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PubMed2000

A 39-year followup of the Genain quadruplets.

The Genains, a unique group of monozygotic female quadruplets, all developed a schizophrenic disorder by age 24. They have been studied since the 1950s, because of the rarity of this occurrence (estimated to be one in 1.5 billion) and because their illnesses varied in severity. The identical inheritance would tend to rule out genetic differences as the cause of the neuropsychological differences; however, we cannot disentangle the effects of early brain injury and harsh punitive treatment as factors accounting for the differences in the severity of their disorders. We conducted neuropsychological examinations of the Genains at age 66, compared their test profiles, and contrasted certain test scores at 66 with those at ages 27 and 51. Test results indicate generally stable (or even improved) performance over time and support the notion that cognitive decline is not a degenerative process in schizophrenia. The Genains remind us of the exquisite interaction among variables that must be understood before additional, satisfactory progress can be made in preventing the development and predicting the course of schizophrenia.

Adult↗
PubMed2006

Maternal syphilis infection is associated with increased risk of mother-to-child transmission of HIV in Malawi.

OBJECTIVE: To determine the association between maternal syphilis and HIV mother-to-child transmission (MTCT). DESIGN: Prospective cohort study. METHODS: Pregnant women admitted at Queen Elizabeth Central Hospital (Malawi) in late third trimester were screened for HIV (by HIV rapid tests) and syphilis (by rapid plasma regain test and Treponema pallidum hemagglutination assay). HIV-infected women and their infants received nevirapine, according to the HIVNET 012 protocol. They were followed up at 6 and 12 weeks postpartum. Infant HIV infection was diagnosed by DNA PCR. FINDINGS: Of the 1155 HIV-infected women enrolled, 1147 had syphilis test results, of whom 92 (8.0%) were infected. Only 751 HIV-positive women delivered live singleton infants who were tested for HIV at birth. Of these, 65 (8.7%) were HIV-infected, suggesting in utero (IU) HIV MTCT. Of the 686 infants who were HIV-negative at birth, 507 were successfully followed up. Of these, 89 (17.6%) became HIV-infected, suggesting intrapartum/postpartum (IP/PP) HIV MTCT. Maternal syphilis was associated with IU HIV MTCT, after adjusting for maternal log10 HIV-1 viral load and low birth weight (LBW) [adjusted relative risk (ARR), 2.77; 95% CI, 1.40-5.46]. Furthermore, maternal syphilis was associated with IP/PP HIV MTCT (ARR, 2.74; 95% CI, 1.58-4.74), after adjusting for recent fever, breast infection, LBW and maternal log10 HIV-1 viral load. CONCLUSION: Maternal syphilis is associated with IU and IP/PP HIV MTCT. Screening and early treatment of maternal syphilis during pregnancy may reduce pediatric HIV infections.

Adult↗
PubMed2006

Incidence and determinants of peripartum hysterectomy.

OBJECTIVE: Most studies of peripartum hysterectomy are conducted in single institutions, limiting the ability to provide national incidence estimates and examine risk factors. The objective of this study was to provide a national estimate of the incidence of peripartum hysterectomy and to examine factors associated with the procedure. METHODS: We used data for 1998-2003 from the Healthcare Cost and Utilization Project Nationwide Inpatient Sample, an annual nationally representative survey of inpatient hospitalizations. Peripartum hysterectomy was defined as a hysterectomy and delivery occurring during the same hospitalization. Odds ratios (ORs) and 95% confidence intervals (CIs) were adjusted for maternal and hospital characteristics using logistic regression. RESULTS: During 1998-2003, an estimated 18,339 peripartum hysterectomies occurred in the United States (0.77 per 1,000 deliveries). Compared with vaginal delivery without a previous cesarean delivery, the ORs of peripartum hysterectomy for other delivery types were as follows: repeat cesarean, 8.90 (95% CI 8.09-9.79); primary cesarean, 6.54 (95% CI 5.95-7.18); and vaginal birth after cesarean, 2.70 (95% CI 2.23-3.26). Multiple births were associated with an increased risk compared with singleton births (OR 1.41, 95% CI 1.16-1.71). CONCLUSION: Our results suggest that vaginal birth after cesarean, primary and repeat cesarean deliveries, and multiple births are independently associated with an increased risk for peripartum hysterectomy. These findings may be of concern, given the increasing rate of both cesarean deliveries and multiple births in the United States. LEVEL OF EVIDENCE: III.

Adolescent↗
PubMed2003

Populations at risk for developing respiratory syncytial virus and risk factors for respiratory syncytial virus severity: infants with predisposing conditions.

According to National Vital Statistics Reports, premature infants (< 36 weeks gestation) account for approximately 7.4% of all births. During the 8 years from 1989 to 1997, multiple births steadily increased across all categories from twin to quintuplet and higher orders. During that same period low birth weight (< 2500 g) births increased almost 12%, and very low birth weight (< 1500 g) births increased approximately 20%.Attendant to these national trends in multiple and preterm births, overall gestation-specific survival rates have improved substantially. This improved outcome can be attributed in large measure to advances in neonatal care and technology. Despite the encouraging statistics on survival, infants born prematurely, at low or very low birth weights and/or with chronic conditions that predispose to lower respiratory tract illness, continue to incur serious risk of long term morbidity and the consumption of inpatient hospital services. In a recent 2-year study of US children, low and very low birth weights were found to be independent risk factors for bronchiolitis-associated mortality. In the past 14 years what defines bronchopulmonary dysplasia (BPD)/chronic lung disease (CLD) has shifted away from clinical, radiographic and pathologic findings in the preterm infant toward the pathophysiology of arrested lung development and the need for supportive care beyond 36 weeks corrected gestational age. The incidence of BPD/CLD ranges from 14 to 43%, with higher rates observed among infants of lower gestational age and birth weight. The health care team approach to the management of BPD directs its efforts toward minimizing pulmonary vascular resistance, alleviating airway obstruction and improving short term lung mechanics. Measures to prevent BPD/CLD attempt to forestall both acute and chronic lung function abnormalities. To that end researchers have investigated the early use of continuous positive airway pressure, vitamin supplementation and recombinant human copper/zinc superoxide dismutase. Despite significant gains in the survival of infants born at lower gestational ages, prematurity, low birth weight and/or underlying chronic pulmonary disease put the pediatric patient at risk for increased frequency and severity of respiratory syncytial virus lower respiratory tract illness and the potential for its long term sequelae.

Airway Obstruction↗
PubMed2005

A feeling of well-being accompanied by a period of prosperity and birthweight in Chile: a possible link?

The aims of the study were to describe the trend in birthweight from 1985 to 2000 in Chile and ascertain the possible factors that may explain the changes in birthweight during the period. We used time series of birthweight and length at birth of all live births (n > 4,000,000). Multivariable regression analyses were carried out to assess whether the gender of the newborn, maternal education, maternal age and marital status could explain the trend in the total time series and by period. Birthweight adjusted for gestational age was analysed in terms of grams and Z scores. There was an increase in birthweight of 100 g between 1989 and 1994 that coincided with the re-establishment of democracy and economic growth in Chile. The changes in birthweight were not explained by the available independent variables and trends of caesarean section, maternal obesity and post-mature deliveries over the period. The birthweight difference between mothers with university education and those with primary education was 0.2 Z scores (equivalent to 110 g) in 1985 and was greatly reduced by 2000 (equivalent to 40 g). A positive sense of social well-being and economic growth may have influenced an increase in birthweight between 1989 and 1994 as socio-economic growth preceded and continued after the period of increasing birthweight. Our study showed a remarkable decrease in the differences in birthweight by educational level not shown in other countries of similar wealth.

Adolescent↗
PubMed2006

Effect of multiple birth on infant mortality in Bangladesh.

AIM: Levels of infant and child mortality in many developing countries remain unacceptably high, and they are disproportionably higher among high-risk groups such as newborn and infant of multiple births, particularly in countries where advanced medical cares are available only at regional referral levels with limited access by the poor rural women and children. This study examined the relationship between high-risk infant of multiple birth and infant mortality in Bangladesh. METHODS: The analysis uses information on 7001 childbirths in 5 years preceding the 2004 Bangladesh Demographic and Health Survey to examine the relationship between multiple birth and infant mortality using multivariate analysis, controlling for child's sex, birth order, prenatal care, delivery assistance; mother's age at child birth, nutritional status, education level; household living conditions and several other risk factors. RESULTS: Results indicate that children born multiple birth were more than six-times as likely to die during infancy as those born singletons (hazard ratio = 6.51; 95% confidence interval: 4.10, 10.36). Controlling for all other risk factors does not change the strength and direction of the relationship (hazard ratio = 6.18; 95% confidence interval: 3.65, 10.46). Receiving prenatal care and access to safe drinking water are associated with lower risk. CONCLUSION: Multiple births are strongly negatively associated with infant survival in Bangladesh independent of other risk factors. This evidence suggests that improving maternal and child health at the community level, screening for high-risk pregnancies and making referral services for these conditions more accessible to the rural women and children will be key to improving child survival in Bangladesh.

Bangladesh↗
PubMed2005

Reference birth-length range for multiple-birth neonates in Japan.

AIM: To clarify the birth length of twins according to gestational age. METHODS: We studied a total of 51,910 live-birth-live-birth pairs of twins, 4,561 triplet live births and 256 quadruplet live births, using data obtained from corresponding birth certificates. The birth length of twins was analyzed according to gestational age. RESULTS: Compared to singleton neonates, the median birth length of twins was approximately 0.5 cm smaller after the gestational age of 34 weeks, increasing to approximately 2.0 cm at 42 weeks of gestation. The median birth length according to gestational age was found to be the greatest in twins, lower in triplets and the lowest in quadruplets, in which the difference was <2.0 cm. CONCLUSION: The birth length of twins was smaller than that of singletons, but the difference was smaller than the difference in birthweight between twins and singletons.

Birth Order↗
PubMed2004

Causes of late fetal death in New Zealand 1980-1999.

BACKGROUND: In recent years there has been an emerging interest in sudden unexplained intrauterine death. AIMS: To determine the major causes of late fetal death (LFD) in New Zealand during 1980-1999 and to document the proportion of deaths considered unexplained. In addition, to quantify the number of LFD undergoing post-mortem during this period. METHODS: Using the Office for National Statistics (UK) hierarchical classification system, all information available on death certificates was used to assign a single cause to LFD for the period 1980-1999. Trends were analysed using logistic regression and risk factor profiles established for each cause of death. Post-mortem rates and the characteristics of those failing to undergo post-mortem were analysed for the period 1989-1999. RESULTS: LFD rates declined from 60.1 per 10 000 in 1980-1981 to 30.5 in 1998-1999. The declines were not uniform across all causes, with intrapartum deaths declining 73%, congenital anomalies 70% and antepartum asphyxia 50%. In contrast, unspecified deaths increased 1%, and with the decline in other causes of death, also increased proportionally, from 10.8% of LFD in 1980-81 to 28.1% in 1998-1999. Post-mortem rates fell by 31% during 1989-1999, with Maori and Pacific babies and those in more deprived New Zealand Deprivation Index areas being significantly less likely to undergo post-mortem. CONCLUSIONS: While total LFD rates declined significantly during 1980-1999, rates of unspecified LFD remained static. Low post-mortem rates, however, suggest that many of these deaths may be uninvestigated rather than truly unexplained. Nevertheless, the persistence of a category of death which, to date, has failed to improve with advances in obstetric technology suggests that further measures are necessary if New Zealand's LFD rates are to continue to decline.

Adult↗
PubMedDate not supplied

Breastfeeding twins and higher-order multiples.

The benefits of breastfeeding for pre-term and full-term infants are well documented. Breastfeeding facilitates maternal-infant attachment, provides optimal infant nutrition and immunologic protection, and minimizes economic impact. These benefits are multiplied with twins and higher-order multiples, who often are born at risk. Supporting a mother as she initiates and continues to breastfeed one infant requires specific knowledge and skills. Health professionals need additional knowledge and skills if they are to provide appropriate assessment, intervention, and support when a mother breastfeeds twins or higher-order multiples.

Breast Feeding↗
PubMedDate not supplied

Co-bedding versus traditional bedding of multiple-gestation infants in the NICU.

This study was part of a large departmental performance improvement initiative to implement and evaluate developmental and family-centered care as "best practice" in the neonatal intensive care unit (NICU). The goal was to evaluate the safety, effect on infant clinical and developmental outcomes, and maternal satisfaction of co-bedding of multiple-gestation infants compared to traditionally bedded infants/mothers. A secondary purpose was to evaluate co-bedding and American Academy of Pediatrics-recommended "back to sleep" behaviors in the same infants/mothers after discharge. A retrospective, comparative, descriptive design was used. Chart reviews and mailed written surveys were used to collect study data. Findings showed no significant differences in demographic variables or clinical and developmental outcomes between the total traditionally bedded and co-bedded groups. All mothers reported positive experiences with the NICU. Co-bedding may promote maternal bonding and has no negative clinical or developmental outcomes. Once policies and education are in place, parents should be offered the option to co-bed multiple-gestation infants in the NICU. There is a performance improvement opportunity regarding the education provided to parents of multiple-gestation infants before discharge on the "back to sleep" recommendations.

Benchmarking↗
PubMed2004

Survival of very preterm infants: Epipage, a population based cohort study.

OBJECTIVE: To evaluate the outcome for all infants born before 33 weeks gestation until discharge from hospital. DESIGN: A prospective observational population based study. SETTING: Nine regions of France in 1997. PATIENTS: All births or late terminations of pregnancy for fetal or maternal reasons between 22 and 32 weeks gestation. MAIN OUTCOME MEASURE: Life status: stillbirth, live birth, death in delivery room, death in intensive care, decision to limit intensive care, survival to discharge. RESULTS: A total of 722 late terminations, 772 stillbirths, and 2901 live births were recorded. The incidence of very preterm births was 1.3 per 100 live births and stillbirths. The survival rate for births between 22 and 32 weeks was 67% of all births (including stillbirths), 85% of live births, and 89% of infants admitted to neonatal intensive care units. Survival increased with gestational age: 31% of all infants born alive at 24 weeks survived to discharge, 78% at 28 weeks, and 97% at 32 weeks. Survival among live births was lower for small for gestational age infants, multiple births, and boys. Overall, 50% of deaths after birth followed decisions to withhold or withdraw intensive care: 66% of deaths in the delivery room, decreasing with increasing gestational age; 44% of deaths in the neonatal intensive care unit, with little variation with gestational age. CONCLUSION: Among very preterm babies, chances of survival varies greatly according to the length of gestation. At all gestational ages, a large proportion of deaths are associated with a decision to limit intensive care.

Birth Weight↗
PubMed2004

Economic implications of multiple births: inpatient hospital costs in the first 5 years of life.

OBJECTIVES: To estimate long term health service costs for hospital stays associated with singleton, twin, and higher order multiple births up to 5 years of age. DESIGN: Costs from specialty based data from the English Department of Health's NHS Trust Financial Returns were applied to admissions recorded in the Oxford record linkage study during 1970-1993. SETTING: Oxfordshire and West Berkshire, United Kingdom. SUBJECTS: A total of 276,897 children, of whom 270,428 were singletons, 6284 were twins, and 185 were higher order multiple births. MAIN OUTCOME MEASURES: Duration of hospital admissions during the first 5 years of life. Costs, expressed in pound sterling and valued at 1998-1999 prices, of hospital inpatient services. RESULTS: The total duration of hospital admissions for twins and triplets were respectively twice and eight times that for singletons, once duration of life had been taken into account. Inpatient costs were significantly higher for multiple births than for singletons, with the cost differences concentrated in the first year of life. Over the first 5 years of life, the adjusted mean cost was estimated at 1532 pounds (95% confidence interval (CI) 1516 pounds to 1548 pounds) for singletons, 3826 pounds (95%CI 3724 pounds to 3929 pounds) for twins, and 8156 pounds (95%CI 7559 pounds to 8754 pounds) for higher order multiple births (p < 0.0001). CONCLUSIONS: Multiple births contribute disproportionately to hospital inpatient costs, especially during the children's first year of life.

Age Factors↗