Glen R. Graves

Immunogenicity of hepatitis B vaccine in healthy very low birth weight infants.

We studied the immunogenic response to hepatitis B vaccine of infants weighing < or = 1500 gm at birth. Infants were divided into two groups: those weighing < or = 1000 gm (n = 22) and those weighing 1001 to 1501 gm (n = 28). When immunized early (3 days of age, n = 25), these infants had a response rate (defined as antibody to hepatitis B surface antigen titer > 10 mIU/ml) of 68%, whereas when the first vaccine was given at 1 month of age (n = 25), a 96% response rate was noted, irrespective of birth weight and weight at the time of immunization (p < 0.02).

Tachycardia as a sign of early onset neonatal sepsis.

A prospective study in two parts was designed to assess tachycardia in neonates (less than 72 hours of age) and its role as an early indicator of neonatal sepsis. In Part I of the study we determined the incidence of tachycardia among all inborn neonates in 1 year, and in Part II we assessed the presence of tachycardia in inborn and outborn infants evaluated for sepsis. Twenty-one infants were tachycardic among 4530 live births (incidence, 4.64/1000). Ten tachycardic infants were septic. Of 82 infants who were evaluated for sepsis, 13 had proved sepsis, 12 of whom had tachycardia as one of their presenting symptoms. Of the remaining nonseptic infants 6 of 69 had tachycardia. There was a significant difference in the two groups (P less than 0.001). The results demonstrate that tachycardia is an important sign of neonatal sepsis.

Long Term Outcome of Infants at the Margin of Viability

The outcome of babies at extremely short gestational age (22 to 26 weeks) effects our clinical decisions regarding their care. We looked at survival and presence of disability at 25 +/- 11 months of age in 246 of these infants born at our hospital between 1992 and 1996 who were average weight for gestational age. Babies were evaluated in our follow up clinic by a pediatrician, and a physical therapist for cerebral palsy, blindness and deafness, and by a psychologist with the Bayley II. Chances for survival without disability exceeded 50% of live born infants at 25 weeks gestation or a birth weight of 700 to 800 grams. Chances for survival exceeded 50% of live born infants at 24 weeks gestation or a birth weight of 600 to 700 grams. Chances for intact survival reached 50% of survivors at 23 weeks gestation or a birth weight of 400 to 500 grams.

Relationship of cranial midline shift to outcome of very-low-birth-weight infants with periventricular hemorrhagic infarction.

The purpose of this study was to determine the relationship of a cranial midline shift accompanying periventricular hemorrhagic infarction to subsequent handicap in very‐low‐birth‐weight infants. A study group of 44 infants with intraventricular hemorrhage and an associated periventricular hemorrhagic infarction was retrospectively selected from 1,080 very‐low‐birth‐weight infants evaluated by cranial sonography. A cranial midline shift is defined sonographically as displacement of the septum pellucidum (or cavum septi pellucidi) more than 3 mm from the spatial midline. The midline is measured as half the distance between the right and left inner tables on an anterior coronal view. Other sonographic data recorded were the size of the lateral ventricle, the intracranial hemisphere, and the periventricular hemorrhagic infarction. Also noted was the appearance of the area of infarction at the time of initial detection of a midline shift. After discharge, the infants were periodically evaluated for major handicap in vision, hearing, cognition, and motor activity. A midline shift was identified in 29 (66%) of 44 infants with periventricular hemorrhagic infarction. Seven (24%) of the 29 infants with midline shift and 3 (20%) of the 15 infants without a midline shift died. In all of the 22 surviving infants with a midline shift and in 3 (25%) of 12 survivors without a midline shift, a handicap developed (p < 0.01). As a predictor of handicap, midline shift showed a sensitivity of 88% and a specificity of 100%. Predictability was not improved by combining midline shift with the size of the parenchymal infarct. Cranial midline shift associated with periventricular hemorrhagic infarction is a valuable predictor of handicap in very‐low‐birth‐weight infants.

USE OF NITRIC OXIDE. 2052

This randomized study was designed to evaluate afficacy of nitric oxide(NO) in treatment of persistant pulmonary hypertension of the newborn(PPHN). Infants who were on 1.0 FIO2, 30cm H2O or greater PIP, had PO2 less than 60 and adequately ventilated were eligible for the study. Diagnosis of PPHN was confirmed by echocardiogram and informed consent was obtained. Starting level of NO was 10 ppm and increased at 15 minutes or greater interval by 5 to 10 ppm as indicated till response noted, the higher limit of NO being 80 ppm. Both NO and NO2 were monitored by electrochemical sensor. Statistical significance was defined as p value of <0.05. Data from 4 infants who received NO are available. Mean NO used was 25 ppm, the highest being 50 ppm. Mean duration of NO administration was 85 hrs, the longest being 120 hrs. Mean age of starting NO was 33 hrs. Highest Methb level was 3.1. All survived and mean age for discharge home was 18 days. Mean oxygen indexes (OI) 1 hr prior to zero time was 69% in reference to OI at zero time (100%). Mean OI in percentage in reference to zero time are shown inTable: When analyzed OI using repeated measure ANOVA, significant reduction in OI was noted at all time periods, compared to baseline value (p<0.001). In conclusion during the preliminary stage of the study, in a small number of patients the use of nitric oxide appears to be effective in the treatment of PPHN, and no short term adversed effects were noted. Nitric oxide was supplied by BOC gases.