How common are rib fractures in extremely low birth weight preterm infants?

BACKGROUND: This study was prompted by incidental finding of healing rib fractures on chest radiographs of ex-preterm born infants, who were admitted to hospital with acute respiratory illnesses within a few weeks of discharge from the neonatal intensive care unit (NICU). Rib fractures in infants, particularly those situated posteriorly, are considered to be specific for non-accidental injury (NAI). METHODS: Retrospective examination of radiographs of extremely low birth weight (ELBW) infants (< or =1000 g) with a gestation range of 22 of 33 weeks, cared for at a tertiary NICU, between 1998 and 2002, and who had survived > or =4 weeks. RESULTS: Five out of 72 (7%) infants studied had radiologically apparent rib fractures. None involved posterior rib shafts. All infants with rib fractures died on the NICU. CONCLUSIONS: The possibility of NAI should be considered in ex-ELBW infants found to have rib fractures.

Bone status of children aged 5-8 years, treated with dexamethasone for chronic lung disease of prematurity.

BACKGROUND: It is not known whether treatment with dexamethasone in the neonatal period may lead to reduced bone mineral density in childhood. METHODS: Anthropometric and bone densitometry measurements were taken of children aged 5-8 years who had chronic lung disease (CLD) in the neonatal period (n = 22). 15 of these children were treated with dexamethasone. A control group consisted of children born preterm who did not develop CLD (n = 29). RESULTS: Total body bone mineral content and bone mineral apparent density of the lumbar spine were lower in children whose CLD was treated with dexamethasone in the neonatal period, compared with the preterm controls. CONCLUSION: Dexamethasone treatment in the neonatal period appears to cause impairment of mineralisation which persists into childhood.

Relationship of tibial speed of sound and lower limb length to nutrient intake in preterm infants.

BACKGROUND: Metabolic bone disease of prematurity is characterised by impaired postnatal mineralisation of the rapidly growing infant skeleton. OBJECTIVE: To longitudinally evaluate postnatal changes in tibial speed of sound (tSOS; which reflects cortical thickness and bone mineral density) and lower limb length (LLL; a measure of tibial growth) in very low birthweight preterm infants receiving contemporary neonatal care. METHODS: tSOS and LLL were measured using a quantitative ultrasound device and an electronic neonatal knemometer, respectively, in the same limb, weekly, for a median period of four weeks (3-16 weeks) in 84 preterm infants (median gestation 26.8 weeks (range 23-35.2 weeks) and median birth weight 869.5 g (range 418-1481 g)). RESULTS: Initial tSOS and LLL were correlated with gestation (r = 0.42, p<0.001; r = 0.76, p<0.001, respectively) and birth weight (r = 0.23, p = 0.038; r = 0.93, p<0.001, respectively). Postnatally, tSOS decreased (r = -0.15, p = 0.011) whereas LLL increased (r = 0.96, p<0.001) with age. The rate of postnatal change in LLL, but not in tSOS, was positively influenced by intake of calcium (p = 0.03), phosphorus (p = 0.01) and vitamin D (p = 0.03). CONCLUSIONS: The postnatal decline in tSOS, which is probably due to cortical thinning secondary to endocortical bone loss, and increase in LLL provide new insight into the development of long bones in preterm infants.

Seasonality of invasive Candida infection in neonates.

AIM: To evaluate season of birth as a risk factor for the development of invasive Candida in our population of preterm low-birthweight infants. METHODS: Retrospective identification of Candida-positive blood or cerebrospinal fluid (CSF) cultures in infants < 32 wk over an 8-y period. RESULTS: There were 1400 admissions of infants < 32 wk gestation, of whom 52 (3.7%) developed invasive Candida infection. Thirty-eight of 52 (73%) occurred during the months September to February. CONCLUSIONS: It may be appropriate to consider seasonal associations when targeting selective antifungal chemoprophylaxis.

Gestational age and the C reactive protein response.

C reactive protein (CRP) concentrations are used routinely in the investigation and monitoring of neonatal sepsis. In this study, CRP responses were examined in the first week after birth. Among infants showing a clinically relevant CRP response, CRP concentrations > 60 mg/l were more likely with increasing gestational age.

Extravasation injuries on regional neonatal units.

This survey of regional neonatal intensive care units determined a prevalence of 38 per 1000 neonates who sustained an extravasation injury that caused skin necrosis. Most injuries occurred in infants of 26 weeks gestation or less, with parenteral nutrition infused through intravenous cannulae. Common treatments were exposing wounds to the air, infiltration with hyaluronidase and saline, and occlusive dressings.

Tibial speed of sound in term and preterm infants.

The tibial speed of sound (SOS) was measured in 91 healthy singleton infants between 31 and 42 weeks of gestation and 12 sick preterm infants. In healthy infants, the tibial SOS was associated with corrected gestational age (r = 0.40, p < 0.001) but not birth weight. The median tibial SOS in 12 sick preterm infants (2,772, range 2,566-2,934 m/s), whose corrected gestational age was between 31 and 42 weeks, was lower (p < 0.001) than that of 69 healthy gestation-matched healthy infants (3,100, range 2,870-3,381 m/s). Tibial SOS measurements may allow radiation-free assessment of metabolic bone disease of prematurity.