[Perinatal herpes infection. Clinical aspects--therapy--follow-up]. / Die perinatale Herpesinfektion. Klinik--Therapie--Verlauf.

Herpes simplex virus may cause serious infections in neonates. In case of foetal infection in the first trimenon, abortions, stillbirth, prematurity, intrauterine growth retardation (not obligatory) and various malformations may result. Neonatal HSV infection is mostly the consequence of intrapartum virus acquisition during passage through the birth canal. The infection is mostly localised on the skin, at the eyes or the mouth or disseminated with or without HSV meningoencephalitis. It is difficult to establish the diagnosis, because neonatal herpes disease in the early stage is not easy to distinguish from other diseases in the newborn such as RDS, NEC or ICH. Antiviral therapy with aciclovir is the treatment of choice and seems to improve the outcome of neonatal herpes. Prognosis depends on early therapy. Treatment should be initiated in relation to clinical findings, because available diagnostic techniques do not always permit an early detection of the disease.

[Intrauterine stab injury with a knife in the head of a fetus in the 29th week of pregnancy]. / Intrauterine Messerstichverletzung des Kopfes bei einem Feten in der 29. Schwangerschaftswoche.

Penetrating head trauma in children causes uncommon and potentially life-threatening injuries. We report on a case of penetrating cranial stab wound to the right parietal region of the head to a 29-week fetus. The child was delivered by emergency Caesarian section. Neurosurgical intervention after birth was necessary. The injury caused a posthaemorrhagic hydrocephalus. Real-time ultrasound examination visualises the brain damage and the development of a hydrocephalus e vacuo.

[Intracerebral hemorrhage and neuron-specific enolase in premature and full-term infants--a clinical study]. / Intrazerebrale Blutungen und neuronenspezifische Enolase bei Früh- und Termingeborenen--Eine klinische Studie.

In a prospective study 199 risk newborn infants were examined by means of cerebral ultrasound scanning and after this the influence of diagnosed intracerebral events on the concentration of neuron-specific enolase (NSE) was determined. The NSE may be valid as an indicator of intracerebral damage. A significant relationship between increased concentration of NSE and intracerebral haemorrhage of type II could be found only for the NSE-1 (determination from cordblood or from blood of the first or second day of life). The same relationship results for intracranial cystic rebuildings, destructions and enlargements of ventricles. The diagnostic tests of NSE-1 for intracerebral haemorrhages don't prove with a validity of 57.4% high prognostic value. Not until a NSE-1-level of 16.0 micrograms/l a predictive value of the positive test of 100% was calculated.

[The status of biological risk factors and the optimality concept in diagnosis of early childhood developmental disorders]. / Die Stellung biologischer Risikofaktoren und des Optimalitätskonzeptes in der Diagnostik frühkindlicher Entwicklungsstörungen.

In a prospective study the psychomotor development up to the end of the second year of life of 409 preterm and term newborn infants was examined in order to identify which optimality score might be associated with disturbances of normal childlike development. Significant connections between 24 and 55 risk factors and the mortality could be demonstrated, but only 3 factors (sex, apgar, acidosis) exert influence on psychomotor development. The risk loading of the collective was high, not one of the children showed an optimal score. Decreased patients possessed a stronger reduced optimality than survivors. The optimality concept is not suitable for the prediction of later disturbed development of children, because the items are unspecific. The marker of hypoxia, the erythrocytic-density-test, as well as the neuron-specific enolase showed better diagnostic values than the optimality concept.

[Intracerebral hemorrhage and its sequelae in high risk newborn infants in relation to oxygen deficiency status]. / Intrazerebrale Blutungen und ihre Folgezustände bei Risikoneugeborenen in Abhängigkeit von Sauerstoffmangelzuständen.

In a prospective study 325 risk newborn infants were examined by means of ultrasound scanning. Children with and without intracerebral haemorrhages were classified, according to pre-, intra-, and postnatal periods of oxygen privation. For the characterization of short-term hypoxia the blood-gas analysis was used for the ascertainment of longtime hypoxia the erythrocytic-density-test (EDT). In dependence on PO2-values less than or equal to 5 kPa intracerebral haemorrhages of variable states increased significantly (p = 0.01). Evaluating the results of erythrocytic-density-test it may be concluded that the prenatal hypoxia has the greatest influence on the rate of intracerebral bleedings. Thus only 37.5% of our patients with prenatal hypoxia remained free of haemorrhages, in contrast of 70.2% of children without deficiency of oxygen.

[Psychomotor development of newborn infants at risk with reference to the neuron-specific enolase]. / Psychomotorische Entwicklung von Risikoneugeborenen unter Berücksichtigung der Konzentration der neuronenspezifischen Enolase.

In a prospective study the psychomotor development of an unselected collective of risk newborn infants up to the end of the second year of life was examined. 199 children have developed normal, 21 showed developmental abnormalities, 84 light to moderate disturbances, and 30 severe disabilities. Already in the newborn period the concentration of neuron-specific enolase in the serum was evaluated. The NSE could be an indicator of brain damage. The determined values of NSE showed a log-normal-distribution at the three times (cord-blood, first or second day of life, third or fourth day of life, and ninth to eleventh day of life). Significant relationship between the psychomotor development during the first two years of life and of NSE-concentration was not found. Nevertheless the diagnostic value of the NSE is better with a specificity of 47.7% and a sensitivity of 80.0% than those of the results of intracranial ultrasound examination or of the erythrocytic-density-test. In contrast to these results the use of the neuron-specific enolase alone for the prediction of individual prognosis of children is not be recommended.