Extreme hyperbilirubinaemia in term and near-term infants in Denmark.

AIM: To determine the incidence amongst infants born at term or near-term of extreme hyperbilirubinaemia, i.e., with a serum concentration of unconjugated bilirubin exceeding the limit above which an exchange transfusion was indicated according to the authorized guidelines. METHOD: The investigation period covered 2 y, 1 January 2000 to 31 December 2001, and included all infants born alive at term or near-term in Denmark. All infants with extreme hyperbilirubinaemia admitted to paediatric departments were recorded. RESULTS: Thirty-two infants developed extreme hyperbilirubinaemia, i.e., an incidence of 25 per 100 000. The maximum total serum bilirubin concentration (TSB) was 492 (385-689) micromol/I (median (range)). The median value of the exchange transfusion limits was 450 micromol/l. Twelve infants had signs and symptoms of central nervous system involvement; 11 had acute bilirubin encephalopathy phase-1 symptoms; and one had phase-2 symptoms. Nineteen infants developed extreme hyperbilirubinaemia during primary admission to the maternity ward or neonatal department; the others after having been discharged. There was no difference in maximum TSB between those infants not discharged from hospital and those infants admitted to hospital from home. Maximum TSB appeared latest amongst those infants admitted from home (p < 0.01), and these more often had signs and symptoms of central nervous system involvement (p < 0.05). Ten infants were of non-Caucasian extraction. Less than half of all Danish mothers receive both verbal and written information after birth on jaundice in the infant. CONCLUSION: Twenty-five per 100 000 infants born at term or near-term developed extreme hyperbilirubinaemia, the majority of them whilst in hospital. Infants admitted from home more often had signs and symptoms of central system involvement.

The Danish national study in infants with extremely low gestational age and birthweight (the ETFOL study): respiratory morbidity and outcome.

AIM: To describe and analyse neonatal care, short and long-term morbidity with special reference to ventilatory support and chronic lung disease (CLD) in a population-based study. METHODS: During 1994 and 1995 a prospective, nation-wide, multicentre study was conducted, comprising 477 liveborn infants with gestational age (GA) < 28 wk and/or birthweight < 1000 g. Of these, 407 infants received active treatment. The ventilatory treatment was based on the principle of permissive hypercapnia and early nasal continuous positive airway pressure (NCPAP) supplemented with surfactant and ventilator therapy in case of CPAP failure. RESULTS: Among actively treated infants 85% received CPAP and 23% mechanical ventilation from the first day of life. A total of 269 infants (56%) survived to discharge. Of these, 195 had a GA < 28 wk. One-hundred and five survivors with GA < 28 wk survived with NCPAP as sole respiratory support. In surviving infants, periventricular leucomalacia/intraventricular haemorrhage grade 3-4 was found in 10%, retinopathy of prematurity grade > 2 in 4%, and oxygen requirement at 36 and 40 wk of postmenstrual age (CLD) in 16 and 5%, respectively. Three infants either died of CLD (n = 1) or required oxygen therapy beyond 43 wk of postmenstrual age. Logistic regression analysis showed significant associations between oxygen requirement at 40 wk and GA, septicaemia, mechanical ventilation, symptomatic patent ductus arteriosus and Clinical Risk Index for Babies score. Only the two last-mentioned factors proved significant in infants with GA < 28 wk. No infant died after discharge and 253 (94%) were followed up at 2 y of corrected age; one or more moderate to severe impairments were found in 66 (26%) of the examined children. CONCLUSION: Ventilatory treatment in extremely premature and extremely low-birthweight infants based on early NCPAP and permissive hypercapnia may result in comparable survival rates and sensorineural outcome; however, the incidence of CLD seems lower than that reported on conventional treatment.

[Attitudes of parents towards treatment of extremely premature infants]. / Foraeldreholdninger til behandling af ekstremt tidligt fødte børn.

The aim of this study was to evaluate the attitude among parents of extremely premature newborn children towards fixed lower limits for treatment and towards parent involvement in decisions about the treatment of their child. All parents with extremely premature newborns admitted from January 1, 1992 to June 30, 1994 to the Neonatal Department, Hvidovre Hospital, Copenhagen, Denmark, were asked to fill in questionnaires. The study population comprised the parents of 58 children. The parents of 14 children did not want to participate. Of the remaining 44, 36 children were alive and eight had died at the time of the study. Almost all parents stated that neither birth weight nor gestational age were acceptable as criteria for treatment or non-treatment of premature newborns. This attitude contrasted with the recommendation in 1994 from The Danish Council of Ethics. Half of the parents expressed a wish to be involved in the decisions about the treatment of their newborn child. This attitude agreed with the recommendation from the Danish Council of Ethics.

Candida albicans septicemia in a premature infant successfully treated with oral fluconazole.

A premature male infant, birth-weight 1460 g, was treated successfully for a Candida albicans septicemia with orally administered fluconazole for 20 days. Dosage was 5 mg/kg/day. No side effects were seen. Fluconazole may present a major progress in treatment of invasive C. albicans infections in neonatology.

Birthweight-for-gestational age charts based on early ultrasound estimation of gestational age.

Birthweight-for-gestational age charts were based on the analysis of 3888 consecutive births in which the gestational age was estimated by measuring the fetal biparietal diameter before the 20th week of gestation. The data showed, in contrast to previous studies, a linear relation between gestational age and birthweight without inflection after term. The regression parameters showed a strongly significant difference between girls and boys. Thus, boys were 1.5% heavier than girls at 190 days gestation and 3.6% heavier at 300 days gestation. The linearity in the birthweight-for-gestational age charts could be due to the more reliable gestational age based on early ultrasound.

Serum lipids and lipoproteins in 157 insulin dependent diabetic children and adolescents in relation to metabolic regulation, obesity and genetic hyperlipoproteinemia.

Serum lipids and lipoproteins were measured in 157 insulin dependent diabetic children and adolescents (IDDM) and in 350 healthy reference individuals. Serum triglyceride values were lower and total cholesterol and high density lipoprotein cholesterol higher in IDDM. Metabolic regulation reflected by glucosuria, postprandial blood glucose, number of hypoglycemic episodes and hemoglobin A1c all correlated strongly with serum triglyceride and very low density lipoprotein cholesterol. Serum lipids and lipoproteins did not correlate with obesity. Three children had genetic hyperlipoproteinemia. In IDDM measurement of serum lipids and lipoproteins can thus be used to further assess metabolic regulation. Measurement of serum lipids and lipoproteins seems warranted for future evaluation of the risk of cardiovascular disease in IDDM.

Oral absorption of pivampicillin and ampicillin in young children: cross-over study using equimolar doses of a suspension.

In a cross-over study, the oral absorption following equimolar doses of ampicillin corresponding to 16.7 mg/kg administrered as pivampicillin ('Pondocillin') suspension and ampicillin ('Doktacillin') suspension respectively, was investigated in 11 children aged from 8 months to 4.5 years. Pivampicillin produced a mean peak serum concentration of 10.7 microgram ampicillin/ml compared with 5.8 microgram/ml after ampicillin. The mean area under the serum concentration-time curves was 29.2 microgram/ml-h after pivampicillin and 16.7 microgram/ml-h after ampicillin, reflecting the superior bioavailability of the ester form. In 4 of the children aged between 8 and 12 months, the serum levels after pivampicillin were consistenly lower than those recorded in the remaining 7 children beyound the age of 1 year. The mechanism and therapeutic implications of this finding require further study.