[Care of premature infants and nursing--lessons from premature infant care: based on records of clinical training in premature infant care for midwifery students].
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Humans↗
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The mechanical properties of prematurely and non--prematurely ruptured membranes. Methods and preliminary results.
The mechanical properties of the chorioamniotic membranes have been studied by several investigators over the past 100 years. No relationship between membrane strength, as measured by rupture tension, and premature or non-premature rupture of the membranes has been demonstrable. In the present study, several measures of the mechanical properties of the chorioamniotic membranes were examined. These included thickness, rupture tension, work to rupture, strain to rupture, and moduli of elasticity (Young). Prematurely and non-prematurely ruptured membranes differed with respect to thickness near the rupture site and Young's modulus near the placenta. Differences between the groups for the other parameters were not significant. This study suggests that there may be inherent differences between membranes which rupture prematurely and those which do not.
Biomechanical Phenomena↗
[Clinical problems of premature labor. 1. Diagnosis of threatening premature labor and the screening procedure].
At first the allround etiology of premature birth is explained in the paper. There are to distinguish three groups: 1. Causes with known etiologic mechanism. 2. Causes with partly known etiologic mechanism. 3. Dispositions for premature birth. These are concluded from statistically investigations. In the last group are collected the patients from which are established some known scores for diagnosis of the risk of premature birth. All the scores but have a detriment. If they want to detect about 90% from premature births one must carry out examination and observation about 40% from all pregnant women. For this the scores are not suitable for selection of patients to observe in a special consultation. The organised care for pregnant women must be in such a way that all the criterias of imminent prematurity will be detected. This way has been successfull in our hospital.
Adolescent↗
[Premature rupture of fetal membranes and premature labor].
The portion of early rupture of the membranes among 521 premature births from 1962 to 1971 was 43.4%. The statistically sure effects of the early rupture of the fetal membranes to some irregularities in pregnancy and delivery on 214 premature births are reported, compared with 202 premature births without early rupture of the membranes. Twins are not considered. The therapeutic management of that time in the hospital consisted of staying in bed without tokolytics or antibiotics. After premature rupture of fetal membranes occured very often: irregular obstetrical presentation, hemorrhage and fever during labour, cesarean section and forceps delivery; the perinatal morbidity was increased. From that aspects for prophylaxis and therapy were deduced.
Amniocentesis↗
[Clinical studies on imipenem/cilastatin sodium in the early therapy of preterm premature rupture of the membrane or threatened abortion and premature delivery].
The efficacy and safety of early therapy with imipenem/cilastatin sodium (IPM/CS) were studied in patients who had chorioamnionitis with preterm PROM or threatened abortion and premature delivery. The following results were obtained. 1. The clinical efficacy of IPM/CS administered by intravenous drip infusion at daily dosages of 1 to 2 g as concurrent treatment with antiuteronics (ritodrine hydrochloride or terbutaline sulfate) was studied in patients with threatened abortion and premature delivery in the 11th to 34th week of pregnancy (n = 9), or premature PROM in the 23rd to 36th week (n = 9). 2. Response to IPM/CS were good in all of the patients with threatened abortion and premature delivery. Latent periods were prolonged for more than 7 days in 44.4% (4/9) of the patients with preterm PROM. 3. Changes in elastase appeared to be significant as those in CRP for inflammatory markers. 4. These findings combined with our previous results indicate that treatment of preterm PROM before the 32nd of pregnancy prolongs the latent period.
Abortion, Threatened↗
Haemophilus influenzae amnionitis associated with prematurity and premature membrane rupture.
Prematurity and premature rupture of the membranes present major obstetric problems. When associated with amnionitis, the result may be disastrous. A case of Haemophilus influenzae aminionitis in association with premature rupture of the membranes is presented. The rarity of this organism as a causative agent in amnionitis and its possible causative role in premature membrane rupture are considered in review of the scant relevant literature.
Adult↗
Erythropoietic progenitor cells from premature neonates studied using a validated serum-deprived medium. Evidence that peripheral blood BFU-E from premature neonates are increased in number and are highly dependent upon burst promoting activity for in vitro growth.
We have examined a serum-deprived culture system in order to verify that it is suitable for the study of burst forming unit erythroid (BFU-E) progenitor cells from premature neonates. Optimum growth of BFU-E from premature neonates was observed with each media constituent using the same concentration as that previously described for adult subjects. Growth of immature BFU-E from premature neonates were highly dependent upon a source of Burst Promoting Activity and mature BFU-E derived colonies emerged at day 12 compared to day 14 in adults. Our preliminary results with the validated medium suggest that premature infants have increased peripheral blood concentrations of BFU-E compared to healthy adult controls.
Adult↗
[Investigations on the utilization of parenterally administered amino acids by premature and small-for-dates neonates. I. Free amino acids in the blood of premature and small-for dates neonates (author's transl)].
The fasting levels of free amino acids were determined in the serum of 23 premature and 7 small-for-dates newborns during the first 4 weeks of life. This was done by ion-exchange chromatography after ultrafiltration of the serum, which allowed quantification. Differences were recognized in regards to age, and nutritional state: 1. Small-for-dates newborns at term showed significantly lower asparagine and glycine levels when compared to hypotrophic prematures. 2. Leucine was lower in male than in female prematures. 3. Leucine and phenylalanine were lower in hypotrophic than in eutrophic prematures. 4. Nearly all investigated fasting amino acid levels were highest in the 3rd week of life. A decrease was observed during the 4th week of life. Threonine, Proline, Alanine, Valine, Isoleucine, Lysine and Arginine were significantly higher in the 3rd compared to the 1st week.
Age Factors↗
Clinical use of the LH-RH in assessing gonadotropic reserve in children with idiopathic precocious puberty, premature thelarche and premature adrenarche.
Serum LH and FSH were assayed in 31 girls with normal pre puberty, precocious puberty, premature thelarche, and premature adrenarche, aged 2 to 9 years. The effect of synthetic luteinizing hormone-releasing hormone (LH-RH) on serum gonadotropins was evaluated in eleven of them. In all girls with precocious puberty, serum LH was increased up to high levels. The mean releasable LH in two girls with idiopathic precocious puberty was significantly greater than in normal prepubertal or pubertal children. Basal FSH in children with precocious puberty was within the limits of normal prepuberal children, and FSH secretion in response to LH-RH was not significantly greater than in the group of normal prepubertal and pubertal girls. In children with premature thelarche and premature adrenarche, basal levels of LH and FSH, as well as gonadotropin response to LH-RH were in the prepubertal range. These preliminary results show that the LH-RH test might be of clinical value in differenitating abnormal puberal development.
Age Factors↗
Ocular cosmesis in retinopathy of prematurity. The Cryotherapy for Retinopathy of Prematurity Cooperative Group.
We report the externally apparent outcome in the natural history cohort (n = 4099) that was followed up prospectively in the Multicenter Trial of Cryotherapy for Retinopathy of Prematurity. The overall incidence of an adverse cosmetic outcome in the survivors who were examined 12 months post term (n = 2759) was 15.1%. Adverse cosmetic outcomes included strabismus (12.8%), nystagmus (3.3%), total retrolental membrane (1%), epiphora (0.6%), corneal opacity (0.6%), cataract (0.3%), and episcleral hyperemia (0.3%). A comparable subgroup examined 24 months post term showed strabismus (14.4%), nystagmus (2.2%), epiphora (0.5%), corneal opacity (0.7%), cataract (0.5%), episcleral hyperemia (0.5%), lid fissure asymmetry (2.4%), and corneal diameter asymmetry (2.0%). The rate of adverse aesthetic outcome was greatest in eyes that had developed more severe acute retinopathy of prematurity and an unfavorable structural outcome. In patients with bilateral threshold retinopathy of prematurity who underwent no therapeutic ocular procedures, other than randomized assignment to undergo cryotherapy in one eye, more frequent adverse cosmetic outcomes were found in the untreated eyes.
Acute Disease↗
[Premature rupture of the membranes and RDS incidence in prematures (author's transl)].
In the years 1974, 1975 and 1976 495 children were born alive with a birthweight less than 2500 g in the Ist Department of Gynecology and Obstetrics of the University of Vienna. We selected all cases with dystrophy or factors, which were a disposal for RDS, so we got a rest of 188 prematures with a weight from 1000 g to 2500 g. For these children we checked the influence of time of rupture of the membranes (ROM) before delivery to the incidence of RDS. We found a lower incidence of RDS of the newborns when duration of ROM exceeded the time of 12 hours. This fact was statistically significant in the class of premature newborns with a weight of 1500 g to 2000 g. The similar trend was found in 119 dystrophic newborns with a weight between 1000 g to 2500 g, although there was no statistical significance. No influence of duration of labor on the incidence of RDS neither in selected premature nor dystrophic newborns was found.
Birth Weight↗
Fetal lung maturity. I. Mode of onset of premature labor. Influence of premature rupture of the membranes.
In a prospective study of 133 spontaneous premature deliveries the relation between premature rupture of the membranes (PRM) and development of respiratory distress syndrome (RDS) in newborn infants is examined. PRM is associated with a significantly decreased incidence of RDS in newborn infants (P less than 0.002). This relation is valid at a gestational age of 28 weeks or more and a birthweight greater than 1000 g. Total respiratory morbidity in newborn infants (transient tachypnea + RDS) is also significantly decreased when labor is associated with PRM (P less than 0.005). Assessment of the influences of sex of the infant, fetal asphyxia, and delivery by cesarian section shows that PRM bears a stronger relation than each of these individual factors to a decreased incidence of RDS. Duration of the latent period has no influence on protection from RDS, and it is suggested that fetal lung maturity occurs before the membranes rupture.
Birth Weight↗
[Relationship between premature labor and maternal age, as well as between premature labor and parity].
Various publications of the last years and own studies, too demonstrate that birth rank and maternal age, as well, in each case independently influence the risk of prematurity. The rate of prematurity for primiparous and multiparous women is above the average; it is just the same for very young and comparatively old women. Basing on a review of literature eventual causes are briefly discussed.
Female↗
In vitro effects of inosine-pyruvate-phosphate on P50 values and DPG contents of fresh and stored blood from healthy neonates, symptom-free premature infants and premature infants with respiratory distress syndrome.
A study was made of the effect of a 3-hour incubation with inosine-pyruvate-phosphate (IPP) on the P50 values and 2,3-DPG contents of fresh blood and blood which had stood for 96 h, from healthy adults, term neonates, 1-2-week-old symptom-free premature infants and RDS premature infants. It was found that the P50 value and the 2,3-DPG content could be increased considerably by IPP treatment in both the fresh and the stood blood in the various groups of neonates. The question remains open as to whether the effect of IPP, in significantly improving the O2 transport in neonates, is a consequence of the 2,3-DPG alone or of some other metabolite. In RDS the stimulating effect of the IPP mixture is appreciably lower.
Adult↗
The mechanism of supraventricular tachycardia induced by a single premature beat in the isolated left atrium of the rabbit. I. Circus movement as a consequence of unidirectional block of the premature impulse.
In the isolated left atrium of the rabbit tachycardia could be elicited by a single stimulus shortly after the refractory period. The activation pattern of the preparation was mapped by means of multiple extracellular recordings. It could be demonstrated that a circus movement of the activation in a relatively small part of the atrial myocardium was responsible for the tachycardia. This phenomenon was studied on a cellular level with multiple microelectrode recordings. The impulse of the premature beat, when followed by a tachycardia, was one way only, while in the other directions the conduction failed completely or occurred with such decrement that the impulse died out. These differences in conductivity were connected with spatial differences in the refractory period. Therefore the excitability of the fibers surrounding the stimulating electrod was not restored to the same level at the moment the premature beat was elicited. Spatial dispersion in the refractory period was important for the occurrence of unidirectional block and thus for the initiation of circus movement and tachycardia.
Action Potentials↗
[Induction of lung maturation in pending premature delivery and scheduled premature delivery].
At the Women's Hospital of the Medical Academy of Erfurt we have examined the efficiency of dexamethasone on fetal lungs maturation at imminent premature birth and planned untimely delivery. Dexamethasone was given in a randomized series at a dosage of 12-mg per day orally on three successive days. The effectiveness of induction was measured at the percentage of the total phospholipid fraction in the amniotic fluid and at the mortality of RDS in both groups. A successful induction with dexamethasone we can only reach after the 32nd week of pregnancy.--Because this effect is not always continuous, we recommend to make the induction of fetal lungs maturation with dexamethasone and--if it necessary--its repetition after one week conditional upon the content of total phospholipids in amniotic fluid.
Adult↗
Regressed retinopathy of prematurity: the relationship between clinical risk factors of the newborn period and regressed retinopathy of prematurity severity in a preterm born population of Stockholm county 1976-81.
In a retrospective study, clinical risk factors of the neonatal period were correlated with the severity of regressed retinopathy of prematurity (ROP) in a population of preterm infants (bw less than 1500 g and or gestational age less than 33 weeks). At the age of 5-11 years 134 out of 528 preterm born infants (25.4%) were found to be under ophthalmic care. Reliable information on eye fundus status could be obtained in 105 of them. Regressed ROP was found in 61, the moderate form in 48 (9.1%) and the severe form in 13 (2.5%) patients. Twelve patients (2.3%) had visual acuity of less than 0.3 on the worst eye and two (0.4%) of these patients were blind from ROP. Twenty-four clinical factors of the newborn period were correlated with the severity of regressed ROP. The results suggest that long oxygen exposure in combination with other factors interfering with retinal vasotonus are associated with the degree of the disease developed.
Birth Weight↗
[The fate of very early premature babies. Mortality, morbidity and 2-year follow-up in a population of 96 very early premature babies].
The neonatal fate, and outcome at 2 years in a population of 96 premature babies born after no more than 28 weeks of amenorrhea is described. Mortality was directly influenced by the gestational age (< 26 WA = 52% vs. > or = 26 WA = 21.1%, p < 0.01) and the birth weight (< 1,000 g = 41.5% vs. > 1,000 g = 20%, p < 0.05). Two other factors with a harmful impact were identified: retarded growth (neonatal mortality doubled) and fetal multiplicity (increased fourfold). Investigation of the neonatal morbidity highlights the importance of respiratory, neurological and digestive problems. Assessment of the longer-term outcome has shown an 11.3 p. cent incidence of handicap. An estimation of the prognosis on the basis of gestational age is proposed.
Apgar Score↗