Behavior of Weight and Further initial loss of weight is, according to the investigations of Delestre and the writer, less than in full-term children. It depends on the quantity of meconium, on the feeding, especially the ingestion of water, and on external circumstances. The separation of the cord plays no part in this connection. The gain in weight is, at first, despite sufficient feed ing, slower than in the normal child, however it sometimes attains the average, after reaching the normal time of the termination of labor. The further development of the muscular and osseous systems, and of the teeth, and, finally, of the psychic functions, is, in healthy premature infants, backwards about the extent of time that the children are born prematurely. Czerny and Keller certainly speak truly when they assert that these children in later infancy are hardly to be recognized from full-term infants. Debilitated and sick premature children, on the con trary, often remain for years behind their contemporaries.
Special Pathology of the organs of unhealthy premature children are in a state of insufficient development; func tionally they are usually backward and quantitatively deficient. In de bilitated children we may have, in addition to the signs of prematurity, other physiological changes, causing qualitative deviation from the normal; these may or may not, depending upon the organ affected, be a menace to the life and impair the future development of the affected child.
The Nervous contrast to the healthy newborn infant the sleep of the premature child is even and deep and after lasting some time does not become lighter. Besides the somnolence, the indolence of the child's movements and the absence of all reactions arc noticeable. The intelligence and psychic function develop more slowly—a fact which possibly depends on the insufficient development of certain centres.
Spasmophilia, as it has been described by certain writers, is not characteristic of premature children. Spasms, which occur immediately after birth, are not uncommonly the results of birth injuries. Intra cranial hfemorrhages and cerebral diseases are especially apt to occur in small, first-born, premature children, according to Wallich. Premature infants, in fact, have a predisposition to nervous affections. Thus pre maturity plays a prominent role in the etiology of Little's disease. Among 100 such cases Audebert found S2 in premature children. According to French writers, conditions of psychic depression and paralysis in childhood are found with relatively great frequency in premature children. Just how far hereditary syphilis is involved in
these affections of the nervous system remains unsettled; however, it is certain that ninny an instance of cerebral atrophy is only the sequelum of a foetal encephalitis.
Circulatory heart is comparatively strong; ever cardiac weakness sometimes causes cyanosis and oedema (C. Hahn). In a case of prematurity under my observation, I was able to satisfy myself that atelectases, by increasing the resistance in the lesser circulation, can exert a retarding influence on and even entirely interfere with the physiological closure of the foramen ovale and ductus Botalli.
The fragile, brittle condition of the arterial Nv a 1 1 in these children may have a connection with syphilis (mesarteritis syphilitica, Heubner).
The blood of premature children shows a deficient coagulability; there is a great tendency to hemorrhages, especially epistaxis, and also mehena (sepsis?). In young premature children one finds nu cleated red cells. Delestre found that these forms disappear when the temperature of the child rises; they reappear, however, with any ill ness of the child. Leucocytosis was only present in slight degree. The decrease in the alkalinity of the blood has already been mentioned. According to Adriance, the percentage of hemoglobin is excessively high, however, it gives way soon after birth to an increased destruction of cells; this fact probably has sonic connection with the occurrence of icterus, the non-syphilitic forms as well, in these children.
The lymphatic apparatus shows in contrast to the full-term child, a noteworthy anatomical completeness; however, owing to the slow ness of its circulation, it probably more easily permits of the escape of toxins and bacteria.
The Respiratory breathing of little premature children is shallow and irregular. The voice is monotonous and feeble. On auscultation one can barely bear the vesicular respiratory mur mur. The percussion note is flattened toward the bases. Not uncom monly, on account of the diminished respiratory excursion, the lower parts of the lungs remains in a condition of atelectasis; the air does not reach the alveoli, but only the finer bronchi; this explains the predis position to pneumonia that exists in these children. Accompanying this we have, as especially important in the pathology of the premature child, attacks of cyanosis and asphyxia which occur soon after birth, on account of pulmonary atelectasis.