Mode of Delivery and the Survival of Macrosomic Infants in the United States, 1995–1999

ABSTRACT: Background: Although increases in perinatal mortality risk associated with fetal macrosomia are well documented, the optimal route of delivery for fetuses with suspected macrosomia remains controversial. The objective of this investigation was to assess the risk of neonatal death among macrosomic infants delivered vaginally compared with those delivered by cesarean section. Methods: Data were derived from the U.S. 1995–1999 Linked Live Birth‐Infant Death Cohort files and term (37–44 wk), single live births to United States resident mothers selected. A proportional hazards model was used to analyze the risk of neonatal death associated with cesarean delivery among 3 categories of macrosomic infants (infants weighing 4,000–4,499 g; 4,500–4,999 g; and 5,000+ g). Results: After controlling for maternal characteristics and complications, the adjusted hazard ratio for neonatal death associated with cesarean delivery among the 3 categories of macrosomic infants was 1.40, 1.30, and 0.85. Conclusions: Although cesarean delivery may reduce the risk of death for the heaviest infants (5,000+ g), the relative benefit of this intervention for macrosomic infants weighing 4,000–4,999 g remains debatable. Thus, policies in support of prophylactic cesarean delivery for suspected fetal macrosomia may need to be reevaluated. (BIRTH 33:4 December 2006)     

Molecular and genetic characterization of human cell lines resistant tol-asparaginase and albizziin

Human cell lines resistant tol-asparaginase or albizziin were isolated by multistep selection of HT1080 fibrosarcoma and MIA PaCa-2 pancreatic carcinoma cells. Mutants were cross-resistant to both drugs, but more resistant to the drug used for selection. The drug-resistant cell lines expressed elevated levels of asparagine synthetase activity and protein, up to 17-fold over that of the parental cells. Enzyme overproduction was due to gene amplification in the albizziin-resistant cells, whereas increased expression without amplification was observed inl-asparaginase-resistant cells.     

Developmental coordination disorder and aerobic fitness: is it all in their heads or is measurement still the problem?

Developmental coordination disorder (DCD) is characterized by motor inproficiency, resulting in significant impairments in social and/or academic functioning. About 5-9% of all school-age children are affected. Previous research has shown that children with DCD have lower aerobic fitness levels than children without the disorder, although the reasons for this have not been tested in the literature. A potential explanation may lie in perceived adequacy regarding performance in physical activity. Although negative perceptions of adequacy in children with DCD likely reflect an accurate appraisal of actual physical abilities, aerobic fitness tests typically require minimal coordination skills. Children who perceive themselves to be less adequate are unlikely to persist at a task and may give up sooner on these tests of endurance. Using a large community based sample of children ages 9 through 14 (n=586), we examine whether differences in aerobic fitness (assessed by performance on a 20-m shuttle run test) between children who meet the criteria for DCD (n=44) and those who do not (n=542) is due to differences in perceived adequacy toward physical activity. Our results show that one-third of the effect of DCD on VO(2) can be attributed to differences in perceived adequacy. These results suggest that at least part of the reason children perform less well on tests of aerobic endurance is because they do not believe themselves to be as adequate as other children at physically active pursuits. The implications of this for further research are discussed.     

Narrative representations of caregivers and self in maltreated pre-schoolers

This study examined narrative representations of parents and of self, as well as child behavior during the assessment, in maltreated (N = 56) and demographically comparable non-maltreated (N = 37) pre-school-aged children in a one-year longitudinal study. Maltreated children evidenced more negative representations of parents and of self at Time 2, including the juxtaposition of both a negative and a grandiose self. Over time there was a marginal interaction such that maltreated children portrayed fewer disciplining parent representations and nonmaltreated children portrayed more. Also over time, maltreated children portrayed marginally more grandiose self-representations and nonmaltreated children fewer. Furthermore, maltreated children demonstrated less responsivity to the examiner over time and nonmaltreated children demonstrated more. The deleterious effects of maltreatment on representations of self and of others, especially as development proceeds, are discussed, and the importance of providing attachment-informed intervention prior to the consolidation of these negative representations is highlighted.     

Submaximal oxygen cost during incremental exercise in children with developmental coordination disorder

There has been minimal evidence examining the differences in submaximal aerobic power between children with and without probable developmental coordination disorder (pDCD). This is important as most activities of daily living are performed at submaximal levels. The aim of this study was to examine the oxygen cost of work (VO₂) performed during an incremental exercise protocol on a cycle ergometer. Subjects with pDCD (n = 63) were matched for age and gender to 63 typically developing controls (12–13 years of age) using a nested case–control design. Motor coordination was assessed using the Movement Assessment Battery for Children. Children with pDCD had significantly lower VO2 peak values relative to controls (35.0 vs. 42.9 ml/kg/min, p < 0.0001). At the submaximal level, mixed effects modeling demonstrated that, after controlling for relative body fat, and VO₂ peak, children with pDCD had consistently greater oxygen cost (VO₂ ml/kg/min) compared to controls at any given exercise intensity (p = 0.0006). A significant interaction between pDCD and workload indicated that the difference in VO₂ at higher workloads is greater than that at lower workloads (p = 0.0004). Children with pDCD utilize more oxygen to sustain the same submaximal workload. The implication of these findings is that children with pDCD may experience earlier fatigue than well coordinated individuals when engaging in physical activity.