Developmental outcome of infants with neonatal polycythemia.

The study of the developmental outcome of neonatal polycythemia was performed on 47 polycythemic and 21 controlled infants who were born at the same period of time. It was found that at the age of 1 1/2 to 2 years the number of infants with abnormal DQ was higher in the group of total polycythemic infants (47%) and in the group of asymptomatic polycythemic infants (45%) than that of the control groups (19% and 5.6% of the groups including twin sibs and excluding twin sibs respectively). There was no difference in the developmental test between the symptomatic and asymptomatic patients. In asymptomatic infants the benefit of partial plasma exchange transfusion on developmental outcome was not found and only low birthweight and small for gestational age infants are the risk factors for poor developmental outcome.

Intravenous immunoglobulin prophylaxis for infection in very low birth-weight infants.

The effectiveness of intravenous immunoglobulin for prevention of sepsis in very low birth weight infants was studied on 102 neonates at the Children Hospital, Bangkok from February 1988 to February 1990. Infants were randomly allocated into 3 groups of 35 each. Group I and group II received 250 mg/kg and 500 mg/kg of immunoglobulin intravenously respectively within four hours of life. Group III was not given immunoglobulin and served as the control group. It was found that during the early neonatal period the infection rate of group I (14.7%) and group II (14.7%) was significantly lower than that of group III (38.2%). There was no difference in the infection rate of group I and group II. The mortality rate was also higher in group III than in group I and group II. It suggested that the intravenous immunoglobulin dosage of 250 mg per kilogram body weight is effective as well as dosage of 500 mg per kilogram body weight in prevention of sepsis in very low birth weight infants during the early neonatal period.

Early versus late onset neonatal septicemia at Children's Hospital.

An analysis was made of 695 cases of neonatal sepsis at Children's Hospital from 1982 to 1986. The incidence of neonatal sepsis and septicemia were 6.5 and 2.4 per 1,000 livebirths respectively. There were 178 cases of septicemia with onset during the first four days of life (early onset group) and 77 cases with onset after four days of life (late onset group). Both groups did not differ significantly in sex, birth weight and gestational age. Most of the cases had low birth weight and were premature. Pneumonia was the common associated infection. Omphalitis was found more frequently in the early onset of septicemia, whereas, NEC and skin infection were found more in the late onset group. Pseudomonas aeruginosa and Klebsiella pneumoniae were the major causes of infection in both groups. Staphylococcus was more common in late septicemia. No statistical difference in major complications was found between the two groups. Fatality rate in early and late septicemia was 32.6 and 28.2 per cent respectively.

Perinatal mortality at Children's and Rajvithi Hospitals in 1983-1987.

In the period between 1983-1987, there were 101,056 births at Rajvithi hospital. Out of these, 6,158 sick newborn were transferred to Children's hospital for further care. The incidence of low birth-weight infants was 9.42 per cent. Average perinatal mortality was 14.49 per 1,000 births, ranging from 13.44 to 15.52 per 1,000 births. The major causes of early neonatal death were perinatal asphyxia, respiratory distress syndrome (RDS), immaturity (less than 1,000 g), congenital anomalies, and infection. Beyond this period (7-28 days of age) the causes of death were infection, congenital anomalies, bronchopulmonary dysplasia, necrotizing enterocolitis, apnea and others. Asphyxia and RDS are still the major causes of death that could be further reduced.

PIP: This study reveals the perinatal and neonatal mortality between 1983 and 1987 at Children's and Rajvithi Hospitals, Bangkok, Thailand, and the causes of death with the leading early neonatal (END) cause being asphyxia and respiratory distress syndrome (RDS). The late neonatal (7-28 days) and the post natal cause was infection. A decline in perinatal mortality from 28/1,000 births in 1978 to 13.7 in 1987 was due to 1980 improvements in obstetrics and early neonatal care, reflecting a general trend in decreasing perinatal mortality. There was no major cause of late fetal death, however one-third were macerated, and 15% of stillbirths were congenital anomalies including over 60% from anencephaly and other central nervous system defects. 101,056 births were recorded at Rajvithi with Children's Hospital transfers of those who were sick or weighed less than 2000 grams. 9.42% were low birth weight with males more than females. 30% died within the first 24 hours of life. Mortality was 14.49/1000 births. 4.67% of ENDs were low birthweight, while only .19 for a full-sized infant. The author attributed quality of care at Children's and the low socioeconomic (SES) status of the population to the presence of sepsis and nocosomial infections and asphyxia and RDS. Ramathibodi Hospital with better care and a higher SES reports the leading cause of death between 1979 and 1983 as congenital anomalies; death due to asphyxia and RDS is no longer a significant cause of death. The author urges better prenatal care and hospital conditions.