Effects of maternal labetalol on the newborn infant.

Forty eight neonates, born to mothers suffering from pregnancy induced hypertension and receiving labetalol for control of blood pressure, were studied for the possible adverse effects of the drug. These were compared with eighty one neonates matched for gestation and weight and born to mothers with pregnancy induced hypertension treated with drugs other than labetalol. Incidence of birth asphyxia and intrauterine growth retardation (IUGR) in the study population was 10.4 and 22.9%, respectively and in the control group 5 and 19.7%, the difference between two groups was not statistically significant (p > 0.05). However, the incidence of hypoglycemia was significantly higher (p < 0.01) in the study group (47.9%) as compared to the control group (17.2%). Two-thirds of the hypoglycemic babies in the study population were asymptomatic and they were managed with sugar-fortified milk feeds. In the study population, the symptomatic hypoglycemic babies had hypoglycemia for prolonged duration of 43.3 +/- 23.3 hours as compared to 11.5 +/- 6.3 hours in symptomatic hypoglycemic babies of the control group (p < 0.01). The mothers of the symptomatic babies in the study group received higher doses of labetalol in the range of 287.6 +/- 142.3 mg/day while rest of the mothers in the same group whose babies had either asymptomatic hypoglycemia or normal blood glucose levels, received 239.5 +/- 118.5 mg/day, though the difference was not statistically significant. It is concluded that maternal labetalol therapy is associated with increased risk of neonatal hypoglycemia.     

A radiologic update on medical diseases of the newborn chest

This paper reviews the common spectrum of medical diseases of the neonatal chest. Emphasis is on radiographic changes that have been produced by the introduction of new therapeutic maneuvers, particularly the use of artificial surfactant in treating hyaline membrane disease and the survival of profoundly premature newborns (less than 650 g). A discussion of meconium aspiration syndrome, neonatal pneumonia, transient tachypnea of the newborn, congenital lymphangiectasia, and congenital heart disease is also included. The effects on the neonatal chest radiograph of extracorporeal membrane oxygenation and high-frequency ventilation are also mentioned.     

新生儿期先天性心脏病的诊断和内科治疗

新生儿期先天性心脏病 (先心病 )复杂畸形较年长儿多见 ,临床表现常不典型 ,急诊发生率高 ,病死率高 ,故早期诊断、早期治疗十分重要。1　新生儿先心病的诊断1.1　主要临床表现　依发生频率排在前几位的主要是心脏杂音、青紫、呼吸急促和心力衰竭 ,其次还有苍白、肢软、声音嘶哑、吃奶呛咳以及合并心外畸形等。1.1.1　心脏杂音　新生儿期先心病杂音多有不典型、不稳定的特点 ,有杂音不一定有先心病 ,无杂音亦不一定无先心病。生后头几天即有单纯收缩期杂音常提示肺动脉狭窄或主动脉狭窄 ;室间隔缺损开始可听不到杂音或杂音很轻微 ,以后才日…     

Effects of newborn screening of cystic fibrosis on reported maternal behaviour.

Screening for cystic fibrosis is highly controversial. Concerns have been expressed that newborn screening may cause mothers, who had considered their child to be healthy before diagnosis, to overprotect their child. Some critics of screening also suggest that a period of delay from onset of symptoms to diagnosis may help a mother adjust to the reality of the child''s lethal condition. This study compared the strength of overprotective child rearing attitudes of 29 mothers whose children were screened (13 had symptomatic children and 16 asymptomatic children) with the attitudes of 29 mothers whose children were diagnosed after the onset of symptoms. Results indicate that newborn screening had not increased a mother''s tendency to overprotect her child with cystic fibrosis and in some cases the tendency had decreased. Further, delay in diagnosis when screening was not conducted usually caused mothers considerable personal distress.     

Effects of naloxone on the breathing pattern of a newborn exposed to maternal opiates

Aim: To give new insights into how an infant responded to naloxone, given after acquiring a maternal opiate by recording the breathing pattern directly after birth. Method: A respiratory recording is presented of an infant during resuscitation in the delivery room after receiving naloxone for respiratory depression, resulting from maternal remifentanyl use. Results: The infant was born apneic and bradycardic. Normal resuscitation manoeuvres had no effect on the respiratory drive. Directly after administration of naloxone, a tachypneic breathing pattern with sporadic expiratory breaking manoeuvres was observed. Conclusion: The immediate tachypnoea is most likely a direct effect of the naloxone causing an immediate ‘rebound response’ after the release of the opiate‐induced inhibition of the respiratory drive.     

The influence of maternal smoking on maternal and newborn oxidant and antioxidant status

Background  Maternal smoking has been suggested as a source of oxidant stress in pregnant women and in newborns exposed in utero. The aim of this study was to determine the influence of maternal smoking on oxidant status and antioxidant vitamins of mother–infant pairs. Materials and methods  Socioeconomic and diet characteristics were recorded from 20 smoker and 20 non-smoker pregnant women of 36 weeks’ gestation. On the day of delivery, venous blood samples of the women and cord bloods were taken. On postpartum day 7, milk and infant urine samples were collected. Plasma and milk β-carotene, retinol, α-tocopherol and cotinine levels, plasma malondialdehyde levels, and urine cotinine levels were measured. Results  Milk α-tocopherol levels of smoking mothers were lower than those of non-smoking mothers. In smokers, there were no correlations between maternal vitamin A intakes and milk levels of retinol, and between maternal plasma levels and milk levels of β-carotene. Conclusions  Maternal smoking may lead to decreased milk levels of vitamin E, as a result of making use of this antioxidant in order to limit lipid peroxidation, as well as may lead to a possible limitation on the transfer of lipophilic antioxidants including vitamin A from blood plasma to milk. Further investigations conducted in large populations will be needed to assess the effects of maternal smoking on the oxidant and antioxidant status of breast milk.     

Benefits of maternal participation in newborn nurseries

Objective : To evaluate the outcome of active involvement of mothers/mother substitutes in day-to-day care of high risk neonates admitted in a level II newborn care unit.Methods : An observational study was carried out over a period of eleven years incorporating active participation of mothers/substitute in the day to day care of their sick neonates. The outcome is assessed in terms of mortality due to the three major illnesses (asphyxia, sepsis and prematurity) during this phase. The data is compared with that of a similar level II care centre where conventional neonatal care is practised.Results : There is a significant and sustainable reduction in neonatal mortality due to the three major illnesses when the mothers are also involved in the neonatal care, in spite of a considerable increase in the number of admissions during this period.Conclusion : The concept of active participation of mother/substitute in neonatal nursery ensures 1:1 care at all times. It is a cheap and effective alternative to inadequacy of bed:nurse ratio (BNR).