Postmature Infants Research Articles

Descriptive study for neonatal death in neonatal care unit in maternity and children teaching hospital in Aldiwaniah, Iraq

Of the estimated 130 million infants born each year worldwide,1 4 million die in the first 28 days of life. Three-quarters of neonatal deaths occur in the first week, and more than one-quarter occur in the first 24 hours.1,2 Neonatal deaths account for 40% of deaths under the age of 5 years worldwide. This study was descriptive-analytical prospective one and the population of the study included all infants hospitalized in NICU of maternity and children teaching hospital in aldiwaniah governorate from first of September 2013 to the end of august 2014. About 1644 neonate patients was admitted to the neonatal care unit directly either from the labor room or from the operation room and the neonate only in contact with health personnel ; from those we study all 193 hospitalized neonates that died due to different causes. In this study, of 1466 neonates , were hospitalized in NICU (neonatal intensive care unit ) in maternity and children teaching hospital from first of September 2013 through august 2014 ; from which 193 ( 13.1% )cases were died . A total of 193infants died in the hospital form which 64.25% were male and ( 35.75% )of them were female. ; 36.8% of them were full term and 63.2 % were premature . the most common cause of the neonatal death were the RDS (respiratory distress syndrome) 93 (48.1%) and the second most common cause were the complication of prematurity other than the RDS which form55( 28.4% ). The birth asphyxia, congenital anomalies and sepsis represent 15 ( 7.7 % ), 8 (4.1%) , 11 ( 5.6% ) respectively. the meconium aspiration syndrome mainly in postmature infant represent about 9 (4.6 % )and miscellaneous causes( hydrops fetalis and intraventriculer haemorrhage and congenital heart disease ) was 3 ( 1.5 %) . The common cause of neonatal death was sever immaturity with its complications and mainly the respiratory distress syndrome. Almost the death occur in premature and LBW babies. We can prevent of born these babies by high quality prenatal care. The study proves the relations between certains maternal and neonatal factors and neonatal mortality; since low-weight premature infants are at more risk of dying in infancy, it is suggested that pregnant mothers should be placed under the required cares to avoid the birth of premature infants as possible.

ANALIZA VODENJA POTERMINSKE NOSEČNOSTI V SLOVENIJI V LETU 2012

Introduction: There are various definitions of post-term pregnancy found in the literature, so guidelines for its management also vary. Pregnancy after 41 weeks of gestation results in additional risks for the foetus,so a decision to induce labour is often taken. However, induction can also cause certain complications and increase the need for proceeding to an operative birth. Methods: A quantitative approach was used in the research, which was based on data taken from the national perinatal information system. 10,163 births following post-term pregnancies were included in the analysis. Analysis was conducted with the statistical programme SPSS version 18.0, using descriptive statistics. Results: It has been established that with the extension of the pregnancy, the induction rate increases; after the 42nd week of gestation it reaches 41.8 %. Simultaneously, also the rate of operative deliveries grows and reaches 24.9 % after the 42nd week of gestation. Discussion and conclusions: The results on the type of labour in the case of post-term pregnancies in Slovenia confirm the findings of foreign research studies. Further research should focus on the state of health of post-mature newborn infants since the manner of completing the pregnancy does not necessarily indicate the well-being of a newborn infant. It might be useful to research Apgar scores, admission rates to intensive care units, blood pH values and reanimation procedures.

Analysis on growth status of children under 3 years of age in Nankai district of Tianjin city

Objective The study aimed to explore the growth status of children under 3 years of age in Nankai district of Tianjin city, provide reference evidence for children's health care work of the local area. Methods Convenience sampling was used to collect physical examination records of children under 3 years old from Wangdingdi hospital in Nankai district of Tianjin city. The records of 2 880 children' physical examination data were collected. Results The median scores of weight for height (WHZ) of children of 6, 9, 12, 18 months old were 0.74 (0.01,1.49), 0.73 (0.08, 1.38), 0.58 (0.11,1.27 ), 0.54 (0.14, 1.22), while children of 3, 24, 36 months old were 0.29 (0.45,1.03), 0.17 (0.61,0.95), 0.22 (0.36,0.80), the difference between them had statistical significance, χ2=21.71, P<0.05. The median scores of height for age (HAZ) of children of 3, 6, 9, 12, 16 months old were 1.05 (0.33,1.76), 1.09 (0.32,1.85), 1.22 (0.41,2.02), 1.00 (0.20,1.79), 1.09 (0.19,1.99), while children of 18, 24 months old were 0.79 (0.06,1.51), 0.86 (0.15,1.56), the difference between them had statistical significance, χ2=27.83, P<0.05. The median scores of weight for age (WAZ) of children of 3, 12, 18 ,24, 36 months old were 0.88 (0.29,1.46), 0.96 (0.31,1.61), 0.85(0.19,1.51), 0.64 (0.04,1.23), 0.91 (0.28,1.54), while children of 6, 9 months old were 1.10 (0.43,1.76), 1.09 (0.43,1.74), the difference between them had statistical significance, χ2=36.95, P<0.05. The prevalence of stunting, wasting and overweight were 0.3% (10/2 880), 0.8% (22/2 880) and 9.3% (267/2 880). The physical condition between premature and full term infants and post-mature infants had statistical significance, t=140.23, 100.64, P<0.05. Conclusions The growth and development status of children in Tianjin Nankai district under 3 years old was generally good, and there was no significant difference between boys and girls, however, overweight has been the most serious problem at present. Compared with full-term and post-mature infants, the physical condition of premature newborn was lower. Key words: Child; Growth and development; Z score

Neonatal Menstruation Explains Epidemiological Links between Fetomaternal Conditions and Adolescent Endometriosis

Background Different fetomaternal conditions may influence the risk of endometriosis during adolescence and in adult life; here we focus on the hormonal maturation of the fetal endometrium in the final stages of pregnancy and on the theory that neonatal menstruation should be considered, similar to cyclic menstruation in the adult, as a risk factor for adolescent endometriosis. Methods The literature on neonatal menstruation and associated factors was systematically searched, and 19 relevant articles, published in different languages between 1950 and 1984, were retrieved. After closer scrutiny, 11 publications were selected as relevant. Results At birth, the neonatal endometrium displays different degrees of progesterone resistance, varying from a complete absence of progesterone responses, to secretory activity, decidualization and menstrual-like shedding. A temporal relationship exists between endometrial maturation and the incidence of neonatal menstruation, supporting the hypothesis that vaginal bleeding at birth is triggered by progesterone withdrawal. Neonatal menstruation occurs rarely in preterm babies, increases in those born at term and is a relatively frequent event in postmature infants. Analysis of archival clinical studies indicates that being born postterm or to a preeclamptic mother increases the risk of neonatal menstruation. Low birthweight may also enhance the likelihood of neonatal menstruation, whereas prematurity could be protective, although the available data are inconclusive. Conclusions The available data suggest that fetomaternal risk factors associated with neonatal menstruation could also potentially be useful in identifying women at risk of endometriosis. However, archival clinical studies have important limitations, including lack of accurate dating of pregnancy, therefore necessitating prospective studies and systematic registration of neonatal menstruation.

Surveillance study of apparent life-threatening events (ALTE) in the Netherlands

SIDS and ALTE are different entities that somehow show some similarities. Both constitute heterogeneous conditions. The Netherlands is a low-incidence country for SIDS. To study whether the same would hold for ALTE, we studied the incidence, etiology, and current treatment of ALTE in The Netherlands. Using the Dutch Pediatric Surveillance Unit, pediatricians working in second- and third-level hospitals in the Netherlands were asked to report any case of ALTE presented in their hospital from January 2002 to January 2003. A questionnaire was subsequently sent to collect personal data, data on pregnancy and birth, condition preceding the incident, the incident itself, condition after the incident, investigations performed, monitoring or treatment initiated during admission, any diagnosis made at discharge, and treatment or parental support offered after discharge. A total of 115 cases of ALTE were reported, of which 110 questionnaires were filled in and returned (response rate 97%). Based on the national birth rate of 200,000, the incidence of ALTE amounted 0.58/1,000 live born infants. No deaths occurred. Clinical diagnoses could be assessed in 58.2%. Most frequent diagnoses were (percentages of the total of 110 cases) gastro-esophageal reflux and respiratory tract infection (37.3% and 8.2%, respectively); main symptoms were change of color and muscle tone, choking, and gagging. The differences in diagnoses are heterogeneous. In 34%, parents shook their infants, which is alarmingly high. Pre- and postmature infants were overrepresented in this survey (29.5% and 8.2%, respectively). Ten percent had recurrent ALTE. In total, 15.5% of the infants were discharged with a home monitor. In conclusion, ALTE has a low incidence in second- and third-level hospitals in the Netherlands. Parents should be systematically informed about the possible devastating effects of shaking an infant. Careful history taking and targeted additional investigations are of utmost importance.

Motoric responses to sucrose in postmature and term infants

Postmature infants calm less when presented with sucrose solutions than term infants. To further assess the influence of postmaturity on sucrose responsivity, several motoric responses were examined in healthy term neonates and chronically stressed postmature (≥ 288 days gestational age (GA) e.g., > 41 weeks) neonates with Clifford's Syndrome tested between 5–91 h of age. Following baseline observations, each subject was presented with 0.1 ml of a 14% sucrose solution for 10 s each min for 5 min, and observations were continued for 5 min following stimulation. During sucrose stimulation and poststimulation phases, postmature infants showed more tremors during quiet state than term infants. Across conditions, postmature infants exhibited increased finger sucking, rhythmic sucking, but less mouth opening and arm movements than healthy, term infants. Sequence analysis revealed that short-latency mouthing, repetitive movements of the upper and lower lips, followed sucrose infusion reliably in postmature infants, but not term infants. These results suggest that postmaturity is associated with: 1. Increased oral behaviors associated with arousal and self soothing; and 2. Increased sucrose reactivity, as indicated by contingent mouthing and increased tremors.

Differential activation of a “primitive feeding system” between term and postmature infants in the sucrose calming test

In a study of a sample of 317 conceptional basal body temperature (BBT) curves obtained from normal women, the authors have applied new definitions of prematurity and postmaturity which take into account the time of ovulation. They were thus able to estimate (1) the error rates associated with the classical definitions-incorrect classification as pre- or postmature and nondetection; in particular, for this series, the percentage of incorrectly classified postmatures is high (70 per cent) and is even more so when considering only the unwanted births (80 per cent); (2) the order of magnitude in terms of days of the error made in assessing postmaturity by the classical method. This was found to be quite substantial for the misclassified cases.

Philosophy as I remember it: Bergson

Called "Ohnree" by his French friends and all those with a year of college French, he was a postmature infant who, while awaiting birth, occupied a private womb. For this reason he fell into the habit of contemplating his navel. Little wonder he became a mystic. A mystic is one who writes a book to prove a book cannot be written on the subject of the book, and succeeds (Fig. 1). Bergson invented a type of mystic experience called "creative involution." During one of these experiences Bergson discovered involutional malcoholia, as have many Frenchmen before, after, and during Bergson. According to Bergson, there are three mental functions.

Diminished reactivity of postmature human infants to sucrose compared with term infants.

Sucrose is an effective calming and analgesic agent in infant humans, and characteristics of this calming effect suggest it may occur through an opioid pathway. Implications of this would be that infants who have experienced chronic prenatal stress and concomitantly elevated levels of endogenous opioids resulting in tolerance should therefore be less responsive to sucrose than nonstressed infants. To test this, we compared healthy term infants (M = 39 weeks 3 days) and chronically stressed, postmature infants (M = 42 weeks) with respect to the sucrose-mediated calming effect at 5-91 hr of age

Diminished reactivity of postmature human infants to sucrose compared with term infants.

Diminished reactivity of postmature human infants to sucrose compared with term infants.

Hyaline Membranes in Postmature Infants

Hyaline membranes in 21 of postmature infant autopsies were studied, using 27 term infant autopsies as the control population. The occurrence of hyaline membranes was much higher in postterm (86%) than term infant autopsies (26%). Seventeen of 21 postmature infants had clinical and microscopic evidence of aspiration, contaminated by meconium in 14, suggesting that meconium and/or amniotic aspiration may be an etiologic factor in postmature hyaline membrane formation. Thirteen infants had severe hyaline membrane formation, microscopically distinguishable from hyaline membrane disease of the premature only by the maturity of the underlying lung. Besides the pulmonary findings, little difference in organ histology was observed between the two groups. This study showed that hyaline membrane formation resulted in asphyxia and respiratory failure in the majority of the postmature infants who were already troubled with hypoxia and a combined respiratory and metabolic acidosis secondary to meconium aspiration, and eventually led to death.

Congenital Dislocation of the Hip in Western Australia A Comparison of Neonatally and Postneonatally Diagnosed Cases

Speculation that neonatally diagnosed congenital dislocation of the hip (CDH) may have a different etiology from cases diagnosed in the postneonatal period has not been examined in Australia because insufficient data have been available. A population-based study of CDH in children up to the age of two years who were born in Western Australia (WA) in 1981, 1982, or 1983 is the subject of this report. Study material comprised cases of CDH from the WA Congenital Malformations Register and denominator data (all births in WA for 1981-1983) from the Health Department of WA. From this material, rates of CDH were calculated for each of the study variables of interest. The rate of CDH was low for babies born to aboriginal mothers, and it is postulated that this may have a cultural basis, possibly in infant carrying postures. Overall, the prevalence of CDH for 1981-1983 was 6.4 cases per 1000 births, with 4.2/1000 diagnosed in the neonatal period and 2.2/1000 in the postneonatal period. Epidemiologic differences were noted between infants diagnosed in the neonatal period and those diagnosed postneonatally; rates of neonatally diagnosed CDH were higher in first births, breech presentation, and postmature infants than were rates of postneonatally diagnosed cases. Bilateral dislocation was more common (45.3%) in neonatally diagnosed cases than in postneonatally diagnosed cases (23.3%). These findings tended to support the idea that the time of diagnosis may define two distinct entities in CDH.

Objective method of diagnosing oligohydramnios in postterm pregnancies.

Oligohydramnios is an important factor influencing the management of postterm pregnancies. However, sonographic assessment of oligohydramnios has been based largely on the subjective judgement of the sonologist. From January 1982 to December 1984, 54 patients had articulated-arm B-scan ultrasound examinations and were identified as postterm. Of these patients, 25 were subjectively diagnosed as having oligohydramnios. Five patients were considered to have low normal amounts of amniotic fluid. The remainder were considered to have normal or greater than normal quantities of amniotic fluid. From this population, an amniotic fluid index was determined for each patient by finding the product of the length, width, and depth of the largest amniotic fluid pocket. Patients with a fluid index less than 60 showed a strong association with the postmaturity syndrome. Indeed, all but one postmature infant was born of a pregnancy with a fluid index less than 60. No other fetal or perinatal complications were statistically correlated with oligohydramnios in this small patient series.

Estriol in pregnancy: VII. Unconjugated plasma estriol in prolonged gestation

This study was undertaken to determine the course of unconjugated plasma estriol (E3) concentrations after 40 weeks' gestation and to assess whether the latter may be used as a first-line test in the management of term pregnancies with poor dates and prolonged gestation. Plasma E3 was measured twice weekly in 134 women with well-dated pregnancies of 40 weeks or more and in 213 women with pregnancies of unverified age but believed to be in excess of 40 weeks from the last menstrual period. The obstetric management was based upon twice weekly determinations of urinary E3 and antepartum heart rate testing, but not all patients complied. Plasma E3 levels were not available for management of the patients. The results indicate that unconjugated plasma E3 levels are highest at 40 weeks' gestation and decline thereafter by 12% each week. Because of this slow decline, biweekly assays suffice. Increasing and plateauing serial plasma E3 levels reveal that a patient approaches term or has reached 39 to 41 weeks' gestation, respectively, whereas decreasing E3 concentrations indicate that the patient is well beyond 40 weeks, and that her fetus may be about to or has become postmature. Only seven of the 347 patients studied were delivered of a postmature infant. Their last plasma E3 levels ranged from 3.8 to 8.0 ng/ml, i.e., were below the 95% confidence limits established for normal term pregnancies. It was found that 73% of the 347 patients had plasma E3 levels of 12 ng/ml or more, and that all their pregnancies ended normally, except for three instances of presumed intrapartum fetal distress. However, in 19 (20%) of the other 27% of the 347 patients who had plasma E2 levels of less than 12 ng/ml, abnormal outcome was encountered: postmaturity (seven), fetal death (four), intrauterine growth retardation (three), malformations (two), or intrapartum fetal distress (three). These results allow the conclusion that twice weekly assays of unconjugated plasma E2 may be used as a first-line test in the management of prolonged gestation.

Neutrophil chemotaxis in preterm infants with infections

different than those employed by Holroyde et al. We found a significant linear correlation of percent pocked erythrocyte and gestational age, with the most premature infants having the highest counts, in the range of postsplenectomized individuals. The correlation is less significant with birth weight. It appears that the infant's splenic RE function as assessed by this technique correlates better with gestational age than with birth weight; therefore, splenic function may be more a reflection of maturational factors rather than birth weight. We have observed a lower percentage of pocked erythrocytes in second trimester fetuses compared to premature neonates of 25- to 32-week gestation. The reason(s) for this must remain speculative but may include differences in fetal erythrocyte membrane characteristics, or may be due to the time required ,for the acquisition of these membrane pocks. The very short life span of these early fetal erythrocytes may not allow sufficient time for the development of these autophagic vacuoles. Holroyde and Gardner 1~ have demonstrated that pocks appear in transfused red cells in asplenic patients over the course of 15 to 20 days in adult patients. Our study indicated an increase in the percent of pocked cells in post-term infants; this may reflect placental insufficiency as pregnancy proceeds post-term. In post-term infants with birth weights less than 90% of term values, major organs have fewer cells than normal, with the abnormality most apparent in the spleen. 13 The apparent decrease in reticuloendothelial function in the postmature infants may be a consequence of fetal hypoxia and malnutrition, leading to a diminution in splenic size and functional capacity. The authors acknowledge the excellent care given by the nurses in the Newborn Special Care Unit. We also thank David Scott, Ph.D., for statistical advice and Debra Camputaro for assistance in preparation of the manuscript.

A First-Year Follow-Up of High-Risk Infants: Formulating a Cumulative Risk Index

Multiple developmental assessments were made at 4-month intervals over the first year of life for 2 groups of infants born at risk and 1 normal group. The groups included 46 preterm respiratory distress syndrome infants, 46 postterm postmaturity syndrome, and 59 term normal infants. The mothers were white, multiparous, middle-class, high school graduates averaging 25 years of age. Analyses of group differences revealed that the preterm respiratory distress syndrome (RDS) infants continued to exhibit delays in motor and mental development and the postmature infants in mental development. Discriminant function analyses suggesting that the most efficient predictors and accurate discriminators of continuing risk were as follows: the Parmelee obstetric and postnatal complications scores and the Brazelton interactive and motoric process scores at birth; the Denver rating, mother-infant interaction and Carey temperament ratings at 4 months; and the Bayley mental and motor scores at 8 months. On the basis of their weighted assessment scores, infants were assigned a cumulative risk index at each assessment period.

The mother's assessment of the behavior of her infant

The Brazelton Neonatal Behavioral Assessment Scale was modified to be used by mothers. Mothers assessed their infants at birth and at one month on all Brazelton items except reflexes. Trained testers assessed the same infants at birth using the unmodified Brazelton scale. Ratings were converted to a priori process scores. Bayley developmental assessments were made at 8 months to determine relationships between neonatal ratings and later development. The infants included in the study were 32 normal infants who received optimal Brazelton scores and 32 postterm postmature infants who received nonoptimal scores. The latter group was included to check the mothers' objectivity in assessing infant behaviors regardless of the difficulty they presented. There were no differences between mothers' and testers' assessments except that testers assigned more optimal interactive process scores. Normal term infants received more optimal scores from both mothers and testers. Mothers assigned more optimal ratings at one month than at birth. Motoric process scores were correlated with 8-month Bayley motor scores. The adaptiveness of mothers' objectivity in assessing their infants is discussed.

Further investigation on the predictive value of human placental lactogen in high-risk pregnancies

Blood samples were taken from 254 women with pregnancies with various complications and 119 completely normal pregnant women for measurement of serum human placental lactogen (hPL) during the third trimester. The value of this test in the management of these pregnancies was retrospectively evaluated through details of outcome. Serum hPL and urinary estriol were compared as tools for assessment of fetal condition. Serum hPL was found to be very efficient in the prenatal diagnosis of intrauterine growth retardation associated with maternal hypertension. Low hPL levels were recorded in all severely hypertensive patients who were delivered of small-for-dates infants (a 100 per cent prediction rate), while 30 per cent of these patients had normal estriol values. Prediction rate of postmature infants by serum hPL level was 70 per cent as compared to 50 per cent by urinary estriol level. The diagnostic significance of low hPL levels is emphasized, with stress upon its value in early detection of unfavorable intrauterine environment. The importance of preterm deliveries in pregnancies involving intrauterine growth retardation and low hPL levels is discussed and demonstration cases are presented.

Developmental effects of prolonged pregnancy and the postmaturity syndrome

The development of 40 postterm, postmature infants was compared to that of 40 normal control infants during the first year of life. The postterm, postmature infants had more prenatal complications and received lower Brazelton interaction and motor scores at birth. At four months they scored lower on the Denver developmental scale and were rated "difficult" babies by their mothers. At eight months their Bayley motor scores were equivalent to those of the control infants, but their mental scores were lower. At this time their mothers reported a higher incidence of illnesses and of feeding and sleep disturbances.

Somatomedin-C Receptor Ontogeny and Levels in Porcine Fetal and Human Cord Serum

The ontogeny of somatomedin receptors in tissues of fetal pigs and levels of somatomedin-C in fetal pig serum at various gestational ages and in human cord serum was investigated. Specific binding of 125I somatomedin-C by particulate membranes prepared from fetal organs from a variety of gestational ages almost always exceeds specific 125I insulin binding. In liver, kidney, heart and the maternal portion of the placenta, apparent binding affinity for somatomedin is relatively constant throughout gestation and is the same for membranes from fetal and adult animals. In contrast, in the fetal portion of the placenta, specific somatomedin-C binding and apparent binding affinity increases as gestation progresses. The changes in this tissue correlate temporally with the acceleration of growth of the pig fetus. Membranes prepared from fetal lungs exhibit higher specific binding of somatomedin and higher affinity constants than adult lung membranes. Somatomedin levels in fetal pig serum are about 25% of those observed in the sow and are constant throughout fetal life. Somatomedin in human cord serum is likewise low compared to adult levels. Small-for-gestational age infants and large, postmature infants have lower mean somatomedin levels than normal weight, full-term infants. The identification of specific somatomedin receptors in fetal tissues opens the possibility that somatomedin-C stimulates growth of the fetus. Although not resolved, the relatively low levels of somatomedin in fetal serum may reflect low levels of the somatomedin binding protein rather than an absolute deficiency of biologically active somatomedin.