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The higher mortality rate among black infants than among white infants in the United States results largely from the greater frequency of low birth weight and prematurity among black infants. Higher rates of low birth weight and preterm delivery have been associated with shorter intervals between pregnancies.We studied a racially mixed population of women in military families, who had access to free, high-quality health care. A total of 1992 white and black women had two consecutive, singleton pregnancies during the study period. We determined the outcome of the second of each pair of pregnancies and the length of time between the pregnancies.Short interpregnancy intervals (calculated from delivery to the next conception) were more frequent among black than among white women. A total of 7.7 percent of the 298 black women and 3.2 percent of the 1628 white women delivered premature, low-birth-weight infants (P0.001). Among the black women, an interpregnancy interval of less than nine months was associated with a significantly greater prevalence of preterm delivery and low birth weight in the neonates (11.6 percent, vs. 4.4 percent for longer interpregnancy intervals; P = 0.020). Among the white women, only intervals of less than three months between pregnancies were associated with a greater prevalence of prematurity and low birth weight in the infants (11.8 percent vs. 2.8 percent; P0.001). Of the black women, 46.3 percent had interpregnancy intervals of less than nine months; 4.2 percent of the white women had interpregnancy intervals of less than three months.A short interval between pregnancies is a risk factor for low birth weight and preterm delivery, and such intervals are more common among black than among white women. The relative frequency of intervals of less than nine months between pregnancies may be an important factor in the wide disparity in pregnancy outcomes between white and black women in the United States.

Neonatal duration of hospital stay correlated with both birth weight and gestational age in positively skewed, nonlinear relationships. Within increments of birth weight, gestational age had a semi-independent influence on length of stay. Log length of stay correlated with both birth weight and gestational age in linear, normally distributed relationships. A nomogram is provided for predicting individual lengths of stay.

Prediction of the duration of hospital stay of preterm, low-birth-weight infants currently requires inconvenient referral to published tables.To determine whether postconceptional age (gestational age plus chronologic age) could serve as a useful clinical marker for the more convenient prediction of individual durations of hospital stay.Case series.Regional military teaching medical center with level III obstetric and neonatal services.Nine hundred sixty surviving preterm, low-birth-weight infants in the neonatal intensive care unit.The strength of the relationship of birth weight to postconceptional age at the time of discharge was tested by analysis of variance.Postconceptional age at the time of hospital discharge varied in a highly predictable manner with birth weight (P.001). The mean and variance were greatest for infants with very low birth weights and decreased with increasing birth weight. Postconceptional age at the time of discharge reached a minimum of 36.0 +/- 1.4 weeks (mean +/- SD) for infants with birth weights of 1750 to 2240 g.Most preterm, low-birth-weight infants meet current eligibility criteria for hospital discharge at a postconceptional age of 35 to 37 weeks. This level of maturity is sufficiently predictive to serve as a convenient, easy-to-remember clinical marker for expected durations of hospital stay. For infants with birth weights of less than 1000 g, discharge at a post-conceptional age of 37 to 42 weeks is a more realistic expectation.

• Mortality among black infants in the United States is approximately twice that among white infants. The disparity has been attributed in large part to the higher incidence of poverty and limited access to health care among black Americans. We investigated race- and rank-specific infant mortality rates among dependents of military officers and soldiers at Madigan Army Medical Center, Tacoma, Wash, between 1985 and 1990. The overall infant mortality rate was 9.3 deaths per 1000 live births compared with 10.1 deaths per 1000 live births in the United States in 1987. Mortality rates for infants born to families of junior enlisted soldiers were similar to those for infants born to families of noncommissioned and commissioned officers. The mortality rate among black infants was 11.1 deaths per 1000 live births compared with 17.9 deaths per 1000 live births among all black Americans in 1987. These lower rates of mortality among black infants may be due to guaranteed access to health care and higher levels of family education and income in the multiracial subpopulation served by our medical center compared with the nation as a whole. ( AJDC . 1992;146:313-316)

The syndrome of megacystis-microcolon-intestinal hypoperistalsis has been reported in a total of seven female infants. Massive abdominal distention secondary to a distended urinary Fig 1. Plain film of markedly distended abdomen with no air beyond stomach. Stomach is displaced upward toward left. der was the major presenting characteristic. Iutestinal hypoperistalsis, apparent in the early neonatal period, persists without improvement. Exploratory laparotomy reveals malrotation and malfixation of a small microcolon. No anatomic cause of intestinal or bladder obstruction can be found. Intestinal and/or rectal biopsy specimens contain abundant ganglion cells and nerve fibers. The outcome has been uniformly fatal, with survival in the reported cases ranging from two days to 34 months.

The effect of furosemide on the course of transient tachypnea of the newborn was evaluated in a controlled, prospective study. Fifty infants with transient tachypnea of the newborn were randomly assigned to control or treatment groups. Those in the treatment group were given furosemide, 2 mg/kg orally, at the time of diagnosis followed by 1 mg/kg 12 hours later if the symptoms persisted. Infants in the control group received a placebo. Compared with infants in the control group, the furosemide-treated group demonstrated no significant difference in the duration of tachypnea nor in the length of hospitalization. It is concluded that oral furosemide, at the doses used in this study, does not significantly affect the clinical course of transient tachypnea of the newborn.

Rarete de l'association de ces 2 malformations. Malgre la reparation de la hernie diaphragmatique et la creation d'une gastrostomie, deces du nouveau-ne au 20eme jour

This prospective study was designed to test the correlation of blood volume per kilogram of body weight with birthweight in polycythemic neonates. One hundred and sixty-four neonates with venous hematocrits of 65% or greater were treated with partial exchange transfusion. Follow-up venous hematocrits were obtained, and BV/kg was estimated for each infant based on the exchange volume used and the observed change in hematocrit. Birth weight ranged from 1,210 to 5,080 gm. Individual blood volume estimates ranged from 44 to 176 ml/kg, with a mean of 88.4 +/- 23.5 ml/kg. There was a highly significant negative linear correlation of BV/kg with birth weight (P less than 0.001), the regression line intersecting 100 ml/kg at 2,000 gm and 70 ml/kg at 4,500 gm. This correlation has clinical application in the management of polycythemic neonates with partial exchange transfusion. A nomogram is provided for estimating BV/kg in polycythemic neonates based on birth weight.

Transient Tachypnea of the Newborn (TTN) prolongs neonatal hospitalization and occasionally results in serious complications. The most widely accepted theory of the etiology of TTN is a delay in the absorption of fetal lung fluid. Furosemide has been shown to affect fluid dynamics in the lung. We hypothesized that a pharmacologically-induced diuresis of body water may reverse the mechanism of TTN and shorten the course of the illness. We designed a controlled, prospective trial of oral furosemide in infants with TTN. 50 consecutive infants presenting with the clinical and radiographic findings of TTN were randomly assigned to two groups. Infants in the treatment group received 2 mg/kg of oral furosemide at the time of diagnosis followed by a 1 mg/kg dose 12 hours later if the tachypnea (RR> 60) persisted. Infants in the control group received an equal volume of placebo. There were no significant differences in the prenatal and perinatal courses, nor in the demographic characteristics between the two groups. Although mean weight loss at discharge was similar in the two groups, the furosemide-treated group lost significantly more weight in the first 24 hours after birth (p

Gentamicin toxicity and efficacy studies have indicated desired peak and trough serum concentrations of 4-12 mcg/ml and less than 2 mcg/ml, respectively. Choosing an appropriate dose and dosage interval for premature infants is complicated by decreasing glomerular function with decreasing gestational age. We tested a regimen in which 24 infants less than 7 days of age,who were born between 26 and 36 weeks of gestation, received 2.5 mg/kg of gentamicin intravascularly every 18 hours. Trough serum gentamicin concentrations exceeded 2 mcg/ml in 33%; peak serum concentrations exceeded 12 mcg/ml in none but were less than 4 mcg/ml in 12.5%. Regression analysis of the data revealed inverse linear correlations between peak and trough serum gentamicin concentrations and gestational age (p

We statistically compared neonatal mortality data from Tripler Army Medical Center (TAMC) to those recently reported from the University of Colorado Health Sciences Center (UCHSC). TAMC delivery and neonatal death summaries from 1977 through 1981 were reviewed: 17,102 live births and 102 in-born deaths occurred. These results were compared to similar data obtained from 14,413 births and 252 deaths at UCHSC from 1974 through 1980. Premature deliveries were less common at TAMC, possibly resulting from fewer high-risk pregnancy referrals: 0.57% were born before 29 weeks gestation at TAMC, compared to 1.61% at UCHSC. Fifty-three percent of the neonatal deaths at TAMC and 54% at UCHSC occurred in this category. The overall neonatal mortality rate was 0.67% at TAMC, in contrast to 1.75% at UCHSC. However, analysis of mortality in relation to birthweight, gestational age, and combined BW-GA categories developed by UCHSC Mortality by Combined BW-GA Category revealed no significant differences between TAMC and UCHSC (Table). We conclude that in terms of outcome, neonatal care delivered at TAMC is similar to that delivered in a prestigious civilian institution.

• Clinical data from 100 neonates with transient tachypnea of the newborn (TTN) and 100 well neonates were compared for the relative incidence of various neonatal and obstetric factors. The incidences of male sex and macrosomia were substantially higher in infants with TTN. Obstetric histories of mothers of neonates with TTN were characterized by longer labor intervals and a higher incidence of failure to progress in labor leading to cesarean delivery. Excessive maternal sedation, perinatal asphyxia, and elective cesarean delivery without preceding labor were not seen more frequently when TTN developed. ( AJDC 1984;138:869-871)

Peak gentamicin serum concentrations (GSC) of 4-12 mcg/ml and trough concentrations < 2 mcg/ml are recommended for effective therapy without toxicity. Currently recommended gentamicin dosage regimens for premature neonates within the first week of life have a significant incidence of toxic or subtherapeutic GSC. In a previous study by the authors using a standard regimen with fixed DI, an inverse linear correlation was found between peak and trough GSC and GA. A new gentamicin dosage regimen was formulated based on this correlation using a one-compartment pharmacokinetic model. This regimen consists of a 3.5 mg/kg dose given at a DI which is inversely related to GA: DI = 50.5 - 0.76 GA. This regimen is designed to yield peak and trough GSC of 8.0 mcg/ml and 1.5 mcg/ml, respectively, in premature infants, irrespective of GA. To test this new regimen, 32 premature neonates were studied within the first week of life. Mean GA was 31.4 weeks (range 25-36); mean birth weight was 1675 grams (range 570-2900). Mean peak and trough GSC (± SD) were 7.0 ± 1.17 mcg/ml and 1.1 ± 0.26 mcg/ml, respectively. All GSC were within the recommended range. This is the lowest incidence of inappropriate GSC in any series reported in the literature. Serial peak and trough GSC did not vary significantly in individual patients during the first 4 days of therapy. The previously observed correlation between GSC and GA was lost with this regimen. We conclude that relating DI to GA in this fashion is a simple and effective way of achieving optimal peak and trough GSC in premature infants of various GAs.

To the Editor.— As defined in The American Heritage Dictionary of the English Language (Boston, Houghton Mifflin Co, 1979): Kid (kid) n. 1. A young goat. 2. Leather made from the skin of a young goat. 3. Slang. a. A child. b. A young person. -adj. 1. Made of kid. 2. Informal. Younger: My kid brother. -tr. Informal. 1. To mock playfully; to tease. 2. To deceive in fun; to fool. English kide, kyde from Old Norse kidh, young goat.

The value of frequent routine prenatal clinic visits in seemingly uncomplicated pregnancies has been questioned. To determine whether routine outpatient care significantly influences the incidence of premature delivery, we analyzed prenatal care compliance among low-risk patients who delivered over a one-year period. Prenatal care records of 50 patients who delivered prematurely were compared to those of 175 randomly selected patients who delivered at term. There were no demographic differences between the two groups. Rates of clinic attendance were significantly lower (p < 0.01) among patients who delivered severely premature infants (Table). Mortality among premature infants with a history of poor prenatal care was 23% in contrast to 2% among prematures with adequate prenatal care (p < 0.001). We conclude that seemingly low-risk obstetric patients who demonstrate poor early prenatal care compliance are at high risk for premature delivery and neonatal demise. Routine prenatal care may be an important factor in limiting both the incidence and degree of prematurity.

Elevated intrauterine hydrostatic pressures occurring during labor may redistribute blood within the feto-placental unit in the direction of the fetus. The induction of fetal intravascular hypervolemia is a recognized precursor of neonatal polycythemia. Prolonged labor might thus occur more commonly in association with neonatal polycythemia. To investigate this hypothesis, data from neonatal and obstetric records relating to the births of 30 polycythemic neonates were compared to analogous data from records relating to the births of 100 randomly selected normocythemic neonates. Infants in the two groups were similar for gestational age, gender, birth weight, Apgar scores, and mode of delivery. The umbilical cord was clamped immediately after the delivery of each infant in both groups. Mothers in the two groups were similar for age, gravidity, parity, and obstetric complications. Mothers in the polycythemic group had a greater incidence of hypertension (23% vs. 11%); however, the difference was not highly significant. Mean duration of labor (±SD) in the polycythemic group was 9.0 ± 5.8 hours with a range of 1 to 26 hours. Duration of labor in the normocythemic group was 8.9 ± 6.1 hours with a range of 0 to 30 hours. There was no significant difference in the two groups in the duration of labor or in the duration of ruptured fetal membranes prior to delivery. There was no correlation of calculated neonatal blood volumes per kilogram birth weight with duration of labor in the polycythemic group. Prolonged labor is unlikely to be an important factor in the pathophyslology of neonatal polycythemia.

Sir .—Recent reports advocate treating bone and joint infections with oral antibiotics after an initial course of intravenous (IV) therapy. 1-5 This mode of therapy has not been recommended for newborns because of lack of information on the reliability of absorption of orally administered antibiotics in this age group. 6 Satisfactory clinical response has been reported in five newborns with acute osteomyelitis treated in this manner; however, monitoring of peak and trough killing titers achieved in the infants' blood against the causative organism, as is recommended by most authorities, was not performed. 7 Report of a Case .—We recently treated a 2,780-g term neonate with osteomyelitis. This male infant was delivered by emergency cesarean section because of fetal distress. A large amount of meconium was aspirated from his trachea immediately after delivery. His Apgar scores were 2 and 6 at one and five minutes, respectively. The baby subsequently manifested persistent