Ellen Bowman

Changing mortality and causes of death in infants 23-27 weeks' gestational age

Objective: To contrast the mortality rates and changes in the causes of death of very preterm infants (23–27 weeks), before and after the introduction of exogenous surfactant in 1991, and to identify any preventable causes of death remaining in the 1990s.

Impact of erythromycin on respiratory colonization of Ureaplasma urealyticum and the development of chronic lung disease in extremely low birth weight infants

BACKGROUND Chronic lung disease (CLD) is a significant cause of neonatal morbidity and mortality despite advances in neonatal care. Ureaplasma urealyticum colonization of the lower respiratory tract has been associated with CLD, particularly in extremely low birth weight infants. Despite numerous studies demonstrating the pathogenicity of this organism, treatment remains controversial. This study examines neonates colonized with U. urealyticum in the lower respiratory tract and treated with erythromycin, as compared with noncolonized neonates. METHODS A prospective cohort study of 124 neonates weighing <1000 g at birth, requiring endotracheal intubation and ventilation. Endotracheal aspirates were cultured for U. urealyticum and conventional bacteria twice weekly for the duration of endotracheal intubation. Infants colonized with U. urealyticum were treated with intravenous erythromycin. Maximal ventilatory requirements, CLD at Day 28 and 36 weeks postconception, duration of ventilation, oxygen dependency and hospital stay were documented. RESULTS Twenty-two infants (18%) were identified as being U. urealyticum colonized in endotracheal aspirates. Colonization was significantly associated with younger maternal age, prolonged rupture of membranes, premature labor and vaginal delivery. Of colonized neonates 14% were delivered by cesarean section, with intact membranes. As compared with noncolonized infants, there were no statistically significant differences in chronic lung disease, duration of oxygen therapy or time to discharge. CONCLUSIONS Seven published cohort studies of similar high risk populations where U. urealyticum-colonized infants did not receive erythromycin therapy, show a consistent association with CLD (pooled relative risk + 5.21; 95% confidence interval, 2.93 to 9.64). This association was not demonstrated in the current study and adds further weight to the need for a randomized controlled trial to be performed to evaluate this treatment regimen.

Role of Ureaplasma urealyticum and Chlamydia trachomatis in lung disease in low birth weight infants

&NA; Forty four ventilated premature infants from three Neonatal Intensive Care Units around Melbourne were evaluated prospectively for evidence of Ureaplasma urealyticum and Chlamydia trachomatis infection in the respiratory tract. No C. trachomatis was found and this probably reflects the low prevalence of genital carriage in antenatal patients in our population. Nine percent of babes were colonized at birth with Ureaplasma urealyticum and 5% acquired colonization. One child whose mother was bacteremic for ureaplasma, had evidence of persistent respiratory colonization and development of pneumonia at day 16 of life, supporting a role for this organism as a respiratory pathogen. Bronchopulmonary dysplasia (BPD) occurred in 39% of the infants. Ureaplasma carriage correlated significantly with BPD development, as 29% of infants with BPD were ureaplasma positive compared to 4% of those without development of BPD (p = 0.02).

Changing Outcome for Infants of Birth‐weight 500‐999g Born Outside Level 3 Centres in Victoria

Summary: The aim of this study of extremely low birth‐weight (ELBW, birth‐weight 500–999 g) infants born in Victoria was to determine the changes between 3 distinct eras; 1979‐80, 1985‐87, and 1991‐92, in the proportions who were born outside level 3 perinatal centres (outbom), the proportions of outborn infants who were transferred after birth to a level 3 neonatal unit, the survival rate for outborn infants, and sensorineural impairment and disability rates in outborn survivors. The proportion of ELBW livebirths who were outborn fell significantly over successive eras, from 30.2% (106 of 351) in 1979‐80, to 23.0% (129 of 560) in 1985‐87, and to 15.6% (67 of 429) in 1991‐92. Between 1979‐80 and 1985‐87, die proportions who were outborn fell predominantly in those of birth‐weight from 800–999 g, whereas between 1985‐87 and 1991‐92 the proportions who were outborn fell predominandy in those of birth‐weight 500–799 g. The proportions of outborn infants who were transferred after birth to a level 3 neonatal unit were similar in die 3 eras, at 49.1%, 38.0% and 41.2%, respectively. The survival rates for outborn infants were lower in each era dian for infants born in a level 3 perinatal centre. Only 1 outborn infant not transferred after birth to a level‐3 unit survived in any era. The survival rates for infants transferred after birth were similar in the first 2 eras, but rose significantly in 1991‐92 (34.6%, 36.7% and 60.7%, respectively). The rates of sensorineural impairments and disabilities in survivors fell significantly between die first 2 eras, and remained low in the last era. It is pleasing that the proportion of tiny babies who were outborn fell significantly over time, reflecting increased referral of high‐risk mothers to level 3 perinatal centres before birth. For ELBW outborn infants, survival prospects free of substantial disability are reasonable, but not as good as for those born in level 3 perinatal centres.

The cost of improving the outcome for infants of birthweight 500-999 g in Victoria: THE VICTORIAN INFANT COLLABORATIVE STUDY GROUP

The aim of this study was to conduct an economic evaluation of neonatal intensive care for extremely low birthweight (ELBW) infants born in the state of Victoria. Two distinct eras (1979–80 and 1985–87) were compared. Follow‐up data at 2 years of age were available for all 89 survivors from the 351 live births in 1979–80, and for 211 of 212 survivors from the 560 live births in 1985–87. The overall cost‐effectiveness for ELBW infants during 1985–87 compared with 1979–80 was

Home-based detoxification for neonatal abstinence syndrome reduces length of hospital admission without prolonging treatment

104 990 (

Reappraisal of C-reactive protein as a screening tool for neonatal sepsis

A 1987) per additional survivor, or

Assisted ventilation and survival of extremely low birthweight infants

5390 (

Ventricular size in newborn infants.

A 1987) per additional life year gained. Cost‐effectiveness improved with increasing birthweight. If the quality of life of the survivors was considered, the economic outlook was more favourable. The cost per quality‐adjusted life year gained was

Safety of synthetic surfactant use before preterm newborn transport

5090 (