John H. Drew

Auditory steady-state evoked potential in newborns

Steady-state evoked potential responses were recorded from 337 normal full-term sleeping newborns to combined amplitude and frequency modulated tones. Responses were automatically detected by statistical analysis of the response phase. Responses were most easily and consistently recorded at carrier frequencies of 500 Hz, 1500 Hz and 4000 Hz when the modulation frequency was between 60 Hz and 100 Hz. In this modulation frequency range, the response latencies were found to be between 11 ms and 15 ms, depending on carrier frequency, and the mean response thresholds for the three carrier frequencies were found to be 41.36 dB HL, 24.41 dB HL and 34.51 dB HL respectively. The results of this study suggest that steady-state evoked potentials at modulation rates in excess of 60 Hz may be useful for frequency specific, automated hearing screening in newborns.

Outcome in infants with birth weight 500 to 999 gm:A regional study of 1979 and 1980 births

During 1979 and 1980, 351 infants weighing 500 to 999 gm were born in the State of Victoria, Australia; 89 (25.4%) survived to 2 years of age. Survival was better for tertiary center births (29%) than for those born elsewhere (17%). Multidisciplinary teams reviewed 83 of the survivors at 2 years of age postterm; some data were available for the other six children. Overall, 22.5% of infants had severe functional handicap, 29.2% had either moderate or mild handicap, and 48.3% had no handicap. Severe functional handicap was present in 50% of outborn infants; this was significantly more common than in those born in tertiary centers (15.5%), and the Bayley Mental Developmental Index was also significantly lower in outborn infants. The prevalence of cerebral palsy (13.5%), bilateral blindness (3.4%), and severe sensorineural deafness (3.4%) did not differ significantly in the inborn and outborn infants. Singleton inborn infants of appropriate weight for gestational age had significantly less severe functional handicap (9.1%), compared with 37.5% for the group of infants who were either small for gestational age or one of multiple births. Six of the 18 outborn infants could have been transferred in utero, and improvements in immediate neonatal care were possible in seven other infants.

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

Jaundice: Clinical Practice in 88,000 Liveborn Infants

104 990 (

Cord whole blood hyperviscosity: Measurement, definition, incidence and clinical features

A 1987) per additional survivor, or

Prospective Study of the Quality of Survival of Infants with Critical Fetal Reserve Detected by Antenatal Cardiotocography

5390 (

Neonatal whole blood hyperviscosity: the important factor influencing later neurologic function is the viscosity and not the polycythemia

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

Second Twin: Quality of Survival if Born by Breech Extraction Following Internal Podalic Version

5090 (

Perhaps vigintiphobia should only apply to infants with Rhesus erythroblastosis

A 1987), approximately one‐tenth of that obtained from the only previous full economic evaluation of neonatal intensive care. Although neonatal intensive care is expensive, it compares favourably with some other health care programmes, particularly as the outcome for ELBW infants continues to improve.