Contribution of twin pregnancy to perinatal mortality and fetal growth retardation; reversal of growth retardation after birth.

A survey of factors associated with perinatal mortality in 511 twins and fetal growth retardation and its reversal in 262 twins is presented. The incidence of stillbirth was almost 50% higher in twins than in singletons and the neonatal mortality was six times as high. Eighty percent of the neonatal deaths occurred in infants born prior to or at 30 weeks of gestation; 93% of the deaths were in infants weighing less than 1500 g and 75% occurred within 48 hours of birth. Fetal malnutrition was the main cause of stillbirth, and respiratory distress syndrome and asphyxia neonatorum were the main causes of neonatal death. One quarter of the twins had fetal growth retardation, a prevalence 10 times that in singletons. In almost all, the growth retardation was reversed by high-energy feedings. Although twins represented only 1% of all pregnancies and 2% of live births, they composed 12% of infants with early neonatal death and 17% of growth-retarded infants. A program is suggested for reduction of twin mortality and morbidity.     

Mortality in the Children of Atomic Bomb Survivors and Controls

A continuing study of mortality rates among children born to survivors of the atomic bombings and a suitable group of controls has been updated; the average interval between birth and verification of death or survival is 17 years. The mortality experience is now based on 18,946 children liveborn to parents one or both of whom were proximally exposed, receiving jointly an estimated dose of 117 rem; 16,516 children born to distally exposed parents receiving essentially no radiation; and 17,263 children born to parents not in Hiroshima or Nagasaki at the time of the bombings. No clearly significant effect of parental exposure on child's survival can be demonstrated either by a contingency chi(2) type of analysis or regression analysis. On the basis of the regression data, the minimal gametic doubling dose of radiation of this type for mutations resulting in death during (on the average) the first 17 years of life among liveborn infants conceived 0-13 years after parental exposure is estimated at 46 rem for fathers and 125 rem for mothers. On the basis of experimental data, the gametic doubling dose for chronic, low-level radiation would be expected to be three to four times this value for males and as much as 1000 rem for females.     

Nutrition and immune system: the size of the thymus as an indicator of the newborn's nutrition status

Summary: The thymus is a central lymphatic organ reaching its largest size after the delivery. Its size is significantly affected by endogenous and exogenous negative factors. In our research, we investigated the relationship between the size of the thymus determined by sonography and anthropometric parameters as well as indexes demonstrating the nutritional status. The examined group consisted of 212 full-term newborns, all of which passed an anthropometric examination during the first five days after delivery (birth weight and length, mid-arm and head circumference). The following nutritional status indexes were calculated from estimated anthropometric dimensions: Quételet's index, Rohrer's index, birth weight-to-length ratio and mid-arm-to-head circumference ratio. The size of the thymus was assessed by sonography and expressed as the multiple of transversal width of the cranial thymus part and sagittal area of the major thymus lobe (so-called 'Thymic Index'). The Thymic Index showed a positive correlation with the majority of indicators of the newborn's nutritional status, but all of these correlations are low (Spearman correlation coefficients 0.228-0.409). The correlation of the size of thymus with the birth weight or birth weight-to-length ratio was stronger than the correlation with the Quételet's index or mid-arm circumference. The size of the thymus reflects the newborn's nutritional status assumed by anthropometry and can represent one of the "barometers of nutrition". Normal nutrition in the prenatal period plays a relatively critical role in the development of the immune system.     

Early discharge of infants of low birth weight: a prospective study.

A total of 495 African infants of low birth weight were discharged from Harari Maternity Hospital, Salisbury, between October 1972 and September 1973. Criteria used for discharge were (a) no clinical evidence of disease, (b) satisfactory feeding by mouth (breast or bottle or both), and (c) stable temperature control under normal room conditions. Of the 495 babies 264 fulfilled these criteria when they weighed 1801-1900 g (group 1), 99 when they weighed 1901-2000 g (group 2), and 132 (group 3) when they weighed 2001-2500 g. The overall follow-up rate of those infants living in greater Salisbury was 85-5%, the health visitor playing an important contributory role in their progress, especially those in group 1. More than two clinic visits in the first four to five weeks after discharge were essential for continuing weight gain in groups 1 and 2 but not in group 3. The mean daily weight gain for all babies at the end of four to five weeks was 26 g. Readmission rates for babies in groups 1,2, and 3 were 9-5%, 1%, and 0-8%, respectively, the largest single cause for readmission being bronchopneumonia associated with hypothermia. Altogether 60% of the readmissions occurred during the two winter months (June and July). Hypothermia, associated with low environmental temperatures played a significant part in morbidity and mortality, and twins, particularly in group 1, had a mortality rate three times greater than singletons in the same group. In general, even in underdeveloped communities singleton babies born outside the winter months with reasonable clinic or home visiting facilities can be discharged at a weight of 1800 g or more.     

Cardiovascular risk factors in British children from towns with widely differing adult cardiovascular mortality.

OBJECTIVE--To examine whether cardiovascular risk factors differ in children from towns in England and Wales with widely differing adult cardiovascular death rates. DESIGN--School based survey conducted during 1994 in 10 towns, five with exceptionally high adult cardiovascular mortality (standardised mortality ratio 131-143) and five with exceptionally low adult cardiovascular mortality (64-75). Towns were surveyed in high-low pairs. SUBJECTS--3415 white children aged 8-11 years with physical measurements (response rate 75%), including 1287 with blood samples (response rate 64%), of whom 515 had blood samples taken 30 minutes after a glucose load. RESULTS--Children in towns with high cardiovascular mortality were on average shorter than those in towns with low mortality (mean difference 1.2 cm; 95% confidence interval 0.3 to 2.1 cm; P = 0.02) and had a higher ponderal index (0.34 kg/m3; 0.16 to 0.52 kg/m3; P = 0.006). Mean systolic pressure was higher in high mortality towns, particularly after adjustment for height (2.0 mm Hg; 0.8 to 3.2 mm Hg; P = 0.009). Mean waist:hip ratio, total cholesterol concentration, and 30 minute post-load glucose measurements were similar in high and low mortality towns. The differences in height and blood pressure between high and low mortality towns were unaffected by standardisation for birth weight. CONCLUSIONS--The differences in height, ponderal index, and blood pressure between towns with high and low cardiovascular mortality, if persistent, may have important future public health implications. Their independence of birth weight suggests that the childhood environment rather than the intrauterine environment is involved in their development.     

Estimation of gluconeogenesis in newborn infants

The rate of glucose turnover (R(a)) and gluconeogenesis (GNG) via pyruvate were quantified in seven full-term healthy babies between 24 and 48 h after birth and in twelve low-birth-weight infants on days 3 and 4 by use of [(13)C(6)]glucose and (2)H(2)O. The preterm babies were receiving parenteral alimentation of either glucose or glucose plus amino acid with or without lipids. The contribution of GNG to glucose production was measured by the appearance of (2)H on C-6 of glucose. Glucose R(a) in full-term babies was 30 +/- 1.7 (SD) micromol. kg(-1). min(-1). GNG via pyruvate contributed approximately 31% to glucose R(a). In preterm babies, the contribution of GNG to endogenous glucose R(a) was variable (range 6-60%). The highest contribution was in infants receiving low rates of exogenous glucose infusion. In an additional group of infants of normal and diabetic mothers, lactate turnover and its incorporation into glucose were measured within 4-24 h of birth by use of [(13)C(3)]lactate tracer. The rate of lactate turnover was 38 micromol. kg(-1). min(-1), and lactate C, not corrected for loss of tracer in the tricarboxylic acid cycle, contributed approximately 18% to glucose C. Lactate and glucose kinetics were similar in infants that were small for their gestational age and in normal infants or infants of diabetic mothers. These data show that gluconeogenesis is evident soon after birth in the newborn infant and that, even after a brief fast (5 h), GNG via pyruvate makes a significant contribution to glucose production in healthy full-term infants. These data may have important implications for the nutritional support of the healthy and sick newborn infant.     

Coenzyme Q concentration and total antioxidant capacity of human milk at different stages of lactation in mothers of preterm and full-term infants

Coenzyme Q10(CoQ10) in human milk at different stages of maturity in mothers of preterm and full-term infants and its relation to the total antioxidant capacity of milk is described for the first time. Thirty healthy breastfeeding women provided colostrum, transition-milk and mature-milk samples. Coenzyme Q, alpha-, gamma- and delta-tocopherol, fatty acids and the total antioxidant capacity of the milk were analyzed. Coenzyme Q10 was found at higher concentrations for colostrum (0.81+/-0.06 vs. 0.50+/-0.05 micromol/l) and transition milk (0.75+/-0.06 vs. 0.45+/-0.05 micromol/l) in the full-term vs. the preterm group (similar results were found for total antioxidant capacity). Concentrations of alpha- and gamma-tocopherol were higher in the full-term group and decreased with time. In conclusion, CoQ10 is present in breast milk, with higher concentration in mothers of full-term infants. CoQ10 in breast milk decreases through lactation in mothers delivering full-term infants. Also, CoQ10, alpha- and gamma-tocopherol concentration in human milk directly correlates with the antioxidant capacity of the milk.     

Sex ratio and mortality in a laboratory colony of the common marmoset (Callithrix jacchus).

In a retrospective study sex ratio and mortality were analysed in a captive colony of common marmosets (Callithrix jacchus). Seven hundred and thirty-five infants in 294 litters (20 singletons, 119 twins, 140 triplets, 14 quadruplets) out of 57 breeding females were evaluated. The sex ratio at birth was 0.95 males:1.0 females. The frequency of males and females, as well as the sex composition of twins and triplets confirm the assumption of dizygotic twinning in the common marmoset. According to age at death, 9 categories were differentiated, with perinatal mortality being the highest. Once early infancy had passed the probability of a common marmoset infant of our colony reaching childhood is nearly 95%. Sixty per cent of all liveborn infants survived beyond 18 months. Mortality of infants at birth from primiparous mothers did not differ from that of pluriparous females, nor did the survival rate of infants with the filial generation the respective female had reached (F1 to F6). Females with a high ratio of triplets and quadruplets had a lower reproductive success than females with a majority of singleton or twin deliveries. Differential mortality between males and females was not observed. The frequency of stillbirths was not strongly related to parity, but was to litter-size. Most stillborn babies were seen in sets of quadruplets, most abortions in singletons. A normal socialization in a stable social environment, as well as not pairing the animals before they are fully adult, are considered important factors in good breeding success and infant survival.     

Normative data for total and free acid-labile subunit of the human insulin-like growth factor-binding protein complex in pre- and full-term newborns and healthy boys and girls throughout postnatal development

Insulin-like growth factors (IGFs) circulate in plasma as part of a 150-kD complex that also contains IGF-binding protein-3 (IGFBP-3), a protein that binds IGF-I and IGF-II with high affinity, and an acid-labile subunit (ALS) that does not directly bind IGFs. Because the ALS assay methods currently being used are relatively new, there is a need for updated normative reference data. We report the normative data in 17 preterm infants (10 males and 7 females), 30 normal full-term newborns (15 males and 15 females) and 150 normal children who where divided into 5 groups according to their Tanner stage (15 males and 15 females per group). Serum levels of total and free ALS were significantly lower in premature infants than in full-term newborns, but all newborns had significantly lower levels than Tanner stage-I children (p<0.001, ANOVA). A significant increase was seen between Tanner stages I-III in both sexes (p<0.001, ANOVA). No differences were found between sexes at any developmental age studied. Significant correlations (p<0.001) were seen between total and free ALS concentrations and IGF-I (r = 0.50 and 0.60, respectively), free IGF-I (r = 0.37 and 0.36), IGF-II (r = 0.37 and 0.27), IGFBP-1 (r = -0.48 and -0.49), IGFBP-2 (r = -0.44 and -0.51) and IGFBP-3 (r = 0.67 and 0.59) at all Tanner stages. However, no correlation was found with IGFBP-1, -2 or -3 levels at birth. This study shows normal values in a population of preterm infants and healthy Spanish newborns and subjects of both sexes at all stages of pubertal development and indicate the different relationships between the components of the IGF system during intra- and extrauterine life.     

Adaptive norm and stabilizing selection for anthropometric characters at birth]

Analysis carried out on medical documentation containing data on several thousand healthy and affected babies has revealed patterns of differential mortality and differential morbidity for newborns and infants which allow to estimate relative risk as a function of birth weight and body length. Adaptive norm for anthropometric traits at birth was defined as the weight or length interval in which mortality/morbidity rates were lower than the overall population level. The intensity of stabilizing selection associated with birth weight calculated from these data is several times higher in the neonatal period than for the age interval 1-12 months. Neonatal mortality in more than 50% cases can be attributed to the effects of stabilizing selection associated with birth weight.     

Coenzyme Q concentration and total antioxidant capacity of human milk at different stages of lactation in mothers of preterm and full-term infants

Coenzyme Q₁₀(CoQ₁₀) in human milk at different stages of maturity in mothers of preterm and full-term infants and its relation to the total antioxidant capacity of milk is described for the first time. Thirty healthy breastfeeding women provided colostrum, transition-milk and mature-milk samples. Coenzyme Q, α-, γ- and δ-tocopherol, fatty acids and the total antioxidant capacity of the milk were analyzed. Coenzyme Q₁₀ was found at higher concentrations for colostrum (0.81 ± 0.06 vs. 0.50 ± 0.05 μmol/l) and transition milk (0.75 ± 0.06 vs. 0.45 ± 0.05 μmol/l) in the full-term vs. the preterm group (similar results were found for total antioxidant capacity). Concentrations of α- and γ-tocopherol were higher in the full-term group and decreased with time. In conclusion, CoQ₁₀ is present in breast milk, with higher concentration in mothers of full-term infants. CoQ₁₀ in breast milk decreases through lactation in mothers delivering full-term infants. Also, CoQ₁₀, α- and γ-tocopherol concentration in human milk directly correlates with the antioxidant capacity of the milk.     

The Changing Body Mass–Mortality Association in the United States: Evidence of Sex-Specific Cohort Trends from Three National Health and Nutrition Examination Surveys

The association between body mass index (BMI) categories and mortality remains uncertain. Using three National Health and Nutrition Examination Surveys covering the 1971–2006 period for cohorts born between 1896 and 1968, this study estimates separately for men and women models for year-of-birth (cohort) and year-of-observation (period) trends in how age-specific mortality rates differ across BMI categories. Among women, relative to the normal weight (BMI 18.5–24.9 kg/m²), there are increasing trends in mortality rates for the overweight (BMI 25–29.9) or obese (BMI ≥ 30). Among men, mortality rates relative to the normal weight decrease for the overweight, do not change for the moderately obese (BMI 30–34.9), and increase for the severely obese (BMI ≥ 35). Period and cohort trends are similar, but the cohort trends are more consistent. In the latest cohorts, compared with the normal weight, mortality rates are 50 percent lower for overweight men, not different for moderately obese men, and 100–200 percent higher for severely obese men and for overweight or obese women. For U.S. cohorts born after the 1920s, a lower overweight than normal weight mortality is confined to men. I speculate on possible reasons why the mortality association with overweight and obesity varies by sex and cohort.     

Seasonal relationships of ovary weight, liver weight and fat stores with body weight in the goldfish, Carassius auratus (L.)

The relationships of ovary weight, liver weight and visceral lipid stores to body weight in the goldfish were examined at different times of the year. Both arithmetic and logarithmic relationships were examined. Ovary weight significantly increased relative to increasing body weight in goldfish and the exact nature of this relationship changed from month to month. However, larger fish were found to have proportionately larger ovaries than small fish at specific times of the year. Regression lines for liver weight versus body weight were also determined. Monthly differences were found in the liver weight-body weight relationship. Visceral lipid stores expressed per gram of protein were found to be independent of body weight. Lipid stores expressed in this manner peaked in February while ovary weight peaked in April. The consequences of compensating for body size when expressing organ (liver, ovary) sizes, such as hepatosomatic index and gonosomatic index, are discussed.     

Tissue selenium accretion in premature and full-term human infants and children

Development of supplementation guidelines for formulated diets and total parenteral nutrition requires knowledge of Se tissue accretion. To this end, the total organ Se content was calculated from the Se concentrations that were measured by neutron activation analysis in postmortem samples of liver (n=56), kidney (n=11), adrenal cortex (n=9), and pancreas (n=6) from infants and children from birth to 10 yr including 17 born prematurely. Hepatic Se concentrations were similar in full-term and premature newborns, decreased from birth to 1 yr, and then increased thereafter. The total hepatic Se content was significantly greater in full-term than in preterm newborns and increased with age and liver size after 1 yr. No significant differences were found between the concentrations of Se in kidney, pancreas, and adrenal tissues. Falling hepatic Se concentrations in the full-term infant concurrent with stable total organ Se content may indicate inadequate dietary intake or may reflect a normal redistribution of the nutrient. Premature infants are born with smaller stores than full-term infants and are at greater risk of developing a deficiency.     

胎膜早破早产的临床分析

目的:探讨胎膜早破早产的临床处理方法及其对新生儿的影响.方法:以2009年3月至2012年1月在我院产科住院的妊娠满28～36+6周的205例胎膜早破早产患者为研究对象,针对不同孕周,采用相应的治疗方法,并对其妊娠结局和早产儿的状况进行观察和分析.结果:胎龄28～34+6周的早产儿并发症的发生率和死亡率分别为52.2％和10％,胎龄35～35+6周的早产儿并发症的发生率和死亡率分别为32.3％和4.8％,分别明显高于胎龄＞36周出生的早产儿(1.6％和0),差异具有统计学意义(P＜0.05);但孕周在36周以上出生的新生儿的并发症的发生率和死亡率与足月出生的新生儿相比无明显差异(P＞0.05).结论:胎膜早破早产是新生儿患病和死亡的主要原因,胎龄越小新生儿的患病率和死亡率越高,对于胎膜早破早产的孕妇,应针对不同孕周采用不同的治疗方法,以延长孕周以降低早产儿的患病率和死亡率.     

Analysis of ethnic differences in perinatal statistics.

The 3996 mothers delivered at Dudley Road Hospital, Birmingham, in 1979 were analysed for their ethnic origins. Social classes IV and V predominated in all groups. A high proportion of Indian mothers fell into the low-risk group based on age and parity but had the highest stillbirth and perinatal mortality rates (15.1 and 27.5/1000 respectively) and infants of low mean birth weight (2986 g). Elderly and multiparous mothers were characteristic of the Pakistani and Bangladeshi groups. Young, primiparous mothers were more common among the West Indians and Europeans, in whom the stillbirth and perinatal mortality rates were low; infants in the European group had a mean birth weight higher than in any other group (3231 g). From these findings ethnic origin of the mother is apparently an important factor in perinatal mortality.     

Influence of maternal insulin-dependent diabetes mellitus on neonatal morbidity.

OBJECTIVE: To compare the neonatal morbidity rates (corrected for gestational age at delivery and method of delivery) among infants of women with insulin-dependent diabetes mellitus and those of women without diabetes. DESIGN: Historical cohort analysis. SETTING: Tertiary care centre. PATIENTS: All liveborn infants of women with insulin-dependent diabetes mellitus (IDM group) born between Jan. 1, 1980, and Dec. 31, 1989, each matched for gestational age at delivery, method of delivery and year of birth with two newborns of women without diabetes (control group). MAIN OUTCOME MEASURES: Neonatal respiratory distress, jaundice, hypoglycemia, polycythemia, hypocalcemia, intraventricular hemorrhage, seizure and macrosomia. RESULTS: There were 230 infants in the IDM group and 460 in the control group. Compared with the control group the IDM group had significantly higher incidence rates of glucose infusion (odds ratio [OR] 5.38), birth weight above the 90th percentile (OR 4.15) and neonatal jaundice (OR 1.94). No significant difference was found in the incidence rate of respiratory distress, polycythemia or hypocalcemia. The maternal serum hemoglobin A (HbA) level was not significantly related to birth weight, and neither the serum HbA level nor the presence of macrosomia was predictive of neonatal morbidity. Nearly 25% of the infants in the IDM group were born before 37 weeks'' gestation; 48.2% of these were delivered early because of maternal hypertension. CONCLUSIONS: Neonatal morbidity in infants of women with diabetes is determined more by gestational age at delivery than by the maternal diabetes. Within the limits obtained in this study the degree of control of the diabetes does not seem to affect neonatal morbidity.     

The influence of birth timing upon infant growth and survival in Captive Rhesus Macaques (Macaca mulatto)

Weights, growth rates, and mortality data of 815 captive-born Macaca mulattainfants were studied to determine if date of birth influences infant growth and survival. The six groups studied displayed a unimodal spring-summer birth season that has become systematically more restricted since 1977. Males exhibited higher rates of stillbirth and neonatal death and were more frequently born outside the normal birth season, when infant mortality was more common. Within the normal birth season, infant weight increased linearly with birth date, and infant growth rate declined linearly with birth date. Female infants with weights and growth rates near the developmental norm, especially those born in the middle of the birth season, have the greatest probability of survival. Males are more likely to survive if their weights and growth rates exceed the developmental norm, and thus male infants might be initially more costly to produce than female infants. These results are inconsistent with the hypothesis that offspring of high-ranking males, which conceived predominantly in the first third of the breeding season, enjoy a selective advantage.     

Effect of maturation on the extrathoracic airway stability of infants.

The influence of maturation on extrathoracic airway (ETA) stability during quiet sleep was determined in 13 normal preterm infants of 1.41 +/- 0.14 (SD) kg birth weight and 32 +/- 2 wk estimated gestational age. Studies began in the first week of life and were performed three times at weekly intervals. A drop in intraluminal pressure within the ETA was produced by external inspiratory flow-resistive loading (60 cmH2O.l-1 x s at 1 l/min); an increase in intrinsic resistance, indicating airway narrowing, was sought as a measure of ETA instability. Baseline total pulmonary resistance was not significantly different between weeks 1, 2, and 3 (88 +/- 35, 65 +/- 24, and 61 +/- 17 cmH2O.l-1 x s, respectively) but increased markedly above baseline with loading to 144 +/- 45 cmH2O.l-1.s during week 1 (P < 0.001), 89 +/- 28 cmH2O.l-1 x s at week 2 (P < 0.01), and 74 +/- 25 cmH2O.l-1 x s at week 3 (n = 10). The increment with loading was significantly greater during week 1 than during weeks 2 or 3 (P < 0.02). Similar studies were also done in seven full-term infants in the first week of life to evaluate the influence of gestational maturity on ETA stability. Despite a relatively greater drop in intraluminal pressure within the ETA of term vs. preterm infants with loading (P < 0.001), total pulmonary resistance failed to increase (68 +/- 21 to 71 +/- 32 cmH2O.l-1.s). These data reveal that ETA instability is present in preterm infants at birth and decreases with increasing postnatal age. Full-term neonates, by comparison, display markedly greater ETA stability in the immediate neonatal period.