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.     

Influence of Bacillus Calmette-Guèrin vaccination at birth and 2 months old age on the peripheral blood T-cell subpopulations [gamma/delta (γδ) and alpha-beta (αβ) T cell]

The neonatal immune system is immature and may be affected by Bacillus Calmette-Guèrin (BCG) vaccine. We investigated the influence of BCG given at two different ages on the peripheral blood (PB) T-cell subpopulations. Forty full term healthy newborns were randomly chosen. Twenty of them were vaccinated with BCG at birth (group I) and the remaining at the age of 2 months (group II). The cell analysis were carried out before (pre-BCGI and pre-BCGII), and 2 months after (post-BCGI and post-BCGII) the vaccination. The analysis of the gamma/delta and alpha/beta T-cell receptor (TCR) antigens was done by two-colour flowcytometer. The purified protein derivative (PPD) response was investigated 2 months after vaccination. The results showed that although T-cell (TCR+ cell) counts showed no difference in PB before and after vaccination in both study groups, the total lymphocyte and non-T cell (TCR- cell) populations increased significantly whereas alphabetaT-cell population significantly decreased after vaccination. On the contrary, gammadeltaT-cell counts in PB increased significantly 2 months after vaccination in group I but not in group II. Total lymphocyte and non-T cell counts in vaccinated infants at 2 months of age (post-BCGI) were significantly higher than in unvaccinated infants of the same age whereas alphabetaT-cell count in vaccinated infants was significantly low. However, total T-cell and gammadeltaT-cell counts showed no difference. PPD positivity was similar in both study groups (61% in group I, 66% in group II). Neither alphabetaT- nor gammadeltaT-cell counts were different in PPD positive and PPD negative infants. Our study shows that BCG causes marked quantitative changes in the PB T-cell subpopulations in young infants.     

In vitro immunoglobulin response of fetal B-cells is influenced by perinatal infections and antibiotic treatment: a study in preterm infants

The aim of our study was to analyse the influence of perinatal infections and administration of antibiotics on B-cell activity in blood cell cultures of preterm infants. We studied spontaneous and Escherichia coli induced immunoglobulin (Ig) secretion in 148 infants of 24 to 36 weeks of gestation: 53 healthy infants (Group I), 40 healthy infants receiving prophylactically antibiotics (Group II), 14 infants with intra-uterine infection (Group III) and 41 with nosocomial infection (Group IV). Spontaneous Ig secretion was significantly lower in neonates with intra-uterine infection (Group III) than in healthy infants of Group I. Nosocomial infections in Group IV increased spontaneous Ig synthesis, but only in the first days after birth. E. coli stimulation of peripheral blood mononuclear cells significantly increased Ig synthesis in healthy infants of Group I, whereas induced minimal Ig production in infected infants of Groups III and IV. Antibiotics given as prevention to Group II decreased Ig production in cell cultures as compared to healthy infants (Group I). Conclusion The results indicate that perinatal infections and administration of antibiotics depress immunoglobulin secretion in cell cultures. We suggest that in vivo B-cell activity in infected preterm infants, and infants prophylactically receiving antibiotics, could also be depressed and result in decreased immunoglobulin production in these infants. Received: 8 April 1997 / Accepted in revised form: 24 November 1998     

Fecal sodium and potassium losses in low brith weight infants

We measured 24-hour fecal losses of sodium (Na) and potassium (K) in immediate post natal period of preterm neonates to determine the role of this route in the electrolyte imbalances seen in such infants. The values from preterm infants were compared to a group of age matched term infants. Eleven studies were done on unfed extremely low birth weight infants (group I, birth weight <1200 gms), seven on fed preterm infants (group II, birth weight 1201–2500 gms) and nine on fed term infants (group III, birth weight 2501–4000 gms). Measured and derived variables compared between the groups were 24 hour fecal volume, total fecal electrolyte contents, Na or K lost per kg of body weight and per gm of stool and Na or K losses as percent of intake. Although 24 hour fecal volume was lowest in group I, none of the variables related to Na differed between groups I and II whereas all of them were significantly lower in group I when compared with group III. Groups II and III differed only in terms of Na loss/gm stool which was lower in the previous group. Conversely K loss/gm of stool was significantly higher in group I when compared with both groups II and III and the only variable that differed between groups II and III was a higher fecal K content as fraction of intake. Fecal K/Na ratio was highest in group I, and decreased progressively with advancing gestational age, whereas creatinine clearance was lowest in group I and increased along with gestational age. Serum electrolyte levels were normal, although serum Na concentration was lowest in group I and serum K concentration highest in group II. We conclude that very low birth weight infants have relatively higher fecal K concentrations in the first week of extrauterine life, and speculate that this might have physiological significance as these infants are prone to hyperkalemia during this period.     

小于胎龄儿生后早期肾脏功能初探

目的对小于胎龄儿(SGA)生后早期肾脏功能进行回顾性对照研究,以探寻SGA儿早期肾功能损害的诊断方法。方法选择早产SGA儿40例、足月SGA儿33例作为研究组,并以早产适于胎龄儿(AGA)80例、足月儿AGA 33例作为对照组。比较各组入院48 h内血清尿素氮(BUN)、血清肌酐(SCr)、估算肾小球滤过率(eGFR)、血压、单位体重尿量以及蛋白尿的发生情况。结果早产儿SGA组的BUN低于AGA组(P0.05),两组间SCr、eGFR、血压的差异无统计学意义(P0.05)。与足月儿AGA组比较,SGA组的SCr较高、eGFR较低,差异均有统计学意义(P0.05);两组间BUN、血压的差异无统计学意义(P0.05)。早产儿或足月儿AGA与SGA之间单位体重尿量的差异无统计学意义(P0.05)。早产儿AGA与SGA之间蛋白尿发生率的差异无统计学意义(P0.05),足月儿AGA与SGA组均无蛋白尿发生。结论 SCr、eGFR对评估SGA早期肾脏损害较为敏感。足月儿SGA较AGA肾脏功能减低。     

Continuous gastric pH measurement in young and older healthy preterm infants receiving formula and clear liquid feedings

Gastric pH was recorded with an intragastric pH electrode for 12 h in two groups of healthy, preterm infants with similar birth weights (range 1.4 to 2.0 kg). Group I infants (n = 13) were less than 7 days old and Group II infants (n = 10) were 7-15 days old. Infants were fed three formula feedings and one clear liquid feeding during the study. In Group I, mean gastric pH measured at 15-min intervals was above 4.0 for 3 h after either feeding. In Group II mean gastric pH was lower particularly after clear liquid feedings, where it remained below pH 4.0 for the entire 3-h postprandial period. The percent of monitored time at gastric pH less than 4.0 was low in Group I--15.2 +/- 4.2% and 20.6 +/- 6.4% after formula and clear liquid, respectively. The percent time was greater in Group II--42.7 +/- 8.0% and 61.9 +/- 7.3% after formula and clear liquid, respectively. In the younger preterm infant, gastric pH does not appear sufficiently low to support peptic activity.     

Growth of 519 Small for Gestational Age Infants during the First Two Years of Life

ABSTRACT. The physical growth of 519 small for gestational age infants (SGA), with a birth weight below the 10th percentile on our own growth curve, born in the region of University Central Hospital of Turku during the period June 1,1981-May 31, 1982, was studied. The study population consists of 4 517 term, appropriate for gestational age (AGA) infants, 488 term SGA infants, 320 preterm AGA infants and 31 preterm SGA infants. The degree of intrauterine growth retardation (IUGR) seemed to have an effect on physical growth in term SGA infants. Those term SGA infants with a low Ponderal Index (PI) (type II) were taller and had a larger head circumference at the age of 24 months than term SGA infants with adequate PI (type I). Among the preterm SGA infants the degree of IUGR seemed to have no effect on later growth. Smoking is still one of the main risk factors associated with poor intrauterine growth. In this study we also found that smoking has an effect on later growth; the children of smoking mothers were smaller than those of non-smoking mothers in the AGA group. Among the SGA infants the infants of non-smoking mothers were bigger than those of smoking mothers. This difference could be explained by other factors associated with SGA. We found that in spite of the catch-up growth during the first months, 26% of the severely SGA infants (birth weight below the 2.5th percentile) still had a weight below the 2.5th percentile at the age of 24 months.     

Effect of phototherapy in preterm infants on growth in the neonatal period

A total of 120 preterm infants were randomly divided at 24 hr of age into three groups: Group I, controls; Group II, continuous phototherapy for 5 days; and Group III, intermittent phototherapy (12 hr on and 12 hr off) for 5 days. At the end of week 1 80% of the control group regained and surpassed their birth weight as opposed to 44 and 57.6% in the continuous and intermittent phototherapy groups, respectively. In weeks 2 and 3 both phototherapy groups had greater weight gain than the control group. Similar but less marked differences were observed in body lenth and head circumference in the three groups. Data suggest decreased growth during phototherapy with subsequent catch-up in growth during weeks 2 and 3. Differences were less marked between infants on intermittent (rather than continuous) phototherapy and controls. Increased metabolic demands and decreased intestinal absorption during phototherapy may be two of the factors responsible for the observed differences in growth in the three groups.     

High risk appropriate for gestational age (AGA) and small for gestational age (SGA) preterm infants. Neurological handicap and developmental abnormalities at five years of age

Outcome at five years of age of 110 high risk AGA, 71 high risk SGA preterm infants with similar birth weight and 102 term control infants was studied. Mean IQ in the 3 groups was not statistically different. Major handicaps were found in 16.3% of the AGA and in 8.5% of the SGA preterms. There was no major handicap among the controls. Minor neurodevelopmental abnormalities were present in 25.6% of AGA, 28.2% of SGA and 19.6% of controls. The types of neurodevelopmental handicaps were different in the 3 groups and generally more severe in the AGA group. All the major handicaps among AGA preterms were found in children with severe neonatal complications. In the SGA preterm group, only 1/3 of the major handicaps can be related to perinatal complications. Affective and behavior disorders were probably related in some way to neurodevelopmental achievement. This study showed that preterm infants with GA less than or equal to 32 weeks are more at risk than more mature SGA preterms with similar birth weight.     

Elevated neonatal salivary anti-casein immunoglobulin A antibodies as an indicator of atopic risk

Elevation of salivary SIgA-anti-casein has been shown to occur in newborn infants at risk of allergy. The present study was designed to follow 158 infants over 3 years to relate the onset of clinical disease to SIgA levels at birth. Newborn infants were divided into 3 groups according to their risk of allergy: Group I, ( n = 62; no allergy risk); Group II, ( n -30; low allergy risk); Group III ( n = 66; high risk group). The groups were matched for smoking, social background, sex, and dietary habits of the patients. SIgA-anti-casein was determined by a direct ELIS A. During the first year 59 infants developed atopic diseases ( n = 37 of Groups I and II; n = 22 of Group III). After 3 years 37/61 infants of the high risk group had developed allergic symptoms. The frequency of atopic disease correlated with increased salivary antibody titers at birth (p < 0.05). 54% of infants with antibody titers > 250 EU/ml developed atopic symptoms at 1 year, 76% high risk infants with this titer developed atopic symptoms at 3 years of age. This study provides evidence that elevation of SIgA-anti-casein at birth not only reflects atopic risk as defined by cord blood IgE or family history, but correlates with the actual development of allergic disease during the first 3 years of life.     

Catch-up growth in appropriate- or small-for-gestational age preterm infants

The aim was to evaluate postnatal growth of preterm infants in childhood and to determine factors that have an effect on catch-up growth (CUG). Ninety-six (42F, 54M) preterm born children with a gestational age of 32.6+/-2.9 weeks and birth weight of 1815+/-668 g were evaluated at age 4.7+/-1.1 years. Preterm children with birth weight and/or length below 10th percentile were accepted as small-for-gestational age (SGA) and those above as appropriate-for-gestational age (AGA). Height SDS was similar (-0.5+/-1.0) in preterm AGA and SGA children. Both groups had low body mass index (BMI) SDS (-0.6+/-1.4 and -1.0+/-1.5, respectively). Of the preterm SGA children, 65.8% showed a CUG in height and 3.8% catch- down growth. These rates were 24.6% and 33.5% in preterm AGA children. CUG in height was best explained by birth length and mother's height and CUG in weight by birth weight and mother's weight. In conclusion, although most of the preterm SGA children show CUG, they reach a compromised height in childhood. A number of preterm AGA children show a catch-down growth.     

Neurodevelopmental outcome at 12 months of age related to cerebral ultrasound appearances of high risk preterm infants

A prospective neurological and developmental assessment at 12 months of age corrected for prematurity was performed on 54 surviving preterm infants of 34 weeks' gestation or less. The babies were allocated into three groups according to their ultrasound (US) appearances: Group I (n = 29), normal scan; Group II (n = 10), isolated periventricular-intraventricular haemorrhage (PVH); Group III (n = 15), association of PVH, periventricular leukomalacia (PVL) and ventricular dilatation. The developmental outcome evaluated with the Griffiths' development quotient (DQ) was good and similar in Groups I and II, while it was worse and variable in Group III. There was also a higher incidence of neurological abnormalities in Group III, as 47% of children only were found to be normal compared to 86% and 80% in Groups I and II, respectively. A major handicap was diagnosed in 5 children of Group III. Infants with small lesions of PVH or PVL or with ventricular dilatation developed as well as children with normal US scan, whereas more diffuse or extensive US changes of PVL had a poorer prognosis. The outcome of a cerebral injury seems to depend on the type, the size and localisation of the lesion, and to some extent, on the neuroplasticity of the developing brain.     

Birth weight categorization according to gestational age does not reflect percentage body fat in term and preterm newborns

This study was performed to prove the applicability of the small-for-gestational age (SGA), appropriate-for-gestational age (AGA), and large-for-gestational age (LGA) classification depending on birth weight to predict percentage body fat (%BF) measured by dual-energy X-ray absorptiometry (DXA) in term and preterm infants. The data of 159 healthy term and preterm neonates (87 boys and 72 girls) with a gestational age at delivery of 38.4 weeks from two longitudinal studies were analyzed. Anthropometry and body composition data were assessed within the first 10 days after birth. Correlations between anthropometric parameters and fat mass measured by DXA were calculated. Prevalences of observations with low, middle, and high %BF measured by DXA were compared between SGA, AGA, and LGA groups, according to sex and gestational age. In term infants, 42.9% of the newborns with less than 10% body fat were classified to be AGA; 9.9% of all AGA newborns had less than 10% body fat. For the whole group, among the ratios investigated, the weight-length ratio (r=0.82) showed the best correlation to fat mass measured by DXA. The %BF at the time of study was higher in girls (14.75%) than in boys (11.95%). In conclusion, traditional classification based on birth weight centiles does not reflect %BF in term and preterm newborns.     

Neurosonographic findings in premature infants and infants with intrauterine growth retardation with a birth weight below 1,500 grams]

The cranial ultrasound of 111 preterm infants were reviewed. 57 patients were appropriate for gestational age (AGA) and 54 small for gestational age (SGA). In the two groups, the incidence of peri-intraventricular hemorrhage (PIVH), posthemorrhagic ventricular dilation (VM) and peri-ventricular leucomalacia (PVL) was compared. PIVH was more common in AGA than in SGA babies (36.8% vs 18.5%). In both groups (AGA and SGA), birth weight less than 1000 g should be considered a further risk factor for hemorrhagic brain lesion (72.2% in AGA babies less than 1000 g and 20.5% ind AGA babies greater than 1000 g birth weight, p less than 0.01) (34.8% in SGA babies less than 1000 g and 6.4% in SGA babies greater than 1000 g birth weight, p less than 0.05). However, ischemic brain lesions (PVL) were not dependent from birth weight (p greater than 0.5). This study shows that low birth weight infants are an eterogeneous group of babies with different risk of hemorrhagic or ischemic cerebral lesion depending on gestational age and birth weight.     

Longitudinal measurements of bone status in preterm infants

BACKGROUND: Quantitative ultrasound measurement of the speed of sound (SOS) through bone has been investigated as a means of assessing bone status in preterm infants. Few studies report longitudinal measurements. OBJECTIVE: To assess longitudinal changes in bone SOS in preterm infants. METHODS: Sixty preterm infants with gestational ages of < 33 weeks and with birth weight appropriate for gestational age (AGA), and 48 healthy, term AGA infants were enrolled. SOS measurements of the tibia were made within the first week of life in the preterm infants, and within the first 72 hours of life in the term infants. During their hospital stay, weekly measurements of tibial SOS were made in 29 of the preterm infants, who were divided into three gestational age groups: Group 1: 24-26 weeks (n = 8), Group 2: 27-29 weeks (n = 9), and Group 3: 30-32 weeks (n = 12). RESULTS: The median SOS value for the 60 newborn preterm infants was significantly lower than that for the 48 newborn term infants (2,924 versus 3,036 m/sec, p < 0.001). At each time point, SOS values for each of the preterm infant gestational age groups were significantly lower than the term newborn infant SOS values. SOS values decreased significantly over time for the entire cohort of 29 preterm infants (p < 0.001), and for Groups 1 (p = 0.015) and 2 (p = 0.003). At several time points, there was a significant negative correlation between serum alkaline phosphatase levels and SOS values, and a significant positive correlation between serum phosphorus levels and SOS values. CONCLUSION: SOS measurements of the tibia decline during hospitalization in preterm infants, suggesting a progressive loss of bone strength. Longitudinal measurements of bone SOS in combination with serum alkaline phosphatase and serum phosphorus levels may identify infants at risk of developing osteopenia of prematurity.     

AMPHETAMINE ADDICTION AND PREGNANCY

Abstract. Billing, L., Eriksson, M., Larsson, G. and Zetterström, R. (Department of Paediatrics, Karolinska Institute, St. Göran's Children's Hospital, Stockholm, Sweden). Amphetamine addition and pregnancy. Acta Paediatr Scand, 69: 675, 1980.—Sixty-six infants born to amphetamine-addicted mothers were followed during their first year of life. The children were divided into three groups, according to whether or not the mother stopped her abuse in early pregnancy (Group I) or continued (Group II) and whether or not the latter children were placed in foster homes immediately after birth (Group III). All but 2 of 16 mothers in Group I stayed off drugs and mostly met non-addicted friends. In Group II, on the contrary, all but 2 of 36 mothers continued their abuse one year after delivery. At the age of one year, all but one child in Group I were in their mothers' custody and all children in Group III had remained in foster care. In Group II one-third of the children lived in foster homes after revocation of the maternal custody. Several infants in Group II had experienced multiple transfers between the biological home and different foster homes. There were indicators that maternal amphetamine abuse causes temporary drowsiness in the infants during the first months after birth. However, all children at the age of 12 months, regardless of group, had a somatic and psychomotor development in accordance with the normal Swedish standard. In all groups there was an increased rate of medical care mainly because of infections. Some infants in Group II compared to none in Groups I and III were hospitalized be-cause of failure to thrive or suspected physical abuse. Symptoms indicating emotional disturbance were more common in infants of Group II than in infants of Groups I and III.     

Body water content of extremely preterm infants at birth

BACKGROUND: Preterm birth is often associated with impaired growth. Small for gestational age status confers additional risk. AIM: To determine the body water content of appropriately grown (AGA) and small for gestational age (SGA) preterm infants in order to provide a baseline for longitudinal studies of growth after preterm birth. METHODS: All infants born at the Hammersmith and Queen Charlotte's Hospitals between 25 and 30 weeks gestational age were eligible for entry into the study. Informed parental consent was obtained as soon after delivery as possible, after which the extracellular fluid content was determined by bromide dilution and total body water by H(2)(18)O dilution. RESULTS: Forty two preterm infants were studied. SGA infants had a significantly higher body water content than AGA infants (906 (833-954) and 844 (637-958) ml/kg respectively; median (range); p = 0.019). There were no differences in extracellular and intracellular fluid volumes, nor in the ratio of extracellular to intracellular fluid. Estimates of relative adiposity suggest a body fat content of about 7% in AGA infants, assuming negligible fat content in SGA infants and lean body tissue hydration to be equivalent in the two groups. CONCLUSIONS: Novel values for the body water composition of the SGA preterm infant at 25-30 weeks gestation are presented. The data do not support the view that SGA infants have extracellular dehydration, nor is their regulation of body water impaired.     

Vaginally born low-risk preterm infants: fetal acidosis and outcome at 6 years of age

In a population of vaginally born low-risk preterm infants fetal acidosis (scalp pH less than 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.     

Decreased bone mineral content in small-for-gestational-age infants compared with appropriate-for-gestational-age infants: normal serum 25-hydroxyvitamin D and decreasing parathyroid hormone

Bone mineral content was determined by photon absorptiometry, adapted for use in neonates, in 23 small-for-gestational-age (SGA) infants of 31 to 42 weeks of gestational age, for 12 weeks. At birth, term SGA infants had lower bone mineral content than term appropriate-for-gestational-age (AGA) infants; postnatal increase in bone mineral content was slow and lagged significantly behind that of term AGA infants. Preterm SGA infants had bone mineral content that was similar to that of preterm AGA infants at birth; postnatal bone mineral content was similar to that of preterm AGA infants, but was decreased compared with the expected intrauterine bone mineral content. Serum 25-hydroxyvitamin D concentrations and parathyroid hormone levels were the same for SGA and AGA infants. Serum 25-hydroxyvitamin D concentrations decreased slightly with postnatal age and remained within normal limits. Serum parathyroid hormone concentrations decreased in both SGA and AGA infants and reached undetectable levels at 10 to 12 weeks of age.