Detection of digitalis compounds using a surface plasmon resonance-based biosensor

A prospective national investigation comprising 633 extremely low birthweight (ELBW) infants born alive in the 2-y period 1990-1992 with a birthweight of < or = 1000 g and gestational age of > or = 23 completed weeks was conducted regarding neurosensory outcome and growth. Three-hundred and sixty-two (98%) surviving ELBW infants were assessed at a median age of 36 months, using a specially designed protocol. At follow-up, mean height, weight and head circumference in both boys and girls were significantly lower than the reference values. The incidence of cerebral palsy was 7% among all children and 14%, 10% and 3% in children born at 23-24, 25-26 and > or = 27 gestational weeks, respectively. At least one obvious handicap was present in 14%, 9% and 3% of these three groups of children, respectively. After adjustment for gestational age, a significantly increased risk of handicap was found in children with intraventricular haemorrhage grade > or = 3 and/or periventricular leucomalacia and in children with retinopathy of prematurity stage > or = 3. The results show that more than 90% of ELBW children born at > or = 25 completed gestational weeks were without neurosensory handicap at 36 months of corrected age. In infants born at 23-24 weeks of gestation, both survival and long-term outcome were less favourable.     

Frequency of neurologic disorders in the neonatal intensive care unit

Neonatal intensive care unit survival rates have improved significantly over the past decade. This improvement primarily reflects declining mortality rates among preterm infants. Neurologic morbidity increases with prematurity and is the major predictor of long-term disability. Accordingly, concern has been expressed that the burden of neurologic dysfunction among contemporary neonatal intensive care unit survivors may be increasing. To define the trends of neurologic disorders in the contemporary neonatal intensive care unit, all 4164 admissions between 1986 and 1995 to a tertiary neonatal intensive care unit were examined. Neonatal intensive care unit admissions (413 +/- 49 per year), proportion of births at less than 37 weeks (70 +/- 3% per year), and referral patterns were stable between 1986 and 1995. Over the study period, 773 (18%) of 4164 neonatal intensive care unit infants had a total of 1062 neurologic disorders. The neonatal intensive care unit mortality rate declined from 12% in 1986 to 4.2% in 1995 (P < .01). Neurologic disorders declined, from 27% of infants born in 1986 to 12% in 1995 (P < .001): 356 had seizures (14% in 1986 to 4% in 1995; P < .001), 235 had hypoxic-ischemic encephalopathy (8% in 1986 to 4% in 1995, P < .01), and 167 had intraventricular hemorrhage (7% in 1986 to 1.4% in 1995, P < .005). Frequency of congenital or chromosomal aberration affecting the nervous system was relatively constant (4.5% per year). Despite a three-fold improvement in neonatal intensive care unit survival between 1986 and 1995, the frequency of perinatally acquired neurologic disorders declined by more than 50%.     

Outcome of very low birth weight infants in industrialized countries: 1947-1987

Neonatal intensive care has led to a progressive improvement in the survival of very low birth weight (VLBW, < 1,500 g) infants. However, it has not been established whether there has been a simultaneous increase or decrease in the prevalence of handicapping conditions in this group of children. To explore this question, a meta-analysis was performed using outcome data of 32 developmental studies of VLBW infants born in industrialized countries between 1947 and 1987. The authors' results show that the proportion of VLBW infants who survived and had an intact outcome progressively increased between 1947 and 1987--from 147 per 1,000 live births in the period 1947-1965 to 498 per 1,000 in the period 1980-1987 (p < 0.01). The prevalence of major handicapping conditions for the subset of VLBW infants who weighed < 1,000 g at birth increased, resulting from the increasing survival rates. However, the prevalence of major handicapping conditions among all children with VLBW decreased from 147 per 1,000 live births in 1947-1965 to 45 per 1,000 in 1980-1987 (p = 0.02). The authors' meta-analysis suggests that improved survival of VLBW infants has not been accompanied by an increase, but more likely a decrease, in the prevalence of handicapping conditions in this birth weight group.     

Cryotherapy of retinal prematurity in Denmark 1992-1996

Retinopathy of prematurity (ROP) is a vasoproliferative disorder often met in infants of very preterm delivery. Lower stages usually regress spontaneously, but progression to so-called threshold-ROP should lead to anterior retinal ablation therapy, by cryopencil or laser. Fifty-three Danish infants born 1992-96 were evaluated in the University eye clinic of Rigshospitalet for the disease; 65 eyes of 36 infants had cryotherapy; eight infants developed severe bilateral visual handicap (22%). The reason for not giving cryotherapy to the remaining 17 was: too late referral in five, and ROP below threshold in 12; seven of the 17 later appeared in the (mandatory) national register for childhood visual handicap. Perusing these data the other way round, 15 of the registered 18 cases were thus known to us, while three had escaped referral. With reservation for the small numbers included, the national trend at present is an increasing annual number of subjects receiving retinal ablation therapy for ROP, and a decrease in severe visual impairment due to the disorder. Obviously all preterm infants at risk should be under early regular ophthalmic surveillance for ROP.     

A comparison of left ventricular volumes and regurgitant fraction by Doppler echocardiography and angiography in children

In the period 1985-1991, 21,675 infants were born at the University Hospital of Copenhagen, Hvidovre Hospital, Denmark. Two hundred and twenty-four infants (10.3%) with birth weights < or = 1500 g and gestational ages < or = 32 completed weeks were transferred to the neonatal intensive care unit of the hospital. One hundred and eighty survived to at least 8 weeks of age and 170 had eye examinations. Forty-five of the 170 infants examined (26.5%) had retinopathy of prematurity (ROP) and 18 (40%) of these developed blindness or severely impaired vision, a higher incidence than reported in other studies. Significant differences were found between infants with and without ROP for: birth weight, gestational age, Apgar score at 1 min, resuscitation, ventilator treatment, duration of supplementary oxygen, severe complications in the neonatal period and sequels from the central nervous system. Statistical analysis, corrected for correlations, showed that the occurrence of ROP was related significantly to early intubation, hypotension, persistent ductus arteriosus and necrotizing enterocolitis.     

Survival and disability at 7-8 years of age in New Zealand infants less than 28 weeks gestation

AIMS: To determine the survival and disability rates at 7-8 years in infants of less than 28 weeks gestation born in New Zealand in 1986 and admitted to a neonatal unit. METHODS: In 1986, all infants with birthweight less than 1500 g and admitted to neonatal units were enrolled in a prospective audit of retinopathy of prematurity. Surviving infants, including the subset born at less than 28 weeks gestation, have been assessed at a home visit. Parents completed a comprehensive questionnaire and children underwent a visual assessment and were tested on the Wechsler Intelligence Scale for Children. RESULTS: Of 126 liveborn infants less than 28 weeks gestation, 80 (64%) survived to 7-8 years. Sixty eight children (97% survivors resident in New Zealand) were assessed: 72% had no, and 86% no or only mild disability, 77% had some visual problem, with close to one-third having myopia, strabismus or requiring spectacles and 32% received Ministry of Education funded special needs assistance. CONCLUSIONS: There have been few long-term follow-up studies of infants of less than 28 weeks gestation born in a defined geographical area. The outcome for New Zealand infants is comparable with that in other published data.     

Brachial plexus paralysis: its incidence, predisposing factors and outcome

METHODS: We have studies, retrospectively, the risk factors, incidence and outcome of obstetric palsy in all infants delivered between January 1990 and December 1994 at the Obstetric and Gynecological Department and afferent to the Neonatological Division of the University of Messina. Twenty-eight of the 5556 live born full term infants (5/1000) were at birth diagnosed as having a brachial plexus paresis. Of these eight (1.6/1000) had persistent palsy. RESULTS: In about 40-50% of the infants with brachial plexus palsy the obstetric history was characterized by high birthweight, shoulder dystocia, and parity 1. The infants who recovered totally did so during the first 12 months of life. All infants had upper brachial plexus, or Erb's palsy, which is more favorable than entire brachial plexus palsy. At follow-up (15 months-5 years), all infants with persistent palsy were afflicted by varying degrees of arm function compromise. CONCLUSIONS: We stress that, in several cases, obstetric brachial plexus palsy results in life-long handicap, and that prevention, early diagnosis and therapy need to be the goals of the obstetrical and pediatric management.     

Retinal arteriovenous malformation with fluctuating vision and ischemic central retinal vein occlusion and its sequelae: 25-year follow-up of a case

A comparison was made of the outcome of 73 neonates born with their birth weight of 500-999 gm in National Taiwan University Hospital during the period between January 1, 1993 and December 31, 1996 (Period II), with the outcome of 21 such neonates born between April 1, 1988 and October 31, 1992 (Period I). Exclusion criteria included parental refusal for resuscitation, and major anomalies. Data were collected via a predetermined record sheet. The incidences of the extremely-low-birth-weight infants were 23/10,173 (0.23%) and 81/13,835 (0.59%) in Periods I and II, respectively. Early neonatal mortality rate was significant decreased in Period II (43% versus 14%). The limit of viability was improved from gestational age of 26 weeks or 700 gm to gestational age of 24 weeks or 600 gm. The incidence of neonatal morbidity (80% versus 50%) and total survival rate (48% versus 60%) have not changed significantly as seen in this limited number of cases. This study concluded that, with the introduction of exogenous surfactant and modern neonatal care, early neonatal survival rate and the limit of viability were improved.     

Infants with birth weight 1,000-1,499 grams born in three time periods: has outcome changed over time?

The objective of this study was to see whether outcome of infants of larger birth weight (1,000-1,499 grams) has changed with advances in neonatology. The outcome of infants born in a recent time period (1989-1991) was compared with that of infants born previously, in 1984-1986 and 1979-1981. Univariate analyses were conducted on the association of medical risk factors and date of birth with outcome. More than 90% of infants in each time period were neurologically normal and more than 80% were cognitively normal. Predictor variables were intracranial hemorrhage for poor neurologic outcome and days on oxygen for poor cognitive outcome. We found that neurodevelopmental outcome was stable over three time periods.     

A community based stroke register in a high risk area for stroke in north west England

The occurrences of histologic changes in the central nervous system of very low birth weight infants (500 to 1500 grams) according to gestational age and postnatal age are incompletely reported. In order to better understand the abnormalities present in this patient population, the brains of 67 very low birth weight infants who died after having had at least one cranial ultrasound scan were studied. More than half the infants were born at gestational ages of 24 to 26 weeks, and only 28% died within 24 hours (h) of birth. The slides of the brains of all 67 infants were reviewed simultaneously by 3 neuropathologists who had to agree on the presence and/or absence of each histologic characteristic. Among infants who died within 24 h of birth, fully one quarter had parenchymal hemorrhage, 42% had petechial hemorrhages in the white matter, and more than 20% had hypertrophic astrocytes. These data indicate that in utero, prepartum, injury to the nervous system was common. Compared with infants who died before the sixth day, those who survived at least 6 days were twice as likely to have moderate/severe ventriculomegaly, rarefaction, amphophilic globules, hypertrophic astrocytes, macrophage foci, coagulative necrosis, and hemorrhagic necrosis than those who died before the 7th postnatal day. Parenchymal hemorrhage and moderate/severe ventriculomegaly decreased in frequency with increasing gestational age. On the other hand, the older the gestational age, the higher the likelihood of finding amphophilic globules, hypertrophic astrocytes, macrophage foci, and zones of coagulative necrosis upon neuropathologic examination. Our data indicate that several central nervous system abnormalities appear to increase with both older gestational age and older postnatal age for infants born weighing less than 1500 grams. We were unable, however, to determine the relative contribution of gestational age and postnatal age to the specific neuropathologic findings in this study.     

Maternal hypertension and neurodevelopmental outcome in very preterm infants

AIM: To determine the outcome of preterm infants born to mothers with hypertension during pregnancy, and preterm controls. METHODS: 107 infants of 24-32 weeks gestation, born to hypertensive mothers, and 107 controls matched for gestational age, sex, and multiple pregnancy, born to normotensive mothers, were prospectively enrolled over 2 years. Information on maternal complications and medication was obtained and neonatal mortality and morbidities recorded. Survivors were followed up to at least 2 years, corrected for prematurity. RESULTS: One third of the hypertensive mothers were treated with antihypertensive drugs, while 18% received convulsion prophylaxis with phenytoin. Magnesium sulphate was not prescribed. Both groups had a mean gestational age of 29.9 weeks, with the study infants having a significantly lower birthweight than the controls. Four study and three control infants died in the neonatal period. Cerebral palsy was not diagnosed in any infant of a hypertensive mother compared with five of the controls. The mean general quotient for the two groups was very similar and no difference in the incidence of minor neuromotor developmental problems was shown. CONCLUSIONS: Maternal hypertension seems to protect against cerebral palsy in preterm infants without increasing the risk of cognitive impairment. This was independent of the use of maternally administered magnesium sulphate.     

Survival and morbidity among children with low birth weight

Stillbirth and the mortality rate in low birthweight infants (less than 2,500 g) have been greatly reduced since 1967. 95% of all infants born in 1991-93 whose birthweight was between 500 and 999 g, and who survived to one year of age, would have died under the same circumstances in 1967-69. This improved survival is not, to any appreciable extent, related to an increase in demand at seven years of age for a basic grant or attendance benefit because of cerebral palsy or mental retardation. The number of basic grant and attendance benefits because of eye diseases has been reduced by about half for 7-year olds whose birthweight was low. On the whole, however, the number of basic grant and attendance benefits increased from about 1% in 1974-85 to 2.2% in 1986-94. This increase can be particularly attributed to skin and lung diseases. These results have been obtained by coordinating the record of the Medical Birth Registry of Norway and the records of the Social Security offices for all births (1,566,763) registered during the years 1967-93.     

Audit of early experience with inhaled nitric oxide in New Zealand neonatal intensive care units

AIMS: To audit the use of inhaled nitric oxide for the treatment of persistent pulmonary hypertension of the newborn in New Zealand neonatal intensive care units. METHODS: Prospective data collection on all infants treated with inhaled nitric oxide in neonatal intensive care units in the 20-month period from first use to December 1995. Data included perinatal factors, principal diagnosis, echocardiogram results, ventilation details and response to nitric oxide, adverse reactions and outcome. RESULTS: Twenty-eight infants received nitric oxide in three centres, all bar one being 36 weeks or more gestation. Overall survival was 68%. Thirteen infants (46%) responded to nitric oxide treatment, 12 (92%) surviving. Seven (47%) of non-responders survived. Infants with primary pulmonary hypertension or meconium aspiration syndrome had 90% survival and more often responded to nitric oxide than infants with congenital diaphragmatic hernia (40% survival) or pulmonary hypoplasia (no survivors). No serious complications of treatment were recorded. CONCLUSIONS: Inhalational nitric oxide was not universally successful treatment for pulmonary hypertension of the newborn but was likely to have been life-saving in a proportion of cases. Future studies may allow better case selection. Ongoing audit of this new treatment is warranted.     

Expression of HER-2/neu oncogene in normal, hyperplastic, and malignant endometrium

The development of new technologies in neonatal intensive care which appeared this last decade increased the viability of premature newborns and contributed to the increase in the number of admissions of very low birth weight (VLBW) newborns in the intensive neonatal care services (12.6% of admissions in 1987, 15.2% in 1996). In a retrospective epidemiology survey in French speaking Belgian Community, we collected the data of 1521 newborns whose birth weight was under 1500 g, from January 1990 to December 1994, in order to improve our knowledge or regional mortality and morbidity rates and to estimate the impact of new procedures. We do not notice any variation of annual mortality (+/- 20%), nor of morbidity (sequelae risks to survivors at the departure of the hospital +/- 23%) on the global population during the survey period. However the mortality of infants born between 30 and 33 weeks drops dramatically (17% in 1990, 3.6% in 1994). As it has been demonstrated in randomised surveys, we recover the beneficial effect of antenatal corticotherapy which allows us to reduce to more than 50% the mortality of newborns from treated mothers (11% mortality versus 24%). In comparison to figures of international literature, our survival rate without sequelae is at least 10% lower than Américan results for infants whose birth weight is < 1000 g and at least 5% lower for infants between 1000 and 1500 g. In conclusion, although the introduction of surfactant and high frequency ventilation during this period, mortality rate of VLBW infants doesn't seem to decrease significantly from 1990 to 1994. However, multivariate statistical study of predictable mortality and morbidity factors need to be performed in order to define or promote preventive strategy.     

Group B streptococcus: maternal carriage rate and early neonatal septicaemia

Between January 1984 and December 1994, 30 cases of early neonatal group B streptococcus (GBS) septicaemia were managed in the Neonatal Unit, University Hospital, Kuala Lumpur. Two neonates were outborn and 28 were inborn, giving an average annual incidence of neonatal GBS septicaemia of 0.4/1000 livebirths among inborn babies. In a separate survey over a three-month period, GBS genital carriage rate among 196 parturients was found to be 9.7%. Of the infants with GBS septicaemia, the mean gestational age was 37.5 +/- 3.8 weeks and the mean birthweight was 2540 +/- 716 g. Twelve (40%) were preterm infants and 14 (47%) were low birthweight infants. Male and female infants were almost equally affected. Prolonged rupture of membranes and maternal pyrexia accounted for only 5 (17%) and 3 (10%) of the cases respectively. Twenty-four (80%) neonates had onset of symptoms within 6 hours of life and respiratory symptoms were observed in 24 (80%) of the cases, while meningitis was uncommon. Six (20%) neonates died. Preterm and low birthweight infants had higher mortality than their term counterparts: 42% versus 6% and 36% versus 6% respectively. Of those who died, 4 (67%) required respiratory support right from birth and the mean time of onset of symptoms was 4 hours (range 0 to 21 hours) and the duration of survival was only 28.8 hours (range 12 to 38 hours). As the incidence of neonatal GBS septicaemia was low, mass screening and chemoprophylaxis for GBS were not recommended. All the GBS isolates were sensitive to penicillin and ampicillin, thus one of these antibiotics should be included in the antimicrobial therapy of septic neonates.     

Infants entering foster care compared to other infants using birth status indicators

OBJECTIVE: Infants comprise nearly one fourth of all entries to foster care. Linkage of administrative birth and placement data can provide information about these infants that may otherwise be unavailable or difficult to obtain. METHOD: Statewide birth records and foster care placement histories were linked via probability matching. Logit regression was used to compare 26,460 maltreated infants who entered foster care between 1989 and 1994 with a random sample of 68,401 other infants born during that time frame. RESULTS: Infants in care were more than twice as likely to have single parents and be born with low birthweight, and twice as likely to have been born with a birth abnormality as other infants, controlling for other factors. The largest difference was in the eightfold increased likelihood for mothers of infants in care to have had no prenatal care. Infants in care were nearly three times as likely to be born into larger families (third or greater live births to the mother). Mothers of infants in care were more than twice as likely to be African American compared to White than mothers of other infants, while Hispanic and Other ethnic groups were underrepresented in the group of infants in care. Foreign born mothers, especially Hispanic women, were much less likely to have infants in care than they were to have children in the other group. CONCLUSIONS: Administrative datasets, while often limited in the number of variables they include and scope of their information, can be a valuable tool when used to understand demographics and frame questions for future research. Infants who enter foster care differ in substantial ways from other children. These findings have important implications for future research aimed toward targeting of child welfare services and supports.     

Prognosis after perinatal asphyxia in full-term infants. A literature review

Reviewing the literature published during the last 30 years we found comparable systematic studies of outcome for 1042 term infants born alive after likely intrapartum hypoxia-ischaemia. Fifty-two percent had no sequelae, 8% had developmental delay without associated handicaps, 4% had a single handicap, 11% were multihandicapped and 14% were dead as a consequence of the intrapartum hypoxia-ischaemia. The frequency of single handicaps exceeded the frequency found among the controls and in population studies. The frequency of children with developmental delay did not differ from that found among the controls. Outcome is closely related to the severity of hypoxic-ischaemic encephalopathy in the newborn.     

The premature infant below 1000 g

74 premature infants with a birth weight of 1000 g or less were hospitalized in the period 1963-1975. 20 babies survived the first 4 weeks of life and 2 died during the second month of life from progressive lung disease. 77% of all patients were mechanically ventilated and 9 ventilated patients survived. The main causes of death were cerebral hemorrhage, severe asphyxia and septicemia. Prognosis was impaired by hypothermia, IRDS, gestational age below 27 weeks and premature rupture of membranes with bacterial infection. At the age of 1 year 8 out of 12 survivors followed up showed normal mental and motoric development. 3 children had minor or obvious signs of cerebral paresis and one further child has partial retrolental fibroplasia. Due to modern intensive care the survival rate of these very small premature babies has now reached 40%. The prognosis is favourably influenced by optimal obstetric and neonatal care, while special precautions should be undertaken to avoid hypothermia. Our results with mechanical ventilation justify the administration of full intensive care to these very small premature babies.