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Newborn preterm infants have large losses of fluid from their immature skin. To minimize fluid and heat loss and reduce the risk of dehydration and hypothermia, infants are routinely nursed in humidified and temperature-controlled incubators. The incubator care can be interrupted by periods of skin-to-skin care (STS). However, data are limited on how to reduce fluid and heat loss from very preterm infants during STS. To investigate the effect of clothing during STS we measured the evaporation of water from the surface of a body/skin model designed to simulate the skin temperature and ambient conditions of an extremely preterm infant during the first days of life. A semi-permeable membrane was placed on top of a water filled chamber heated to body temperature and kept in an incubator at relevant environmental conditions. The evaporation rate (ER) was determined by evaporimetry from the membrane surface alone or from the membrane covered with layers of fabric. The effect of fabric clothing was also determined in a group of extremely preterm infants during incubator care. The evaporation rate (ER) was 51 ± 2.7 g/m2 h from the membrane only. When layers of fabric were applied, ER decreased for each added layer. The ER and temperatures recorded in the model system were in the range relevant for preterm infants. In the infants, fabric clothing also resulted in a decreased ER. We conclude that layers of a simple cotton fabric provide a significant barrier to vapor diffusion thereby reducing evaporative loss of water and heat. [ABSTRACT FROM AUTHOR]

Aim: To study cognitive function at 10y of age in a cohort of children who required neonatal intensive care within the Uppsala Neonatal Follow-up Study.Methods: 226 children, who were born in 1986-1989 and had required neonatal intensive care (NIC) and 72 full-term, healthy control children were enrolled in the study. NIC children were grouped according to gestational age (group I, 23-31 wk; subgroup IA, 23-27 wk; IB 28-31 wk; group II, 32-36 wk; group III, > 36 wk), with infants with congenital malformation (IWCM) included and excluded from the main groups. The Kaufman Assessment Battery for Children (K-ABC) was administered and results were analysed in relation to the K-ABC global scales: sequential, simultaneous, mental processing composite and achievement.Results: The great majority of children had well-developed cognitive function, reaching scores at an average level or above. When groups were compared, full-term children that required NIC (group III) showed lower scores than controls on all scales measured by the K-ABC. Preterm children from all the studied groups (groups IA, IB, II) showed poorer performance than controls in the simultaneous processing scale, and group IA scored lower than controls in the achievement scale. The incidence of major cognitive impairment (IQ < 70) was low in NIC children (< 5%), but children from group IA showed significant higher frequency of impairment in the simultaneous, mental processing composite and achievement scales. Children from group IA presented a high frequency of discrepancy between the K-ABC scales, with lower simultaneous and higher sequential scores. Analysis with IWCM excluded from the main groups revealed identical results.Conclusion: Most children who needed neonatal intensive care had developed well their cognitive function at 10 y of age. The long-term effect of neonatal intensive care on cognitive function was more evident in extremely preterm infants (group IA), especially in tasks involving simultaneous ways of processing information. [ABSTRACT FROM AUTHOR]

We provide descriptive data on women who delivered at 23–25 wk of gestation, and to relate foetal and neonatal outcomes to maternal factors, obstetric management and the principal reasons for preterm birth. Medical records of all women who had delivered in two tertiary care centres in 1992–1998 were reviewed. At the two centres, policies of active perinatal and neonatal management were universally applied. Logistic regression models were used to identify prenatal factors associated with survival. Of 197 women who delivered at 23–25 wk, 65% had experienced a previous miscarriage, 15% a previous stillbirth and 12% a neonatal death. The current pregnancy was the result of artificial reproduction in 13% of the women. In 71%, the pregnancy was complicated either by pre-eclampsia, chorioamnionitis, placental abruption or premature rupture of membranes. Antenatal steroids were given in 63%. Delivery was by caesarean section in 47%. The reasons for preterm birth were idiopathic preterm labour in 36%, premature rupture of membranes in 41% and physician-indicated deliveries in 23% of the mothers. Demographic details, use of antenatal steroids, caesarean section delivery and birthweight differed between mothers depending on the reason for preterm delivery. Of 224 infants, 5% were stillbirths and 63% survived to discharge. On multivariate logistic regression analysis comprising prenatally known variables, reasons for preterm birth were not associated with survival. Advanced gestational duration (OR: 2.43 per wk; 95% CI: 1.59–3.74), administration of any antenatal steroids (OR: 2.21; 95% CI: 1.14–4.28) and intrauterine referral from a peripheral hospital (OR: 2.93; 95% CI: 1.5–5.73) were associated with survival. Women who deliver at 23–25 wk comprise a risk group characterized by a high risk of reproductive failure and pregnancy complications. Survival rates were similar regardless of the reason for preterm birth. Policies of active perinatal management virtually eliminated intrapartum stillbirths. [ABSTRACT FROM AUTHOR]

Aim: To study language development at age 6.5 y in 230 children who had required neonatal intensive care (NIC) and 71 full-term neonatally healthy control children, all born in 1986-1989, with a focus on comparison between genders.Methods: Eight aspects of spontaneous speech, 3 fine motor functions, 10 linguistic areas, Peabody Picture Vocabulary Test, and digit recall (ITPA) were assessed.Results: Achievements for gender and gestational age groups were analysed (group I, 23-31 wk; subgroup IA, 23-27 wk; IB, 28-31 wk; group II, 32-36 wk; group III, >36 wk), with children with congenital malformations as a separate group. As a group, at 6.5 y NIC girls had more developed spontaneous speech than NIC boys, and performed better than NIC boys in some linguistic areas. NIC girls of group I had lower results than control girls in spontaneous speech aspects such as speech motor function, interaction and motivation, and in many areas of linguistic skills. In contrast, NIC boys of group I had higher results than control boys in auditory memory, and only regarding information and speech motor function in spontaneous speech were their results lower. Analysis of results of matched pairs of group I NIC girls versus control girls and group I NIC boys versus control boys revealed even more marked differences between NIC girls and their matched controls than between NIC boys and their matched controls.Conclusion: Language development in extremely or very preterm NIC boys seems to be less influenced than that in NIC girls by the need for and administration of NIC. The neonatal factors associated with low scores in girls are different from those in boys. [ABSTRACT FROM AUTHOR]

Unlabelled: Linguistic skills at 6 1/2 y of age, corrected for gestational age at birth, were examined in a cohort of 230 children who had required neonatal intensive care (NIC) in 1986-89, and in 71 fullterm neonatally healthy control children (C) matched to the NIC children born at < 32 gestational weeks. Ten linguistic areas were assessed. The 10th percentile score of the controls was identified in each linguistic area and used for comparisons. In 77.5% of the controls and 63.5% of the NIC children, no score was lower than the 10th percentile score of the controls. Scores lower than the 10th percentile score were more common in NIC children born at term or at 23-31 wk, and within this group of children those born at 23-27 wk, than in controls.Conclusion: In preterm children of < 32 wk the results in the linguistic areas of imitation of articulatory positions, comprehension of logical grammatical constructions, phonemes and word fluency differed from those of the matched controls, and in NIC children born at > or = 32 weeks the results for imitation of articulatory positions, articulatory patterns and sentences, auditory discrimination and word fluency were poorer than those of the controls. [ABSTRACT FROM AUTHOR]

Unlabelled: Spontaneous speech at 6 1/2 y of age was studied in a follow-up of 230 children born in 1986-89 who had required neonatal intensive care (NIC) and 71 fullterm neonatally healthy control children. Eight aspects of spontaneous speech were examined: Information, speech motor function, sound pattern, word finding, word selection, grammar, interaction and motivation. The results were analysed in relation to gestational age groups (group I, 23-31 wk; subgroup IA, 23-27 wk; IB, 28-31 wk; group II, 32-36 wk; group III, >36 wk) and a separate group of children with congenital malformations (IWCM). Between 66.7% (group IA) and 55.7% (group III) had no obvious deviations in any aspect of spontaneous speech compared with 80.3% of controls. Children born at <32 wk of gestation (group I) had few pronounced deviations in speech motor function or formal aspects of spontaneous speech. No ability, or hardly any ability, in an aspect of spontaneous speech was only found in children born at >32 wk. Deviations in prosody and poor facial expressions accompanying spontaneous speech were more common in group I than in controls.Conclusion: Most children who needed intensive care neonatally had well-developed spontaneous speech. [ABSTRACT FROM AUTHOR]

Ten newborn infants, born at 25-41 wk of gestation and nursed in a neonatal intensive care unit or in a neonatal intermediate care unit, underwent monitoring of heart and respiratory rates with a new technique using an optical sensor, 0-60 d postnatally. The aim of this study was to compare the heart and respiratory rates recorded in infants by photoplethysmography with a probe positioned on three monitoring sites, namely the leg, buttock and interscapular region, with the rates recorded by ECG and transthoracic impedance, respectively. The recordings were compared in order to determine which individual heart beats and respiratory cycles were recorded with one or both relevant techniques. A high degree of association (r =0.99) was found between the respiratory rates recorded by photoplethysmography and by transthoracic impedance. Recordings of heart rates by ECG were also highly associated with the photoplethysmographic rates as measured at two (r = 0.99) of the three monitoring sites. It is concluded that heart and respiratory rates in infants can be monitored satisfactorily by the new method based on photoplethysmography. This method offers the advantage of recording several physiological parameters non-invasively with a single probe during the neonatal period. [ABSTRACT FROM AUTHOR]

Speech and language skills at 6.5 y of age were studied in a follow-up of a cohort of children who had required neonatal intensive care (NIC) at Uppsala University Children's Hospital. An interview with the parents indicated that preterm and full-term NIC children were older than control children when they reached certain stages in language development (short sentences, intelligible speech). Absence of babbling was more common in NIC children born at 23-27 wk than in other preterm NIC children, and occurrence of stuttering was more commonly noticed in preterm NIC children born at 23-27 wk than in those born at ≥32 wk and controls. [ABSTRACT FROM AUTHOR]

Linguistic skills at 6½ y of age were examined in a cohort of 284 children requiring neonatal intensive care (NIC) and in 40 controls. Ten linguistic areas were assessed. The results are presented for gestational age groups. The 10th percentile score of the controls was identified in each linguistic area. Seventy percent of the controls and <27% of the NIC children had no score lower than the 10th percentile score. Scores lower than the 10th percentile score were more common in NIC children born at term or at 23-31 wk, and within the latter group in those born at 28-31 wk, than in those born at 32-36 wk gestational age. The linguistic areas of auditory discrimination, imitation of articulatory positions and imitation of sentences were most frequently affected. NIC children born at 32-36 wk performed better in the last two areas than those born at <32 wk. To be a twin and born at 28-31 wk was associated with an increased risk of having more than five scores lower than the 10th percentile score of the controls. [ABSTRACT FROM AUTHOR]

Plasma concentrations of caffeine and theophylline were simultaneously determined in 17 preterm infants after oral administration of aminophylline for treatment of apnoea. The ratio of caffeine/theophylline concentration in plasma increased during the first 2 weeks of treatment, owing to the longer time required for caffeine than for theophylline to reach steady state. The caffeine/theophylline ratio at steady state was 0.57±0.03 (mean±SE). Thus, caffeine contributed significantly to the total methylxanthine load in the infants. The plasma clearance of theophylline was calculated from the plasma steady state concentrations. In 3 preterm infants treated with oral aminophylline, repeated sampling showed an approximately linear increase in clearance with time from 16.8±0.4 (mean±SE) at a postnatal age of 6-11 days to 30.9±2.5 ml/kg/h at 64-69 days. In 1 full-term infant treated with oral theophylline from 3.5 to 11.5 months of age, the plasma clearance of theophylline increased in a roughly linear manner, reaching a plateau of about 100 ml/kg/h at 6-7 months of age. This corresponds to the clearance found in 1-4 year old infants. [ABSTRACT FROM AUTHOR]

Electrical stimulation of nerves has become an established method in long-term treatment of patients with disturbances in the central or peripheral nervous system. This type of treatment raises questions as to the long-term consequences of implantation in terms of tissue and electrode reactions. The aim of the present study was to find out whether the structure of peripheral nerve tissue is altered after long-term contact with platinum electrodes and the way in which platinum electrodes are changed by prolonged implantation. The study was performed in six dogs which had undergone experiments in which stimulation electrodes were placed bilaterally on the carotid sinus nerves. Fibrotic changes in the nerve bundle and the perineurium were observed after 12·5 years. Accumulation of organic material on the electrode surface was revealed by Auger electron spectroscopy. The surfaces of the implanted electrodes had oxidised and had a high concentration of carbon and measurable amounts of sulphur, indicating corrosion. [ABSTRACT FROM AUTHOR]

The rate of evaporation of water from the skin of 13 infants born at 24 (n=3) and 25 (n=10) weeks of gestation was measured on the first day after birth and at postnatal ages of 1, 3, 7 and 28 d, using the gradient method. Transepidermal water loss was estimated from this rate and corrected to an ambient relative humidity (RH) of 50%. Transepidermal water loss, corrected to 50% RH, was high on the first day after birth (58.4+/-14.8 g m(-2) h(-1)) and remained at the same level during the second day (59.3+/-17.6 g m(-2)h(-1)). It then decreased significantly to 43.8+/-9.5 at a postnatal age of 3 d, 36.1+/-12.6 at 7 d and 24.2+/-7.7 g m(-2) h(-1) at 28 d (p < 0.001). Within the group investigated, there was no significant correlation between transepidermal water loss and body or skin temperature, birth weight, gender, mode of delivery or gestational age. Transepidermal water loss on the first day after birth was somewhat lower than the highest losses previously found in infants born at 25 weeks of gestation, and of the same magnitude as previously reported for infants born at 25-27 weeks. Transepidermal water loss at postnatal ages of 1, 3, 7 and 28 d in the present study was higher than that previously found in the group of infants born at 25-27 weeks. In conclusion, in infants born at 24-25 completed weeks of gestation transepidermal water loss was high immediately after birth and decreased with increasing postnatal age, but at a slower rate than previously reported for slightly more mature infants. [ABSTRACT FROM AUTHOR]

The rate of evaporation of water from the skin of 13 infants born at 24 (n = 3) and 25 (n = 10) weeks of gestation was measured on the first day after birth and at postnatal ages of 1, 3, 7 and 28 d, using the gradient method. Transepidermal water loss was estimated from this rate and corrected to an ambient relative humidity (RH) of 50%. Transepidermal water loss, corrected to 50% RH, was high on the first day after birth (58.4 ± 14.8 g m[sup -2] h[sup -1]) and remained at the same level during the second day (59.3 ± 17.6 g m[sup -2] h[sup -1]). It then decreased significantly to 43.8 ± 9.5 at a postnatal age of 3 d, 36.1 ± 12.6 at 7 d and 24.2 ± 7.7 g m[sup -2] h[sup -1] at 28 d (p < 0.001). Within the group investigated, there was no significant correlation between transepidermal water loss and body or skin temperature, birth weight, gender, mode of delivery or gestational age. Transepidermal water loss on the first day after birth was somewhat lower than the highest losses previously found in infants born at 25 weeks of gestation, and of the same magnitude as previously reported for infants born at 25-27 weeks. Transepidermal water loss at postnatal ages of 1, 3, 7 and 28 d in the present study was higher than that previously found in the group of infants born at 25-27 weeks. In conclusion, in infants born at 24-25 completed weeks of gestation transepidermal water loss was high immediately after birth and decreased with increasing postnatal age, but at a slower rate than previously reported for slightly more mature infants. [ABSTRACT FROM AUTHOR]

A prospective national investigation comprising 633 extremely low birthweight (ELBW) infants born alive in the 2-y period 1990-1992 with a birthweight of < or = 1000 g and gestational age of > or = 23 completed weeks was conducted regarding neurosensory outcome and growth. Three-hundred and sixty-two (98%) surviving ELBW infants were assessed at a median age of 36 months, using a specially designed protocol. At follow-up, mean height, weight and head circumference in both boys and girls were significantly lower than the reference values. The incidence of cerebral palsy was 7% among all children and 14%, 10% and 3% in children born at 23-24, 25-26 and > or = 27 gestational weeks, respectively. At least one obvious handicap was present in 14%, 9% and 3% of these three groups of children, respectively. After adjustment for gestational age, a significantly increased risk of handicap was found in children with intraventricular haemorrhage grade > or = 3 and/or periventricular leucomalacia and in children with retinopathy of prematurity stage > or = 3. The results show that more than 90% of ELBW children born at > or = 25 completed gestational weeks were without neurosensory handicap at 36 months of corrected age. In infants born at 23-24 weeks of gestation, both survival and long-term outcome were less favourable. [ABSTRACT FROM AUTHOR]