungen fuhren jedoch zur Verunsicherung von Beratungskraften und Eltern/Betreuungspersonen, zu geringer Akzeptanz und zu unzureichender Umsetzung der Empfehlungen. Vertreterinnen und Vertreter der relevanten Fachgesellschaften und -gruppen bewerteten in einem vom Netzwerk Gesund ins Leben koordinierten Prozess die wissenschaftliche Evidenz, unter Berucksichtigung von Umsetzbarkeit und Erreichbarkeit auch von Familien mit erhohtem Kariesrisiko. In einem mehrstufigen Prozess wurden gemeinsame Empfehlungen formuliert. Von der Geburt bis zum Zahndurchbruch sollen Sauglinge ein Supplement mit 400–500 I.E. Vitamin D und 0,25 mg Fluorid erhalten. Nach dem Zahndurchbruch wird das Kind behutsam und allmahlich an das Zahneputzen herangefuhrt. Dabei soll entweder die Weiterfuhrung der systemischen Fluoridanwendung (0,25 mg Fluorid und 400–500 I.E. Vitamin D) oder die Fluoridanwendung durch Zahnpasta mit 1000 ppm Fluorid (bis zu 2‑mal taglich, jeweils bis zu 0,125 g, Reiskorngrose) gewahlt werden; das Vitamin-D-Supplement wird bis zum zweiten erlebten Fruhsommer weitergefuhrt. Ab 12 Monaten wird das 2‑mal tagliche Zahneputzen mit einer fluoridhaltigen Zahnpasta (1000 ppm Fluorid) fur alle Kinder empfohlen, zunachst mit einer geringen Zahnpastamenge (jeweils bis zu 0,125 g, Reiskorngrose), ab 24 Monaten mit einer groseren Menge (jeweils bis zu 0,25 g, Erbsengrose). Um eine zu hohe Fluoridaufnahme zu vermeiden, ist eine korrekte Dosierung der Zahnpasta unerlasslich. Die Aufklarung und Beratung zur Kariespravention und zur korrekten Umsetzung der Empfehlungen sollen im Rahmen der padiatrischen und zahnarztlichen Fruherkennungsuntersuchungen sowie im Rahmen der zahnmedizinischen Gruppenprophylaxe nach § 21 SGB V erfolgen.

Position paper of the Federal Association of German Hospital Pharmacists, the nutrition committees of the German and Austrian Societies of Pediatrics and Adolescent Medicine and the working group on intestinal failure of the Society of Pediatric Gastroenterology and Nutrition. In 2019 the German Federal Institute for Drugs and Medical Devices (Bundesinstitut fur Arzneimittel und Medizinprodukte, BfArM) launched a “doctors letter” (Rote-Hand-Brief) recommending light protection of all parenteral nutrition (PN) solutions during administration for preterm infants, term infants and children less than 2 years of age. The aim of the present paper is to review the available evidence and provide evidence-based recommendations for hospital and home PN light protection in children. The Federal Association of German Hospital Pharmacists, the nutrition committees of the German and Austrian Societies of Pediatrics and Adolescent Medicine and the working group on intestinal failure of the Society of Pediatric Gastroenterology and Nutrition recommend in accordance with the recommendations of the ESPGHAN, ESPEN, ESPR and CESPEN guidelines on pediatric parenteral nutrition: 1. Lipid emulsions and/or vitamins containing PN solutions should be protected from light during administration (bags and tubing) to prevent the generation of oxidants. 2. There is no conclusive evidence for recommending light protection for PN solutions without lipid emulsions and without vitamins during administration (solutions containing, e.g. amino acids, glucose, electrolytes, or trace elements). In addition, in home PN non-light-protected spiral tubing may be used because validated light-protected spiral tubing is currently not available, given that spiral tubing improves the range of motion and safety in infants and young children.

Eine adaquate Energie- und Nahrstoffversorgung ist Grundlage fur ein gesundes Wachstum und Voraussetzung fur die Erhaltung von Gesundheit und Leistungsfahigkeit. Im Krankheitsfall erschwert eine Fehlernahrung den Heilungsprozess und begunstigt die Entwicklung von Komplikationen. Auffallend ist die hohe Pravalenz einer Malnutrition, besonders bei Kindern unter 2 Jahren und solchen mit chronischen Erkrankungen wie beispielsweise M. Crohn, Zoliakie, Diabetes mellitus, Asthma, Allergien und Epilepsie. Eine qualifizierte Ernahrungstherapie kann den Therapieerfolg verbessern und damit krankheitsbedingte Komplikationen reduzieren. Dabei ist eine praventive und therapeutische Ernahrungsberatung im Kindesalter im Vergleich zum Erwachsenenalter wesentlich personal- und zeitintensiver, da diese individualisiert unter Mitbehandlung der Familie und anderer Betreuungspersonen uber Alters- und Entwicklungsabschnitte hinweg in Kontext und Verlauf der Grunderkrankung erfolgen muss. Die Behandlung der Malnutrition im Kindes- und Jugendalter erfordert nicht nur Beratungstatigkeit im Rahmen einer multiprofessionellen ganzheitlichen Behandlung mit nachhaltiger Anbindung, sondern auch die Erarbeitung und Umsetzung von fachgerechten Schulungskonzepten. In dieser Stellungnahme werden Standards der padiatrischen Ernahrungstherapie fur den ambulanten und den stationaren Bereich beschrieben, die zur Erreichung der individuellen Therapieziele mit den dazu erforderlichen Ressourcen dringend notig erscheinen. Hierzu gehort die interdisziplinare Zusammenarbeit im Team aus Padiater, Ernahrungsfachkraft, Kinderpflegekraften sowie ggf. Psychologen und Sozialarbeitern. Um jedoch eine entsprechende zeit- und personalintensive Behandlung von Kindern und Jugendlichen mit Malnutrition zu gewahrleisten, ist eine Ubernahme durch die Kostentrager sicherstellen. Dies erfordert daher die Erweiterung der Heilmittel-Richtlinie fur alle padiatrischen Patienten mit ernahrungsabhangigen Erkrankungen sowie die Erganzung des Fallpauschalensystems, um eine kostendeckende Erstattung der padiatrischen Ernahrungsberatung und -schulung nicht nur in Praxen, sondern auch in Kliniken zu ermoglichen.

Die neue Richtlinie der Europaischen Kommission zu Sauglings- und Folgenahrungen sieht vor, dass alle in der Europaischen Union vertriebenen Sauglingsanfangs- und Folgenahrungen ab Februar 2020 einen hohen Gehalt von 20–50 mg der Omega-3-Fettsaure Docosahexaensaure (DHA)/100 kcal (≈0,5–1 % der Fettsauren), aber keine Arachidonsaure (ARA, Omega-6-Fettsaure) enthalten mussen. Dieses neuartige Konzept der Zusammensetzung von Sauglingsnahrungen hat Besorgnis und Kontroversen ausgelost, da keine Belege fur die Eignung und Sicherheit vorliegen. In Ubereinstimmung mit der Europaischen Akademie fur Padiatrie empfiehlt die Ernahrungskommission, Sauglingsanfangs- und Folgenahrung zu verwenden, die sowohl DHA als auch mindestens die gleiche Menge ARA enthalten, solange zu Eignung und Sicherheit einer anders gearteten Zusammensetzung keine uberzeugende Datenlage aus klinischen Studien mit adaquatem Studiendesign und adaquater Fallzahl vorliegt.

Purpose This is an official S3-guideline of the German Society of Gynaecology and Obstetrics (DGGG), the Austrian Society of Gynaecology and Obstetrics (ÖGGG) and the Swiss Society of Gynaecology and Obstetrics (SGGG). The guideline contains evidence-based information and recommendations on indications, complications, methods and care associated with delivery by caesarean section for all medical specialties involved as well as for pregnant women. Methods This guideline has adapted information and recommendations issued in the NICE Caesarean Birth guideline. This guideline also considers additional issues prioritised by the Cochrane Institute and the Institute for Research in Operative Medicine (IFOM). The evaluation of evidence was based on the system developed by the Scottish Intercollegiate Guidelines Network (SIGN). A multi-part nominal group process moderated by the AWMF was used to compile this S3-level guideline. Recommendations Recommendations on consultations, indications and the process of performing a caesarean section as well as the care provided to the mother and neonate were drawn up.

Background Value assessment of vaccination programs against serogroup B invasive meningococcal disease (IMD) is on the agenda of public health authorities. Current evidence on the burden due to IMD is unfit for pinning down the nature and magnitude of the full social and economic costs of IMD for two reasons. First, the concepts and components that need to be studied are not agreed, and second, measures of the concepts that have been studied are weak and inconsistent. Thus, the economic evaluation of the available serogroup B meningococcal (MenB) vaccines is difficult. The aims of this DELPHI study are to: (1) agree on the concepts and components determining the burden of MenB diseases that need to be studied; and (2) seek consensus on appropriate methods and study designs to measure quality of life (QoL) associated with MenB induced long-term sequelae in future studies. Methods We designed a DELPHI questionnaire based on the findings of a recent systematic review on the QoL associated with IMD-induced long-term sequelae, and iteratively interviewed a panel of international experts, including physicians, health economists, and patient representatives. Experts were provided with a controlled feedback based on the results of the previous round. Results Experts reached consensus on all questions after two DELPHI rounds. Major gaps in the literature relate (i) to the classification of sequelae, which allows differentiation of severity levels, (ii) to the choice of QoL measures, and (iii) to appropriate data sources to examine long-term changes and deficits in patients’ QoL. Conclusions Better conceptualisation of the structure of IMD-specific sequelae and of how their diverse forms of severity might impact the QoL of survivors of IMD as well as their family network and care-providers is needed to generate relevant, reliable and generalisable data on QoL in the future. The results of this DELPHI panel provide useful guidance on how to choose the study design, target population and appropriate QoL measures for future research and hence, help promote the appropriateness and consistency in study methodology and sample characteristics. Electronic supplementary material The online version of this article (10.1186/s12955-019-1159-0) contains supplementary material, which is available to authorized users.

Zunehmend werden purierte Beikostprodukte fur Sauglinge und Kleinkinder mit Verpackung in quetschbaren Kunststoffbeuteln, ublicherweise mit einer Tulle und einem Schraubverschluss, angeboten. Sauglinge und Kleinkinder sollten purierte oder flussige Lebensmittel nicht aus einem Plastikbeutel saugen. Beikost soll mit dem Loffel oder durch die Hand des Kindes zugefuhrt werden. Ihnen sollte die Moglichkeit gegeben werden, eine Vielzahl von Lebensmitteln mit groberer und stuckiger Textur durch das Essen mit dem Loffel bzw. bei stuckigen Lebensmitteln auch mit der Hand kennenzulernen, unterstutzt durch eine responsive Interaktion zwischen Kind und Eltern bzw. weiteren Betreuungspersonen. Die angebotenen Beikostprodukte in Quetschbeuteln haben oft eine hohe Energiedichte und uberwiegend extrem hohe Zuckergehalte bis zu nahezu 90 % des gesamten Energiegehalts, tragen aber kaum zur Zufuhr kritischer Nahrstoffe bei. Bei regelmasigem Verzehr muss mit einer unausgewogenen Nahrstoffzufuhr und einem erhohten Risiko fur Karies und Ubergewicht gerechnet werden. Beikost fur Sauglinge und Kleinkinder sollte ausgewogen, den Empfehlungen der Deutschen Gesellschaft fur Kinder- und Jugendmedizin (DGKJ) entsprechend zusammengesetzt sein und nur eine begrenzte Menge an Zucker enthalten. Vom Verzehr purierter Beikostprodukte aus Quetschbeuteln wird abgeraten.

Background Despite the introduction of vaccination against rotavirus, and even though it can often be treated on an outpatient basis, acute infectious gastroenteritis is nevertheless the second most common non-traumatic cause of emergency hospitaliza - tion in children aged 1 to 5 years, accounting for approximately 9% of cases (39 410 cases in 2017). The most common path - ogens are viruses (47% rotavirus, 29% norovirus, and 14% adenovirus). Methods This review is based on publications retrieved by a selective search in PubMed employing the terms "acute gastro - enteritis children" AND "dehydration" OR "rehydration" OR "prevention," and by manual searching (based, for example, on reference lists and expert knowledge), with subsequent evaluation including consideration of the relevant guidelines. Results The degree of dehydration can be judged from weight loss and other clinical findings. In 17 randomized controlled trials conducted on a total of 1811 children with mild or moderate dehydration, oral rehydration with oral rehydration solution was just as effective as intravenous rehydration with respect to weight gain, duration of diarrhea, and fluid administration, and was associated with shorter hospital stays (weighted mean difference, -1.2 days; 95% confidence interval [-2.38; -0.02]). Oral rehydration therapy failed in 4% of patients [1; 7]. In children who are vomiting or who refuse oral rehydration solution, continuous nasogastric application is just as effective as intravenous rehydration and is the treatment of first choice. Conclusion In Germany, children with mild or moderate dehydration are often hospitalized for intravenous rehydration therapy, despite the good evidence supporting ambulatory oral rehydration. Obstacles to intersectoral care, the nursing shortage, and inadequate reimbursement must all be overcome in order to reduce unnecessary hospitalizations and thereby lessen the risk of nosocomial infection.

The influence of an early (within 24 h) vs. a late (from day 8) start of parenteral nutrition (PN) was investigated in 1440 pediatric intensive care patients in a prospective, randomized, controlled, multicenter investigation (PEPaNIC trial). The indications for PN were estimated on the basis of a nutrition screening score. The authors of the PEPaNIC investigation concluded on the basis of the study results that PN should generally be withheld for 1 week in pediatric intensive care patients. This publication presents the comments of the nutritional committee (NC) of the German Society for Pediatric and Adolescent Medicine (DGKJ) on the PEPaNIC investigation and the interpretation of the results by the authors. According to the view of the NC the data harvested from the PEPaNIC investigation do not show that it is beneficial for all pediatric intensive care patents to avoid PN for the first 8 days of intensive care treatment. Pediatric intensive care patients should initially receive oral or enteral nutrition adapted to their nutritional state. The amount should be increased depending on the individual nutritional tolerance and needs.

Pureed complementary feeding products packed in squeezable plastic pouches, usually with a spout and a screw cap, have been increasingly marketed. The Committee on Nutrition recommends that infants and young children should not suck pureed or liquid complementary foods from baby food pouches. Complementary foods should be offered with a spoon or should be fed as finger foods. Infants and young children should be given the opportunity to get to know a variety of foods and food textures including pieces of foods, supported by responsive feeding between the child and their parents or caregivers. Complementary foods marketed in baby food pouches often have a high energy density and are predominantly extremely high in sugar content, with up to almost 90% of the total energy content. Regular consumption bears the risks of imbalanced nutrient provision and increased risks for dental caries and overweight. Complementary foods for infants and young children should have a balanced composition following the recommendations of the German Society of Pediatrics and Adolescent Medicine (DGKJ) and should contain only limited amounts of sugar. We discourage the feeding of pureed complementary foods from baby food pouches. Electronic supplementary material The online version of this article (10.1186/s40348-019-0089-6) contains supplementary material, which is available to authorized users.

Clinical course, diagnostic and therapeutic management, and neurodevelopmental outcome were evaluated in 11 patients with glutaryl-coenzyme A dehydrogenase deficiency. In 9 patients macrocephalus was present at or shortly after birth and preceded the neurological disease. In 7 children an acute illness resembling encephalitis appeared after a period of normal development; 2 had developmental delay and progressive "dystonic cerebral palsy." Later, all 9 displayed typical signs of a disorder of the basal ganglia. In 1 patient with macrocephalus the disorder was diagnosed before the onset of neurological disease; in another it was diagnosed prenatally. Computed tomography and magnetic resonance imaging scans revealed severe generalized cerebral atrophy, most striking in the frontal and temporal lobes in 10 patients. Further deterioration was halted after initiation of treatment consisting of low-protein diets, special formulas low in lysine and tryptophan, and supplements of riboflavin and L-carnitine. Only 1 patient showed a slight clinical improvement. Later, dietary therapy was discontinued in 2 older patients and relaxed in a third without observed adverse effects. Two patients in whom treatment could be initiated before the onset of neurological symptoms have developed normally. However, duration of follow-up (6 and 29 months) does not yet allow classification of glutaryl-coenzyme A dehydrogenase deficiency as a treatable disorder. Total body production of glutaric acid, reflected in the daily urinary output, was efficiently reduced by therapeutic measures. Levels of glutaric acid in plasma and cerebrospinal fluid remained unchanged, which may in part explain the overall unsatisfactory outcome. All patients presented with a severe secondary deficiency of carnitine. L-Carnitine appears to play an important pathobiochemical role in the pathogenesis of the disorder. It is concluded that glutaryl-coenzyme A dehydrogenase deficiency is an acute to subacute neuropathic disorder of infancy or early childhood. Later in the course of the disease further deterioration appears to subside. The lack of significant metabolic derangements may cause this disorder to remain frequently undiagnosed. Glutaryl-coenzyme A dehydrogenase deficiency should have high priority in the differential diagnosis of any child with acute profound dyskinesia, subacute motor delay accompanied by increasingly severe choreoathetosis, and dystonia. It should especially be considered when there is macrocephalus in an infant together with progressive atrophic changes on computed tomography or nuclear magnetic resonance imaging, as neurological handicap can potentially still be prevented.