Concepcion G. Sia

Xiphopagus conjoined twins: A 300-year review of the obstetric, morphopathologic, neonatal, and surgical parameters☆

Obstetric, morphopathologic, neonatal, and surgical features of 36 reported cases of xiphopagus conjoined twins were correlated and reveal: (1) a 6% incidence of prenatal diagnosis; (2) a 36% rate of dystocia; (3) a 19% incidence of stillbirths; (4) variation in the extent of fusion; (5) a high rate of occurrence of concurrent congenital malformations, not limited to a conjoined area, especially of the heart (25%) and gastrointestinal tract (33%); (6) the importance of diagnostic tests to elucidate conjoined or abnormal structures because of the high rate of concurrent malformations; (7) opisthotonos as the body alignment position of choice; (8) a 69% female sex bias; (9) surgical separation usually in the first year of life; and (10) a 53% survival rate. This paper correlates the world literature for xiphopagus conjoined twins for the past 300 years.

Oral rehydration solutions: increased water and sodium absorption by addition of a viscosity-enhancing agent in a rat model of chronic osmotic diarrhea.

Viscosity-enhancing agents such as carboxymethylcellulose (CMC) can alter absorption of solutes and fluid exchange in the small intestine. We investigated whether the standard World Health Organization oral rehydration solution (WHO-ORS) with the addition of CMC would improve net water and sodium absorption in rats using an in vivo intestinal perfusion technique. Four WHO-ORS, containing either 0, 2.5,5.0, or 10.0 g/L of CMC, were perfused in rats with a well-tested model of cathartic-induced chronic osmotic diarrhea (D) and in normal controls (C). In D rats, the ORSs with CMC improved sodium absorption at the three concentrations used (p < 0.01). The same effect was shown in C rats. Net water absorption was also enhanced in D rats given ORSs with CMC, although the changes in C animals were less marked. The improvement in sodium and water absorption in both C and D rats positively correlated with the log of relative ORS viscosity. Ultrastructural examination of tissues perfused with 10 g/L of CMC showed an extended brush border glycocalyx. This study indicates that CMC added to WHO-ORS in the perfused rat jejunum improves the effectiveness of the solution by increasing sodium and water absorption.

Failure of cesarean section to prevent intracranial hemorrhage in siblings with isoimmune neonatal thrombocytopenia

Two siblings with isoimmune neonatal thrombocytopenia developed severe neurological sequelae secondary to intracranial hemorrhage despite delivery by cesarean section. These cases demonstrate that cesarean section alone will not prevent intracranial hemorrhage, in utero or postnatally, in isoimmune neonatal thrombocytopenia.

CONJUGATED HYPERBILIRUBINEMIA |[lpar]|CH|[rpar]|: A PREDICTOR OF PREINATAL MORTALITY AND POOR NEUROLOGIC OUTCOME

Thirty-six of 1236 high-risk newborns transported to NSUH between 1/73 and 12/82 developed CH (direct bilirubin >2.0 mg/dl or >50% of total); 36 transports matched for sex, race, gest. age ± 2 wk, weight ± 200 gm, birthdate ± 1 yr, served as controls. All charts were reviewed to determine association between CH and various factors.These results indicate that CH is significantly associated with shock, hemolytic disorders, multiple Tx, exchange Tx, higher mortality and subsequent poor neurologic outcome. T.P.N. was not significantly associated with CH. The outlook for survival and normal development for the neonate with CH is poorer than has been previously recognized.

Mothers in the Neonatal Intensive Care Unit: An Examination of Some Problems and Consequences of Modern Intensive Care on Mother-Infant Interaction

For those parents whose infants are critically ill in neonatal intensive care units, a perplexing problem faces the physician: How can complex intensive care be administered and, atthe same time, time-dependent maternal-infant reciprocal interactions be allowed to proceed? Facets of this problem are explored.

AN ANALYSIS OF THE NEONATAL NURSE CLINICIAN (NNC)

84 NNCs from 28 randomly selected NICUs were interviewed via telephone between Jan-Mar 82. The interview included 7 open-ended, 21 fixed-alternative and 5 scaled-item questions. Sequence and wording were predetermined to delineate the group biographic profile, professional education, lines of responsibility,skills utilized and psychosocial aspects. 81(96%) were female, 80(95%) Caucasian, 38(45%) married and 9(11%) divorced. Educational preparation varied:18(22%) held a masters degree, 35(41%) a bachelors, 23(28%) a diploma and 8 (9%) an associates. 66(79%) completed formal NNC programs; others completed inhouse NNC programs. 62(75%) remained in their 1st employment position since beginning their career; leaving time ranged from 6 mo-6 yr with 50% leaving after the 2nd employment year. Of 22 who left 15 remained in the NNC role. A trend was noted towards NNCs with associates degrees performing more invasive tasks than those with masters degrees. Absence of a defined role was the primary factor felt to be responsible for nurse-physician conflict. The study documents the wide range of NNC education, demonstrates the group stability, points out the low crude turnover rate, and indicates the need for the NNC role to be more specifically defined.

1619 PERIVENTRICULAR LUCENCY: THE MOST COMMON CT LESION IN FULL-TERM NEONATES WITH CNS DISEASE

In 1979 74 CT head scans were obtained on 57 AGA (31 male, 26 female), >2500-gm, 28 days-of-age newborns with suspected CNS disease in the NSUH NICU. Indications for CT scan included: CNS bleed - 2; cyanotic episode - 3; myelomeningocele - 3; seizure - 34; macro/microcephalus - 10; miscellaneous - 6. Eight scans were normal; 4 showed CNS bleed; 4 showed congenital malformations; 6 showed hydrocephalus; and 37 showed periventricular lucencies: 8 mild, 12 moderate, and 17 severe. Of the infants with periventricular lucencies, respirator support was required for 27% (10/37); Apgar scores were <6 in 27% (10/37); abnormal EEGs occurred in 49% (18/37); and seizures occurred in 68% (26/37). Hospitalization stay averaged 27 days. In our experience, periventricular lucency is the most common CT head scan abnormality found in full-term infants with neurologic disease and correlates with other parameters of negative neurologic outcome.

95 HOW FLOWS THE MILK OF HUMAN KINDNESS

Establishment of a human milk supply is the sine qua non for the development of a Human Milk Bank. In response to a plea for donors, 568 lactating mothers volunteered to donate milk to the NSUH Human Milk Bank without financial recompense. Of the 568 volunteers, 309 failed to complete the medical screening process; 97 never submitted the medical forms; and 4 completed the medical screening process but were dropped for medical reasons, leaving 158 qualified donors. Of the 158, 81 actually donated milk. All were white; 52% were between 26-30 years of age; 35% were working mothers of which 41% were registered nurses. Seventy-five of the 81 donors donated 2,813 ounces of milk (37%) while 6 donated 4,765 ounces or 63% of the total milk received! The longest time a donor supplied milk was 10 months. By the end of the first 10 months, 59 of the 81 donors had abandoned the effort, for a drop-out rate of 73% in 10 months. The milk of human kindness is hard to find and depends upon the generosity of a few dedicated individuals.

THE EFFECT OF INFANT INTERHOSPITAL TRANSFER UPON PATTERNS OF PARENTAL RESPONSE

Parents of all infants who stayed 2 weeks or longer in the neonatal intensive care unit were surveyed to (1) assess the levels of contact and anxiety experienced by parents of infants transferred to the neonatal intensive care unit; and (2) to compare these levels with those of parents of infants who were born in-hospital. Morbidity was assessed using the Infant Morbidity Score. Thirty-three were parents of transfer infants and 58 were parents of born-in infants. There was no significant difference among the transfer and born-in infants in severity of illness or length of hospitalization. Parents of transfer infants had significantly less infant contact than parents of born-in infants (p<0.05). Anxiety levels in each group of parents were similar. There were significant positive correlations between contact and anxiety (p<0.03) and between infant morbidity and anxiety (p<0.01) in both groups. These findings suggest that the decreased contact by parents of transfer infants due to early separation and to distance did not alter the pattern of response to their infants illness.