Correlation of neurologic assessment in the preterm newborn infant with outcome at 1 year

A prospective study was undertaken of the outcome at 1 year in 129 preterm infants of less than 34 weeks gestation (range 27 to 34 weeks) who underwent detailed neurologic assessment and ultrasound scanning in the neonatal period and again at 40 weeks postmenstrual age, and an independent neurodevelopmental assessment at 12 months chronologic age. Of the 129 infants, 37 (29%) had ultrasound evidence of periventricular hemorrhage. At 40 weeks postmenstrual age the infants were classified as neurologically normal, abnormal, or borderline on the basis of the neurologic examination. Of the 62 infants considered normal at 40 weeks, 57 (91%) were assessed as normal at one year, compared to only 14 (35%) of the 39 infants considered abnormal (P less than 0.001). Ten (85%) of the 12 normal infants with associated periventricular hemorrhage were normal at 1 year, compared to 47 (94%) of the 50 normal infants without periventricular hemorrhage, whereas 5 (25%) of 20 abnormal infants with associated periventricular hemorrhage and 9 (47%) of the 19 without periventricular hemorrhage were normal at 1 year. There was no direct correlation in individual cases between the severity of neurologic deficit and the presence or severity of periventricular hemorrhage. Infants with a cluster of abnormal signs were more likely to have later dystonia or cerebral palsy than those with marked hypotonia but no other abnormality.     

Effect of calcium therapy in the sick premature infant with early neonatal hypocalcemia

Twenty-seven sick premature infants with serum calcium concentrations less than 6.0 mg/dl during the first day of age were enrolled in a prospective controlled study involving two treatment regimens--calcium given as a bolus or a drip--or no treatment. Mean total calcium concentration was 5.5 +/- 0.8 mg/dl, and ionized calcium was 3.1 +/- .3 mg/dl, with no significant difference between treatment groups. By 24 hours, in all groups total calcium had increased to greater than 6.0 mg/dl (bolus 6.5 +/- 1.1, drip 7.0 +/- 0.4, control 6.6 +/- 0.4) and ionized calcium to greater than 3.5 mg/dl (bolus 3.9 +/- 0.3, drip 3.6 +/- 0.6, control 3.6 +/- 0.3). Ionized and total calcium concentrations were significantly correlated (r = 0.562; P less than 0.001), but total calcium did not predict ionized calcium in any group. These data support the concept that, even in sick infants, early neonatal hypocalcemia is a physiologic phenomenon that may not require treatment.     

The diurnal variations of serum prolactin levels before and during pregnancy in normal and hyperprolactinemic patients

Although it seems likely that some patients with unexplained repeated abortions have early or subclinical autoimmune disease, there are no reports on the incidence of autoimmune serologic abnormalities in such patients by use of a series of tests. This diagnosis would suggest a treatable etiology for reproductive loss. We performed 11 serologic autoimmune tests in sera from 14 patients with three or more unexplained abortions (group II) and compared these results to those of 16 control patients with an established diagnosis for repeated abortions (group I). The groups were similar in age, gravidity, number of spontaneous abortions and live births, and in the interval from last abortion to serum sampling. A positive antinuclear antibody test plus at least one other positive test was found in four of 14 (29%) patients in group II (p less than 0.05). The tests that identified all these patients included levels of antinuclear antibody, antibodies to DNA or extractable nuclear antigen, and low levels of complement 3.     

Increased inorganic sulfate in mother and fetus at parturition: evidence for a fetal-to-maternal gradient

Inorganic sulfate is a cosubstrate for numerous sulfoconjugation reactions, including sulfation of estrogen steroids in the fetoplacental unit. It is known that the availability of inorganic sulfate can be the rate-limiting factor in these reactions, but fluxes of inorganic sulfate across the maternal-placental barrier have not been well characterized. Therefore, we measured serum inorganic sulfate in matched samples from 46 mothers and fetuses at parturition to identify any maternal-fetal gradient and explore clinical correlations. The concentration of inorganic sulfate, measured by controlled-flow anion chromatography, was significantly higher (p = 0.006) in fetal cord blood [458 +/- 10 microM; mean +/- SE] than in the maternal circulation [431 +/- 19 microM]. That a gradient was not observed for chloride ion rules out sampling artifact as a source of the difference. Maternal and fetal concentrations of inorganic sulfate were highly correlated (r = 0.84, p less than 0.001). No influence was observed for gestational history, newborn weight, sex, or Apgar scores, but values were significantly higher in those with relatively shorter (less than 36 weeks) or longer (greater than 41 weeks) gestations. We demonstrated that a small but significant fetal-to-maternal inorganic sulfate gradient exists at birth, but the origin of this gradient is not known.     

Myometrial electrophysiologic activity and gap junctions in the pregnant rabbit

Electromyographic activity of the myometrium, intrauterine pressure, and myometrial gap junctions were examined in rabbits at various stages of pregnancy and during parturition. Electromyographic activity occurred throughout pregnancy and was characterized by electromyographic bursts lasting up to 5 minutes at a frequency of one to four per hour. The gap junction area of plasma membrane showed a significant increase at delivery at a time when electromyographic activity changed to rhythmic bursts of short duration at a frequency of about one per minute. This study shows that the rabbit uterus is active throughout pregnancy; furthermore, the development of large numbers of gap junctions between myometrial cells occurs at a time when uterine activity changes to the expulsive activity required for labor.     

The effect of a progestin on gallbladder function in young women

Female sex hormones have been considered to be a risk factor for the development of cholesterol gallstone disease, because of increased cholesterol saturation of bile. Impaired gallbladder function is an additional factor which is suspect but unproved. We investigated gallbladder function in 10 young women on two occasions: first during the follicular phase of the menstrual cycle, when endogenous progesterone is low, and again after the ingestion of medroxyprogesterone acetate, 10 mg/day for 10 days, just prior to the next menstrual period. Another group, 15 young women, was studied during their luteal phase, when endogenous progesterone is high. Gallbladder filling and emptying in response to cholecystokinin (0.02 U/kg-min) was quantitated by ^99mTc-HIDA cholescintigraphy. Gallbladder filling and emptying were no different in women in the follicular phase than in women in the luteal phase of the menstrual cycle. In both menstrual phases, the administration of the exogenous progestin significantly (p < 0.05) reduced the fraction of hepatic bile entering the gallbladder. Gallbladder emptying was also depressed: the total amount ejected was less, the time to empty half the contents was prolonged, and the rate was slower (p < 0.05). Thus, different phases of the normal menstrual cycle do not appear to have any effect on gallbladder function. Administration of an exogenous progestin, however, significantly impairs both gallbladder filling and emptying, factors which could predispose to the formation of cholesterol gallstones.     

Outcome and effect of medical intervention in women experiencing infertility following removal of an ectopic pregnancy

The outcome of pregnancy and the effect of medical intervention were reviewed in patients who had had a previous ectopic pregnancy and a subsequent history of infertility. The case records of 3.650 patients were reviewed. Seventy met the study criteria. Twenty patients either voluntarily withdrew or were discouraged on medical grounds; one conceived. Five of the remainder of the patients conceived prior to laparoscopy. In the other 45 patients, the remaining tube was normal in 13, irreparable in 16, and suitable for surgical repair in 16. To date, among the original patients, there have been 13 live births (18.5%) and two ectopic pregnancies (2.8%). One patient was delivered of a live-born infant subsequent to surgical intervention. The pregnancy outcome in this group of patients is poor. Medical intervention was useful primarily in ruling out other causes of infertility and to provide advice to the couple on future fertility. Medical intervention altered outcome in a very few cases.