Gherardo Rapisardi

Catch-Up Growth in Short-at-Birth NICU Graduates

The statural catch-up growth, defined as reaching at least tenth length/height percentile (P10) for normal population standards (–1.28 SD score, SDS), was studied in 73 infants short at birth (length < P10 for gestational age) admitted to NICU. Mean gestational age at birth was 35.2 weeks (range 29–41) and mean birth length standard deviation score –2.31 (–4.52/–1.46). Infants were measured at birth, at 3, 6, 12, 18, and 24 months corrected age and then once a year until 6 years chronological age. Statural catch-up growth was studied, with reference both to normal population standards and to individual genetic target. With reference to normal population standards, 44% of infants had caught-up at 3 months of age, 51% at 3 years, 66% at 4 years and 73% at 6 years. In the case of individual genetic targets, a similar trend was present, but the absolute values were slightly higher from 4 to 6 years (73 vs. 66% and 78 vs. 73%, respectively). Statistically significant changes in mean standard deviations score for chronological age were present from birth to 3 months, 3 to 12 months, 3 to 4 years and 5 to 6 years (p < 0.05). No differences were found in this trend of recovery when considering ponderal index (PI) at birth (symmetrical vs. asymmetrical), sex (male vs. female) or gestational age (p > 0.05). In the majority of cases infants with short stature at birth admitted to a NICU had a statural catch-up growth within the first years of life. This is more evident when considered in relation to individual genetic target rather than to normal population standards.

Abnormal brain-stem function (brain-stem auditory evoked response) correlates with acoustic cry features in term infants with hyperbilirubinemia.

We hypothesized that changes in brain-stem auditory evoked responses related to bilirubin would be associated with changes in cry because of the anatomic proximity in the brain stem of cranial nerves 8 (auditory) and 9 to 12 (vagal complex, which controls cry). Brain-stem auditory evoked responses and computerized cry analysis were used to study the concurrent effects of moderate hyperbilirubinemia on auditory function and cry. Fifty term infants were divided equally into two groups on the basis of serum bilirubin concentrations: low (less than 8 mg/dl; 136) mumol/L and moderate (10 to 20 mg/dl, 170 to 342 mumol/L). Forty-three infants had successful tracings of brain-stem auditory evoked responses recorded with a Cadwell model 5200A evoked response unit during two successive trials, and a cry recording of each infant was analyzed by computer. The moderate serum bilirubin group had an increase in percent cry phonation (p less than 0.02) and an increase in the variability of the first formant (p less than 0.04) in comparison with the low serum bilirubin group. Serum bilirubin values correlated positively with brain-stem conduction time (r = 0.36, p less than 0.01), percent phonation (r = 0.42, p less than 0.004), and variability of the first formant (r = 0.39, p less than 0.02). Percent phonation, the voiced component produced by increased neural control, correlated with the interpeak of waves latencies I to III (r = 0.32, p less than 0.03) and brain-stem conduction time (wave I to V) (r = 0.35, p less than 0.01). We conclude that hyperbilirubinemia affects adjoining areas of the brain stem that control hearing and cry production.

Assessment of infant cry variability in high-risk infants

Two studies were conducted to determine the relationship between variability in acoustic features of the infant cry and medical risk factors. In study 1, 3 groups of preterm infants (healthy, sick and CNS pathology) were compared with term infants at 40 weeks gestational age. The cry was analyzed by computer. The coefficient of variability of cry amplitude and the formant features of the cry differed among the groups of preterm infants. In study 2, 3 groups of term infants at low, moderate and high levels of hyperbilirubinemia were compared on the cry measures. More variability in the formant features of the cry was found in infants with higher levels of bilirubin. The correlation between the coefficient of variation in the cry formants and level of bilirubin was statistically significant. These two studies suggest that variability in the acoustic features of the cry relate to the medical status of the infant and may provide a measure of neurophysiological integrity.

Fibreoptic phototherapy in the management of jaundice in low birthweight neonates

A fibreoptic phototherapy device has been compared with conventional white and special blue fluorescent phototherapy lamps to evaluate its efficacy in lowering serum bilirubin levels in low‐birthweight neonates. Fibreoptic phototherapy was found to be as effective 21s white light and less effective than blue light, as assessed by (i) the bilirubin concentration after 24 h of phototherapy and at the end of phototherapy, (ii) the duration of phototherapy, (iii) the percentage daily decline rate and (iv) the overall percentage decline rate (p < 0.05). There were no failures of phototherapy and the need for re‐exposure was low (4.7% of the total sample), with no difference between groups. The fibreoptic approach represents a promising way to aggregate synergically the most recent optical technologies and develop a modern, efficient and caring phototherapy system for low‐birthweight infants.

Food allergy in preterm infants fed human milk.

In 80 preterms aged 9-24 months (mean age: 15.9) and in 80 sex- and age-matched full-terms the frequency of atopic diseases and of positive skin tests to 8 food and 6 inhalant allergens was determined. The two groups did not differ as to overall percentages of cutipositive subjects and patients with atopic diseases. In particular, frequencies of positive skin tests to foods and of atopic dermatitis (the peak prevalence of which occurs early in infancy) were similar in preterm (16.2 and 7.5%, respectively) and full-term (13.7 and 5.0%, respectively) infants. We suggest that preterm infants fed human milk are not at increased risk of developing food allergy and related diseases and that the absorption of antigens through the immature intestine does not seem to favor the development of an IgE sensitization to foods.

A new device for computerized infant cry analysis in the NICU

A new transportable device for computerized infant cry analysis is presented, which uses digital signal processing techniques and allows quick and complete evaluation of the most important parameters of infant cry. The procedures used to calculate the fundamental frequency (F0) and the formants (F1, F2, F3) are described in detail. The system has proved to be useful in functional neurodevelopmental assessment of infants affected by CNS diseases and it is valid for use within the Neonatal Intensive Care Unit (NICU).<<ETX>>

Behavior of the Newborn during Skin-to-Skin:

Background: Early skin-to-skin contact (SSC) significantly increases the breastfeeding rate in healthy term infants. Objective: This study aimed to confirm previously described behavioral sequences during SSC. Methods: We recorded live and videotaped infant behavioral sequences during SSC in a cohort of healthy term infants, whose outcome was then evaluated. Results: We studied 17 mother-infants dyads. While the majority of infants (59%) had behavioral phases that have been previously reported, some of them had alternative sequences. We observed the infant’s massage of the mother’s breast with its hand during SSC, which had not been previously reported. We found no correlations between behavioral sequence during SSC, breastfeeding, and neonatal outcome. Moreover, maternal pain stimuli did not affect the neonatal SSC behavioral sequence. Conclusion: Our study confirms that immediate and undisturbed postpartum SSC is characterized by specific behavioral phases whose sequence may vary without affecting the suckling rate at the end of SSC, breastfeeding success, or the short-term neonatal outcome.

Long Chain Polyunsatured Fatty Acids and Early Neural and Visual Development in Preterm Infants. 71

Long Chain Polyunsatured Fatty Acids and Early Neural and Visual Development in Preterm Infants. 71

CRY ANALYSIS AND MEDICAL AND NEUROLOGICAL STATUS IN PRETERM INFANTS

The purpose of this study was to relate acoustic characteristics of the cry to medical and neurological status in preterm infants. The sample included 40 infants divided into 4 groups, a group of term controls and 3 groups of preterms all born < 34 weeks gestational age and <1700 grams. The preterm groups included healthy preterms, sick infants who did not have CNS disease and sick infants with CNS disease. The cry was elicited by pain stimulus and recorded at 40 weeks conceptional age and analyzed by computer as in previous work. Medical risk was measured with the Hobel scale, neurological status with the Dubowitz exam. Preterm infants with CNS disease showed a longer cry, (p<.05), lower first formant (p<.03) than the other preterm groups. Term infants showed more energy in the cry than preterms (p<.004). Higher risk on the Hobel scale was correlated with a longer cry duration ( r=. 46, p<.04 ), lower first formant (r=.49, p<,.05) and more variability in cry duration (r=.60, p<.007). Abnormal scores on the Dubowitz were correlated with a lower first formant (r=.44, p<.05). Results suggest cry analysis may be useful in the early detection of the infant at risk.

EFFECT OF MODERATE HYPERBILIRUBINEMIA ON ORIENTING RESPONSES & CRY IN TERM INFANTS

Brazelton auditory orienting responses and acoustic cry patterns were evaluated in 10 moderately jaundiced term infants, (BR-15.2±2.5 mg/dl, Mean±S.D.) and 11 non-jaundiced infants (BR-4.1±1.1 mg/dl). The groups did not differ in birthweight, gestational or postnatal age, or 5 min. Apgar score. Jaundiced infants scored lower on auditory orienting items, (4.7±1.25 vs 5.64±0.55, p<0.02) and on the global orientation cluster (4.96±0.92 vs 5.9±0.53, p<0.01). Cries were recorded during blood sampling, and analyzed by computing the log magnitude spectrum in 25 msec blocks for each cry unit; summary measures were computed across the 25 msec blocks of each cry unit. In jaundiced infants, the first cry utterance showed an increase in average first formant during dysphonation (AvDF1-1876±376 Hz vs 1434±470 Hz, p<0.05), and in the summation of first formant during dysphonation (SumDF1-2102±324 Hz vs 1192±786 Hz, p<0.005). 9 of 10 jaundiced and 4 of 11 non-jaundiced infants had episodes of hyperphonation, and jaundiced infants had greater variability (S.D.) in the maximum fundamental frequency of hyperphonation (Max HFo) for the entire cry (p=0.03 for S.D. Max HFo vs non-jaundiced infants). In summary, moderate hyperbilirubinemia decreases the global capability for orienting responses, and increases the frequencies and variability of some acoustic cry characteristics in term newborns.