Outcome of very low birth weight infants at 12 to 18 months of age in Soweto, South Africa.

OBJECTIVE: To describe the long-term outcome of very low birth weight infants growing up in poor socioeconomic conditions in Soweto, South Africa. METHODS: A stratified sample of infants weighing < 1500 g surviving to hospital discharge was enrolled. Group 1 consisted of 49 infants 1000 to 1499 g who required mechanical ventilation; group 2 consisted of 39 infants 1000 to 1499 g who did not require mechanical ventilation; and group 3 consisted of 25 infants < 1000 g (such infants are not routinely ventilated). Growth and neurological status were recorded at follow-up visits at 3, 6, and 12 months' corrected age and the infants were evaluated further using the Bayley scales of infant development between 12 and 18 months. RESULTS: Fifteen infants died during the period between hospital discharge and 1 year corrected age, and 12 others were lost to follow-up. Although some catch-up growth was noted in the early months, all group means for weight and length were below the 25th percentile at 1 year. Cerebral palsy was diagnosed in nine infants (8 from group 1). Periventricular leukomalacia and/or porencephaly was diagnosed in eight of the nine infants during their initial hospital stay and was also the strongest negative predictor of the Bayley scores. Higher maternal education and better intrauterine growth were associated with higher Bayley scores. CONCLUSIONS: Mortality after hospital discharge in this study cohort was extremely high. However, despite marked differences in socioeconomic conditions and tertiary care facilities, the handicap rates were comparable with recent studies from developed countries, and some of the predictors of handicap, eg, periventricular leukomalacia and porencephaly, were also similar.

Effects of suboptimal intra-uterine growth on preterm infants between 30 and 32 weeks' gestation.

OBJECTIVE: To investigate the affects of suboptimal intra-uterine growth on the outcome of low-birth-weight (LBW) infants. DESIGN: Prospective observational study. SETTING: Neonatal unit of a tertiary care hospital. PATIENTS: A total of 104 LBW infants with a gestation of 30-32 weeks were selected from a larger cohort that had previously been studied to ascertain the prevalence of respiratory distress syndrome (RDS) and periventricular-intraventricular haemorrhage (PV-IVH). OUTCOME MEASURES: Multivariate analysis was used to examine the association between RDS, PV-IVH and death, and the adequacy of intra-uterine growth. RESULTS: Infants with a higher birth weight ratio or birth weight > or = 25th percentile had an increased risk of developing RDS, particularly where ventilatory support was required. However, PV-IVH was associated with immediate perinatal events and not with intra-uterine growth. Mortality was not affected by intra-uterine growth, since those < 25th percentile. In spite of being at lower risk for RDS, showed a trend towards more infection-related deaths. CONCLUSIONS: The 'intra-uterine stress' experienced by infants with suboptimal intra-uterine growth appears to protect partially against RDS, but confers no overall advantage in terms of survival.

Prenatal diagnosis of fetal disseminated intravascular coagulation associated with umbilical cord arteriovenous malformation.

BACKGROUND: Congenital disseminated intravascular coagulation (DIC) has been reported in a variety of clinical settings, but to our knowledge, it has never been documented before birth. We describe prenatal identification of an umbilical cord vascular tumor and echogenic foci in the fetal liver leading to the diagnosis of fetal DIC by funipuncture. CASE: A large vascular tumor of the umbilical cord was identified using prenatal sonography. At 31 weeks' gestation, echogenic areas, which were thought to represent infarcts or thrombi, were seen in the liver. When funipuncture revealed florid fetal DIC, delivery was accomplished by cesarean to prevent intracranial bleeding. Pathologic examination of the umbilical cord tumor showed it to be a large arteriovenous malformation. CONCLUSION: Arteriovenous malformations may cause fetal coagulopathy. This case illustrates that funipuncture may be used to diagnose this condition and that timely cesarean delivery may contribute to a favorable outcome.

Early-onset respiratory failure caused by severe congenital neuromuscular disease.

Two unrelated infants with low Apgar scores, pneumothoraces, and severe pulmonary hypertension were treated with extracorporeal membrane oxygenation while receiving chemical sedation and neuromuscular paralysis. After decannulation from extracorporeal membrane oxygenation, hypotonia and hypoventilation persisted. Neurologic evaluation confirmed that both infants had a congenital myopathy.

Prevalence of hyaline membrane disease in black and white low-birth-weight infants.

Previous studies in South Africa and elsewhere have suggested that there are ethnic differences in the prevalence of hyaline membrane disease (HMD). This study compared the prevalence of HMD between black and white infants with birth weights of 1,000-1,749 g. A cohort of black and one of white low-birth-weight infants were enrolled at Baragwanath and Johannesburg Hospitals respectively. Black infants were found to have a higher rate of intra-uterine growth retardation. When compared according to either birth weight or gestational age categories, black infants had a significantly lower prevalence of HMD. For example, between 29 and 34 weeks' gestation 36.2% of black and 62.5% of white infants developed HMD (P < 0.001). The reasons for these differences are not clear, however, and require further study.

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.

Autoradiography of L-[3H]aspartate binding sites.

The distribution, pharmacology and binding properties of L-[3H]aspartate were determined in sections from rat brain. No binding was detected in the absence of sodium ions. With the addition of sodium ions to the incubation medium, binding was found to be NMDA, AMPA and CNQX insensitive, but was potently inhibited by threo-beta-hydroxyaspartate, D-aspartate and L-2,4 trans-pyrrolidine dicarboxylate; compounds which have been shown to be specific inhibitors of the sodium-dependent EAA transporter. Autoradiography of L-[3H]aspartate closely resembled the pattern of sodium-dependent D-[3H]aspartate binding. Cerebellar binding showed higher affinity and maximal levels of binding than forebrain, consistent with reports of heterogeneous populations of sodium-dependent EAA binding sites. These results suggest that under these conditions, L-[3H]aspartate specifically labels the sodium-dependent EAA transporter.