Mineral status of premature infants in early life and linear growth at age 3.

BACKGROUND: Preterm infants are at significant risk of reduced bone mineral content and subsequent bone disease (metabolic bone disease of prematurity, MBDP). MBDP is frequently found in very low-birthweight (VLBW) infants, but long-term height prognosis is not well known. METHODS: VLBW infants from two major neonatal intensive care units were studied. Medical records were reviewed. A total of 143 subjects were analyzed after excluding subjects who died, or who had severe complications that could affect linear growth, Silver-Russell syndrome, severe cholestasis, and/or chromosomal abnormality. The relationship between MBDP and height at age 3 was investigated. RESULTS: Height standard deviation score (SDS) at age 3 negatively correlated with peak serum alkaline phosphatase (ALP) activity in early life (r = -0.30, P = 0.0003) and positively correlated with serum phosphorus (P) at peak ALP (r = 0.33, P = 0.0002). In addition, serum P independently affected height SDS at 3 years of age (ß = 0.19, P = 0.018), and was significantly different between infants with and without catch-up growth in height (difference: 0.23 mmol/L, 95%CI: 0.09-0.36, P = 0.0010). CONCLUSIONS: MBDP, particularly hypophosphatemia in the early period of life, is associated with linear growth until 3 years of age in VLBW infants.

Effect of l-thyroxine supplementation on infants with transient hypothyroxinemia of prematurity at 18 months of corrected age: randomized clinical trial.

OBJECTIVE: Our objective was to evaluate effects of levothyroxine (l-T4) supplementation against neurodevelopmental outcomes at 18 months of corrected age in very-low-birth-weight (VLBW) infants with hypothyroxinemia but without elevated thyroid-stimulating hormone (TSH) concentration. METHODS: VLBW infants who had plasma TSH concentrations <10 µU/mL and free thyroxine (FT4) concentrations <0.8 ng/dL between 2 and 4 weeks of age were enrolled. They were randomly assigned to either the Treated (n=25) or Untreated group (n=45). The Treated group received l-T4 at a dose of 5 µg/kg/day. We compared growth and neurodevelopmental outcomes at 18 months of corrected age in the two groups. RESULTS: There were no significant differences in growth, the incidences of developmental delay, cerebral palsy, visual impairment, and hearing impairment in the two groups. CONCLUSIONS: In such infants, l-T4 supplementation at a dose of 5 µg/kg/day did not affect FT4 levels and showed no beneficial effect at 18 months of corrected age.

[Optimum timing of initial examination for retinopathy of prematurity].

OBJECTIVE: To determine when to begin examination for retinopathy of prematurity (ROP). METHODS: We retrospectively reviewed the medical records of 663 infants with birth weights of less than 1,500 g in Tokyo Metropolitan Bokutoh Hospital between June 1999 and March 2009, and investigated the timing of onset and initial treatment. In addition, we investigated visibility of fundus for infants of less than 27 weeks gestational age (GA). RESULTS: The mean GA was 28.7 weeks and the mean birth weight was 1,032.6 g. For infants of less than 27 weeks GA, the earliest onset was 29 weeks postmenstrual age (PMA) and the earliest initial treatment was performed at 30 weeks 0 days PMA. Regarding the visibility of the fundus, zone I could be seen for 50.8% of those infants receiving examination during the latter half of 29 weeks PMA and 71.7% of those infants receiving examination during the former half of 30 weeks. For the infants of a GA of 27 weeks or more, the earliest onset was 2 weeks chronologic age (CA) and the earliest initial treatment was performed at 3 weeks 3 days CA. CONCLUSIONS: The optimum timing of initial examination for ROP proved to be between the latter half of 29 weeks and 30 weeks 0 days PMA for infants of a GA of less than 27 weeks; and 3 weeks CA for the infants of a GA of 27 weeks or more.

Developmental characteristics of very low-birthweight infants at 18 months' corrected age according to birthweight.

BACKGROUND: The objective of the present study was to describe developmental profiles of very low-birthweight (VLBW) infants compared by birthweight, because those of infants with birthweight <750 g might be different from other VLBW infants. METHODS: VLBW infants from four medical centers were followed at each site with the same protocol at 18 months' corrected age. The protocol by the Society for the Study of Follow up for High-Risk Infants, which includes a standardized developmental test, the Kyoto Scale of Psychological Development (KSPD), was used. Five hundred and sixty-four VLBW infants without neurological or neurosensory impairment were divided into four groups using 250 g birthweight intervals and outcomes were compared between the four groups. RESULTS: Developmental characteristics of extremely low-birthweight infants (birthweight <750 g) in comparison with other VLBW infants were as follows: (i) more infants were judged clumsy in their fine motor skills; (ii) fewer were able to speak meaningful words although they were able to understand oral simple orders; (iii) developmental quotients (DQ) of KSPD was significantly lower; and (iv) more infants were judged as hyperactive. CONCLUSION: Developmental profiles of VLBW infants without major handicaps at 18 months' corrected age correlated significantly with their birthweight sequence. These results provide useful information on developmental outcomes of VLBW infants.

[Retinopathy of prematurity in extremely low birth weight infants: a Tokyo multicenter study].

OBJECTIVE: To investigate how the increase in survival rate in extremely low birth weight (a birth weight of 1,000 g or less) infants had affected the incidence of retinopathy of prematurity (ROP) and the frequency of laser treatment. METHODS: We retrospectively reviewed the medical records of 122 surviving premature infants with birthweights less than 1,000 g to determine the severity of ROP observed at 16 neonatal intensive care units in Tokyo between April and October 2002. RESULTS: The survival rate was 85.6%. The mean gestational age was 26.74 weeks and the mean birth weight was 782.25 g. One-hundred-and-five infants (86.1%) developed ROP, fifty (41.0%) received laser treatment, and six (4.9%) had retinal detachment. The median postmenstrual age (gestational age at birth plus chronological age in weeks, PMA) at the onset of ROP was 32.5 weeks, and the first laser treatment was performed at the median PMA of 35.7 weeks. CONCLUSIONS: In these extremely low birth weight infants, there was an increase in the survival rate and in the incidence of severe ROP that progressed to the stage that required treatment.

Congenital prepubic sinus: is it a residual cloacal membrane and umbilicophallic groove?

We report two cases of congenital prepubic sinus (CPS) and discuss theories about its embryology and the etiology of its variants to improve the global understanding of this uncommon anomaly. Based on a review of the scant number of reported cases and our own experience, we postulate that CPS may be caused by a residual cloacal membrane and umbilicophallic groove and that its depth may determine the position of its ending.

Ilio-psoas abscess caused by methicillin-resistant Staphylococcus aureus (MRSA): a rare but potentially dangerous condition in neonates.

We report a case of methicillin-resistant Staphylococcus aureus ilio-psoas abscess (IPA) in a neonate. This case has clinical importance because this neonate had toxic shock syndrome-like exanthematous disease, known as NTED, before developing IPA. A high index of suspicion is required for IPA if a neonate presents with limb disuse and fever of unknown origin. Our case required surgical drainage, since ultrasound-guided percutaneous needle aspiration failed.