report on a premature infant weighing 822 grams

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trial of A.C.T. (asthma care training)for kids. Pediatrics 1984;74:478-86.

8. Kotses H, Bernstein IL, Bernstein DI,Reynolds RV, Korbee L, Wigal JK, etal. A self management program foradult asthma. Part 1: Developmentand evaluation. J Allergy Clin Im-munol 1995;95:529-40.

9. Bailey WC, Richards JM, BrooksCM, Soong SJ, Windsor RA, Manzel-la BA. A randomized trial to improveself-management practices of adults

with asthma. Arch Intern Med 1990;150:1664-8.

10. Baker JW, Mellon M, Wald J, WelchM, Cruz-Rivera M, Walton-Bowen K.A multiple-dosing, placebo-controlledstudy of budesonide inhalation suspen-sion given once or twice daily for treat-ment of persistent asthma in youngchildren and infants. Pediatrics1999;103:414-21.

11. Shao J, Tu D. The Jacknife and Boot-strap. New York: Springer: 1995. p. 291.

12. Agresti A. Categorical data analysis.New York: Wiley; 1990. p. 366-8.

13. Kelloway JS, Wyatt RA, Adlis SA.Comparison of patients’ compliancewith prescribed oral and inhaled asth-ma medications. Arch Inter Med1994;154:1349-52.

14. Bender B, Milgrom H, Rand C. Non-adherence in asthmatic patients: isthere a solution to the problem? AnnAllergy Asthma Immunol 1997;79:177-85.

50 Years Ago in The Journal of PediatricsREPORT ON A PREMATURE INFANT WEIGHING 822 GRAMS

Scott R, Bourne I. J Pediatr 1950;36:512-4

A female infant born in 1948 at 24 weeks’ gestation and 822 g survived and was followed up to 19 months of age. Thesurvival of infants <2 pounds in the 1950s was <2%, in sharp contrast to the survival rates in the late 1990s of >80% forinfants of similar birth weights. This remarkable infant was placed in an incubator and given supplemental oxygen andrequired minimal interventions. Feedings were delivered with a medicine dropper and no intravenous lines were placed.By 24 hours of age, she was started on 28 cal/oz formula and advanced to full enteral feedings by 9 days of age. Hergrowth was excellent by our standards today. She was discharged after 78 days of hospitalization at 35 weeks’ gesta-tion, weighing 2580 g. Today, the average length of hospitalization for infants weighing 800 g is 87 days, with a dis-charge weight of around 2000 g.

This infant reached full enteral feedings more quickly, regained birth weight sooner, and was heavier at dischargethan infants of similar birth size today. Growth after hospital discharge was adequate, although she did not exhibitmuch catch-up growth during her first 19 months. Postnatal growth failure continues to be a significant problem formany preterm infants. Formulas have been developed to meet the special needs of preterm infants; however, growthcurves like the one for this infant are not uncommon.

The child was not walking unassisted or talking at 19 months, although she “looked normal and was alert.” This de-scription would fit about 20% of the children of similar birth weight being seen in premature newborn follow-up clinicstoday. Despite newer technologies in the neonatal intensive care unit, improved nutrition, and aggressive early inter-vention, neurodevelopmental handicaps for very low birth weight infants continue to be common, with 30% to 50% ofinfants exhibiting some abnormality.

Anna M. August, MDDivision of Neonatology

Children’s Hospital Medical CenterCincinnati, OH 45229-3039