SEPTICAEMIA OF THE NEWBORN, ASSOCIATED WITH RUPTURED FOETAL MEMBRANES. DISCOLOURED AMNIOTIC FLUID OR MATERNAL FEVER

Abstract. The incidence of neonatal septicaemia associated with prolonged rupture of foetal membranes, discoloured amniotic fluid and/or maternal fever was investigated. A total of 807 blood cultures were performed on 329 neonates, the placental end of 239 umbilical cords and on 239 mothers. The study showed that in 97% of the neonates with a complicated delivery there was no evidence of septicaemia. Septicaemia was verified in 3% of the infants, and was intimately associated with low birth weight ( p =0.02), neonatal asphyxia ( p <10^-4), clinical evidence of septicaemia ( p <10^-4) and maternal fever ( p =0.002). The incidence was particularly high in premature infants with neonatal asphyxia (27%) and in neonates born to febrile mothers (20%). None of the mothers showed any evidence of septicaemia, and haematogenous, transplacental spread of infection to the child was not seen. Routine prophylactic antibiotic therapy in neonates with a complicated delivery should therefore be reserved, in our opinion, for those infants at high risk of infection.     

超早产儿出生窒息的危险因素分析

目的 探讨超早产儿发生出生窒息的危险因素.方法 选取2017年1月至2020年6月,解放军总医院第七医学中心儿科医学部超早产重症监护病房收治的超早产儿为研究对象,纳入窒息组184例,对照组153例.回顾性收集超早产儿及其母亲的临床资料,分析超早产儿发生出生窒息的危险因素.统计学方法采用t检验、χ2检验、单自变量和多自变...     

Vitamin D status does not influence the breast-milk calcium concentration of lactating mothers accustomed to a low calcium intake

Plasma 25-hydroxy-vitamin D and breast-milk calcium concentration were measured at 3 months of lactation in 60 Gambian mothers accustomed to a low calcium diet, of whom 30 were consuming a calcium supplement and 30 were receiving a placebo, and in 48 British mothers. The plasma 25-hydroxy-vitamin D concentration of the Gambian women was not affected by either calcium supplementation (supplemented, 64. 4 ± 2. 5 nmol 1^-1; placebo, 64. 9 ± 3. 5 nmol l^-1; mean ± SE) or season. The British average was lower (53. 9 ± 3. 0 nmol 1^-1, p = 0. 004), owing to marked seasonal effects. The breast-milk calcium concentration was lower in The Gambia (supplemented, 5. 38 ± 0. 13 mmol 1^-1; placebo, 5. 10 ± 0. 13mmol 1^-1; British, 6. 93 ± 0. 15 mmol 1^-1, p < 0. 0001). There was no relationship between plasma 25-hydroxy-vitamin D and breast-milk calcium concentration in any group. There was no trend towards lower breast-milk calcium concentration in women with vitamin D status towards the bottom of the normal range or in British women during the winter. This study provides no support for the hypothesis that breast-milk calcium concentration is influenced by vitamin D status or that lactating women with a low calcium intake are at particular risk of vitamin D deficiency.     

Effects of volume expansion on cardiac output in the preterm infant

Clinical and echocardiography haemodynamic evaluations of response to volume expansion are described in 12 preterm neonates aged < 7days presenting without cardiac dysfunction and with a low cardiac output. They received 10% albumin solution (20 ml kg^-1) for 3h. Measurements were made before infusion, at volumes 5, 12. 5 and 20 ml kg^-1 and 1 h later. All infants increased significantly their cardiac output (CO) (from a median of 177 to 283 ml kg^-1 min^-1). The rise of CO decreased with the volume infused. The index of systemic vascular resistance (SVR = ratio of mean arterial pressure to the CO) decreased for the six patients without PDA (from 272 to 193 mmHg 1^-1 kg^-1 min^-1, p < 0. 05) showing that the hypovolemic preterm infant is able to shut down peripherally in response to hypovolemia. The four hypotensive infants responded by increasing mean arterial blood pressure (from 29 to 44 mmHg). Cutaneous refilling time decreased during infusion (from 6. 7 to 3. 8 s, p < 0. 01). One infant had an haemodynamically significant ductus arteriosus revealed by volume expansion, another one developed myocardial dysfunction.     

Parental and perinatal factors affecting childhood anthropometry of very-low-birth-weight premature infants: a population-based survey

Background: The perinatal–neonatal course of very-low-birth-weight (VLBW) infants might affect their childhood growth. We evaluated the effect of parental anthropometry and perinatal and neonatal morbidity of VLBW neonates on their childhood growth.
Methods: We obtained parental anthropometry, height and weight at age 6–10.5 years of 334 children born as VLBW infants. Parental, perinatal and neonatal data of these children were tested for association with childhood anthropometry.
Results: (1) Maternal and paternal weight standard deviation score (SDS) and discharge weight (DW) SDS were associated with childhood weight SDS (R²= 0.111, p < 0.00001); (2) Maternal and paternal height SDS, corrected gestational age (GA) at discharge, maternal assisted reproduction and SGA status were associated with childhood height SDS (R²= 0.208, p < 0.00001); (3) paternal weight SDS, DW SDS and surfactant therapy were associated with childhood body mass index (BMI) SDS (R²= 0.096, p < 0.00001). 31.1% of VLBW infants had DW SDS < −1.88, and are to be considered small for gestational age ('SGA'). One quarter of these infants did not catch up by age 6–10.5 years.
Conclusion: Childhood anthropometry of VLBW infants depends on parental anthropometry, postnatal respiratory morbidity and growth parameters at birth and at discharge. Almost one-third of VLBW premature infants had growth restriction at discharge from neonatal intensive care unit (NICU), a quarter of whom did not catch up by age 6–10.5 years.     

Decreased ferritin levels, despite iron supplementation, during erythropoietin therapy in anaemia of prematurity

Erythropoietin (rHuEPO) therapy has been shown to be beneficial in preventing and treating anaemia of prematurity and to decrease the need for blood transfusions. There is, however, only scanty data on the effect of rHuEPO therapy on iron metabolism. We studied 29 preterm infants (age 34 ± 14 days) who were randomly assigned to receive either rHuEPO 900 U kg^-1 week^-1 with 6 mg kg^-1 day^-1 of iron for 4 weeks ( n= 15) or no therapy. The following parameters were evaluated and compared between and within groups at the beginning, during and at the end of the study: Haematocrit (SI), reticulocytes (10⁹μgl^-1), serum ferritin (μg1^-1) and iron (μmol 1^-1). The results were as follows. At the baseline, erythropoietin levels were similar in both groups: 7.2 ± 5.6 versus 6.2 ± 3.2 mU ml^-1 (NS). In the treated infants the haematocrit remained stable during the study and was significantly higher than in the control group by the end of the study: 0.34 ± 0.03 versus 0.28 ± 0.05 ( p = O.001). rHuEPO therapy increased the reticulocyte count from 130 ± 70 to 430 ± 200 ( p = 0.0002). However, rHuEPO therapy depleted both serum ferritin and it-on levels from 321 ± 191 to 76 ± 58 $uMgl^-1 ( p = 0.04) and from 18 ± 5 to 13 ± 4 μmoll^-1 ( p = 0.03), respectively. We conclude that rHuEPO therapy prevented anaemia and its sequelae; however, serum ferritin and iron levels were depleted. We suggest that the effect of rHuEPO may be further increased by higher iron supplementation.     

Maternal fever and neonatal depression: preliminary observations.

The objectives of this study were to determine in term infants: (1) the importance of maternal fever (maternal temperature > 38 degrees C) as a risk factor for neonatal depression and (2) the clinical course of infants admitted to the Neonatal Intensive Care Unit (NICU) born to mothers with fever. For 2 years, 59 (0.24%) of 25,000 term infants had a 5-minute Apgar score < or = 5 and 22 (0.08%) infants were administered chest compressions with or without epinephrine as part of cardiopulmonary resuscitation (CPR) in the delivery room. The perinatal event most commonly associated with a 5-minute Apgar score < or = 5 was maternal fever in 19 infants (32%), with meconium + fetal heart rate (FTHR) abnormalities in 15 (25%), and FTHR abnormalities only in 13 (22%), additional associations (n = 13). By stepwise linear regression analysis, a 5-minute Apgar < or = 5 was related only to the initial infant temperature (p = 0.009, r = 0.33). Maternal fever noted in six infants (27%) was also commonly associated with CPR, as was the presence of meconium + FTHR abnormalities in seven (32%), and FTHR abnormalities only in four (18%). One hundred thirteen (7.5%) of the approximately 1,500 term infants born to mothers with maternal fever were admitted to the NICU. In addition to fever, the labor was complicated by meconium (in 16 infants), meconium + FTHR abnormalities (in 19 infants), and FTHR abnormalities only (in 11 infants). Resuscitative interventions in the delivery room included oxygen only in 43 infants, bag and mask ventilation in 38, continuous positive airway pressure in 10, intubation in 16, and CPR in six infants. Forty-nine infants (43%) had an initial temperature > 38 degrees C including 13 (11%) with an initial temperature > 39 degrees C. Twelve (10%) infants remained intubated on admission and five required ventilator support > 24 hours. One blood culture was positive although all mothers were pretreated with antibiotics. One infant developed hypoxic ischemic encephalopathy including seizures. Maternal fever is the perinatal event most frequently associated with a 5-minute Apgar score < or = 5 and a common association with the need for CPR. Clinicians attending the delivery of a mother with fever should anticipate the potential for neonatal depression; such awareness should facilitate appropriate preparation before delivery and potentially reduce the need for more intensive resuscitation.     

Benign neonatal sleep myoclonus in newborn infants of opioid dependent mothers

Objective: The aim of our study was to evaluate the incidence, duration and risk factors for benign neonatal sleep myoclonus (BNSM) in infants with neonatal abstinence syndrome (NAS) treated with opioids or sedatives, compared with control infants.
Methods: This is a single centre observational case control study. Seventy-eight near term and term infants with neonatal opiate abstinence syndrome confirmed by meconium analysis were included. Exclusion criteria were cerebral malformation, intracranial haemorrhage and perinatal asphyxia. The babies were assessed eight hourly with a modified Finnegan score that included sleep myoclonus. Seventy-eight infants not exposed to opiates during pregnancy, hospitalized for at least 14 days and matched for gestational age were used as controls.
Results: The median gestational age was 38 ¹/₇ (95% CI: 35 ³/₇–41 ²/₇) weeks, birth weight 2730 (95% CI: 1890–3600) g, umbilical artery pH 7.25 (CI 7.10–7.37) and Apgar score at 5 minutes 9 (95% CI: 7–10). The control infants did not differ in these characteristics.
Sleep myoclonus was diagnosed in 52 (67%) of the infants with NAS and 2 (2.6%) of the controls (OR 26 [95% CI: 7–223], p < 0.001). Myoclonus appeared as early as day 2 and as late as day 56 of life (median day 6) and lasted for 1 to 93 days (median 13 days). All infants had serum glucose > 2.5 mmol/L at first occurrence. The neurological examinations as well as cerebral ultrasound scans were normal. An electroencephalogram (EEG) carried out in 18 infants showed no signs of epileptic activity.
Conclusion: BNSM has a high incidence in infants with NAS. The diagnosis can be made clinically. In the absence of other neurological symptoms further investigations such as EEG are not necessary and anticonvulsive treatment is not indicated.     

Use of brain lactate levels to predict outcome after perinatal asphyxia

Perinatal asphyxia is an important cause of neurological disability, but early prediction of outcome can be difficult. We performed proton magnetic resonance spectroscopy (MRS) and global cerebral blood flow measurements by xenon-133 clearance in 16 infants with evidence of perinatal asphyxia. Cerebral blood flow was determined daily in the first 3 days after birth in seven cases. Proton MRS was performed in 11 infants within the first week (mean 3.7 days), the rest within the first month (mean 22.2 days), and all had a scan around 3 months of age. Four infants died neonatally, three showed neurological deficits and the rest seemed to be progressing normally at neurodevelopmental follow-up at 1 year of age. A significant correlation was found between initial brain lactate levels and severe outcome ( p = 0.0003) just as between cerebral hyperperfusion (mean cerebral blood flow (CBF) 86ml(100g)^-1min^-1), ( p = 0.02) and outcome. The diagnostic and prognostic implications of early MRS and CBF are predictive of poor outcome in severely asphyxiated infants.     

Clinical features and epidemiology of septicaemia and meningitis in neonates due to Streptococcus agalactiae in Copenhagen County, Denmark: a 10 year survey from 1992 to 2001

AIM: To elucidate the clinical and biochemical features, and to estimate the incidence and outcome of invasive culture-verified group B streptococcal (GBS) septicaemia/meningitis in neonates in Denmark. METHODS: Clinical microbiology laboratory records in patients 0-3 mo of age were searched for culture-verified GBS during 1992-2001 in Copenhagen County. Clinical records at the neonatal intensive care unit were reviewed retrospectively. Selected clinical and biochemical parameters were evaluated. RESULTS: 61 neonates had culture-verified GBS septicaemia/meningitis. The mean annual incidence was 0.76 cases per 1000 livebirths (range 0.0-1.91). A significant decrease in incidence was observed in the latest 3 y. The male:female ratio was 1.3:1. Eighty percent of the neonates had early-onset GBS within 24 h, 57% with symptoms at birth. Predominant initial symptoms were respiratory (72%), cardiovascular (69%) and neurological (63%). Only 4% developed GBS by day 7-90. Seventy-five percent had maternal or neonatal risk factors for early-onset GBS disease; 21% had clinical asphyxia, 37% of the mothers had premature rupture of membranes and 31% of the mothers were febrile. Initial C-reactive protein (CRP) was low, but increased significantly after more than 12 h duration of symptoms in 82% of patients. Leucopenia was an important initial haematological marker. CONCLUSION: The incidence of early-onset GBS has decreased significantly in Denmark, probably because of preventive measures in pregnancy and during birth. Respiratory symptoms are early signs of early-onset GBS. Initial leucopenia and a late (12-48 h) increase in CRP are valuable markers for invasive GBS.     

影响早产儿行为神经测定因素的分析

目的 探讨新生儿行为神经测定(NBNA)在早产儿的应用及影响其评估指标的因素.方法 选择2006年1月至2007年6月在我院新生儿科住院治疗的123例早产儿,分别在纠正胎龄40周时进行NBNA评分,分析胎龄、出生体重、是否机械通气以及机械通气时间、围生期是否有致脑损伤的高危因素对NBNA评分的影响.结果 胎龄<30周、～32周、～34周早产儿及出生体重<1 250 g、～1 500 g、～2 000 g早产儿NBNA评分差异均具有显著性(P<0.01),胎龄越低、出生体重越低,NBNA评分越低;需机械通气的早产儿NBNA评分明显低于未上呼吸机者(P<0.01),机械通气时间＞7 d NBNA评分明显低于＜7 d者(P<0.05);围生期有出血性和缺血性脑损伤、间接胆红素≥256.5 μmol/L、血糖反复<2.6 μmol/L、发生感染者NBNA评分明显降低(P<0.01);臀位、钳产、吸引产早产儿NBNA评分明显低于剖宫产和顺产者(P<0.01);Apgar评分为0～3分者NBNA评分明显低于4～7分和≥8分者(P<0.01).结论 胎龄、出生体重、是否机械通气、机械通气时间、异常的分娩方式、合并重度窒息均影响早产儿的NBNA评分.对于早产儿,特别是胎龄<32周,出生体重<1 500 g,存在致脑损伤高危因素的早产儿,生后3～7 d内应行头颅B超检查,及早发现颅内病变,尽早干预,减少后遗症的发生.     

The captopril test in children with renovascular and renal hypertension

We used the captopril test (CT) in 32 children, 8 with renovascular hypertension (RVH), 17 with renal hypertension (RH) and 7 with normal blood pressure, in order to study the renin-angiotensin system activation (RASA). All children affected by RVH presented a positive CT: a post-captopril plasma renin activity (PRA) of 12 ng ml^-1 h ^-1 or more, an absolute PRA increase of 10 ng ml ^-1 h ^-1 or more and a 150% increase or more, or 400% or more if the baseline PRA was less than 3 ng ml^-1 h^-1. The CT may be useful for demonstrating the RASA in RVH.     

Perinatal asphyxia in infants of insulin-dependent diabetic mothers

Infants of diabetic mothers are thought to be at risk for perinatal asphyxia. We hypothesized that the following are significant risk factors for perinatal asphyxia: poor third-trimester glycemic control, diabetic vascular disease (nephropathy, retinopathy) appearing in pregnancy, pregnancy-associated hypertension, smoking, prematurity, fetal macrosomia, and maternal hyperglycemia and hypoglycemia within 6 hours preceding delivery. We prospectively studied 162 infants born to 149 diabetic mothers (White classes B through R-T). Perinatal asphyxia was defined clinically as fetal distress during labor (late decelerations, persistent fetal bradycardia, or both), 1-minute Apgar score less than or equal to 6, or intrauterine fetal death. Forty-four infants (26.7%) had perinatal asphyxia. The presence of perinatal asphyxia did not correlate with third-trimester glycemic control, pregnancy-associated hypertension, smoking, fetal macrosomia, or maternal hypoglycemia before delivery, but it did correlate significantly with nephropathy appearing in pregnancy, maternal hyperglycemia before delivery, and prematurity. We speculate that (1) the appearance of diabetic vasculopathy (nephropathy) during pregnancy is accompanied by placental vascular disease and subsequently by fetal compromise and (2) in pregnancy complicated by diabetes, maternal and subsequently fetal hyperglycemia before delivery leads to fetal hypoxemia.     

PLASMA NEUROTENSIN IN TERM AND PRETERM NEONATES

Abstract. Lucas A.¹, Aynsley-Green, A.¹, Blackburn, A. M.², Adrian, T. E.² and Bloom, S. R.² (¹University Department of Paediatrics, John Radcliffe Hospital, Oxford, and ²Hammersmith Hospital, London, England). Plasma neurotensin in term and preterm neonates. Acta Paediatr Scand, 70:201, 1981. –The new ileal peptide neurotensin has not been studied hitherto in the human neonate. Plasma concentrations of neurotensin were measured by radioimmunoassay in 276 healthy term or preterm infants either at birth or pre- or post-prandially during the neonatal period. In addition, a group of 10 6-day-old preterm infants were studied who had never been enterally fed on account of hyaline membrane disease. Plasma neurotensin values were obtained also in 12 healthy fasting adults. Term infants had higher plasma neurotensin concentrations than preterm infants at birth. Both groups showed a significant postnatal surge in basal (pre-prandial) neurotensin concentrations exceeding adult values, but no postnatal neurotensin elevation was found in the unfed group. In preterm infants, who were studied further into the neonatal period than term infants, there was a progressive increase in the rise of neurotensin following a milk feed, with a massive neurotensin response by 24 days of age. In 6-day-old term infants, the neurotensin response to bottle feeding was significantly greater than to breast feeding. These findings add further weight to the concept that neurotensin may be of physiological importance as a gut hormone. The high neurotensin levels and large feed responses seen in neonates may indicate a unique role for neurotensin in early life.     

THE EFFECT OF VITAMIN E ON ERYTHROCYTE HEMOLYSIS AND LIPID PEROXIDATION IN NEWBORN PREMATURE INFANTS

ABSTRACT. The biochemical effect of vitamin E supplementation to mothers with threatened premature delivery and to premature infants after birth has been studied. Although a weak correlation was found between maternal and cord blood vitamin E levels at birth, cord blood levels were not significantly higher in the infants from supplemented mothers than those from unsupplemented mothers. Furthermore, maternal vitamin E treatment did not prevent either erythrocyte hemolysis or lipid peroxide formation in the premature infants after birth. On the other hand, intramuscular vitamin E to infants after birth produced a marked biochemical effect, with both zero erythrocyte hemolysis and low lipid peroxide formation when serum vitamin E increased above 2 mg/100 ml. We conclude that intramuscular vitamin E immediately after birth is necessary to achieve a biochemical effect of vitamin E in the early neonatal period. (No cases of retrolental fibroplasia occurred in the present study.)     

Risk factors for maternal intrapartum fever and short-term neonatal outcome

Our objective was to determine maternal risk factors for developing intrapartum fever during term labor and to evaluate perinatal outcomes for infants exposed to mothers with fever. We performed a retrospective cohort study of 330 mothers and their infants and 330 controls in a single institution. Prolonged labor, nulliparity, maternal disease, and prolonged membrane rupture were found to be the most significant predictors for developing intrapartum fever. Caesarean section and instrumental delivery were more commonly performed. Bacteriuria was present in 10 % of the mothers. Babies born to mothers with fever were more likely to have meconium-stained amniotic fluid. More babies in this group were symptomatic (mostly dyspnea) on admission. No cases of neonatal infection were recorded, and no severe morbidity or mortality was present. We concluded that in low-risk asymptomatic intrapartum fever, infection is the least common explanation. Perinatal outcomes may be influenced by medical decisions due to fever onset, such as delivery mode. Short-term outcomes are favorable.     

Postnatal changes in maternal and neonatal plasma antioxidant vitamins and the influence of smoking

OBJECTIVE: To study the postnatal changes in the plasma concentrations of fat soluble antioxidant vitamins and malondialdehyde (MDA) in mothers and their newborns and their relation to smoking. DESIGN: Prospective cohort study. SETTING: Tertiary perinatal centre. SUBJECTS: Eighteen non-smoking and 14 smoking mothers and 33 infants. MAIN OUTCOME MEASURES: Plasma concentrations of vitamins E, A, and beta-carotene and MDA were measured in mothers and infants at delivery and on day 4 post partum. RESULTS: Neonatal plasma levels of vitamins E, A, and beta-carotene were significantly lower than maternal levels both at delivery and on day 4 in both groups. There was a significant postnatal increase in plasma vitamin E levels in smoking mothers and neonates of both groups. A significant postnatal increase in maternal, but not neonatal, plasma vitamin A was noted in both groups. Cord plasma vitamin E levels were significantly lower in infants of smoking mothers (mean 4.7 v 6.5 micromol/l, p = 0.041). Plasma MDA was paradoxically lower in smoking mothers at delivery (3.19 v 4.01 micromol/l, p = 0.03) and on day 4 (1.37 v 3.29 micromol/l, p = 0.005) and in infants of the smoking group on day 4 (2.18 v 3.12 micromol/l, p = 0.014). Also, there was a significant postnatal fall in plasma MDA levels on day 4 in mothers and infants in the smoking group. CONCLUSIONS: The postnatal changes in plasma vitamin E were more pronounced in the smoking group. The postnatal changes in plasma vitamins A and beta-carotene were similar in both groups. The rapid decline in plasma MDA in smoking mothers and their infants suggests withdrawal of oxidative stress from smoking around delivery. This coincided with the increase in plasma vitamin E.     

Prevention of Neonatal HBV Infection with the Combination of HBIG and HBV Vaccine and Its Long-Term Efficacy in Infants Born to HBeAg Positive HBV Carrier Mothers

Seventy-three infants born to HBeAg positive HBV carrier mothers were protected from neonatal HBV infection with our standard prevention schedule consisting of two doses of HBIC (0, 2 mo) and three doses of HBV vaccine (2, 3, 5 mo). In 62 infants who successfully responded to HBV vaccine with a titer of anti-HBs greater than 2³, anti-HBs titer was monitored for as long as 48 months (25.6 ±11.0 mo) and found to decrease as follows: 5.1 ± 1.7 at 12 mo., 4.5 ± 1.8 at 18 mo., 4.2 ± 1.8 at 24 mo., 4.0± 1.6 at 30 mo., 3.7 ± 1.7 at 36 mo., 32 ± 2.0 at 48 mo. During the follow-up period, eight HBV events (11.9%) were demonstrated: one case showed an increase of anti-HBs, three showed a reappearance of anti-HBc alone, three showed a reappearance of anti-HBc with increase of anti-HBs, and one became a chronic HBV carrier. All infants were further divided into three groups by their maximal response of anti-HBs to HBV vaccine: Group I (2⁶), Group II (2³-2⁵), and Group III (2²). Group I sustained a higher titer from 12 to 30 months of age and had less HBV events than (3-II and G-III. Our study suggests that acquisition of a high titer of anti-HBs is important in long-term prevention of HBV infection as well as in the neonatal period in infants born to HBeAg positive HBV carrier mothers.     

EFFECT ON SERUM CALCIUM OF lα-HYDROXY-VITAMIN D3 SUPPLEMENTATION IN INFANTS OF LOW BIRTH WEIGHT, INFANTS WITH PERINATAL ASPHYXIA, AND INFANTS OF DIABETIC MOTHERS

Abstract. Petersen, S., Christensen, N. Chr. and Fogh-Andersen, N. (Department of Neonatology and Department of Clinical Chemistry, Rigshospitalet, Copenhagen, Denmark). Effect on serum calcium of lα-hydroxy-vitamin D₃ supplementation in infants of low birth weight, infants with perinatal asphyxia, and infants of diabetic mothers. Acta Paediatr Scand, 70: 897, 1981.-Thirty infants of low birth weight, 34 infants with perinatal asphyxia, and 16 infants of diabetic mothers were investigated for early neonatal hypocalcaemia. The infants were randomized into a group prophylactically given lα-hydroxy-vitamin D₃, 0.05 or 0.10 μ/kg i.v. on the first 3 days of life, and an untreated control group. In infants of low birth weight and infants of diabetic mothers there were no differences in serum ion-Ca concentrations on days 2, 3, 5, and 7 between the treated and untreated groups. In infants with perinatal asphyxia, however, serum ion-Ca concentrations on days 5 and 7 were significantly higher in the treated than in the untreated group, while on days 2 and 3 the differences were not statistically significant. The hypocalcaemia in asphyctic infants was not correlated to bicarbonate treatment, but infarits with severe signs of asphyxia had lower serum ion-Ca concentrations than infants with only mild or no signs. Hypocalcaemia in asphyctic infants might be explained by a decreased concentration of 1 α, 25-dihydroxy-vitamin D₃ following reduced lα-hydroxylation in the kidney as a consequence of anoxia during perinatal asphyxia.     

Intrauterine versus postnatal transport of the preterm infant: a short-distance experience

AIM: The purpose of this study was to compare neonatal outcome (mortality, respiratory distress syndrome, intraventricular hemorrhage, necrotising enterocolitis, persisting ductus arteriosus, and septicaemia) after intrauterine transport versus neonatal transport in an area where short-distance transport is the rule. METHODS: The study was retrospective in nature. The files of all neonates delivered between 24 and 34 weeks from 1994 to 1998 and transported intrauterine or postnatally to the Antwerp University Hospital were reviewed. Cases of intrauterine fetal death and mothers discharged before delivery were excluded, as were infants with lethal congenital anomalies. RESULTS: A total of 328 deliveries after intrauterine transport, resulting in 416 neonates and 187 neonates transported postnatally were included. The maximum distance patients had to be transported was 40 km. Placental abruption was more frequent in the mothers of the neonatal transport group (13 vs. 5%, P=0.001). Corticosteroids were administered significantly less in the neonatal transport group (67 vs. 13%, P<0.0001). Preterm rupture of the membranes (36 vs. 20%, P<0.0001), preterm labour (73 vs. 36%, P<0.0001), and pre-eclampsia (10 vs. 7%, P<0.0001) were more frequent in the intrauterine transport group and this group had a lower mean birthweight and gestational age. There was no significant difference for overall neonatal mortality, respiratory distress syndrome, intraventricular hemorrhage, necrotising enterocolitis, persisting ductus arteriosus or septicaemia.