morphine and Birth-Weight

Topics: Acidosis; Amniotic Fluid; Bicarbonates; Birth Weight; Carbon Dioxide; Estriol; Female; Fetal Diseases; Fetal Heart; Fetus; Growth; Heart Rate; Humans; Hydrogen-Ion Concentration; Hypoxia; Labor, Obstetric; Maternal-Fetal Exchange; Meconium; Muscle Contraction; Oxygen; Oxygen Consumption; Oxygen Inhalation Therapy; Oxytocin; Pregnancy; Pregnancy in Diabetics; Scalp; Ultrasonography; Uterus

Topics: Birth Weight; Contrast Media; Enterocolitis, Pseudomembranous; Female; Humans; Infant; Infant, Newborn; Infant, Newborn, Diseases; Infant, Premature, Diseases; Intestinal Mucosa; Intestinal Perforation; Intestines; Male; Meconium; Necrosis; Pneumatosis Cystoides Intestinalis; Pneumoperitoneum; Radiography

Topics: Birth Weight; Diagnosis, Differential; Humans; Infant Food; Infant, Newborn; Infant, Newborn, Diseases; Intestinal Obstruction; Meconium; Megacolon; Therapeutic Irrigation

Glycerin suppositories are often used to facilitate meconium evacuation in premature infants. The evidence for this practice is inconclusive. The purpose of this study was to assess the feasibility of a multicenter randomized controlled trial on the effectiveness of this treatment strategy.. We conducted an external pilot study for a multicenter randomized controlled trial of premature infants randomized to glycerin suppositories or placebo procedure. Participants were included if they were gestational age of 24 weeks 0 days to 31 weeks 6 days and/or birthweight of 500 to 1500 grams. We excluded infants with life-threatening congenital anomalies, contraindications to receiving suppositories, or signs of clinical instability. Outcomes included cost, recruitment, and treatment-related adverse events.. A total of 109 were screened, 79 were initially eligible, and 34 consented to participate. Four of these infants were excluded prior to randomization due to thrombocytopenia, 30 were randomized, and 26 reached full enteral feeds. Three infants (10%) experienced rectal bleeding 5 to 43 days after completing study treatments. An anal fissure was noted in two of these patients. There were no cases of rectal perforation but one infant assigned to active treatment developed necrotizing enterocolitis.. Conducting a multicenter randomized controlled trial on the use of glycerin suppositories in premature infants is feasible. Minor modifications to the study protocol are needed to increase participant recruitment and simplify the administration of study treatments.

Topics: Birth Weight; Cathartics; Clinical Protocols; Enteral Nutrition; Female; Gestational Age; Glycerol; Humans; Infant, Newborn; Infant, Premature; Male; Meconium; Outcome and Process Assessment, Health Care; Pilot Projects; Suppositories

Neonates who swallow a considerable amount of maternal blood may exhibit vomiting and suckling disorder during the first few days of the postnatal period. Some clinicians treat these neonates with gastric lavage (GL) to prevent vomiting and the establishment of enteral feeding empirically, but there was no study assessing the effect of GL for neonates with coffee-ground emesis. We designed a multicenter randomized controlled trial to evaluate the efficacy and safety of GL in neonates with coffee-ground emesis. Vigorous neonates with birth weight ranging from 2500 g to 3999 g and gestational age between 37w0d and 41w6d who presented with coffee-ground emesis on more than twice and diagnosed as false melena, were divided into two groups using computerized randomization. We defined feeding intolerance (FI) as (1) ≥2 vomiting episodes in 4h or ≥3 episodes in 24h and/or (2) feeding failure on at least two occasions because of retching or poor sucking. Primary outcome is percentage of infants who present FI within 24 hours from admission. We also assessed the residual volumes, number of vomiting episodes, percentage of weight reduction at postnatal day 4, rates of body weight gain at 1 month of age, and peak serum total bilirubin value before discharge. To our knowledge, this is the first study to evaluate the safety and efficacy of GL for neonates with coffee-ground emesis. This trial is registered at UMIN Clinical Trials Registry as UMIN000026483.

Topics: Birth Weight; Female; Gastric Lavage; Humans; Infant, Newborn; Male; Meconium; Prospective Studies; Software; Vomiting

Meconium retention is associated with feeding intolerance. Trials using glycerol and Gastrografin to expedite the evacuation of meconium have failed to generate clinically valid results for efficacy and safety.. We assessed the feasibility of aggressive meconium evacuation with saline rectal washout (RW) in very-low-birth-weight infants to reduce the time it took them to reach full enteral feeds.. We conducted an open-label, pilot, randomized controlled trial (RCT) (birth weight stratified, i.e., to 750-999 g and 1,000-1,500 g) of early aggressive meconium evacuation with twice-daily normal saline RW compared to conventional management with glycerin suppositories (GS), until full enteral feeds (110 mL/kg/day) were reached. Primary outcome was time to reach full enteral feeds. Safety, process, and secondary efficacy outcomes were also evaluated.. Sixty-one infants were randomized, 28 to RW and 33 to GS. The process and feasibility outcomes were met. RW was found to be safe; none of the RW-randomized infants developed necrotizing enterocolitis (≥ stage II) or complications secondary to RW. Evidence of efficacy was supported: in the 750-999 g stratum (n = 15), the median time to full enteral feeds was shorter with RW (11.0 days, 95% CI: 10.4-11.6) than with GS (15.6 days, 95% CI: 13.0-18.2) by a reduction of 4.6 days (p = 0.027). In the 1,000-1,500 g stratum (n = 46), there was no evidence of benefit: RW 10.2 days (95% CI 8.3-12.1) and GS 10.1 days (95% CI 9.3-10.9, p = 0.304).. Our protocol was feasible and an adequately powered RCT is required to confirm the findings of this trial.

Topics: Adult; Birth Weight; Enema; Enteral Nutrition; Feasibility Studies; Female; Gestational Age; Glycerol; Humans; Infant, Newborn; Infant, Premature; Infant, Very Low Birth Weight; Intensive Care Units, Neonatal; Intestinal Obstruction; Male; Meconium; Pilot Projects; Singapore; Sodium Chloride; Suppositories; Therapeutic Irrigation; Time Factors; Treatment Outcome

To assess whether endotracheal suctioning of nonvigorous infants born through meconium stained amniotic fluid (MSAF) reduces the risk and complications of meconium aspiration syndrome (MAS).. Term, nonvigorous babies born through MSAF were randomized to endotracheal suction and no-suction groups (n=61 in each). Risk of MAS, complications of MAS and endotracheal suction, mortality, duration of neonatal intensive care unit stay, and neurodevelopmental outcome at 9 months were assessed.. Maternal age, consistency of meconium, mode of delivery, birth weight, sex, and Apgar scores were similar in the groups. In total, 39 (32%) neonates developed MAS and 18 (14.8%) of them died. There were no significant differences in MAS, its severity and complications, mortality, and neurodevelopmental outcome for the 2 groups. One infant had a complication of endotracheal suctioning, which was mild and transient.. The current practice of routine endotracheal suctioning for nonvigorous neonates born through MSAF should be further evaluated.. Clinical Trial Registry of India: CTRI/2013/03/003469.

Topics: Amniotic Fluid; Apgar Score; Birth Weight; Delivery, Obstetric; Female; Humans; Infant; Infant, Newborn; Intensive Care Units, Neonatal; Intensive Care, Neonatal; Intubation, Intratracheal; Male; Meconium; Meconium Aspiration Syndrome; Suction

Neonates born with meconium stained amniotic fluid (MSAF) can develop feed intolerance during first few days of post -natal period. A randomized controlled trial was conducted with the objectives of to find out the incidence of feed intolerance in vigorous neonates with MSAF who received gastric lavage (GL) as compared to those in whom it was not performed.. This was a randomized controlled trial on 500 neonates satisfying the inclusion criteria, 230 were allocated to GL and 270 to no lavage group through computer generated random numbers.. No significant difference in the incidence of vomiting was found between GL and no lavage group (8.7 % vs 11.5 %, p = 0.305). Feed intolerance had no relationship with gestational age, gender, birth weight and mode of delivery. No neonates of GL group developed any complications related to the procedure.. Thus, it may be concluded that gastric lavage is not required in neonates born with MSAF.

Topics: Amniotic Fluid; Birth Weight; Female; Gastric Lavage; Gestational Age; Humans; Infant, Newborn; Male; Meconium; Nausea; Vomiting

Few investigations have used placenta as an alternative matrix to detect in utero drug exposure, despite its availability at the time of birth and the large amount of sample. Methadone-maintained opioid-dependent pregnant women provide a unique opportunity to examine the placental disposition of methadone and metabolite [2-ethylidene-1,5-dimethyl-3,3-diphenylpyrrolidine (EDDP)], to explore their correlations with maternal methadone dose and neonatal outcomes, and to test the ability to detect in utero exposure to illicit drugs.. We calculated the correlations of placental methadone and EDDP concentrations and their correlations with maternal methadone doses and neonatal outcomes. Cocaine- and opiate-positive placenta results were compared with the results for meconium samples and for urine samples collected throughout gestation.. Positive correlations were found between placental methadone and EDDP concentrations (r=0.685), and between methadone concentration and methadone dose at delivery (r=0.542), mean daily dose (r=0.554), mean third-trimester dose (r=0.591), and cumulative daily dose (r=0.639). The EDDP/methadone concentration ratio was negatively correlated with cumulative daily dose (r=-0.541) and positively correlated with peak neonatal abstinence syndrome (NAS) score (r=0.513). Placental EDDP concentration was negatively correlated with newborn head circumference (r=-0.579). Cocaine and opiate use was detected in far fewer placenta samples than in thrice-weekly urine and meconium samples, a result suggesting a short detection window for placenta.. Quantitative methadone and EDDP measurement may predict NAS severity. The placenta reflects in utero drug exposure for a shorter time than meconium but may be useful when meconium is unavailable or if documentation of recent exposure is needed.

Topics: Analgesics, Opioid; Apgar Score; Birth Weight; Body Size; Cephalometry; Cocaine; Female; Gestational Age; Humans; Infant, Newborn; Maternal Exposure; Meconium; Methadone; Opiate Substitution Treatment; Opioid-Related Disorders; Placenta; Pregnancy; Pregnancy Complications; Pregnancy Outcome; Pregnancy Trimesters; Pyrrolidines; Tissue Distribution

In an effort to minimise the stress and pain of mechanically ventilated neonates, the application of opioids has increased markedly. Abdominal adverse effects of opioid analgesics are constipation and increased pressure in the biliary system. Our aim was to evaluate the impact of continuous intravenous infusion of fentanyl on the volume of the neonatal gallbladder and to assess potential gastrointestinal side effects.. We prospectively matched pairs of 40 mechanically ventilated neonates (28-42 gestational weeks) under total parenteral nutrition and midazolam sedation. One group (20 patients) received continuous fentanyl infusions (dose 0.5-2 microg kg(-1) h(-1)) the other group (20 patients) served as controls. Sonographic measurements of gallbladder length, depth and width were performed to calculate gallbladder volume using the ellipsoid method. Repeated ultrasound images, date of meconium release and serum bilirubin levels were documented.. Fentanyl application was not associated with gallbladder sludge/stones, gallbladder hydrops, hyperbilirubinemia or prolonged meconium release. Neonatal gallbladder length, width and volume did not differ significantly (data expressed as mean, standard deviation, median, interquartile range: length (cm) 3.16+/-0.68, 3.3, 0.675 vs 3.06+/-0.62, 3.3, 1.1; P=0.645; width (cm) 1.02+/-0.23, 1.0, 0.28 vs 0.89+/-0.27, 0.9, 0.38, P=0.12; volume (cm(3)) 1.52+/-0.67, 1.7, 0.86 vs 1.22+/-0.77, 1.09, 1.19, P=0.20).. In our study fentanyl caused no major complications in the biliary system and intestine of ventilated preterm and term neonates. Sonographic investigations of the gallbladder under fentanyl treatment may be dispensable. Further investigations are required to assess adverse gastrointestinal effects.

Topics: Age Factors; Anesthetics, Intravenous; Bilirubin; Birth Weight; Data Interpretation, Statistical; Female; Fentanyl; Gallbladder; Gestational Age; Humans; Infant; Infant, Newborn; Infant, Premature; Infusions, Intravenous; Male; Meconium; Organ Size; Parenteral Nutrition; Pilot Projects; Prospective Studies; Respiration, Artificial; Respiratory Distress Syndrome, Newborn; Single-Blind Method; Time Factors; Ultrasonography

To identify associations between cocaine exposure during pregnancy and medical conditions in newborn infants from birth through hospital discharge.. Multisite, prospective, randomized study.. Brown University, University of Miami, University of Tennessee (Memphis), and Wayne State University. Subjects A total of 717 cocaine-exposed infants and 7442 nonexposed infants.. Results of physical examination and conditions observed during hospitalization.. Cocaine-exposed infants were about 1.2 weeks younger, weighed 536 g less, measured 2.6 cm shorter, and had head circumference 1.5 cm smaller than nonexposed infants (all P<.001). Results did not confirm previously reported abnormalities. Central and autonomic nervous system symptoms were more frequent in the exposed group: jittery/tremors (adjusted odds ratio, 2.17; 99% confidence interval, 1.44-3.29), high-pitched cry (2.44; 1.06-5.66), irritability (1.81; 1.18-2.80), excessive suck (3.58; 1.63-7.88), hyperalertness (7.78; 1.72-35.06), and autonomic instability (2.64; 1.17-5.95). No differences were detected in organ systems by ultrasound examination. Exposed infants had more infections (3.09; 1.76-5.45), including hepatitis (13.46; 7.46-24.29), syphilis (8.84; 3.74-20.88), and human immunodeficiency virus exposure (12.37; 2.20-69.51); were less often breastfed (0.26; 0.15-0.44); had more child protective services referrals (48.92; 28.77-83.20); and were more often not living with their biological mother (18.70; 10.53-33.20).. Central and autonomic nervous system symptoms were more frequent in the exposed cohort and persisted in an adjusted analysis. They were usually transient and may be a true cocaine effect. Abnormal anatomic outcomes previously reported were not confirmed. Increased infections, particularly sexually transmitted diseases, pose a serious public health challenge. Exposure increased involvement of child protective services and out-of-home placement.

Topics: Abnormalities, Drug-Induced; Acute Disease; Adolescent; Adult; Birth Weight; Cocaine; Cocaine-Related Disorders; Female; Fetus; Gestational Age; Humans; Infant, Newborn; Meconium; Middle Aged; Neonatal Screening; Pregnancy; Prenatal Exposure Delayed Effects; Prevalence; Prospective Studies; United States

The objective of the study was to compare the effectiveness, safety, and side effects of low-dose oral misoprostol with vaginal dinoprostone for cervical ripening and labor induction.. Women with Bishop score 6 or less admitted for labor induction at term were eligible for this randomized controlled trial. Exclusion criteria were multiple pregnancy, breech, fetal distress, or previous uterine scar. The allocation to the oral misoprostol group (20 microg given every 2 hours increased to 40 microg depending on uterine contractions) or to the vaginal dinoprostone group (2 mg twice, 6 hours apart) was contained in a sealed, opaque, and consecutively numbered envelope.. Two hundred women (100 in each group) were included. The proportion of vaginal delivery within 24 hours was 56% in the misoprostol group and 62% in the dinoprostone group (relative risk 0.90, 95% CI 0.72-1.14). The risk of cesarean section was 18% and 19%, respectively. The median interval to delivery, calculated from survival analysis, was longer in the misoprostol group (1305 minutes) compared with the dinoprostone group (1080 minutes). The log-rank test was not significant (P =.35). Uterine hyperstimulation occurred in 9% of women in the misoprostol group compared with 14% in the dinoprostone group (P =.27). The only significant difference in neonatal outcomes was a more frequent presence of thick meconium in the misoprostol group (P =.03).. We found no difference in terms of effectiveness and safety between low-dose oral misoprostol and vaginal dinoprostone used for induction of labor. This regimen avoids the excessive uterine contractility noted in previous studies, where higher doses of misoprostol were administered at longer intervals.

Topics: Administration, Intravaginal; Administration, Oral; Adult; Birth Weight; Cesarean Section; Delivery, Obstetric; Dinoprostone; Dystocia; Female; Fetal Membranes, Premature Rupture; Heart Rate, Fetal; Humans; Infant, Newborn; Labor, Induced; Length of Stay; Meconium; Misoprostol; Oxytocics; Pregnancy; Pregnancy Outcome

The appropriate date of delivery in twin pregnancies is supposed to be earlier than that in singleton pregnancy. The aim of this study was to compare two strategies for managing twin pregnancies (i.e., immediate induction and expectant management).. Seventeen patients underwent immediately induced labor by administration of oral prostaglandin E(2) at 37 weeks, while 19 patients underwent expectant management.. The average gestational age at delivery in the induction group was 37.5 +/- 0.4 weeks, significantly earlier than that in the expectant management group (39.0 +/- 1.1 weeks). However, there were no significant differences in the average birth weight between the two groups (2, 700 +/- 330 g in the induction group vs. 2,672 +/- 392 g in the expectant management group). The cesarean delivery rate in the induction group was 18%, not significantly different from that in the expectant management group (32%). The most common indication for cesarean section in the expectant management group was maternal infection, while there was no maternal infection in the induction group (p = 0.08).. It may be acceptable do intervene in twin pregnancies earlier than in singleton pregnancies during term.

Topics: Adult; Apgar Score; Birth Weight; Cesarean Section; Dinoprostone; Female; Fetal Membranes, Premature Rupture; Gestational Age; Humans; Labor, Induced; Meconium; Pregnancy; Twins

To clarify the safety of elective induction of labor at 39 weeks of gestation.. Prospective randomized study.. Uncomplicated nulliparas (N = 194) were randomly assigned at 36 weeks of gestation. Labor was electively induced in 63 women at 39 weeks of gestation in the active management group (I group, N = 98). Spontaneous labor onset was expected with semi-weekly nonstress test (NST) and amniotic fluid index (AFI) by 42 weeks of gestation in the expectant group (E group, N = 96). Perinatal events were compared between the 2 groups.. A significantly higher incidence of meconium-stained amnios (19.4% vs 3.2%) and fetal resuscitation (16.7% vs 4.8%) was found in the E group than in the I group. Also, although a significantly higher incidence of epidural analgesia was noted in the I group (89%) than in the E group (54%) (labor onset > or = 39 weeks, N = 72), the duration of the 1st stage was shorter in I group and the duration of the 2nd stage was not significantly different. No other significant difference was noted between the 2 groups in terms of the rate of C-section, blood loss, incidence of pathological FHR, birth weight, Apgar score, umbilical arterial pH, or admission to NICU.. Active management of labor at 39 weeks could be made as safely as expectant management with modified biophysical profile monitoring.

Topics: Adult; Amniotic Fluid; Analgesia, Epidural; Apgar Score; Birth Weight; Dinoprost; Dinoprostone; Female; Heart Rate, Fetal; Humans; Infant, Newborn; Labor, Induced; Laminaria; Meconium; Oxytocin; Pregnancy; Pregnancy Outcome; Pregnancy Trimester, Third; Prospective Studies

A prospective controlled randomized study of the use of extracorporeal membrane oxygenation to treat newborns with respiratory failure was carried out using the "randomized play-the-winner" statistical method. In this method the chance of randomly assigning an infant to one treatment or the other is influenced by the outcome of treatment of each patient in the study. If one treatment is more successful, more patients are randomly assigned to that treatment. A group of 12 infants with birth weight greater than 2 kg met objective criteria for high mortality risk. One patient was randomly assigned to conventional treatment (that patient died); 11 patients were randomly chosen for extracorporeal membrane oxygenation (all survived). Intracerebral hemorrhage occurred in one of 11 surviving children. Extracorporeal membrane oxygenation allows lung rest and improves survival compared to conventional ventilator therapy in newborn infants with severe respiratory failure.

Topics: Birth Weight; Clinical Trials as Topic; Extracorporeal Circulation; Follow-Up Studies; Hernia, Diaphragmatic; Hernias, Diaphragmatic, Congenital; Humans; Infant, Newborn; Meconium; Oxygenators, Membrane; Persistent Fetal Circulation Syndrome; Pneumonia, Aspiration; Prospective Studies; Pulmonary Veins; Random Allocation; Respiratory Distress Syndrome, Newborn; Respiratory Insufficiency

Previous studies investigated prenatal exposure to neurotoxic metals in relation to birth anthropometrics. However, limited information has been developed on associations with birth outcomes of fetal exposure to metal mixtures using the meconium as a biomarker. The purpose of this study was to evaluate relationships of the combined effects of mercury (Hg), lead (Pb), cadmium (Cd), and arsenic (As) concentrations in the meconium on birth outcomes (i.e., birth weight, birth length, and head circumference). This cross-sectional study was conducted in northern Taiwan between January 2007 and December 2009. We collected 526 meconium samples within the first 24 h after birth to measure the in utero mixed-metal exposure determined using inductively coupled plasma/mass spectrometry (ICP-MS). We used a multivariable regression and Bayesian kernel machine regression (BKMR) to estimate associations of the combined effects and identify important mixture components with growth impairments. Our results revealed Hg, Pb, Cd, and As concentrations in the meconium and enhanced the quantity of research on meconium analyses. The overall effects of Hg, Pb, Cd, and As concentrations in the meconium as prenatal exposure biomarkers were negatively associated with birth growth. Fetal exposure to Hg and Pb was correlated with decreased birth weights. Hg and Pb concentrations in the meconium were linearly inversely related to the birth weight, birth length, and head circumference. Effects of fetal exposure to As and Cd on birth outcomes were not obvious. A significant increasing relationship was detected between Hg concentrations in the meconium and maternal fish consumption during pregnancy. Higher Pb concentrations in the meconium were observed among infants of mothers who consumed Chinese herbal medicines. Reducing maternal fish consumption and Chinese herbal medicine consumption during pregnancy could limit infant exposure to metals.

Topics: Animals; Arsenic; Bayes Theorem; Birth Weight; Cadmium; Cross-Sectional Studies; Female; Humans; Infant, Newborn; Lead; Maternal Exposure; Meconium; Mercury; Pregnancy; Prenatal Exposure Delayed Effects; Taiwan

Paclitaxel is often excluded during pregnancy for women with breast cancer due to limited neonatal follow-up. We confirmed in utero fetal Paclitaxel exposure for 8 newborns. Birth details and follow-up to 36 months of age is reported. Meconium samples from newborns exposed to chemotherapy were screened by liquid chromatography-high resolution mass spectrometry while blinded to maternal treatment during pregnancy. Newborn information at birth and annually was obtained. Mean gestational age (GA) at cancer diagnosis and start of chemotherapy was 8.7 + 6.2 weeks and 17.1 ± 3.5 weeks. Paclitaxel was started at a mean GA of 27.0 ± 5.8 weeks. Paclitaxel followed Doxorubicin/Cyclophosphamide in 6 cases, 5-Fluouracil/Doxorubicin/Cyclophosphamide in 1, and was used alone in 1. Mean number of days between Paclitaxel and birth was 23 ± 15. Identification of Paclitaxel and/or metabolites was made in all meconium from paclitaxel-exposed fetuses. Birthweight was < 10% for GA in 3 infants. Three anomalies occurred: mild hip dysplasia without further treatment and mitral valve stenosis. The third child was diagnosed with Cleidocranial Dysostosis, a familial anomaly. Mean age at pediatric follow-up is 18.7 + 9.3 months. Pediatricians report eczema and recurrent otitis media in 1 child, iron deficiency anemia and upper respiratory infection in 2. One child is < 10% for height and weight at 15 months. All are meeting developmental milestones at median age of 18.7 months, range: 6-36 months.. Up to 3 years of age, follow-up of neonates exposed to Paclitaxel in utero is reassuring. Continued observation of neonatal development is essential.. • Chemotherapy during the second and third trimester of pregnancy does not result in an increase in congenital malformations or developmental delay. • In non-human primate studies by Van Calsteren et al., variable plasma and/or tissue concentrations of taxanes, carboplatin, and trastuzumab were encountered in the fetal compartment. • Pilot data reported by the current investigators proved that paclitaxel crosses the human placenta.. • This current article provides medical and developmental follow up on the newborns from this exposure for 3 years after birth.

Topics: Birth Weight; Child; Female; Follow-Up Studies; Gestational Age; Humans; Infant, Newborn; Meconium; Paclitaxel; Pregnancy

Antenatal exposure to organic pollutants is a leading public health problem. Meconium is a unique matrix to perform prenatal studies because it enables us to retrospectively evaluate fetal exposure accumulated during the second and third trimester. The aim of the present study was to evaluate associations between organic pollutant levels in meconium and birth weight in NW Spain.. In this study, we quantify the concentrations of 50 organic pollutants together with the total values of the most important chemical groups in meconium using gas chromatography coupled to tandem mass spectrometry.. Organochlorine pesticides, polychlorinated biphenyls and polybrominated diphenyl ethers were detected with the highest levels in meconium from small for gestational age newborns. It was estimated that several congeners were statistically significant (p<0.05). However, organophosphorus pesticides attained higher concentrations in newborns with an appropriate weight.. The occurrence of transplacental transfer can be confirmed. Prenatal exposure to organic pollutants was associated with a decrease in birth weight and, therefore, organic pollutants could have an impact on fetal growth. Nevertheless, these results need validation in larger sample sized studies.

Topics: Adolescent; Adult; Birth Weight; Case-Control Studies; Environmental Pollutants; Female; Fetal Development; Gas Chromatography-Mass Spectrometry; Humans; Infant, Newborn; Infant, Small for Gestational Age; Linear Models; Male; Maternal Exposure; Meconium; Organic Chemicals; Pregnancy; Prospective Studies; Retrospective Studies; Spain; Young Adult

Very low birth weight (VLBW) neonates experience various problems, including meconium-related ileus (MRI). This study investigated the risk factors of MRI and surgical MRI in VLBW infants. VLBW neonates admitted to the Neonatal Intensive Care Unit of Seoul National University Children's Hospital from October 2002 to September 2016 were included in the study. The diagnostic criteria for MRI were a decreased frequency of defecation with intolerable feeding, vomiting, and increased gastric residue (>50%); meconium-filled bowel dilatation in an imaging study; and no evidence of necrotizing enteritis or spontaneous intestinal perforation. Medical MRIs and surgical MRIs were managed through conventional treatment and surgical intervention. Of 1543 neonates, 69 and 1474 were in the patient and control groups, respectively. The risk factors for MRI include low birth weight (BW), cesarean section delivery, fetal distress, maternal diabetes, maternal hypertension, and maternal steroid use. Low BW and fetal distress were independent risk factors for MRI. Compared to the medical MRI group (n = 44), the risk factors for surgical MRI (n = 25) included males, younger gestational age, low BW, and meconium located at the small bowel. Male gender and low BW were independent risk factors for surgical MRI. Low BW and fetal distress were independent risk factors for MRI and male gender and low BW were independent risk factors for surgical MRI. In VLBW neonates, careful attention to the risk factors for MRI could minimize or avoid surgical interventions.

Topics: Apgar Score; Birth Weight; Case-Control Studies; Disease Susceptibility; Enterocolitis, Necrotizing; Female; Gestational Age; Humans; Ileus; Infant, Extremely Low Birth Weight; Male; Meconium; Prognosis; Republic of Korea; Risk Assessment; Risk Factors

Topics: Amniotic Fluid; Birth Weight; Enterocolitis, Necrotizing; Female; Humans; Infant, Newborn; Infant, Premature; Infant, Very Low Birth Weight; Meconium; Pregnancy; Retrospective Studies; Risk Factors

Delayed meconium passage is usually a signal to congenital distal bowel dysfunction. Timing of meconium passage may vary depending on race, sex and several perinatal factors. Understanding the timing and associated perinatal factors in any given population will help in prompt diagnosis and adequate management of cases in that population.. To determine the timing of first meconium passage amongst Nigerian neonates, and evaluate the impact of various associated perinatal factors.. A cross-sectional study using interviewer-administered questionnaires to obtain data from mothers of apparently normal infants attending the postnatal clinic of the University of Nigeria Teaching Hospital, Enugu, Nigeria. Data acquisition and analysis were done using SPSS version 20. A P-value of < 0.05 was adjudged statistically significant.. There were 276 male and 277 female infants. Mean birth weight was 3.4kg and mean gestational age at delivery 38.8weeks. The median age at presentation was 42days. Preterm deliveries were in 6.3%(32/510) and 3.7%(20/536) weighed less than 2.5kg at birth. Sixty-five percent (339/519) had spontaneous vertex delivery and 35%(180/519) had caesarean delivery. Passage of first meconium was within 24hours in 56.6%(307/543) and in 48hours 91.3%(496/543) had passed meconium. Fifty-four percent (54%, 288/537) commenced breastfeeding within 24hours and 85% (n=456/537) within 48hours. Exclusive breastfeeding was done in 61.5%(326/533) of subjects. Timing of first meconium passage was significantly affected by gestational age at delivery (p<0.001), mode of delivery (p<0.01), birth weight (p=0.02), first minute APGAR score (p<0.001), timing of commencement of breastfeeding (p<0.001) and feeding before breastfeeding is commenced (p = 0.02).. Compared to other studies, we found smaller proportion of neonates passing meconium in the first 24 hours. Term neonates, birth weight ≥ 2.5kg, spontaneous vertex delivery, high Apgar score, commencement of breastfeeding within 24 hours of birth, feeding before breastfeeding is commenced, are perinatal factors associated with earlier first meconium passage.

Topics: Apgar Score; Birth Weight; Breast Feeding; Defecation; Delivery, Obstetric; Female; Humans; Infant, Newborn; Infant, Premature; Male; Meconium; Nigeria; Premature Birth; Time Factors

The association between antibiotic use during pregnancy and neonatal birth outcomes has received considerable attention. Most of the previous assessment of antibiotic exposure during pregnancy relied on questionnaires and clinical prescriptions, and very few studies examined pregnancy exposure to antibiotics using human biomonitoring data.. To explore the association between the cumulative exposure of antibiotics during the whole pregnancy and neonatal birth measurements using biomonitoring data of antibiotics in meconium.. Three hundred and sixty nine pregnant women within the Maternal Psychological and Environmental Assessments of Kids Cohort Study were randomly selected into this study. Eighteen common antibiotics of six categories (six β‑lactams, three tetracyclines, four sulfonamides, one phenicols, one lincosamides and three fluoroquinolones) were selected as the target antibiotics in meconium. The measurement was conducted by ultraperformance liquid chromatography coupled to quadrupole time-of-flight mass spectrometry platform. Neonatal birth measurements were obtained from the medical records. Multiple linear regression models were used to examine the associations of antibiotic exposure with neonatal birth outcome (birth weight, birth length) and placental growth indicators (placental surface area, placental weight). Logistic regressions were used to evaluate associations with small for gestational age (SGA) and large for gestational age (LGA).. Twelve of the eighteen antibiotics were found in 62.1% of the meconium, with detection rates ranging from 0.3% to 43.9%. The three antibiotics with the highest detection rates were chlortetracycline (43.9%), penicillin (16.5%) and chloramphenicol (10.8%), respectively. The highest antibiotic concentration among detected antibiotics was penicillin (24,243.15 μg/kg). The concentration of penicillin was positively associated with the birth weight (β: 0.025; 95% CIs: 0.003-0.047). A significant positive association was also observed between the concentration of chlortetracycline and the placental surface area (β: 2.559; 95% CIs: 0.296-4.822). These associations were sex related and mainly observed in female newborns. Exposure to penicillin was also found to be associated with increased risk of LGA, which was consistent with changes in birth weight.. Pregnancy exposure to certain antibiotics was associated with altered fetal growth and development, which may affect the normal growth trajectory of infants and children in later life.

Topics: Adult; Anti-Bacterial Agents; Birth Weight; Child; Cohort Studies; Environmental Monitoring; Female; Fetal Development; Humans; Infant, Newborn; Infant, Small for Gestational Age; Meconium; Placenta; Placentation; Pregnancy; Young Adult

Meconium passage during labour is a quite common finding. Studies describing correlation between meconium stained liquor, fetal distress and specific placental pathology are sparse. This case control study had been designed to ascertain these lacunae of knowledge.. Placentae from 41 cases of otherwise uncomplicated antenatal and intranatal pregnancies with meconium stained liquor at 37 completed weeks of gestation were studied, both grossly and microscopically, comparing them with controls of 41 cases of clear liquor. Apgar score of all newborns at 1 minute and 5 minutes were recorded and correlated with histopathological findings.. Both cases and controls were found to be age matched. Meconium stained liquor was associated with more caesarian section than the clear ones. Significant correlation was found with meconium stained liquor and low Apgar scores. Histopathology of placenta revealed many statistically significant associations between specific placental histopathology in meconium stained liquor and depressed Apgar score. Evidence of placental vasculopathy rather than meconium induced placental damage came out as the potential culprit in causing a low Apgar score in this case control study.. Placental vascular changes have a role in meconium staining of liquor. If timely interventions are taken, the chance of development of fetal distress is low.

Topics: Adult; Amniotic Fluid; Apgar Score; Birth Weight; Case-Control Studies; Cesarean Section; Emergencies; Female; Fetal Blood; Fetal Distress; Fetal Mortality; Gestational Age; Humans; Hydrogen-Ion Concentration; Infant, Newborn; Meconium; Meconium Aspiration Syndrome; Morbidity; Placenta; Pregnancy; Pregnancy Complications; Risk Factors; Young Adult

Understanding the pathomechanisms underlying high meconium calprotectin concentrations is the key to the potential uses of this parameter for the assessment of the intrauterine environment in which the fetus develops. The aim of this study was to measure calprotectin concentrations in serial meconium portions passed after birth and to calculate the individual variations in the total meconium calprotectin content accumulated during gestation.. Calprotectin concentrations were measured using Calprotectin ELISA kit (Immundiagnostik AG) in all meconium portions (n = 81) from 20 healthy neonates. For each neonate, total meconium calprotectin was calculated, reflecting the sum of calprotectin content in all meconium portions from this neonate.. The calprotectin concentration in meconium was (mean ± SD) 286.5 ± 214.6 μg/g (range 34.7-1,067.1). Calprotectin concentrations in the last portions passed were nearly 3-fold higher than in the first portions (p = 0.0004). The total individual calprotectin content of (mean ± SD) 3,668.7 ± 1,819.0 μg (range 1,158.9-8,155.5) was related to the birth weight (r = 0.46, p = 0.042).. Wide intra- and interindividual differences in calprotectin concentrations in the meconium may reflect intestinal inflammation associated with the fetal adaptation to life outside the uterus. Calprotectin may serve as a biomarker useful for the identification of endogenous and exogenous factors with impact on the intrauterine environment.

Topics: Biomarkers; Birth Weight; Enzyme-Linked Immunosorbent Assay; Female; Gestational Age; Humans; Infant, Newborn; Leukocyte L1 Antigen Complex; Male; Meconium; Parturition; Pregnancy

The presence of echogenic amniotic fluid at term gestation on sonography is uncommon. The aim of our study was to investigate the incidence of echogenic amniotic fluid at term pregnancy, and to determine how often echogenic amniotic fluid was associated with meconium.. All singleton pregnant women at term who were admitted to our labor unit and who delivered within 24 h of the ultrasound scan were included in the study. For each woman, gestational age, maternal age, gravidity, parity, the character of the amniotic fluid on ultrasound at admission (clear or echogenic), birth weight, and the character of the amniotic fluid on artificial or spontaneous rupture of membranes or on cesarean section (clear/with vernix/meconium-stained) were recorded.. When amniotic fluid was assessed on ultrasound, among 278 patients, 9 (3.2%) patients' amniotic fluid was echogenic. When the amniotic fluid was assessed at delivery, the rates of meconium-stained amniotic fluid in women with and without echogenic amniotic fluid were 44.44% (4/9) and 9.3% (25/269), respectively; the difference was statistically significant (p = 0.035). We found a sensitivity and specificity of 13.79 and 97.99%, and a positive and negative predictive value of 44.44 and 90.7%, respectively, for echogenic amniotic fluid seen on ultrasound in identifying meconium-stained amniotic fluid.. The incidence of echogenic amniotic fluid at term gestation was found as 3.2 and 44.4% of cases of echogenic amniotic fluid was associated with meconium.

Topics: Amniotic Fluid; Birth Weight; Cesarean Section; Female; Gestational Age; Humans; Incidence; Infant, Newborn; Labor, Obstetric; Maternal Age; Meconium; Parity; Pregnancy; Sensitivity and Specificity; Term Birth; Turkey; Ultrasonography

Many studies on prenatal tobacco exposure (PTE) effects have relied on single item retrospective measures of PTE. However, it is unclear how these single item measures may relate to more intensive maternal self-reports and to biological markers of maternal use and/or fetal exposure. It is also unclear whether these measures may be more valid predictors of fetal growth (gestational age, birthweight, head circumference, and birth length).. Data were obtained from 258 women during their pregnancy. PTE was assessed by four methods: a single item question, a calendar-based self-report measure from each trimester of pregnancy, maternal salivary cotinine assays, and nicotine and metabolites in infant meconium. We hypothesized that the more intensive measures and biological assays would account for additional variance in birth outcomes, above and beyond the single item measure.. The single item self-report measure was not related to fetal growth. However, the more intensive calendar based self-report measure and the biological assays of PTE (ie, maternal salivary assays and infant meconium) were significant predictors of poor fetal growth, even with the single item measure in the model.. The negative effects of PTE on important child outcomes may be greatly underestimated in the literature as many studies use single item self-report measures to ascertain PTE. Whereas more intensive self-report measures or biological assays may be cost prohibitive in large scale epidemiological studies, using a combination of measures when possible should be considered given their superiority both identifying prenatal smokers and predicting poor fetal growth.. The present work underscores the importance of measurement issues when assessing associations between PTE and fetal growth. Results suggest that we may be greatly underestimating the negative effects of prenatal smoking on fetal growth and other important child outcomes if we rely solely on restricted single item self-report measures of prenatal smoking. Researchers should consider more intensive prospective self-report measures and biological assays as viable and superior alternatives to single item self-report measures.

Topics: Biomarkers; Birth Weight; Cotinine; Female; Fetal Development; Gestational Age; Humans; Infant, Newborn; Longitudinal Studies; Maternal-Fetal Exchange; Meconium; Nicotine; Pregnancy; Pregnant Women; Saliva; Self Report; Smoking; United States

To estimate the levels of malondialdehyde (MDA) and 8-hydroxy-2-deoxyguanosine (8-OH-dG) in cord blood plasma of newborns born through meconium-stained amniotic fluid (MSAF) and also to find out the correlation between their levels with birth weight and gestation, we measured the cord blood plasma levels of MDA and 8-OH-dG in 59 newborns born through MSAF and 50 newborns born through clear liquor. The levels of cord blood plasma MDA and 8-OH-dG were significantly higher in full-term and late-preterm newborns born through MSAF. On further comparison, it was found that both full-term and late-preterm intrauterine growth restricted (IUGR) neonates had higher levels of these markers as compared to babies born as appropriate for gestational age (AGA) through MSAF. Plasma levels of MDA and 8-OH-dG were significantly correlated with birth weight even after controlling the relationship with gestational age for all cases as well as all full-term cases. These markers are also significantly correlated to each other.. The present study suggest that the neonates born through MSAF experience higher degrees of oxidative stress, as evidenced by increased levels of cord blood plasma MDA and 8-OH-dG. What is known: • Aspirated meconium has been found to induce free radical generation and cellular damage in animal studies. • Its role in free radical generation and oxidative damage in human neonates is scarce. What is new: • Neonates born through meconium-stained amniotic fluid experience significant oxidative stress.

Topics: 8-Hydroxy-2'-Deoxyguanosine; Amniotic Fluid; Biomarkers; Birth Weight; Chi-Square Distribution; Cross-Sectional Studies; Delivery, Obstetric; Deoxyguanosine; Enzyme-Linked Immunosorbent Assay; Female; Fetal Blood; Fetal Growth Retardation; Gestational Age; Humans; Infant, Newborn; Malondialdehyde; Meconium; Oxidative Stress; Pregnancy

The aim was to measure concentrations of four neutrophil-derived proteins in meconium as biomarkers describing prenatal environment.. Calprotectin, lactoferrin, myeloperoxidase and PMN-elastase concentrations were measured using ELISA kits in serial meconium portions (n = 81) from 20 healthy neonates.. The highest concentration was for calprotectin (286.5 ± 214.6 µg/g) with a positive correlation (r = 0.75, p < 0.0001) with myeloperoxidase (1.81 ± 1.72 µg/g). For PMN-elastase (1.70 ± 2.69 µg/g) a negative correlation was observed with calprotectin and myeloperoxidase (r = -0.51, p < 0.0001; r = -0.60, p < 0.0001, respectively). Concentration of lactoferrin (45.07 ± 78.53 µg/g) correlated only with that of myeloperoxidese (r = 0.36, p = 0.0009).. Calprotectin, lactoferrin, myeloperoxidase and PMN-elastase concentrations in meconium are interrelated. These proteins may serve as objective biomarkers describing and/or assessing the intrauterine environment.

Topics: Adult; Biomarkers; Birth Weight; Enzyme-Linked Immunosorbent Assay; Female; Gestational Age; Humans; Infant, Newborn; Inflammation; Lactoferrin; Leukocyte Elastase; Leukocyte L1 Antigen Complex; Male; Meconium; Neutrophils; Peroxidase

Tobacco exposure during pregnancy is a major factor of morbidity and mortality for both the pregnant woman and the fetus. Several studies in the past have detected and quantified tobacco smoke biomarkers in infant meconium samples. Aim of this study was to measure prenatal exposure to tobacco smoke by detecting nicotine and cotinine in meconium and to try to evaluate the extent of exposure to smoke through passive smoking as well as the relationship between tobacco biomarker meconium concentrations and neonatal outcomes. Tobacco smoke biomarkers nicotine and cotinine were detected and quantitated in meconium from tobacco exposed and non-exposed Greek neonates using liquid chromatography-tandem mass spectrometry. The study included 45 neonates from active, passive and non-smoking women during pregnancy. The results showed significant values of nicotine and cotinine concentration in neonates from both active and passive smokers which reached 125 ng g(-1) for nicotine and 98.5 ng g(-1) for cotinine and varied according to the type and level of exposure. In general nicotine and cotinine concentrations correlated with the degree of active smoking by the mother. Similarly, nicotine and cotinine were measured in the meconium of infants of passive smokers at concentrations comparable to those of infants whose mothers were moderate smokers. Our findings show that exposure of the fetus to tobacco biomarkers can be substantial even in passive maternal smoking and there is a statistically significant negative correlation between nicotine or cotinine concentrations in meconium and birth weight or gestational age at birth.

Topics: Adult; Biomarkers; Birth Weight; Chromatography, Liquid; Cotinine; Female; Fetal Development; Gestational Age; Greece; Humans; Infant; Infant, Newborn; Mass Spectrometry; Maternal Exposure; Maternal-Fetal Exchange; Meconium; Nicotine; Pregnancy; Smoking; Tobacco Smoke Pollution

This study aimed to assess the therapeutic results of ultrasound (US)-guided water-soluble contrast enema in very low birth weight (VLBW) preterm infants (<1,500 g) with meconium obstruction and to study factors that affect therapeutic results.. This study included a total of 33 consecutive VLBW infants with clinically diagnosed meconium obstruction underwent US-guided water-soluble contrast enema, from April 2007 to March 2014. Patients were classified into two groups based on to procedure outcome: the success group (evacuation of the meconium plug resolution followed by improved bowel distention within 2 days of the procedure, without additional interventions), and the failure group (the contrast enema failed to relieve the obstruction, or other procedure-related complications occurred). Patient- and mother-related clinical factors and procedure-related factors were compared between both groups.. Overall success rate was 54.5%, with 18 successful (M:F=10:8), and 15 failure (M:F=7:8) cases. When compared with the failure group, the success group patients showed statistically significant older gestational age (29(+1) vs. 27 weeks; p=0.028), larger birth weight (1023.1g vs. 790.3g; p=0.048), and higher body weight on the day of the procedure (1036.2g vs. 801.6g, p=0.049). However, no statistically significant differences were seen between other patient and maternal factors. Among the procedure-related factors, retrial of contrast injection during the procedure was associated with significantly higher success than the single trial (p=0.027). The presence of refluxed contrast into the distal ileum was the statistically significant predictor for success of the procedure (p=0.038). There were three cases of bowel perforation (9.1% per person).. US-guided water-soluble contrast enema in VLBW infants with meconium obstruction showed a 54.5% success rate and a 9.1% perforation rate per person. Among the procedure-related factors, retrial of contrast injection during the procedure and the presence of refluxed contrast into the distal ileum were related to the success of the procedure.

Topics: Acetylcysteine; Birth Weight; Cathartics; Contrast Media; Diatrizoate Meglumine; Enema; Expectorants; Female; Gestational Age; Humans; Ileal Diseases; Infant, Newborn; Infant, Premature; Infant, Very Low Birth Weight; Intestinal Obstruction; Intestinal Perforation; Iothalamic Acid; Male; Meconium; Radiography; Retreatment; Sodium Chloride; Time Factors; Treatment Outcome; Ultrasonography, Interventional

Identification of women with moderate alcohol abuse during pregnancy is difficult. We correlated self-reported alcohol consumption during pregnancy and patient characteristics with objective alcohol indicators measured in fetal meconium.. A total of 557 women singleton births and available psychological tests, obstetric data and meconium samples were included in statistical analysis. Alcohol metabolites (fatty acid ethyl esters (FAEEs) and ethyl glucuronide (EtG)), were determined from meconium and correlated with patient characteristics.. We found that 21.2% of the 557 participants admitted low-to-moderate alcohol consumption during pregnancy. Of the parameters analyzed from meconium, only EtG showed an association with alcohol history (P < 0.01). This association was inverse in cases with EtG value above 120 ng/g. These values indicate women with most severe alcohol consumption, who obviously denied having consumed alcohol during pregnancy. No other associations between socioeconomic or psychological characteristics and the drinking status (via meconium alcohol metabolites) could be found.. Women who drink higher doses of ethanol during pregnancy, according to metabolite measures in meconium, might be less likely to admit alcohol consumption. No profile of socioeconomic or psychological characteristics of those women positively tested via meconium could be established.

Topics: Adult; Alcoholism; Birth Weight; Cohort Studies; Female; Germany; Humans; Infant, Newborn; Male; Meconium; Pregnancy; Pregnancy Complications; Prospective Studies; Psychological Tests; Young Adult

Obesity is a public health problem and is increasing in all populations, including pregnant women. It influences maternal and neonatal outcomes; however, data are scarce in developing countries. We aimed to compare perinatal results between obese and non-obese pregnant women in a low-risk maternity.. Transversal study of 1,779 40-week-pregnancies from 2005 to 2009 that completed a standard questionnaire with sociodemographic, obstetrical and neonatal variables and performed an ultrasound with amniotic fluid index (AFI) measurement and foetal vitality (FBP, non-stress test). They were analysed about their association with obesity on pregnancy.. When compared with non-obese women, the group of obese patients had higher systolic (118.1 vs 109.2 mmHg; p < 0.01) and diastolic (76.6 vs 70.4 mmHg; p < 0.01) pressure levels, AFI (12.52 vs. 9.61 cm; p = 0.02), presence of meconium on labour (20.52 vs. 14.67%; p = 0.02), birthweight (3602 vs. 3437 g; p < 0.01) and caesarean section (39.74 vs. 29.98%, p < 0.01).. Labour induction before 40 weeks in the antenatal period associated with foetal weight estimation should be considered as a recommendation for decreasing high percentages of caesarean delivery found in obese women.

Topics: Adult; Amniotic Fluid; Birth Weight; Blood Pressure; Body Mass Index; Brazil; Cesarean Section; Female; Fetal Macrosomia; Humans; Infant, Newborn; Labor, Induced; Meconium; Obesity; Pregnancy; Surveys and Questionnaires; Ultrasonography; Young Adult

Meconium is a biomarker matrix that can be used to assess cumulative exposures in epidemiologic studies of prenatal risk factors. Depending on when meconium is collected, different exposure windows during pregnancy can be measured. However, little guidance exists regarding the extent to which timing of meconium collection will influence resulting effect estimates.. We performed a simulation study of prenatal tobacco smoke exposure (assessed from meconium nicotine) and birth weight. We discuss four typical meconium collection methods capturing different exposure windows and assess the biases induced by these methods.. In simulations assuming that exposure to tobacco smoke only during late gestation was of etiologic relevance to birth weight, use of a meconium collection method that captured exposure windows other than late gestation resulted in biased estimates of the true nicotine-birth weight association.. Using meconium collection methods that do not reflect an exposure window of etiologic relevance can lead to biased results and erroneous conclusions regarding the nature of prenatal exposure-outcome associations. Understanding how prenatal exposure patterns vary across the pregnancy and exposure windows of etiologic relevance is essential in determining when and how to collect meconium for use in biomarker studies of prenatal exposure.

Topics: Biomarkers; Birth Weight; Female; Humans; Infant, Newborn; Male; Maternal Exposure; Meconium; Nicotine; Pregnancy; Pregnancy Trimesters; Prenatal Exposure Delayed Effects; Smoking; Time Factors; Tobacco Smoke Pollution

The aim of the study was to determine whether longitudinal measurements of fecal S100A12, a damage-associated molecular pattern protein, which is released from neutrophils or monocytes under stress, can detect very-low-birth-weight (VLBW) infants at risk for intestinal distress apart from necrotizing enterocolitis.. This prospective study included 46 VLBW infants with intestinal distress and 49 reference patients. Meconium and stool samples were collected prospectively on alternate days for 4 weeks, and fecal S100A12 was measured by enzyme-linked immunosorbent assay.. Gestational age and weight at birth were significantly lower in patients with intestinal distress when compared to unaffected reference infants. Median levels of fecal S100A12 were significantly higher in patients with intestinal distress at onset of disease and before compared with unaffected reference infants. Median levels of fecal S100A12 declined steadily to baseline levels within 2 weeks after disease onset. The ideal cutoff value for identifying patients with intestinal distress within 7 days before disease onset was 60 μg/kg (sensitivity 0.73; specificity 0.55).. Fecal S100A12 levels are increased in VLBW infants with intestinal distress; however, the potential for S100A12 as an early biomarker is largely limited by overlaps between values of infants with intestinal distress and the reference population.

Topics: Biomarkers; Birth Weight; Enzyme-Linked Immunosorbent Assay; Feces; Female; Gestational Age; Humans; Infant; Infant, Newborn; Infant, Newborn, Diseases; Infant, Very Low Birth Weight; Intestinal Diseases; Intestinal Mucosa; Leukocytes; Longitudinal Studies; Male; Meconium; Monocytes; Neutrophils; Prospective Studies; Reference Values; S100 Proteins

The coagulation system of the foetus is markedly different from that of adults. To assess the influence of maternal age, mode of delivery and intrapartum events, and foetal gender and weight on the foetal coagulation system. Cord blood was collected from 154 healthy pregnant women, with gestational age 37 - 42 weeks at birth. Mann-Whitney test was used for analysis of binary data and continuous variables were analysed using Pearson's correlation coefficient. Mean cord blood levels of FVIII:C, VWF:Ag, VWF:CB, FIX, FXI, FXII and plasminogen were significantly higher in babies delivered after labour, compared to those delivered after an elective caesarean. Mean cord blood levels of FII (P = 0.003), FV (P = 0.009), FVII (P = 0.0004) and FX (P = 0.0009) were significantly lower in the babies with meconium stained liquor in labour, compared with those with clear liquor. Augmentation with oxytocin, instrumental delivery, did not affect any of the factor levels and duration of labour did not have an effect on the level of coagulation proteins in cord blood. This study provides valuable information about effect of labour on the coagulation system of the foetus. It is concluded that, in cord blood, the results of coagulation parameters in the newborn baby should be considered in light of mode of delivery and events of labour.

Topics: Adult; Birth Weight; Blood Coagulation; Blood Coagulation Factors; Cesarean Section; Delivery, Obstetric; Female; Fetal Blood; Humans; Infant, Newborn; Labor, Obstetric; Male; Maternal Age; Meconium; Middle Aged; Multivariate Analysis; Oxytocin; Pregnancy; Term Birth; Young Adult

To determine delivery outcome in women undergoing induction of labor for postdate pregnancy in relation to fetal gender.. A total of 365 nulliparous and 127 multiparous women carrying singleton postdate pregnancies with unfavorable cervix were enrolled. Clinical characteristics and delivery outcome were analyzed in relation to fetal gender.. Women carrying male fetuses showed higher rate of caesarean section than those carrying females, in both nulliparous and multiparous women. Moreover, women carrying male fetuses presented more frequently with (i) interval between induction of labor and delivery >24 hours (P < .0002); (ii) augmentation of labor after cervical ripening (P < .0391); (iii) meconium-stained liquor (P< .0126); and (iv) higher neonatal weight (P < .0011) than those carrying females.. Male fetuses are more likely to be associated with higher rates of cesarean section. In maternal fetal medicine, gender differences may add prognostic information on the delivery outcome in women induced for postdate pregnancy.

Topics: Adult; Birth Weight; Cervical Ripening; Cesarean Section; Female; Gestational Age; Humans; Infant, Newborn; Labor, Induced; Labor, Obstetric; Male; Meconium; Odds Ratio; Parity; Pregnancy; Pregnancy, Prolonged; Retrospective Studies; Risk Factors; Sex Factors; Time Factors

To explore risk factors for group B Streptococcus (GBS) colonization during pregnancy and at delivery, estimate the predictive value of early GBS colonization for colonization at delivery and in the newborn, and explore the relationship to adverse perinatal factors.. Cohort study of pregnant women from three communities in Zimbabwe.. Information collected by questionnaire at inclusion and from delivery records. Vaginal and rectal swabs collected for GBS culture at 20 and 26 weeks gestation, at delivery and from the newborn infant.. GBS colonization in pregnancy, colonization of mother and newborn, and perinatal factors.. GBS culture results were obtained at one or more occasion for 780 (75.2%) of 1,037 women recruited. Altogether, 470/780 women (60.3%) tested positive for GBS, with colonization rates at 20, 26 weeks and delivery of 47%, 24.2% and 21%, respectively. Positive GBS culture at 20 and 26 weeks gestation had a low positive predictive value on colonization at delivery and in the newborn. Women living in rural areas were significantly more often colonized than those who lived in urban areas (p < 0.001). Other socio-economic, demographic and obstetric factors were not statistically associated with GBS colonization. GBS transmission was not statistically significantly associated with adverse perinatal outcomes.. GBS colonization was common among pregnant women in Zimbabwe. Dwelling in a rural area was significantly associated with GBS colonization while other risk factors were not. Early GBS colonization had a low predictive value for colonization at delivery and colonization was not associated with adverse perinatal outcome.

Topics: Birth Weight; Cohort Studies; Delivery, Obstetric; Female; Gestational Age; Humans; Infant, Newborn; Infectious Disease Transmission, Vertical; Meconium; Predictive Value of Tests; Pregnancy; Pregnancy Complications, Infectious; Risk Factors; Rural Population; Streptococcal Infections; Streptococcus agalactiae; Urban Population; Zimbabwe

Preterm infants may pass meconium only after the first 48 hours of life, even in absence of any gastrointestinal disease. The role of various factors in determining the time of meconium elimination has been recently assessed. Gestational age and start of feeding had been demonstrated to influence first meconium timing. The aim of our study was to evaluate time of first meconium passage and the time to achieve regular bowel movements (RBM), correlating these two events to different factors such as gestational age (GA), sex, type of delivery [caesarean section (CS) vs spontaneous delivery (SD)], 1' and 5' Apgar score (1'AS, 5'AS), time and type of feeding, oxygen requirement and any mode of respiratory support.

Topics: Apgar Score; Birth Weight; Bottle Feeding; Breast Feeding; Cesarean Section; Defecation; Delivery, Obstetric; Female; Gestational Age; Humans; Infant; Infant, Newborn; Infant, Premature; Meconium; Oxygen Inhalation Therapy; Pregnancy

The present study compares the clinical presentation and diagnostic features of meconium ileus (MI) in newborns with and without cystic fibrosis (CF). A retrospective study of 43 patients treated in the Pediatric Surgical Center of Amsterdam was performed. Twenty-three of the patients (53.5%) were diagnosed as having CF. Complex MI was significantly more frequent in patients without CF, and these patients had lower gestational ages and birth weights than patients with CF. All of the patients with complex MI had homozygous DF508 mutations, whereas the patients with simple MI also had other mutations. None of the patients with other mutations had complex MI. Therefore, we conclude that the clinical entity of MI represents a spectrum of underlying pathologies.

Topics: Birth Weight; Cystic Fibrosis; Cystic Fibrosis Transmembrane Conductance Regulator; Genotype; Gestational Age; Humans; Ileus; Incidence; Infant, Newborn; Meconium; Mutation; Retrospective Studies

The evaluation of infant meconium as a cumulative matrix of prenatal toxicant exposure requires comparison to established biomarkers of prenatal exposure.. We calculated the frequency of detection and concentration of tobacco smoke metabolites measured in meconium (nicotine, cotinine, and trans-3'-hydroxycotinine concentrations) and three serial serum cotinine concentrations taken during the latter two-thirds of pregnancy among 337 mother-infant dyads. We estimated the duration and intensity of prenatal tobacco smoke exposure using serial serum cotinine concentrations and calculated geometric mean meconium tobacco smoke metabolite concentrations according to prenatal exposure. We also compared the estimated associations between these prenatal biomarkers and infant birth weight using linear regression.. We detected nicotine (80%), cotinine (69%), and trans-3'-hydroxycotinine (57%) in most meconium samples. Meconium tobacco smoke metabolite concentrations were positively associated with serum cotinine concentrations and increased with the number of serum cotinine measurements consistent with secondhand or active tobacco smoke exposure. Like serum cotinine, meconium tobacco smoke metabolites were inversely associated with birth weight.. Meconium is a useful biological matrix for measuring prenatal tobacco smoke exposure and could be used in epidemiological studies that enroll women and infants at birth. Meconium holds promise as a biological matrix for measuring the intensity and duration of environmental toxicant exposure and future studies should validate the utility of meconium using other environmental toxicants.

Topics: Adult; Biomarkers; Birth Weight; Cohort Studies; Cotinine; Female; Humans; Infant, Newborn; Male; Maternal Exposure; Meconium; Nicotine; Pregnancy; Prenatal Exposure Delayed Effects; Prospective Studies; Tobacco Smoke Pollution

Buprenorphine is under investigation in the U.S. as pharmacotherapy for opioid-dependent pregnant women. Buprenorphine and metabolites were quantified in umbilical cord specimens from women receiving daily buprenorphine doses. Correlations between maternal buprenorphine dose, buprenorphine and metabolite umbilical cord concentrations, and neonatal outcomes were investigated, as well as the ability to identify heroin and cocaine relapse during pregnancy. Umbilical cord concentrations were compared to those of matched umbilical cord plasma and meconium. Buprenorphine metabolites were detected in all cords, but buprenorphine itself was absent. Concentration ranges were 1.2-5.1 ng/g norbuprenorphine, 1.7-4.2 ng/g buprenorphine-glucuronide, and 8.3-23 ng/g norbuprenorphine-glucuronide. Cord concentrations were similar to those in plasma, and lower (16-210-fold), although statistically correlated, than those in meconium. Significant positive correlations were observed for buprenorphine-glucuronide concentrations in umbilical cord and mean maternal BUP daily dose throughout pregnancy and third trimester, but buprenorphine biomarker concentrations did not predict neonatal outcomes. Opiate concentrations were lower (200-fold) in umbilical cord than in meconium, and when cocaine was present in meconium, it was not identified in cord. Umbilical cord can serve as an alternative matrix for identifying prenatal drug-exposure, but is much less sensitive than meconium. Buprenorphine provided a controlled drug administration model for evaluating drug disposition in the maternal-fetal dyad.

Topics: Adult; Analgesics, Opioid; Apgar Score; Birth Weight; Buprenorphine; Dose-Response Relationship, Drug; Drug Monitoring; Female; Fetal Blood; Gestational Age; Humans; Infant, Newborn; Length of Stay; Maternal Exposure; Meconium; Opiate Substitution Treatment; Pregnancy

The time of passing meconium and the subsequent stooling pattern is an important marker in the diagnosis of colonic motility problems in newborns, particularly in Hirschsprung's disease (HD).. A cross-sectional study of the passage of meconium and stooling pattern in 280 normal newborns was undertaken using questionnaires administered to mothers attending a postnatal clinic.. There were 143 boys and 137 girls aged 6-49 days (median 19 days); 266 (95%) had been full-term infants, 252 (90%) normal deliveries and 28 (10%) delivered by caesarean section. The birthweight of 25 (9%) had been <2.5 kg. Of 267 infants whose mothers knew the time of first passing meconium, it had been delayed for up to 48 hours in 45 (16.9%) and up to 72 hours in 15 (5.6%), and six (2.2%) passed meconium after 72 hours. Overall, 201 (75.3%) passed meconium within 24 hours of birth, 246 (92.1%) within 48 hours and 261 (97.8%) within 72 hours. Irrespective of the time of passing meconium, 80 (31%) infants continued to pass stools at least once daily, 107 (42%) twice daily and 65 (24%) three or more times daily. Only 11 infants were on artificial milk along with breast milk; the remainder were exclusively breastfed. Mode of delivery, birthweight and artificial milk had no effect on time of passing meconium and the subsequent stooling pattern.. This study has shown that only 76% of normal infants passed first meconium within 24 hours and, by 3 days of life, a small minority still had not passed meconium. Nearly all normal infants being breastfed should defaecate at least once daily. These findings should be useful in the evaluation of newborns suspected to have HD in this and similar settings.

Topics: Birth Weight; Breast Feeding; Cross-Sectional Studies; Defecation; Female; Gastrointestinal Motility; Hirschsprung Disease; Humans; Infant; Infant, Newborn; Male; Meconium; Nigeria; Predictive Value of Tests; Time Factors

Contrast enema is the initial study of choice for simple meconium ileus to confirm diagnosis and to relieve obstruction. Despite favorable historically published results, our clinical impression suggests decreased effectiveness of the contrast enema resulting in more surgical interventions in contemporary practice.. A retrospective multiinstitutional review for a 12-year period was conducted for neonates diagnosed with meconium ileus by contrast enema. The neonates were divided into 2 groups-historic group (HG = before 2002) and contemporary group (CG = after 2002). T test was used for comparison of continuous variables and chi(2) for categorical data.. Thirty-seven total patients were identified (21 females and 16 males). Obstruction was relieved in 8 neonates (22% overall success rate). Average enema attempt per patient was decreased in the CG group compared to HG (1.4 vs 1.9). The success rate in the CG group was 5.5% (1/18) compared to 39% (7/18) in HG.. In this review, success of contrast enema for relief of meconium ileus has significantly decreased over time. These findings may be because of reluctance to repeat enemas, change in radiologist experience, or use of contrast agent. As a result, higher rates of operative intervention are now observed. In stable patients, surgeons should recommend repeat enemas before exploration.

Topics: Birth Weight; Cystic Fibrosis; Diatrizoate Meglumine; Enema; Female; Gestational Age; Humans; Ileus; Infant, Newborn; Male; Meconium; Preoperative Care; Radiography; Retrospective Studies; Treatment Outcome

The incidence of meconium aspiration syndrome (MAS), associated perinatal factors, morbidity and deaths varies widely. This study aimed to assess the perinatal attributes and morbidity associated with MAS.. Over a 2-year period, all neonates born through meconium-stained amniotic fluid (MSAF) were observed for respiratory distress (RD). Birth details, chest radiograph (CXR) and clinical course were documented. Neonates with consistent CXR findings whose RD could not otherwise be explained were defined as MAS.. Of 409 neonates born through MSAF, meconium was thick in 196 (47.9%). Fifty-five (13.4%) had RD and 45 (11.3%) were consistent with MAS. Six (1.5%) neonates died. Mean (SD) birthweight and gestation of MAS infants were 2721.9 (510.2) g and 38.67 (1.09) weeks, respectively. About one-third were of low birthweight and 28 were born by caesarean section. On univariate analysis, caesarean delivery, meconium in the trachea and thick meconium were the significant perinatal factors for the development of MAS. On multiple regression analysis, thick meconium was the only independent factor for MAS (OR 7.08, 95% CI 3.08-16.27, p<0.001). An Apgar score of

Topics: Amniotic Fluid; Apgar Score; Birth Weight; Delivery, Obstetric; Female; Gestational Age; Humans; Infant, Newborn; Meconium; Meconium Aspiration Syndrome; Pregnancy; Prospective Studies; Respiration, Artificial; Risk Factors

First passage of stool after birth, meconium, is delayed in preterm infants compared to term infants. The difference in duration of meconium passage until transition to normal stools has however never been assessed in preterm and term infants.. Preterm infants have prolonged duration of passage of meconium (PoM) compared to term infants.. Between August and November 2006, all infants born in an academic and non-academic hospital with gestational age (GA) 25-42 weeks and without metabolical, congenital diseases or gastrointestinal disorders, were included. Infants were divided into four groups: (A) GA < or =30 weeks; (B) GA between 31 and 34 weeks; (C) GA between 35 and 36 weeks; (D) GA > or = 37 weeks (term born).. A total of 198 infants (102 males); 32, 62, 33 and 71 infants in groups A, B, C and D, respectively, were included. With decreasing gestation a trend was found for delayed first PoM (p<0.001). Compared to term infants 79% (56/71), less preterm infants passed their first stool within 24 h after birth--group A: 44% (14/32); group B: 68% (42/62); and group C: 73% (24/33). With decreasing gestation a trend for prolonged PoM was found (p<0.001). The mean (SD) PoM duration was prolonged in group A: 7.8 days (2.5); group B: 4.3 days (2.4); and group C: 2.9 days (1.3) compared to term infants. Furthermore, PoM was associated with birth weights < or =2500 g (p = 0.03) and morphine therapy (p = 0.03). Duration of PoM was not associated with type of feeding, small for gestational age, large for gestational age or need for respiratory support.. PoM was not only delayed but also prolonged in preterm infants. Duration of PoM was associated with GA, birth weight and morphine therapy.

Topics: Analgesics, Opioid; Birth Weight; Female; Gastrointestinal Transit; Humans; Infant Nutritional Physiological Phenomena; Infant, Newborn; Infant, Premature; Meconium; Morphine; Pregnancy; Time Factors; Treatment Outcome

The purpose of this study was to evaluate the obstetric outcomes and pathologic findings in women with sickle cell trait.. In this retrospective case control study, pregnant women with sickle cell trait were studied over a 4-year period (2001-2005). The women who were delivered at > 16 weeks of gestation were compared with a cohort group of subjects with normal hemoglobin levels, and the placentas were sent for pathologic evaluation.. A total of 180 pregnancies were studied with a like number of control patients. Subjects who had sickle cell trait demonstrated shorter average duration of pregnancy (233 +/- 45 days vs 255 +/- 34 days; P < .001) and lower birth weight (2114 +/- 1093 g vs 2672 +/- 942 g; P < .001). The rate of fetal death was significantly higher among study group patients (3.5% vs 9.7%; P = .015) when compared with the control group. Additionally, in study women, acute ascending amniotic infection and meconium histiocytosis were noted much more frequently. Sickling in the intervillous space and decidual vessels that were not associated with artifactual change was also found among patients sickle cell trait.. Patients with sickle cell trait appear to be at increased risk for fetal loss compared with women with normal hemoglobin levels, and placental abnormalities may play a causal role.

Topics: Abortion, Spontaneous; Acute Disease; Amnion; Birth Weight; Case-Control Studies; Delivery, Obstetric; Female; Fetal Death; Fetal Diseases; Fetal Viability; Gestational Age; Histiocytosis; Humans; Incidence; Infections; Meconium; Pregnancy; Pregnancy Complications, Hematologic; Pregnancy Complications, Infectious; Pregnancy Trimester, First; Retrospective Studies; Sickle Cell Trait

Evaluation of the relationship between umbilical coiling index (UCI) and adverse perinatal outcome.. A prospective study was performed on 699 pregnant women who were 37-40 weeks. UCI was determined by dividing the total number of the complete vascular coiling by the total umbilical cord length in centimeters. Then the relationship between UCI and neonatal weight, amniotic fluid index, meconium, Apgar score, and fetal distress were evaluated.. There was a significant difference between normo- and hypocoiled groups according to the Apgar score less than 7 in minute 5, AFI

Topics: Adolescent; Adult; Amniotic Fluid; Birth Weight; Cross-Sectional Studies; Diabetes, Gestational; Female; Fetal Distress; Humans; Infant, Newborn; Meconium; Multivariate Analysis; Obstetric Labor Complications; Pregnancy; Pregnancy in Diabetics; Pregnancy Outcome; Prospective Studies; Regression Analysis; Risk Factors; Umbilical Cord

To investigate (A) the determinants of infant stress response at delivery and (B) test the hypothesis that stress at birth, as reflected by cord arterial cortisol, influences cortisol response to vaccination at two months.. Prospective observational study.. Tertiary referral maternity hospital.. One hundred and seventy-two primiparous women with uncomplicated singleton pregnancies.. Women were recruited antenatally. At birth, cord arterial blood and obstetric data were collected. Saliva was collected from infants immediately before and after vaccination at two months. Cortisol was analysed from cord blood and saliva by radio-immunoassay.. Stress response at birth, as demonstrated by cord arterial cortisol; association with saliva cortisol response to vaccination at two months.. Cord arterial cortisol varied with mode of delivery, combined spinal/epidural use and pH. Salivary cortisol response at two months correlated with cord arterial cortisol (r= 0.24, P < 0.05). Infants with the highest and lowest cord arterial cortisol had markedly different cortisol responses at two months (P= 0.017). These groups had different modes of delivery with caesarean rates of <8% in the high cortisol response group and 83% in the low cortisol response group (P < 0.0001).. Babies born vaginally mount greater cortisol responses at birth than those delivered by caesarean section. Stress at delivery may influence the infant HPA axis response for up to two months.

Topics: Amniotic Fluid; Analysis of Variance; Birth Weight; Cohort Studies; Delivery, Obstetric; Female; Fetal Blood; Humans; Hydrocortisone; Hydrogen-Ion Concentration; Male; Meconium; Prospective Studies; Stress, Physiological

The mineral concentration of meconia of small for gestational age (SGA) newborns were compared with those of appropriate for gestational age (AGA) newborns of similar gestational ages (GA) to determine whether differences may provide clues of possible nutritional deficits of SGA infants, given that levels of meconium minerals could indicate the use of minerals by the fetus and the sufficiency of the maternal supply of minerals. Twenty-one SGA and 24 AGA newborns were included. Eleven SGA and 15 AGA were < or = 35 weeks GA. Ten SGA and nine AGA infants were > or = 36 weeks GA. All meconia from each neonate was processed and assayed for iron, zinc, copper, manganese, calcium, magnesium, and phosphorus. In the < or = 35-week subgroups, the SGA infants had lower meconium iron and manganese concentrations than that of the AGA. Among > or = 36-week newborns, SGA infants had a higher birthweight-adjusted copper concentration than AGA infants, but no differences were observed for the remaining elements. Lower iron and manganese meconium in < or = 35-week SGA infants may reflect either a greater use or a decreased maternal supply. The higher birthweight-adjusted meconium copper in the > or = 36-week SGA infants may be due to a comparatively reduced fetal use or increased maternal supply. These data may assist in clarifying potential mechanisms affecting intrauterine growth and/or potential nutrient deficits in the neonatal period.

Topics: Birth Weight; Female; Gestational Age; Humans; Infant, Newborn; Infant, Small for Gestational Age; Male; Meconium

The incidence of preterm meconium staining of the amniotic fluid (MSAF) is uncertain. It may be an indicator of possible listeriosis. It is unclear how great this risk is or whether preterm MSAF is a risk factor for adverse neonatal outcome.. To investigate the incidence of preterm MSAF, the incidence of associated maternal and neonatal infection, and the outcomes of the infants at discharge.. Retrospective case-control study.. Infants < 33 weeks gestation with preterm MSAF born in the Simpson Memorial Maternity Pavilion, Edinburgh between 1 January 1994 and 2 January 2001 were matched with the next infant of the same sex and gestation with clear liquor. Maternal and infant characteristics, culture results, placental histology, and clinical outcomes were compared.. Preterm MSAF was observed in 45/1054 (4.3%) infants below 33 weeks gestation. No maternal or infant listeriosis was identified in cases or controls. There was no significant difference in birth weight, Apgar score, or first pH between cases and controls. Preterm MSAF was associated with prolonged rupture of the membranes (odds ratio (OR) 3.34, 95% confidence interval (CI) 1.07 to 10.49), but not maternal hypertension, sepsis, or chorioamnionitis. Severe (grade 3/4) intraventricular haemorrhage was significantly more common in infants with preterm MSAF (OR 2.03, 95% CI 1.62 to 2.53). There was no significant difference in mortality. Early onset sepsis was observed in two cases and three controls.. Preterm meconium staining of the amniotic fluid may be associated with increased risk of intraventricular haemorrhage. It does not appear to be a useful indicator of listeriosis.

Topics: Amniotic Fluid; Birth Weight; Cerebral Hemorrhage; Chronic Disease; Epidemiologic Methods; Female; Humans; Infant, Newborn; Infant, Premature, Diseases; Leukomalacia, Periventricular; Lung Diseases; Male; Meconium; Pregnancy; Pregnancy Complications, Infectious; Prognosis; Scotland; Twins

Trefoil factor 3 (TFF3) or intestinal trefoil factor (ITF), a peptide normally expressed and secreted by goblet cells at the mucosal surface of the small intestine and colon, is important for the maintenance and repair of the intestinal mucosal barrier.. To study the ontogeny and developmental expression of TFF3 in human intestine.. We examined TFF3 expression in formalin-fixed and paraffin-embedded intestinal tissues from 24 fetuses (gestational age [GA] 12-23 weeks) and 5 adults by immunohistochemical staining. To determine whether TFF3 is excreted into the fetal intestinal tract, first-passed meconium samples were collected from 43 newborn infants (gestational age 24-41 weeks). The presence of TFF3 was examined by Western blot analysis and the relative levels of TFF3 in the meconium were quantified with a slot blot assay.. TFF3 can be detected by immunohistochemistry in human intestine as early as 12 weeks gestation. TFF3 is present in the meconium of newborn infants; no significant difference exists in TFF3 levels in the meconium of premature infants with birth weight (BW) less than 1500 g compared to those with birth weight equal to or more than 1500 g.. Premature infant's susceptibility to intestinal mucosal injury is unlikely to be explained by developmental expression of TFF3 in human intestine since secreted TFF3 is not deficient in premature infants.

Topics: Adult; Birth Weight; Blotting, Western; Electrophoresis, Polyacrylamide Gel; Gestational Age; Humans; Immunohistochemistry; Infant, Newborn; Infant, Premature; Intestinal Mucosa; Intestines; Linear Models; Meconium; Mucins; Muscle Proteins; Peptides; Trefoil Factor-3

To evaluate the effect of gender, gestational age, birthweight, mode of delivery, 5'-Apgar score and maternal conditions on calprotectin concentrations in meconium.. Calprotectin was measured in 131 neonates, in the first passed meconium.. Calprotectin levels (mean +/- SD) resulted in 145.2 +/- 78.5 mg kg(-1) meconium, significantly correlated with birthweight (r = -0.333; p < 0.001), gestational age (r = -0.206; p = 0.018) and 5'-Apgar score (r = -0.243, p = 0.035). The estimated regression model was: calprotectin levels (mg kg(-1)) = 269.58-41.54 weight (kg): r = 0.383, p < 0.001. No differences were found in relation to gender, mode of delivery and maternal conditions.. Calprotectin is already present in the first passed meconium, with higher levels in preterm and low birthweight neonates, as well as in neonates with some degree of perinatal asphyxia, as indicated by the negative correlation with 5'-Apgar score. These findings are probably secondary to both the immaturity of the intestinal mucosa and its hypoxic-ischaemic damage.

Topics: Apgar Score; Birth Weight; Delivery, Obstetric; Female; Gestational Age; Humans; Infant, Newborn; Intestinal Diseases; Leukocyte L1 Antigen Complex; Male; Maternal Welfare; Meconium; Predictive Value of Tests; Pregnancy; Sex Factors

The purpose of this study was to determine whether meconium-stained amniotic fluid is associated with puerperal infection and whether the quality of the meconium is further associated with this risk.. We designed a retrospective cohort study of all deliveries beyond 37 weeks gestational age from 1992 to 2002 at a single community hospital. Data were collected on rates of chorioamnionitis, endomyometritis, quality of amniotic fluid, and length of labor and analyzed with bivariate and multivariate analyses.. We found that, among the 43,200 women who were delivered at term, 18.9% of the women had meconium staining (8.8% thin, 5.5% moderate, 4.6% thick). Compared with deliveries with clear amniotic fluid, those with meconium-stained amniotic fluid had higher rates of chorioamnionitis (2.3% vs 4.1%, P<.001) and endomyometritis (1.0% vs 1.7%, P<.001). Further, the severity of meconium staining was associated with increased rates of infection.. We found that the presence and severity of meconium-stained amniotic fluid is associated with puerperal infection even when being controlled for confounders.

Topics: Adult; Amniotic Fluid; Analysis of Variance; Birth Weight; Cesarean Section; Chorioamnionitis; Delivery, Obstetric; Educational Status; Endometritis; Ethnicity; Female; Gestational Age; Humans; Maternal Age; Meconium; Obstetric Labor Complications; Odds Ratio; Parity; Pregnancy; Pregnancy Outcome; Puerperal Infection

In vitro studies and animal experiments have provided evidence that albumin, bilirubin, meconium and inflammatory mediators act as surfactant inhibitors. The aim of this research was to establish whether their elevated concentrations in gastric aspirates, as representative samples of amniotic fluid, could contribute to the development of respiratory distress syndrome (RDS) in preterm infants.. Infants born before the 35th week of gestation between 1 March 1996 and 1 April 1997 were included. They were divided into two groups: the RDS and non RDS group. Gastric aspirates, taken immediately after birth, were used for biochemical measurements of albumin, bilirubin, meconium and E-alpha 1-PI concentrations.. Sixty-one preterm infants were enrolled: 23 in the RDS group. The concentrations of albumin, bilirubin and meconium in gastric aspirates were higher in the RDS group (p < 0.01, p = 0.01 and p = 0.02, respectively). The E-alpha 1-PI concentration showed no significant difference between the two groups. Logistic regression analysis showed that a markedly increased risk of RDS was only represented by albumin concentrations of over 1.6 mmol/l and gestational age of under 31 weeks.. Our observations indicate that increased levels of albumin in the gastric aspirate, taken immediately after birth, may contribute to the development of RDS in preterm infants. Despite the established inhibitory effects of bilirubin, meconium and inflammatory mediators in vitro, we could not confirm their influence on the development of RDS.

Topics: Albumins; alpha 1-Antitrypsin; Amniotic Fluid; Bilirubin; Birth Weight; Female; Gastric Juice; Gestational Age; Humans; Infant, Newborn; Infant, Premature; Leukocyte Elastase; Logistic Models; Male; Meconium; Pulmonary Surfactants; Respiration, Artificial; Respiratory Distress Syndrome, Newborn; ROC Curve

The objectives of this study were 1) to assess whether there is an independent association between the level of prenatal cocaine exposure and infants' developmental test scores after control of potential confounding variables; and 2) if such an association exists, to determine which biological and social variables, individually and in interaction with each other, may modify it.. In a prospective, longitudinal study of 203 urban term infants, 3 cocaine exposure groups were defined by maternal report and infant meconium assay: unexposed, heavier cocaine exposure (>75th percentile self-reported days of use or meconium benzoylecognine concentration), or lighter cocaine exposure (all others). Examiners, masked to exposure history, tested infants at 6, 12, and 24 months of age with the Bayley Scales of Infant Development.. The final mixed linear regression model included as fixed covariates level of prenatal exposure to cocaine, alcohol, and cigarettes; prenatal marijuana exposure; gestational age and birth weight z score for gestational age; and gender. Age at test, caregiver at time of each test (biological mother, kinship caregiver, unrelated foster caregiver), and any previous child-focused early intervention were included as time-dependent covariates. There were no significant adverse main effects of level of cocaine exposure on Mental Development Index (MDI), Psychomotor Development Index (PDI), or Infant Behavior Record. Child-focused early intervention interacted with level of cocaine exposure such that heavily exposed children who received such intervention showed higher adjusted mean MDI scores than all other groups. Although the sample was born at or near term, there was also a significant interaction of cocaine exposure and gestational age on MDI scores, with those in the heavier exposure group born at slightly lower gestational age having higher mean MDI scores compared with other children born at that gestational age. There was also a significant interaction on MDI between child's age and caregiver. At 6 months, the adjusted MDI of children living with a kinship caregiver was 15.5 points lower than that of children living with their biological mother, but this effect was diminished and was no longer significant at 24 months (difference in means: 4.3 points). The adjusted mean MDI of children in unrelated foster care at 6 months was 8.2 points lower than children of biological mothers, whereas it was 7.3 points higher at 24 months. Early intervention attenuated the age-related decline in PDI scores for all groups. Birth weight <10th percentile was associated with lower PDI scores for children with heavier cocaine exposure and with lower MDI scores for all groups.. Heavier prenatal cocaine exposure is not an independent risk factor for depressed scores on the Bayley Scales of Infant Development up to 24 months of age when term infants are compared with lighter exposed or unexposed infants of the same demographic background. Cocaine-exposed infants with birth weight below the 10th percentile for gestational age and gender and those placed with kinship caregivers are at increased risk for less optimal developmental outcomes. Pediatric clinicians should refer cocaine-exposed children to the child-focused developmental interventions available for all children at developmental risk.

Topics: Birth Weight; Boston; Cannabis; Caregivers; Child Development; Cocaine; Confounding Factors, Epidemiologic; Female; Humans; Infant, Newborn; Linear Models; Longitudinal Studies; Meconium; Models, Statistical; Multivariate Analysis; Pregnancy; Prenatal Exposure Delayed Effects; Prospective Studies; Psychomotor Performance; Risk Factors; Surveys and Questionnaires; Tobacco Smoke Pollution

Maternal use of cocaine during pregnancy remains a significant public health problem, particularly in urban areas of the United States and among women of low socioeconomic status. Few longitudinal studies have examined cocaine-exposed infants, however, and findings are contradictory because of methodologic limitations.. To assess the effects of prenatal cocaine exposure on child developmental outcomes.. Longitudinal, prospective, masked, comparison birth cohort study with recruitment in 1994-1996.. Obstetric unit of a large US urban teaching hospital.. Four hundred fifteen consecutively enrolled infants (218 cocaine-exposed and 197 unexposed) identified from a high-risk, low-socioeconomic status, primarily black (80%) population screened through clinical interview and urine and meconium samples for drug use. The retention rate was 94% at 2 years of age.. The Bayley Mental and Motor Scales of Infant Development, assessed at 6.5, 12, and 24 months of corrected age.. Controlled for confounding variables, cocaine exposure had significant effects on cognitive development, accounting for a 6-point deficit in Bayley Mental and Motor Scales of Infant Development scores at 2 years, with cocaine-exposed children twice as likely to have significant delay (mental development index <80) (odds ratio, 1.98; 95% confidence interval, 1.21-3.24; P =.006). For motor outcomes, there were no significant cocaine effects.. Cocaine-exposed children had significant cognitive deficits and a doubling of the rate of developmental delay during the first 2 years of life. Because 2-year outcomes are predictive of later cognitive outcomes, it is possible that these children will continue to have learning difficulties at school age.

Topics: Apgar Score; Birth Weight; Cocaine-Related Disorders; Cognition; Developmental Disabilities; Female; Gestational Age; Humans; Infant; Longitudinal Studies; Male; Meconium; Neuropsychological Tests; Pregnancy; Pregnancy Complications; Prenatal Exposure Delayed Effects; Psychomotor Performance; Socioeconomic Factors; Statistics, Nonparametric

To clarify electronic fetal heart rate (FHR) monitoring characteristics in pregnancies with preterm delivery before 32 weeks of gestation, using the late second-trimester nonstress test.. Among 953 children born from 1993 to 1996, we identified 100 singleton infants born before 32 weeks of gestation in whom second-trimester (24-27 weeks of gestation) electronic fetal monitoring (EFM) records were obtained. Individual components of the FHR patterns [baseline rate, baseline FHR variability, presence of acceleration (at least 10 beats/min for at least 10 s) and periodic or episodic deceleration (at least 25 beats/min for at least 15 s)] and birth characteristics were compared between pregnancy with or without second-trimester decelerations.. Among 100 infants, 65 had and 35 did not have second-trimester decelerations. There were no significant differences in gestational age at birth, birth weight, cord arterial blood pH, Apgar score and meconium staining between pregnancies with second-trimester decelerations and those without second-trimester decelerations. There were no significant differences in baseline rate and baseline variability between pregnancies with or without second-trimester decelerations. The number of accelerations in pregnancies with second-trimester decelerations was significantly more frequent than that in pregnancies without second-trimester decelerations (p < 0.001). There was a significant increase in the occurrence of premature rupture of the membranes (PROM; 60.0%) in pregnancies with second-trimester decelerations, when compared with events (37.1%) related to pregnancies without second-trimester decelerations (p < 0.05). There were no significant differences in the onset of breech presentation, cervical incompetency, preeclampsia and abnormal FHR pattern at birth between pregnancies with second-trimester decelerations and those without second-trimester decelerations. Pregnancies with PROM after second-trimester EFM were significantly more likely to have second-trimester decelerations than those without PROM (75.0 vs. 54.2%, p < 0.05).. Periodic or episodic decelerations during late second-trimester EFM were associated with an increased risk of the occurrence of PROM in pregnancies with preterm delivery before 32 weeks of gestation.

Topics: Adult; Apgar Score; Birth Weight; Breech Presentation; Female; Fetal Blood; Fetal Membranes, Premature Rupture; Fetal Monitoring; Gestational Age; Heart Rate, Fetal; Humans; Hydrogen-Ion Concentration; Infant, Newborn; Infant, Premature; Meconium; Obstetric Labor, Premature; Pre-Eclampsia; Pregnancy; Uterine Cervical Incompetence

The objective of this study was to describe drug use by pregnant women participating in the 4-site Maternal Lifestyle Study of in utero cocaine and/or opiate exposure.. Meconium specimens of 8527 newborns were analyzed by immunoassay with GC/MS confirmation for metabolites of cocaine, opiates, cannabinoids, amphetamines, and phencyclidine. Maternal self-report of drug use was determined by hospital interview.. The prevalence of cocaine/opiate exposure in the 4 sites was 10.7% with the majority (9.5%) exposed to cocaine based on the combination of meconium analysis and maternal self-report. However, exposure status varied by site and was higher in low birth weight infants (18.6% for very low birth weight and 21.1% for low birth weight). Gas chromatography/mass spectrometry (GC/MS) confirmation of presumptive positive cocaine screens was 75.5%. In the cocaine/opiate-exposed group, 38% were cases in which the mother denied use but the meconium was positive. There was 66% agreement between positive meconium results and positive maternal report. Only 2% of mothers reported that they used only cocaine during pregnancy and mothers were 49 times more likely to use another drug if they used cocaine.. Accurate identification of prenatal drug exposure is improved with GC/MS confirmation and when the meconium assay is coupled with a maternal hospital interview. However, the use of GC/MS may have different implications for research than for public policy. We caution against the use of quantitative analysis of drugs in meconium to estimate the degree of exposure. Our study also highlights the polydrug nature of what used to be thought of as a cocaine problem.

Topics: Adolescent; Adult; Amphetamines; Birth Weight; Cannabinoids; Cocaine; Female; Gas Chromatography-Mass Spectrometry; Humans; Infant, Newborn; Life Style; Longitudinal Studies; Meconium; Narcotics; Phencyclidine; Pregnancy; Pregnancy Complications; Substance-Related Disorders

Our aim was to compare the clinical characteristics of meconium aspiration syndrome in cases with pH > or =7.20 and in those with pH <7.20.. Medical records of diagnostic codes from the International Classification of Diseases, Ninth Revision, were used to identify neonates with severe meconium aspiration syndrome who had been delivered at our institution from 1994 through 1998. Severe meconium aspiration syndrome was defined as a mechanical ventilator requirement of >48 hours. Clinical data including neonatal outcomes of cases of meconium aspiration syndrome associated with umbilical pH > or =7.20 at delivery were compared with data on outcomes of cases with pH <7.20.. During this 4-year study period, 4985 singleton term neonates were delivered through meconium-stained amniotic fluid. Forty-eight cases met all study criteria, and pH values at delivery were as follows: pH > or =7.20, n = 29, and pH <7.20, n = 19. There were no differences between groups in the incidence of clinical chorioamnionitis, in the presence of meconium below the vocal cords, or in birth weight. Neonates with meconium aspiration syndrome and umbilical pH > or =7.20 at delivery developed seizures as often as those with pH <7.20 (20.1% vs 21.1%; P = 1.0).. Normal acid-base status at delivery is present in many cases of severe meconium aspiration syndrome, which suggests that either a preexisting injury or a nonhypoxic mechanism is often involved.

Topics: Acid-Base Equilibrium; Adult; Birth Weight; Chorioamnionitis; Delivery, Obstetric; Female; Humans; Hydrogen-Ion Concentration; Incidence; Infant, Newborn; Meconium; Meconium Aspiration Syndrome; Pregnancy; Seizures; Vocal Cords

To determine the incidence of meconium-stained amniotic fluid (MSAF) and neonatal morbidity in near-term and term deliveries with histologic acute chorioamnionitis and/or funisitis compared to those with normal placental histology.. In a retrospective case-control design, we compared the incidence of MSAF and neonatal outcome in 45 cases of acute histologic chorioamnionitis and/or funisitis with 89 cases of normal placental histology. We reviewed the obstetric and neonatal records for perinatal complications and neonatal morbidity.. Mean birthweights (3372+/-473 vs 3287+/-518 g) were similar in infants born to mothers with histologic chorioamnionitis and/or funisitis compared to infants born to mothers with normal placental histology. The incidence of MSAF was significantly higher in the group with acute chorioamnionitis/funisitis (p<0.05). Similarly, the incidence of admissions to newborn intensive care unit, respiratory distress, meconium aspiration syndrome, and presumed sepsis was also significantly higher (p<0.05) in this group.. The incidence of MSAF and neonatal morbidity is higher in the presence of acute inflammation of placental membranes. The presence of meconium in the amniotic fluid should alert the physician to the potential for infection and increased neonatal morbidity.

Topics: Acute Disease; Amniotic Fluid; Birth Weight; Case-Control Studies; Chorioamnionitis; Female; Fetal Distress; Hospitalization; Humans; Infant, Newborn; Meconium; Morbidity; Pregnancy; Pregnancy Outcome; Retrospective Studies; Umbilical Cord

We sought to determine whether umbilical cord plasma erythropoietin levels were different in deliveries complicated by meconium passage and to determine whether this response is influenced by gestational age.. Fetal erythropoietin levels were measured in 203 appropriately grown neonates at 37 to 43 weeks of gestation; among those, 70 had passed meconium.. Meconium passage in the entire population was associated with elevated fetal erythropoietin levels (68 vs 31 mIU/mL; P <.001). Cord blood gases, pH, base deficit, and PO (2), as well as the 1- and 5-minute Apgar scores, were not different between the meconium and no-meconium groups. Gestational age and birth weights were significantly higher in the meconium group. Stepwise multiple regression analysis with meconium and gestational age used as the independent variables showed both meconium and gestational age to be independently associated with fetal erythropoietin levels (r = 0.356, F = 14.5; meconium, P <.001; gestational age, P <.01).. These results suggest that meconium passage can be associated with chronic fetal hypoxia as demonstrated by elevated fetal erythropoietin levels, independent of gestational age.

Topics: Apgar Score; Birth Weight; Erythropoietin; Female; Fetal Blood; Fetal Hypoxia; Gestational Age; Humans; Hydrogen-Ion Concentration; Infant, Newborn; Logistic Models; Meconium; Odds Ratio; Oxygen; Pregnancy; Regression Analysis

The purpose of this study was to evaluate the meconium staining of amniotic fluid (AF) in term of fetal distress, meconium aspiration syndrome, and perinatal morbidity and mortality. In a prospective study at Princess Badeea Teaching Hospital from April to November 1999, women with a singleton cephalic pregnancy of completed 37-42 weeks and with no pre-defined risk factor were recruited into the study. Study patients comprised 390 (10%) patients with meconium and 400 patients as controls but with clear amniotic fluid. Virtually meconium staining of the amniotic fluid was significantly associated with poor neonatal outcome in all outcomes measures assessed. Perinatal mortality increased from 2 per 1000 births with clear AF to 10 per 1000 with meconium (P<0.001). Other adverse outcomes also increased; e. g., severe fetal acidemia, Apgar score < or = 3 at 1 min and 5 min, and meconium aspiration syndrome. Delivery by cesarean section also increased with meconium from 7-14% (P<0.001). We concluded that meconium in the amniotic fluids associated with an obstetric hazard and significantly increase risks of adverse neonatal outcomes. Women with thin meconium in the presence of normal fetal heart rate can be safely managed at the clinical level. Mod-thick meconium alone should alert the obstetrician to a high risk fetal condition. Continuous fetal heart rate monitoring during labour and reassurance of fetal well-being by acid-base assessment were most significant factors in the reduction of meconium aspiration syndrome.

Topics: Adult; Amniotic Fluid; Birth Weight; Cesarean Section; Chorioamnionitis; Female; Fetal Blood; Heart Rate, Fetal; Humans; Hydrogen-Ion Concentration; Infant, Newborn; Labor, Induced; Labor, Obstetric; Meconium; Meconium Aspiration Syndrome; Pregnancy; Pregnancy Outcome; Respiration, Artificial; Respiratory Distress Syndrome, Newborn; Suction

In order to evaluate the presence of nuchal cord entanglement and to measure resistance index with Doppler color ultrasonography, a prospective, observational, cross-sectional study was carried out, 132 low risk term pregnant women were included, 50 of them had umbilical cord encirclement (37%), the sensitivity, specificity, positive predictive and negative predictive values were 92%, 87%, 81% and 95%, respectively. McNemar'test for discordance had a p = 0.121 in comparing ultrasonography result with the gold standard. Patients with nuchal cord entanglement had higher frequency of cesarean section (70%, p < 0.05) than those without it. On the other hand, normal vaginal delivery was more common (46%, p < 0.05) in patients without nuchal coiling of the umbilical cord. There were no significant difference in evaluating acute fetal distress, meconium stained amniotic fluid, newborn Apgar scores at one and five minutes, birth weight, neonatal intensive care unit admissions and intrapartum stillbirths. In our patients with nuchal cord entanglement the resistance index average values were 0.59 and those without nuchal cord were 0.60 (p = 0.712). We concluded that color flow Doppler ultrasonography is a reliable tool to detect nuchal coiling of the umbilical cord, and therefore Doppler color waveforms assessment in nuchal cord entanglements might helpful for clinicians to decide a closer surveillance in labor by using intrapartum cardiotocography.

Topics: Adolescent; Adult; Apgar Score; Birth Weight; Cesarean Section; Cross-Sectional Studies; Delivery, Obstetric; Female; Fetal Distress; Fetus; Humans; Infant, Newborn; Meconium; Neck; Predictive Value of Tests; Pregnancy; Pregnancy Outcome; Prospective Studies; Sensitivity and Specificity; Ultrasonography, Doppler, Color; Ultrasonography, Prenatal; Umbilical Cord; Vascular Resistance

A 26-year-old, gravida 3 presented at 31 weeks of gestation with polyhydramnios. On ultrasound there was marked foetal ascitis with unilateral hydrocele. Patient delivered a 3.15 kg, large-for-date baby at 33 weeks and 3 days of gestation. On basis of clinical, radiological and sonographic features, diagnosis of meconium peritonitis was made. Ascitic tapping was done. Surgery was withheld, as there were no signs of intestinal obstruction. DNA testing for cystic fibrosis was negative. Baby did not deteriorate so he was discharged. Baby was doing well on 2 months follow up. Hydrocele and ascitis were resolving. Rarely meconium peritonitis may occur without an underlying cause when peritonitis may be innocuous and intervention may not be required.

Topics: Adult; Ascites; Birth Weight; Female; Fetal Diseases; Gestational Age; Humans; Infant, Newborn; Meconium; Peritonitis; Polyhydramnios; Pregnancy; Ultrasonography, Prenatal

Meconium ileus (MI) is a form of neonatal intestinal obstruction due to an abnormal thickened meconium within the terminal ileum. The aim of this retrospective paper is to review our experience with neonates affected from MI treated at our institute over a twenty year period.. This report deals with 23 neonates with MI: 14 newborns had uncomplicated MI due to obstruction of the terminal ileum with meconium pellets, while 9 presented with complications (intestinal atresia, volvulus, pseudocyst, peritonitis).. A water soluble contrast enema (Gastrografin) was attempted in 12 cases with a success rate of 7/12 (58%). The remaining sixteen neonates underwent laparotomy, with 4 treated by resection and primary anastomosis, 7 by enterostomy (chimney or double-barrelled) and 5 managed with T-tube enterostomy. Survival rate was 93% in uncomplicated MI and 67% in complicated forms.. On the basis of personal experience the authors suggest that the treatment of choice for uncomplicated MI is Gastrografin enema, with T-tube enterostomy to be reserved for enema failure. The surgical treatment of the complicated forms depends on the intra-abdominal findings; nowadays chimney or double barrelled enterostomy is to be reserved in cases where peritonitis, late diagnosis, prematurity or associated anomalies complicate the disease.

Topics: Age Factors; Birth Weight; Enema; Female; Gestational Age; Humans; Infant, Newborn; Intestinal Obstruction; Male; Meconium

The significance of meconium-stained amniotic fluid (MSAF) is discussed, both in regards to obstetric and pediatric management. The primary concerns regarding MSAF have been its significance as a sign of fetal distress/perinatal asphyxia and the prevention of associated morbidity such as meconium aspiration syndrome. The objectives of our study were: (1) To know the incidence and type of MSAF, (2) to study the associated morbidity in newborns with MSAF admitted to the Neonatal Care Unit (NCU), and (3) to analyze the perinatal differences between newborns with moderate versus thick MSAF.. A retrospective study was performed to know the incidence of MSAF in all of the deliveries in our hospital during a 4 year period. The consistency of meconium was classified into 3 classes, thin (light), moderate or thick (heavy). On the other hand, a prospective analysis was undertaken to determine the morbidity of all meconium-stained neonates admitted to our NCU during this period, mainly in relation to perinatal asphyxia, pulmonary, gastrointestinal and infectious pathology and neonatal mortality.. The presence of MASF complicates 18% of all of our deliveries with it being mild in 10.8%, moderate in 4.4% and severe in 2.8%. Of all newborns with MSAF, one third were admitted to the NCU, mainly for two reasons, association with perinatal asphyxia (124 cases) and observation of a risk of meconium aspiration syndrome (85 cases). The main neonatal morbidities associated with MSAF in our populations were perinatal asphyxia in 56.1% (32 cases of severe perinatal asphyxia and 92 non-severe), pulmonary pathology in 34% (meconium aspiration syndrome in 32 cases and other respiratory abnormalities in 43) and gastrointestinal pathology in 30.5% (transitory feeding intolerance in all cases). Four cases of meconium-stained neonates were exitus. The neonatal morbidity is significantly more frequent in relation to thick meconium and also if perinatal asphyxia is associated to MSAF.. Although the relationship between MSAF and perinatal asphyxia is controversial, their association increases neonatal morbidity. In accordance with our results, thick meconium is implicated as a risk factor influencing the well being during the intrapartum and postpartum periods.

Topics: Birth Weight; Chi-Square Distribution; Female; Gestational Age; Humans; Incidence; Infant, Newborn; Male; Meconium; Meconium Aspiration Syndrome; Prospective Studies; Retrospective Studies; Spain; Statistics, Nonparametric; Viscosity

We hypothesized that the concentration of major essential mineral elements in meconium correlate with gestational age (GA) or birth weight. To verify this premise we determined the concentration in meconium of calcium, magnesium, phosphorus, copper, zinc, iron, and manganese.. Thirty-four appropriate for age singleton infants without major congenital anomalies were divided into four GA groups (in weeks): 24 to 28; 29 to 33; 34 to 37; 38 to 42, or in birth weight groups (in g): < 1500; 1500-1999; 2000-2499; > or = 2500. Meconium was collected until the appearance of transitional stools and lyophilized for analysis.. When adjusted for birth weight, the concentrations of calcium, copper, iron and phosphorus were higher in the meconium of 24 to 28 week GA infants than in those of the 38 to 42 week GA newborns. Birth weight adjusted copper concentration was highest in the 29 to 33 week GA group, while the remaining elements did not change across the range of GA. Meconium copper concentration in infants born with < 2000 g was higher than in those born with a weight > or = 2500 g.. These results could serve as normative data of a noninvasive examination of the mineral nutritional "history" of the fetus, and, eventually, to better evaluate possible neonatal deficiencies in infants with intrauterine growth retardation or other types of complicated intrauterine courses.

Topics: Birth Weight; Gestational Age; Humans; Infant, Newborn; Infant, Premature; Meconium; Minerals

To determine the mortality rate, during the first 2 years of life, in infants who were exposed to cocaine, opiate, or cannabinoid during gestation.. For a period of 11 months, a large group of infants were enrolled and screened at birth for exposure to cocaine, opiate, or cannabinoid by meconium analysis. Death outcome, within the first 2 years after birth, was determined in this group of infants using the death registry of the Michigan Department of Public Health.. A total of 2964 infants was studied. At birth, 44% of the infants tested positive for drugs: 30. 5% positive for cocaine, 20.2% for opiate, and 11.4% for cannabinoids. Compared to the drug negative group, a significantly higher percentage (P < .05) of the drug positive infants had lower weight and smaller head circumference and length at birth and a higher percent of their mothers were single, multigravid, multiparous, and had little to no prenatal care. Within the first 2 years of life, 44 infants died: 26 were drug negative (15.7 deaths per 1000 live births) and 18 were drug positive (13.7 deaths per 1000 live births). The mortality rate among cocaine, opiate, or cannabinoid positive infants were 17.7, 18.4, and 8.9 per 1000 live births, respectively. Among infants with birth weight

Topics: Birth Weight; Cannabinoids; Cannabis; Cocaine; Confidence Intervals; Data Interpretation, Statistical; Female; Humans; Infant; Infant Mortality; Infant, Newborn; Male; Meconium; Narcotics; Neonatal Screening; Odds Ratio; Opioid-Related Disorders; Pregnancy; Pregnancy Complications; Prenatal Exposure Delayed Effects; Registries; Sudden Infant Death

To determine the clinical significance of meconium-stained amniotic fluid (AF) observed at amniocentesis in patients with preterm labor.. A nested case-control study was constructed based on the color of AF during amniocentesis. Forty-five women admitted with preterm labor and meconium-stained AF were matched for gestational age at admission and compared with 135 women with preterm labor and clear AF. All AF samples were cultured for aerobic and anaerobic bacteria and mycoplasma.. The rates of positive AF cultures for microorganisms, overall preterm birth (before 36 weeks), preterm birth before 32 weeks, and clinical chorioamnionitis were all significantly higher in patients with meconium-stained AF than in those with clear AF (positive AF cultures, 38 versus 11%, P < .001; preterm delivery before 36 weeks, 73 versus 41%, P < .001; preterm delivery before 32 weeks, 51 versus 17%, P < .001; and clinical chorioamnionitis, 22 versus 6%, P = .003). In contrast, no significant differences were observed between groups with respect to maternal age, gravidity, parity, abruptio placentae, placenta previa, fetal distress, cesarean rate, or puerperal morbidity.. Patients with preterm labor and meconium-stained AF had higher rates of microbial invasion of the amniotic cavity, clinical chorioamnionitis, and premature deliveries than those with clear AF.

Topics: Adult; Amniotic Fluid; Apgar Score; Bacteria; Birth Weight; Case-Control Studies; Chorioamnionitis; Female; Gestational Age; Humans; Infant, Newborn; Meconium; Obstetric Labor, Premature; Pregnancy; Pregnancy Complications; Pregnancy Outcome

Among 95 term infants with benzoylecgonine, the cocaine metabolite, detectable in their meconium, there was an inverse relation between the concentration of benzoylecgonine and birth weight, length, and head circumference. Multiple regression analysis confirmed these relations after controlling for gestational age and maternal use of marijuana, cigarettes, and alcohol. These data suggest a dose-response relation between the magnitude of prenatal cocaine exposure and impaired fetal growth.

Topics: Birth Weight; Cocaine; Embryonic and Fetal Development; Female; Humans; Infant, Newborn; Linear Models; Meconium; Pregnancy; Prenatal Exposure Delayed Effects

The objectives of this study were to identify, by means of two third-trimester scans, fetuses with ultrasound evidence of inadequate growth but who were born with birth weights above the 10th centile for gestational age; and to determine if these infants constitute a high-risk group by comparing the incidence of obstetric intervention, of intrapartum complications and of neonatal morbidity between this group and the group of infants who showed no ultrasound evidence of intrauterine growth restraint. A total of 285 women with singleton pregnancies who were referred for a third-trimester ultrasound examination were included in this prospective study. Fetal weight was estimated by ultrasound twice in the third trimester and at each examination was assigned a centile score. A fall of > 20 centiles was taken as evidence of inadequate growth. The outcomes measured were the incidence of abnormal umbilical artery Doppler, induction of labor, meconiumstaining of the liquor, intrapartum fetal blood sampling, operative vaginal delivery, Cesarean section, Apgar score of < 7 at 5 min and admission to the neonatal intensive care unit. Seventy-five patients showed a drop of > 20 centiles between the first and second scans. The incidence of admission to the neonatal intensive care unit was greater in those infants who had ultrasound evidence of growth restraint. We conclude that infants of normal birth weight with inadequate growth diagnosed on ultrasound are not at increased risk, they have an increased incidence of admission to the neonatal intensive care unit, and they are more commonly found in mothers with diabetes mellitus.

Topics: Apgar Score; Birth Weight; Cesarean Section; Delivery, Obstetric; Embryonic and Fetal Development; Female; Fetal Blood; Fetal Growth Retardation; Gestational Age; Humans; Incidence; Infant, Newborn; Infant, Newborn, Diseases; Intensive Care, Neonatal; Ireland; Labor, Induced; Meconium; Pregnancy; Pregnancy in Diabetics; Pregnancy Trimester, Third; Prospective Studies; Risk Factors; Ultrasonography, Prenatal; Umbilical Arteries

To determine the rates of maternal ingestion of cocaine, marijuana, and opiates in women from Minneapolis-St Paul, Minn, in 1993 and compare them with rates observed in 1989; and to compare outcomes of newborns born to those women with and without evidence of prenatal drug ingestion.. The meconium from newborns of a representative cluster-based sample of women from Minneapolis-St Paul was analyzed for metabolites of cocaine, marijuana, and opiates. The newborns were consecutive births in four urban and suburban hospitals. Maternal demographic information and newborn outcome data were collected and matched to the meconium samples. The race, age, and socioeconomic status of the mothers whose newborns were screened were the same as the demographic characteristics of all women delivering babies in Minneapolis-St Paul in 1990 and 1991.. Metropolitan hospitals of Minneapolis-St Paul.. Of the 1333 samples, 27 (2.0%) were cocaine positive, 35 (2.6%) were tetrahydrocannabinol positive, and 16 (1.2%) were opiate positive. There were 168 women (22.6%) reporting that they smoked. Detection of tetrahydrocannabinol and cocaine was more common in newborns of women of color, those receiving medical assistance, and those over age 23 years. Newborns with meconium samples positive for cocaine or tetrahydrocannabinol had slightly lower average birth weights but were no more likely to be premature or to require neonatal intensive care unit admission than newborns with no drugs detected in their meconium. Newborns of mothers who smoked throughout pregnancy had lower average birth weights and higher rates of prematurity and neonatal intensive care unit admissions. Standardized rates of cocaine detection in the four hospitals decreased from 4.0% in 1989 to 2.0% in 1993.. Rates of perinatal cocaine detection have declined in the Twin Cities of Minneapolis-St Paul over the past 4 years. In this population, self-reported smoking was associated with more serious adverse outcomes of the newborns than was the detection of cocaine, marijuana, or opiates.

Topics: Adolescent; Adult; Birth Weight; Cocaine; Dronabinol; Female; Health Promotion; Humans; Infant, Newborn; Infant, Premature; Meconium; Minnesota; Narcotics; Pregnancy; Pregnancy Complications; Prenatal Exposure Delayed Effects; Prevalence; Smoking; Socioeconomic Factors; Substance Abuse Detection; Substance-Related Disorders

The number of newborn infants with symptoms suggesting drug withdrawal is increasing. As only part of prenatally exposed infants show typical drug withdrawal, and drug-use reported by addicted mothers is often unreliable the prevalence of neonates that were exposed to illicit drugs before birth is unknown. The purpose of this study was to evaluate prospectively the prevalence of drugs in meconium and to define risk factors for intrauterine drug exposure.. During a period of 4 months meconium was collected twice in 420 nonselected newborn infants. Meconium was analysed with a modified test developed for toxicology screening in urine. Information on pre- and postnatal risk factors including drug-use during pregnancy was obtained.. Among 415 mothers four reported illicit drug use and ten licit drug use during late pregnancy. In all these infants meconium drug test was positive. After exclusion of these infants and of five second twins 401 infants with negative drug history remained. 45 of them (11%) had one or two drugs in the meconium: opiate 17x, amphetamine 16x, barbiturate 15x, benzodiazepine 3x, cannabinoid 2x, cocaine 1x (in 9 infants two substances were detected). None was positive for LSD or phencyclidine. The infants with positive drug tests had the following risks compared to those with negative tests: prematurity (odds ratio 2.3, 95% confidence interval 1.3-4.3). Microcephaly or macrocephaly (2.0:1.01-4.1), Apgar-Score below 5 at 1 min (2.4:1.5-5.4), Apgar score below 7 at 10 min (4.0: 1.6-9.9), mother academic (2.8:1.2-6.2).. Newborn infants may have been exposed to illicit drugs in utero even if their mothers deny drug use and even if they do not show withdrawal symptoms. Prematurely born infants and infants with problems in postnatal adaptation have an increased risk of having been exposed to drugs.

Topics: Birth Weight; Cross-Sectional Studies; Female; Gestational Age; Humans; Illicit Drugs; Incidence; Infant, Newborn; Meconium; Neonatal Abstinence Syndrome; Neonatal Screening; Pregnancy; Psychotropic Drugs; Socioeconomic Factors; Switzerland

We determined the prevalence of prenatal cocaine use in a racially mixed sample of urban and suburban mothers and correlated its use with maternal demographics and newborn measurements.. Meconium from 621 consecutive newborns delivered at two university-affiliated urban hospitals were assayed for benzoylecgonine. Maternal and infant characteristics were linked anonymously with the results. Statistical analysis included t test, Fisher's exact test, Duncan's multiple range analysis, and analysis of covariance, with a value of p < 0.05 considered significant.. We found that 3.4% of meconium samples had benzoylecgonine levels exceeding 0.1 micrograms/ml. Its presence was statistically correlated with maternal and neonatal characteristics. A nurse's opinion of cocaine use was correct 22% of the time.. Prenatal cocaine use was statistically associated with multiparity, multigravidity, late-onset and clinic-based prenatal care, public assistance, nonwhite race, and low academic achievement. A nurse's opinion was a poor predictor of maternal cocaine use. Cocaine-exposed infants were significantly smaller, and this correlated best with nonwhite background.

Topics: Birth Weight; Cocaine; Female; Humans; Infant, Newborn; Meconium; Nurses; Pregnancy; Pregnancy Complications; Prenatal Care; Prevalence; Sensitivity and Specificity; Substance Abuse Detection; Substance-Related Disorders; Suburban Population; Urban Population

This study was undertaken to determine the influences of increased maternal prepregnancy weight and increased gestational weight gain on pregnancy outcome.. This was a longitudinal retrospective study of 7407 term pregnancies delivered from 1987 through 1989. After excluding cases with multiple fetuses, stillbirths, fetal anomalies, no prenatal care, selected medical and surgical complications, and those with incomplete medical records, 3191 cases remained for analyses by determination of odds ratios for obstetric outcomes, by chi 2 tests for significant differences and by adjustment for risk factors with stepwise logistic regression.. Both increased maternal prepregnancy weight (body mass index) and increased maternal gestational weight gain were associated with increased risks of fetal macrosomia (p less than 0.0001), labor abnormalities (p less than 0.0001), postdatism (p = 0.002), meconium staining (p less than 0.001), and unscheduled cesarean sections (p less than 0.0001). They were also associated with decreased frequencies of low birth weight (p less than 0.001). The magnitude of the last was less than that of the other outcomes.. Increased maternal weight gain in pregnancy results in higher frequencies of fetal macrosomia, which in turn lead to increased rates of cesarean section and other major maternal and fetal complications. Because these costs of increased maternal weight gain appear to outweigh benefits, weight gain recommendations for pregnancy warrant careful review.

Topics: Apgar Score; Birth Weight; Body Weight; Cesarean Section; Female; Fetal Heart; Fetal Macrosomia; Heart Rate; Humans; Incidence; Infant, Low Birth Weight; Infant, Newborn; Meconium; Obstetric Labor Complications; Pregnancy; Pregnancy Outcome; Pregnancy, Prolonged; Resuscitation

The relation between the frequency of breast-feeding and intake, weight loss, meconium passage, and bilirubin levels was studied in 140 healthy, full-term, breast-fed, Japanese neonates born vaginally without complications. Factors affecting the frequency of breast-feeding were also evaluated. Mothers nursed their neonates, on average, 4.3 +/- 2.5 (SD) times (range 0 to 11) during the first 24 hours after birth, and this frequency increased significantly to 7.4 +/- 3.9 times during the next 24 hours (P less than .001). There was a significant correlation between the frequency of breast-feeding during the first and second 24 hours after birth (r = .69, P less than .001). The frequency of breast-feeding during the first 24 hours correlated significantly with frequency of meconium passage (r = .37, P less than .01), maximum weight loss (r = -.22, P less than .05), breast milk intake on day 3 (r = .50, P less than .01) and day 5 (r = .34, P less than .05), transcutaneous bilirubin readings on day 6 (r = -.18, P less than .05), and weight loss from birth to time of discharge (day 7) (r = -.32, P less than .01). There was a strong dose-response relationship between feeding frequency and a decreased incidence of significant hyperbilirubinemia (transcutaneous bilirubin readings greater than or equal to 23.5) on day 6. The time of birth also affected the frequency of breast-feeding during the first 24 hours.(ABSTRACT TRUNCATED AT 250 WORDS)

Topics: Adult; Apgar Score; Birth Weight; Breast Feeding; Female; Gestational Age; Humans; Hyperbilirubinemia; Infant, Newborn; Male; Maternal Age; Meconium; Time Factors

We set out to determine if the clinical course or genetic profiles of patients with cystic fibrosis who had meconium ileus differed from those of other patients with cystic fibrosis. Since 1950 we have followed 158 patients with meconium ileus among 1175 patients with cystic fibrosis (13.4%). Patients with meconium ileus had lower birth weight (3026 +/- 610 gm) than patients with no meconium ileus (3169 +/- 534 gm; p less than 0.008); the deficit was especially evident in female patients. Survival in the first year of life increased from 55% in those born between 1958 and 1972 to 96% in those born between 1973 and 1987. Since 1973 the median survival of male and female patients with meconium ileus was similar to that in female patients with no meconium ileus (21 years), whereas 78% of males with no meconium ileus survived to this age (p less than 0.0001). Patients with meconium ileus born before 1972 had lower weight and height percentiles at age 13 years compared with patients with no meconium ileus, but this difference was not as apparent in patients born after 1973. There were no differences between the two groups in forced vital capacity, forced expiratory volume in 1 second, or forced expiratory flow in the middle half of forced vital capacity. Patients with meconium ileus acquired Pseudomonas aeruginosa at a younger age than did patients with no meconium ileus (4.20 +/- 4.67 vs 7.18 +/- 5.19 years), but there was no difference in age of acquisition of P. cepacia. In families in which the first child had meconium ileus, 29% of subsequent siblings with cystic fibrosis had meconium ileus, compared with 6% of siblings born to families in which the first child did not have meconium ileus. Allelic frequencies and haplotypic variants for cystic fibrosis chromosomes with respect to DNA markers closely linked to the cystic fibrosis locus were similar in families with cystic fibrosis with meconium ileus and those with no meconium ileus. These findings suggest that patients with cystic fibrosis and those without meconium ileus do not have major intrinsic differences and that the previously poor outlook in patients with meconium ileus has improved greatly.

Topics: Adolescent; Alleles; Anthropometry; Birth Weight; Child; Cystic Fibrosis; Female; Gene Frequency; Genetic Markers; Haplotypes; Humans; Infant, Newborn; Intestinal Obstruction; Longitudinal Studies; Male; Meconium; Prognosis

The etiology of bowel perforations leading to meconium peritonitis was investigated in an attempt to explain the occurrence of such perforations in the absence of primary intestinal obstruction. Bowel specimens from 22 patients who had presented with meconium peritonitis during a 15-year period, as well as specimens from five patients with intestinal atresia without associated meconium peritonitis, were re-evaluated microscopically. An extensive review of the literature concerning meconium peritonitis, involving 1,084 patients, was compared with the results of a retrospective study of 69 patients from The Netherlands. In approximately 50 per cent of these cases there was no detectable primary cause of the bowel perforation. The pathologic findings, in combination with earlier experimental studies, indicate that vascular insufficiency may result in bowel wall perforation without prior intestinal obstruction. It is suggested that temporary decrease of mesenteric blood flow could lead to intestinal atresia and/or meconium peritonitis.

Topics: Birth Weight; Cystic Fibrosis; Gestational Age; Humans; Infant, Newborn; Intestinal Atresia; Intestinal Perforation; Intestines; Meconium; Peritonitis; Splanchnic Circulation

The successful management of 15 infants suffering from persistence of fetal pulmonary circulation and in severe respiratory failure is presented. The treatment regimen focused on minimizing barotrauma. Infants were intubated nasotracheally and ventilated with intermittent mandatory ventilation. Peak inspiratory pressures were determined by the clinical assessment of chest excursion. Ventilator settings and fractional inspiratory oxygen (FiO2) were selected to maintain a PaO2 between 50 and 70 mm Hg; PaCO2 was not a controlling parameter and was allowed to increase as high as 60 mm Hg. Hyperventilation and muscle relaxants were not used. High ventilator rate was used in ten infants who required high inspiratory pressure to maintain chest excursion, with a favorable response in five. Tolazoline was given to 14 infants of whom ten showed an improvement in oxygenation; dopamine was given to three infants who were oliguric. All infants survived, and only one infant developed chronic lung disease which was defined by the infant's need for supplemental oxygen beyond 30 days of life.

Topics: Birth Weight; Dopamine; Humans; Hyperventilation; Infant, Newborn; Intubation, Intratracheal; Meconium; Persistent Fetal Circulation Syndrome; Pneumonia, Aspiration; Respiration, Artificial; Respiratory Distress Syndrome, Newborn; Respiratory Insufficiency; Tolazoline

Topics: Adolescent; Adult; Apgar Score; Birth Weight; Female; Fetoscopy; Humans; Infant, Newborn; Meconium; Pregnancy; Risk

Reported is the analysis of morbidity, mortality, and mode of delivery in 38 cases of ventral wall defects identified from among 128,500 consecutive live births in Maine (January 1975 to December 1982). Thirteen of the ventral wall defects were classified as gastroschisis, and only one had an additional defect not directly attributable to the ventral wall defect itself. By contrast, 16 of the 25 omphalocele cases had additional defects, including eight congenital heart lesions, four genitourinary malformations, two neural tube defects, and three trisomies. Ten cases of omphalocele and one of gastroschisis died, all as a result of independent defects or involvement of adjacent structures. Intrauterine growth retardation was prominently associated with gastroschisis. Vaginal delivery occurred in three of the six ventral wall defects diagnosed antenatally and in 28 of the 32 ventral wall defects not diagnosed until delivery. The only episode of birth trauma to ventral wall defect sac or abdominal viscera occurred during cesarean section in an undiagnosed case. The present data provide a basis for prognosis and management of antenatally diagnosed ventral wall defects and suggest that these defects are not, a priori, an indication for abdominal delivery.

Topics: Abdominal Muscles; Abnormalities, Multiple; Adolescent; Adult; Amniotic Fluid; Apgar Score; Birth Weight; Delivery, Obstetric; Female; Heart Ventricles; Hernia, Umbilical; Humans; Infant Mortality; Infant, Newborn; Maine; Male; Maternal Age; Meconium; Pregnancy; Prenatal Diagnosis

The relationship of placental size to perinatal outcome was investigated in a population of low-risk infants. A trimmed and drained placenta was weighed for each of 417 low-risk infants, and for 108 infants whose intrapartum course was complicated only by compression of the umbilical cord. Tracings from intrapartum electronic fetal heart rate monitoring were analyzed by an investigator who was unaware of the fetal weight/placental weight ratio. The incidence of perinatal problems was increased in those infants whose fetal weight/placental weight ratio was greater than 11: intrapartum fetal distress, 20% (p = 0.0046); meconium-stained amniotic fluid, 28.9% (p = 0.0017); Apgar score less than 7, 11.1% (p = 0.04); and hyperbilirubinemia, 24.4% (p = 0.0008). On the basis of these data, the conclusion drawn was that there is a population of presumably low-risk infants who are at increased risk because they have outgrown their placentas.

Topics: Amniotic Fluid; Apgar Score; Birth Weight; Black People; Female; Fetal Distress; Fetal Monitoring; Fetus; Growth; Heart Rate; Humans; Infant, Newborn; Jaundice, Neonatal; Meconium; Organ Size; Placenta; Pregnancy; Prospective Studies; Risk

Results from a previous epidemiologic study indicate that marijuana use near term may elevate risk of abnormal progress of labor and meconium staining. We conducted a study of the association of self-reported marijuana use and perinatal problems in a series of 313 women enrolled in a home-birth center. The 41 marijuana users were similar to non-users with respect to most potentially confounding factors, but users had lower mean income and exhibited more tobacco and alcohol use during pregnancy than non-users. Users experienced slightly elevated rates of dysfunctional labor (43% vs. 35% in non-users), precipitate labor (13% vs. 8%) and meconium staining (17% vs. 13%); differences with respect to most other outcomes were smaller or nonexistent. The observed differences were smaller in both relative and absolute terms than those reported by the earlier study, and were little changed upon adjustment for potentially confounding factors (including alcohol use, cigarette use, parity and income). After accounting for statistical variation, the results appear consistent with the earlier findings but further research is recommended.

Topics: Adult; Birth Weight; Cannabis; Female; Home Childbirth; Humans; Infant, Newborn; Infant, Newborn, Diseases; Meconium; Obstetric Labor Complications; Pregnancy; Regression Analysis

The levels of urinary estriol (U-E3), serum leucine aminopeptidase (LSP) and heat stable alkaline phosphatase (HSAP) were determined in toxemic and normal pregnancies. The significance of differences was established by weekly estimation of the parameters for both groups after the 28th week of gestation. Assayed values were classified into 4 types (type I-IV) by the mean values for 3 serial 24h assays and 3 patterns (pattern a-c) observed with these three determinations. The distribution rate for each type and pattern was examined according to the following: Severe toxemia, low birth weight, meconium staining at parturition and low apgar score groups. For U-E3, the incidence of the low value type (type IV) and the descending pattern (pattern c) both increased linearly in all the above groups. These findings suggest the clinical applicability of U-E3 as a reasonable indicator for evaluating intrauterine fetal well being because of the close correlation to the listed conditions. Thus these biochemical parameters should be considered in the antepartum fetal management of third trimester toxemic pregnancies.

Topics: Alkaline Phosphatase; Apgar Score; Birth Weight; Estriol; Female; Humans; Infant, Newborn; Leucyl Aminopeptidase; Meconium; Pre-Eclampsia; Pregnancy

Patients with perinatal asphyxia from a total population of 15,216 births were studied prospectively. A total of 76 newborn infants achieved the criteria for inclusion. These were distributed in three populations: 53 (73%) without acute renal failure (ARF); 17 (22%) with ARF of prerenal type; 6, (8%) with ARF of renal type. Incidence of several perinatal factors were compared (gestational age, birth weight, meconial amniotic fluid, cord and/or placental disturbances, type of delivery, APGAR Score, and resuscitation). Authors observed that in the group of preterm infants, ARF is present, always was of renal type. In the population with ARF of renal type perinatal asphyxia was clinically worse: greatest frequency of meconial amniotic fluid (p less than 0,025) and worse response to resuscitation with a lower increment in the APGAR Score between one and five minutes (p less than 0.005).

Topics: Acute Kidney Injury; Amniotic Fluid; Apgar Score; Asphyxia Neonatorum; Birth Weight; Gestational Age; Humans; Infant, Newborn; Infant, Premature, Diseases; Meconium; Prospective Studies

The clinical histories, chest X-ray appearances, skin prick test results, pulmonary function and IgE levels of 20 patients with cystic fibrosis (C.F.) complicated by nasal polyps have been compared with those of 97 C.F. controls. The patients who had developed polyps had a different clustering of symptoms to the controls with heavier birthweights, later presentations, milder gastrointestinal symptoms in infancy, less infection with Staphylococcus aureus and better vital capacities. There was no evidence on history, skin testing or IgE levels that the polyps patients were more allergic. It is likely, therefore, that nasal polyps in C.F. are due to a primary effect of the C.F. gene, although they could also be the effect of chronic nasal infection.

Topics: Birth Weight; Child, Preschool; Cystic Fibrosis; Humans; Hypersensitivity; Infant, Newborn; Intestinal Obstruction; Meconium; Nasal Polyps; Staphylococcal Infections; Vital Capacity

Topics: Acid-Base Equilibrium; Amniotic Fluid; Apgar Score; Asphyxia Neonatorum; Birth Weight; Female; Gestational Age; Humans; Infant, Newborn; Larynx; Meconium; Pregnancy; Prognosis; Suction

Topics: Amniotic Fluid; Apgar Score; Birth Weight; Female; Fetal Heart; Fetal Monitoring; Heart Rate; Humans; Infant, Newborn; Meconium; Pregnancy; Staining and Labeling

Sixty-six patients with chronic hypertension were cared for during a total of 72 pregnancies. Patients were treated at home primarily by greater than or equal to 4 hours of bed rest daily in the left recumbent position. Only patients whose diastolic blood pressures remained greater than 110 mmHg were treated with hydralazine (Apresoline, Ciba). With this plan of treatment there were only 3 perinatal deaths for an uncorrected perinatal mortality of 4.1% (1.4% corrected). Twenty-nine percent of the patients had babies that were small for gestational age, 13.8% had positive oxytocin challenge tests, and 36.8% developed superimposed preeclampsia. When compared with the outcome of previous pregnancies, the program of bed rest lowered perinatal mortality from 16.8 to 8.8%. Thus, it is suggested that bed rest together with the avoidance of diuretics and the judicious use of hydralazine results in the most favorable fetal outcome.

Topics: Bed Rest; Birth Weight; Chronic Disease; Female; Fetal Death; Humans; Hydralazine; Hypertension; Infant Mortality; Infant, Newborn; Infant, Small for Gestational Age; Meconium; Oxytocin; Pre-Eclampsia; Pregnancy; Pregnancy Complications, Cardiovascular

The results of foam tests carried out on postnatal stomach contents from 267 neonates were analyzed to see whether a correlation can be found between the incidence of RDS and the foam-test values. The test proved to be a good indicator in the recognition of RDS. If ++, + positive, on negative foam-tests are obtained development of RDS can be expected in about 60% of the cases. By this quick and simple test neonates with the risk of RDS can be screened off and transported in time to centres of intensive care.

Topics: Birth Weight; Humans; Infant, Newborn; Meconium; Methods; Respiratory Distress Syndrome, Newborn; Risk

Topics: Amniotic Fluid; Apgar Score; Birth Weight; Female; Fetal Distress; Gestational Age; Humans; Infant, Newborn; Labor, Obstetric; Meconium; Pregnancy

The significance of MSAL as a sign of fetal distress is controversial. To better assess this condition, we present a classification of MSAL based on the timing and quantity of meconium passed and divided into early light, early heavy, and late passage of MSAL. By means of this classification with a problem-oriented risk assessment system, 2,933 pregnancies were prospectively evaluated during labor. The incidence of meconium passage was 22 per cent, of which early light constituted 53.6 per cent, early heavy 25.2 per cent, and late passage 21.2 per cent. Early heavy MSAL is associated with increased fetal and neonatal morbidity and death, and with a number of antecedent obstetric problems. Late passage of MSAL encountered no perinatal losses, but is associated with increased neonatal morbidity occurring late in labor. Early light MSAL, constituting over half of all our meconium group of patients, is not associated with any increased intrapartum or neonatal morbidity or death. This classification of MSAL is an effective tool for risk assessment during labor.

Topics: Amniotic Fluid; Birth Weight; Classification; Delivery, Obstetric; Female; Fetal Death; Fetal Diseases; Gestational Age; Humans; Infant Mortality; Infant, Newborn; Infant, Newborn, Diseases; Inhalation; Labor, Obstetric; Meconium; Pregnancy; Prospective Studies; Risk; Syndrome; Time Factors

Meconium was present on the fleece of 114 newborn lambs in sixty-two per cent of the cases. It was observed in forty per cent of the firstlings of primiparae, whereas the highest proportion (eighty-two per cent) was seen in the group of the lambs of pluriparous ewes, which were born later. A short normal gestation period (less than 144 days), a low birth-weight (less than 4.0 kg.) and a short period of parturition appear to result in a reduced incidence of the presence of meconium.

Topics: Animals; Animals, Newborn; Birth Weight; Delivery, Obstetric; Female; Fetal Death; Gestational Age; Labor Presentation; Labor, Obstetric; Meconium; Pregnancy; Sheep; Sheep Diseases

In 13 patients, episodes of transient fetal cardiac arrest were observed in a group of 594 extensively monitored labors during a given 3-year period. The number of episodes per patient ranged from one to six, with a maximal duration of cardiac arrest (R-R interval) being 5.2 seconds. All of the patients responded to changing maternal position or termination of pregnancy except 1. This patient received Atropine as a premedication for cesarean section. The parasympatholytic properties of Atropine minimized the severity of cardiac arrest. The effect of cardiac arrest on fetuses is not clearly shown in these preliminary observations. The prompt elimination of cardiac arrest is thought to be imperative in reducing perinatal loss. Cardiac arrest is though to be an extensive form of severe variable deceleration. The hypothesis is made that these fetuses had an unbalanced autonomic nervous system and/or an overwhelming vagal tone. If these signs are detected early by fetal monitoring, attention should be paid to the possibility of cardiac arrest.

Topics: Acid-Base Equilibrium; Adult; Apgar Score; Birth Weight; Delivery, Obstetric; Electrocardiography; Female; Fetal Diseases; Fetal Heart; Fetal Monitoring; Heart Arrest; Humans; Infant, Newborn; Meconium; Pregnancy; Pressure; Uterus

Till now there is no unequivocal diagnostic tool for the discovery of prolonged pregnancy. Therefore the present study was performed to evaluate whether HPL-values correlate with the presence of postmaturity syndrome in coherence with other known symptoms. 86 cases, partly with signs of postmaturity (n = 12), partly without such signs (n = 74), were compared with a non-postmature group. In prolonged pregnancy HPL-values were distinctly lower than at term. The more severe the condition, the lower were the HPL-values. There was a significant incidence of higher rates of meconium stained amniotic fluid beyond 42 weeks of gestation. After careful delivery the babies were generally in good condition. There was a slight shift to lower Apgar-values, but base excess and actual pH were found to be normal in umbilical artery. Birth-weights of the postmature infants did not show any differences to those born at term.

Topics: Amniotic Fluid; Birth Weight; Female; Humans; Meconium; Placental Lactogen; Pregnancy; Pregnancy Complications; Pregnancy, Prolonged

Topics: Animals; Animals, Newborn; Birth Weight; Gestational Age; Horses; Meconium; Respiration

Topics: Birth Weight; Cystic Fibrosis; Humans; Immunodiffusion; Immunoglobulin A; Immunoglobulin G; Immunoglobulin M; Immunoglobulins; Infant, Newborn; Infant, Premature, Diseases; Meconium; Time Factors

Meconium staining of the placenta and/or fetal body was present at birth in 10.3 per cent of 42,000 live-born infants, but present disproportionately in 18.1 per cent of 788 neonatal deaths. The neonatal mortality rate was 3.3 per cent in the stained group and 1.7 per cent in the nonstained group. Among infants who died, the incidence of erythroblastosis was quadrupled and that of cardiovascular malformation was doubled in the stained group. Meconium staining was associated with a decrease in the expected frequency of hyaline membranes and atelectasis even in premature infants; hypotheses for this phenomenon were presented. Meconium staining of the fetus or placenta requires several hours of exposure. As a hypothesis, the observed increase of deaths in stained neonates may be related to the stresses of cumulative or chronic hypoxia which may occur after the initial passage of meconium if delivery is prolonged.?23AUTHOR

Topics: Amniotic Fluid; Autopsy; Birth Weight; Congenital Abnormalities; Erythroblastosis, Fetal; Female; Fetal Diseases; Hemorrhage; Humans; Hyaline Membrane Disease; Hypoxia; Infant, Newborn; Infant, Newborn, Diseases; Meconium; Obstetric Labor Complications; Placenta; Pneumonia; Pregnancy; Pregnancy Complications; Pregnancy in Diabetics; Pulmonary Atelectasis; Time Factors

A five-year review of 127 elderly patients (35 years of age and over), in their first pregnancies, defines the risk to the fetus in terms of perinatal death and neonatal morbidity. With the equivalent of a perinatal mortality rate of 94/1,000, an 11 per cent incidence of small-for-dates infants, and a neonatal morbidity rate of 18 per cent, there would still appear to be a need for an increased awareness of the fetal risks in this group and an increased emphasia on their prevention. Areas of management in prenatal care and labor which might reduce these figures are defined.

Topics: Adult; Apgar Score; Birth Weight; Cesarean Section; Congenital Abnormalities; Delivery, Obstetric; Extraction, Obstetrical; Female; Fetal Death; Fetal Diseases; Follow-Up Studies; Gestational Age; Humans; Infant Mortality; Infant, Newborn; Infant, Newborn, Diseases; Infant, Premature; Labor, Induced; Labor, Obstetric; Maternal Age; Meconium; Middle Aged; Parity; Pregnancy; Pregnancy Complications; Pregnancy, Prolonged

We performed a retrospective study of the morbidity and mortality rates of 125 infants, born through meconium-stained amniotic fluid, and admitted to the newborn intensive-care unit for observation. A comparison was made of maternal age, history of toxemia, type of anesthesia, duration of analgesia, presence of cord complications, abnormalities of fetal heart rate, duration of meconium staining, birth weight, gestational age, 1 and 5 minute Apgar scores, and type of resuscitation between infants who were symptomatic or asymptomatic in the unit. Forty-three developed respiratory distress (symptomatic) and eight died; 82 were asymptomatic. The only difference between the two groups was a history of immediate tracheal suction in the delivery room. Of 97 infants receiving immediate tracheal suction, 27 became symptomatic and one died--an infant with Down's syndrome and endocardial cushion defect. On the other hand, of 28 infants who did not receive immediate tracheal suction, 16 became symptomatic and seven died of massive meconium aspiration pneumonitis (P less than 0.001). We concluded that in infants born through meconium-stained amniotic fluid, immediate tracheal suction is a safe procedure that significantly lowers the morbidity and mortality rates and produces no further respiratory depression of the infant.

Topics: Amniotic Fluid; Apgar Score; Autopsy; Birth Weight; Catheterization; Drainage; Female; Gestational Age; Humans; Infant, Newborn; Infant, Newborn, Diseases; Inhalation; Intubation, Intratracheal; Laryngoscopy; Meconium; Methods; Pneumonia, Aspiration; Pregnancy; Respiratory Distress Syndrome, Newborn; Retrospective Studies; Trachea

Topics: Barium Sulfate; Birth Weight; Enema; Female; Fetal Diseases; Humans; Infant, Newborn; Intestinal Atresia; Intussusception; Japan; Jejunum; Male; Meconium; Occult Blood; Pregnancy; Uterine Diseases

Topics: Amniocentesis; Amniotic Fluid; Anemia, Sickle Cell; Bilirubin; Birth Weight; Blood; Color; Coloring Agents; Delivery, Obstetric; Embryonic and Fetal Development; Erythroblastosis, Fetal; Female; Gestational Age; Humans; Hyperbilirubinemia; Infant, Newborn; Meconium; Oxazines; Placenta Diseases; Pre-Eclampsia; Pregnancy; Pregnancy Complications; Pregnancy in Diabetics; Prospective Studies; Respiratory Distress Syndrome, Newborn; Staining and Labeling; Vagina

Topics: Birth Weight; Chromatography, Thin Layer; Gestational Age; Humans; Infant, Newborn; Intubation, Intratracheal; Lung; Meconium; Pharynx; Phosphatidylcholines; Pneumonia; Pneumonia, Aspiration; Prognosis; Respiratory Distress Syndrome, Newborn; Sphingomyelins; Trachea

Topics: Adult; Amniotic Fluid; Birth Weight; Cholecystectomy; Cholecystography; Cholelithiasis; Cholestasis; Female; Follow-Up Studies; Gallbladder Diseases; Humans; Infant, Newborn; Jaundice; Liver Function Tests; Meconium; Middle Aged; Pregnancy; Pregnancy Complications; Pruritus

Topics: Amniotic Fluid; Asphyxia Neonatorum; Birth Weight; Cholestasis; Female; Fetal Death; Follow-Up Studies; Gestational Age; Hepatitis A; Humans; Infant, Newborn; Infant, Newborn, Diseases; Jaundice; Male; Maternal-Fetal Exchange; Meconium; Obstetric Labor Complications; Pregnancy; Pregnancy Complications; Pregnancy Complications, Infectious; Pruritus; Recurrence

Topics: Adolescent; Adult; Age Factors; Birth Weight; Body Height; Body Weight; Dysmenorrhea; Female; Germany, West; Gestational Age; Humans; Hyperemesis Gravidarum; Infant, Newborn; Infant, Premature; Maternal Age; Meconium; Menstruation; Obstetric Labor, Premature; Occupations; Placenta; Pregnancy; Psychotherapy

Topics: Birth Weight; Blood; Diphosphoglyceric Acids; Erythrocytes; Female; Fetal Diseases; Gestational Age; Hematocrit; Humans; Hydrogen-Ion Concentration; Hypoxia; Infant, Newborn; Male; Meconium; Pregnancy; Umbilical Cord; Umbilical Veins

Topics: Apgar Score; Asphyxia Neonatorum; Birth Weight; Carbon Dioxide; Cardiac Catheterization; Cyanosis; Diagnosis, Differential; Female; Follow-Up Studies; Gestational Age; Heart Defects, Congenital; Humans; Hypertension, Pulmonary; Infant, Newborn; Infant, Newborn, Diseases; Male; Meconium; Obstetric Labor Complications; Oxygen; Partial Pressure; Pregnancy; Pulmonary Artery; Radiography

Topics: Apgar Score; Arrhythmias, Cardiac; Birth Weight; Cesarean Section; Female; Fetal Death; Fetal Diseases; Fetal Heart; Gestational Age; Heart Rate; Hospitals, Community; Humans; Infant Mortality; Infant, Newborn; Labor, Obstetric; Maryland; Meconium; Monitoring, Physiologic; Obstetric Labor Complications; Pre-Eclampsia; Pregnancy; Retrospective Studies; Uterine Inertia

Topics: Anthropometry; Asphyxia Neonatorum; Birth Weight; Child Development; Congenital Abnormalities; Emaciation; Female; Fetal Death; Fetal Diseases; Gestational Age; Humans; Infant; Infant Mortality; Infant, Newborn; Infant, Newborn, Diseases; Meconium; Nails; Neurologic Manifestations; Organ Size; Pregnancy; Pregnancy, Prolonged; Sleep Wake Disorders; Social Behavior; Thumb; Umbilical Cord

Topics: Adolescent; Age Factors; Barium Sulfate; Biopsy; Birth Weight; Child; Child, Preschool; Constipation; Enema; Female; Humans; Infant; Infant, Newborn; Male; Meconium; Megacolon

Topics: Amniotic Fluid; Birth Weight; Delivery, Obstetric; Extraembryonic Membranes; Female; Fetus; Gestational Age; Humans; Infant, Newborn; Iodine Isotopes; Labor, Obstetric; Meconium; Methods; Oxytocin; Parity; Pregnancy; Radioimmunoassay; Time Factors

Topics: Age Factors; Birth Weight; Cystic Fibrosis; Female; Humans; Infant, Newborn; Infant, Newborn, Diseases; Intestinal Obstruction; Male; Meconium; Postoperative Complications; Pyloric Stenosis; Time Factors

Topics: Analysis of Variance; Apgar Score; Birth Weight; Computers; Cyanosis; Electrocardiography; Extraction, Obstetrical; Female; Fetal Death; Fetal Heart; Humans; Infant, Newborn; Infant, Premature; Labor Presentation; Labor, Obstetric; Male; Maternal Age; Meconium; Placenta Diseases; Pregnancy; Pregnancy Complications; Twins

Topics: Birth Weight; Blood Proteins; Feces; Humans; Immunodiffusion; Immunoelectrophoresis; Infant, Newborn; Infant, Premature; Meconium

Topics: Birth Weight; Blood Gas Analysis; Cyanosis; Helium; Humans; Hyaline Membrane Disease; Infant, Newborn; Infant, Premature; Inhalation; Meconium; Methods; Oxygen; Pulmonary Atelectasis; Radiography, Thoracic; Respiration; Spirometry

Topics: Age Factors; Apnea; Birth Weight; Body Temperature; Female; Humans; Infant Mortality; Infant, Newborn; Infant, Premature; Inhalation; Male; Meconium; Respiration, Artificial; Respiratory Distress Syndrome, Newborn; Respiratory Insufficiency; Time Factors

Topics: Amniotic Fluid; Bile Pigments; Bilirubin; Birth Weight; Cesarean Section; Defecation; Female; Humans; Infant, Newborn; Intestinal Absorption; Jaundice, Neonatal; Maternal-Fetal Exchange; Meconium; Pre-Eclampsia; Pregnancy; Time Factors

Topics: Amniotic Fluid; Birth Weight; Creatinine; Diabetes Mellitus; Erythroblastosis, Fetal; Female; Fetus; Gestational Age; Humans; Infant, Newborn; Infant, Premature; Meconium; Pregnancy; Pregnancy Complications

Topics: Birth Weight; Delivery, Obstetric; Drainage; Female; Humans; Hyaline Membrane Disease; Infant, Newborn; Infant, Newborn, Diseases; Male; Meconium; Mediastinal Emphysema; Methods; Pneumothorax; Radiography; Respiration, Artificial; Respiratory Distress Syndrome, Newborn

Topics: Biopsy; Birth Weight; Female; Humans; Hyaline Membrane Disease; Infant; Infant, Newborn; Infant, Premature; Inhalation; Lung; Male; Meconium; Oxygen; Oxygen Inhalation Therapy; Radiography; Respiratory Distress Syndrome, Newborn; Respiratory Insufficiency; Ventilation-Perfusion Ratio

Topics: Animals; Animals, Newborn; Birth Weight; Calcium; Cats; Cetacea; Dogs; Elephants; Embryonic and Fetal Development; Female; Fetus; Humans; Infant Nutritional Physiological Phenomena; Infant, Newborn; Maternal-Fetal Exchange; Meconium; Mice; Phosphates; Pregnancy; Rats; Swine; Uterus

Topics: Adult; Anti-Bacterial Agents; Bacteriuria; Birth Weight; Female; Fetal Death; Germany, West; Hematuria; Humans; Infant, Newborn; Maternal-Fetal Exchange; Meconium; Obstetric Labor Complications; Pregnancy; Pregnancy Complications, Infectious; Pyelonephritis

Topics: Asphyxia; Birth Weight; Brain Diseases; Child; Child, Preschool; Female; Follow-Up Studies; Gestational Age; Humans; Infant; Infant, Newborn; Infant, Newborn, Diseases; Male; Meconium; Motor Skills; Neurologic Examination; Pregnancy; Psychological Tests; Respiratory Distress Syndrome, Newborn

Topics: 17-Ketosteroids; Adrenal Glands; Birth Weight; Chorionic Gonadotropin; Chromatography, Thin Layer; Dehydroepiandrosterone; Estriol; Feces; Female; Humans; Infant, Newborn; Male; Meconium; Pre-Eclampsia; Pregnancy; Umbilical Arteries; Umbilical Veins