N. W. Svenningsen

Ten‐year follow‐up of children born before 29 gestational weeks: health, cognitive development, behaviour and school achievement

Since the mid‐1990s several studies have reported poor school performance in extremely preterm infants. The necessity to provide a full picture of the childs situation has been indicated. In a southern Swedish population 32 120 infants were born during the 2‐y period 1985‐1986. In total, 121 infants (0.4%) were reported liveborn before the 29th gestational wk and 12 (0.04%) were reported stillborn. Only 65 infants (50%) survived to the age of 10 y. The aim of this study was to evaluate the situation of extremely preterm (EPT) children at school, compared with that of full‐term (FT) control children, at the age of 10 y. Health, cognitive development, school achievement and behaviour were measured. Ninety‐two percent of the preterm children had no major neurological disability and most were in good health. The EPT children had an IQ of 90 ± 15 vs 106 ±15 (mean ± SD) for the FT children (p < 0.001), and on the test of Visual‐Motor Integration, the EPT children had 93.3 ± 12.2 vs 109.6 ± 14.2 for FT peers (p < 0.001). On both tests the differences between the groups corresponded to approximately one standard deviation. Thirty‐eight percent of the EPT children performed below grade level at school. Thirty‐two percent had general behavioural problems and 20% had attention deficit hyperactivity disorder, compared with 10% and 8%, respectively, in the FT group. EPT children require interventions to support their development and reduce behavioural problems. □Behaviour, development, extremely preterm, follow‐up, health, school achievement

Respiratory distress syndrome in infants with impaired intrauterine growth

The recently introduced intrauterine growth curve, based on ultrasonically estimated foetal weights, was retrospectively applied to an inborn population of 883 infants bom before 33 gestational weeks at the University Hospital of Lund, during 1985–94. The estimation of birthweight deviation resulted in 630 (71.3%) infants with a birthweight appropriate for gestational age (AGA), 244 (27.6%) infants with a birthweight small for gestational age (SGA) and 9(1.1%) infants with a birthweight large for gestational age. Birthweight deviation was associated with an increased mortality [odds ratio (OR) adjusted for gestational age 1.29 per SD (12%) change in birthweight for gestational age, 95% CI: 1.10–1.50; p= 0.002]. At gestational age 25–28 weeks, SGA‐infants had an increased incidence of respiratory distress syndrome (RDS) as compared to AGA‐infants (OR adjusted for gestational age: 1.98,95% CI: 1.12–3.52; p= 0.019). At gestational age 29–32 weeks, SGA‐infants had a lower incidence of RDS as compared to AGA‐infants (OR adjusted for gestational age: OR 0.52,95% CI: 0.34–0.80; p= 0.003). After adjustment for confounding variables, infants born at gestational age 25–28 weeks from mothers with pre‐eclampsia, appeared to be a high‐risk group for RDS, whereas at the age of 29–32 gestational weeks, negative birthweight deviation had a protective effect against RDS. Antenatal corticosteroid administration appeared to have a less beneficial effect on mortality, RDS and cerebral haemorrhage in infants born SGA vs in those born AGA.

The Epidemiology of Sudden Infant Death Syndrome and Attacks of Lifelessness in Sweden

ABSTRACT. Infants who died showing the syndrome of sudden infant death (SIDS) and infants who survived attacks of lifelessness (AL) were examined in a prospective epidemiological multicentre study over 24 months covering close to 40% of all births in Sweden. Seventy SIDS cases and 34 cases of AL were observed, giving an incidence for SIDS of 0.94/1000 and for AL of 0.46/1000. This SIDS incidence is higher than that observed during the seventies. The boy/girl ratio was 1.4: 1 for SIDS and 1.6: 1 for AL. The age distribution for AL resembled that for SIDS. Similarities were also seen with regard to place of occurrence. Sixty per cent of the SIDS cases occurred during the daytime/evening. Twenty‐nine per cent of the infants with AL had more than one apneic spell during the three‐day‐period around the attack, indicating a period of respiratory instability, but only 12% had such spells later on. None of the infants who had had AL died from SIDS. The possible relationship between AL and SIDS is discussed.

Intrauterine infection may be a major cause of stillbirth in Sweden.

Aim of the study. To investigate intrauterine infection as a cause for unexplained stillbirth.

EVALUATION OF MECHANICAL VENTILATION IN NEWBORN INFANTS: I. Techniques and survival rates

Abstract. Lindroth, M., Svenningsen, N. W., Ahlström, H. and Jonson, B. (Neonatal Unit, Department of Paediatrics, University Hospital, Lund, Sweden). Evaluation of mechanical ventilation in newborn infants. 1. Techniques and survival rates. Acta Paediatr Scand, 69: 143, 1980.—The short‐term outcome with survival rate, causes of death and neonatal complications in a 6‐year material comprising 253 infants treated with intermittent positive pressure ventilation (IPPV) in the neonatal period has been analyzed in relation to different primary disorders necessitating IPPV treatment. The total survival rate was 53%. For the different diagnoses the survival rates were: hyaline membrane disease (HMD) 41%, apnoea repetens of immaturity 85%, severe birth asphyxia 46% and septicemia 59%. The total rate of pneumothorax during IPPV was 15% but occurred more often in the HMD group (28%). Trends in survival rates over the study period are discussed as are measurements for improvements.

Agenesis of the ductus venosus and its correlation to hydrops fetalis and the fetal hepatic circulation: case reports and review of the literature.

Under normal conditions about 50% of the placental venous return bypasses the liver through the ductus venosus. This blood flow is preferentially directed toward the foramen ovale and provides optimum oxygenation to the fetal heart and brain. Absence of the ductus venosus is a rare vascular anomaly, the significance of which has been disputed. We distinguish the pattern in which the liver is entirely bypassed, a manifestation of a fundamental malformation in the umbilical venous system, from the pattern in which the ductus venosus is absent despite a normal course of the umbilical vein. We review the literature regarding the latter and report eight new cases. Three of the four previously reported cases showed associated malformations and two of them suffered from portal congestion and hydrops. Among our eight cases three showed severe malformations in the cardiovascular system. Three cases presented themselves with hydrops fetalis and disturbance in the portal circulation, and two cases expressed signs of intrauterine asphyxia. The absence of the ductus venosus might be a minor vascular maldevelopment resulting in an early disturbance in the portal circulation. Our findings suggest that this anomaly might induce hydrops fetalis.

PULMONARY MECHANICS, CHEST X-RAY AND LUNG DISEASE AFTER MECHANICAL VENTILATION IN LOW BIRTH WEIGHT INFANTS

Abstract. Lindroth, M., Jonson, B., Svenningsen, N. W. and Mortensson, W. (Neonatal Unit, Department of Paediatrics, University Hospital, Lund, Sweden). Pulmonary mechanics, chest X‐ray and lung disease after mechanical ventilation in low birth weight infants. Acta Paediatr Scand, 69:761, 1980.—Pulmonary mechanics, chest X‐ray and the incidence of clinical lung disease were studied in 41 low birth weight infants treated with intermittent positive pressure ventilation (IPPV) in the neonatal period. Shortly after IPPV most patients, irrespective of X‐ray findings, had signs of lung damage reflected in low dynamic compliance or high pulmonary resistance. Both parameters, however, had a strong tendency towards normalization during the first year of life. Overdistention on chest X‐ray was common at 6–12 months of age. Pneumonia and bronchitis were common during the first two years of life but subsided later on. Development of BPD or later respiratory disease were not correlated to treatment with high inspired oxygen concentrations but commonest in patients with hyaline membrane disease. The combined findings of pulmonary mechanics and chest X‐ray shortly after IPPV were correlated to later clinical lung disease.

Neonatal outcome of extremely small low birthweight liveborn infants below 901 g in a Swedish population

ABSTRACT. In a regional population of 32120 liveborn newborn infants 65 (0.2%) had a birthweight ≤900 g (extremely small low birthweight = ESLBW) with mean gestational age 26.4 (range 22–31) completed weeks of gestation. The total 0–1 year survival rate was 48%. For the 42 infants treated in the Level III regional neonatal intensive care unit (NICU) the 0–1 year survival rate was 55% versus 34% for 23 infants not transferred to the Level III unit. In the ESLBW infants treated in the regional NICU the major complications were respiratory disorders requiring artificial ventilation (73%), bronchopulmonary dysplasia (26%), intracranial haemorrhages (40%), symptomatic persistent ductus arteriosus (36%) and sepsis (14%), persistent retinopathy of prematurity (8%). Duration of NICU treatment was 51 days (range 10–95) for survivors. Mode of delivery and rate of perinatal complications did not differ between survivors and non‐survivors. Previous legal abortion occurred in 24%, fertility problems in 29% and 21% of the mothers, were immigrants. Otherwise no significant abnormalities were found in maternal or socioeconomic conditions. Factors deciding neonatal outcome in the tiniest babies seem to be a combination of prenatal circumstances and neonatal minute fine care procedures.

CONTINUOUS POSITIVE AIRWAY PRESSURE WITH A FACE CHAMBER IN EARLY TREATMENT OF IDIOPATHIC RESPIRATORY DISTRESS SYNDROME

CPAP treatment started early with a new face chamber was found to be convenient and, without risks. Treatment of IRDS applied early with the presented technique appears to radically improve the prognosis.

Consecutive study of early CPAP-application in hyaline membrane disease

Continuous positive airways pressure (CPAP) has been applied with a face-chamber in 74 infants with hyaline membrane disease (HMD) before 10 h of age. The total survival rate was 91% and the complication rate of pneumothorax was low (5%). The incidence of long term developmental and neurological sequelae was also low (4%). Among the 19 surviving very low birth-weight (VLBW) infants below 1501 g, only one has shown neurological sequelae at follow-up examinations after 18 months to 3 years of age. The incidence of cerebellar hemorrhage was not higher in infants treated with the CPAP face chamber than in infants not receiving assisted ventilation. Bronchopulmonary dysplasia did not occur in any infant treated with CPAP face chamber only. The main advantages with the face chamber technique are: no disturbance of glottis function, no mucosal damage and tube obstruction, or sudden pressure drops, as seen with other modes of CPAP application. The face chamber technique is suitable for early application of CPAP in infants with HMD as it is efficient, without hazards, and easily applied.