Search

Aims: To determine the neurodevelopmental outcome of infants with birthweight < 1000 g at 2 years., Methods: Prospective, regional case-control cohort., Results: Of 141 liveborn infants with birthweight between 500-999 g born to mothers of central North Island domicile, 83 (58.9%) were alive at 2 years. Sixty nine of the survivors completed a neurodevelopmental assessment at a corrected age of 2 years along with 29 control infants. Neurological disability was present in 27.5% of survivors, and 20.7% of controls, with severe disability being more prevalent amongst survivors (10.1% vs 3.4%). The mean developmental index, expressive and receptive language scores were not significantly different between the groups., Conclusion: Infants with birthweight < 1000 g are at increased risk of major neurodevelopmental disability at age 2 years compared with a control cohort.

Aims: To assess the impact, mortality, morbidity and economic costs, of respiratory distress syndrome severe enough to warrant ventilation in one year in New Zealand., Methods: Review of data from all five New Zealand regional neonatal intensive care units' participation in the international OSIRIS trial of exogenous surfactant (Exosurf) treatment for respiratory distress syndrome (involving 6700 infants in 21 countries), and extrapolation of these data to a full year., Results: There were 265 New Zealand infants entered in the OSIRIS trial; the mean birthweight was 1335 g and mean gestation 29 weeks; 61% of infants were less than 30 weeks gestation. Forty-seven infants (17.7%) died prior to discharge from hospital, 40 deaths being attributed to prematurity or respiratory distress syndrome. One hundred and two infants (38.5% of the cohort; 45% of surviving infants) were oxygen dependent and 36 infants (13.6%) were dead at 28 days of age. Thirty-four infants (12.8% of the cohort; 15% of surviving infants) were oxygen dependent and 40 infants (15%) were dead at the expected date of delivery. Infants were intubated for a mean 12.5 days, with surviving infants of less than 27 weeks gestation intubated for a disproportionately long period of time. Seventy-two infants (29% of the 246 infants examined) had an abnormality detected by cranial ultrasound scan at 1 or 6 weeks of age and in 23 (9%) this was a major abnormality. Of surviving infants 16 (7.5% of 213 examined) had a major abnormality on cranial ultrasound scan. Amongst infants at high risk for respiratory distress syndrome (gestation less than 30 weeks) 53% received antenatal steroids, compared with 22% in the OSIRIS trial overall. In a full year the cost of caring for infants with respiratory distress syndrome sufficiently severe enough to warrant ventilation is estimated to be NZ$12.5 million. The average cost of caring for a surviving infant was roughly NZ$52,500 and a nonsurviving infant was NZ$24,500., Conclusions: In a full year (total births 60,000) approximately 350 New Zealand infants may require ventilation for respiratory distress syndrome. Increasing the percentage of infants who receive antenatal steroids is likely to be extremely cost effective. In the era of antenatal steroids and exogenous surfactant, 85% of infants with respiratory distress syndrome requiring ventilation survive to discharge home and over 90% of survivors are likely to be healthy normal adults.

The incidence, aetiologic organism and mortality associated with neonatal septicaemia were retrospectively reviewed over a seven year period (June 1983 to July 1990). Trends with time were evaluated by dividing the study period in half. Although there was no significant change in the incidence of septicaemia during the study period (3.59 vs 3.40 per 1000 livebirths), there was a marked increase in the numbers of very low birthweight infants developing early onset group B streptococcal sepsis and an associated increase in mortality.

Sixty-five infants with seizures in the neonatal period were followed to the age of one year. There were 27 nonsurvivors, with 14 neonatal deaths from causes directly related to the initial neurologic insult, and 13 postneonatal deaths, eight related to neurologic sequelae and five to unrelated causes. Twenty-four (63.2%) of the survivors were neurologically normal, while five (13.2%) had seizures at age one year. Multivariate stepwise analysis identified low birthweight (p less than 0.01) and the number of anticonvulsants used to control the initial seizure(s) (p less than 0.05) as being significantly associated with nonsurvival and neurodevelopmental sequelae amongst the survivors was significantly associated with the duration of initial seizure (p less than 0.05).

A cohort of very low birthweight (VLBW) infants (ie, less than 1500 g) who were admitted to the newborn unit, Waikato Hospital between 1984 and 1988 were followed to the age of 12 months. Four hundred and twenty-five infants were admitted with 385 surviving the neonatal period. A further 29 infants died in the postneonatal period (68.2 per 1000 livebirths). Sixteen of the infants died during their initial hospitalisation - primarily from complications of prematurity, while the remaining 13 died following discharge from hospital (9 from sudden infant death syndrome). The postneonatal mortality rate was 3-5 fold greater than that described in similar studies, reflecting the generally increased rate in New Zealand and a lower neonatal mortality rate. The duration of mechanical ventilation was associated with an increased risk of postneonatal death, but no risk factors for posthospital discharge death could be identified.

A ten year (1 January 1978 to 31 December 1987) review of neonatal surgery at Waikato Hospital is reported. There were 367 operations performed on 296 infants aged 0-28 days, with 144 of the operations being classified as a major. Of the 31 deaths, three occurred preoperatively and 28 postoperatively, with diaphragmatic hernia (n = 8) and necrotising enterocolitis (n = 7) being the commonest causes. A significant increase in the number of operations (% major operations), infants with birthweights less than 1500 g, preoperative ventilation and the proportion of operations performed by paediatric surgeons and anaesthetists was seen in the five year period 1983-7, when compared with 1978-82. It is recommended that neonatal surgery only be undertaken at hospitals with level III neonatal intensive care facilities and only by paediatric surgeons and anaesthetists.

Haemorrhagic disease of the newborn is preventable by the routine administration of vitamin K to newborn babies. Despite this, prophylactic administration of Vitamin K1 remains controversial and haemorrhagic disease of the newborn continues to cause significant morbidity and mortality. We present two cases of this disease occurring recently in this region of New Zealand; one resulting in an infant's death, the other baby suffering from an intraventricular haemorrhage and secondary hydrocephalus. These cases prompted us to survey major New Zealand hospitals to assess their policy as regards routine vitamin K administration to newborn infants. The results of this survey suggest that there is now a uniform policy in New Zealand hospitals of giving intramuscular vitamin K. However, intramuscular vitamin K administration may still be objected to by some parents and lead to further cases of this preventable disease. Evidence now available shows that vitamin K1 given orally in a dose of 1 mg is effective in preventing haemorrhagic disease of the newborn.

Whooping cough continues to be a major health problem in New Zealand. In a twelve month period, 64 cases were admitted to the paediatric wards of Christchurch Hospital. Of these 64 patients, 24 (37.5%) were fully immunised. The possible explanations for the large number of children contracting whooping cough, who have been immunised according to the schedule used in New Zealand, is discussed.

Twenty-two months experience with a transcutaneous bilirubinometer (TCB) at Waikato Hospital is reported. During this period 2787 paired TCB and serum bilirubin samples were collected. Correlation coefficients for TCB (forehead and sternum) versus serum bilirubin in both Maori and caucasian infants ranged from 0.57 to 0.67.