Early Human Development, 22 (1990) 1 OS- 113 Elsevier Scientific Publishers Ireland Ltd.

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EHD 01059

Abstracts of papers presented at the Neonatal Society Meeting

The relation between faecal fat and water in low birthweight infants. M. De Cur&‘, C. Kempsonb, V. Venturab, N. Carterb and N. McIntosh, “Department of Pediatrics, 2nd School of Medicine, Naples, Italy and bDepartment of Child Health, St George’s Hospital, London, U.K.

In 9 preterm infants, birthweight 1081 (173) g (M (S.D.)), gestational age 28.4 (2.1) weeks and postnatal age range 9-90 days metabolic balances were performed while they were wholly enterally fed and were growing well. Five infants were fed on fresh expressed milk and 4 on preterm formula. 39,24 or 72 h stool collections were carried out between carmine markers. Individual stools were collected in napkin liners and stored frozen at - 20°C. Each collection was then pooled, freeze dried and analyzed for fat content by a gravimetric method. In preterm infants there was a close inverse relationship between the faecal fat and the faecal water (r = - 0.95, P < 0.01) which was independent of the type of feed and which was present over a very wide range of fat and water content.

There was also a close inverse relation (r = - 0.96, P < 0.01) between stool fat and waer content in term babies with birthweight 2964 (420) g, gestational age 38.5 (1 .O) weeks with postnatal age range of 34 -70 days while receiving infant formula (Milupa). Validation experiments confirmed the reproducibility and reliability of this relationship.

The correlation in preterm and fullterm infants is clinically and experimentally so close that measure- ment of stool water by freeze-drying a sample is an accurate indirect measure of faecal fat when the daily stool weight is known.

Is intensive care appropriate for severely asphyxiated newborns? C. Day, A.C.G. Meeks and M.F. Smith, Jessop Hospital for Women, Leavygreave Road, Sheffield, U.K.

We report the outcome of 30 newborns of gestation greater than 34 weeks with severe hypoxic ischaemic encephalopathy (HIE). Severe HIE was defined as profound hypotonia, seizures or coma with failure to maintain adequate ventilation. Those with coma failed to establish adequate spontaneous respirations after resuscitation and before transfer to the intensive care unit. All others were extubated after initial resuscitation but required mechanical ventilation for apnoea, respiratory problems or electively.

Survivors were followed up prospectively in a multidisciplinary clinic. Major disability was defined as one or more of: cerebral palsy impairing locomotion, developmental delay likely to preclude normal schooling, sensorineural hearing loss, visual impairment and epilepsy requiring medication. Minor dis- ability would not interfere with locomotion or education.

Ten were ventilated for coma, 11 for apnoea, 8 for respiratory problems and 1 electively. Manage- ment was supportive.

Nine babies died prior to discharge. Of the survivors, 5 are normal (24%) but 16 (76%) have major disabilities at a mean of 19 months follow-up. There was no difference in duration of ventilatory support between normal and disabled survivors.

Our figures for normal survival are very similar to those of Levene et al. [l]. However, overall survival is increased but at the expense of increased disability.

We question the benefit of mechanical ventilation in infants with severe HIE.

0378-3782/90/$03.50 0 1990 Elsevier Scientific Publishers Ireland Ltd. Published and Printed in Ireland

Number Deaths Normal survivors Disabled survivors

Meeks et al. 30 9 5 16 Levene et al. 21 13 5 3

1 Levene, M.I., Sands, C., Grindulis, H. and Moore, J.R. (1986): Lancet, i, 67-69.

How safe is emergency transfer after delivery? K. Denham, U. Wariyar and E. Hey, introduced by E. Hay, Northern Regional Health Authority Survey Office, Princess Mary Maternity Hospital, Newcastle upon Tyne, NE2 3BD, U.K.

Data from the Northern Regional collaborative perinatal mortality survey for the years 1982-87 were reviewed to evaluate the safety of emergency transfer amongst non-malformed babies born alive to mothers resident in the Region.

Neonatal survival for 0.5-l .5 kg birthweight babies born to mothers resident in the 11 districts with no facilities for sustained ventilatory suuport (type 1 units) was similar to that achieved in the district with two referral centres (type 3 units) (761/1034 vs. 144/204). Regional mortality compared well with National figures. This outcome was achieved by providing a single coordinated referral service for the whole Region; 648 babies of less than 1.5 kg were cared for by that service in 1982-87; and 65% of these transfers took place only after delivery. The prognosis for babies born in the four units that had started to build up their own intensive care facilities (type 2 units) was worse than for those born in units without any intensive care facilities (53% vs. 74%).

A separate analysis of similar births in 1983, analysed using gestation rather than weight, produced similar findings (such data were only available in 1983, but have been collected regularly since 1988). Neonatal survival for babies of less than 30 weeks gestation booked for delivery in type 1, 2 and 3 units was 70% (54/77), 47% (33/70) and 59% (16/27), respectively. Long-term prognosis also followed the same pattern with a two-year survival rate without disability of 60070, 36% and 48% in type 1, 2 and 3 units, respectively. The poorer prognosis for babies born in type 2 units was seen mostly amongst babies of under 1 kg or less than 28 weeks gestation. In the four type 2 districts fewer babies were classified as dying in labour producing an apparent excess of early neonatal death.

Our present integrated pattern of neonatal care across the Region provides a service that is just as good for babies born in type 1 units as for those born in type 3 units. The arrangement that currently exists for supervising inter-hospital transfer and providing all new paediatric residents with coordinated practical teaching in the resuscitation and immediate care of the very immature baby appears to be of very real value.

Paradoxical bone miaeralisation in the twin-twin transfusion syndrome. N. Bishop’, F. King”, P. Wardb, J. Rennieb and A. Dixonc, aMRC Dunn Nutrition Unit and University of Cambridge Departments of bPediatrics and ‘Radiology.

Twin preterm infants suffering from the twin-twin transfusion syndrome were noted on plain chest radi- ographs to have very different bone densities. Interestingly, the growth plates were normal, and there were no subperiosteal resorption pits or fractures seen.

Estimation of bone mineral content was undertaken using photonabsorptiometry (Lunar SP2 instru- ment), and confirmed the radiographical observations of osteopaenia (decreased bone mineral content) in the plethoric twin, and substantial osteosclerosis (increased bone mineral content) in the anaemic twin,