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PubMed1985

[Fetal or neonatal autopsy and genetic counseling. Experience of the Human Genetic Service of Liège].

From January 1976 to June 1984, 308 necropsies were performed on neonates and fetuses of various gestational age, mainly coming from hospitals of the province of Liege. 41% of the necropsied infants have at least one malformation and 34% of the malformed show multiple birth defects. There were 17 anatomo-clinic diagnoses of chromosomal aberrations but only 12 cases were confirmed by caryotype, for practical or technical reasons. One third of the parents of the necropsied infants came for genetic counselling with a high recurrence risk in 13% of the advices. For further improvement of the possibilities of diagnosis, we are pleading in favour of more frequent radiological and chromosomal fetal examinations. This must lead us to better convince obstetricians and neonatologists and get more favourable practical conditions to carry out the necropsies.

Abnormalities, Multiple↗
PubMed1984

Outcome in infants with birth weight 500 to 999 gm: a regional study of 1979 and 1980 births.

During 1979 and 1980, 351 infants weighing 500 to 999 gm were born in the State of Victoria, Australia; 89 (25.4%) survived to 2 years of age. Survival was better for tertiary center births (29%) than for those born elsewhere (17%). Multidisciplinary teams reviewed 83 of the survivors at 2 years of age postterm; some data were available for the other six children. Overall, 22.5% of infants had severe functional handicap, 29.2% had either moderate or mild handicap, and 48.3% had no handicap. Severe functional handicap was present in 50% of outborn infants; this was significantly more common than in those born in tertiary centers (15.5%), and the Bayley Mental Developmental Index was also significantly lower in outborn infants. The prevalence of cerebral palsy (13.5%), bilateral blindness (3.4%), and severe sensorineural deafness (3.4%) did not differ significantly in the inborn and outborn infants. Singleton inborn infants of appropriate weight for gestational age had significantly less severe functional handicap (9.1%), compared with 37.5% for the group of infants who were either small for gestational age or one of multiple births. Six of the 18 outborn infants could have been transferred in utero, and improvements in immediate neonatal care were possible in seven other infants.

Age Factors↗
PubMed1997

Magnesium sulfate in labor and risk of neonatal brain lesions and cerebral palsy in low birth weight infants. The Neonatal Brain Hemorrhage Study Analysis Group.

OBJECTIVES: We tested the hypothesis that administration of magnesium sulfate in labor protects against the development of neonatal brain lesions and cerebral palsy (CP) in low birth weight infants. METHODS: Magnesium exposure was ascertained in a population-based cohort of 1105 infants weighing 2000 g or less through review of medical records of maternal magnesium sulfate administration and, where available, elevated maternal serum magnesium levels. Neonatal germinal matrix/intraventricular hemorrhage and parenchymal brain lesions were ascertained by a prospective, timed ultrasound scanning protocol in the first week of life. CP was ascertained at 2 years of age by clinical examination in 80% of survivors and by interview and medical record review in another 6% and was classified as disabling or nondisabling. RESULTS: No significant reduction in risk of nondisabling CP (adjusted odds ratio [OR], 1.00; 95% confidence interval [CI], 0.53 to 1.88) or disabling CP [DCP] (adjusted OR, 0.63; 95% CI, 0.32 to 1.24) CP with magnesium exposure was found in a logistic regression model that controlled for gestational age, fetal growth, gender, multiple birth status, mode of delivery, amnionitis, and hypertensive disorders. In a small subset of infants, those with onset of parenchymal lesions at 7 days of age or later (n = 29), magnesium exposure was associated with a significantly reduced risk of DCP (OR, 0.10; 95% CI, 0.02 to 0.65). Magnesium sulfate exposure was not associated with germinal matrix/intraventricular hemorrhage (adjusted OR, 0.89; 95% CI, 0.64 to 1.25) or with parenchymal brain lesions (adjusted OR, 0.83; 95% CI, 0.53 to 1.30). CONCLUSIONS: The hypothesis that magnesium sulfate use reduces the risk of neonatal brain lesions or CP in low birth weight infants was not statistically supported in this study, although a modest reduction in risk of DCP cannot be excluded. The data further suggest that magnesium exposure may be associated with reduction in risk of CP in low birth weight infants who have late-onset brain lesions, but this unpredicted observation requires confirmation in another data set.

Adult↗
PubMed1986

An analysis of the obstetric outcome of 125 consecutive pregnancies conceived in vitro and resulting in 100 deliveries.

One hundred twenty-five consecutive pregnancies conceived in vitro resulted in 100 deliveries of 115 babies. There were 23 clinical abortions (18.4%) and two tubal pregnancies. During the same interval 30 preclinical pregnancies occurred, but these pregnancies did not progress. There were 26 multiple pregnancies (37.1%) before the twelfth week; these reduced spontaneously to 14 (22.2%) multiple births at delivery. Eight infants were delivered prematurely, and three of these died. Three babies had some congenital abnormality. Vaginal bleeding occurred during pregnancy in 59% of patients. Cesarean section was the method of delivery in 56% of patients. Other complications of pregnancy were similar to those of comparable populations.

Abortion, Spontaneous↗
PubMedDate not supplied

Pediatric coverage of the delivery room: an analysis of manpower utilization.

OBJECTIVES: To determine the frequency and pattern of pediatric calls to the delivery room and the actual type of medical care administered to the newborn in the delivery room. STUDY DESIGN: This was a prospective observational study of 2554 births in a university-affiliated tertiary care hospital. Existing protocols required the attendance of a pediatric resident or neonatal fellow at all deliveries other than uncomplicated vaginal term births. The pediatrician's activity in the delivery room was characterized as either "medical care" or "minimal care." Results were analyzed by diagnostic category. RESULTS: Pediatricians attended 646 of the deliveries (25%). Medical care was administered in 204 of the deliveries, representing 31% of the time they were at a delivery and 8% of all deliveries. The three major indications for pediatric delivery room attendance were cesarean sections (n = 253; 39%), presence of meconium in amniotic fluid (n = 117; 18%), and vacuum deliveries (n = 117; 18%). Medical care was required only in 1 of 56 cases of elective repeat cesarean sections, in 1 of 20 cases of a cesarean section for nonprogress of labor, and in 1 of 38 cases when thin meconium was present. In contrast, medical care was needed in 52 of 81 (64%) cases of cesarean sections for fetal distress, in 11 of 11 (100%) of the cesarean sections for multiple births, and in 67 of 89 (85%) cases of thick meconium (p < 0.05). There was a need for medical attendance after the birth in less than 1% of 1908 cases for which the pediatrician was not initially called to delivery room. CONCLUSION: Because their medical skills were needed only one of three times that pediatricians were called to the delivery room, and then mostly in specific risk situations, more selective use of pediatric manpower for delivery room coverage may lead to a more efficient use of medical resources without any apparent increase in patient morbidity.

Cost-Benefit Analysis↗
PubMedDate not supplied

Linking survey data with administrative health information: characteristics associated with consent from a neonatal intensive care unit follow-up study.

BACKGROUND: Health services and population health research often depends on the ready availability of administrative health data. However, the linkage of survey-based data to administrative data for health research purposes has raised concerns about privacy. Our aim was to compare consent rates to data linkage in two samples of caregivers and describe characteristics associated with consenters. METHODS: Subjects included caregivers of children admitted at birth to neonatal intensive care units (NICU) in British Columbia and caregivers of a sample of healthy children. Caregivers were asked to sign a consent form enabling researchers to link the survey information with theirs and their child's provincially collected health records. Bivariate analysis identified sample characteristics associated with consent. These were entered into logistic regression models. RESULTS: The sample included 1,140 of 2,221 NICU children and 393 of 718 healthy children. The overall response rate was 55% and the response rate for located families was 67.1%. Consent to data linkage with the child data was given by 71.6% of respondents and with caregiver data by 67% of respondents. Families of healthy children were as likely to provide consent as families of NICU children. Higher rates of consent were associated with being a biological parent, not requiring survey reminders, involvement in a parent support group, not working full-time, having less healthy children, multiple births and higher income. CONCLUSION: The level of consent achieved suggests that when given a choice, most people are willing to permit researcher access to their personal health information for research purposes. There is scope for educating the public about the nature and importance of research that combines survey and administrative data to address important health questions.

British Columbia↗
PubMed2004

Bias in reported neurodevelopmental outcomes among extremely low birth weight survivors.

OBJECTIVES: The purpose of this study was to investigate possible bias in the evaluation of neurodevelopment and somatic growth at 18 to 22 months' postmenstrual age among extremely low birth weight (ELBW) survivors (401-1000 g at birth). METHODS: Data from a cohort of 1483 ELBW infant survivors who were born January 1993 through December 1994 and cared for at centers in the Neonatal Research Network of the National Institute of Child Health and Human Development were examined retrospectively. Children who were compliant with an 18- to 22-month follow-up visit, who visited but were not measured, or who made no visit were compared regarding 4 outcomes: 1) Bayley Scales of Infant Development, 2nd edition, Mental Developmental Index (MDI) <70 and 2) Psychomotor Developmental Index (PDI) <70, 3) presence or absence of cerebral palsy, and 4) weight <10th percentile for age. Logistic regression models were used to predict likelihood of these outcomes for children with no follow-up evaluation, and predicted probability distributions were compared across the groups. RESULTS: Compared with children who were lost to follow-up, those who were compliant with follow-up were more likely to have been 1 of a multiple birth, to have received postnatal glucocorticoids, and to have had chronic lung disease. These factors were significantly associated with MDI and PDI <70 in the compliant group. Chronic lung disease was associated with increased risk of cerebral palsy (CP). MDI and PDI scores <70 were found in 37% and 29% of children who were evaluated at follow-up, respectively. Prediction models revealed that 34% and 26% of infants in the no-visit group would have had MDI and PDI scores <70. Compliant children tended to have greater incidence of MDI <70 compared with those predicted in the no-visit group but not PDI <70. CP was identified in 17% of the compliant group and predicted for 18% of the no-visit group. Predicted probabilities of having CP were marginally higher among the no-visit infants compared with those who were compliant with follow-up. There were no statistically significant somatic growth differences among the compliant, visit but not measured, and no-visit groups. CONCLUSION: ELBW infant survivors who weighed 401 to 1000 g at birth and who are compliant with follow-up evaluations may have worse Bayley Scales of Infant Development, 2nd edition, MDI scores than infants with no visit. Thus, follow-up studies based on infants who are compliant with follow-up care may lead to an overestimation of adverse outcomes in ELBW survivors.

Bias↗
PubMed2001

High prevalence of postpartum anemia among low-income women in the United States.

OBJECTIVE: To determine the prevalence of anemia from 4 to 26 weeks post partum and to examine prenatal predictors of postpartum anemia. STUDY DESIGN: Retrospective cohort analysis of 59,428 participants in the Special Supplemental Nutrition Program for Women, Infants, and Children in 12 US states. RESULTS: The prevalence of postpartum anemia was 27%. Anemia rates were higher among minority women, reaching 48% among non-Hispanic black women. Of 9129 women who had normal hemoglobin in the third trimester, 21% had postpartum anemia. Prenatal anemia was the strongest predictor of postpartum anemia (adjusted odds ratio, 2.7; 95% confidence interval, 2.5-2.8). Maternal obesity, multiple birth, and not breast-feeding also predicted postpartum anemia. CONCLUSION: The high prevalence of post partum anemia among low-income women highlights the importance of anemia screening at 4 to 6 weeks post partum. These data suggest that screening should not be limited, as it is at present, to women considered at high risk.

Adolescent↗
PubMed2002

Triplet placentas: reference values for weights.

The occurrence of twins, triplets, and other multiple births increased significantly between 1970 and 2000 in the United States and other industrialized countries. The number of triplet placentas submitted for examination as pathologic specimens has also markedly increased, but no reference values are published for triplet weights. We examined 196 normal triplet placentas. Specimens with associated conditions known to affect the weights of the placentas were excluded. The gestational ages ranged between 20 and 38 weeks. Mean weights for different gestational ages are summarized as follows: 253 g for 20 weeks, 319 g for 22 weeks, 406 g for 24 weeks, 509 g for 26 weeks, 621 g for 28 weeks, 738 g for 30 weeks, 855 g for 32 weeks, 965 g for 34 weeks, 1,065 g for 36 weeks, and 1,147 g for 38 weeks. Weight gain of triplet placentas appears to parallel that of twin placentas. The mean values of placental weights for triplets at each gestational age are less than triple those of singleton weights for the same duration of gestation. The placental weights in multiple gestations do not increase proportionately with the number of fetuses.

Female↗
PubMed1997

Gestational age, birth weight, and perinatal death among births to Norwegian farmers, 1967-1991.

Perinatal health was investigated by linkage with the Medical Birth Registry of Norway for 192,417 births that took place between 1967 and 1991 among parents identified as farm holders in Norwegian agricultural censuses in 1969-1989. In a comparison with 61,351 births to nonfarmers in agricultural municipalities, farmers' births had an advantageous distribution of gestational ages and birth weights. Perinatal mortality was similar in the two groups, but the proportion of late-term abortions (gestational weeks 16-27) was higher among farmers' birth (odds ratio (OR) = 1.9, 95% confidence interval (CI) 1.6-2.3). Exposure indicators were classified on the basis of information given in the agricultural censuses and climate data for the grain harvest seasons of 1966-1991. The main hypotheses were that perinatal death is associated with parental exposure to pesticides. Toxoplasma contracted from infected sheep or pigs, or mycotoxins found in grain farming. There was no convincing evidence that perinatal death is associated with use of pesticides, sheep farming, or pig farming. The increase in late-term abortion among the farmers could to some extent be attributed to an excess of midpregnancy (weeks 21-24) deliveries among grain farmers; grain farmers had 132 deliveries at this time in pregnancy (2.8 per 1,000 pregnancies), while the nongrain farmers had 236 deliveries in midpregnancy (1.8 per 1,000). The authors found odds ratios (95% CI) that indicated that grain farming risk was higher after the harvest (1.8, 1.1-2.8), in seasons with a poor quality harvest (2.4, 1.5-3.8), and in pregnancies with multiple births (3.8, 1.7-8.2). These results support the hypothesis that occupational exposure to mycotoxins in grain induces labor at an early stage of pregnancy.

Abortion, Spontaneous↗
PubMed1994

Increased incidence of high-order and singleton conceptions after ovulation induction in winter.

The possible relationship between the season of conception after ovulation induction and high-order multifetal pregnancies, was investigated. From 1975 to 1989, 111 high-order multiple births after ovulation induction were recorded at the Chaim Sheba Medical Center. This group was compared with 142 singleton pregnancies that resulted from induction of ovulation during 1989. Composite monthly cohorts of high-order multifetal pregnancies were constructed for each month of the year, and the probability of such pregnancies was estimated. The period of ovulation induction and the day of presumed conception were noted. A statistically-significant increase in the probability of high-order and singleton conceptions occurred during the winter. Our observation indicates a seasonal pattern in high order and singleton conceptions after ovulation induction.

Adolescent↗
PubMedDate not supplied

A health program's effect on neonatal mortality in eastern Kentucky.

We examined the impact of an innovative rural health program in central Appalachia on neonatal mortality by comparing improvements in the neonatal mortality rates of the serviced counties to those of the 13 control counties. Using data on all births and neonatal deaths in the study and control counties from 1970 to 1978 (tabulated by mother's county of residence), an expected neonatal mortality rate of each county was calculated by standardizing for the most important risk components: birth weight, sex, and birth multiplicity. An index of medical care effectiveness, the standardized mortality rate (SMR) for the study and control counties was computed by dividing the observed neonatal mortality rate by the expected rate. The SMRs of the study and control counties were then compared using a standard normal test statistic. The results indicated that the SMRs were significantly different in the control and study counties in the preintervention period 1970-1972. In subsequent years the SMRs converged, resulting in nearly equal rates for 1977-1978. The improvement in neonatal mortality in both areas may be due to their improved economic status rather than health care alone.

Child Health Services↗
PubMed1990

Regulation of heart rate variation by the autonomic nervous system in neonatal lambs.

We studied the role of the autonomic nervous system in the regulation of heart rate variation (HRV) in 12 chronically instrumented neonatal lambs. HRV was quantified from ECG tracings by computing periodic HRV distributions at frequencies of 0.02-1.00 Hz, using power spectral analysis of heart rate, and also by HRV indices. Heart rate declined more during the 1st than the 2nd mo after birth. Multiple regression analysis showed that the heart rate responses to vagal and to beta-adrenergic blockade had an independent negative association both with age and with the initial mean heart rate, whereas the overall HRV response had a positive association with age. Vagal blockade led to a 70-80% decrease in the beat-to-beat HRV in all lambs (p less than 0.001). The overall HRV indices decreased by 40-65% in lambs (less than 30 d old (p less than 0.001) and about 30% in those greater than 30 d old (p less than 0.05). In the power spectrum the greatest decrease was seen in the high-frequency components of HRV. beta-Blockade led to a decrease of about 50% in all HRV (p less than 0.001) in the younger lambs, without frequency selection. In the older lambs, it had no effect on the beat-to-beat HRV, but the overall HRV (coefficient of variance) decreased maximally by 40% (p less than 0.01), with a significant reduction in the low-frequency components of HRV. These results suggest that in the regulation of HRV after birth dual control via the autonomic nervous system is most important. In the older lambs, developmental changes result in precise regulation of the fast heart rate fluctuations mainly by the vagal division, whereas the slow fluctuations are partially regulated by the vagal and beta-adrenergic divisions.

Animals↗
PubMed2002

Surfactant proteins and genetic predisposition to respiratory distress syndrome.

Respiratory distress syndrome (RDS) is caused by surfactant deficiency at birth. The risk of RDS decreases from the gestational age of 24 weeks to full-term. Genetic and acquired factors additionally influence the risk of RDS. Surfactant deficiency in RDS is mainly caused by immaturity and a lack of differentiation of the alveolar epithelial cells involved in surfactant synthesis and secretion. A network of hormones and growth factors regulate perinatal development. Host-related factors, including the levels of expression of surfactant proteins (SP), modulate the responsiveness of growth factors. SP-A has roles in surface activity and regulatory roles particularly in innate immunity; SP-B is essential for the processing of surfactant and for the surface activity; SP-C has roles in surfactant metabolism and function; the regulatory roles of SP-D mainly pertain to innate immunity. The genetic variation of SP-A and SP-B genes and the risk of RDS have been studied. Both SP-A and SP-B associate with susceptibility to RDS. The association between the SP-A allele and genotypes and the risk of RDS is dependent on the SP-B genotype and significantly influenced by the degree of prematurity, antenatal glucocorticoid therapy, multiple birth, and birth order. The alleles/genotypes of SP-A, SP-C, or SP-D also associate with several other inflammatory lung and airway diseases. Rare mutations in SP-B or SP-C cause serious, often fatal lung diseases. Genetic and post-genomic research is likely to eventually result in new diagnostic applications and specific therapies for the prevention of respiratory failure and inflammatory lung diseases.

Embryonic and Fetal Development↗
PubMed1995

Changing patterns of survival and outcome at 4 years of children who weighted 500-999 g at birth.

OBJECTIVE: To evaluate the impact of changing perinatal practices on survival rates and 4 year neurodevelopmental outcome for infants of birthweight 500-999 g. METHODOLOGY: The study was a tertiary hospital-based prospective cohort study that compared survival, impairment and handicap rates between two eras, July 1977 to December 1982 (era 1) and January 1983 to June 1988 (era 2). All 348 live, inborn infants and 49 outborn infants of birthweight 500-999 g were prospectively enrolled in a study of survival and outcome. Rates of survival, neurodevelopmental impairment and functional handicap at 4 years were compared between eras. Perinatal risk factors for handicap were also compared between eras. RESULTS: Four year survival rates for inborn infants 500-999 g improved from 32.6% in era 1 to 49.2% in era 2 (OR 2.1, 95% CI 1.26-3.48) but for outborn infants the improvement between 31.8% and 53.6% was not significant. There were significant improvements in survival for inborn infants in birthweights 800-899 g and 900-999 g between study periods. The rates of functional handicap between the first and second eras (mild 10 vs 7%; severe or multiply severe 14 vs 16%) were not significantly different. Although the rate of cerebral palsy increased from 0 to 12% (P < 0.01) other rates of impairment such as blindness 0 vs 3%, deafness 2 vs 2% and developmental delay 12 vs 11% did not change. The chance of a survivor being free of handicap remained unchanged at 78% and 76% for the two eras, respectively. Although the absolute number of intact survivors more than doubled (41 vs 83) so too did the number of severe or multiply severe handicapped survivors (7 vs 17). Multivariate logistic regression analysis for the entire study cohort revealed male gender, multiple birth, prolonged mechanical ventilation and cerebral ventricular dilatation but not birthweight or gestational age to be independently associated with severe or multiply severe handicap. CONCLUSIONS: The advances in neonatal intensive care for extremely low birthweight infants between July 1977 and December 1982 and January 1983-June 1988 resulted in an increased number of non-disabled survivors but had no impact on incidence of severe disability. The application of prediction of mortality or severe handicap to clinical practice has the potential to reduce the proportion and absolute number of severely handicapped survivors.

Blindness↗
PubMed1988

Grief in multifetal death.

The grief process is examined within the framework of multifetal pregnancy in a variety of demise situations. The case studies examined were obtained from approximately 120 letters and interviews with families predominantly of higher order multiple births, who have experienced either partial or total loss in their pregnancy or afterwards. Objective and subjective factors were addressed. Results indicate the steps of the grief response are worked through in the same order as a singleton demise, but differ in intensity, duration, and frequency, depending on the individual circumstances, type of loss, gestational age, and the parents' backgrounds, expectations and beliefs. A unique feature discovered is that the entire grieving process, from shock through acceptance, appears to be completely experienced twice, with a large percentage of parents experiencing all of the stages three or more times. The general conclusion of the study is that the grieving pattern in multifetal death indeed follows a cycle and pattern of its own and requires special considerations.

Female↗
PubMed1988

Diabetic embryopathy and fuel-mediated organ teratogenesis: lessons from animal models.

The growing recognition that faulty maternal metabolism during early organogenesis may be implicated in the increased incidence of birth defects in pregnancies complicated by diabetes has prompted worldwide efforts to institute improved preconceptional metabolic regulation. However, the failure to identify the periods of greatest risk for diabetic embryopathy, the mediating teratogen(s), and the underlying mechanisms have complicated attempts to establish precise therapeutic guidelines and targets. Some of the reported in vivo and in vitro experiences with rodent models have been reviewed to derive relevant insights. Substantial literature indicates that diabetes (experimental as well as spontaneous) in pregnant rats and mice is attended by retardation of growth and developmental delay during embryogenesis, and a variable incidence of birth defects. Poor metabolic regulation of the diabetic mother during early organogenesis may also be followed by subsequent resorption of the conceptus at the site of implantation. Vulnerability to diabetes-related resorptions and all other forms of embryopathy appears to begin during the early postimplantation period and is greatest near the onset of neurolation. Overall susceptibility is markedly influenced by genetic factors and may be modified by the antecedent metabolic exposures of the conceptus ("carry-over effects"). Mediation for the anomalous embryo development in pregnancies of diabetic rodents appears to be multifactorial; all the aberrant fuels and fuel-related components of "the diabetic state" (e.g. high glucose; ketones; somatomedin inhibitor(s); osmolality, etc.) which have been tested to date display dysmorphogenic potential ("fuel-mediated organ terato-genesis") in vitro. All tissues in the conceptus appear to be at risk. Dose-response relationships for the individual metabolic teratogens may be influenced by additive and synergistic interactions so that the integrated possibilities cannot be assessed fully by measurements confined to a single fuel or fuel-related component. In the context of the day-to-day variability in diabetes "control" of the poorly regulated mother, and the relatively longer duration of organogenesis, these multifactorial possibilities may account for the multiple birth defects that can occur in individual offspring, and the seemingly non-specific pattern of diabetic embryopathy. Insulin therapy diminishes the dysmorphogenic effects of "the diabetic state" in rodents with experimental or spontaneous diabetes.(ABSTRACT TRUNCATED AT 400 WORDS)

Animals↗
PubMed1992

Breastfeeding more than one: multiples and tandem breastfeeding.

The concurrent breastfeeding of two or more infants is associated with multiple births or non-twin siblings, which sometimes is referred to as tandem breastfeeding. In these situations, the "supply and demand" production principle of lactation is a compensatory mechanism. It ensures the availability of adequate amounts of human milk, no matter how many infants are breastfeeding. A lack of time for the increased number of breastfeedings, physical and emotional difficulties associated with caring for more than one infant, and a lack of social support generally are greater hindrances than an inability on the part of the mother's body to produce milk for all infants. The nurse helps by explaining the process of milk production adaptability and sharing intervention strategies to help the mother minimize the obstacles to breastfeeding more than one.

Adult↗