In a 2-year (1990-92) prospective national investigation, comprising all stillborn and live-born ELBW infants with a birthweight of < or = 1000 g born at 23 completed weeks of gestation or more, we examined the incidence, neonatal mortality, major morbidity and infant survival in relation to level of care and place of residence. A total of 633 ELBW infants were live-born, i.e. 0.26% of all live-born infants, and 298 were stillborn. The average neonatal mortality was 37% and 91% at 23 weeks, 70% at 24 weeks, and 40% at 25 weeks of gestation. Of neonatal survivors, 8% had intraventricular haemorrhage grade 3, 10% retinopathy of prematurity of stage > or = 3, 2% necrotizing enterocolitis, and 28% were oxygen-dependent at a time corresponding to 36 weeks of gestation. In all, 77% were treated with mechanical ventilation, whereas 19% survived without, almost all of them being CPAP treated. Infant mortality among infants born at level III (tertiary centres) was 30%, at level IIa (with full perinatal service) 46% and at level IIb (with basic neonatal service) 55%. Only 1% was born at hospital level I. Regarding the relation to place of residence, the mortality rates among infants residing in the areas served by levels III, IIa and IIb hospitals were 36%, 45% and 41%, respectively. The referral system thus functioned well, but can be improved, and increased perinatal referral, at borderline perinatal viability, might provide a better quality of care and a better chance of survival.

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Arterial concentrations of glycerol, FFA, glucose, lactate and β‐hydroxybutyrate were serially measured during the first two hours after birth in normal fullterm infants in a thermo‐controlled environment. Blood gas tensions, acid‐base balance, pulmonary gas exchange, motor activity and heart rate were also determined: a detailed report of these data will be published separately. In 22 infants the glycerol concentrations showed a rapid immediate increase after birth wheras the rises in FFA concentrations were delayed until between 30 and 120 minutes, indicating a prompt increase in lipolysis and a suppression of lipid mobilization during the first half hour after birth. This suppression might be explained by a high rate of reesterification or oxidation of FFA within adipose tissue. The influence of environmental temperature (2 8.7‐3 4.8 oC) and degree of acidosis on the pattern of changes in FFA and glycerol were only marginal. No inhibition of lipolysis and lipid mobilization was shown in an infant who developed postnatal asphyxia.At 120 min after birth, when acidosis had been eliminated, an inverse correlation was found between the rise in FFA from birth to 120 min and the respiratory exchange ratio (V̇co2/V̇o2).The glucose concentrations were related neither to the FFA nor to the glycerol concentrations. The rate of elimination of lactate and β‐hydroxybutyrate was not influenced by environmental temperature or acidosis. Minute amounts of administered heparin caused an increased rise in FFA and glycerol concentrations which were associated with the appearance of lipoprotein lipase activity.

SUMMARY Sixty low birthweight infants (1000-2000 g) admitted to a neonatal care unit in Turkey were studied. Those not requiring intensive care were randomly assigned for treatment either in a cot on a heated, water filled mattress kept at 37°C (n=28) or in air heated incubators with a mean air temperature of 35°C (n=32). On admission 53 (88-3%) of the infants had body temperatures between 300 and 36°C. There was good correlation between axillary and rectal temperatures in the infants while they were hypothermic. Normal temperatures were achieved within the first day and remained within this range during the subsequent days after admission in all the infants treated on the heated, water filled mattress, whereas they were not achieved until three days later in the incubator group. The neonatal mortality among those treated on the heated, water filled mattress was 21%, and among those treated in the incubator 34%. The heated, water filled mattress provides a good alternative to skin to skin contact with the mother, and to the use of a complex and expensive incubator for rapidly attaining and maintaining normal temperatures in the low birthweight newborn.Hypothermia and cold injuries were among the main causes of neonatal death in the early 19th century.' The influence of thermal environment on