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The effects of the long-term usage of single and repeat courses of antenatal corticosteroids on children are examined. The courses are found to improve several neonatal outcomes in infants, though they increase the risk of intrauterine growth restriction.

Intramuscular injections of vitamin A three times a week for several weeks appears to improve lung function in extremely-low-birth-weight babies. These infants have a high risk of lung diseases caused by extreme prematurity. Researchers randomly assigned 807 such infants to receive intramuscular shots of vitamin A or a placebo. Only 55% of the infants who received vitamin A died or developed lung disease compared to 62% of those who received placebo.

Giving pregnant women in premature labor phenobarbital just prior to delivery does not appear to reduce the risk of intracranial hemorrhage in the baby. Researchers gave phenobarbital or a placebo intravenously to 610 women who were in premature labor and expected to deliver within 24 hours. They continued to receive oral phenobarbital once a day if they did not deliver within 24 hours. Ultrasound scans of the baby following its birth revealed that intracranial hemorrhage occurred in 23% of the infants in both groups. Phenobarbital also did not reduce infant mortality.

The effect of vitamin A deficiency on the immune response of children was examined in 236 Indonesian children. Normal and mildly xeophthalmic children were randomly assigned to groups receiving either vitamin A supplements or placebo and were immunized with diphtheria-pertussis-tetanus vaccine two weeks after treatment. Enzyme-linked immunosorbert assay measurement of immunoglobulin synthesis showed that normal and xerophthalic children who received vitamin A supplements had higher immunoglobulin G response to tetanus than those with unsupplemented diets. This indicates a relative immune depression in vitamin A-deficient subjects.

Objectives. The purposes of this study were to report the neurodevelopmental, neurosensory, and functional outcomes of 1151 extremely low birth weight (401-1000 g) survivors cared for in the 12 participating centers of the National Institute of Child Health and Human Development Neonatal Research Network, and to identify medical, social, and environmental factors associated with these outcomes. Study Design. A multicenter cohort study in which surviving extremely low birth weight infants born in 1993 and 1994 underwent neurodevelopmental, neurosensory, and functional assessment at 18 to 22 months' corrected age. Data regarding pregnancy and neonatal outcome were collected prospectively. Socioeconomic status and a detailed interim medical history were obtained at the time of the assessment. Logistic regression models were used to identify maternal and neonatal risk factors for poor neurodevelopmental outcome. Results. Of the 1480 infants alive at 18 months of age, 1151 (78%) were evaluated. Study characteristics included a mean birth weight of 796 [+ or -] 135 g, mean gestation (best obstetric dates) 26 [+ or -] 2 weeks, and 47% male. Birth weight distributions of infants included 15 infants at 401 to 500 g; 94 at 501 to 600 g; 208 at 601 to 700 g; 237 at 701 to 800 g; 290 at 801 to 900 g; and 307 at 901 to 1000 g. Twenty-five percent of the children had an abnormal neurologic examination, 37% had a Bayley II Mental Developmental Index [is less than] 70, 29% had a Psychomotor Developmental Index [is less than] 70, 9% had vision impairment, and 11% had hearing impairment. Neurologic, developmental, neurosensory, and functional morbidities increased with decreasing birth weight. Factors significantly associated with increased neurodevelopmental morbidity included chronic lung disease, grades 3 to 4 intraventricular hemorrhage/periventricular leukomalacia, steroids for chronic lung disease, necrotizing enterocolitis, and male gender. Factors significantly associated with decreased morbidity included increased birth weight, female gender, higher maternal education, and white race. Conclusion. ELBW infants are at significant risk of neurologic abnormalities, developmental delays, and functional delays at 18 to 22 months' corrected age. Pediatrics 2000;105:1216-1226; extremely low birth weight, neurologic outcome, developmental outcome, functional outcome, prematurity, cerebral palsy, Bayley., ABBREVIATIONS. ELBW, extremely low birth weight; NICHD, National Institute of Child Health and Human Development; IVH, intraventricular hemorrhage; PVL, periventricular leukomalacia; CP, cerebral palsy; SD, standard deviation; OR, odds ratio; [...]

Factors affecting preschool children's receipt of vitamin A during the first year of a semiannual program are examined. The program operated in 230 villages in Indonesia. Coverage was best in the more rural and less developed villages. The best performance was achieved by village distributors who were average people for the area (farmers, or non-farmers with minimal education), rather than by upwardly mobile and highly educated residents. Coverage was not affected by the nature of the household or its children. These results may be relevant to planning direct-service projects in the community.