Päivi Korhonen

Cerebral Palsy Among Children Born Moderately and Late Preterm

OBJECTIVE: To compare the incidence of and risk factors for cerebral palsy (CP) in moderately preterm (MP) (32+0–33+6 weeks) and late preterm (LP) (34+0–36+6 weeks) infants with those in very preterm (VP) (<32+0 weeks) and term infants (≥37 weeks). METHODS: The national register study included all live-born infants in Finland from 1991 to 2008. Infants who died before the age of 1 year, had any major congenital anomaly, or had missing data were excluded. A total of 1 018 302 infants were included in the analysis and they were analyzed in 4 subgroups (VP, MP, LP, and term) and 3 time periods (1991–1995, 1996–2001, and 2002–2008). RESULTS: By the age of 7 years, 2242 children with CP were diagnosed (0.2%). CP incidence was 8.7% in the VP, 2.4% in the MP, 0.6% in the LP, and 0.1% in the term group. The risk of CP was highest in the study period 1991–1995 in all groups. Factors predictive of an increased CP risk in the MP and LP groups included resuscitation at birth (odds ratio 1.60; 95% CI 1.01–2.53 and 1.78; 1.09–2.90), antibiotic treatment during the first hospitalization (1.63; 1.08–2.45 and 1.67; 1.13–2.44), 1-minute Apgar score <7 (1.70; 1.15–2.52 and 1.80; 1.21–2.67) and intracranial hemorrhage (7.18; 3.60–14.3 and 12.8; 5.58–29.2). CONCLUSIONS: The incidence of CP is higher in LP and MP infants compared with term infants. There is a nonlinear decrease in incidence over time and with increasing gestational age.

Inflammatory activity at school age in very low birth weight bronchopulmonary dysplasia survivors

Airway inflammation is involved in the pathogenesis of bronchopulmonary dysplasia (BPD). The aim of the study was to evaluate the inflammatory activity in plasma and exhaled air in very low birth weight (VLBW) BPD survivors at school age.

Preoperative embolization of giant sacrococcygeal teratoma in a premature newborn

Resection of a large vascular sacrococcygeal teratoma (SCT) in a newborn has the potential to be a fatal procedure caused by hemolysis, rupture, or bleeding of the tumor. Usually, most blood supply of an SCT is derived from the middle sacral artery. As soon as these arteries have been ligated, further blood loss is minimal. There is only one previous presentation about preoperative embolization of these arteries. We present a case in which the feeding arteries of a giant SCT were embolized in an infant born at 30 weeks and 3 days of gestation. Although bleeding during the surgery was minimal, continuous need of transfusions and life-threatening hyperkalemia created severe problems during surgery, until tumor resection was completed. This is the smallest reported patient in whom SCT was preoperatively treated by embolization.

Very low birthweight bronchopulmonary dysplasia survivors show no substantial association between lung function and current inflammatory markers.

The role of inflammation in the bronchopulmonary dysplasia (BPD) survivors is indistinct. We evaluated lung function in relation to inflammatory markers in plasma, exhaled breath condensate and exhaled air in school‐aged very low birthweight (VLBW) survivors with and without radiographic BPD.

Decreased Free Water Clearance Is Associated with Worse Respiratory Outcomes in Premature Infants

Objective The goal was to elucidate predictors of decreased free water clearance (DFWC) in very low birth weight (VLBW) infants. We hypothesized that DFWC and fluid retention are linked to the severity of pulmonary problems and prolonged respiratory support, especially to nCPAP treatment. Methods The investigation was carried out at Tampere University Hospital between 2001 and 2006. The study population comprised 74 VLBW infants born at 29.21 (24.57–34.14) weeks of gestation. Median birth weight was 1175 (575–1490) grams. We measured plasma and urine osmolality and 24-hour urine volume to calculate free water clearance (FWC) for each infant. If FWC was less than 30 ml/kg/day the infant was classified as having DFWC. Results There were 38 (51.4%) infants with DFWC in the study population. The median duration of the observed DFT period was 14 (4–44) days. The gestational age at birth was lower for DFWC infants compared to infants with normal FWC (NFWC), 28.29 (24.57–32.86) vs. 30.00 (25.57–34.14) weeks (p = 0.001). DFWC infants also needed longer ventilator treatment, 2 (0–23) vs. 0.50 (0–23) days (p = 0.046), nCPAP treatment 30 (0–100) vs. 3 (0–41) days (p<0.0001) and longer oxygen supplementation 47 (0–163) vs. 22 (0–74) days (p = 0.011) than NFWC infants. All values presented here are medians with ranges. Conclusions DFWC appears to be frequently connected with exacerbation and prolongation of pulmonary problems in VLBW infants. Cautious fluid administration seems to be indicated in VLBW infants with prolonged respiratory problems and DFWC.

Hospital admissions for lower respiratory tract infections in children born moderately/late preterm

To evaluate the frequency and predictors of hospital admissions for lower respiratory tract infections (LRTIs) in moderately preterm (MP, 32+0 to 33+6 weeks) and late preterm (LP, 34+0 to 36+6 weeks) infants compared to term (T ≥37 weeks) and very preterm (VP, <32+0 weeks) infants.

Asthma and atopic dermatitis after early-, late-, and post-term birth

To assess the incidence and risk factors of asthma and atopic dermatitis by seven years of age after early‐term (ET) (37+0‐38+6 weeks), full‐term (FT) (39+0‐40+6 weeks), late‐term (LT) (41+0‐41+6 weeks), and especially post‐term (PT) (≥42 weeks) birth.

The incidence and risk factors of epilepsy in children born preterm: A nationwide register study

OBJECTIVES The aim was to compare the incidence of epilepsy between very preterm (VP) (<32+0 weeks), moderately preterm (MP) (32+0-33+6 weeks), late preterm (LP) (34+0-36+6 weeks) and term infants (≥37 weeks) and to establish and compare risk factors of epilepsy in these groups. METHODS The national register study included all live born infants in Finland in 1991-2008. Excluding infants with missing gestational age, a total of 1,033,349 infants were included in the analysis and they were analyzed in four subgroups (VP, MP, LP and term) and three time periods (1991-1995, 1996-2001 and 2002-2008). RESULTS 5611 (0.54%) children with epilepsy were diagnosed. The incidence of epilepsy was 2.53% in the VP, 1.08% in the MP, 0.75% in the LP and 0.51% in the term group. Intracranial hemorrhage (OR 3.48; 95% CI 2.47-4.89) and convulsions in the neonatal period (OR 13.4; 95% CI 10.2-17.6) were associated with an increased risk of epilepsy. Compared to the term group, preterm birth (VP OR 4.59; 95% CI 3.79-5.57, MP 1.97; 1.48-2.63, LP 1.44; 1.25-1.68) was associated with an increased risk of epilepsy after adjusting for maternal, pregnancy, delivery and sex variables. CONCLUSIONS The incidence of epilepsy decreased by advancing gestational age at birth and preterm birth predicted an increased risk of epilepsy in childhood. Intracranial hemorrhage and neonatal convulsions were strongly associated with an increased risk of epilepsy.

Severe Bronchopulmonary Dysplasia, Growth, Nutrition, and Adipokines at School Age:

This study evaluated nutrition and growth in relation to plasma adipokine levels in 21 very-low-birth-weight (VLBW) children with radiographic bronchopulmonary dysplasia (BPD), 19 VLBW controls, and 19 term controls with a median age of 11.3 years. We took anthropometric measurements; assessed plasma levels of adipsin, resistin, adiponectin, and leptin; and analyzed the children’s 3-day food records. Children with BPD had a smaller age-adjusted head circumference and more microcephaly but no other significant growth differences. Daily recommended nutritional intake levels were poorly met but did not differ between the groups. Leptin levels correlated positively with the body mass index standard deviation score in VLBW children. No other associations between adipokine concentrations and growth were found. There were negative correlations between leptin concentrations and fat intake, resistin levels and carbohydrate intake, and adiponectin, adipsin, and leptin levels and energy intake.

An unexpected cause of gastric perforation in a term-born neonate

CASE A 37-week-old male of 3050 g birth weight was born vaginally in a regional hospital. The mother’s vaginal Streptococcus agalactiae test was negative. The amniotic membranes ruptured 17 h before delivery, and the mother received one dose of penicillin intravenously (i.v.) during labour. The fluid appeared normal. The 1and 5-min Apgar scores were 9 and 10. The newborn passed meconium normally. Enteral feedings were started. During the second day of life he became irritable and febrile. On admission to the neonatal intensive care unit (NICU), his serum C-reactive protein (CRP) was 1 mg/L, white blood cell (WBC) count 17.2 × 109/L, platelet count 290 × 109/L, and blood glucose 12.7 g/L. Septic infection was suspected and i.v. ampicillin and gentamicin started. Four hours later the infant’s abdomen became distended; X-rays showed pneumoperitoneum. The infant was transferred to a tertiary centre. At 2 days of age laparotomy revealed peritonitis and a 2-cm wide gastric perforation. The perforation was sutured and a subclavian catheter inserted. I.v. metronidazole and omeprazole were initiated, and i.v. immunoglobulin administered. Leukopenia (WBC count 1.2 × 109/L) was treated with a 3-day course of granulocyte colony-stimulating factor (G-CSF) (10 g/kg/day). The blood cultures obtained at 2 and 4 days were negative. The clinical situation at first improved, but at 9 days laparotomy had to be again performed due to abdominal distension and radiological pneumoperitoneum. A rerupture of the perforation was sutured. At this point the causative organism was reported to grow in the peritoneal fluid culture obtained in the first operation.