There are early gender-related differences in need for ventilatory and circulatory support that may contribute to the worse long-term outcome in prematurely born male infants.

The fetal gender seems to affect the occurrence of pre-eclampsia, and possibly also polyhydramnios. The finding could be due to an increased risk for spontaneous abortions in pregnancies with male fetuses, but could also be associated with the etiology of these conditions. Evaluation of antenatal pregnancy complications from a fetal/newborn gender perspective may contribute to new insights regarding their pathophysiological mechanisms.

Newborn boys have higher morbidity and mortality than girls. Several studies have shown that male newborn sex is an independent risk factor for adverse outcome. The specific mechanisms leading to the increased risks for newborn boys are not known. However, several sex-specific reactions and physiologic responses have been described in both the fetus and newborn infants. Some of these differences persist during childhood; although later other sex and gender-specific differences become more important. Recently, the research aiming at explaining the vulnerability in male infants has been intensified. Experimental data from newborn animals have shown that many sex differences can be explained by differences in hormonal function and stress responses. However, if these findings apply to humans as well is not yet known. The aim of this paper is to review literature on very early sex-specific differences and shed some light on the increased risks for male fetuses and newborn boys. ß 2004 WPMH GmbH. Published by Elsevier Ireland Ltd.

Background: Previous studies indicate that there may be infant gender differences in cytokine expression associated with differences in neonatal morbidity. Objective: We tested the hypothesis that umbilical cord interleukin-1 receptor antagonist (IL-1ra) correlates with infant gender and neonatal outcome in preterm infants. Study Design: IL-1ra was measured in cord blood taken from 58 preterm infants (33 males, 25 females) with gestational age less than 32 weeks. Receiver operating characteristics (ROC) curve were used for identifying IL-1ra values with high sensitivity and specificity for neonatal morbidity and adverse outcome, i.e., death or survival with severe intraventricular hemorrhage or periventricular leukomalacia. Results: In the female infants, but not the male infants, cord IL-1ra values correlated with postnatal depression, expressed as Apgar scores at 1 min (correlation coefficient, r_s; p value: –0.542; 0.005), 5 min (–0.571; 0.018), and 10 min (–0.442; 0.035); and postnatal age at intubation (–0.799; 0.001). The ROC area under the curve (AUC) was 0.735 for adverse outcome (p = 0.013), and 0.683 for bronchopulmonary dysplasia (p = 0.021) when all infants were included. However, there was a significant gender difference in the ROC curve for adverse outcome (p = 0.026), with AUC 0.640 (p = 0.240) in males and AUC 0.929 (p = 0.008) in females. Above a chosen cutoff at 13,500 ng/l for IL-1ra cord the sensitivity and specificity for predicting adverse outcome was 100 and 81%, respectively in females versus 50 and 84% in males. Conclusion: Increased levels of cord IL-1ra levels are associated with neonatal morbidity and adverse outcome in preterm infants. Comparable levels of IL-1ra have different predictive value depending on infant gender.

Background: Corticosteroids (CS) given after birth in ventilator dependent infants facilitate extubation and reduce the rate of chronic lung disease, whether they are given early, moderately early, or later in the newborn period. However, recent controversy about adverse long-term effects of corticosteroids on the brain have led to a decrease in the use of CS, or to prescribing of smaller doses than shown to work in the existing randomised trials. The DART study was an international multicentre randomised controlled trial that had as its main aim to assess the effects of low-dose dexamethasone on long-term survival free of major neurologic disability. However, enrollment had to stop when recruitment fell to a rate that was too low to complete the study. A secondary aim of the DART study was to determine acute effects of low dose dexamethasone.Aim: To determine the acute respiratory effects of low-dose dexamethasone, given after the first week of life, in ventilator-dependent very preterm/extremely low birthweight (ELBW) infants.Methods: Very preterm (Ͻ28 weeks) or ELBW (birthweight Ͻ1000g) infants who were ventilator dependent after the first week of life and in whom the clinician considered corticosteroids were a treatment option were eligible for the study. After informed consent, infants were randomly allocated to receive either a 10-day tapering course of dexamethasone (0.89 mg/kg total over 10-days) or saline placebo. Random allocation was balanced within individual participating centres. Data were recorded on demographic variables, and ventilator settings at baseline and daily through the 10 days of treatment. Oxygen requirements at 36 weeks post-menstrual age were recorded.Results: A total of 70 infants were recruited from 11 centres. The infants were comparable at baseline, with overall mean gestational ages of 24.9 (SD 1.3) weeks, birthweights of 701 (140) g, and postnatal ages of 24.6 (12.6) days. More infants were successfully extubated by 10 days in the dexamethasone group than in the controls (odds ratio 11.2, 95% CI 2.9, 51.6; PϽ0.001). The mortality rate appeared lower in the dexamethasone group but the comparison lacked precision (OR 0.52, 95% CI 0.10, 2.31; Pϭ0.32). There was little evidence for a reduction in the rate of oxygen dependency at 36 weeks (OR 0.58, 95% CI 0.08, 3.32; Pϭ0.71).Conclusions: Low dose dexamethasone clearly facilitates extubation in ventilator-dependent very preterm/ ELBW infants after the first week of life. EFFICACY OF A MULTI-DISCIPLINARY THERAPY PROGRAMME FOR MORBIDLY OBESE CHILDREN AND ADOLESCENTS AFTER A MEAN DURATION OF 7 MONTHS TREATMENT S Drennig, A Bartsch, S Dietrich, K Widhalm Department of Pediatrics,University of Vienna, Division Nutrition and Metabolism, Vienna, AustriaBackground/Aims: Concering the treatment of morbid obesity in childhood there still do exist few evaluated treatment programmes. In Germany only 49% of 119 investigated outpatient treatment programmes work with the evidential successful combination of psychological, nutrition-oriented and phy...