Bone in the pregnant mother and newborn at birth

BACKGROUND: Changes in maternal bone during pregnancy may affect fetal bone mineralization. ISSUES: The biphasic changes in maternal bone histology (temporary loss of cancellous bone in early pregnancy restored by term gestation) are consistent with corresponding blood biochemistry changes; increased bone resorption markers in the first trimester, while bone formation markers increased in the last trimester. Postpartum bone mineral density (BMD) by DEXA is increased at cortical bone and decreased at trabecular bone sites compared with prepregnancy values. The mean reduction of spine BMD is 3.5% from prepregnancy to immediate postpartum. Neonatal bone mineral content (BMC) is different by season of birth, low weight relative to gestation, and having a diabetic mother. Lower total body BMC and high bone resorption marker in winter vs. summer-born newborns was related to low vitamin D, indicating alterations of fetal bone metabolism by maternal D deficiency. Lower BMC and decreased bone formation marker in infants born small for gestational age than those born appropriate for gestation may relate to reduced transplacental mineral transfer. Low BMC in infants of diabetic mother was correlated inversely with poor control of maternal diabetes during early pregnancy. CONCLUSIONS: During pregnancy, maternal bone mineral metabolism are changed, and influences on fetal bone mineralization occur in utero.     

Intracerebral hemorrhage due to hemorrhagic disease of the newborn and failure to administer vitamin K at birth

In infants, intracerebral hemorrhage (ICH) is most likely the result of trauma or disturbances of coagulation function. Routine and standard care of the newborn includes the administration of vitamin K to prevent hemorrhagic disease of the newborn. We present two infants, the products of home deliveries, who did not receive vitamin K at birth. Both infants developed ICH at 5 weeks of age and presented with signs and symptoms of increased IC pressure. In both cases, recombinant factor VIIa was administered to correct coagulation function and allow immediate surgical intervention which included craniotomy and hematoma evacuation in one patient and placement of a ventriculostomy in the other to treat increased IC pressure. Despite this therapy, both infants were left with severe neurologic sequelae. These two cases illustrate that hemorrhagic disease of the newborn can occur when prophylactic vitamin K is not administered and that it can have devastating consequences. Given these issues, the routine administration of vitamin K to all infants is mandatory and should not be considered optional.     

POC tests cut screening time down to 20 minutes

Point-of-care testing can significantly reduce your door-to-diagnosis times. Choose device(s) that mirror your most common diagnoses. Training techs as well as RNs helps meet needs of the patient. Be prepared to justify cost by demonstrating improved turnaround.     

早期母婴皮肤接触对新生儿行为状态的影响

目的探讨早期母婴皮肤接触对新生儿行为状态的影响及其安全性与可行性。方法在北京市某三级甲等医院选取足月新生儿50例,按照随机数字表余数分组法分为干预组和对照组各25例。干预组新生儿进行常规产科护理后与母亲进行1h的母婴早期皮肤接触,对照组只进行常规产科护理。观察干预组新生儿在母婴皮肤接触期间和出生后第5-6h期间的行为状态,并实录其发出的有声音的啼哭。干预结束后采用访谈法了解干预组母亲对早期母婴皮肤接触的感受和评价,对照组也在相应的时间段进行观察和录音。结果干预组新生儿在出生后1h内和第5-6h期间的啼哭次数少于对照组,啼哭持续时间也明显短于对照组,差异均有统计学意义(P0.01);在两个时间段两组新生儿行为状态的差别具有统计学意义(P0.01)。另外,访谈结果显示,干预组新生儿及其母亲可以接受1h的早期母婴皮肤接触。结论早期母婴皮肤接触可以减少新生儿出生后1h内和第5-6h期间的啼哭次数和啼哭持续时间,增加新生儿睡眠时间。     

Classification of major newborn birth injuries

A classification system of various forms of major newborn birth injuries is clearly lacking in the literature. Currently, no scales exist for distinguishing degrees, extent, or distinctions of major birth injuries. The purpose of this study was to use published and online literature to explore the timing, prediction, and outcomes of major newborn birth injuries. Potential antecedents and causes were used in depicting what were reported to be major birth injuries. The outcome of this literature search was the development of a classification table synthesizing the most frequently reported (n = 20) major newborn birth injuries. This classification was developed according to (1) types of tissue involved in the primary injury, (2) how and when the injury occurred, and (3) the relationship of the injury to birth outcomes. A classification scheme is critically needed as the first step to achieving preventive interventions and plans for long-term recovery from birth injuries. Because major birth trauma contributes to increased neonatal morbidity and mortality, its occurrence requires careful study and preventive efforts to better promote newborn health.     

Validated ultrasonic power measurements up to 20 W

A project has been completed to develop reference methods for the measurement of ultrasonic power with a validated measurement uncertainty of < 7% at power levels of 1 to 20 W over the frequency range 1 to 3 MHz of collimated beams. The project is the result of collaborative research between the Physikalisch-Technische Bundesanstalt, Germany (PTB, DE), the National Physical Laboratory, UK (NPL, UK) and the Netherlands Organisation for Applied Scientific Research, Prevention and Health (TNO-PG, NL). The work has been undertaken under the 4th Framework Programme of the European Community (EC). Primary standard designs of radiation force balances based on both absorbing and reflecting targets have been constructed. To avoid heating effects, the measurements should be done relatively quickly (10 to 20 s). The methods have been validated using ultrasound (US) transducers that demonstrated an adequate short and long-term stability; a method to detect cavitation based on monitoring the acoustic signals produced by bubble oscillation and collapse has been confirmed. It has been shown that only the detection of the subharmonic can be used in practice as cavitation detector. Different procedures for obtaining degassed water have been investigated. A method showing significant promise to be used in a clinical or manufacturer's environment involves the addition of sodium sulphite (Na2SO3). During the validation process, commercially available radiation force balances and ultrasonic physiotherapy devices have also been evaluated. Limitations of current measurement methods and practices, including power measurements made on transducers exhibiting a diverging beam, have been identified. It has been shown that a reflecting target is not appropriate to measure powers of transducers with a ka-value < 30. Based on beam shape and target distance, it has been shown also that proper power measurements using a 45 degrees convex-conical reflecting target can never be performed for transducers with a ka-value < 17.4.     

Interventions promoting exclusive breastfeeding up to six months after birth: A systematic review and meta-analysis of randomized controlled trials

BackgroundThe World Health Organization (WHO) recommends that mothers practice exclusive breastfeeding (EBF) of their infants for 6 months. Various breastfeeding support interventions have been developed to encourage mothers to maintain breastfeeding practices. Research aim: This study aims to review how effectively breastfeeding support interventions enable mothers to practice EBF for 6 months and to suggest the best intervention strategies.MethodsSix databases were searched, including MEDLINE, EMBASE, Cochrane, CINAHL, PsycINFO, and KoreaMed. The authors independently extracted data from journals written in English or Korean and published between January 2000 and August 2017. Randomized controlled trials (RCTs) reporting EBF until 6 months were screened.ResultsA total of 27 RCTs were reviewed, and 36,051 mothers were included. The effectiveness of breastfeeding support interventions to promote EBF for 6 months was significant (odds ratio [OR] = 2.77; 95% confidence interval [CI]: 1.81–3.76). A further subgroup analysis of intervention effects shows that a baby friendly hospital initiative (BFHI) intervention (OR = 5.21; 95% CI: 2.15–12.61), a combined intervention (OR = 3.56; 95% CI: 1.74–7.26), a professional provider led intervention (OR = 2.76; 95% CI: 1.76–4.33), having a protocol available for the provider training program (OR = 2.87; 95% CI: 1.89–4.37) and implementation during both the prenatal and postnatal periods (OR = 3.32; 95% CI: 1.83–6.03) increased the rate of EBF for 6 months.ConclusionWe suggest considering a multicomponent intervention as the primary strategy and implementing BFHI interventions within hospitals. Evidence indicates that intervention effectiveness increases when a protocol is available for provider training, when interventions are conducted from the pre- to postnatal period, when the hospital and community are connected, and when healthcare professionals are involved.     

针对性体重管理干预对新生儿出生体重及分娩结局的影响

目的:探讨针对性体重管理干预对新生儿出生体重及分娩结局的影响。方法:选取2013年1月~2014年1月124例孕妇作为观察组,选取2012年12月~2013年12月128例孕妇作为对照组,对照组给予常规的定期产前检查、围产期保健及相关健康教育,观察组实施针对性体重管理干预,比较两组干预效果。结果:两组孕妇体重增长情况比较差异有统计学意义(P0.05,P0.01);两组体重及巨大儿、低体重儿发生率比较差异有统计学意义(P0.05);观察组正常分娩率高于对照组(P0.05),产后抑郁发生率低于对照组(P0.05)。结论:针对性体重管理干预可有效控制孕妇及新生儿体重,减少并发症。     

Changes in mortality of low birth weight infants after the introduction of newborn intensive care (author's transl)

The Newborn Intensive Care Centre at the Landeskinderkrankenhaus Linz is the referral centre serving an area in which 20% of births in Austria occur. During a 4-year period ending 1976, after the facilities for intensive care had been introduced, the overall mortality of low birth weight infants (LBWI) was reduced by 44% (from 26% to 14%), whilst the mortality of LBWI born at the Landes-Frauenklinik Linz, which works in close collaboration with the Landeskinderkrankenhaus, went down by 60% (from 24% to 9%). The chances of survival decreased with increasing transportation distance and suboptimum standards of obstetrical care, in spite of intensive treatment after referral. It is suggested that the improved methods of perinatal care applied at the obstetrical and neonatal units are the cause of this remarkable improvement in survival rate of LBWI. These improvements in neonatal survival rate contributed considerably to the 40% decline in infant mortality in Upper Austria from 26.7% in 1973 to 16.2% in 1976..     

Painful Ophthalmoplegia of the Right Eye in a 20-Year-Old Man

Background

Painful ophthalmoplegia is an infrequent but very important presentation in the acute care setting and requires a thorough neurologic evaluation to determine its cause. This clinical sign has a large differential and generally indicates a serious cerebrovascular process.

Case Report

We describe a patient with a subacute presentation of painful ophthalmoplegia, ultimately diagnosed as Tolosa-Hunt syndrome, a rare inflammatory process of the cavernous sinus.

Conclusion

This case highlights the importance for the Emergency Physician to quickly recognize painful ophthalmoplegia and rapidly elucidate the cause to prevent further complications for the patient.