Search

In the newborn preterm infant a combination of inadequate reserves and increased loss of essential minerals is common and frequently compounded by difficulties in obtaining an intake sufficient to replace losses and restore reserves. Deficiencies in calcium and phosphate and disturbed balance between them are frequently encountered, and may lead to significant impairment of bone deposition. Osteopenia of prematurity – also known as neonatal rickets, rickets of prematurity or neonatal metabolic bone disease – is a common and important concern in neonatology, and effective management is hindered by difficulties in accurately assessing calcium and phosphate status and the ‘quality’ of bone deposition. It is well known that preterm infants are at risk of reduced bone mineral content (BMC) and subsequent bone disease and that many factors may contribute to this. The majority of calcium and phosphate accretion and bone mineralisation occur in the third trimester of pregnancy and from 24 weeks of gestation onwards, it has been estimated that the fetus in utero gains about 30 g in weight each day, and this daily requirement includes 310 mg of calcium and 170 mg phosphorus.1 It has been shown that BMC and bone mineral density (BMD) correlate positively with gestational age, birth weight, body area and length.2 Mineral deposition may be affected before an infant is born as a number of prenatal factors, particularly placental function, have been shown to play a part in the development of osteopenia. The placenta converts vitamin D to 1,25-dihydrocholecalciferol which enables phosphate to be transported across the placenta.3 A reduced ability to do so explains the higher incidence of postnatal rickets that may be seen in infants with intrauterine growth restriction suggesting that chronic injury to the placenta may limit the ability to transfer phosphate.4 Poor mineralisation may also occur in …

Background Small studies show that many children born as extremely preterm infants have neurologic and developmental disabilities. We evaluated all children who were born at 25 or fewer completed weeks of gestation in the United Kingdom and Ireland from March through December 1995 at the time when they reached a median age of 30 months. Methods Each child underwent a formal assessment by an independent examiner. Development was evaluated with use of the Bayley Scales of Infant Development, and neurologic function was assessed by a standardized examination. Disability and severe disability were defined by predetermined criteria. Results At a median age of 30 months, corrected for gestational age, 283 (92 percent) of the 308 surviving children were formally assessed. The mean (±SD) scores on the Bayley Mental and Psychomotor Developmental Indexes, referenced to a population mean of 100, were 84±12 and 87±13, respectively. Fifty-three children (19 percent) had severely delayed development (with scores more t...

Concentrations of circulating antioxidants may be important in the aetiology of disease in premature infants. Blood samples were taken from 49 premature infants within two hours of birth. Plasma ascorbic acid, caeruloplasmin, and the ability of plasma to prevent lipid peroxidation in vitro were measured. Plasma ascorbic acid concentrations at birth ranged from 26.3 to 185.4 mumol/l. Plasma antioxidant activity at birth (microliter plasma required to inhibit lipid peroxidation) showed a strong negative correlation with plasma ascorbic acid and the plasma ascorbic acid to caeruloplasmin ratio. After correcting for gestational age and birth weight, plasma antioxidant activity at birth remained a significant predictor of mortality. Such plasma antioxidant activity is partly determined by the ferroxidase activity of caeruloplasmin. This may be modulated by high concentrations of ascorbic acid which may inhibit the antioxidant activity of plasma and thereby influence outcome.

Preterm birth currently occurs in approximately 12% of pregnancies and appears to be increasing despite improvements in obstetric care. Improvements in neonatal care have led to increased survival, particularly at extreme prematurity, but survival may be associated with significant morbidity. This may be acute, reflecting the difficulties in supporting an individual in a hostile extrauterine environment to which they should not be exposed, or chronic, reflecting disturbances to fragile, immature body systems. Brain, lungs, intestines and eyes are particularly vulnerable and damage may be severe. For some infants the consequences of this damage may be permanent disability and impairment. Despite this, the limited information currently available suggests that adult outcomes may be comparable with those for infants born at term.

Aims: To describe perinatal factors associated with later morbidity among extremely preterm children at 30 months of age corrected for prematurity. Population: Of 308 surviving children born at ⩽25 weeks gestation in the United Kingdom and Ireland from March to December 1995, 283 (92%) were evaluated at 30 months of age corrected for prematurity. Methods: Cerebral palsy, severe motor disability, and Bayley scores were used as dependent variables in sequential multiple regression analyses to identify factors associated with adverse outcomes. Results: Adverse outcomes were consistently more common in boys. Factors related to perinatal illness, ultrasound evidence of brain injury, and treatment (particularly postnatal steroids) were associated with adverse motor outcomes (cerebral palsy, disability or Bayley psychomotor development index). Increasing duration of postnatal steroid treatment was associated with poor motor outcomes. A score was developed for severe motor disability with good negative predictive value. In contrast, mental development was associated with a broader range of factors: ethnic group, maternal educational level, the use of antenatal steroids, and prolonged rupture of membranes in addition to chronic lung disease. Conclusion: Male sex is a pervasive risk factor for poor outcome at extremely low gestations. Avoidable or effective treatment factors are identified, which may indicate the potential for improving outcome.

Aim: To define growth outcomes of a geographically defined population of extremely preterm babies. Population: The EPICure study identified all surviving children in the United Kingdom and Ireland born at ⩽ 25 weeks 6 days gestation between March and December 1995. Of 308 survivors, 283 (92%) were evaluated at 30 months of age corrected for prematurity. Methods: Growth was measured as part of a medical and full neurodevelopmental assessment. Growth parameters were evaluated in relation to other 30 month outcomes and perinatal variables. Results: The children were smaller in each of the five growth measures compared with published population norms: mean (SD) standard deviation scores were −1.19 (1.32) for weight, −1.40 (1.37) for head circumference, −0.70 (1.19) for height, −1.00 (1.38) for body mass index, and −0.75 (0.95) for mid-upper arm circumference. Despite being of average size at birth, children were significantly lighter with smaller head circumferences at the expected date of delivery, compared with population norms, and only weight showed later catch up, by 0.5 SD. Poorer growth was found in children whose parents reported feeding problems and with longer duration of oxygen dependency, as a marker for neonatal respiratory illness. Although severe motor disability was associated with smaller head circumference, overall there was no relation between Bayley scores and head growth. Conclusions: Poor growth in early childhood is common in extremely preterm children, particularly when prolonged courses of systemic steroids have been given for chronic lung disease. Improving early growth must be a priority for clinical care.

We describe the clinical presentation and pathological features of an unusual case of tracheal agenesis. The axial derivatives of the primitive foregut between the larynx and stomach were represented by a single structure featuring sequential segmentation into regions showing exclusively tracheal or esophageal differentiation in a pattern that is not easily classified by existing nosologic systems nor explained by the conventional hypothesis of dysontogenesis.

1. Non-protein-bound iron has been implicated in the aetiology of chronic lung disease of prematurity. 2. The modification of a method for the measurement of non-transferrin-bound iron in small volumes of plasma and bronchoalveolar lavage fluid from preterm babies is described. 3. The assay runs with a good degree of precision and a lower limit of detection of 0.02 μmol/l. 4. Non-transferrin-bound iron was detected in 50% of plasma samples and 11% of bronchoalveolar lavage fluid samples collected over the first week of life from babies born prematurely.

High concentrations of total vitamin C have been measured in the plasma of premature infants. At these concentrations ascorbic acid inhibited the ferroxidase activity of caeruloplasmin measured directly in vitro. The degree of inhibition was dependent on the ratio of ascorbic acid: caeruloplasmin. Values for the ratio of vitamin C: caeruloplasmin measured in premature babies would be predicted to inhibit ferroxidase activity by up to at least 80%. Ferroxidase activity measured in the plasma of premature babies increased from birth but was significantly lower than in plasma collected from adults (

A second male twin was born at 36 weeks’ gestation by emergency caesarian section owing to failure to progress following spontaneous onset of labour. He was difficult to deliver because of a transverse lie. He developed respiratory distress shortly after birth, requiring oxygen and antibiotics, and became lethargic, hypothermic (temperature 36.1°C) and tachycardic (174 …

To describe the trends in birthweight and their association with socioeconomic status in a 10 year birth cohort in Sheffield.Data for all live singleton births were extracted from the Sheffield Child Development Study (SCDS) database for 1985-94. Enumeration districts (EDs), derived from postcodes, were ranked into deciles by Townsend Deprivation Index (TDI), based on the 1991 census. Birthweight by 500 g group and mean birthweights for the city and by ED decile were calculated by year. chi2 analyses for linear trend were calculated. The proportion of variance in birthweight explained by ED decile and raw TDI score was estimated by year. Absolute risk difference of birthweight3500 g for the most compared with the least deprived deciles and proportion of births3500 g statistically "attributable" to social inequality were calculated.The mean birthweight for all births increased by 34 g between 1985 and 1994. This difference is largely accounted for by a positive trend in births/=3500 g and a negative trend in births of 3000-3499 g. Similar trends were noted across all ED deciles. Around 10% of the variance in birthweight was explained by area deprivation level. Absolute risk difference for births3500 g was 12.5% for the 10 years (range 8.3-18.4). The proportion of births3500 g statistically "attributable" to social inequality for the 10 year period was 9.6% (range 4.3-15.5).Despite an overall increase in mean birthweight, large social differences persisted during the study period. An average of 350 births a year were not in the group (/=3500 g) bestowing most health advantage throughout the life course, as a result of social inequality.