Growth and catch-up growth of Australian infants of low birthweight

Abstract The growth of 90 infants of low birthweight (1500–2499 g) has been studied longitudinally from birth to 2 years of age. Seventy-five per cent of those infants were of birthweight that was appropriate-for-gestational age (AGA) and of mean gestational age 33.6 weeks (boys) and 34.5 weeks (girls). Twenty-four per cent were small-for-gestational age (SGA) and of mean gestational age 39.4 weeks (boys) and 38.5 weeks (girls). The data showed that, when gestational age was considered, the growth of AGA infants was similar to that of full-term infants of normal birthweight; SGA infants displayed accelerated growth ('catch-up'), particularly in the first months of life with upward percentile crossing from below the 5th toward the 50th. These results provide further evidence of the need to consider gestational age and whether AGA or SGA when assessing the growth of low birthweight infants.     

Obstetric acute renal failure 1956–1987

Summary. A total of 142 women with severe acute renal failure (ARF) resulting from obstetric causes was treated by dialysis at a single centre from 1956 to 1987. One-year survival was 78·6%, which compares favourably with other causes of ARF. Abortion, haemorrhage and preeclampsia comprised 95% of cases, with survival being best (82·9%) with abortion. Survival was adversely affected by increasing age. Acute cortical necrosis (12·7% of patients) carried 100% mortality after 6 years. Follow-up of survivors showed normal renal function up to 31 years following ARF; 25-year patient survival was 71·6%. Improvements in obstetric care and the disappearance of illegal abortions have resulted in a dramatic decline in the incidence of obstetric ARF.     

Interruption of first trimester human pregnancy following Epostane therapy. Effect of prostaglandin E2 pessaries

Summary. The effect of Epostane, a competitive inhibitor of the 3β hydroxy steroid dehydrogenase enzyme system in combination with prostaglandin E₂ (PGE₂) for induction of abortion in early first trimester pregnancy has been studied in a group of 20 women awaiting termination of pregnancy. The women were consecutively assigned to four treatment groups. The first group was treated with PGE₂ alone, administered vaginally as a lipid based (Witepsol) pessary. The remaining three groups received Epostane at differing doses for 5 days, and were treated with PGE₂ on the fourth day. Significant falls in serum progesterone and oestradiol occurred in the Epostane-treated patients. Abortion was induced in one of the five control patients and in three of 10 patients treated with low doses (300–400 mg) of Epostane. Intra-utrine pressure monitoring showed an increased reactivity to PGE₂ in the treated groups. At the highest dose (600 mig) of Epostane, serum progesterone and oestradiol showed the greatest decline to 8% and 21% of the pretreatment values, a prompt and sustained pressure response occurred to PGE₂ and abortion was induced in all five patients. A critical degree of progesterone suppression appears to sensitize the myometrium to exogenous prostaglandin. This combined treatment is an effective method of early pregnancy termination and may have a role in the management of mid-trimester abortion.     

Developments in chemotherapy for medium- and high-risk patients with gestational trophoblastic tumours (1979–1984)

Summary. Identification of various prognostic factors at the start of chemotherapy allows patients with gestational trophoblastic tumours to be categorized into low-, medium- and high-risk groups so that they can be given the minimum treatment necessary to eliminate their disease. Most patients in the low-risk category can be treated with minimal toxicity using a methotrexate/folinic acid regimen and these patients are not considered in this report. Before 1979 patients in the medium-risk category were treated with a sequence of drugs which included, hydroxyurea, methotrexate, 6-mercaptopurine, actinomycin D, vincristine and cyclophosphamide. Since 1979 etoposide has been substituted for vincristine and cyclophosphamide. The 76 patients treated between 1979 and 1983 are all alive and in remission 1·1.85. Three patients (4%) relapsed and required retreatment and all are in remission. Fifty-six patients in the high-risk group, most at risk of developing drug resistance, were treated with a regimen incorporating etoposide with methotrexate, actinomycin D (EMA) and vincristine and cyclophosphamide (CO). EMA and CO were given on alternate weeks, resulting in an overall survival rate of 84%. Patients who had received prior chemotherapy had a survival rate of 74% and a relapse rate of 19% compared with 93% survival and 3% relapse rate in those who had not received prior chemotherapy. Toxicity with the EMA/CO regimen was significantly less than with an earlier regimen (CHAMOCA) used in the high-risk group.     

Maternal determinants of birthweight in normal pregnancy

Partial and multiple regression analysis was performed to find out the correlation between birthweight and maternal anthropometric variables. Pearson regression analysis revealed significant dependence of birthweight on gestation of pregnancy, maternal weight, symphysis-sternal distance and height, but not on armspan and skin thickness. However, the only maternal variable bearing significant influence on birthweight in partial regression analysis was bodyweight. The effects of maternal determinants on birthweight, though some of them were statistically significant, were clinically unimportant.     

Psychosexual trauma of an abnormal cervical smear

Summary. The psychosexual sequelae of diagnosis and treatment of pre-invasive cervical atypia were assessed in three groups of women. The first group included 30 women referred to a colposcopy clinic with an abnormal cervical smear indicating cervical intraepithelial neoplasia (CIN), the second comprised 50 women who were traced as sexual partners of men with penile human papillomavirus (HPV) infection; 26 of them had histologically proven cervical atypia and 24 had no such evidence. The third group included 25 women traced as partners of men with non-specific urethritis and who did not have cervical disease. Before and after questionnaires assessed six aspects of sexual behaviour and responses before diagnosis and 6 months after treatment in women with cervical atypia. These were compared with answers given by women investigated and treated, if necessary, as partners of men with sexually transmitted disease (control group). There were statistically significant adverse psychosexual sequelae associated with diagnosis and treatment of pre-invasive cervical epithelial disease.     

A comparison of the effects of maternally administered meptazinol and pethidine on neonatal acid-base status

Summary. A randomized double-blind study compared the effects of equi-analgesic doses of maternally administered meptazinol (1.5 mg/kg) and pethidine (1.5 mg/kg) on neonatal acid-base status. Heel-prick samples were taken for assessment of acid-base status at 10 and 60 min after delivery. Maternal antenatal history, details of labour and neonatal status at delivery were also recorded. Meptazinol produced less neonatal respiratory depression than pethidine: the mean 10 min acid-base data from 16 infants whose mothers received pethidine were indicative of a respiratory acidosis (pH 7.13, SD 0.08, P co₂,9.11, SD 2.2 kPa; standard bicarbonate 22.3, SD 3.1 mmol/1). This was not evident in the mean acid-base data from 16 infants whose mothers received meptazinol (pH 7.23, SD 0.07; P co₂ 6.83, SD 1.6 kPa; standard bicarbonate 20.9, SD 4.2 mmol/1). The mean pH and P co₂ in the two treatment groups were significantly different (P<0.002) at 10 min but not at 60 min after delivery.     

A continuing use for Kielland's forceps?

Summary. A retrospective study over a 5–year period compared neonatal outcomes after birth by Kielland's forceps with those after caesarean section in the second stage of labour. The 253 babies born by these two modes of delivery showed no difference in Apgar score, the need for active resuscitation, incidence of jaundice or abnormal neurological behaviour. The neonatal outcome was no worse in the small number of patients where Kielland's forceps delivery was attempted but failed. This study offers support for the continuing role of Kielland's forceps in modern obstetrical practice.     

Ratio of the concentration of hypoxanthine to creatinine in urine from newborn infants: a possible indicator for the metabolic damage due to hypoxia

Summary. The ratio of the urinary concentrations of the ATP metabolite, hypoxanthine, to that of creatinine was determined in normal newborn infants. An increase in this ratio reflects high hypoxanthine excretion and thus ATP breakdown. The ratio can be determined on random urine samples, thus simplifying sampling. Urinary changes are persistent; abnormalities are detectable on the second day of life after intrapartum hypoxia. Preliminary results suggest that this ratio on a sample during the second day of life could'diagnose'intrapartum hypoxia and might therefore quantitatively assess those obstetric'risk factors'believed to operate through hypoxia.