Perinatal and neonatal mortality in Northwest Greece (1996-2004).

OBJECTIVE: An improvement in perinatal mortality is reported in various countries. This is a retrospective analysis of perinatal and neonatal mortality in Northwest (NW) Greece. METHODS: Analysis was made of the births and deaths register in NW Greece and records of the regional referral tertiary care center and the National Hospitals at the same area for the period 1996-2004. Perinatal mortality was analysed according to birthweight (BW) and gestational age (GA) for two separate periods, 1996-1999 (I) and 2000-2004 (II), corresponding to an increase in antenatal steroid use from 20% to 63%. RESULTS: Neonatal mortality improved between the two periods in infants with very low BW [very low birth weight (VLBW), <1500 g] and the very preterm infants (<28 weeks GA). Severe respiratory distress syndrome (RDS) decreased (p<0.001) for infants with GA≤34 weeks and those with BW 751-1500 g (p<0.02), and perinatal asphyxia is no longer a leading cause of death. Intrauterine transfer increased (p<0.001) for infants with BW≤1500 g. The main cause of death as derived from birth records and neonatal intensive care unit records is prematurity, alone or with complications. CONCLUSIONS: With the introduction of antenatal steroids and increase in intrauterine transfer there has been a decrease in neonatal mortality of VLBW infants in NW Greece.

Effect of calcitonin in early and late stages of experimentally induced osteoarthritis. A histomorphometric study.

OBJECTIVE: To investigate both prophylactic and therapeutic roles of salmon calcitonin on the articular cartilage of rabbit's knees. METHODS: Right knee instability was produced in 30 New Zealand white rabbits by sectioning the cranial cruciate ligament (CCL). Animals were separated into four groups: placebo prophylactic-stage group (n=6), killed 8 weeks post surgery, calcitonin prophylactic-stage group (n=6), treated immediately after surgery with salmon calcitonin and killed at 8 weeks, placebo therapeutic-stage group (n=9) killed at 16 weeks post surgery and calcitonin therapeutic-stage group (n=9), treated with salmon calcitonin from 8th to 16th week and killed at 16 weeks post surgery. A histomorphometric study was based on the morphological changes of the articular cartilage and subchondral bone (degeneration indexes), as well as the articular cartilage thickness, chondrocytes' arrangement and their metabolic activity (regeneration indexes). RESULTS: Calcitonin groups showed smoother articular surface, no or minimal signs of ulceration, smaller osteophytes, and less subchondral cystic formation than placebo groups. Normal distribution of chondrocytes or hypercellularity was noticed in areas of mild osteoarthritic (OA) changes in the calcitonin groups indicating regeneration activity. Periodic Acid Schiff's and Alcian blue staining were negative in the placebo groups while increased absorption in the calcitonin groups revealed high anabolic activity. CONCLUSIONS: In prophylactic stages salmon calcitonin seemed to inhibit the progression of osteoarthritis by increasing the layers of hyaline cartilage, restoring the cellular metabolism, and decreasing the volume of osteophytes. In therapeutic stages, the hormone had a healing effect by decreasing the subchondral cysts, regenerating the hyaline cartilage and restoring cellular metabolism. Both macroscopic and histological findings of this study supported the biochemical results of previous studies showing the therapeutic effect of calcitonin on osteoarthritis.

Incidence and risk factors for cerebral palsy in infants with perinatal problems: a 15-year review.

OBJECTIVE: Cerebral palsy (CP) is associated with prenatal, perinatal and postnatal factors. This is a retrospective case-control study aiming to determine the frequency of CP and examine risk factors for CP among infants cared for in the Neonatal Intensive Care Unit (NICU) covering Northwest Greece. DESIGN AND PATIENTS: All neonates who were admitted to the NICU during the period 1989-2003 inclusive, and subsequently developed CP, were enrolled in the study, with matched controls. The incidence of CP was evaluated according to gestational age (GA): GA<34 weeks (group A) and GA>34 (group B), and study period: 1989-1996 (period I) and 1997-2003 (period II, during which intrauterine transfer and prenatal steroids were used). RESULTS: CP was diagnosed in 78 children, 55 in group A and 23 in group B. The incidence of CP increased significantly with decreasing GA. Survival without CP increased significantly in children of GA<34 weeks during period II. The main factors associated with CP, identified by multivariate analysis, were (odds ratios, confidence interval), for group A: being small for gestational age (SGA) (2.5, 1.2-4.5) and patent ductus arteriosus (PDA) (3.4, 1.3-9.2) in period I, periventricular leucomalacia (PVL) (27, 4.8-209), prolonged rupture of membranes (PROM) (5.6, 1.8-18) and duration of mechanical ventilation (1.1, 1.05-1.2) in period II, and for group B: SGA (3.6, 1.3-9.9), neonatal transfer (3.06, 1.2-7.6), duration of mechanical ventilation (1.1, 1.06-1.25) and sepsis-meningitis (4.3, 1.2-16). CONCLUSION: Improvement in survival without CP was observed in infants of GA<34 weeks during the later period of the study, and risk factors for CP in preterm infants depended on the study period. PVL, PROM and PDA were the most powerful independent predictors of CP in children of GA<34 weeks and SGA, neonatal transfer and sepsis/meningitis in children of GA>34 weeks.

Effect of recombinant human erythropoietin in preterm infants.

Twenty-five premature infants (mean gestational age+/-SD, 31.4+/-1.9 weeks) were administered subcutaneously recombinant human erythropoietin (rHuEpo) at a dose of 300 u/kg of body weight three times a week beginning on the third day of life and continuing for 6 weeks. The controls (n=23) were premature infants with a mean gestational age of 32.2+/-2.3 weeks who did not receive rHuEpo. Haematological indices, haemoglobin and serum phosphate (Pi), and red blood cell (RBC) phosphate metabolites (ATP, 2,3-DPG, RBCPi) were tested monthly until the 6th month and thereafter at the 9th and 12th months of life. The level of serum soluble transferrin receptors (sTfR) correlated significantly with rHuEpo (p<0.05). The ratio of sTfR to log (ferritin) was significantly higher (p<0.001) in the infants treated with rHuEpo than the controls. Intracellular organic and inorganic Pi changes were not affected by the Epo administration. The RBC 2,3-DPG seemed adequate in infants receiving rHuEpo.