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Query: UMLS:C0728731 (prematurity)
 7,134 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Imprecise diagnosis of birth asphyxia coupled with uncertainties about causal factors for neurologic abnormalities in the newborn have greatly fueled the current litigation crisis in obstetrics. Our goal was to more precisely define birth asphyxia based on fetal condition as measured by umbilical artery blood pH, Apgar scores, and neurologic condition of newborns. We selected for study 2738 patients with singleton pregnancies with cephalic presentations who were delivered of infants at term to avoid complications such as prematurity, which may affect infant outcome independent of birth condition. The basis for study of these particular patients were defined criteria for high risk and an indicated arterial cord pH value. A total of five infants demonstrated cerebral dysfunction as evidenced by seizures during the neonatal period. Infection was linked to seizures in three of these infants; one infant had neonatal asphyxia and only one infant's clinical course could be attributed solely to birth events (uterine rupture). Stratification of umbilical artery blood pH values, Apgar scores, and combinations of these dependent variables in relation to newborn clinical outcomes revealed that infants must be severely depressed at delivery before birth asphyxia can be reliably diagnosed. Such depression includes Apgar scores less than or equal to 3 at 1 and 5 minutes plus umbilical artery pH values less than 7.00.
Am J Obstet Gynecol 1989 Sep
PMID:Diagnosis of birth asphyxia on the basis of fetal pH, Apgar score, and newborn cerebral dysfunction. 278 67

During the last 40 years, 579 babies with oesophageal atresia and/or tracheo-oesophageal fistula have been admitted to the Royal Children's Hospital (RCH), Melbourne. There are 393 survivors. Advances in the surgical management have contributed to lowering the morbidity and mortality rates. This paper describes current surgical management of each anatomical variant at RCH; specific reference is made to the problems of the long gap oesophageal atresia and prematurity.
Aust N Z J Surg 1989 Sep
PMID:Current surgical management of oesophageal atresia and/or tracheo-oesophageal fistula. 278 94

Lung function was recorded in a cohort of 130 age specific children of low birth weight (under 2000 g) and a reference population of 120 unselected local schoolchildren at 7 years of age. Children of the cohort were similar in height and forced vital capacity to the reference group, but had significantly reduced forced expiratory volume in 0.75 second and expiratory flow indices. Although neonatal respiratory illness was associated with reduced airway function, we were unable to confirm that this was a consequence of oxygen treatment or mechanical ventilation. Low birth weight, however, was closely associated with poor airway function independent of neonatal respiratory illness. Other factors of importance included the male gender and maternal smoking. The reduction in airway function observed in the low birthweight children was associated with cough but not wheeze. The disparity between the relatively well preserved vital capacity and reduced airway function suggests that very low birth weight, and hence prematurity, has its greatest effect on the subsequent growth of airway function. The absence of an association between neonatal oxygen score or mechanical ventilation and childhood lung function suggests that the long term effect of neonatal respiratory treatment is small compared with that of birth weight, maternal smoking, and male sex.
Arch Dis Child 1989 Sep
PMID:Lung function in children of low birth weight. 281 49

The rate of retrolental fibroplasia in relation to prenatal and neonatal characteristics was explored on the basis of a cohort of 3,025 neonates with birth weight less than 1,750 g. The overall rate of retrolental fibroplasia of any degree at hospital discharge was 11%, varying from 43% for those with birth weight between 500 and 749 g to 3% for those in the 1,500- to 1,750-g category. Among the potential determinants, the main interest was in nonhyperoxic characteristics, conditional on measures of prematurity and oxygen supplementation. Maternal diabetes and antihistamine use during the last 2 weeks of pregnancy were associated with significantly higher rates of retrolental fibroplasia, whereas toxemia was associated with lower rates. Frequent apneic spells, bronchopulmonary dysplasia, and sepsis in the neonate were also associated with significantly higher rates. On the other hand, the data indicate no independent role of low Apgar score, intraventricular hemorrhage, exchange transfusion, patent ductus arteriosus, or certain other characteristics previously postulated as risk factors.
Pediatrics 1985 Sep
PMID:Risk factors for retrolental fibroplasia: experience with 3,025 premature infants. National Collaborative Study on Patent Ductus Arteriosus in Premature Infants. 286 4

Systolic/diastolic ratios of umbilical velocimetry have been used to assess downstream placental vascular resistance. Reverse end-diastolic flow velocity during end diastole suggests extreme abnormality in waveform and resistance. We reviewed our experience of patients showing reverse end-diastolic flow velocity over a 2 1/2-year period. Out of 550 high-risk patients studied with umbilical velocimetry over this period, 12 patients showed the finding. All patients were delivered of small for gestational age fetuses and the perinatal mortality in this group was 50%. There was also significant perinatal morbidity as judged by cesarean section performed because of fetal distress, low Apgar scores, days in neonatal intensive care, prematurity, placental infarcts, and lethal anomalies. These findings suggest that reverse end-diastolic velocity on umbilical velocimetry is associated with catastrophic perinatal outcome, and aggressive perinatal management may be advised in this group of patients.
Am J Obstet Gynecol 1988 Sep
PMID:Reverse end-diastolic flow velocity on umbilical artery velocimetry in high-risk pregnancies: an ominous finding with adverse pregnancy outcome. 297 17

Long-term developmental outcome of the prematurely born is generally related to birth weight as a reflection of gestational age: The more immature the infant, the greater the risk of abnormal developmental outcome. Due to improvements in fetal and neonatal care over the past 25 years, developmental outcome of the preterm group has steadily improved, now approaching the expected outcome for term neonates for those born weighing over 1,000 g. For the group of very immature infants (birth weight less than 1,000 g) abnormal developmental outcome remains a significant risk. For any individual preterm infant, long-term developmental outcome is generally related to the severity and duration of initial illness and the postdischarge environment. Specific causation of developmental abnormality in a particular infant is usually speculative. The overall improvement in the long-term outcome for preterm infants has been gained at great cost in medical resources and is accompanied by emotional costs to families that remain unmeasured. The key to further reducing the risk of abnormal developmental outcome remains the prevention of prematurity. Until that can be accomplished, continued meticulous attention to all the details of superb fetal and neonatal intensive care must be exercised to minimize the risk of handicap in this vulnerable group of patients.
Clin Obstet Gynecol 1988 Sep
PMID:Follow-up of prematurely born infants. 297 76

Prevention of prematurity is the principal goal of all obstetric care. Although conquest of preterm births may yet be a distant goal that will require substantial improvements in understanding the pathophysiology of PTD, interim progress is possible. Increased attention to prematurity prevention as the focus of prenatal care can have an impact now, without introducing unproven or hazardous techniques or medication. Reproductive health care aimed at the prevention and elimination of social, demographic, and medical correlates of prematurity can yield results if obstetricians take the lead in educating both patients and society at large about the hazards of prematurity. Progress is more likely if a global strategy is used in all pregnancies as reported by Papiernik et al., Meis et al., and Herron et al. These studies have similar messages of hope and caution: All reported benefit in decreasing the frequency of preterm births, all required substantial and widespread patient and provider education, and all required a sustained effort before any effect was noted. Main et al. showed that these programs are not likely to produce a quick turnaround in PTD rates in all populations; progress will be slow. Reports of limited success or even failure should not result in abandonment of the goal, but rather in renewed and imaginative efforts toward it.
Clin Obstet Gynecol 1988 Sep
PMID:Prevention of preterm birth. 306 45

The ultrastructure of squirrel monkey (Saimiri sciureus) follicular oocytes inseminated in vitro was studied at the Endocrine Research Center of Michigan State University in the United States. Adult female squirrel monkeys were induced to ovulate with FSH-hCG, followed by laparoscopy 16 hours after hCG to collect ovarian follicular oocytes. A total of 45 oocytes were inseminated 21 hours after recovery by adding sperm collected by electroejaculation, followed by insemination culture for 24 hours. Inseminated oocytes were examined by light microscopy and transmission electron microscopy. Only three (6.7%) of inseminated oocytes were judged to be fertilized morphologically, but no sperm remnant was found in the cytoplasm of the oocytes. Fifteen (33.3%) had reached the second metaphase stage. As a whole, the maturation rate was 40%. Ultrastructurally, acrosome reacted sperm were observed in the cumulus cell layer, confirming the occurrence of sperm capacitation in the in vitro culture system. Cortical granules were seen throughout the cytoplasm of the germinal vesicle oocyte, especially in the vicinity of the Golgi complexes, suggesting the possibility that cortical granules originate from Golgi complexes. Metaphase chromosome, first polar body and cortical granules were observed at the second metaphase oocyte. Of three oocytes judged to be fertilized, one oocyte contained six pronucleus-like structures and another oocyte contained a pronucleus supposing fusion of two pronuclei (syngamy). But the ultrastructural morphology of a normal appearing fertilized oocyte could not be obtained. The possible cause of the low fertilization rate in the present study is supposed to be the poor follicular response and the prematurity of the cytoplasm due to repeated administrations of exogenous gonadotropins.
Nihon Sanka Fujinka Gakkai Zasshi 1988 Sep
PMID:[Ultrastructural observations of follicular oocytes inseminated in vitro in squirrel monkeys (Saimiri sciureus)]. 317 Dec 70

Ehlers Danlos syndrome type IV is an often lethal disease caused by various mutations of type III collagen genes. It presents in infancy and childhood in several ways, and the symptoms and signs include low birth weight, prematurity, congenital dislocation of the hips, easy inappropriate bruising (sometimes suspected as child battering), and a diagnostic facial phenotype. These features predict a lethal adult disease often complicated by fatal arterial rupture in early or middle adult life. Most affected patients can be diagnosed from radiolabelled collagen protein profiles by polyacrylamide gel electrophoresis. Prenatal diagnosis by specific type III collagen restriction fragment length polymorphisms is possible in some families, and will become increasingly important. Prenatal diagnosis and prevention of the disease in selected families is already possible and will be widely available in the future.
Arch Dis Child 1988 Sep
PMID:Clinical presentations of Ehlers Danlos syndrome type IV. 317 63

The immediate causes of preterm birth (preterm labor, PPROM, maternal complications, and fetal distress) are well-established. Similarly, the epidemiologic and medical risk factors discussed are well-known. Most risk factors, unfortunately, are not easy to modify. Furthermore, the connection between epidemiologic risks and preterm birth is often unclear. As this brief discussion of potential mediators linking risk status to preterm birth indicates, much more research is needed to define and assess potential mechanisms. It is unclear how important the five mediating factors chosen for presentation will prove to be or if other more significant mechanisms exist. However, as Eastman noted 40 years ago, "only when the factors causing prematurity are clearly understood, can any intelligent attempt at prevention be made."
Clin Obstet Gynecol 1988 Sep
PMID:The epidemiology of preterm birth. 322 57


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