Aage Knudsen

Pain-Relieving Effect of Sucrose in Newborns during Heel Prick

We assessed the effect of sucrose as a pain reliever in a population of newborns when cuddled and comforted during heel prick for diagnosis of phenylketonuria. In addition, the influences of gender, gestational age, postnatal age, ponderal index and behavioural state of the infant before the heel prick were studied, as judged by the neonatal infant pain scale (NIPS) score, on crying time (CT) and subsequent NIPS score. 100 healthy full-term infants were enrolled in this double-blind, randomized controlled trial. Before the heel prick, the newborns, when cuddled by the parent(s), were either given 2 ml 50% sucrose solution or 2 ml sterile water. The sessions were videotaped and analyzed for determination of CT and NIPS scores. The frequency distribution of CT showed a bimodal pattern in both the sucrose and the placebo groups. Sucrose significantly reduced CT and NIPS scores after the heel prick. No influence of gender, gestational age, postnatal age or ponderal index on CT was found. NIPS scores before the heel prick correlated significantly and positively with CT and subsequent NIPS scores in both the sucrose and the placebo groups. Intra-orally administered sucrose given before heel prick can be recommended as a useful pain reliever. Furthermore, the findings indicate that factors calming the newborn and creating low NIPS scores before the procedure can reduce the pain reaction equivalently and additively to sucrose administration.

The cephalocaudal progression of jaundice in newborns in relation to the transfer of bilirubin from plasma to skin

The cephalocaudal progression of jaundice was studied in 136 mature, clinically well newborns. The yellow colour of the skin was measured with the transcutaneous bilirubinometer. Significant positive correlation was found between the yellow colour of the skin in four regions and the plasma bilirubin concentration (forehead: rho = 0.83, abdomen: rho = 0.89, knee: rho = 0.82, and foot: rho = 0.65, all P less than 0.00001). The values obtained from the forehead were significantly higher than the values obtained from the abdomen (P less than 0.0001), the knee (P less than 0.00001), and the foot (P less than 0.00001). The cephalocaudal progression of jaundice correlated positively with the plasma bilirubin concentration (rho = 0.58, P less than 0.00001) and inversely with the gestational age (rho = -0.28, P less than 0.01). The results support a proposed hypothesis explaining the cephalocaudal progression of jaundice in newborns. According to the hypothesis, the cephalocaudal colour difference may be caused by the presence of young bilirubin-albumin complexes in the blood undergoing conformational changes.

Upper gastrointestinal symptoms in the third trimester of the normal pregnancy

OBJECTIVES To report on the prevalence of well-being, heartburn, nausea, and vomiting related to gestational week, parity, and age in the third trimester of the normal pregnancy. STUDY DESIGN Self-administered questionnaire filled in daily by 180 women from 31st gestational week to delivery. RESULTS The study was completed by 120 women. The weekly prevalence of well-being decreased from 50% at the 31st gestational week to 24% at the 42nd gestational week (P = 0.00001). The weekly prevalence of heart-burn (approximately 60%), nausea (approximately 16%) and vomiting (approximately 7%) was nearly constant throughout the study period. Well-being was inversely related to parity, (P = 0.006), heartburn positively related to age (P = 0.016), and nausea and vomiting inversely related to age (P = 0.003 and P = 0.044). CONCLUSION Discomforts are customary in the third trimester of normal pregnancy. However, heartburn and especially nausea and vomiting appeared occasionally and were not present for longer periods. The findings that heartburn, nausea and vomiting had different relations to age may suggest different etiologies.

Predicting the Need for Phototherapy in Healthy Mature Neonates Using Transcutaneous Bilirubinometry on the First Postnatal Day

Since newborn infants are frequently sent home within 24-48 h after birth, the prediction of severe hyperbilirubinaemia, requiring treatment, is important. We tested the prediction of the need for phototherapy by measuring the yellow skin colour and the progression in yellow skin colour over 6 h using transcutaneous bilirubinometry (TcB), during the first 33 h of age. The first TcB reading at median 21 h (11-33 h, 5th and 95th percentiles) of age and the difference in readings over a 6-hour interval were reliable predictors of later phototherapy. An even better prediction was possible using the first TcB reading and the 6-hour difference in TcB readings.

Cephalocaudal Progression of Jaundice in Newborns Admitted to Neonatal Intensive Care Units

The influence of several clinical factors on the cephalocaudal progression of neonatal jaundice was investigated in 377 newborns admitted to the neonatal intensive care unit for various reasons. Multiple regression analysis showed that, beyond the relationship to the plasma bilirubin concentration, the cephalocaudal color gradient was significantly, negatively related to gestational and postnatal age. Furthermore, the cephalocaudal progression of jaundice seemed more extended in females compared to males. The results are in agreement with a theory explaining that the cephalocaudal color gradient is due to conformational changes in the newly formed bilirubin albumin complexes.

Maternal Bilirubin, Cord Bilirubin, and Placenta Function at Deliveryd the Development of Jaundice in Mature Newborns

The study material comprised 213 newborns with a birth weight above 2000 g, and their mothers. At delivery, blood samples were obtained from the umbilical cord and the mothers cubital vein for determination of the transplacental bilirubin gradient and assessment of placental function by means of the HPL concentration in the rnaternal blood. The HPL concentration showed no relation to the transplacental bilirubin gradient or the umbilical cord bilirubin concentration. Therefore, to the extent that the the HPL concentration reflects the rate constants for bilirubin transfer, an increased transplacental bilirubin gradient or an increased cord bilirubin concentration could not be explained by an impaired ability of the placenta to transfer bilirubin. When the infants who became jaundiced were compared with the non‐jaundiced, significantly higher transplacental bilirubin gradient (p<0.00001), cord bilirubin (p<0.00001) and maternal bilirubin values at the time of delivery (p<0.03) were found among the jaundiced infants. On the basis of the results it was possible to define subgroups of infants with significantly higherllower risk of subsequent jaundice.

The influence of the reserve albumin concentration and pH on the cephalocaudal progression of jaundice in newborns

The relationship between cephalocaudal progression of jaundice and bilirubin concentration, reserve albumin concentration and plasma pH was studied in 47 newborn infants. Furthermore, the cephalocaudal progression of the yellow colour of the skin was measured in 131 newborns at birth and on the third postnatal day. The cephalocaudal colour difference correlated positively to the bilirubin concentration (P much less than 0.001), to the reciprocal of the reserve albumin concentration (P less than 0.05) and to the squared hydrogen ion concentration (P = 0.04). The cephalocaudal colour gradient at birth correlated positively to the gradient at the third postnatal day (P less than 0.0004). The results support the hypothesis that the cephalocaudal progression of jaundice in icteric newborn infants may be explained by conformational changes in the young bilirubin-albumin complex.

Maternal smoking and the bilirubin concentration in the first three days of life

The effect of maternal smoking on the plasma bilirubin concentration in the first three postnatal days was investigated in 137 mature newborns. Forty-three percent of the mothers reported on smoking during pregnancy. The median increase in plasma bilirubin concentration during the first 24 h of postnatal life was significantly higher in the group of neonates born to smokers compared to the group of neonates born to non-smokers (P less than 0.02). By contrast, the median increase in plasma bilirubin concentration from the 1st to the 3rd postnatal day was significantly lower among the neonates born to smokers compared to the group with non-smoking mothers (P less than 0.04). The overall frequency of clinical jaundice and the frequency of neonates with plasma bilirubin concentration above 175 microM on the 3rd postnatal day was almost identical in the two groups. It is suggested that maternal smoking may affect the postnatal plasma bilirubin concentration in the offspring by various mechanisms.

Association of Previous Cesarean Delivery With Surgical Complications After a Hysterectomy Later in Life

Importance In recent decades, the global rates of cesarean delivery have rapidly increased. Nonetheless, the influence of cesarean deliveries on surgical complications later in life has been understudied. Objective To investigate whether previous cesarean delivery increases the risk of reoperation, perioperative and postoperative complications, and blood transfusion when undergoing a hysterectomy later in life. Design, Setting, and Participants This registry-based cohort study used data from Danish nationwide registers on all women who gave birth for the first time between January 1, 1993, and December 31, 2012, and underwent a benign, nongravid hysterectomy between January 1, 1996, and December 31, 2012. The dates of this analysis were February 1 to June 30, 2016. Exposure Cesarean delivery. Main Outcomes and Measures Reoperation, perioperative and postoperative complications, and blood transfusion within 30 days of a hysterectomy. Results Of the 7685 women (mean [SD] age, 40.0 [5.3] years) who met the inclusion criteria, 5267 (68.5%) had no previous cesarean delivery, 1694 (22.0%) had 1 cesarean delivery, and 724 (9.4%) had 2 or more cesarean deliveries. Among the 7685 included women, 3714 (48.3%) had an abdominal hysterectomy, 2513 (32.7%) had a vaginal hysterectomy, and 1458 (19.0%) had a laparoscopic hysterectomy. In total, 388 women (5.0%) had a reoperation within 30 days after a hysterectomy. Compared with women having vaginal deliveries, fully adjusted multivariable analysis showed that the adjusted odds ratio of reoperation for women having 1 previous cesarean delivery was 1.31 (95% CI, 1.03-1.68), and the adjusted odds ratio was 1.35 (95% CI, 0.96-1.91) for women having 2 or more cesarean deliveries. Perioperative and postoperative complications were reported in 934 women (12.2%) and were more frequent in women with previous cesarean deliveries, with adjusted odds ratios of 1.16 (95% CI, 0.98-1.37) for 1 cesarean delivery and 1.30 (95% CI, 1.02-1.65) for 2 or more cesarean deliveries. Blood transfusion was administered to 195 women (2.5%). Women having 2 or more cesarean deliveries had an adjusted odds ratio for receiving blood transfusion of 1.93 (95% CI, 1.21-3.07) compared with women having no previous cesarean delivery. Conclusions and Relevance Women with at least 1 previous cesarean delivery face an increased risk of complications when undergoing a hysterectomy later in life. The results support policies and clinical efforts to prevent cesarean deliveries that are not medically indicated.

The Clinical Significance Of The Genital Microbiologic Flora At Vacuum Aspiration Following Miscarriage

85 women undergoing vacuum aspiration following miscarriage were studied. At the time of vacuum aspiration, immunofluorescent stainings for detection of C. trachomatis proved positive in 5.9% of the patients. Group 8 streptococci were isolated in 7.5%, coliforms in 3.5%, and Gardnerella vaginalis in 51% of the patients. The overall frequency of postabortal pelvic inflammatory disease (PID) was 3.5%. whereas 40% of chlamydia‐positive women contracted postabortal PID (p < 0.05). No significant relation between other microorganisms and postabortal PID was observed. The duration of postabortal bleeding was unrelated to the genital microbiologic flora. Based on anamnestic information about previous pregnancies and duration of preoperative bleeding it was possible to define subgroups at risk of harboring C. trachomaris and coliforms. The clinical significance of this is unknown.