Weight Infants Research Articles

Utilization of conventional radiography in a regional neonatal intensive care unit in Ireland

Objective: To audit the demand and radiation exposure of conventional radiography in a regional neonatal intensive care unit (NICU) in Ireland.Methods: A retrospective study of radiographs performed on all admissions to the NICU in University Maternity Hospital Limerick (UMHL) over 2 years.Results: A total of 1405 radiographs were performed on 506 infants. 153.5 radiographs per 1000 live births was the observed demand and 44% of radiographs were done out of hours. 47% of all radiographs were performed on infants <1500 g. Median number of radiographs per infant was one (IQR 1–2; range 1–39). Significant negative correlation was observed between number of radiographs and gestational age. Mean lung radiation doses estimated using published values for normal weight (>2500 g), very low birth weight (VLBW), and extremely low birth weight (ELBW) infants based on the median number of chest X-rays were 31.7 µGym, 84.66 and 232.75 µGy, respectively.Conclusions: Conventional radiography remains a key diagnostic tool in neonatology particularly in VLBW and ELBW infants and is invaluable in supporting timely clinical decision making. Clinicians should be aware of the cost and potential hazards of neonatal radiography and is recommend that the cumulative radiation exposure among the ELBW and VLBW infants is monitored. Increasing awareness and standardisation of point-of-care ultrasonography could decrease the reliance on conventional radiography in neonatal units.

Dietary Intervention And/Or Probiotic Capsules in Obese Pregnant Women–Effect on Gestational Weight Gain and Infant Birthweight: Healthy Mums and Babies (HUMBA) Trial

Dietary Intervention And/Or Probiotic Capsules in Obese Pregnant Women–Effect on Gestational Weight Gain and Infant Birthweight: Healthy Mums and Babies (HUMBA) Trial

Прогнозування ефективності реабілітаційних програм для дітей, народжених передчасно з дуже низькою та екстремально низькою масою тіла

The prediction problem of long-term outcomes of premature very low (VLBW) and extremely low birth weight (ELBW) infants' development and health status continue to be relevant.Objective: to determine the prognostic factors of the premature infants' health deterioration, to determine a forecast model of the neurological condition and assessing the need for prolonged rehabilitation.Material and methods. There were 70 children under the catamnestic observation during the first three years of their life (26 out of them with ELBW and 44 with VLBW). Neurological status was studied using the NACS scale.Results. Children were divided into two groups of comparison: Group 1 was comprised of 32 children, who received rehabilitation on the basis of the Regional Centre of Early Social Rehabilitation, and Group 2, which consisted of 38 children, treated at the Centre of Primary Health and Social Care. A significant factor concerning the prognosis of the rehabilitation outcomes was the score on the C. Amiel-Tison scale (1982). A paired linear regression model describing the dependence of neurological condition prediction at the age of three years on the Amiel-Tison scores at the age of 3.6 months was obtained. A multiple linear regression model describing the dependence of neurological condition prediction at the age of three years on the Amiel-Tison scores at the age of 3.6 and 10.5 months was obtained as well.Conclusions. The Amiel-Tison scores at the age of 3.6 and 10.5 months for VLBW and ELBW infants are strongly predictive for neurological condition at the age of three years. The proposed two models of prediction of their neurological status allow estimating at the age of 12 month the need for further rehabilitation prolongation, correction of its techniques at the appropriate times.

Evaluation of Cases with Neonatal Cholestasis

Amaç: Çalışmanın amacı, neonatal kolestaz nedeniyle takip edilen çocuk hastaların etiyoloji, tanı yöntemleri, laboratuvar bulguları, tedavi şekilleri ve uzun dönem prognozları açısından geriye dönük olarak incelenmesi amaçlandı. Gereç ve Yöntem: Yaşamın ilk üç ayında kolestazı olan hastalar çalışmaya alınmıştır. Hastalar ekstrahepatik kolestaz ve intrahepatik kolestaz olarak gruplandırılmıştır. Ekstrahepatik kolestaz grubu içerisine biliyer atrezi, koyulaşmış safra sendromu ve koledok kisti dâhil edilmiştir. Bunların dışında kalan hastalar intrahepatik kolestaz grubu içerisinde değerlendirilmiştir. Hastaların tanıları, yakınmaları, klinik seyirleri, laboratuvar bulguları ve tedaviye yanıtları incelenerek geriye dönük olarak prognozları değerlendirilmiştir. Bulgular: Çalışma grubu kolestaz tanısı alan hastalar 43’ü kız (%41), 62’si erkek (%59) cinsiyete sahip olmak üzere toplam 105 hastadan oluştu. Vakaların 46’sı (%43.8) prematüre doğmuştu. Otuz altı hasta (%34.3) 30-37 haftalar arasında; 10 hasta (%9.5) 30 haftanın altında olup, 39’unda ise (%37.1) düşük doğum ağırlığı mevcuttu. Hastaların %81’inde intrahepatik, %19’unda ekstrahepatik nedenlere bağlı kolestaz geliştiği saptandı. Akolik dışkı ekstrahepatik kolestaz vakaların %90’ında (18 vaka), intrahepatik vakaların %15.3’ünde (13 vaka) olmak üzere toplam 31 vakada görülmüştür. İntrahepatik kolestaz vakalarında doğum ağırlığının ekstrahepatik kolestaz vakalarına göre daha düşük olduğu saptandı. Klinik seyirlerinde intrahepatik kolestaz hastası 38 vaka (%44.7), ekstrahepatik kolestaz hastası 7 vaka (%35) düzeldi. Sonuç: Çalışmamızda, hastaların literatür oranlarından daha geç tanı aldığı görülmüştür. Bu gecikme özellikle biliyer atrezi vakalarının erken cerrahi müdahale şansını azaltmaktadır. Ultasonografik görüntülemede “triangular cord sign” belirtisinin literatürden farklı olarak hiç görülmemesi bu konuda eğitim ve tecrübe eksikliğinin olduğunu düşündürmüştür. Bunun dışında, GGT yüksekliği, spenomegali, doğum ağırlığı, akolik dışkılama gibi karaciğer hastalığı için anlamlı olacak bulguların gözden kaçması, tanı için hızlı davranılamaması çocuk hekimlerinin farkındalığını artırılması gerektiğine işaret etmektedir.

Anaesthetic management of an infant for Achilles tendon lengthening by combined intrathecal and ultrasound guided sciatic nerve blocks

A four-month old, 4.5kg weight infant with normal mentation was posted for Achilles tendon lengthening for bilateral club foot. Anaesthesia was provided with intrathecal administration of 0.4ml of 0.5% bupivacaine and popliteal sciatic nerve block with 0.2 % bupivacaine 1.5ml to each side. The sciatic nerve was looking hypoechoic than the classical honeycomb possibly due to lesser development of connective tissue. The infant had satisfactory analgesia for 12hrs post-surgery and there was no analgesic requirement. Routine follow up for three months was uneventful. We conclude that intrathecal bupivacaine supplemented with ultrasound guided peripheral nerve blocks can be administered even in infants. As case reports like this are rare to find in literature, we report this case for its uniqueness.

Risk factors for extrauterine growth retardation in moderate and late preterm infants

Objective To study the incidence and risk factors for extrauterine growth retardation (EUGR) at discharge in moderate and late preterm infants. Methods A retrospective analysis was performed on 607 premature infants who were admitted to the neonatal intensive care unit between January 1st, 2016 and December 31st, 2016.These subjects were classified into EUGR (n=159) and non-EUGR groups (n=448) based on the body weight at discharge.The risk factors for the occurrence of EUGR were studied by multivariate logistic regression analysis. Results Based on the body weight, the incidence of EUGR at discharge was 26.2%(159/607). The incidence of EUGR in intrauterine growth restriction (IUGR) infants was significantly higher than in non-IUGR infants (P<0.001). The very low birth weight (VLBW) infants had a higher incidence of EUGR than non-VLBW infants (P<0.05). Compared with the non-EUGR group, the fasting time, the age to achieve full enteral feeds, the length of mechanical ventilation, oxygen therapy and the length of hospital stays were significantly greater in the EUGR group (P<0.05). The percentages of caesarean section, multiple gestation, pregnancy-induced hypertension, intrahepatic cholestasis of pregnancy and umbilical cord abnormality in the EUGR group were higher than in the non-EUGR group(P<0.05). The incidences of septicemia, hypoalbuminemia, anemia, retinopathy of prematurity, brain injury in premature infants and mechanical ventilation in the EUGR group were higher than in the non-EUGR group(P<0.05). The logistic regression analysis showed that birth weight, IUGR, multiple gestation, abnormality of umbilical cord and the length of hospital stays were the independent risk factors for EUGR. Conclusion The causes of EUGR are multi-factorial.To strengthen pregnancy care, aggressive and reasonable nutritional strategy, prevention and treatment of complications may facilitate to reduce the occurrence of EUGR. Key words: Premature infant; Extrauterine growth retardation; Intrauterine growth retardation; Retinopathy of prematurity

Comparison of Various Kangaroo Mother Care Carriers on Maternal Comfort: A Pilot Study

ABSTRACTKangaroo mother care (KMC) is an evidence-based approach that has been scientifically proven to have a positive effect on mothers and infants. One of the barriers to performing KMC at home is the absence of a special KMC carrier. The most widely used KMC carriers in Indonesia are kangaroo pouch, thari, wrap and traditional wraps in the form of a long strip of fabric. This study’s aim was to compare the level of maternal comfort when performing KMC with three different KMC carriers. The study used crossover design involving 20 mothers with low birth weight (LBW) infants as responders, selected through a consecutive sampling method. Data were collected using a maternal comfort questionnaire, maternal anxiety questionnaire, and KMC observation sheet. The results of repeated analysis of variance (ANOVA) showed that there was no significant difference in maternal comfort when performing KMC with any of three KMC carriers (maternal comfort p = .366, α = .05). Therefore, KMC can be implemented using any of the types of carriers including kangaroo pouch, thari wrap, and traditional wrap.

IVH in VLBW Preterm Babies – Therapy with Recombinant Activated F VII?

Backround Intraventricular hemorrhage (IVH) remains a dangerous and frequent complication in very low birth weight (VLBW) infants. Activated factor VII (aFVII) activates the coagulation cascade and is a potential tool for stopping active bleeding, including limiting the extent of an IVH. This retrospective treatment observation compared data for infants with IVH progression treated with fresh frozen plasma (FFP) alone or with a combination of FFP and aFVII. Methods/Intervention All infants were subject to cranial ultrasonography at least twice daily. When an IVH was detected, treatment with FFP (5-20 ml/kg every 4-6 h) was commenced and the parents were informed. If the parents endorsed aFVII treatment and the IVH showed progress, aFVII (30-50 µg/kg body weight 4-6 times within 16-24 h) was given. Otherwise, infants were treated with FFP only. We compared the course of IVH between the aFVII+FFP treated infants and a control group (FFP only). Results 35 patients throughout were included in the analysis (17 control and 18 aFVII group). Demographic data was not different between groups. The progress of IVH was significantly less in the aFVII group (p<0.01). During the hospital stay, 2 of the infants in the aFVII group died compared to 4 in the control group. A posthemorrhagic hydrocephalus developed in 3 aFVII and 6 control infants. All other outcome parameters and follow-up-results 2 years after treatment did not differ significantly. Conclusion These data show that in the case of a progressing IVH, aFVII may be a candidate for limiting its extent. A prospective randomized trial is warranted.

The Use of Benzoyl-Dl-Arginine-Naphthylamide (Bana) Test as A Screening Test for Mother at Risk for Delivery of Pre-Term and Low Birth Weight in A Rwandan Population

Oral infections can act as the site of origin for dissemination of periodonto-bacteria and their toxins as well as induce inflammatory mechanisms to distant body sites, thus linking periodontal diseases to pre-term delivery of low birth weight (PLBW) infants. Periodontal disease is an infection of the tissues surrounding and supporting the teeth. Researchers showed that between 18 and 50 % of all pre-term deliveries are associated with periodontal disease. Porphyromonasgingivalis, Treponema denticola and Tannerella forsythia are among the subgingival microflora most frequently associated with periodontal disease. The presence of these bacteria can be identified by their ability to hydrolyse BANA. BANA is a rapid and effective diagnostic aid shown to correlate well with the clinical indices used to diagnose periodontal disease. The objective of this study was to investigate the association between the presence of member of the red complex (BANA positive species) in subgingival plaque and pre-term delivery of low birth weight in a Rwandan population. Three clinical indices (PI,GI and PD) were measured for each patient. Plaque sample were collected by inserting a sterile probe into the base of the pocket and this served for the measurement of the BANA enzyme test. The age of the population study was between 18 and 47 years with a mean of 30.8 (± 5.34). Among the 450 women examined, 57.1 % had a PI score of 2, 56.0 % had GI score of 2 and 89.6 % had a PD between 4-6 mm. At a level of 5%, a significant association of p-value=0.000 was found between PI vs BANA, GI vs BANA and PD vs BANA. No significant association (p-value=0.073) was found between BANA and mothers who delivered preterm of low birth weight (PLBW). In conclusion, findings of this study showed that BANA cannot be used for now as screening test for mother at risk for preterm delivery, while waiting for a multicenter study which will help to verify the cause of these discrepancies of results. In the other hand we can recommend BANA to be used as a routine test for the detection of periodontal disease due it strong relationship with clinical indices used to diagnose periodontal disease.

Lactobacillus acidophilus/Bifidobacterium infantis probiotics are associated with increased growth of VLBWI among those exposed to antibiotics

We performed an observational study with very-low-birth weight infants (VLBWI) ≤33 weeks of gestation born in centers of the German Neonatal Network (GNN; (total n = 8534, n = 6229 received probiotics). The primary objectives of our study were (a) to assess the effect of Lactobacillus acidophilus/Bifidobacterium infantis probiotics on growth in VLBWI during primary stay in hospital and (b) to determine whether this effect is modified by antibiotic exposure. In linear regression models the administration of probiotics was independently associated with improved weight gain [g/d; effect size B = 0.62 (95% CI: 0.37–0.87), p < 0.001], and higher growth rates for body length [(mm/d; B = 0.06 (95% CI: 0.04–0.08), p < 0.001] and head circumference [mm/d; B = 0.03, 95% CI: 0.02–0.04, p < 0.001]. This effect was pronounced in infants with postnatal exposure to antibiotics; i.e. weight gain [g/d; B = 0.66 (95% CI: 0.32–1), p < 0.001], growth rate body length [(mm/d; B = 0.09 (95% CI: 0.06–0.12), p < 0.001] and head circumference [mm/d; B = 0.04, 95% CI: 0.02–0.06, p < 0.001]. In the small subgroup that was available for analysis at 5-year-follow-up (with probiotics: n = 120 vs. without probiotics: n = 54) we noted a sustained effect of probiotics in infants who received postnatal antibiotics. Probiotics may improve growth in antibiotic-treated infants which needs to be confirmed in randomized-controlled trials.

Differential microRNA expression in human placentas of term intra-uterine growth restriction that regulates target genes mediating angiogenesis and amino acid transport.

Placental insufficiency leading to intrauterine growth restriction (IUGR) demonstrates perturbed gene expression affecting placental angiogenesis and nutrient transfer from mother to fetus. To understand the post-transcriptional mechanisms underlying such placental gene expression changes, our objective was to identify key non-coding microRNAs that express biological function. To this end, we initially undertook microarrays targeting microRNAs in a small sub-set of placentas of appropriate (AGA) versus small for gestational age (SGA) weight infants, and observed up-regulation of 97 miRs and down-regulation of 44 miRs in SGA versus AGA. In a larger cohort of samples (AGA, n = 21; SGA, n = 11; IUGR subset, n = 5), we validated by qRT-PCR differential expression of three specific microRNAs (miR-10b, -363 and -149) that target genes mediating angiogenesis and nutrient transfer. Validation yielded an increase in miR-10b and -363 expression of ~2.5-fold (p<0.02 each) in SGA versus AGA, and of ~3-fold (p<0.005) in IUGR versus AGA, with no significant change despite a trending increase in miR-149. To further establish a cause-and-effect paradigm, employing human HTR8 trophoblast cells, we assessed the effect of nutrient deprivation on miR expression and inhibition of endogenous miRs on target gene expression. In-vitro nutrient deprivation (~50%) increased the expression of miR-10b and miR-149 by 1.5-fold (p<0.02) while decreasing miR-363 (p<0.0001). Inhibition of endogenous miRs employing antisense sequences against miR-10b, -363 and -149 revealed an increase respectively in the expression of the target genes KLF-4 (transcription factor which regulates angiogenesis), SNAT1 and 2 (sodium coupled neutral amino acid transporters) and LAT2 (leucine amino acid transporter), which translated into a similar change in the corresponding proteins. Finally to establish functional significance we performed dual-luciferase reporter assays with 3’-insertion of miR-10b alone and observed a ~10% reduction in the 5’-luciferase activity versus the control. Lastly, we further validated by microarray and employing MirWalk software that the pathways and target genes identified by differentially expressed miRs in SGA/IUGR compared to AGA are consistent in a larger cohort. We have established the biological significance of various miRs that target common transcripts mediating pathways of importance, which are perturbed in the human IUGR placenta.

Varied factors causing haemodynamic instability following surgical ligation of patent ductus arteriosus (PDA) in extremely low birth weight (ELBW) infants

Varied factors causing haemodynamic instability following surgical ligation of patent ductus arteriosus (PDA) in extremely low birth weight (ELBW) infants

Gestational weight gain and the risk of infant mortality amongst women with normal prepregnancy BMI: the Friedmann-Balayla model

Objective: The study of the association between gestational weight gain (GWG) and infant mortality is riddled with methodological concerns, particularly with limitations in accounting for gestational age-specific weight gain. In our study, we developed a new model, which accounts for gestational age, to determine whether insufficient or excessive GWG is associated with an increased risk of infant death amongst women with normal prepregnancy BMI (18.5–24.9 kg/m2).Methods: We developed and implemented the Friedmann-Balayla model to mitigate gestational age-related biases in our assessment, and conducted a population-based cohort study using the CDC’s 2013 Period-Linked Birth-Infant Death data. The impact of GWG according to the 2009 IOM guidelines on the risk of infant mortality was estimated using logistic regression analysis, adjusting for relevant confounders.Results: Our cohort consisted of 1,517,525 singleton deliveries and 6138 infant deaths. Overall, relative to women achieving adequate GWG, neither women gaining insufficient nor excessive weight had greater odds of infant death during the first year of life (OR [95%CI]): 1.06 [0.97–1.17] (p = 0.174), and 0.98 [0.91–1.04] (p = 0.523), respectively. This relationship did not change when restricting our analysis to term or preterm deliveries or when conducting sensitivity analyses accounting for maternal morbidities (p > 0.05).Conclusion: Using this novel analytic approach, there does not appear to be an increased risk of infant mortality if GWG falls outside of the IOM guidelines in women with normal prepregnancy BMI. Future studies should apply this methodology to other BMI categories.

Feeding of low birth weight (LBW) and very low birth weight (VLBW) Infants

Feeding of low birth weight (LBW) and very low birth weight (VLBW) Infants

Hypoglycemia Occurs Frequently in Very Low Birth Weight Premature Infants with Cholestasis

Objective: The study purpose was to examine the incidence of hypoglycemia in very low birth weight (VLBW) infants with cholestasis while on complete enteral nutrition. Methods: A retrospective study of 270 VLBW ( 4.1 mg/dl (before full enteral feeds) predicts hypoglycemia while on full enteral feeds, with a sensitivity of 100%, specificity of 50%, and negative predictive value of 100%. Conclusion: Hypoglycemia is an unrecognized complication occurring in a high percentage of VLBW infant with history of cholestatic jaundice while receiving full enteral feeds. We propose that care-givers in the neonatal ICU monitor glucose levels in this select group of VLBW infants to avoid recurrent asymptomatic hypoglycemia.

Trends of Neonatal Mortality in context of Case Overload in Al - Alwyia Pediatric Teaching Hospital at Baghdad during 2005-2012

Background: Data on the impact of neonatal and total pediatric admissions volume on neonatal mortality are sparse. Objectives: This study is done to estimate the neonatal mortality in relation to neonatal admissions and to total hospital admissions in Al-Alwyia Pediatric Teaching Hospital through years 2005-2012 Type of the study: A retrospective study.Methods: statistical records of all cases admitted to APTH were studied during 2005-2012.Results: Neonatal mortality decreased to the nadir at last year of study period (2012) and reached 6.1% of neonatal admissions compared to 2005 level which was 9.7 %. Mortality rate among premature and low birth weight (LBW) infants decreased also. The study also reveals that neonatal mortality constitute significant a contribution to childhood mortality (61.4 %) and morbidity (28.3%) throughout the study years. With a highly significant p value parallel to increasing number of neonatal admissions (case over load) , there is a trend of neonatal mortality rate to be decreased Case fatality rate also decreased among overall children to 3.5% in 2005 and to 3.3% in 2013 in spite of 2.4 times increase in neonatal admission during the study period.This neonatal overload is more than overall pediatric over load, because the total hospital admissions are increased just 1.2 times.Conclusions: The neonatal admissions case overload is high and increasing and constitutes a significant proportion of total childhood mortality. Neonatal mortality including premature and (LBW) infants is decreasing .Further actions are needed to meet global goals.

PENGALAMAN IBU DALAM PELAKSANAAN PERAWATAN METODE KANGURU DI RUMAH TERHADAP BAYI BERAT BADAN LAHIR RENDAH DI WILAYAH KERJA PUSKESMAS PARONGPONG KABUPATEN BANDUNG BARAT

ABSTRAK Pendahuluan: perawatan Metode Kanguru (Kangaroo Mother Care) adalah perawatan untuk bayi berat lahir rendah atau bayi yang lahir prematur dengan melakukan kontak kulit antara bayi dan kulit ibu atau skin to skin contact, dimana ibu menggunakan suhu tubuhnya untuk menghangatkan bayi. Tujuan: penelitian ini bertujuan untuk mengidentifikasi pengalaman ibu mengenai pelaksanaan perawatan metode kanguru di rumah pada BBLR di Wilayah kerja Puskesmas Parongpong Kecamatan Bandung Barat. Metode: penelitian ini menggunakan metode kualitatif fenomenalogi. Penelitian ini melibatkan 3 orang Key Informant dengan teknik proposive sampling, memenuhi kriteria memiliki BBLR dan berpengalaman menggunakan PMK selama di rumah. Pengumpulan data dilakukan dengan cara wawancara yang dilengkapi dengan pedoman wawancara. Wawancara direkam kemudian di buat transkrip verbatim dan dianalisis dengan metode Colaizzi. Hasil: dalam penelitian ini adalah tiga tema dan dua belas kategori yang muncul. Diskusi: hasil penelitian memberikan saran bagi ibu, institusi kesehatan keluarga agar mendukung ibu yang memiliki BBLR dalam melaksanakan PMK dan menjadi pedoman penelitian lanjutan bagi bidang penelitian. ABSTRACT Introduction: : Kangaroo Care (Kangaroo Mother Care) is a treatment for low birth weight baby or infants born prematurely with contact the skin between baby and mother's skin or skin to skin contact, which is body temperature can be spark the baby. Objective: this study aims to identify the mother's experience over the treatment method of kangaroo in the house for low birth weight in the work area of the Puskesmas Parongpong West Bandung. Method: this research is a qualitative phenomenology which involved three Key Informants using proposive sampling technique with criteria experienced using kangaroo care at home for baby with low birth weight. The data collected through indepth interview, which is equipped with the guidelines interview. The interview recorded and transcript to using verbatim and analyzed by the method of Collaizzi. Results: there are three themes and twelve categories merges in this study. Discussion: this study provided advice for mothers, the family's health to support mothers with LBW in implementing the PMK and to guide further research for the wide research field of research.

Fatores maternos para o nascimento de recém-nascidos com baixo peso e prematuros: estudo caso-controle

Objective: To identify maternal factors most associated with the birth of low weight and premature infants. Materials and Methods: Case-control study with 111 mothers who sought care at a public hospital in Feira de Santana (BA). The case group consisted of mothers of newborns with low birth weight (<2500g) and <37 weeks; and the control group of mothers of newborns with normal weight (≥2500g) and term. Birth weight and gestational age were obtained from hospital records. The main risk factors for low birth weight and prematurity were assessed by bivariate analysis and by calculating the odds ratio (OR). Results: 18.9% of mothers had preterm deliveries and, in 38.1% of cases, delivered before 34 weeks. Most of these women were aged between 14 and 25 years (66.7%), black or mulatto (85.7%), had a partner (81.0%), vaginal delivery (57.0%) and visited dentist during pregnancy (95.2%). There was a statistically significant association between low birth weight/premature delivery and consumption of alcoholic beverages (OR: 7.9; p=0.001), number of antenatal visits less than 6 (OR: 2.94; p=0.02) and the use of abortive medication (OR: 5.05; p=0.04). Conclusion: The findings showed that women who consumed alcohol, had fewer than six prenatal consultations and used abortive medication, had a greater chance of delivering a baby with low birth weight and premature. Thus, these risk factors deserve special attention in public policies to face this disease.

Chorioamnionitis and subsequent bronchopulmonary dysplasia in very-low-birth weight infants: a 25-year cohort.

To determine whether chorioamnionitis (CA) or sepsis were associated with bronchopulmonary dysplasia (BPD) in a 25-year cohort of very-low-birth weight (VLBW) infants. VLBW infants ⩽32 weeks gestation admitted to the neonatal intensive care unit between 1989 and 2014 were reviewed. BPD was defined using the National Institutes of Health consensus definition. CA was defined clinically. Logistic regression models were used for BPD prediction. One thousand six hundred and eighty-seven infants were included; 44% (n=740) had moderate or severe BPD. In multivariable analysis, lower gestational age (odds ratio (OR) 1.12 per week (95% confidence interval (CI) 1.11, 1.14)), sepsis (OR 2.03 (95% CI 1.49, 2.77)) and birth year ⩾1995 (OR 1.49 (95% CI 1.09, 2.04)) were significant predictors of BPD. CA was not associated with BPD (OR 1.18 (95% CI 0.66, 2.11)). Sepsis, but not CA, is associated with the development of moderate or severe BPD in VLBW infants after controlling for gestational age.

Risk Factors of Transient Early Wheezing in Infants below 2 years in Fayoum City

The three different phenotypes of wheezing in infants and children are transient early wheezing, non-atopic preschool wheezing and atopic or asthmatic wheezing. Early transient wheezers suffer from wheezing only during the first two years of life due to small airways caliber being more likely to narrow and obstruct. The main phenomena are the absence of personal history and/or family of atopy, so they are born with lung deficiency. Transient early wheezing to represent about 60% among children. There are many risk factors, which predispose to transient early wheezing such as: maternal complications during pregnancy, type of delivery, type of feeding during infancy, overweight infants, passive smoking and day care attendance during infancy. The previous risk factors were studied well in many developed countries but not in our communities including Egypt. Study these risk factors among infants between two months and two years of age and this is the first study done for this common problem among Egyptian children. The study included 160 infants between 2 months and two years, 80 of them were diagnosed as TEW (group 1) and another 80 healthy infants as a control group. Infants were subjected to the following: Detailed history with special emphasize on gestational age -infant gender-infant weight-prenatal and natal history- history of smoking in family- type of delivery -type of feeding. History of recurrent wheezing, need for hospitalization. Full Clinical Examination 3-Investigations: chest x ray and Laboratory tests: Full picture analysis and IgE total enzyme assay. The study revealed that TEW was encountered with large percentage among infants with history of: maternal disease during pregnancy (diabetes, hypertension and urinary tract infection), caesarian section delivery, over weight infants, family history of smoking, artificial feeding, consuming cow milk during first year of life and attendance to daycare during infancy. Overweight is a new risk factor that was observed in our study. Most of the noted risk factors are similar to that reported in studies done in developed countries in addition to overweight infants are associated.