G. E. Andersen

“Minitouch” treatment of very low‐birth‐weight infants

In a cohort study with historical controls of non‐asphyxiated very low‐birth‐weight infants (birth weight 1500 g and gestational age <33 completed weeks), we evaluated the use of a “minitouch” regime for stabilization after birth and treatment of respiratory distress. This combination of early (prophylactic) treatment with nasal continuous positive airway pressure and minimal handling was introduced as a routine in our Department in 1986. We compared infants born in 1987 and in 1985, when ventilator treatment was used initially in all infants with progressing respiratory distress. The frequency of mechanical ventilation was reduced significantly from 76% in 1985 to 35% in 1987 (p = 0.00001). This reduction reflected the smaller number of infants who received ventilator treatment for less than one week, whereas the frequency of long‐term ventilator treatment remained unchanged. Intracranial haemorrhage grade 11‐IV was reduced from 49% in 1985 to 25%) in 1987 (p = 0.01). Mortality rate, average duration of hospitalization, numbcr of infants with pneumothorax, patent ductus arteriosus, need for oxygen at 28 days and number of surviving infants with handicap did not differ significantly between the two study periods. Septicaemia was diagnosed in 16%) of the infants in 1987 versus 7% in 1985 (p = 0.045). This difference coincided with an increased use of total parented nutrition (18% in 1987 versus 3%) in 1985, p= 0.007). We conclude that the minitouch regime prevents progression of respiratory distrcss, reduces the need for ventilator treatment and is a safe and convenient alternative to mechanical ventilation in preterm infants with mild respiratory problems. The infants need to be monitored continuously to recognize respiratory insufficiency demanding ventilator treatment.

Investigation of 89 children born by drug-dependent mothers. I. Neonatal course.

ABSTRACT. Among 89 infants born by opiate‐ and methadone‐addicted mothers 20% were preterm and 31% were light for gestational age. Mean gestational age. Mean gestational age and birth weight were lower in infants of mothers who had taken mainly opiates compared with infants of mothers who had taken mainly methadone. Preterm labor was more frequent among women who had been acutely withdrawn on methadone within the last month before birth than among women who were maintained on methadone at birth. 85% of the newborns had withdrawal symptoms and 12% had convulsions the severity of which was not correlated with the type of drug abuse. The duration of withdrawal, however, correlated with the amount of methadone taken by the mother at birth. 20% had signs of perinatal asphyxia and had an increased frequency of neonatal convulsions. These babies represent a special high‐risk group of newborns. Prevention, therapy and care demand extraordinary combined efforts by politicians, social welfare personnel, midwives, doctors and nurses.

Delayed Growth and Reduced Intelligence in 9–17 year old Intrauterine Growth Retarded Children Compared with Their Monozygous Co-twins

ABSTRACT. Fourteen pairs of monozygous twins who differed from one another mainly in terms of intrauterine growth the one being ±25 % lighter at birth than the other were studied at a mean age of 13 years. There had been no major problems during pregnancy or the neonatal period and no serious diseases during childhood. The twins grew up in the same environment. At follow‐up height, head circumference, global IQ and performance IQ were reduced in the originally light twins. Intrauterine growth retardation of a certain magnitude thus has a long‐term deleterious effect upon growth and development.

INVESTIGATION OF 89 CHILDREN BORN BY DRUG-DEPENDENT MOTHERS.: II. Follow-up 1–10 Years after Birth

ABSTRACT. 72 of 89 children born by opiate‐ and methadone‐addicted mothers were reinvestigated 1 to 10 years after birth. Only 25% were found to be physically, mentally and behaviorally normal. 56% were hyperactive, aggressive, with a lack of concentration and social inhibition. 10% had a severely and 11% a moderately impaired psycho‐motor development mainly due to deprivation. 43% of the children had been removed from their mothers by the courts. The average number of shifts from one milieu to another was 6 per child with an upper range of 30 shifts for some of the children. The average number of shifts from one caregiver to another was 5 with an upper range of 11. These findings indicate that there is an urgent need for politicians, social welfare and health personnel to reexamine their roles in helping these children, who will otherwise develop into a new generation of social loosers.

SCREENING FOR HYPERLIPOPROTEINEMIA IN 10 000 DANISH NEWBORNS Follow-up Studies in 522 Children with Elevated Cord Serum VLDL-LDL-Cholesterol

Abstract. Among 10440 newborns, 522 with upper 5 percentile values for very low‐low density lipoprotein cholesterol in cord serum were selected for follow‐up studies. Follow‐up was possible in 446 of these 522 families (85%) and familial hypercholesterolemia (FH) was diagnosed in 11. In 273 of the 522 children, serum lipids were determined between the ages of 1 and 2 years and were now found to be normal, except in the 11 children with FH. Furthermore the serum lipids were compared in subgroups of these 273 children divided according to obstetric complications (i.e. low birth‐weight, perinatal asphyxia and antepartum betamethasone treatment), which may cause a rise in serum lipids at birth. No differences were found between these subgroups at the age of 1–2 years.

Intravascular fat accumulation after Intralipid infusion in the very low-birth-weight infant

RECENTLY THREE GROUPS of investigators ~3 have warned against the use of intravenous infusion of Intralipid (Vitrum, Stockholm) to sick low-birth-weight infants with pulmonary disease after they had demonstrated accumulation of lipid material in the lung capillaries in some of these infants. Since no controls were included in these studies, we have investigated the lungs and brains of 24 low-birth-weight infants who had died in Our department within the last 30 months. SUBJECTS AND METHODS Among the 24 infants autopsy was not allowed by the parents in one case, and in two cases lung material was not suitable for histologic investigation. Mean birth weight of the remaining 21 infants was 1,050 gm (range 540 to 1,440). Mean gestationaI age was 29 weeks (range 28 to 34). There were 10 boys and 11 girls. Thirteen had one-minute Apgar scores below 7. Seventeen were treated with assisted ventilation for one to 19 days. Thirteen developed intracranial hemorrhage, six developed septicemia, and two had neCrotizing enterocolitis. Nine of the 21 infants had been treated with 20% Intralipid (+IL) for an average of eight days (range 1 to 27) and had received 2.0 _+ 0.5 gm/kg/day (mean _+ 1 SD) of fat infused continuously over 24 hours. The maximum amount of fat given was 3.4 _+ 1.2 gm/kg/day. The clearance of IL was evaluated by daily visual inspection of the plasma sampled during infusion. Twelve of the 21 infants had been fed human milk (mean 46 ml/kg/day, range 0 to 231 ml/kg/day) and given carbohydrate solutions intravenously, but no IL (-IL). There were no differences between the two groups with respect to gestational age, birth weight, and Apgar scores. The survival time, however, was lower in -IL compared with +IL infants (P < 0.01). The lungs and the brains were fixed in 10% formolsaline. Two tissue blocks were taken from each lung and

Metabolic events in infants of diabetic mothers during first 24 hours after birth. III. Changes in plasma amino acids.

ABSTRACT. Changes in plasma glycerol (FG), free fatty acids (FFA) and triglyceride (TG) were studied in 24 normo‐ and 8 hypoglycemic infants of diabetic mothers (IDM). In both groups a normal rise in plasma FG 2 hours after birth was found indicating unimpaired lipolysis. The rise in plasma FFA, however, was only about 50% of normal in normoglycemic IDM and about 25% of normal in hypoglycemic IDM. The rise in plasma TG was normal in normoglycemic and about 70% of normal in hypoglycemic IDM. The 2 hour rise in plasma FFA correlated with the 2 hour concentration of insulin and glucose, whereas the rise in plasma FG and TG did not. Maternal plasma FFA correlated with fetal FFA retention (unbilical vein minus artery (V‐A) FFA concentrations). No correlations were found between maternal plasma FFA values and birth‐weights nor between umbilical V‐A FFA concentrations and birth‐weights.

Vitamin K to Neonates: Peroral versus Intramuscular Administration

ABSTRACT. In a randomized study of 300 infants, the effect of 1 mg of peroral vitamin K given at birth was compared to the same dose given as an intramuscular injection. The combined activity of coagulation factor II + VII + X taken after 48 and before 72 hours after delivery served as the primary endpoint. Prothrombin (antigen) and PIVKA II (acarboxyprothrombin) were also measured. All infants were observed for events of bleeding until discharge from the hospital, normally on the fifth day. No significant differences between the groups in any of the biochemical markers were observed. The 95% confidence limits of the differences were very narrow for all factors. No cases of bleeding were observed. We conclude that administration of 1 mg peroral vitamin K is as efficient as intramuscular administration of the same dose in the prevention of classical hemorrhagic disease of the newborn.

CORONARY HEART RISK FACTORS IN 177 CHILDREN AND YOUNG ADULTS WHOSE FATHERS DIED FROM ISCHEMIC HEART DISEASE BEFORE AGE 45

ABSTRACT. The occurrence of the classical coronary heart risk factors hypertension, hyperlipemia, tobacco smoking and physical inactivity was investigated in a risk group consisting of 177 children and young adults whose fathers died from ischemic heart disease before age 45 and in randomly selected reference individuals. Only hyperlipemia and especially permanent hypercholesterolemia and familial hypercholesterolemia (FH) was much more common in the risk group than in the reference group. Blood pressure values, smoking habits and physical activity level were almost identical in the two groups. Although FH was about ten times more frequent among risk children it does not explain the majority of early coronary deaths among their fathers.

Hyperlipoproteinemia in newborn infants. A study of 1025 families.

ABSTRACT. Andersen, G. E., Lous, P. and Friis‐Hansen, B. (Neonatal Department, Rigshospitalet, and the Department of Clinical Chemistry, Bispebjerg Hospital, Copenhagen, Denmark). Hyperlipoproteinemia in newborn infants. A study of 1025 families. Acta Paediatr Scand, 68: 683, 1979.—As part of a screening study for the detection of hyperlipoproteinemia in 10000 newborns, cord serum lipids and lipoproteins were measured in detail in 1025 infants. Elevated cord serum VLDL‐LDL‐cholesterol could easily be identified by a rapid turbidimetric estimation of cord serum VLDL‐LDL. Cord serum VLDL‐LDL‐cholesterol was found to be significantly higher than normal in premature, asphyxiated and betamethasone‐phenobarbital‐ritodrine treated infants. Other obstetric complications, however, were not associated with hyperlipoproteinemia. Furthermore all 2050 parents had their serum cholesterol determined. 3 parents had familial hypercholesterolemia (FH). One child also had FH, though her cord serum total cholesterol and VLDL‐LDL‐cholesterol were normal. The 2 other children of the 3 FH parents, had normal lipids and lipoproteins both at birth and follow‐up.