Yolande Smith

Developmental Outcome of Preterm Infants with Intraventricular Hemorrhage at One and Two Years of Age.

Around 1980, many perinatal centers began prospective cranial screening of preterm infants using portable ultrasonography at the bedside. This study examined developmental outcome at 1 and 2 years in relation to the presence and severity of neonatal intraventricular hemorrhage (IVH). It varies from earlier reports in the size of the sample, restriction to infants without periventricular leukomalacia (PVL), and an attempt to formulate a predictive model by examining development longitudinally. Parametric and nonparametric analyses demonstrated that IVH related to Bayley mental and motor scores and neurologic ratings at 1 year but not at 2 years. Developmental delay and/or neurologic abnormality were more prevalent in infants with severe IVH but were far from universal. Regression analyses on prediction from neonatal and 1-year performance to 2-year scores revealed significant associations between the 1- and 2-year measures but not the neonatal and outcome measures. A direct insult to the CNS such as IVH thus constitutes only a limited model of risk status.

Respiratory Distress Syndrome in the Newborn: Relationship to Serum Prolactin, Thyroxine, and Sex

Prolactin and thyroxine levels were measured by radioimmunoassay in cord blood of 61 premature infants of 26-36 weeks gestation. 30 of the infants subsequently developed respiratory distress syndrome (RDS). The infants who developed RDS had a mean cord prolactin level of 174.5 +/- 24.5 ng/ml and a mean cord thyroxine level of 5.9 +/- 0.4 micrograms/dl. In the 31 healthy infants, the mean cord prolactin and thyroxine levels were significantly higher (226.3 +/- 25.8 ng/ml and 7.1 +/- 0.4 micrograms/dl, respectively). The correlation coefficient between prolactin and thyroxine was r = 0.56 in infants with RDS (p less than 0.0008). Both prolactin and thyroxine correlated with gestational age in the RDS group (r = 0.71 and 0.47, respectively). Discriminant analysis shows that the correlation between prolactin and thyroxine is independent of gestational age (r2 = 0.32, p less than 0.05). There was no correlation between the levels of prolactin and thyroxine in infants without RDS. In the healthy group, the cord prolactin levels were significantly higher (p less than 0.01) in female (335.8 +/- 47.7 ng/ml) than in male infants (209 +/- 17.2 ng/ml). Premature infants who develop RDS have significantly lower thyroxine and prolactin levels in cord blood than infants who remain healthy.

Effect of Total Parenteral Nutrition on Lipase Activity in the Stomach of Very Low Birth Weight Infants

Lipase activity was quantitated in gastric aspirates of 7 premature infants (gestational age 24-29 weeks) during periods of total parenteral nutrition (TPN), mixed parenteral nutrition and gavage feeding or exclusive gavage feeding. The infants were studied from birth until the establishment of exclusive gastric gavage feeding. Lipase activity in gastric aspirates (quantitated by the hydrolysis of 3H-triolein at pH 4.2 and expressed in nmol 3H-oleic acid released/min/ml gastric aspirate) did not differ significantly as a function of mode of feeding: 570 +/- 235 during TPN, 260 +/- 145 during mixed parenteral nutrition and gavage feeding, and 374 +/- 149 during exclusive gastric gavage feeding. The data suggest that, contrary to the intestine and pancreas, the digestive function of the stomach is not impaired during TPN in the very preterm infant.

INCIDENCE OF SUDDEN INFANT DEATH SYNDROME (SIDS) IN PRETERM MULTIPLES (TWIN, TRIPLETS, QUADS, AND QUINTS). 614

INCIDENCE OF SUDDEN INFANT DEATH SYNDROME (SIDS) IN PRETERM MULTIPLES (TWIN, TRIPLETS, QUADS, AND QUINTS). 614

HOME MONITORING DECREASES SUDDEN INFANT DEATH SYNDROME (SIDS) IN HIGH-RISK PRETERM INFANTS. 1669

Between January 1990 & June 1995, 1141 preterm infants (24-36 weeks gestation) on home monitors were followed in our Neonatology High-Risk Clinic. Infants had been referred because of 1) persistence of clinical apneas (A) and bradycardias (B) prior to discharge, 2) need for home oxygen, Caffeine or Aminophylline therapy, or 3) positive pre-discharge screen for A/B by event monitor or overnight multichannel oxipneumocardiogram.

NONNUTRITIVE SUCKINO(NNS) DOES NOT STIMULATE THE SECRETION OF LIN6UAL AND GASTRIC LIPASES IN PREMATURE INFANTS

NNS improves weight gain and allows earlier hospital discharge of low birth weight (LBW) infants (Pediatrics 71:41, 1983). The improved weight gain could be due to more efficient nutrient digestion and absprption. Preduodenal lipases have a compensatory function in fat digestion during physiologic (developmental) or pathologic (cystic fibrosis, alchoholism related) pancreatic insufficiency (J Clin Invest 67:838, 1981; 73:374, 1984; Padietr Res 18:402, 1984 and Gestroenterol 1987, in press). We have therefore investigated whether NNS stimulates the secretion of these lipases in LBW infants. Two separate studies were conducted: 1) 9 infants (gest. age 30.5±0.8 wks, postnatal age 29±3 days) received gavage feeding (GF) with and without NNS, each infant being his/her own control. 2) 10 infants (gest. age 29.7±0.8 wks, postnatal age 32±5 days) were divided into two groups: 4 infants received GF without NNS and 6 infants received GF with NNS. Lipase activity was measured in gastric aspirates.These data suggest, that increased secretion of lipases is not the cause of improved weight gain in infants fed by gavage with nonnutritive sucking. (Support: NIH grant HD 10823.)

1707 PERIVENTRICULAR LEUKOMALACIA: INCIDENCE AND SIGNIFICANCE IN PREMATURE INFANTS

Portable cranial sonography was done on 389 infants with birth weights of 1750g or less admitted to Georgetown University Hospitals Intensive Care Nursery during the 3-year period May 1981 to April 1984. Periventricular leukomalacia(PVL) was diagnosed in 28 infants (7.2%) with birthweights of 680-1730g with appropriate gestational ages 26-33 weeks. The lesions were bilateral in 89% and widespread along the ventricular borders in 86%. Survival in the PVL group was 75%, statistically not significant from 83% on infants without PVL.Twenty of the 21 PVL survivors have been evaluated quarterly using the Bayley Scales of Motor (PDI) and Mental(MDI) Development and standard neurological criteria. All infants demonstrated generalized hypertonia/spasticity on follow-up to 6-35 months (mean 17.6 months). Ninety percent had severe motor deficits, and 75% had significant delay in mental scores (MDI). Cortical blindness was present in 25%. The infants with significantly abnormal MDI and PDI (scores<50) all had bilateral widespread PVL, in contrast to the infants within the normal range who demonstrated focal and/or unilateral lesions.Conclusions: 1)PVL occurs in 7.2% of premature infants weighing 1750g or less at birth; 2) significant neuro-developmental handicaps are present in infants with bilateral widespread PVL; and 3) infants with focal and/or unilateral lesions have a better chance for reasonable developmental outcome.

IMPROVED 2-YR OUTCOME OF PREMATURE INFANTS WITH MAJOR INTRAVENTRICULAR HEMORRHAGE

Portable cranial sonography was performed serially on 137 infants weighing 1750 or less at birth and admitted to the intensive care nursery from January 1980 to December 1981. Hemorrhage was graded by a modified Papiles classification with Grades I&II considered Minor and III&IV designated Major. Forty-nine infants were diagnosed with major IVH.Full developmental evaluation was done at 3, 6, 9, 12, 18 and 24 months on 23 (70%) of the 31 survivors of major IVH using Bayley Scales of Motor (PDI) and Mental (MDI) Development and a standard neurological examination. Bayley scores were corrected for gestational age; scores > 84 were considered normal. At 2 years Mental evaluations were normal in 18 infants (80%) and motor scores were normal in 15 (65%), although there was persistent mild neurological deficit in 11 infants (48%). Sixteen infants (70%) were functioning within normal limits at 2 years of age. There was significant improvement of motor scores in the 2nd year of life; normal mental scores with or without normal motor scores at 1 year of age tended to predict normal mental and motor functioning at 2 years of age.The outcome of premature infants with major IVH is not as grim as previously reported, with 70% of the infants in our group normal at 2 years of age. Caution must be exercised in making drastic medical decisions on the basis of the severity of IVH alone.