Pamela A. Davies

Very Low Birthweight and Later Intelligence

Intelligence testing using Wechsler, Bender Gestalt and reading tests has been carried out in 105 of 120 children who weighed 1500g or less at birth, born in or admitted to Hammersmith Hospital during the years 1961–68 inclusive. The mean full‐scale iq of 72 whose birthweight had been appropriate for dates was 99–2 and of 33 who were small for dates it was 92.0 (p = 0.04). No definite correlations could be found with birthweight, gestational age or neonatal illness. No significant difference in mean full‐scale iq was found between appropriate‐for‐dates children born between 1961 and 1964, whose food intake and body temperature was significantly lower in the first weeks of life, and the otherwise similar group born between 1965 and 1968. As expected, social class differences in intelligence were marked, and there was an excess of children born to parents in social classes IV and V. Learning difficulties were present in one‐fifth of the children, many of whom had a normal full‐scale iq, and the importance of early recognition of these difficulties is emphasised.

VERY LOW BIRTH WEIGHT AND LATER INTELLIGENCE

Intelligence testing, using the Wechsler Intelligence Scale for Children and the Wechsler Preschool and Primary Scale of Intelligence, has been carried out on nearly 100 children who weighed 1500 G and less at birth. They were born between 1961 and 1968 inclusive, and were cared for at Hammersmith Hospital, London. The youngest child had reached 4 years at the time of testing.Significant differences in food intake and body temperature in the neonatal period existed between the years 1961-64 and 1965-68. The influence, if any, of these factors and of other perinatal events on subsequent events is discussed. The performance of children of low birth weight for gestational age is contrasted with that of children who were appropriately grown at the time of birth.

Later Progress of 100 Infants Weighing 1,000 to 2,000g. at Birth Fed Immediately with Breast Milk

The progress at two years of 100 infants weighing 1,000–2,000 g. at birth is reported; all were fed on undiluted breast milk and were given 60 ml./kg. on the first day of life, increasing to 150 ml./kg. by the fourth day.

Feeding the newborn baby.

SYMPOSIUM PROCEEDINGS ‘969 essential to give also a complete vitamin supplement and supplements of the elements which are deficient in galactomin if it is to be used for more than a few weeks. Although disaccharide intolerance causes severe diarrhoea it may not last long and cow’s milk feeds can be cautiously resumed. The control of infection in the bowel is often difficult because the causal organism is not susceptible to available chemotherapy and may even be encouraged by it.

Sex and the Single Transverse Palmar Crease in Newborn Singletons

The single transverse palmar crease, present in 3–7 per cent of 6,299 newborn infants, was found twice as commonly in the male.

Diagnosis and Management of Bacterial Meningitis

SummaryBacterial meningitis is one of the most important of medical emergencies and has its highest incidence in early childhood. It is responsible for a variable mortality and morbidity, despite the wide range of antibacterial drugs available. Early diagnosis is the most important factor in determining the final outcome, and delay may be associated with significant central nervous system handicap in survivors. It is especially important to entertain the diagnosis in very young children, in whom the accepted clinical signs of meningitis are frequently absent. After the first weeks of life, three organisms — Haemophilus influenzae, Neisseria meningitidis and Diplococcus pneumoniae — are responsible, in that order of frequency, for the majority of cases. In the neonatal period a wide variety of bacteria may cause meningitis, but Gram-negative organisms predominate.Expert bacteriological advice is essential for proper interpretation of the Gram stain of cerebrospinal fluid. The newer technique of counter immunoelectrophoresis may also prove useful in rapid identification of the infecting organism. When immediate diagnosis is impossible, treatment should be started at once to cover the three most common pathogens, and ampicillin in a dose of 200 to 400 mg/kg/day intravenously, is at present acceptable. Dosage should not be decreased with clinical improvement, as cerebrospinal fluid penetration of the drug is directly related to the protein and cell content. Benzylpenicillin is the drug of choice for meningococcal and pneumococcal meningitis and can be substituted as the results of culture become known with certainty. If localising abnormal central nervous system signs are present when the patient is first seen, chloramphenicol may be preferred for H. influenzae meningitis, but in cases diagnosed early ampicillin remains, at present, the drug of choice. Drugs for intravenous use should not be mixed with acidic infusion fluids such as dextrose, but given as a slow injection at 4 or 6 hourly intervals. In the neonatal period, when the infecting organism is not known, a combination of ampicillin and gentamicin is advisable, and in meningitis due to Gram-negative organisms at least, and when hydrocephalus is present, intrathecal therapy will also be necessary.There are still unanswered questions in the management of meningitis and new treatment regimens as other drugs become available need constant evaluation. Vigilant examination of the patient during the course of the illness is essential if complications are to be recognised and treated early. Follow up is important, and in very young children should always include an expert assessment of hearing. Prevention of meningitis may be a more positive line of approach for the future. The development of vaccines against H. influenzae and N. meningitidis is a step in this direction.

MANAGEMENT OF THE PIERRE ROBIN SYNDROME

12. Drillien, C. M. (1968) ‘Studies in mental handicap. 11. Some obstetric factors of possible aetiological significance.’ Archives of Disease in Childhood, 43, 283. Bishop, E. H., Israel, S. L., Briscoe, C. C. (1965) ‘Obstetric influences on the premature infant’s first year of development.’ Obstetrics and Gynecology, 26, 628. Vartan, C. K. (1945) ‘The behaviour of the foetus in utero, with special reference to the incidence of breech presentation at term.’ Journal of Obstetrics and Cynaecology of the British Empire, 52, 417.

Maternal and fetal infection.

Publisher Summary This chapter presents an overview of maternal and fetal infections. The great majority of infants born at term to apparently healthy women are free of readily identifiable infection. Preterm infants, on the other hand, are at greater risk for their birth is sometimes preceded or accompanied by low-grade genital infection in the mother that rarely affects her well-being and is thus unsuspected. Viral and protozoal infections acquired in the first trimester because of rubella, cytomegalovirus, herpes simplex virus (HSV), and Toxoplasma can be devastatingly crippling for the individual child. Numerically speaking, however, such early damaging infections are in the minority, and, with the possible exceptions of rubella early in the second trimester and HSV at any time, acquisition of viral and protozoal infections later in pregnancy or even during delivery leads to mild or inapparent clinical involvement of the child. Many early and later spontaneous abortions may be accompanied by chorioamnionitis, and ascending bacterial infection may have a causal role. Women with many sexual partners and of poor social background are more likely to be colonized with a number of microorganisms, which may be transmitted to the fetus in labor. Surgical induction and transvaginal monitoring may occasionally increase the risk of ascending infection.

The Single Umbilical Artery: A Five‐Year Survey

The single umbilical artery proved to be the most frequently detected malformation among 12,078 Oxford infants delivered consecutively between Jan. 1, 1961 and Dec. 31, 1965; it was present in 0–94 per cent.

Feeding Pre-Term Infants with Raw and Heat-Sterilised Human Milk: Effects on Faecal Flora

Bacterial infection, particularly that caused by enteric organisms, occurs more commonly in pre-term than in mature infants. In the last ten years the care of low birth weight babies has become increasingly technical and complex, and survival rates, especially in the smallest infants, are continuing to rise. As this intensive care becomes regionalised, certain units tend to have relatively large numbers of very small, often ill babies, in whom both the risks of infection and the use of antimicrobial drugs are increased; and illnesses such as necrotizing enterocolitis have also increased, perhaps in parallel. The scientific basis for the antimicrobial properties of human milk has now become more firmly established (I), and there has been renewed interest in the ability of such milk to augment the pre-term newborn’s fragile defences against infenction. When the food is human rather than cow’s milk there is also evidence that certain at least of the constituents are more effectively assimilated, and that metabolic imbalance is less (2, 3, 4). The fact of establishing and continuing lactation, too, may be of psychological help to a mother, faced as she often is with a period of separation from her baby after birth.