Prenatal risk factors for intraventricular hemorrhage, neonatal death and impaired psychomotor development in very low birth weight infants.

AIM: The aim of this study was to determine the relationship between preterm risk factors and neonatal death, cerebral hemorrhage and psychomotor development in very low birth weight infants. METHODS: A retrospective analysis based on a multivariate logistic regression model was conducted on 253 VLBW infants. Cerebral hemorrhage was assessed by cerebral ultrasound screening within 24 hours of life, psychomotor development by Bailey Psychomotor and Development Index test. RESULTS: Pre-eclampsia and elective cesarean section (CS) are statistically protective factors in the prevention of cerebral hemorrhage; gestational age is a protective factor for neonatal death; whereas, multiple pregnancy, symmetrically small for gestational-age infants, asphyxia at birth, altered cardiotocography, and cerebral hemorrhage are risk factors for neonatal death; emergency CS and gestational age are protective factors for problems in psychomotor development. The number of fetuses and cerebral hemorrhage are risk factors for impaired psychomotor development at 2 years of age. CONCLUSION: The great number of obstetrical variables related to neonatal outcome makes it difficult to identify the really important steps, in obstetric management, to prevent long term sequelae. The main risk factors related to psychomotor development still remain gestational age and multiple pregnancy.

Clinical approach to the analysis of causes of death in the first two years of life of very-low-birthweight infants in a multicentre setting.

Mortality in the first 2 years of 634 very-low-birthweight infants admitted to eight neonatal intensive care units in Italy, and the factors associated with the net probability of death from each cause, were studied by means of the Cox proportional hazard model. A clinical classification of the causes of death was used. Overall mortality was 33.7% (intercentre range 12.6-52.9%). The highest cause-specific mortality rates were observed for respiratory problems, intra-ventricular haemorrhage (IVH) and infections (14.5%, 6.3% and 5.7% respectively). The leading causes of death were respiratory problems and IVH in the first week of life, infections from the second week up to the end of the first month, and bronchopulmonary dysplasia (BPD) afterwards. Birthweight < 1000 g, gestational age < 30 weeks, absence of spontaneous respiratory activity, unknown body temperature and pH < 7.20 at admission were associated with death from respiratory problems and IVH. Male sex, birthweight < 1000 g and unknown body temperature at admission were associated with death from BPD. Mortality from infections was higher in one centre; no other differences emerged among the eight NICUs. The classification of the causes of death employed and the use of the net probabilities of death appear as practical and useful instruments to study the relationship between specific aspects of medical care and mortality, and to investigate the reasons for differences in performance between neonatal units.

[Communication in the neonatal intensive therapy unit: the opinions of parents and of medical personnel compared]. / La comunicazione in terapia intensiva neonatale: opinioni dei genitori e del personale sanitario a confronto.

Within the framework of an European international project, the issue of parents-staff communication in Neonatal Intensive Care Units was explored. 5 Italian unit participated in the project. 80 mothers and 62 fathers of singleton, not malformed, very low birthweight babies were interviewed during the fourth week of their baby's life, while the views of the health personnel (60 doctors and 106 nurses) were collected through an anonymous, self-administered questionnaire. Most of the staff feels that parents should be informed completely about their baby's conditions and prognosis, while the actual practices about transmission of information are reported differently according to professional status: more nurses than doctors feel that the information is not as complete as it should be. Uncertainty of prognosis is the most commonly quoted reason for restricting the information. Parents, on the other hand, are generally satisfied about the information received, although some of them complain about the style of communication, and especially the need to ask repeatedly in order to be informed. These results show some of the gaps existing in communication both within the staff and with parents, and suggest possible ways of improvement.

Italian multicentre study on very low-birth-weight babies. Neonatal mortality and two-year outcome.

The Italian multicentre study on very low-birth-weight babies is the first collaborative project in Italy on the health status of newborns weighing 500-1499 g at birth: 634 such babies were admitted in 1987-88 to eight Italian NICUs; 424 infants survived and were followed until two years of age, corrected for prematurity. Logistic regression analysis of pre-admission risk factors of in-hospital mortality identified eight statistically significant variables: birth weight, gestational age, sex, antepartum steroids, 1-min Apgar score and, on admission to the NICU, body temperature, pH and absence of spontaneous respiration. Using the equation derived from the logistic model, a theoretical mortality rate was calculated for each centre, predicted on the basis of the local incidence of preadmission risk factors. In no case was the predicted mortality significantly different from the observed one. At two years of age, 8 children were blind and 48 had motor disability. Of these, 46 had cerebral palsy: based on a functional evaluation score 14 had severe (degree 4), 20 intermediate (degree 3) and 12 mild cerebral palsy (degree 2). Among 25 variables entered in a logistic regression as risk factors for cerebral palsy, only periventricular leukomalacia and acidosis were significantly associated with the outcome.

Italian Multicenter Study on Very Low Birth Weight Babies.

The Italian Multicenter Study on Very Low Birth Weight babies (IMS-VLBW) is the first collaborative investigation performed in Italy on the health status of newborns weighing less than 1500 g at birth. Eight Neonatal Intensive Care Units (NICUs) participated in the study: Cagliari, Napoli, Padova, Palermo, Roma, Sassari, Trieste, Udine. Data were analyzed in the Laboratorio di Epidemiologia e Biostatistica of the Istituto Superiore di Sanità. The objectives of the study were established in the following: a) to collect accurate descriptive data on neonatal morbidity, mortality and long term outcome of VLBW babies admitted to NICUs; b) to analyze the risk factors of unfavourable outcome (death or handicap) and to analyze, with respect to outcome, the relationships between risk factors, neonatal diseases and therapeutical procedures; c) to test the feasibility of a multicenter follow-up programme based on the use in all participating Centers of the same diagnostic criteria (the results of follow-up will be presented in a forthcoming paper). In the years 1987 and 1988, 634 newborns weighing 500-1499 g at birth were enrolled in the study. In-hospital mortality for the whole group was 33.1% (65.1% in the 500-999 g birth weight class and 19.2% in the 1000-1499 g class). Mortality was not different for inborn vs outborn babies. A high incidence of unfavourable perinatal conditions was observed in these babies, namely birth asphyxia, sub-optimal care during transport, poor clinical conditions on arrival to the NICU. Neonatal diseases, like respiratory distress syndrome and peri-intra ventricular hemorrhage were also frequent and severe. A logistic regression analysis of pre-admission risk factors of in-hospital death identified eight statistically significant variables: birth weight; gestational age; sex; antenatal steroid stimulation of lung maturity; first minute Apgar score; absence of spontaneous respiration, body temperature and pH on arrival to the NICU. Using the equation derived from the logistic regression analysis a theoretical mortality rate, predicted on the basis of the local incidence of pre-admission risk factors, was calculated for each Center. In no case the predicted mortality was statistically different from the observed one, suggesting that in our study differences in observed mortality rates from one Center to another are largely influenced by pre-admission risk factors.

[Evaluation problems and indications for handling premature infants (VLBW)]. / Problemi di valutazione e indicazioni per l'handling del neonato pretermine (VLBW).

The authors present their approach to the care of the preterm very-low-birth-weight infant. They consider the importance of the handling of the preterm infant in the Neonatal Intensive Care Unit (NICU) and the co-operation among the neonatologist, the physiotherapist and the parents in the individualized care, both in the NICU and in the follow-up.

[Hematoma of the sternocleidomastoid. Results of a non-invasive treatment in newborn infants]. / L'ematoma dello sternocleidomastoideo. Risultati di un trattamento non invasivo in età neonatale.

Nine infants with haematoma of the SCM muscle were evaluated. A review of previous reports and a comparison of the clinical features of this group of patients to ones considered in other reports is reported and a simple therapeutic program is outlined: during the first year of life, postures and simple exercises performed by the mother under the pediatrician's supervision are suggested. In the eight cases in which the therapeutic program was followed, the long-term outcome was satisfactory from both cosmetic and functional point of view. Therefore this method should be preferred during the first year of life, also taking into account the lack of negative influence on the mother-infant relationship and on the infant's neurological development.