SUMMARY Forty children who had had artificial ventilation during the neonatal period were studied at the age of 8-10 years with spirometry, the nitrogen washout test, bicycle exercise test, pulse oximetry, electrocardiogram, vectorcardiogram, and chest radiography. The median gestational age at birth was 29 weeks, and the median birth weight was 1310 g. Hyaline membrane disease was the indication for neonatal ventilation in 25 children. Bronchopulmonary dysplasia was diagnosed from radiographs in 11 infants (27%).Airway obstruction was observed in 10 of 11 children who had had bronchopulmonary dysplasia and in nine of 29 children who had not. After inhalation of terbutaline, the forced expiratory volume in one second (FEV1) was significantly increased. General hyperinflation was found in 16 of 17 children with abnormal chest radiographs (eight who had had bronchopulmonary dysplasia and nine who had not). Functional residual capacity was significantly higher in children with abnormal radiographs. Each child had a normal maximum working capacity and a normal electrocardiogram, and all but two had normal vectorcardiograms. Oxygen saturation at maximum work load decreased significantly in both groups of children. The risk of future respiratory problems calls for further follow up of lung function and chest radiography.

The recently introduced intrauterine growth curve, based on ultrasonically estimated foetal weights, was retrospectively applied to an inborn population of 883 infants born before 33 gestational weeks at the University Hospital of Lund, during 1985-94. The estimation of birthweight deviation resulted in 630 (71.3%) infants with a birthweight appropriate for gestational age (AGA), 244 (27.6%) infants with a birthweight small for gestational age (SGA) and 9 (1.1%) infants with a birthweight large for gestational age. Birthweight deviation was associated with an increased mortality [odds ratio (OR) adjusted for gestational age 1.29 per SD (12%) change in birthweight for gestational age, 95% CI: 1.10-1.50; p = 0.002]. At gestational age 25-28 weeks, SGA-infants had an increased incidence of respiratory distress syndrome (RDS) as compared to AGA-infants (OR adjusted for gestational age: 1.98, 95% CI: 1.12-3.52; p = 0.019). At gestational age 29-32 weeks, SGA-infants had a lower incidence of RDS as compared to AGA-infants (OR adjusted for gestational age: OR 0.52, 95% CI: 0.34-0.80; p = 0.003). After adjustment for confounding variables, infants born at gestational age 25-28 weeks from mothers with pre-eclampsia, appeared to be a high-risk group for RDS, whereas at the age of 29-32 gestational weeks, negative birthweight deviation had a protective effect against RDS. Antenatal corticosteroid administration appeared to have a less beneficial effect on mortality, RDS and cerebral haemorrhage in infants born SGA vs in those born AGA.

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The aim of the present study was to investigate (1) the risk of seizure recurrence within the first year of life after neonatal seizures in a high risk neonatal intensive care population, and (2) whether the routine procedure of stopping antiepileptic treatment early after established seizure is associated with a high risk of seizure recurrence. MethodsFrom 1 January 1990 to 31 December 1991, 1283 patients were treated at our neonatal intensive care unit, a tertiary level facility. Neonatal seizures were diagnosed in 58 (4 5%) of the infants up to 46 weeks' postconceptional age. Another 25 newborn infants with suspected seizures did not fulfil the criteria, and were not included in the study.Of the 58 infants, 33 were outborn and 25 inborn: 27 were preterm (mean gestational age 29 weeks (range 24-36) and mean birthweight 1415 g (range 570-4960)) and 31 full term (mean gestational age 39 weeks (range 37-42) and mean birth weight 3420 g (range 2290-4585)). Initial mortality (death before first discharge from hospital) was 36-2% (21/58) overall, 51 9% in the preterm subgroup and 22.6% in the full term subgroup.Follow up data were obtained from clinical records in survivors at a mean age of 19 months (range 12-31). Only one infant was lost to follow up, a preterm survivor whose family moved to another part of Sweden. Figure 1 shows aetiology of the seizures, as well as the mortality and seizure recurrence for the different subgroups. Haemorrhagic or ischaemic lesions and birth asphyxia were the most common causes of neonatal seizures. The second largest subgroup of infants was heterogenous, and no clear aetiology for the

Svenningsen, N.W., Lindroth, M. and Lindquist, B. (Department of Paediatrics, University of Lund, Sweden). A comparative study of varying protein intake in low birthweight infant feeding. Acta Paediatr Scand. Suppl. 296: 28, 1982. — In a prospective longitudinal study of 48 very low birthweight and preterm infants with mean birthweight 1 385±343 and gestational age 30.8±2.9 w an assessment was made of the impact of varying the protein intake in the postnatal period from the 3rd to 7th week of life. The infants were randomly allocated to one of three dietary groups with isocaloric energy supply but different protein content—i.e. human milk (1.6 g/100 kcal), formula 1 (2.3 g/100 kcal) and formula 2 (3.0 g/100 kcal). In the human milk group 12 of 18 infants were fed their own mother's breastmilk. During the study period the mean weight gain was slightly higher in the infants fed formula 1 and 2. There were no group differences in S‐albumin whereas B‐urea‐N and B‐base deficit were significantly increased in the formula fed infants in comparison to infants fed human milk. After the study period until around 15 weeks of age the slope in weight gain remained slightly higher for formula fed infants. However, the gain in body length and head circumference was equal in all three groups. After around 8 months of age there was no difference in any growth parameter. Neurodevelopmental examinations showed no group differences during the follow‐up period to 2 years of age.

Thirty-eight infants admitted to a neonatal intensive care unit because of pneumonia (14 patients) and pulmonary maladaption syndrome (PMA) (24 patients) were included in the study. Samples of potentially pathogenic, facultatively anaerobic bacteria were taken from the external ear, blood, throat, nasopharynx, umbilicus and gastric aspirates of the children, and from urethra and cervix of the mothers. Group B streptococci (GBS) and Escherichia coli were the only potentially pathogenic bacteria isolated from the infants. Out of 14 infants with pneumonia 11 (79%) harboured one of these bacteria, in contrast to 3 out of 24 (13%) with PMA (P less than 0.001). GBS was found in 8/14 infants with pneumonia and in 1/24 infants with PMA (P less than 0.001). The respective frequencies for Escherichia coli were 3/14 and 2/24 (not significant). The infant and/or the mother in 10/14 pneumonia cases harboured GBS, in contrast to 4/24 pairs in the PMA group (P less than 0.001). The levels of antibodies against GBS in sera of mothers to infants with pneumonia did not differ from the antibody levels in control sera (parturient GBS-carriers giving birth to healthy infants). The results gave evidence for an important manifestation of neonatal GBS-infection: pneumonia without septicemia. The incidence of the disease is estimated to be 1:25 parturient GBS-carriers. Finally, maternal fever, gestational age above 42 weeks, more severe respiratory difficulties and the occurrence of severe changes in fetal heart rate during the first stage of labour were found to be typical characteristics of pneumonia, as compared to PMA.

These findings support the notion that antibodies to GBS surface proteins contribute to the protection against neonatal infection.

SUMMARYThe effect of applying brain-orientated neonatal intensive care for term infants with severe neonatal asphyxia was studied. Such treatment included protective phenobarbitone administration together with assisted ventilation and other measures to counteract postasphyxial cerebral oedema and any abrupt changes in blood pressure and oxygenation. The mortality rate and incidence of long-term sequelae were reduced appreciably, resulting in a 0-1 year mortality rate of 14% (previously 50%) and an incidence of neurodevelopmental handicap at 18 months of 17 % (previously 50%). It is important in the management of infants with severe asphyxia at birth to avoid blood pressure fluctuations and to control neuronal epileptic activity by the use of barbiturates and early ventilator treatment.