Assessment of skeletal development using a nonionizing method would be desirable in critically ill preterm infants. We investigated the second metacarpus by quantitative ultrasound (QUS). Cross-sectional data were collected in 132 preterm or term infants measured within 24 h from birth and in 142 term infants up to the age of 18 mo. Longitudinal data were collected in 150 preterm infants up to the age of 14 mo. Cross-sectional data were used to devise reference curves for metacarpal speed of sound (mcSOS) and metacarpal bone transmission time (mcBTT). Both parameters increase during the last trimester of gestation. After birth, mcSOS declines up to the 6 mo and then increases up to 18 mo of life. McBTT values remain stable after birth. At birth, QUS values of preterm infants are lower than those observed at birth in term infants. In the longitudinal study, mcSOS showed a trend similar to that observed among term infants, nevertheless, values are lower up to 4 -6 mo of life. Among preterm infants, mcBTT increases until it reaches values observed in term infants. Preterm infants in their first months of life have lower QUS values compared with term infants of same weight or length. This study demonstrates that it is possible to follow skeletal development and maturation by QUS in preterm infants. More specifically, the mcBTT values may provide information on bone tissue that is independent of length and weight of the preterm infant. The method here described is safe, repeatable, and reliable. The incidence of congenital disorders of skeletal development is estimated to be about 1 in 4000 births (1). Most of them are clinically apparent at birth. Numerically more prominent are neonates suffering from intrauterine growth retardation. Further, in infants born before 28 wk of gestation and/or weighing less than about 800 g at a few weeks after birth, a temporary postnatal scarcity of bone tissue may appear. This is called osteopenia of prematurity, and may lead to spontaneous fractures (2,3). Presently, DXA is the most extensively used method for the assessment of bone mineralization (4). DXA has been used to measure bone mineral content in newborns (5-7). In longitudinal studies, DXA suffers from important limitations such as cumulative radiation dose and motion artefacts; a further limitation to the use of DXA is represented by the fact that mineral accretion and bone growth are not parallel (3). In these infants, the assessment of skeletal development at birth and in early infancy using a nonirradiating method would be desirable.QUS technique has been used for the past 10 y to assess bone tissue in postmenopausal osteoporosis (8 -11). Recent studies have shown that ultrasound can be utilized to assess bone mineral disorders in children and neonates. In preterm and term newborns, radius, humerus, and tibia were used as sites of measurement (12-16). Bearing in mind the special caution demanded by critically ill and very small infants, we sought an ultrasound method and site of measurement to achieve reliable and repe...

For the first time a multimodal approach to NEC prophylaxis is reported, consisting of early trophic feeding with human breast milk, and enteral administration of an antibiotic, an antifungal agent, and probiotics. A retrospective analysis of local protocol of NEC prophylaxis is presented. Included were all VLBWI admitted to the NICU, including transfers within the first 28 days of life. These infants were divided into two groups, an "inborn group" (infants admitted within the first 24 h of life) and an "outborn group" (infants admitted after the onset of their second day of life). Prophylaxis of NEC according to protocol was started at the day of admission, and was continued until discharge. Between 1998 and 2004, 405 VLBWI were admitted, including all transfers within the first 28 days of life. A total of 334 (82%) infants were admitted within the first 24 h of life (inborn group), and 71 (18%) were admitted after 24 h of life (outborn group). Five infants developed clinical features of necrotizing enterocolitis. The inborn group showed a NEC incidence of 0.7% (two infants), whereas the outborn group showed a NEC incidence of 4.5% (three infants), respectively. This difference was significant (P=0.049, Fisher's exact test). A surgical treatment with bowel resection was performed in two infants (both from the outborn group). The present study used a combination of different strategies, all having shown to have some beneficial effect, but not having brought a clinical breakthrough in single administration studies. Combinated were the beneficial effects of human breast milk feeding, oral antiobiotics, oral antifungal agents, and the administration of probiotics. In a homogenous group of preterm infants, using this protocol of multimodal NEC prophylaxis, there was a very low incidence of NEC, when started within the first 24 h of life.

Over a 5-year period (1984-1988) intra- and periventricular hemorrhage (IVH/PVH) was observed in 299 preterm infants. Sixty-eight infants developed posthemorrhagic hydrocephalus (PH); of these, 23 infants died and 40 infants could be followed up for assessment of neurological development (5 patients were lost to follow-up). At 1 year of corrected age 15% (25% at 5 year follow-up) of the infants were determined to have developed normally, 35% (25% at 5-year follow-up) showed mild neurological symptoms and/or slight developmental delay, 32.5% (28% at 5-year follow-up) had handicaps and/or moderate mental retardation, and 17.5% (22% at 5-year follow-up) had severe handicaps and/or severe mental retardation. There was a significantly worse outcome in infants with grade 4 IVH/PVH (P < 0.05) and a significantly worse outcome in the group requiring ventriculoperitoneal (VP) shunt (P < 0.05). The results at 1 year of corrected age proved to be a quite realistic predictor of neurological functioning at 5 years of age (80% predicted correctly in the non-shunted-group--one patient lost to follow-up; 95% predicted correctly in the shunted group--four patients lost to follow-up). Cystic periventricular leukomalacia had been diagnosed in 7 (10%) patients and was associated with poor neurodevelopmental outcome. Gestational age, birth weight, time of shunt placement, and peripartum asphyxia had no significant influence on neurodevelopmental outcome. Infants with shunt infections and a high number of shunt revisions were found to have a significantly worse neurodevelopmental outcome (P < 0.01).

Over a 6-year period (1989-1995), gastrointestinal (GI) perforation was diagnosed in nine preterm infants (mean gestational age 27 weeks, mean birth weight 872 g). Three presented with necrotizing enterocolitis (NEC), two with indwelling-tube-induced perforation of the stomach, one with small-left-colon syndrome, and another with meconium ileus. Spontaneous intestinal perforation occurred in two similar very-low-birth-weight (VLBW) infants, in the distal ileum, on days 8 and 9 of life, respectively. The only clinical sign was extensive abdominal distension, and abdominal X-ray studies revealed free peritoneal air. All findings were distinct from those associated with NEC. Their further clinical course was complicated by reperforation on day 32 and 39, respectively. They subsequently recovered and presented without GI problems at the corrected ages of 4 and 2 months, respectively. In contrast to high mortality of 57% in the group with non-spontaneous intestinal perforations, spontaneous perforation seems to have a good prognosis even in VLBW infants if diagnosed and treated promptly.

In order to measure the intracranial pressure (ICP) of 8 newborn with posthemorrhagic hydrocephalus (group A) we used the noninvasive technique via the anterior fontanel (Ladd monitor). The ICP was monitored in two different head positions (30 degrees elevated, horizontal). The median measurements were: elevated head position, 13 mm Hg, horizontal head position, 16 mm Hg. For comparative reasons, we also measured the ICP of 12 healthy newborns (group B). The median results were: elevated head position, 4 mm Hg, horizontal head position, 6.5 mm Hg. Significant differences were found between groups.