Integration of facial features under memory load.

Simple visual items and complex real-world objects are stored into visual working memory as a collection of independent features, not as whole or integrated objects. Storing faces into memory might differ, however, since previous studies have reported perceptual and memory advantage for whole faces compared to other objects. We investigated whether facial features can be integrated in a statistically optimal fashion and whether memory maintenance disrupts this integration. The observers adjusted a probe - either a whole face or isolated features (eyes or mouth region) - to match the identity of a target while viewing both stimuli simultaneously or after a 1.5 second retention period. Precision was better for the whole face compared to the isolated features. Perceptual precision was higher than memory precision, as expected, and memory precision further declined as the number of memorized items was increased from one to four. Interestingly, the whole-face precision was better predicted by models assuming injection of memory noise followed by integration of features than by models assuming integration of features followed by the memory noise. The results suggest equally weighted or optimal integration of facial features and indicate that feature information is preserved in visual working memory while remembering faces.

Follow-up study of the early, randomised paracetamol trial to preterm infants, found no adverse reactions at the two-years corrected age.

AIM: We examined the long-term outcomes and safety of early intravenous paracetamol for ductus arteriosus closure at a corrected age of two years. METHODS: This was a follow-up of the 2013-2014 randomised, double-blind Preterm Infant's Paracetamol Study at Oulu University Hospital, Finland, which recruited 48 very preterm infants within 24 hours of birth. They received intravenous paracetamol or a placebo for four days. In 2015-2017, we followed up 44 infants (92%) at two years of corrected age. This included clinical and neurodevelopmental assessments and a parental medical history questionnaire. RESULTS: The 44 infants (55% boys) were born at 235 -316 weeks of gestation. No differences in the cardiac parameters, including blood pressures and ultrasound scan results, were found. Neurodevelopmental stages, as quantified by the Griffiths test, were similar. No signs of autism were reported. Asthma medication was more common in the control group, but the difference was not significant. Atopy scores, numbers of infections and the use of public health services were similar between the two groups. CONCLUSION: No long-term adverse reactions of early intravenous paracetamol were detected two years later. Larger trials are needed on the safety and efficacy of paracetamol prophylaxis for early ductal closure in very preterm infants.

Intravenous paracetamol was associated with closure of the ductus arteriosus in extremely premature infants.

AIM: Symptomatic patent ductus arteriosus may lead to serious complications in extremely preterm and extremely low birthweight infants and is often resistant to medication. We evaluated early intravenous paracetamol for pain prevention during respiratory therapy, in an attempt to understand the ductal treatment of such infants. METHODS: Our cohort were 295 extremely preterm or extremely low birthweight infants, born at less than 28 weeks or 1000 g, respectively, who were treated in the neonatal intensive care unit of Oulu University Hospital from 2002 to 2015, before and after intravenous paracetamol was introduced in June 2009. Ductal closure dates, paracetamol medication details, morbidities and mortality data were evaluated. RESULTS: Intravenous paracetamol was given to 128 infants, starting at a median of 4.4 hours age (range: 0-169 hours), with a mean total dosage of 212 mg/kg (range: 7.5-1175 mg/kg). We also included 167 controls who were mainly treated before we used intravenous paracetamol. Ibuprofen (p < 0.001) and ligation (p = 0.002) were lower in the paracetamol group than controls. No adverse effects were detected. Paracetamol was not associated with other morbidities. CONCLUSION: We found that early use of intravenous paracetamol decreased the incidence of ductal therapies in extremely premature or extremely low birthweight infants.

A follow-up of a randomised study of metformin and insulin in gestational diabetes mellitus: growth and development of the children at the age of 18 months.

OBJECTIVE: To compare the growth and development of children born to mothers with gestational diabetes mellitus (GDM) requiring pharmacological treatment, and randomised to treatment with metformin or insulin. DESIGN: Follow-up of a randomised controlled trial (RCT) comparing metformin and insulin treatment of GDM. SETTING: Data were gathered during routine visits to child welfare clinics at the ages of 6, 12, and 18 months, including weight and height measurements, and assessment of motor, social, and linguistic development. SAMPLE: The children of mothers with GDM randomised to metformin (n = 47) or insulin (n = 50) treatment during pregnancy. METHODS: Data were collected from the structured questionnaire filled in at the child welfare clinics. MAIN OUTCOME MEASURES: The growth and development of the children until the age of 18 months. RESULTS: Children exposed to metformin were significantly heavier (10.47 versus 9.85 kg, 95% CI 0.04-1.20) at the age of 12 months and taller and heavier (83.9 vs 82.2 cm, 95% CI 0.23-3.03, 12.05 vs 11.32 kg, 95% CI 0.04-1.43) at the age of 18 months. The mean ponderal index (PI) did not differ significantly. The motor, social, or linguistic development evaluated at the age of 18 months did not differ between the groups. CONCLUSIONS: Children prenatally exposed to metformin were heavier at the 12 months measurements and taller and heavier at the 18 months measurements than those exposed to insulin, but their body composition defined by PI did not differ. Over the short term, metformin does not seem to be harmful with regards to early motor, linguistic, or social development.

Metformin should be considered in the treatment of gestational diabetes: a prospective randomised study.

OBJECTIVE: To examine if oral metformin is as effective as insulin in the prevention of fetal macrosomy in pregnancies complicated with gestational diabetes mellitus (GDM). DESIGN: Open-label prospective randomised controlled study. SETTING: Maternity outpatient clinics in a secondary and tertiary level hospital in Finland. SAMPLE: One hundred women with GDM who did not attain euglycaemia with diet. METHODS: Women were randomised to therapy with insulin (n = 50) or oral metformin (n = 50). MAIN OUTCOME MEASURES: Incidence of large-for-gestational-age (LGA) infants and neonatal morbidity. RESULTS: There were no statistically significant differences in the incidence of LGA (8.5 versus 10.0%, P = 0.97), mean birthweight, mean cord artery pH or neonatal morbidity between the insulin and metformin groups. Fifteen (31.9%) of the 47 women randomised to metformin needed supplemental insulin. They were more obese (with a body mass index of 36 versus 30 kg/m(2), P = 0.002), had higher fasting blood glucose levels in an oral glucose tolerance test (6.1 versus 5.0 mmol/l, P = 0.001) and needed medical treatment for GDM earlier (26 versus 31 gestational weeks, P = 0.002) than women who were normoglycemic with metformin. There was a tendency to a higher rate of caesarean sections in the metformin group than in the insulin group (RR 1.9; 95% CI 0.99-3.71). CONCLUSIONS: Metformin seems to be suitable for the prevention of fetal macrosomy, especially in lean or moderately overweight women developing GDM in late gestation. Women with considerable obesity, high fasting blood glucose and an early need for pharmacological treatment may be more suitable for insulin therapy.

The effect of spacing regularity on visual crowding.

Crowding limits peripheral visual discrimination and recognition: a target easily identified in isolation becomes impossible to recognize when surrounded by other stimuli, often called flankers. Most accounts of crowding predict less crowding when the target-flanker distance increases. On the other hand, the importance of perceptual organization and target-flanker coherence in crowding has recently received more attention. We investigated the effect of target-flanker spacing on crowding in multi-element stimulus arrays. We show that increasing the average distance between the target and the flankers does not always decrease the amount of crowding but can even sometimes increase it. We suggest that the regularity of inter-element spacing plays an important role in determining the strength of crowding: regular spacing leads to the perception of a single, coherent, texture-like stimulus, making judgments about the individual elements difficult.

Blood glucose level in preterm infants after antenatal exposure to glucocorticoid.

AIM: To determine the impact of antenatal glucocorticoid on neonatal glucose homeostasis. METHODS: This is a retrospective gestationally paired survey followed by a randomized study. On the basis of the interval between last antenatal dexamethasone and birth, 228 preterm infants born before 34 weeks were divided into Short (< 24 h), Intermediate (1-6 days), and Long (> or = 7 days) exposure groups and compared their gestationally paired controls. After a single course of betamethasone, the parturients remaining undelivered for one week were randomized to receive either one dose of betamethasone (n = 52) or placebo (n = 53). Glucose values were recorded at 11 time points in the first 3 days of life. Hypoglycaemic and hyperglycaemic values were counted. RESULTS: There were no overall differences in mean glucose levels between the antenatal glucocorticoid and the control groups. However, the long exposure time to antenatal glucocorticoid was associated with increased risk of hyperglycaemia (OR 4.1; 2.2-7.6). CONCLUSION: Antenatal glucocorticoid administration was associated with subtle disturbances of glucose homeostasis in preterm infants. These differences were dependent on the length of drug-delivery interval so that long exposition time seemed to increase the incidence of hyperglycaemia during the first days of life.

Changing incidence and outcome of infants with respiratory distress syndrome in the 1990s: a population-based survey.

AIM: To evaluate the trends in the incidence, clinical course and outcome of respiratory distress syndrome (RDS) in the newborn in the Oulu University Hospital region in northern Finland. METHODS: In the population of 58 990 infants, the incidence rates of RDS specific to gestational age and birthweight in two consecutive periods, 1990-95 and 1996-99, were calculated. Clinical course and other neonatal morbidities were reported. All surviving infants were followed up until 1 y of corrected age. RESULTS: The overall incidence of RDS did not change significantly (8.7/1000 livebirths in 1990-95 vs 7.6 in 1996-99; p = 0.15), but the gestational age-adjusted incidence decreased between the two consecutive periods (p = 0.005). The frequency of infants with gestational age below 28 wk tended to increase towards the late 1990s, while their RDS incidence remained unchanged. RDS-related neonatal mortality decreased in parallel with neonatal mortality, accounting for 15% of all neonatal deaths. The duration of oxygen therapy shortened (8.0 vs 5.5 d) and the incidence of pneumothorax decreased (9.7 vs 4.1%), whereas the rate of chronic lung disease at 36 wk of postconceptional age (16.4 vs 16.7%) and at 1 y of corrected age (9.2 vs 8.2%) remained unchanged, as did also associated neurosensory morbidity (8.8 vs 9.5%). CONCLUSION: During the 1990s, the incidence of RDS shifted towards more immature infants and the gestational-age specific incidence decreased. The course of the disease shortened and acute complications decreased. The frequency of chronic pulmonary sequelae (and associated neurosensory morbidity) at the age of 1 y did not change significantly.

Effects of short-term dexamethasone treatment on collagen synthesis and degradation markers in preterm infants with developing lung disease.

AIM: To assess the effects of dexamethasone treatment on collagen turnover in preterm infants. METHODS: The serum concentrations of the amino-terminal propeptide of type I and III procollagens (PINP and PIIINP), which reflect rates of type I and III collagen synthesis, respectively, and the carboxy-terminal telopeptide of type I procollagen (ICTP), which reflects the rate of type I collagen degradation, were monitored in 13 preterm infants receiving dexamethasone and 13 matched control infants without glucocorticoid treatment for a total period of 12 mo. Dexamethasone was started at a median age of 12 d and continued at tapering doses for a median total duration of 10 d. Blood samples were taken immediately after birth, at 7, 14 and 28 d of age and at 2, 3, 6, 9 and 12 mo. The same markers were also measured just before the initiation of dexamethasone and on days 1, 3, and 7 of treatment. RESULTS: A striking decrease in all of the markers was already observed in every case on day 1 of dexamethasone, the suppression being greatest on day 3 and still considerable on day 7. The percentages from the pretreatment levels recorded on days 1, 3 and 7 were: for PINP 51, 26 and 45%; for PIIINP 63, 44% and 52%; and for ICTP 64, 41 and 51%. A rebound rise in PINP levels was seen in dexamethasone-treated infants, the levels exceeding those of the controls at 3 and 6 mo of age. A similar phenomenon was noted concerning PIIINP at 3 mo. The levels settled down at 9 and 12 mo. CONCLUSION: Dexamethasone causes an immediate, inevitable, deep suppression of type I and III collagen synthesis and also type I collagen degradation. This should be taken into consideration, e.g. when assessing for the indications for steroid treatment in sick preterm infants and its dosing and duration.

Nitric oxide treatment and acute pulmonary inflammatory response in very premature infants with intractable respiratory failure shortly after birth.

AIM: Premature infants with respiratory failure and early-onset pneumonia have low inducible nitric oxide synthase (NOS2) and no evidence of nitric oxide (NO) toxicity. However, inhalation of NO may not be indicated in sepsis because excessive NO generation has been reported. This prospective study was designed to test the hypothesis that inhaled NO is effective in a select group of small premature infants and that the responsiveness to NO is associated with low NOS2 enzyme. METHODS: 246 very low birthweight infants (birthweight <1500 g, VLBW) were screened for severe, intractable respiratory failure (oxygenation index >40, arterial-alveolar ratio for oxygen tension <0.10) that does not respond to two doses of surfactant within 5 h from birth. Infants with severe cardiac failure or a bleeding disorder were excluded. Five of the nine eligible cases received inhaled NO. They all had prolonged rupture of foetal membranes, early-onset pneumonia and persistent pulmonary hypertension. RESULTS: All five responded strikingly, survived and appeared normal in follow-up. Airway specimens during the first day of life revealed very low NOS2, interleukin-1beta and surfactant protein A, compared with VLBW infants who had no acute infection despite histological chorioamnionitis. In early-onset pneumonia, NOS2 and other inflammatory mediators increased first during the recovery 1-2 d after birth. CONCLUSION: VLBW infants with progressive respiratory failure and infection at birth have deficient pulmonary NOS2 and cytokine response. After surfactant therapy, these infants responded strikingly to inhaled NO. An acute pulmonary inflammatory response may contribute to respiratory adaptation in early-onset pneumonia.

Interscalene brachial plexus block is superior to subacromial bursa block after arthroscopic shoulder surgery.

BACKGROUND: Arthroscopic shoulder surgery is often associated with severe postoperative pain. The results concerning subacromial bursa blockade (SUB) as a method of pain relief have been contradictory. We hypothesized that a SUB and interscalene brachial plexus block (ISB) would similarly reduce early postoperative pain and the need for oxycodone as compared to placebo (PLA). METHODS: Forty-five patients scheduled for arthroscopic shoulder surgery were enrolled in this randomised, prospective study. The ISB and SUB blockades were performed with 15 ml of ropivacaine (5 mg/ml). In the PLA group, 15 ml of 0.9% saline was injected into the subacromial bursa. All patients received general anaesthesia. RESULTS: The mean intravenously patient-controlled delivered oxycodone consumption during the first 6 h was significantly lower in the ISB group (6 mg) than in the SUB group (24.1 mg; P=0.001) or in the PLA group (27 mg; P<0.001). No significant differences were detected between the SUB and PLA groups (P=0.791). The postoperative pain scores during the first 4 h at rest and during the first 6 h on movement were significantly lower in the ISB group than in the SUB and PLA groups. CONCLUSION: After arthroscopic shoulder surgery SUB has a minor effect only on postoperative analgesia, whereas an ISB with low-dose ropivacaine effectively relieves early postoperative pain and reduces the need for opioids.

Oral ondansetron, tropisetron or metoclopramide to prevent postoperative nausea and vomiting: a comparison in high-risk patients undergoing thyroid or parathyroid surgery.

BACKGROUND: Oral antiemetic prophylaxis may be a practical alternative to intravenous administration. Intravenous ondansetron and tropisetron prevent postoperative nausea and vomiting (PONV) at least as efficiently as traditional antiemetics, droperidol and metoclopramide. We tested the hypothesis that the incidence of PONV after oral ondansetron or tropisetron prophylaxis is lower compared with metoclopramide among high-risk patients. METHODS: In a prospective, double-blind study we studied 179 high-risk patients who received either ondansetron 16 mg, tropisetron 5 mg, or metoclopramide 10 mg orally 1 h before the operation. A standard general anesthetic technique and postoperative analgesia were used. The incidence of PONV and the need for rescue antiemetic medication was recorded for 24 h. RESULTS: In the postanesthesia care unit, the incidence of PONV was lower after premedication with tropisetron compared with ondansetron and metoclopramide (15%, 32% and 39%, respectively). The incidence of PONV during 0-24 h was the same in each group (68%, 58% and 75% in the ondansetron, tropisetron and metoclopramide group, respectively), but the incidence of vomiting was significantly lower after ondansetron (34%) and tropisetron (22%) prophylaxis compared with metoclopramide (53%). The need for additional antiemetics was significantly lower after tropisetron prophylaxis compared with metoclopramide. Patient satisfaction was significantly higher after tropisetron than after metoclopramide. CONCLUSIONS: In the initial period, the incidence of PONV was lower after premedication with oral tropisetron than after ondansetron or metoclopramide. Considering the entire 24-h postoperative period, the incidence of PONV was the same after all three premedications, but the incidence of vomiting was lower after oral ondansetron and tropisetron than after metoclopramide.

Effect of short-term antenatal dexamethasone administration on type I collagen synthesis and degradation in preterm infants at birth.

UNLABELLED: To assess the effects of antenatal corticoid administration on foetal collagen metabolism, cord serum concentrations of the aminoterminal propeptide and carboxyterminal telopeptide of type I procollagen (PINP and ICTP), which reflect rates of type I collagen synthesis and degradation, respectively, were measured in 67 consecutive preterm infants with gestational ages ranging from 24 to 32 wk. The samples were divided into three groups, depending on the administration and timing of antenatal corticosteroid treatment for enhancement of foetal lung maturity: cases in which the mothers had received a full 2-dose administration of dexamethasone on consecutive days 1 to 6 d before delivery (n = 23; Complete-Dexa), those who had received only a single dose of dexamethasone less than 24 h before delivery (n = 17; Partial-Dexa) and those who had not received any antenatal steroids (n = 27; No-Dexa). Infants in the Complete-Dexa group had significantly lower median PINP levels than those in the No-Dexa group (3,326 vs 4,028 microg/l; p = 0.036); the median PINP level in the Partial-Dexa group (3,999 microg/l) was close to that of the No-Dexa group. No significant differences in ICTP concentrations were seen between the groups. CONCLUSION: A significant suppression of foetal collagen synthesis but not degradation was found to be associated with antenatal dexamethasone administration. This should be taken into consideration, e.g. when assessing whether to administer repeated or single courses of corticosteroids antenatally in high-risk pregnancies.

Two percent lidocaine spinal anaesthesia compared with sevoflurane anaesthesia in ambulatory knee surgery - cost-effectiveness, home readiness and recovery profiles.

A total of 60 patients scheduled for elective knee arthroscopy were randomized to receive spinal anaesthesia (SA) with 2% lidocaine (n=30) or general anaesthesia with sevoflurane (SE) (n=30). SA and SE were compared in terms of the total costs of anaesthesia. The time to reach home readiness and the total time spent in the recovery unit (RU) were assessed. The early postoperative period and recovery at 24 h and 1 week were evaluated in terms of the incidence of pain, sedation, nausea and general satisfaction with the method of anaesthesia and postoperative instructions. The total costs of anaesthetic materials in the operation theatre (OT) and anaesthetic materials and personnel costs until home readiness was achieved in the RU were 160.7 FIM (1 FIM=0.17 EUR) for SA and 171.0 FIM for SE (not significant). The corresponding sums were 197.2 FIM for SA and 224.4 FIM for SE (P=0.001) when the total stay in RU was considered. The time to reach home readiness was 140.8 min (S.D. 52) in the SA group and 96.4 min (S.D. 62) in the SE group (P=0.02). There were no differences in the total RU time (224.0 min (S.D. 67) for SA and 218.0 min (S.D. 59) for SE). The level of postoperative pain was generally low, as all the SA patients and 86.7% of the SE patients had VAS<4 2 h postoperatively. Six SA patients (20.0%) had postoperative headache and two of them also had headache in the supine position. There were no headaches in the SE group (P=0.024). None of the patients in the SA group and six SE patients (20.0%) had nausea (needed treatment) in the RU (P=0.024). Four patients (13.3%) in the SE group and 1 patient (3.3%) in the SA group had nausea during the first 24 h postoperatively. All the patients were alert 60 min postoperatively with no difference between the groups and they were very satisfied during the first 24 h. All patients would have liked to have a similar operation done on an ambulatory basis. 93.3% said they would choose the same kind of anaesthesia. 91.7% were satisfied with the first week.General anaesthesia with SE is more cost-effective than SA with 2% lidocaine in ambulatory knee surgery if a short RU time is needed. The patients do generally well, but the incidence of postspinal headache with SA, adequate postoperative pain treatment and the possibility to have nausea with SE must be kept in mind.

Type I collagen markers in cord serum of appropriate vs. small for gestational age infants born during the second half of pregnancy.

BACKGROUND: The serum concentration of the N-terminal propeptide of type I procollagen (PINP) reflects the synthesis rate of type I collagen, whereas the corresponding C-terminal telopeptide (ICTP) mirrors its degradation. DESIGN: PINP and ICTP were measured in a total of 690 cord serum samples from 592 appropriate-for-gestational-age (AGA) infants and 98 smal-for-gestational-age (SGA) infants. These markers were compared between AGA and SGA infants of different gestational ages, ranging from 23 to 41 weeks, and birth weights, from 620 to 4555 g. RESULTS: Both PINP and ICTP levels were very high in the preterm AGA infants and declined significantly with advancing gestational age, paralleling the shape of the fetal growth velocity curve. Regardless of the quite large interindividual variations observed in these markers, PINP was significantly lower in both the preterm and term AGA infants than in the SGA infants. This was also the case for ICTP in the preterm infants of gestational age less than 36 weeks. In stepwise multiple regression analyses, gestational age, being either AGA or SGA and head circumference were significant factors to explain the levels of PINP and ICTP. The levels of PINP and ICTP were correlated with each other highly significantly in both the AGA and SGA infants (rs = 0.700 and 0.692, respectively; P < 0.001 in both). CONCLUSIONS: The levels of type I collagen markers seem to follow closely the shape of the fetal growth velocity curve during different stages of gestation. However, because of the large interindividual variations observed, further studies are needed before the significance of these markers for the assessment of normal and abnormal fetal growth can be established.

Postoperative nausea and vomiting after sevoflurane with or without ondansetron compared with propofol in female patients undergoing breast surgery.

IMPLICATIONS: We studied 180 female patients undergoing breast surgery. The patients were randomly allocated to receive one of three anesthetic techniques. Compared with either propofol or sevoflurane alone, sevoflurane with ondansetron resulted in a decreased incidence of postoperative nausea and vomiting. Sevoflurane with ondansetron prophylaxis is a good alternative to propofol with respect to avoiding postoperative nausea and vomiting.

One-week recovery profiles after spinal, propofol, isoflurane and desflurane anaesthesia in ambulatory knee arthroscopy.

There are comprehensive findings on the immediate recovery of patients from different types of anaesthesia, but more information is needed on how patients manage at home after ambulatory surgery. One hundred and seventy-three elective knee arthroscopy patients were randomised into four different anaesthesia groups to receive either spinal anaesthesia (SA) with 5% lidocaine or general anaesthesia (GA) with propofol infusion, isoflurane inhalation or desflurane inhalation. The patients were interviewed over the phone on the next day and asked to complete a questionnaire after 1 week. One hundred and sixty-eight patients (97%) were reached by phone. The questionnaire was returned by 163 patients (94%). After 24 h, all the patients were satisfied with the type of anaesthesia they had received, but 2% of the SA patients would have chosen GA and 4.3% of the GA patients would have chosen SA for the next operation. Based on the questionnaires returned after 1 week, 8.3% of the SA patients would have wanted to have GA, and 4.7% of the GA patients would have wanted to have SA in the future. The incidence of nausea (4.2%) and vomiting (1.8%) was very low in the whole series, with no differences between the anaesthesia groups. Headache after 24 h was experienced by 15.7% of the SA and 10.3% of the GA patients. After 1 week, SA patients reported headache upon standing in 13.5% of the cases, backache in 36.5% and lower leg pain in 59.6%. The corresponding figures for GA patients were 4.5, 9.9 and 39.6% (P<0.05). In spite of the good immediate recovery profile in the all anaesthesia groups, the fact that SA patients reported a higher incidence of headache, backache and lower leg pain after 1 week may be signs of post spinal headache and transient neurologic symptoms (TNS). For overall patient comfort, GA might be a better anaesthetic choice in ambulatory surgery.

Prematurity-associated nephrocalcinosis and kidney function in early childhood.

To assess the impact of prematurity-associated nephrocalcinosis on kidney function later in life, 20 premature children with neonatal nephrocalcinosis and 20 controls, matched for birth weight and postnatal age but without nephrocalcinosis, were examined (birth weight 905+/-209 vs. 957+/-226 g; study age 4.7+/-1.1 vs. 4.6+/-0.9 years). Distal tubular acidification capacity was measured with the oral acetazolamide test, in which the response was abnormal in 1 out of the 20 children with a history of nephrocalcinosis, but in none of the controls. Urinary calcium and beta(2)-microglobulin excretion were higher in the children with nephrocalcinosis, but no differences were found in fractional excretion of sodium and potassium or tubular reabsorption of phosphate. Estimated creatinine clearance was not different between the groups. Of the 6 children with nephrocalcinosis lasting beyond 2 years of age, 5 had had chronic lung disease neonatally and exhibited a tendency for compensated respiratory acidosis at the time of the examination. Neonatal nephrocalcinosis seems to lead to some signs of renal tubular dysfunction in early childhood of preterm infants. Glomerular function, however, appears not to be specifically disturbed by nephrocalcinosis.

Nephrocalcinosis in full-term infants receiving furosemide treatment for congestive heart failure: a study of the incidence and 2-year follow up.

UNLABELLED: In order to study the incidence and course of nephrocalcinosis in full-term infants with congestive heart failure receiving long-term furosemide treatment, 36 such infants (median age 2.9 months, range 1.2-8.0) and 36 full-term control infants not receiving any diuretics (median age 3.4 months, range 1.1-8.4) were studied by renal ultrasonography and random urine calcium variables. The infants with nephrocalcinosis were followed at 3-6 month intervals up to 2 years of age, or until ultrasonic resolution. Nephrocalcinosis was found in 5 out of the 36 (14%) treated infants, but in none of the controls (P = 0.03). The dose of furosemide was higher in the infants with nephrocalcinosis than in those without (1.9+/-0.6 vs. 1.3+/-0.4 mg/kg per day; P = 0.01). The urinary calcium concentration was higher in the infants receiving furosemide than in controls and a similar trend was observed in the urinary calcium/creatinine ratio, but these variables did not differ between the study infants with and without nephrocalcinosis. Ultrasonic resolution of nephrocalcinosis was observed in 3 of the 5 infants at 12 months, but in the other 2 the condition still persisted at 24 months. CONCLUSIONS: Long-term furosemide treatment in full-term infants with congestive heart failure entails a considerable risk of developing nephrocalcinosis. Renal ultrasonography is warranted in these patients within a few months after initiation of the treatment and in the case of nephrocalcinosis alteration of the diuretic regimen is to be considered.

Incidence, ultrasonic patterns and resolution of nephrocalcinosis in very low birthweight infants.

This longitudinal study was undertaken in order to elucidate the incidence and natural course of nephrocalcinosis in preterm infants and to evaluate whether the ultrasonic classification for nephrocalcinosis used here is suitable for predicting subsequent resolution of the condition. A total of 129 very low birthweight infants were screened for nephrocalcinosis by renal ultrasonography at 2 wk, 6 wk and 3 mo. The pyramidal changes were classified as peripheral, scattered or extensive. Follow-up renal ultrasonography was performed on the infants with nephrocalcinosis at 6, 12, 18 and 24 mo, and thereafter annually up to 6 y of age, or until ultrasonic resolution. The overall incidence of nephrocalcinosis was 20% (26/129). Nephrocalcinotic changes were peripheral in 14 out of the 26 infants (54%), scattered in 7 (27%) and extensive in 5 (19%). Ultrasonic resolution had taken place in all the cases with peripheral nephrocalcinosis by 12 mo, but 3 of the 7 infants with the scattered pattern and 3 of the 4 with the extensive pattern (1 died) were still affected at 24 mo. In two cases with extensive nephrocalcinosis the condition still persisted at 5-6 y of age. We conclude that about 20% of very low birthweight infants develop nephrocalcinosis during the first 3 mo of life. In about half of the affected infants renal changes are restricted and transient, but more extensive forms may last several years. The classification of nephrocalcinosis used here is appropriate for predicting later ultrasonic resolution.