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PubMed1997

Cerebral palsy.

Cerebral palsy is caused by a static lesion to the cerebral motor cortex that is acquired before, at, or within 5 years of birth. Multiple causes for the condition exist and include cerebral anoxia, cerebral hemorrhage, infection, and genetic syndromes. Cerebral palsy is commonly classified according to the type of movement problem that is present (spastic or athetoid) or according to the body parts involved (hemiplegia, diplegia, or quadriplegia). To care for children with cerebral palsy, a team approach is most effective; the team should include the pediatrician and orthopedist, among others. In the nonambulatory patient, good sitting posture, the prevention of hip dislocation (spastic hip disease), and the maintenance of proper custodial care are prime concerns. Careful monitoring and treatment of spastic hip disease and the correction of scoliotic spinal deformity are also important. In the ambulatory patient, the main goal is to maximize function. Computerized gait analysis in patients with complex gait patterns helps to show whether orthotic or surgical treatment is indicated. In this paper, we also review both the proper indications for orthopedic intervention in patients with upper extremity involvement and recent methods to control spasticity, such as selective dorsal rhizotomy and administration of botulinum toxin or intrathecal baclofen.

Cerebral Palsy↗

PubMed2004

Perinatal mortality in first- and second-born twins in the United States.

OBJECTIVE: To evaluate the prevailing mortality paradox that second-born twins are at higher risk of perinatal mortality than first-born twins. METHODS: We used the 1995-1997 United States "matched multiple birth" data files assembled by the National Center for Health Statistics, for analysis of risk of perinatal mortality in first- and second-born twins (293788 fetuses). Perinatal mortality was defined to include stillbirths after 20 weeks of gestation and neonatal deaths (deaths within the first 28 days). Gestational age-specific risk of perinatal mortality (per 1000 total births), stillbirth (per 1000 total births), and neonatal mortality (per 1000 livebirths) by order of twin birth were based on the fetuses-at-risk approach. Associations between order of birth and mortality indices were evaluated by fitting multivariable logistic regression models based on the method of generalized estimating equations. These models were adjusted for several potential confounding factors. RESULTS: Perinatal mortality was 37% higher in second-born (26.1 per 1000 total births) than in first-born (20.3 per 1000 total births) twins (adjusted relative risk [RR] 1.37; 95% confidence interval [CI] 1.32, 1.42). The increased risk of perinatal mortality in second-born twins was chiefly driven by a 2.46-fold (95% CI 2.29, 2.63) increase in the number of stillbirths. However, the risk of neonatal mortality was very similar between first- and second-born twins (RR 0.99, 95% CI 0.95, 1.04). CONCLUSIONS: The increased risk of perinatal death in second-born twins is driven chiefly by increased rates of stillborn second twins. Thus, the increased mortality in second-born over first-born twins probably is an artifact of mortality comparisons.

Adult↗

PubMed2005

Body mass index, provider advice, and target gestational weight gain.

OBJECTIVE: To study the relationships among prepregnancy body mass index (BMI), women's target gestational weight gain, and provider weight gain advice. METHODS: Project WISH, the acronym for Women and Infants Starting Healthy, is a longitudinal cohort study of pregnant women in the San Francisco Bay area. We excluded subjects with preterm birth, multiple gestation, or maternal diabetes. RESULTS: Among overweight women (prepregnancy BMI 26.1-29.0), 24.1% reported a target weight gain above the Institute of Medicine (IOM) guidelines, compared with 4.3% of normal weight women (P < .001). Among women with a low prepregnancy BMI (< 19.8), 51.2% reported a target weight gain below the guidelines, compared with 10.4% of normal weight women (P < .001). These patterns persisted in a multivariate analysis. Latina ethnicity, lower maternal education, low prepregnancy BMI (< 19.8), lack of provider advice about weight gain, and provider advice to gain below guidelines were all independently associated with a target weight gain below IOM guidelines. Prepregnancy BMI more than 26, multiparity, lower age, and provider advice to gain above guidelines were all associated with a target gain above IOM guidelines. CONCLUSION: Women's beliefs about the proper amount of weight gain and provider recommendations for weight gain vary significantly by maternal prepregnancy BMI. Many women report incorrect advice about gestational weight gain, and women with high or low prepregnancy BMI are more likely to have an incorrect target weight gain. New approaches to provider education are needed to implement the IOM guidelines for gestational weight gain.

Body Mass Index↗

PubMed2006

PrPSc accumulation in fetal cotyledons of scrapie-resistant lambs is influenced by fetus location in the uterus.

Placentae from scrapie-infected ewes have been shown to accumulate PrPSc when the genotype of the fetus is of a susceptible genotype (VRQ/VRQ, ARQ/VRQ or ARQ/ARQ). Cotyledons from fetuses of genotypes ARR/ARR, ARQ/ARR and ARQ/VRR have previously been shown to be resistant to PrPSc accumulation. By using ewes from a naturally infected scrapie flock, cotyledons from fetuses of multiple births of different genotypes were examined. PrPSc was detected in fetal cotyledons of genotype ARQ/ARQ, but not in cotyledons from their dizygotic twin of genotype ARQ/ARR. This confirms earlier reports of single fetuses of these genotypes, but is the first description of such a finding in twin fetuses, one of each genotype. It is also demonstrated that cotyledons from sibling fetuses of genotypes ARQ/VRQ and ARQ/ARQ have different patterns of PrPSc accumulation depending on whether the dam is of genotype ARQ/ARQ or ARQ/VRQ. Lastly, it is shown that cotyledons from fetuses with resistant genotypes are weakly positive for PrPSc when they have shared the same pregnant uterine horn with a fetus of a susceptible genotype with cotyledons positive for the detection of PrPSc. Additionally, a PCR product for the Sry gene, a product specific to males, was found in cotyledons from female fetuses that had shared a uterine horn with a male fetus. This indicates that some sharing of fetal blood occurs between placentomes and fetuses residing in the same uterine horn, which can result in PrPSc accumulation in cotyledons with resistant genotypes.

Animals↗

PubMed2002

Caesarean delivery and outcome in very low birthweight infants.

OBJECTIVE: To determine the relationship between mode of delivery, intraventricular haemorrhage (IVH), and mortality in very low birthweight (VLBW) infants. STUDY DESIGN: A historical cohort study of infants admitted to a single level III neonatal intensive care unit during a five-year period. Infants < 1500 g born by caesarean delivery (n = 400) were compared to those born by vaginal delivery (n = 305). RESULTS: After controlling for potential confounding variables including: gestational age, fetal presentation, and multiple birth, caesarean delivery was not associated with a decreased odds of IVH (odds ratio 1.2, 95% CI 0.7-2.0), severe IVH (1.9, 0.9-4.0), or mortality (1.2, 0.6-2.4). CONCLUSIONS: In our population of very low birthweight infants, caesarean delivery is not associated with a decreased risk for mortality or intraventricular haemorrhage.

Analysis of Variance↗

PubMed2006

Multiparity reveals the blunting effect of breastfeeding on physiological reactivity to psychological stress.

Rat studies show that hypothalamic-pituitary-adrenal (HPA) responsiveness to physical and emotional stressors is attenuated during lactation, although situations evoking pup endangerment can supersede this phenomenon. In the human population, blunted cortisol responses are seen in primiparous breastfeeding compared to bottlefeeding mothers following physical stress, but not after psychosocial stress. It is currently unknown whether stressor salience (child-related versus nonrelated stressor) has a differential effect on cortisol reactivity as a function of infant feeding choice and whether HPA responses to stress could be modified by parity. We investigated the impact of infant feeding type and maternal parity on salivary cortisol and alpha-amylase response to stress in 5-20-week postpartum mothers using exposure to the Trier Social Stress Test (TSST) and to an emotional film evoking threats to a child. Analyses show that alpha-amylase responses were similar in all groups and for both types of stress, suggesting that sympathetic reactivity was independent of infant feeding type and parity. By contrast, cortisol response was affected by these variables. In primiparous mothers, cortisol reactivity to psychological stressors did not vary as a function of infant feeding type while, among multiparous mothers, breastfeeding was associated with reduced responsiveness to the TSST and child-related stressor. We speculate that changes in neural mechanisms occurring as a result of pregnancy and lactation and that modulate the HPA axis in women might be exacerbated with multiple repeats of the pregnancy/lactation period. This would serve to 'desensitise' stress circuits and reduce the overall stress-induced cortisol secretion after multiple births.

Adaptation, Physiological↗

PubMed1992

Genetic and developmental influences on susceptibility to epilepsy: evidence from twins.

This study evaluated genetic and developmental contributions to epilepsy, using data on epilepsy and multiple births in the sibships of 1981 probands with epilepsy. Prevalence of a history of epilepsy was much higher in monozygotic (MZ) than in dizygotic (DZ) co-twins of probands (35.0% vs. 3.7%), but prevalence was not significantly higher in DZ co-twins than in singleton siblings. The proportion of individuals who were MZ twins was higher among probands with epilepsy than among their non-co-twin siblings without epilepsy (odds ratio 2.5, 95% CI 1.31-4.85). However, the proportion who were DZ twins was similar among probands and unaffected siblings (odds ratio 1.0, 95% CI 0.67-1.60). These findings suggest that the increased prevalence of epilepsy in MZ co-twins of probands may be partly explained by developmental factors related to MZ twinning, rather than by their genetic identity with the probands.

Disease Susceptibility↗

PubMed1990

Mean organ weights of an Australian population of fetuses and infants.

Charts of organ weights for an Australian population of fetuses and infants are presented. The organ-weight charts were compiled from 1337 stillbirths and liveborn babies whose gestational age ranged from 20 to 43 weeks, and who lived less than 72 h. Macerated stillbirths, multiple births and malformed organs were excluded. Pathological conditions aside from malformations were not excluded, leading to higher standard deviations compared with currently used charts. The organ weights are presented in two-week increments from 20 to 43 weeks' gestation as means, with standard deviations.

Australia↗

PubMed1995

Antenatal and intrapartum factors associated with sudden infant death syndrome in the New Zealand Cot Death Study.

OBJECTIVE: To describe the relationship between antenatal and intrapartum factors and sudden infant death syndrome (SIDS). METHODOLOGY: The New Zealand Cot Death Study was a 3 year case-control study, with 485 infants who died from SIDS in the postneonatal period and 1800 randomly selected control infants. Data were obtained from obstetric records, parental interview and community nursing records. RESULTS: This study confirms many of the antenatal and intrapartum risk factors for SIDS noted in studies from both the southern and northern hemispheres. After controlling for potential confounders, such as occupational group and marital status, significant inverse effects were noted for interpregnancy interval, birthweight and gestation. Other factors that retained a significantly increased risk of SIDS were: increasing parity, bacteriological evidence of urinary tract infection (UTI) (adjusted odds ratio 1.73, 95% CI 1.10-2.73); smoking antenatally (AdjOR 2.14, 95% CI 1.61-2.84); less than six antenatal checks attended (AdjOR 1.84, 95% CI 1.19-2.84); second stage of labour less than 16 min (AdjOR 2.06, 95% CI 1.35-3.14) and multiple birth (AdjOR 3.23, 95% CI 1.70-6.02). No interaction was observed between maternal haemoglobin and antenatal smoking. Interactions were tested for and not found between antenatal smoking and three antenatal risk factors (UTI, short second stage of labour and number of antenatal appointments). The only significant interaction between these three factors and three modifiable postnatal risk factors (prone sleeping, bed sharing and bottle feeding) was between bed sharing and fewer antenatal appointments. The risk of SIDS associated with bed sharing was greater among those whose mothers had fewer antenatal appointments. CONCLUSIONS: Although many of the previously identified antenatal and intrapartum risk factors for SIDS are confirmed, the risks of SIDS associated with obstetric factors are in general considerably lower than the risks associated with the four modifiable postnatal risk factors.

Case-Control Studies↗

PubMed2006

Growth of infant communication between 8 and 12 months: a population study.

AIM: To describe changes in infant prelinguistic communication skills between 8 and 12 months, and identify factors associated with those skills. METHODS DESIGN: Parent questionnaire data for a prospective population-based cohort of infants in metropolitan Melbourne, Australia. PARTICIPANTS: 1911 infants born November 2002-August 2003. OUTCOME: Infant communication (Communication and Symbolic Behaviour Scales (CSBS)) at 8 and 12 months. Potential risk factors: sex; prematurity; multiple birth; sociodemographic indicators; maternal mental health, vocabulary and education; non-English speaking background; and family history of speech-language difficulties. Linear regression models were fitted to total standardised CSBS scores at 8 and 12 months. RESULTS: Social communication, especially the use of gesture, developed rapidly from 8 to 12 months. Female sex, twin birth, and family history were strongly associated with CSBS scores. The combined model accounted for 5% and 6% of the total variation at 8 and 12 months, respectively. CSBS score at 8 months strongly predicted CSBS score at 12 months (coefficient = 0.56, partial R(2) = 37.0). CONCLUSIONS: There is a dramatic increase in communication skills between 8 and 12 months, particularly the development of gesture, which (as in previous studies) predates and predicts future language development. Risk factors explained little variation in early communication trajectories and therefore, based on our findings, this developmental course is more likely to be biologically predetermined. Rather than focusing on risk factors, we suggest that language promotion activities in otherwise healthy young infants should either be universal or, if targeted, be based on the level of communication skills displayed.

Australia↗

PubMed1992

Outcome of 143 pregnancies conceived by assisted reproductive techniques.

One hundred and forty-three pregnancies conceived by assisted reproductive techniques (ART) from October 1985 to June 1989 in the National University Hospital, Singapore, resulted in 66 deliveries and 89 babies. There were 27 (18.7%) biochemical pregnancies, 44 (30.7%) clinical miscarriages and 6 (4.2%) ectopic pregnancies when total pregnancies were considered. Of those who continued pregnancy to second trimester multiple births occurred in 20 (13.3%) patients. A high incidence of vaginal bleeding and hypertension in pregnancy was noted in 32 (48.5%) patients and 18 (27.3%) patients, respectively. Caesarean section was the method of delivery in 48.5% of patients. Twenty-six (29.2%) babies required admission to the neonatal intensive care unit. All babies except one set of twins delivered at 24 weeks of amenorrhoea survived. Fetal abnormality was noted in 2 cases.

Adult↗

PubMedDate not supplied

Developmental trajectories of externalizing behaviors in childhood and adolescence.

This article describes the average and group-based developmental trajectories of aggression, opposition, property violations, and status violations using parent reports of externalizing behaviors on a longitudinal multiple birth cohort study of 2,076 children aged 4 to 18 years. Trajectories were estimated from multilevel growth curve analyses and semiparametric mixture models. Overall, males showed higher levels of externalizing behavior than did females. Aggression, opposition, and property violations decreased on average, whereas status violations increased over time. Group-based trajectories followed the shape of the average curves at different levels and were similar for males and females. The trajectories found in this study provide a basis against which deviations from the expected developmental course can be identified and classified as deviant or nondeviant.

Adolescent↗

PubMed1981

Etiological factors in cerebral palsy: an historical review.

The etiological factors in 1503 patients with cerebral palsy seen since 1947 are listed. Prematurity was the most prominent factor, being present in 27.8 per cent of cases. 38.5 per cent of the causes were prenatal in origin, 46.3 per cent natal, and 15.2 per cent postnatal. Since 1947, the number of patients seen rose to a maximum in the 1950s and has fallen since. A steadily increasing percentage of the patient population has been children with spasticity, especially paraplegia and quadriplegia. Although small, the atonic group has shown a marked increase, from 0.8 per cent in the 1950s to 3.4 per cent in the 1970s. There has been a dramatic decrease in the incidence of athetosis, from 38 per cent to about 3 per cent, and a slight decrease in the rigidities. The incidence of some of the etiological factors has increased, such as hydrocephalus, prematurity, trauma and multiple birth. There has been a striking decrease in the incidence of erythroblastosis as a factor, which dropped to nil in the 1970s. There have been lesser decreases in encephalitis, dystocia and idiopathic factors.

Birth Injuries↗

PubMed1994

Clomiphene citrate and pregnancy outcome.

Data from Australia and elsewhere have shown consistently that adverse perinatal outcomes such as preterm birth and perinatal mortality are more common in pregnancies resulting from assisted conception with IVF and GIFT than normally conceived pregnancies. Factors that may contribute to the excess of poor outcomes include maternal factors, the assisted conception procedures themselves and possibly the influence of drugs used to induce superovulation. This review examines the medical literature describing pregnancies following ovulation induction with one of the drugs used to induce superovulation, clomiphene citrate, and compares their outcomes with Australian IVF and GIFT pregnancy outcomes. The review shows that whilst some studies have suggested higher rates of ectopic pregnancy, spontaneous abortion and congenital malformations in clomiphene citrate induced pregnancies, the findings are inconsistent and the data are flawed. There are only very poor data available on the incidence of preterm birth. Multiple pregnancy is a well-recognized adverse outcome of clomiphene citrate induced pregnancies. Attempts to improve perinatal outcomes of pregnancies following assisted conception will be helped by a better understanding of the relative contributions of maternal and treatment factors and further studies of pregnancy outcome after ovulation induction are needed.

Abortion, Spontaneous↗

PubMedDate not supplied

A breastfeeding protocol.

Specific guidelines for assisting patients in breastfeeding their infants are outlined, beginning in the prenatal period and continuing through initiation of nursing and established lactation. Prevention of possible problems is emphasized, but included are methods for relieving difficulites encountered during breastfeeding, such as flat nipples, sleepy babies, sore nipples, oversupply, engorgement, multiple births, forceful expulsion of milk, and breast infections.

Breast Feeding↗

PubMedDate not supplied

Sending infants home on low-flow oxygen.

A program for sending infants on low-flow oxygen home or to less-specialized hospitals is described. Problems identified in the development of the program are outlined. In establishing the program, its benefits for increasing infant-parent bonding, decreasing hospital costs, and eliminating the risk of nosocomial infection were considered. A comprehensive teaching package was established to ensure that parents were adequately instructed and confident before discharge. Some families had older children, multiple births, or other complicating factors, but most were able to adapt to their infant's needs. Of the 51 infants discharged between April 1979 and June 1982, two had to be readmitted until weaned from oxygen and three died of other causes.

Adult↗

PubMed1995

Clinical and immunohistochemical findings in a case of neonatal Marfan syndrome.

A newborn girl with extreme cardiomegaly discovered by fetal ultrasound after 34 gestational weeks is presented. The girl was delivered through a Caesarean section. After birth, multiple skeletal stigmata and generalized cardiac involvement with abnormal valves and dilated great arteries suggested Marfan syndrome. The girl died at the age of 10 h. The postmortem examinations showed cardiovascular lesions typical of Marfan syndrome. Immunofluorescence studies from cultured fibroblasts of the patient showed decreased amounts of immunostained fibrous material, supporting the clinical diagnosis of a severe Marfan syndrome.

Antibodies, Monoclonal↗

PubMed1985

Prevalence and disabilities in 4 to 8 year olds with cerebral palsy.

A register of children born between 1970 and 1979 in the South East Thames Regional Health Authority, and diagnosed as having pre-, peri-, and postnatal cerebral palsy, was set up between 1978 and 1981. We report the 527 children born between 1970 and 1974 for whom ascertainment is virtually complete. The estimated prevalence was 2.2 per 1000, with 7.4% multiple births, and 58% boys. Birthweight distribution is as expected, with 35% weighing less than 2500 g at birth. Parental permission for release of detailed medical information was sought, and the clinicians responsible gave us data on the type of cerebral palsy; details of impairments, disabilities, and anticipated future prospects; and an opinion on the probable timing of the cause. There was a high incidence of orthopaedic defects which must represent a considerable use of resources, although the prevalence of hearing and vision defects suggested that some of these may be undetected.

Age Factors↗