Neurologic evolution of children of low birth weight

The prematurity is still an important problem for either pediatricians and neuropediatricinas. All the mechanisms that can produce lowbirth weight, are not known, although many of them are related to genetics and environmental intra-uterine factors. Having in mind tha study of the development of such type of children, a group of investigators has been working for 9 years now, envolving aspects related to the Pediatry, Social Pediatry, Neuropediatry, Psychiatry, Otorhynolaringology, Ophtalmology and Odontology. In this study they are trying to envolve all the possible aspects on growth and development of children with lowbirth weight. In 189 children, 129 were followed during several years. Most of them were observed up to 5 years of age and few of them up to 9 years of age. The children were divided into three groups as follow: Group I-Children with weights under 1.750 g; Group II-Children with weights between 1.751 and 2.000 g; Group III-Children with weights over 2.001 g and under 2.500 g. The neurol-gical tests were done according to the used system at the Neurologic Clinic of the Faculty of Medicine (University of S?o Paulo). The present work starts with a general revision on the most important existent papers on the prematures neurological evolution. After presenting his own results, the authors make a correlaction of the neurologic evolution with the developmental quotient (DQ), which were gotten through Gesell's tests and its variations, in order to verify the existence of what is known as "continuum of lesion" of Knobloch and col.     

The structure of the morbidity in very low birth weight premature infants]

A relationship between the qualitative and quantitative characteristics of representatives of the normal microflora in biocenosis of the colonic lumen (CL) was studied in 18 patients with subacute bacterial endocarditis, 18 patients with rheumatic heart disease, 13 with chronic renal failure and 50 healthy individuals without clinical signs of dysbacteriosis. The number of intermicrobial relationships was found to be rather small both in health and in disease. However, a disease shows a considerably greater number of different relations, synergic ones in particular. Analysis indicated that in the conditions under study 72 to 93% of relations that were realized in the healthy human CL biotope disappeared and the established intermicrobial relationships were found 86-97% quite new. Summing up, the authors have concluded that, first, the CL microflora exists under the conditions of excess nutrient substrate and is not a factor of self-regulation, second, changes in the body's metabolic systems are primary in the diseases examined, which the normal lumenal microflora is responsive to.     

Tracheostomy: acute and long-term mortality and morbidity in very low birth weight premature infants

Thirty-six very low birth weight premature infants (VLBW-PT) born at 24 to 32 weeks gestation and with birth weights 635 to 1,360 g who had tracheostomies performed for acquired subglottic stenosis or for prolonged mechanical ventilation were followed in relation to acute and long-term mortality and morbidity. Mortality due to the tracheostomy occurred in 4 patients (11%); mortality from all other causes was 25%. Death after hospital discharge was associated with the nonuse of prescribed cardiorespiratory monitors. Complications < 1 week postsurgery occurred in 31% of infants and complications > or = 1 week postsurgery occurred in 64% of infants. Fifty percent of infants required tracheostomy for > 2 years and/or extensive reconstructive surgery of the airway. Parents should be counselled that VLBW-PT infants with a tracheostomy may require extended medical and home care. An effective home care program requires parental training in tracheostomy care, the use of ancillary equipment, and infant cardiopulmonary resuscitation.     

Changes in the visual system in low birth weight children

PURPOSE: Evaluation of the visual system, especially refraction, in children with low birth weight under observation between 1990-1992. MATERIAL AND METHODS: 248 children with birth weight 600-2500 g and gestational age 26-37 weeks underwent ophthalmological examination including USG, ERG and VER. The children were first examined between 3-4 weeks of life, then at 8 and 12 weeks and 6, 12, 18 and 24 months. RESULTS: Refractive errors were found in 216 of patients, in 85.2% hypermetropia. ROP occurred in 7 children with birth weight below 1500 g and gestational age 27-32 weeks. Other ocular changes were observed in 19 (7.6%) of the examined children.     

Factors in low birth weight

In this paper we compare the acute psychiatric wards in Hedmark county and the catchment area of Ullev?l hospital with regard to involuntary hospitalizations and admission rates for psychosis during the period 1989-94. In the former area the percentage of involuntary admissions decreased from 58% to 48% during the period, but in the Ullev?l catchment area it remained fairly stable at 85%. The latter area showed a higher percentage of involuntary hospitalizations for both psychotic and non-psychotic patients. The admission rate for psychotic patients was higher in the Ullev?l catchment area and tended to increase in the course of the study period. We relate our findings primarily to a higher incidence of psychiatric disorders in a city like Oslo. Structural differences in psychiatric and primary care, especially for long-term patients may also be a contributory factor.     

Comparative outcome of low birth weight babies

The rapid evaluation method (REM) was developed by WHO in order to assess the performance and quality of health care services, identify operational problems, and assist in taking managerial action. It was tested in five developing countries (Botswana, Madagascar, Papua New Guinea, Uganda and Zambia) between 1988 and 1991. REM consists of a set of observation- and survey-based diagnostic activities, carried out mainly in health care facilities. The article describes the various steps of REM, methodological issues such as setting objectives and using an issue-information matrix, preparation of survey instruments, use of computer software (Epi Info), data quality control, fieldwork, and the use of data to produce useful information for decision-makers. REM aims at bringing prompt and relevant information to planners and decision-makers who need it for a specific purpose. In the present examples, REM provided information for preparing a programme proposal for external funding, for establishing baseline data for a situation analysis, and for assessing staff performance after extensive training in order to improve the curriculum.     

Oral feeding in low birth weight infants

To gain a better understanding of the development of sucking behavior in low birth weight infants, the aims of this study were as follows: (1) to assess these infants' oral feeding performance when milk delivery was unrestricted, as routinely administered in nurseries, versus restricted when milk flow occurred only when the infant was sucking; (2) to determine whether the term sucking pattern of suction/ expression was necessary for feeding success; and (3) to identify clinical indicators of successful oral feeding. Infants (26 to 29 weeks of gestation) were evaluated at their first oral feeding and on achieving independent oral feeding. Bottle nipples were adapted to monitor suction and expression. To assess performance during a feeding, proficiency (percent volume transferred during the first 5 minutes of a feeding/total volume ordered), efficiency (volume transferred per unit time), and overall transfer (percent volume transferred) were calculated. Restricted milk flow enhanced all three parameters. Successful oral feeding did not require the term sucking pattern. Infants who demonstrated both a proficiency > or = 30% and efficiency > or = 1.5 ml/min at their first oral feeding were successful with that feeding and attained independent oral feeding at a significantly earlier postmenstrual age than their counterparts with lower proficiency, efficiency, or both. Thus a restricted milk flow facilitates oral feeding in infants younger than 30 weeks of gestation, the term sucking pattern is not necessary for successful oral feeding, and proficiency and efficiency together may be used as reliable indicators of early attainment of independent oral feeding in low birth weight infants.     

Maternal risk factors in infants with very low birth weight

To determine whether maternal risk factors associated with the delivery of very low birth weight infants under 1501 g are different from those associated with low birth weight infants of 1501 to 2500 g, prenatal data on 12,247 deliveries were evaluated. The sample contained 302 very low birth weight infants. Maternal race, age, height, weight, gravidity, parity, past pregnancy performance, and pregnancy complications were analyzed. Factors related to very low birth weight but not to low birth weight infants were previous abortions, previous fetal deaths, and hypertensive vascular disease. Race, maternal height, and prepregnancy weight were not related to very low birth weight but were associated with an increase in low birth weight. There was no significant difference in the rate of very low birth weight or low birth weight by maternal age from 14 to 40 years. These results contradict the concept of a uniform set of predisposing factors for birth of all infants weighing 2500 g or less.     

Very low birth weight children at school age: comparison of neonatal management methods

The outcome of 293 infants born to a geographically defined community and weighing 501-1500 g was investigated. Medical intervention in the newborn period had been avoided. Morbidity was assessed at school age. Of the infants, 236 had been live born in the labour ward of this hospital; of these, 117 (49.6%) died in the neonatal period, one (0.4%) died in the first year, four (1.7%) were untraced, 13 (5.5%) had major handicap, 29 (12.3%) had minor handicap, and 72 (30.5%) were considered to be normal. In terms of survival, handicap, and intellectual with that of infants born over the same period (1963-71) in areas where intensive methods of perinatal care were used. These results imply that postnatal survival and potential of infants of very low birth weight are by no means prejudiced when only experienced nursing care is available.     

First-trimester growth and the risk of low birth weight

BACKGROUND: Previous studies have demonstrated a correlation between first-trimester size and birth weight. It is not known, however, whether low birth weight is related to first-trimester growth. We sought to determine whether the risk of low birth weight and birth weight that was low for gestational age is related to the size of the embryo or the fetus in the first trimester. METHODS: From a data base of ultrasound records of more than 30,000 pregnancies, we identified women who had no important medical problems, a normal menstrual history, and a first-trimester ultrasound scan in which the crown-rump length of the embryo or fetus had been measured. We examined the relation between the outcome of 4229 pregnancies and the difference between the measured and the expected crown-rump length in the first trimester, expressed as equivalent days of growth. RESULTS: A first-trimester crown-rump length that was two to six days smaller than expected was associated with an increased risk (as compared with a normal or slightly larger than expected crown-rump length) of a birth weight below 2500 g (relative risk, 1.8; 95 percent confidence interval, 1.3 to 2.4), a birth weight below 2500 g at term (relative risk, 2.3; 95 percent confidence interval, 1.4 to 3.8), a birth weight below the fifth percentile for gestational age (relative risk, 3.0; 95 percent confidence interval, 2.0 to 4.4), and delivery between 24 and 32 weeks of gestation (relative risk, 2.1; 95 percent confidence interval, 1.1 to 4.0), but not with delivery between 33 and 36 weeks (relative risk, 1.0; 95 percent confidence interval, 0.7 to 1.5). CONCLUSIONS: Suboptimal first-trimester growth may be associated with low birth weight, low birth-weight percentile, and premature delivery.     

Geographic patterns of low birth weight in Hawaii

This study examines areal variations in low birth weight, using the census tract as the unit of analysis. Reports from the 1980 U.S. census were used to develop summary indicators of environmental and socio-economic conditions, including poverty, employment, education and crowding, for 155 census tracts in the state of Hawaii. Maternal socio-demographic, prenatal care utilization, and medical risk indicators and low birth weight percentages for resident, single live births were extracted from the Hawaii 1979-1987 vital record live birth files and aggregated by census tract. Multiple regression analysis was used to develop a model that predicted 61% of the variation among census tracts in the percentage of low birth weight. Patterns of low birth weight were primarily associated with ethnic patterns of maternal residence and single marital status. There was no association between inadequate prenatal care and low birth weight at the census tract level.     

Long-term developmental outcomes of low birth weight infants

Advances in neonatal medicine have resulted in the increased survival of infants at lower and lower birth weight. While these medical success stories highlight the power of medical technology to save many of the tiniest infants at birth, serious questions remain about how these infants will develop and whether they will have normal, productive lives. Low birth weight children can be born at term or before term and have varying degrees of social and medical risk. Because low birth weight children are not a homogeneous group, they have a broad spectrum of growth, health, and developmental outcomes. While the vast majority of low birth weight children have normal outcomes, as a group they generally have higher rates of subnormal growth, illnesses, and neurodevelopmental problems. These problems increase as the child's birth weight decreases. With the exception of a small minority of low birth weight children with mental retardation and/or cerebral palsy, the developmental sequelae for most low birth weight infants include mild problems in cognition, attention, and neuromotor functioning. Long-term follow-up studies conducted on children born in the 1960s indicated that the adverse consequences of being born low birth weight were still apparent in adolescence. Adverse sociodemographic factors negatively affect developmental outcomes across the continuum of low birth weight and appear to have far greater effects on long-term cognitive outcomes than most of the biological risk factors. In addition, the cognitive defects associated with social or environmental risks become more pronounced as the child ages. Enrichment programs for low birth weight children seem to be most effective for the moderately low birth weight child who comes from a lower socioeconomic group. Continued research and attempts to decrease the rate of low birth weight and associated perinatal medical sequelae are of primary importance. Ongoing documentation of the long-term outcome of low birth weight children needs to be mandated, as does the implementation of environmental enrichment programs to help ameliorate the long-term consequences for infants who are born low birth weight.     

Spatial location memory discriminates children born at extremely low birth weight and late-preterm at age three.

Objective: The spatial location memory of preschool-aged children born preterm has rarely been studied primarily due to an absence of developmentally sensitive measures. This study aimed to address this gap in the literature. Method: We administered a modification of the Hopkins Board to 135 children at age 3 who were born extremely low birth weight (ELBW) (n = 20), late-preterm (LPT) (n = 75), or at term (TERM) (n = 40). Five measures were obtained: naming, trials-to-criterion, errors-to-criterion, delayed item recall, and delayed location recall. Results: ANCOVA indicated that the groups differed in naming (p = .019), errors-to-criterion (p = .002), and delayed item recall (p = .025). For these measures, ELBW performed worse than TERM and LPT, but LPT did not differ from TERM. Corrected age and sociodemographic factors did not eliminate the deficit in spatial location learning for ELBW participants. A MANCOVA found a significant difference in learning, with post hoc tests indicating significant learning across trials in the LPT and TERM groups, but not in the ELBW group. Conclusions: ELBW is a significant risk factor for developmental delay or impairment of spatial location learning. These findings suggest that the modified Hopkins Board identifies at-risk premature children. This modification may be more broadly useful to assess preschoolers' neurodevelopmental maturation. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Attachment security in very low birth weight infants.

34 infants of very low birth weight (VLBW) and a comparison group of 40 full-term infants were observed in the Strange Situation of M. D. Ainsworth et al (1978) at 14 and 19 mo and observed in the home at 14 mo of age, using E. Waters's (1995) Attachment Q-set. Results indicated that at 14 mo VLBW infants were more likely than the full-term infants to be insecurely attached when rated using the Q-set but not when using the Strange Situation. However, at 19 mo VLBW infants were also more likely than full-term infants to be insecurely attached in the Strange Situation assessment. There were no associations between the Q-set and Strange Situation measures of attachment security. These results are discussed in terms of the social-emotional development of VLBW infants. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Caffeine intake and low birth weight: a population-based case-control study

The authors conducted a matched case-control study to investigate the effects of caffeine intake during pregnancy on birth weight. From January to November 1992, in the first 24 hours after delivery, 1,205 mothers (401 cases and 804 controls) were interviewed and their newborns were examined to assess birth weight and gestational age by means of the method of Capurro et al. (J Pediatr 1978;93:120-2). The cases were children with birth weight < 2,500 g and gestational age > or = 28 weeks. Cases and controls were matched for time of birth and hospital of delivery and were recruited from the four maternity hospitals in Pelotas, southern Brazil. Daily maternal caffeine intake during pregnancy for each trimester was estimated. To assess caffeine intake, 10% of the mothers were reinterviewed at their households and samples of reported information on drip coffee and maté (a caffeine-containing drink widely used in South America) were collected and sent to the laboratory for caffeine determination through liquid chromatography. When instant coffee was reported, the weight of powder was measured using a portable scale, and caffeine intake was estimated from a reference table. Caffeine intake from tea, chocolate, soft drinks, and medicines was estimated from a reference table. Analyses were performed by conditional logistic regression. Crude analyses showed no effect of caffeine on low birth weight, preterm births or intrauterine growth retardation. The results did not change after allowing for confounders.     

Cerebral MRI of very low birth weight children at 6 years of age compared with the findings at 1 year

The objective was to describe a new surgical technique to manage a posteriorly dislocated crystalline lens. Four patients with posteriorly dislocated lenses were studied. Two patients had dislocated lenses secondary to trauma, 1 had undergone retinal detachment surgery, and 1 had an idiopathic lens dislocation. Pars plana vitrectomy was carried out on all 4 eyes, followed by an injection of perfluoro-n-octane to float the lens off the retina. The lens was phacoemulsified through a limbal incision, and an intraocular lens was positioned in the ciliary sulcus with suture fixation. Perfluoro-n-octane was replaced by a balanced salt solution. Postoperative visual acuity ranged from 1.0-1.5. Transient choroidal detachment and hypotony were observed in 3 eyes in the early postoperative period. Postoperative ocular hypertension was noted in 2 eyes and was well-controlled with topical antiglaucoma agent. These results indicate that limbal lensectomy of a posteriorly dislocated lens using perfluorocarbon liquids is a beneficial and relatively safe method.     

On carnitine requirements in full term and low birth weight neonates

The concentration of total carnitine in the blood serum of 15 newborns between days 5-21 of life was determined. The concentration of carnitine in low-birth-weight newborns is decreased in comparison with normal weight newborns; this deficiency may increase as a consequence of lack of carnitine provided with food or concomitant infection. The authors suggest that supplementation with carnitine be provided to this group of patients so as to prevent possible metabolic and clinical consequences.