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Individuals born extremely preterm are at significant risk for impaired neurodevelopment. After discharge from the neonatal intensive care, associations between the child’s well-being and factors in the home and social environment become increasingly apparent. Mothers’ prenatal health and socioeconomic status are associated with neurodevelopmental outcomes, and emotional and behavioral problems. Research on early life risk factors and on mechanisms underlying inter-individual differences in neurodevelopment later in life can inform the design of personalized approaches to prevention. Here, we review early life predictors of inter-individual differences in later life neurodevelopment among those born extremely preterm. Among biological mechanisms that mediate relationships between early life predictors and later neurodevelopmental outcomes, we highlight evidence for disrupted placental processes and regulated at least in part via epigenetic mechanisms, as well as perinatal inflammation. In relation to these mechanisms, we focus on four prenatal antecedents of impaired neurodevelopment, namely, (1) fetal growth restriction, (2) maternal obesity, (3) placental microorganisms, and (4) socioeconomic adversity. In the future, this knowledge may inform efforts to detect and prevent adverse outcomes in infants born extremely preterm. Impact This review highlights early life risk factors and mechanisms underlying inter-individual differences in neurodevelopment later in life.The review emphasizes research on early life risk factors (fetal growth restriction, maternal obesity, placental microorganisms, and socioeconomic adversity) and on mechanisms (disrupted placental processes and perinatal inflammation) underlying inter-individual differences in neurodevelopment later in life.The findings highlighted here may inform efforts to detect and prevent adverse outcomes in infants born extremely preterm.

Follow-up of very preterm infants is essential for reducing risks of health and developmental problems and relies on parental engagement. We investigated parents' perceptions of post-discharge healthcare for their children born very preterm in a European multi-country cohort study.Data come from a 5-year follow-up of an area-based cohort of births32 weeks' gestation in 19 regions from 11 European countries. Perinatal data were collected from medical records and 5-year data from parent-report questionnaires. Parents rated post-discharge care related to their children's preterm birth (poor/fair/good/excellent) and provided free-text suggestions for improvements. We analyzed sociodemographic and medical factors associated with poor/fair ratings, using inverse probability weights to adjust for attrition bias, and assessed free-text responses using thematic analysis.Questionnaires were returned for 3635 children (53.8% response rate). Care was rated as poor/fair for 14.2% [from 6.1% (France) to 31.6% (Denmark)]; rates were higher when children had health or developmental problems (e.g. cerebral palsy (34.4%) or epilepsy (36.9%)). From 971 responses, 4 themes and 25 subthemes concerning care improvement were identified.Parents' experiences provide guidance for improving very preterm children's post-discharge care; this is a priority for children with health and developmental problems as parental dissatisfaction was high.In a European population-based very preterm birth cohort, parents rated post-discharge healthcare as poor or fair for 14.2% of children, with a wide variation (6.1-31.6%) between countries. Dissatisfaction was reported in over one-third of cases when children had health or developmental difficulties, such as epilepsy or cerebral palsy. Parents' free-text suggestions for improving preterm-related post-discharge healthcare were similar across countries; these focused primarily on better communication with parents and better coordination of care. Parents' lived experiences are a valuable resource for understanding where care improvements are needed and should be included in future research.

The effect of human milk intake on neurodevelopment in preterm infants is uncertain. We analyzed data from 611 participants in the DHA for Improvement of Neurodevelopmental Outcomes study, enrolled at ≤33 wk gestation from five Australian perinatal centers. The main exposures were (i) average daily human milk intake during the neonatal hospitalization and (ii) total duration of human milk intake before and after discharge. Outcomes were Bayley Scales of Infant Development, 2nd Edition Mental (MDI), and Psychomotor (PDI) Development Indexes. Adjusting for confounders in linear regression, human milk intake was not associated with higher MDI (0.2 points per 25 ml/kg/d; 95% confidence interval (CI): −0.6, 1.0) or PDI (−0.3 points; 95% CI: −1.1, 0.4). Longer duration of human milk intake was also not associated with MDI (0.1 points per month; 95% CI: −0.2, 0.3) or PDI (−0.2 points per month; 95% CI: −0.5, 0.01) scores, except in infants born 29–33 wk gestation (n = 364, MDI 0.3 points higher per additional month, 95% CI: 0.1, 0.6). We found no associations of human milk intake during the neonatal hospitalization with neurodevelopment at 18 mo corrected age.

Effect of Psychological Intervention on the Developmental Status of Premature Infants after Discharge from the Hospital

Aim: This Audit was done to assess existing local and national practice in the follow-up of newborns at risk (less than 32weeks gestation and or under 1500grams birth weight). Data collection: 202 questionnaires were sent to neonatal units across the United Kingdom and the response was collected. Results: 108 units responded, of which 88 (81%) were district general and 20 (19%) were tertiary hospitals. 70 (65%) units had a local guideline for follow up, where as 38(35%) didn't. 59 (50%) hospitals reviewed them at six weeks for the first follow up and second between 3-6 months in 43 (40%) hospitals. Subsequent follow up was at 6 months in 32 (29%) and 12 months in 38 (35%) hospitals. Most units 76 ( 70%) discharged around two years of age. Consultants conducted these clinics 107 (99%) and 76 (70%) had follow up with other teams like physiotherapy 46 (42.5%) and occupational therapy 55 (50.9%). An assessment tool was used in 82 (75.9%) hospitals which included Bayley 22 (20%) and Griffiths 26 (24%). These assessments were performed by consultants/ trainees in 68 (63%), the community support team in 21 (19%) hospitals. The timing varied between 1and 2 years of age with the majority being at 2 years, 26 (24%). Conclusion: Individual units have own practices utilising their resources. Evidence that if these children are identified and supported early, the impact on the long term development of these infants will be minimised. We therefore recommend a national guideline.

Background: Preterm babies with significant CLD may require home oxygen after hospital discharge. Due to the risk of winter viral ilnesses we hypothesised that CLD babies discharged home during winter would require oxygen therapy for longer after discharge. Methodology: We reviewed our database of babies with CLD discharged home on oxygen between 1/1/2007 and 31/12/2010. We compared the age at discharge and duration of home oxygen between babies discharged in summer (April - September) with those in winter (October - March). All babies were managed by the Neonatal Outreach Team and oxygen was weaned according to established unit protocols. Results: During the study period a total of 74 babies (38 male, 36 female) were discharged home who weaned off oxygen therapy. Mean (±SD) birthweight was 967±260g and gestation 27.3±2 weeks. The babies were discharged at a mean gestation of 38.7±4.6 weeks and discontinued oxygen at a gestation of 47.7±13.2 weeks. n=31 babies were discharged over winter and n=43 in summer. There were no differences in birthweight and gestation between the two cohorts. Discharge gestation and corrected gestation at discontinuation of oxygen did not differ between the groups. There were no correlations between duration of oxygen therapy and month of discharge or gender. Conclusion: Home oxygen babies discharged home in winter did not have an increase in hospital length of stay and did not require oxygen for a longer. In contrast to our hypothesis the duration of home oxygen therapy in CLD babies was not affected by the season of discharge.

Giving birth prematurely and having your baby hospitalized in a neonatal intensive care unit (NICU) may cause consequences for the family lasting far beyond the hospitalization. Research shows, that parents experience stress sometimes lasting for months or years after discharge. This can influence the familyformation and establishment of a healthy family. Quality of communication with healthcare-professionals is of great importance to how the hospitalization influences the parents and their stressmanagement. The importance of personal communication is well documented but a method to ensure this to take place in practice is still needed. Hypothese: Using a method to guide communication between parents and healthcare-professionals will reduce parents stress and facilitate transition to home. The method Guidet Familycentered Care (GFC) has been developed on the basis of litterature study combined with many years of experience within this speciality. The method consists of regular dialogues throughout hospital stay focusing on issues perceived by the parents as challenging. Focusing on the essential to the parents is guided by the parents preparing for some dialogues filling out reflection sheets. Method: Guided Family-centered Care intervention in a mixed methods design. Part one: Participatory research aimed at developing and implementing GFC in a NICU. Part two: Effect measured in RCT. Participants: 75 families with prematurely born babies in interventiongroup and 75 in controlgroup, 25 NICU nurses. Instruments for effect-measurement: Parental Stress Scale:NICU and Nurse-Parent-Support-Tool. Part three: Qualitative approach with individual interviews with 10 – 20 families strategically chosen.

Purpose of Study: The objective of our study is to compare the pre- and post-discharge growth of infants with severe BPD enrolled in the LUMC Neonatal Home Care program to the growth after discharge of other infants with mild BPD seen at the neonatal follow-up clinic. Design and Methods: Adequate growth velocity of premature infants is 26 to 40 grams per day at one month corrected gestational age (GA). In this prospective study, 70 infants admitted to LUMC NICU from 9/1/04 until 10/31/05 with a birth weight ≤ 1500 grams were enrolled. Infants with an O2 requirement for ≥ 28 days were selected. LUMC Home Care Program follows infants discharged home requiring O2, NG feedings, monitors or special needs. Infants requiring O2 at home were the severe BPD group, and infants without home care and on room air were the mild BPD group. While in the NICU, length, weight and head circumference were recorded weekly in nutrition rounds. After discharge, the severe BPD group had their weight and length recorded at each home visit up to 6 months corrected GA, according to the severity of their disease. The mild BPD group had data collected at the NICU Follow-Up Clinic. Feedings and average daily calories were recorded. Results: 70 patients completed the study. 39 were in the severe BPD group, and 31 were in the mild group. The data was analyzed with the student t-test. Conclusion: While in the NICU, the infants in the severe group had decreased weight gain compared to those with mild BPD. After discharge, the infants with severe BPD gained weight as rapidly as those in the mild group. The change in length before and after discharge was not statistically significant. Our study shows that with proper follow-up, infants with severe BPD can grow as well as infants in the same birth weight group but with milder disease.

The Incidence of Apnea after Discharge in Infants Less Than 34 Weeks Gestation with Normal Pre-Discharge Pneumocardiograms

NICU care is expensive, and outcomes for survivors may be less than might be hoped for. Permanent neurologic disability is a serious burden, and surrogate decision-makers may wish to consider this possibility in the benefit/burden calculations they face anew each day. We wondered how accurate medical caretakers were in their daily predictions of residual neurologic disability for NICU patients.

The NICU environment is very stressful and costly. To address specifically these problems, we have instituted since September 1995 an aggressive program of early discharge from our NICU. Nurses from the neonatal intensive care unit visit the babies after discharge for a variable period of time. We have previously reported on the shortened length of stay and the decreased readmission rate with the program. To address the issue of patient satisfaction, a survey was mailed to all the families whose infants were sent home under the integrated neonatal home care program. A follow-up contact was made either by phone or during a visit to the neonatal clinic.

Graduates of the Neonatal Intensive Care Unit (NICU), Saskatoon - Prevalence of Death after Discharge. 54

BACKGROUND. We discharge formula-fed PI without iron supplementation, except that present in term formulas without apparent ill-effects. SUBJECTS. LBW (≤1750g) preterm (≤34wks) infants from discharge to 6mns corrected age. INTERVENTION. Subjects were randomised into GpA (LBW formula, 0.9mg/dl Fe, n=24), GpB (Term formula, 0.5mg/dl Fe, n=26), GpC (LBW formula to term, then a term formula, n=20). Formula intake was calculated from difference in weight of preweighed formula cartons. INS (Hb,MCV,MCH,zinc protoporphyrin (ZPP) and ferritin (SF) was assessed at discharge, every 2weeks until term, then monthly. RESULTS. Groups were similar at birth and discharge. Iron intake was higher in GpA (1.2mg/kg/d±.14) than GpB (0.8±.13,p

The purpose of the study is to determine the impact of discharge teaching on maternal decision making regarding her baby's sleeping position after discharge. Mothers were instructed by the nursing staff to place the infant on his/her side or back during sleep to prevent sudden infant death syndrome(SIDS) as recommended by the American Academy of Pediatrics. Mothers were interviewed prior to discharge by one of the authors to obtain information regarding their preference for the baby's sleeping position at home. In addition, factors that influence their decision and information about their socioeconomic factors were collected.

Plasma immunoglobulin concentrations of premature infants of birth weight less than 1500 g were measured longitudinally from birth to 10 months chronological age. Infants were divided into two groups based on gestational age (group I: 25-28 wk; group II: 29-32 wk). In the 1st wk of life, plasma IgG levels correlated with gestational age (r = 0.5, p less than 0.001). At 3 months chronological age, the geometric mean plasma IgG levels were 60 mg/dl in group I and 104 mg/dl in group II infants. Most infants remained hypogammaglobulinemic at 6 months with seven of 11 infants in group I and 13 of 21 infants in group II having plasma IgG levels below 200 mg/dl. In the 1st wk of life, plasma IgM concentrations were 7.6 and 9.1 mg/dl in groups I and II, respectively. They rose to 41.8 and 34.7 by 8 to 10 months of life. Plasma IgA concentrations were comparable for groups I and II in the 1st wk of life (1.2 and 0.6 mg/dl, respectively), but at 1 month of age group I infants had a transient increase in IgA which was not seen in the group II infants (4.5 versus 1.9 mg/dl, respectively, p less than 0.02). This transient elevation in IgA did not correlate with type or route of feeding or amounts of transfused blood. Group I and group II infants had comparable rates of infections prior to discharge from the nursery (p = 0.27). After discharge, the 43 preterm infants followed until 10 months chronological age had a significantly higher incidence of infections than 41 term infants (p = 0.04).(ABSTRACT TRUNCATED AT 250 WORDS)

The degree and duration of hypoxemia in babies with RSV has not been studied. We used an ear oximeter to measure dally the arterial satuation(% Sat)on 32 infants consecutively admitted with RSV bronchiolitis and pneumonia; median age 2 months. Oximetry readings compared to simultaneous arterial gases gave a correlation coefficient of 0.95, and 0.7 compared to capillary gases. On admission these infants' mean % Sat was 86%(pO2=53 mm Hg), range 75-95%(pO2 41-75). The lowest mean value was not until day 3 and was 85%(pO2 51) with a range of 53-96%(pO2 28-87). The severity of hypoxemia fluctuated in any given day and was prolonged. At discharge the mean % Sat=90%(pO2 60) range 83-98% (pO2 47-113); only 3 infants had values >93%(or >pO2 66). Mean % Sat of 9 infants 3-7 weeks after discharge was 96%(pO2 87), range 93-98%(pO2 66-113). Clinical detection of hypoxemia was difficult. Marked hypoxemia existed without cyanosis. However, severity of hypoxemia correlated with cyanosis, respiratory rate, younger age and % bands. No correlation existed with total WBC, PMNs, nor clinical severity judged by retraction and lethargy. Thus, RSV hypoxemia may be severe, prolonged, and clinically occult. Ear oximetry is a valuable and non-invasive technic in the management of infants with RSV lower respiratory tract disease.

Nineteen infants of mothers using methadone plus other drugs developed significant thrombocytosis for more than 16 weeks. These prospectively studied newborns had varying degrees of withdrawal during the first week of life; one had seizures. All were formula fed. As part of a study, 10 received paregoric, 3 phenobarbital and 6 no drugs. Complete blood counts were done every 3 to 7 days in hospital and weekly after discharge. Platelet counts in the first week were the same in both study (mean 258,000±18,000/mm3 S.E.M.) and control (255,000±40,000) infants. Maternal platelet counts were all normal. By the second week there was significant thrombocytosis in study (521,000±68,000) versus control (240,000±45,000) infants (p

To identify incidence and patterns of medication usage 134 breastfeeding mothers were surveyed 4-6 weeks after discharge from hospital. 96% were using one or more meds; 55% were self-medicated, non-Rx items, & 41% were physician prescribed. 64% of those breastfeeding had completed one or more yrs. of college although ed. level was not correlated with predictions of med. usage patterns. A significant (p

To determine how young children respond to separation from their mothers hospitalized for the birth of a second child, 19 mothers and their first born children (age 1-3 years) were observed 14 days before and 8 days after the mother's confinement. Data included two 90 minute naturalistic observations in the home, detailed questionnaires and filmed analyses of a standardized reunion at discharge. 8 days after discharge, the children showed many problems not present before maternal hospitalization. Changes occurred in both eating(p

Mortality rates for neonatal intensive care units are often reported as neonatal deaths (

In a study to evaluate mothers' own milk for pre mature infants, we followed nonfasting serum triglyceride and cholesterol in 13 infants (gest age=29÷1 [S.D.] wks, birth wt 1205÷209 g) exclusively fed own mother's milk for > 18 wks. Triglycerides during hospitalization were 166-121, 153÷67. and 154÷96 mg/dl at 31, 33, and 35 wks post conceptional age respectively. Mean cholesterol in the nursery was 138÷31 mg/dl, and mean fat intake was 5.3÷1.6 g/kg/day which did not correlate with triglyceride or cholesterol. After discharge (mean stay 60÷18 days) triglyceride rose to 371÷324 mg/dl by 47÷6 wks post conceptional age (p

A one-year study (1985) review showed a high proportion of infants with congenital anomalies admitted to the NICU of our perinatal center. Congenital anomalies were present in 79 (10%) out of 790 admissions. Classification of the congenital anomalies fell into two groups. 1) Single defect (51%): Deformation-2; Malformation-38 (CSV 12, GU 10, Pulm.7, CNS 6, GI 3). II) Multiple anomalies (49%): Chromosomal-13; Monogenic-11, Unknown-15 (i.e. about 40% of the multiple congenital anomalies could not be diagnosed). Clinical profile of these infants will be presented in percentage and compared to the overall NICU admission in brackets. 1) Gestational age, range 25-42 wks: preterm 73% [76%]; full-term 27% [24%]. 2) Intrauterine growth retardation in 22% [6%]. 3) Multiple births in 6% [16%]. 4) Fetal anomalies were suspected antenatally in 65%. 5) Delivery by cesarean section occurred in 43% [38%] and was performed primarily for fetal reasons in 74%. Of these, 64% had lethal congenital anomalies, chromosomal disorders or recognized syndromes with grave outcome. 6) Mortality in NICU was 25% [10%]; all of these deaths were attributed to congenital anomalies, none to prematurity. Another 10% [1%] died within the first year after discharge/transfer. 7) These cases accounted for 2580 patient-days (13% of NICU workload). These findings raise concerns about the perinatal diagnosis and management of neonates with congenital anomalies, particularly those suspected antenatally.

The cost of maintaining 34 developmentally disabled (DD) infants during the first 2 years after discharge from a neonatal intensive care unit was evaluated prospectively. All infants had neurologic sequelae and additional deficits,including visual impairment(10), hearing deficits (2), seizures (13) and speech impairment(12). Nineteen infants matched for age, birth weight, gestation, neonatal medical course and socio-economic status who had normal neurological and developmental examinations served as controls.

Medical costs including that of primary health care, diagnostic and therapeutic medical care were computed from Neonatal Intensive Care Unit (NICU) discharge to 3 yrs of age in two groups of infants. Thirty-five infants with neurological or developmental defects were matched for neonatal and social risk factors with 25 infants who had normal outcomes. Costs are reported per infant per month following discharge from NICU. The costs of primary health care were comparable in both groups ($7.6 ± 1.3 in the control vs 8.0 ± 1.4 in the disabled group). The highest cost per service was developmental testing in the control group (9.7 ± 4.4) and occupational and physical therapy in the disabled group ($22.0 ± 4.1). Twenty-two disabled infants were hospitalized on 53 occasions, with a cost per admission of $3612 ± 571, compared to one hospitalization for a control infant ($1110). The total medical costs were compared to the U.S. Dept. of Agriculture estimates of the medical cost of raising an urban child which ranges from $22-26.8/infant/month (July, 1983). Our study demonstrates that medical costs of developmentally or neurologically disabled infants after discharge from NICU are significantly higher than control infants.

The purpose of the study was to determine if mothers can learn to reduce their anxiety and function as therapeutic allies in the hospital to reduce the stress experienced by their preschool children undergoing cardiac catheterization. It was designed to compare, singly and in combination, three models of patient preparation: 1) directed attention and information about hospitalization and catheterization, 2) supportive counseling, and 3) stress management training. Fifty mothers and their children were randomly assigned to 1 of 5 experimental groups. Group E served as the control group and received the current routine preparation for catheterization. Group D received the information model only. Group C received both the information and counseling models. Group B received both the information and stress management models. Group A received all three models. Assessment of treatment effects for both mothers and children included self-report measures completed by the mothers, behavioral observations recorded at key stress points by blind raters and physiologic responses recorded by a computerized biofeedback system. Results indicated significant treatment effects for all intervention models. The stress management model had the greatest effect as measured by positive changes in the mothers' self-reported anxiety scores, electromyographic readings and electrodermal responses. Both children and their mothers who received the stress management model demonstrated more adaptive behavior in the hospital and after discharge than those who did not. The study would suggest that although information and counseling reduce stress and anxiety related to hospitalization, stress management training can provide additional benefits.

Infants with BW

We followed 17 babies who were found to have elevated blood pressure (BP) at or after discharge from neonatal ICU (systolic BP > 115 mm Hg, repeated 3 times under quiet conditions); babies with hypertension during their stay were excluded. All 17 babies had nursery stays longer than 48 hr. Follow-up was 6 months to 3½ years. Five babies had the following secondary diagnoses: 2 UPJ obstruction, 1 coarctation of the aorta, 1 neuroblastoma and 1 renal artery thrombosis. Five babies had umbilical artery catheters (UAC) for more than 24 hours; three of these babies are included in the group with secondary diagnoses. Thus, 10 babies developed hypertension without obvious cause. Sex, age of gestation, type of feeding, ventilator use or antibiotic use, proved insignificant. Sixteen of 17 babies were treated with 1-2 mg/kg/day of propranolol and/or 10-20 mg/kg/day of chlorthiazide. All children older than 2 years were off medication and were normotensive. We conclude: 1) follow-up of babies discharged from neonatal ICU should include careful BP measurements; 2) high BP may develop in babies who have not had prolonged use of UAC; 3) even when no secondary cause can be elucidated, hypertension responds to medication; 4) further study is needed to determine if babies discharged from neonatal ICU are at high risk for elevated BP and to determine the natural history, prognosis and best form of treatment for these babies.

Flower, et. al. have reported that newborn animals made hypercarbic had both an increased incidence and severity of RLF. This study concerns data on 74 surviving infants with birth weights ≤ 1000 grams, half of whom (37 infants) had RLF diagnosed either while in hospital or shortly after discharge. Twenty eight independent variables were analyzed to determine their role in the occurrence of RLF. By discriminant analysis, 9 of these variables correlated with the development of RLF (r=.70) and accounted for 49% of the variance. The total function (nos. 1-9) yielded a Chi-square of p 50 TORR) which occurred simultaneously with an elevated PaO2 (> 100 TORR). Other variables included the total number of PaO2's > 100 TORR (#3), the Apgar Score at 1 minute (#4), the Ponderal Index (#5), total days on CPAP (#6), the highest recorded PaO2 (#7), total respirator days (#8) and the Ponderal Index Percentile (#9). These data suggest that PaCO2 may be a very significant variable in the development of RLF. Retinal vasoconstriction, if viewed as protective, may be abolished by hypercarbia; thereby allowing free flow of potentially toxic hyperoxic blood into the retinal tissues. We suggest that continuous PaCO2 monitoring may be as important as PaCO2 monitoring in the prevention of RLF.

Previous investigations have demonstrated an increased sensitivity to the behavior of premature infants in the first 6 months of life. It has been assumed that this difference is a result of the mothers' experience of the infants' behavior after discharge. This study reports on the attitudes of mothers of preterm infants before hospital discharge. Twenty-two mothers of AGA preterm infants (28-32 weeks gestation) with medical complications completed the Cohler Maternal Attitude Scale, a 233 item Likert-type instrument, when their infants reached 34 weeks post-conceptional age. We examined 5 issues which assess attitudes towards maternal and infant attachment and infant separation. Scores were compared with Cohler's norms of 212 full-term uncomplicated deliveries. Two issues had elevated values: “period of reciprocal exchange”(2½-5 months,p< 0.01), and “period of early directed infant activity”(5-9 months,p < 0.02). There were no statistically significant differences in the three remaining issues (’focalization on the mother”, “widening reciprocity of interchange”, and “female sexuality”.) This suggests that mothers of ill prematures tend to be more sensitive to the infants' early efforts at stimulating and opening new areas of reciprocity with the mother, and that maternal attitudes toward premature infants are formed before hospital discharge of the baby.

Top of pageAbstract Medical and neurodevelopmental data were/are being collected prospectively in South Bavaria (62000 deliverles/ year) and in Uusimaa/SF(15000/y)of all newborn infantsover 1 year (1985/86) who needed special care(group I) In 19/6 units and of randomly selected not-transferred controls (group II). Total numbers: Group I: 6288/1409 (hospital deaths 232/50; after discharge 16/0) group II: 742/623 (0/0,-3/1). The frequency distribution (%) of individuals with none (-), minor (s/n) or major (S/N) somatic disorders and/ or neurologic abnormality after birth and at 5 months of age is shown in tne table. Regional differences in group I- spectra are mainly due to different prevalence of prematurity and malformations. There was aclose relationship between non-optimal obstetric and neonatal conditions, and both contribute to unfavourable outcome. Funded by BMFT - PKE 24

In a 6 year period 23 children age 5 to 14 yrs were trained for regular HHD usually with the mother as partner. Cimino fistulae, parallel-flow dialyzers and bed scales were used almost uniformly. The mean number of dialysis sessions(3x/wk) from start to discharge was 55(41-71). The mean distance between center and home was 150 km. HHD was supervised mainly by phone calls and home visits by nurses, technicians and the psychosocial team. 3% of all dialysis sessions after discharge were done on holidays and 16% after readmission to hospital for problems of vascular access(54%), overhydration/hypertension(12%),transfusions(5%),subsequent training (13%),social(6%), and other reasons (11%). One child died. School performance of most pts was comparable to that of healthy children. Tolerance to the considerable stress varied depending on the family structure. 16 pts were transplanted within 1-59(mean 15) months after start of HHD. In conclusion, HHD is an acceptable transient treatment form, which in our experience is possible in about half the children with end-stage renal failure. It requires cooperative, emotionally stable patients and parents and continuous support by an expert dialysis team.

Patients with AN reduce their metabolic rates to compensate for decreased caloric intake. Little is known, however, on substrate utilization during refeeding. 9 malnourished girls with AN (age range 14.4-16.9 years old), weight as ideal weight for height 73.2 ± 11.5% were studied for the changes in Resting Energy Expenditure (REE) and substrate utilization in hospital (4-8 weeks) and while maintaining their weight after discharge (20-50 weeks). REE was measured by open circuit indirect calorimetry after overnight fast (12-14 h). Substrate utilization was calculated from protein oxidation derived from urine nitrogen excretion and non-protein RQ (nPRQ.). The contribution of each macronutrient expressed as % of total REE. On admission, body weight and REE were reduced. On refeeding, carbohyrobrate utilization increased and net fat synthesis was seen. Protein oxidation increased almost twice than normal. On normal weight and weight maintenance substrate utilization returned to normal. We concluded that refeeding changes substrate utilization after overnight fast, causes an excess use of protein and futile cycle, synthesizing fat from carbohydrate.

Between January 1980 and December 1985 a number of 28,975 live-born were delivered at Kaplan Hospital. The group of the very very low birth-weight infants (VVLBW) 501 to 1000g included 157. Fifty-four of them were discharged home. A survival of 10.4% (7/67) between 501-750g and 52.2% (47/90) between 751 and 1000g. During the first year after discharge 3 infants died. The mean weight of the consecutive 51 VVLBW infants enrolled in this study was 883g with a mean gestational age of 26.7 weeks. The developmental quotient (DQ) was determined according to Gesell's charts between 24 to 72 months of age. The outcome of the population was evaluated according to a “functional handicap” score, based on combined DQ, degree of cerebral palsy and sensorineural impairment. Functional handicaps were found in 21% of the survivors [11% moderate to severe, 10% mild). Our results correlated with the better survival prognosis for the 751 to 1000g group without significant rate of morbidity, among the survivors. The mean DQ of 90 and low rate of functional handicap among the survivors seems to justify the intensive care approach for this very high-risk population.

The incidence and success of those women who deliver AGA premature infants with BW ≤ 2000 gm and who wish to breast-feed (BF) their infants has been studied with a structured interview about infant feeding that was administered to 200 (77%) of 260 consecutive, eligible women within 7 days of delivery and then with a follow-up interview given only to breast-feeders after lactation ceased. III (55.5%) of these women indicated they wished to BF, compared to 84 (47%) who chose to formula-feed and 5 (2.5%) who were undecided at the initial interview. 72 follow-up interviews have been completed. 54 (75%) of these women maintained lactation during their infant's hospitalization, were breast-feeding at their infant's discharge, and continued to BF for 20.7 ± 2.0 wks (M±SE) after discharge. This group was composed of 7 of the 12 women (58%) who had infants with BW ≤ 1000 gm, 12 of the 17 women (71%) who had infants with BW between 1001-1500 gm, and 35 of the 43 women (81%) who had infants with BW between 1501-2000 gm. Also that group was composed of 28 of the 32 women (87.5%) who had infants that were hospitalized for

Prematurity predisposes to mothering disorders expressed in poorer care of infants at risk for developmental disability. Most efforts have been focused on mothers prior to nursery discharge. To improve the quality of nurture after discharge, weekly home visits were made in the first half year by PHNs specially trained in therapeutic and supportive techniques for mothers. Close backup was provided by a team of pediatrician, psychologist and social worker. Specific aims were to enhance maternal: attachment bonds to infants (AB), independent coping with develonmental aberrations (IC) and collaboration with professional care. 53 intervention cases and 47 matched controls were assessed by video measures of home infant care (feeding, bathing, clothing and playing) following intervention at 6 mos. and again at 12. Intervention appeared to benefit mothers of high but not low socioeconomic status (SES). Thus, at both ages, higher SES was associated with higher AB scores (p