[School maladjustment common among children with very low birth weight Special attention and support are required during school start]. / Skolsvårigheter vanliga hos barn med mycket låg födelsevikt. Extra uppmärksamhet och stöd behövs vid skolstart.

Children of very low birth weight (VLBW), defined as less than 1500 g, and normal birth weight controls (NBW) were enrolled in a long-term follow-up study. Five of 86 surviving VLBW children had a neurological handicap. Seventy VLBW children and 72 NBW children were re-examined at the age of nine, which entailed a neurological examination, a non-verbal intelligence test and a test for reading ability, mathematical skills and vocabulary. Their behavior was rated regarding hyperactivity, social behavior and fine and motor skills. The two groups differed with regard to the neurological examination and the tests, with poorer results shown for the low birth weight group. The VLBW children were also more hyperactive and scored lower on fine motor skills. Considering only those who scored normally as regards non-verbal intelligence (54% of VLBW children and 88% of controls), practically all differences disappeared.

Morbidity and neurological function of very low birthweight infants from the newborn period to 4 y of age. A prospective study from the south-east region of Sweden.

All 107 infants weighing < or = 1500 g at birth (VLBW) and born alive in the south-east region of Sweden during a 15-month period in 1987-88 were enrolled in a prospective study to determine the prevalence of handicap and to assess neurological function in comparison with controls. Eighty-six (80%) infants survived. Twenty (19%) had intracranial haemorrhages (ICH) assessed by ultrasound examinations in the neonatal period and 2 (2.3%) retinopathy of prematurity stage 3 or more. The VLBW infants who survived had fewer optimal neurological responses than the controls at 40 weeks post-conceptional age. Eighty-two VLBW children were followed to 4 y of age. Three (4%) children had a neurological handicap and 9 (11%) had a moderate neurological deviation. Neither the size of ICH nor neonatal optimality score correlated to neurological outcome at 4 y of age. The VLBW children without neurological handicap or deviation (n = 70) had a delay in psychomotor development in comparison with the controls. Mental development and school performance, in particular language development, will be examined at school age.

Catch-up primary vaccination with acellular pertussis vaccines in 3-4-year-old children--reactogenicity and serological response.

In order to evaluate the optimum number of doses for catch-up primary vaccination against pertussis, 248 Swedish children 3-4 years of age were randomized to receive either two or three doses of a three-component or a five-component acellular pertussis vaccine. Adverse reactions were mild, but increased with increasing number of doses, especially in a subgroup of 17 children with serological signs of earlier pertussis. There were no clinically significant differences between the two vaccines. Antibody levels against pertussis were higher after two doses in this age group than after three doses in infancy. A primary vaccination program for older children can use two instead of three doses.

[Good prognosis for very low birth weight infants]. / God prognos för barn med mycket låg födelsevikt.

A population-based multicentre study, comprising all very low birthweight (VLBW; < or = 1,500 g) infants born alive in the south-east region of Sweden during a 15-month period, was performed in the late 1980s. Among the VLBW infants there were 107 lifebirths (a rate of 0.72%), 86 (80.4%) neonatal survivors and no late deaths. Twenty (18.4%) had intracranial complications, two (2.3%) retinopathy of prematurity, grade 3, and six (5.6%) bronchopulmonary dysplasia. At follow-up at 18 months of uncorrected age, the VLBW infants were still lighter in weight and of shorter stature than control group infants. Of the five (5.8%) of the surviving VLBW infants who had significant neurological disorder at 18 months of age, all had weighed less than 800 g at birth, and had manifested neurological symptoms at 6 months of age. The hospitalisation rate during the first 18 months of life was greater in the VLBW than the control group.

Small bowel biopsy in Swedish paediatric clinics.

The capsule technique for small bowel biopsy performed at Swedish paediatric clinics was evaluated using two questionnaires in 1990 and 1993, respectively. Replies were received from all 45 centres which together perform approximately 2300 biopsies per year. Clotting function tests prior to biopsy were carried out in 42% of the centres. The biopsies were performed under intubation anaesthesia in 13% of the centres. The most striking difference between the answers to the two questionnaires was the mode of sedation. The use of intravenous sedatives increased from 40% of the centres in the first questionnaire to 59% in the second one. The use of the oral, rectal and intramuscular routes decreased correspondingly. The most frequently used drugs for intravenous sedation were benzodiazepines, in the first questionnaire diazepam and in the second one midazolam. The failure rate was approximately 5%. In the first questionnaire, no complication was encountered. In the second questionnaire, three cases of intramural duodenal haematoma were reported, one of which led to pancreatitis. We conclude that by focusing on questions of sedation these rather simple questionnaires may have resulted in more effective sedation of children undergoing small bowel biopsy.

Oral versus intravenous premedication for small bowel biopsy in children: effect on procedure and fluoroscopy times.

Oral alimemazine and cisapride, or diazepam and cisapride, or iv midazolam and metoclopramide were given as premedication for small bowel biopsy to three groups of children from a total population of 185 individuals. The biopsy procedures were performed under intermittent fluoroscopy and times for both were recorded. The median biopsy procedure time was significantly shorter in children given iv midazolam and metoclopramide (6 min) compared to those given oral premedication (10 min) (p < 0.001). The median fluoroscopy time was very short in all groups, ranging between 3 and 6 s. It is concluded that iv premedication is superior to oral premedication for small bowel biopsy in children because more effective sedation is obtained.