POVERTY AND VERY LOW BIRTH WEIGHT INFANTS IN DC

The single largest contributor to infant mortality in the District of Columbia, and elsewhere in the United States, is immaturity. In the district the dead newborns are not simply those born a little too early; they are extraordinarily premature, babies weighing less than 2 pounds 4 ounces at birth. The cause of their premature birth is not known. It is not just teenage pregnancy, poor maternal nutrition, infectious disease, cigarette smoking, drug abuse or alcohol—although each of these is statistically associated with an increased risk for early delivery. The major common factor repeatedly identified is poverty. It is apparent that the overriding influences on infant mortality are social and cultural, not medical.

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Low Birth Weight, Vital Records, and Infant Mortality

PEDIATRICS ◽

10.1542/peds.78.6.1143 ◽

1986 ◽

Vol 78 (6) ◽

pp. 1143-1145

Author(s):

MYRON E. WEGMAN

Keyword(s):

Birth Weight ◽

Infant Mortality ◽

Low Birth Weight ◽

Very Low Birth Weight ◽

The United States ◽

Low Birth Weight Infants ◽

Neonatal Deaths ◽

Live Births ◽

Order Of Magnitude ◽

Almost All

About one tenth of all infant deaths occur in babies weighing less than 500 g at birth, almost all of whom die very shortly thereafter. In 1983, when the United States reported 3,638,933 live births, 4,368 of them were less than 500 g; that year there were 26,507 neonatal deaths. This means that slightly more than 0.1% of all live births contributed to 17% of neonatal mortality. Given this order of magnitude, any change in the numbers relating to these tiny babies can have a disproportionate influence on reported infant mortality and on interstate comparisons. Two questions promptly arise. How accurate and meaningful are the data regarding babies born weighing less than 500 g? What can be done to decrease the deaths in this category? Wilson et al1 call attention to how the number of very low birth weight infants reported by a state may be affected by the state's definition of a live birth.

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Benzyl Alcohol: Toxic Agent in Neonatal Units

PEDIATRICS ◽

10.1542/peds.72.3.356 ◽

1983 ◽

Vol 72 (3) ◽

pp. 356-358 ◽

Cited By ~ 1

Author(s):

◽

Keyword(s):

Benzyl Alcohol ◽

Multiple Dose ◽

Antimicrobial Agents ◽

Very Low Birth Weight ◽

Newborn Infants ◽

Isotonic Saline ◽

The United States ◽

Low Birth Weight Infants ◽

Toxic Agent ◽

Arterial Blood

As advances have been made in the care of very low-birth-weight infants, some techniques or practices have caused unexpected complications. One such practice is umbilical vessel catheterization to monitor an infant's arterial blood pressure, infuse fluids and medications, and obtain blood specimens for laboratory examinations. The catheters frequently are flushed with sterile isotonic saline or a 5% solution of dextrose in water, with the flush solution frequently being obtained from a multiple-dose vial. The United States Pharmacopeia requires all medications or solutions marketed in a multiple-dose vial to contain an antimicrobial preservative. Benzyl alcohol, an aromatic alcohol, is used for this purpose in a wide variety of medications and fluids for parenteral therapy, usually in a concentration of 0.9%. Two groups of investigators, Gershanik et al1 (New Orleans) and Brown et al2 (Portland), independently concluded that an intravascular infusion of flush solutions containing 0.9% benzyl alcohol caused severe metabolic acidosis, encephalopathy, respiratory depression with gasping, and perhaps other abnormalities leading to the death of a total of 16 infants. Blood and urine from several affected infants had high levels of both benzoic and hippuric acids, known metabolites of benzyl alcohol. Both groups stated that no additional cases occurred after solutions with benzyl alcohol preservative were banned in their nurseries. Subsequently, in May 1982, the Food and Drug Administration3 with the concurrence of the American Academy of Pediatrics and the Centers for Disease Control,4 urged pediatricians and other personnel in hospitals not to use fluids preserved with benzyl alcohol (or other antimicrobial agents) as intravascular flush solutions for newborn infants and not to use diluents with this preservative to reconstitute or dilute medications for infants.

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Births to Teens Older and Younger Than 17 Years in San Bernardino County and California

Californian Journal of Health Promotion ◽

10.32398/cjhp.v2i2.1730 ◽

2004 ◽

Vol 2 (2) ◽

pp. 20-27

Author(s):

Kofi Adade Boafo ◽

Bruce Smith ◽

Naomi N Modeste ◽

Thomas J Prendergast, Jr

Keyword(s):

Infant Mortality ◽

Very Low Birth Weight ◽

Age Groups ◽

Mortality Rates ◽

Teen Mothers ◽

Mortality Data ◽

San Bernardino County ◽

Low Birth Weight Infants ◽

Data Set ◽

San Bernardino

Objective: The purpose of this cohort, descriptive study was to attempt to understand the variables associated with discordant infant mortality among teenagers 17-19 years old whose infants demonstrated higher mortality than infants of teenagers who were younger than 17 years old in San Bernardino County, California. The intent was to elicit further research and/or define appropriate interventions for teen mothers within the age range 17-19 years. Methods: Data was abstracted from an electronic infant mortality data set, the State of California Birth Cohort File in which birth records from San Bernardino County for the period 1989 through 1993 were matched with mortality records. Results: The data showed that infants of white teens within the 17-19 age groups were more likely to have higher infant mortality rates when compared to their younger peers. Infant mortality rates among offspring of Hispanic and black teenage mothers showed no discrepancy between the two groups nor between county and state rates. Conclusions: Further study is needed to answer why infants of white teen mothers in the 17-19 age groups have higher mortality rates. There is also a need to review the services rendered to pregnant and parenting adolescents in San Bernardino County. In addition, very low birth weight infants were much more likely to die when born to older teens than when born to younger teens.

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Will Neonatology Vanish in 1995?

PEDIATRICS ◽

10.1542/peds.77.5.792 ◽

1986 ◽

Vol 77 (5) ◽

pp. 792-793

Author(s):

EMILE PAPIERNIK

Keyword(s):

United States ◽

Birth Weight ◽

Low Birth Weight ◽

Prevention Program ◽

Very Low Birth Weight ◽

The United States ◽

Low Birth Weight Infants

In Reply.— The interest of neonatologists in preventing preterm deliveries is remarkable in the United States. In France, where a policy of prevention was developed nationally in 1971, the first impulse also came from the neonatologists and specifically Alex Minkowski, who challenged the obstetricians to propose a real prevention program. The results of this program have now been published.1 incidence of very low birth weight infants in France in 1972 was 0.8 and in 1981 0.4.2

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Socioeconomic Disparities in Pregnancy Outcome and Infant Mortality: Extremely Low Birth Weight and Very Low Birth Weight Infants in Korea, 1995-2010

Health Policy and Management ◽

10.4332/kjhpa.2015.25.4.277 ◽

2015 ◽

Vol 25 (4) ◽

pp. 277-284

Author(s):

Hye-Jeong Park ◽

Mia Son

Keyword(s):

Birth Weight ◽

Infant Mortality ◽

Low Birth Weight ◽

Pregnancy Outcome ◽

Very Low Birth Weight ◽

Socioeconomic Disparities ◽

Extremely Low Birth Weight ◽

Low Birth Weight Infants ◽

In Pregnancy

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84 Looking back to move forward; can fetal placental inflammatory response play a role in risk of sepsis and clinical decision making in preterm infant

Paediatrics & Child Health ◽

10.1093/pch/pxab061.066 ◽

2021 ◽

Vol 26 (Supplement_1) ◽

pp. e60-e61

Author(s):

Jo-Anna Hudson ◽

Isabelle Viel-Thériault ◽

Dina El Demellawy ◽

Brittany Ruschkowski ◽

Yvonne Tan ◽

...

Keyword(s):

Inflammatory Response ◽

Clinical Decision Making ◽

Very Low Birth Weight ◽

Event Analysis ◽

Low Birth Weight Infants ◽

Perinatal Medicine ◽

Vlbw Infants ◽

Early Onset Sepsis ◽

Increased Risk ◽

Fetal Response

Abstract Primary Subject area Neonatal-Perinatal Medicine Background Sepsis adversely impacts the survival of very low birth weight infants (VLBW), with a mortality risk up to 50%. Its diagnosis in premature infants is challenging. Conversely, prolonged antibiotic use is associated with perilous potential consequences, propelling the need to better identify those at risk of sepsis. The presence of a histological intra-amniotic inflammation (IAI) response may be associated with an increased risk of early onset sepsis (EOS). Currently, it is unknown how the diagnosis of histological IAI impacts the risk of sepsis. Objectives Our research goal is to explore histological fetal and maternal inflammation in the placenta in VLBW infants and to evaluate if specific recommendations about antibiotic management of VLBW infants with histological fetal response can be proposed. Design/Methods Retrospective cohort study of all infants < 1500 g born to a mother with histologically confirmed IAI. Demographic information about the pregnancy, delivery and postnatal course up to 28 days of life was extracted. Descriptive statistical analysis was conducted to compare the characteristics of infants with histological fetal response using χ2 test or Fisher’s exact test and Wilcoxon rank sum test or ANOVA. Results Seventy-three mother-baby pairs were reviewed. EOS prevalence (19%) in our IAI group of VLBW infants is much higher than EOS observed in all VLBW infants from the Canadian Neonatal Network database (below 3%). In our cohort, the majority had fetal inflammatory stage 1 (31.6%) and fetal inflammatory grade 0 (50%). There was no statistically significant distribution amongst the fetal stages or grades. Time to sepsis event analysis showed that the earlier fetal inflammatory grade was associated with positive cultures occurring earlier, while in the later grades there demonstrated longer latency to positive cultures. This trend was also true when looking at the maternal inflammatory stages. Nine infants who had antibiotics discontinued from day of life (DOL) 2-5 developed a positive blood culture ≤ DOL8. Conclusion Our results suggest that the presence of mild fetal inflammatory changes is associated with earlier positive cultures. We hypothesize that later grades may be associated with longer infection exposure leading to prolonged maternal antibiotics, resulting in less EOS. Majority of positive cultures were within the 3-8 day window, suggesting a role of knowing the fetal inflammatory response when deciding duration of antibiotic treatment.

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Impact of Improved Survival of Very Low Birth Weight Infants on Recent Secular Trends in the Prevalence of Cerebral Palsy

PEDIATRICS ◽

10.1542/peds.91.6.1094 ◽

1993 ◽

Vol 91 (6) ◽

pp. 1094-1100

Author(s):

Vidya Bhushan ◽

Nigel Paneth ◽

John L. Kiely

Keyword(s):

United States ◽

Cerebral Palsy ◽

Birth Weight ◽

Low Birth Weight ◽

Very Low Birth Weight ◽

The United States ◽

Epidemiologic Studies ◽

Secular Trends ◽

Industrialized Countries ◽

Low Birth Weight Infants

Objective. To review recent secular trends in the prevalence of cerebral palsy in industrialized countries that have population-based cerebral palsy registries and to estimate such time-trends for the United States, where until recently such registries were absent. Data sources. Recent epidemiologic studies of cerebral palsy published in peer-reviewed journals in English, and US vital data bearing on the principal demographic determinants of cerebral palsy—birth rates, the birth weight distributions, birth weight-specific mortality risk, and cerebral palsy risk among survivors. Results. Most epidemiologic studies from industrialized countries show a rise in the childhood prevalence of cerebral palsy in recent decades, largely because of the increasing contribution of children of low and very low birth weight to its prevalence. The only demographic determinant of cerebral palsy prevalence that is changing rapidly in the United States is survival of low birth weight and very low birth weight infants. Based on the magnitude of change in the survival of low and very low birth weight infants, it is estimated that childhood prevalence of cerebral palsy rose about 20% between 1960 and 1986 in the United States. Conclusion. An apparently unavoidable side effect of the increasing success of newborn intensive care is a moderate rise in the childhood prevalence of cerebral palsy.

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Feeding the Very Low-Birth-Weight Infant

Pediatrics in Review ◽

10.1542/pir.14.4.123 ◽

1993 ◽

Vol 14 (4) ◽

pp. 123-132

Author(s):

Rene Romero ◽

Ronald E. Kleinman

Keyword(s):

Birth Weight ◽

Low Birth Weight ◽

Very Low Birth Weight ◽

The United States ◽

Full Term ◽

Nutrition Support ◽

Low Birth Weight Infants ◽

Term Infants ◽

Stage Of Development ◽

Organ Systems

Unfortunately, premature birth occurs commonly in the United States. Improving the survival of very low-birth-weight (VLBW) infants depends in large part upon understanding the physiologic capabilities of their immature organ systems and providing appropriate support as they mature. Advances in the nutritional support of these infants have contributed to the better outcomes we have come to expect today, even for the smallest infants. In this review, we will discuss the limitations of gastrointestinal function and the unique nutritional requirements of very low-birth-weight infants and describe the current methods of enteral and parenteral nutrition support used to meet these requirements. Developmental Physiology By 24 to 26 weeks of gestation, the fetal gastrointestinal tract is morphologically similar to that of the full-term infant; however, functional development is far from complete. Maturation of gastrointestinal motility, digestion, and absorption continues through much of the first year of life, even in full-term infants, as a result of an interplay between the preprogrammed "biological clock" and environmental influences. The decision to feed the VLBW infant must take into account the developmental limitations as well as the potential for enhancing intestinal maturation at each stage of development (Table 1). Fetal swallowing is evident at the beginning of the second trimester.

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