Blood pressure patterns in the first three days of life

Current blood pressure data for healthy newborn infants consist primarily of single measurements of systolic and diastolic pressure in the first 48 hours of life. The purpose of this study was to determine if blood pressure levels are stable or are changing during the first few days of life. To determine blood pressure level and trend, indirect blood pressure was measured on day 1 through day 3 of life in all infants admitted to the well newborn nursery at Hahnemann University Hospital in Philadelphia. Systolic pressure correlated significantly with birthweight on day 1 of life (P less than .03). Repeated measures analysis of variance demonstrated a significant increase in both systolic and diastolic pressures over the first 72 hours of life (P less than .001). There was no difference in blood pressure among racial groups (black, Hispanic, white, Asian). In healthy newborns, there was no correlation of blood pressure with maternal conditions: toxemia, diabetes, substance abuse. These data demonstrate that blood pressure correlates with birthweight in well newborns. There is, however, a significant progressive increase in both systolic and diastolic blood pressure over the first 3 days of life, regardless of birthweight or maternal conditions.     

Migration of leucocytes into the uterus after acute removal of ovarian progesterone during early pregnancy in the sheep

The effects of acute deprivation of progesterone during early pregnancy on the occurrence of maternal leucocytes in uterine tissues was studied in sheep. Ovariectomy on day 21 of pregnancy resulted in a rapid influx of polymorphonuclear (PM) leucocytes into both caruncular and intercaruncular (glandular) endometrium but not into the myometrium. The infiltration had commenced by 24 hours after ovariectomy when the fetal membranes appeared histologically normal. By 72 hours after ovariectomy infiltration of PM leucocytes and degradation of the fetal syncytium were severe and extensive. The effect was specifically due to progesterone deprivation in pregnant animals since it was not seen in progesterone-treated ovariectomized pregnant animals or in non-pregnant animals ovariectomized in the mid luteal phase of the oestrous cycle. The PM leucocyte influx was not associated with changes in the number of intra-epithelial lymphocytes, the occurrence of which was only slightly reduced at the time of attachment. The results implicate maternal progesterone as a local anti-inflammatory agent within the gravid uterus and also show that total expulsion of lymphocytes from uterine epithelia at implantation is not a mechanism for immunoprotection of the sheep fetal allograft.     

Cytokine concentrations during the first days of life

OBJECTIVE: To evaluate the cytokine concentration patterns during the first 5 days of life by measuring serum concentrations of type-1 cytokines, like interleukin-2 (IL-2) and interferon-gamma (IFN-gamma) and type-2 cytokines, like IL-4, as well as the receptors of IL-2 (sIL-2R) and IL-4 (sIL-4R) during the early neonatal period. SUBJECTS AND METHODS: Forty-two healthy term neonates were included in the study. Cytokine concentrations were measured in umbilical cord, in the 1st and 5th day after birth and compared with those in serum of 30 healthy adults. RESULTS: IL-2 concentrations presented a decrease trend from umbilical cord to 5th day, while sIL-2R showed a significant elevation from umbilical cord to 5th day after birth. IL-4 concentrations did not differ significantly among umbilical cord, the 1st and the 5th day, while the sIL-4R showed the highest values in the 1st day after birth. Both IL-4 and sIL-4R concentrations in neonatal samples were elevated compared to adults. IFN-gamma concentrations increased significantly from umbilical cord to 5th day of life. CONCLUSION: Our findings indicate a dysregulation among IL-2, IL-4 and IFN-gamma concentrations during the 1st day after birth, favoring a more precocious expression of IL-2 and IL-4 against IFN-gamma that seems to be ameliorated in the end of the 1st week of life.     

Maternal smoking and the bilirubin concentration in the first three days of life

The effect of maternal smoking on the plasma bilirubin concentration in the first three postnatal days was investigated in 137 mature newborns. Forty-three percent of the mothers reported on smoking during pregnancy. The median increase in plasma bilirubin concentration during the first 24 h of postnatal life was significantly higher in the group of neonates born to smokers compared to the group of neonates born to non-smokers (P less than 0.02). By contrast, the median increase in plasma bilirubin concentration from the 1st to the 3rd postnatal day was significantly lower among the neonates born to smokers compared to the group with non-smoking mothers (P less than 0.04). The overall frequency of clinical jaundice and the frequency of neonates with plasma bilirubin concentration above 175 microM on the 3rd postnatal day was almost identical in the two groups. It is suggested that maternal smoking may affect the postnatal plasma bilirubin concentration in the offspring by various mechanisms.     

Bioavailability of nasally administered progesterone

8 healthy women volunteers between the ages of 22-38 participated in a study designed to explore the relationship between endogenous estradiol (E2) levels and progesterone (P) absorption. Physical and pelvic examinations and laboratory screening tests revealed no abnormalities. All women had regular menstrual cycles, at 24-32-day intervals, and all were free of a significant menstrual cycle symptoms. 2 studies were performed at least 72 hours apart in the follicular phase of the menstrual cycle. The following medications were administered in random order: nasal P (Pronasone), 20 mg and nasal P (Pronasone), 30 mg. Serum P levels were drawn at the following times: 0, 3, 6, 10, 20, 30, 60, 120, 180, 240, 360, and 480 minutes. Serum for E2 assay was taken from the 0 time sample. The women were examined with a nasal speculum after each nasal absorption study. Serum was separated and frozen for subsequent assay. The data were analyzed using the CLINFO system from the National Institutes of Health. All of the women complained of a mildly unpleasant taste within several minutes following Pronasone administration. No evidence of nasal irritation was observed in any woman. The similar absorption curves obtained with Pronasone 20 mg and 30 mg doses and the aberrantly high values and delayed peaks ob tained in 2 subjects with the 30 mg dose imply that further work on dosage range, ointment formulation, and the method of application may be necessary before dependable clinical utility can be demonstrated. The peak levels of P that were reached compare favorably with results using similar doses (25 mg) in cocoa butter rectal or vaginal suppositories but are somewhat lower than those seen with polyethylene glycol base suppositories. The apparent inverse relationship between serum E2 levels and P levels obtained with Pronasone in the 20-mg dose was not expected. Alterations of nasal vascularity, interstitial hydration, and mucous blanket production all might influence absorption. The study demonstrates that the intranasal route is a potentially useful approach for the administration of unmodified sex steroid medications and is likely to be clinically safe and acceptable to patients.     

Immunosuppressive effect of serum progesterone during pregnancy depends on the progesterone binding capacity of the lymphocytes

Cytotoxic activity and progesterone binding capacity of the lymphocytes, together with serum progesterone concentrations, were determined in women with normal pregnancy or with a clinical diagnosis of threatened abortion or threatened premature labour. The lymphocytes of women with threatened abortion or threatened premature labour showed significantly higher cytotoxic activity (P < 0.001) and significantly lower progesterone binding capacity (P < 0.001) than did lymphocytes obtained from the healthy pregnant women. Significant inverse correlation was found between progesterone binding capacity and cytotoxic activity of the lymphocytes (P < 0.001), but the progesterone concentration of the pregnancy serum appeared to have no influence on the other two parameters. The findings indicate that intact progesterone binding capacity of the lymphocytes is an essential factor for the manifestation of the blocking effect exerted by pregnancy serum on lymphocyte cytotoxicity in vitro.     

Idarubicin administered during pregnancy: its effects on the fetus

Acute myeloblastic leukemia, subtype M1, was diagnosed in a 39-year-old G2P1 Japanese woman at 21 weeks' gestation. Remission-induction polychemotherapy, including daunorubicin, performed for one cycle, did not lead to remission. Second-line chemotherapy, including idarubicin, performed for one cycle, was administrated during the early third trimester of pregnancy. Septic shock occurred due to severe myelosuppression. An emergent cesarean section was performed in response to a nonreassuring pattern of the fetal heart rate and a rapid decrease in fetal amniotic fluid. The neonate delivered at 32 weeks' gestation showed no signs of cardiac failure but did show signs of transient myelosuppression, hepatopathy, and elevated creatine kinase. Complete remission was established with idarubicin including chemotherapy.     

Aortic and pulmonary blood velocities during the first 3 days of life

Newborn infants undergo major cardiovascular changes to accomplish the transition from fetal to newborn circulation. These include a drop in pulmonary vascular resistance and closure of the ductus arteriosus. We measured blood velocities by pulsed-Doppler ultrasound in the great vessels of normal newborns during this transition period. Our goals were to understand the timing of these changes and to assess cardiac function as measured by flow velocities. We concluded that shunting of blood through the ductus arteriosus continues for 1-2 days after birth without apparent hemodynamic consequences, cardiac function, as assessed by the Doppler technique, remains remarkably stable during this time period, the timing of ductal closure is not affected by the mode of delivery, and Doppler ultrasound is a portable, reproducible method which is useful in assessing the cardiovascular system of the neonate.     

A role for estrogen in progesterone production during baboon pregnancy

The present study determined whether estrogen is important in the production of progesterone (P) during primate pregnancy. Serum P production rates (metabolic clearance rate [MCR] x peripheral serum concentration) were determined in baboons prior to and following maternal administration of the antiestrogen ethamoxytriphetol (MER-25) at 30, 15, 6, or 3 mg/kg of body weight by mouth daily for 10 or 20 day periods during or throughout the last one third of gestation. Maternal peripheral serum P concentrations decreased (p less than 0.05 to P less than 0.001, t test) 37 to 60% in 7 of 9 baboons following daily administration of MER-25. Since mean MCR-P prior to (1,567 1/day) and following (1,361 1/day) MER-25 were similar, the decline in serum P concentration reflected decreased P production. Serum P concentrations in five untreated baboons during the last one third of gestation fluctuated in level, but no significant sequential rise or fall occurred. The decrease in P production in baboons following antiestrogen administration suggests that the action of estrogen is required for sustaining the elevated P production typical of baboon pregnancy.     

Myomectomy during the first and second trimester of pregnancy

Myomectomy was performed on five symptomatic women in the first and second trimester of pregnancy who were resistant to medical therapy. All the patients ended theirs pregnancies without complications. Three patients of five (60%) underwent spontaneous delivery while the other two patients (40%) had cesarean section. Myomectomy during pregnancy, when necessary, is proving highly effective today.     

妊娠20周前甲状腺功能参考范围和甲状腺功能异常患病率

目的 分析健康初产妇妊娠20周前甲状腺功能的变化,建立妊娠20周前孕周特异的甲状腺功能参考范围,探讨妊娠期甲状腺功能异常的患病情况. 方法 对2010年9月至2011年6月期间在首都医科大学附属北京友谊医院产科门诊行产前检查的1605例单胎健康初产妇和200例同期行妊娠前检查的健康非妊娠妇女进行研究,其中1243例排除甲状腺疾病高危因素的初产妇作为制定正常参考范围的“标准人群”.采用化学发光免疫法检测促甲状腺激素(thyroid stimulating hormone,TSH)、游离甲状腺素(free thyroxine,FT4)及甲状腺过氧化物酶抗体(thyroid peroxidase antibody,TPOAb).分析妊娠20周前甲状腺功能的变化特点,建立妊娠期特异的TSH和FT4参考范围,探讨妊娠期甲状腺功能异常的患病情况. 结果 (1)TSH中位数值于妊娠8周最低(0.91 mU/L),较非妊娠期下降29.56％,妊娠12周后逐渐升高;FT4中位数值在妊娠9周最高,为11.33 pmol/L,较非妊娠妇女升高7.79％,妊娠12周后逐渐下降.(2)非妊娠期、妊娠8～12周、13～16周、17～19+6周TSH[中位数(第2.5,第97.5百分位)]分别为1.59 (0.15,5.91)、1.12(0.03,3.67)、1.21(0.05,3.74)、1.50(0.31,4.33) mU/L;FT4[中位数(第2.5,第97.5百分位)]分别为9.91(6.69,14.03)、10.68(7.98,18.66)、10.04(6.18,16.22)、9.40(6.44,13.51) pmol/L.(3)妊娠20周前1605例妊娠妇女甲状腺功能异常(包括甲状腺功能亢进、临床甲状腺功能减低、亚临床甲状腺功能减低和低T4血症)的总患病率为3.55％ (57/1605),其中妊娠8～12+6、13～16+6、17～19+6周甲状腺功能亢进的患病率分别为0.00％(0/611)、0.13％(1/761)、0.00％(0/233);临床甲状腺功能减低的患病率分别为0.00％(0/611)、0.13％(1/761)、0.00％(0/233);亚临床甲状腺功能减低的患病率分别为3.60％(22/611)、2.76％ (21/761)、3.00％ (7/233);低T4血症的患病率分别为0.16％ (1/611)、0.26％(2/761)、0.86％(2/233).TPOAb总阳性率为18.82％ (302/1605),其中妊娠8～12+6、13～16+、17～20周TPOAb的阳性率分别为22.91％ (140/611)、16.56％ (126/761)、15.45％ (36/233),TPOAb中位数值分别为38.90、41.87、39.10 mU/L. 结论 妊娠20周前孕妇甲状腺功能发生特定变化,妊娠8～12+6周TSH水平下降,后逐渐升高;而FT4水平在妊娠8～12+6周升高,后逐渐下降.妊娠期无甲状腺疾病史的妇女中,甲状腺功能异常并不少见.以孕周特异的甲状腺功能参考范围为标准,妊娠20周前甲状腺功能异常中以亚临床甲状腺功能减低最常见,建议妊娠早期筛查甲状腺功能.     

Cardiotoxic transplacental effect of idarubicin administered during the second trimester of pregnancy

Polychemotherapy including idarubicin was administered during the second trimester to treat acute lymphoblastic leukemia. The infant delivered at 28 weeks' gestation had acute cardiac failure attributed to the cardiotoxic effect of idarubicin. Cardiotoxicity may be caused by idarubicin's biophysical properties that facilitate its transplacental passage. Idarubicin should be used with extreme caution during pregnancy.