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Presence of anti-c in the serum of 42 women giving birth to c positive babies: serological and clinical findings.

During routine ante-natal testing during the period 1953-73 anti-c was found in the serum of 63 women. Twenty-four of them had received blood transfusion previously and of these 22 were multigravidae. In 39 women pregnancies alone were responsible for the immunization. The anti-c titres of the 42 women giving birth to c positive babies showed that the probability of developing haemolytic disease increases with higher titres. But low titres by no means exclude the existence of such disease. Among the 42 c positive babies 32 had a positive direct antiglobulin test. Some of the affected infants had a serious degree of haemolytic disease.

Blood Transfusion↗

Time-temperature analysis of cell killing of BHK cells heated at temperatures in the range of 43.5 degrees C to 57.0 degrees C.

Baby hamster kidney (BHK) cells were heated at temperatures in the range of 43.5 degrees C to 57.0 degrees C to determine the time-temperature relationship of cell killing. The cells were grown on 0.025 mm thick pieces of mylar to minimize warm-up times. After heating, the cells were plated for the colony formation assay. The endpoints of 1%, 10%, or 90% isosurvival, or the D0 values of the survival curves were used to construct plots of the logarithm of the reciprocol of the exposure time versus the reciprocol of the absolute temperature. The data for each endpoint resulted in a straight line plot, indicating that the time-temperature relationship for cell killing remained constant from 43.5 degrees C to 57.0 degrees C; namely, a 1.8-fold increase in exposure time was required for a 1 degree C decrease in temperature in order to obtain isosurvival. Heated BHK cells were also examined using electron microscopy. The threshold level of altered morphology was the dissociation of polyribosomal structure and the formation of electron-dense granules within the mitochondria. The time-temperature relationship for the induction of this altered morphology was identical to that for the 90% isosurvival endpoint. Hence, the appearance of altered morphology appears to be related to cell killing.

Animals↗

Follow-up of transmission of hepatitis C to babies of human immunodeficiency virus-negative women: the role of breast-feeding in transmission.

BACKGROUND: The studies on hepatitis C virus (HCV) vertical transmission, the effect of potential risk factors and the role of breast-feeding have reported conflicting results. PATIENTS AND METHODS: Seventy-three infants of 63 anti-HCV-positive and anti-HIV-negative mothers were studied from 1993 to 1999 in the south of Spain. The mean period of follow-up in children was 29.2 +/- 19 months (range, 8 to 76 months); 6 (8%) children were lost to follow-up. Breast milk was studied for HCV-RNA in 68 samples of 35 mothers. RESULTS: Alanine aminotransferase was high in 19 (26%) and HCV-RNA was positive in 46 (63%) pregnant woman. Breast milk HCV-RNA was negative in nonviremic mothers and positive in 20% of the viremic mothers. The overall rate of vertical HCV transmission was 11.9% (n = 8) (95% confidence interval, 6 to 23%) if HCV-RNA was positive one or more times, but only 1.5% (n = 1) (95% confidence interval, 0.1 to 9%) if HCV-RNA was permanently positive. Seven HCV-infected children did not develop antibodies to HCV, and they had a spontaneous clearance of the virus. A 10-month-old baby was HCV-RNA-positive from birth to the end of the follow-up. The genotype in each of the infants was consistent with that of their mother. The rate of HCV transmission was higher for infants of mothers with higher HCV viremia (P < 0.01) and also for infants whose mothers were HCV-RNA-positive in breast milk (P < 0.05). There were no statistically significant differences between other risk factors. CONCLUSION: The presence of transitory viremia without seroconversion indicates that the vertical transmission of HCV is not important. This could be related to the viral charge and ingestion of milk of HCV-RNA-positive mothers. However, to advise avoidance of maternal breast feeding, it would be necessary to conduct larger studies.

Adult↗

How should randomised trials including multiple pregnancies be analysed?

OBJECTIVE: To compare the effects of four methods of analysis on the results of randomised controlled trials that recruit women with multiple pregnancies and measure outcomes on their babies. DESIGN: Analysis of one real and two simulated data sets. SETTING: Secondary analysis of perinatal randomised controlled trials. POPULATION: Randomised controlled trials including women with multiple pregnancies. METHODS: The analytical methods compared were (a) assuming independence among babies, (b) analysing outcomes per women, counting a woman as having an outcome if any of her babies had it (equivalent to selecting the worst outcome among any of a woman's babies), (c) randomly selecting one baby from each set of multiples for inclusion in the analysis, (d) adjustment of the analysis to take account of non-independence of babies from multiple pregnancies, using methods developed for analysis of cluster randomised trials. MAIN OUTCOME MEASURES: Odds ratios for trials' main outcomes. RESULTS: Results from application of cluster trial methods were similar to those from assuming independence among babies, but with slightly wider confidence intervals, reflecting the reduced effective sample size caused by non-independence between babies from the same pregnancy. Results were more variable using the other two methods, and in some cases, departed markedly from the results of the cluster trial methods. CONCLUSIONS: Cluster trial methods provide a simple way of adjusting the analysis to take account of non-independence between babies from the same pregnancy. Random selection and analysis by pregnancy (methods (b) and (c)) have disadvantages and do not report outcomes for all of the babies in the trial. This may cause problems with incorporating trials analysed using these methods into systematic reviews.

Cluster Analysis↗

[Blood in the feces as an aid to the diagnosis of necrotizing enterocolitis].

The presence of macro or microscopic blood in the stools of 300 premature babies was studied prospectively in relation with the future risk of necrotizing enterocolitis (NEC). The microscopic blood was investigated using the bililabstix reactive stripe. Four group were made up: group A babies, with no blood in their stools. Group B babies with microscopic blood in feces. Group C babies with macroscopic or gross blood and group D babies with initially microscopic and later gross blood in their feces. The frequency of NEC for these groups were as follows: group A 0.0%, group B 0.47%, group C 63.3% and group D 89.6%. We conclude that it is possible to predict absence of manifestations of NEC when a premature baby does not show gross blood in the stools during the first 21 days of life. When the babies show gross blood in the feces, the frequency of NEC is 63.3% and the higher frequency (89.6%), belongs to the babies with initially microscopic and later gross blood.

Enterocolitis, Pseudomembranous↗

The effect of antenatal dexamethasone administration on glomerular filtration rate and renal sodium excretion in premature infants.

Creatinine clearance (Ccr) and renal sodium (Na+) excretion were measured in 10 premature infants (gestational age less than 34 weeks) whose mothers had received dexamethasone before delivery (group D) and in 11 whose mothers were not so treated (control, group C). Babies were studied twice: on days 2-5 (study 1. all infants) and days 6-10 (study 2, six infants in each group). In study 1, absolute and fractional Na+ excretion were significantly lower (P less than 0.01) and urinary K+:Na+ ratio significantly higher (P less than 0.025) in group D than in group C, while Cr did not differ between groups. In study 2, Ccr in group D had increased compared both with values obtained in the same babies in study 1 (P less than 0.05) and with group C babies in study 2 (P less than 0.05), but significant differences between groups in urinary Na+ excretion and urinary K+:Na+ ratio were no longer found. We conclude that exogenous glucocorticoids accelerate maturation of renal function in immature human infants, probably by inducing tubular Na+. K(+)-ATPase activity. Our findings support the view that endogenous glucocorticoid hormones may play an important part in the normal maturation process.

Adult↗

The mental health of women 6 months after they give birth to an unwanted baby: a longitudinal study.

This study reports a longitudinal prospective study of the impact of an unwanted pregnancy on the mental health of the mother. Data are derived from a Brisbane, Australian sample of 8556 mothers who were enrolled at their first clinic visit (mean gestation 18 weeks) and then interviewed again some 3-5 days after the birth and when the baby was 6 months of age. Standard scales of mental health were administered on each of these occasions and mothers whose babies were unwanted were compared with the rest of the sample. The results indicate that mothers of unwanted children have somewhat higher rates of anxiety and depression than the comparison group, but that the magnitude of the mental health differences between the two groups: (a) diminishes over the period of the follow-up, (b) may be partly attributable to the prior poor mental health of women giving birth to an unplanned and unwanted baby, (c) is such that relatively few women who give birth to an unwanted baby experience mental health problems. The paper considers the implications of these results for health planners, notes the absence of contrary data and the need to acknowledge that these results may reflect situational factors which are characteristic of but not necessarily limited to Brisbane.

Adolescent↗

A comparative study of a premature infant formula and preterm breast milk for low birthweight infants.

Although the unique composition of preterm milk (PTM) has led to its increasing use in feeding of low birthweight (LBW) infants, controversy exists as to whether such milk adequately meets their requirements. This study compares the clinical tolerance and anthropometric, biochemical and haematological parameters of LBW infants fed exclusively with their own mother's PTM, a premature infant formula (Alprem; Nestlé Australia) and a mixture of PTM and Alprem. Of 90 enrolled LBW infants (1000-1750 g birthweight), 78 completed the feeding trial for a mean duration of 42 days. Twenty-eight babies were fed Alprem (Group A), 31 received a mixture of Alprem and PTM (Group B) and 18 received PTM (Group C). Babies in Groups A and B were smaller, less mature and more asphyxiated at birth than those in Group C. Weight gain from full enteral feeding was greater in Group A (18.1 g/kg per day) and Group B (17.6 g/kg per day) than in Group C (13.0 g/kg per day). Throughout the trial, weight gain in Groups A and B exceeded predicted intra-uterine growth rates, whereas that for Group C approximated the predicted intra-uterine growth rates. Growth rates of length and head circumference were also greatest in the Alprem-fed babies. Infants receiving PTM were supplemented with calcium, sodium, vitamins and energy, whereas the only three infants requiring mineral supplementation in the Alprem group were those receiving Frusemide therapy for chronic lung disease. lower serum concentrations of phosphorus, iron, albumin and urea, and higher zinc and alkaline phosphatase concentrations were found in infants receiving PTM (P less than 0.05).(ABSTRACT TRUNCATED AT 250 WORDS)

Anthropometry↗

Pharmacokinetics of two generic fixed-dose combinations for HIV-infected children (Pedimune Baby & Pedimune Junior) are similar to the branded products in healthy adults.

OBJECTIVES: Cipla Pharmaceuticals have developed generic fixed-dose combinations of stavudine, lamivudine and nevirapine for HIV-infected children (Pedimune Baby and Junior). We determined the pharmacokinetic profiles of stavudine, lamivudine and nevirapine in Pedimune and compared these with the branded products. METHODS: This Phase I, comparative, single-centre, open-label, three-period, single-dose study was designed as a pilot study to exclude large differences in pharmacokinetics. Six healthy males were randomized to the following regimen sequences: ABC; ACB; BCA; BAC; CAB; CBA (A = reference, B = Pedimune Baby, C = Pedimune Junior). Single doses of medication were administered at 3 time points 4 weeks apart. An 8 h pharmacokinetic curve was recorded at day 1 of every cycle after medication intake. In addition, blood samples were taken on days 2, 3, 4, 8 and 15. RESULTS: Non-parametric statistical tests revealed no statistically significant differences in Cmax (0.173 < or = P < or = 0.753) and Tmax (0.317 < or = P < or = 1.000) of stavudine, lamivudine and nevirapine between the two Pedimune formulations and the branded drugs. Also, there were no significant differences in AUC(0-infinity) of stavudine, lamivudine and nevirapine between Pedimune Junior and the branded drugs (0.345 < or = P < or = 0.600) and between Pedimune Baby and the branded drug for nevirapine (P = 0.463). In contrast, the AUC(0-infinity) of stavudine (mean change: +21%; P = 0.046) and lamivudine (mean change: +14%; P = 0.028) differed significantly between Pedimune Baby and the branded drugs, but these changes were considered not clinically significant. CONCLUSIONS: The pharmacokinetic profiles of stavudine, lamivudine and nevirapine in Pedimune Baby and Junior are comparable to the branded products. Based on these results, it is acceptable to test the pharmacokinetics and dosing requirements of Pedimune in HIV-infected children.

Adult↗

Esophageal atresia. A 41-year experience.

Since the first attempted repair in 1935, a total of 365 infants have undergone treatment for esophageal atresia with or without tracheoesophageal fistula. To evaluate the improvement in our results, we have divided our patients into four, approximately equal, time periods. The overall late survival has indeed improved during each of the four decades from between 36% and 53% to 68% in the last ten years. During this past decade, the group A risk infants (35 patients) had a 3% mortality, the group B (20 patients) had a 5% mortality, but the group C babies (22 patients) had a 41% mortality due to associated anomalies or severe prematurity. Anastomotic leaks and recurrent fistulas were each encountered in approximately 5% of the cases in all decades. Postoperative stricture has been encountered in 20% of the entire series and no esophageal replacements have been required.

Abnormalities, Multiple↗

An approach to setting maxima in infant formulas.

It is clearly necessary to set upper limits for a nutrient in a formula where the nutrient can have a direct toxic effect (e.g., vitamin A) or can lead to a reduced margin of safety (e.g., high dietary renal solute load during gastroenteritis). In addition, there are plausible arguments for setting upper limits for any nutrient added during manufacture. Various expert groups have used different approaches in setting upper limits, particularly for fat and minerals. Evidence of clinical toxicity and various biochemical measurements have been commonly used to determine appropriate upper levels. Less use has been made of the empirical evidence provided by nutrient concentrations in commonly used foods, e.g., breast milk and cow's milk. Four "rules" for setting maxima are suggested: a) Use evidence of clinical toxicity or reduced margin of safety if available; b) Avoid nutrient concentrations that lead to biochemical values in body fluids or tissues very different from those seen in breast-fed babies; c) An upper limit should be set for even apparently harmless nutrients that are added during manufacture; and d) When a nutrient is added, its final concentration should not normally exceed that in breast or cow's milk, whichever is the greater. Using these "rules," suggested maxima for 33 nutrients are listed.

Female↗

Transmission of community-associated methicillin-resistant Staphylococcus aureus from breast milk in the neonatal intensive care unit.

Methicillin-resistant Staphylococcus aureus (MRSA) has become increasingly common in neonatal intensive care units and can lead to severe outcomes. Baby C, of a set of quadruplets, died of MRSA sepsis. The surviving siblings were colonized with MRSA. Expressed breast milk was fed to all infants; tested breast milk samples were all MRSA-positive. Pulsed field gel electrophoresis results of isolates from the infants and breast milk were indistinguishable.

Adult↗

Carriage of group B Streptococcus in pregnant women and newborns: a 2-year study at Perugia General Hospital.

OBJECTIVE: To study the prevalence of group B Streptococcus (GBS) colonization in pregnant women and their newborns at Perugia General Hospital. METHODS: The number of mother---child pairs examined was 2300. Vaginal swabs were collected from the mothers at delivery, and auricular and pharyngeal swabs and gastric aspirate from the newborns at birth. Maternal risk factors for GBS disease, including premature delivery, intrapartum fever, prolonged rupture of membranes and multiple births, were evaluated. RESULTS: Maternal and neonatal colonization rates were 11.3% and 4.6%, respectively. GBS was isolated in 41.5% of the neonates born to colonized mothers and in 0.1% of those born to non-colonized mothers. No significant difference was observed in vertical transmission rates in the presence or absence of maternal risk factors. The external auditory canal was the most frequent (93.5%) and heavily colonized body site. Type Ib was the most common serotype among GBS isolates from mothers and babies. C surface protein was not detected in serotype V and VIII isolates, but was frequent in all other serotypes. Early-onset disease was observed in 0.4/1000 live births. CONCLUSIONS: The prevalence of maternal and neonatal colonization at Perugia General Hospital was similar to that obtained in other studies performed in Italy. The external auditory canal was confirmed as the most reliable body site to be sampled for the detection of neonates exposed to maternal GBS colonization.

Journal Article↗

Dimensions of individuality in the mother-infant relationship at six months of age.

Prior studies on mothers and infants have explored a great many individual variations. To date, however, the empirically based meaningfulness of these variations is quite limited. The current study attempts to achieve a relatively comprehensive empirical description of the mother-infant relationship at the age of 6 months, with special focus on possible correlates of infant developmental competence. 168 mother-infant pairs contributed data on a wide variety of measures, including the following categories: (a) observed interactions, at home and in the laboratory; (b) mother perception of the infant's temperament, mother personality, social support, and family adjustment to the new baby; (c) infant performance on the Bayley test; and (d) background variables such as birth order and economic status. Relationships among the various measures were modeled with factor analytic methods and interpreted in connection with current research issues. The most important findings are the following: (1) The main factor is widely generalizable dimension in maternal behavior of warm, responsive interaction with the infant. (2) Some elements of this main factor overlap with another factor indexing the extent to which mother impresses observer as educationally stimulating. Social class was associated with this teaching factor, but not with the first, more affection- and play-oriented, dimension. (3) Mother perceptions of difficult temperament in the infant were associated with objectively observed crying and fussing but were essentially independent of the major dimensions of maternal behavior. (4) Observed active and happy behaviors of the infant were somewhat related to normative status on the Bayley test, but neither active and happy behavior nor Bayley score correlated with the important dimensions of maternal behavior.

Child Development↗

Old injuries of the lower cervical spine treated surgically.

The present study involves 16 surgically treated patients who had sustained an old injury of their lower cervical spine. This group represents the 29% of the 55 patients that were admitted in our Department with an old injury of the cervical spine. The aim of the present study is to see the effect of surgery on these old injuries in relation to clinical and radiological parameters. Operative treatment was indicated in the presence of instability and the resulting deformity or pain or, more important, in case of further deterioration (or development) of the neurological status. The patients were followed up for 1-14.4 years (mean 5.5 years). At follow-up, fusion was sound in all but 1 patient and the deformity was improved in 12 cases. As for the clinical evaluation, pain was still present in two patients and the neurological status was improved in all but one patient with complete tetraplegia. Surgical treatment is of value irrespective of time delay to avoid fixed deformities and/or permanent neurological lesions.

Adult↗