[Care of premature infants and nursing--lessons from premature infant care: based on records of clinical training in premature infant care for midwifery students].
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Humans↗
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[Amniocentesis following premature rupture of fetal membranes and suspected premature rupture of fetal membranes in late pregnancy].
Amniocentesis during the third pregnancy trimenon in case of suspected premature rupture is performed for two reasons: on the one hand, the maturity parameters can be determined as usual from the amniotic fluid, and on the other hand it serves to determine the presence of germs that may have caused the premature rupture. At the same time, it is possible to confirm the suspicion of premature hydrorrhoea gravidarum by instillation of dyestuff into the amniotic cavity. Premature rupture was confirmed in 21 of 65 cases where clinical findings had not supplied safe evidence; in the remaining 44 cases this method permitted the exclusion of premature hydrorrhoea. An evaluation was performed by means of a retrospective study of parturitions between 1975 and 1985 with regard to late amniocenteses in cases of suspected premature rupture, the investigated parameters being the course of pregnancy and of birth, postpartal state of well-being, bacteriological findings in the amniotic fluid, and results of instillation of blue dyestuff.
Amniocentesis↗
Multicenter trial of cryotherapy for retinopathy of prematurity. Three-month outcome. Cryotherapy for Retinopathy of Prematurity Cooperative Group.
We report the results of the national multicenter trial of cryotherapy for retinopathy of prematurity, as determined 3 months after randomization. The threshold severity of retinopathy required for entry into the clinical trial was defined as five or more contiguous or eight cumulative 30 degree sectors (clock hours) of stage 3+ retinopathy of prematurity in zone 1 or 2. Transscleral cryotherapy to the avascular retina was applied in one eye when there was threshold retinopathy in both eyes, or in half the eyes when the threshold severity existed in only one eye (18% of patients). Of the 279 infants who survived 3 months following randomization, 273 returned for outcome examination at that time. Of these infants, 260 had fundus photographs taken that could be graded for anatomic outcome. An unfavorable outcome was defined as posterior retinal detachment, posterior retinal fold (usually involving the macula), or retrolental tissue that obscured the view of the posterior pole. Whereas 51.4% of control eyes had an unfavorable outcome, this was significantly less frequent in the eyes that received cryotherapy (31.1%). No deaths were attributed to the cryotherapy procedure. These data, together with numerous additional ocular findings and preliminary 12-month postrandomization outcome results reported herein, support the efficacy of cryotherapy in reducing the risk of unfavorable ocular outcome from threshold retinopathy of prematurity. We have previously recommended cryotherapy for at least one eye in all patients with threshold retinopathy of prematurity. Now we add the recommendation cryotherapy be considered for both eyes whenever stage 3+ retinopathy of prematurity involves the posterior retina (zone 1) of both eyes.
Analysis of Variance↗
The mechanical properties of prematurely and non--prematurely ruptured membranes. Methods and preliminary results.
The mechanical properties of the chorioamniotic membranes have been studied by several investigators over the past 100 years. No relationship between membrane strength, as measured by rupture tension, and premature or non-premature rupture of the membranes has been demonstrable. In the present study, several measures of the mechanical properties of the chorioamniotic membranes were examined. These included thickness, rupture tension, work to rupture, strain to rupture, and moduli of elasticity (Young). Prematurely and non-prematurely ruptured membranes differed with respect to thickness near the rupture site and Young's modulus near the placenta. Differences between the groups for the other parameters were not significant. This study suggests that there may be inherent differences between membranes which rupture prematurely and those which do not.
Biomechanical Phenomena↗
[Acute retinopathy of prematurity: shift of the manifestation risk to extremely premature infants by neonatal intensive care medicine].
A total of 381 surviving prematures (birthweight less than or equal to 2500 g) at the heidelberg University Children's Hospital were examined ophthalmologically between January 1986 and June 1988. Of the 762 eyes, 112 (14.7%) showed acute retinopathy of prematurity (ROP). In our study, a correlation between birthweight, gestational age and retinopathy of prematurity was confirmed. In addition, the results concerning severity, differences between the right and left eye, and the incidence in twins and multiple births were demonstrated. Data were compared with the data in 29 papers dealing with the prevalence of acute ROP since 1968: 12,468 preterm infants were investigated in all papers; 2,087 of these infants (16.7%) showed ROP. In the literature, 8.4% of the premature babies with a birthweight of 1501 to 2500 g were found to have ROP. In our group with the same birthweight, only one baby (birthweight 1510 g) had retinopathy (0.6%). The fact that the average ROP prevalence has not changed significantly indicates that the risk of having retinopathy of prematurity has switched over to the more immature preterms, whose prognosis of survival has improved in the last few years as a result of the improvement in neonatal care.
Female↗
[Clinical problems of premature labor. 1. Diagnosis of threatening premature labor and the screening procedure].
At first the allround etiology of premature birth is explained in the paper. There are to distinguish three groups: 1. Causes with known etiologic mechanism. 2. Causes with partly known etiologic mechanism. 3. Dispositions for premature birth. These are concluded from statistically investigations. In the last group are collected the patients from which are established some known scores for diagnosis of the risk of premature birth. All the scores but have a detriment. If they want to detect about 90% from premature births one must carry out examination and observation about 40% from all pregnant women. For this the scores are not suitable for selection of patients to observe in a special consultation. The organised care for pregnant women must be in such a way that all the criterias of imminent prematurity will be detected. This way has been successfull in our hospital.
Adolescent↗
[Premature rupture of fetal membranes and premature labor].
The portion of early rupture of the membranes among 521 premature births from 1962 to 1971 was 43.4%. The statistically sure effects of the early rupture of the fetal membranes to some irregularities in pregnancy and delivery on 214 premature births are reported, compared with 202 premature births without early rupture of the membranes. Twins are not considered. The therapeutic management of that time in the hospital consisted of staying in bed without tokolytics or antibiotics. After premature rupture of fetal membranes occured very often: irregular obstetrical presentation, hemorrhage and fever during labour, cesarean section and forceps delivery; the perinatal morbidity was increased. From that aspects for prophylaxis and therapy were deduced.
Amniocentesis↗
[Clinical studies on imipenem/cilastatin sodium in the early therapy of preterm premature rupture of the membrane or threatened abortion and premature delivery].
The efficacy and safety of early therapy with imipenem/cilastatin sodium (IPM/CS) were studied in patients who had chorioamnionitis with preterm PROM or threatened abortion and premature delivery. The following results were obtained. 1. The clinical efficacy of IPM/CS administered by intravenous drip infusion at daily dosages of 1 to 2 g as concurrent treatment with antiuteronics (ritodrine hydrochloride or terbutaline sulfate) was studied in patients with threatened abortion and premature delivery in the 11th to 34th week of pregnancy (n = 9), or premature PROM in the 23rd to 36th week (n = 9). 2. Response to IPM/CS were good in all of the patients with threatened abortion and premature delivery. Latent periods were prolonged for more than 7 days in 44.4% (4/9) of the patients with preterm PROM. 3. Changes in elastase appeared to be significant as those in CRP for inflammatory markers. 4. These findings combined with our previous results indicate that treatment of preterm PROM before the 32nd of pregnancy prolongs the latent period.
Abortion, Threatened↗
Haemophilus influenzae amnionitis associated with prematurity and premature membrane rupture.
Prematurity and premature rupture of the membranes present major obstetric problems. When associated with amnionitis, the result may be disastrous. A case of Haemophilus influenzae aminionitis in association with premature rupture of the membranes is presented. The rarity of this organism as a causative agent in amnionitis and its possible causative role in premature membrane rupture are considered in review of the scant relevant literature.
Adult↗
Erythropoietic progenitor cells from premature neonates studied using a validated serum-deprived medium. Evidence that peripheral blood BFU-E from premature neonates are increased in number and are highly dependent upon burst promoting activity for in vitro growth.
We have examined a serum-deprived culture system in order to verify that it is suitable for the study of burst forming unit erythroid (BFU-E) progenitor cells from premature neonates. Optimum growth of BFU-E from premature neonates was observed with each media constituent using the same concentration as that previously described for adult subjects. Growth of immature BFU-E from premature neonates were highly dependent upon a source of Burst Promoting Activity and mature BFU-E derived colonies emerged at day 12 compared to day 14 in adults. Our preliminary results with the validated medium suggest that premature infants have increased peripheral blood concentrations of BFU-E compared to healthy adult controls.
Adult↗
[Investigations on the utilization of parenterally administered amino acids by premature and small-for-dates neonates. I. Free amino acids in the blood of premature and small-for dates neonates (author's transl)].
The fasting levels of free amino acids were determined in the serum of 23 premature and 7 small-for-dates newborns during the first 4 weeks of life. This was done by ion-exchange chromatography after ultrafiltration of the serum, which allowed quantification. Differences were recognized in regards to age, and nutritional state: 1. Small-for-dates newborns at term showed significantly lower asparagine and glycine levels when compared to hypotrophic prematures. 2. Leucine was lower in male than in female prematures. 3. Leucine and phenylalanine were lower in hypotrophic than in eutrophic prematures. 4. Nearly all investigated fasting amino acid levels were highest in the 3rd week of life. A decrease was observed during the 4th week of life. Threonine, Proline, Alanine, Valine, Isoleucine, Lysine and Arginine were significantly higher in the 3rd compared to the 1st week.
Age Factors↗
[Differential diagnosis of so-called premature performance failure or premature aging].
In a district of about 70,000 inhabitants (two thirds urban, one third rural population) from 1978 to 1987 32 women at the age between 50 and 60 years and 63 men at the age between 50 and 65 years with premature decrease in vitality on cerebrovascular basis were observed and treated. The cases were differential-diagnostically subdivided. 32 patients belonged to the group of more distinct chronic cerebro-organic psychosyndromes, additionally also involution psychoses; the number of the untimely retirement from the working process was 100%. In 24 patients there were pseudoneurasthenic syndromes of the cerebral arteriosclerosis; 75% early retired from the working process. In 39 patients the cases in question were the proper premature decrease in vitality or a so-called premature ageing on biophysical basis; 41% early retired. A premature ageing may exist also without any so-called organ-valued findings, the symptoms are credibly described. Conflicts with the environment and psychic false reaction may be the result. Optimum therapeutic and rehabilitative troubles may bring successes which are not to be underestimated in the cases without distinct organic processes. The question of invalidization is thoroughly to be examined individually.
Aged↗
Clinical use of the LH-RH in assessing gonadotropic reserve in children with idiopathic precocious puberty, premature thelarche and premature adrenarche.
Serum LH and FSH were assayed in 31 girls with normal pre puberty, precocious puberty, premature thelarche, and premature adrenarche, aged 2 to 9 years. The effect of synthetic luteinizing hormone-releasing hormone (LH-RH) on serum gonadotropins was evaluated in eleven of them. In all girls with precocious puberty, serum LH was increased up to high levels. The mean releasable LH in two girls with idiopathic precocious puberty was significantly greater than in normal prepubertal or pubertal children. Basal FSH in children with precocious puberty was within the limits of normal prepuberal children, and FSH secretion in response to LH-RH was not significantly greater than in the group of normal prepubertal and pubertal girls. In children with premature thelarche and premature adrenarche, basal levels of LH and FSH, as well as gonadotropin response to LH-RH were in the prepubertal range. These preliminary results show that the LH-RH test might be of clinical value in differenitating abnormal puberal development.
Age Factors↗
Prematures with and without regressed retinopathy of prematurity: comparison of long-term (6-10 years) ophthalmological morbidity.
Forty-two ex-prematures having had regressed forms of retinopathy of prematurity (ROP) during the neonatal period were compared with 42 matched non-ROP ex-premature controls at ages 6 to 10 years. The overall incidence of ophthalmologic problems was 55% in the ROP and 36% in the non-ROP group. Strabismus, amblyopia, and refraction anomalies occurred more frequently in the ROP group. In this group, a significantly greater number of children had decreased vision in one or both eyes compared to the non-ROP group. Although the incidence of ophthalmologic problems in the ROP group was considerably higher, the incidence in the non-ROP group still turned out unexpectedly high. this implicates that non-ROP very low birth weight neonates should also be considered to be at a greatly increased risk for later visual problems. Regular ocular examinations, mandatory for the ROP group, thus should be included in follow-up programs of non-ROP very low birthweight neonates as well.
Amblyopia↗
[Retinopathy of prematurity--ophthalmologic care at units for premature infants in type I and II hospitals].
The author assessed by means of questionnaires organizational aspects of ophthalmological care of premature infants in departments for premature infants in type I and II hospitals. He discusses therapeutic possibilities of children with developing retinopathies of the premature in these departments. In the conclusion he emphasizes that from the organizational aspect consultant services at this level are ensured in a satisfactory way. The actual professional standard cannot be evaluated from questionnaires.
Humans↗
[Reflex labor induction in premature labor complicated by premature rupture of fetal membranes].
Labor induction in impending premature delivery complicated by premature rupture of the membranes is controversial. Problems arise both with choice of a mode of delivery and induction manoeuvres to be used in biologically premature delivery. The paper addresses the results with a reflex method of labor induction based on transcutaneous electroneurostimulation (TENS). An appropriate TENS regimen was found to be a highly efficient method of labor induction allowing one to reduce the incidence of perinatal complications.
Adolescent↗
Total complement activity in maternal sera, amniotic fluids and cord sera in women with premature labor, premature rupture of membranes or chorioamnionitis.
Total hemolytic complement activity (CH50) was determined in maternal sera, amniotic fluids or cord sera, or all, from 119 patients with preterm uterine contractions, premature rupture of membranes or chorioamnionitis, or all, at 24 to 40 weeks of gestation. The mean CH50 of maternal sera exceeded the mean CH50 of both amniotic fluids and cord sera. The mean CH50 of amniotic fluids exceeded that of cord sera and increased significantly at 32 weeks. This rise preceded that of the mean CH50 of cord sera, which occurred at a fetal weight of approximately 2,500 grams. The mean CH50 of amniotic fluids varied significantly and inversely with that of cord sera. The levels of CH50 in these three fluids did not distinguish between patients with preterm uterine contractions who delivered prematurely and those who delivered at term. The CH50 in patients with premature rupture of membranes did not differ from a control population of women with uncomplicated pregnancies. The mean CH50 of maternal sera was increased in patients with chorioamnionitis but was not predictive of chorioamnionitis. The mean CH50 of maternal sera was decreased in patients who smoked cigarettes and in patients who received intravenous ritodrine.
Amniotic Fluid↗
Magnesium therapy decreased the rate of intrauterine fetal retardation, premature rupture of membranes and premature delivery in risk pregnancies treated with betamimetics.
A higher percentage of intrauterine growth retarded (IUR) infants was found in patients treated with tocolytic drugs, indicating that placental insufficiency could be the cause of both premature labor and IUR. In order to evaluate the results of oral treatment with betamimetics and magnesium at different dosages, 534 (10.9%) pregnancies treated with tocolysis + cerclage (TC) of 4,905 single pregnancies managed in our hospital between 1979 and 1982 wee studied retrospectively. Addition of magnesium to betamimetics: since 1979/1980 3-6 mEq Mg2+ daily per os aimed towards 'cardioprotection', and since 1981, to 'support tocolyis' 30-40 mEq Mg2+ daily per os in the form of Mg aspartate. We compared: mean age, parity, percentage supplemented with Mg and outcome of pregnancy for each year; these parameters were also compared with those of normal pregnancies. The frequency of (completed) gestational periods less than or equal to 36 weeks was about 11% in the TC groups (only 2% in normal pregnancies). However, this was reduced annually from 11.0% in 1979 to 4.9% in 1982. The frequency of premature ruptured membranes (PROM) in premature infants was about 6% in the TC groups from 1979 to 1980. It was reduced to 2.2% in 1981 and to 1.6% in 1982 (normal pregnancies, about 1%). In the TC group the frequency of IUR (less than 10th percentile; Bavarian Perinatal Evaluation; BPE) amounted to 20.5% in 1979, and to 17.5% in 1980. It was reduced to 8.8% in 1981 and to 10.6% in 1982 (normal groups, between 8.3 and 11.5%).(ABSTRACT TRUNCATED AT 250 WORDS)
Adrenergic beta-Agonists↗