OBJECTIVE: To evaluate the effects of gestational age at the timing of elective caesarean section (ECS) on the incidence of respiratory dysfunction in the newborn. STUDY GROUP AND METHODS: This was a retrospective study. All infants born by ECS at the Landspitali-University Hospital Iceland over a 10 years period (1996-2005) at >or=37 weeks gestation and diagnosed with transient tachypnoea of the newborn (TTN) or respiratory distress syndrome (RDS) were included in the study. RESULTS: Of the 1486 infants delivered by ECS over the study period 57 (3.8%) developed TTN (50 infants) or RDS (7 infants). The incidence of respiratory dysfunction was inversely related to gestational age, 13.8% at 37 weeks gestation and 2.5% at 40 weeks gestation. A statistically significant reduction in the incidence of TTN or RDS was observed from 38 weeks to 39 weeks gestation (6.6% and 2.3% respectively; p<0.001). There has been a reduction in the incidence of ECS before 39 weeks gestation since 2001, when guidelines regarding optimal timing of ECS were set at our hospital. CONCLUSION: The incidence of respiratory dysfunction in neonates born by ECS is inversely related to gestational age, even in the term infant. It is important to delay ECS until 39 weeks gestation whenever possible, in order to minimize the risk of respiratory dysfunction in the newborn infant.

OBJECTIVE: To evaluate the effects of normal vaginal delivery (NVD) on oxygen transport to the fetus. Study group and methods: Fifty newborn infants born by NVD and as a control group 50 infants born by elective Cesarean section (ECS) were studied. Factors reflecting oxygen transport to the fetus were measured in venous and arterial cord blood: pH, partial pressure of oxygen (pO2) and carbon dioxide (pCO2), oxygen saturation (SO2), blood oxygen content, base deficit, and lactic acid concentrations, erythropoietin concentrations, number of nucleated red blood cells and haemoglobin concentrations. RESULTS: There was no significant difference in venous blood oxygen content between the two groups of infants. However, arterial blood oxygen content was significanlty lower in the infants born by ECS than in those born by NVD (p<0.001). Infants born by NVD had significantly lower pH (p<0.001), greater base deficit (p<0.001), higher lactic acid (p<0.001) and erythropoietin concentrations (p=0.01), more nucleated red blood cells (p=0.004), and higher hemoglobin concentrations (p=0.002) in venous blood than in the infants born by ECS. pH was lower (p<0.001) and lactic aicid concentrations were higher (p<0.001) in arterial blood than venous blood in both groups of infants. Conclusions:(1) NVD causes reduction in oxygen transport to the fetus, resulting in acidosis and stimulation of blood forming tissues.(2) ECS is associated with more reduction in umbilical arterial cord blood oxygen content than NVD.(3) When evaluating acidosis in newborns after delivery it is more reliable to measure pH and lactic acid concentrations in arterial rather than venous cord blood.

AIM: To evaluate the influence of maternal smoking during pregnancy on factors influencing fetal growth. METHODS: Thirty newborns of smoking mothers were prospectively compared with 60 newborns of non-smoking mothers. Pre-albumin, albumin, triglycerides, glucose, insulin, insulin-like growth factor I, IGF binding protein 3, pH, lactic acid, erythropoietin and hemoglobin concentrations were measured in umbilical cord blood. RESULTS: Infants of smoking mothers had a significantly lower birth weight (3418 +/- 533 vs. 3863 +/- 503 g; p < 0.001), length (50.5 +/- 2,6 vs. 52.3 +/- 1.9 cm; p < 0.001) and head circumference (34.6 +/- 1.8 vs. 35.8 +/- 1.1 cm; p < 0.001) than controls. They also had significantly lower insulin (3.2 (2.0-4.9) vs. 5.8 (4.6-7.1) mU/L; p = 0.008), insulin-like growth factor I (54.4 +/- 32.5 vs. 93.8 +/- 54.5 microg/L; p = 0.001) and IGF binding protein 3 (1664 +/- 432 vs. 1943 +/- 421 microg/L; p = 0.01) concentrations, than controls. Infants of smoking mothers also had significantly higher hemoglobin (167 +/- 14 vs. 157 +/- 13 g/L; p = 0.002) and erythropoietin (42.3 (25.1-72.4) vs. 26.3 (21.9-30.9) U/L; p = 0.03) than controls, but not pH or lactate concentrations. There was no significant difference in pre-albumin, albumin, triglycerides and glucose concentrations. CONCLUSIONS: Smoking during pregnancy causes symmetrical fetal growth impairment, possibly due to decreased oxygen transport to the fetus and decreased concentrations of fetal insulin, insulin-like growth factor I and IGF binding protein 3.

In a crosssectional study, 2751 healthy Icelandic boys aged 6-16 years, were examined for physical signs of puberty. The study was performed in 1983-1987 and was a part of a larger crosssectional growth study of 5526 Icelandic children all of whom were examined by the authors. Testicular volume of 4 ml (T 4) was considered the first sign of puberty in boys. The mean age of Icelandic boys reaching T 4 was 11.89 years (SD 1.08). The mean time interval between T 4 and T 12 was 2.21 years. The first signs of pubic hair growth, Tanner stage 2 (PH 2), were found at 12.74 years (SD 1.37). The mean time interval between PH 2 and PH 5 was 2.43 years. Even though comparison with studies from other countries is difficult because of different methods and different study design, we find that the timing and tempo of puberty in Icelandic boys is similar to what has been reported from other Nordic countries and countries in Western-Europe.

In a crosssectional study, 2775 healthy Icelandic girls, aged 6-16 years, were examined for physical signs of puberty. The study was performed in 1983-1987 and was a part of a larger crosssectional study of growth and development of 5526 Icelandic children all of whom were examined by the authors. Breast development stage 2 according to Tanner (B 2) was considered the first sign of puberty in girls. The mean age of Icelandic girls reaching B 2 was 10.84 years (SD 1.43). The mean time interval between B 2 and menarche was 2.42 years. The first signs of pubic hair growth, Tanner stage 2 (PH 2) were found at 11.46 years (SD 1.25). The mean time interval between PH 2 and PH 5 was 3.40 years. Comparison with studies from other countries is difficult because of different methods and different study designs, but the timing and tempo of puberty in Icelandic girls seems to be similar to what has been reported from other Nordic countries and countries in Western-Europe.

Introduction: Monitoring growth rate in children reflects the state of health and nutrition of the individual as well as the state of health of a nation. Until now little information has been available about the growth pattern of Icelandic children. We report here the results of a nationwide cross-sectional study of growth in Icelandic children aged 6-20 years. Material and methods: Height, standing and sitting and weight were measured in a total of 6500 schoolchildren, 3173 girls and 3327 boys. The measurements were performed 1983-1987. Children were randomly selected from The National Registry according to date of birth from both urban and rural areas of the whole country of Iceland. Stature was measured by a Harpenden stadiometer and the children were weighed in underwear only using a standardized scale. Results: The mean values and standard deviations for height, standing and sitting and weight are presented in tables. Growth charts for height weigt and sitting height are presented. No difference in height and weight was found between children from rural and urban areas. The results show that the growth of Icelandic children is in all age groups almost identical to the growth of Norwegian children. Compaired to other Nordic and WHO growth standards, Icelandic children are tall, especially during early pubertal development. Conclusions: Icelandic children are tall and the growth of Icelandic and Norwegian children follows the same pattern wich supports the theory that the two nations are closely related.

Objective: To determine the carrier rate of group B beta-haemolytic streptococci (GBS) of pregnant women in Iceland and the colonisation of their newborns. Material and methods: A prospective study was conducted from October 1994 until October 1997, where culture specimens for GBS were taken from vagina and rectum of pregnant women attending the prenatal clinics at the Department of Obstetrics and Gynecology, Landspitali University Hospital and the Reykjavik Health Centre. The samples were taken at 23 and 36 weeks gestation and at delivery. Culture samples were also taken from axilla, umbilical area and pharynx of their newborn infants immediately after birth. Included in the study were pregnant women born on every fourth day of each month. Carrier state was not treated during pregnancy, but Penicillin G was given i.v. at delivery if the last culture before delivery was positive and gestational age was <37 weeks, rupture of membranes was >12 hours before delivery or the mother had a fever >38 degrees C. Results: Cultures were taken from 280 women and their children. GBS carrier rate of pregnant women in Iceland was 24.3%. Twelve newborns had GBS positive cultures. No newborn had a confirmed septicemia. Cultures from 25% of newborns, who s mothers were still GBS carriers at birth, were positive for GBS. Positive predictive value of cultures taken at 23 weeks gestation was 64% and 78% at 36 weeks. Negative predictive value was 95% and 99% respectively. Conclusion: One out of every four pregnant women in Iceland is a GBS carrier. Twentyfive percent of newborns become colonised with GBS if the mother is a GBS carrier at delivery. When screening for GBS carrier state is done cultures from both vagina and rectum is more sensitive than cultures from vagina only. At least five percent of all newborns in Iceland are therefore expected to have positive skin cultures at birth. If the mother does not have positive GBS cultures during pregnancy, the likelihood that she will give birth to a GBS colonised child is almost none.

OBJECTIVE: To evaluate the efficacy of high frequency ventilation (HFV) in infants failing conventional ventilator therapy at our institution. STUDY GROUP AND METHODS: Medical records of all infants managed on HFV after having failed conventional ventilator management from 1994-2004 were reviewed. Ventilatory settings, blood gases and pH just prior to starting HFV, and two and four hours after starting HFV were recorded. RESULTS: Sixty one infants met the study criteria. At two hours of HFV there was a significant improvement in oxygenation (Alveolar to arterial oxygen tension difference), ventilation and acid-base balance. These values were not significantly different between two and four hours of HFV. There was no significant difference in oxygenation between survivors (n=41) and non-survivors (n=20) prior to HFV, but after two hours of HFV the survivors had significant improvement in oxygenation. Thirty one of the survivors had improved oxygenation at two and four hours of HFV, but only eight of the nonsurvivors (p=0.03). CONCLUSIONS: HFV results in significant improvements in oxygenation, ventilation and acid-base balance in most infants failing conventional ventilatory management. The immediate response to HFV may be a predictor of survival in infants with severe hypoxic respiratory failure.

Objective: To increase our knowledge of burn injuries in children in Iceland and to induce education and prevention in order to reduce the incidence of burn injuries among children. Material and methods: Data was collected from hospital records of all children 15 years and younger admitted with burn injuries to the University Hospital of Iceland, Paediatric Department, from 1982-1995. Results: There were 290 children admitted, 179 boys and 111 girls, sex ratio 1.6. Children four years and younger were 72.8%. Approximately 21 children were admitted annually. Seasonal variation was noted with most admittances in December. The times when the injuries occurred peaked at lunch and dinner times. Scalds was most common, hot water caused 45.8% of the burn injuries, most frequently due to bathwater (15.2%). Hot liquids caused 26.9%, most often caused by coffee-, tea- and cacao drinks (19.3%). Flames caused 12.4% of the burn injuries, fireworks 5.5% and hot object 5.2%. Most of these accidents occurred at home (81.4%). Conclusion: Children four years and younger are most susceptible for burn injuries. Hot water and liquids caused most of these burn injuries. Burn injuries are common in childhood. Our data provide basis for better prevention.

Introduction: Epidemiological studies have shown that high intake of omega-3 fatty acids correlates with low incidence of various diseases such as cardiovascular diseases, asthma, diabetes mellitus and various auto-immune disorders. It may therefore be suggested that omega-3 fatty acids have substantial impact on the immune system. Studies of the effect of omega-3 fatty acids on survival in bacterial infections have however been contradicting. A Dutch study from 1991 showed increased survival in mice fed fish-oil following infection with Klebsiella pneumoniae. Because of the contradicting results the authors conducted a study with the hypothesis that fish-oil intake increases survival after severe Klebsiella pneumoniae infection. Methods: Thirty mice were fed fish-oil enriched diet (10%), olive-oil enriched diet (10%) or standard chow diet. After six weeks the mice were injected intramuscularly with l.óxlO2 cfu of Klebsiella pneumoniae. The survival was measured at regular time intervals for 120 hours. Results: After 56 hours, 93% of the mice fed fish-oil were alive and 68% and 40% of the mice fed olive-oil and standard chow respectively. The overall survival after 120 hours was 40% in the fish-oil group, 25% in the olive-oil group and 20% in the standard group. The survival after 120 hours of the mice fed the fish-oil enriched diet was significantly better when compared to the two other groups (p=0.0034). Discussion: We conclude that fish-oil enriched diet increases survival of NMRI mice following infection with Klebsiella pneumoniae when compared to olive-oil supplementation or standard chaw. We therefore conclude that the difference in survival is probably based on the effect of omega-3 fatty acid on the immune system. The immunological pathway is still unknown and our results encourage further studies.

Hyponatremia, defined by a serum sodium concentration of less than 135 mmmol/l, is a complex clinical occurrence frequently manifested in newborns admitted to the neonatal intensive care unit. The pathogenetic mechanisms and clinical timing underlying the onset of hyponatremia have not been well established in the newborn. Aim of this review is to present a practical approach and management of hypotonic hyponatremia in newborns, with particular emphasys on nephrogenic syndrome of inappropriate antidiuresis, recently described by us for the first time in the literature in a newborn.

Newborn children normally lose up to 10% of their birth weight during the first week of life. With greater weight loss one must consider low intake and pathological losses. We describe a 6-day-old girl with nearly 19% weight loss and hypertonic dehydration caused by hypogalactia. Principles for treatment of hypertonic dehydration and strategies for finding these children are discussed.

Vitamin A (VA) deficiency in very low birth weight (VLBW) infants is associated with an increased risk for disorders related to kidney and lung maturation and function. VA losses through increased urinary retinol (ROH) excretion might contribute to this deficiency risk. The mechanism accounting for ROH loss in the urine has not yet been clarified. The aim of this study was to assess the excretion of ROH, retinol-binding protein 4 (RBP4) and transthyretin (TTR) in urine from VLBW infants in comparison with that in term infants in relation to kidney function. Urine specimens were collected from 15 VLBW infants (birth weight < 1,500 g) as well as from 20 term infants during the first 2 days after birth. ROH in urine was detectable in 14 of the 15 VLBW infants at a median concentration of 234 nmol/g creatinine. In the group of term infants, 17 of the 20 excreted ROH, but at an approximately five-times lower concentration (P < 0.001). Excretion of RBP4 and TTR was also much higher in VLBW infants (both P< 0.001). The urinary ROH excretion in VLBW infants may be related to the impaired tubular handling of its carrier proteins RBP4 and TTR. Thus, ROH excretion might contribute to an increased risk of VA deficiency, especially in VLBW infants.

BACKGROUND: Extreme hyponatremia (<105 mmol/l) has rarely been reported in infants. It is potentially life-threatening and requires intensive care treatment. PATIENT: We report on a male infant with absence of weight gain from birth to day 33 of life despite adequate nutrition. On admission serum sodium and potassium were 104 and 5.9 mmol/L respectively. The infant's physical status revealed dehydration, but normal activity with no apparent neurological, circulatory or respiratory impairment. MAIN RESULTS: Global adrenocortical insufficiency was diagnosed and treated with hormonal substitution in addition to intravenous application of fluid, glucose and electrolytes. The rise of serum sodium was carefully monitored and adjusted to a target rate of 0.5 mmol/L/h. X-linked adrenal hypoplasia congenita (X-AHC) was confirmed by the identification of a novel nonsense NR0B1 (DAX-1) mutation (W236X). CONCLUSIONS: X-AHC in infants may present as failure to thrive despite adequate nutrition. Extreme hyponatremia may be associated with little symptoms if developing slowly. Rehydration and slow correction of serum sodium with solutions containing less sodium than normal saline is essential.

INTRODUCTION: Birth weight (BW) is considered an important measure of the health status of a population. Objectives. 1) to assess secular trends in average BW, low birth weight (LBW,<2.500 g), very low birth weight (VLBW,< 1.500 g) and BW > or = 3.000 g of liveborn infants in Argentina; 2) calculate risks of LBW, VLBW and > or = 3.000 g; 3) influence of underreported birth weight. MATERIAL AND METHODS: In this national-based study 7.113.931 liveborn infants born in Argentina from 1992 to 2002 were included. BW was assessed from the National Ministry of Public Health. Annuals mean BW and residual distribution (RD) following the Wilcox-Russell approach were calculated, and also LBW, VLBW and > or =3.000 g proportions. RESULTS: A decrease of 32 g in average BW (p= 0.577) and 24 g between 2000 and 2002 (p <0.001) was observed. RD reached 4%. The significant increase in LBW (12%, p= 0.034) and VLBW (26%, p= 0.002) proportions was paralleled by a reduction of 3.6% in BW > or =3.000 g (p= 0.011, average 75.2%). Risks of being LBW and VLBW were 1.13 (95% CI 1.12-1.15) and 1.30 (1.25-1.35), respectively; for BW > or =3.000 g was 0.86 (95% CI 0.85-0.87). No significant correlations between underreported BW and proportions of LBW (r= 0.10) or VLBW (r= 0.01) were observed. CONCLUSION: A negative secular trends of BW was observed, all categories of LBW and VLBW were increased, BW > 3.000 g was diminished and under-reported BW did not influenced these results.

This study compared the characteristics of infants hospitalized with apnea that participated in a vaccine trial compared with two control groups which consisted of 100 infants randomly selected from the same vaccine trial and 52 consecutively born very low birth weight (VLBW) infants. A total of 23 infants were admitted with apnea of whom 19 weighed <1500g at birth and all were born at <37 weeks gestation. More of the VLBW infants in the apnea group had neonatal neurological complications compared with the VLBW control group (p=0.005). Ten of 11 children with apnea within 72h of immunization were possibly related to vaccination.

AIM: Hyponatremia can potentially have serious effects in the premature infant, Therefore, it is important to recognize its causes and prevent it if possible. The aim of this study was to evaluate the causes of hyponatremia in very low birth weight (VLBW) infants cared for at the Neonatal Intensive Care Unit (NICU) of Children's Hospital Iceland. SUBJECTS AND METHODS: Retrospective descriptive study of 20 VLBW infants at the NICU of Children's Hospital Iceland, born after <30 weeks gestation with birth weight of < or =1250 g. Information was obtained on fluid administration, weight loss, sodium administration and serum sodium concentrations during their first ten days of life. RESULTS: The median gestational age was 27 weeks (24-29 weeks) and the median birth weight was 905 g (620-1250 g). A negative correlation was found between birth weight and the amount of fluids given (R2=-0.42; p=0.002). The median weight loss was 10.6%(3.1-29.5%). A positive correlation was found between weight loss and the amount of fluids the infants received (R2=0.76; p<0.001). The amount of sodium given was on the average 5.7+3.1 mmól/kg/24 hours. The median serum sodium concentration was 137 mmól/L (127-150 mmól/L). A negative correlation was found between the amount of sodium given and serum sodium concentrations (R2=-0.42; p<0.001). There was no correlation between the amount of fluids given and serum sodium concentrations (R2=0.006; p=0.7). A negative correlation was found between birth weight and serum sodium concentrations (R2=-0.24; p=0.027). CONCLUSION: High sodium requirements in VLBW infants at our hospital suggests that their hyponatremia is mainly due to the immaturity of their kidneys, which is known to result in excessive loss of sodium in the urine.

The use of music as part of a stress reduction therapy has been applied both to premature infants and their parents in the Neonatal Reanimation Service. This aim of music therapy amounts to an attempt to help the premature infant regaining its physical and neurological balance, so important to its psychological and physical development, mainly by masking the sometimes excessive noise present in the intensive care unit and/or in the incubator. Studies have demonstrated the positive impact of music therapy on oxygen saturation, heartbeat, and on the general level of relaxation experienced by premature infants. In this project, the palliative technique used was that of live singing, directly to the infant, accompanied by a pentatonic harp. The aim was to improve the state of health, both physical and psychological, of a group of premature infants, whose gestation period varied between 23 and 36 weeks. The technique used was to apply what amounts to a protective cocoon of sounds to a premature infant in the neonatal unit, which measurably reduced the level of stress as indicated by the babies' increasingly relaxed demeanour and induced a measurable increase on the level of oxygen saturation and a reduction of heart rate.

Background: The aim of the present paper was to define the incidence, complications, morbidity and mortality of hypernatremic dehydration due to inadequate breast-feeding in a neonatal intensive care unit. Methods: A retrospective study was carried out between 2002 and 2005, to identify the term breast-fed neonates with serum sodium level >/=150 mEq/L at the Ministry of Health Ankara Diskapi Children's and Research Hospital. Results: The incidence of hypernatremic dehydration secondary to inadequate breast-feeding was 4.1%, occurring in 169 term infants among 4136 hospitalized term neonates with the following characteristics: mean gestational age, 39.1 weeks (37-42 weeks); birthweight, 3352 g (2200-4500 g); mother's age, 26.1 years (17-38 years); weight loss, 15.9%(5.4-32.7%); proportion of spontaneous vaginal deliveries, 75.7%; and proportion of first-time mothers, 74.6%. Major presenting symptoms were neonatal jaundice (47.3%) and poor infant suck (29.6%). The median sodium; blood urea nitrogen (BUN); and creatinine levels on admission were 155 mmol/L (150-194 mmol/L), 35 mg/dL (7-253 mg/dL), and 0.9 mg/dL (0.2-10 mg/dL), respectively. Major complications were as follows: acute renal failure, 82.8%; elevated liver enzymes, 20.7%; disseminated intravascular coagulation, 6.5%; brain edema, 5.2%; intracranial hemorrhage, 3.6%; cavernous sinus thrombosis, 1.2%; and bilateral iliac artery thrombosis, 0.6%. Ten patients (5.9%) developed seizure within the first 24 h of rehydration therapy with a mean sodium decrease of 11.9 mmol/L per day (4-19 mmol/L per day). Two patients (1.2%) died. There were positive correlation between weight loss and serum sodium, BUN, bilirubin levels (P < 0.01); there was no correlation between weight loss and mothers' age, education level, delivery route, or first-born status (P > 0.05). Conclusions: Hypernatremic dehydration in neonates due to inadequate breast-feeding is a serious, potentially devastating and life-threatening disorder, and can damage the central nervous system. Follow up of infants for adequate breast-feeding is important. Pediatricians must maintain a high level of suspicion, especially in cases of pathologic infant weight loss after delivery.