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To examine the growth and body composition of small for gestational age (SGA) and appropriate for gestational age (AGA) very low birth weight infants (VLBW) and their outpatient neurodevelopmental outcomes. From 2006–2012, VLBW infants (n = 57 of 92) admitted to the Neonatal Intensive Care Unit (NICU) had serial air displacement plethysmography (ADP) scans and were followed as outpatients. Serial developmental testing (CAT/CLAMS, Peabody Gross Motor Scales) and anthropometrics were obtained from n = 37 infants (29 AGA and 8 SGA) and analyzed via repeated measures analyses of variances. The percentage of body fat, percentage of lean mass, and weight gain were statistically significant between SGA and AGA groups at the first ADP assessment. There was no difference between the two groups in outpatient neurodevelopmental testing. Weight gain as “catch-up” body fat accrual occurs by 67 weeks of PMA. This catch-up growth is associated with normal SGA preterm neurodevelopment as compared to AGA preterm infants.

Background Vitamin D has neuroprotective and immunomodulatory properties, and deficiency is associated with worse stroke outcomes. Little is known about effects of hypoxia-ischemia or hypothermia treatment on vitamin D status in neonates with hypoxic-ischemic encephalopathy (HIE). We hypothesized vitamin D metabolism would be dysregulated in neonatal HIE altering specific cytokines involved in Th17 activation, which might be mitigated by hypothermia. Methods We analyzed short term relationships between 25(OH) and 1,25(OH)2 vitamin D, vitamin D binding protein, and cytokines related to Th17 function in serum samples from a multicenter randomized controlled trial of hypothermia 33°C for 48h after HIE birth versus normothermia in 50 infants with moderate to severe HIE. Results Insufficiency of 25(OH) vitamin D was observed after birth in 70% of infants, with further decline over the first 72h, regardless of treatment. 25(OH) vitamin D positively correlated with antiinflammatory cytokine IL-17E in all HIE infants. However, Th17 cytokine suppressor IL-27 was significantly increased by hypothermia, negating the IL-27 correlation with vitamin D observed in normothermic HIE infants. Conclusions Serum 25(OH) vitamin D insufficiency is present in the majority of term HIE neonates and is related to lower circulating anti-inflammatory IL-17E. Hypothermia does not mitigate vitamin D deficiency in HIE.

Objective: Evaluate brain metabolites, which reflect neuroinflammation, and relate to neurodevelopmental outcomes in healthy term neonates exposed to chorioamnionitis. Study Design: Thirty-one healthy term neonates with documented fetal inflammatory response after maternal chorioamnionitis underwent magnetic resonance spectroscopy (MRS), with voxels placed in basal ganglia (BG) and frontal white matter. Bayley III examinations were performed at 12 months of age. Result: Infants with below average outcomes did not show the same increase in NAA/Cho ratios postnatally as the group with normal outcomes. Decreased NAA/Cho and increased Lac/Cr in BG correlated with lower motor and cognitive composite scores, respectively, controlling for postnatal age. In males, increased lactate/NAA in BG were associated with lower motor scores. Funisitis severity was associated with decreased NAA/Cho and increased mI/NAA in males. Conclusion: In healthy term newborns with chorioamnionitis, MRS ratios shortly after birth may provide evidence of occult neuroinflammation, which may be associated with worse performance on 1-year neurodevelopmental tests.

Objective: Sex is an important determinant of neonatal outcomes and may have a significant role in the physiologic response to maternal chorioamnionitis. Our goal was to determine cerebral blood flow (CBF) parameters by sex and subsequent neurodevelopment in healthy term infants exposed to chorioamnionitis. Study Design: CBF by Doppler ultrasound in anterior and middle cerebral (ACA, MCA) and basilar arteries were analyzed for time-averaged maximum velocity (TAMX) and corrected resistive index in 52 term control and chorioamnionitis-exposed infants between 24 and 72 h after birth. Placental pathology confirmed histologic evidence of chorioamnionitis (HC). Bayley Scales of Infant Development-III were administered at 12 months. Result: HC male infants had significantly greater TAMX in the MCA and lower mean MCA and ACA resistance than HC females. Abnormal CBF correlated negatively with neurodevelopmental outcome. Conclusion: CBF is altered in term infants with histologically confirmed chorioamnionitis compared with control infants with sex-specific differences.

Objectives:To determine systemic hypothermia’s effect on circulating immune cells and their corresponding chemokines after hypoxic ischemic encephalopathy in neonates.Design:In our randomized, controlled, multicenter trial of systemic hypothermia in neonatal hypoxic ischemic encephalopathy, we measu

BACKGROUND Body composition is a key metric for assessing nutrition in preterm infants. In many neonatal intensive care units body composition is estimated using anthropometric indices which mathematically combine body weight and length. However, the accuracy of these indices is unknown in preterm infants. In contrast, air-displacement plethysmography (ADP) has been shown to accurately measure neonatal fat mass, but it is not widely available. OBJECTIVE The aim was to determine which anthropometric index is most correlated to infant fat mass, as determined by ADP. DESIGN We performed a retrospective observational study, comparing ADP-determined percent body fat at 366 time points for 239 preterm infants (born

Compare customized versus population-based growth curves for identification of small-for-gestational-age (SGA) and body fat percent (BF%) among preterm infants.Prospective cohort study of 204 preterm infants classified as SGA or appropriate-for-gestational-age (AGA) by population-based and customized growth curves. BF% was determined by air-displacement plethysmography. Differences between groups were compared using bivariable and multivariable linear and logistic regression analyses.Customized curves reclassified 30% of the preterm infants as SGA. SGA infants identified by customized method only had significantly lower BF% (13.8 ± 6.0) than the AGA (16.2 ± 6.3, p = 0.02) infants and similar to the SGA infants classified by both methods (14.6 ± 6.7, p = 0.51). Customized growth curves were a significant predictor of BF% (p = 0.02), whereas population-based growth curves were not a significant independent predictor of BF% (p = 0.50) at term corrected gestational age.Customized growth potential improves the differentiation of SGA infants and low BF% compared with a standard population-based growth curve among a cohort of preterm infants.

This study explores parental perception of child vulnerability (PPCV) and parent overprotection (POP) and their relationship to neonatal medical problems, child development and behavior. Participants included 90 lower income parents of NICU graduates ages 22–81 months consecutively enrolled at a high-risk neonatal developmental follow-up clinic. Parents completed the Child Vulnerability Scale (CVS), the Parent Protection Scale (PPS) and the Child Behavior Checklist (CBCL) regarding their children. Step-wise regression analysis revealed the CVS as the sole predictor of child behavior, accounting for 13% of the variance in the CBCL Total T-score (R2 = .13, $be = .86, p < .006). Neonatal medical problems, Child DQ, and most parental demographic variables did not correlate with CVS or PPS scores. A significant correlation between CVS and the separation subscale of the PPS was noted (r = .31, p < .01). We conclude that NICU graduates perceived vulnerable by their caretakers have significant behavioral difficulties compared to those perceived as not vulnerable. Future research should address early parental antecedents of PPCV, the persistence of PPCV, and its effects on behavioral outcomes.

Hair analysis for the major metabolite of cocaine, benzoylecgonine (BZE) was performed in a cohort of 251 predominantly African-American newborns utilizing a modified radioimmunoassay (RIA) (Abuscreen Roche Laboratories, Nutley, N.J., USA). Maternal drug intake was confirmed by positive urine drug screen for cocaine metabolites at the time of delivery. The BZE concentrations reported here are the composites of both the parent compound cocaine (hydrolyzed to BZE) and the native BZE metabolized by the patient and deposited in the hair follicle. Hair analysis as an indicator for gestational cocaine exposure had a sensitivity of 88%, specificity of 100%, positive predictive value of 100%, and negative predictive value of 85%. The range of BZE was 99–23,300 ng/g of hair, with 79% having hair BZE levels

Perinatal asphyxia remains one of the most devastating neurologic processes. Although the understanding of the pathophysiology after perinatal asphyxia is extensive, there are few therapeutic interventions available to prevent or even mitigate the devastating process that unfolds after injury. The search for a safe and efficacious therapy has prompted scientists and clinicians to consider various promising therapies. One such therapy is therapeutic hypothermia. On the basis of adult, pediatric, and animal research, there is increasing evidence to suggest that therapeutic hypothermia may be an effective intervention to lessen the secondary neuronal injury that ensues after a hypoxic-ischemic insult. In this article the historic and modern-day uses of therapeutic hypothermia are first reviewed. The pathophysiology of neonatal asphyxia is examined next, with emphasis on the changes that occur when therapeutic hypothermia is implemented. Potential side-effects of the therapy in the neonate and the debate over systemic vs selective hypothermia are discussed. Lastly, although hypothermia as a potential treatment modality for neonates with hypoxic-ischemic encephalopathy is supported by numerous studies, the need for well-designed multicenter trials with detailed patient entry criteria and therapeutic conditions is emphasized.

Several social or recreational drugs singly or together have demonstrated effects on the fetus and neonate, with those effects extending into adulthood. The use of recreational drugs during pregnancy remains a major health problem, with adverse effects including higher rates of fetal distress and demise, lower Apgar scores, growth retardation, and adverse neurodevelopmental outcome. Ethanol has the most profound effects, with physical stigmata of the drug seen in one third of exposed infants. In children without the affected physical appearance, profound neurodevelopmental sequelae have been demonstrated. Other drugs, such as cocaine, heroin, amphetamines, and nicotine, have been associated with impaired fetal growth and acute withdrawal during the neonatal period. Subsequently, these infants and children have an increased risk for altered neurodevelopment and long-term health status. Long-term follow-up and assessment are essential. The risk of neonatal withdrawal or abstinence syndrome is greatest with narcotic drugs but has been found to occur in neonates following exposure to cocaine, nicotine, and amphetamines. Early treatment with tincture of opium, paregoric, or phenobarbital is crucial. Assessment of the overall health status of the infant should include growth parameters, signs and symptoms of infection (especially hepatitis, syphilis, and immunodeficiency viruses), and neurobehavioral function. Such assessments should not be limited to the newborn period, as neurodevelopmental sequelae may not be manifest until later in infancy and childhood. In addition, evaluation of the social milieu is warranted because of the increased risk for neglect and abuse of drug-exposed infants and children. Early intervention, maternal drug rehabilitation treatment, and parenting classes are frequently prescribed, but their efficacy is variable. Further investigations should study the potential benefits of these recommendations.

This study explores parental perception of child vulnerability (PPCV) and parent overprotection (POP) and their relationship to neonatal medical problems, child development and behavior. Participants included 90 lower income parents of NICU graduates ages 22-81 months consecutively enrolled at a high-risk neonatal developmental follow-up clinic. Parents completed the Child Vulnerability Scale (CVS), the Parent Protection Scale (PPS) and the Child Behavior Checklist (CBCL) regarding their children. Step-wise regression analysis revealed the CVS as the sole predictor of child behavior, accounting for 13% of the variance in the CBCL Total T-score (R(2) =.13, $be =.86, p.006). Neonatal medical problems, Child DQ, and most parental demographic variables did not correlate with CVS or PPS scores. A significant correlation between CVS and the separation subscale of the PPS was noted (r =.31, p.01). We conclude that NICU graduates perceived vulnerable by their caretakers have significant behavioral difficulties compared to those perceived as not vulnerable. Future research should address early parental antecedents of PPCV, the persistence of PPCV, and its effects on behavioral outcomes.

This study examined the validity of a parent-report inventory, the Child Development Inventory (CDI), as a developmental screening instrument in high-risk toddlers and preschoolers. Seventy-six children, aged 15-70 months, were assessed in a neonatal high-risk developmental follow-up clinic. The data included the completion of CDIs by parents/caregivers and developmental evaluations by a physician using either the Clinical Adaptive Test/Clinical Linguistic Auditory Milestone Scale (CAT/CLAMS) (15-35 months) or Slosson Intelligence Test (36-70 months). Analysis revealed a good level of sensitivity (true "abnormals"—73%) and specificity (true "normals"—87%) for the CDI General Development score. The findings suggested that the CDI is a valid and useful screening instrument for high-risk infants. Clin Pediatr. 1999;38:535-539

Although the role of humoral and cell mediated immunity in neonatal defense against candida infections is not precisely defined, one of the contributing immunologic factors may be a lack of decreased specific passive humoral immunity. Thus, serum samples from the umbilical veins of 98 term gestation and 105 premature neonates (majority less than 33 wk gestation) and their mothers (n = 100) were tested for the presence of hemagglutinating antibodies to commercially available candida antigen. The titers of candida antibodies (mean log2 +/- SEM) were significantly higher in 11 term neonates (4.73 +/- 0.69) of mothers with high antibody titers (5.18 +/- 0.40, less than 0.001) as contrasted with 87 normal term (2.38 +/- 0.15) and 105 premature (2.87 +/- 0.15) infants with normal mothers (1.96 +/- 0.13 and 3.31 +/- 0.26, respectively). Contrary to our belief 81% of term infants and all of the preterm infants (majority less than 33 wk gestation) had passive specific anti-candida antibody titers less than 1:16.

We assessed the usefulness of the Bayley Infant Neurodevelopmental Screener (BINS) and the Clinical Adaptive Test/Clinical Linguistic Auditory Milestone Scale (CAT/CLAMS) for screening high-risk infant populations in a sample of 78 infants followed after premature birth and/or perinatal insults. Both measures were highly correlated with the Bayley Scales of Infant Development-II, but sensitivity and specificity analyses revealed disparities related to the tests administered and the cutoffs used. The BINS had optimal sensitivity (true positives) of 90% when referral was made for a BINS score of high or moderate. The CAT/CLAMS had excellent specificity (true negatives) of 95% to 98% but poor sensitivity (5%-36%). Until the cutoff issue can be clarified, clinicians should be cautious in using the CAT/CLAMS as the primary screening instrument in settings in which early identification of infants with developmental problems is the main goal.

Objective The objective of the study was to compare prenatal ultrasound parameters for intrauterine growth restriction (IUGR) with newborn percent body fat (%BF). Study Design This was a prospective study of 87 pregnancies followed with ultrasound. Subjects were categorized into 3 groups: estimated fetal weight (EFW) less than the 10th percentile, abdominal circumference (AC) less than the fifth percentile, and normal biometry. Neonatal %BF by air displacement plethysmography was compared between each group using multivariable analyses. Results The %BF in the EFW less than the 10th percentile group (5.1 ± 2.9%) was significantly lower than either AC less than the fifth percentile (9.5 ± 3.3%) or normal groups (11.6 ± 5.6%). EFW less than the 10th percentile best predicted %BF by regression model. Neonatal morbidity was not significantly higher in the EFW less than the 10th percentile group. Conclusion Newborn %BF was significantly lower in infants with EFW less than the 10th percentile compared with AC less than the fifth percentile, an intermediate finding. An AC less than the fifth percentile on ultrasound does not reflect the same severity of IUGR as EFW less than the 10th percentile.

Objective: To determine degree of exposure to cocaine in-utero by analysis of BZE in hair at birth, and relationship to neurodevelopmental outcome at 3 years and above, under similar socioeconomic status.

Objective: To examine the predictors of neurodevelopmental outcome (NDO) of ECMO and near-ECMO survivors at 2.5 to 6 years.

1424 RADIONUCLIDE SCANS (RS) AND PLASMA RENIN ACTIVITY IN HYPERTENSIVE NEONATES WHO RECOVER

During the management of a 3 kg term black female infant whose chylothorax was diagnosed at 7 days of age, a total of 450 ml of chyle was removed by repeated thoracentesis before spontaneous healing occured. The total number of lymphocytes removed during 18 days was greater than 109. Monoclonal antibody studies showed 95% of these cells were T-lymphocytes which were functionally immature as evidenced by their non-responsiveness to mitogen-There was no associated peripheral blood lymphopenia. Nevertheless, peripheral T-cells were abnormal as shown by lack of sheep RBC rosette formation and lack of response to mitogens. The thymus which was absent during the 18 days of therapy, reappeared 2 weeks after disappearance of the chylothorax accompanied by normalization of peripheral T-lymphocyte functions. Loss of large volumes of chyle in congenital idiopathic chylothorax can cause transient severe depletion of T-lymphocytes associated with cell mediated immune deficiency as evidenced by a decrease in T-cell forming rosettes with either sheep RBC or lymphoblastoid B cell lines, and functional tests of cellular immunity.