Biomedical subjects
Publications and source records attributed to R G Dillard.
Two sibs are reported with Walker-Warburg syndrome including hydrocephalus, agyria, anterior chamber dysgenesis, and encephalocele. In addition, both had cleft lip and cleft palate and intrauterine growth retardation, findings not previously noted in this condition.
Early treatment of premature infants with indomethacin has been proposed as a means of reducing the morbidity associated with respiratory distress syndrome complicated by symptomatic patent ductus arteriosus. We identified 26 infants less than 48 hours old with severe respiratory distress syndrome who had an asymptomatic patent ductus arteriosus. These infants were treated with either indomethacin or placebo. There was a significant difference in the frequency of ductal closure after receiving indomethacin treatment. No significant difference was observed in the time required for mechanical ventilation, time receiving supplemental oxygen, or time in the hospital, and there were no significant differences in the incidence of bronchopulmonary dysplasia, intraventricular hemorrhage, retinopathy of prematurity, or death between the two groups.
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The outcome in infants without fetal neural tube defect born to mothers with elevated maternal serum alpha-fetoprotein was studied. Elevated maternal serum alpha-fetoprotein with normal amniotic fluid alpha-fetoprotein was found to be associated with an increased incidence of intrauterine growth retardation and nonneural tube congenital anomalies. There was no increased incidence of developmental disabilities in infants born to mothers with elevated maternal serum alpha-fetoprotein. It is speculated that adverse events occurring early in gestation may simultaneously result in congenital anomalies and subsequently elevated maternal serum alpha-fetoprotein, perhaps through disruption of the normal placental barrier between the fetal and maternal circulations.
The purpose of this study was to assess the psychological impact of maternal serum alpha-fetoprotein screening on pregnant women with normal results and their male partners. Assessments of anxiety (as measured by the state-trait anxiety inventory) and attitudes toward pregnancy (as measured by the maternal attitude to pregnancy instrument) were conducted sequentially beginning at 16 weeks' gestation in women participating in the maternal serum alpha-fetoprotein screening with normal results and in women without access to screening. Screened subjects exhibited similar or lower levels of anxiety at each point in time as compared to unscreened subjects. In addition, they exhibited a similar or more positive attitude toward pregnancy. No differences in anxiety were observed between male partners in the two groups. Participation in screening appeared to have no adverse psychological effect on the subjects studied.
The purpose of this study was to assess the psychological impact of maternal serum alpha-fetoprotein screening on pregnant women with false positive elevations of maternal serum alpha-fetoprotein and on their male partners. Subjects with maternal serum alpha-fetoprotein elevations and their partners exhibited significantly heightened anxiety as measured by the State-Trait Anxiety Inventory following notification of the elevation, and this anxiety persisted until normal results were obtained by further testing. Heightened anxiety was not alleviated by counseling prior to definitive testing. Once normal results were obtained, anxiety returned to control levels and heightened anxiety was not observed throughout the remainder of pregnancy. Maternal serum alpha-fetoprotein elevations had little effect on maternal attitudes toward pregnancy as measured by the Maternal Attitudes to Pregnancy Inventory. Similarly, no differences were observed between subjects with normal and elevated maternal serum alpha-fetoprotein levels with regard to depression, marital discord, work attendance, or work productivity.
We report on an infant with the prune belly syndrome who was unusual in that the typical manifestations of the disorder were accompanied by an anterior abdominal wall defect. We speculate that this defect may have occurred as a result of splitting of the abdominal wall secondary to massive bladder dilatation and stretching of the abdominal muscles. An alternative explanation is that the defect may have been the result of secondary pressure necrosis from stretching forces or from contact with another structure, such as the cervix. This case lends further support to the hypothesis that bladder distention with overdistention of the abdomen may be the primary event leading to the findings observed in the prune belly syndrome.
Primitive reflexes and motor development were evaluated in 127 very low birth weight (VLBW) infants (birth weight less than 1501 grams) at four months corrected age. The asymmetrical tonic neck reflex, tonic labyrinth reflex, and Moro reflex were assessed for each child. The ability of each child to reach (obtain a red ring) and roll were observed. The child's performance on the gross motor scale of the Denver Development Screening Test was recorded. Thirty-seven term infants were administered identical evaluations at four months of age. The VLBW infants retained stronger primitive reflexes and exhibited a significantly higher incidence of motor delays than term infants. Significant correlations existed between the strength of the primitive reflexes and early motor development for VLBW infants. This study confirms a high incidence of motor delays among VLBW infants and demonstrates a clear association between retained primitive reflexes and delayed motor development in VLBW infants.
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Pancuronium bromide treatment in severely ill, mechanically ventilated infants has been shown to result in lower peak transpulmonary pressure, with an accompanying lower-than-expected incidence of pneumothorax. Infants, treated with pancuronium often demonstrate an ominous abdominal roentgenographic finding: the "gasless abdomen." Of 38 mechanically ventilated infants, 22 of 24 pancuronium-treated infants (as compared with four of 14 untreated infants) had diminished or absent bowel gas. There was no significant difference between the two groups with regard to birth weight, mortality, or incidence of respiratory distress syndrome. Pancuronium prevents swallowing of air but does not inhibit gut peristalsis, thus accounting for the evacuation of abdominal gas three hours or more after administration of the drug. Clinicians who treat infants with pancuronium should be aware of the phenomenon, to avoid needless roentgenographic studies.
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Neonatal illness frequently leads to problems for parents. An intensive care nursery (ICN) program was developed to ameliorate the effects of neonatal illness on parents. The approach to parents used crisis intervention techniques and was coordinated by two full time social workers. Mothers taking part in the program, when compared with mothers of healthy term infants, had at the time of discharge similar attachment feelings and perception of their infants, as well as similar attitudes toward pregnancy and medical care.
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