A Cytologic Study on Vaginal Smears in Neonates with Special Reference to Neonates Suffering from Icterus Gravis

Abstract

Gravely icteric neonates including those having Rh incompatibility, were submitted to an observ- ation of vaginal smears and estimation of hormones in the urine for consecutive postnatal days.This was done in order to compare the resultswith those previously reported in respect to nor- mal mature infants, and at the same time to ex- plore liver functions in neonates suffering fromicterus gravis as well as the involvement of adrenal glands in diseases of the liver.1. Vaginal smears were found to be geneoallyhypochromatic. Estrogen effect observed on the1st and 2 nd postnatal days was not significant, but disappeared somewhat later. An and rogeneffect manifesten itself around the 8 th day andwas slightly observable during the 12 th to 15 thdays. This effect was a little more marked thanin normal infants.2. Regarding hormones in the urine, estriol generally indicated low levels and disappearedslowly. A high 17-OHCS level was reached whentotal bilirubin began to fall from a peak. A high 17-KS level was seen later, i. e., when total bili- rubin returned to normal value.3. These variations in vaginal smears approx- emately corresponded with those in urinary hormone levels.4. The protracted excretion of estriol may bedue to the reduction associated with severe jaundice in the liver's metabolic capacity to createestrogen. The finding that high 17-OHCS and 17KS levels were obtained in concent with or alittle later than the peak of total bilirubin maybe explained by the defensive function of theadrenocortex being mobilized in the event of ict- erus gravis, with the resultant transitory increasein hormonal secretion.5. The finding that 17-OHCS levels varied incloser correspondence with total bilirubin than 17-KS levels may be reasonably understood inview of 17-OHCS being derived from adrenocortical glucocorticoid and hence is considered to bea more sensitive indicator of adrenocortical fun- ctioning than 17-KS.6. In cares of no serious jaundice with Rhincompatibility, vaginal smears approximatelycorresponded with those in normal mature infa- nts. This suggests that hormonal secretion ormetabolism may be affected not by Rh incompa- tibility per se but by icterus gravis.