Chiara Vegni

Polymerase chain reaction, virus isolation and antigen assay in HIV-1-antibody-positive mothers and their children

Diagnosis of perinatal HIV-1 infection is complicated by the persistence of maternal antibodies and the conflicting reports on polymerase chain reaction (PCR) reactivity in children born to HIV-1-seropositive mothers. We have compared PCR with other diagnostic methods for perinatal HIV-1 infection and have attempted also to identify maternal markers which correlate with risk of transmission. PCR was the most sensitive method for early diagnosis of perinatal transmission of HIV-1, but the PCR-positive children (n = 11) developed at least one additional sign of infection. The PCR-negative children (n = 76) were clinically healthy, virus isolation negative, and their serum was HIV-1-antigen-negative. All children who had become seronegative (n = 36) were both PCR- and isolation-negative. Antigenaemia in the mothers correlated significantly with higher risk of perinatal transmission of HIV-1, while no other parameters (clinical stage, lymphocyte subsets, PCR and isolation) showed such a correlation. This indicates that the level of virus expression may be of key importance for the risk of vertical transmission of HIV-1 infection.

Twelve-month neurofunctional assessment and cognitive performance at 36 months of age in extremely low birth weight infants.

OBJECTIVE. The objective of this study was to investigate whether an early neurofunctional assessment (at 12 months’ corrected age) is predictive of cognitive outcome at 36 months of age in extremely low birth weight infants. METHODS. We conducted an observational longitudinal study. Neurodevelopmental outcome by means of a neurofunctional assessment was evaluated at 12 months’ corrected age and 36 months’ chronological age in 141 extremely low birth weight children. Cognitive outcome was assessed with use of the Griffiths Mental Developmental Scale. RESULTS. A significant association was found between the 12-month neurofunctional status and cognitive performance at 36 months. A higher general quotient on the Griffiths Mental Developmental Scale at 36 months was observed in infants who exhibited normal (score: ≤1) neurodevelopment compared with children who exhibited minor (score: 2) and major (score: ≥3) dysfunctions at the 12-month neurofunctional evaluation (99 ± 6.8 vs 85.3 ± 16.3 vs 57.3 ± 22.0). A score of ≥2 at the 12-month neurofunctional assessment, abnormal brain MRI results at term, and chronic lung disease remained predictive of cognitive delay at 36 months of age and also after adjustment for confounders. CONCLUSIONS. The 12-month neurofunctional evaluation may be an additional useful clinical tool in predicting later cognitive outcome in extremely low birth weight children.

Role of umbilical doppler velocimetry in the biophysical assessment of the growth-retarded fetus : answers from neonatal morbidity and mortality

We compared umbilical Doppler velocimetry with biophysical parameters, obstetrical management, and neonatal morbidity. The study of 85 pregnancies was prospective and blind both to the obstetric and pediatric staff. Our results show that under the same biophysical diagnosis, ie, abnormal fetal growth, oligohydramnios, and nonreactive cardiotocographics, the prevalence of neonatal morbidity was significantly higher in fetuses with associated abnormal umbilical pulsatility index (PI) in utero. Newborns with abnormal PI were delivered earlier, mostly for fetal indication, and were smaller and more asymmetrical than newborns with a normal PI in utero. The analysis of morbidity for homogeneous classes of weight showed that in the group of newborns between 1500 and 2500 g, newborns with normal umbilical PI did show only metabolic disturbances and one respiratory distress syndrome. On the contrary, newborns of the same gestational age and of the same weight with abnormal PI had more severe morbid episodes. In the class of weight between 1500 and 1000 g not only the severity but also the prevalence of neonatal morbidity was significantly higher in newborns with an abnormal PI in utero. None of the newborns delivered below 1000 g had a normal umbilical PI. Five died in the early neonatal period. Three suffered from mild neuromotor sequelae. Practical consequences of these findings on fetal management are the scheduled frequency of biophysical examinations, which must be closer and on an inpatient basis whenever abnormal, and the interpretation of other abnormal biophysical parameters, which must be considered as more severe whenever associated with an abnormal umbilical velocimetry.

Regional fat distribution in children born preterm evaluated at school age.

Children born preterm may have aberrant adiposity. At school age, we evaluated body fat and fat distribution in 45 former preterm infants (birth weight ≤1800 g and gestational age <34 weeks) and 40 children born at term using dual-energy x-ray absorptiometry. Children born preterm exhibited lower total body fat mass and total body fat mass index compared with children born at term. Fat mass indexes in the limbs but not the trunk were lower in children born preterm than in children born at term. In conclusion, children born preterm, evaluated at school age, may be at risk for altered regional adiposity.

Allergic manifestations in very low-birthweight infants: a 6-year follow-up.

The incidence of allergic manifestations was evaluated from birth until 6 y of age in 83 very low‐birthweight infants (VLBWIs). In the same period 98 full‐term babies were followed from birth to 24 mo of life. All the subjects were examined by paediatricians to establish the presence of atopic dermatitis (AD), gastrointestinal disturbances (GD) and asthma (AS). The incidence of total allergic manifestations (31.3%) in VLBWIs was significantly lower than that (52%) in 24‐mo‐old infants, born at full term. The incidence of allergies in VLBWIs did not differ at all at the subsequent checks, up to 6y of age. AD (33.7%) was the most common symptom, statistically higher in full‐term infants than in VLBWIs (7.2%). GD had a similar distribution (8.2% in full‐term infants vs 7.2% in VLBWIs). AS (16.8%) was significantly higher in VLBWIs than in those born full term (10.2%). In the various VLBWI subgroups analysed, AD was more prevalent in babies weighing >1000 g and in babies >30 wk of age; the incidence of GD was higher in infants weighing <1000g and in SGA infants, and AS was more prevalent in infants weighing <1000g, in infants <30 wk of age and in babies appropriate for gestational age. A family history of allergy was related to a major incidence of allergies.

Post-discharge nutrition of the very low-birthweight infant: interim results of the multicentric GAMMA study.

This report presents the interim results up to 12 mo corrected age (c.a.) of a multicentric, prospective, controlled study on very low‐birthweight infants, randomized at 40 wk post‐conception in two different groups of formula feeding: 80 Kcal/dL (group A) vs 70 Kcal/dL (group B) up to 55 wk of postconceptional age. Subsequently, all the babies were fed with a follow‐on formula, with the introduction of solid foods at 6 mo c.a. Weight, length, head circumference and neurological conditions with psychomotor development (evaluated by the Griffiths’Developmental Scale) were measured at regular intervals and all of these parameters were satisfactory in both groups. For growth, in group A there was a greater increase in weight in boys at 55 wk and at 6 mo c.a., and small for gestational age (SGA) babies had a greater increase in length at 1 y of age, while head circumference caught up on growth from week 40 to week 55. Measured by the Griffiths’Developmental Scale, the SGA group fed 80 Kcal/dL had a better score at 6 mo; similarly boys fed 80 Kcal/dL had a better score at 6 and at 9 mo.

EEG sleep patterns and endogenous opioids in infants of narcotic-addicted mothers

The early symptoms of brain dysfunction in infants born to heroin-addicted mothers were studied during the first month of life by a multimethod approach. Neurological examination and polygraphic EEG studies of sleep patterns were performed; concomitantly plasma levels of beta-endorphin and met-enkephalin were measured. Whenever possible, these parameters were correlated with each other and with the severity of the withdrawal syndrome. While the neurological examination of addicted newborns was almost negative, altered sleep cycles with a decrease in active sleep and an increase in quiet sleep were noted together with a marked increase in the plasma concentration of the endogenous opioid peptides. Furthermore, instead of reverting to the adult values (as for normal babies), the peptides remained at high levels up to the 40th day of life.

Umbilical flow waveforms versus fetal biophysical profile in hypertensive pregnancies

The pulsatility index (PI) of the umbilical arteries was measured in 40 hypertensive pregnancies. Doppler-velocimetric data were kept unknown to the clinical staff. An abnormal PI was found in 79% of cases in which an abnormal fetal growth in utero had been diagnosed by ultrasonographic measurements. Serial PI findings showed worsening figures in most of the cases with an abnormal fetal growth, irrespective of the last absolute value. Amniotic fluid estimation and PI data were significantly correlated. PI values were markedly abnormal in fetuses with non-reactive heart-rate tracings. A high sensitivity and an optimal specificity were found for umbilical PI versus the diagnosis of fetal growth retardation made by the coexistence of different biophysical criteria. However, false normal results may occur. 62% of the newborns weighed below the 5th percentile. The sensitivity of abnormal PI values to detect these light fetuses resulted to be only 67%. However the prevalence of neonatal morbidity in fetuses with abnormal PI values was 74%, while morbidity occurred only in 14% of cases with normal PI values. In hypertensive pregnancies, this simple velocimetric parameter proved to correlate with abnormal biophysical monitoring and complicated neonatal outcomes.

Influence of different types of post-discharge feeding on somatic growth, cognitive development and their correlation in very low birthweight preterm infants.

The influence of appropriate post‐discharge nutrition on somatic growth and cognitive development of very low‐birthweight infants in the first year of life is currently a major topic in infant nutrition. Appropriate intakes of proteins, iodine and the addition of LC‐PUFAs (arachidonic acid (AA), docosahexaenoic acid (DHA)) in the “right” quantities improve cognitive development and are conducive to a good correlation between somatic growth and neurodevelopment.

396 Factors Associated with Recovery of Growth in Extremely Low Birth Weight Infants

AIMS: To examine the growth pattern through the first 36 months of life in infants born extremely low birth weight (ELBW) and to investigate whether any relationship exists between growth, neonatal characteristics and neurodevelopment outcome at 36 months of chronological age (c.a.).METHODS: One hundred forty-five ELBW infants (mean (SD) gestational age 27.9 (1.9) weeks, birth weight 841 (123) g), consecutively born 1996–2001, without congenital or chromosomal diseases, were evaluated by standardized growth z scores, calculated by the EUROGROWTH software version 2000, through the first 36 months of life. The Griffiths Mental Development Scale (DS) was administered at 36 months of c.a. Statistical analysis was based on Anova for repeated measures and multiple linear regressionRESULTS: Mean (range) weight (W), length (L) and head circumference (HC) at birth were, respectively, 841 (520–1000) g, 34 (26–40) cm, and 25 (20–30) cm. Mean (SD) W, L, and HC z scores recovered through the first 36 months of life (P<0.0001) ranging, respectively, from -2.62 (1.67) at 3 months to-1.85 (1.32) at 36 months (P<0.0001), -2.67 (1.48) to-1.04 (1.13) (P<0.0001), and -1.62 (1.37) to -1.56 (1.06) (P=0.080). At 36 months of c.a. respectively 38%, 17%, 34% of infants had W, L, HC z score <-2. At stepwise multiple regression analysis only birth weight was independently associated with z score for W (adjusted r=0.48, P <0.01), for L (adjusted r=0.41, P <0.01), for HC (adjusted r=0.39, P <0.05). Neonatal characteristics (gender, birth weight, lenght and head circumference, being SGA, gestational age, ventilation) and DS at 36 months entered the model as confounders.CONCLUSIONS: Through the first 36 months of life ELBW infants show progressive recovery of growth, although growth impairment is still present. More unfavourable neonatal anthropometrics appear to be a major factor associated with lower recovery at 36 months.AIMS: To examine the growth pattern through the first 36 months of life in infants born extremely low birth weight (ELBW) and to investigate whether any relationship exists between growth, neonatal characteristics and neurodevelopment outcome at 36 months of chronological age (c.a.).METHODS: One hundred forty-five ELBW infants (mean (SD) gestational age 27.9 (1.9) weeks, birth weight 841 (123) g), consecutively born 1996–2001, without congenital or chromosomal diseases, were evaluated by standardized growth z scores, calculated by the EUROGROWTH software version 2000, through the first 36 months of life. The Griffiths Mental Development Scale (DS) was administered at 36 months of c.a. Statistical analysis was based on Anova for repeated measures and multiple linear regressionRESULTS: Mean (range) weight (W), length (L) and head circumference (HC) at birth were, respectively, 841 (520–1000) g, 34 (26–40) cm, and 25 (20–30) cm. Mean (SD) W, L, and HC z scores recovered through the first 36 months of life (P<0.0001) ranging, respectively, from -2.62 (1.67) at 3 months to-1.85 (1.32) at 36 months (P<0.0001), -2.67 (1.48) to-1.04 (1.13) (P<0.0001), and -1.62 (1.37) to -1.56 (1.06) (P=0.080). At 36 months of c.a. respectively 38%, 17%, 34% of infants had W, L, HC z score <-2. At stepwise multiple regression analysis only birth weight was independently associated with z score for W (adjusted r=0.48, P <0.01), for L (adjusted r=0.41, P <0.01), for HC (adjusted r=0.39, P <0.05). Neonatal characteristics (gender, birth weight, lenght and head circumference, being SGA, gestational age, ventilation) and DS at 36 months entered the model as confounders.CONCLUSIONS: Through the first 36 months of life ELBW infants show progressive recovery of growth, although growth impairment is still present. More unfavourable neonatal anthropometrics appear to be a major factor associated with lower recovery at 36 months.