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PubMed2001

Validity of birth certificate data for the outcome of the previous pregnancy, Georgia, 1980-1995.

The author evaluated the validity of four historically based variables collected on Georgia birth certificates: outcome of preceding pregnancy, history of delivery of a low- (<2,500 g) or high- (>4,000 g) birth-weight infant, and death of the baby resulting from the preceding pregnancy. Data were derived from birth and fetal death certificates that were linked for the first and second deliveries of 231,075 women in Georgia from 1980 through 1995. Deaths that occurred during the infant's first year of life were also linked to the birth certificate. For all but the survival variable, the outcome of the first birth as reported on the certificate for the second birth was compared with the outcome recorded on the certificate for the first birth, which was assumed to be correct. Except for ascertainment of death of the firstborn infant, sensitivities for the history of poor outcomes were low. Furthermore, sensitivities were higher when an extremely adverse outcome occurred in the first pregnancy or an adverse outcome recurred. The only high sensitivity was for past infant death (85.4%). These results suggest caution when using these variables to identify high-risk subsets for further research or control for confounding.

Birth Certificates↗
PubMed2006

Serum creatinine in very low birth weight infants during their first days of life.

OBJECTIVES: Little is known about the relationship between gestational age (GA) or birth weight (BW) and serum creatinine (SCr) in very low birth weight (VLBW) infants. We sought to study postnatal SCr changes and determine if there is a correlation between GA or BW and SCr in VLBW infants, during their first days of life. STUDY DESIGN: Medical records of all VLBW infants, who were admitted to our neonatal intensive care unit (NICU) between 1 May 1998 and 1 May 2001, were reviewed. Medical records were reviewed for: BW, GA, gender, race, APGAR scores, mechanical ventilation, use of medications, fluid intake, urinary output, protein intake, blood urea nitrogen (BUN) and SCr during the first days of life. Patients with anuria/oliguria, major congenital anomalies, low APGAR scores at 5 min, on high ventilator settings (on the oscillator), hemodynamically unstable (on pressors, inotropes) and on indomethacin and diuretics were excluded. RESULTS: In total, 138 infants met our inclusion criteria. SCr was found to decrease postnatally, reaching a plateau on day 5 of life in all VLBW infants (repeated measure analysis of variance; P=0.004); however, there was a delay in the decrease of SCr in the subgroup of infants <29 weeks GA, and <1000 g BW. SCr (on day 5 of life) was also found to decrease with increasing GA and BW (Pearson correlation coefficient: -0.206 (P=0.05) and -0.236 (P=0.05) respectively). CONCLUSION: In VLBW infants SCr decreases significantly during the first days of life; however, in infants younger than 29 weeks GA or smaller than 1000 g BW there is a delay in the decrease of their SCr that extends beyond the first days of life. We also conclude that during the first days of life, and in VLBW infants SCr decreases with advancing GA and BW.

Anti-Bacterial Agents↗
PubMed1992

Copper status of very low birth weight infants during the first 12 months of infancy.

The Cu intake and status of 106 very low birth weight (VLBW) infants (birth weight 1152 +/- 251 g, gestational age 29 +/- 3 wk, mean +/- SD) were determined approximately 1 mo before hospital discharge, at discharge (time 0), and at 3, 6, 9, and 12 mo +/- 3 wk corrected for gestational age. Infants were fed either formula plus supplemental Zn/Cu (SUPPL, n = 29); formula plus placebo (PLAC, n = 26); or a low birth weight formula (LBWF, n = 26) or were breast-fed (BRMLK, n = 25). Plasma Cu levels in the formula-fed infants increased significantly at each time period with no significant differences between feeding groups. Hair Cu was significantly higher in the SUPPL group compared to the PLAC, LBWF, and BRMLK groups at 3 and 6 mo. Erythrocyte Cu,Zn-superoxide dismutase (CuZnSOD) activity was lowest in the PLAC group. Cu intake was positively correlated with both hair Cu (r = 0.291, p less than 0.0001) and erythrocyte CuZnSOD activity (r = 0.281, p less than 0.001) but not with plasma Cu. An increasing number of formula-fed infants had very low CuZnSOD activity (less than 2 SD below mean) with increasing age (n = 1, 2, 8, 11, and 13 infants at times 0, 3, 6, 9, and 12 mo, respectively). At 12 mo, approximately one third of the formula-fed VLBW infants in this study had low Cu status as assessed by CuZnSOD activity. Infants with the lowest CuZnSOD activity were those with the largest weight gains from 0 to 6 mo and were observed in all formula-fed groups.(ABSTRACT TRUNCATED AT 250 WORDS)

Body Weight↗
PubMed2003

First-trimester uterine artery blood flow and birth weight.

OBJECTIVES: To determine reference values for first-trimester uterine artery resistance index (RI) in healthy pregnant women with uncomplicated pregnancies and to investigate the relationship between uterine artery Doppler indices and birth weight. METHODS: This was a cross-sectional study of 265 consecutive pregnant women attending routine ultrasound examination at 11-14 weeks' gestation. Both uterine arteries were identified using color Doppler ultrasound and the RI was measured. The presence or absence of an early diastolic notch was also noted. Pregnancy outcomes were obtained from the delivery suite database and birth weight was expressed as Z-scores. RESULTS: The 5(th), 50(th) and 95(th) centiles for uterine artery RI between 11 and 14 weeks' gestation were 0.53, 0.71 and 0.85, respectively. Complete pregnancy outcome data were available for 246 fetuses. There was a significant negative correlation between birth-weight Z-scores and first-trimester uterine artery mean RI (r = - 0.219, P = 0.001). The difference in birth weight between fetuses with absent and those with bilateral diastolic notches was also significant (P < 0.001). Multiple regression analysis demonstrated that both mean RI (standardized regression coefficient = - 0.14, P = 0.039) and uterine artery notching (standardized regression coefficient = - 0.17, P = 0.017) contributed independently towards the prediction of birth-weight Z-score. CONCLUSIONS: A significant negative correlation exists between birth weight and first-trimester uterine artery Doppler parameters, a reliable and non-invasive method of examining uteroplacental perfusion. The value of first-trimester uterine artery Doppler as a prognostic screening tool, either in isolation or in conjunction with maternal biochemistry, remains to be determined.

Adolescent↗
PubMed1998

Incidence of passive exposure to crack/cocaine and clinical findings in infants seen in an outpatient service.

OBJECTIVES: Passive exposure to crack/cocaine and the associated clinical symptoms may present a significant health risk to very young infants and children. This study was designed to determine the incidence of cocaine exposure, presumed to be passive, in ill infants younger than 1 year of age, using a threshold of detection for cocaine and/or its major metabolite, benzoylecognine (BE), that is lower than the current National Institute on Drug Abuse standard. The study also investigates the morbidity associated with passive cocaine exposure in this population. METHODS: We prospectively obtained 124 samples of urine from 122 children younger than 1 year of age for routine clinical indications from the emergency department at Yale-New Haven Hospital. Samples were analyzed by radioimmunoassay (RIA) for cocaine, with cross-reactivity for BE. The presence of BE in a portion of the RIA-positive samples also was detected in additional analyses by enzyme-multiplied immunoassay technique or by gas chromatography-mass spectrometry. A chart review was conducted on all 122 patients by reviewers blind to the urine toxicology results. Presenting complaints, symptoms, vital signs, and diagnosis were obtained for all visits before the first birthday. Birth history, including maternal drug history and birth weight, demographics, and number of medical visits in the first year, were recorded as well. RESULTS: Of the 124 samples, 45 (36.3%) were positive (>/=50 ng/mL of BE equivalents) for cocaine and/or cocaine metabolite by RIA testing. The positive results, determined by RIA, were highly correlated with patients who had lower and upper respiratory symptoms and sought medical care more often. CONCLUSIONS: The incidence of unsuspected, passive cocaine exposure in ill infants seeking medical care primarily through an emergency service may be as high as 1 in 3 to 6 infants from our predominantly inner city population. Current immunoassay methods, specific for BE, and their routine threshold of detection (200 to 300 ng/mL) may not be sensitive enough to detect cocaine and BE in the urine samples of children younger than 1 year of age who are exposed passively. The development of upper and lower respiratory symptoms is correlated significantly with positive urine results in this study. The increased use of health care resources correlated with passive cocaine exposure in this sample may serve as an indirect marker for the increased medical needs of these infants.

Cocaine↗
PubMed1989

[Studies on the development and growth of the human maxilla--special references to the anterolateral, infratemporal and orbital surfaces].

Morphological and macroscopical studies were made on the lateral surface of the human maxilla. The materials consist of 128 cases of human fetuses ranging from the fourth to the tenth month and 306 cases of human juveniles and adults. The earliest month in which the loci with the scientific name (Nomina Anatomica) of the maxilla was observed was as follows; the frontal process, zygomatic process, anterior nasal spine and the nasal notch were first observed on the fourth fetal month. The infraorbital foramen and anterior lacrimal crest were first observed in some cases on the fourth fetal month and in all cases on the fifth fetal month. The infraorbital suture, lacrimal notch and alveolar process were first observed on the fifth to the sixth fetal month. The infraorbital sulcus and infraorbital canal were first formed on the fifth to the seventh fetal month. The following loci on the lateral surface of the maxilla which are related to the development of the maxillary teeth were first observed after birth as follows; the alveolar foramina were first observed in 3 to 7 years after birth and the maxillary tuberosity was first observed in 6 to 7 years after birth. The canine fossa was first observed in 6 years after birth. As far as the development of the maxilla is concerned, the frontal process and infraorbital margin were first observed and secondly the alveolar part was observed and finally the maxilla body which involved the maxillary sinus was formed.

Adolescent↗
PubMed2006

Dose end-tidal carbon dioxide measurement correlate with arterial carbon dioxide in extremely low birth weight infants in the first week of life?

OBJECTIVE: To study the correlation and agreement between end-tidal carbon dioxide (EtCO2) and arterial carbon dioxide (PaCO(2)) in ventilated extremely low birth weight (ELBW) infants in the first week of life. METHODS: Retrospective chart review of all ELBW (<1,000 g) infants admitted to a level III NICU from January 2003 to December 2003. Data collected included demographic details and simultaneous EtCO(2) (mainstream capnography) and arterial blood gas values (pH, PaCO(2), PaO(2)). OUTCOME: The correlation coefficient, degree of bias with 95% confidence interval between the EtCO(2) and PaCO(2). RESULTS: There were 754 end-tidal and arterial CO(2) pairs from 31 ELBW infants (21 male and 10 female). The overall EtCO(2) values were significantly lower than PaCO(2) value. In only 89/754(11.8%) pairs, the EtCO(2) was higher than the PaCO(2). The overall bias was 5.6 +/- 6.9 mmHg (95% C.I. 5.11-6.09). The intraclass correlation coefficient was 0.81. Using EtCO2 ranges of 30 to 50 mmHg, the capnographic method was able to identify 84% of instances where PaCO(2) was between 35 (<35 = hypocarbia) and 55 mmHg (>55= hypercapnia). CONCLUSIONS: There is good correlation and agreement between end-tidal CO(2) and arterial CO(2) in ELBW infants in the EtCO(2) range 30-50 mmHg. End-tidal CO(2) monitoring can be helpful in trending or for screening abnormal PaCO(2) values in ELBW infants in first week of life.

Blood Gas Analysis↗
PubMed1966

The development of the adrenal medulla of the foetal and new-born calf.

1. The output of adrenaline and noradrenaline from the adrenal medulla during asphyxia, stimulation of the splanchnic nerves or the intra-arterial injection of acetylcholine, has been investigated in foetal and new-born calves up to 3 weeks of age.2. Between 180 days' gestation and term ( approximately 281 days) the response of the foetal adrenal gland of the calf to asphyxia appeared to be independent of its nerve supply and the discharge consisted largely of noradrenaline. A similar type of discharge was obtained after the intra-arterial injection of acetylcholine, but stimulation of the splanchnic nerves resulted in only a small discharge of both adrenaline and noradrenaline.3. Rapid changes occurred in the response of the adrenal medulla to all forms of stimulation during the first 24 hr after birth. For the first 4-6 hr the adrenal medulla was hypersensitive; thereafter the response rapidly declined and a variable period of depressed excitability followed. The changes affected the output of noradrenaline rather than that of adrenaline and were more pronounced during asphyxia or after the intraarterial injection of acetylcholine. Within 24 hr of birth the amount of noradrenaline released in response to either form of stimulation was less than 25% of that found immediately after birth.4. During the hypersensitive phase immediately after birth splanchnic nerve activity appeared to potentiate the direct effect of asphyxia on the noradrenaline cells since the maximum output of noradrenaline was attained more rapidly and at a higher P(O2) if the splanchnic nerves were intact.5. The non-nervous direct response of the adrenal medulla to asphyxia decreased rapidly after birth and disappeared within 24 hr. It did not reappear at any age and was a feature of foetal life.6. The recovery of the response to acetylcholine occurred between 3 and 8 days after birth with a return of the high level of noradrenaline secretion; no similar increase in the output of adrenaline occurred at this stage.7. The response to asphyxia was not restored to the level found in the new-born calf until 2-3 weeks after birth. At this time the effect on the adrenal medulla appeared to be mediated almost entirely by the splanchnic nerves.8. The effects of chloralose and pentobarbitone anaesthesia on the changes in the nervous response to asphyxia after birth were compared. Essentially the same pattern of changes was found with both anaesthetics although the absolute level of discharge under chloralose was greater and a considerably larger amount of adrenaline was secreted at 3 weeks of age.9. At certain ages stimulation of the splanchnic nerves enhanced the response of the adrenal medulla to subsequent injections of acetylcholine. The noradrenaline output was only significantly increased by this procedure during the period of depressed excitability whereas the adrenaline discharge was always increased throughout the first 3 weeks of life.10. The changes in adrenaline and noradrenaline content of the adrenal glands during the 3-week period after birth were investigated. The noradrenaline concentration was low immediately after birth during the hypersensitive phase and increased during the period of reduced sensitivity. The output of this amine was thus inversely related to its content in the adrenal gland. A similar relation did not occur with adrenaline, the concentration of which remained relatively constant during the first 3 weeks of life.

Acetylcholine↗
PubMed2001

The ontogeny of growth hormone sensitivity.

For many years it was believed that the growth hormone (GH) axis does not play a role in growth before birth or during the first year after birth. More recently, however, studies of genetic disorders of growth have led to developments in our understanding of the onset of GH sensitivity and the relationships between the maternal and fetal GH axes. Many children whose GH deficiency (GHD) is diagnosed in late childhood have a good rate of growth in their first year of life. This can be explained when one considers the differences between pituitary and hypothalamic GHD. Many children in whom GHD is diagnosed later in childhood have hypothalamic GHD, which may be masked in the first year of life by a relative lack of somatostatin secretion. Genetic defects in the GH axis lead to a slight degree of growth retardation at birth, consistent with growth impairment in the third trimester only. Conversely, a boy with a deletion in the insulin-like growth factor I (IGF-I) gene showed severe growth retardation at birth, indicating a role for IGF-I during the second and third trimesters. From these results, there are two possible models for the relationship between IGF-I production and other components of the maternal-fetal GH axis: independence of the IGF-I axis from somatotropic influences during the second trimester or, alternatively, redundancy of somatotropic hormones and their receptors. From reports of individuals with naturally occurring mutations that eliminate contributors to the GH axis, redundancy does indeed appear to be a feature of the maternal-fetal GH axis, with GH sensitivity arising around mid-gestation.

Embryonic and Fetal Development↗
PubMed1983

Development of the lipolytic activity in isolated perfused perinatal rabbit lungs and the influence of maternal cigarette smoke exposure on it.

The ability of the lungs to release fatty acids from circulating triglycerides or lipoproteins for its own phospholipid synthesis may be one of the factors which limit the rate of surfactant formation. Therefore, the development of the lipolytic activity of lungs obtained from late fetal and neonatal rabbits has been studied and the results correlated to the phospholipid content of lungs of similar ages. Isolated lungs were perfused with a medium which contained cold and radioactive triglyceride, and the release of fatty acids into the perfusion medium was analyzed by both colorimetric and radiochemical methods. The phospholipids of the postmitochondrial supernatant fractions of the lungs were extracted and quantified by measuring inorganic phosphorus. Finally, the influence of maternal cigarette smoke exposure on the lipolytic activity of the lungs of their litters were studied. A high lipolytic activity in the lungs of 28-day-old fetuses was detected. The activity decreased towards birth, and was lowest on the first day after birth (about 20% of that observed in 28-day-old fetuses). However, it increased again during the first week after birth. Exposure of the mothers to cigarette smoke during the last 10 days before delivery did not affect the pulmonary lipolytic activity of the offspring. Although the lung phospholipid content increased 3.6-fold from 28 days of fetal life to 1 week after birth, it remained unchanged on the days when the lung lipolytic activity was lowest. We conclude that changes in lung lipolytic activity influence lung phospholipid synthesis, and consequently influence also surfactant formation in the lungs.

Animals↗
PubMed1990

Iron status of very-low-birth-weight infants during the first 15 months of infancy.

The adequacy of iron stores in infants of very low birth weight (defined as less than 1500 g) in Canada is unknown. We monitored the iron status of 81 such infants at 3, 6, 9, 12 and 15 months of age. All of the infants were fed formula fortified with iron (13 mg/L) for at least 6 months, starting at 2 months of age. The plasma ferritin level decreased after the formula was no longer used. Although 90% of the infants were given cereal fortified with iron (30 mg of iron per 100 g) by 9 months of age, the plasma ferritin level continued to decrease. The level was less than 10 micrograms/L in 54% of the infants at 12 months of age and in 74% at 15 months; this indicated depleted iron stores. Because of delayed development very-low-birth-weight infants eat small amounts of cereal and therefore require iron-fortified formula throughout infancy.

Aging↗
PubMed1991

The safety of team midwifery: the first decade of the Monash Birth Centre.

OBJECTIVE: To review the safety of team midwifery care, in terms of perinatal mortality, for pregnant women assessed at their first visit as being at low risk of complications. DESIGN: A cohort study. SETTING: Team midwifery unit (Birth Centre) in a tertiary hospital. PATIENTS: All women who made a booking and met the selection criteria at their first antenatal visit (3085), excluding those with spontaneous or induced fetal loss before 20 weeks (89) and those who withdrew at their own request to seek an alternative form of care (138); the 2858 remaining women gave birth to 2874 infants. MAIN OUTCOME MEASURES: Perinatal mortality rate; and birthweight specific perinatal mortality ratio with reference values being specific rates for birthweight in Victoria for 1984-1985. RESULTS: The perinatal mortality rate was 7.7 per 1000 births (95% confidence interval [CI] 4.8-11.6) for the whole cohort; for women beginning labour in the Birth Centre it was 1.3 per 1000 births (95% CI, 0.3-3.9). The birthweight standardised perinatal mortality ratio was 80 (95% CI, 50-122). CONCLUSION: Within this setting, with explicit criteria for booking and referral, and a framework for consultation, team midwifery care is as safe as the standard maternity care provided within the State.

Birth Weight↗
PubMedDate not supplied

Feeding issues for mothers of very low-birth-weight, premature infants through the first year.

Adequate feeding is an area of concern for both clinicians and parents of very low-birth-weight, premature infants while in the special-care nursery and through at least the first postterm year. How feeding issues are labeled or described may make a difference in the effectiveness with which they are addressed by families and professionals. Internal working models of parenting offer a framework to explore meaning (goals, expectations, and intentions) and to evaluate progress in addressing feeding issues, viewed from the perspective of both the nurse and the family. Three case studies are presented to illustrate the framework, as used by nurses, to assess the adequacy of the infant's nutrient intake in the first year post birth. Questions are raised for further study.

Bottle Feeding↗
PubMed1996

Relationships between childbearing and some food and alcohol habits: the Nordland Health Study.

The aim of the study was to describe associations between childbearing pattern (parity and age at first and last birth) and food and alcohol habits in middle aged women. This was done in a cross-sectional survey of 3576 women aged 40-42 years living in a county in northern Norway, involving 71 percent of all women in the age bracket living in the county. Information about childbearing and food and alcohol habits was obtained from a self-administered questionnaire. High parity was positively related to indicators of a high intake of fat and low intake of fruits, vegetables and alcoholic beverages. High age at first birth was correlated with presumably healthy food habits and with a high wine and a low spirits consumption. High age at last birth was particularly related to relatively high vegetable and bread consumption and to low frequency of use of beer and spirits. As childbearing pattern and food and alcohol habits are correlated, they may be confounders for each other in analyses of risk factors for diseases with complex and multifactorial etiology (e.g. breast or colorectal cancer).

Adult↗
PubMed1990

The effect of parental and maternal-fetal histocompatibility at MHC on sex ratio in offspring.

The secondary sex ratio (male births of total births) variation was investigated as a function of MHC antigens. Previous studies have indicated that at conception male zygotes are more frequent than female ones and abortions of male fetuses prevail. The present investigation addresses the question whether the histocompatibility relationships either between parents or between mother and offsprings may favor or hinder the outcome of pregnancy: particular combinations may cause distortions in the sex ratio. The results of the analysis of a sample of fertile families, demonstrate that, in first parities, female births are favored when parents share antigens at both HLA-A and -B loci (S.R. = 0.389), and mothers and fetuses share antigens at the HLA-B locus (S.R. = 0.222). The lack of antigens shared by parents at the three loci HLA-A, -B and -DR increases first male births (S.R. = 0.696). In the case of fetal maternal histocompatibility at DR locus only a slight, non-significant, increase in male first births (S.R. = 0.667) was observed. The effect of histocompatibility at HLA-B locus alone requires further investigation in order to assess the possible selective effect against male histocompatible embryos.

Embryo, Mammalian↗
PubMed1996

Population policies and reproductive patterns in Vietnam.

BACKGROUND: Vietnam's population policy since the 1980s had stipulated a limit on family size to two children, born 3-5 years apart, and recommends a minimum age of 19 for the mother of a first child. We analysed trends in the timing of marriages and births, and in fertility and abortion rates, among women born between 1945 and 1970, to assess the impact of these policies on reproductive patterns. METHODS: Reproductive histories were recorded in a random sample of 1432 married women aged 15-49 in a rural province in northern Vietnam. Mean age at marriage and at birth of the first child, birth intervals, fertility, and abortion rates were examined in relation to the woman's year of birth. FINDINGS: Later-born women married and had their first child at a younger age than women born earlier. Birth intervals had increased among later-born women but 25% still had only a 1-year interval between first and second child. Fertility had gradually decreased while abortion ratios had increased rapidly. Childbearing patterns had become "earlier, longer, and fewer" rather than "later, longer, and fewer" as stipulated by the policies. The results also show that women with more schooling married and had their first child later. Women involved in farming had shorter spacing between children. INTERPRETATION: There are signs that Vietnam's population policy has focused too strongly on contraception and abortion while ignoring the connection between fertility and women's opportunities for education and employment. In these respects, rural women are at particular risk.

Abortion, Induced↗
PubMed2002

Perinatal predictors of respiratory symptoms and lung function at a young adult age.

A longitudinal cohort of 2,957 babies, born in 1975-1978, was used to investigate whether perinatal factors predict respiratory morbidity at a young adult age. In 1997, the presence of asthmatic (wheeze, nocturnal dyspnoea) and bronchitic (cough, phlegm, dyspnoea grade 3) symptoms and the level of lung function was determined in this cohort. The independent association between smoking during pregnancy, being first-born, birth weight and respiratory symptoms and lung function at young adult age was investigated using multiple regression models, taking other potential risk factors into account. Of 1,568 responders, 608 (39%, aged 18-22 yrs) had at least one respiratory symptom. The young adults who had a mother that smoked during pregnancy had a significantly lower level of lung function than their nonintra-uterine exposed peers (regression coefficient (B) (standard error): peak expiratory flow (PEF) -0.257 (0.131) L x s(-1); forced expiratory flow when 25% of the forced vital capacity has been exhaled (FEF25) -0.290 (0.129) L x s(-1)), although they were not at increased risk of having respiratory symptoms. Young adults who were first-born had better levels of lung function (B (SE): forced expiratory volume in one second (FEV1) 0.090 (0.042) L) and were less likely to have asthmatic symptoms (odds ratio (95%, confidence interval): 0.58 (0.35-0.95)) than those not first-born. Low birth weight (FEV1 -0.013 (0.004) L for a reduction of 100 g) was also predictive of reduced achieved levels of lung function at young adult age, independent of other potential risk factors, e.g. current smoking habits or familial predisposition. This study adds to the knowledge of the role of perinatal factors, such as smoking during pregnancy, as important predictors of respiratory morbidity.

Adolescent↗