Search

A preterm baby given intravenous feeding developed severe rickets. Laboratory investigation revealed hypophosphatemia as the main cause of this picture. Recovery was achieved by giving extra phosphorus supplementation. This case demonstrates that conventional infusates do not meet the phosphorus requirement of rapidly growing infants.

The special risks for preterm breech delivered infants are related to the vulnerability of the preterm baby as such, to occurrence of trauma in delivery, asphyxia intrapartum, and anaemia or haemorrhages. Congenital anomalies must also be taken into consideration.

To discuss the pathological anatomy of a haemorrhage is a somewhat uninteresting task as the main feature is blood which differs little from one bleed to another! I shall therefore be discussing the lesion complex of the preterm infant within which bleeding into the ventricles is a characteristic feature. I shall outline the main accepted structural components and evolution of this lesion complex and the theories on pathogenic mechanisms which can be derived mainly from consideration of the structure. I shall not stray too far into cerebral circulatory physiology however as this falls within the area to be discussed by Dr. Lou.

Immunoglobulin concentrations were determined in 64 consecutively born preterm babies at birth and serially throughout each baby's stay in the neonatal unit. No significant IgG generation was found during the first 15 weeks of life, regression analysis giving an exponential decay model. Concentrations fell to 2 g/l or less in 10 (16%) babies (gestational age 25 to 32 weeks), and were as low as 1 g/l in four babies (gestational age 25 to 29 weeks). The effects of gestational age and birthweight on the concentration of IgG at birth were highly interdependent and significant. Most babies had no detectable IgA at birth, and no effect of gestational age or birthweight, or both, on either initial IgA or IgM concentrations could be shown.

A very low birthweight preterm baby with respiratory distress at birth was found to have severe congenital tracheobronchomalacia. Continuous positive airway pressure was given through an endotracheal tube without tracheostomy for 15 weeks before unassisted respiration could be maintained. Diagnosis was made and progress monitored by laryngobronchoscopy on three occasions.

A method for securing umbilical catheters is described. It has been used successfully in over 350 babies. It is a simple and rapid method that allows for easy repositioning and, unlike some established techniques, has no potential for damage to the preterm baby's skin.

Gastric aspirates were obtained soon after delivery from 167 babies 24 to 40 weeks gestation. Bubble clicking and foam stability tests were compared for their reliability in determining pulmonary maturity. Both tests predicted mature lungs accurately in 90-91% of babies, however their ability to predict immature lungs was less, bubble clicking predicting it accurately in 88% of babies and foam stability test predicting it in 77% of babies. Bubble clicking, foam stability tests, L/S ratio and two dimensional thin layer chromatography were done in 26 gastric aspirates obtained from 22 babies with mature lungs and 4 babies with with hyaline membrane disease. Phosphatidyl glycerol was present in 21 of the 22 babies with mature lungs. Bubble clicking demonstrated a 95% accuracy and foam stability test 100% accuracy in predicting the presence of phosphatidyl glycerol. Bubble clicking is a useful and easily preformed test in the clinical assessment of a preterm baby.

Plasma theophylline levels were measured by an enzyme immunoassay method in 6 preterm babies. The method gave accurate and rapid results. The study showed a considerably prolonged half life of an oral preparation.

Transient tachypnea of the newborn (TTN) is usually a benign and self-limited disease of the newborns and the prognosis is generally excellent. It is believed to be resulting from incomplete resorption of fluid from the lungs of the newborn. Infants present with respiratory distress, requiring oxygen supplement for 2-3 days. However some infants with severe symptoms and hypoxaemia may need prolonged oxygen supplement and sometimes mechanical ventilation. Here we present a borderline preterm baby with TTN, who required mechanical ventilation.DOI: 10.3329/pulse.v3i1.6549Pulse Vol.3(1) July 2009 p23-24

Plasma 17α-Hydroxyprogesterone can vary considerably in the first few days of life. Bloodspot 17α-hydroxyprogesterone, plasma cortisol, plasma sodium and urinary 17α-hydroxyprogesterone, cortisol, sodium and creatinine levels were determined in 24 term and 31 preterm infants on the third, eighth and fourteenth day of life. Preterm infants, whether ‘well’ or ‘sick’ had significantly raised bloodspot 17α-hydroxyprogesterone levels (up to 158 nmol/l) compared with those found in term sick or well infants (up to 18.8 nmol/l). Urinary 17α-hydroxy-progesterone/creatinine ratios were also higher in preterm infants. Plasma cortisol results showed similar ranges for term and pre-term infants, and bloodspot 17α-hydroxyprogesterone/plasma cortisol ratios for day 3 specimens correlated with the degree of prematurity. These results may be due either to immature enzyme systems in the preterm baby or to an excess of related steroids cross-reacting in the 17α-hydroxyprogesterone assay.