[Folic acid supplementation--voluntary enrichment of different foodstuffs or mandatory fortification of a single staple food?]. / Folsäure--Freiwilliger Zusatz bei diversen Lebensmitteln oder obligate Anreicherung eines Grundnahrungsmittels?

Regular, customary nutrition is not sufficient to cover the recommended daily intake of 400 microg of folic acid as it has been defined by several scientific committees. The provision of various foodstuffs enriched with folic acid would therefore seem to be justified. Whether such products would have a prophylactic effect against different homocysteine-associated diseases of the second part of life is not (yet) proven but certainly a well founded hypothesis. It has been shown that for the prevention of neural tube defects and other embryonic malformations, as well as malignancies of early childhood a pharmaceutical supply of 0,4-0,8 mg before and during the first 12 weeks of pregnancy is required. Mandatory general fortification of all grain products would be an attractive alternative to meet this goal. This measure has been successful in many countries, mainly on the North American continent. The controversy surrounding possible mandatory folic acid fortification of flour in our country is discussed.

[Are the swiss dying out? Demographic facts and perspectives concerning the current situation of child-bearing in Europe]. / Stirbt die Schweiz aus? Demografische Fakten und Perspektiven zur heutigen Reproduktionssituation in Europa.

In the last decades, the birthrates in most European countries have fallen considerably below the target value needed for the maintenance of a constant population. In Switzerland, the total fertility is 1.37 children per woman between 15 and 48 years of age (target 2.1), and in Swiss women along-excluding foreigners-it has reached the historical low of 1.21 children. The birth excess of the native population has been negative since 1998, which means that the number of inhabitants in Switzerland is only kept constant by immigrants. If the low birthrate continues for another 200 years, the native population-without immigration-will melt down to 2% of today's size, in other words: it will become extinct. The reasons for this deplorable evolution and possible countermeasures will briefly be discussed.

Provision of supplementary fluids to breast fed infants and later breast feeding success.

It has been shown that altering hospital policies in a way to avoid interference of routine prescriptions with initiation of breast feeding and to provide active encouragement to mothers and personnel can result in significant benefit for later breast feeding success. It is less clear, however, which of the elements of a promotional programme such as UNICEF/WHO's "ten steps to successful breast feeding" are absolutely essential and which can be adapted to local cultural habits. We performed an open randomized multicenter study in Switzerland to evaluate, whether restriction of supplementary fluids for breast fed infants in the first week of life and strict avoidance of artificial teats and pacifiers affects later breast feeding success. Follow up to 6 months was ensured by mailed questionnaires. 602 mother infant pairs were enrolled. Of 294 infants in the intervention group 39% were excluded from the final analysis because of protocol violations, mainly maternal request for the use of pacifiers or bottles. Though the number of dextrin maltose supplements during the first two days (1.7 vs. 2.2 on day 1, 2.2 vs. 2.6 on day 2) and the percentage of infants receiving any supplement (85% vs. 96.6%) was significantly smaller in the intervention group, the difference was disappointingly small. The prevalence of breast feeding was 100% vs. 99% at day 5, 88% vs. 88% at 2 months, 75% vs. 71% at 4 months and 57% vs. 55% at 6 months, none of the differences being significant. We conclude that rigorous adherence to all of the ten steps may encounter obstinate resistance from cultural habits even in a population highly favourable to breast feeding. An improvement in adherence does not necessarily lead to better breast feeding success. The results of the few comparable studies in the literature show also that cultural practices during the first months of life may influence profoundly the long term effects of interventions during the first days of life.

[Perinatally acquired thombocytopenias in the newborn infant]. / Perinatal erworbene Thrombozytopenien beim Neugeborenen

The neonatal thrombocytopenias (TP) can be classified into congenital (i.e. inherited), connatal (i.e. acquired in utero), perinatal and postnatal forms. In the following survey, only the perinatal TP are considered in detail. These arise from transit of immune antibodies or coagulation-activating material across the placenta or from hypoxia due to placental insufficiency. The auto- and isoimmune TP are illustrated by relevant clinical observations. The existence of a platelet deficiency is not a rarity in newborns or in high-risk infants. If is often an important leading symptom for a side range of different conditions.

[Neonatal vitamin K prophylaxis and vitamin k deficiency hemorrhages in Switzerland 1986-1988]. / Neonatale Vitamin-K-Prophylaxe und Vitamin-K-Mangelblutungen in der Schweiz 1986-1988.

On the basis of an inquiry held in Switzerland in May 1988, over 99% of all newborn receive vitamin K prophylaxis, 59% orally and 41% intramuscularly. In the previous 2 1/2 years, ten cases of bleeding due to vitamin K deficiency had been observed, of which two were inadequately documented. In two children there was early haemorrhage and late haemorrhage in eight. The latter were all exclusively breast-fed and had received oral vitamin K prophylaxis. Seven presented with vitamin K deficiency due to cholestasis or chronic diarrhea. The only "idiopathic" case is insufficiently documented. The advantages and disadvantages of oral and intramuscular prophylaxis are discussed. A definite stand in favour of the one route or the other is not possible at present. However, the continuation of general prophylaxis is undoubtedly necessary.

[Familial Mediterranean fever. Study of a Swiss child]. / Familiäres Mittelmeerfieber. Beobachtung bei einem Schweizerkind.

Familial Mediterranean fever (FMF) has been observed in a Swiss child without ethnic predisposition. The case is analyzed and the current literature briefly reviewed. Recurrent attacks of fever, accompanied by abdominal pain, colic and arthritic symptoms, and often by pleuritic pain and a transitory skin rash, are the hallmarks of FMF, which is predominantly seen in ethnic groups of the Mediterranean area, notably Sephardic Jews, Turks and Armenians. However, it rarely occurs among individuals without an ethnic predisposition. Its most ominous manifestation is amyloidosis, which leads to chronic renal failure within a matter of years. Thanks to colchicine treatment, which is now widely accepted, patients often lead normal lives, and it appears that amyloidosis can be prevented.

[Neonatal thrombocyte values in children with Down's syndrome and other autosome trisomies]. / Neonatale Thrombozytenwerte bein Kindern mit Down-Syndrom und anderen autosomalen Trisomien.

Platelet counts were determined in 70 neonates with trisomy-21, 10 neonates with trisomy-18 and 6 neonates with trisomy-13 during the first days of life. 60% of all infants with trisomy-aberrations were found to have thrombocytopenia. Platelet counts in Down's syndrome averaged 104600 (SD 53000; median 90500; 10- and 90-percentile at 45000 and 175000) per microliter. A correlation with other hematological features of trisomy-21 was examined. There was no significant correlation between platelet counts and hemoglobin concentration. Similarly the difference in platelet counts between trisomy-neonates with and without polycythemia was statistically not significant. In contrast, 27 normal neonates with polycythemia showed significantly higher platelet counts (mean = 13400) than their trisomy-counterparts (mean = 98900; P = 0.01). In addition, there was no correlation, in trisomy infants, between either erythroblastosis or low birth weight and platelet count. These findings point to defective hematopoiesis as a primary cause of thrombocytopenia in trisomy-infants.

[Convulsions after whooping-cough vaccination]. / Zerebrale Krampfanfälle nach Pertussis-Impfung.

Convulsions or status epilepticus in 11 infants after pertussis vaccination are reported. In 3 cases grand mal epilepsy persisted and 2 children developed infantile epileptic encephalopathy (Lennox syndrome). On the basis of our own experience, the incidence of seizures approximates 1:4800 infants vaccinated or 1:12 800 vaccinations. According to a recent prospective study from the USA, the incidence of seizures may be closer to 1:600 infants. Since there is a significant difference between the incidence of spontaneous fits in children of the same age group and the incidence after vaccination, a causal relationship between the seizures and vaccination appears to be confirmed. The following conclusions are drawn from these observations: 1. In view of the usually benign course of whooping cough today, current vaccination against pertussis is hardly satisfactory. Improvement of the available vaccines is an urgent necessity. The protection should include the population most at risk, i.e. infants during the first few months of life. 2. Parents should be better informed about the risks involved in pertussis vaccination. 3. Booster inoculations should be abandoned. 4. Health authorities should decide whether the current pertussis vaccination program should be continued. 5. Complications following vaccination should be registered at a national centre.

Partial trisomy 7q and probable partial monosomy of 5p in the son of a mother with a reciprocal translocation between 5p and 7q.

An underweight male newborn revealed a complex pattern of abnormal findings including severe neurologic dysfunction, a catlike cry, defective ossification of the calvarian bones, hypertelorism, downward slanting palpebral fissures, epicanthal folds, a short and flat nose with a flattened bridge, broad thumbs, clenched fingers 3--5 on the right hand, simian creases, a congenital heart defect, internal hydrocephalus, and bilateral hydronephrosis. He died on day 26 of his life. Chromosome examination disclosed a maternally inherited reciprocal translocation between 5p and 7q, resulting most probably in monosomy of 5p15 and trisomy of 7q32 leads to qter (46,XY,der(5), t(5;7)(p15;q32)mat).

[Infant nutrition in Switzerland 1978. A prospective study on feeding habits during the first 6 months. II. Artificial feeding]. / Die Säuglingsernährung in der Schweiz 1978 Eine prospektive Studie über die Ernährungsgewohnheiten in den ersten 6 Lebensmonaten II. Teil: Die künstliche Ernährung.

The term "artificial feeding" includes a) the various infant formulas (including homemade formulas) substituting or supplementing mother's milk; b) the so-called "Beikost", i.e. minor additions to mothers milk or formula, such as fruit juices, fruit, meat and eggs; c) solid foods replacing part of the liquid food after a few weeks or months (weaning food). The use of these preparations in no- or partially-breastfed infants was studied and correlated with various socioeconomic parameters. The most striking observations were (1) during the first three months a decline in homemade formulas in favour of adapted readymade preparations; (2) a reduction in milk-cereal preparations with an increase in the use of yoghurt. Both trends reduce the carbohydrate content of the food. Except for breast-feeding, there are only minor differences in feeding habits between different socioeconomic classes. 96% of all infants received prophylactic doses of vitamin D, while 81% were given fluorides as prophylaxis against caries. On average the first gliadins were given after 16 weeks, in 10% earlier than the sixth week and in 16% after the sixth month only.

[Nutrition in the first days of life: how many infants need supplemental food?]. / Ernährung in den ersten Lebenstagen: Wie viele Kinder brauchen eine Zusatznahrung?

A prospective study of 280 consecutive newborns (birth weight greater than 2500 g) showed that on discharge from hospital 88.5% were fully and 8.6% partly breastfed. Only 8 children (2.9%) were weaned. In the group of the fully breastfed infants, 8.5% received no prelacteal food or fluid, 85.9% received a 10% dextromaltose (DM) solution and in only 5.6% of the children was there additional feeding with an adapted milk formula for some days. This restrictive attitude concerning supplemental feeding involved no observable drawbacks. The increasing incidence of atopic diseases--especially cow's milk allergy, the evolution of which is essentially promoted by the administration of foreign proteins in the first days of life--justifies a feeding policy on these lines. The elimination of bovine proteins in the newborn period is of considerable preventive significance. On the other hand, restriction of water supply (10% DM solution) is not advisable in our opinion.