Periventricular-intraventricular haemorrhage in low-birth-weight infants at Baragwanath Hospital.

The prevalence of periventricular-intraventricular haemorrhage (PV-IVH) among very-low-birth-weight infants at Baragwanath Hospital has not been well documented. In this prospective study, a total of 282 live-born infants with birth weights of 1,000-1,749 g were studied over a 4 1/2-month period. Every infant had at least one cranial ultrasound examination at 7-10 days of age, while one-third of non-ventilated and all ventilated infants had ultrasound examinations on days 3, 7 and 14. Where possible, all infants had a follow-up ultrasound scan at 40 weeks' post-conceptional age. The overall prevalence of PV-IVH was 53% for infants weighing less than 1,500 g at birth and 52% for infants born at less than 35 weeks' gestation, but only 12% had either grade III or grade IV haemorrhages. The prevalence and severity of PV-IVH increased with both decreasing birth weight and decreasing gestational age and was also predicted by the need for active resuscitation at birth, mechanical ventilation and the development of pneumothorax. A total of 93% of infants without PV-IVH survived, but survival decreased with increasing grade of PV-IVH. Germinal matrix cysts were noted on follow-up in 55% of surviving infants with grade I PV-IVH. Very-low-birth-weight infants at Baragwanath Hospital therefore seem to have a higher prevalence of PV-IVH when compared with reported figures, but this is due mainly to an increase in smaller haemorrhages.

Prophylactic miconazole oral gel for the prevention of neonatal fungal rectal colonization and systemic infection.

Prior rectal colonization with fungi may be an important risk factor for development of systemic fungal infection in the neonate. This placebo-controlled study evaluated the benefits of miconazole oral gel in the prevention of fungal rectal colonization and systemic infection in high risk neonates admitted to the Neonatal Intensive Care Unit. Repeated oral application of miconazole gel reduced the overall prevalence of postnatally acquired rectal colonization; a yeast was grown in 19.5% of the weekly rectal swabs in the miconazole-treated group compared with 36.2% in the control group (69 of 354 vs. 146 of 403, P < 0.0001). There was no reduction in the incidence of systemic fungal infection in the two groups although the overall incidence of the infection was low in both groups, at 2.0% vs. 2.6% (6 of 298 vs. 8 of 302, P not significant). No relationship was shown between prior rectal colonization and subsequent systemic fungal infections in either of the two groups. This study does not support the use of prophylactic miconazole oral gel for the prevention of neonatal systemic fungal infections.