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The use of logit models to investigate social and biological factors in infant mortality. V: A multilogit analysis of stillbirths, neonatal and post-neonatal mortality.

Infant mortality data for England and Wales, cross classified by mother's age, parity and social class were published for 1949/50 and 1975. Previous analyses of these data have been based on graphical, tabular and logit models of stillbirths, neonatal and post-neonatal deaths separately. This paper summarizes the overall changes in infant mortality using a multilogit model. The model selected is illustrated by appropriate graphical presentations.

Adolescent↗

Follow-up study of a nation-wide neonatal metabolic screening program in Japan. A collaborative study group of neonatal screening for inborn errors of metabolism in Japan.

A nationwide neonatal screening program for phenylketonuria (PKU), maple syrup urine disease (MSUD), homocystinuria, histidinemia and galactosemia was started in Japan in 1977. The total number of infants screened had reached 6,311,754 by March, 1982. A follow-up study revealed the incidence of the disease in Japan: 1/108,823 for PKU; 1/450,840 for hyperphenylalaninemia (HPA); 1/1,577,939 for biopterin deficiency; 1/525,980 for MSUD; 1/1,051,959 for homocystinuria; 1/8,371 for histidinemia, and 1/788,969 for galactosemia type 1. The incidences of PKU, HPA, homocystinuria, and galactosemia (type 1) were found to be markedly low in Japan as compared with those in Caucasian countries. There was no great difference in the incidence of MSUD between both. On the other hand, the incidence of histidinemia was higher in Japan. It was found that most of the patients with PKU, HPA, MSUD, homocystinuria, or galactosemia are developing normally due to the early initiation of dietary treatment. These results clearly indicate that the neonatal mass screening program plays a great role in preventing the occurrence of handicapped children.

Biopterins↗

The membranous portion of the interventricular septum in neonates. An anatomic study in neonatal cadavers.

The membranous portion of the interventricular septum (MPIS) has been described as a small, oval portion of the cardiac septum that lies immediately below the aortic valve. Its location and relationship with the aortic valve are very important in surgical interventions. Several studies have been reported in adults but few in neonates. For this reason, studies of the MPIS were made in the hearts of 26 (12 male, 14 female) fulterm neonates. The left side of the MPIS was photographed with transillumination from the right ventricle. The shapes of the septum were assessed from the photographic images. In addition, in accordance with the ruler in the photographs a millimetric scale was prepared on the tracing paper and the surface area of the MPIS and its distance from the superior border of the aortic valve were measured. In these 26 cases, the following shapes of MPIS were found: semilunar, 7 (26.92%); triangular, 6 (23.07%); quadrangular, 5 (19.23%); oval, 4 (15.38%); circular, 2 (7.69%); irregular, 2 (7.69%). Its surface area varied from 2-21 mm2 (mean 5.84 mm2). The superior border of MPIS was in close relationship with the aortic valve. In 10 cases (38.46%) the MPIS was in direct continuity with the attachments of both the right and posterior aortic cusps, in 8 (30.76%) only with the posterior aortic cusp, in 5 (19.23%) only with the right aortic cusp, while in 3 (11.53%) the superior border of MPIS was below the attached portion of both cusps. The distance between the superior border of the MPIS and the attachment of the right or posterior aortic cusps did not exceed 3.5 mm. There were no statistically significant sex-related differences in shape, surface area and relationship with the aortic valve.

Aortic Valve↗

Clinical evaluation of the fetus and neonate. Relation between intra-partum cardiotocography, Apgar score, cord blood acid-base status and neonatal morbidity.

The relation between intra-partum cardiotocography (CTG), cord blood acid-base status, Apgar score and neonatal morbidity was studied in 1228 consecutively live-born babies and in a subgroup of 200 babies (148 babies with a 1 min Apgar score < or = 8 and 52 randomly selected babies with a 1 min Apgar score > or = 9). The scores for the individual components of the 1 min Apgar score were strongly associated with each other, whereas the scores for the individual components of the 5 min Apgar score were less strongly associated. At 1 min the scores for muscle tone, reflex irritability and respiration but not the scores for heart rate and skin colour were associated with arterial and venous cord blood pH (low scores being associated with low pH). Out of the individual components of the Apgar score, heart rate and reflex irritability at 1 min were the best discriminators between "healthy or relatively healthy" and "severely ill" babies. Intrapartum CTG, total Apgar score and cord blood acid-base status were only weakly related. Venous cord blood pH was the best predictor of the 1 min Apgar score. Intra-partum CTG (silent pattern), 5 min Apgar score and venous cord blood pH were the best predictors of severe neonatal morbidity.

Acid-Base Equilibrium↗

Transient neonatal hair loss: a common transient neonatal dermatosis.

For many years the aetiology of neonatal occipital alopecia (NOA) has been reported to be friction. We have made a retrospective check to see if the incidence of NOA has increased since the new paediatric tendencies of putting children back to sleep in the safest way have been used (APP guidelines). The results of this study in 301 neonates demonstrated that it has not. The aetiology of this phenomenon is the physiological shedding of hair in the first weeks of life. The pillow, which is often blamed, only aids this shedding. Parents should be informed that there is no relationship between the sleep position and the onset of this problem, to prevent them from changing the position of the sleeping child, which could lead to a fatal outcome.

Alopecia↗

Neonatal hemochromatosis, renal tubular dysgenesis, and hypocalvaria in a neonate.

We report a neonate with neonatal hemochromatosis (NH), renal tubular dysgenesis (RTD), and hypocalvaria. NH is a fatal condition of the newborn, characterized by severe idiopathic liver failure of intrauterine onset and siderosis, intra- and extrahepatic, with sparing of the reticuloendothelial system. RTD is characterized by short, abnormally developed cortical tubules that lack proximal tubule differentiation. Although both NH and RTD have been reported as entities with a genetic component, similar findings can be secondary to in utero insults. Hypocalvaria has been reported in association with fetal hypoxia including that secondary to angiotensin converting enzyme inhibitors. This 38-week-old infant died at 8.5 h. The small nodular liver weighed 44 g. Grossly, the kidneys were normal. Hypocalvaria was present. Microscopically, the hepatic parenchyma was distorted by fibrous tracts, proliferation of bile ducts, and abundant iron deposition in hepatocytes. Extrahepatic siderosis in the pancreas, myocardium, and other organs was consistent with NH. Proximal convoluted tubules were not seen on routine stains and markers for proximal tubules were negative. Previous reports have linked NH with RTD and RTD with hypocalvaria. This infant had all three of these rare conditions, which have been hypothesized or shown to be due to genetic factors, hypoxia, or drugs. The etiology in this case is unknown.

Abnormalities, Multiple↗

Neonatal mortality in infants born weighing 501 to 1000 grams. The influence of changes in birth weight distribution and birth weight-specific mortality rates on neonatal survival.

We analyzed changes over time in neonatal mortality rates for infants born weighing 501 to 1000 gm. The decline in total mortality in this weight group due to improved small-group, birth weight-specific mortality was contrasted to the increase in mortality caused by changes in the birth weight distribution resulting from the care of smaller infants. Had the birth weight distribution remained unchanged, the total improvement in neonatal mortality for the entire 501 to 1000 gm group would have been substantially greater.

Alabama↗

Fetal and neonatal cerebral blood velocity in the normal fetus and neonate: a longitudinal Doppler ultrasound study.

In a longitudinal Doppler ultrasound study fetal and early neonatal cerebral blood flow velocities were assessed in the middle cerebral artery in 40 uncomplicated pregnancies during the third trimester of pregnancy and in 22 neonates born from these pregnancies. Peak systolic (PSFV), temporal mean (TMFV), and end diastolic flow velocities (EDFV) were determined and pulsatility index (PI = (PSFV - EDFV)/TMFV) and Pourcelot's resistance index (RI = (PSFV - EDFV)/PSFV) calculated. PSFV, TMFV and EDFV increased during the third trimester of pregnancy and were significantly higher from 36 weeks of gestation onward as compared to values obtained at 28 weeks of gestation, suggesting an increase in actual cerebral blood flow. PI and RI of the MCA did not differ significantly during this period. Immediately after birth PSFV, TMFV and EDFV decreased significantly and remained lower during the first 5 postnatal days compared to fetal values. PI and RI of the MCA tended to decrease during the first postnatal day, but stabilized afterwards.

Adult↗

Neonate with benign familial neonatal convulsions: recorded generalized and focal seizures.

A neonate with benign familial neonatal convulsions is presented. Ictal electroencephalography demonstrated a seizure of right frontal onset with generalization and one of right frontal onset which remained confined to that hemisphere. Very few ictal recordings of this entity exist. In this patient a partial seizure and a seizure with generalization were recorded, emphasizing the difficulties with the present classification.

Arousal↗

Effect of neonatal isolation on outcome following neonatal seizures in rats--the role of corticosterone.

Emerging evidence indicates that early maternal care permanently modifies the activity of hypothalamic-pituitary-adrenal (HPA) axis and is a critical factor in determining the capacity of the brain to compensate for later encountered insults. The purpose of this study was to determine the role of corticosterone (CORT) in the detrimental effects of neonatal isolation (NI) on seizures. Rats were assigned randomly to the following five groups: (1) control (CONT) rats; (2) NI rats that underwent daily separation from their dams from postnatal day 2 (P2) to P9; (3) status epilepticus (SE) rats, induced by lithium-pilocarpine (Li-Pilo) model at P10; (4) NI plus SE (NIS) rats and (5) NISM rats, a subset of NIS rats receiving metyrapone (100 mg/kg), a CORT synthesis inhibitor, immediately after SE induction. At P10, plasma CORT levels were compared at baseline in CONT and NI rats and in response to Li-Pilo-induced SE among SE, NIS and NISM rats. We evaluated the spatial memory in the Morris water maze at P50 approximately 55, the expression of hippocampal cyclic adenosine monophosphate (cAMP)-responsive element-binding protein phosphorylation at serine-133 (pCREBSer-133) at P55, hippocampal neuronal damage at P80 and seizure threshold at P100. The isolated rats exhibited higher CORT release in response to SE than non-isolated rats, and the NIS rats had greater cognitive deficits and decreased seizure threshold compared to the CONT, NI and SE groups. By contrast, the NISM group, compared to the NIS group, showed a normal CORT response to SE and better spatial memory but no difference in seizure threshold. Compared to the CONT group, the hippocampal pCREBSer-133 level was significantly reduced in all experimental groups (NI, SE, NIS, NISM) with no differences between groups. All rats were free of spontaneous seizures later in life and had no discernible neuronal loss in the hippocampus. Results in this model demonstrate repetitive NI enhances response of plasma CORT to SE, and exacerbates the neurological consequences of neonatal SE. Amelioration of neurological sequelae following reduction of the SE-induced excessive rise in plasma CORT implicates CORT in the pathogenesis of NI increasing the vulnerability to seizures.

Animals↗

The effects of REM sleep-inhibiting drugs in neonatal rats: evidence for a distinction between neonatal active sleep and REM sleep.

Neonatal active sleep (AS) has been considered to be homologous and continuous with rapid-eye-movement (REM) sleep in adult animals. We have recently proposed an alternative view that AS is an undifferentiated sleep state distinct from REM sleep. To test these opposing views on the relationship of AS and REM sleep, neonatal rats (P11, P14 and P20) were systemically injected with compounds that inhibit REM sleep in adults. Zimelidine (ZMI) and desipramine (DMI) are monoamine uptake inhibitors which increase synaptic concentrations of serotonin and norepinephrine, respectively. Serotonin and norepinephrine inhibit brainstem cholinergic neurons important in REM sleep generation. Atropine (ATR) is a muscarinic receptor antagonist that blocks the post-synaptic effects of cholinergic projections. Only DMI (5 mg/kg) suppressed AS at P11. ZMI (6 mg/kg) and ATR (6 mg/kg) did not suppress AS until P14. These data suggest that serotonergic and cholinergic regulation of AS are absent before P14. The fact that AS in P11 rats is not affected by cholinergic antagonists supports the hypothesis that AS and REM sleep represent different sleep states.

Adrenergic Uptake Inhibitors↗

Oliguria in the incubating neonate. Emergency aortography and urography in neonates using mobile X-ray equipment.

Neonates in incubators underwent umbilical aortography, excretory urography and suprapubic cysto-urethrography using a mobile X-ray machine in the Premature Baby Unit to define the cause of their oliguria. The techniques were easy to perform without endangering the infants by moving them. The radiological findings in the four neonates investigated contributed significantly to the management of their illnesses.

Anuria↗

Pulmonary hemorrhage in premature infants after treatment with synthetic surfactant: an autopsy evaluation. The American Exosurf Neonatal Study Group I, and the Canadian Exosurf Neonatal Study Group.

In an across study analysis of five multicenter, placebo-controlled trials of the synthetic surfactant, Exosurf Neonatal in infants weighing at least 700 gm, the incidence of clinical pulmonary hemorrhage was 1.9% in treated infants and 1.0% in control infants. To investigate whether a similar increase was also present histologically at postmortem examination, a blinded retrospective review of all autopsy reports from infants dying during these five trials was conducted. Pulmonary hemorrhage was present in 55% of 159 infants undergoing autopsy; the incidence was not different in infants treated with surfactant or air placebo. Birth weight was inversely related to the incidence of pulmonary hemorrhage in both groups. Pulmonary pathologic findings significantly associated with pulmonary hemorrhage included pulmonary interstitial emphysema and necrotizing laryngotracheitis in both groups. In the surfactant group, patent ductus arteriosus, intraventricular hemorrhage, and pneumothorax were significantly more frequent among those who developed pulmonary hemorrhage. In contrast to clinical diagnosis, pathologic diagnosis of pulmonary hemorrhage at autopsy was not more common in infants treated with Exosurf Neonatal.

Autopsy↗

Neonatal asphyxia. II. Neonatal mortality and long-term sequelae.

Neonatal asphyxia, defined in this study as delay of greater than 1 minute in onset of spontaneous respiration at birth, occurred in 1% of 13,221 live-born infants of birth weight greater than 500 gm between 1970 and 1971. Seventy-five (56%) of 133 asphyxiated infants survived the neonatal period. Survival was directly related to gestational age. The 65 survivors of asphyxia available for study were seen at a mean age of 4.8 years to determine the incidence and extent of neurologic and developmental abnormalities. Twelve children (18.5%) had severe impairment: nine had both neurologic and intellectual handicaps, two had neurologic impairment alone, and one had intellectual impairment alone. The incidence and severity of impairment were not related to gestational age. Postasphyctic seizures were associated with poor outcome.

Asphyxia Neonatorum↗

One-year follow-up of 89 infants with birth weights of 500 to 749 grams and respiratory distress syndrome randomized to two rescue doses of synthetic surfactant or air placebo. Canadian Exosurf Neonatal Study Group. Canadian Exosurf Neonatal Follow-Up Group.

Double-blind neurodevelopmental and physical evaluations were conducted at 1-year adjusted age in 89 infants with birth weights of 500 to 749 gm who had respiratory distress syndrome in the neonatal period and were randomized to receive two rescue doses of a synthetic surfactant (Exosurf Neonatal, Burroughs Wellcome Co., Research Triangle Park, N.C.) or air placebo. The trial used a common protocol and was conducted at 13 hospitals; patients were entered in the trial between February 1988 and September 1990. Ninety-five percent of surviving infants were assessed. Growth and development in the two groups were equivalent. Mean Bayley Scales of Infant Development scores were comparable (mental development index, 79 +/- 22 vs 87 +/- 20; psychomotor development index, 73 +/- 18 vs 81 +/- 19 for air placebo and synthetic surfactant, respectively). The incidence of severe retinopathy of prematurity was significantly decreased in the surfactant group compared with the air placebo group (15% vs 34%; relative risk 0.428; 95% confidence interval 0.2 to 0.9). Overall, administration of surfactant appeared to increase the probability of a favorable outcome. Confirmation of the trends observed in this study would provide a strong rationale for the rescue use of synthetic surfactant in extremely low birth weight infants with respiratory distress syndrome even if overall mortality is not reduced.

Air↗

Tumor necrosis factor alpha and interleukin-6 mRNA expression in neonatal Lewis rat Schwann cells and a neonatal rat Schwann cell line following interferon gamma stimulation.

There is increasing evidence that Schwann cells play an important role in the pathogenesis of autoimmune inflammatory peripheral nerve disease. Schwann cells have been reported to express major histocompatibility complex class I and II (MHC I and II) and intercellular adhesion molecule-1 (ICAM-1), and to produce interleukin-1 (IL-1), prostaglandin E2 and thromboxane A2. In this study we investigated freshly dissociated neonatal Lewis rat Schwann cells and a SV40 transfected neonatal rat Schwann cell line (Schwann cell line) for production of mRNA for the immunomodulatory cytokines IL-2, IL-4, IL-6, IL-10, interferon-gamma (IFN gamma), and tumor necrosis factor-alpha (TNF alpha) employing RT-PCR. Primary Schwann cells and Schwann cell line were examined following IFN gamma stimulation and were found to express TNF alpha and IL-6 mRNA. These results further support a role for Schwann cell participation in inflammatory responses within the peripheral nervous system (PNS).

Animals↗

[Seizures in premature neonates and in full-term neonates (author's transl)].

Normal EEG rhythms depend on conceptional age (CA), i.e., gestational age plus legal age. To assess whether pathological rhythms are also related to the level of maturation. EEG seizures have been compared in 26 premature neonates (PN) - 16 from 26 to 32 weeks of CA, 10 from 33 to 36 weeks of CA - and in 20 full-term neonates (FTN). The amplitude, the frequency, the polarity, the duration of paroxysmal discharges, the presence of variations in localization and the presence of clinical seizures are not related to CA. In FTN, the discharges during seizures, display a more complex pattern; the foci of spike discharges are more often on the rolandic area; spikes or delta waves are more often asynchronous than in PN. In PN less than 32 weeks of CA, seizures occur more often in females than in males. The prognosis of seizures is more severe in PN than in FTN. The prognosis is also more severe in FTN with brief discharges (less than 3 min) than in those with long-lasting discharges. The seizures are mainly related to extensive intraventricular haemorrhage in PN, to cortical lesions in FTN.

Brain↗