Birth weights of infants of first generation Asian women in Britain compared with second generation Asian women

OBJECTIVES: To compare birth weights of infants of first generation Asian women (women born in the Indian subcontinent) with those of infants of second generation Asian women (born in the United Kingdom). DESIGN: Retrospective case note study. SETTING: Bolton District General Hospital. SUBJECTS: 331 Asian women who gave birth between January 1989 and December 1989: 220 of these women were first generation Asians and 111 were second generation Asians. MAIN OUTCOME MEASURE: Birth weights of babies born to first and second generation Asian women. RESULTS: At all gestational ages at delivery, babies born to second generation Asian women were heavier than those born to first generation women. The mean birth weight for babies of second generation women was 3196 g, 249 g more than the mean birth weight of 2946 g of babies of first generation women (P < 0.001). After a stepwise multiple regression analysis was carried out the adjusted difference in birth weights was 280 g, greater than the crude difference. CONCLUSION: Birth weights are important in relation to perinatal mortality, which is notoriously high among Asians. The results of this study indicate that there is hope for lowering of perinatal mortality and improving postnatal growth in babies of second generation Asians.     

Birthweight-specific trends in perinatal mortality by hospital category in South Australia, 1985-1990

OBJECTIVE: To investigate differences by birthweight in risk of perinatal death between level 3 hospitals (which provide care for high risk pregnancies and neonatal intensive care) and other hospitals in South Australia, using perinatal data for the 1985-1990 period. DESIGN: Analysis of birthweight-specific trends in risk of perinatal death by hospital category for singleton births, adjusting for risk factors. SUBJECTS: 114 725 singleton births of at least 400 g birthweight (or at least 20 weeks' gestation) born in hospitals in the 1985-1990 period and notified to the perinatal data collection. MAIN OUTCOME MEASURE: The relative odds of a perinatal death, as opposed to a live birth which survived the neonatal period. RESULTS: Births at level 3 hospitals had a higher crude risk of perinatal death than those at other hospitals, but this was due to the higher frequency of low birthweights at level 3 hospitals. For birthweights under 2000 g, and especially for the very low birth-weights, there was a higher risk at non-level-3 than level 3 hospitals. There was also the unexpected finding that births at level 3 hospitals in the 2500-2999 g range had a comparatively high risk of perinatal death. There was little difference in risk for births of higher birthweight. CONCLUSIONS: The greatly reduced risk of perinatal death in level 3 hospitals for babies with birthweights under 2000 g seems likely to be due to the specialist services in these hospitals. Further investigation is required to determine why babies in the 2500-2999 g range of birthweights had a comparatively high risk of perinatal death at these hospitals. This appears to be due, at least in part, to an excess contribution of deaths from congenital abnormalities. Also, it seems that the higher prevalence of complications in pregnancy in level 3 hospitals, and the transfers for induction of labour after intrauterine fetal death, would have made a contribution. These same factors may also have affected the risk in level 3 hospitals for higher birthweight births.     

Mothers' pelvic size, fetal growth, and death from stroke and coronary heart disease in men in the UK

BACKGROUND: People who have a low birthweight show increased death rates from coronary heart disease and a higher prevalence for its risk factors. These findings have led to the hypothesis that the disease is programmed in fetal life. The aim of this study was to explore whether risk of stroke in adult life was linked to impaired fetal growth. METHODS: We ascertained deaths from stroke and coronary heart disease in 13 249 men in two cohorts from Hertfordshire and Sheffield, UK. We related death rates from these disease to body size at birth, weight at 1 year, and to measurements of the mothers' pelvises. FINDINGS: Death rates from both stroke and coronary heart disease tended to be highest in men whose birthweight had been low. Standardised mortality ratios (SMRs) for stroke fell by 12% (95% Cl 1-22) and for coronary heart disease by 10% (6-14) between each of five groupings of increasing birthweight (< or = 5.5 lb, 5.6-6.5 lb, 6.6-7.5 lb, 7.6-8.5 lb, and > 8.5 lb). Mortality from stroke was most strongly associated with low birthweight in relation to head size, and low placental weight in relation to head size. These patterns of growth occurred in offspring of mothers with flat bony pelvises. The SMR in sons of these women was 184 (67-396) compared with 104 (78-138) in the remainder of the cohort. In contrast, mortality from coronary heart disease was associated with small head circumference, thinness or shortness at birth and an altered ratio of placental weight to birthweight. INTERPRETATION: Stroke may originate in poor nutrition during the mother's childhood, which deforms the bony pelvis and subsequently impairs her ability to sustain the growth of the placenta and fetus in late pregnancy. Coronary heart disease, on the other hand, seems to originate in adaptations made by the fetus to inadequate delivery of nutrients when it occurs for reasons other than failure of placental growth.     

Co-trimoxazole and stavudine interference in a high-performance liquid chromatographic analysis for didanosine in human plasma

We have analysed birthweights of 4,508 Aboriginal and Torres Strait Islander livebirths in the Kimberley region of Western Australia from 1981-93. Mean birthweight varied significantly according to month of birth (F(11) = 2.57, p = 0.003) and low birthweight babies were more common during the wet season. A significant increase in the proportion of very low birthweight (VLBW) babies was observed during the wet season compared with the dry season (OR 2.73; 95% CI 2.3-3.67; p < 0.001); whereas babies weighing 1,500-2,499 g were not significantly more common during the wet season (OR 1.06; 95% CI 0.96-1.17; p = ns). The results indicate that adverse environmental conditions may be associated with increased risk of VLBW. Since newborns weighing less than 1500 g are very likely to be pre-term (< 37 weeks' gestation), the findings also suggest that seasonality of birthweight may be due to an increase in pre-term births rather than an increase in intrauterine growth retardation. Further research is required to identify the underlying causes of an increase in VLBW babies during the wet season.     

Zoonotic cutaneous leishmaniasis to the north of Isfahan. Human infection in 1991

OBJECTIVE: To review the survival rate, the incidence and severity of retinopathy of prematurity (ROP), and the rate of blindness caused by ROP in extremely low birth weight (ELBW, birth weight 500 to 999 g) infants born between January 1, 1977, and December 31, 1992, and to determine whether increasing survival rates of ELBW infants are accompanied by an increase in the rates of severe ROP or blindness. DESIGN: Prospective cohort study of ELBW infants. Survival rates and visual outcomes were contrasted between children born in successive 8-year periods (1977 through 1984 and 1985 through 1992, inclusive). SETTING: The premature nurseries at the Royal Women's Hospital, Melbourne, a level-3 perinatal center. PATIENTS: Of 1001 inborn ELBW infants over the 16-year period, 457 (45.7%) survived their initial hospitalization: of the survivors, 434 (95.0%) were examined by the ophthalmologist, starting at 2 weeks of age if possible, then 2-weekly unit discharge. Children were reassessed after discharge at ages ranging from 1 to 10 years. RESULTS: Survival rates to hospital discharge rose significantly over time, from 34.5% (145/420) in 1977 through 1984, to 53.7% (312/581) in 1985 through 1992 (odds ratio [OR] 2.2, 95% confidence interval [CI] 1.7 to 2.8). Of the 434 surviving ELBW infants seen by the ophthalmologist, ROP was detected in 48.2% (68/141) in 1977 through 1984, which dropped significantly to 35.8% (105/293) in 1985 through 1992 (OR 0.6, 95% CI 0.4 to 0.9). Severe ROP (bilateral stages 3 to 5) was detected in 25.5% (36/141) in 1977 through 1984, and 17.7% (52/293) in 1985 through 1992, but the reduction was not quite statistically significant (OR 0.6, 95% CI 0.4 to 1.0). Bilateral blindness (visual acuity in each eye less than 6/60) caused by ROP occurred in only 4 (0.88%) survivors overall, 2 in each era. CONCLUSION: The increase in the survival rate of ELBW infants is not always accompanied by an increase in the rate of severe ROP or blindness, at least for ELBW infants born in some large level-3 centers.     

Hormone replacement therapy as a risk factor for epithelial ovarian cancer: results of a case-control study

OBJECTIVE: To evaluate the role of hormone replacement therapy (HRT) as a risk factor for the development of epithelial ovarian cancer. METHODS: A case-control study was performed that used 491 patients with epithelial ovarian cancer frequency matched for age at diagnosis (+/-5 years) with a control population of 741 patients with malignancies of nonestrogen-dependent tissues. The odds ratio (OR) for the development of epithelial ovarian cancer was estimated using logistic regression analysis with adjustment for age at diagnosis, parity, oral contraceptive use, smoking history, family history of epithelial ovarian cancer, age at menarche, menopausal status, income, and education. RESULTS: One hundred of 491 patients (20.4%) in the study population had ever used HRT, and 160 of 741 patients (21.6%) in the control population had ever used HRT (OR 0.85; 95% confidence interval [CI] 0.62, 1.2). A significant association between HRT and specific histologic subtypes of epithelial ovarian cancer was not demonstrable for serous cystadenocarcinoma (OR 1.2, 95% CI 0.8, 1.7), Clear cell carcinoma (OR 1.1, 95% CI 0.4, 3.4), or endometrioid carcinoma (OR 0.4; 95% CI 0.2, 1.2). A significant association between duration of use of HRT and the risk of developing epithelial ovarian cancer was not demonstrable for under 5 years (OR 0.8; 95% CI 0.5, 1.2), 5-9 years (OR 0.6; 95% CI 0.3, 1.1), or 10 or more years (OR 0.6; 95% CI 0.3, 1.4). CONCLUSION: A significant association between the use of HRT and the risk of developing epithelial ovarian cancer, even with prolonged exposure, is not demonstrable.     

The association of calcium and vitamin D, and colon and rectal cancer in Wisconsin women

BACKGROUND: Calcium and vitamin D have been hypothesized to reduce colorectal cancer risk. Epidemiological evidence, however, is mixed. METHODS: To explore those relationships, data were collected as part of a population-based, case-control study of colorectal cancer in Wisconsin women (678 controls, 348 colon and 164 rectal cancer cases). A semi-quantitative food frequency questionnaire was used to ascertain food and dietary supplement intake 2 years prior to interview. Logistic regression models were used to calculate odds ratios (OR). RESULTS: Higher levels of calcium intake were associated with reduced colon and rectal cancer risk. The following adjusted OR and 95% confidence intervals (CI) were observed, comparing the fifth quintile (based on control intake) with the first: colon cancer: OR = 0.6, 95% CI: 0.4-1.0, P-trend: 0.03; rectal cancer: OR = 0.6, 95% CI: 0.3-1.1, P-trend: 0.07. Similar relationships were observed for vitamin D intake, although OR were closer to the null value and did not always behave in a step-wise fashion (fifth quintile versus the first--colon cancer: OR = 0.7, 95% CI: 0.4-1.1, P-trend: 0.05; rectal cancer: OR = 0.8, 95% CI: 0.5-1.5, P-trend: 0.42). CONCLUSION: These data support a protective association of calcium on colon and rectal cancer risk.     

Thyroxine values from newborn screening of 919 infants born before 29 weeks' gestation

OBJECTIVES: Severe transient hypothyroxinemia in premature infants is associated with cerebral palsy and mental retardation: this study assessed its prevalence in very premature infants. METHODS: Congenital hypothyroidism screening programs in three states provided thyroxine values for 919 newborn infants younger than 29 weeks who were enrolled in a multicenter study. RESULTS: Thyroxine values were lower than 4.0 micrograms/dL in 21% of survivors and increased each week by 0.6 microgram/dL (95% confidence interval [CI] = 0.4, 0.7). At tests done 1 to 2 days after birth, levels were 2.5 micrograms/dL higher (95% CI = 1.8, 3.3) than at tests done at 8 to 14 days. In New York, levels were 1.0 microgram/dL higher (95% CI = 0.3, 1.6) than elsewhere. The levels of infants who died were 1.3 micrograms/dL lower (95% CI = 0.6, 2.0) than those of survivors. CONCLUSIONS: Severe transient hypothyroxinemia is common in very premature infants and deserves further study.     

In vivo efficacy of silver-coated (Silzone) infection-resistant polyester fabric against a biofilm-producing bacteria, Staphylococcus epidermidis

OBJECTIVE: To study the characteristics of birthweight and gestational age of third trimester fetal deaths which occurred before the onset of labour. DESIGN: Review of computerised confidential perinatal mortality records. Data originated from the 1992 Trent Region Perinatal Mortality Survey. SAMPLE: One hundred and forty-nine antepartum stillbirths of at least 24 weeks of gestation confirmed by early ultrasound scan. Congenital abnormalities and multiple pregnancies were excluded. MAIN OUTCOME MEASURES: Reported causes of stillbirth; weight-for-gestational age centiles based on a standard derived from normal pregnancies; pregnancy characteristics compared with the local maternity population. RESULTS: Of 149 stillbirths, 83 (56%) were preterm and 66 were at term, and the majority (126; 85%) occurred from 31 weeks. Most of the deaths (97; 65%) were reported as 'unexplained' even though post-mortems had been carried out in 60% of all cases. Using a gestational age-specific fetal weight standard derived from normal, term live births, 41% of all cases of stillborn infants were small-for-gestational age (< 10th centile; OR 6.2; 95% CI 3.3-11.5); 39% of which had been classified as unexplained were small for gestational age (OR 5.6; 2.6-12.0). This excess of small stillbirths was most pronounced between 31 and 33 weeks, where the weights of 63% of all stillbirths and 72% of unexplained fetal deaths were < 10th centile. Overall, a higher proportion of preterm (< 37 weeks) than term stillbirths were small for gestational age: 53% vs 26% (OR 3.3; 1.6-6.5). However, at term there were also more subtle differences in weight deficit, with more fetuses with a weight between the 10th and 50th centiles than between 50th and 90th (36 vs 11; OR 3.3; 1.4-7.8). Mothers of pregnancies ending in stillbirth were similar in age, size, parity and ethnic group to mothers of live born babies, but were more likely to be smokers (37 vs 27%, OR 1.6; 1.2-2.3). CONCLUSIONS: Many stillborn babies are small for gestational age. In the absence of significant differences in physiological pregnancy characteristics, this is unlikely to be a constitutional smallness, but represents a preponderance of intrauterine growth restriction. For a full appreciation of the strength of this association, appropriate weight standards and classifications need to be applied in perinatal mortality surveys. Many antepartum stillbirths which are currently designated as unexplained may be avoidable if slow fetal growth could be recognised as a warning sign.     

Nitroglycerin and ventricular performance. Differential effect in the presence of reversible and irreversible asynergy

During the five-year period 1964-68 96 733 births were registered in the 28 hospitals equipped with maternity facilities in the Uppsala hospital region. Of these babies, 1 636 were born in 818 twin deliveries. Data on gestational age, sex, weight and length at birth, birth order, hospital type, congenital malformations and perinatal mortality are analysed. Altogether 17.3 per 1 000 of the children born during this period were born in multiple births. The perinatal mortality for the twin babies was 64 per 1 000 born, with the mortality higher in the less specialized hospitals than the others. Twin no. 1 suffered perinatal death in 67 cases per 1 000 and twin no. 2 in 60 cases per 1 000. For twins of primiparae the losses were 92 per 1 000 children and for twins born to multiparae 51 per 1 000. Altogether 72 per 1 000 male twins died perinatally compared to 52 per 1 000 female twins. The most heavy losses occurred among the low-weight premature twins and in these cases both twins often suffered perinatal death.     

Predicting outcome in very low birthweight infants using an objective measure of illness severity and cranial ultrasound scanning

AIM: To investigate the feasibility of developing an objective tool for predicting death and severe disability using routinely available data, including an objective measure of illness severity, in very low birthweight babies. METHOD: A cohort study of 297 premature babies surviving the first three days of life was made. Predictive variables considered included birthweight, gestation, 3 day cranial ultrasound appearances and 3 day CRIB (clinical risk index for babies) score. Models were developed using regression techniques and positive predictive values (PPV) and likelihood ratios (LR) were calculated. RESULTS: On univariate analysis, birthweight, gestation, 3 day CRIB score and 3 day cranial ultrasound appearances were each associated with death. On multivariate analysis, 3 day CRIB score and 3 day cranial ultrasound appearances remained independently associated. A 3 day CRIB score > 4 along with intraventricular haemorrhage (IVH) grade 3 or 4 was associated with a PPV of 64% and an LR of 9.8 (95% confidence limits 3.5, 27.9). Only 3 day CRIB score and 3 day cranial ultrasound appearances were associated with severe disability on univariate analysis. Both remained independently associated on multivariate analysis. A 3 day CRIB score > 4 along with an IVH grade of 3 or 4 was associated with a PPV of 60% and an LR of 24.2 (95% CI 4.4, 133.3). CONCLUSION: Incorporating objective measures of illness severity may improve current prediction of death and disability in premature infants.     

Risk factors for perinatal and postnatal mortality in lambs

Factors associated with preweaning mortality in lambs were identified by developing risk profiles with logistic regressions for perinatal and postnatal mortality. Compared with heavy lambs, lambs of low birth weight had almost twice the risk of perinatal mortality (odds ratio [OR] = 1.9) and lambs of average weight had a slightly lower risk (OR = 0.7). Two of four lambing location categories affected perinatal mortality, with lambs born at unmonitored areas at greatest risk (OR = 2.7). Multiple births increased the risk of perinatal mortality (OR = 1.5), especially among Targhee lambs (OR = 4.0). Breed variations in perinatal mortality were significant in Suffolk lambs (OR = 1.9) and Booroola Rambouillet lambs (OR = 2.1). Lambs born weak had an increased risk of postnatal mortality while strong lambs had a decreased risk (OR = 3.7 and 0.6, respectively) if the dam had an adequate milk supply. Poor milk supply increased the risk of postnatal mortality for lambs of average vigour (OR = 3.3), but did not change the risk for weak or strong lambs. Male lambs castrated at 30 days of age were at less risk of postnatal mortality (OR = 0.3) than females. There were slight increases in the risk of postnatal mortality for intact males (OR = 1.3), low birth weight lambs (OR = 1.6), and lambs born in sheds (OR = 1.3). Suffolk lambs (OR = 1.8) and Targhee lambs (OR = 1.6) had a higher risk of postweaning mortality.     

Teenage primigravidae: a comparative study

A review of history sheets of obstetric cases recorded in a district hospital in 1992 was done to compare the obstetric outcome in 200 teenage first pregnancies (Study group) with that in Control group i.e. 20 years to 29 years. It revealed that incidence of complications of pregnancy like anaemia, pregnancy induced hypertension (PIH) and preterm labour were significantly higher among teenage mothers. The normal mode of delivery was commoner in teenagers (82.5%) in comparison to control group (76.5%), probably because of higher number of low birth weight babies. The fetal outcome was significantly worse in teenage mothers with high incidence of perinatal mortality (8%) and low birth weight babies (35%). There was not a single newborn with birthweight above 3500 gms, in teenage group, whereas, control group had 5 babies (2.5%) in the category.     

Epidemiologic determinants of endometriosis: a hospital-based case-control study

PURPOSE: Risk factors for endometriosis were identified through data obtained from a case-control study at Brigham and Women's Hospital in Boston, Massachusetts. METHODS: Cases were 50 women with infertility-associated endometriosis. The primary control group consisted of 89 fertile women without endometriosis, and an alternate control group consisted of 47 infertile women without endometriosis. RESULTS: The risk of endometriosis was positively associated with height (OR), 2.8 per 10 cam increase; 95% confidence interval (CI), 1.4-5.6) and inversely associated with weight (OR, 0.7 per 10 kg increase; 95% CI, 0.5-1.0) and body mass index (OR, 0.7 per 5 kg/m2 increase; 95% CI, 0.4-1.1). We observed an inverse association with exercise (OR, 0.6; 95% CI, 0.3-1.5), but the effect was limited to women who exercised > or = 4 hours per week (OR, 0.4; 95% CI, 0.2-1.2). Endometriosis was not associated with either smoking or alcohol consumption. CONCLUSIONS: Our findings suggest that the fertility status of controls can strongly influence associations seen with menstrual characteristics. This study is one of few to address the issue of control selection for a case-control study of endometriosis. Specifically, potential problems encountered using fertile and infertile control women are examined and discussed.     

Mothers' birth weight and survival of their offspring: population based study

OBJECTIVE: To test the hypothesis that a baby's survival is related to the mother's birth weight. DESIGN: Population based dataset for two generations. SETTING: Population registry in Norway. SUBJECTS: All birth records for women born in Norway since 1967 were linked to births during 1981-94, thereby forming 105104 mother-offspring units. MAIN OUTCOME MEASURES: Perinatal mortality specific for weight for offspring in groups of maternal birth weight (with 500 g categories in both). RESULTS: A mother's birth weight was strongly associated with the weight of her baby. Maternal birth weight was associated with perinatal survival of her baby only for mothers with birth weights under 2000 g. These mothers were more likely to lose a baby in the perinatal period (odds ratio 2.3, 95% confidence interval 1.4 to 3.7). Among mothers with a birth weight over 2000 g there was no overall association between mother's weight and infant survival. There was, however, a strong interaction between mother's birth weight, infant birth weight, and infant survival. Mortality among small babies was much higher for those whose mothers had been large at birth. For example, babies weighing 2500-2999 g had a threefold higher mortality if their mother's birth weight had been high (> or = 4000 g) than if the mother had been small (2500-2999 g). CONCLUSION: Mothers who weighed less than 2000 g at birth have a higher risk of losing their own babies. For mothers who weighed > or = 2000 g their birth weight provides a benchmark for judging the growth of their offspring. Babies who are small relative to their mother's birth weight are at increased risk of mortality.     

Perinatal mortality in breech presentation sibships

OBJECTIVE: To compare perinatal mortality in breech presentation delivered vaginally and by cesarean in individual births and in sibships. METHODS: A national, population registry-based study, 1967-1994, was conducted, with maternal record linkage of sibships, comprising the first to the third birth of a mother. The main outcome was perinatal mortality. Odds ratios of perinatal mortality were calculated and adjusted by logistic regression analysis. RESULTS: The overall relative perinatal mortality was 4.3 (95% confidence interval [CI] 4.1, 4.5) in breech compared with nonbreech presentation and 5.4 (95% CI 4.7, 6.2) in vaginal compared with cesarean delivery. The relative perinatal mortality in breech compared with nonbreech presentation was lowest in birth order one compared with birth orders two and three. In breech vaginal delivery compared with cesarean delivery, the opposite effect of birth order was found. The highest perinatal mortality was found in a current breech presentation of a sibship with no previous breech births. In birth subsequent to breech births, perinatal mortality was more or less independent of current presentation, without respect to delivery method. The increased perinatal mortality in breech presentation is explained partly by its association with other risk factors for perinatal death. CONCLUSION: Women with recurring breech presentation represent a lower risk of adverse perinatal outcome. This might be explained by a biologic mechanism or by increased quality of antenatal care. An increased mortality in subsequent nonbreech siblings after a breech presentation was surprising.     

Neonatal morbidity and mortality associated with triplet pregnancy

OBJECTIVE: To compare neonatal morbidity and mortality in a large cohort of triplet pregnancies with singleton and twin neonates managed at a single tertiary center over a short time. METHODS: Records from all triplet pregnancies managed and delivered from 1992 to 1996 were reviewed for neonatal outcome data. Pregnancies delivered before 20 weeks' gestation and neonates with lethal congenital anomalies were excluded. The comparison group comprised all singleton and twin neonates managed in the same neonatal intensive care unit (NICU) during the same period. RESULTS: During the 5-year period, 55 triplet pregnancies and their resulting 165 neonates were managed and delivered at this center. Their outcomes were compared with those of 959 singleton and 357 twin neonates born at similar gestational ages. The median gestational age at delivery for triplets was 32.1 weeks, and 149 of the 165 infants were admitted. Sixteen triplet neonates were not admitted to our neonatal intensive care unit, 12 because of previable gestational age, three because of stillbirth, and one because of a lethal congenital anomaly. The crude perinatal mortality rate in triplets was 121 per 1000 births, and there was no significant difference in outcome based on triplet birth order. There were no significant differences in survival rates between singleton, twin, and triplet neonates, with an overall neonatal survival of 95%, 95%, and 97%, respectively. The only significant differences in morbidity were an increased incidence of mild intraventricular hemorrhage (relative risk [RR] 6.20; 95% confidence interval [CI] 2.64, 14.61), mild retinopathy of prematurity (RR 20.05; 95% CI 3.59, 111.79), and severe retinopathy of prematurity (RR 46.69; 95% CI 6.25, 348.85) in triplets compared with singletons, and severe retinopathy of prematurity (RR 6.83; 95% CI 1.24, 37.56) in triplets compared with twins. CONCLUSION: When stratified by gestational age, triplet neonates delivered at 24-34 weeks' gestation have similar outcomes as singleton and twin neonates, with the only clinically significant difference being an increased incidence of retinopathy of prematurity in triplets.     

Meningiomas in the region of the cavernous sinus: a review of 21 patients

OBJECTIVE: To compare the morbidities in the very low birthweight (VLBW; < 1500 g) and normal birthweight (NBW; > or = 2500 g) Malaysian infants during the first year of life. METHODOLOGY: Prospective observational cohort study of consecutive surviving VLBW infants and randomly sampled NBW infants born in the Kuala Lumpur Maternity Hospital between 1 December 1989 and 31 December 1992. Infants were followed up regularly during the first year of life, after correction for prematurity. RESULTS: Compared with NBW infants (n = 106), VLBW infants (n = 127) had significantly higher risk of failure to thrive (odds ratio [OR] = 8.0, 95% confidence intervals [CI]: 1.1 to 354.3), wheezing (OR = 3.7, 95% CI: 1.6 to 9.3), rehospitalization (OR = 2.3, 95% CI: 1.1 to 5.0), cerebral palsy (OR = 8.6, 95% CI: 2.0 to 77.6), neurosensory hearing loss (OR = 12.0, 95% CI: 1.7 to 513.6) and visual loss (7.9 vs 0%, P = 0.002). The mean mental developmental index (MDI) and mean psychomotor developmental index (PDI) at 1 year of age were significantly lower among VLBW infants (MDI 99 [SD = 28], PDI 89 [SD = 25]) than NBW infants (MDI 106 [SD = 18], PDI 101 [SD = 18]) (95% CI for difference between means being MDI: -14.1 to -1.7; and PDI: -17.6 to -6.0). Logistic regression analysis showed that among VLBW infants: (i) male sex, Malay ethnicity and bronchopulmonary dysplasia were significant risk factors associated with wheezing; (ii) longer duration of oxygen therapy during the neonatal period, seizures after the post-neonatal period and wheezing were significant risk factors associated with rehospitalization; and (iii) longer duration of oxygen therapy during the neonatal period was a significant risk factor associated with adverse neurodevelopmental outcome during the first year of life. CONCLUSIONS: Compared with NBW infants, VLBW Malaysian infants had significantly higher risks of physical and neuro-developmental morbidities.     

Cholestasis syndrome in newborn infants: value of gallbladder ultrasound

AIM OF STUDY: To review the incidence, morbidity and mortality of Meconium Aspiration Syndrome (MAS). To identify possible predictors of MAS in newborns with thick meconium-stained amniotic fluid (MSAF) at delivery. METHODOLOGY: Case records of babies with MSAF delivered in Singapore General Hospital from 1.1.1991 to 31.12.1993 were studied retrospectively. RESULTS: In the study period, 1,893 babies (15% of live births) had MSAF and 174 babies (1.4% live births) developed MAS. The incidences of MAS in newborns with light, moderate and thick MSAF were 0.3%, 5.8% and 61% respectively. Complications associated with MAS were metabolic acidosis (52%), air leak syndrome (2%), persistent pulmonary hypertension (2%) and hypoxic ischaemic encephalopathy (0.5%). The mortality rate of babies with MAS was 2%. Newborns with thick MSAF were more likely to develop MAS if they were males, small-for- gestational-age, had fetal distress and meconium was sucked from the trachea at birth. CONCLUSION: Vigilant perinatal monitoring of high risk babies with MSAF and proper resuscitation at birth would help reduce the incidence of MAS and its associated complications.     

Increasing social variation in birth outcomes in the Czech Republic after 1989

OBJECTIVES: This study investigated social variation in birth outcome in the Czech Republic after the political changes of 1989. METHODS: Routinely collected records on singleton live births in 1989, 1990, and 1991 (n = 380,633) and 1994, 1995, and 1996 (n = 286,907) were individually linked to death records. RESULTS: Mean birthweight fell from 3,323 g to 3,292 g (P < .001) between 1989 and 1991 and then increased to 3,353 g by 1996. The gap in mean birthweight between mothers with a primary education and those with a university education, adjusted for age, parity, and sex of infants, widened from 182 g (95% confidence interval [CI] = 169, 19) in 1989 to 256 g (95% CI = 240, 272) in 1996. Similar trends were found for preterm births. Postneonatal mortality declined most among the better educated and the married. The odds ratio for postneonatal death for infants of mothers with a primary (vs university) education, adjusted for birthweight, increased from 1.99 (95% CI = 1.52, 2.60) in 1989 through 1991 to 2.39 (95% CI = 1.55, 3.70) in 1994 through 1995. CONCLUSIONS: Despite general improvement in the indices of fetal growth and infant survival in the most recent years, social variation in birth outcome in the Czech Republic has increased.