摘要:

ABSTRACT.A description is first given of respiratory activity in the fetus and its control. Evidence suggests that when the fetus makes respiratory movements, it is in a state comparable to REM sleep in the newborn and adult and that in the alternating periods of apnoea, it is in quiet sleep. It does not appear that the respiratory movements are normally regulated by chemical or reflex, e. g. Hering Breuer, inputs though they are enhanced by CO2and depressed by hypoxia. In the apnoeic periods, breathing movements are virtually impossible to elict by chemical or reflex means. Evidence from examination of peripheral inputs indicates that: the carotid body chemoreceptors are inhibited at receptor level, stimulation of the aortic chemoreceptors affects the circulation only and although pulmonary stretch receptors are active and are excited by inflation of the fetal lung, such inflation does not affect discharge in medullary respiratory units or phrenic nerve. Since there is no real evidence of immaturity of the respiratory system in late gestation and since chemical and most reflex inputs appear to provide an adequate stimulus, it is most probable that the periods of apnoea are caused by an inhibitory process, possibly of supra‐pontine origin which acts close to medullary respiratory units and effectively inhibits the operation of the automatic component. This inhibitory process may operate periodically; or continuously and be periodically overridden in REM sleep. After birth, breathing is normally continuous and sensitive to lung inflation, CO2and after a variable delay, to hypoxia. This may be due to the lifting of the inhibitory process allowing activation of the automatic component. However, there is evidence that even in normal, full term infants, full maturation of the automatic component is not complete until about three months of age and in the meanwhile, breathing tends to be imperfectly regulated and subject to damped oscillations when disturbe

ISSN:0803-5253    

DOI:10.1111/j.1651-2227.1982.tb09470.x

出版商:Blackwell Publishing Ltd    

年代:1982

数据来源: WILEY

摘要:

ABSTRACT.Mean arterial blood pressure (MABP) was measured continuously for 3 to 5 days after birth in 27 premature infants with a birth weight under 1500 g, and who required umbilical artery catheterisation. All had respiratory distress syndrome (RDS). Intraventricular hemorrhage (IVH) occurred in 9 infants (33%), diagnosed by computered tomography (CT). IVH was more common in infants of lower gestational age, in infants delivered vaginally and in infants with perinatal asphyxia. Variable increases in MABP over the resting value occurred in all infants associated with increases in both active and passive motor activity. In 6 infant pairs matched for birth weight, gestational age, mode of delivery and severity of perinatal asphyxia, the infants who developed IVH had higher peak MABP valued compared to matched controls. Resting and minimum MABP values were not different in the two groups. We conclude that the large increases in arterial blood pressure which occur with both spontaneous motor activity and in association with nursing procedures, are an important cause of development of IVH in very low birth weight infants. An example is given to show that pressure peaks can be abolished by phenobarbitone sedation.

ISSN:0803-5253    

DOI:10.1111/j.1651-2227.1982.tb09471.x

出版商:Blackwell Publishing Ltd    

年代:1982

数据来源: WILEY

摘要:

ABSTRACT.An unselected series of 116 dyskinetic cerebral palsy cases born 1959‐70 was delineated and subgrouped according to neurological criteria into 35 hyperkinetic (30%) and 81 dystonic (70%) cases. Of the hyperkinetics, 80% had a mild motor disability, while 90% of the dystonics had moderate or severe disability. Subordinated spastic signs were found in 9% of the hyperkinetic and in 44% of the dystonic cases. IQ was>90 in 69% of the hyperkinetics and 25% of the dystonics and<50 in 11% and 41%, respectively. Two or more additional neurological abnormalities (spasticity, mental retardation, epilepsy, anarthria, dysarthria, hearing deficit) were detected in 46% hyperkinetic and 81% dystonic cases. A heavy multihandicap complex was present predominantly in the dystonic subgroup. The 5‐19 year mortality rate was 6 % and was confined to the most severely handicapped dystonic cases. The twin rate was 5%. A total of 9% had birth weights ≤ 1500 g, and 31% had ≤ 2500 g. The weight‐ and age‐specific incidences increased rapidly with decreasing birth weights and gestational ages. The crude incidence of hyperkinetic cerebral palsy was 0.07 and dystonic cerebral palsy 0.17 per thousand

ISSN:0803-5253    

DOI:10.1111/j.1651-2227.1982.tb09472.x

出版商:Blackwell Publishing Ltd    

年代:1982

数据来源: WILEY

摘要:

ABSTRACT.In an unselected series of 116 dyskinetic cerebral palsy cases, 35 hyperkinetic and 81 dystonic, 21% of the cases were considered to derive from the prenatal period, 67% from the perinatal, and 7% from the postnatal period, while 5% were untraceable. Isolated risk factors were found in 24% of the hyperkinetic and 24% of the dystonic cases and various combinations in 68 % and 72 %, respectively. Preterm appropriate‐for‐gestational‐age cases with hyperbilirubinemia were found significantly more often among the hyperkinetics (47%) than among the dystonics (11%). Term appropriate‐for‐gestational‐age cases with asphyxia were found significantly more often among the dystonics (30%) than among the hyperkinetics (9%). Term and preterm small‐for‐gestational‐age cases with asphyxia and/or perinatal hypoxia were only found in the dystonic subgroup (14%). Both the hyperkinetic and the dystonic subgroups had significantly lower mean birth weights–2795 g and 2872 g, respectively–than that of the general population, 3500 g. The dystonic subgroup had birth weights significantly below the mean for gestational age. Both subgroups had birth weights significantly below the mean for the respectively birth length. This was particularly pronounced for the cases with birth asphyxia. All infants with birth weights ≤−2.0 SD below the mean for birth length had had birth asphyxia, and the proportion decreased successively t

ISSN:0803-5253    

DOI:10.1111/j.1651-2227.1982.tb09473.x

出版商:Blackwell Publishing Ltd    

年代:1982

数据来源: WILEY

摘要:

ABSTRACT.The immediate effect of parenteral antibiotic treatment (gentamicin and ampicillin) on the aerobic and anaerobic faecal flora of 14 infants with suspected or proven neonatal septicaemia was studied. Eight infants of similar gestational and postnatal age were studied for comparison. All control infants showed an abundant growth of both aerobic and anaerobic bacteria as early as the first 2 weeks of life. The treated infants generally had lower counts of aerobic and especially of anaerobic bacteria; in 10 of 16 cultures no anaerobes were isolated. In relation to aerobic strainsE. colidominated in untreated infants and Klebsiella pneumoniae in treated ones.

ISSN:0803-5253    

DOI:10.1111/j.1651-2227.1982.tb09474.x

出版商:Blackwell Publishing Ltd    

年代:1982

数据来源: WILEY

摘要:

ABSTRACT.The post‐prandial pattern of total serum bile acids was studied in 47 newborns: 12 prematures (less than 36 weeks), 17 term low‐birth‐weight infants (less than the 3rd percentile), 18 term normals. The study was made at the end of the first month. Blood was collected in a peripheral vein using a microcatheter. Samples were taken at fasting time and 30, 60, 120, 180 min after a test meal intake (40 ml/kg of “humanized” milk based formula). Bile acids were assayed using an original enzymatic micromethod which needed only 50 μl of serum and showed a sensitivity of 0.3 pmol in 200 μl of reaction medium. The response of serum bile acids after the test meal was very similar in normal term newborns and in adults. Prematures exhibited bile acid levels slightly higher than normals, but this difference was significant only at 0 and 180 min. Low‐birth‐weight infants showed very high values of serum bile acids at all times during the test, compared to normal and premature infants. Serum levels of total bilirubin and alkaline phosphatase were similar in all 3 groups. These results are not consistent with cholestasis but rather indicate a specific dysfunction in bile acid metabolism in low‐bir

ISSN:0803-5253    

DOI:10.1111/j.1651-2227.1982.tb09475.x

出版商:Blackwell Publishing Ltd    

年代:1982

数据来源: WILEY

摘要:

ABSTRACT.The incidence of otitis media was studied in 237 healthy children in reference to the duration of breast‐feeding, with a follow‐up from birth to three years of age. Recurrent otitis media was strongly associated with early bottle‐feeding, in contrast to prolonged breast‐feeding which had a long‐term protecting effect up to three years of age. It is uncertain whether the prophylactic effect of prolonged breast‐feeding on recurrent otitis is due to protection by human milk from infections or allergy, or to avoidance of harmful effects caused by

ISSN:0803-5253    

DOI:10.1111/j.1651-2227.1982.tb09476.x

出版商:Blackwell Publishing Ltd    

年代:1982

数据来源: WILEY

摘要:

ABSTRACT.Twenty‐two infants of diabetic mothers (IDM) were studied and were divided into two groups: a first group of 14 IDM did not receive vitamin D3 and was studied at birth and at 2, 24, 48 and 120 hours; a second group was given daily dosage of 60 μg of vitamin D3 from 3 hours to 120 hours and was studied at 2 hours and 120 hours.In the first group, serum calcium levels decreased markedly during the first 24 hours of life (mean ± SD: 1.77±0.3 mmol/1,p<0.01) and remained low at 5 days. Serum phosphorus levels remained normal but serum magnesium levels decreased significantly at 24 hours (mean ± SD: 0.64±0.108 mmol/1,p<0.01) and returned to normal at 5 days. Serum immunoreactive parathormone levels increased consistently to high levels at 24 hours and remained elevated at 120 hours (p<0.001). Serum immunoreactive calcitonin levels increased at 24 hours (p<0.001) and decreased at 120 hours to low or undetectable values in all infants.In group II, serum 25O‐HD levels and 1.25 OH2D levels increased significantly (p<0.001) respectively to 27.2±2.7 ng/ml and 114±20 pg/ml at 5 days. The results of this study show hypocalcemia to be a common event in IDM during the first days of life and furthermore hypophosphatemia, hypoparathyroidism, hypomagnesemia or defect of vitamine D metabolism would not seem to be the main etiologic

ISSN:0803-5253    

DOI:10.1111/j.1651-2227.1982.tb09477.x

出版商:Blackwell Publishing Ltd    

年代:1982

数据来源: WILEY

摘要:

ABSTRACT.Gonadotropin response to 100 μg/m2LHRH was determined in 31 patients with growth hormone deficiency. According to their bone ages the patients were divided into a “prepubertal” (n=18) and a “pubertal” (n=13) group. The results were compared with the LHRH tests from 16 healthy prepubertal boys and girls and 32 healthy adult probands, respectively. The maximum increment of LH and FSH was evaluated. In the “prepubertal” group five patients had an insufficient rise of LH and FSH, four of them having additional anterior pituitary hormone deficiencies. In the “pubertal” group nine patients were found to be gonadotropin deficient, all of them had additional hormone deficiencies, TSH being the most frequently affected hormone. Only one of 14 gonadotropin‐deficient patients had no other than growth hormone deficiency in addition. An isolated decreased FSH increment without LH deficiency was found in 6 male and 2 female patients and is not thought to be of diagnostic value. No influence of growth hormone treatment or growth velocity on the gonadotropin responsiveness was found. Patients with an additional thyreotropic defect could be classified as pituitary or hypothalamic disorder due to their reaction in the TRH test. These groups could not be differentiated by a single bolus LHRH test, indicating the need of prolonged stimulation to recover the pituitary hyporesponsiveness. Due to methodological problems the diagnosis of gonadotropin deficiency in an individual patient of the prepubertal age group might be questioned. However, a normal gonadotropin response to LHRH can be expected in prepubertal patients with growth hormone deficiency and may indicate a normal gon

ISSN:0803-5253    

DOI:10.1111/j.1651-2227.1982.tb09478.x

出版商:Blackwell Publishing Ltd    

年代:1982

数据来源: WILEY

摘要:

ABSTRACT.The activity of erythrocyte superoxide dismutase in patients with trisomy 21 and controls has been determined by both an enzymatic method and by radioimmunoassay. Increased activity, in a ratio of 1.5 to controls was seen in trisomy 21, while the specific activity of the enzyme was not altered. Of the other enzymes of the redox system, only glutathione peroxidase showed increased activity. These modifications could be one of the causes of the increased haemolysis seen in trisomy 21.

ISSN:0803-5253    

DOI:10.1111/j.1651-2227.1982.tb09479.x

出版商:Blackwell Publishing Ltd    

年代:1982

数据来源: WILEY