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PubMed1997

Assessment of general movements: towards a better understanding of a sensitive method to evaluate brain function in young infants.

The consistent presence of an abnormal quality of general movements (GMs) during the first postnatal months points to a high risk for the development of a neurological disability. To elucidate the significance of abnormal GMs during a single assessment, a classification system for abnormal GMs was developed. To this end six term and ten preterm infants with abnormal GMs were studied longitudinally with video and electromyographic (EMG) recordings till 59 weeks postmenstrual age (PMA). Two basic categories of abnormal GMs were distinguished: (1) mildly abnormal GMs (two types), which lacked fluency while conserving pattern complexity, and (2) definitely abnormal GMs (four types), which lacked fluency and complexity altogether. GM type before 39 weeks PMA correlated with findings on neonatal ultrasound brain scans. GM quality after 47 weeks PMA was strongly related to neurodevelopmental outcome at 1 1/2 years of age, suggesting that the absence of the age-specific 'fidgety' character of GMs could be a herald of disability.

Brain↗

PubMed1998

Delayed visual maturation: pupillary responses implicate subcortical and cortical visual systems.

Vision in very early infancy is probably subserved by subcortical pathways, with many cortical processes only fully emerging by 3 months of age. The improvement of vision in delayed visual maturation (DVM) occurs around this time, and this has given rise to the suggestion that the condition may have a subcortical basis that resolves with the appearance of cortical function. To explore further the role of cortical and subcortical visual systems in DVM we studied the visual development in identical twins, one of whom had type 1b DVM. Two non-invasive methods of investigating visual pathway function were employed: the acuity card procedure (a behavioural response) and luminance and grating pupillometry. While the former reflects both subcortical and cortical function and can be detected at birth, pupil responses to gratings reflect cortical activity alone and normally become measurable at 1 month of age. Development of both behavioural and pupillary responses was delayed in DVM, indicating that although the underlying defect is primarily subcortical, secondarily it delays the emergence of cortically mediated responses. The observed rapidity of improvement--over a very few days and within a narrow age range--suggests a discrete rather than a widespread structural abnormality, the improvement of which is closely linked to postmenstrual age.

Failure to Thrive↗

PubMed1980

The adjustment of basal body temperature measurements to allow for time of waking.

During one menstrual cycle, each of eleven volunteer student nurses at Northwick Park Hospital recorded their vaginal temperature on waking and noted the clock time. Waking times varied between 0530 hours and 1100 hours. Regression analysis revealed significant linear relation between temperature and time of waking, with a slope of 0.086 degrees C/hour (SE, 0.009 degrees C/hr) in the postmenstrual (hypothermal) phase. A rounded adjustment factor of 0.1 degrees C/hour is shown to improve the interpretability of basal body temperature (BBT) charts in a group of seven women regularly using natural family planning methods. The adjustment factor is simple to apply and only involves counting one square on a BBT chart for each hour that the waking time differs from normal.

Body Temperature↗

PubMed1985

Ultrasound demonstration of increased frequency of functional ovarian cysts in women using progestogen-only oral contraception.

Asymptomatic volunteer women with a regular pattern of uterine bleeding and using the progestogen-only oral contraceptive pill were compared with control women who were not exposed to hormones. Pelvic ultrasound scanning at the end of the next bleeding episode after recruitment demonstrated functional cysts with maximum diameters ranging between 30 and 58 mm in eight of the 21 pill users, four of whom also had palpable ovaries, three cysts regressed during the next cycle. Of the 13 women with normal ovaries initially, four developed a new functional cyst of which two were associated with pain. Of the 12 women with cysts seven complained of pain at some time during the monitored cycle. Among 21 control women only one symptom-free (42 mm) cyst was shown on the initial postmenstrual ultrasound scan and this resolved painlessly during the scanned cycle with ovulation from the opposite ovary. Ovulation was also demonstrated in 16 of the remainder; but in none of the three control women who developed asymptomatic functional cysts (35-47 mm in size) while under observation. Since 11 of the 14 pill-users who failed to ovulate also had a functional cyst, the contraceptive efficacy may depend in part on this association. Pain symptoms may make the method less acceptable and give rise to diagnostic problems and inappropriate therapies.

Adult↗

PubMed2005

A randomised controlled trial of microwave endometrial ablation without endometrial preparation in the outpatient setting: patient acceptability, treatment outcome and costs.

OBJECTIVE: To compare outpatient microwave endometrial ablation (MEA) in the postmenstrual phase to standard MEA treatment after drug preparation in a day case theatre environment. DESIGN: A randomised controlled trial. SETTING: A large United Kingdom teaching hospital. POPULATION: Two hundred and ten women complaining of excessive menstrual loss. METHODS: Two hundred and ten women with excessive menstrual loss were randomised. Ninety-seven women were treated as outpatients in the immediate post-menstrual phase and 100 were treated in an operating theatre after hormonal preparation. All procedures were commenced under local anaesthesia with or without conscious sedation. Analysis was by modified intention to treat. MAIN OUTCOME MEASURES: Primary outcome measures were satisfaction with treatment (measured at one year) and acceptability of treatment (measured at two weeks). Secondary outcome measures were menstrual outcome and financial cost. RESULTS: Significantly more women found treatment post-menses acceptable; 86 (89.5%) versus 76 (76.0%) [difference in proportions 13.6%, 95% CI (3.0%, 23.9%)]. Similar numbers in each arm were totally or generally satisfied with the treatment, 86 (92.5%) versus 84 (88.4%) [difference in proportions 4.1%, 95% CI (-4.7%, 12.9%)] while amenorrhoea rates at one year were comparable, 52 (55.9%) versus 60 (61.9%). [difference in proportions -5.9%, 95% CI (-19.8%, 7.6%)]. The mean health service costs were 124 pounds (95% CI 86-194 pounds) lower for the patients in the post-menses group. CONCLUSION: MEA performed under local anaesthesia (with or without conscious sedation) in the post-menstrual phase achieves high levels of satisfaction is very acceptable to patients and results in significantly reduced health service costs. Importantly menstrual outcomes are not affected by omission of drug preparation. There is now good evidence to support the use of MEA, without drug endometrial preparation, in the outpatient setting.

Adult↗

PubMedDate not supplied

Cyclic fluctuation in alcohol consumption among female social drinkers.

The main objective of this study was to investigate the relationship between menstrual cycle phase and alcohol use in female social drinkers. Sixty-nine normally menstruating women monitored alcohol consumption and basal body temperature daily over three consecutive menstrual cycles. Temperature charts were used to ascertain five cycle phases (menstrual, postmenstrual, ovulatory, luteal, and premenstrual) and data were analyzed using single-group repeated measures analysis of variance. Whereas frequency of alcohol use did not vary among the five cycle phases, quantity of alcohol consumed significantly fluctuated and peaked in the luteal phase. These data suggest that female drinking patterns may be influenced by hormonal fluctuations associated with the menstrual cycle.

Adult↗

PubMed1995

Fertility among women with recurrent spontaneous abortions--the effect of paternal cell immunization treatment.

PROBLEM: The risk of women whose chief complaint is recurrent spontaneous abortions (RSA) for secondary infertility (infecundability) has not been evaluated prospectively. The effect of paternal mononuclear cell immunization on conception rates is unknown. METHOD: Two hundred women whose chief complaint was RSA were randomly assigned to be immunized with paternal mononuclear cells either before or after (up to 6 postmenstrual weeks) conception. Fertility rates (both conception and live birth) were evaluated for the group immunized before conception and compared to those for the control group, who were not immunized until after conception, using life table and multiple logistic regression analyses. RESULTS: Prospectively ascertained, age-related conception rates for nonimmunized RSA controls appeared to be similar to those for general populations. Immunization before pregnancy had no significant effect (power +/- 14%) on rates of conception (66% before, 77% after) or time to conceive (median weeks before 19.5, after 27.0). Live birth rates (before 59%, after 63%) were also similar for both groups (P = 0.7). CONCLUSION: Women whose only prior complaint was RSA were not at high risk for secondary infecundability, and immunization did not alter either conception rates or time to conceive. Postponement of immunization until after conception did not affect live birth rates for women selected for study because they did not have a history of prior infecundability or early repeated miscarriages.

Abortion, Habitual↗

PubMed1975

Control of respiration in newborn babies. III. Developmental changes of respiratory depth and rate responses to CO2.

Thirteen healthy babies with PM ages varying between 32 and 43 weeks were investigated with regard to respiratory depth and rate changes on exposure to 4% CO2 in air. Two different types of responses were seen: above 37 weeks of postmenstrual age, the changes of depth and rate corresponded mostly to what is known in the adult human with a rate increase appearing only when the tidal volume had increased markedly ("Type A" responses). The preterm babies (i.e. under 37 weeks of PM age) responded mostly with a prompt rate increase without any preceding increase of the tidal volume ("Type B" response). The results indicate that the preterm baby in contrast to fullterm babies and adults may be dependent on the pulmonary vagal mechanoreceptor system for the regulation of the breathing in eupnoe.

Abdomen↗

PubMed1976

Control of respiration in newborn babies. IV. Rib cage stability and respiratory regulation.

The recordings from an earlier study regarding the respiratory depth and rate changes induced by exposure to 4% CO2 in air in 13 babies with PM age varying between 32 and 43 weeks were reexamined with regard to the pattern of thoracic abdominal breathing excursion in breathing immediately prior to the CO2 exposure and the type of response induced. The pattern was called "stable" when the thoracic breathing excursions were in phase and congruent with the abdominal ones. When the thoracic excursions in comparison with the abdominal excursions were totally inverted, or incongruous but in phase, or rapidly varying between those two, the pattern was called "unstable". "Unstable" pattern of the breathing prior to the CO2 exposures was followed in an incidence of 60% by the type of response to CO2 which is characterized by a prompt rate increase (the "Type B" response) and only in 16% by the type characterized by an increased breathing amplitude (the "Type A" response). When the excursion pattern of the breathing prior to the CO2 exposures was "stable" "Type A" responses were induced in 59% and "Type B" responses in only 14%. The excursion pattern present when a baby is exposed to 4% CO2 thus seems to affect the type of respiratory depth and rate changes achieved. With increasing postmenstrual age the excursion pattern of the spontaneous breathing is more often "stable" and respiratory depth and rate changes of the "Type B" induced by CO2 less common. The variabilities of the breathing seen preferably in the preterm baby regarding regularity, rate and tidal volumes (as they could be approximated by the registration methods used) were noted most when the excursion pattern was "unstable". The results can be hypothetically interpreted to indicate a dynamic interaction between the thoracic wall and pulmonary mechanoreceptor systems of respiratory regulation. The decreasing variability of the breathing seen with increasing maturation in the baby could be explained by an increasing maturation of the neuromuscular ability to provide stability to the rib cage which would act stabilizing on the pulmonary vagal afferent input to the respiratory center.

Abdomen↗

PubMed1983

Glomerular tubular balance in preterm and fullterm infants.

The development of glomerular and tubular function was studied in preterm and fullterm infants of varying gestational and postnatal age. The results indicate that glomerular functional development precedes tubular functional development until the 34th postmenstrual week. After the 34th week the tubular transport capacity seems to be more vulnerable than the glomerular filtration rate in states of disease. The release of a postulated renal vasoconstriction could account for the rapid changes in renal function after birth. The purpose of such a vasoconstriction could be to protect the tubules from an overload.

Absorption↗

PubMed1989

Bone age at birth; method and effect of hypothyroidism.

Bone maturity at birth (or during the neonatal period) can be estimated from the ossified distal femoral epiphyses (FE). In congenital hypothyroidism (CHT) bone maturation is retarded and neonatal bone age reflects the severity of prenatal thyroid failure. In our reference group of 111 healthy infants, the size of these epiphyses depended not only on the age but also on body size. Thus, if bone age is estimated from the size of an epiphysis, the size of the infant is a potential confounder. This problem was avoided by estimating the maturation lag from the difference between the observed and predicted heights of FE (FEHs). Models for predicting FEH were constructed from data from the reference group by multiple linear regression and confirmed in a separate group of 37 healthy infants. In 52 hypothyroid newborns both FEH and FEH lag correlated with serum thyroxine concentration, indicating that FEH can be used as a measure of bone maturation in a population that is fairly homogeneous for (postmenstrual) age and size. Otherwise FEH lag is a better indicator.

Age Determination by Skeleton↗

PubMed1995

Brain lactate in preterm and growth-retarded neonates.

Glucose is the predominant cerebral energy source under physiological conditions, although other substrates may support cerebral metabolism. The present study was undertaken to determine if lactate is present in the immature human brain, and if so, whether or not concentrations of lactate differ between small-for-gestational-age and appropriate-for-gestational-age infants. Thirty stable, healthy infants with normal brains were investigated. As the only nutrient, all received milk enterally prior to the investigation, which was carried out without sedation. Mean gestational age was 35 completed weeks (range 28-41 weeks) and mean birth weight was 2170 g (range 855-4100 g). Proton nuclear magnetic resonance spectra from the striatal region were obtained while the infants were sleeping quietly. Lactate was present in all 10 preterm small-for-gestational-age and 10 of 13 preterm appropriate-for-gestational-age infants, and the concentration was inversely related to postmenstrual age (p < 0.002). In addition, lactate increased with the degree of growth retardation (p < 0.01). At present the significance of lactate is unclear. Lactate may be produced locally or in peripheral tissues, and may support brain metabolism.

Brain↗

PubMed2005

Sipping/lapping is a safe alternative feeding method to suckling for preterm infants.

AIM: To determine whether sipping/lapping is a safe alternative to suckle bottle-feeding without any hydrostatic pressure, in terms of physiological stability and the relationship between swallowing and respiration. In addition, tongue movement was compared between sipping/lapping and suckling (bottle- and breastfeeding). METHODS: Eighteen infants (30-35?wk of gestation at birth) were studied while sipping/lapping and suckling a bottle without any hydrostatic pressure at different feeding sessions on the same day of the first oral feeding. The postmenstrual age at the time of study was 34.6+/-0.2 wk. We evaluated the amounts ingested and administration times. The heart rate, O(2) saturation (SpO(2)), and relationship between swallowing and respiration were examined while feeding. Tongue movements were also observed by ultrasonography. Statistical analysis was performed by a paired t-test. RESULTS: The amounts ingested and intake volume per minute were lower while sipping/lapping compared to suckling. The overall heart rate and SpO(2) showed no statistically significant difference. The frequency of swallows followed by inspiration (27.6+/-0.8% and 31.0+/-1.3%) and swallows followed by expiration (46.4+/-0.9% and 45.4+/-1.4%, sipping and suckling, respectively) also showed no difference. Tongue movements while sipping/lapping differed from those while suckling a bottle or breast. CONCLUSION: Because physiological parameters and the relationship between swallowing and respiration while sipping/lapping are comparable to those while suckle bottle-feeding without any hydrostatic pressure, sipping/lapping is a safe alternative feeding method to suckle bottle-feeding, even in preterm infants.

Bottle Feeding↗

PubMed1983

Autonomic reactivity in the premenstrual phase.

The aim of the present experiment was to determine the effects of the premenstrual cycle phase on autonomic arousal. In a repeated measurement study 40 female subjects were tested premenstrually and postmenstrually for their autonomic reactivity during stress (cold pressor test, mental arithmetic) and for their acquisition of conditioned electrodermal responses, using a standardized auditory conditioning procedure. None of the differences between the cycle phases were significant. Similar results were obtained in the subjects' answers in a mood adjective list and their stimulus ratings. There was a general decrease in autonomic reactivity from the first to the second recording session, independent of the menstrual cycle periods.

Adolescent↗

PubMed1981

Adherence of bacteria to vaginal epithelial cells at various times in the menstrual cycle.

Adherence of vaginal isolates of Escherichia coli, Lactobacillus species, group B streptococci, Gardnerella vaginalis and Neisseria gonorrhoeae to exfoliated vaginal epithelial cells was studied in 10 healthy, sexually active medical students. Studies were done pre- and postmenstrually and at midcycle for two consecutive menstrual cycles. The mean number of adherent bacteria per vaginal epithelial cell (range) was 3.4 (0 to 14) for E. coli, 60.5 (12 to 152) for Lactobacillus species, 54.8 (21 to 76) for group B streptococci, 67.4 (15 to 161) for G. vaginalis, and 58.9 (15 to 186) diplococci for N. gonorrhoeae. Adherence of G. vaginalis increased with increasing acidity of the test medium (pH 4 to 8). There were no significant differences in adherence to vaginal epithelial cells obtained at the various times in the menstrual cycle for any of the organisms (p greater than 0.05). The pattern and extent of adherence among the women was similar for each organism. In this in vitro model, adherence characteristics did not vary with the menstrual cycle.

Adhesiveness↗

PubMed2005

Does the use of 50% oxygen at birth in preterm infants reduce lung injury?

BACKGROUND: Bronchopulmonary dysplasia is an inflammatory fibrotic condition produced as a consequence of injurious influences in the neonatal lung. Exposing the premature lung to high concentrations of oxygen is thought to play an important part in lung injury pathogenesis. OBJECTIVE: To see if the amount of oxygen used during resuscitation at birth triggers events that lead to the subsequent lung injury and if a reduction in oxygen used leads to a reduction in lung injury. METHOD: The outcomes of newborn babies less than 31 weeks gestation who were resuscitated using either 50% or 100% oxygen were examined. Eight of the babies receiving 50% oxygen required an increase in their oxygen concentration. Evidence of pulmonary inflammation was determined by quantifying interleukin 6, 1beta, and 10 and tumour necrosis factor alpha in bronchoalveolar lavage fluid by enzyme linked immunosorbent assay. RESULTS: There were no significant differences in any of the cytokines studied in either of the groups. Death occurred in 5/26 (19%) babies who received 100% oxygen and 4/26 (15%) babies who received 50% oxygen. Survival without bronchopulmonary dysplasia at 36 weeks postmenstrual age occurred in 14/26 (54%) and 13/26 (50%). CONCLUSION: Reducing the oxygen to 50% at resuscitation did not influence either short or long term outcomes, but a small benefit could not be excluded. There was no increase in adverse clinical outcomes in babies who received 100% oxygen.

Asphyxia Neonatorum↗

PubMed2005

Risk factors for respiratory morbidity in infancy after very premature birth.

OBJECTIVES: To determine the occurrence of respiratory morbidity during infancy after very premature birth and to identify risk factors. DESIGN: Prospective follow up study. SETTING: The United Kingdom oscillation study. PATIENTS: 492 infants, all born before 29 weeks gestation. INTERVENTIONS: Structured questionnaires were completed by local paediatricians when the infants were seen in outpatients at 6 and 12 months of age corrected for prematurity. MAIN OUTCOME MEASURES: Cough, wheeze, and treatment requirements and the composite measure of respiratory morbidity (cough, frequent cough, cough without infection, wheeze, frequent wheeze, wheeze without infection, and use of chest medicine) and their relation to 13 possible explanatory variables. RESULTS: At 6 and 12 months of corrected age, 27% of the infants coughed and 6% had frequent (more than once a week) cough, and 20% and 3% respectively had wheeze or frequent wheeze. At 6 and 12 months, 14% of infants had taken bronchodilators and 8% inhaled steroids. After adjustment for multiple outcome testing, four factors were associated with increased respiratory morbidity: male sex, oxygen dependency at 36 weeks postmenstrual age, having older siblings aged less than 5 years, and living in rented accommodation. CONCLUSIONS: Male infants are particularly vulnerable to respiratory morbidity in infancy after very premature birth. It is important to identify a safe and effective strategy to prevent chronic oxygen dependency.

Bronchodilator Agents↗

PubMed2006

Moderately premature infants at Kaiser Permanente Medical Care Program in California are discharged home earlier than their peers in Massachusetts and the United Kingdom.

OBJECTIVE: To compare gestational age at discharge between infants born at 30-34(+6) weeks gestational age who were admitted to neonatal intensive care units (NICUs) in California, Massachusetts, and the United Kingdom. DESIGN: Prospective observational cohort study. SETTING: Fifty four United Kingdom, five California, and five Massachusetts NICUs. SUBJECTS: A total of 4359 infants who survived to discharge home after admission to an NICU. MAIN OUTCOME MEASURES: Gestational age at discharge home. RESULTS: The mean (SD) postmenstrual age at discharge of the infants in California, Massachusetts, and the United Kingdom were 35.9 (1.3), 36.3 (1.3), and 36.3 (1.9) weeks respectively (p = 0.001). Compared with the United Kingdom, adjusted discharge of infants occurred 3.9 (95% confidence interval (CI) 1.4 to 6.5) days earlier in California, and 0.9 (95% CI -1.2 to 3.0) days earlier in Massachusetts. CONCLUSIONS: Infants of 30-34(+6) weeks gestation at birth admitted and cared for in hospitals in California have a shorter length of stay than those in the United Kingdom. Certain characteristics of the integrated healthcare approach pursued by the health maintenance organisation of the NICUs in California may foster earlier discharge. The California system may provide opportunities for identifying practices for reducing the length of stay of moderately premature infants.

California↗