Early neonatal mortality at Songklanagarind Hospital from 1987 to 1997.

During the 11 year period (1987-1997), there were 23,584 livebirths at Songklanagarind Hospital. The average incidence of low birth weight was 8.17 per cent, it has increased slightly during the last 6 year period (8.53 per cent) compared to the first 5 year period (7.59 per cent). There has been little decrease in the early neonatal mortality rate (ENMR) during the last 6 years (3.94 per 1000 livebirths) compared to the first 5 years (4.71 per 1000 livebirths). ENMR was markedly reduced when we compared ENMR of the first year (6.73 per 1000 livebirths in 1987) to the last year (1.52 per 1000 livebirths in 1997). During the last 6 year period, early neonatal mortality (ENM) of neonates less than 1000 g and 1000-1499 g has greatly reduced from 57.14 per cent to 16.67 per cent and from 50 per cent to 6.25 per cent respectively. The major cause of ENM was congenital anomalies in the first 5 year and the last 6 year period and all birth weight groups except the group less than 1000 g of which the leading cause of death was respiratory distress syndrome.

Hypophosphatasia: the importance of alkaline phosphatase in bone mineralization.

The authors describe a neonate who was diagnosed with "perinatal hypophosphatasia". The clinical manifestations in this patient were small head size, soft calvarium (caput membranaceum), and short bowing forearms and legs. Laboratory investigations revealed hypercalcemia at 12.7 mg/dl, hyperphosphatemia 8.6 mg/dl, and extremely low alkaline phosphatase 0 unit/L. Roentgenographic studies of the skull showed calcification only at frontal bone and base of the skull. Spines were small and flattened. Long bones were hypomineralized and deformed. The functions of alkaline phosphatase to bone development and mineralization were reviewed. Because perinatal hypophosphatasia is a fatal condition and inherited as an autosomal recessive pattern, prenatal diagnosis is necessary. The most reliable and suitable method in our facility is serial ultrasonography from which the diagnosis can be made by the second trimester.

Growth patterns of low-birth-weight infants: 2-year longitudinal study.

A 2 year longitudinal study of the growth of 147 low birthweight (LBW) < 2,500 g infants who had no known factors disturbing growth was conducted. The infants were divided into 6 groups according to birthweight and maturity: group 1--appropriate for gestational age (AGA) with birthweight < 1,500 g (n = 18); group 2--AGA 1,500-1,999 g (n = 41); group 3--AGA 2,000-2,499 g (n = 26); group 4--small for gestational age (SGA) < 1,500 g (n = 5); group 5--SGA 1,500-1,999 g (n = 20); group 6--SGA 2,000-2,499 g (n = 37). The control group consisted of 149 normal birthweight (> 2,500 g) infants. Weight, height, and head circumference were measured at birth, 2, 4, 6, 9, 12, 18, and 24 months postnatally and recorded in standard deviation score (SDS). All groups showed catch-up growth in the first 6 months. At 2 years old, all infants were above -2 SDS. However, the SGA infants with birthweight < 1,500 g were significantly lighter (-0.9 SDS, p = 0.003), shorter (-0.6 SDS, p = 0.001) and had smaller head size (-0.65 SDS, p = 0.027) whereas, the other groups were not different compared to the control group. We also compared those LBW infants who, at 2 years of age, weighed below -1 SDS to those who weighed above -1 SDS and found no significant difference in familial income, parental education, nursing care or parental height. We concluded that with adequate nutritional intake and nursing care, LBW infants have the potential for good catch-up growth. For the SGA infants with birthweight < 1,500 g, although they showed good catch-up growth, they still remained smaller than their peers at 2 years of age.