Seventh Day Of Life Research Articles

Unforgettable tetanus

Unforgettable tetanus

Systemic group B streptococcal disease in neonates and young infants in Norway 1985-94.

In the period 1985-94, 237 out of 575,248 (0.41 per 1000) live born infants in Norway were reported to suffer culture-confirmed systemic group B streptococcal disease before their 90th day of life. The annual incidence increased from 0.20 per 1000 live births in 1985 to 0.64 in 1994, due solely to an increase in cases with an onset before the seventh day of life. Future studies should address the possible causes of this increase.

Lateral ventricular effacement as an isolated sonographic finding in premature infants: prevalence and significance.

The sonographic finding of effaced lateral ventricles in premature infants, defined as the absence of visible CSF within the lateral ventricles on both coronal and sagittal sonograms, may be cause to suspect diffuse cerebral edema, especially as published reference standards do not address this phenomenon. This investigation was undertaken to determine the prevalence and significance of effaced lateral ventricles without associated parenchymal abnormality (isolated lateral ventricular effacement, or ILVE) in premature infants. Sonographic records of 398 consecutive newborns examined from January 1 to December 31, 1993, were reviewed retrospectively to identify those premature infants (< 36 weeks of gestational age) whose initial sonograms showed no evidence of intracranial hemorrhage, ventriculomegaly, structural abnormality, or abnormal parenchymal echogenicity. We identified 142 neonates who met these criteria. Patients were separated into two groups on the basis of whether they had at least one sonographic study in which CSF was not visible within both lateral ventricles on coronal and sagittal images. Medical records were reviewed to assess neurologic outcome. Forty patients (28%) had at least one sonogram demonstrating ILVE, with neurologic follow-up in 33 (representing group A). One hundred two patients (72%) never demonstrated ILVE, with neurologic follow-up established in 86 (representing group B). A comparison of the two groups showed no significant difference in the development of ischemic injury (one patient in each group). ILVE was first detected on the initial sonogram obtained (mean, 4 days) in 30 of the 33 neonates in group A. ILVE was demonstrated beyond the seventh day of life in 30%. Of the 89 patients whose initial sonograms showed CSF in the lateral ventricles (86 in group B and three in group A), three (3%) subsequently had sonograms that showed ILVE; all three were normal at follow-up. ILVE in premature infants is common and not associated with neurologic deficits indicative of hypoxic-ischemic encephalopathy. By itself, ILVE is not a significant finding.

Altered kinetics of cytochrome c oxidase in a patient with severe mitochondrial encephalomyopathy

Deficiency of cytochrome c oxidase activity was established in a girl born to consanguineous parents. She showed symptoms of dysmaturity, generalized hypotonia, myoclonic seizures and progressive respiratory failure, leading to death on the seventh day of life. Structural abnormalities of the central nervous system consisted of severe cerebellar hypoplasia and optic nerve atrophy. Biochemical analysis of a muscle biopsy specimen demonstrated deficiency of cytochrome c oxidase activity. Cultured fibroblasts from this patient also showed a selective decrease in the activity of cytochrome c oxidase, excluding a muscle-specific type of deficiency. Further investigations in cultured fibroblasts revealed that synthesis, assembly and stability of both the mitochondrial and the nuclear subunits of the enzyme were entirely normal. The steady-state concentration of cytochrome c oxidase in the fibroblasts of the patient was also normal, suggesting that the kinetic properties of the enzyme were altered. Analysis of the kinetic parameters of cytochrome c oxidase demonstrated an aberrant interaction between cytochrome c oxidase and its substrate, cytochrome c, most likely because of a mutation in one of the nuclear subunits of the enzyme.

Unusual Cause of Neonatal Septic Shock: Neonatal Shigellosis

Unusual Cause of Neonatal Septic Shock: Neonatal Shigellosis

Recovery of intralipid from lumbar puncture after migration of saphenous vein catheter.

A term female infant was admitted to the intensive care unit with the diagnosis of tetralogy of Fallot with critical pulmonary stenosis. On the seventh day of life a long saphenous line was inserted that remained without complications until seven days later when the infant appeared septic. A lumbar puncture demonstrated the presence of intra-lipid in the cerebrospinal fluid that we interpreted as due to migration of the saphenous catheter. The child had an uneventful recovery.

Developmental Patterns for Pancreatic Opioids in the Rat

Developmental patterns for rat pancreatic opioid peptides and islet hormones were studied from gestational day 20 through adulthood. Fetal tissue was obtained as well as pancreas at birth (day 0), and postnatal days 3, 7, 14, and 21, and 7 weeks. The hormones measured included insulin, glucagon, and somatostatin. The opioids measured were beta-endorphin, Met- and Leu-enkephalins, and the high molecular weight enkephalin precursors. Pancreata were pooled as necessary and extracted (acid alcohol, or hot acetic acid), and opioids were further purified on reversed-phase C-18 (Sep-pak) cartridges. In all instances measurements were made by radioimmunoassays. Precursor peptides were first digested (with trypsin and carboxypeptidase B) prior to immunoassay. All opioids and hormones except the precursors for enkephalins showed a well-defined surge in pancreatic concentration during the first postnatal week. In contrast, the precursors had the highest concentration in the fetus, and by the seventh day of life had decreased by greater than 50%. This progressive decrease may represent maturation of the enkephalin convertase and trypsin-like enzymes in the islets. The opioid and hormonal surges that we have described are similar to the surge in islet concentration of thyroid-releasing hormone (TRH) previously described in neonatal rat islets. It is suggested that these postnatal alterations in opioid and hormone concentration relate to a specific function in the development of the endocrine pancreas.

Pulmonary function in preterm infants following treatment with intravenous indomethacin.

Pulmonary function tests, including measurements of arterial blood gas levels, total pulmonary compliance, and arterial-alveolar oxygen ratios, were performed in 38 ventilator-dependent preterm infants with respiratory distress syndrome who weighed less than 1500 g at birth. Twenty-seven had a physiologically significant patent ductus arteriosus (PDA). Twelve were assigned at random to receive three doses of intravenous indomethacin, 0.2 mg/kg per dose, on the fourth day of life. This treatment resulted in ductal closure in seven infants by the seventh day of life. Another concurrently observed group of 15 infants with PDA received no indomethacin. A third group of 11 infants lacked evidence of a PDA. Pulmonary function in the infants who received indomethacin did not differ significantly from that in the other two groups.

Passive total respiratory system compliance and gas exchange in newborns with hyaline membrane disease.

Passive total respiratory system compliance (CRS) and gas exchange measurements were performed in nine newborns during the course of hyaline membrane disease. None of the subjects presented bronchopulmonary dysplasia at follow-up investigations. Gestational age ranged from 29 to 37 weeks. CRS was measured by the multiple occlusion technique. Gas exchange parameters were the fraction of inspired oxygen concentration (FIO2) and the arterial/alveolar ratio for oxygen (a/AO2 ratio). In each subject four tests were performed: test 1 during the first day of life; test 2 during the second day of life; test 3 between the fourth and the seventh days of life; test 4 after extubation. CRS/BW (CRS normalized for body weight) was not statistically different at tests 1-3, but it significantly increased (P less than 0.001) between tests 3 and 4. FIO2 and a/AO2 ratio presented no statistical difference at tests 1-2 but several significant differences were noted thereafter: FIO2 decreased significantly (P less than 0.001) when results from tests 2 and 3 were tabulated. The a/AO2 ratio increased significantly between tests 2 and 3 (P less than 0.001), and a further significant increase (P less than 0.01) was also noted when results obtained during tests 3 and 4 were compared. A significant relationship existed during the evolution of the disease between CRS/BW and gas exchange parameters (FIO2 and a/AO2 ratio) (P less than 0.01), but gas exchange improved earlier than lung mechanics.

A national survey of severe group B streptococcal infections in neonates and young infants in Denmark, 1978-83.

During a six-year period, 1978-83, 80 cases of culture proven group B streptococcal (GBS) bacteraemia and meningitis were identified in neonates and young infants up to 12 weeks of age in a national retrospective survey. Two thirds (68%) were early onset disease (EOD) while one third was late onset disease (LOD) occurring later than the seventh day of life. The overall incidence for the period was 0.24 per 1,000 live-born with a trend towards decline through the period. EOD was associated with low birthweight, twin delivery and congenital anomalies as well as with obstetric risk factors like premature or prolonged rupture of membranes and intrapartum fever. The overall case fatality rate was 23%, both in EOD and LOD. Seven (11%) of the surviving infants, six of whom had had meningitis, developed neurological sequelae. Newborns that showed signs of infection with 12 hours of delivery were at a significantly higher risk of running a fulminant course than newborns whose infections developed later (p = 0.02). Nosocomial transmission of GBS seemed limited and most hospital-acquired cases were unconnected.

Stool pH and sugar in preterm neonates.

The stool pH and sugar were examined in 76 breast fed and 38 formula fed premature infants. The stool pH decreased gradually till 5th day of life and then increased again. Stool sugar was not more than 0.75 percent in breast fed and 0.5 percent in formula fed during first seven days of life. A premature infant with stool pH 0.5 percent after seventh day of life needs to be investigated for pathological sugar malabsorption.

Diuresis and pulmonary function in premature infants with respiratory distress syndrome

A prospective study of 99 premature infants with severe respiratory distress syndrome who were randomly assigned to receive diuretic treatment with either furosemide or chlorothiazide was analyzed to examine the relationship of diuretic administration and diuresis to survival and to the duration and degree of mechanical ventilatory support. Subjects were given a diuretic, usually beginning on the second or third day of life, if they had not initiated the expected spontaneous diuresis and did not show pulmonary improvement. Infants given furosemide experienced a postnatal weight loss nearly identical to that in infants who were deemed not to need a diuretic; infants given chlorothiazide lost weight more slowly and had significantly greater body weight on postnatal days 4 and 5. Four factors were independently correlated with improved survival: furosemide usage, high birth weight, low initial mean airway pressure, and the absence of intraventricular hemorrhage. Ventilator mean airway pressure on the seventh day of life and duration of mechanical ventilation were both related to diuresis. These data provide additional evidence for the importance of water homeostasis in determining the course of respiratory distress syndrome in premature infants and indicate that furosemide administration is beneficial when spontaneous diuresis does not occur. Furosemide may be particularly effective if combined with early closure of the ductus arteriosus.

Stool sugar and pH in term breast fed neonates.

Stool samples from 58, exclusively breast milk fed, term neonates were, examined for first seven days of life, for pH and reducing substances. Stool pH >7 and sugar >0.5% were not recorded in any neonate. On fourth day of life pH stool was 0.1% in 60.35% of the neonates. No detectable sugar was found in 82.7% of neonates, on seventh day of life.

Postnatal maturation of gonadotropes in the male rat pituitary.

The postnatal maturation of gonadotropes was studied with the use of electron microscopic-immunocytochemical strains for the beta-chains of LH and FSH on serially sectioned fields. A third serially sectioned field was stained with antiserum to ACTH-(17-39). Morphometric studies on semithin and ultrathin plastic sections stained for LH and FSH showed a 200-300% increase in the percentages of LH and FSH cells during the first week of postnatal life. In the 1- to 2-week-old rats, the percentage of gonadotropes in the population was greater than that in the adult. Analysis of the hormone content of serially sectioned gonadotropes showed that storage patterns similar to those in the adult were reached by the seventh day of life. In the neonatal group, 66% of the serially sectioned cells contained both FSH and LH, 20% contained only LH, and 14% contained only FSH. In the 7- to 15-day-old rats, the percentages of gonadotropes containing both hormones increased to 79% while 10-11% of the cells contained only LH or FSH. This is similar to the findings in the adult rat population (75% LH and FSH cells, 14.2% LH cells, and 11% FSH cells). The fields stained for ACTH showed that 35-80% of the gonadotropes contained ACTH-like immunoreactivity during neonatal development, with the highest values seen in the 7- to 15-day-old rats. In the normal adult rats, 2-10% of the gonadotropes contain ACTH activity. Cells containing only ACTH were also seen in all age groups examined. The morphological analysis showed that immature gonadotropic cells contained scattered storage granules, arranged either at the cell periphery or concentrated near the nucleus. They were small, irregularly shaped, and often exhibited a high nucleo-cytoplasmic ratio. They were difficult to distinguish from corticotropes. More mature cell types were found after 1 week of age. These were ovoid and contained numerous large and small granules, features similar to the adult type I cell. The granules, however, were more irregularly shaped (pleomorphic). Immature forms were observed in the gonadotrope population as late as 15 days of age. Most gonadotropes from the 20- to 25-day-old rats resembled those in the adult population. Our findings support the physiological studies which show that the first week of life is an important time for functional and morphological maturation of the gonadotrope population. They also support the finding that immature gonadotropes are larger, more numerous, and more heterogeneous than those in the adult male rat population. Finally, we propose that a subpopulation of gonadotropes may serve as a stem cell or may be involved in the development of adrenal-gonadal interactions.

Study of the Malformed Fetus and Infant

Humans sustain a reproductive loss of approximately two of every three fertilizations; prenatally, much of this death is associated with malformations that are mainly due to chromosome abnormalities. Up to half of all pre- and postimplantation ova in man may have chromosome defects that are more than 98% lethal. The earlier the stage of development at the time of the spontaneous abortion the greater is the number of malformations and chromosome defects; nearly 80% of embryos that reach a 2-week stage of development have a chromosome defect, as do more than 60% of those developing to 12 weeks, approximately 6% of stillborn infants, and 0.6% of all live-born infants. Even nonchromosomally caused single congenital defects have a high prenatal death rate. Besides chromosome defects, multifactorial traits and single gene (mendelian) mutations are the next most common class of congenital defects. Prior fetal wastage with or without prematurity of previous live-born infants increases the risk of subsequent fetal loss; the greater the number of preceding spontaneous abortions the smaller is the chance of a subsequent live-born child. One fourth of all stillborn fetuses have one or more than one malformation or a syndrome, in many cases associated with a substantial risk of recurrence. After "certain diseases of early infancy" (mostly prematurity and hyaline membrane disease) congenital malformations remain the most important cause of infant mortality (60% of which occurs by the seventh day of life). It is important for pediatricians to take much greater cognizance of the amount of genetic disease involved in fetal wastage and infant death, to collaborate more effectively with obstetricians, pathologists, anatomists, and geneticists in determining diagnosis and risk of recurrence, and to counsel more accurately those who have lost a fetus or infant. Such fetuses and infants deserve the same meticulous examination, evaluation, and documentation as an older malformed child being brought in for diagnostic, prognostic, and genetic counseling. A fetal loss may cause as much sorrow as an infant death; this grief must be addressed explicitly but gently and sympathetically before any other considerations are put before the parents as they decide on whether or not to create a new life.

Study of the Malformed Fetus and Infant

Humans sustain a reproductive loss of approximately two of every three fertilizations; prenatally, much of this death is associated with malformations that are mainly due to chromosome abnormalities. Up to half of all pre- and postimplantation ova in man may have chromosome defects that are more than 98% lethal. The earlier the stage of development at the time of the spontaneous abortion the greater is the number of malformations and chromosome defects; nearly 80% of embryos that reach a 2-week stage of development have a chromosome defect, as do more than 60% of those developing to 12 weeks, approximately 6% of stillborn infants, and 0.6% of all live-born infants. Even nonchromosomally caused single congenital defects have a high prenatal death rate. Besides chromosome defects, multifactorial traits and single gene (mendelian) mutations are the next most common class of congenital defects. Prior fetal wastage with or without prematurity of previous live-born infants increases the risk of subsequent fetal loss; the greater the number of preceding spontaneous abortions the smaller is the chance of a subsequent live-born child. One fourth of all stillborn fetuses have one or more than one malformation or a syndrome, in many cases associated with a substantial risk of recurrence. After certain diseases of early infancy (mostly prematurity and hyaline membrane disease) congenital malformations remain the most important cause of infant mortality (60% of which occurs by the seventh day of life). It is important for pediatricians to take much greater cognizance of the amount of genetic disease involved in fetal wastage and infant death, to collaborate more effectively with obstetricians, pathologists, anatomists, and geneticists in determining diagnosis and risk of recurrence, and to counsel more accurately those who have lost a fetus or infant. Such fetuses and infants deserve the same meticulous examination, evaluation, and documentation as an older malformed child being brought in for diagnostic, prognostic, and genetic counseling. A fetal loss may cause as much sorrow as an infant death; this grief must be addressed explicitly but gently and sympathetically before any other considerations are put before the parents as they decide on whether or not to create a new life.

Perinatal death—two microprocessor applications that may help to reduce its incidence

The perinatal death rate is still too high. For every 1000 deliveries in England in 1975, there were 19 deaths during the period between the start of labour and the seventh day of life. Eight of these deaths occurred after birth. All work towards lowering the risk is of benefit, and may contribute to the gradual decline in perinatal mortality that has been seen since records began

Adrenal Calcification in Beckwith-Wiedemann Syndrome

The features of the Beckwith-Wiedemann syndrome are characterized by exomphalos, macroglossia, macrosomia, visceromegaly, ear lobe anomaly, nevus flammeus, hemihypertrophy, and other abnormalities. Adrenal calcifications can be seen in a variety of pediatric conditions. More than 171 children with the Beckwith-Wiedemann syndrome have been described in the pediatric literature, but none of these patients have been reported as having adrenal calcification.1The present communication describes two girls with the Beckwith-Wiedemann syndrome who were demonstrated to have adrenal calcifications at ages 7 and 4 years, respectively. Report of Cases.—Case1.—This 7-day-old girl was hospitalized because of macrosomia (4.8 kg), macroglossia, and a history of poor feedings. She had been born at term, following a traction delivery. On admission macrosomia, macroglossia, peculiar facies, relative microcephaly, navel hernia, and visceromegaly were striking. Serum bilirubin level on the seventh day of life was 18.8 mg/100 ml. A diagnosis of cretinism was suspected

Carcinoma of the male breast following thymic irradiation.

A white male teenager with carcinoma of the breast had received radiation therapy for an asymptomatic enlarged thymus on the second, fourth and seventh days of life. The dose delivered to the infant breasts, the latent period, and the unusually young age of the patient suggest that the malignancy was related to the course of radiotherapy.

Correlation between G-6-PDH Activity of the Erythrocytes and the Sex Chromatin Frequency in the Somatic Cells in New-Born Girls

It was demonstrated in investigations performed in 44 new-born girls, that the G-6-PDH activity of the erythrocytes gradually decreases up to the seventh day of life. This process goes hand in hand with the increase of sex chromatin, i.e. of heterochromaticchromosomes. These phenomena can be indirectly ascribed to the estrogens. No similar changes in enzyme activity were found in 28 new-born boys investigated as controls.