Curtis L. Lowery

Late Preterm Infants: Birth Outcomes and Health Care Utilization in the First Year

OBJECTIVE: To distinguish the effects of late preterm birth from the complications associated with the causes of delivery timing, this study used propensity score–matching methods on a statewide database that contains information on both mothers and infants. METHODS: Data for this study came from Arkansas Medicaid claims data linked to state birth certificate data for the years 2001 through 2005. We excluded all multiple births, infants with birth defects, and infants at <33 weeks of gestation. Late preterm infants (LPIs) (34 to 36 weeks of gestation) were matched with term infants (37–42 weeks of gestation) according to propensity scores, on the basis of infant, maternal, and clinical characteristics. RESULTS: A total of 5188 LPIs were matched successfully with 15303 term infants. LPIs had increased odds of poor outcomes during their birth hospitalization, including a need for mechanical ventilation (adjusted odds ratio [aOR]: 1.31 [95% confidence interval [CI]: 1.01–1.68]), respiratory distress syndrome (aOR: 2.84 [95% CI: 2.33–3.45]), and hypoglycemia (aOR: 1.60 [95% CI: 1.26–2.03]). Outpatient and inpatient Medicaid expenditures in the first year were both modestly higher (outpatient, adjusted marginal effect:

Human Papillomavirus is More Prevalent in First Trimester Spontaneously Aborted Products of Conception Compared to Elective Specimens

108 [95% CI:

Magnetoencephalographic recordings of visual evoked brain activity in the human fetus

58–

Fetal MEG redistribution by projection operators

158]; inpatient,

Development of auditory evoked fields in human fetuses and newborns: A longitudinal MEG study

597 [95% CI:

Trophoblasts are the preferential target for human papilloma virus infection in spontaneously aborted products of conception

528–

Short-term serial magnetoencephalography recordings offetal auditory evoked responses.

666]) for LPIs. CONCLUSIONS: LPIs are at increased risk of poor health-related outcomes during their birth hospitalization and of increased health care utilization during their first year.

Fetal magnetoencephalography: current progress and trends.

In this study the possible role of human papillomaviruses (HPV) in spontaneous abortions is addressed by assaying for HPV DNA in first trimester spontaneous and electively aborted products of conception materials enriched for chorionic villi. The presence of HPVs was measured by polymerase chain reacton (PCR) amplification and DNA dot blot hybridization using an internal probe. The “broad spectrum” HPV primers were directed to amplify E6/E7 junction sequences, while the probe was of an HPV-16 sequence with significant homology to HPV-6/11. The quantity and quality of isolated DNA was also analyzed and compared by observing the PCR amplification of a cellular sequence from the human β-globin gene. Fifteen of the 25 spontaneous samples (60%) were found to be positive for HPV E6/E7 sequences. In comparison, only 3 of the 15 elective samples (20%) were positive. This is the first study of HPV in fetal materials to incorporate material from elective abortions as a control group. Although confounding contamination from the cervix and vagina can’t be ruled out, these data are significant and strongly suggest that HPVs are elevated in spontaneously aborted products of conception. Furthermore, these results suggest the possibility that HPVs may be etiologic agents of at least some spontaneous abortions.

Functional development of the visual system in human fetus using magnetoencephalography.

We investigated the feasibility of recording visual evoked brain activity in the human fetus by use of non-invasive magnetoencephalography (MEG). Each recording lasted 6 min and consisted of a sequence of 180 flashes with 33 ms duration delivered 2 s apart over the maternal abdomen. Four of ten fetuses included showed a response; the ranges of amplitude and latency of peak response were 15-30 x 10(-15) Tesla and 180-390 ms, respectively. Six fetuses showed no discernible response. With improvement, this method could aid in the testing of fetal neurological status throughout pregnancy.

Synchronization analysis of the uterine magnetic activity during contractions

The fetal magnetoencephalogram (fMEG) is measured in the presence of large interference from the maternal and fetal magnetocardiograms. This interference can be efficiently attenuated by orthogonal projection of the corresponding spatial vectors. However, the projection operators redistribute the fMEG signal among sensors. Although redistribution can be readily accounted for in the forward solution, visual interpretation of the fMEG signal topography is made difficult. We have devised a general, model-independent method for correction of the redistribution effect that utilizes the assumption that we know in which channels the fMEG should be negligible (such channels are distant from the known fetal head position). In a simplified case where the fMEG can be explained by equivalent current dipoles, the correction can also be obtained from fitting the dipoles to the fMEG signal. The corrected fMEG signal topography then corresponds to the dipole forward solution, but without orthogonal projection. We illustrate the redistribution correction on an example of experimentally measured flash evoked fMEG.