Impact of prematurity on exercise capacity and agility of children and youth aged 8 to 18.

BACKGROUND: Preterm (PT) birth and low birth mass (LBW) can impair growth and development of children and may therefore affect their physical performance up to adulthood. AIMS: Our aim was to evaluate long-term consequences of prematurity, especially (an)aerobic exercise capacity and agility up to adulthood, by comparing premature and full-term (FT) individuals. STUDY DESIGN, SUBJECTS: From 474 subjects born in 1987, who were enrolled into a longitudinal study, 396 (178 PT and 218 FT (with 127 of them LBW)) were followed-up into their early adulthood. Their mass, respiratory status at birth, and results of SLOfit monitoring system (i.e. results of exercise capacity and agility) were monitored on a yearly basis from their age of 8 to 18years. Data were compared statistically with Student t-test or ANOVA. OUTCOME MEASURES, RESULTS: PT (or LBW) individuals performed aerobic (time of 600-meter run of females) and the majority of anaerobic tests (sit-ups, standing broad jump, and time of 60-meter run, but not bent arm hang) worse (p<0.05) than FT individuals. Before puberty, however, the agility and fine motor tests (arm plate tapping, polygon backwards, and standing reach touch) were performed better (p<0.05) by PT (or LBW) females, as compared to their FT peers, with no similar results in males. CONCLUSIONS: Our results clearly demonstrate that prematurity (especially extreme prematurity) diminishes exercise capacity and agility on the long-term scale, therefore, PT children should be encouraged towards more regular participation in physical activities from early childhood onwards.

Mediastinal teratoma with hydrops fetalis in a newborn and development of chronic respiratory insufficiency.

BACKGROUND: Mediastinal fetal teratoma can be detected as a mass in the chest during a routine prenatal ultra-sound screening. Because of the pressure on mediastinal structures it can be the cause of non-immune hydrops fetalis and polyhydramnion. The development of hydrops fetalis leads to fetal death or premature delivery in most reported cases. Early surgical removal is important, but, the result of treatment depends on the stage of development of mediastinal organs and complications in the postoperative period. CASE REPORT: A 31-year-old gravida carrying twins, with spontaneous membrane rupture at 32 weeks gestation underwent urgent caesarean section after antenatal ultrasound revealed severe polyhydramnion and hydrops fetalis in geminus A. The child was intubated immediately after birth due to severe respiratory distress. Ultrasound and X-ray revealed a tumour mass in the right hemithorax. Tumour resection was performed at the age of 7 days. Histology examination revealed an encapsulated immature teratoma. The postoperative course was complicated with respiratory insufficiency which turned into chronic at the age of eight months. CONCLUSION: This is the fifth reported child with fetal mediastinal teratoma and severe hydrops fetalis that survived the neonatal period. Additional diagnostic search revealed abnormal course of both pulmonary arteries, which was probably one of the main causes of respiratory insufficiency.

Intrauterine inflammation and the onset of peri-intraventricular hemorrhage in premature infants.

BACKGROUND: Peri-intraventricular hemorrhage (P/IVH) is a common neonatal morbidity among premature infants. The aim of the study was to examine the association between placental and/or fetal inflammation and the onset of P/IVH in premature infants. METHODS: A prospective study included 125 infants with gestational age 23-29 weeks. Placentas were examined for the presence of chorioamnionitis and funisitis, cord blood was sampled for the measurement of cytokines (IL-6 and IL-8). Fetal inflammation was defined as levels of IL-6 higher than 7.6 pg/ml. P/IVH was defined as early if diagnosed within the 1st day after birth; thereafter P/IVH was defined as late. RESULTS: Adjusted for the influence of gestational age, early-onset sepsis (OR 3.2, p = 0.045) and no or incomplete antenatal steroid course (OR 6.0, p = 0.001) significantly predicted early P/IVH. Funisitis (OR 1.6, p = 0.06) and fetal inflammation (OR 2.6, p = 0.06) were only partially associated with early hemorrhage. Contrary to that, respiratory distress syndrome (OR 3.4, p = 0.04), mechanical ventilation (OR 5.9, p = 0.008), low blood pressure (OR 3.5, p = 0.02), and vasopressors (OR 5.7, p = 0.002) were associated with late P/IVH. In multivariate analysis no or incomplete steroid course remained independent predictors for early and use of vasopressors for late P/IVH. The interaction of fetal inflammation and vaginal delivery with no or incomplete steroid course increased the risk of early P/IVH. CONCLUSIONS: These results indicate different risk factors for early and late P/IVH. Neither funisitis nor fetal inflammation independently predicts the onset of P/IVH. However, the interaction of fetal inflammation and vaginal delivery with no or incomplete antenatal steroid course increase the risk of early but not also late P/IVH.

Role of surfactant inhibitors in amniotic fluid in respiratory distress syndrome.

AIM: In vitro studies and animal experiments have provided evidence that albumin, bilirubin, meconium and inflammatory mediators act as surfactant inhibitors. The aim of this research was to establish whether their elevated concentrations in gastric aspirates, as representative samples of amniotic fluid, could contribute to the development of respiratory distress syndrome (RDS) in preterm infants. METHODS: Infants born before the 35th week of gestation between 1 March 1996 and 1 April 1997 were included. They were divided into two groups: the RDS and non RDS group. Gastric aspirates, taken immediately after birth, were used for biochemical measurements of albumin, bilirubin, meconium and E-alpha 1-PI concentrations. RESULTS: Sixty-one preterm infants were enrolled: 23 in the RDS group. The concentrations of albumin, bilirubin and meconium in gastric aspirates were higher in the RDS group (p < 0.01, p = 0.01 and p = 0.02, respectively). The E-alpha 1-PI concentration showed no significant difference between the two groups. Logistic regression analysis showed that a markedly increased risk of RDS was only represented by albumin concentrations of over 1.6 mmol/l and gestational age of under 31 weeks. CONCLUSION: Our observations indicate that increased levels of albumin in the gastric aspirate, taken immediately after birth, may contribute to the development of RDS in preterm infants. Despite the established inhibitory effects of bilirubin, meconium and inflammatory mediators in vitro, we could not confirm their influence on the development of RDS.