Hyaline membrane disease in black newborns: does fetal lung maturation occur earlier?

Debate has developed among several authors about possible accelerated maturation of black fetuses in comparison with whites. In Guadeloupe, French West Indies, where 85% of the population is of black African-American origin, it has been noted that the incidence of hyaline membrane disease (HMD) represents a significant drop beginning after the 32nd week of gestation. Over a 3-year period, 419 black low-birthweight singleton newborns were admitted in the University Hospital's Neonatal Department covering 70% of all births of the island. The incidence of HMD was 50% among very low birthweight (< 1500 g) and 8.3% among moderate low birthweight (> or = 1500 g; P < 0.001). The incidence of HMD was 48.8% among the very preterm (< 32 weeks) and 7.8% (26/331) among the moderate preterm (> or = 32 weeks; P < 0.001). These differences were similar for appropriate for gestational age and small for gestational age infants. Significant differences remained after controlling for several maternal risk factors. These results suggest that the 32nd week of gestation represents a significant drop in the risk for respiratory distress syndrome in black premature compared with that reported in literature on European infants (34th week) and therefore may implicate different obstetrical decisions in the management of critical pregnancies in this population.

Neonatal bacterial septicemia in a tropical area. Four-year experience in Guadeloupe (French West Indies).

During a four-year study (1987-1990) at the Neonatal Department, University Hospital Pointe-à-Pitre (French West Indies), blood culture was systematically performed on all admitted newborns. The incidence of septicemia was 48 of 1000 admissions and 8.9 of 1000 inborn live births. Among the 107 neonatal positive blood cultures, group B streptococcus accounted for 37% of blood culture isolates and was the most frequent cause of septicemia. The overall mortality rate was 8.4%. The incidence of neonatal bacterial septicemia was among the high rates reported in the literature. The incidence of neonatal bacterial septicemia is discussed as a public health problem in perinatology in Guadeloupe in spite of good medical care. A review of the literature on bacterial septicemia in tropical or developing countries compared to the Guadeloupean experience allows speculation that this problem might be underestimated in third world countries.

Validity of postnatal assessments of gestational age in low birthweight infants from a Caribbean community.

The Dubowitz assessment of gestational maturity was compared with the best obstetric estimate of gestational age based on date of last menstrual period (LMP) or ultrasonography performed early in the pregnancy or both. This study involved 384 low birthweight infants admitted to the neonatal tertiary center in Guadeloupe, French West Indies, during the period 1986 through 1988. The Dubowitz assessment exceeded the best obstetric estimation by an average of nearly 5 days. This overestimation by the Dubowitz method was observed at every gestational age and was greatest at gestational ages of less than 35 weeks. The physical characteristics of the postnatal assessment were in closer agreement with the best obstetric estimate than the neurological characteristics. These findings concur with other investigations that indicate that the Dubowitz postnatal assessment of gestational age overestimates the gestational age interval from date of LMP in low birthweight and preterm infants.

PIP: Physicians used data on 384 low birth weight neonates born between January 1986 and December 1988, who were in the neonatal intensive care unit at Pointe-a-Pitre Hospital in Guadeloupe, to compare the Dubowitz assessment of gestational age with the best obstetric estimate of gestational age. They needed a valid estimate of gestational age to quickly differentiate premature newborns from small-for-dates newborns. The hospital had limited technical and human resources, so it needed to determine which infants were at greater risk. The Dubowitz assessment resulted in a mean gestational age about 5 days longer than the obstetric estimate. There was almost a 2 week difference in mean gestational age between the neurological component and the physical component of the Dubowitz assessment (35 weeks, 4 days vs. 33 weeks, 5 days). The 2 estimates agreed completely in just 25% of cases. They disagreed by at least 2 weeks in 18% of the cases and by at least 3 weeks in 8% of cases. The analysis indicated that the Dubowitz assessment consistently overestimated gestational age in both low birth weight and premature infants and that the mean difference increased as gestational ages fell. The Dubowitz assessment even had this effect when the researchers separated the newborns into those whose gestational age was based just on last menstrual period (LMP) and those whose gestational age was based just on last (LMP) confirmed by ultrasound at a gestational age 20 weeks. The neurological component significantly overestimated both the combined Dubowitz and obstetric values for premature infants, while the physical component tended to agree.

Introducing total parenteral nutrition in a neonatal care unit - abstract

From October 1985 to November 1987, 150 out of 845 newborns hospitalized in the Pointe-a-Pitre Hospital Neonatal Care Unit have received total parenteral nutrition (TPN). Two hundred and four catheterizations have been performed on 150 newborns, 74 per cent less than 2,000 gm birth weight. Sixty-one per cent of the latter were less than 32 weeks of gestation. Indications for TPN were as follows: 66 (44 per cent)less than 1,500 gm birth weight (6 with necrotizing enterocolitis), 84 (56 per cent) 1,500 gm or more birth weight, 47 with pre-existing perpartum distress, 22 with gastrointestinal disorders, 11 with necrotizing enterocolitis and 4 with gastrointestinal congenital malformations. On average, central venous catheterization was performed on the eighth day of life, and infusion time was 25 days. The commonly observed TPN complications are glucose intolerance, hepatic cholestasis and phosphocalcific metabolism disorders (osteoporosis, ricketts). A clear-cut distinction is made between an introductory phase of the technique (1985-1986), and a second phase where better prevention of complications was achieved (1986-1987). TPN has become a necessary alternative for the management of newborns at high risk with gastrointestinal problems. In our patients, it has produced an average daily weight gain of 21 gm (AU)