Measuring for nonsynostotic head deformities in preterm infants during NICU management: A pilot study.

BACKGROUND: Research has focused on the presence of nonsynostotic head deformities (NHD: plagiocephaly, dolichocephaly, brachycephaly) in preterm infants at discharge and within the first year after discharge. However, there is limited data on NHD in preterm neonates during neonatal intensive care unit (NICU) stay. AIM: To acquire quantitative data on head shapes among preterm neonates during NICU hospital stay. STUDY DESIGN: Investigators performed weekly head measurements on 68 premature infants starting within two weeks of birth or when medically stable until discharge. Infants recruited for the study were born at <34 weeks gestational age. OUTCOME MEASURES: Cranial index (CI) and cranial vault asymmetry index (CVAI) were calculated from Ballert cranial caliper measurements during the infants stay (27 to 40 weeks postmenstrual age) in the NICU/Special Care Nursery (SCN) setting. Inter-rater retest reliability was determined for CI and CVAI. RESULTS: Throughout the measurement period, CI consistently demonstrated dolichocephaly (CI < 0.76), and CVAI fluctuated above and below the range indicating plagiocephaly (CVAI ≥ 3.5%). Good to acceptable levels of test-retest reliability was demonstrated; prevalence of dolichocephaly and plagiocephaly at discharge was 82% and 36%, respectively; and mean head dimension measurement time for different combinations of bed types and support systems ranged from 1.1 to 1.9 min. CONCLUSIONS: Following the progression of CI and CVAI during the NICU stay using the cranial caliper method is reliable, and a substantial presence of NHD was reported.

Outcome of extremely low birth weight infants with leukemoid reaction.

BACKGROUND: Leukemoid reaction (LR) is defined as an absolute neutrophil count (ANC) of >30 x 10(3)/mm(3). No previous study has systemically examined the clinical and prognostic significance of this phenomenon in extremely low birth weight (ELBW) infants. OBJECTIVE: The purpose of this study was to examine the effect of LR in morbidity, mortality, and long-term developmental outcome in ELBW infants. METHOD: Infants with gestational age of 30 x 10(3)/mm(3). RESULTS: LR was detected in 17% of the study infants (26 of 152). ANC increased postnatally in LR (n = 26) and no-LR (n = 126) infants during hospitalization, peaked in the second week of life (43 +/- 3 vs 14 +/- 1 x 10(3)/mm(3)), and remained significantly higher in LR infants during the first 5 weeks of life. LR occurred more frequently during the first 2 weeks of life and lasted for 3 +/- 1 days. There was no significant difference between the LR and no-LR infants in gestational age, birth weight, delivery mode, gender, Apgar scores, or incidence of respiratory distress syndrome, patent ductus arteriosus, necrotizing enterocolitis, intraventricular hemorrhage, and retinopathy of prematurity. LR infants required a significantly longer duration of ventilatory support (36 +/- 4 vs 21 +/- 2 days), longer duration of oxygen requirement (58 +/- 6 vs 40 +/- 3 days), and had a higher incidence of bronchopulmonary dysplasia (BPD) (54% vs 25%) compared with no-LR infants. Furthermore, the length of hospitalization was significantly longer in LR infants (69 +/- 6 vs 54 +/- 3 days). There was no significant difference between the groups in developmental outcome at 2 years of age including receptive/expressive language, fine/gross motor skills, and hearing. Incidence of abnormal neurodevelopment outcome was also similar between LR and no-LR infants. CONCLUSIONS: LR in ELBW infants is associated with a prolonged need for ventilatory and oxygen support, a higher incidence of BPD, and a tendency for lower mortality. The findings from our study suggest that LR is associated with conditions known to have an excess of proinflammatory cytokines. Additional prospective study is needed to understand the relationship between LR, proinflammatory cytokines, and development of BPD.