Abstract: In a study population of 151 newborn infants less than 35 weeks gestation, who required intensive care for more than 24 hours, clinical and biochemical factors associated with the presence of intraventricular hemorrhage (IVH) were prospectively evaluated. The diagnosis of IVH was confirmed by computed tomography, ventricular tap, or autopsy. Alveolar rupture was highly correlated with the presence of IVH. Other factors associated with IVH were: hypoxemia, hypercarbia, mechanical ventilation, peak inflation pressure >25 cm H2O, inspiratory to expiratory ratio >1:1, patent ductus arteriosus, bicarbonate administration after the first day of life, volume expansion in the first day of life, hypotension, stages III and IV hyaline membrane disease, and intrauterine growth retardation. Early bicarbonate administration (first day), sodium administration >8 mEq/kg/day, acidosis and birth weight ≤1,200 gm were associated with IVH only in the infants who died with IVH. Factors not associated with IVH were Apgar ≤5 at one and five minutes, birth weight, gestational age, male sex, osmolality ≥300, serum sodium ≥150, hypothermia, continuous distending pressure > 6 cm H2O, positive end-expiratory pressure > 5 cm H2O, outborn birth, obstetric trauma, or coagulopathy. Certain therapeutic interventions may lead to an increase incidence of intracerebral hemorrhage in the high-risk preterm infant.

Abstract: Computerized birth files compiled by the State of North Carolina for the years 1975-1977 were analyzed for omissions and inaccuracies. A wide range in the per cent missing values was found for different data items, from essentially none missing (birthweight, sex, race) to about 20 per cent missing (gestational age, paternal social data). Recorded birthweight showed the expected skewing from a normal distribution. The only demonstrable inaccuracy was in the form of digit preference, probably causing errors of +/- 1 oz (28.3 g). Reported gestational ages were more suspect, falling outside the range of biologically plausible gestation length in 2.8 per cent of cases. An additional 1.5 per cent of gestational ages were found to be misdated by four to 20 weeks based on the observed bimodal weight distributions among births of the same reported gestational age. Hospitals of various sizes and administrative affiliations submitted records with missing or inaccurate gestational age data with roughly equal frequency. These records were found to come from a socio-demographically high-risk subpopulation. The implications of elimination of incomplete or erroneous birth record data in perinatal epidemiologic research are discussed.

Abstract: Serial ultrasound estimates of fetal biparietal diameter and abdominal circumference were used as differential indices of intrauterine growth of insulin-insensitive and insulin-sensitive structures, respectively, in 23 White's classes A to C diabetic women. Biparietal diameter in all fetuses conformed to growth patterns for fetuses of nondiabetic mothers. However, two patterns were noted for abdominal circumference. Normal increases occurred in 13 fetuses; in the remaining ten, growth of abdominal circumference exceeded upper normal limits from weeks 28 to 32 of gestation onward. This latter group with putative "accelerated somatic growth" in utero had more immunoreactive insulin in amniotic fluid, weighed more at birth, and had more subcutaneous fat. Serial differential ultrasonography may be useful for detecting evolving macrosomia in diabetic pregnancies, and fetal insulin or insulin-like principles may contribute to the macrosomia. ( JAMA 243:2405-2408, 1980)

Abstract: To determine the incidence of periodic breathing (PB) episodes during sleep, 48 subsequent sudden infant death syndrome siblings and 48 control infants, matched by sex, gestational age, and chronologic age, were studied by home pneumogram technique. The sudden infant death syndrome siblings had a statistically significant increase in the percent of sleep time spent in PB, in the number of episodes/100 minutes of PB, in the longest episode of PB, and in the average duration of all episodes of PB. We conclude that PB is present in a higher amount in sudden infant death syndrome siblings as compared to control infants.

Abstract: Beginning in 1963 we have administered fast-acting insulin in three daily injections up to the maximal tolerated dose (M.T.D.), which can be defined as the highest quantity that can be given without bringing about hypoglycemic disturbances. This therapeutic criteria was applied both to gestational (280 pregnant women) and clinical (199 pregnant women) diabetes. M.T.D. was established on first admission to hospital and afterward controlled weekly in the outpatient clinic and during short periods of hospitalization (average of 53 days per patient). The average increase of the M.T.D. was 38 IU from 15 wk until delivery. As regards maternal blood sugar, at the M.T.D. average values at fasting and over the 24-h period were very close to the corresponding values of the control group (normal pregnancy). Total perinatal mortality (P.M.) was 2.9%; in the gestational diabetes group it was 2%. The incidence of congenital malformations (C.M.) (2.4%) increased with the severity of diabetes. No congenital defects were observed in 96 infants of patients treated before the 15th wk. Labor started spontaneously in 90.4% of the cases. The incidence of cesarean section was 21% in patients in White9s Classes Al and A2 (as recently redefined by Freinkel and Metzger 8 ) and 28% in other classes and that of forceps and vacuum extraction was 1% and 6%, respectively. The incidence of small-for-dates and overweight newborns from mothers with gestational and clinical diabetes without vascular complications is consistent with normal figures (macrosomia 3.4%). Small-for-dates newborns from pregnant diabetic women with vascular complications had a significant incidence. Respiratory distress syndrome (RDS) was 0.6% and hypoglycemia was 13.4%. No case of death was due to these two causes. Clinical results are discussed.

Abstract: Newborn infants, chronically exposed in utero to low doses of methadone with or without concomitant heroin, display more rapid eye movement sleep and less quiet sleep than control infants, while babies fetally exposed to both opiates and nonopiates have less organization of sleep states. Other perinatal factors, such as birth weight and gestational age, are related more to the amount of fetal drug exposure than to the type.

Abstract: The capacity of cells from thymus, liver, spleen, mesenteric lymph nodes, peripheral blood, and bone marrow to respond to in vitro phytolectin and allogeneic lymphocyte-stimulation was determined in 16 pony fetuses 61 to 200 days old (gestational age). Phytolectin-responsive cells were detected in the thymus at the 80th gestational day, peripheral blood at 120 days, lymph node at 160 days, and spleen at 200 days. Mixed lymphocyte culture-responsive cells were detected in thymus at 100 days and in the spleen at 200 days (gestational age). Immunoglobulins (Ig) M and IgG were quantitated by radioimmunoassay. They were detected in fetuses prior to 200 days of age. All of 50 normal newborn foals had detectable quantities of IgM (165 +/- 56 micrograms/ml of serum). Quantities of IgG in normal newborn foal serum were lower and more variable. The minimal-maximal concentrations of IgG were 2 to 170 micrograms/ml of serum with a mean and SD of 51 +/- 49 micrograms/ml. The results indicate that (1) functional T lymphocytes are present in the fetus by 100 days (gestational age), (2) functional B lymphocytes are present by 200 days, and (3) that foals are immunocompetent before birth.

Abstract: Neonatal heart rate variability (NHRV) was studied in 92 preterm infants (birth weight, 750 to 2,500 gm; gestational age, 28 to 36 weeks). Each infant was monitored continuously during the first 6 hours and for one hour at 24, 48, and 168 hours of life. During each hour NHRV was quantified and related to the following parameters: sex, gestational age, postnatal age, heart rate, and the presence and severity of respiratory distress syndrome (RDS). NHRV in healthy preterm infants was inversely related to heart rate level and directly related to the infant's postnatal age. In healthy babies with gestations of 30 to 36 weeks there was no significant correlation between NHRV and gestation. Decrease in NHRV was significantly related to the severity of RDS, and the reappearance of NHRV in infants with RDS was associated with a good prognosis. Decreased NHRV significantly differentiated the infants with RDS who survived after the fifth hour of life. The data reveal that NHRV (1) should be corrected for heart rate level and postnatal age; (2) is decreased in RDS; and (3) can be used as an indicator of morbidity and mortality in preterm infants with RDS.

Abstract: Neonatal heart rate variability (NHRV) was studied in 92 preterm infants (birth weight, 750 to 2,500 gm; gestational age, 28 to 36 weeks). Each infant was monitored continuously during the first 6 hours and for one hour at 24, 48, and 168 hours of life. During each hour NHRV was quantified and related to the following parameters: sex, gestational age, postnatal age, heart rate, and the presence and severity of respiratory distress syndrome (RDS). NHRV in healthy preterm infants was inversely related to heart rate level and directly related to the infant's postnatal age. In healthy babies with gestations of 30 to 36 weeks there was no significant correlation between NHRV and gestation. Decrease in NHRV was significantly related to the severity of RDS, and the reappearance of NHRV in infants with RDS was associated with a good prognosis. Decreased NHRV significantly differentiated the infants with RDS who survived after the fifth hour of life. The data reveal that NHRV (1) should be corrected for heart rate level and postnatal age; (2) is decreased in RDS; and (3) can be used as an indicator of morbidity and mortality in preterm infants with RDS.

Abstract: The relationship between maternal hypertensive disease of pregnancy (HDOP) and idiopathic respiratory distress syndrome (IRDS) was analyzed in 2,105 premature infants weighing between 1,000 and 2,199 gm and born between January 1968 and December 1975 at the Kings County Hospital Center and State University Hospital. HDOP was diagnosed in 250 mothers of 2,105 infants studied. The incidence of IRDS (15.2%) in the HDOP group was significantly lower than the 29.9% in the non-HDOP group (P less than .001). In infants whose gestational age was 32 weeks or less, the incidence of IRDS was 26.1% in the HDOP group and 40.8% in the non-HDOP group (P less than .01). In infants whose gestational age was 33 weeks or more, the incidence (9.3%) in the HDOP group was significantly lower than the 18.4% in the non-HDOP group (P less than .005). The low incidence of IRDS in the HDOP group remained even after eliminating infants with known predisposing and protecting factors from the development of IRDS. The incidence of IRDS was inversely related to the severity of maternal toxemia. The total mortality and mortality with IRDS were not significantly different in both HDOP and non-HDOP groups. When the infants did not develop IRDS, the mortality rate in the HDOP group was significantly higher than that in the non-HDOP group especially in the lower gestational age group. These data suggest that chronic stress accelerates fetal lung maturation and severe chronic stress is even more effective in accelerating fetal lung maturation. When maternal toxemia was severe enough to accelerate the fetal lung maturation, the mortality rate of the infants without IRDS increased.

Abstract: • Sixty-four infants with birth weights of 500 to 1,500 g were studied to determine the incidence and outcome of intracranial hemorrhage. Thirty-seven (58%) had hemorrhage and of these 60% died. Of the survivors, progressive hydrocephalus requiring treatment developed in only two infants. Serial computerized tomographic scans with measurement of ventricular-brain width ratios were found to be useful in objectively evaluating hydrocephalus. Review of perinatal data showed no association of maternal or obstetrical factors with neonatal hemorrhage but the infants who had intracranial bleeding showed a high incidence of low Apgar scores, respiratory distress syndrome, acidosis, hypoxia, apnea, hypotension, seizures, and requirement for respiratory support. Multiple regression analysis of potentially causative factors assigned importance to low gestational age, respiratory distress syndrome, birth asphyxia (low Apgar score), and vaginal delivery. ( Am J Dis Child 134:855-859, 1980)

Abstract: Hyperglycemia and glucosuria, which may lead to an osmotic diuresis, are often seen in low birth weight infants receiving glucose infusions during parenteral alimentation This study was designed to examine the degree of glucose tolerance and the renal handling of glucose, solute, and water during intravenous glucose infusions in low birth weight infants Twenty infants (mean birth weight, 1,170 gm; gestational age, 30 weeks) were studied between 1 and 20 days of age At similar glucose infusion rates, 12 of 20 infants of lower gestational ages (29 ± 06 weeks, mean ± SEM) had higher plasma glucose concentrations and developed glucosuria while the remaining eight of 20 infants of higher gestations (314 ± 05 weeks, P

Abstract: Summary: Plasma and urine free carnitine concentration during human development was evaluated. A positive correlation was found between plasma level and body weight in premature neonates weighing between 1.15 and 1.80 kg. In full terms newborns, the free carnitine concentration (mean ± S.E., 31.2 ± 2.5. nmoles/ml) is similar to that of premature babies with 33 to 36 wk of gestational age (37.5 ± 3.1 nmoles/ml) but significantly lower than that of premature babies aged 30 to 33 wk of gestation (43.0 ± 5.6 nmoles/ml). In the first 2 wk of life, free carnitine level showed a good correlation with age in the full-term newborns. Adult levels are reached by the end of the first 6 months. No sex related difference was observed in any of the different groups during growth. Urinary excretion of free carnitine per day is significantly lower in infants 0 to 3 years old (mean ± S.E., 15.5 ± 1.8 μmoles/24 hr) and in children 3 to 10 years old (115.3 ± 11.4μmoles/24 hr) than in subjects ranging in age from 22 to 70 years (216.9 ± 20.6 μmoles/24 hr). We found no difference between day- and nighttime urinary excretion in newborns and infants. Speculation: The present observations suggest that fetal free carnitine storage mainly occurs during the 30th to 33rd wk of life. Because the fatty acids are the main energy fuel in the postnatal period and their /%oxidation is carnitine dependent, an exogenous source of this substance seems useful to maintain plasma levels similar to those found in the fetus. The lower free carnitine excretion observed in our children group compared to adult may be related to a smaller muscle mass, different kidney excretion, or reduced endogenous synthesis.