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Biomedical subjects

R Gale

Publications and source records attributed to R Gale.

At least 55 records · Page 3Linked to original sources
PubMed1992

A 2-year prospective study of very low birthweight infants.

A prospective 2-year follow-up study was carried out on 68 of the 69 surviving very low birthweight (VLBW) infants (< 1,501 g) born in Bikur Holim Hospital in the years 1985-87. The aims were a) to determine the incidence of major disability, and b) to compare the 2-year outcome of VLBW infants without major disability with that of a control group of full-term small-for-gestational-age infants, using the Mental Development Index (MDI) of the Bayley Scales. Mean birthweight of the VLBW infants was 1,234 +/- 216 g and mean gestational age was 30.7 +/- 2.4 weeks. Their neonatal mortality during the study period was 29.8%. Major disability was diagnosed in 11/68 infants (16%). At age 2 years there was no significant difference between the mean MDI of the VLBW infants without major disability (97.7 +/- 19.5) and that of the controls (99.7 +/- 17.0). These data, representing the outcome of VLBW infants from a community-based hospital with neonatal intensive care facilities, are comparable in incidence of major disability with data of large tertiary centers. Cognitive ability of VLBW infants without major disability at age 2 years was equivalent to that of their full-term peers.

Analysis of Variance↗
PubMed1992

Is cord blood erythropoietin a marker of intrapartum hypoxia?

A sensitive assay was used to compare the biological activity of cord serum erythropoietin in two groups of infants born with or without labor-induced hypoxia. The mean cord serum erythropoietin activity in 161 infants delivered after vaginal labor was 116 +/- 36 mU/mL, and was indistinguishable from that observed in 23 infants delivered by preplanned, elective cesarean section, 114 +/- 12 mU/mL (P = .75). The bioassay measured effective erythropoietin activity, including the contribution of potentiators in serum. These results indicate that duration and intensity of labor are insufficient to cause a significant increase in effective erythropoietin activity.

Cesarean Section↗
PubMed1992

Birth weight and intellectual performance in late adolescence.

The impact of birth weight on cognitive performance in late adolescence was assessed in a study of 20,567 male infants born in Jerusalem between 1964-1970. The 17-year follow-up was performed by matching computerized data base records. Stepwise multiple regression analysis was used to estimate the effect of birth weight on intelligence test scores, adjusting for the influence of ethnic origin, maternal and paternal education, social class (determined by area of residence), maternal age, and birth order. These confounders explained 22% of the variance in intelligence test scores. The adjusted differences in intelligence test scores were significantly lower for groups with birth weight less than 2000 g (-6.5 points), 2000-2499 g (-3.6 points), and 2500-2999 g (-1.6 points) compared with the group weighing 3000-3499 g. Most low birth weight infants achieved intellectual performance within the normal range. However, despite this reassuring finding, low weight at birth in male subjects was found to have a statistically significant independent association with inferior intelligence test achievements in late adolescence.

Adolescent↗
PubMed1991

Long-term effects of vacuum and forceps deliveries.

The long-term effects of vacuum and forceps deliveries are largely unknown. We determined the long-term outcome of instrumental deliveries in 52,282 infants born in Jerusalem between 1964 and 1972. For each individual, events at birth were related to results of an intelligence test and medical examination done at 17 years of age by the Israeli Defence Forces draft board. 1747 individuals were delivered by vacuum, 937 by forceps, 47,500 by spontaneous delivery, and 2098 by caesarean section. Crude data showed that mean intelligence scores at 17 were significantly higher (p less than 0.0001) in the vacuum and forceps deliveries groups than in the spontaneous-delivery group; however, after adjustment for confounding factors by stepwise multiple regression, these differences were no longer seen. Although the forceps-delivery group had functional impairment of feet, vision, and retina compared with the spontaneous-delivery group, and the vacuum-extraction group had impairment of the legs, differences were small. Our findings suggest that infants delivered by vacuum or forceps are not at risk of physical and cognitive impairment at 17 years of age.

Adolescent↗
PubMed1991

Birth weight, current body weight, and blood pressure in late adolescence.

Objective--To study the effect of birth weight and body weight on blood pressure in late adolescence. Design--Analysis of data on weight, height, and blood pressure at age 17 of subjects from the Jerusalem perinatal study, according to their birth weight. Data for men and women were analysed separately. Setting--Jerusalem, Israel. Subjects--32,580 subjects (19,734 men and 12,846 women) born in the three major hospitals in Jerusalem during 1964-71 and subsequently drafted in to the army. MAIN OUTCOME MEASURES--Correlations between birth weight and blood pressure at age 17 and weight and height at age 17 and blood pressure. Results--Diastolic and systolic blood pressures were associated with birth weight in both young men and young women, but the correlation coefficients were low. A high body weight at age 17 (greater than 66 kg for women, greater than 75 kg for men) rather than a low birth weight (less than 2500 g) was linked with higher systolic and diastolic blood pressures in both men and women (p less than 0.01). Conclusions--Intrauterine environment, as reflected by birth weight, has little effect on blood pressure in young men and women. Modification of factors which lead to excess weight during adolescence may have a major role in preventing hypertension in adults.

Adolescent↗
PubMed1991

The effects of high parity and socioeconomic status on obstetric and neonatal outcome.

We studied the interaction of social status and high parity in 15,102 consecutive births in one inner-city hospital, of which 1874 (12.4%) occurred in mothers who had given birth to seven or more infants (Grand multiparae). Group 1 consisted of 1258 grand multiparae from a socioeconomically stable and homogeneous ultra-orthodox Jewish community in Jerusalem, and group 2, included all other grand multiparae of relatively greater age and lower socioeconomic status. A significantly higher rate of small for gestational age, low birth weight and preterm infants was found in group 2 compared with group 1. The results suggest that grand multiparity is not of itself a risk factor, but reflects the confounding effect of environmental conditions.

Adult↗
PubMed1991

Pre-eclampsia and offspring's blood pressure, cognitive ability and physical development at 17-years-of-age.

OBJECTIVE: To investigate the influence of maternal pre-eclampsia on the blood pressure, physique and intelligence of the offspring at the age of 17 years. DESIGN: Data obtained at the age of 17 during assessment for drafting to the Israel Defence Forces and from the records of the mothers' pregnancies from the Jerusalem Perinatal Study. SUBJECTS: Study subjects were 145 girls and 283 boys whose mothers had had pre-eclampsia and controls were 12,701 girls and 20,416 boys whose mothers did not have pre-eclampsia. MAIN OUTCOME MEASURES: Systolic and diastolic blood pressure, weight, height and intelligence scores at the age of 17 were related to birthweight and the occurrence of pre-eclampsia during their mothers' pregnancies. RESULTS: Systolic blood pressure was greater than 140 mmHg in 6.9 and 11.0% of the study girls and boys, compared with 2.9 and 9.9% of the control girls and boys. The study boys but not the girls had a higher mean body mass index than the controls (P less than 0.001). There were no differences in the intelligence scores. Using multiple logistic regression to allow for the confounding effects of body mass index, weight and birthweight, the odds ratio for the risk of a systolic pressure greater than 140 mmHg was 2.30 (95% CI 1.80-4.46) for the study girls but was not significantly increased for the study boys. CONCLUSION: Maternal pre-eclampsia does not impair growth and cognitive performance in the children who reach late adolescence but may be associated with hypertension.

Adolescent↗
PubMed1991

Is low birth weight a risk factor for asthma during adolescence?

The effect of low birth weight on the incidence of asthma by 17 years of age was investigated by studying medical draft examination records of 20,312 male subjects born in Jerusalem between January 1967 and December 1971. Additional information on birth weight and other demographic factors was abstracted from the Jerusalem Perinatal Study computerised database. A stepwise multiple logistic regression was used to estimate the odds ratios for developing asthma by 17 years of age in 500 g birthweight categories from less than 2000 g to 4500 g. The odds ratios were adjusted for the confounding effects of ethnic origin, social class (determined by area of residence), paternal education, maternal age, and birth order. The group with low birth weights (less than 2500 g, n = 1004) had a significantly increased risk of developing asthma by 17 years of age, with an adjusted odds ratio of 1.44 (95% confidence interval (CI) 0.79 to 2.66) for birthweight group less than 2000 g and 1.49 (95% CI 1.05 to 2.12) for birthweight group 2000-2499 g compared with the reference group of 3000-3499 g. We conclude that infants with birth weights of less than 2500 g may have a higher risk of asthma during childhood and adolescence than infants who were heavier at birth.

Adolescent↗
PubMed1991

Quality assurance of immunodiagnostic tests in Australasia.

A Royal College of Pathologists of Australasia (RCPA) sponsored Quality Assurance Program (QAP) in Clinical Immunology, involving 128 laboratories over a 1 yr period, revealed the following: successful participation in the program by 16 overseas laboratories (distant from Australia); only 30% of laboratories succeeded in returning their results by the scheduled date on every occasion; quantitation of urinary total protein and Bence Jones protein was poor and varied over a log scale; immunofixation was more successful in characterizing urinary paraprotein than immunoelectrophoresis; densitometry of protein electrophoresis appeared the method of choice in quantitating serum paraproteins accurately; nephelometric techniques gave better concordance between laboratories than turbidometric, radial immunodiffusion or agglutination techniques; poor concordance between laboratories in detecting weakly positive antinuclear antibodies (ANA); some laboratories had difficulties in identifying ANA patterns (only 60% of laboratories correctly identified the anticentromere pattern); few laboratories could correctly identify antibodies to extractable nuclear antigens (ENA); flow cytometry gave a smaller dispersion of lymphocyte subpopulation percentages than microscopy. A method was established to rank laboratory performance of selected tests over the 1 yr period. Such a comparative ranking scheme may alert laboratories in identifying specific or generalized deficiencies in performance.

Antibodies, Antinuclear↗
PubMed1991

Neonatal hyperbilirubinemia and physical and cognitive performance at 17 years of age.

To estimate the effect of neonatal hyperbilirubinemia on long-term cognitive ability in full-term newborns with a negative Coombs test, we performed a 17-year historical prospective study of 1948 subjects. Intelligence tests and medical examinations performed at the military draft board were stratified according to serum bilirubin concentration. A logistic regression analysis was used to adjust for the confounding effects of gestational age, birth weight, Apgar score, ethnic origin, socioeconomic class, paternal education, birth order, and the administration of phototherapy and exchange transfusion. No direct linear association was shown between neonatal bilirubin levels and intelligence test scores or school achievement at 17 years of age. However, the risk for low intelligence test scores (IQ score less than 85) was found to be significantly higher (P = .014) among full-term male subjects with serum bilirubin levels above 342 mumol/L (20 mg/dL) (odds ratio, 2.96; 95% confidence interval, 1.29-6.79). This association was not observed among female subjects. We conclude that severe neonatal hyperbilirubinemia, among full-term male newborns with a negative Coombs test, could be associated with lower IQ scores at 17 years of age.

Adolescent↗
PubMed1991

Apgar scores and cognitive performance at 17 years of age.

The association between low Apgar scores (7 or less) at 1 and 5 minutes and cognitive performance in late adolescence was assessed. A 17-year follow-up of 1942 subjects was performed. The intelligence test scores at 17 years of age were matched with 1- and 5-minutes Apgar scores. A multiple linear regression analysis was used to control for the possible confounding effect of perinatal factors (birth weight, gestational age, serum bilirubin levels, birth order) and demographic characteristics (ethnic origin, paternal education, social class). The sensitivity and positive predictive value of a low 1-minute Apgar score were 8 and 8% and of a low 5-minute Apgar score 1.5 and 5%, respectively. Low Apgar scores are poorly correlated with long-term intellectual outcome.

Adolescent↗
PubMed1991

A longitudinal study of birth weight and being overweight in late adolescence.

A total of 33,413 infants born in Jerusalem between 1964 and 1971 were followed up at 17 years of age by matching computerized database files. A logistic regression model was used to estimate the odds ratios for being overweight at 17 years of age for 500-g birth weight categories from less than 2500 g to 4500 g or greater. Information on the ethnic origin, paternal education, birth order, maternal age, and area of residence at birth was available, and these factors were used as possible confounders. The adjusted odds ratios for being overweight (greater than or equal to 90th percentile; body mass index greater than 24.6 kg/m2) and severely overweight (greater than or equal to 97th percentile; body mass index greater than 27.8 kg/m2) at 17 years of age was elevated for the three birth weight categories above the normal reference category of 3000 to 3499 g, with an estimate of 2.16 and 2.30 for male subjects with a birth weight greater than 4500 g and 2.95 and 4.39 for female subjects. The data suggest that higher birth weights correlate strongly with being overweight in late adolescence independently of other factors considered. However, the predictive power of this association is poor.

Adolescent↗
PubMed1990

[Intraosseous emergency infusion].

Difficulties in establishing an intravenous line in the critically ill child may lead to failure and thus endanger life. The technique of intraosseous infusion, once common, was abandoned in the early 1950s, but is now being reintroduced. It is safe, does not require prior skills, has few complications and may be lifesaving. Substances absorbed through the bone marrow are delivered into the blood circulation as soon as after intravenous injection. A critically ill, preterm neonate who needed emergency fluids and in whom intraosseous infusion was given, is presented.

Blood Transfusion↗
PubMed1990

Facilitated uptake of zinc into human erythrocytes. Relevance to the treatment of sickle-cell anaemia.

The ability of a number of heterocyclic metal chelators to deliver zinc into red cells, to release the liganded zinc to haemoglobin and thereby cause a left shift in the oxygen dissociation curve of intact red cells has been investigated. Incubation of neutrally charged zinc-pyrone and zinc-pyridin-2-one complexes with red cells led to the rapid accumulation of zinc within cells, whereas unliganded zinc in the form of zinc acetate, zinc chloride or zinc sulphate accumulated only slowly. The rate at which zinc was delivered to red cells by pyrone and pyridin-2-one ligands increased with increasing lipid solubility of the ligands. The uptake of zinc into both normal adult and sickle red cells was associated with a dose-dependent increase in the oxygen affinity of haemoglobin. The degree of left shift in the oxygen dissociation curve following the incubation of red cells with zinc-pyrone and -pyridin-2-one complexes suggests that these complexes may find application as agents to increase the oxygen affinity of haemoglobin in sickle cell disease and thereby decrease the probability of intravascular sickling at low tissue oxygen tensions. Ethylmaltol appears to be a particularly useful agent due to its known low toxicity.

Anemia, Sickle Cell↗
PubMed1990

Genetics of conotruncal malformations: review of the literature and report of a consanguineous kindred with various conotruncal malformations.

Genetic predisposition in congenital heart disease is considered to be a component of multifactorial inheritance. Recently, monogenic inheritance in conotruncal malformations has been suggested. We describe a consanguineous kindred with various conotruncal malformations, the presence of which lends support to the idea that this spectrum of malformation is monogenically inherited. Theoretical background and experimental and clinical data are reviewed and discussed.

Consanguinity↗
PubMed1990

Epidemiology of neonatal jaundice in the Jerusalem population.

Of 10,122 singleton babies born from January 1, 1984 to March 31, 1988, we compared 1,154 term infants with high serum bilirubin levels (greater than 12.9 mg/dl) to 1,154 infants with low serum bilirubin levels (less than or equal to 12.9 mg/dl) randomly selected from the remaining 8,968 subjects. We found that a high bilirubin level was significantly associated with male sex; maternal diabetes (chronic and gestational); pregnancy-induced hypertension; previous sibling with neonatal jaundice; delivery by cesarean section, vacuum, or forceps; epidural anesthesia; mother with blood type O; first delivery; cephalohematoma; short gestation; lower birth weight; and lower birth order (p less than 0.01); and older maternal age, low percentile for birth weight, and the percentage of weight loss during hospitalization (p less than 0.05). Variables with significantly different frequencies in control and study groups were used in a multivariate analysis, thus further refining the data by the use of logistic regression. Teenage mothers (less than or equal to 19 years old) had the lowest risk, whereas older mothers (greater than 35 years old) had the highest risk of all age groups for having an infant with neonatal jaundice. First delivery and previous sibling with neonatal jaundice were also risk factors. Male sex, short gestation, and delivery by vacuum extraction were other notable risk factors. Our results suggest that, even among industrialized Western societies, risk factors may interact differently to produce higher neonatal serum bilirubin levels. The importance of a risk factor may also be dependent upon its relative prevalence in a parturient population.

Female↗