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1.  Size for gestational age at birth: impact on risk for sudden infant death and other causes of death, USA 2002 
Background
Small for gestational age (SGA) infants have been reported to be at higher risk for sudden infant death syndrome (SIDS).
Objective
To compare the risk of SIDS among SGA and large for gestational age (LGA) infants with that of death from other causes of sudden unexpected deaths in infancy (SUDI) and the residual “other” causes of infant death.
Methods
The 2002 US period infant birth and death certificate linked file was used to identify infant deaths classified as SIDS (ICD‐10 code R95), SUDI (ICD‐10 codes R00‐Y84 excluding R95) or all other residual codes. The 2002 race and sex‐specific birth cohorts were used to generate the 10th and 90th percentiles of birth weight for each gestational age week from 24 to 42 weeks' gestation. Demographic variables previously identified as associated with SIDS were used in multiple logistic regression equations to determine the risk for death among SGA and LGA infants (birth weight <10th percentile and >90th percentile, respectively) independent of other potentially confounding variables.
Results
Complete data on 1956 SIDS deaths, 2012 SUDI, and 11 592 other deaths were available. The adjusted OR for SIDS, SUDI and “other” causes for SGA infants was 1.65 (95% CI 1.47 to 1.85), 1.78 (1.59 to 2.00) and 4.68 (4.49 to 4.88), respectively. The adjusted OR for LGA infants was reduced for SIDS (0.73 (0.60 to 0.89)), SUDI (0.81 (0.68 to 0.98)) and “other” (0.42 (0.38 to 0.46)).
Conclusion
Although SGA infants seem to be at slightly increased risk for SIDS or SUDI their risk for “other” residual causes is about 2.5 times higher. LGA infants seem to be at reduced risk of mortality for all causes. The mechanisms by which restricted intrauterine growth increases risk of mortality and excessive intrauterine growth offers protective effects are uncertain.
doi:10.1136/adc.2006.107094
PMCID: PMC2675379  PMID: 17314115
3.  Towards rational management of the patent ductus arteriosus: the need for disease staging 
Perspective on the review by Bose and Laughon (see page 498)
doi:10.1136/adc.2007.118117
PMCID: PMC2675381  PMID: 17951547
ductal ligation; indometacin; patent ductus arteriosus; staging
4.  A good idea that doesnt work the Parent Baby Interaction Programme 
Perspective on the paper by Glazebrook et alsee page 438
PMCID: PMC2675382  PMID: 17951548
interaction; parental stress; preterm infant; very premature birth
5.  Small for gestational age infants and sudden infant death syndrome: a confluence of complex conditions 
Perspective on the paper by Malloy (see page 473)
doi:10.1136/adc.2006.112243
PMCID: PMC2675383  PMID: 17951549
6.  Use of umbilical cord blood gas analysis in the assessment of the newborn 
Analysis of paired arterial and venous specimens can give insights into the aetiology of acidosis in the newborn
doi:10.1136/adc.2006.099846
PMCID: PMC2675384  PMID: 17951550
7.  Neurology of congenital heart disease: insight from brain imaging 
Understanding of the specific pathophysiology of acquired brain injury in infants with CHD will help optimise treatment and brain protection strategies
doi:10.1136/adc.2006.108845
PMCID: PMC2675385  PMID: 17848505
8.  Randomised trial of a parenting intervention during neonatal intensive care 
Objective
To evaluate the influence of parenting intervention on maternal responsiveness and infant neurobehavioural development following a very premature birth.
Design
Cluster‐randomised controlled trial, with a crossover design and three‐month washout period.
Setting
Six neonatal intensive care units.
Patients
Infants born <32 weeks' gestation.
Intervention
The Parent Baby Interaction Programme (PBIP) is a supportive, educational intervention delivered by research nurses in the neonatal intensive care unit, with optional home follow‐up for up to six weeks after discharge.
Main outcome measures
Parenting stress at 3 months adjusted age, as measured by the Parenting Stress Index (PSI). Other outcomes included the Neurobehavioural Assessment of the Preterm Infant (NAPI) and maternal interaction as assessed by the Nursing Child Assessment Teaching Scale (NCATS) and the responsivity subscale for Home Observation for Measurement of the Environment (HOME).
Results
112 infants were recruited in the intervention phases and 121 in the control phases. Mean standardised NAPI scores at 35 weeks did not differ between the PBIP and control groups. Both groups had low but similar NCATS caregiver scores before discharge (36.6 in the PBIP group and 37.4 in control, adjusted mean difference −0.7, 95% CI −2.7 to 1.4). At three months, adjusted age mean PSI scores for the PBIP group were 71.9 compared with 67.1 for controls (adjusted mean difference 3.8, 95% CI −4.7 to 12.4). NCATS scores and HOME responsivity scores were similarly distributed between the groups.
Conclusion
This early, nurse‐delivered, parent‐focused interaction programme intervention had no measurable effects on short‐term infant neurobehavioural function, mother–child interaction or parenting stresses.
doi:10.1136/adc.2006.103135
PMCID: PMC2675386  PMID: 17301114
cluster randomised trial; interaction; parental stress; preterm infant; very premature birth
9.  Cardiorespiratory effects of changes in end expiratory pressure in ventilated newborns 
Background
Positive pressure ventilation in premature infants can improve oxygenation but may diminish cerebral blood flow and cardiac output. Low superior vena cava (SVC) flow increases risk of intraventricular haemorrhage, and higher mean airway pressure is associated with low SVC flow. Whether this is a direct effect of positive pressure ventilation or a reflection of severity of lung disease is not known. This study aimed to determine if positive end expiratory pressure (PEEP) in ventilated newborns could be increased without clinically relevant cardiorespiratory changes.
Method
Ventilated newborns were studied before and 10 min after increasing PEEP (5 cm H2O to 8 cmH2O) and again when PEEP returned to baseline. Echocardiographic and respiratory function measurements were collected during the intervention.
Results
In 50 infants, increased PEEP was associated with a non‐significant difference in mean SVC flow of −5 ml/kg/min (95% CI −12 to 3 ml/kg/min) but a significant reduction in right ventricular output of 17 ml/kg/min (95% CI 5 to 28 ml/kg/min). The increase in lung compliance was non‐significant (median difference 0.02 ml/cmH2O/kg) and the decrease in lung resistance (18 cmH2O/l/s; 95% CI 10 to 26 cm H2O/l/s) was significant. Changes (%) in lung compliance and SVC flow, when corrected for Paco2, were positively associated (regression coefficient 0.4%; 95% CI 0.2% to 0.6%).
Conclusion
A short‐term increase in PEEP does not lead to significant changes in systemic blood flow, although 36% of infants in the present study had clinically important changes in flow (±25%). The intervention can improve dynamic lung function, especially airway resistance. Improvements in compliance tend to be associated with improvements in blood flow.
doi:10.1136/adc.2006.103929
PMCID: PMC2675387  PMID: 17460022
11.  Nosocomial infection in small for gestational age newborns with birth weight <1500 g: a multicentre analysis 
Objective
To investigate whether preterm newborns who are small for gestational age are at increased risk of nosocomial infections and necrotising enterocolitis.
Design, setting and subjects
The German national surveillance system for nosocomial infection in very low birthweight infants uses the US Centers for Disease Control and Prevention criteria. 2918 newborns (24–28 weeks), born between 2000 and 2004, were selected after application of predefined inclusion criteria to ensure similar proportions of small and appropriate weight for gestational age newborns across gestational age groups.
Main outcome measures
The outcome criterion was at least one episode of nosocomial sepsis, pneumonia or necrotising enterocolitis. Adjusted odds ratios and corresponding 95% CIs were calculated based on general estimating equation models.
Results
The study population consisted of 13% (n = 392) small and 87% (n = 2526) appropriate weight for gestational age infants. 33% (n = 950) of the infants experienced at least one episode of sepsis: 42% (n = 163) of small and 31% (n = 787) of appropriate weight for gestational age newborns (adjusted OR 1.41, 95% CI 1.05 to 1.89). Pneumonia was diagnosed in 6% (n = 171) of infants: 8.4% (n = 33) of small and 5.5% (n = 138) of appropriate weight for gestational age newborns (adjusted OR 1.57, 95% CI 1.19 to 5.57). Necrotising enterocolitis was documented in 5.2% (n = 152) of infants: 7.1% (n = 28) of small and 4.9% of (n = 124) appropriate weight for gestational age newborns (adjusted OR 1.20, 95% confidence interval 0.75 to 1.94).
Conclusions
Growth‐retarded preterm infants seem to be at increased risk of nosocomial infection, irrespective of the responsible pathogen. Future immunological research should elucidate potential causal associations.
doi:10.1136/adc.2006.114504
PMCID: PMC2675389  PMID: 17460021
12.  Selective fluconazole prophylaxis in high‐risk babies to reduce invasive fungal infection 
Objectives
To evaluate the impact of selective fluconazole prophylaxis on incidence of invasive fungal infection and emergence of fluconazole resistance in neonatal intensive care.
Design
Retrospective study of very low birthweight (VLBW) babies (<1500 g birth weight) admitted to a neonatal intensive care unit (NICU) in the period 1 year before and after the implementation of an antifungal prophylaxis guideline.
Patients
VLBW babies with an additional risk factor: colonisation of Candida species from surface sites with a central venous catheter; third generation cephalosporin treatment; or total duration of antibiotic treatment >10 days.
Fluconazole protocol
Fluconazole 6 mg/kg for 3 weeks. Dose interval is every 72 h during the first 2 weeks of life. Thereafter, dose interval is reduced to every 48 h until 3 weeks old when daily fluconazole is given. Fluconazole is administered orally when enteral feeding achieved.
Results
121 and 107 VLBW babies were admitted to the NICU in the year before and after the guideline was implemented, respectively. Data were available in 110 and 102 charts. 33/110 and 31/102 babies were eligible for fluconazole prophylaxis in the period before and after guideline implementation. 6/33 babies eligible for prophylaxis developed culture proven Candida sepsis before compared with no (0/31) babies after the guideline was implemented (p = 0.03). One baby (1/31) did develop probable Candida sepsis in the post guideline implementation period. During both study periods all Candida isolates remained fully susceptible to fluconazole.
Conclusions
Selective antifungal prophylaxis has reduced invasive fungal sepsis in one NICU without evidence of fluconazole resistance emerging.
doi:10.1136/adc.2006.094359
PMCID: PMC2675390  PMID: 17460023
14.  Chest computed tomography findings in bronchopulmonary dysplasia and correlation with lung function 
Objective
With changes in the predominant pathogenic factors in the new form of bronchopulmonary dysplasia (BPD), a different pattern of CT findings may be expected. This study aimed to (1) describe CT findings in infants with BPD and (2) correlate the CT findings with lung function abnormalities.
Study design and method
Retrospective review of 41 very low birthweight infants with BPD, who were referred for pulmonary investigations at between 10 and 20 months after birth because of persistent respiratory symptoms, and underwent CT and lung function tests.
Results
None of the infants had normal CT findings. The most frequent abnormalities were hyperlucent areas (n = 36; 88%), linear opacities (n = 39; 95%), and triangular subpleural opacities (n = 26; 63%). Bronchiectasis was not seen. None of the CT abnormalities correlated with the maximum expiratory flow at functional residual capacity (VmaxFRC). In contrast, increased number of subpleural opacities and limited linear opacities were associated with low FRC and longer duration of neonatal oxygen exposure. The numbers of triangular subpleural opacities also correlated with duration of mechanical ventilation.
Conclusions
Despite advances in neonatal care, many CT findings in infants with BPD are similar to those observed in the pre‐surfactant era, and are still associated with duration of supplemental oxygen and mechanical ventilation. The absence of bronchial involvement in the present study was the most striking difference from previous studies.
doi:10.1136/adc.2006.111765
PMCID: PMC2675392  PMID: 17379740
16.  Clinical assessment of infant colour at delivery 
Objective
Use of video recordings of newborn infants to determine: (1) if clinicians agreed whether infants were pink; and (2) the pulse oximeter oxygen saturation (Spo2) at which infants first looked pink.
Methods
Selected clips from video recordings of infants taken immediately after delivery were shown to medical and nursing staff. The infants received varying degrees of resuscitation (including none) and were monitored with pulse oximetry. The oximeter readings were obscured to observers but known to the investigators. A timer was visible and the sound was inaudible. The observers were asked to indicate whether each infant was pink at the beginning, became pink during the clip, or was never pink. If adjudged to turn pink during the clip, observers recorded the time this occurred and the corresponding Spo2 was determined.
Results
27 clinicians assessed videos of 20 infants (mean (SD) gestation 31(4) weeks). One infant (5%) was perceived to be pink by all observers. The number of clinicians who thought each of the remaining 19 infants were never pink varied from 1 (4%) to 22 (81%). Observers determined the 10 infants with a maximum Spo2 ⩾95% never pink on 17% (46/270) of occasions. The Spo2 at which individual infants were perceived to turn pink varied from 10% to 100%.
Conclusion
Among clinicians observing the same videos there was disagreement about whether newborn infants looked pink with wide variation in the Spo2 when they were considered to become pink.
doi:10.1136/adc.2007.120634
PMCID: PMC2675394  PMID: 17613535
infant; newborn; resuscitation; colour; pulse oximetry
18.  Car seat test for preterm infants: comparison with polysomnography 
Objectives
To monitor preterm infants in a cot and a car seat and compare an observed car seat trial with polysomnography (PSG).
Design
Non‐randomised controlled trial.
Setting
Regional neonatal unit.
Patients
Preterm infants before discharge.
Interventions
Nap PSG respiratory and sleep variables were measured including gastro‐oesophageal pH. Nurse observations included respiratory distress, apnoea measured by apnoea alarm, oxygen saturation and heart rate. Infants were studied supine in a cot and then in a car seat. Nursing observations were compared with PSG during the car seat trial only. Criteria for failure of the PSG and observed tests were predefined.
Main outcome measures
Difference in respiratory instability between cot and car seat. Concurrence regarding failure of the car seat trial between nurse‐observed data and PSG.
Results
20 infants (median gestation 33 weeks (range 28–35 weeks; median postmenstrual age (PMA) at study 36.5 weeks (range 35–38 weeks)) were studied. There were sufficient car seat data on 18 infants for comparison. There were fewer central apnoeas and arousals in the cot than the car seat (p = 0.047 and p = 0.024, respectively). Airway obstruction was not more common in the car seat. Younger PMA at time of study predicted failure in both car seat (p = 0.022) and cot (p = 0.022). The nurse‐observed test had low sensitivity for predicting PSG failure but more accurately predicted airway obstruction on PSG.
Conclusions
Immature infants exhibit respiratory instability in cots and car seats. A car seat test does not accurately detect all adverse events during sleep in the seat.
doi:10.1136/adc.2006.109488
PMCID: PMC2675396  PMID: 17412748
20.  Prevalence and pathogenesis of congenital anomalies in cerebral palsy 
Background
It has been hypothesised that cerebral palsy (CP) and other congenital anomalies are attributable to feto–fetal transfusion problems in a monochorionic multiple gestation. Thus more than one organ could be compromised leading to the coexistence of two or more anomalies in a fetus. Such anomalies in a singleton birth may be attributable to early demise of the co‐conceptus as a vanishing twin.
Aim
To determine whether the coexistence of congenital anomalies and CP is greater than a chance finding by comparing the prevalence of congenital anomalies in children with CP with that in the general population of children.
Methods
A population‐based register of children with CP born in 1966–1991 in the counties of Merseyside and Cheshire, UK, comprised the index population. Coexisting congenital anomalies were recorded. For comparison the population prevalence of congenital anomalies was obtained from eight congenital malformation registers in the UK.
Results
Children with CP were found to have highly significant increases in risk for microcephaly, isolated hydrocephaly, congenital anomalies of the eye, congenital cardiac anomalies, cleft lip and/or palate and congenital dislocation of the hips and talipes (p<0.001) and atresias of the oesophagus (p<0.001) and intestines (p<0.01). The relative risks ranged from 3.1 (95% CI 1.9 to 4.8; p<0.001) for congenital malformations of the cardiac septa to 116.09 (95% CI 84.0 to 162.3; p<0.001) for microcephaly.
Conclusions
Congenital anomalies in children with CP are found much more frequently than expected by chance. A common pathogenic mechanism may account for the coexistence of disparate congenital anomalies. A hypothesis is proposed for such a common pathogenic mechanism.
doi:10.1136/adc.2006.107375
PMCID: PMC2675398  PMID: 17428819
21.  Fetal growth restriction: relation to growth and obesity at the age of 9 years 
Objective
To assess growth patterns of 9‐year‐old children, some of whom had intrauterine growth restriction (IUGR).
Method
75 9‐year‐old children (41 were IUGR infants) were weighed and measured at birth, at 1 year, at 2 years and at 9 years of age. Using general linear models for continuous data, changes in weight z scores were used to quantify growth rate between birth and 9 years of age.
Results
IUGR children were smaller at birth (weight z score –2.1 v 0.2 in normal children; p<0.001) but showed a greater increase in their weight between birth and 9 years (change of weight z score 1.5 v 0.4 in normal children; p = 0.001). At the age of 9 years the weight, height and body mass index (BMI) z scores were lower in IUGR children than the control children (weight z score –0.4 v 0.6, respectively; p<0.001, height z score –0.5 v 0, respectively; p = 0.002, BMI z score −0.2 v 0.7, respectively; p = 0.002). The predictors of these differences were IUGR, birth weight and maternal and paternal heights.
Conclusion
IUGR infants grow faster but remain shorter and lighter than their normal counterparts—that is, they fail to fully catch up by 9 years of age.
doi:10.1136/adc.2006.109728
PMCID: PMC2675399  PMID: 17301112
child; intrauterine growth restriction; postnatal growth; catch‐up growth
23.  Effect of parental smoking on cotinine levels in newborns 
Background
Smoking is a major risk factor for cot death. Many infants smoke passively as a result of parental smoking. This paper reports on infants exposed to a smoking environment and how they accumulate metabolites of cigarette smoke, such as cotinine, which may be physiologically harmful.
Aim
To assess cotinine levels in infants of smoking parents.
Method
Cotinine excretion in urine was assessed in 104 infants, of whom 71 had smoking parents and 33 had non‐smoking parents. All cotinine levels were measured at approximately 12 weeks of age. The subjects were selected from a database of infants in developmental physiological studies which assessed the impact of various factors on early postnatal development.
Results
On average babies with at least one parent who was a current cigarette smoker excreted 5.58 (95% CI 3.4 to 9.5) times as much cotinine in the urine as did the babies of non‐smoking parents. Maternal smoking was the largest contributing factor. Co‐sleeping (p = 0.037) and the minimum room temperature (p = 0.028) were significant contributory factors.
Conclusion
Infants from smoking households accumulate cotinine, a metabolite of nicotine, which may have a detrimental effect on the cardiorespiratory system.
doi:10.1136/adc.2006.108506
PMCID: PMC2675401  PMID: 17580319
passive smoking; infant; cotinine; nicotine; SIDS
24.  Zinc, copper, selenium and manganese blood levels in preterm infants 
Objective
To measure the zinc, copper, selenium and manganese blood levels in a cohort of 68 preterm infants, and to establish any associations with growth and/or dietary intake.
Design
Blood samples were collected at an infant's expected date of delivery (term) and 6 months later. Serum zinc, plasma copper and whole blood manganese were analysed by atomic absorption spectrometry, plasma and red cell selenium were determined by mass spectrometry. Growth and dietary intake determinations have been previously published.
Setting
Hampshire, England.
Results
Mean (SD) birth weight of the infants was 1.47 (0.434) kg and mean gestation was 31.4 (2.9) weeks. Mean blood levels at term and 6 months were: serum zinc 12.0 (2.6) µmol/l and 13.8 (2.5) µmol/l; plasma copper 10.1 (2.6) µmol/l and 19.2 (3.6) µmol/l; plasma selenium 0.49 (0.15) µmol/l and 0.72 (0.14) µmol/l; red blood cell selenium 1.68 (0.40) µmol/l and 1.33 (0.19) µmol/l; and blood manganese 320 (189) nmol/l and 211 (68) nmol/l, respectively. There were no significant associations between levels of zinc and copper and dietary intakes of those nutrients at either age (dietary intakes of selenium and manganese were not determined). Only copper levels at term were significantly associated (r = 0.31; p = 0.05) with a growth parameter (head circumference).
Conclusion
These results provide new information about trace element status in this vulnerable population.
doi:10.1136/adc.2006.107755
PMCID: PMC2675402  PMID: 17468128

Results 1-25 (2178)