Volume 27, Issue 6

no abstract available

Christian tradition treats birth in several characteristic motives. The most frequent is the Birth of Jesus Christ, while much rarer is the apocryphal motive of the birth of St. Mary. By analyzing three paintings from Croatian 16–17th-century sacral-art heritage, depicting the parturition of St. Anne (St. Mary's Mother), the authors of this paper are trying to define the role of ethnomedical notions in the formation of modern medical and general culture.

Diagnostic ultrasound has been used for many years with a remarkable history of safety during the standard clinical practice. Introduction of color and pulsed Doppler modes resulted with higher levels of transmitted and absorbed ultrasonic energy. This fact raised the question for the safety of its use in early pregnancy. This article presents the pros and contras regarding the safety and summarized actual guidelines and safety limits suggested and prescribed by several instances that supervise the use of ultrasound in medicine (WFUMB, ECMUS, ECURS, AIUM/NEMA). In addition, different clinical and experimental applications of Doppler ultrasound in early pregnancy are discussed regarding the safety limits. Generally, there are no strictly defined limits for the use of Doppler ultrasound in the early pregnancy. However, there is an unequivocal demand for carefulness that is best expressed by the ALARA principle. The prudent use of Doppler takes into account benefits against the possible theoretical risks, rather than prohibiting clinically useful technology or applications.

This report form part of the European Community Multi-Center Trial "Fetal ECG Analysis during Labor". Aim of this prospective trial was to identify changes in the fetal ECG waveform with cases of verified fetal hypoxia. In this paper we also report on the use of a newly developed automatic system for identification of ST waveform changes (ST Log). All ECG were recorded with the STAN recorder (Neoventa Medical AB, Gothenburg, Sweden). The ECG information was not displayed during labor in order not to influence the clinical management. This report includes data from 320 cases and include six cases of fetal intrapartum hypoxia. Twenty seven cases showed changes in ST waveform. All five cases with the most marked ST change (a rise in T/QRS of ﹥0.10 units and lasting more then 10 minutes) had signs of ongoing intrapartum hypoxia. Six out of six cases with evidence of intrapartum asphyxia, showed ST changes. On the basis of our multi-center trial it appears that the combined analysis of CTG and ST waveform changes provides an accurate way to identify adverse events during labor. The work is continuing with a new STAN recorder developed by Neoventa Medical in Göteborg and currently being tested in a Swedish randomized, controlled multi-center trial.

Aim: To identify pre- and perinatal risk factors for autism. Method: Case control study. We matched names of patients from North Dakota who met DSM criteria for autism, a pervasive developmental disorder, and autisticdisorder with their birth certificates. Five matched controls were selected for each case. Results: Univariate analysis of the 78 cases and 390 controls identified seven risk factors. Logistic modeling to control for confounding produced a five variable model. The model parameters were χ 2 = 36.6 and p <0.001. The five variables in the model were decreased birth weight, low maternal education, later start of prenatal care, and having a previous termination of pregnancy. Increasing father's age was associated with increased risk of autism. Conclusion: This methodology may provide an inexpensive method for clinics and public health providers to identify risk factors and to identify maternal characteristics of patients with mental illness and developmental disorders.

Aims: To assess the outcome of preterm prelabor rupture of the membranes (PPROM) before 26 weeks of gestation and to develop a prediction model for survival. Methods: 148 consecutive cases of PPROM before 26 weeks of gestation, collected between 1988 and 1996, were retrospectively analyzed. A multivariate analysis (generalized estimating equations) of 21 process and 5 short and long term outcome variables was performed. Results: 40 out of 148 children (27 ％) died before or during birth, 57 (38.5 ％) of the children survived more than 28 days, from which still 5 died after one month. Amongst the 52 survivors (35.1 ％), the Bayley Mental Development Index and Psychomotor Development In- dex at a corrected age of 7 months was normal in respectively 85.7％ and 75.5％ of the cases. At 6–7 years of age, 24 out of 33 children (73 ％) performed adequately at school. Sex, gestational age at PPROM, birth weight, the administration of steroids and interactions of steroid administration with sex and with gestational age at the time of PPROM largely determined the chances of survival. Conclusions: Overall fetal survival after PPROM before 26 weeks of gestation was 35.1 ％. Survival can be predicted with an accuracy of 75 ％, a sensitivity of 85％and a specificity of 60 ％. More than 70％of the survivors behaved and performed adequately at school age, but 27％ require special long-term attention and care.

A total of 71 pregnant women diagnosed by ultrasound to have viable fetus in late mid-trimester pregnancies of normal, IUGR, hydrops fetalis and chromosomal anomalies were studied for their coagulation, fibrinolytic and inhibitor levels with association on eventual obstetrics outcome. A hypercoagulable state was observed in all the pregnancies studied. However, higher hypercoagulation evidenced by significantly raised prothrombin formation and clot elasticity together with higher levels of D-dimer, uPA antigen and PAI-1 than observed in normal pregnancy suggests a hyperfibrinolytic/inhibitor state in hydrops fetalis pregnancy associated with bad obstetric outcome. In IUGR pregnancy associated with good outcome further enhanced clot elasticity was seen whilst no significant differences were observed in pregnancy with chromosomal anomalies when compared to uncomplicated normal pregnancy. Our study suggests that in hydrops fetalis pregnancy, further enhanced prothrombin formation and hyperfibrinolysis/inhibitor at late mid-trimester is associated with a poor obstetric outcome.

The purpose of this study was to determine oxygen consumption (VO 2 ), carbon dioxide production (VCO 2 ), and energy expenditure (EE) in a group of preterm ventilated infants during the first 3 weeks of life, and to determine the major factors that influence EE. Thirty-eight indirect calorimetry studies were performed in 18 ventilated infants with mean gestational age of 27.9 ± 0.6 (SEM) weeks. The relationship of demographic factors, nutrient intake, and severity of illness assessments on EE were determined by regression analysis. Repeated measure analysis was performed for the effect of multiple studies in the same patient. Although VO 2 , VCO 2 , and EE all tended to increase over the first 3 weeks of life, there was a wide range of values. EE was best predicted by non-protein calorie intake and postnatal age, while there was no correlation with birthweight, weight at the time of study, gestational age, protein intake, or severity of illness. Multiple regression analyses demonstrated a strong interaction between PNA and EI. In this population EE is best predicted by PNA and EI. The interactive effect between PNA and EI on EE is probably explained by the clinical practice of daily increments in substrate intake in these patients.

Objective: To determine neonatal outcome of single fetal death in twin pregnancy. Methods: Retrospective study was performed on 30 cases of single fetal death in twin pregnancy during the period from August 1971 to December 1997 at Kitasato university hospital. Results: The incidence of single fetal death in twin pregnancy was 6.2％ among total number of 481 twins. Prognosis of surviving infants was satisfactory except in one case, with malformation in 10 cases of dichorionic twins (total 242 sets). In contrast, neonatal death occurred in 6 cases of 20 monochorionic twins (total 239 sets), 4 of which were among 7 cases of twin-to-twin transfusion syndrome (TTTS). Cerebral palsy occurred in 2 infants of monochorionic twins. One case was diagnosed as periventricular leukomalacia (PVL) within one week after birth, and this was the case of delivery 1 day after one twin fetal death. Conclusion: Single fetal death itself occurs more often in monochorionic twins. There seems to be a benign outcome for the surviving dichorionic twins. On the other hand, there may be a grave outcome, though infrequent, for monochorionic twins when concomitant TTTS has existed. It is very important to identify the chorionicity by ultrasound examination in early pregnancy.

Aim: To assess whether plasma creatine kinase brain isoenzyme (CKBB) levels or Sarnat scores are more accurate for prediction of poor neurological outcome in babies with suspected birth asphyxia. Methods: In a retrospective study of 97 babies CKBB levels were compared to the presence of severe hypoxic ischaemic encephalopathy (HIE) as a predictive test for these outcomes: developmental delay, cerebral palsy, visual problems, deafness or death from perinatal asphyxia. The tests were compared using positive predictive values (PPV) and likelihood ratios (LR) with confidence intervals (CI) Results: 3 babies had died from perinatal asphyxia and 14 survivors were found to have neurological or developmental problems. CKBB was elevated in babies with severe HIE (p=0.0004). A receiver operator characteristic (ROC) curve showed the optimal discriminating value for CKBBto be 21 IU/L but theCKBB was a poor predictive test. For prediction of adverse outcome: CKBB > 21 sensitivity 76％, specificity 40％, PPV 21％ and LR 1.3 (95％ CI 0.8–1.7). Severe HIE sensitivity 53％, specificity 95％, PPV 69％ and LR 10.6 (95％ CI 3.8–29.2). Conclusion: CKBB is elevated following birth asphyxia but is a poor predictor of adverse neurological outcome.

Background: There still is a controversy as to the neonatal outcome of small for gestational age (SGA) infants compared to a appropriate for gestational age (AGA) preterm infants. As a part of a randomized multicenter trial on timing of bovine surfactant therapy, we aimed at investigating short-term outcome variables in SGA-infants compared with AGA-infants. Methods: SGA-infants were classified weighing below the 10 th percentile at birth and were compared to AGA-infants in terms of prenatal and neonatal characteristics and neonatal outcome. Results: A total of 317 infants were enrolled, 59 SGA-and 258 AGA-infants. Both groups did not differ in gestational age, however, SGA-infants had a lower birth weight. Preterm premature rupture of fetal membranes was observed more frequently in AGA-, preeclampsia in SGA-infants. The rate of intubation, severity of RDS, rate of surfactant administration, pulmonary airleaks and days on the ventilator did not differ between both groups. However prolonged nasal CPAP, supplemental oxygen therapy and chronic lung disease at 28 days and 36 weeks was diagnosed more often in SGA-infants. Furthermore mortality was significantly higher in SGA-infants as well as total NICU and total hospital days. Conclusion: As SGA-infants have an increased mortality rate and an increased risk for developing chronic lung disease, further studies should focus on prevention of intrauterine growth restriction and its complications.

Aim: To compare mortality and respiratory morbidity in preterm infants born at 4 United Kingdom centers during 1994 and 1995. Method: Collection of CRIB scores, respiratory parameters and mortality rates from unit databases. Results: Mortality in center A was 27％ (actual number of deaths 36/135), in center B was 30％ (39/130), in center C was 28％ (51/182), in center D was 39％ (60/156). The rate of chronic lung disease (36 week definition) in center A was 16 ％, in center B was 12 ％, in center C was 13 ％, in center D was 15 ％. The predicted number of deaths by CRIB scores in center A was 54 (95％ confidence intervals 45–63), in center B was 33 (25–41), in center C was 53 (43–63), in center D was 46 (37–56). Conclusion: Center A had a lower than predicted mortality. Center D had a higher than predicted mortality. There is an urgent need for a national neonatal database to allow comparison between center and to identify reasons for variation in outcomes.

The authors present the results of their follow-up studies of data from the last four years on patients with congenital ventriculomegaly. Objective: To study the psychomotor and mental developmental outcome of neonates with congenital ventriculomegaly diagnosed prenatally. In addition, patients were also classified into subgroups with subgrouping based on the etiology and complications of congenital ventriculomegaly and on the absence of ventriculoperitoneal shunt placement, and the findings compared between the different subgroups. Methods: Level 3 fetal ultrasonography was used for the prenatal diagnosis of congenital ventriculomegaly in 30 infants. Using neurological examination and the modified Brunet-Lézine infant test performed postnatal follow-up of motor and sensory development and intelligence, respectively. Results: The results show thirteen symptomless, well-developing patients, ten moderately handicapped patients and seven severely handicapped patients. Newborns with isolated, moderate ventriculomegaly have the best outcome.