Using a method described earlier, the evaporation rate (ER) from the skin was studied at different ambient humidities in 14 full-term and 10 pre-term small for gestational age (SGA) infants. Transepidermal water loss (TEWL) was estimated in 25 SGA infants born after 30-40 weeks of gestation. Comparisons were made with infants appropriate for gestational age (AGA). A linear relationship was found between ER and ambient humidity in full-term SGA infants, but with lower ER values than in AGA infants. Lower ER values were also found in moderately pre-term SGA infants at different ambient humidities. ER was higher at lower ambient humidities in both SGA and AGA infants. In full-term and moderately pre-term SGA infants TEWL was lower than in corresponding AGA infants.
Despite favorable outcomes for many children born at the limit of viability, these children are at risk for mental health problems, with poorer school results.
In a 2-year (1990-92) prospective national investigation, comprising all stillborn and live-born ELBW infants with a birthweight of < or = 1000 g born at 23 completed weeks of gestation or more, we examined the incidence, neonatal mortality, major morbidity and infant survival in relation to level of care and place of residence. A total of 633 ELBW infants were live-born, i.e. 0.26% of all live-born infants, and 298 were stillborn. The average neonatal mortality was 37% and 91% at 23 weeks, 70% at 24 weeks, and 40% at 25 weeks of gestation. Of neonatal survivors, 8% had intraventricular haemorrhage grade 3, 10% retinopathy of prematurity of stage > or = 3, 2% necrotizing enterocolitis, and 28% were oxygen-dependent at a time corresponding to 36 weeks of gestation. In all, 77% were treated with mechanical ventilation, whereas 19% survived without, almost all of them being CPAP treated. Infant mortality among infants born at level III (tertiary centres) was 30%, at level IIa (with full perinatal service) 46% and at level IIb (with basic neonatal service) 55%. Only 1% was born at hospital level I. Regarding the relation to place of residence, the mortality rates among infants residing in the areas served by levels III, IIa and IIb hospitals were 36%, 45% and 41%, respectively. The referral system thus functioned well, but can be improved, and increased perinatal referral, at borderline perinatal viability, might provide a better quality of care and a better chance of survival.
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