Variability of plasma cortisol levels in extremely low birth weight infants.

Cortisol is secreted by children and adults in a pulsatile pattern of 15-30 peaks and nadirs each day with a circadian rhythm. Newborns are known to lack the circadian pattern, leading to uncertainty about the appropriate time for blood sampling for assessment of adrenal function. Because extremely low birth weight (ELBW) infants may manifest signs of adrenal insufficiency, knowledge of the pattern of cortisol levels is necessary to guide the appropriate timing of blood sampling.

Subgaleal hematoma: the need for increased awareness of risk.

Subgaleal hematoma, also known as subaponeurotic hemorrhage, is a serious complication of birth that is associated with vacuum-assisted delivery. Despite a high rate of mortality associated with subgaleal hematoma, it has received relatively little attention in the medical literature. Lack of awareness may lead to delayed diagnosis and serious consequences for infants.

A scoring system for evaluating the condition of transported neonates.

A scoring system for the evaluation of the clinical status of transported small premature infants was modified to make it applicable to the evaluation of both premature and term infants. Blood glucose concentration, systolic blood pressure, blood pH and PO2, and body temperature were assessed and given scores of 0, 1 or 2 for abnormal, borderline and normal values, respectively. The scoring system was used for quality assurance studies of changes in patient status during transport from community hospitals to the neonatal intensive care unit and proved useful in identifying inadequate attention to body-temperature maintenance.

Transient myeloproliferative disorder of the Down type in the normal newborn.

Two infants with congenital nonlymphoblastic leukemia were discovered to have mosaicism for trisomy 21. Both infants achieved durable spontaneous remissions. Trisomy was apparently restricted to the leukemic clone and could be detected in neither phytohemagglutinin-stimulated peripheral blood cells or bone marrow in either patient nor in myeloid progenitor cells from the second patient after resolution of the transient myeloproliferative disorder.

Nutritional balance studies of VLBW infants fed their mothers' milk fortified with a liquid human milk fortifier.

This article reports the results of a study designed to compare human milk fortified with a liquid human milk fortifier to a preterm infant formula by analyzing the metabolic balances of certain nutrients when these milks are fed to premature infants. Ten very low birth weight (VLBW) infants were studied during 4-day equilibration periods, then 4-day metabolic balances of N, fat, Ca and P, while each consumed a 1:1 mixture of a pool of its own mother's milk and the liquid human milk fortifier (HM/LF). For comparison, another 10 VLBW infants were studied in similar fashion while consuming the preterm infant formula (PF).

Prolonged inactive phases during the discontinuous pattern of prematurity in the electroencephalogram of very-low-birthweight infants.

A consecutive cohort of 46 very-low-birthweight infants, who had routine electroencephalograms (EEGs) while in the neonatal intensive care unit, were studied. Two infants were lost to follow-up and were excluded, leaving a study population of 44 infants. Their mean birthweight was 945 +/- 166 g, gestation 27.

Insulin infusion with parenteral nutrition in extremely low birth weight infants with hyperglycemia.

From Nov. 7, 1983, to Nov. 6, 1986, all infants with birth weight less than or equal to 1000 gm admitted to Oregon Health Sciences University who had persistent hyperglycemia and glycosuria were treated with graded insulin infusion while energy intake was increased to at least 100 kcal/kg/day (419 kilojoules/kg/day).

Outcome for fetus with ascites and cytomegalovirus infection.

The prenatal and neonatal course of a fetus with cytomegalovirus infection and ascites found on ultrasonographic examination at 27 weeks' gestation is reported. The ascites resolved within 4 weeks and the neonate had evidence only of mild congenital cytomegalovirus infection at birth. The factors predictive of the long-term outcome for an infant with congenital cytomegalovirus infection are reviewed.

Benzyl alcohol toxicity: impact on mortality and intraventricular hemorrhage among very low birth weight infants.

Benzyl alcohol preservative in intravascular flush solutions has been reported to cause neurologic deterioration and death in very low birth weight infants. Following the widespread discontinuation of the use of such solutions in newborns, scattered reports of decreased mortality and decreased incidence of intraventricular hemorrhage among small premature infants appeared in the pediatric literature. To better assess the true impact of benzyl alcohol toxicity in this group of infants, we undertook a detailed review of the medical records of all babies less than 1,250 g birth weight admitted to our neonatal intensive care unit for 13 months before and 13 months after the use of solutions containing benzyl alcohol was stopped.

Benzyl alcohol toxicity: impact on neurologic handicaps among surviving very low birth weight infants.

Benzyl alcohol preservative in solutions used to flush intravascular catheters has been linked with increased mortality and incidence of intraventricular hemorrhage in small preterm infants. This study evaluated the outcome of surviving very low birth weight infants exposed to benzyl alcohol while in our neonatal intensive care unit. Surviving infants, less than 1,250 g birth weight, admitted during the 12 months prior to discontinuation of benzyl alcohol (period I), were compared with those infants admitted during the 12 months after discontinuation of benzyl alcohol (period II).

Serum vitamin E levels in very low-birth weight infants receiving vitamin E in parenteral nutrition solutions.

Serum vitamin E levels were measured in 17 very low-birth weight infants in the first 2 wk of life, before and after the institution of intravenous vitamin E supplementation in a dosage of 4.5 mg/day, as a component of MVI Pediatric multivitamin preparation. Serum vitamin E levels were 0.

[Seizures in premature and newborn infants under 2,500 grams birth weight].

Seizures in premature babies pose a special problem which occur more often than in term neonates. The data of 156 neonates weighing less than 2 500 grams consecutively admitted to a neonatal intensive care unit during a 6 month period were evaluated. 33 infants (21%), of whom 21 were less than 31 weeks of gestational age suffered from seizures.

Selenium and vitamin E sufficiency in premature infants requiring total parenteral nutrition.

A randomized prospective study of LBW infants was undertaken to evaluate the effect of parenteral lipid infusions upon their antioxidant systems. Ten babies received a parenteral nutrition regimen with lipid emulsion, and ten received a regimen without lipid. Although the addition of lipid emulsion to the total parenteral nutrition regimen led to a rise in vitamin E levels, the selenium levels fell in both groups.

[EEG in newborn infants with intracranial hemorrhages: a comparison with clinical findings and CT scan].

This study was undertaken to evaluate the usefulness of the EEG in neonates with intracranial hemorrhage (ICH) and to correlate the EEG with clinical findings and the CT-scan. Thirty-eight infants with intraventricular hemorrhage (IVH) and/or subarachnoid hemorrhage (SAH) had EEG examinations. Repetitive sharp waves were present in IVH (48%) and also seen in SAH (33%).

Growth graphs for the clinical assessment of infants of varying gestational age.

Two graphs are presented showing means and 1 and 2 SD for growth in weight, length, and head circumference: (1) a fetal-infant graph with lines of growth from 26 weeks of gestational age until one year of age after ""term'' has been reached: and (2) a similarly constructed graph for children ages one through ten years. The standards of growth were obtained from published data in which the subjects received optimal health care. The graphs allow comparisons of infants of varying gestational age with standards for that age.