Quantitated fetal heart rhythm at 20, 32 and 38 weeks of gestation and dependence on rest-activity patterns.

Quantitative parameters of fetal heart rate (FHR) were automatically analysed at 20, 32 and 38 weeks of pregnancy. FHR was obtained both by the fetal ECG method and by wide range Doppler ultrasound with autocorrelation. At 32 and 38 weeks, FHR was studied in relation to fetal rest-activity according to the fetal behavioural state concept (coincidence 1F and 2F). Basal fetal heart rate was significantly higher at 20 weeks of gestation than at 32 and 38 weeks. The number of accelerations increased significantly from 20 weeks to 32 and 38 weeks for C2F periods. Parameters of FHR variability, i.e. ID, ABB, LTI indices and bandwidth, were higher during periods C2F compared to periods C1F. Lowest values of all four parameters were found at 20 weeks gestation. The ID index, which is a measure of short-term variability increased significantly between 32 to 38 (C2F). The absolute values of ID, ABB and LTI were lower for ultrasound recordings than for the fetal ECG.     

Diurnal and other variations in fetal movement and heart rate patterns at 20-22 weeks

It was investigated when diurnal and other variations in fetal movements and in heart rate pattern emerge during the course of pregnancy. Real-time ultrasound observations were made at 13 weeks of gestation in 7 nulliparous women and at 20-22 weeks in 10 nulliparous women. The observations took place at 0800, 1300 and 2200 and lasted 60 min/session at 13 weeks and 120 min at 20-22 weeks. The fetal heart rate was recorded for 24 h at 20-22 weeks using electrocardiographic electrodes. No diurnal variations were found for any of the movement patterns at 13 weeks. At 20-22 weeks, however, significant diurnal changes were observed in the total activity, the incidence of general movements and the breathing movements, with the lowest values in the morning and the highest during the evening. Fetal breathing movements already appeared to be related to maternal meals at 20-22 weeks as their incidence was significantly lower during the third hour after meals compared to the second hour. The rank order of the incidence of movements (from high to low incidence) was fairly constant over the course of the day both at 13 and at 20-22 weeks. This confirms earlier findings that the rank order of movements is strictly age dependent. Diurnal rhythms were observed for both the fetal heart rate and its variation. The fetal heart rate was lowest between 2400 and 0600 and the heart rate variation was lowest between 0600 and 1100. The incidence of accelerations and decelerations showed no systematic fluctuations over the 24-h period. Decelerations occurred more frequently than accelerations. Episodes of high heart rate variation were associated with an increased incidence of general movements. The various diurnal variations over 24 h at 20-22 weeks generally followed the same temporal sequence as those found near term, although the changes were considerably smaller.     

Neurodevelopmental outcome at 2 years in 23 to 26 weeks old gestation infants

BACKGROUND: Assessment of neurologic and developmental outcome at 2 years age of infants with gestational age (GA)<27 weeks, born between 1996-2001. PATIENTS: A total of 110 live-born preterm infants with GA<27 weeks. METHODS: Main outcome criterions: Neurologic examination (according to Touwen) and classification of cerebral palsy by using the Gross Motor Function Classification System (GMFCS) at the corrected age of 1 and 2 years; assessment of mental and psychomotor development by using the Griffith Mental Development scales at the corrected age of 2 years; growth assessment at birth, 1 and 2 years. RESULTS: Mortality was 52%. Regular follow up was performed in 48 (91%) of the 53 surviving infants. Neurologic outcome: at 1 year age: 2% nonambulant cerebral palsy, 25% mild neurologic signs and 73% normal; at 2 years age: 4% nonambulant cerebral palsy, 2% ambulant cerebral palsy, 4% mild neurologic signs and 90% normal neurology. Developmental outcome at 2 years age: 40% DQ>-1 SD, 6% DQ between -1 SD and -2 SD (mild delay), 35% DQ between -2 SD and -3 SD (moderate delay) and 19% DQ<-3 SD (severe delay). Overall disability was found in 64%, severe disability in 27% of the infants. Profound growth failure in weight and head circumference<3rd centile at 2 years age was recorded in 39 and 19% of the infants, respectively. CONCLUSION: Developmental delay is very common in preterm infants<27 GA and exceeds the number of neurological disabilities (including cerebral palsy).     

Radiographic patterns and viral studies in childhood pneumonia at various ages

We aimed at evaluating the relationship between microbial, etiology and chest radiograph appearance in various types of pneumonia. In a prospective study, the radiographic findings in 479 cases of acute pneumonia in children were compared with viral etiology and growth of potential bacterial pathogens in nasopharyngeal secretion. As the basis for viral etiology was most conclusive, the material was here classified according to the viral findings. The patients were divided into three age groups: 0–2, 3–5 and 6–15 years. The chest radiograms were analyzed blindly for the presence of hyperinflation and interstitial, alveolar and mixed interstitial-alveolar infiltrates. There was a statistically significant relationship between low age and occurrence of hyperinflation and interstitial infiltrates, and between high age and alveolar infiltrates. No unequivocal relationship was found between type of infiltrates or presence of atelectasis and proven viral etiology. We conclude that chest radiographs are not a useful indicator of microbial etiology in childhood pneumonia.     

Position of heart in relation to sternum and nipple line at various ages.

Frontal X-ray pictures of 210 healthy children from birth to twelve years of age with radio-opaque markers at sternal ends and both nipples were reviewed. The position of centre of cardiac silhouette was correlated with sternal areas and internipple line. The heart was found to descend with age, its centre lying beneath mid-sternum during first six months of life and beneath lower sternum after infancy (p less than 0.001). The position did not vary with age in relation to internipple line (p greater than 0.05). In 77.6% of all children, it was below the internipple line and in 22.4% above or at the internipple line. Because of the erratic relationship of cardiac centre with internipple line, the latter should not be considered a landmark for cardiac position. External cardiac massage should be applied in relation to sternum and at different locations according to the age. Sites for optimal compression have been suggested. No sexual dimorphism was observed.     

Feeding patterns of full-term and preterm infants at forty weeks postconceptional age

Little research exists that addresses the differences in feeding skills between preterm (PT) infants at term and full-term (FT) infants. The purpose of this study was to quantify and examine the differences in sucking abilities of PT infants when measured at 40 weeks postconceptional age (PCA) and newly born FT infants. The sample consisted of 213 infants who were divided into three groups on the basis of their gestational age at birth (24-29 wk, 30-32 wk, and 38-42 wk). The Kron Nutritive Sucking Apparatus (KNSA) was used to examine the microstructure of sucking and feeding behaviors. There were significant differences among the three groups in several of the sucking variables: number of bursts (p = .005), intersuck interval (p = .0212), sucks per burst (p = .0003), suck width (p < .0001), intersuck width (p < .0001), mean maximum pressure (p < .0001), and intersuck width/interburst width (p = .02). The findings from this study demonstrate the importance of both maturation at birth and experience as factors influencing feeding behaviors.     

Iron status at 1 and 6 years versus developmental scores at 6 years in a well-nourished affluent population

Aim: To examine the association between iron status at 1 and 6 years with development at 6 years.
Methods: In a longitudinal study of children (n = 77), iron status was measured at 1 and 6 years and the Icelandic Developmental Inventory, which evaluates children's motor and verbal development, was filled in by mothers near the children's sixth birthday.
Results: Children, iron-deficient at 1 year (n = 10), had lower fine motor development scores at 6 years than non–iron-deficient (n = 56) (46.7 ± 4.1 vs. 49.3 ± 2.0; p = 0.011). Fine motor scores were also lower in children with depleted iron stores at 1 year (n = 26) than non–iron-depleted children (n = 40) (48.0 ± 3.3 vs. 49.5 ± 1.8; p = 0.045). Multiple regression analyses, with iron status indices at 6 years, showed that mean corpuscular volume along with male gender predicted significantly positively for expression (adj. R ²= 0.15; p = 0.018; n = 73), while regression analyses, including iron status at 1 and 6 years, showed that haemoglobin at 6 years was positively associated with gross motor (adj. R ²= 0.05; p = 0.038; n = 63).
Conclusions: In an affluent society, iron deficiency and depleted iron stores at 1 year may contribute to worse fine motor developmental scores at 6 years, while low mean corpuscular volume and haemoglobin at 6 years might affect subsequent expression and gross motor scores negatively.
Sponsorship: The Icelandic Research Council.     

不同胎龄新生儿心电图心率及各时限特点的研究

目的 观察不同胎龄新生儿心率、P-R、QRS问期及经心率校正后的QT间期(QTLc)的特点,为新生儿心电图诊断提供科学依据.方法 不同胎龄新生儿共142例,按胎龄分为:28～30周组、31～33周组、34～36周组、37～40周组.测量心率、P-R、QRS时限及QTLc.结果 不同胎龄新生儿心率随胎龄增长而减慢,P-R间期相应延长,各组间比较差异有非常显著性(P＜0.01);不同胎龄新生儿QRS间期及QTLc无明显变化.结论 不同胎龄新生儿心率及P-R间期变化与胎龄相关,而QRS间期及QTLc与胎龄无明显相关.     

长沙市2～12 岁儿童睡眠障碍流行病学调查

目的：了解长沙市2～12岁儿童的睡眠时间和睡眠障碍的发生情况,为有针对性的进行干预提供指导。方法：2006年6月~2007年4月,在长沙市5个行政区采用分层随机抽样方法调查3 756名2～12 岁儿童的睡眠情况,由专人负责对其家长进行问卷调查。结果2～12 岁儿童每天平均睡眠时间为10.60 h。从2~12岁共11个年龄组儿童的每天平均睡眠时间分别为12.26,11.57,11.33,11.26,10.95,10.64,10.62,10.45,10.28,9.83和9.61 h。2～12 岁儿童睡眠障碍总发生率为40.9%,其中睡眠时频繁鼾症发生率为8.2%,喉头哽咽1.5%,睡眠呼吸暂停0.8%,睡眠不安7.6%,张口呼吸4.9%,睡眠中多汗22.6%,睡眠中肢体抽动3.2%,磨牙9.5%,梦呓5.5%,梦游0.9%,夜间遗尿2.5%(≥5岁),不明原因睡眠中觉醒或憋醒1.9%。白天睡得多、夜间清醒者1.5%,入睡过早 2.1%,易惊醒者1.6%,睡眠中出现尖叫、哭喊者1.8%。不同症状的发生率存在性别、年龄差异。结论长沙市2～5岁年龄组儿童睡眠时间略低于儿童保健学要求的同年龄段儿童睡眠时间需求标准,长沙市2～12 岁儿童睡眠障碍发生率较高,高于其他城市的调查水平,需引起儿童保健工作者及儿童父母的重视。     

Behaviour at 2 years of age in very preterm infants (gestational age < 32 weeks)

AIM: The objective of this study was to determine behavioural outcome and risk factors for abnormal behaviour at 2 y corrected age in very premature infants in a regionally defined, prospective cohort study. METHODS: The Leiden Follow-Up Project on Prematurity includes all liveborn infants of < 32 wk gestational age, born in 1996/1997 (n = 266). Behaviour was assessed with the Child Behaviour Checklist 2-3. RESULTS: An analysis of 158 questionnaires of 206 survivors (77%) was carried out. Fourteen children (9%) had a total problem score > p90 ("clinical range"). This percentage is comparable with the 10% found in a sample of 2- to 3-y-olds from the Dutch general population. Univariate analysis showed higher syndrome scale scores in one or more of the Child Behaviour Checklist scales in children of lower gestational age, small for gestational age (birthweight < p10), with neurological abnormalities at term or at 2 y and of non-Dutch origin. Lower socioeconomic status and postnatal treatment with dexamethasone were associated with higher scores in the somatic problems scale and lower maternal age at birth with a higher total problem score. After correction for confounding variables, the associations between small for gestational age, neurological abnormalities at 2 y and the anxious/depressed and/or withdrawn scales remained significant. CONCLUSION: The prevalence of behavioural problems at 2 y corrected age in this cohort of very premature infants (gestational age < 32 wk) was comparable with that in a general population sample. Children born small for gestational age or with neurological abnormalities at 2 y of age had higher syndrome scale scores, mainly for anxious/depressed and/or withdrawn behaviour.     

Language skills at age 6 years in Swedish children screened for language delay at 2(1/2) years of age

This study concerns language outcome in 6-y-old children who participated in a longitudinal community-based study of 105 children screened for language delay (LD) at 2(1/2) y of age. The purpose was to investigate (1) whether results from the 2(1/2)-y screening were persistent at 6 y of age, and (2) what language domains at age 6 were difficult for (a) children with LD at age 2(1/2) y and (b) children with normal language (LN) at the same age. Significant differences between LD and LN at age 2(1/2) y were persistent at age 6. The vulnerability that was identified at 2(1/2) y of age, such as problems with going from single-word utterances to multi-word utterances, seems to persist as delayed development at different language levels and across language domains. CONCLUSION: This study has shown that children who failed the 2(1/2)-y screening are at high risk of having persistent language problems at age 6 y.     

Sonographic markers of aneuploidies at 6-10 weeks of gestation

Objectives

To determine if sonographic features of live embryos at 6-10 weeks' gestation are altered in aneuploidies.

Methods

Embryonic crown rump length (CRL), embryonic heart rate, gestational sac diameter (GSD) and yolk sac diameter (YSD) were measured by transvaginal sonography in 5603 live embryos from singleton pregnancies at 6-10 weeks' gestation. The measurements were expressed as differences from the expected normal mean for CRL (delta values) and median delta values in the aneuploid cases were compared to the euploid group.

Results

5393 pregnancies resulted in the live birth of phenotypically normal neonates and these cases constituted the euploid group. In 55 cases there was subsequent prenatal diagnosis of aneuploidies (trisomy 21, n = 28; trisomy 18, n = 10; trisomy 13, n = 10; triploidy, n = 4; Turner syndrome, n = 3). The median and interquartile range (IQR) of delta embryonic heart rate in trisomy 18 was − 19.44 (− 23.77 to − 7.20) bpm and in trisomy 13 it was 11.12 (7.25 to 20.39) bpm, which were significantly lower and higher, respectively, than in euploid embryos (median − 0.05, IQR − 6.18 to 6.21 bpm). The median delta YSD in trisomy 21 was higher than in euploid fetuses (median 0.56, IQR 0.23 to 0.79 and median − 0.17, IQR − 3.11 to 2.82 mm). There were no other significant differences in measurements between the groups.

Conclusion

At 6-10 weeks' gestation there are sonographically detectable differences between euploid and trisomic embryos.     

Renal transplantation in children ages 1 to 5 years.

Renal transplantation was carried out in 21 children ages 1 to 5 years. Eighteen received grafts from a living, related donor (LRD). Four children died, one following rejection, and three because of infection. Five children lost their initial grafts and two have received new transplants. Cumulative patient survival two and four years following LRD transplantation was 94% and 76%, respectively. This was similar to results found in children ages 6 to 14 years. Accelerated growth rates were seen in the first posttransplant year in those small children who were severely growth-retarded at the same time of transplantation and who achieved normal graft function. However, only one of these children ultimately reached the tenth percentile for height for chronological age. We conclude that renal transplantation is warranted in the very young child with renal failure.     

Neonatal behaviour characteristics and psychological problems at 6 years

Aim: To examine the predictive capacity of the Neonatal Behavioral Assessment Scale (NBAS) on psychological problems at the age of 6 y. Methods: Eighty full-term infants of optimal health were evaluated at 3 d and 4 wk of age with the NBAS and at 6 y with the Child Behavior Checklist (CBCL) and the Inattention-Overactivity with Aggression Conners Teacher's Rating Scale (IOWA). Results: The NBAS clusters' predictive value was different at 3 d and at 4 wk. Orientation at 3 d and habituation at 4 wk were the best predictors of psychological problems. At 3 d, lower orientation scores and higher motor and habituation scores predicted higher scores in externalizing problems. Externalizing problems were least influenced by background variables. Only in girls were internalizing problems associated with lower orientation scores. At 4 wk, lower habituation cluster scores predicted higher scores in internalizing problems.
Conclusion: These findings suggest that the NBAS could be useful for identifying neonates at risk of later psychological problems.