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PubMed1998

Reproductive health outcomes among female flight attendants: an exploratory study.

Recent studies have suggested that female flight attendants may experience increased rates of spontaneous abortion. We conducted a survey of female flight attendants who were pregnant at any time between January 1, 1990, and December 31, 1991 (n = 418) using a mailed self-administered interest survey (response rate, 60 %) and follow-up questionnaire regarding reproductive outcomes and potential risk factors for adverse outcomes (response rate, 64%). The cumulative hazard of spontaneous abortion was 17% when maternal age, smoking, alcohol use, and prior spontaneous abortions were control led for, using a Cox life-table regression model. Of the female flight attendants who worked outside the home, 47 of 321 (15%) experienced a spontaneous abortion, compared with 6 of 73 (8%) who did not work outside the home during the pregnancy period (odds ratio [OR] = 1.91, 95 % confidence interval [CI] = 0.78-4.66). Flight attendants who experienced a spontaneous abortion during their first pregnancy during the study period reported working significantly more flight hours per month during their pregnancy (74 hours per month) than did flight attendants who delivered a live birth (64 hours per month) (Student's t = -3.30, P = 0.002). We conclude that although the results of this study must be considered preliminary because of the relatively low overall response rate (38%), we did not find an overall increased risk for spontaneous abortion among flight attendants, compared with other working women (10%-20%). Women who continue working as flight attendants during pregnancy and those who work relatively higher numbers of flight hours during pregnancy may, however, be at increased risk for spontaneous abortion, compared with flight attendants who do not perform such work.

Abortion, Spontaneous↗

PubMed1980

Serum levels of thyrotropin, thyroxine, 3,3',5-triiodothyronine and 3,3',5'-triiodothyronine (reverse T3) in the first six days of life.

Serum concentrations of thyrotropin (TSH), thyroxine (T4), 3,3',5-triiodothyronine (T3), and 3,3',5'-triiodothyronine (rT3) were determined in blood samples from 140 full-term healthy newborns, 110 appropriate weight and 30 large-for-gestational age, aged 1 to 6 days, delivered vaginally and breast-fed. Serum TSH levels decreased progressively from the 1st to the 4th day; serum T4 levels increased, with a peak on the 2nd day, and then progressively decreased until the 6th day; serum T3 levels increased to a maximum value on the 2nd day and then decreased to a minimum on the 5th day; serum rT3 levels increased during the 1st day and the level remained constant from the 2nd to the 4th day and later decreased slightly. The decrease of T3 was more pronounced than that of T4, while rT3 remained at high levels until the 4th day. Dividing the data into narrower intervals of time, it was possible to show that the maximum value of TSH was followed first by a net increase in serum T3, then in T4, and lastly in rT3 ant T3 levels. These data indicate that the rapid increase after birth of serum T3 levels is prevalently TSH-dependent; the following increase in serum levels of T3 and the increase in rT3 are prevalently T4-dependent. This study provides data concerning physiological changes in TSH and thyroid hormones in serum from a large number of infants, during the first week of life. They should be useful for the understanding of thyroid function in early postnatal life.

Age Factors↗

PubMed2005

Effect of carbon dioxide on background cerebral electrical activity and fractional oxygen extraction in very low birth weight infants just after birth.

Decreased arterial carbon dioxide tension (PaCO2) results in decreased cerebral blood flow, which is associated with diminished cerebral electrical activity. In such a situation, cerebral fractional oxygen extraction (CFOE) would be expected to increase to preserve cerebral oxygen delivery. This study aimed to determine whether changes in blood gases in infants less than 30 wk' gestation were associated with changes in background electroencephalograms (EEG) and CFOE. Thirty-two very low birth weight infants were studied daily for the first three days after birth. Digital EEG recordings were performed for 75 min each day. CFOE, mean blood pressure and arterial blood gases were measured midway through each recording. EEG was analysed by (a) spectral analysis and (b) manual calculation of interburst interval. Blood pressure, pH and PaCO2 did not have any effect on the EEG. On day one, only PaCO2 showed a relationship with the relative power of the delta frequency band (0.5-3.5 Hz) and the interburst interval. The relative power of the delta band remained within normal limits when PaCO2 was between 24 and 55 mmHg on day one. There was a negative association between PaCO2 and CFOE. The associations between PaCO2 and EEG measurements were strongest on day one, weaker on day two, and absent on day three. The slowing of EEG and increased CFOE at lower levels of PaCO2 are likely to be due to decreased cerebral oxygen delivery induced by hypocarbia. When PaCO2 was higher, there was suppression of the EEG.

Blood Gas Analysis↗

PubMed1999

Quantitative assessment of subclinical spasticity in human T-cell lymphotropic virus type I infection.

OBJECTIVE: To compare human T-cell lymphotrophic virus type I (HTLV-I) seropositive and seronegative women for symptoms and signs of spasticity. BACKGROUND: Infection with HTLV-I causes tropical spastic paraparesis/ HTLV-I-associated myelopathy (TSP/HAM). Certain populations, including female commercial sex workers (FSW), are at increased risk of developing this infection. Fewer than 5% of HTLV-I-seropositive persons develop TSP/HAM, which is typically associated with spasticity. METHODS: Cross-sectional study of 255 registered FSW in Callao, Perú, involving a questionnaire detailing demographics and neurologic symptoms, standard neurologic examination, quantitative assessment of spasticity (QSA) of muscle tone, and serologic testing for HTLV-I. Participants and examiners were blinded to serology results. RESULTS: On the questionnaire and neurologic examination, none of the 32 HTLV-I-seropositive or 223 seronegative women had signs or symptoms of spasticity. However, mean values on QSA were significantly higher among seropositive women (27.1 Newton-meters/radian [N-m/r]) than among seronegative women (21.6 N-m/r, p = 0.01), indicating a subclinical increase in lower extremity tone. With values of QSA divided into tertiles, and the first tertile serving as the comparison group, the odds ratio for seropositivity was 1.4 (95% confidence interval [CI] 1.0 to 2.0) in the second and 3.1 (95% CI 2.2 to 4.3) in the third tertile, after adjusting for age and place of birth. CONCLUSIONS: Although a standard neurologic evaluation could not distinguish between women with and without HTLV-I infection, QSA indicated significantly increased lower extremity tone in those with infection. Long-term follow-up will determine whether these subclinical findings in asymptomatic women progress to overt TSP/HAM.

Adult↗

PubMed1992

Breastfeeding, lactational, infecundity, contraception and the spacing of births: implications of the Bellagio consensus statement.

While the nutritional, immunological and anti-bacterial benefits of breast milk are incontestable, the contraceptive effect of breastfeeding is more apparent in the aggregate than at the level of the individual. Nevertheless, it has recently been recommended that lactating women not consider adopting contraception until the earliest of their first post-partum menstruation, the introduction of supplementary feeding or their child's reaching six months of age. This article employs microsimulation to quantify the implications of this recommendation for the spacing of births and, in particular, for the proportion of birth intervals that are unacceptably short. The findings are not encouraging. The implementation of this protocol would not produce better birth spacing than a simpler strategy of initiating contraception early in the post-partum period and, unless implemented perfectly, the outcomes would be considerably worse. Breastfeeding should be viewed not as a method of birth control but as the best form of infant nourishment. Efficient contraception is the best way to ensure that children in modernizing societies can reap the benefits of breastfeeding, without being endangered by being weaned too early because of a new pregnancy.

Amenorrhea↗

PubMed2002

[Statistical analysis of secondary sex ratio variation in sable Martes zibellina L].

The secondary sex ratio in sable Martes zibellina L. maintained in captivity was estimated for the first time ever. The data obtained at the Pushkin pedigree breeding farm (Moscow oblast) in 1982 through 1987 were analyzed. In total, 1705 litters of 414 females were examined. The total frequency of male births (P) was 0.527 +/- 0.007; the 95%-confidence interval of p (the probability of birth of a male) was within the limits 0.513 << p << 0.541, and the deviation from the expected 1:1 ratio was statistically significant. No effect of parental age and litter size on the number of male progeny was found. This may indicate a small influence of the parental hormonal and immunological status on sex ratio, which was reported in many other mammal species including those related to sable. Apparently, there is an evolutionary mechanism underlying the stable excess of males in sable litters.

Age Factors↗

PubMedDate not supplied

Individualizing phenobarbital dosing in neonates.

A method was developed for estimating elimination rate constants for phenobarbital in neonates on the basis of two serum samples drawn at any interval. Phenobarbital serum concentrations were obtained for 16 neonates being treated for fetal asphyxia, intraventricular hemorrhage, narcotic withdrawal, or seizure activity. The mean birth weight was 2.18 kg, mean gestational age was 34.8 weeks, and mean postnatal age was 12.1 days. The first blood sample was drawn two hours after an i.v. loading dose of phenobarbital sodium 7-15 mg/kg; maintenance doses ranging from 1.3 to 7.5 mg/kg/day were given by single i.v. injection. On the third day of therapy, trough concentration was determined; elimination rate constants were calculated using the two concentrations and the total dosage administered. Maintenance doses were adjusted to achieve desired serum concentrations, and predicted concentrations were compared with actual concentrations on the seventh day of therapy. Measured and predicted serum concentrations on day 7 were not significantly different. Only one patient exhibited phenobarbital toxicity. Phenobarbital serum half-life did not show a correlation with either gestational age or postnatal age. This method is clinically useful for individualizing phenobarbital dosing in neonates because it allows for integration of therapeutic drug monitoring with maintenance dosing based on the patient's metabolic capacity for the drug.

Dose-Response Relationship, Drug↗

PubMed1996

Menstrual and reproductive factors and biliary tract cancers.

The relationship between the risk of biliary tract cancers and menstrual and reproductive factors has been studied in a case-control study conducted in Milan, northern Italy, between January 1984 and February 1993 on 31 incident, histologically confirmed cases and 377 controls in hospital for acute, non-neoplastic, non-gynaecological, non-hormone-related conditions. Odds ratios (ORs) together with their corresponding 95% confidence intervals (CIs) and the significance of the linear trends in risk were estimated by unconditional multiple logistic regression, after adjustment for age and cholelithiasis. Menopause was associated with a decreased risk of biliary tract cancers (OR 0.2), while late menopause and the use of hormone replacement therapy tended to increase the risk (ORs 1.8 and 2.2 respectively). Age at menarche and regular menstrual cycles were not associated. A trend in risk was found with parity, while total abortions and age at first and last birth were not related. Thus, the protective effect of early menopause and the apparent association of multiple full-term pregnancies suggest a role of female hormones in the aetiology of biliary tract cancers.

Abortion, Induced↗

PubMed1992

A randomized trial of psychosocial support during high-risk pregnancies. The Latin American Network for Perinatal and Reproductive Research.

BACKGROUND: It is often suggested that psychological and social support and health education for women at high risk for delivering a low-birth-weight infant can improve the outcomes of pregnancy, but the evidence is inconclusive. We undertook this prospective trial to evaluate a program of home visits designed to provide psychosocial support during pregnancy. METHODS: At four centers in Latin America, 2235 women at higher-than-average risk for delivering a low-birth-weight infant were recruited before the 20th week of pregnancy. The women were randomly assigned either to an intervention group (n = 1115) that received four to six home visits from a nurse or social worker in addition to routine prenatal care or to a control group (n = 1120) that received only routine prenatal care (with a mean of eight prenatal visits). The principal measures of outcome were low birth weight (< 2500 g), preterm delivery (< 37 weeks of gestation), and specified categories of maternal and neonatal morbidity. RESULTS: The women who received the home visits as well as routine prenatal care had outcomes that differed little from those of the women who received only routine care. The risks of low birth weight (odds ratio for the intervention group as compared with the control group, 0.93; 95 percent confidence interval, 0.68 to 1.28), preterm delivery (odds ratio, 0.88; 95 percent confidence interval, 0.67 to 1.16), and intrauterine growth retardation (odds ratio, 1.08; 95 percent confidence interval, 0.83 to 1.40) were similar in the two groups. There was no evidence that the intervention had any significant effect on the type of delivery, the length of hospital stay, perinatal mortality, or neonatal morbidity in the first 40 days. There was no protective effect of the psychosocial-support program even among the mothers at highest risk. CONCLUSIONS: Interventions designed to provide psychosocial support and health education during high-risk pregnancies are unlikely to improve maternal health or to reduce the incidence of low birth weight among infants.

Adolescent↗

PubMed1991

[Birth spacing: collaborative study of eight state maternities].

We collected data con 2,434 deliveries of live newborns (1.5% of the total for the country) in 8 state supported maternity wards of urban areas in Chile. First children, stillbirths and twins were excluded. Proportion of the sample according to city was: West Santiago 41%, Talcahuano 16%, Valparaíso 14%, Arica 8%, Chillan 7%, Valdivia 6%, Punta Arenas 6%, and Coyhaique 2%. The intergenesic interval was over 5 years in 38%, over 4 years in 48% and under 1 year in only 1.9% of cases, with minimal inter-city variation. Contraceptive agents were used by 26% of mothers with intergenesic interval under 1 year and 21% of those over 5 years, significantly higher than that found in the other intervals. Maternal age was between 20 and 29 years in 60%; only 8% of mothers were younger than 20 or older than 40 years of age. The incidence of cesarean section increased from 21 to 28.6% with increasing intergenesic interval. Mean weight of newborns was 3,338 g, significantly lower in the intergenesic interval under 1 year (3,251 g). The incidence of low birth weight was also highest in the latter group.

Adult↗

PubMed2004

Sepsis and multisystem organ failure in a woman attempting interval delivery in a triplet pregnancy: a case report.

BACKGROUND: Interval delivery of the fetuses in multiple gestations has been shown to increase perinatal survival. CASE: A woman attempting interval delivery of triplets at 21 weeks developed chorioamnionitis, acute respiratory distress syndrome and tubular necrosis 7 days after delivery of the first fetus. CONCLUSION: When counseling women about the typically favorable outcomes of delayed interval deliveries, physicians should also warn of the potential risk of complications.

Adult↗

PubMed1993

Maternal age at first childbirth and risk of low birth weight and preterm delivery in Washington State.

OBJECTIVE: To study the consequences of delayed first childbearing in a large, population-based US sample, with separate analysis of women aged 40 years or more and adjustment for socioeconomic factors, smoking, medical and reproductive conditions, and route of delivery. DESIGN AND SETTING: Retrospective survey of Washington State birth certificates from 1984 through 1988. SUBJECTS: First liveborn singleton infants of women aged at least 20 years. Of eligible white infants, all those born to women aged 35 to 39 years (n = 4019) and 40 years or more (n = 410) and a maternal age-stratified random sample of white infants of younger women were studied. All eligible black infants were studied. OUTCOME MEASURES: Low (< 2500 g) and very low (< 1500 g) birth weight and preterm delivery (< 37 weeks of gestation). RESULTS: Adjusted odds ratios for delivering a low-birth-weight white infant increased progressively with each 5-year maternal age group, reaching 2.3 (95% confidence interval, 1.6 to 3.4) for women aged 40 years or more compared with those aged 20 to 24 years. The maternal age effects for very low birth weight and preterm delivery were similar; for each, the odds ratio was 1.8 for the oldest group. No significant maternal age effect was found among births of black infants, but only 127 births to women aged 35 years or more were studied. CONCLUSION: Increasing maternal age at first childbirth is an independent risk factor for low birth weight and preterm delivery of white infants in the United States.

Adult↗

PubMed2006

Antenatal corticosteroids for accelerating fetal lung maturation for women at risk of preterm birth.

BACKGROUND: Respiratory distress syndrome (RDS) is a serious complication of preterm birth and the primary cause of early neonatal mortality and disability. OBJECTIVES: To assess the effects on fetal and neonatal morbidity and mortality, on maternal mortality and morbidity, and on the child in later life of administering corticosteroids to the mother before anticipated preterm birth. SEARCH STRATEGY: We searched the Cochrane Pregnancy and Childbirth Group Trials Register (30 October 2005). SELECTION CRITERIA: Randomised controlled comparisons of antenatal corticosteroid administration (betamethasone, dexamethasone, or hydrocortisone) with placebo or with no treatment given to women with a singleton or multiple pregnancy, expected to deliver preterm as a result of either spontaneous preterm labour, preterm prelabour rupture of the membranes or elective preterm delivery. DATA COLLECTION AND ANALYSIS: Two review authors assessed trial quality and extracted data independently. MAIN RESULTS: Twenty-one studies (3885 women and 4269 infants) are included. Treatment with antenatal corticosteroids does not increase risk to the mother of death, chorioamnionitis or puerperal sepsis. Treatment with antenatal corticosteroids is associated with an overall reduction in neonatal death (relative risk (RR) 0.69, 95% confidence interval (CI) 0.58 to 0.81, 18 studies, 3956 infants), RDS (RR 0.66, 95% CI 0.59 to 0.73, 21 studies, 4038 infants), cerebroventricular haemorrhage (RR 0.54, 95% CI 0.43 to 0.69, 13 studies, 2872 infants), necrotising enterocolitis (RR 0.46, 95% CI 0.29 to 0.74, eight studies, 1675 infants), respiratory support, intensive care admissions (RR 0.80, 95% CI 0.65 to 0.99, two studies, 277 infants) and systemic infections in the first 48 hours of life (RR 0.56, 95% CI 0.38 to 0.85, five studies, 1319 infants). Antenatal corticosteroid use is effective in women with premature rupture of membranes and pregnancy related hypertension syndromes. AUTHORS' CONCLUSIONS: The evidence from this new review supports the continued use of a single course of antenatal corticosteroids to accelerate fetal lung maturation in women at risk of preterm birth. A single course of antenatal corticosteroids should be considered routine for preterm delivery with few exceptions. Further information is required concerning optimal dose to delivery interval, optimal corticosteroid to use, effects in multiple pregnancies, and to confirm the long-term effects into adulthood.

Adrenal Cortex Hormones↗

PubMed1998

Pregnancy outcome following gestational exposure to fluoroquinolones: a multicenter prospective controlled study.

Concerns regarding the teratogenicity of fluoroquinolones have resulted in their restricted use during gestation. This is despite an increasing need for their use due to emerging bacterial resistance. The objectives of the present investigation were to evaluate pregnancy and fetal outcomes following maternal exposure to fluoroquinolones and to examine whether in utero exposure to quinolones is associated with clinically significant musculoskeletal dysfunctions. We prospectively enrolled and followed up 200 women exposed to fluoroquinolones (norfloxacin, ciprofloxacin, ofloxacin) during gestation. Pregnancy outcome was compared with that for 200 controls matched for age and for smoking and alcohol consumption habits. Controls were exposed to nonteratogenic, nonembryotoxic antimicrobial agents matched by indication, duration of therapy (+/- 3 days), and trimester of exposure. Rates of major congenital malformations did not differ between the group exposed to quinolones in the first trimester (2.2%) and the control group (2.6%) (relative risk, 0.85; 95% confidence interval, 0.21 to 3.49). Women treated with quinolones had a tendency for an increased rate of therapeutic abortions compared with the rate among women exposed to nonteratogens (relative risk, 4.50; 95% confidence interval, 0.98 to 20.57), resulting in lower live-birth rates (86 versus 94%; P = 0.02). The rates of spontaneous abortions, fetal distress, and prematurity and the birth weight did not differ between the groups. Gross motor developmental milestone achievements did not differ between the children of the mothers in the two groups. We concluded that the use of fluoroquinolones during embryogenesis is not associated with an increased risk of major malformations. There were no clinically significant musculoskeletal dysfunctions in children exposed to fluoroquinolones in utero. The higher rate of therapeutic abortions observed in quinolone-exposed women compared to that for their controls may be secondary to the misperception of a major risk related to quinolone use during pregnancy.

Abnormalities, Drug-Induced↗

PubMed1992

Polymorphous ventricular tachycardia in a newborn with the long QT interval.

We have reported a case of long QT syndrome in a neonate who had ventricular tachycardia 30 minutes after birth. On the third day, while being weaned from lidocaine, the patient had ventricular flutter and required cardioversion. Treatment with propranolol (5 mg/kg/day) maintained normal sinus rhythm. We believe this may be the first reported case of long QT syndrome and normal AV conduction in a neonate who had multiple episodes of ventricular tachycardia despite medical treatment.

Female↗

PubMed2002

Bacterial vaginosis in early pregnancy may predispose for preterm birth and postpartum endometritis.

BACKGROUND: Bacterial vaginosis (BV) has been reported to be associated with spontaneous preterm delivery and infectious morbidity after birth in non-Swedish populations. Our intention was to investigate the situation in a Swedish population. METHODS: In this cohort study, 924 patients were enrolled consecutively. A Papanicolaou (Pap) smear, which included a posterior fornix sample, was obtained at the first visit (median: 12 weeks and 1 day) at the two antenatal care units in central Göteborg 1990-91. Clue cells in the Pap smear were considered to be consistent with BV. The principal outcome variables were spontaneous preterm birth (< 37 weeks) and postpartum endometritis. A relative risk (RR) was calculated with a 95% confidence interval. RESULTS: The prevalence of BV was 15.6%. An association was seen between BV in early pregnancy and postpartum endometritis [RR 3.26 (1.38-7.71)]. A non-significant association was found between BV and spontaneous preterm birth [RR 2.10 (0.90-4.94)]. A multiple logistic regression analysis was performed adjusting for primi-/multiparity and antibiotics during pregnancy and the odds ratio was 2.16 (0.87-3.64). CONCLUSIONS: The prevalence of BV was 15.6% in this Swedish pregnant population. The risk for postpartum endometritis was tripled among women with BV in early pregnancy. The risk for spontaneous preterm birth among women with BV was doubled but non-significant, although the samples were obtained early in pregnancy.

Adolescent↗

PubMed2002

Rebound in serum bilirubin level following intensive phototherapy.

OBJECTIVES: To document the need for repeated phototherapy (as an index of significant rebound in serum bilirubin levels) following the discontinuation of intensive phototherapy and to compare the use of repeated phototherapy in infants who first received phototherapy during their birth hospitalization with the use of first-time phototherapy on readmission after infants were discharged from their birth hospitalization. DESIGN: A retrospective review of the medical records of 303 term and near-term newborns treated between January 1996 and December 1998, who received phototherapy in our well-baby nursery during their birth hospitalization (group 1, n = 158) or who had been discharged from the nursery and were readmitted for phototherapy (group 2, n = 144). All infants received intensive phototherapy but were managed by individual attending pediatricians. Rebound measurements were included if a bilirubin level was obtained between 4 and 48 hours after discontinuing phototherapy. SETTING: Newborn nursery and pediatric ward of a large community hospital. MAIN OUTCOME MEASURES: The number of infants who received repeated phototherapy and the magnitude of the bilirubin-level rebound. RESULTS: Thirteen (8.2%) of 158 (95% confidence interval [CI], 3.9-12.4) infants treated with phototherapy before discharge from the nursery (group 1) and only 1 (0.7%) of 144 (95% CI, 0-2.0) infants who first received phototherapy on readmission (group 2) received repeated phototherapy (P =.002). Phototherapy was discontinued when mean +/- SD total serum bilirubin levels were, 10.4 +/- 1.8 mg/dL (178 +/- 31 micromol/L) in group 1 and 12.3 +/- 1.3 mg/dL (210 +/- 22 micromol/L) in group 2. The mean +/- SD increase in the total serum bilirubin levels following rebound was 1.3 +/- 2.0 mg/dL (22 +/- 34 micromol/L) in group 1 and 0.27 +/- 1.46 mg/dL (4.6 +/- 25 micromol/L) in group 2 (P<.001). CONCLUSIONS: It is not necessary to keep infants in the hospital to check for rebound. However, for infants who require phototherapy during their birth hospitalization and for those with significant hemolytic disease, we recommend obtaining a follow-up bilirubin level 24 hours after discharge. This is probably not necessary in those who are readmitted for phototherapy but, because rare instances of significant rebound have occurred in these infants, additional clinical follow-up is appropriate, particularly if phototherapy is discontinued at higher total serum bilirubin levels than used in this study.

Bilirubin↗

PubMed1996

A 45-year perspective of congenital diaphragmatic hernia.

The records of 174 consecutive patients with congenital diaphragmatic hernia were reviewed to analyse the changes in the presentation, treatment and outcome during the 45-year interval from 1948 to 1992. For comparison the period was divided into years 1948-1962, 1963-1972, 1973-1982 and years 1983-1992. The proportion of high-risk cases (symptomatic within 6 h of birth) increased from 50 per cent during the first period to 77 per cent during the second, to 86 per cent during the third and to 94 per cent during the fourth. The primary mortality rate (death within 30 days of diaphragmatic repair) increased from 25 per cent during the first period to 35 per cent during the second, 46 per cent during the third and 49 per cent during the fourth. No change occurred in the proportion of infants with diaphragmatic hernia who were stillborn or who died in the maternity unit. Post-mortem lung weight was available in 56 children. Severe pulmonary hypoplasia correlated with early postoperative death and clinical severity. The mean(s.d.) lung weight ratio (combined lung weight divided by the lung weight expected for the body-weight) decreased from 0.70(0.49) during the second period to 0.56(0.36) during the third and 0.40(0.18) during the fourth. The increased proportion of more severe cases with very hypoplastic lungs explains the rise in the mortality rate of patients operated on for congenital diaphragmatic hernia. This may reflect a real change in the disease spectrum rather than improved referral.

Autopsy↗