Intrapartum Exposure Research Articles

The Association Between Common Labor Drugs and Suckling When Skin-to-Skin During the First Hour After Birth.

BackgroundIntrapartum drugs, including fentanyl administered via epidural and synthetic oxytocin, have been previously studied in relation to neonatal outcomes, especially breastfeeding, with conflicting results. We examined the normal neonatal behavior of suckling within the first hour after a vaginal birth while in skin‐to‐skin contact with mother in relation to these commonly used drugs. Suckling in the first hour after birth has been shown in other studies to increase desirable breastfeeding outcomes.MethodProspective comparative design. Sixty‐three low‐risk mothers self‐selected to labor with intrapartum analgesia/anesthesia or not. Video recordings of infants during the first hour after birth while being held skin‐to‐skin with their mother were coded and analyzed to ascertain whether or not they achieved Stage 8 (suckling) of Widström's 9 Stages of newborn behavior during the first hour after birth.ResultsA strong inverse correlation was found between the amount and duration of exposure to epidural fentanyl and the amount of synthetic oxytocin against the likelihood of achieving suckling during the first hour after a vaginal birth.ConclusionsResults suggest that intrapartum exposure to the drugs fentanyl and synthetic oxytocin significantly decreased the likelihood of the baby suckling while skin‐to‐skin with its mother during the first hour after birth.

NPY ő a regulator of hypoxic cerebrovascular remodeling in fetal lambs (853.4)

Prenatal, intra‐partum or post partum exposure of a fetus to hypoxia results in structural and functional changes in cerebral arteries, known as remodeling. Sympathetic nerves have been suggested to contribute to this process. Whereas NE is suggested as the major mediator of adrenergic effects, our preliminary experiments show that there is a guanethidine‐resistant (norepinephrine‐independent) component. This study explores the hypothesis that NPY contributes to hypoxic cerebrovascular remodeling in the fetal cerebral circulation. Chronic hypoxia (CH) produced a 254% ↑ in K‐induced tone and a 30% ↓ in stretch‐induced myogenic tone in fresh nerve‐intact fetal cerebral arteries. CH also increased the magnitude of nerve stimulation induced guanethidine‐resistant contractile tone. Immunohistochemistry revealed that CH significantly ↑ cerebrovascular NPY whereas sympathectomy (SANX) ablated this effect. Likewise, Western blot quantification of NPY‐Y1 receptors revealed that CH increased Y1 receptors 73%. Whereas SANX in normoxic tissues had no significant effect, SANX produced a 30% ↓ in Y1 receptors in hypoxic arteries. Together these results suggest that NPY released from sympathetic cerebrovascular nerves contributes to hypoxic remodeling through increased NPY content/release and Y1 receptor density.Grant Funding Source: Supported by NIH Grants HD‐31266 and NS‐076945

Group B Streptococcus Exposure and Self-Limited Respiratory Distress in Late Preterm and Term Neonates

Background: Self-limited respiratory distress is a common neonatal respiratory morbidity for which effective treatments are lacking. Supportive care with non-invasive respiratory support is the norm. Animal models suggest that intrapartum exposure to group B Streptococcus (GBS) may cause mild pulmonary hypertension in the neonate, resulting in self-resolving respiratory distress. Treatments for pulmonary hypertension are currently not provided to neonates with self-limited respiratory distress empirically. Objectives: This study examines the hypothesis that the incidence and severity of self-limited respiratory distress are altered by intrapartum exposure to GBS and antibiotic prophylaxis (IAP) in a human population. Methods: This is a 10-year single-center cohort study of retrospective data of late preterm and term neonates diagnosed with self-limited respiratory distress. Multiple logistic models were fitted to examine associations between exposure to GBS and IAP, and markers of self-limited respiratory distress severity. Additional linear regression models were fitted to examine the association between exposure to GBS and IAP, and duration of respiratory support for self-limited respiratory distress. Finally, crude and gestational age-adjusted incidence of self-limited respiratory distress among GBS-exposed and -unexposed infants, as well as the odds of self-limited respiratory distress based on GBS exposure were calculated. Results: 584 neonates met study criteria. Neither GBS exposure nor IAP exposure was associated with severity of self-limited respiratory distress in multiple models. Crude and adjusted incidence of self-limited respiratory distress among neonates did not differ by GBS exposure history. Conclusions: Although animal studies indicate that GBS-mediated pulmonary hypertension may contribute to self-limited respiratory distress, neither exposure to GBS nor IAP was associated with an increased severity or incidence of self-limited respiratory distress in our human study population. Treatments for pulmonary hypertension are unlikely to speed symptom resolution for patients with self-limited respiratory distress.

1169 Ampicilline Resistance Epidemiology in Neonatal Sepsis in the ERA of Intrapartum Antimicrobial Prevention of Early-Onset Group B Streptococcal (GBS) Sepsis

ObjectiveTo determine EOS ampicillin-resistant (AR) epidemiology and risk factors associated with ampicillin-resistant infection in newborns in the era of GBS prophylaxis.MethodsThis was a retrospective analysis between 2002 and 2009, from...

The Prevalence of Prenatal Opioid and Other Drug Use in Utah

Determine the prevalence of prenatal opioid and other drug positivity among women delivering infants in Utah and compare the findings with national data. Umbilical cord tissue samples and nonidentifiable demographic data were collected anonymously in 13 labor and delivery units throughout Utah. Samples were analyzed for opioids, amphetamines, cannabinoids, cocaine, phencyclidine, barbiturates, benzodiazepines, propoxyphene, and alcohol biomarkers. Fifty-eight (6.8%) of 850 umbilical cord samples were positive for one or more substances. Opioids were the most frequently detected drugs (4.7%). Fewer samples were positive for alcohol (0.4%), methamphetamine (0.1%), cocaine (0.1%), and marijuana (0.4%). Opioids were the most frequently detected drugs at delivery. Although some of the samples positive for opioids might have been a result of intrapartum exposure, a significant number were positive for opioids that are not given during labor. This parallels the increasing nonmedical use of prescription pain medications in the general population and has important implications for neonates because of the potential for significant morbidity secondary to neonatal abstinence syndrome.

Intrapartum antibiotic exposure and early neonatal, morbidity, and mortality in Africa.

Infants born to women who receive intrapartum antibiotics may have higher rates of infectious morbidity and mortality than unexposed infants. Our goal was to determine the association of maternal intrapartum antibiotics and early neonatal morbidity and mortality. We performed secondary analysis of data from a multisite randomized, placebo-controlled clinical trial of antibiotics to prevent chorioamnionitis-associated mother-to-child transmission of HIV-1 and preterm birth in sub-Saharan Africa. Early neonatal morbidity and mortality were analyzed. In an intention-to-treat (ITT) analysis, infants born to women randomly assigned to antibiotics or placebo were compared. In addition, non-ITT analysis was performed because some women received nonstudy antibiotics for various clinical indications. Overall, 2659 pregnant women were randomly assigned. Of these, 2466 HIV-1-infected and HIV-1-uninfected women delivered 2413 live born and 84 stillborn infants. In the ITT analysis, there were no significant associations between exposure to antibiotics and early neonatal outcomes. Non-ITT analyses showed more illness at birth (11.2% vs 8.6%, P = .03) and more admissions to the special care infant unit (12.6% vs 9.8%, P = .04) among infants exposed to maternal intrapartum antibiotics than among unexposed infants. Additional analyses revealed greater early neonatal morbidity and mortality among infants of mothers who received nonstudy antibiotics than of mothers who received study antibiotics. There is no association between intrapartum exposure to antibiotics and early neonatal morbidity or mortality. The associations observed in non-ITT analyses are most likely the result of women with peripartum illnesses being more likely to receive nonstudy antibiotics.

Changing Patterns in NeonatalEscherichia coliSepsis and Ampicillin Resistance in the Era of Intrapartum Antibiotic Prophylaxis

The goal was to determine current trends in Escherichia coli-related early- and late-onset sepsis and patterns of ampicillin resistance in relation to institutional changes in the use of intrapartum antibiotic prophylaxis. A retrospective review of data for all infants with E. coli sepsis at Yale-New Haven Hospital from 1979 to 2006 was performed. Study periods were based on predominant intrapartum antibiotic prophylaxis practices at Yale-New Haven Hospital, that is, (1) 1979 to 1992 (no formal intrapartum antibiotic prophylaxis), (2) 1993 to 1996 (risk factor-based), and (3) 1997 to 2006 (screening-based). Sepsis rates and patterns of ampicillin resistance were compared. Fifty-three cases of E. coli early-onset sepsis and 129 cases of E. coli late-onset sepsis were identified over 3 eras. In very low birth weight (<1500 g) infants, increases in E. coli early-onset sepsis (period 1: 2.83 cases per 1000 very low birth weight admissions; period 2: 7.12 cases per 1000 very low birth weight admissions; period 3: 10.22 cases per 1000 very low birth weight admissions), intrapartum ampicillin exposure, and ampicillin-resistant E. coli were observed. Intrapartum ampicillin exposure was determined to be an independent risk factor for ampicillin-resistant E. coli early-onset sepsis. For the first time, a significant increase in E. coli late-onset sepsis was observed in preterm infants (period 1: 10.39 cases per 1000 very low birth weight admissions; period 2: 16.01 cases per 1000 very low birth weight admissions; period 3: 21.66 cases per 1000 very low birth weight admissions) and term infants (period 1: 4.07 cases per 1000 admissions; period 2: 4.22 cases per 1000 admissions; period 3: 8.23 cases per 1000 admissions). Studies to provide a better understanding of potential consequences of intrapartum antibiotic exposure and its contribution to evolving trends in neonatal sepsis are urgently needed.

Magnesium sulfate exposure increases fetal blood flow redistribution to the brain during acute non-acidemic hypoxemia in goats

Background It is still controversial that intrapartum exposure to magnesium may or may not reduce brain damage in premature infants in human and animal models. Aims We investigated the effect of hypoxemia alone under magnesium exposure on fetal cardiovascular changes in chronically catheterized goat fetuses. Study design We performed a 3-day experimental protocol with control (10% glucose) on day 1, recovery on day 2, and magnesium on day 3. Magnesium sulfate was directly infused to fetuses in a bolus dose of 270 mg/kg followed by 80 mg/kg/h. Hypoxemia was induced by maternal inhalation of nitrogen gas on day 1 and on day 3. Cerebral blood flow was measured by colored microsphere techniques. Repeated measure ANOVA and Bonferroni's/Dunn's test were used for comparison. Subjects Six Japanese Saanen goats at 0.85 gestation. Outcome measures Fetal heart rate, blood pressure, and cerebral blood flow. Results Ionized magnesium concentrations were significantly increased. Fetal PO 2 decreased significantly from 30 mmHg to 14 mmHg without acidemia. Magnesium exposure significantly attenuated hypoxemia-induced bradycardia but did not affect blood pressure. Hypoxemia significantly increased fetal brain blood flow from the pre-hypoxic levels on day 1. Magnesium exposure further increased hypoxemia-induced brain blood flow on day 3, but statistical significance was limited to the cerebral cortex. Conclusion In near-term, initially healthy goat fetuses, brain blood flow during acute hypoxemia was significantly increased with magnesium sulfate exposure.

Intrapartum Magnesium Sulfate Exposure Attenuates Neutrophil Function in Preterm Neonates

Background: Prenatal exposure to magnesium sulfate, a drug that is frequently used for attempted tocolysis in preterm labor, could alter neutrophil functional activity in infants born preterm. Objectives: To determine the association between maternal tocolysis with magnesium sulfate and the cord blood neutrophil functional activity of preterm neonates. Methods: The chemotaxis, random motility, and chemiluminescence of neutrophils were compared in the cord blood of 10 preterm neonates born to mothers tocolysed with magnesium sulfate, 10 preterm infants whose mothers had not received any tocolysis, and 10 term infants. Data regarding the maternal and neonatal magnesium and calcium levels were collected and analyzed in association with the cord blood neutrophil functional activity of the preterm infants. Results: Neutrophil functional activity in the cord blood of the preterm neonates was significantly lower than in term neonates. However, the alteration of neutrophil chemotaxis, random motility and chemiluminescence was more noticeable in neonates with intrapartum exposure to magnesium sulfate as compared to preterm infants whose mothers received no tocolysis (30.9 ± 2.3 vs. 36.7 ± 2.7 µm, p < 0.01; 26.6 ± 1.9 vs. 33.1 ± 3.1 µm, p < 0.01; and 74.3 ± 6.5 vs. 89.9 ± 6.25 ×10³ counts per min (cpm), p < 0.01, respectively). Furthermore, the reduction in neutrophil functional activity of preterm infants with intrapartum exposure to magnesium was directly correlated with the maternal serum magnesium levels (r = –0.90 to –0.85, p < 0.01). Conclusion: In infants born preterm, intrapartum exposure to magnesium sulfate is a risk factor contributing to the alteration in neutrophil motility and post-phagocytic bactericidal capacity.

Intrapartum Exposure to Nevirapine and Subsequent Maternal Responses to Nevirapine-Based Antiretroviral Therapy

Survey of Anesthesiology: February 2005 - Volume 49 - Issue 1 - p 17-18 doi: 10.1097/01.sa.0000151210.76215.69

Association of maternal antepartum management with mortality and morbidity of the extremely low birthweight (ELBW) neonate

MORBIDITY OF THE EXTREMELY LOW BIRTHWEIGHT (ELBW) NEONATE AMY WHITSEL, AARON INSEL, HEMA DESILVA, BRUCE BERNSTEIN, University of Connecticut Health Center, Obstetrics and Gynecology, Farmington, Connecticut, Saint Francis Hospital, Pediatrics, Hartford, Connecticut OBJECTIVE: Explore the associations of antepartum management with ELBW neonatal outcomes: hospital mortality, hospital morbidity and length of stay. STUDY DESIGN: Hospital outcomes of 118 viable, non-anomalous infants %1000 g and/or !28 weeks born January 1997-December 2002 and their obstetrical data were evaluated via retrospective record review. Antepartum management factors were delivery route and indication (preterm labor, preeclampsia, abruption, chorioamnionitis, non-reassuring fetal status), steroids, magnesium sulfate and antibiotic exposure (none, prophylactic or treatment). Neonatal outcomes included mortality, length of stay (LOS), oxygen dependence at day 28 and 36 weeks corrected estimated gestational age (EGA), pneumothorax, retinopathy of prematurity, intraventricular hemorrhage, periventricular leukomalacia, necrotizing enterocolitis, patent ductus arteriosis, and both early and late sepsis. Bivariate relationships between maternal variables and neonatal outcomes were explored with chi square and t tests. Multivariate logistic regression and analysis of covariance models were used to control for possible confounders. RESULTS: The overall hospital mortality rate was 17.8% (21/118). The median survivors’ LOS was 90 G 32 days. Neontal mortality, LOS and morbidity were similar when compared by delivery route (61.9% cesarean deliveries), indication for delivery and use of antenatal steroids (83.5%) when corrected for EGA and birthweight. Prophylactic antibiotics were given to 43% of the women for group B streptococcal risk and/or preterm rupture of membranes and 25% received antibiotics for known or clinically suspected infection. Neonatal mortality and morbidity were similar in the antibiotic naive, prophylactic and treatment groups. Intrapartum exposure to magnesium sulfate did not change the mortality rate; however, a greater incidence of late bacterial sepsis was noted (P = .046). CONCLUSION: The ELBW neonatal survival rate and morbidity were related to birthweight and EGA and not the indication for delivery, route, steroids or exposure to antibiotics. SMFM Abstracts S75

Increased Risk of Mother‐to‐Infant Transmission of Hepatitis C Virus by Intrapartum Infantile Exposure to Maternal Blood

Virological and clinical data from 73 hepatitis C virus (HCV)-infected pregnant women who gave birth to 75 children were merged retrospectively, by logistic regression analysis, to investigate risk factors for vertical transmission of HCV. Eighty-two percent of the HCV-infected mothers were HCV-RNA-positive during pregnancy, and 10% were coinfected with human immunodeficiency virus (HIV). Nine children were HCV infected, 1 was HIV infected, but none was HIV-HCV coinfected. Among vaginal deliveries, the mean HCV load of mothers who transmitted HCV to their infants was higher than that of those who did not (8.1 x 10(5) vs. 1.4 x 10(4) copies/mL; P=.056). A reduction in umbilical cord-blood pH (relative risk, 3.9; P=.04) or the occurrence of perineal or vaginal laceration (relative risk, 6.4; P=.028) during vaginal delivery significantly increased the risk of vertical HCV transmission. In conclusion, high maternal viremia, infantile hypoxia, and intrapartum exposure to virus-contaminated maternal blood increased the risk of HCV transmission during vaginal deliveries. Consequently, cesarean section may reduce the risk of vertical HCV transmission in selected cases.

Antibiotic use in pregnancy and drug-resistant infant sepsis

Objective: We sought to evaluate the effect of antepartum and intrapartum antibiotic use on antimicrobial-resistant neonatal sepsis. Study Design: We analyzed perinatal outcomes for 8474 pregnancies (8593 live births) delivered at 6 hospitals. Data were collected regarding maternal antibiotic use and perinatal course, neonatal cultures, and outcomes. The diagnosis of confirmed neonatal sepsis required at least one positive blood or cerebrospinal fluid culture. Neonatal cultures were evaluated on the basis of the occurrence and timing of maternal antibiotic exposure. Results: There were 96 neonates with confirmed sepsis (11.2/1000 live births). Sepsis was 19.3-fold more common after preterm birth (57 vs 3.1/1000; P < .001), with 76% of septic infants being delivered preterm. Forty-five percent of pathogens were ampicillin resistant. Ampicillin resistance increased with preterm birth (50% vs 26%; P = .04), antepartum antibiotics (57% vs 34%; P = .03), intrapartum antibiotics (55% vs 28%; P < .01), and any prenatal antibiotic exposure (52% vs 22%; P = .01). Infection with an organism resistant to at least one maternal antibiotic was more common with intrapartum antibiotic exposure than with antepartum exposure only (57% vs 17%; P = .01). Regarding early-onset sepsis (n = 55), ampicillin resistance was more common with intrapartum antibiotics (50% vs 16%; P < .01), and resistance to at least one maternally administered antibiotic was more frequent with intrapartum exposure (56.7% vs 0%; P < .01). Conclusions: Maternal antibiotic treatment is associated with neonatal sepsis by organisms resistant to ampicillin and to maternally administered antibiotics. (Am J Obstet Gynecol 1999;181:816-21.)

Do antepartum herpes simplex virus cultures predict intrapartum shedding for pregnant women with recurrent disease?

OBJECTIVE: To examine antenatal screening as a predictor of intrapartum shedding of herpes simplex virus (HSV) and to determine its usefulness in guiding the appropriate route of delivery for patients with recurrent HSV in pregnancy. METHODS: A population of 198 pregnant women with a history of recurrent genital HSV were cultured in the last weeks of their pregnancy by specially-trained personnel and intrapartum by their delivering attendants. RESULTS: Of cultures from a total of 906 antenatal visits, 17% were culture positive, with an asymptomatic shedding rate of 3.4%. Asymptomatic shedding occurred in 12.6% of women. Over the 8-week antepartum period, viral culture-positivity rates for each visit ranged from 11% to 19.5%. This provided an expected delivery culture-positivity rate of 15.3%. However, actual intrapartum viral culture positivity occurred in only three of 191 women (1.5%; P < 0.001). Because previous studies have suggested antepartum culture positivity fails to predict intrapartum viral shedding, evaluations, including cultures, as well as predictive values for subsequent culture positivities, were determined under the supervision of an infectious disease specialist. Under these conditions, positive predictive values were 59% when the interval between visits was 2 days, but only 19% when days between visits were >2 (P < 0.0001). No cases of neonatal herpes were seen in this population, although cesarean deliveries were performed in 31% of the patient population, with genital herpes as the indication for 56% of those. CONCLUSIONS: Antepartum serial screening by viral culture is not predictive of an infant's risk of intrapartum viral exposure when conducted at weekly intervals. However, more frequent assessments of patients can be predictive of an infant's exposure risk to HSV; for patients with frequent recurrent disease near term or primary infection in pregnancy, frequent late antepartum screening may be appropriate.

Do Antepartum Herpes Simplex Virus Cultures Predict Intrapartum Shedding for Pregnant Women With Recurrent Disease?

Objective: To examine antenatal screening as a predictor of intrapartum shedding of herpes simplex virus (HSV) and to determine its usefulness in guiding the appropriate route of delivery for patients with recurrent HSV in pregnancy.Methods: A population of 198 pregnant women with a history of recurrent genital HSV were cultured in the last weeks of their pregnancy by specially‐trained personnel and intrapartum by their delivering attendants.Results: Of cultures from a total of 906 antenatal visits, 17% were culture positive, with an asymptomatic shedding rate of 3.4%. Asymptomatic shedding occurred in 12.6% of women. Over the 8‐week antepartum period, viral culture‐positivity rates for each visit ranged from 11% to 19.5%. This provided an expected delivery culture‐positivity rate of 15.3%. However, actual intrapartum viral culture positivity occurred in only three of 191 women (1.5%; P &lt; 0.001). Because previous studies have suggested antepartum culture positivity fails to predict intrapartum viral shedding, evaluations, including cultures, as well as predictive values for subsequent culture positivities, were determined under the supervision of an infectious disease specialist. Under these conditions, positive predictive values were 59% when the interval between visits was 2 days, but only 19% when days between visits were &gt;2 (P &lt; 0.0001). No cases of neonatal herpes were seen in this population, although cesarean deliveries were performed in 31% of the patient population, with genital herpes as the indication for 56% of those.Conclusions: Antepartum serial screening by viral culture is not predictive of an infant′s risk of intrapartum viral exposure when conducted at weekly intervals. However, more frequent assessments of patients can be predictive of an infant′s exposure risk to HSV; for patients with frequent recurrent disease near term or primary infection in pregnancy, frequent late antepartum screening may be appropriate. Infect. Dis. Obstet. Gynecol. 7:230–236, 1999.

Intrapartum mucosal exposure to human immunodeficiency virus type 1 (HIV-1) of infants born to HIV-1-infected mothers correlates with maternal plasma virus burden.

The majority of vertical infections with human immunodeficiency virus type 1 (HIV-1) occur at or near delivery, strongly suggesting a mucosal route of transmission. The frequency and level of intrapartum mucosal exposure to HIV-1 of 22 infants born to infected mothers was investigated. Maternal plasma HIV-1 RNA and CD4 cell count were measured at delivery. Infant oropharyngeal aspirates obtained at birth were examined for HIV-1 RNA by reverse transcription-polymerase chain reaction and qualitative nucleic acid sequence-based amplification. Nine infants (41%) had detectable levels of HIV-1 RNA, 3 of which were quantifiable (mean, 3000 copies/mL). This mucosal exposure to HIV-1 during delivery did not lead to infection of any infant. Cesarian delivery did not reduce mucosal exposure to HIV-1. Mucosal exposure did not correlate with maternal CD4 cell count but did correlate with maternal plasma virus load and was reduced by antiretroviral therapy.

Timing of maternal-infant HIV transmission

To investigate the hypothesis that labour and delivery events, perinatal characteristics, and maternal factors are only associated with intrapartum HIV transmission, and not with intrauterine HIV transmission. In the New York City Perinatal HIV Transmission Collaborative Study 276 infants of HIV-infected women were followed prospectively and had results of early polymerase chain reaction (PCR) tests available. Among infected children, intrauterine infection was presumed if HIV DNA was detected by PCR in samples collected from children aged < or = 3 days, and intrapartum infection was presumed if HIV DNA was not detected in these early samples. The proportion of infants with presumed intrauterine and intrapartum infections were compared by selected intrapartum, perinatal and maternal characteristics. Presumed intrapartum infection was found in 7% of infants delivered by Cesarean section and, among infants delivered vaginally, those with longer duration of membrane rupture (> 4 h) were significantly more likely to have presumed intrapartum HIV infection (22%) than those with shorter duration (9%; P = 0.02). There were no differences in presumed intrauterine HIV infection by mode of delivery or longer duration of membrane rupture. Infants born preterm and small for gestational age had significantly higher risks of presumed intrapartum infection, but only those who were small for gestational age had higher risks of intrauterine infection. Our results support the notion that selected intrapartum conditions, long duration of membrane rupture prior to delivery in particular, are independent risk factors for maternal-infant transmission, and suggest that preterm infants may be especially vulnerable to intrapartum HIV exposure.

Diagnosis of Viral Hepatitis

Letters to the EditorDiagnosis of Viral Hepatitis Subhash Chandra AryaMBBS, PhD Subhash Chandra Arya Search for more papers by this author Published Online:1 Sep 1995https://doi.org/10.5144/0256-4947.1995.544SectionsPDF ToolsAdd to favoritesDownload citationTrack citations ShareShare onFacebookTwitterLinked InRedditEmail AboutIntroductionTo the Editor: Your editorial on the diagnosis of viral hepatitis points to a sequential serologic approach in Saudi patients with acute hepatitis to identify hepatitis B, C, D and E infections.1 An apparently insignificant role of HAV towards the incidence of acute hepatitis in Saudis might not last very long. With continuous improvement in the socioeconomic status of the natives, many Saudis would soon lack HAV antibodies as against the less than 3% reported during the early 1980s.2 Many affluent Saudis domiciled in metropolitan Jeddah, Riyadh, Dammam, etc. might already be HAV seronegative. Any hemophiliacs in such communities, if administered factor VIII concentrates regularly, could be afflicted by an HAV-induced acute hepatitis since the solvent detergents used in the purification of concentrates do not kill HAV.3 Moreover, like Japan, a maternal-fetal HAV transmission could be possible in Saudi Arabia following intrapartum exposure of the infant to maternal blood or feces.4The commercial availability of sensitive and specific kits for viral serologic markers, outlined in Table 1 of the Editorial,1 would per se not ensure a specific viral differential diagnosis in remote or isolated locations in the 14 different administrative regions in Saudi Arabia. Many test procedures, like tests for IgM antibody RNA, are complex, multistep, and cannot be completed without trained personnel and laboratory equipment. Rapid, simplified testing procedures, like the latex agglutination test for HBsAg, which can be carried out by minimally trained personnel in ordinary laboratories including physicians’ offices, need to be encouraged. Tests like the gelatin particle agglutination for HCV with 5 (μL volumes of reagents with a visual reading of results,5 or HAV through finger prick blood,6 would be invaluable in the diagnosis of Saudis with acute or chronic hepatitis. Furthermore, sophisticated laboratory facilities are required at few centers in Saudi Arabia for carrying out polymerase chain reaction, in situ hybridization and tests to detect hepatitis B virus escape mutants and typing of HCV isolates. Such an infrastructure would enable the clinicians to follow cases of chronic hepatitis on lamivudine, hepatitis B vaccine, and alpha interferon therapy.Extended serologic investigations on hepatitis patients do leave some hepatitis B infections undefined. In spite of rigorous testing at the Albert-Ludswigs University at Freiburg in Germany, HBV was transmitted from donors negative for HBsAg and anti-HBs. HBV DNA was demonstrated through polymerase chain reaction in four of 20 patients with unexplained post-transfusion hepatitis and in five patients with mildly increased aminotransferases.7 The sophisticated facilities for viral hepatitis molecular biology investigations in Saudi Arabia would indeed ensure timely detection of any low titer, immunologically negative HBV infections.ARTICLE REFERENCES:1. Zeldis JB, Shabib SM, Tufenkeji H. "Diagnosis of viral hepatitis" . Ann Saudi Med. 1995; 15:1-5. Google Scholar2. Ashraf SJ, Arya SC, Parande CM, Kristensen E. "Brief Report: Hepatitis A virus among natives and expatriates in Saudi Arabia" . J Med Virol. 1986; 19:151-3. Google Scholar3. Thomas DP. "Viral contamination of blood products" . Lancet. 1994; 343:1583-4. Google Scholar4. Tanaka I, Shima M, Kubota Y, Takahashi Y, Kawamata O, Yoshioka A. "Vertical transmission of hepatitis A virus" . Lancet. 1995; 345:397. Google Scholar5. Mizui M, Moriya T, Yoshizawa H, et al. "A novel agglutination method for screening of HIV and HCV antibody testing with 5 μL reagents: reduction of cost and time with high sensitivity" . Vox Sanguinus. 1994; 67:315-6. Google Scholar6. Adler R, Shouvel D. "A finger stick assay for determination of immunity to hepatitis A: a preliminary report" . J Hepatol. 1993; 18(suppl2):S27-S31. Google Scholar7. Rasenack JWF, Schlayer H-J, Hettler F, Peters T, Preisler-Adams S, Gerok W. "Hepatitis B virus infection without immunological markers after open heart surgery" . Lancet. 1995; 345:355-7. Google Scholar Previous article Next article FiguresReferencesRelatedDetails Volume 15, Issue 5September-October 1995 Metrics History Published online1 September 1995 InformationCopyright © 1995, Annals of Saudi MedicineThis work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.PDF download

Mother-to-child transmission of human immunodeficiency virus type 1: report from the Nairobi Study.

Mother-to-child transmission of human immunodeficiency virus type 1 (HIV-1) is a significant problem in countries with endemic HIV-1 infection. Between 1986 and 1991, 365 children of HIV-1-infected mothers and 363 control children were studied in Kenya. The overall risk of transmission from mother to child, determined by serologic evidence of infection by age > or = 12 months and excess mortality in the HIV-1-exposed group, was 42.8% (range, 27.6%-62.2%). Marriage was the only maternal characteristic associated with transmission (odds ratio, 2.2; 95% confidence interval, 1.2-4.2; P < .05). Children who experienced growth failure were more likely to be infected. In 44% of children ultimately infected, the pattern of antibody response implied intrapartum or postnatal exposure to HIV-1. Of potential postnatal exposures examined, duration of breast-feeding beyond age 15 months and the mother being married were independently associated with increased risk of infection and seroconversion of children. The percentage of HIV infection attributable to breast-feeding > or = 15 months was 32%. The frequency of mother-to-child transmission of HIV-1 was high; a substantial proportion of infection occurred postnatally, possibly through breast-feeding.

Meconium analysis for improved identification of infants exposed to cocaine in utero

We screened anonymously all mothers and infants born during a 3 1/2-month period to determine the prevalence of intrapartum cocaine use, test the maternal characteristics that are specific predictors of intrauterine cocaine exposure (IUCE), and compare the sensitivity of infant urine versus meconium samples for identification of IUCE. Of 1237 live births during the study period, a sample was obtained from 1201 mother-infant pairs. The overall prevalence of documented intrapartum cocaine exposure was 66 (5.5%) of 1201 pairs. Previously developed drug screening guidelines had a sensitivity of 89% for detecting IUCE in infants. Direct comparisons of samples from the same mother-infant pair revealed that there were no cases in which cocaine was found in infant urine but not in meconium; however, infant urine testing missed 25% of the infants who had positive findings in meconium. We conclude that (1) meconium testing was more likely than urine testing to identify an infant with IUCE, detecting an additional 33%; (2) there was significant maternal cocaine use (5.5%) in a teaching hospital with a mixed patient population; (3) maternal characteristics known to identify infants at risk of having IUCE were useful in our population; and (4) IUCE of neonates admitted to the neonatal intensive care unit was more common than that of infants admitted to the regular newborn nursery.