Cranial ultrasound examinations were performed on 533 infants of between 48 and 96 hours of age to establish the range of ventricular size in neonates of different gestational ages in whom there was no evidence of intraventricular hemorrhage or neural tube defects. It was found that ventricular size did not vary in infants with gestational age of 26 weeks or more. Only 15 (2.8 per cent) neonates had a ventricular width of greater than 3 mm. Of these 15 infants, 13 were re-examined within the first year of life and found to be neurologically and developmentally normal.

6 Lubin JH, Burns PE, Blot WJ, et al. Risk factors for breast cancer in women in northern Alberta, Canada, as related to age at diagnosis. J7NCI 1982;68: 211-7. 7 Janerich DT, Hoff MB. Evidence for a cross-over in breast cancer risk factors. confounding variables by logistic function regression the risk of dying for those transferred remained significantly higher than that for infants who remained (relative odds=4-6, 95% confidence interval 1-8 to 12-1).As the requirement for neonatal intensive care is episodic and unpredictable more flexibility has to be built into the perinatal health care system to enable preterm infants delivered in tertiary perinatal centres to be cared for where they are born.

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Aim-To determine if the intestinal isoenzymes of alkaline phosphatase (ALP) are biochemical markers of bowel necrosis in neonates. Methods-Plasma ALP isoenzymes were measured in 22 babies with bowel necrosis, histologically confirmed, and in 22 matched controls. The isoenzymes were also measured in 16 infants with signs of necrotising enterocolitis, who recovered without histological confirmation of bowel necrosis. The isoenzymes were separated by polyacrylamide gel electrophoresis. Auxiliary tests for identification included neuraminidase digestion and treatment with monoclonal and polyclonal antiplacental antibodies. Results-Intestinal ALP was detected in 16 infants with bowel necrosis-13 had fetal intestinal ALP (FI-ALP) and three had adult intestinal ALP (AI-ALP). FI-ALP was detected in nine of the controls. In the babies with bowel necrosis intestinal ALP was found over all gestations, but in the controls only in those less than 34 weeks. The percentages of total ALP activity due to intestinal ALP were significantly higher in those with bowel necrosis compared with matched controls (p = 0.028). In babies of all gestations diagnostic sensitivity for the presence of intestinal ALP as a marker of bowel necrosis was 73% and diagnostic specificity 590/o. In babies greater than 34 weeks' gestation, diagnostic sensitivity fell to 60% but the test became completely specific. In two babies FI-ALP increased from zeroltrace to high activity coincident with the episode of bowel necrosis. In 16 babies with signs of necrotising enterocolitis but unconfirmed bowel necrosis FI-ALP was detected in four. Conclusion-Intestinal ALP seems to be released into the circulation in some babies with bowel necrosis, but its detection does not have the diagnostic sensitivity and specificity to be a reliable biochemical marker of the condition.

Cranial ultrasounds were performed on 218 (96%) of 227 liveborn infants of birthweight 500‐1500 g delivered in the Royal Women's Hospital, Melbourne, Australia, in an 18‐month period concluding in March 1982. Seventy‐two (31.7%) of the children died; 28 children (38.9%) had cerebroventricular haemorrhage, 35 (48.6%) showed no bleeding and there were nine (12.5%) with no data. Paired necropsy and ultrasound data were congruent in 22 (88%) of 25 children. One hundred and forty‐eight (95.5%) of 155 survivors were seen at 2 years of age. Forty‐one (28%) had cerebroventricular haemorrhage; nine children (6%) had both ventricular dilatation and haemorrhage and two had ventricular dilatation alone. Apart from a marginal advance in gestation and higher number of immigrant and less educated mothers in children without cerebroventricular haemorrhage, all other perinatal, biographical and social variables between those with haemorrhage and those without were similar. The major handicap rate overall was 14.2% (21 patients). The children with cerebroventricular haemorrhage had a trend for greater prevalence of handicap and lower mean Bayley psychological scores. This was even more evident with ventricular dilatation being present. Of children with major handicap 57.1% (12/21) had normal serial ultrasound findings during their primary hospitalization. Major handicap occurred in 15% (3/20) of children with grade 1 haemorrhage, 23.5% (4/17) with grade 2 or 3 bleeds and 25% (1/4) of those with grade 4 haemorrhage. Laterality of cerebral palsy did not correlate with ultrasound findings. Ultrasound findings did not improve statistical prediction of deaths or major handicap.

SUMMARY Sequential real-time ultrasound examinations were performed in 174 neonates to determine the time of occurrence of cerebroventricular haemorrhage (CVH). Of Real-time ultrasound equipment has assumed an important role in the detection of intraventricular haemorrhage in preterm infants. Since there is no known risk ofthe procedure and minimal disturbance to the neonate during its use, we considered it could be employed serially to time the occurrence of cerebroventricular haemorrhages (CVH) (that is germinal layer or intraventricular haemorrhage). Subjects and methodsDuring a 12-month period all infants weighing less than 1500 g at birth, together with those exceeding this weight who had other risk factors-such as severe hyaline membrane disease requiring assisted ventilation-were examined using an ADR real-time ultrasound scanner with a 7 MHz linear array transducer. Examinations were performed as soon as possible after birth, repeated daily for 3 days, and then again at one week. The brain was examined using a series of oblique coronal sections through the anterior fontanelle by angling the transducer forwards then slowly rotating it backwards with the anterior fontanelle as the fulcrum. CVH was diagnosed when the appearance of echogenic blood clot was visible in, or immediately inferolateral to, the lateral ventricle. The extent of the haemorrhage in the anteroposterior direction was assessed by an oblique parasagittal scan. We had confirmed the accuracy of our technique previously by comparison with computerised tomography (CT) scans and necropsy results.' Results A total of 174 infants was studied. In 47 CVH was detected. Of the 124 infants of birthweight less than 1500 g, 38 (31°) developed CVH. Of the 16 infants of birthweight less than 1500 g who were outbom, 9 (56%) developed CVH (all these being present at the time of admission to our hospital), while haemorrhage occurred in 29 (27%) of the 108 very low birthweight infants born within the hospital. This difference was statistically significant (P = 0.04,

In comparison with a cohort of normal birth weight children, those of very low birth weight (<1501 g birth weight) had more wheezing illnesses and hospital readmissions for respiratory problems in the first 2 years of life; from 2 years to 8 years of age respiratory health was unrelated to birth weight. Lung function measurements at 8 years of age in very low birth weight children were similar to expected values; few children had severely abnormal lung function. On univariate analyses, forced vital capacity (FVC) and forced expired volume in 1 second (FEV1), but not flow rates, were lower in children who had survived bronchopulmonary dysplasia. However, the univariate analyses were misleading, because bronchopulmonary dysplasia occurred more frequently with lower birth weight, and lower birth weight in turn was strongly related to reduced FVC and FEV1. After adjusting for birth weight and other potential confounding variables, FVC and FEV1 were unrelated to bronchopulmonary dysplasia, and to neonatal ventilation. Flow rates were largely uninfluenced by perinatal events, but were reduced in children with asthma or recurrent bronchitis at 8 years of age. Passive smoking was unrelated to lung function at 8 years of age. However, the effects of passive or active smoking, or perinatal events, on respiratory function or health beyond 8 years of age in very low birth weight survivors remain to be determined.