Metoclopramide effect on faltering milk production by mothers of premature infants.

Metoclopramide treatment has been shown to augment milk production by stimulating prolactin secretion in women in whom lactational insufficiency develops after a full-term pregnancy. The effect of metoclopramide therapy in 23 women who were delivered of premature infants (birth weight 1,314 +/- 115 g, gestational age 30.4 +/- 0.

Bacterial meningitis as an etiology of perinatal cerebral infarction.

Despite significant improvement in mortality rate, survivors of neonatal bacterial meningitis experience a significant incidence of neurodevelopmental sequelae. Neuropathologic studies have demonstrated vasculitis, arachnoiditis, and ventriculitis with secondary edema and encephalomalacia. Areas of cerebral infarction, most commonly thought to be venous in origin, have been reported as well.

Cassette electroencephalography in the evaluation of neonatal seizures.

Three-channel cassette electroencephalographic (EEG) recording for up to 24 hours was obtained from 37 neonates with clinically diagnosed or suspected seizures but no seizure activity on routine EEG. EEG seizures were recorded in seven patients, five of whom had experienced clinical seizures in the 24 hours prior to cassette EEG recording. EEG seizures were detected in only one of nine neonates with recurring clinical episodes believed unlikely to be seizures and in only one of 18 without recent clinical events.

Randomized indomethacin trial for prevention of intraventricular hemorrhage in very low birth weight infants.

We admitted 48 preterm neonates (600 to 1250 gm birth weight, normal 6-hour echoencephalograms) to a randomized prospective indomethacin or placebo trial for the prevention of neonatal intraventricular hemorrhage. Beginning at 6 postnatal hours, indomethacin or placebo was administered intravenously every 12 hours for a total of five doses. Cardiac ultrasound studies to assess the status of the ductus arteriosus were performed at 6 postnatal hours and on day 5.

Early childhood developmental follow-up of infants with GMH/IVH: effect of methylxanthine therapy.

Theophylline, aminophylline, and caffeine are methylxanthines frequently used in the treatment of idiopathic apnea of prematurity. These agents alter both cerebral blood flow and metabolism and are frequently administered to small preterm neonates, many of whom have experienced germinal matrix and/or intraventricular hemorrhage (GMH/IVH) and thus may suffer underlying disturbances of both cerebral blood flow and metabolism. Our data demonstrate that infants with GMH/IVH required methylxanthine therapy in the neonatal period more often than their nonhemorrhage peers.

Cassette electroencephalographic recording of neonates with apneic episodes.

To evaluate the practical importance of seizures as a cause of neonatal apnea, we obtained extended cassette electroencephalographic recording for periods as long as 24 hours from 50 neonates experiencing apneic episodes unassociated with clinical seizure activity. Electroencephalographic recording through definite apneic episodes was obtained in 37 neonates; a total of 153 episodes were detected. None was associated with electroencephalographic seizure activity, although one term neonate without documented apneic episodes had seizure activity detected by cassette electroencephalography and may have had apneic seizures.

A comparison of sonographic estimation of fetal weight and obstetrically determined gestational age in the prediction of neonatal outcome for the very low-birth weight fetus.

A comparison of sonographic estimation of fetal weight and obstetrically determined gestational age in the prediction of neonatal outcome for the very low-birth weight fetus was conducted in a study population of 122 fetuses. With stepwise logistic regression, obstetric gestational age was found to be the best predictor of neonatal death, while sonographic estimated fetal weight did not add significantly to this prediction. However, both variables were important in the prediction of adverse neonatal outcome (neonatal death together with major neonatal complications of prematurity.

Neurodevelopmental assessment of very low birth weight neonates: effect of germinal matrix and intraventricular hemorrhage.

During a recent 36-month interval, all neonates of less than or equal to 1250 gram birth weight who were admitted to our Newborn Special Care Unit and survived the first 36 postnatal hours underwent either computed tomography or echoencephalography or both for the assessment of neonatal germinal matrix hemorrhage and intraventricular hemorrhage. Seventy of the 164 long-term surviving infants experienced neonatal germinal matrix and/or intraventricular hemorrhage (GMH/IVH Group), whereas 94 infants had studies that were negative (Non-hemorrhage Group). Serial neurodevelopmental assessments were performed on 142 (87%) of the 164 long-term surviving infants; these assessments included the Bayley Scales of Infant Development at 3, 6, 12, and 18 months (corrected age) and the Stanford-Binet and Peabody Picture Vocabulary examinations at 30 months (corrected age).

Absorption of calcium in premature infants as measured with a stable isotope 46Ca extrinsic tag.

Absorption of dietary calcium was evaluated with the extrinsic tag approach and stable isotope methodology in growing premature infants. Fractional absorption of a bolus dose of 46Ca was determined on 16 occasions in 13 premature infants (birth weight 1135 +/- 40 g, gestational age 29.5 +/- 0.

Clonidine treatment of neonatal narcotic abstinence syndrome.

Clonidine hydrochloride, an alpha 2-adrenergic agonists, was used to treat seven infants who were passively addicted to narcotics because of maternal methadone maintenance. In six of seven infants, the major symptoms of narcotic withdrawal were ameliorated after a total daily oral dose of 3-4 micrograms/kg/day was achieved. One infant failed to respond.

Perinatal cerebral infarction.

The diagnosis of perinatal cerebral infarction, although frequently suggested clinically, has been made most commonly at postmortem examination; few infants surviving stroke are reported in the literature. We evaluated 18 infants with perinatal cerebral infarction in a recent twelve-month interval. Seven were preterm neonates, 6 of whom had experienced neonatal intraventricular hemorrhage.

Total lipid content and fatty acid composition of preterm human milk.

The total lipid content and fatty acid composition of preterm human colostrum and milk were analyzed from aliquots of 24-h collections of colostrum, transitional milk, and mature milk obtained from 21 women who had delivered premature infants with a mean birth weight of 1,049 +/- 38 g (mean +/- SEM) and a mean gestational age of 29 +/- 0.4 weeks. The total lipid content increased significantly with time of lactation (p less than 0.

Delayed hemorrhagic infarction. A cause of late neonatal germinal matrix and intraventricular hemorrhage.

Although a single perinatal or postnatal event may be directly correlated to intraventricular hemorrhage (IVH) in some infants, in other infants IVH may be related to a series of insults. Asphyxia, hypotension, and a pressure-passive low cerebral blood flow (CBF) may lead to an infarction. Subsequent events known to cause sudden rises in the CBF may then produce a hemorrhage into damaged tissues.

Determination with stable isotopes of the dietary bioavailability of zinc in premature infants.

Dietary zinc bioavailability was evaluated with the extrinsic tag approach of stable isotope enrichment technology in growing premature infants. The fractional absorption of one dose of 70Zn was determined on 16 occasions in 13 premature infants (birth weight 1135 +/- 40 g, gestational age 29.5 +/- 0.

Intraventricular hemorrhage in the preterm neonate: timing and cerebral blood flow changes.

Serial cranial ultrasound studies, 133xenon inhalation cerebral blood flow determinations, and risk factor analyses were performed in 31 preterm neonates. Contrast echocardiographic studies were additionally performed in 16 of these 31 infants. Sixty-one percent were found to have germinal matrix or intraventricular hemorrhage.

Posthemorrhagic hydrocephalus. Low incidence in very low birth weight neonates with intraventricular hemorrhage.

In addition to seizures and long-term neurodevelopmental handicaps, infants with intraventricular hemorrhage (IVH) are at risk for posthemorrhagic hydrocephalus (PHH), and the incidence of this problem in preterm infants with known IVH has been reported to vary from 25% to 74%. Over a 46-month period, 438 neonates of 1250-gm birth weight or less were admitted to this Newborn Special Care Unit, and 269 survived the first 36 postnatal hours. Of these, 265 patients underwent computerized tomography and/or cranial ultrasound scanning for evaluation of germinal matrix and/or intraventricular hemorrhage (GMH/IVH): 133 infants were found to have experienced GMH/IVH, and 27 of these died within the 1st postnatal week.

Craniofacial anomalies in the amniotic band disruption complex.

We describe a newborn with multiple congenital anomalies due to the Amniotic Band Disruption Complex. Cerebral computerized tomography and plain films of the extremities corroborated the clinical diagnosis. The purpose of this case report is to alert the radiologist to the varied radiographic appearance of this little known entity and to provide a historical and embryologic background.

Evidence for late developmental deficit in very low birth weight infants surviving intraventricular hemorrhage.

88 very low birth weight preterm infants who had been evaluated with neonatal computed tomography scanning and/or echoencephalography were subsequently brought to follow-up. Serial neurodevelopmental testing at 6, 12, and 18 months corrected age demonstrated that even the lesser grades of germinal matrix and intraventricular hemorrhage may be associated with a relatively less favorable neurodevelopmental outcome.

Postpartum perfusion of the preterm brain: relationship to neurodevelopmental outcome.

Bayley developmental assessments were performed at 12 months corrected age on 11 preterm infants, all of whom had undergone 133-Xenon cerebral blood flow measurements (CBF) on the 1st day of life and neonatal computerized tomography scans for the detection of intraventricular hemorrhage. The Bayley mental index was found to vary as a quadratic function of CBF to the left hemisphere, with moderate CBF values associated with more favorable outcomes than either low or high CBF values.

Pharmacokinetics of a single intramuscular injection of vitamin E to premature neonates.

The pharmacokinetics of parenterally administered vitamin E (d, l-alpha tocopherol) in serum were developed using data from five premature neonates (1,500 +/- 100 gm) receiving a single 20 mg/kg intramuscular injection. Blood samples were obtained immediately prior to drug administration to establish baseline vitamin E concentrations: then further sampling was performed at various intervals for up to 7 days. It was assumed that dietary intake of vitamin E did not markedly alter serum concentration of vitamin E during the 7-day study and that the total intramuscular dose was absorbed.