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PubMed1988

Birthweight and perinatal mortality of second births conditional on weight of the first.

A woman's successive offspring tend to have similar birthweights. We use data from the Medical Birth Registry of Norway to describe weight and perinatal mortality of second births given the weight of the mother's first birth. Mean weights among second births differ by as much as 1000 grams, depending on the weight of the first. Furthermore, the survival of the second baby at any given weight is strongly affected by its weight relative to the first baby's weight. A baby may be average size compared to the whole population, but small compared to its sibling; such a baby has the increased mortality that goes with being relatively small. For example, an infant of 3250 grams is relatively large if the mother's previous baby was 2250 grams, but relatively small if the previous birth weighed 4250 grams. In the first case, the mortality risk of the 3250-gram baby is 2.2 per thousand, while in the second case, risk for the same weight infant is 9.0, or four times higher. Implications of these observations for the more general analysis of birthweight and perinatal mortality are discussed.

Birth Order↗
PubMed1976

The use of nutritional 'positive deviants' to identify approaches for modification of dietary practices.

The paper describes methodology for doing nutrition surveys among deprived population groups of grossly homogeneous socioeconomic status so as to identify those families in which a child between age six months and five years falls in the upper 25 per cent in height and weight measurements. These families are labeled as being "Positive Deviants" from the undernutrition that prevails in the population. They are then studied anthropologically to uncover any practices related to food sources, storage, preparation, consumption, and content. The information would be used in designing food supplementation or other nutritional promotion in the population at large on the assumption that the observed "favorable" practices, although atypical, are feasible and culturally acceptable because they are indigenously rather than extraneously derived. In addition, the survey collected data on fertility because of findings concerning the close interrelatedness among a woman's nutritional state, her age when first giving birth, intervals between births, and the growth and development of her young children. Severe undernutrition raised a woman's safe age threshold for first birth above 20 years and a reasonably safe birth interval to more than three years.

Adult↗
PubMed2004

Mifepristone-induced abortion and birth weight in the first subsequent pregnancy.

OBJECTIVES: To assess the effect of a medically induced abortion (MA) on birth weight in the first subsequent pregnancy. METHODS: Pregnant women who had had a MA, a surgical abortion (SA), or primigravidas with no history of abortion (NA), were recruited for a prospective cohort study between July 1998 and February 2001. The sample for the present analysis included 12995 singleton live births at term. RESULTS: The overall incidence rate of low birth weight (LBW) was 1.0%. The rates of LBW in the MA, SA, and NA groups were 1.0%, 0.9%, and 1.2, respectively. There were no significant differences in LBW rates between the MA and SA groups, neither between the MA and NA. Logistic regression analysis was used to estimate the effects of MA on birth weight, and we found no relationship between risk of LBW and MA. CONCLUSIONS: We did not find a statistically significant relationship between a history of one medically induced abortion and LBW for the first subsequent term pregnancy.

Abortifacient Agents, Steroidal↗
PubMed2001

Risk factors for low birth weight among first-time mothers in southern Taiwan.

BACKGROUND AND PURPOSE: Low birth weight (LBW) greatly affects infant development, the family, and health care financial systems. Nonetheless, the risk factors for LBW in Taiwan have not been investigated. The purpose of this study was to determine the risk factors for LBW in Kaohsiung County. METHODS: In this cross-sectional study, we recruited 1,147 first-time mothers, including all adolescent mothers (< 20 years old) who gave birth during the period from June 1994 through May 1995 and all adult mothers (> or = 20 years old) who gave birth in January and February 1995. The subjects were interviewed during home visits or by telephone by public health nurses in each township. Logistic regression analysis was used to identify the risk factors for LBW in adolescent and adult mothers. RESULTS: The prevalence of LBW in the study population was 6.2%, ranging from 7.6% in adolescent mothers to 4.9% in adult mothers. Univariate analysis showed that mothers who had low pregravid weight (< 45 kg), infrequent prenatal visits (< 10), anemia, low gestational weight gain (< 10 kg), or habits of alcohol consumption or cigarette smoking were more likely to give birth to LBW infants. In logistic regression analysis, after controlling for covariates, the significant risk factors for LBW were low gestational weight gain (< 10 kg) and low pregravid weight (< 45 kg) for adolescent mothers. Infrequent prenatal visits (< 10) was the only significant risk factor for adult mothers. CONCLUSIONS: In this study, the risk factors for LBW among adolescent and adult mothers were different. This suggests that programs for prevention of LBW should be tailored according to maternal age, begin before conception, and continue with enhanced surveillance during prenatal visits.

Adolescent↗
PubMed1989

[Adaptation of the cardiac activity in healthy newborn infants during the first 5 days after birth according to the hours of life].

It has been revealed for the first time that adaptation of cardiac activity in normal neonates of the first five days of life is wavy in nature. At the same time the load of the right heart reduced during the first 12 hours and from 42 to 60 hours and increased from 15 to 39 hours and from 63 to 72 hours of the children's life. As a result of the establishment of the pulmonary circulation, the load of the right heart appreciably declined on day five after birth as compared with the first hour of the neonates' life.

Adaptation, Physiological↗
PubMed1977

Some changes in the composition of blood during the first 24 hours after birth in normal and growth retarded lambs.

Changes in the composition of blood which occurred during the first 24 hr after birth were examined in 18 lambs whose prenatal growth had been reduced by limiting the size of the placenta (group CE) and in 18 lambs born to untreated ewes (group R). The gestational period was about 4.5 days shorter in group CE than in group R and the birth-weights of group CE lambs were reduced by about 0.5 kg. At birth the PCV and the plasma concentrations of glucose were significantly higher and the plasma concentrations of thyroxine (T4) and fructose were significantly lower in group CE than in group R. During the first 24 hr the rates of change in the PCV and the plasma concentrations of insulin T4 and immunoglobulin G (IgG) were similar in the two groups, but there were significant between-group differences in the rates of change in the plasma concentrations of corticosteroids, glucose, lactate and fructose. The PCV and concentrations of T4, corticosteroids, lactate and fructose generally decreased and the concentrations of insulin, glucose, and IgG generally increased during the first day. Many of the between-group differences observed at birth and subsequently can be explained by the hypothesis that reducing the size of the placenta causes lambs to become hypoxaemic before birth and that after birth the attainment of normoxaemia in these lambs is delayed.

Adrenal Cortex Hormones↗
PubMed2004

Risk factors for umbilical hernia in Holstein heifers during the first two months after birth.

OBJECTIVE: To determine risk factors associated with identification of an umbilical hernia during the first 2 months after birth in Holstein heifers. DESIGN: Case-control study. ANIMALS: 322 Holstein heifers born in a single herd (45 with an umbilical hernia and 277 without). PROCEDURE: Risk factors that were examined included sire, whether the dam had a history of umbilical hernia, milk yield, duration of gestation, whether the dam had a history of dystocia, whether the heifer had a twin, birth weight, total serum protein concentration, and whether the heifer had an umbilical infection. Logistic regression was used to analyze risk factors. RESULTS: Heifers born to sires with > or = 3 progeny with an umbilical hernia were 2.31 times as likely to develop an umbilical hernia as were heifers born to sires with < or = 2 progeny with an umbilical hernia. Heifers with umbilical infection were 5.65 times as likely to develop an umbilical hernia as were heifers without umbilical infection. CONCLUSIONS AND CLINICAL RELEVANCE: Sire and umbilical infection were associated with risk of an umbilical hernia during the first 2 months of life in Holstein heifers. Attributable proportion analysis indicated that the frequency of umbilical hernias in Holstein heifers with umbilical infection would have been reduced by 82% if umbilical infection had been prevented.

Animals↗
PubMed1992

Growth and morphological changes in the small and the large intestine in piglets during the first three days after birth.

Growth and morphological changes in the small and the large intestine of piglets were examined during the first three days after birth. There was a 72% increase in small intestinal weight, virtually all of which occurred during the first day and was due primarily to a 115% increase in the weight of the mucosa. Associated with the tissue weight gain there was a 24% increase in small intestinal length, a 15% increase in small intestinal diameter, a 33-90% increase in villus height and a 14-51% increase in villus diameter, during the first day. The cellular population in the small intestinal mucosa, as indicated by its DNA content, increased progressively with age, and at three days had increased by 84-154%. The percentage increase in mucosal DNA content was highest in the duodenum, intermediate in the jejunum and lowest in the ileum. Histological features and tissue protein contents revealed a transient epithelial cellular swelling related to intracellular accumulation of protein on the first day. Protein accumulation was evident in the jejunum and ileum but not in the duodenum. The positions of the nuclei in the epithelial cells suggested that on the first day protein absorption was at a more advanced stage in the jejunum and the proximal ileum than in the distal ileum. Large intestinal weight increased by 33% during the first day and had doubled by the third day, and this weight gain was due to both mucosal and non-mucosal tissue growth. Villus-like structures were observed in the caecum and the proximal colon in piglets at birth and one day after birth but not in piglets three days after birth. It is speculated that such villus-like structures may have a functional significance during the transition to complete dependence on oral nutrition in newborns.

Aging↗
PubMed1998

Diet influences development of the pig (Sus scrofa) intestine during the first 6 hours after birth.

Structural and functional responses of the intestine to colostrum, milk replacer, oral electrolyte solution and food deprivation were examined during the first 6 h after birth in pigs. Total intestinal weight, surface area and mucosal mass were highest (P < 0.05) in pigs fed colostrum. The other diet groups did not differ, except that food-deprived pigs had lower surface area than the other groups. Feeding colostrum was associated with higher mucosal protein content (P < 0.05). Total intestinal brush border membrane protein content of pigs fed milk replacer, oral electrolyte solution and food-deprived pigs were 61, 44 and 56%, respectively, of those fed colostrum (P < 0.05). Pigs fed colostrum had higher total mucosal maltase activities than those that were food deprived, and total brush border membrane activities were higher than in those fed oral electrolyte solution. Total intestinal brush border membrane aminooligopeptidase activity was higher in pigs fed colostrum than in those given oral electrolyte solution or deprived of food, but total intestinal homogenate activities did not differ among groups. Diet influenced lactase activity only in the mid-region, and sucrase was not responsive to diet. Intestinal glucose transport capacity by intact intestinal tissues did not differ among diet groups. The ability of brush border membrane vesicles to actively accumulate glucose was lost when pigs were fed colostrum and milk replacer, but not when fed oral electrolyte solution or deprived of food. Our findings reveal how diet during the first 6 h after birth influences the structure and functional characteristics of the intestine. The responses vary between brush border membrane proteins and intestinal regions, and appear to differ from those described for older animals.

Animals↗
PubMed1984

Intrapatient variation in tobramycin kinetics in low birth weight infants during first postnatal week.

Nineteen newborn infants receiving tobramycin, 2.5 mg/kg every 12 h were studied on two occasions at steady-state during the first week of postnatal age. The two studies were separated by two to four days. Total body clearance of tobramycin averaged 1.15 and 1.14 ml/min/kg (p greater than 0.05), apparent volume of distribution averaged 0.82 and 0.68 l/kg (p greater than 0.05), and elimination half-life averaged 8.6 and 7.1 h (p greater than 0.05), during the first and second study, respectively. When the data were further analyzed based on the birth weight, tobramycin kinetics changed during the second study compared to the first study in very low birth weight infants. In eight infants less than or equal to 1.5 kg birth weight, although total clearance of tobramycin was similar, the average apparent volume of distribution decreased from 1.04 l/kg during the first study to 0.73 l/kg during the second study (p less than 0.05) and elimination half-life from 11.1 h during the first study to 8.7 h during the second study (p less than 0.05). These data indicate that these infants may require a change in dosing interval with continued tobramycin therapy during the first week of postnatal age. Intrapatient variation in tobramycin kinetics should be considered, in addition to the interpatient variation reported previously, when monitoring the serum concentration to individualize tobramycin therapy in newborn infants less than or equal to 1.5 kg birth weight.

Female↗
PubMed2003

Improving growth of very low birth weight infants in the first 28 days.

OBJECTIVE: To increase weight gain in the first 28 days after birth for very low birth weight (VLBW) infants by isolating and sharing meaningful process differences between high- and low-weight-gain centers within a neonatal network. DESIGN/METHODS: We identified weight gain as an important target for improvement in 1999 for our national group practice of neonatologists. Site-specific average weight gain during the first 28 days was the primary outcome measure. Our target population was defined as inborn infants who survived and remained in the hospital of birth, whose birth weights were between 401 and 1500 g (VLBW), and who were >22 weeks' estimated gestational age. A team of 6 neonatologists and 1 nurse met, reviewed processes that might influence growth, and developed a structured observation guide for site visits. Weight gain data were obtained from an existing administrative database for the period January 1, 1997, through June 30, 1999. Centers were ranked and divided into upper, middle, and lower thirds. Seven team members visited 1 high- and 1 low-weight-gain center without being informed of the center's performance. Following the site visits, the team isolated 16 meaningful differences between high- and low-weight-gain sites. Meaningful differences were defined as processes observed in all or virtually all (for this project, 6 or 7 of 7 centers) of the high and none or virtually none (for this project, 0 or 1 of 7) of the low centers. The meaningful differences were distributed to our medical directors in August 2000 along with their site-specific weight-gain performance. To document the impact of sharing this material, we compared weight gain in a baseline period of January 1 through December 31, 1999 and a posteducational intervention period of January 1 through September 30, 2001. RESULTS: Compared with neonates admitted to our national neonatal practice in 1999, neonates admitted in 2001 were similar in birth weight, gestational age at birth, exposure to antenatal steroids, and male gender. Average daily weight gain during the first 28 days increased from 10.4 +/- 6 g for neonates cared for in 1999 to 12.5 +/- 6 g for neonates cared for in 2001. Thirty-nine of 51 (76%) units noted improvements, 4 were unchanged and 8 noted a decrease in average weight gain. Despite similar average lengths of stay, the average discharge weight for neonates sent home increased from 2.15 +/- 0.5 kg for 1999 to 2.29 +/- 0.5 kg for 2001. There were no differences in frequencies of mortality or major morbidities, including severe intraventricular hemorrhage, retinopathy, or necrotizing enterocolitis, between the 2 time periods. An increase in the use of continuous positive airway pressure was noted in the post implementation period. CONCLUSIONS: Variation in common processes can alter clinical outcomes. Although temporal trends in weight gain may be, in part, responsible for this trend, it appears that isolation and implementation of meaningful differences in processes can augment our desire to rapidly improve clinical outcomes.

Female↗
PubMed1993

First established pregnancy and birth after ovarian stimulation with recombinant human follicle stimulating hormone (Org 32489).

This case report describes the first established pregnancy and birth after ovarian stimulation with Org 32489, pure recombinant human follicle stimulating hormone (recFSH, Organon International). A patient with tubal infertility participated in an open efficacy study of recFSH evaluating the efficacy of combined gonadotrophin-releasing hormone (GnRH)-agonist/recFSH treatment in women undergoing in-vitro fertilization (IVF) and embryo transfer. Ovarian stimulation was induced by recFSH in association with buserelin (Suprecur, 4 x 150 micrograms/day) using a short protocol. After 9 days of recFSH treatment (75 IU/day), six pre-ovulatory follicles (> or = 15 mm) were observed and 10,000 IU human chorionic gonadotrophin were administered. Nine mature oocytes were retrieved by oocyte puncture and after IVF, three embryos were replaced in the uterus. A viable singleton intra-uterine pregnancy was revealed at a gestational age of 7 weeks. The pregnancy progressed normally and ended with a vaginal delivery at a gestational age of 39.5 weeks. A healthy girl was born and paediatric examination did not demonstrate any abnormality.

Adult↗
PubMed1975

[Effects of alpha-methyl-dopa on new born kitten sleep. Behavioral evolution during the first month post-birth (author's transl)].

The paradoxical sleep (PS)-suppressing effect of alpha-methyl-Dopa was studied in kittens at birth. The new burn animal received daily injections of alpha-methyl-Dopa during the 2 first weeks of life. States of sleep were studied during the treatment (days 1 to 14) and after administration of the drug way halted (days 15 and 16). Daily injections of alpha-methyl-Dopa induce an average PS-deprivation of 72%. This deprievation is compensated for by a significant increase in quiet sleep (QS)-rate which is found to be up to 3.5 times that of kittens not receiving alpha-methyl-Dopa. A progressive return of PS-ratio to normal, without PS rebound, is observed after drug administration ceases. Alpha-methyl-Dopa produces a sedative effect on the kitten which remains relatively hypotonic during the treatment. Behavioural studies carried out over the first month after birth show no significant delay in the ponderal growth nor in the acquisition of stereotyped behaviour patterns. However motor coordination is delayed 2 weeks in these kittens.

Aging↗
PubMed1992

Misclassification bias related to definition of menopausal status in case-control studies of breast cancer.

It is often assumed, but has not been consistently observed, that some characteristics of reproductive history are specifically related to breast cancer of pre- or postmenopausal onset. To determine whether inconsistent reports may be due to differences in definition of menopause, we computed the relative odds (RO) of breast cancer for nulliparity, age at first live birth, family history of breast cancer and prior history of benign breast disease, separately in pre- and postmenopausal women, using seven different definitions of menopause. Results show that (i) relative odds of breast cancer and their confidence intervals may vary according to definitions of menopause; (ii) age-based definitions of menopause are associated with moderate differential misclassification bias between cases and controls; (iii) nulliparity, late age at first birth and family history of breast cancer seem to be specific risk factors for pre- but not postmenopausal breast cancer when cutoff for menopausal status is 10 years or more after last menses; and (iv) when information on menstrual history is not available, 50 years of age may be the best proxy for all menses-based definitions of menopause. We conclude that inconsistent findings on the effect of menopausal status in the association of breast cancer with some reproductive factors are partly due to statistical imprecision and differential misclassification bias associated with different age-based or menses-based definitions of menopause. Researchers should either test whether their conclusions hold using several definitions of menopause or give a biological rationale for the choice of a given definition of menopause.

Age Factors↗
PubMed2004

Prognostic significance of amplitude-integrated EEG during the first 72 hours after birth in severely asphyxiated neonates.

Amplitude-integrated EEG (aEEG) is used to select patients for neuroprotective therapy after perinatal asphyxia because of its prognostic accuracy within several hours after birth. We aimed to determine the natural course of aEEG patterns during the first 72 h of life, in relation to neurologic outcome, in a group of severely asphyxiated term infants. Thirty infants, admitted to our neonatal intensive care unit from October 1998 until February 2001, were studied retrospectively. The aEEG traces obtained during the first 72 h after birth were assessed by pattern recognition: continuous normal voltage (CNV), discontinuous normal voltage (DNV), burst suppression (BS), continuous low voltage, and flat trace. Epileptic activity was also determined. The course of aEEG patterns was examined in relation to neurologic findings at 24 mo. Initially, 17 of 30 infants had severely abnormal aEEG patterns (BS or worse), which changed spontaneously to normal voltage patterns (CNV, DNV) in 7 within 48 h. The sooner the abnormalities on aEEG disappeared, the better the prognosis. The likelihood ratio of BS or worse for adverse outcome was 2.7 (95% confidence interval 1.4-5.0) between 0 and 6 h and increased to a highest value of 19 (95% confidence interval 2.8-128) between 24 and 36 h; after 48 h, it was not significant. Normal voltage patterns (CNV and DNV) up to 48 h of life were predictive for normal neurologic outcomes (negative likelihood ratios <0.3). Our findings indicate that the course of aEEG patterns adds to the prognostic value of aEEG monitoring in asphyxiated infants. Spontaneous recovery of severely abnormal aEEG patterns is not uncommon.

Asphyxia Neonatorum↗