Post-discharge nutrition of the very low-birthweight infant: interim results of the multicentric GAMMA study.

UNLABELLED: This report presents the interim results up to 12 mo corrected age (c.a.) of a multicentric, prospective, controlled study on very low-birthweight infants, randomized at 40 wk post-conception in two different groups of formula feeding: 80 Kcal/dL (group A) vs 70 Kcal/dL (group B) up to 55 wk of postconceptional age. Subsequently, all the babies were fed with a follow-on formula, with the introduction of solid foods at 6 mo c.a. Weight, length, head circumference and neurological conditions with psychomotor development (evaluated by the Griffiths' Developmental Scale) were measured at regular intervals and all of these parameters were satisfactory in both groups. For growth, in group A there was a greater increase in weight in boys at 55 wk and at 6 mo c.a., and small for gestational age (SGA) babies had a greater increase in length at 1 y of age, while head circumference caught up on growth from week 40 to week 55. Measured by the Griffiths' Developmental Scale, the SGA group fed 80 Kcal/dL had a better score at 6 mo; similarly boys fed 80 Kcal/dL had a better score at 6 and at 9 mo. CONCLUSION: Nutrition of very low birthweight infants post-discharge could have an influence on physical growth and on neurodevelopmental outcome. This interim report needs to be confirmed at the end of the study.

Seizures in the neonatal intensive care unit of the 1980s. Types, Etiologies, Timing.

A retrospective review was taken of 150 newborns with seizures evaluated at the same medical center and by the same investigator(s) from 1982 to 1987. The aims of the study were to determine in this current population the distribution of clinical seizure types, the distribution of causative etiologies, and the relation of etiology to the timing of onset of the seizures. Seizures were classified as subtle, multifocal clonic, generalized tonic, focal clonic, and myoclonic. Subtle (65% of total) and multifocal clonic seizures (54% of total) were the most common seizure types. Subtle seizures usually occurred in combination with other seizure types. Only one seizure type was related to gestational age, i.e., focal clonic seizures in the term infant. Hypoxic-ischemic encephalopathy (65% of total) was by far the most common etiology in both preterm and term infants. Seizures with hypoxic-ischemic encephalopathy occurred characteristically early in the neonatal period, i.e., 90 percent in the first 2 days of life. Moreover, 80 percent of all seizures in the first 2 days of life were related to hypoxic-ischemic encephalopathy.

[Substitutive therapy with surfactants in premature infants with respiratory distress syndrome]. / Terapia sostitutiva con surfattante in prematuri affetti da respiratory distress syndrome.

The main pathogenetic moment of the respiratory distress syndrome (RDS) is recognized to be the lack of alveolar surfactant. Many attempts of substitutive therapy with several kinds of surfactants have been tried (artificial, synthetic, from amniotic fluid, exosurf). After the considerable results obtained in animals, the use of substitutive surfactant proved to be useful also in human newborns with RDS. The authors report the personal data relative to the TA-surfactant (artificial surfactant made of phospholipids + DPPC + protein substances extracted from bovine lung). They analyse first results and, on this ground, they put forward some assumptions in order to obtain a more rational and efficient use.

Short and long term prognostic significance of neurological anomalies of the first year in very low birthweight infants.

The short and long term, prognostic significance of early neuromotor anomalies was assessed in infants with birthweight under 1500 g (VLBW infants), who have a high risk of developing cerebral palsy (CP) but who also have transient neurological anomalies. The series comprises 35 VLBW infants born between 1 January 1978 and 31 March 1980 with regular neurological follow-up until the second year of life: 10 with CP of varying severity and 25 without CP. The latter were examined in the first year of school by means of an age-specific method designed to elicit minor neurological dysfunctions (MND). Analysis of neuromotor development in the first year of life identified important grounds for clinical suspicion in the first semester of corrected age, especially on the basis of a global neurological assessment including optimal neurological items score at presumed term age and the combination of two or more major neurological signs in the first semester. The diagnosis of CP cannot be established until the 2nd semester of life, in 70% of cases by the end of the 3rd trimester. It rests on the following criteria: persistence of two or more major neurological signs (abnormalities of limb tone, axial tone and of movement), specific pathological pattern of limb tone, always associated with retarded postural control. Neurological examination at school age revealed a significantly higher frequency of MND in the VLBW children than in a group of normal controls. The quantity of MND correlated significantly with the severity and duration of the first year neurological anomalies but not with the obstetric and postnatal neurological risk factors.(ABSTRACT TRUNCATED AT 250 WORDS)