These attacks often occur without warning in well-developed children, the face and hands becoming cyanotic. Respiratory pauses, one or more minutes in duration, recur so that the breathing resembles the Cheyne–Stokes type. Convulsions are also observed. The pulse is greatly slowed-down to 40 beats per minute or less.
The cause of these attacks is not clearly established. Finkelstein believes them to be the consequence of a subtly developing carbonic acid intoxication, which is brought about by insufficient breathing or also by meteorismus and the consequent encroachment upon the intra thoracic capacity.
Budin considers them to be the consequence of chronic under feeding and sees them disappear with the institution of forced feeding. From several personal observations, I have gained the impression that they are cerebral in origin, but cannot substantiate this belief with autopsy findings. Occasionally the attacks seem to be elicited by the feeding of the child.
Billard and, after him, other writers have described a condition in the premature child, with which respiration is entirely wanting. The heart's action is weak and slowed. The blood flows from the right heart through the ductus Botalli into the aortic system without ever passing through the lungs. In this manner a "vita minima" can be maintained for a few days; such observations, however, belong to the rarities and are without practical importance.
The Digestive considers the digestive tract to be the most vulnerable "organ-system" of the premature child; still the difficulties can usually be overcome through a properly instituted feeding. Small premature children are incapable of suckling and even larger ones are thereby easily exhausted. Swallowing is slowed. The digestive fluids (ferments) are quantitatively and qualitatively deficient as compared with the normal, although exact researches concerning this are not at hand. French authors write of functional disturbances of the liver in weaklings. The meconium, which is usually scant, is delayed in its passage; likewise one often encounters, in the first weeks, a constipation or rather pseudo-constipation which is the result of diminished intestinal activity or underfeeding.
Finkelstein has repeatedly observed an atrophy of the stomach occurring in the later months and this justifies his warning against the overfeeding of premature infants.
Skin and skin is more or less intensely reddened and covered with lanugo hairs; the redness persists somewhat longer than with full-term children; the external ears lie, as folciless skin tabs, close against the skull; the nails are either absent or else fall short of the end of the phalanges; the insertion of the umbilical cord lies deeper than normal, and the epidermal desquamation is slowed. Owing to the absence of the adipose layer in the subcutaneous cellular tissue, the skin lies loose and movable over the underlying parts. Ero sions occur easily after the slightest injuries; these losses of substance occur especially over the malleoli and the heels. Besides sclerema and sclercedema, to which these children are very prone, there occurs a form of icthyosis described by French authors, concerning which, however, nothing definite is known.
The frequent occurrence of uric acid infarctions is explicable through the deficient oxidation and the insufficient circu lation and respiration; the ingestion of too small a quantity of water may also have something to do with this. Uric acid infarction can give rise to a suppression of urine lasting for one or more days, which in turn occasionally leads to colicky and convulsive states (encephalo pathie Parrot).
Baumel cites a case ending in recovery, in which a premature child urinated through the umbilicus (urachus). According to Charrin the quantity of urine is low and the acidity and toxicity are raised.
The proportion of ammonium N to total N is less than the normal; c, on the contrary is increased, which points to an increase in the decomposition processes. According to Nobecourt and Lemaire, lowering of the freezing point (Q) of the urine of premature infants is likewise present.
Her-nice, especially umbilical hernie, occur with relative frequency in premature children.
The bacterial infections, which can occur intra-uterine, intra partum, or extra-uterine, play a weighty and characteristic part in the pathology of the premature child.