Clinical Observations in Newborn Premature Infants

Abstract

A study of 155 "premature" infants has been carried out, with special reference to clinical behavior in the first 4 days of life. The purpose was to gain information concerning morbidity in the early neonatal period, and in particular the causes and significance of regurgitation during this period. The following conclusions were made In agreement with general experience, the greatest mortality took place before the 3d day of life. Mortality and morbidity were found to be related both to birth weight and gestational age. Infants somewhat larger than would be predicted from the length of gestation were found to have a high morbidity rate. Relatively mature, undersize babies tended to be lively and healthy. Regurgitation significantly influenced weight loss in the neonatal period. It is more common in immature infants, probably because of the higher rate of illness among such infants. Abnormal regurgitation was usually manifest within 12 hours after birth and before feeding, and was not found to be related to the amount or type of feeding given. It is suggested that sedation, tube feeding and, possibly, gastric aspiration are of value in minimizing regurgitation. These measures should be instituted early and prophylactically in infants who show clinical evidence of "aspiration" during birth, those who vomit within a few hours of birth, and those with minor degrees of neurological or respiratory difficulty. Weight loss during the first 4 days of life in premature infants is variable. The presence of clinical edema is not invariably associated with unusually large weight losses. It is suggested, and some evidence is presented, that the occurrence of large weight losses suddenly after birth represents discharge of edema, and is a phenomenon of recovery in ill infants. Attention is called to the delay in the onset of steady weight gain which appears to be related to gestational maturity. The presence of respiratory or neurological illness was found to be associated with a low body temperature only partially attributable to treatment with chlorpromazine. Under the conditions of routine care employed, moderate hyperpyrexia without clinical dehydration was commonly found in the first days of life. The most reliable indication of gestational maturity during the first days of life was found to be evidence of hunger.