Sudden infant death syndrome temperament before death.

A retrospective study was made of the behavioral patterns of 46 infants whose deaths were attributed to the sudden infant death syndrome. Controls were the victims' siblings. Data concerning the infants' behavioral pattern were collected retrospectively from the parents, utilizing a modification of the Carey temperament questionnaire. The parents' recollection of the victims indicated that they: (1) had less intense reactions to environmental stimuli, (2) were less active physically, (3) were more breathless and exhausted during feeding, and (4) had more abnormal cries. The behavioral characteristics had a positive correlation with various postmortem evidences of antecedent chronic hypoventilation and hypoxemia. It would be a serious error for any parent to be told that their infant was at risk based on the behavioral pattern reported retrospectively by parents of victims of SIDS, because the pattern is also a common one in other infants.     

Outcome for survivors of mechanical ventilation weighing less than 1,250 gm at birth

We investigated the outcome in 28 survivors of mechanical ventilation weighing less than 1,250 gm at birth. Fifteen infants (54%) had neurodevelopmental sequelae, of whom eight had major handicaps. These eight infants differed significantly from the rest of the infants studied in the following manner: lower mean birth weight and gestational age, delay in transportation to our Neonatal Intensive Care Unit, and high incidence of bacterial sepsis. The remaining seven infants with NDS were functionally normal or minimally impaired at the time of the study, although significant problems may yet emerge with continued follow-up. Retrolental fibroplasia was diagnosed in 11 infants (39%) and resolved in two. The development of RLF was associated with prolonged oxygen exposure and the presence of bacterial sepsis. However, since major handicap, RLF, and sepsis were all problems observed in the smallest infants, a cause-and-effect relationship between sepsis and these sequelae remains speculative.     

Pacemakers in young patients: 1977

Recent experience with implanted cardiac pacemakers in nine young patients is reported. Advance in technology include improved pacemaker generator design and placement, and improved lead design and placement. No patients died; our only complication, failure to capture, required repositioning of the lead. All pacemaker replacements were elective. This series helps to define the more favorable current prognosis for the young patient needing pacemaker therapy.     

Platelet dysfunction in the neonate with essential fatty acid deficiency.

Platelet aggregation in response to ADP was studied in five EFA-deficient sick premature newborn infants who were receiving fat-free parenteral nutrition. EFA deficiency was diagnosed by analysis of plasma lipid fatty acid values. The deficient infants had impaired platelet aggregation when compared to other low-birth-weight infants fed orally who served as control subjects (maximum 18.1% versus 43.4% at 2.5 muM ADP; 34.5% versus 52.2% at 5.0 muM ADP). In addition, the platelets from EFA-deficient infants demonstrated clearly evident disaggregation. On recovery from their deficient state, the low-birth-weight infants had platelet functions similar to those of apparently healthy premature infants. Clinical hemorrhage occurred in four of the EFA-deficient infants. Thus a deficiency of arachidonic acid, the precursor of thromboxane A2, is correlated with an impairment of the aggregation of platelets, a phenomenon mediated by thromboxane A2. This correlation provides the basis for a hypothesis that the observed EFA deficiency is causally related to the platelet dysfunction.     

Cord blood fatty acid composition in infants and in their mothers during the third trimester

Since essential fatty acids are required for normal brain development, we studied plasma lipids and EFA levels in 16 postpartum mothers (28 to 44 weeks) and in the umbilical vein and artery of 32 newborn infants. Groups of eight 24 to 33-, 34 to 37-, 38 to 42-, and 43 to 44-week-old infants were studied. Plasma fatty acid composition was studied in PL, CE, TG, and FFA by thin-layer and gas-liquid chromatography. Increased values for PL, CE, and TG (P less than 0.001) were noted in maternal plasma compared to cord plasma; linoleic acid was lower (P less than 0.001) in cord plasma PL, CE, and FA. EFA derivatives dihomo-gamma-linolenic, arachidonic, and docosahexaenoic acids were higher in cord plasma (P less than 0.001). Total polyenoic EFA increased with advanced gestation, and at term, was close to maternal levels. delta-5,8,11-eicosatrienoic acid (elevated in EFA deficiency) was elevated in cord plasma as compared with maternal values (P less than 0.001); other criteria of EFA deficiency were absent. These data indicate that fetal EFAs are elongated and desaturated during the third trimester. These higher polyenoic acids may incorporate into lipids in the developing CNS. The lower linoleic acid levels in the fetus may be important to the transplacental transport of EFA.     

Gonadotropin excretion during puberty in malnourished children

p6nadotropins were measured by radioimmunoassay of urine samples from 285 privileged Nairobi adolescents and from 238 rural peripubertal Kenyan boys and girls who had had moderate malnutrition during childhood. Gonadotropins were reduced at all ages in the rural adolescents, but pubertal stage-matched comparisons showed no differences between children of the two study areas in middle or late phases of sexual maturity. These results document the pattern of gonadotropin changes in an environment of reduced caloric intake and confirm the presumed hypothalamic-pituitary origin of the delayed adolescence that occurs under such circumstances.     

Umbilical cord length: clinical significance

Umbilical cord length in 35,779 neonates was analyzed to determine values after mid-gestation and to see if abnormal values have clinical significance. Growth slowed after twenty-eighth week of gestation but did not stop before term. Cord length had a positive correlation with maternal height, pregravid weight, pregnancy weight gain, socioeconomic status, and the fetus being male. Short cords were associated with subsequent psychomotor abnormalities, but taken alone their predictive value was low because the normal range of cord lengths is large. Short cords were much better predictors of subsequent impairments when they were combined with other neonatal predictors. Short cords doubled or tripled the predictive values of low Apgar scores and several other neonatal abnormalities for subsequent low IQ values and neurologic abnormalities.