Biomedical subjects
J Cadman
Publications and source records attributed to J Cadman.
CMV trials struggle to enroll.
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Optimizing PCP therapy.
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Minor congenital anomalies, major congenital malformations and development in children conceived from cryopreserved embryos.
A total of 91 children (68 singletons, 20 twins and three triplets) who were conceived from cryopreserved embryos between 27 December 1989 and 18 January 1994, and 83 normally conceived control children (81 singletons and two twins) of a similar age, sex and social class, were assessed for minor congenital anomalies and major congenital malformations. Their development was assessed using the Griffiths Scales of Mental Development. The incidence of minor congenital anomalies (31.9% in the cryopreserved embryo group and 21.7% in the controls) and major congenital malformations (3.3 and 2.4% respectively) in our two groups of children was statistically similar. The relative risk (odds ratio and 95% confidence interval) in the cryopreserved embryo group compared with the controls was 1.7 (0.8, 3.3) for minor congenital anomalies and 1.4 (0.2, 8.5) for major congenital malformations. The minor congenital anomalies were mostly naevi and haemangiomas. The major congenital malformations included Down's syndrome, Beckwith-Wiedemann syndrome and hypophosphataemic rickets in the cryopreserved embryo group and hydronephrosis and gastroschisis in the controls. The Griffiths assessment showed that children from the cryopreserved embryo group and the controls were functioning at a similar level. The mean Griffiths quotient and subquotient values were greater than the standard 100 in children with or without congenital abnormalities. These results in the cryopreserved embryo group are reassuring in that the minor congenital anomaly and major congenital malformation rates were similar to those in normally conceived children of a similar age, sex and social class and their development was not adversely affected by cryopreservation.
Outcome in children from cryopreserved embryos.
A cohort of 91 children from cryopreserved embryos and 83 control children who were conceived normally had their development assessed using the Griffiths's scales of mental development. The controls (81 singletons and two twins) of a similar age, sex, and social class were selected from siblings, cousins, and peers of the cryopreserved embryo group (68 singleton, 20 twins, and three triplets). Children from cryopreserved embryos had a lower mean birth weight and mean gestational age and a higher proportion were born by caesarean section. One child from the cryopreserved embryo group had Down's syndrome, three had squints, and four had conductive hearing loss while in the control children, six had squints, and nine had conductive hearing loss. In both groups, including the child with Down's syndrome, the mean Griffiths's quotient was greater than the standard 100. In the children from cryopreserved embryos, the singleton and multiple birth subgroups had statistically similar assessment results. The mean (SD) Griffiths's quotient was 105.69 (13.55) in children from cryopreserved embryos and 108.18 (9.80) in controls at a chronological age of 25.08 (12.86) and 29.19 (14.65) months respectively. Overall, the development in children from cryopreserved embryos did not cause concern though formal testing had highlighted small differences compared with other children conceived normally and of a similar social class.
Oxytocin induction of labour: hyponatraemia and neonatal jaundice.
To determine the effects of fluid restriction in induced labour with oxytocin in 5% dextrose solution, maternal venous blood and fetal cord venous blood were examined in 164 mothers in induced labour and 29 mothers with a spontaneous onset of labour. After satisfactory uterine activity was induced either the oxytocin infusion was managed according to routine delivery unit practice (n = 36), or infusion rates were halved (n = 45), or quartered (n = 43), or discontinued (n = 40). Despite fluid restriction during labour the mean sodium concentration in maternal blood or cord blood had fallen to a similar extent in all four induced groups at delivery. Potassium, urea, creatinine, total protein, and albumin in maternal blood or cord blood were affected differently by induced labour as compared with sodium. The fall in sodium concentration in maternal blood was a more consistent reflection of the total volume of fluid received, mean infusion rates and cord blood sodium after infusion rates were quartered or discontinued. The incidence of hyponatraemia was 5% in mothers and 8% in infants. A comparison of hyponatraemic and normonatraemic cord blood showed no significant differences in serum bilirubin levels or red cell counts, but more hyponatraemic infants developed neonatal jaundice. It is suggested that in induced labour fluid restriction alone does not prevent hyponatraemia and neonatal jaundice.
Head size, brain growth, and lateral ventricles in very low birthweight infants.
Ninety eight newborn infants weighing less than 1500 g at birth and with gestational ages from 26 to 32 weeks were followed prospectively. They were grouped according to real time ultrasound scans in the neonatal period: infants in group A (n = 20) had periventricular haemorrhage (PVH) and normal ventricles; infants in group B (n = 26) had PVH and dilated ventricles (none with clinical hydrocephalus); and infants in group C, who formed the control group (n = 52), had no PVH and normal ventricles. At outpatient follow up a static image ultrasound scanner was used to measure the width of the lateral ventricles and brain hemispheres. The three groups of infants showed similar growth in occipitofrontal circumference, biparietal diameter, and brain hemispheres irrespective of a history of PVH or ventricular dilatation. The relation of ventricle size to biparietal diameter was similar in those infants in groups A (PVH alone) and C (controls) who had a good outcome. About a third (n = 8) of the infants in group B had persistent ventricular dilatation in relation to biparietal diameter and a poor outcome associated with developmental delay and cerebral palsy. By contrast, the remaining two thirds (n = 18) of the infants in group B who later had smaller ventricles in relation to biparietal diameter showed fewer neurodevelopmental sequelae. It is suggested that persistent ventricular dilatation in relation to biparietal diameter at follow up carries a bad prognosis, which might be due to brain atrophy.
Umbilical venous blood pH: a useful aid in the diagnosis of asphyxia at birth.
Umbilical venous blood, and umbilical arterial blood pH, PO2, PCO2, and base excess were determined in 453 term infants at birth. The results indicate that umbilical venous blood pH, and umbilical arterial blood pH are significantly related to each another. Acidosis, as defined by an umbilical venous blood pH less than 7 X 27, is associated with a lower PO2, a raised PCO2, and a reduced buffer base when compared with PO2, PCO2, and buffer base associated with a normal pH (7 X 27-7 X 42), or alkalosis (pH greater than 7 X 42). The infant's condition at birth was recorded using modified Apgar scores, in which the gradings were vigorous (5-6), intermediate (3-4), or depressed (0-2). In the neonatal period, neurological abnormalities occurred in infants who had been in a depressed condition at birth in the presence of acidosis. Other infants, who had been in a depressed condition with a normal pH or alkalosis and the remaining infants who had an intermediate or a vigorous condition at birth, did not manifest neurological abnormalities in the neonatal period. Our findings suggest that measurement of umbilical venous blood pH, whose values correlate well with those of umbilical arterial blood pH, in infants who are in a depressed condition at birth improves the clinical assessment of the severity of asphyxia.
Ganciclovir implants: one year later.
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Roche brings new formulation of saquinavir to FDA. Food and Drug Administration.
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Candidiasis in immune-compromised women.
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Rapid advances in preventing vertical transmission.
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Early treatment for HIV-infected infants.
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Improved ganciclovir regimens.
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CMV viremia: a look at the other viral load.
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Working to improve pregnancy outcomes.
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Ritonavir users put on liquid diet.
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Debate widens over protease inhibitor side effects.
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