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PubMed1990

Effects of birth weight and sociodemographic variables on mental development of neonatal intensive care unit survivors.

Neonatal intensive care unit survivors (N = 494) from 10 tertiary care centers were evaluated over the first 4 to 5 years of life to determine the relative contributions of birth weight and sociodemographic factors to mental development. Six sociodemographic factors were studied: sex, race, family income, and mother's marital status, age, and educational level; the last five factors also are known to be associated with premature birth. Mental development was measured with the Bayley Scales of Infant Development (12 to 24 months) and the Stanford Binet Intelligence Test (4 to 5 years). Each factor's influence was assessed by multivariate analysis. Birth weight had limited long-term implications; at 4 to 5 years, only infants with birth weights less than 1000 gm had significantly lower scores than those in other birth weight categories. Sociodemographic variables had a greater impact on mental development, with age-dependent differences found between nonwhite and white children and between children with mothers of low, medium, and high educational levels.

Adult↗
PubMed2005

Autophagic cell death of pancreatic acinar cells in serine protease inhibitor Kazal type 3-deficient mice.

BACKGROUND & AIMS: Serine protease inhibitor Kazal type 1 (SPINK1), which is structurally similar to epidermal growth factor, is thought to inhibit trypsin activity and to prevent pancreatitis. Point mutations in the SPINK1 gene seem to predispose humans to pancreatitis; however, the clinical significance of SPINK1 mutations remains controversial. This study aimed to elucidate the role of SPINK1. METHODS: We generated Spink3-deficient (Spink3(-/-)) mice by gene targeting in mouse embryonic stem cells. Embryonic and neonatal pancreases were analyzed morphologically and molecularly. Specific probes were used to show the typical autophagy that occurs during acinar cell death. RESULTS: In Spink3(-/-) mice, the pancreas developed normally up to 15.5 days after coitus. However, autophagic degeneration of acinar cells, but not ductal or islet cells, started from day 16.5 after coitus. Rapid onset of cell death occurred in the pancreas and duodenum within a few days after birth and resulted in death by 14.5 days after birth. There was limited inflammatory cell infiltration and no sign of apoptosis. At 7.5 days after birth, residual ductlike cells in the tubular complexes strongly expressed pancreatic duodenal homeodomain-containing protein 1, a marker of pancreatic stem cells, without any sign of acinar cell regeneration. CONCLUSIONS: The progressive disappearance of acinar cells in Spink3(-/-) mice was due to autophagic cell death and impaired regeneration. Thus, Spink3 has essential roles in the maintenance of integrity and regeneration of acinar cells.

Animals↗
PubMed1994

Birth defects in relation to threatened abortion.

The evidence for the association between threatened abortion and birth defects is limited and inconsistent. This study examined this relation using data from the Shanghai Birth Defects Monitoring Program. A total of 1,013 cases of birth defects and an equal number of controls were analyzed. Our study showed that women with threatened abortion had a 50% higher risk of having a baby with birth defects compared with those without this complication, controlling for other factors (adjusted odds ratio = 1.5; 95% confidence interval = 1.1-2.1). Threatened abortion was generally related to defects of the urogenital system, heart and circulatory system, and musculoskeleton and limbs and was specifically associated with polydactyly, undescended testicle, and hypospadias.

Abortion, Threatened↗
PubMed1978

Limitations in prediction of gestational age and birth weight by ultrasonographic methods.

The index of predictability of estimated gestational age (EGA) and birth weight (BW) from biparietal diameter (BPD) was tested in 1333 normal pregnancies; 96% of the patients were black. The correlation BPD and actual weeks to delivery was 0.834, r2 =69.5%. Confidence limits were established and a nomogram for EGA was derived. Our nomogram and two similar ones were compared. The overall correlation between them was good, but that for specific BPD and EGA was not. In addition, our BPD values were smaller for corresponding gestational ages in other nomograms. The overall accuracy of estimated delivery date was +/- 1.6 weeks. We were not able to predict birth weight at all from a single, random BPD measurement. We have demonstrated the serious limitations that exist in the prediction of gestational age from previously established nomograms. We infer that this error is even greater when homogenous populations are so studied. We suggest that any published BPD-EGA or BPD-BW nomogram be given close, intensive statistical scrutiny, within the population studied, before it is used. When such scrutiny is not possible, serial sonographic determinations, or longitudinal use of growth charts, would be more acceptable.

Adolescent↗
PubMed1998

Limitations of clinical and sonographic estimates of birth weight: experience with 1034 parturients.

OBJECTIVE: To compare the accuracy of clinical and sonographic estimates of fetal weight made throughout the third trimester of pregnancy. METHODS: Patients in early labor had fetal weight estimated by two approaches: 1) clinical evaluation and palpation followed by 2) sonographic mensuration of fetal biparietal diameter, abdominal circumference, and femur length applied to Hadlock's formula. The accuracy of these two methods of estimating fetal weight was compared using Student t test, Wilcoxon test, and chi2 tests. P < .05 was considered significant. Prediction limits (50th, 90th, and 95th percentiles) were calculated for both techniques by obtaining the range of actual weights associated for a particular estimated fetal weight (EFW). RESULTS: We enrolled 1034 parturients whose clinical EFWs yielded significantly higher mean (+/- standard deviation) simple error (48.2 +/- 411 g) and standardized absolute error (130 +/- 122 g/kg) than were obtained by use of sonographic formulas for EFW (-6.6 +/- 381 g and 104 +/- 89 g/kg, respectively). When the population was partitioned by gestational age, we found that sonographic EFW was more accurate than clinical EFW in preterm (n = 373) but not in term (n = 460) or post-term (n = 201) pregnancies. Prediction limits indicate that for a given EFW, for example, 800 g, the 90% ranges of actual weight based on clinical and sonographic EFW are 566-1829 g and 469-1667 g, respectively. CONCLUSION: The apparent superiority of sonographic EFW over clinical EFW applies principally to preterm pregnancies. The prediction limitation calculation suggests that either method, for any particular estimate between 500 and 4500 g, has limited value in the estimation of actual birth weight, because this outcome is highly variable and frequently lies outside of the useful bandwidth (+/- 10%) for prospective management.

Adult↗
PubMed1987

Ductus arteriosus blood flow during first 48 hours of life.

A volumetric Doppler technique was used to measure net ductus arteriosus shunt during the first 48 hours of life in 30 infants of less than 33 weeks' gestation, and in 10 full term infants. In the full term infants a left to right shunt of 62 ml/kg/minute (95% confidence limits 43-82) shortly after birth decreased rapidly over the first 12 hours and was not measurable by 48 hours. The preterm infants had smaller left to right shunts shortly after birth--49 ml/kg/minute (95% confidence limits 38-59). There was no obvious subsequent change in the mean shunt, although by 48 hours there was greater variation in the size of the shunt. The respiratory distress syndrome did not affect the size of the ductal shunt, but the shorter the gestation period the larger the shunt by 48 hours. A ductal flow of greater than 70 ml/kg/minute at 48 hours of age predicted the subsequent development of a ductal murmur with 75% sensitivity and 100% specificity.

Blood Flow Velocity↗
PubMed2003

Completeness of state administrative databases for surveillance of congenital heart disease.

BACKGROUND: Tracking birth prevalence of cardiac defects is essential to determining time and space clusters, and identifying potential associated factors. Resource limitations on state birth defects surveillance programs sometimes require that databases already available be used for ascertaining such defects. This study evaluated the data quality of state administrative databases for ascertaining congenital heart defects (CHD) and specific diagnoses of CHD. METHODS: Children's Hospital of Wisconsin (CHW) medical records for infants born 1997-1999 and treated for CHD (n = 373) were abstracted and each case assigned CHD diagnoses based on definitive diagnostic reports (echocardiograms, catheterizations, surgical or autopsy reports). These data were linked to state birth and death records, and birth and postnatal (< 1 year of age) hospital discharge summaries at the Wisconsin Bureau of Health Information (WBHI). Presence of any code/checkbox indicating CHD (generic CHD) and exact matches to abstracted diagnoses were evaluated. RESULTS: Fifty-eight percent of cases with generic CHD were identified by state databases. Postnatal hospital discharge summaries identified 48%, birth hospital discharge summaries 27%, birth certificates 9% and death records 4% of these cases. Exact matches were found for 52% of 633 specific diagnoses. Postnatal hospital discharge summaries provided most matches. CONCLUSION: State databases identified 60% of generic CHD and exactly matched about half of specific CHD diagnoses. The postnatal hospital discharge summaries performed best in both in identifying generic CHD and matching specific CHD diagnoses. Vital records had limited value in ascertaining CHD.

Birth Certificates↗
PubMed1999

Sudden infant death syndrome among twins.

BACKGROUND: Sudden infant death syndrome (SIDS) is a major contributor to infant mortality. Previous studies have suggested that infants born of twin pregnancies are at greater risk for SIDS and that a twin who survives after a co-twin dies is at increased risk for SIDS. OBJECTIVE: To attempt to confirm the increased risk of SIDS among and within twin pairs through the use of US vital statistics data. METHODS: We analyzed data from the US-linked birth and infant death certificate tapes for the years 1987 through 1991 to determine the risk of SIDS in twin births compared with singleton births and to describe the characteristics of twin pairs in whom SIDS occurred. The analysis was limited to live births with weights of 500 g or more and gestational ages of 24 weeks or more. We used an algorithm to match co-twins (infants within a twin pair) to measure sex and birth weight concordancy, to identify twin pairs, in which one or both twins died of SIDS; and to examine, when both twins died, whether they died on the same day. RESULTS: There were 23464 singleton SIDS deaths and 1056 twin SIDS deaths during the 5-year period. The crude relative risk for SIDS among twins compared with singleton births was 2.06 (95% confidence interval, 1.94-2.19). The adjusted relative risk independent of birth weight and sociodemographic variables was 1.13 (95% confidence interval, 0.97-1.31). We successfully matched the co-twins of 172029 twin pregnancies. Of these, 767 were twin pregnancies in which one or both twins died of SIDS. Among the 767 twin pregnancies in which one or both twins experienced SIDS, there were only 7 in which both twins died of SIDS (rate ratio, 4.0 per 100000 twin pregnancies). In only 1 of these 7 did both twins die on the same day (rate ratio, 0.58 per 100000 twin pregnancies). The relative risk for a second twin dying of SIDS was 8.17 (90% confidence interval, 1.18-56.67). CONCLUSIONS: Independent of birth weight, twins do not appear to be at greater risk for SIDS compared with singleton births. In addition, the occurrence of both twins dying of SIDS is uncommon, and the occurrence of both twins dying on the same day is extremely uncommon.

Birth Weight↗
PubMed1988

Thyroid hormone effects on neonatal thermogenesis.

It is clear that thyroid hormones modulate non-shivering heat production of the newborn mammal. While some obvious thyroid hormone effects on thermogenesis can be demonstrated in adult, cold-acclimated or hibernating animals, these findings cannot be directly applied to the newborn, in which changes in amount and composition of brown adipose tissue, as well as sympathetic and thyroid system maturational events, are occurring. Thyroid hormones do influence the prenatal development and subsequent responses of brown adipose tissue in neonates through primary actions on brown adipose tissue iodothyronine 5'monodeiodinase and mitochondrial uncoupling protein. Secondary effects involving brown adipocyte growth, lipid composition, oxidation proteins, and sympathoadrenal activity are of lesser importance in thyroid hormone modulation of newborn thermogenesis. The acute surge in thyroid hormones that occurs at birth seems of limited significance with regard to neonatal thermogenesis. The stimulation of sympathoadrenal activity at the time of birth, as well as continued in situ conversion of T4 to T3 in the brown adipocyte, are of critical importance in stimulating and modulating heat production in the newborn.

Adipose Tissue↗
PubMed2000

Gluconeogenesis in the fetus and neonate.

Gluconeogenesis (GNG), a key metabolic process, involves the formation of glucose and glycogen from non-glucose precursors via pyruvate. In the strict sense, it also includes the contribution of glycerol as well as recycled glucose carbon (Cori's cycle). The developmental expression of GNG in the fetus and newborn and the quantitative contribution of GNG to glucose has been extensively investigated in humans and other mammalian species. Data from studies in rodents, rabbits, and sheep fetuses show that the development of GNG is a well-orchestrated process that is regulated by the expression of specific factors involved in the transcription of the genes for specific regulating enzymes, which catalyze GNG. These transcription factors and the genes for gluconeogenic enzymes are expressed at specific time periods during development. Although the fetus has the potential for GNG, the actual formation of glucose from pyruvate is not apparent until after birth because the rate limiting enzyme phosphoenolpyruvate carboxykinase appears only after birth in the immediate newborn period. Several tracer isotope methods have been employed to quantify the contribution of GNG to glucose. Of these, the recently developed stable isotope techniques with deuterium labeled water and the mass isotopomer distribution analysis appear to be the most precise and easily applicable in human studies. The available data show that in the human newborn, GNG appears soon after birth and contributes 30% to 70% to glucose produced. Application of new molecular biology techniques, in combination with sensitive tracer isotopic methods, will allow us to identify and examine metabolic disorders that impact GNG and help develop intervention strategies.

Animals↗
PubMed1981

[Experience with EK-birthing chair (author's transl)].

A birthing chair with a rigid plastic seat was tested for usefulness and safety. The birthing chair was evaluated positively by the delivering patients. The obstetric team was convinced of the advantages of the sitting position for delivery at the end of the evaluation. Minor disadvantages such as increased soiling of the chair were accepted for the advantages. The tested birthing chair impedes operative deliveries from the perineal floor. These may become necessary unexpectedly during the second stage of labor. Under these circumstances the patient must be transferred to a conventional delivery table. This is psychologically and from a standpoint of the work load very disadvantageous. Therefore the EK-birthing chair is of limited usefulness in routine obstetrics. An ideal birthing chair in our opinion is a delivery bed which can be changed into a sitting position and into all intermediate positions between sitting and recumbent.

Delivery, Obstetric↗
PubMedDate not supplied

Prognosis in infants with birth asphyxia.

The risk of neurodevelopmental disability from birth asphyxia secondary to intrapartum complications and obstetric mismanagement is generally overestimated. Between 8-17% of all cerebral palsy is associated with adverse perinatal events suggestive of asphyxia. Less than 10% is probably due directly to birth asphyxia itself. Studies have shown that different methods of intrapartum assessment of fetal well-being (fetal heart rate monitoring, fetal scalp pH, presence of meconium) do not correlate well with each other or with neonatal parameters (acid-base status at birth, Apgar scores, seizures, neurological behaviour) and outcome measures (death, cerebral palsy, mental retardation). The prevalence rate of cerebral palsy in most communities of 2.0-2.5 per 1000 children is not falling in spite of increasing use of obstetric and neonatal interventions aimed at preventing or treating birth asphyxia. Prediction of neurodevelopmental outcome of birth asphyxia is difficult because of a limited ability to measure birth asphyxia quantitatively in the antenatal and neonatal period. The terminology used to describe the condition is often confusing. It has been recommended that substantial cerebral hypoxia can only be presumed when four criteria are met: the infant has an Apgar score < or = 3 at 10 minutes, metabolic acidosis at birth, hypotonia for several hours and seizures. For the paediatrician, a number of clinical observations and laboratory investigations have been suggested as helpful in the prediction of death or disability among term infants with birth asphyxia.

Asphyxia Neonatorum↗
PubMed2026

Sex-stratified mortality trends in preterm birth complications in Sierra Leone: progress, persistence, and equity implications.

BACKGROUND: Preterm birth complications remain a leading cause of neonatal mortality in Sierra Leone, despite recent health system gains. Evidence on long-term sex-specific disparities in mortality due to preterm birth complications is limited, constraining equitable neonatal care planning. OBJECTIVE: To examine two&#x2011;decade trends in sex&#x2011;stratified mortality from preterm birth complications using standardized equity indicators. METHODS: We conducted a retrospective longitudinal analysis of sex-disaggregated mortality estimates from the World Health Organization (WHO) Global Health Estimates (GHE), accessed through the WHO Health Equity Assessment Toolkit (HEAT), Built-in Database Edition (Version 6.0). Mortality rates per 100,000 population were extracted for 2001, 2006, 2011, 2016, and 2021. Inequality was assessed using absolute difference (D), relative ratio (R), population attributable risk (PAR), and population attributable fraction (PAF). RESULTS: Mortality declined substantially between 2001 and 2021 for both males (85.1-49.3 per 100,000) and females (71.2-39.9 per 100,000). Male mortality remained consistently higher across all years, with relative ratios indicating approximately 20-25% excess mortality among male neonates. Absolute inequalities narrowed modestly over time, whereas relative inequalities remained largely unchanged. PAR and PAF remained close to zero throughout the study period. Wider uncertainty intervals in earlier years reflected limited empirical data availability. CONCLUSION: Although preterm mortality declined over two decades, a persistent male disadvantage remained in Sierra Leone. These findings highlight the importance of integrating sex-disaggregated equity monitoring into neonatal policies and programmes. Future research should evaluate strategies to reduce the persistent excess mortality among male neonates while sustaining overall improvements in neonatal survival and progress toward Sustainable Development Goal 3.2.

Humans↗
PubMed2004

Effects of protein deprivation on growth and small intestine morphology are not improved by glutamine or glutamate in gastrostomy-fed rat pups.

OBJECTIVES: Critically ill neonates often have their enteral intake severely limited shortly after birth. Whether glutamine (Gln) or glutamate (Glu) can preserve intestinal structure and function in the neonate undergoing limited enteral feeding is not clear. We hypothesize that Gln and Glu can similarly preserve intestinal structure in the developing small intestine of infant rats fed a low protein diet. METHODS: Using a gastrostomy-fed "pup-in-a-cup" rat model, the effects of Gln and Glu on the developing rat small intestine were examined. Four groups of 6- to 7-day-old pups were fed rat milk substitute (RMS) via gastrostomy tube. One group was provided 100% and three were provided 25% of the protein normally received from their mothers. Two of the groups fed 25% protein received additional Gln or Glu for 6 days. RESULTS: Pups receiving the 100% protein RMS were larger than pups receiving the 25% protein RMS with or without Gln/Glu supplementation (P < 0.001). Average villus height (P < 0.01) and area (P < 0.01) were greater in pups receiving 100% protein RMS than in pups given 25% protein RMS formula. There was no significant difference among the groups in mucosal maltase or alkaline phosphatase activities. Tight junction protein claudin-1 was significantly higher in the group fed 100% protein RMS diet, while occludin did not differ among the 4 groups. Neither Gln nor Glu increased claudin-1 or occludin in rats fed 25% protein. CONCLUSIONS: These results suggest that neither Gln nor Glu supplementation can substitute effectively for whole protein in the developing rat small intestine for the outcomes that were evaluated.

Alkaline Phosphatase↗
PubMed2004

Plagiocephaly and brachycephaly in the first two years of life: a prospective cohort study.

OBJECTIVES: Although referrals for nonsynostotic plagiocephaly (NSP) have increased in recent years, the prevalence, natural history, and determinants of the condition have been unclear. The objective of this study was to assess the prevalence and natural history of NSP in normal infants in the first 2 years of life and to identify factors that may contribute to the development of NSP. METHODS: Two hundred infants were recruited at birth. At 6 weeks, 4 months, 8 months, 12 months, and 2 years, the head circumference shape was digitally photographed, and head shape was quantified using custom-written software. At each age, infants were classified as cases when the cephalic index was > or =93% and/or the oblique cranial length ratio was > or =106%. Neck rotation and a range of infant, infant care, socioeconomic, and obstetric factors were assessed. RESULTS: Ninety-six percent of infants were followed to 12 months, and 90.5% were followed to 2 years. Prevalence of plagiocephaly and/or brachycephaly at 6 weeks and 4, 8, 12, and 24 months was 16.0%, 19.7%, 9.2%, 6.8%, and 3.3% respectively. The mean cephalic index by 2 years was 81.6% (range: 72.0%-102.6%); the mean oblique cranial length ratio was 102.6% (range: 100.1%-109.4%). Significant univariate risk factors of NSP at 6 weeks include limited passive neck rotation at birth, preferential head orientation, supine sleep position, and head position not varied when put to sleep. At 4 months, risk factors were male gender, firstborn, limited passive neck rotation at birth, limited active head rotation at 4 months, supine sleeping at birth and 6 weeks, lower activity level, and trying unsuccessfully to vary the head position when putting the infant down to sleep. CONCLUSIONS: There is a wide range of head shapes in infants, and prevalence of NSP increases to 4 months but diminishes as infants grow older. The majority of cases will have resolved by 2 years of age. Limited head rotation, lower activity levels, and supine sleep position seem to be important determinants.

Beds↗
PubMed2000

The validity of information on "race" and "Hispanic ethnicity" in California birth certificate data.

OBJECTIVE: To evaluate the validity of racial/ethnic information in California birth certificate data. DATA SOURCES: Computerized birth certificate data and postpartum interviews with California mothers. STUDY DESIGN AND DATA COLLECTION: Birth certificates were matched with face-to-face structured postpartum interviews with 7,428 mothers to compare racial/ethnic information between the two data sources. Interviews were conducted in Spanish or English during delivery stays at 16 California hospitals, 1994-1995. PRINCIPAL FINDINGS: The sensitivity of racial/ethnic classification in birth certificate data was very high (94 percent to 99 percent) for African Americans, Asians/Pacific Islanders, Europeans/Middle Easterners, and Latinas (Hispanics). For Native Americans, however, the sensitivity was only 54 percent. The positive predictive value of birth certificate classification of race/ethnicity was high for all racial/ethnic groups (96 percent to 97 percent). CONCLUSIONS: Despite limited training of birth clerks, the maternal racial/ethnic information in California birth certificate data appears to be a valid measure of self-identified race and Hispanic ethnicity for groups other than Native Americans.

Adolescent↗
PubMed1986

Analysis of birth weight percentile as a predictor of perinatal outcome.

Birth weight-gestational age tables are convenient methods for the neonatal evaluation of intrauterine growth, however, the limits of acceptable birth weight for gestational age are controversial. The purpose of this study was to identify the birth weight percentiles that accurately predicted poor perinatal outcome from 28 through 41 weeks' gestational age. In a homogeneous population of 44,811 patients, the birth weight percentile that predicted poor perinatal outcome varied with gestational age. The birth weight percentile that predicted normal outcome in 80% of normal patients declined from the 55th percentile at 28 to 29 weeks to the 24th percentile at 34 to 35 weeks. From 28 through 35 weeks' gestational age, possibly owing to the confounding effects of prematurity, patients classified as normal by birth weight criteria still had a significant risk of poor outcome. After 36 weeks' gestational age, poor perinatal outcome occurred in 3.9% of patients and tended to occur at the extremes of birth weight. Classification by birth weights approximating the tenth and 90th percentiles identified a population in which the majority of the poor perinatal outcome occurred. However, poor outcome occurred in only 10% of patients with birth weights below the tenth or above the 90th percentiles. Among those with birth weights between the tenth and 90th percentiles, outcome was normal in 98%. Therefore, from 36 through 41 weeks' gestational age, the prevalence of poor perinatal outcome was low, and birth weight percentile was a weak predictor of outcome in the individual patient.

Birth Weight↗
PubMed2005

Birth rate and its correlation with the lunar cycle and specific atmospheric conditions.

OBJECTIVE: This study was undertaken to use the Arizona State birth certificate database for Phoenix metropolitan hospitals, in conjunction with National Weather Service records to determine whether there is a relationship between birth rate and meteorologic or lunar conditions. This study attempts to dispel or lend significance to beliefs among hospital staff that the phase of the moon and/or meteorologic conditions are related to birth rate. STUDY DESIGN: Birth records were limited to spontaneous vaginal deliveries, 37 to 40 weeks' gestation, in Phoenix, between 1995 and 2000 (n = 167,956). Daily birth counts were merged with daily surface weather statistics from the National Weather Service for Sky Harbor Airport, and records of lunar phase for the same period. RESULTS: The analyses revealed no significant correlates of birth rate. CONCLUSION: Although there exists a popular belief that the phase of the lunar cycle and weather conditions affect birth rate, no such evidence was found in this study.

Arizona↗