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Objective: To study neurodevelopmental outcome in a two year cohort of extremely low birthweight (ELBW) infants at 1 8 months corrected age, to compare the development of the ELBW infant [...]

OBJECTIVE: To evaluate the differences in adrenal function between very low birth weight (VLBW) infants from singleton and multiple pregnancies. DESIGN AND METHODS: Forty infants of birth weights less than 1500 g underwent an ACTH test. Thirty infants born from singleton pregnancies (singleton group) and ten born from multiple pregnancies (multiple group) were enrolled. A baseline blood sample was drawn for cortisol measurement and thereafter serum cortisol was measured 1 and 2 h after an i.v. injection of ACTH. RESULTS: In multiple pregnancies, the median basal cortisol level of the infants was significantly lower than that in the singletons. The median cortisol level at 1 and 2 h after administration of ACTH was significantly lower in infants from multiple gestations than in singletons. Of infants from the multiple gestation group six, and of the singleton infants 12, had baseline cortisol levels lower than the reference values (P=0.48). One hour after ACTH stimulation all multiple and 53% of the singleton group infants showed a subnormal (<500 nmol/l, P=0.007) cortisol response. Two hours after ACTH, nine multiple group patients and 43% of the singletons had subnormal (<500 nmol/l, P=0.01) stimulated cortisol levels. CONCLUSIONS: We have concluded that VLBW infants from multiple gestations seem to be at an increased risk of insufficient postnatal adrenocortical function. In the future, specific attention should be paid to evaluate further newborn infants from multiple pregnancies with regard to a possible benefit of hydrocortisone substitution in stressful clinical situations.

Bronchopulmonary dysplasia (BPD) is an important cause of chronic respiratory distress in low birth infants. The radiological incidence and course of BPD were assessed in 100 consecutive low birth weight infants. Chest radiographs were examined on admission, at the ages of 3 days, 7 days, 2 weeks and 4 weeks and at later follow-up until the examinations were normal. Twelve of the children died. The severity and typical radiological abnormalities of BPD were assessed. Among the children alive, there were 26 with BPD (29.5%). The BPD incidence was highest between the age of 2 weeks and 3 months (18–21%) declining to 3.4% at the age of 12 months. Radiological evidence of BPD was already seen at the age of 2 weeks in 16 of the children. Most cases (73%) had their maximum BPD score at the age of 1 to 3 months. The normalisation of the chest radiography occurred predominantly in the age between 3 and 6 months. The most frequent underlying condition in BPD was hyaline membrane disease in 81%.

One hundred consecutive low birth weight (LBW) infants (<1751 g) were randomized into a study group having a restricted fluid intake until 4 weeks of age and a control group following the fluid regimen conventionally used in the hospital. Chest X-ray films were examined on admission, at the ages of 3 days, 7 days, 2 weeks and 4 weeks and at bi-monthly visits to the outpatient clinic up to 1 year of age or until the chest examinations were normal. The severity of hyaline membrane disease (HMD) and typical radiological abnormalities of bronchopulmonary dysplasia (BPD) were assessed. Twelve patients succumbed, 1 in the study group and 11 in the control group. The study group seemed to experience less severe HMD than the controls. Of the former 54% and 32% of the latter were alive and had no radiographical signs of BPD at 4 weeks of age (P<0.05). The difference between the groups in the cumulative number of normal chest X-ray examinations during the follow up was even more significant. The percentage of normal X-ray films at 1 year of age was 92% in the study group and 72% in the control group. These results suggest that fluid restriction for the first 4 weeks of life can lower the incidence of radiological abnormalities typical of BPD obtained during the 1st year of life in LBW infants. Pulmonary oedema seems to be a significant aetiological factor causing HMD to develop into chronic lung disease.

Pulmonary oedema is an important problem in premature neonates with surfactant deficiency because of fluid accumulation in the lung interstitium and reduced urine output. Some retrospective reports suggest that excessive early hydration might increase the risk of bronchopulmonary dysplasia (BPD). Only three prospective studies evaluating low or conventional fluid administration regimens to very low birth weight infants have been published. According to their results no significant differences in the incidence of BPD have been shown. However, fluid restriction seems to improve the outcome of the infants because of decreased incidence of haemodynamically significant patent ductus arteriosus, necrotizing enterocolitis, pulmonary air leaks and decreased mortality. The appropriate amount of sodium in the intravenous fluids during the first days of life needs further evaluation. In tiny infants with birth weights from 500 to 800 g intensive monitoring of fluid balance is essential to control the extremely high fluid losses due to evaporation. Undermutrition is a risk factor of BPD and therefore it is important to start parenteral nutrition early. The benefit of the use of colloids as volume expanders is controversial. According to some retrospective reports there might be an association with increased use of colloidal fluids during the first days of life and the development of BPD.

Objective: The goal was to elucidate predictors of decreased fluid tolerance (DFT) in very low birth weight (VLBW) infants. We hypothesized that the fluid retention is linked to severity of pulmonary problems and prolonged respiratory support, especially to nCPAP treatment.Methods: The investigation was carried out at Tampere University Hospital between years 2001 and 2006. The study population comprised 74 very low birth weight (VLBW) infants born at 29.21 (24.57-34.14) weeks of gestation. Median of birth weight was 1175 (575-1490) grams. We measured plasma and urine osmolality and 24 hour urine volume to calculate free water clearance (FWC) for each infant. If FWC was less than 30 ml/kg/day the infant was classified as having a DFT.Results: There were 38 (51.4%) infants with an abnormal FWC (AFWC) in the study population. The median duration of observed DFT period was 14 (4-44) days. The gestational age at birth was lower for AFWC infants compared to infants with normal FWC (NFWC), 28.29 (24.57-32.86) vs. 30.00 (25.57-34.14) weeks (p=0.001). AFWC infants also needed longer ventilator treatment, 2 (0-23) vs. 0.50 (0-23) days (p=0.046), nCPAP treatment 30 (0-100) vs. 3 (0-41) days (p< 0.0001) and longer oxygen supplementation 22 (0-74) vs. 47 (0-163) days (p=0.011) than NFWC infants.Conclusions: Decreased fluid tolerance seems to be frequently connected with exacerbation and prolongation of pulmonary problems in VLBW infants. Fluid restriction might be a more beneficial treatment than diuretics in VLBW infants with prolonged respiratory problems and DFT.

Background and aims: The objective was to seek mother- and infant-dependent predictors influencing breast milk donation. We sought to create the profile of a Finnish breast milk donor, including information on demographics, lifestyle, breastfeeding habits, health, infant`s health, experienced quality of life, connection with the milk bank, problems while breastfeeding and expressing milk and reasons for and barriers to donating milk.Methods: Data were collected by a letter questionnaire and patient records of 80 donors and 59 non-donor controls.Results: The typical donor was young, welleducated, married, a mother of two children and healthy with healthy living habits. Health and rate of pregnancy complications were similar in the study groups. Need for phototherapy was more common and postnatal weight loss was greater in babies of donors compared to non-donors whereas infant`s slow weight gain was later more common among non-donors. Donors were mostly motivated by altruistic considerations. Partner`s support to donation was reported in 95 % of donors and 28 % of non-donors (p <.001). The most common source of information on the need for donated milk reported by both groups was the maternity ward. Difficulty of storing and delivering milk to the milk bank was significantly more common among non-donors.Conclusions: Most donors are motivated by altruistic considerations. Health care professionals play an important role in motivating mothers to donate milk. Information on need for donated milk should also focus on the fathers/partners. Making milk delivery from home to milk bank easier might increase the number of donors.

Background: Single course of BM decreases neonatal morbidity when administrated within 7 days before preterm delivery. The benefits of second course of BM are unknown.Aims: To evaluate the efficacy of second course of BM in increasing the intact survival of preterm infants.Methods: In this randomized, blinded trial, pregnant women (before 34.0 gestational weeks) were eligible if they had remained undelivered more than 7 days after antenatal BM. Single dose of BM (12 mg) or placebo was given, when the preterm delivery was anticipated. Primary outcome was intact survival without respiratory distress syndrome and/or intracerebral hemorrhage (grade 3–4).Results: 251 mothers participated the study. All infants were delivered prior to 35 weeks of gestation. At present the outcome of 285 infants has been analyzed. The intact survival was 48% in BM and 58% in placebo groups (P=0.1). The intact survival was non-significantly higher in BM group (58% vs. 41%, P=0.3), when the study drug was administered more than 24 h before birth (group 1). The incidence of intact survival was lower in BM group (44% vs. 61%, P=0.01), when the intervention took place less than 24 h before birth (group 2). In group 1, the risk of patent ductus arteriosus was 16% in BM and 41% in placebo group (P=0.04), vs. 29% and 27% in group 2. In group 2, systolic and diastolic blood pressures were increased in BM arm (P=0.02 and P=0.03). In group 1, blood pressure levels were similar between study groups. The second course of BM did not influence the acute outcome of preterm infants. The preterm infants benefited from antenatal BM, when treatment was given more than 24 h before delivery. BM given less than 24 hours before delivery was associated with increased blood pressure after birth and with a decrease in intact survival.

To evaluate obstetric predictors of umbilical blood arginine vasopressin (AVP) levels and the timing of first voiding, 87 singleton term newborns were delineated into three groups: group A, vaginal delivery (N=30), group B, cesarean section (CS) during labor (N=26) and group C, elective CS (N=31). 26 (87%) mothers in group A and 21(81%) in group B received labor pain relief. Four (15%) group B mothers received epidural analgesia and spinal anesthesia, 13 (50%) spinal and 9 epidural anesthesia. In the group C 30 (97%) received spinal and 1 epidural anesthesia. Labor pain was evaluated with a visual analog scale (VAS, range 0–5). Data on the infants' health and time of the first voiding was recorded.Results: 70% of group A and 86 % of group B mothers experienced adequate pain relief. The median (range) intensity of pain in the groups A and B were 3.40 (0.90–4.90) and 3.68 (0–4.95) (NS). The median (range) AVP concentration (ng/L) was 120 (0.7–2170) in the group A, 1.8 (0.01–183) in the group B and 0.8 (0.01–30) in the group C (p<0.05), having a positive correlation with duration of labor (p>0.001), time from membrane rupture (p=0.002), umbilical cord length (p=0.002) and gestational age (p=0.025) and a negative correlation with umbilical arterial pH (p=0.007) and mothers' blood loss (p=0.001). The infants voided first time at median (range) age of 8.7 (0–38.9) hours in group A, 7.8 (0–31.0) in group B and 0.8 (0–16.5) in group C (p=0.017). The timing had a positive correlation with time from membrane rupture (p=0.037), gestational age (p=0.003), volume of formula feeding (p<0.001) and umbilical AVP concentration (p=0.023).Conclusion: Maturity, labor and factors, dangerous to placental perfusion, seem to increase AVP secretion in the fetus and affect timing of the first voiding in the neonate. Labor induces mechanisms protecting circulation in the newborn.