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the associations between small for gestational age, neurological abnormalities at 2 y and the anxious/depressed and/or withdrawn scales remained significant.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or with neurological abnormalities at 2 y of age had higher syndrome scale scores, mainly for anxious/depressed and/or withdrawn behaviour.     

Interaction between mothers and infants born at risk during the first six months of corrected age

Abstract The effects of preterm birth and the perinatal infant health condition on mother-infant interactions were analysed in 278 mother-infant pairs, divided into four groups according to infants' gestational age at birth: group 1. 23–31 weeks; group 2,32–36 weeks; group 3, 37–42 weeks; and group 4, a control group of healthy full-term infants. The methodological approach was based on observation of the pairs at 2,4 and 6 months of infants" corrected age (± 1 week) during undressing of the infant and face-to-face interaction. It was found that mother-infant pairs with preterm infants (groups 1 and 2) did not differ in interactional variables from those of the control group. On the other hand, the birth of a full-term infant in need of neonatal intensive care (group 3) affected maternal and infant interactive behaviour. Additionally, infants from group 3 did not show stability in their interactive behaviour between any ages of measurement. This result suggests that interactive behaviour of full-term infants in need of neonatal intensive care are rather unpredictable during their first 6 months of life, which might have contributed to the less optimal interactive pattern observed for their mothers compared with mothers of the control group.     

Agreement of invasive versus non‐invasive blood pressure in preterm neonates is not dependent on birth weight or gestational age

Purpose: Blood pressure constitutes an important parameter in the assessment of the cardiovascular status in preterm infants. Invasive arterial blood pressure (IBP) is considered the ‘gold‐standard’, but non‐invasive blood pressure (NIBP) is used frequently in preterm infants. The aim of this prospective study was to compare mean IBP and mean NIBP arterial blood pressure measurements in three subsets of preterm infants (>1500 g; 1000–1500 g, and <1000 g, and >31 weeks, 28–31 weeks, and <28 weeks of gestation). Methods: Prospective, simultaneous assessment of both IBP and NIBP measurements in 50 preterm neonates at 6, 12, 18, 24 h after birth in a tertiary University centre. Results: Mean gestational age was 26.7 ± 2.2 (24–32) in group I (n= 18), 29.6 ± 2.0 (27–34) in group II (n= 19) and 32.2 ± 1.9(30–36) weeks in group III (n= 13), respectively; mean birth weight was 777 ± 161 (495–995), 1251 ± 154 (1010–1490) and 2010 ± 332 (1590–2550) g. Mean IBP and mean NIBP increased significantly during the first 24 h of life in all three sub‐groups (P < 0.01); IBP and NIBP measurements were significantly correlated, and showed good agreement, irrespective of birth weight and gestational age. Conclusions: Although IBP monitoring is considered the ‘gold standard’, NIBP values showed good agreement with those obtained invasively irrespective of gestational age and birth weight. We conclude that NIBP monitoring constitutes an important parameter in the assessment of the cardiovascular status even in extremely low birth weight infants.     

晚期早产儿中小于胎龄儿的临床特点

目的探讨晚期早产儿中发生小于胎龄儿(SGA)的围产期因素及新生儿期患病特点。方法对2009年10月至2010年9月在我院新生儿重症监护病房住院、胎龄34～36周的晚期早产儿临床资料进行回顾性分析,比较晚期早产儿中SGA和适于胎龄儿(AGA)的围产期因素及新生儿期患病情况。结果 SGA组(179例)住院天数明显长于AGA组(851例)[(16.4±6.2)天比(11.3±4.1)天,P<0.05]。SGA组母亲妊娠期高血压疾病(HDCP)、多胎妊娠、羊水过少和宫内窘迫的比例均高于AGA组(34.1%比17.9%,29.1%比13.7%,21.2%比12.6%,19.6%11.0%,P均<0.01)。SGA组患儿新生儿窒息、喂养不耐受、颅内出血、低血糖和红细胞增多症的发生率亦明显高于AGA组(12.8%比7.9%,7.8%比3.1%,6.1%比2.6%,27.4%比21.4%,3.4%比0.2%,P均<0.05)。结论母亲HDCP和多胎妊娠是造成晚期早产儿SGA的主要原因,SGA患儿相对于AGA患儿具有更高的患病风险,应针对造成SGA的围产期因素以及新生期疾病特点进行相应预防和干预。     

The rate of candidaemia in preterm infants born at a gestational age of 23-28 weeks is inversely correlated to gestational age

AIM: To assess the rate of candidaemia and the associated case fatality rate in relation to gestational age, and the variation in the rate of candidaemia over time in the neonatal period. METHODS: Retrospective review of medical records of infants with a positive blood culture for fungi while in the neonatal unit, Uppsala University Children's Hospital or at autopsy following death in the unit from 1994 to 2001 (n = 30). RESULTS: The number of cases per year was found to vary between zero and eight. The annual rate of infection did not change significantly during the study period. The preterm infants with candidaemia (n = 29) were born at a gestational age ranging from 23-28 wk. The rate of candidaemia in this group was inversely related to gestational age and varied from 2 to 24%. Five infants (17%) died from Candida infection. Of these five, four were born at a gestational age of 23 wk. CONCLUSION: candidaemia in newborns occurs predominately in infants born at a gestational age < or =28 wk, where the rate of infection is inversely correlated to gestational age in infants born at a gestational age of 23-28 wk. The highest case fatality rate is observed in infants born at a gestational age of 23 wk.     

Females born large for gestational age have a doubled risk of giving birth to large for gestational age infants

AIM: To analyse if females born large for gestational age (LGA) have an increased risk to give birth to LGA infants and to study anthropometric characteristics in macrosomic infants of females born LGA. METHODS: The investigation was performed as an intergenerational retrospective study of women born between 1973 and 1983, who delivered their first infant between 1989 and 1999. Birth characteristics of 47,783 females, included in the Swedish Birth Register both as newborns and mothers were analysed. LGA was defined as >2 SD in either birth weight or length for gestational age. The infants were divided into three subgroups: born tall only, born heavy only and born both tall and heavy for gestational age. Multiple logistic and linear regression analyses were performed. RESULTS: Females, born LGA with regard to length or weight, had a two-fold (adjusted OR 1.96, 95% Cl 1.54-2.48) increased risk to give birth to an LGA infant. Females, born LGA concerning weight only, had a 2.6 (adjusted OR 2.63, 95%, 1.85-3.75) fold increased risk of having an LGA offspring heavy only and no elevated risk of giving birth to an offspring that was tall only, compared to females born not LGA. In addition, maternal obesity was associated with a 2.5 (adjusted OR 2.56, 95%, 2.20-2.98) fold increased risk of having an LGA newborn, compared to mothers with normal weight. CONCLUSION: Females, born LGA, have an increased risk to give birth to LGA infants, compared to mothers born not LGA. Maternal overweight increases this risk even further.     

Assessment of behaviour on the Brazelton scale in healthy preterm infants from 32 conceptional weeks until full-term age

20 healthy preterm infants were assessed weekly by the Brazelton Neonatal Behavioural Assessment Scale from 1–2 weeks after birth until they reached their expected date of birth. The gestational age of the infants ranged from 28 to 34 weeks. Although the full scale could not be used before 36 conceptional weeks. obvious progress in development was found for most items of the scale. In particular there was improvement in orienting responses and in motor performance during the observation period. At full-term age comparisons were made with a group of normal-term infants (n = 80). All premature infants underwent standard neonatal neurological examination at full term, and tests of neurological function and psychomotor development up to the age of 18 months.     

Body composition in appropriate and in small for gestational age infants

The body composition of 70 appropriate for gestational age newborn infants whose gestational age ranged from 32 to 41 weeks was determined by dual-energy X-ray absorptiometry during the first 48 h of life. The evolution of the bone mineral content, fat and lean mass was well correlated with gestational age ( r = 0.66, r = 0.66 and r = 0.82. respectively) but even more closely with birthweight ( r = 0.85, r = 0.91 and r = 0.97. respectively). The body composition of 20 symmetric small for gestational age infants (mean gestational age ± SD = 38.1 ± 1.2 weeks: mean birthweight ± SD = 2117 ± 183 g) was also studied. The total body fat, the lean mass and the bone mineral content of small for gestational age infants were decreased significantly in comparison with those of appropriate for gestational age infants with the same gestational age ( p ≤ 0.05, p ≤ 0.0001 and p ≤ 0.05) but was not significantly different from those observed in appropriate for gestational age infants of the same birthweight.     

Effect of exclusive breast‐feeding and early solid food avoidance on the incidence of atopic dermatitis in high‐risk infants at 1 year of age

The aim of this study was to assess the preventive effect of exclusive breast‐feeding and early solid food avoidance on atopic dermatitis (AD) in infancy. This study is part of a dietary clinical trial in a prospective cohort of healthy term newborns at risk of atopy. It was recommended to breast‐feed for at least 4 months and to avoid solid food in the same time‐period. Eight hundred and sixty‐five infants exclusively breast‐fed, and 256 infants partially or exclusively formula‐fed, were followed‐up until the end of the first year following birth. AD and sensitization to milk and egg were considered as study end‐points. The 1‐year incidence of AD was compared between the two study groups. Adjusted odds ratios (OR) with 95% confidence intervals (CI) were calculated by multiple logistic regression. The incidence of AD was calculated in relation to age at introduction of solid food and amount of food given. In the breast‐fed group, the adjusted OR for AD was 0.47 (95% CI 0.30–0.74). The strongest risk factor was the occurrence of AD in the subject's core family. The risk of infants with AD to be sensitized to milk was four times higher, and to egg eight times higher, than in infants without AD. Age at first introduction of solid food and diversity of solid food showed no effect on AD incidence. We conclude that in infants at atopic risk, exclusive breast‐feeding for at least 4 months is effective in preventing AD in the first year of life.     

小于胎龄儿血生化营养指标研究

为提高小于胎龄儿今后的生活质量,探讨其出生后即刻血生化指标的变化,以正确评价小于胎龄儿出生时营养状况,对我科2000年1月～2005年5月出生的早产小于胎龄儿、足月小于胎龄儿、足月适于胎龄儿的血生化营养指标进行比较,现将结果总结如下。1资料与方法1.1临床资料早产小于胎龄儿(A组)27例,胎龄30～36(33.04±1.51)周,体重1020～1565(1235.67±145.57)g;足月小于胎龄儿(B组)35例,胎龄37～41(38.33±1.06)周,体重1500～2000(1801.67±123.99)g;足月适于胎龄儿(C组)30例,胎龄37～41(38.87±1.31)周,体重2595～3885(3331.94±363.20)g。出生时…     

Selenium status of preterm infants: the effect of postnatal age and method of feeding

Indicators of selenium (Se) status were measured in a longitudinal study of 63 preterm and 46 term infants. Se levels in both groups were similar in the first few days of life. Preterm infants fed parenteral nutrition (PN) for several weeks developed very low plasma Se levels (<10/μg/l). In those receiving either breast milk or formula in conjunction with PN, plasma Se also declined over the first 6 weeks. In the breastfed term infants plasma levels increased by 50%, but there was no increase in the term formula-fed group. In healthy preterm infants who received mainly breast milk, plasma Se concentrations remained constant at newborn levels and were below those of breastfed term infants at 6 weeks. Erythrocyte GSHPx activity did not reflect plasma Se or Se intake. In conclusion, the type of feeding, and hence Se intake, influenced plasma Se concentration in preterm infants. Provision of enteral feeding in conjunction with PN was unable to prevent a decline in plasma Se and at 6 weeks levels were well below those of the reference breastfed term infants.     

Head circumference from birth to age 48 months for infants in Sweden

Aim: To describe the development of head circumference, from birth to age 48 mo, of infants in Sweden. Methods: Every infant born on the 15th of any month in the 1981 birth cohort, living in Sweden as of 31 December 1989, was studied from birth to age 48 mo (n=3158). By collecting data from child healthcare records and then analysing these data using piecewise linear regression, means and other statistics were produced for every age. Data were analysed for all and with exclusions for low birthweight and those born outside Sweden. Results: From the sample of 3158, data for 3107 infants were collected, making the percentage of missing individuals 1.6%; thus, non-response bias is minimized and high national representativeness is achieved. Summary statistics for head circumference are presented. Comparisons are made to international reference materials, and to previous and current Swedish reference curves.
Conclusion: For the first time in Sweden, and without selection bias, means and distribution of head circumference measurements are documented longitudinally for a nationally representative sample of infants.     

Iron status in low-birth-weight infants, small and appropriate for gestational age. A follow-up study

Iron nutrition was measured in 84 low-birth-weight infants. At birth, they were assigned to three groups: preterm infants appropriate for gestational age (n = 29); preterm infants small for gestational age (n = 17); and full-term infants small for gestational age (n = 38). A sub-sample of infants was supplemented with iron 3 mg/kg from two to four months of age. At birth, preterm appropriate-for-gestational-age infants had a lower hemoglobin concentration than full-term small-for-gestational-age infants (p < 0.01) and a higher serum ferritin than preterm small-for-gestational-age infants (p < 0.05). In the non-supplemented group, full-term small-for-gestational-age infants had significantly higher hemoglobin concentrations at four months of age. At this age, iron-supplemented preterm infants appropriate or small for gestational age had significantly higher hemoglobin levels than non-supplemented subjects, while iron supplementation did not have an effect on final hemoglobin concentration in full-term small-for-gestational-age infants. We conclude that preterm infants, irrespective of their adequacy for gestational age, show evidence of iron deficiency before four months of age. Full-term infants do not develop iron deficiency up to this age.