Probiotics for Prevention of Severe Necrotizing Enterocolitis: Experience of New Zealand Neonatal Intensive Care Units.

Necrotizing enterocolitis (NEC) affects mainly preterm infants, has a multifactorial etiology and is associated with intestinal dysbiosis and disordered immunity. Use of probiotics for prophylaxis is beneficial with studies indicating reduction in NEC ≥ stage 2, late onset sepsis (LOS) and mortality. However, not all studies have shown a reduction, there are questions regarding which probiotic to use, whether infants <1,000 g benefit and the risk of probiotic sepsis.

Metabolic acidosis in the first 14 days of life in infants of gestation less than 26 weeks.

Unlabelled: Extremely immature newborns develop a self-limiting normal anion gap metabolic acidosis in early life. This study examined the natural history of this acidosis in a population of infants of gestation less than 26 weeks in the first 14 days of life. The acidosis was maximal on day 4 with a mean base deficit of 10.

Plasma aldosterone levels in the 1st week of life in infants of less than 30 weeks gestation.

Unlabelled: Plasma aldosterone levels were measured in 50 infants of less than 30 weeks gestation at 24 h (D1) and 7 days (D7). The relationship between the plasma aldosterone level and a number of clinical and biochemical variables was explored. Plasma aldosterone levels ranged from 1000 to 30000 pmol/l and were inversely correlated with the severity of illness (D1 or D7), serum sodium (D7) and 24 h sodium intake (D1).

Hyponatraemic hypertensive syndrome in two extremely low birthweight infants.

Two cases of hyponatraemic hypertensive syndrome occurring in extremely low birthweight infants are presented. Both infants experienced unilateral renal ischaemia resulting in hyponatraemia and hypertension. A proposed pathophysiological mechanism, namely unilateral renal ischaemia leading to a pressure-natriuresis in the contralateral kidney, is presented.

Randomised trial of dopamine compared with hydrocortisone for the treatment of hypotensive very low birthweight infants.

Aim: To compare the efficacy of hydrocortisone with dopamine for the treatment of hypotensive, very low birthweight (VLBW) infants.

Methods: Forty infants were randomly allocated to receive either hydrocortisone (n = 21) or dopamine (n = 19).

Results: All 19 infants randomised to dopamine responded; 17 of 21 (81%) did so in the hydrocortisone group.

The pharmacokinetics of bupivacaine following interpleural nerve block in infants of very low birthweight.

Infants of very low birthweight (VLBW) who underwent thoracotomy were given 2.0 mg.kg-1 of bupivacaine by the intrapleural route, and serial blood levels were taken to determine the pharmacokinetic profile in this group of babies.

Outcome at 2 years of infants less than 1000 grams: a regional study.

Aims: To determine the neurodevelopmental outcome of infants with birthweight < 1000 g at 2 years.

Methods: Prospective, regional case-control cohort.

Results: Of 141 liveborn infants with birthweight between 500-999 g born to mothers of central North Island domicile, 83 (58.

Respiratory distress syndrome in New Zealand: evidence from the OSIRIS trial of exogenous surfactant (Exosurf).

Aims: To assess the impact, mortality, morbidity and economic costs, of respiratory distress syndrome severe enough to warrant ventilation in one year in New Zealand.

Methods: Review of data from all five New Zealand regional neonatal intensive care units' participation in the international OSIRIS trial of exogenous surfactant (Exosurf) treatment for respiratory distress syndrome (involving 6700 infants in 21 countries), and extrapolation of these data to a full year.

Results: There were 265 New Zealand infants entered in the OSIRIS trial; the mean birthweight was 1335 g and mean gestation 29 weeks; 61% of infants were less than 30 weeks gestation.

Neonatal septicaemia: a changing picture?

The incidence, aetiologic organism and mortality associated with neonatal septicaemia were retrospectively reviewed over a seven year period (June 1983 to July 1990). Trends with time were evaluated by dividing the study period in half. Although there was no significant change in the incidence of septicaemia during the study period (3.

Birth asphyxia associated oliguria: relationship to outcome at 1 year.

The relationship between the degree of oliguria following severe birth asphyxia and outcome at 12 months was examined in 31 infants. All 31 infants developed encephalopathy following severe birth asphyxia and 25 had oliguria for 24 h or more following delivery. Eighteen had persistent oliguria (i.

Overt neonatal seizures: outcome at one year.

Sixty-five infants with seizures in the neonatal period were followed to the age of one year. There were 27 nonsurvivors, with 14 neonatal deaths from causes directly related to the initial neurologic insult, and 13 postneonatal deaths, eight related to neurologic sequelae and five to unrelated causes. Twenty-four (63.

The effect of dexamethasone upon platelets and neutrophils of preterm infants with chronic lung disease.

The effect of a 21-day (reducing dose) course of dexamethasone upon platelet numbers, neutrophil numbers and neutrophil morphology in ventilator-dependent preterm infants with chronic lung disease is reported. Forty-one infants, who were sepsis-free throughout the treatment period, received 46 courses of dexamethasone. In these infants the circulating platelet count increased significantly from 235 +/- 157 to 476 +/- 208 X 10(9)/L.

Postneonatal mortality in a cohort of very low birthweight infants.

A cohort of very low birthweight (VLBW) infants (ie, less than 1500 g) who were admitted to the newborn unit, Waikato Hospital between 1984 and 1988 were followed to the age of 12 months. Four hundred and twenty-five infants were admitted with 385 surviving the neonatal period. A further 29 infants died in the postneonatal period (68.

Neonatal surgery at Waikato Hospital 1978-87.

A ten year (1 January 1978 to 31 December 1987) review of neonatal surgery at Waikato Hospital is reported. There were 367 operations performed on 296 infants aged 0-28 days, with 144 of the operations being classified as a major. Of the 31 deaths, three occurred preoperatively and 28 postoperatively, with diaphragmatic hernia (n = 8) and necrotising enterocolitis (n = 7) being the commonest causes.

Insulin infusions in infants of birthweight less than 1250 g and with glucose intolerance.

Fifteen preterm babies (mean gestation: 26.7 weeks; mean birthweight 860 g) with significant glucose intolerance were treated with insulin infusions. During the insulin infusions there was a significant increase in both the mean energy intake (60.

Avoidable hazard to New Zealand children: case reports of haemorrhagic disease of the newborn.

Haemorrhagic disease of the newborn is preventable by the routine administration of vitamin K to newborn babies. Despite this, prophylactic administration of Vitamin K1 remains controversial and haemorrhagic disease of the newborn continues to cause significant morbidity and mortality. We present two cases of this disease occurring recently in this region of New Zealand; one resulting in an infant's death, the other baby suffering from an intraventricular haemorrhage and secondary hydrocephalus.

Dexamethasone therapy in severe bronchopulmonary dysplasia.

Seven ventilator-dependent infants with severe bronchopulmonary dysplasia were treated with dexamethasone. Six of the seven infants were extubated within 12 days of commencing the dexamethasone, whilst the remaining infant continued to need respiratory support for apnoea, despite significant improvement in the pulmonary disease. All infants survived; although only two were neurologically intact.

Transcutaneous bilirubinometry: 22 months experience at Waikato Women's Hospital.

Twenty-two months experience with a transcutaneous bilirubinometer (TCB) at Waikato Hospital is reported. During this period 2787 paired TCB and serum bilirubin samples were collected. Correlation coefficients for TCB (forehead and sternum) versus serum bilirubin in both Maori and caucasian infants ranged from 0.

Pyloric stenosis: a postoperative ultrasonic study.

Six infants with hypertrophic pyloric stenosis and 20 control infants were studied ultrasonically on four occasions during the first year of life. At each examination the total diameter and muscle wall thickness of the pylorus were measured. Initially the pylorus was significantly (P less than 0.