Felix P. Heald

The young pregnant teenager: Impact of comprehensive prenatal care

Pregnant teenagers under the age of 15 years are known to be at highest risk for delivering low-birth-weight infants, particularly poor black girls. Sixty-seven inner-city pregnant adolescent girls 15 years or less at the time of delivery were followed in a special Teen Obstetric Clinic staffed by an interdisciplinary team trained in adolescent and prenatal health care. Ninety-three percent of the clinic population was black. The fetal outcomes of these girls were compared with the fetal outcomes of 67 girls who attended the regular obstetric clinic. Girls were matched for age at delivery, race, socioeconomic status, and parity. Only 9.0% of the infants of the teenagers in the Teen Obstetric Clinic group weighed less than 2500 g, compared with 20.9% of the infants of the girls in the regular Obstetric Clinic group. This finding has implications for the type of prenatal care provided to young adolescents.

Adolescents who attempt suicide.

A suicide prevention program for teen-agers was established and at the completion of the first two years a review of the data was undertaken. A group of 65 adolescents who attempted suicide were identified in that time period. The median age group was 16 years, and 75% were girls. Ingestion was the predominant method used in these suicidal attempts. The major characteristics of these youngsters included long-term family disruption, social isolation, and academic difficulties. A subgroup of 25 adolescents received psychologic tests. When compared to a matched control group there was a significantly higher rate of minimal brain dysfunction for those adolescents who attempted suicide.

Pneumomediastinum in the newborn infant

Summary Pneumomediastinum in a newborn infant can produce an alarming andunusual clinical picture characterized by: (1) extreme cyanosis; (2) marked precordial bulge; (3) almost absent heart sounds; (4) rapid shallow respirations. Anteroposterior and lateral films of the chest in the case described showedatelectasis of the right upper lobe and air in the anterior mediastinum. The lateral film is pathognomonic of this syndrome. Relief of symptoms (essentially cardiac) was obtained by needle aspiration of the anterior mediastinum, from which 17 c.c. of air was obtained. Recovery was uneventful.

567 OXYGENATED CHOLESTEROLS: NEW RISK FACTORS FOR ATHEROSCLEROSIS?

Previous reports have shown oxygenated derivatives of cholesterol (C) to be angiotoxic in vivo and in-vitro in animal models of atherosclerosis and have demonstrated their presence in processed, C containing foods. In this study abdominal aorta obtained from 8 adolescent trauma victims at autopsy was chemically analysed for the presence of these compounds. All aortas contained atherosclerotic lesions which were dissected out, freed of adventitial fat, minced, extracted in cholorform:methanol 2:1 then saponified in 15% KOH. The non-saponifiable lipid (sterol) was separated in a two stage thin layer chromatography system using Ether:Benzene:Ethyl Acetate then Ether:Heptane on Silica Gel G plates. Bands corresponding to known standards were then scraped and eluted in chloroform, converted to trifluoro-acetates, and quantified by gas liquid chromatography. Significant levels of two oxygenated C derivatives known to be cytotoxic were found. These were (x ± S.D.) 25-OH cholesterol 213 ± 108 μg/100 mg of lipid and cholesterol 5,6 epoxide 25 ± 13 μg/100 mg of lipid. C content was 58 ± 18 mg/100 mg of lipid. The concentration of C in the lesions was positively correlated with the level of 25-OH C. These data are consistent with earlier studies of tissue from older individuals with more advanced lesions and suggest a role for these compounds in the current epidemic of early onset of atherosclerosis.

Serological response to rubella revaccination in adolescent females

The studys purpose was to utilize ELISA in determining rubella susceptibility in teenagers who are seronegative by HI. Ten previously vaccinated, seronegative adolescent females were revaccinated with RA 27/3 and their IgG and IgM responses measured by ELISA. Before revaccination, all 10 were seronegative for rubella by HI (less than 1:10). However, by ELISA, six showed an IgG and no IgM levels. After reimmunization, three showed a significant IgM response by day 6, indicating primary rubella exposure. The remaining seven females failed to demonstrate an IgM response; however, the failure was consistent with a history of prior rubella vaccination. Peak IgG responses were noted by day 12 in nine of the females. The remaining teenager failed to show an IgG response and was considered a vaccine failure. This study confirms the superiority of ELISA as compared to HI titers in determining rubella susceptibility.

13 SUSCEPTIBILITY OF URBAN ADOLESCENT OBSTETRICAL POPULATION TO RUBELLA

Recent surveys, following the introduction of the USA rubella immunization program in 1969, have noted that 66-70% of the rubella cases are occuring in individuals 15 yrs. or older. Current estimates are that 20-30% of 10-19 yr. old females are without rubella antibody. A retrospective study was undertaken to document rubella susceptibility in an urban, low-income adolescent obstetrical population ranging in age from 12-16 yrs. Records were reviewed for all 177 patients (97% black) attending the Adol. OB Clinic from 9/73 to 10/80. Forty-six incomplete charts were excluded. Chart assessment included documentation of age; race; gestational age at first visit; rubella immunization history (as determined by prior health records, immunization cards and/or maternal history of immunizations); and rubella titers. Rubella Hemagglutination Inhibition (HI) titers were determined on a twofold dilution method by the Univ. Serology lab; an HI antibody test of less than 1:10 or non-reactive was considered indicative of susceptibility to rubella.Of the OB adolescent population, urban and predominantly black, 28% (34/131) were serologically susceptible to rubella. It is unclear whether the critical factor in susceptibility was the duration of vaccine-induced immunity or primary vaccine failure. To increase the level of protection in this high risk group, recommendations include: routine booster immunization with family planning for non-pregnant, seronegative adolescents and/or postpartum vaccination in seronegative teenagers.

GESTATIONAL WEIGHT GAIN OF AFRICAN AMERICAN ADOLESCENT MOTHERS OF FAVORABLE BIRTH WEIGHT INFANTS • 30

GESTATIONAL WEIGHT GAIN OF AFRICAN AMERICAN ADOLESCENT MOTHERS OF FAVORABLE BIRTH WEIGHT INFANTS • 30

5 BEACH PARTY: DEPRESSION IN ADOLESCENTS AND YOUNG C ADULTS IN A RESORT COMMUNITY

Depression and suicide are recognized as major problems among adolescents and young adults. Little is known of the epidemiology and risk factors associated with depression. We studied the prevalence of depression in a presumably low risk group. The study was conducted at a general youth clinic in Ocean City, Maryland between June 3, 1984 and September 2, 1984. This clinic serves teen and young adult summer workers, vacationers and some permanent residents. All patients between the ages of 13 and 25 were asked to complete the CES-D depression scale. This is a standardized survey instrument which measures depressive symptomatology among general populations. Demographic data and diagnosis were abstracted from the medical record. 581 patients returned a valid questionnaire. Data collection was complete for 94% of the questionnaires. Overall, 29% of our sample scored in the depressed range. This is significantly greater than the 17% noted in the general population (p<0.05). Depression was not related to the duration of residence at the resort. It was also unrelated to the patients socioeconomic status, educational level or age. Females were significantly more depressed than males. The only diagnosis which was significantly related to depression was pregnancy. We conclude that depressive symptomatology is a significant problem among adolescents and young adults but that its presence in specific patients is not predictable.

Aortic Fatty Streaking and Alterations of Serum Cholesterol, Amino Acids, and Copper in Miniature Pigs Fed Atherogenic Diet

The pig has been used as a model for studies of atherogenesis because it is similar to humans in blood vessel wall structure (French et al., 1965), response to high-fat-high-cholesterol diets (Florentin et al., 1968) and to the development of atherosclerosis (Ratcliffe and Luginbuhl, 1971). Serum cholesterol levels are increased in pigs when they are fed diets containing butter (Bragdon et al., 1957) or beef tallow (Pfeifer and Lundberg, 1958; Barnes et al., 1959a, b). Diets low in protein have also been known to cause hypercholesterolemia (Elvehjem, 1956). While the metabolic interconversion of fat, carbohydrate, and protein has been well established (Conn and Stumpf, 1972), the effects of atherogenic diets on serum free amino acids have received less attention. Among the essential microminerals, manganese, a known cofactor in the biosynthesis of squalene, has been shown to be directly related to serum cholesterol levels in humans and chickens (Doisy, 1972). Schroeder et al. (1971) have shown that chromium deficiency is associated with hypercholesterolemia in rats. An inverse relationship has been reported between serum copper and cholesterol levels in the rat (Murthy and Petering, 1976; Petering et al., 1977), and a high zinc/copper ratio has been implicated in hyperlipidemia (Klevay, 1973) and ischemic heart disease (Chapter 4 of the present volume).

443 CONCENTRATION OF CHOLESTEROL IN DIFFERENT BODY POOLS OF MINI-PIGS FED ATHEROGENIC AND CONTROL DIETS

Relationships of dietary cholesterol to its distribution and deposition in various tissues were studied in male mini-pigs fed isocaloric a high cholesterol-high fat (HC-HF) and control (C) diet from 30 through 55 weeks (wks) of age. Cholesterol was measured in serum at alternate wks throughout the study; in lipoprotein fractions, liver, muscle, and adipose tissue at the end of the experiment. Although cholesterol levels were higher in all tissues of HC-HF group, a statistically significant difference from the C group was observed only in case of cholesterol content of liver, serum and lipoprotein fractions. LDL and HDLc carried the highest amounts of cholesterol in the HC-HF group than the controls which had no HDLc. Cholesterol content of VLDL and HDL was also significantly greater in the HC-HF animals than the C group. A 4-fold increase in serum cholesterol was observed within 5 wks after feeding the HC-HF diet and a peak was reached within 15 wks followed by a significant decline to more or less a constant level after 40 wks of age despite a uniform daily intake of dietary cholesterol. It seems that the pig after 40 wks of age acquires some mechanism(s) to either metabolize dietary cholesterol more effectively or the endogenous synthesis of this steroid is decreased. (Supported from NIH grant (NS 06779-08) and Frank G. Bressler Research Fund.)