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PubMed1998

Preterm infants 30-36 weeks' gestation in Victoria--where should they be delivered?

There is little doubt that very preterm infants <30 weeks' gestation should be born in level-3 perinatal centres. For preterm infants 30-36 weeks' gestation, however, the optimum place of birth is not so clear-cut. The aims of this study of livebirths 30-36 weeks' gestational age born in Victoria were to determine: 1) the proportions delivered outside level-3 centres, and 2) for infants born outside level-3 centres, the proportions transferred after birth to a level-3 nursery in the first days after birth. Data on the number of livebirths 30-36 weeks' gestational age in Victoria in the 3 years 1994-1996, inclusive, were supplied by the Victorian Perinatal Data Collection Unit. Data were obtained from the Newborn Emergency Transport Service (NETS) on all transfers within the first 3 days after birth to a level-3 centre for infants born outside level-3 centres. For the 3 years 1994-1996 there were 11,375 livebirths 30-36 weeks' gestational age in Victoria. The proportion born outside a level-3 perinatal unit was 57.9% overall, and rose with increasing gestational age, from 10.9% at 30 weeks to 69.0% at 36 weeks. Of the 6,587 livebirths outside a level-3 centre, 808 (12.3%) were transferred within the first 3 days after birth by NETS to a level-3 centre, the proportions falling with increasing maturity, being 73.7%, 48.5%, 28.4%, 26.9%, 18.8%, 11.8%, and 7.0% at 30, 31, 32, 33, 34, 35, and 36 weeks, respectively. These data may help medical practitioners when determining the place of delivery for infants 30-36 weeks' gestation.

Delivery Rooms↗
PubMed2000

Modeling the effects of maternal nutritional status and socioeconomic variables on the anthropometric and psychological indicators of Kenyan infants from age 0-6 months.

This paper presents a comprehensive empirical analysis of the factors affecting growth and psychological development of over 100 infants from birth to age 6 months in the Embu region of Kenya. The analysis was divided into four parts. First, infants' birth weight, and length and head circumference as measured few days after birth, were modeled using multiple regression models. Maternal prepregnancy body mass index (BMI), gestation period, and parity were associated with infants' anthropometric measurements (P < 0.05). Second, the scores on seven clusters of the Brazelton Neonatal Behavioral Assessment Scale were explained by health and socioeconomic indicators. While the models had poor predictive power, the scores were comparable to those reported in the literature for Puerto Rican and African American infants. The third part of the analysis modeled infant growth between 1-6 months by analyzing longitudinal data on length, head circumference, and weight. Dynamic models were postulated for the effects of nutritional, socioeconomic, and environmental factors and morbidity on anthropometric variables. The results showed that infants' calcium intakes were positively associated with length (P < 0.05). Maternal BMI and hemoglobin concentration were positively associated with infant weight (P < 0. 05); infant morbidity was negatively associated with weight (P < 0. 05). Lastly, the infants' scores at 6 months on the Bayley Motor Scale and on eight items from the Bayley Infant Behavior Record were explained using anthropometric, socioeconomic, and psychological variables. The infants' arm circumference and intake of protein were significant predictors of scores on the Bayley Motor Scale. In addition, time spent by the mother talking to the infant was positively associated with the scores on the Bayley Infant Behavior Record. The empirical results have implications for identifying vulnerable children in developing countries.

Adult↗
PubMed1987

Respiratory effects of a patent ductus arteriosus in premature newborn lambs.

We examined the respiratory effects of a patent ductus arteriosus in 29 premature lambs (131-135 days gestational age) after infiltrating the ductal wall with formaldehyde solution (Formalin) and placing a snare around the ductus to regulate its patency. The lambs were given sheep surfactant, paralyzed, and mechanically ventilated at birth. We first compared 8 lambs with open ductus and 13 lambs with closed ductus during the 12 h after birth. Although lambs with open ductus had greater pulmonary blood flow (301 +/- 36 vs. 188 +/- 11 ml.min-1.kg-1, mean +/- SE, at 12 h of age) and mean pulmonary arterial (44 +/- 3 vs. 33 +/- 2 mmHg) and left ventricular end-diastolic (6 +/- 0.6 vs 4 +/- 0.7 mmHg) pressures, we found no differences in dynamic respiratory compliance (Cdyn = 0.55 +/- 0.07 vs. 0.55 +/- 0.03 ml.cmH2O-1.kg-1), midtidal volume resistance (62 +/- 5 X 10(-3) vs. 62 +/- 7 X 10(-3) cmH2O.ml-1.s), or functional residual capacity (FRC = 27 +/- 3 vs. 26 +/- 2 ml.kg-1). Alveolar-arterial PO2 difference was lower in the lambs with open ductus (238 +/- 65 vs. 362 +/- 37 Torr). Next, we challenged eight lambs with two separate saline infusions (50 ml.kg-1 over 3 min), each given with the ductus alternately closed or open. When the ductus was closed, FRC was unchanged, but Cdyn increased by 18% immediately after the infusion. When the ductus was open, FRC decreased by 16% and Cdyn decreased by 12%. We conclude that the premature lamb is surprisingly resistant to changes in respiratory function from ductal patency during the immediate neonatal period.

Animals↗
PubMed1989

Childbirth spacing in a rural community of Delhi: profile in various marriage cohorts by decades.

Complete retrospective fertility histories of 843 ever married women of two villages in Delhi, obtained through house to house survey, were analysed to study various marriage cohorts by decades for trends of child birth spacing over a period of 60 years from 1921 to 1980. Spacing between consummation of marriage and first child birth gradually declined over the last 6 decades. For all other subsequent livebirths remained constant at an average of nearly 30 months. Irrespective of the reasons for such a trend, much more efforts are required to be put in to increase child spacing.

Adolescent↗
PubMed1983

Epidemiology of minimal breast cancer.

A case-control study conducted within the Breast Cancer Detection Demonstration Project allowed comparison of epidemiologic factors for benign breast diseases (n = 1,404), in situ cancer (n = 199), small (less than or equal to 1 cm) invasive cancer (n = 210), and larger invasive cancer (n = 788). Control subjects consisted of program participants who were not recommended for breast biopsy. Relationships were similar for small and larger invasive tumors, both showing associations with family history of breast cancer, age at first live birth, history of bilateral oophorectomoy, and obesity. In situ cancer was affected by family history and age at first childbirth but not by oophorectomy or obesity. These findings support the notion that "minimal" breast cancer is indeed cancer. In addition, the results suggest that hormonal influences early in life may initiate the carcinogenic process, while those that operate later may enhance the progression from in situ to invasive disease.

Adult↗
PubMed1993

Factors influencing infant mortality in Vietnam.

Selected determinants of overall infant mortality in Vietnam were examined using data from the 1988 Vietnam Demographic and Health Survey, and factors underlying neonatal and post-neonatal mortality were also compared. Effects of community development characteristics, including health care, were studied by logistic regression analysis in a subsample of rural children from the 1990 Vietnam Accessibility of Contraceptives Survey. Infant neonatal and post-neonatal mortality rates showed comparable distributions by birth order, maternal age, pregnancy intervals, mother's education and urban-rural residence. Rates were highest among first order births, births after an interval of less than 12 months, births to illiterate mothers and to those aged under 21 or over 35 years of age. Logistic regression analysis showed that the most significant predictor of infant mortality was residence in a province where overall infant mortality was over 40 per 1000 live births. In the rural subsample, availability of public transport was the most persistent community development predictor of infant mortality. Reasons for the low infant mortality rates in Vietnam compared to countries with similar levels of economic development are discussed.

Adolescent↗
PubMed1980

RBC values in low-birth-weight infants during the first seven weeks of life.

Hemoglobin, RBC mean corpuscular volume (MCV), and other RBC indices were studied in a group of 40 infants, each with a birth weight of less than 1,500 g. Results indicated that the hemoglobin level fell from 18.2 +/- 2.7 g/dL at birth to a low of 9.5 +/- 1.5 g/dL at 6 weeks of age. During this time, the MCV declined from 115 +/- fentoliters (fL) to 97 +/- 5 fL and did not again rise as the hemoglobin stabilized. Although the decline in MCV may simply reflect an aging RBC population, these data raise the possibility that RBC size may in part be determined by postnatal factors independent of time from conception.

Erythrocyte Indices↗
PubMed1991

The fetal maturity and mode of delivery of a woman's first baby influences the characteristics of her next labour.

There are well documented differences between the characteristics of labour in primigravidae and multigravidae. The present study was undertaken to determine whether the gestational age and mode of delivery of a woman's first baby influences the characteristics of labour in her next pregnancy. Information regarding previous obstetric history and subsequent obstetric performance was derived from a database of 75,974 consecutive singleton births. As a group, women with a history of one preterm vaginal delivery had labour characteristics similar to those women whose one previous pregnancy had resulted in a vaginal delivery at term. When this group were analysed by the gestation at which the previous birth had occurred, a gestation-dependent effect was seen. Women whose first birth had been at less than 28 weeks gestation behaved in a similar manner to primiparous women. On the other hand, the characteristics of labour in women whose first birth had occurred between 33 and 36 weeks gestation were similar to those of women who had had a previous vaginal delivery at term. Women whose first delivery had been by caesarean section behaved in a similar manner to primiparae. The typical differences between the characteristics of first and second labours are the result of a gradual change which appears to be related to the gestation at which the first birth occurred.

Adult↗
PubMed1978

Postnatal development and differentiation of the opossum submandibular gland.

The postnatal development and differentiation of the submandibular salivary gland has been examined in sixteen groups of young opossums. At birth the glandular elements, dispersed in loose connective tissue, consist only of ducts that are immature in appearance and of irregular secretory end-pieces. Development occurs in two phases, the first from birth to approximately 31 days postnatum, and the second thereafter. During the first phase the ductular elements show separation into intercalated and intralobular ducts, and attain structural maturity. The larger ducts are concentrated centrally within each lobule and lie in a markedly vascular connective tissue. The secretory end-pieces, initially acinar in form, are lined by proacinar cells which exhibit intercellular canaliculi at the lateral cell membranes and a few dense granules in the apical cytoplasm. During the second phase of development extensive changes occur within the secretory end-pieces, which elongate to form a system of branching tubules. Component cells show an increased granular content, and those in the main body of the tubules differentiate into mucous cells. By 34 cm postnatum the proacinar cells in the bulbous endings of the tubules are replaced by special serous cells possessing intercellular canaliculi and secretory granules which are either electron-lucent or electron-dense. The sequence of changes that occur during postnatal development is discussed and related to possible functional activities. The early development of the ducts may be correlated with their role in homeostasis, while the later development of secretory tubules and the differentiation of secretory cell types may be related to the onset of weaning, and may possibly be induced by this major change in dietary habit.

Age Factors↗
PubMed1990

Idiopathic thrombocytopenic purpura in pregnancy: a randomized trial on the effect of antenatal low dose corticosteroids on neonatal platelet count.

OBJECTIVE: To determine the efficacy of antenatal low dose oral betamethasone in preventing neonatal thrombocytopenia and/or bleeding in infants of mothers with idiopathic thrombocytopenic purpura (ITP). SETTING: Hospital department of obstetrics and gynaecology, referral centre. PATIENTS: 41 pregnancies in 38 women were randomized. The results of 13 pregnancies were considered non-assessable. The final analysis involved 14 in the betamethasone group and 14 in the non-treatment group. All fulfilled the criteria for ITP. INTERVENTIONS: The treated group received 1.5 mg betamethasone orally per day, from day 259 till day 273 and 1 mg from day 273 till delivery. MAIN OUTCOME MEASURES: Effects of treatment were assessed in terms of maternal platelet counts after the first trimester and neonatal platelet counts at birth and the first week of life and neonatal bleeding episodes. RESULTS: There were no significant differences in neonatal platelet counts at birth. Two infants in the betamethasone group and one in the untreated group had a severe thrombocytopenia either at birth or during the first week of life (less than 50 x 10(9)/l). Seven infants in the betamethasone group and six in the non-treatment group had a mild thrombocytopenia. The overall frequency of neonatal thrombocytopenia was similar: 64% in the betamethasone group and 57% in the untreated group (95% CI of the true difference: -43.5% to +29.5%). There was also no significant difference in neonatal bleeding episodes. CONCLUSIONS: Low-dose betamethasone in pregnant women with ITP does not prevent thrombocytopenia or bleeding in their newborn infants.

Adult↗
PubMed1992

[Weight gain in the first 2 months of life in neonates with a birth weight less than or equal to 1500 g. A comparison between parenteral nutrition and orogastric feeding].

This study was designed to verify the effectiveness of parenteral nutrition (NP) and continuous nasogastric feeding (AOG) in providing a good caloric intake and a good growth in the very low birth weight infants during the first 60 days of life. The study included 108 preterm babies with birth weight less than or equal to 1500 g: 26 received parenteral nutrition, 82 nasogastric feeding. Infants in NP showed a smaller postnatal weight loss and regained birth weight earlier than the AOG group. Caloric intake greater than 120 kcal/kg/die was achieved in 10.2 days of life in the NP group and in 14.1 days in the AOG group. Full enteral feeding was achieved later in the NP than in the AOG group (25.7 days vs 20.7 days). Weight gain at 60 days of life was better in the NP group (23.2 g/die vs 18.2 g/die), while there was no difference in the head circumference gain. The study shows the efficacy of NP in providing a good caloric intake in the very low birth weight infants in the first weeks of life.

Energy Intake↗
PubMed2000

Changes in concentrations of plasma immunoreactive follicle-stimulating hormone, luteinizing hormone, estradiol-17beta, testosterone, progesterone, and inhibin in heifers from birth to puberty.

This study was designed to clarify the characteristics of changes in plasma concentrations of reproductive hormones in heifers from birth to puberty. Weekly or daily hormonal changes were observed in 39 heifers. Daily changes in the concentration of follicle-stimulating hormone (FSH) demonstrated a consistent cycle of hormone changes over a 7- to 8-day period in heifers from approximately 10 days to 9 months old. Weekly changes in reproductive hormones showed that there were three brief periods in heifers between birth and puberty in which dramatic changes occur. The first period was the first week after birth, during which a reciprocal relationship between steroid hormones and gonadotropins was observed. At birth, the concentrations of steroid hormones were higher than those at any other age. These hormone levels rapidly decreased within the first week after birth. Gonadotropin levels, however, increased from birth to 1 week of age. The second period of major change was at approximately 4 weeks of age when there was an increase in the concentrations of luteinizing hormone (LH), estradiol-17beta, testosterone, and immunoreactive inhibin. The third period was the last 5 weeks before the first ovulation, when there was an increase in the concentrations of estradiol-17beta followed by an increase in (LH). These results suggest that regular hormone changes start from 10 days after birth and that the periods from birth to 4 weeks of age and the last 5 weeks before the first ovulation in heifers are important to the development of reproductive functions before puberty.

Animals↗
PubMed1991

Birth order, family size, and achievement: family structure and wage determination.

The influence of birth order and childhood family size on future achievement is discussed. Two major empirical findings are presented by the author. "First, neither birth order nor childhood family size significantly influences the level or growth rate of wages, a result that is consistent with previous research. Second, family size is both a statistically and economically significant determinant of women's employment status: women from small families work less than women from large families when they are young and more than women from large families when they are more mature." The geographical focus is on the United States.

Americas↗
PubMed2004

Breeding season in female cats acclimated under a natural photoperiod and interval until puberty.

The breeding season was investigated in 174 female cats that were acclimated under a natural photoperiod, and determined the interval between birth and initial estrus (puberty) was determined in 125 cats. Although the breeding season differed noticeably among individual animals, the mean was 180.4 +/- 3.0 (SE) days between the end of January and the end of July. The interval between birth and first estrus ranged from 181 to 560 days, with a mean of 345.0 +/- 0.9 days. With respect to month of birth, the mean interval was 343.0 +/- 9.5 days in cats born between March and June. Among cats that were born between July and October, the mean intervals were 242.0 +/- 6.3 days in cats that exhibited estrus the year after birth and 519.2 +/- 5.8 days in those that exhibited estrus 2 years after birth.

Animals↗
PubMed1980

Prevalence of prior hysterectomy in the Seattle-Tacoma area.

Hysterectomy is the most common major surgical procedure performed in the United States. The frequency of hysterectomy among women in the general population is of interest because it affects the population at risk for uterine diseases and because the procedure itself carries significant personal and socioeconomic consequences. We studied factors related to the occurrence of hysterectomy by interviewing a representative sample of women ages 35-74 (n= 1087) in two urban Washington counties during 1976-1977.One-third of the women studied had had a hysterectomy. Later birth cohorts were at higher risk. The ageadjusted prevalence of prior hysterectomy was negatively associated with education and age at first childbirth; it was positively associated with parity, history of irregular menses, and history of a variety of other health conditions. Contrary to expectation, income was negatively associated with hysterectomy rates in one county and showed no association in the other. Part of the income effect was due to confounding by age at first childbirth, which was a surprisingly strong predictive factor. WE CONCLUDE THAT: 1) despite economic predictions based on the discretionary nature of the procedure, hysterectomies are not necessarily more common among high-income women; 2) age at first childbirth may be a more important risk factor for uterine disease than previously thought; and 3) estimates of hysterectomy frequency based on clinic populations may be misleading. (Am J Public Health 70:40-47, 1980.)

Adult↗
PubMed2004

Maternal exposure to first-trimester sunshine is associated with increased birth weight in human infants.

Two alternative hypotheses have been generated to account for seasonal variation in the birth weight of human infants born in industrialized countries. First, it has been hypothesized that low ambient temperature during the second trimester of gestation decreases birth weight. Second, it has been hypothesized that exposure to bright sunshine during the first trimester increases birth weight. We tested these two hypotheses to determine which, if either, accounted for seasonal variation in birth weight of full-term infants. Birth weight data, collected over a 5-year period, were analyzed as a function of peak and trough sunshine and ambient temperature. Although there was no effect of ambient temperature during any trimester on birth weight, infants whose mothers were exposed to peak sunshine during their first trimester were born significantly heavier than infants whose mothers experienced trough levels of sunshine during the same trimester. Furthermore, infants whose mothers were exposed to trough levels of sunshine during their second and third trimesters were born significantly heavier than infants whose mothers were exposed to peak levels of sunshine during the same trimesters. We hypothesize that high levels of sunshine during early gestation may increase the level of insulin-like growth factor (IGF)-1, facilitating prenatal growth.

Adult↗
PubMed1994

Effect of maternal smoking on birth weight of twins: a study from the Dutch Twin Register.

Since twins weigh about 20% less than singletons at birth, maternal smoking may be a more severe risk for them than for singletons. Therefore, the effect of maternal smoking during pregnancy on birth weight was investigated in a group of 5376 twins. All necessary information was collected by a questionnaire filled out by the mother of the twins. Gestational age explains more than 75% of the variance in birth weight. Other effects were tested with gestational age as a covariate. Apart from zygosity (DZ twins weigh more than MZ twins), birth order (first born twins weigh more than second born twins) and sex (boys weigh more than girls), there was a very significant birth weight reducing effect (more than 8%) maternal smoking as well as a significant influence of maternal age (young mothers give birth to smaller children). There were no interactions with maternal smoking.

Birth Weight↗
PubMed2000

Trends in reproductive, smoking, and other chronic disease risk factors by birth cohort in a large occupational study.

PURPOSE: To illustrate the value of using large cohort studies to identify birth cohort trends in several chronic disease risk factors.METHODS: In collaboration with the American Registry of Radiologic Technologists (ARRT) and the University of Minnesota, the National Cancer Institute (NCI) initiated a cohort study of radiologic technologists who were certified by ARRT for at least two years between 1926 and 1982. Over 90,000 technologists (nearly four-fifths female) from all 50 states responded to a mailed questionnaire on reproductive, medical, work, and lifestyle factors. Ten, mostly five-year, birth cohorts, from before 1920 through 1960 and later, were evaluated.RESULTS: In this population, the mean height of both men and women generally rose in each subsequent birth cohort. The proportion of men who smoked before age 18 fell among those born since the late 1920s. In contrast, the proportion of women smoking before age 18 rose among those born since the early 1950s, reaching 14.2% among those born in 1960 and later. The mean age at menarche fell, until leveling off at 12.5, among those born after 1940. Recent birth cohorts (since 1950) show among the highest mean ages at birth of first child (>26 yeras), highest rates of nulliparity at age 25 (>/=63%), and lowest mean parity levels (</=1.7), compared with earlier birth cohorts. The proportion of women ever using oral contraceptives rose steadily by birth cohort, reaching 86 percent in the most recent birth cohort.CONCLUSIONS: Some of the trends observed may help explain historic chronic disease incidence patterns and predict future disease burdens.

Journal Article↗