Macromolecular Absorption in Infants with Infantile Colic

ABSTRACT. Intestinal absorption of macromolecules, using human α-lactalbumin (α-LA) as a marker, was studied in breast-fed and formula-fed infants with infantile colic. Serum samples taken at 30 and 60 min after an intake of human milk were analyzed for α-LA by a competitive radioimmunoassay technique. Breast-fed infants with infantile colic had significantly higher s-α-LA levels compared with age-matched breast-fed control infants 0-1 month of age: median value 926 μg α-LA/I serum/I human milk/kg bodyweight (n= 11) versus 150 (n= 34); 1–2 months of age: 173 (n= 22) versus 31 (n= 16); 2–3 months of age: 132 (n= 8) versus 11 (n= 16). Similarly, formula-fed colicky infants had significantly higher s-α-LA levels than agematched formula-fed control infants 1-2 months of age: median value 126 (n= 12) versus < 10 (n= 14); 2–3 months of age: 156 (n= 11) versus < 10 (n= 10). The increased absorption of the macromolecule human α-lactalbumin in infantile colic suggests that the gut mucosa is affected in infants with infantile colic.     

Early Channels of Mother-Infant Communication: Preterm and Term Infants

The impact of prematurity on the responsiveness of mothers and their 4-month-old infants was examined across three channels of communication: attentional, vocal and affective. Log-linear models were used to determine how the behavior of one partner was conditional upon the behavior of the other during home observations of 24 preterm and 24 term infants and their mothers. Visual attention was elicited by vocalization, and the onset of infant gaze was marked by a maternal smile. Mothers and infants responded to vocalizations with vocalizations, and mothers responded to smiles with smiles. Mothers of preterm infants were particularly responsive to their infants' signals within the attentional, vocal and affective channels. Preterm infants demonstrated correspondingly heightened responsiveness within the vocal and affective channels.     

Macromolecular absorption in small-for-gestational-age infants

Using human alpha-lactalbumin as a marker protein, macromolecular absorption was studied in 40 preterm infants, appropriate for gestational age (AGA), in 12 AGA term infants and in 18 preterm infants, small for gestational age (SGA). The absorption of alpha-lactalbumin was measured as concentration in serum after a human milk feed and expressed as micrograms alpha-lactalbumin/l serum/l human milk/kg body weight on day 7, 14, 21 and 42 after delivery. The serum concentration of alpha-lactalbumin was correlated negatively with maturity and postnatal age. In the SGA infants, the concentration of alpha-lactalbumin was significantly higher than in the AGA infants of similar gestational age. The data show that intrauterine growth retardation causes a delayed postnatal decrease in macromolecular absorption. This may indicate delayed intestinal maturation.     

Heparin Cofactor II, Antithrombin and Protein C in Plasma from Term and Preterm Infants

ABSTRACT. The coagulation inhibitors heparin cofactor II (HCII), antithrombin (AT) and protein C (PC) were measured in healthy term and preterm infants in order to establish reference standards. The mean value for HCII in term infants was found to be about half of the adult values. Values below 25% in healthy infants may suggest hereditary deficiency states. One girl with congenital HC II deficiency was detected. Mean AT and PC levels were somewhat higher than HC II. Healthy preterm infants have significantly lower HC II and AT values than healthy term infants. Serial AT measurements have been used in monitoring seriously ill infants and used as a prognostic indicator. In a small number of unhealthy neonates HC II was reduced to an even greater extent than AT, and on recovery normalized more rapidly than AT.     

Intact Parathyroid Hormone Levels during Pregnancy, in Healthy Term Neonates and in Hypocalcemic Preterm Infants

ABSTRACT. We measured parathyroid hormone levels in pregnant and nonpregnant women and at 1, 2 and 5 days of life in healthy term neonates and in hypocalcemic preterm infants using a new immunoradiometric assay which measures only biologically active intact parathyroid hormone and by a mid-molecule parathyroid hormone radioimmunoassay. During pregnancy intact and mid-molecule parathyroid hormone levels did not show any modification and were not different from parathyroid hormone levels of nonpregnant age-matched controls. Serum calcium and phosphorus levels did not vary during each trimester of pregnancy. In cord serum intact and mid-molecule parathyroid hormone values were low in both term and preterm infants. In term neonates intact and mid-molecule parathyroid hormone levels peaked on day 1; in preterm infants intact parathyroid hormone levels peaked on day 1 while mid-molecule parathyroid hormone values peaked on day 2. Intact parathyroid hormone levels showed a more marked increase in preterm (19-fold) than in term neonates (7.5-fold) on day 1. Our data do not confirm the previously reported "physiologic" hyperparathyroidism in pregnancy. Moreover we found a normal parathyroid gland responsiveness to decreasing serum calcium levels in the first days of life in term and preterm infants. Our results suggest that measurement of intact parathyroid hormone 1-84 by immunoradiometric assay in the first days of life is a more sensitive index of parathyroid gland secretory function than the measurement of middle or carboxyl-terminal parathyroid hormone fragments allowing the detection of the dynamic changes of parathyroid hormone which occur in hypocalcemic preterm infants.     

早产儿和足月儿脑性瘫痪的临床特征

目的探讨早产儿和足月儿脑性瘫痪(CP)的临床特征,确定脑损伤的病因与时间,为病因预防提供依据。方法回顾性分析2005年9月-2007年8月在安徽医科大学第一附属医院小儿神经康复中心住院的267例CP患儿的围生期脑损伤高危因素、临床特点、头颅CT和MRI表现。早产儿组102例。28周≤胎龄<37周;出生体质量1000～4000g,平均2228.82g。足月儿组165例。37周≤胎龄<42周;出生体质量2100～4600g,平均3250.18g。计量资料采用频数分布及中位数,计数资料采用频数分布、百分构成比及χ2检验进行描述与分析。结果早产儿组痉挛型双瘫高于足月儿组(χ2=7.93P<0.01),足月儿组偏瘫型(χ2=8.17P<0.01)和共济失调型(χ2=4.21P<0.05)高于早产儿组。高危因素主要顺位依次为窒息、低出生体质量、黄疸、颅内出血和双胎。早产儿组并2种以上高危因素,病理性黄疸,双胎,低出生体质量的情况较多;而足月儿组并窒息、颅内出血较多。早产儿组癫高于足月儿组(χ2=10.37P<0.01)。除癫癎外,早产儿和足月儿并发症的差异均无显著性意义(Pa>0.05)。头颅影像学方面早产儿组CP集中表现为脑室周围白质软化,足月儿CP影像学异常分布范围较广。结论早产儿和足月儿在CP类型构成、高危因素、并发症和头颅影像学方面均有差异。对早产儿早期随访、早期干预,有利于CP的早期诊断和治疗。     

Tuberculin Conversion Following BCG Vaccination in Preterm Infants

ABSTRACT. Tuberculin conversion following BCG vaccination was evaluated in 3 groups of infants. Group I consisted of 12 preterm appropriate-for-gestational-age (AGA) infants given BCG vaccination at birth; Group II was made up of 15 term AGA infants similarly immunized while 8 preterm AGA infants (Group III) received BCG about the time estimated to be their normal birth-date. The tuberculin conversion rates of 83 %, 93 % and 88 % in groups I, II and III respectively were not significantly different ( p ±0.5). The results suggest that the preterm AGA infants born at 32-36 weeks of gestation can be effectively immunized with BCG at birth.     

未足月胎膜早破对早产儿神经发育的影响

目的探讨未足月胎膜早破对早产儿神经发育的影响。方法将早产儿根据产前有无胎膜早破分为未足月胎膜早破组（n=40）和对照组（n=37）。分别对二组患儿在纠正胎龄至40周、纠正胎龄后3个月、纠正胎龄后6个月进行新生儿神经发育评分（NBNA）及婴幼儿智能运动发育检测（CDCC）,比较二组神经发育情况。结果未足月胎膜早破组3个月及6个月运动心理发育指数（PDI）明显低于对照组,经统计学分析有显著性差异（Pa〈0.05）。二组NBNA评分、3个月及6个月智能发育指数（MDI）比较则无明显统计学差异（Pa〉0.05）。结论未足月胎膜早破对早产儿远期运动心理发育有明显的延迟和滞后的影响。     

Plasma Catecholamine Levels in Preterm Infants

ABSTRACT. Catecholamine levels were measured in cord arterial blood from preterm infants. Relatively lower catecholamine levels were found in the preterm infants than in term infants, although no significant correlation was found between noradrenaline and adrenaline levels and either gestational age or birthweight. Significantly higher catecholamine levels were found after labour. Preterm females had significantly higher catecholamine levels than boys after asphyxia and tended also to have higher catecholamine levels without asphyxia, although not significant. Catecholamine levels were also significantly elevated in those infants with a low Apgar score (<7 at 5 min) and those who were acidotic (cord arterial pH <7.25). A good correlation was found between a low Apgar score and the presence of acidosis.     

Lipid Levels in Very Low Birthweight Preterm Infants

ABSTRACT. Free fatty acid (FFA), triglyceride (TG), total cholesterol (T-C), VLDL + LDL-C, HDL-C and its subfractions were determined in 18 very low birthweight (birthweight: 1064 ± 179 g; gestational age: 28.7 ± 1.6 weeks, mean ± SD) preterm infants on postnatal days 1, 14, 28, 42 and 56 (data are given in mmol/l). FFA levels remained low throughout the study (day 1: 0.13 ± 0.09…day 28: 0.15 ± 0.06…day 56: 0.16 ± 0.06). TG levels increased significantly from day 1 to 14 and from day 14 to 28 (day 1: 0.61 ± 0.06, day 14: 1.14 ± 0.28, day 28: 1.70 ± 0.89), thereafter they remained unchanged. T-C levels increased significantly from day 1 (2.29 ± 0.83) to day 14 (3.05 ± 0.71), continued to increase up to day 28 (3.34 ± 1.58), subsequently decreasing to the level of day 1 (day 56: 2.63 ± 0.87). More marked alterations were seen in VLDL + LDL-C (day 1: 1.51 ± 0.70, day 28: 2.32 ± 1.34, day 56: 1.76 ± 0.74), whereas in HDL-C it was HDL₂-C that changed significantly.     

Mucosal IgA, mucosal cow's milk antibodies, serum cow's milk antibodies and gastrointestinal permeability in infants

We have studied development of the levels of IgA cow's milk (CM) antibodies in the saliva, faeces and serum of 20 term and 20 preterm infants from birth to 8 months. All infants already had IgA in their saliva during the first week of life. The levels peaked at the age of one month, thereafter decreasing in both groups; from the age of three months levels remained stable. Term infants had higher levels than preterm infants, but no differences were found between breastfed and CM-fed infants. Breastfed infants had higher levels of IgA in their faeces than did CM-fed infants; the IgA levels were similar in breast-fed term and preterm infants, being highest at birth, and decreasing thereafter. We also showed rising titers of serum IgA CM antibodies, with higher levels in infants regularly exposed to CM than in breast-fed infants. We sought associations between the magnitude of intestinal permeability to human a-lactalbumin (ALA) measured at the ages of 4-7 days and one month and the levels of IgG antibodies to CM, but no such relation was found.;     

Compensatory Increase of CBF in Preterm Infants during Hypoglycaemia

ABSTRACT. Cerebral blood flow (CBF₀₀) was investigated in 24 preterm infants (mean 30.8 weeks of gestational age) by use of intravenous 133-Xe clearance technique while screening simultaneously for low blood glucose after birth (mean 3 hours). CBF was significantly increased in 10 infants with blood glucose lower than 1.7 mmol/l compared to normoglycaemic infants and tended to decrease rapidly after treatment. Nine of the 10 hypoglycaemic infants were monitored for cerebral function. Well defined visual evoked cortical potentials were elicit-able in all and the aEEG was not less active during the hypoglycaemic episode. Therefore, it is suggested that compensatory increase of CBF may have supported the cerebral metabolism during uncomplicated hypoglycaemia.     

Prediction of Symptomatic Patent Ductus Arteriosus in Preterm Infants Using Doppler and M-mode Echocardiography

ABSTRACT. To investigate whether the development of symptomatic patent ductus arteriosus could be predicted, 26 preterm infants dependent on mechanical ventilation were examined daily with Doppler and M-mode echocardiography until 3 days after birth. The presence or absence of a hemodynamically significant ductus shunt, as judged from echocardiographic criteria, was tested for predictive power in terms of sensitivity, specificity and total error rate. Out of the 26 infants 13 developed symptomatic patent ductus arteriosus at a median age of 5 days (range 2–8). These 13 infants developed echocardiographic evidence of a large shunt at a median age of 2 days (range 1–3). The sensitivity of prediction was 18, 46 and 100% at 1, 2 and 3 days after birth. The specificity was 80, 92 and 85% and the total error rate was 52, 32 and 8%. Thus, accurate prediction was possible 3 days after birth.     

Complement-Dependent Bactericidal Activity for E. coli K12 in Serum of Preterm Newborn Infants

ABSTRACT. Complement-dependent serum bactericidal activity for E. coli K12 was assessed in 12 term infants and in 16 preterm infants. In both groups of newborns, at birth, bactericidal reaction by the classical pathway of complement activation was impaired with respect to normal controls at <0.001 level of significance (as estimated by Student's t -test). The serum bactericidal reaction by the alternative pathway of complement activation was significantly impaired only in preterm newborns, being normal in term infants. At a time corresponding to 40 weeks' gestational age also in preterm newborns alternative pathway mediated bactericidal activity for E. coli K12 was found normal. Classical pathway mediated bactericidal activity became normal only at an age corresponding to 52 weeks' gestational age.     

Reliability of Neurobehavioral Assessments from Birth to Term Equivalent Age in Preterm and Term Born Infants

Neurobehavioral assessments provide insight into the functional integrity of the developing brain and help guide early intervention for preterm (<37 weeks’ gestation) infants. In the context of shorter hospital stays, clinicians often need to assess preterm infants prior to term equivalent age. Few neurobehavioral assessments used in the preterm period have established interrater reliability. Aim: To evaluate the interrater reliability of the Hammersmith Neonatal Neurological Examination (HNNE) and the NICU Network Neurobehavioral Scale (NNNS), when used both preterm and at term (>36 weeks). Methods: Thirty-five preterm infants and 11 term controls were recruited. Five assessors double-scored the HNNE and NNNS administered either preterm or at term. A one-way random effects, absolute, single-measures interclass correlation coefficient (ICC) was calculated to determine interrater reliability. Results: Interrater reliability for the HNNE was excellent (ICC > 0.74) for optimality scores, and good (ICC 0.60–0.74) to excellent for subtotal scores, except for ‘Tone Patterns’ (ICC 0.54). On the NNNS, interrater reliability was predominantly excellent for all items. Interrater agreement was generally excellent at both time points. Conclusions: Overall, the HNNE and NNNS neurobehavioral assessments demonstrated mostly excellent interrater reliability when used prior to term and at term.     

Vaginally Born Low-Risk Preterm Infants: Fetal Acidosis and Outcome at 6 Years of Age

ABSTRACT. In a population of vaginally born low-risk preterm infants fetal acidosis (scalp pH <7.20) was found in 50% (6 out of 12) of infants of 29–33 weeks' gestational age (Group I) and in 9% (2 of 22) infants of 34–36 weeks' gestational age (Group II). At 6–7 years of age the children underwent a neurodevelopmental examination including a Griffith test. Five out of 6 Group I infants with fetal acidosis and 10 out of 20 Group II infants without fetal acidosis had minor or moderate neurodevelopmental problems. On the Griffith test Group II infants scored below Group I with more coordination and fine motor problems on the tested subscales. Fetal acidosis was more common in very preterm infants but cannot be used per se as a reliable indicator of long-term outcome.     

Human Milk Lacto-Engineering: Growth Nitrogen Metabolism,and Energy Balance in Preterm Infants

ABSTRACT. Fourteen 3-day metabolic balance studies were carried out in 8 healthy male preterm infants (birthweight 1270±170 g, gestational age 30±2 weeks) fed 183±7 ml/kg/day of a human milk formula made of incompletely skimmed human milk enriched with lyophilized whole human milk, minerals, medium chain triglycerides and linoleate. Daily intakes per kilo bodyweight were for protein 3.5±0.3 g, fat 7.0±2.1 g, and energy 573±88 kj (137 kcal). Weight gain was 29±5 g per day and nitrogen retention was 317±52 mg/kg/day. Fat absorption was 76± 12 %. Renal acid and solute loads were low and there was no metabolic acidosis, hyperazotemia or hyperaminoacidemia, except for tyrosine. It is concluded that preterm infants fed a human milk formula have similar growth rates and nitrogen retentions as foetuses in utero or preterm infants fed their own mother's milk.     

Acute Oliguria in Preterm Infants with Hyaline Membrane Disease:

ABSTRACT. Ten premature infants with hyaline membrane disease and with acute oliguria were treated with furosemide or furosemide and dopamine. Furosemide alone did not increase diuresis. Furosemide when combined with dopamine, however, caused significant increases in urine output, sodium excretion, fractional sodium excretion and creatinine clearance. These data suggest that the increase in the sodium excretion was due not only to a reduction in the tubular sodium reabsorption but also to an increase in the glomerular filtration rate. Since in premature neonates the creatinine clearance is not a very precise index of the glomerular filtration rate, the extent of contribution of the increase in the glomerular filtration rate to the enhanced sodium excretion cannot be determined. Despite the increase in the sodium excretion, the serum sodium concentration did not fall significantly. We conclude that the combined treatment with dopamine and furosemide is useful for treating furosemide-resistant, severe functional renal failure in preterm infants with hyaline membrane disease.