Adiponectin levels measured in neonatal dried blood spot samples (DBSS) might be affected by both prematurity and being born small for gestational age (SGA). The aim of the study was to measure adiponectin levels in routinely collected neonatal DBSS taken on day 5 (range 3-12) postnatal from infants.
A retrospective case-control study.
One hundred and twenty-two infants: 62 very premature (34 SGA) and 60 mature infants (27 SGA). Adiponectin concentrations were determined in stored neonatal DBSS using a sandwich immunoassay based on flow metric Luminex xMap technology.
Adiponectin was measurable in all samples, and repeated measurements correlated significantly (r = 0.94). Adiponectin concentrations were negatively associated with both SGA (B = -0.283, P = 0.04) and prematurity (B = -2.194, P
The Cerebral Palsy Register in eastern Denmark has collected cases using a uniform data sampling procedure since birth year 1979. We have investigated changes in the rate of cerebral palsy, related to gestational age, mortality and perinatal risk factors in children born 1983--90. The total cerebral palsy birth prevalence decreased from 3.0 in the birth year period 1983--86 to 2.4 per 1000 live births (P
The principles for treatment of very premature deliveries in obstetric, surgical and paediatric departments were investigated by means of a questionnaire. This contained fictitious case histories about transfer in cases of threatened delivery, caesarean section in cases of interuterine asphyxia, resuscitation after delivery, transfer to a paediatric department and employment of respirators in cases of increasing respiratory difficulty following deliveries after 24, 26 and 28 full weeks of pregnancy. Replies were obtained from 26 out of 29 maternity departments, 28 out of 33 surgical departments with more than 100 deliveries in 1985, and 18 out of 18 paediatric departments. In all of the situations, considerable restraint was expressed as regard the most premature deliveries. For example, only two obstetric departments, two surgical and four paediatric departments stated that they would, as a rule, attempt resuscitation after deliveries at gestational ages of 24 weeks. For deliveries at 26 weeks, the figures were 18, 12 and 12, respectively. A certain tendency was observed for less restraint in 1985 as compared with 1979. Tendencies to centralize the very premature deliveries were greater in East Denmark than in West Denmark where respirator treatment was more frequently employed for the smallest infants.
In 2005, we changed our minimally invasive departmental policy for infants born before 26 weeks of gestation to a proactive approach. This included structured guidelines as well as intubation and surfactant in the delivery room, if the parents agreed. The aim of this study was to evaluate the effect of this change of policy.
We compared the Ages and Stages Questionnaire (ASQ) scores, mortality rates and use of mechanical ventilation before (1999-2003) and after (2005-2011) the introduction of the new policy.
Twenty-two per cent of 61 infants in the before group had an ASQ z-score of
OBJECTIVE: To assess the value of fetal weight estimation during routine third trimester ultrasound examinations for the identification of small-for-gestational-age (SGA) fetuses, to promote active pregnancy management and so reduce perinatal morbidity. DESIGN: A prospective controlled randomized study. SETTING: Outpatient clinic at the Department of Obstetrics, Herlev University Hospital, Denmark. SUBJECTS: One thousand pregnant women considered at risk were selected consecutively from April 1985 to September 1987 and randomized to either a revealed-results group or a withheld-results group. INTERVENTION: All the women had an early ultrasound examination for estimation of gestational age. Both groups had routine ultrasound estimates of fetal weight after 28 weeks and then every third week until delivery. The results were available for clinical use only in the revealed group. MAIN OUTCOME MEASURES: Number of interventions during pregnancy (admission to hospital, elective delivery), emergency intervention during labour, and fetal outcome. RESULTS: Revealing the results of ultrasound estimates of fetal weight for gestational age during the third trimester resulted in statistically significantly increased diagnosis of SGA fetuses, of elective deliveries based on this diagnosis, and of healthy preterm babies admitted to the neonatal care unit, but no detectable overall improvement in weight for gestational age at birth, or in neonatal morbidity or mortality. CONCLUSION: This method of screening improved the diagnosis of SGA fetuses, but this was not followed by improved fetal outcome.
AIM: To evaluate neurodevelopmental outcome at age 5 y of age in a cohort of preterm children treated mainly with nasal continuous positive airway pressure (CPAP) in the neonatal period. METHODS: A national prospective observational study was conducted in Denmark which included all 269 surviving children with a birthweight below 1000 g or a gestational age below 28 wk born in Denmark in between 1994 and 1995. A total of 164 children (61%) had been treated with nasal CPAP only in the neonatal period. A reference group (n = 76) of term children was studied in parallel. RESULTS: Of the 269 surviving children, 252 (94%) were examined. Twenty-four children (10%) had cerebral palsy, and three children were blind. No case of hearing impairment was detected. Nineteen percent of the index children had an IQ score
INTRODUCTION: Neonatal transport is difficult and often associated with problems. In 1998, the Neonatal Intensive Care Unit, University Hospital of Copenhagen, H:S Rigshospitalet, set up a neonatal transport team. The aim of this study was to assess whether a better quality of high risk transport could justify the increased consumption of time. METHOD: The schedules for observation and assessment filled in by the transport team were collected and compared with records of the transport of high-risk neonates by local transport. The comparison consisted in the number of infants, severity of the problems, interventions carried out either locally or after arrival at the Neonatal Intensive Care Unit, and the condition of the infants judged on the pH, blood sugar level, blood pressure, and body temperature. RESULTS: The neonatal transport team fetched 68 high-risk infants, whereas 140 high-risk infants were brought by local transport. Infants fetched by the transport team were more sick, both before and during transport, than those brought to us. On arrival at the Neonatal Intensive Care Unit, more infants brought by local transport had problems (31% vs 16%): 12 (9%) transports had more than one critical problem, in contrast to none of the infants fetched by the transport team. The transport team carried out 71 interventions on 44 of the 68 infants (65%). These interventions explain the better condition of the infants on arrival. Acute interventions soon after arrival at the Neonatal Intensive Care Unit were carried out on 91 of the 140 infants brought by local transport (65%). DISCUSSION: Neonatal transport of extremely ill infants is difficult. A specialised (transport) team with local stabilisation and transport reduces the frequency of complications. The number of high-risk neonates transported is so small that it is improbable that adequate expertise can be built up and maintained locally.
The dilemma of proper treatment of very low-birthweight infants is discussed. CONCLUSION: Professionals should be aware of the data in order to consider the chances of every baby and to engage in the relationship with the family, care team and society.
Comment On: Acta Paediatr. 2004 Feb;93(2):149-5215046261
A linear perinatal growth curve, covering the period from 28 weeks gestation to 18 weeks after term birth is presented. The curve was first presented 15 years ago, and is now supported by Danish data, both cross-sectional and longitudinal. It may be used for classification of birth weight in relation to gestational age and at the same time for monitoring of postnatal growth, regardless of gestational age at birth. Limitations of empirical curves are pointed out. The postnatal growth potential of preterm infants is stressed.