Indicators of acid-base equilibrium of blood in full-term, premature and over-mature fetuses and newborn infants in different types of uterine inertia]

A detailed appraisal of the British seafarer and his way of life is described and the prevailing management of sexually transmitted disease in the seafarer is outlined. It is shown that the available statistics on the incidence of sexually transmitted disease among seafarers are inadequate. Management at sea and ashore remains generally unsatisfactory. Suggestions are made to improve the management of venereal disease in foreign ports and a simple method is described of managing sexually transmitted disease at sea with trimethoprim/sulphamethoxazole.     

Morphology of immune destruction of the erythrocytes in fetuses and newborn infants

In the second half of pregnancy destruction of erythrocytes as a result of immunological aggresion in the fetus may occur in different manners: hemolysis in the vessel bed, fragmentation of erythrocytes, phagocytosis of intact erythrocytes and their fragments. Intravascular hemolysis occurs in immature fetuses. At that, the products of erythrocyte decomposition (hemosiderin and lipofuscin) are accumulated in the epithelial cells of the liver and the kidneys, the pancreas, the thyroid and the thymus. Fragmentation of erythrocytes (anuclear forms alone) occurs in the red splenic pulp and less in the vessels of the other organs. This process has been observed in fetuses after 7 months of gestation. Phagocytosis of erythrocytes and their fragments is done mainly by macrophages of the red splenic pulp as well as macrophages of the bone marrow, lymph nodes, and the Kupffer cells of the liver. Massive and long-term effect of iso (rhesus) antibody results in inhibition of the phagocytary activity of macrophages. In such cases, destruction of erythrocytes occurs in the vessel bed by lysis.     

Antioxidant activity, packed cell transfusions, and outcome in premature infants

AIM: To evaluate the relative importance of biochemical markers of antioxidant status, gestational age, and parameters of neonatal care in the clinical outcome of premature infants. METHOD: A prospective, observational, longitudinal study of the association between these factors was conducted. Blood was collected from an in situ arterial line within two hours of birth and at intervals thereafter, when blood was drawn for routine clinical purposes. Outcome was assessed as death, or survival with or without bronchopulmonary dysplasia (BPD). One hundred and forty four babies of 22 to 39 weeks of gestation, who required intensive care at the Jessop Hospital for Women, between January 1993 and April 1994, were recruited. RESULTS: Low gestational age at birth was the most important predictor of mortality and the development of BPD. Having corrected for gestational age, low plasma antioxidant activity at birth was an independent risk factor for mortality. Plasma vitamin C at birth was significantly higher in the babies who died compared with those with a good outcome, but this effect was not sustained after correcting for gestational age. Repeated measures of Analysis of Variance revealed a postnatal increase in antioxidant activity, caeruloplasmin, retinol, cholesterol corrected alpha tocopherol, and red blood cell superoxide dismutase (SOD) activity. Vitamin C, on the other hand, declined in all groups after birth. Logistic regression analysis revealed that the greater the number of packed cell transfusions received during intensive care, and the higher the concentration of vitamin C on the second day of life, the greater the risk of developing BPD. CONCLUSIONS: After correcting for the effect of gestational age, low plasma antioxidant activity at birth was an independent risk factor for mortality. Frequent blood cell transfusions over the first week of life are associated with an increased risk of developing BPD. This association may be causal.     

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.     

The possibilities and dangers of longterm infusion therapy in severely ill newborn and premature infants

The development of pediatric intensive medicine in the past 10 years has today made it possible to carry out specific longterm infusion therapy even in severely ill newborn and premature infants. The present study discusses the various technical possibilities and indications for the introduction of a caval catheter in newborn and premature infants. Although we only used a caval catheter for longterm parenteral nutrition in 9 newborn infants from 1965 to 1969, improved techniques have enabled us over the past 2 years to choose this method in 43 newborn and premature infants presenting with a wide variety of clinical conditions. We conclude that the use of caval catheters still requires a very strong indication.     

Immuno-prevention in newborn infants and infants

The author describes two cases of ambulatory iliac phlebitis occurring in young women, one pregnant, the other taking synthetic oestrogen-progestogen drugs. Anti-coagulants were contraindicated because of the pregnancy in the first case, and because of practical obstacles to their correct use in the second. In consequence both cases were treated as outpatients by physical compression (Nard's method), without any anticoagulant medication : the results were striking and lasting.     

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.     

Clinical problems of premature labor. 2. Therapy of threatening and actual premature labor

The therapy of imminent prematurity needs specific treatment of the respective illness. Moreover there are three fundamental measures: 1. To appease the patients and to applicate sedatives. 2. To carry out tokolysis with medicamentes. 3. To carry out cerclage operation in order to close the uterine mouth. These possibilities must be combined in various ways dependent from the success in every individual case. These measures also are suit in prophylaxis, for example in disorders of former pregnancies. All schemes of therapy adapted to the individual case. The dosis must be determined from the effect of therapy. A particular view point must be the hospitalisation between 28. and 32. week of pregnancy in cases of twins or placenta previa. Also in cases of early rupture of amnion prolongation of pregnancy must be aspired.     

Disappearing suprarenal masses in fetuses and infants

This paper presents 12 infants (9 boys, 3 girls) in whom the diagnosis of a suprarenal mass (10 left, 2 bilateral) was made on antenatal sonography. All were otherwise healthy neonates who were born at term after a normal pregnancy, labor and delivery. The masses ranged from 1 to 3.5 cm in diameter on initial scans at gestational ages of 19-35 weeks. Eleven masses were hyperechoic and 4 of these contained small, well-defined cysts. The 12th was hypoechoic. Follow-up sonography showed complete disappearance of the mass antenatally in 1 case and postnatally by 4-6 months in 5 cases; there was marked diminution in the size of the mass by 2 months of age in 4 infants, by 4 months in 1 case and by 15 months in 1 case. Eleven were managed nonoperatively. Laparotomy (after disappearance of the mass) in the 12th case revealed only some fibrous tissue. The 11 echogenic masses resemble previously reported imaging findings in infants with histologically proven intra-abdominal sequestrated lung. Conservative management with careful sonographic follow-up should, therefore, be considered in otherwise healthy fetuses or neonates with these imaging findings. We are less certain what the hypoechoic mass represented.     

Impaired glutathione peroxidase activity accounts for the age-related accumulation of hydrogen peroxide in activated human neutrophils

BACKGROUND: As assessed by flow cytometry, the increase in hydrogen peroxide in individual neutrophils from old volunteers was significantly greater than in neutrophils from young volunteers. To explain the discrepancy in previous reports that showed reduced superoxide generation with age and our finding, we measured the kinetics of antioxidative enzymes. METHODS: Neutrophils were obtained from young (ages 21-34) and old (ages over 65) volunteers. The increase in hydrogen peroxide following stimulation with formyl peptide in individual neutrophils was assessed by flow cytometry by using dihydrorhodamine 123. The enzyme kinetics was determined from the best fit curve using Michaelis-Menten equations. RESULTS: Aging was associated with a significant reduction in the Vmax for glutathione peroxidase. The decreased activity was not due to selenium deficiency as the serum and neutrophil concentrations were identical with age. Following activation, a significant increase in the Km was noted in neutrophils from young but not from old volunteers. CONCLUSIONS: These results account for the increased intracellular accumulation of hydrogen peroxide as a function of age in stimulated neutrophils. These results provide evidence in humans of an age-related impairment in antioxidative defense mechanisms that support the free radical theory of aging.     

The pathogen spectrum of blood cultures of premature and newborn infants in a neonatal intensive care unit

The bacterial spectrum of blood cultures in a neonatal intensive-care unit was retrospectively assessed in a two-year study. Analysis of positive blood cultures showed a dominance of gram-positive bacteria, especially of coagulase-negative staphylococci. The resistance of these germs points to vancomycin as the most effective antibiotic. B-streptococci, germs that are dreaded especially in neonatology, were not found in any of the cases. Positive blood cultures were mostly in correlation with clinical symptoms, less so to the leukocyte count and/or C-reactive protein levels. There was no case of death directly caused by sepsis.     

Transillumination of the skull in premature infants

Transillumination of the skull in infants is a simple technique which can be used to detect several major abnormalities of the central nervous system. The usefulness of transillumination has been limited, however, by the lack of standard techniques for its performance and by the absence of normal values, especially in premature infants. In healthy premature infants, there is a progressive increase in transillumination with increasing gestational age over three sites--the anterior fontanelle, the frontotemporal fossa, and the parieto-occipital eminence.     

Perinatal problems and the prevention of premature labor]

The article describes the experience of implementing patient-focused care from a physician's perspective. Pitfalls that guarantee failure are presented, many of which are avoidable with early participation by all parties involved: administrators, nursing staff, physicians, and patients. Contamination of the process with downsizing needs, lack of support for staff in dealing with necessary change, loss of administrative commitment, and withholding of appropriated funds are among the key errors to be avoided.     

Role of cerclage in the prevention of abortion and premature labor

In the course of the analysis of the results of 175 cerclage-operations carried out during the last 5 years, the authors intended to answer the question: whether the operation is reasonable on the basis of a prophylactic indication. As indication of this kind has been considered for example the following: when in the case-history of the patient one or more spontaneous abortions have occured after the third month of gravidity--with insufficient symptoms, when the mother's birth was a full-term confinement after cerclage-operation, finally, when the insufficiency of the cervical os had been diagnosed before getting pregnant. At symptoms of incipient abortion the aim of the medical treatment was therapeutic. The prophylactic operation was performed between the 16-18th week of the pregnancy, while the therapeutic one between the 20th and 30th week. In the first group 97,2 per cent was the rate of the viable children, while in the second one: 67,2 per cent. The well-foundedness of the prophylactic indication is proved by the fact that the number of full-term confinements has been quinetupled, compared with the pre-operation state. In our opinion in case of typical anamnesis the cerclage-operation is to be performed earlier than in the practice up till now, before opening the cervical os, and the infection of the amnion.