R.W.I. Cooke

ETHAMSYLATE REDUCES THE INCIDENCE OF PERIVENTRICULAR HAEMORRHAGE IN VERY LOW BIRTH-WEIGHT BABIES

Abstract The effect of ethamsylate, a capillary-stabilising drug, in limiting or preventing periventricular haemorrhage (PVH) in 70 very low birth-weight babies was evaluated in a double-blind trial. PVH developed in 9 of the 35 infants on ethamsylate and 18 of the 35 infants who received placebo. Mortality associated with PVH was similar in both groups, but the incidence of PVH of all grades in survivors was reduced in the ethamsylate-treated group.

INFECTION AND COLONISATION OF NEONATES BY HANSENULA ANOMALA

Over a 13-month period 52 neonates (10% of those admitted to the Mersey Regional Neonatal Intensive Care Unit) were found to be colonised with the ascosporagenous yeast Hansenula anomala. 8 babies became infected, all but 1 of whom were heavily colonised before infection. 7 of the 8 infected babies were of very low birth-weight (less than 1500 g). All 8 had multiple problems associated with low birth-weight and prematurity and were kept in the intensive care unit. 5 babies had fungaemia, 2 had fungaemia and ventriculitis, and 1 had ventriculitis only. In each case H anomala was the sole pathogen isolated. Anti-Hansenula antibodies developed in 5 babies within 3 months of infection. Infected babies were successfully treated with a combination of 5-flucytosine and amphotericin B. Despite extensive searches the babies appeared to be the only reservoir of the yeast.

MULTICENTRE TRIAL OF ETHAMSYLATE FOR PREVENTION OF PERIVENTRICULAR HAEMORRHAGE IN VERY LOW BIRTHWEIGHT INFANTS

The effectiveness of ethamsylate in the prevention of periventricular haemorrhage (PVH) in very low birthweight infants was evaluated by means of a multicentre, placebo-controlled, double-blind trial. In 330 infants without evidence of PVH on initial cranial ultrasound examination there was little difference between ethamsylate and placebo groups with respect to subependymal haemorrhage, but intraventricular and parenchymal haemorrhages developed in 30/162 infants (18.5%) in the treated group, compared with 50/168 (29.8%) in the control group (p less than 0.02). The incidence of intraventricular and parenchymal haemorrhage in survivors was 20/137 (14.6%) in the ethamsylate group and 37/146 (25.3%) in the controls (p less than 0.05). In 30 infants with evidence of PVH on the initial scan, ethamsylate treatment seemed to limit parenchymal extension. Analysis of the total cohort of 360 infants showed that the proportion of infants in whom an increase of two or more grades of severity of PVH was recorded during the trial was lower in the treated than in the placebo group (p less than 0.01). No adverse effects were attributed to ethamsylate therapy. The reported incidence of patent ductus arterious was lower in the treated than in the placebo group (p less than 0.02). Mortality was similar in the two groups.

Survival and morbidity in a geographically defined population of low birthweight infants.

Rates of survival and of neurological impairment in a geographically defined population of low birthweight infants born during 1979-1981 were determined by tracing infants and assessing survivors at pre-school age. Comparison with data from similar studies relating to earlier years shows that the proportion of low birthweight infants who survive with no major impairment has increased significantly; the risk of surviving with an impairment has not altered sufficiently for a significant difference to be apparent from these comparisons.

COST OF NEONATAL INTENSIVE CARE FOR VERY-LOW-BIRTHWEIGHT INFANTS

A detailed costing of the Mersey regional neonatal intensive care unit was made for 1983 (at 1984 prices) for three levels of care; costs per inpatient day were 297 pounds, 138 pounds, and 71 pounds for intensive, special, and nursery care, respectively. Regression of ungrouped patient-specific costs against birthweight showed the explanatory power of birthweight to be negligible. The average cost per very-low-birthweight (less than 1500 g) infant was 4490 pounds for a survivor and 3446 pounds for a non-survivor. A similar study elsewhere showed an almost six-fold difference in cost between survivors and non-survivors. It is postulated that medical management policy largely determines this difference and is crucial to any investigation of cost-efficiency.

Epidemiology of strawberry haemangioma in low birthweight infants

The prevalence of cutaneous haemangiomas in a representative population of low birthweight infants was determined by tracing and assessing survivors of pre‐school age. Data from hospital case‐notes and follow‐up assessments were used to investigate whether prevalence of haemangiomas was related to perinatal factors and childhood morbidity.

Predicting costs and outcomes of neonatal intensive care for very low birthweight infants

A geographically determined cohort of all infants of less than 1,500 g born in 1980 and 1981 were clinically followed up to age four to determine their disabilities which were classified as mild, moderate or severe. A quality adjustment coefficient, determined by the severity of the disability, was used to calculate the number of quality adjusted lives produced. The total cost of care for these children was assessed as the sum of hospital costs to age four (which were specifically determined) and an estimate of the life-time costs of care of disabled children from information provided by the Education and Social Service departments. A very poor predictive power of birthweight with cost was obtained with the ungrouped birthweight data, whereas clinical factors explained up to 60% of the variance of the initial hospital costs for survivors and up to 30% of the variance of life-time costs and the cost of quality adjusted lives produced. Rules for the allocation of resources based on discrimination by birthweight are flawed but the application of clinical discretion is important.