Hyaline Membrane Disease In Infants Research Articles

Relationship Between Incidence of Hyaline Membrane Disease and Maternal Hypertension During Pregnancy

There have been controversies over the eiTect of hypertension in pregnancy on the incidence of type I neonatal respiratory distress syndrome or hyaline membrane disease (HMD). We investigated the relationship between the incidence of HMD and maternal hypertension during pregnancy in 91 infants at 34 weeks gestation or less. This retrospective cross sectional study included all live born babies between May 1, 1994 and April 30, 1995 at Dr. Hasan Sadikin General Hospital, Bandung. Maternal hypertension during pregnancy was diagnosed in 38 mothers of91 infants studied. The incidence of HMD (5%) in the maternal hypertension during pregnancy group was significantly lower than the 62% in the normotensive group (p<0.01). There was a negative correlation between the occurence of HMD and hypertension during pregnancy. We conclude that the risk of developing HMD in infants born to hypertensive mothers is significantly lower than those born to normotensive mothers.

My Personal Tribute to Dr. Mary Ellen Avery

Because my husband was planning to pursue a fellowship in adolescent medicine at Boston Children’s Hospital, I was set to interview there in July of 1974 for a third year of pediatric training. I was just starting my second year of pediatrics in Los Angeles and had been focusing more on the mechanics of completing pediatric training than on choosing a fellowship. Dr. Mary Ellen Avery had just become Children’s Physician-in-Chief. In fact, she was still finding her way about the place, both physically and professionally. It was my second interview, the first resulting in less than positive news about the possibility of my obtaining a senior pediatric residency for the coming year. She did not let me be discouraged, made it known that she would welcome me there, and suggested I could pursue the start of a fellowship before completing my full pediatric training. What type of fellowship? I certainly hadn’t spent much time contemplating this. How about neonatology, she suggested, and immediately arranged for me to see Dr. Bill Taeusch, newly appointed Neonatology Division Director. So serendipity, and more importantly, Dr. Mel Avery are responsible for my career in neonatology: I joined the first official JPN fellows’ group that started training in July of 1975. Dr. Avery was a pioneering researcher in the field of neonatology and a great research motivator as well. She had overseen a recent publication associating an increased risk of hyaline membrane disease in infants of diabetic mothers (1). She “shepherded” me into examining this further, thus leading me both to the delivery room to collect infants’ cord blood for C-peptide measurements (2) and into the animal lab with alloxan-diabetic pregnant rabbits and the lung development of their offspring (3–7). I remember her delight when I presented my findings at research meetings and had my first peer-reviewed publications in the New England Journal of Medicine (2) and Journal of Applied Physiology (3). In fact, when I moved on to University of Miami, I continued the line of research looking at lung development in the animal model of the IDM, this time examining pulmonary antioxidant enzyme development in offspring of streptozotocin-treated rats (8). She opened her heart to me not just professionally but socially and personally as well. I remember a cozy Thanksgiving evening when just she, my husband, and I sat by the fire in her Wellesley condo and dined on delicious leftovers from the day. She hosted the two of us to a very special Boston evening: a “double date” with Dr. Fred Rosen for dinner at the Harvard Club and then to hear the Boston Symphony. When I was about to have my first child, she was glowing when I came to her with the news. She wanted to make sure I would be nursing him which of course I was. When he was born, she presented us with a beautifully framed print of a mother rabbit and her pups (how appropriate!) which we hung above his changing table. And once I had successfully established nursing and returned to work, she invited me to write an article with her on the benefits of breast feeding for the Harvard Medical School Health Letter (9). My respect and admiration for Dr. Mary Ellen Avery are without bounds. There is no doubt that Mel brought me into neonatology, fostered my career, and opened her intellect and heart to me many years ago. For this I am eternally grateful.

Management and outcome of triplet pregnancy

The parameters involved in obstetrical follow-up of triplet pregnancies were evaluated in a retrospective study between 1975–1993 of the follow-up of 91 triplet pregnancies. During this long interval of time, many changes in management of triplets occurred. Considering these differences, two periods in the present study were compared: 1975–1986, which consists of a previously published retrospective analysis of 21 triplet pregnancies; and 1987–1993, during which the modalities of the 7-year follow-up described previously were applied to 70 triplet pregnancies. No improvement was observed between the two periods. Nineteen pregnancies were spontaneous. Thirty-seven allowed treatment with ovulation induction agents and 35 were due to in vitro Fertilization. Early diagnosis of multiple pregnancies allows installation measures for the prevention of prematurity. Management, initiated upon diagnosis, included home rest and a weekly follow-up at home by a midwife every week. Monthly consultations and ultrasounds were performed at the hospital. Hospitalization was not systematic but was done in cases of maternal complications. The mean term for the diagnosis of triplet pregnancy was 13.9±5.3 weeks. The mean gestational age was 33.4 weeks; 90% of the deliveries were by cesarean section. The mean weight of the neonates was 1716 g. The mean Apgar score at 1 and 5 m was 7.7 and 9.3, respectively. The perinatal mortality was 80 per 1000. The main neonatal complications resulted from prematurity. Authors compared rates of Hyaline Membrane Disease in infants of patients treated with corticosteroids and of patients who were not. Hyaline Membrane Disease occurred in 13% of the corticotherapy group and in 31% of the untreated group. The present study supports systematic corticotherapy between 28 and 34 weeks for triplet pregnancies.

A retrospective study on the effects of steroid administration and prolongation of the latent phase in patients with preterm premature rupture of the membranes

To address the issues of whether corticosteroid treatment and prolongation of the latent phase improve the outcome of pregnancy in patients with preterm premature rupture of the membranes, we studied 96 patients with premature rupture of the membranes who were delivered of infants of adequate weight for gestational age with birth weights between 751 and 2000 gm and who had a latent period longer than 48 hours. Of these 96 infants, 53 received treatment with steroids and tocolytic agents and 43 received no treatment. We found a significant decrease in perinatal mortality and in the incidence of moderate and severe hyaline membrane disease in infants whose mothers received glucocorticoids. The protective effect of glucocorticoid therapy was limited to infants with a birth weight between 751 and 1000 gm or with a gestational age of 27 to 28 weeks. We also found a significant increase in perinatal mortality, mainly due to infection, when the latent phase was prolonged for >7 days, regardless of the type of management.