Predicting birth weight by fetal upper-arm volume with use of three-dimensional ultrasonography

Previously, we demonstrated elevated cortisol production/release in response to the administration of the serotonin precursor, L-5-hydroxytryptophan (L-5-HTP) in untreated patients with obstructive sleep apnea (OSA). We hypothesized that if this elevated cortisol response to L-5-HTP was related to OSA, this finding would not be present in OSA patients treated with nasal continuous positive airway pressure (nCPAP). Eleven OSA patients treated for at least 1 month with nCPAP were studied. On two different days, we measured blood cortisol level every 15 min for 4 h following the ingestion of L-5-HTP, 0.4 mg/kg, or placebo, both given with carbidopa, a peripheral tryptophan decarboxylase inhibitor, used to prevent peripheral L-5-HTP metabolism before brain absorption. For a given subject, the cortisol response was calculated as the difference between the area under the curve of the L-5-HTP and placebo responses. In the nCPAP-treated OSA patients, this net cortisol response, 577 +/- 240 min.micrograms/dL, was less than the value found in the previously studied untreated OSA group, 1,198 +/- 227 min.micrograms/dL (p < 0.05) and not different from the previously studied nonapneic control group, 469 +/- 154 min.micrograms/dL. From these results, we speculate that nCPAP treatment reverses the elevated cortisol response to serotonergic stimulation seen in untreated OSA patients.     

A comparison of three MMPI short forms: Limited clinical utility in classification.

A multivariate classification method was used to compare the Mini-Mult, Faschingbauer Abbreviated MMPI, and MMPI-168 with the standard MMPI profiles of 252 psychiatric inpatients (mean age 27.4 yrs). Profiles were classified as 1 of 3 previous identified superordinate types (neurotic, psychotic, and sociopathic), using the standard MMPI profile as a criterion. Overall classification was below clinical utility, with distortions of profile shape the most serious error. No form was judged to be adequate for most clinical purposes. (9 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Screening for fetal abnormalities in multiple pregnancies

Child and adolescent therapy outcome research findings attest to the efficacy of a variety of treatments. This article illustrates promising treatments for selected internalizing (anxiety and depression), externalizing (oppositional, and antisocial behavior), and other (obesity and autism) conditions, and for other aims (preparation for medical and dental procedures). Studies in these areas illustrate worthwhile characteristics that can help inform the search for empirically supported treatments. These characteristics include randomized controlled trials, well-described and replicable treatments, tests with clinical samples, tests of clinical significance, broad-based outcome assessment including measures of real-world functioning, and others. Continued research progress will depend on greater attention to magnitude and maintenance of therapeutic change, long-term follow-up, moderators and mediators of change, and development and testing of treatment in conditions relevant to clinical practice.     

Fundamental and clinical evaluation of cefozopran in low birth weight infants and neonates

We conducted fundamental and clinical evaluations of a cephem antibiotic, cefozopran (SCE-2787, CZOP), in infants with low birth weights and mature infants. (1) Blood concentrations CZOP was intravenously given in bolus dose of 20 mg/kg to the newborn. The blood antibiotic concentrations were 69.7 micrograms/ml at 30 minutes after administration and the elimination half life was 2.99 hours in mature infants aged 1 to 3 days. They were 38.7 micrograms/ml and 2.85 hours in those aged 4 to 7 days, and 40.8 micrograms/ml and 3.81 hours in those aged 8 days or elder, respectively. In infants with lower birth weights aged 4 to 7 days the blood antibiotic concentrations were 48.6 micrograms/ml at 30 minutes after i.v. administration and the elimination half life was 3.77 hours. The blood antibiotic concentrations at 30 minutes after intravenous doses of 10, 20 and 50 mg/kg in mature infants aged 8 days or elder were 21.1, 40.8 and 153.6 micrograms/ml (value at 60 minutes) and the elimination half lives were 2.24, 3.81 and 3.07 hours, respectively. Administration of CZOP at doses of 20 and 40 mg/kg by intravenous drip infusion over 30 minutes gave the blood drug concentrations of 48.0 and 103.2 micrograms/ml at the end of the infusion and the half lives were 2.60 and 3.33 hours, respectively. (2) Urinary excretion The urinary excretion rates after i.v. bolus doses of 10, 20 and 40 mg/kg were 28.4 to 58.6% of dose. The urinary excretion rate after i.v. drip infusion of 40 mg/kg over 30 minutes was 49.0% of dose. (3) Transfer into cereblospinal fluid The transfer of the antibiotic into cereblospinal fluid in patients with serous meningitis was 4.1 to 15.5 micrograms/ml at 1 hours after administration. (4) Clinical results The clinical efficacy was judged "good" or "excellent" in 2 of the 3 patients with septicemia and in all of the 10 patients with suspected septicemia. It was judged "excellent" in all of the 9 patients with pneumonia, 3 with urinary tract infections and 3 with intrauterine infections. Prophylactic use of the antibiotic was effective in all of the 12 patients. Of the patients in whom bacteriological evaluation was successful, 7 of the 10 causative organisms were confirmed to be eradicated. No adverse drug reactions of signs and symptoms were recognized. Fourteen abnormal alterations of the laboratory test values such as elevation of gamma-GTP and that of GPT were recognized in 8 patients (16.7%). None of them were particularly serious. These results indicate that CZOP is a drug useful for treatment and prevention of infections in infants with lower birth weights as well as in mature infants.     

The clinical diagnosis of major congenital abnormalities of the fetal central nervous system

During the ten years between 1965 and 1974, 207 infants with a major congenital abnormality of the central nervous system were born at Mill Road Maternity Hospital, Liverpool; open neural tube defects occurred in 92 per cent of cases. Only cases of anencephaly were frequently diagnosed clinically before labour and this was rarely so for spina bifida alone. Only 11 patients (5-3 per cent) had previously been delivered of an affected infant. The routine screening of pregnant patients is briefly discussed.     

Developmental versus conventional care: a comparison of clinical outcomes for very low birth weight infants

The purpose of this research was to describe the clinical profile of very low birth weight (VLBW) infants receiving conventional versus developmental care during their hospitalization and to determine the appropriateness of developmental-care interventions. A phase-lag study with 124 preterm infants indicated that although there were no significant differences in individual clinical outcomes, developmental care had a significant effect on the physiologic stability of the infant over time. Developmental interventions were used for all infants receiving the developmental-care intervention, with varying frequency.     

Mass screening for neuroblastoma and mortality in birth cohorts

Mortality resulting from neuroblastoma in birth cohorts in both Sapporo City and the whole of Japan was investigated to evaluate the effects of a high-performance liquid chromatography (HPLC) mass screening program, targeting on 6 month-old infants. In Sapporo City, the non-HPLC screened cohort showed no reduction in mortality at 4 years of age compared with the pre-screening cohort. However, the HPLC screened cohort showed a reduction of 69% in mortality compared with the pre-screening cohort. On a nation-wide scale, there was a significant decline in mortality for the non-HPLC screened cohort compared with the pre-screening cohort; for the HPLC screened cohort for 1989-1991, there was also a reduction in mortality for children younger than 2 years of age. The incidence of neuroblastoma at 1-4 years of age in the HPLC cohort in Sapporo City was about half that in the pre-screening cohort, along with and probably because of an increasing incidence among infants in the same cohort. Our findings suggest that HPLC screening may detect some poor-prognosis neuroblastoma cases at early stages, thus providing for more favorable therapy.     

Incidence of chromosomal abnormalities in 153 pregnancies with ultrasound detected fetal abnormalities

We report a caroticocavernous fistula (CCF) treated by an endovascular procedure in a young woman with Ehlers-Danlos syndrome type IV, with severe bilateral carotid and vertebral artery dysplasia. The CCF, which appeared after minor trauma, was successfully occluded by a detachable balloon introduced into the venous side by an arterial approach. Six previously published cases are reviewed, five successfully treated. The difficulties and risks of the endovascular procedure due to the vascular changes, are emphasised. The possibility of the venous approach is discussed.     

Changes of concentrations of umbilical blood monoamines in low birth weight infant and their clinical significance

OBJECTIVE: To investigate the changes of concentrations of umbilical blood monoamines in low birth weight (LBW) infants and their clinical significance. METHODS: By fluorescence spectrophotometry, the concentrations of umbilical plasma norepinephrine (NE), dopamine (DA), 5-hydroxytryptamine (5-HT) and 5-hydroxyindoleacetic acid (5-HIAA) in 18 LBW before and after delivery were measured and compared with 20 normal birth weight (NBW) infants. RESULTS: The concentration of all monoamines, especially of the 2 catecholamines, i.e. NE and DA, were markedly lower in LBW than that in NBW (P < 0.05-0.01), regardless of prepartus or postpartus; the concentrations of all monoamines in postpartal umbilical plasma in both of LBW and NBW were higher than those in prepartal, and the increase of NE in NBW showed significant difference (P < 0.05). CONCLUSIONs: The decrease of all monoamines, especially of catecholamines in LBW could be one of the reasons causing the increase of mortality and the decrease of mental and physical development in LBW.     

Geographic patterns of low birth weight in Hawaii

This study examines areal variations in low birth weight, using the census tract as the unit of analysis. Reports from the 1980 U.S. census were used to develop summary indicators of environmental and socio-economic conditions, including poverty, employment, education and crowding, for 155 census tracts in the state of Hawaii. Maternal socio-demographic, prenatal care utilization, and medical risk indicators and low birth weight percentages for resident, single live births were extracted from the Hawaii 1979-1987 vital record live birth files and aggregated by census tract. Multiple regression analysis was used to develop a model that predicted 61% of the variation among census tracts in the percentage of low birth weight. Patterns of low birth weight were primarily associated with ethnic patterns of maternal residence and single marital status. There was no association between inadequate prenatal care and low birth weight at the census tract level.     

Nuchal translucency screening for chromosomal abnormalities in a routine ultrasound practice

Endometriosis is a benign condition with an aggressive behaviour defined by the presence of ectopic endometrial tissue, outside the uterus. It occurs in 15-20% women with child bearing potential. Most commonly it affects organs such as the ovaries, uterine ligaments, fallopian tubes, rectum and the cervico-vaginal region. Involvement of the urinary tract, however, is rare. It can be seen in just about 1% cases, vesical location being the most frequent of these presentations (84% cases). We describe one case of vesical endometriosis that developed after a cesarean section. The intra-operative findings confirmed the existence of infiltration of the detrusor muscle and the vesical mucosa by endometrial tissue from the area of the uterine incision. A discussion of the different diagnostic and therapeutic options is also included.     

Paternal height and weight as determinants of birth weight in a Chinese population

To evaluate the relationship between paternal weight and height and birth weight, 355 middle class patients with uncomplicated singleton pregnancies who booked within the first trimester were recruited from a homogenous obstetric population from a teaching hospital unit. Maternal height and prepregnant maternal weight were recorded at the booking visit. Paternal height and weight were recorded when the fathers entered the labor ward or visited the postnatal ward at or shortly after the time of delivery. These data were then correlated with the birth weight of the babies. There was a significant correlation between paternal height and weight and the corresponding maternal parameters (correlation coefficients 0.21, p<0.001 and 0.21, p < 0 > 0.01). When the crude birth weight was adjusted for the gestation at delivery, and then controlled for maternal height and weight with the use of a regression model, analysis of variance tests showed that paternal height was significantly correlated to the adjusted birth weight (p<0.01), while paternal weight only showed a marginal correlation (p = 0.05). There was a significant correlation between maternal and paternal height and weight, indicating that couples tend to be of similar sizes. When controlling for maternal size, paternal height was significantly correlated to birth weight, while paternal weight showed only marginal significance. The data suggested that paternal genetic influence could be a significant determinant of in utero fetal growth and thus birth weight.     

Distributions of birth weight in seven Dublin maternity units

Differences in birthweight distribution among babies born to Dublin residents during one year in seven maternity units were analysed. Large differences were found between the hospitals. The evidence indicated that most of the difference was attributable to the differing socioeconomic profile of the mothers in the hospitals. The socioeconomic gradients shown by the hospitals in the proportions of babies weighing less than or equal to 2500 g, less than or equal to 3000 g, and 3001-4499 g diverged with increasing socioeconomic disadvantage. Steepest gradients were found in hospitals where the socioeconomic disadvantage was greatest, and vice versa. The differences between the hospitals in the socioeconomic gradient of birthweight performance were tentatively ascribed to some sort of catchment area effect, which added to the disadvantage of the already most disadvantaged mothers. Differences in antenatal care and induction of labour between hospitals were not assessed but were thought unlikely to have made a major contribution to the differences in socioeconomic gradient.     

Norms and screening utility of the Dutch version of the Children's Depression Inventory in clinical and nonclinical youths.

This study aimed to (a) assess relationships between the Children's Depression Inventory (CDI) and DSM-oriented depression and anxiety scales of the Youth Self Report, (b) develop reliable norms for the CDI, and (c) determine CDI cutoff scores for selecting youngsters at risk for depression and anxiety. A total of 3,073 nonclinical and 511 clinically referred children and adolescents from The Netherlands and Belgium were included. Results showed that CDI scores were significantly related to DSM-oriented symptoms of both depression and anxiety. CDI scores correlated highly with depression symptoms and moderately with anxiety symptoms. Norms for the CDI were determined by means of multiple regression analysis and depended on sex, age, and country. CDI cutoff scores for selecting individuals at risk for depression and anxiety as measured by the DSM-oriented depression and anxiety scales of the Youth Self Report were determined by means of multiple regression analysis and receiver operating characteristic analysis. A CDI score of 16 was found to have the most optimal balance between sensitivity and specificity for depression, whereas a score of 21 provided the best sensitivity and specificity for anxiety in a subsample of children. We conclude that the CDI is an effective instrument for screening depression and to a lesser extent anxiety in primary and secondary care centers, before applying further assessment of high-risk individuals. (PsycINFO Database Record (c) 2011 APA, all rights reserved)     

Problems in using linear ultrasound parameters for the determination of fetal weight

We have developed three formulas for the calculation of fetal weight by means of ultrasound which have proved clinically useful (Formula I for normal size fetuses, Formula II for very small fetuses, and Formula III as a control). From 621 controlled calculations of the fetal weight and the general experience from our ultrasound clinic (over 20,000 examinations) we discuss the inherent problems. We used the Vidoson apparatus manufactured by Siemens (West Germany) which is a rapid imaging B-scan. We have learned from many years of studying means of calculating fetal weight that a regression equation from linear fetal measurements can be used: namely the biparietelllll skull diameter, the sagittal and the transverse thoracic diameter and the length of the trunk (Tab. I)...     

Parameter estimates for direct, maternal, and grandmaternal genetic effects for birth weight and weaning weight in Hereford cattle

Birth and weaning weights adjusted for age of dam from four lines of Hereford cattle were analyzed to determine the relationships among grandmaternal, maternal, and direct genetic effects. Three lines were selected for 1) weaning weight (WWL), 2) yearling weight (YWL), and 3) an index of yearling weight and muscle score (IXL). The fourth line was an unselected control line (CTL). Numbers of observations ranged from 1,699 (CTL) to 2,811 (WWL), and number of animals in the pedigree file ranged from 2,266 to 3,192. Two animal models were used to obtain estimates by REML using an average information method. Model 1 included random direct and maternal genetic, permanent maternal environmental, and residual environmental effects, and fixed sex x year effects. Model 2 additionally included random grandmaternal genetic and permanent grandmaternal environmental effects. For birth weight, Models 1 and 2 gave almost identical estimates for direct and maternal heritability, and for the fraction of variance that was due to maternal permanent environmental effects. Estimates for grandmaternal heritability could be obtained only for IXL (.03) and CTL (.01). For weaning weight, estimates for direct heritability were similar from both models. Estimates for maternal heritability from Model 1 were .18, .20, .13, and .20, and corresponding estimates from Model 2 were .34, .31, .13, and .34 for WWL, YWL, IXL, and CTL, respectively. For IXL, estimates for variances that were due to grandmaternal genetic and grandmaternal permanent environmental variances could not be obtained and were set to zero. Grandmaternal heritability estimates for WWL, YWL, and CTL were .05, .09, and .12. Estimates of correlations between direct and maternal genetic effects were -.13, -.44, -.11, and -.26 for WWL, YWL, IXL, and CTL. Estimates of correlations between direct and grandmaternal genetic effects were .21, .83, and .55, and those between maternal and grandmaternal genetic effects were -.99, -.84, and -.76 for WWL, YWL, and CTL, respectively. These results indicate that grandmaternal effects may be important for weaning weight and that maternal heritability may be underestimated if grandmaternal effects are not included in the model.     

Simplified method of determining fetal brain weight in utero

Analysis of autopsy data shows that, from the 26th through the 38th gestational weeks, fetal brain weight (BrW) is a function of the 3.124 power of the largest head circumference (HC). Because there is excellent correlation between prenatal ultrasound measurement and postnatal tape measurement of the HC, it is possible to determine fetal BrW in utero. An alteration of the BrW:somatic weight (SW) relationship is an important physical stigma of asymmetric intrauterine growth retardation (IUGR). The value of longitudinal studies of fetal BrW and SW as a means of discriminating between normal and asymmetric growth is tested in a population at risk for IUGR.