Factors associated with early severe intraventricular haemorrhage in very low birth weight infants.

OBJECTIVE: The aim of this study was to identify factors associated with early IVH grades III-IV in the first 72 h of life in very low birth weight (VLBW) preterm infants. METHODS: A case-control study was performed in 28 preterm infants and 55 controls. The mean of all blood gas determinations, presence of arterial hypotension, variables related to mechanical ventilation, as well as antenatal and neonatal comorbidities during the first 3 days of life were evaluated. RESULTS: The proportion of infants with pH<7.2, PaCO (2) >55 mmHg and arterial hypotension was higher in the case group. PaCO (2) >55 mmHg was more frequently found in patients with IVH grades III (16.6 vs. 1.8%; p=0.03) and IV (37.5 vs. 1.8%; p=0.0001) than in controls, respectively. Gestational age (beta=-0.30; p=0.04), BE (beta=0.33; p=0.0005) and arterial hypotension (beta=0.40; p=0.00003) were associated to both grades of IVH (R (2)=0.39; p<0.0001 for the model). However, only birth weight and arterial hypotension were identified as factors related to IVH grade III (R (2)=0.44; p=0.0001 for the model) and PaCO (2) >55 mmHg, and BE as factors for IVH grade IV (R (2)=0.32; p=0.0003 for the model). CONCLUSION: Birth weight and arterial hypotension were factors related to early IVH grade III, whereas hypercapnia and large BE were factors related to IVH grade IV in VLBW infants.

Cardiopulmonary adaptation in large for gestational age infants of diabetic and nondiabetic mothers.

AIM: To compare cardiopulmonary adaptation in large for gestational age infants of diabetic and nondiabetic mothers. METHODS: Color Doppler echocardiography was performed in 113 (22 large for gestational age infants of diabetic mothers, 21 of nondiabetic mothers and 70 adequate for gestational age newborns) full-term infants. RESULTS: Pulmonary arterial pressure was significantly higher in infants of diabetic mothers than in those of nondiabetic mothers and normal infants at 24 h (38.5 vs. 32.5, and 35.5 mmHg, respectively). However, slow fall in this parameter was shown in all large for gestational age infants. Open ductus arteriosus was frequent in all large for gestational age infants, but its closure was significantly delayed in infants of diabetic mothers. Septal hypertrophy was higher in infants of diabetic mothers than in large for gestational age infants of nondiabetic mothers. CONCLUSION: Large for gestational age infants born from nondiabetic mothers showed delayed fall in pulmonary arterial pressure similar to those born from diabetic mothers but showed lower proportion of septal hypertrophy. Patent ductus arteriosus persisted for longer period of time in all large for gestational age infants than in normal infants, but its closure was significantly delayed in infants of diabetic mothers.

Response to hepatitis B vaccine in preterm infants: four-dose schedule.

The objective of this study is to test a four-dose Hepatitis B vaccine schedule in premature infants (PI) and assess the immunogenicity of the vaccine with this schedule. We studied 29 PI who received the vaccine against Hepatitis B at birth, 1, 5, and 9 months of age. Antibodies against surface antigen (Anti-HBs) were measured before the third and fourth doses and 12 weeks after the fourth dose. Levels higher than 10 mIU/mL were considered protective, whereas more than 100 mIU/mL was an excellent response. Twenty-nine PI were studied. The average weight at the time of the initial dose was 1398 g, gestational age of 32.5 weeks, and a postnatal age of 9 days. Since the initial measurement, protective levels were achieved in all patients. The response was excellent in 24.1, 75.9, and 89.7%, after the second, third, and fourth doses, respectively. No correlation was found between the type of response and the infants' weight or the postnatal age. The Anti-HBs geometrical levels were 51.9, 133, and 133 mIU/mL after the second, third, and fourth doses, respectively. The favorable results obtained might be due to: the four-dose schedule itself, the dose we used (10 microg), the time interval between the doses, and even a race factor. Our schedule seems to be useful for PI infants and probably is no longer necessary to delay the vaccination, although this should be confirmed by further studies.

[Acute complications in full term neonates with severe neonatal asphyxia]. / Complicaciones agudas en neonatos de término con asfixia perinatal severa.

The acute systemic complications of perinatal asphyxia, defined as an umbilical artery pH at birth of 7.10 or less, were evaluated in fifty full-term newborn infants. We also investigated the prenatal complications that lead to asphyxia, and the relationship between Apgar score and cord pH. Asphyxia or fetal distress was not identified in 56% of the cases. The most common condition associated with asphyxia was prolonged labor followed by abruptio placentae. About half of the babies studied, suffered some degree of renal and brain dysfunction; 24% had severe respiratory disease. Myocardial failure was present in 24%. Regarding metabolic complications, the most frequent was hypocalcemia, present in 44%. On the other hand, there was no correlation between Apgar score and cord pH. Mortality was 22%. The main cause of death was Persistent Pulmonary Hypertension.

[The incidence of external congenital malformations at the Hospital de Ginecopediatría No. 48 in León, Guanajuato]. / Incidencia de malformaciones congénitas externas en el Hospital de Ginecopediatría No. 48 en León, Guanajuato.

From June 1st, 1989 to May 31st, 1990, 16,987 consecutive newborns were examined at the No. 48 Gynecological Pediatric Hospital of the IMSS National Medical Center, looking for external congenital malformations including esophageal atresias, anorectal malformations and congenital hip luxations, all easily detected during a routine exploration. Each deformed newborn assigned two control patients the following two newborn babies showing no birth defects. 308 deformed newborns were detected, an incidence of 1.81%. Among the most frequent defects were midline flat hemangiomas, polyotia, Down syndrome, congenital hip luxation and myelomeningocele. The only significant statistical difference found with respect to the control group was a greater family history of defects in the case group (P less than 0.0001). When comparing our results with those from other studies, including a study done locally 15 years ago, we found differences among specific malformations: congenital hip malformation, polydactylia, foot deformities, flat hemangiomas, nevus and polyotias. Yet, the overall frequency of defects found was similar.

[Spontaneous intestinal perforation in newborn infants. A form of necrotizing enterocolitis]. / Perforaciones intestinales espontáneas en recién nacidos. Una forma de enterocolitis necrosante.

The present study comprised twelve premature infants with "spontaneous" gastrointestinal perforations studied retrospectively during a period of three years. This problem was found to be more frequent in extremely premature babies affected with respiratory distress syndrome and patent ductus arteriosus and accompanied with very high mortality. A clinical-pathological correlation was done with the intestinal biopsy or postmortem studies and according to these findings, it is suggested that "spontaneous" intestinal perforations probably represent a form of necrotizing enterocolitis.