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Background The availability of a score for predicting neonatal outcome prior to discharge may help us to define the risk of developmental disorders in very low birth weight infants. Aim To compare Scheiner's Perinatal Risk Inventory (PERI) with Brazy's Neurobiological Risk Score (NBRS) when applied at discharge, in predicting developmental delay at 24 months of age. Study design To evaluate the predictive power of the two tests, we measured their sensitivity and specificity in predicting outcome (Mental Development Index, MDI, Psychomotor Development Index, PDI, and Amiel–Tison Neurological Examination) in an observational study. Subjects 102 very low birth weight infants (BW Results In the cohort studied, 75.5% of the patients had a normal MDI, while 24.5% showed a delayed performance (8.8% mildly and 15.7% severely so); the PDI was normal in 74.5% patients, whilst 25.5% had a delayed performance (9.8% mildly and 15.7% severely so). According to the Amiel–Tison test, neurological performance was normal in 66% patients, impaired without disability in 19% and impaired with disability in 15%. NBRS showed a sensitivity and specificity respectively of 0.96 and 0.23 (MDI), 0.96 and 0.24 (PDI), 0.94 and 0.25 (Amiel–Tison test); for PERI were 0.88 and 0.54 (MDI), 0.77 and 0.51 (PDI), 0.82 and 0.57 (Amiel–Tison test). The PERI and NBRS can predict the MDI with an AUC > 0.8 and the PDI or Amiel–Tison findings with an AUC of 0.7–0.8. No significant differences were found between the areas under the ROC curves using the NBRS and the PERI. Conclusions : In assessing the prognosis for individual babies, the physician can choose either the PERI or the NBRS to predict PDI, MDI or Amiel–Tison performance.

Background : It is conceivable that a complicated recovery course in a high-risk premature infant managed at home generates apprehension and anxiety in parents. Aims : We attempted to define the evolution of anxiety levels in a population of parents of low-birth-weight premature infants with bronchopulmonary dysplasia enrolled in a prospective home O 2 therapy program. Study design : In the immediate pre-discharge [mean postnatal age 95 (45–158) days], a questionnaire (State–Trait Anxiety Inventory form Y) was given to all parents of the premature infants [mean birth weight 1106 (0.610–1.770) kg; mean gestational age 27.1 (24–31) weeks] present for the discharge. Subsequently, the parents were assessed twice, initially after a week from the discharge of their infants and then at the end of the oxygen therapy phase [mean postnatal age 185 (60–361) days]. They included 10 mothers and 10 fathers, aged 33.5±0.5 and 37±0.2 years, respectively. Results : Our results indicate that these parents present an increased state anxiety level upon hospital discharge of their oxygen-dependent premature infants, which decreases as the improvement of respiratory status and the cessation of oxygen-dependency become evident [mean±S.D. related to age ( T ) maternal values 47.1±7.0, 41.8±5.6, 39.1±4.7, respectively; mean±S.D. related to age ( T ) paternal values 42.2±8.5, 41.1±8.1, 40.5±8.2, respectively]. When assessed separately by parental gender, in the maternal group, state anxiety decreased significantly (ANOVA, p Conclusions : These data indicate that although neonatologists generally define the discharge of prematures with chronic lung disease based upon the acquired stabilization of vital parameters, in the oxygen-dependent group, they should also pay special attention to the emotional support of the parents who we have identified as being at increased risk for pre-discharge anxiety.

Peripartal maternal apprehension and anxiety are associated with abnormal labour, dystocia and higher rates of fetal and maternal morbidity. Since colostral beta-endorphin (beta-EP) concentrations are twofold higher than circulating levels, we hypothesised that substantial maternal emotional distress in puerperium might induce consistent changes in colostral beta endorphin galactopoiesis. To test this hypothesis, we assessed the effects of postpartum maternal anxiety (State-Trait Anxiety Inventory-Y form, Spielberger CD, Palo Alto, CA, USA, 1983) on colostral milk beta-EP levels (beta-endorphin 125I RIA, INCSTAR Corporation-Stillwater, Minnesota, USA) in a population of healthy lactating mothers, on the fourth postpartum discharge day, 14 after at term vaginal delivery, 14 after premature (> or = 34

OBJECTIVE : Studies in animals indicate that stress and anxiety can depress lactation, but there is much less information available concerning humans. We aimed to determine whether maternal anxiety in puerperium, potentially exacerbated by the primiparity inexperience, has a negative impact on breast-feeding outcomes. SUBJECTS AND METHODS : The state-trait anxiety inventory Y form (Spielberger, 1983) was administered to a total of 204 mothers, 101 primiparae, and 103 pluriparae on the third to fourth day postpartum. RESULTS : We found that primiparae had state anxiety (T) scores significantly higher than pluriparae (44.57 +/- 5.85 vs 43.28 +/- 7.10, P = 0.03). Increased state anxiety levels impaired breast-feeding success. In addition, in the logistic regression analysis model used to assess factors predictive of breast-feeding longer than 3 months, maternal state anxiety was the most significant risk factor (odds ratio 0.99; 0.88-0.98, P < 0.01). CONCLUSIONS : In the puerperium, anxiety, potentially exacerbated by primiparae inexperience, is associated with impaired lactation. Alleviating maternal anxiety could be beneficial for stimulating breast-feeding in more vulnerable women.

Background Diagnostic tools of birth asphyxia provide only an uncertain prediction of neurological outcome. Aims To assess whether TOI and ΔCBV, combined with a set of biochemical and neurophysiological variables, have any diagnostic and prognostic value in birth depression or asphyxia. Study design Case control study at the nursery and NICU of the Padova University Children's Hospital. Subjects 22 term neonates with an Apgar score ≤ 6 at 5′, a 1-h umbilical artery pH value ≤ 7.25 with an increased base deficit and a gestational age ≥ 36 weeks; 15 healthy term infants with an Apgar score ≥ 9 at 5′. Outcome measures Troponin I and NIRS measurements (TOI and ΔCBV) were assessed in both groups. Blood gases, neurological evaluation, US, NIRS, EEG and SEP were evaluated in the infants with depression or asphyxia. Results Troponin I was higher in the study group than in controls ( p = 0.04), showing a correlation with base excess values. In the depressed/asphyxiated neonates with an abnormal outcome at 1 year, TOI rose to 80.1% vs 66.4% in controls ( p = 0.04) and 74.7% in infants with a normal 1-year outcome. A multiple regression model showed a significant multiple correlation coefficient, R = 0.79, p Conclusions Troponin I is a useful short-term index of birth asphyxia or perinatal depression. An increased TOI suggests a risk of abnormal neurological outcome at 1 year. Among the cotside variables, BE and evoked potential abnormalities were the best predictors of abnormal outcome in this study.

In critically ill neonates, peripheral perfusion and oxygenation assessment may provide indirect information on the circulatory failure of vital organs during circulatory shock. The development of pulse oximetry has recently made it possible to calculate the perfusion index (PI), obtained from the ratio between the pulsatile and nonpulsatile signals of absorbed light. The main goals of this study were: (1) to study foot PI; and (2) to evaluate the relationship between foot PI, obtained continuously by pulse oximetry, and a number of variables, i.e. blood flow (BF), oxygen delivery (DO(2)), oxygen consumption (VO(2)), and fractional oxygen extraction (FOE), measured indirectly by near-infrared spectroscopy (NIRS) on the calf in 43 healthy term neonates (weight 3474.6 +/- 466.9 g; gestational age 39.1 +/- 1.4 weeks).Calf BF, DO(2) and VO(2) were assessed by NIRS on short-lived venous and arterial occlusion maneuvers. PI was measured on the contralateral foot.Foot PI was 1.26 +/- 0.39. There was a positive correlation between foot PI and both calf BF (r = 0.32, p = 0.03) and DO(2) (r = 0.32, p = 0.03), but no correlation was found between foot PI and calf FOE and between foot PI and VO(2).In the neonatal intensive care unit, continuously measuring foot PI by pulse oximetry seems clinically more feasible for peripheral perfusion monitoring than spot measurements of the calf BF and/or VO(2) by indirect NIRS.

The study aimed to assess how well the severity of clinical conditions in extremely low birth weight infants in the first 12 h of life, as measured by the CRIB (clinical risk index for babies), relates to hospital outcome and subsequent disability at 18 months of age. The CRIB was confirmed as a valid index of initial neonatal risk, even in extremely low birth weight infants, predicting hospital outcome (death or major brain lesions) more accurately than birth weight or gestational age. However, an adjustment of the CRIB score for gestational age might enhance its positive predictive value in relation to short-term developmental outcome in this particular population.

To the Editor. We read with great interest “Lactation Counseling for Mothers of Very Low Birth Weight Infants: Effect on Maternal Anxiety and Infant Intake of Human Milk” by Sisk et al.1 Their objective was to examine whether mothers of very low birth weight infants who initially planned to formula feed were different in terms of their levels of anxiety and maternal stress compared with mothers who had planned to breastfeed their infants. The study showed that counseling mothers …

428 Role of Cerebral Blood Volume, Tissue Oxygenation Index, Troponin I and Neuro-Physiological Variables in Birth Asphyxia, Related to Outcome.