Rajam S. Ramamurthy

A randomized trial of intrapartum versus immediate postpartum treatment of women with intra-amniotic infection

&NA; A randomized trial of intrapartum versus postpartum antibiotic treatment of women with intra‐amniotic infection was conducted. Intra‐amniotic infection was treated with ampicillin and gentamicin during labor (at the time of diagnosis) in 26 women and immediately after umbilical cord clamping in 19 women. Intrapartum treatment led to a lower incidence of neonatal sepsis (0 versus 21%; P = .03) and a shorter neonatal hospital stay (3.8 versus 5.7 days; P = .02) when compared with postpartum treatment. There were no significant differences in the microbiologic results, the gestational age, or the birth weight between the groups. Intrapartum‐treated mothers had a shorter mean postpartum stay, a lower mean number of febrile days, and a lower mean peak postpartum temperature than did postpartum‐treated mothers; these differences were all statistically significant (P = .05). The treatment of clinical intra‐amniotic infection during labor results in improved outcome.

Penicillin in Infants Weighing Two Kilograms or Less with Early-Onset Group B Streptococcal Disease

We studied the effect of penicillin on early-onset Group B streptococcal disease over a 52-month period in neonates who were at high risk of infection. Shortly after birth, 1187 neonates weighing 2000 g or less had blood samples taken for cultures and were randomized into an early-treatment group (given intramuscular penicillin G within 60 minutes of birth) or a control group. The incidence of early-onset disease was 20 per 1000 live births (24 of 1187); the number of infants in the early-treatment group who had disease (10 of 589) was similar to that in the control group (14 of 598). The fatality rates were similar in both groups (6 of 10 vs. 8 of 14). Cultures from blood obtained with one hour of birth were positive in 21 of the 24 infants with disease; 22 of the 24 were symptomatic within four hours of birth. Thus, infection was well established before the first hour of postnatal life. At autopsy, gram-positive cocci were seen in lung sections of four infants in whom cultures of blood obtained after treatment had been sterile; this indicates that giving routine antibiotic therapy before culture samples are obtained can obscure bacteriologic diagnosis. We conclude that penicillin given at birth to neonates weighing 2000 g or less does not prevent early-onset streptococcal disease or reduce excess mortality associated with disease.

Absorption of iodine in the neonate following topical use of povidone iodine

Topical application of povidone iodine on the umbilical cord and normal intact skin of newborn infants resulted in significantly elevated plasma iodine levels. High iodine levels were also found in two neonates who had povidone iodine applied to denuded skin. No significant alteration in thyroid function was seen. The possible toxic manifestations of high plasma iodine levels are discussed.

Impact of early and high amino acid supplementation on ELBW infants at 2 years.

Objective: The aim of the present study was to examine the effects of early and high intravenous (IV) amino acid (AA) supplementation on growth, health, and neurodevelopment of extremely-low-birth-weight (ELBW) infants throughout their first 2 years of life. Methods: Infants were prospectively randomized in a double-masked fashion and treated for 7 days with either IV AA starting at 0.5 g · kg−1 · day−1 and increased by 0.5 g · kg−1 every day to 3 g · kg−1 · day−1 or starting at 2 g · kg−1 · day−1 of IV AA and advanced by 1 g · kg−1 every day to 4 g · kg−1 · day−1. Plasma AA concentrations were determined by reverse-phase high-performance liquid chromatography. Survivors were longitudinally assessed with Bayley II Scales of Infant Development and physical, social, and global health. Results: Forty-three of 51 survivors were studied. Mental Developmental Index (MDI) and Psychomotor Developmental Index were similar between groups; however, the early and high AA group had a lower MDI at 18 months. This difference disappeared at 2 years of age. The early and high AA group z score means for weight, length, and head circumferences were significantly lower than the standard AA group at most visits. Cumulative and single plasma AA concentrations correlated negatively with MDI and postnatal growth. Conclusions: ELBW infants who received early and high IV AA during the first week of life were associated with poor overall growth at 2 years.

Transient neonatal pustular melanosis.

Newborn infants were observed with vesicopustular and pigmented macular skin lesions, which occurred more commonly in black and mature infants and which were distinct clinically and histopathologically from erythema toxicum. Histopathology of skin biopsies of the vesicopustules is characterized by polymorphonuclear infiltration. The lesions often present as, or evolve into, a pigmented macule and persist from three weeks to three months. There are no associated systemic symptoms.

Intravenous supplementation of l-amino acids and dextrose in low-birth-weight infants

The effect of intravenous 3.4 per cent l -amino acid and 10 per cent dextrose supplementation on mortality rate, weight gain, and biochemical blood values was examined in 54 low-birth-weight newborn infants. At 24 to 48 hours of age, the infants were assigned according to birth weight to Group I (701 to 1,000 Gm.), Group II (1,001 to 1,250 Gm.), or Group III (1,251 to 1,500 Gm.). Each group was subdivided randomly into amino acid-treated infants (A) and control subjects (C). There was no significant difference in the case fatality rates between infants in Subgroups A and C. Serial determinations of serum electrolytes, CO 2 combining power, and hematocrit were similar in Groups A and C. Serial blood urea nitrogen concentrations in Group A infants were significantly higher than those in Group C infants. Plasma amino acids showed undue elevations in methionine and glycine concentrations in some of the infants who received supplemental amino acids. At 21 days, a significantly greater increase in weight was observed in Group IIA (178±26 Gm.) compared to Group IIC (54±51 Gm.). Similarly, weight increase in Group IIIA (206±27 Gm.) was significantly greater than that in Group IIIC (58±24 Gm.). Infants in Groups IIA and IIC reached a discharge weight of 2,041 Gm. at 45±11 days and 55±9 days, respectively. Infants in Group IIIA reached the discharge weight significantly earlier than those in Group IIIC (41±1 and 49±2 days, respectively).

Effect of triple dye on staphylococcal colonization in the newborn infant.

The effectiveness of triple dye, hexachlorophene, or liquid soap bathing in the reduction of staphylococcal colonization rate was evaluated in a study of 1,117 infants. Cord colonization rate was 10.5 per cent in the triple dye group, 41.1 per cent in the hexachlorophene group, and 71.5 per cent in the control group. These differences are significant (p

Postdischarge Growth and Development in a Predominantly Hispanic, Very Low Birth Weight Population

OBJECTIVES. The goals were to assess postdischarge growth and developmental progress of very low birth weight (birth weight: <1500 g) premature infants in a predominantly Hispanic population and to identify predictors for neurodevelopmental impairment at 3 years of age. METHODS. A cohort of 135 very low birth weight infants (gestational age: 23 to 35 weeks) were monitored to 3 years of age. Maternal and neonatal characteristics, anthropometric z scores, and developmental performance (using corrected age until 24 months) were analyzed collectively and according to gestational age groups. Specific criteria for failure to thrive and microcephaly were used. RESULTS. A characteristic pattern of poor weight gain in the first 12 months was followed by accelerated weight gain starting at 18 months, whereas head growth decreased at 18 months, with recovery beginning at 30 months of age. Infants born at gestational age of ≤26 weeks remained growth-impaired at 3 years of age, whereas infants born at gestational age of ≥27 weeks achieved catch-up growth by 30 months of age. Mean developmental scores also decreased in infancy, with improvements in motor development emerging at 18 months and cognitive skills at 30 months. Growth z scores, particularly for head growth, correlated with developmental scores. Infants born at gestational age of ≤26 weeks were most likely to have neonatal morbidities, failure to thrive, and neurodevelopmental impairment. With adjustment for gestational age and neonatal morbidities, Hispanic acculturation, failure to thrive, and microcephaly were predictive of neurodevelopmental impairment. CONCLUSIONS. Very low birth weight infants exhibited growth patterns that coincided with developmental progress in the first 3 years of life. Birth at gestational age of ≤26 weeks was associated with greatest risk for developmental impairment, whereas failure to thrive and microcephaly increased neurodevelopmental impairment risk regardless of gestational age.

Perinatal mortality in a large perinatal center: five-year review of 31,000 births.

The perinatal mortality rate for 30,928 babies born at Medical Center Hospital, San Antonio, Texas, between 1978 and 1982, was 20.3/1,000 births. Neonatal and fetal mortality rates were, respectively, 10.1/1,000 live births and 10.4/1,000 births. Exclusion of babies who weighed less than 500 gm yielded adjusted fetal, neonatal, and perinatal mortality rates of, respectively, 9.2, 9.8, and 17.9. Birth weight-specific mortality rates were calculated by groups of 250 gm birth weight for all neonates and by increments of 100 gm for babies who weighed 500 to 1,499 gm. Male infants, intrauterine growth-retarded babies, and babies whose mothers were less than 15 years old contributed more deaths than would be expected from the characteristics of the obstetric population. Presumptive cause of fetal death was unknown in 32%, fetal anoxia in 21%, maternal pathologic conditions in 20%, inappropriate fetal growth in 13%, congenital malformations in 8%, and systemic fetal infections in 6%. Leading presumptive causes of neonatal death were immaturity (29%), congenital malformations (18%), hemorrhages (16%), and systemic infections (10%). Hyaline membrane disease and necrotizing enterocolitis contributed, respectively, 7% and 6% of deaths. Past and future trends of perinatal mortality are discussed.

Decreasing mortality in neonates with early-onset group B streptococcal infection: Reality or artifact

GROUP B BETA HEMOLYTIC STREPTOCOCCUS is currently the leading cause of sepsis or meningitis or both during the first two months of life? 6 In our nursery, early-onset GBS infection accounts for 2 to 11% of the overall neonatal mortality. Reasons for the emergence of GBS as the predominant pathogen remain unexplained. In view of the prevalence of the organism in our population, we examined some of the epidemiologic factors associated with neonatal GBS infection. In this report, we analyzed only the data pertaining to early-onset disease, since complete information on all inborn infants who acquired late-onset disease in the first few months of life is not available. PATIENTS AND METHODS Early-onset GBS infected infants, identified prospectively, were all born at Cook County Hospital, Chicago, from 1972 through 1979 and had onset of symptoms in the first five days of life. GBS was isolated from peripheral venous blood and/or cerebrospinal fluid. Cultures were routinely obtained by the house staff from all infants at high risk for developing infection, infants suspected of sepsis, and symptomatic infants. In addition, blood and CSF cultures were routinely obtained immediately following death from all infants who died. The GBS were identified using streptococcal A (bacitracin) discs on sheep blood agar, bile esculin agar, and either the hippurate hydrolysis test or the cAMP test. The data for the entire eight years were examined first. Subsequently, data from 1972 through 1975 were pooled (period 1) and compared with data from 1976 through 1979 (period 2). The GBS infection rate is defined as the