George Cassady

The value of umbilical cord histology in the management of potential perinatal infection

The value of histologic examination of the placenta and umbilical cord in the prospective management of 351 neonates with potential infection or perinatal asphyxia was evaluated for a one year period. An increased incidence of funisitis was observed in association with both fetal immaturity and prolonged rupture of fetal membranes; this increase in cord inflammation was related to an increased incidence of infection in these groups. A significant association of funisitis with perinatal asphyxia, either with or without meconium staining, was not found. An eightfold increase in the incidence of bacteriologically proved infection was observed in neonates with funisitis. The only proved infections occurring in the absence of cord inflammation were associated with bacterial invasion by group B β-hemolytic streptococcus. Although demonstration of funisitis does not definitively separate the infected from the uninfected fetus or neonate, examination of the adnexa enables the physician to identify a group whose risk is particularly high. Evaluation of adnexal histology is not a substitute, however, for careful clinical observation and appropriate bacteriologic and diagnostic studies.

Transcutaneous monitoring in the newborn infant

Comment: We believe our readers will find this state-of-the-art summary useful. All experienced clinicians can ruefully recall an instance when the laboratory or some instrument led them astray, sometimes to the detriment of the patient. Dr. Cassady gives a fresh and authoritative look at where we are. The particular emphases on misleading results and reasonable applications seem especially welcome at this time.--R.E.M.

Untaxed whiskey and fetal lead exposure.

Summary A 10-week-old infant with evidence of neurologic defects, intrauterine growth retardation, and postnatal failure to thrive was studied for abnormal lead accumulation because of a maternal history of long-term ingestion of untaxed whiskey. After challenge doses of CaEDTA, the infant and the mother each excreted an abnormally large amount of lead in the urine. These data provide suggestive evidence of transmission of lead transplacentally. Because of the widespread ingestion of untaxed whiskey in the southeastern United States, intrauterine lead exposure may be a cause of fetal and neonatal disease.

Intrauterine growth retardation: Clinicopathologic findings in 233 consecutive infants☆

Abstract Clinicopathological perinatal findings in 233 consecutive intrauterine growth retardation (IGR) infants delivered during a one-year period are compared with those of 2,814 normally grown perinates delivered at the same institution during the same time interval. The IGR population constitutes a particularly vulnerable group in which quantitative and qualitative differences in morbidity and mortality are apparent.

Antipyrine space studies and cell water estimates in infants of low birth weight.

Extract: Antipyrine space (APS) studies in 44 normally grown (NG) neonates revealed estimates of total body water (TBW) comparable to those found by earlier investigators utilizing desiccation analyses. Body water per kilogram of body weight was higher in the 32 premature infants than in the 12 mature neonates, even after correction for presumed changes in body fat during growth (mean APS/lean mass was 846 ml/kg in premature and 782 ml/kg in mature infants, P < 0.01), suggesting less hydration of lean mass with maturity. Cell water (ICW) estimates, obtained by concurrent bromide and antipyrine dilution studies revealed no differences between mature and premature neonates after fat corrections (mean ICW/lcan mass was 391 ml/kg in premature and 368 ml/kg in mature neonates, P > 0.10). Prompt decrease in cell water was evident in the mature NG infants (correlation coefficient for ICW/APS versus study age: r = −0.76; ICW versus study age: r = −0.58), whereas such changes were absent in the premature infants (ICW/APS versus study age: r = −0.08; ICW versus study age: r = −0.16).Total water and cell water estimates in 23 intrauterine growth-retarded (IGR) neonates also studied were comparable to those of weight peers (mean APS, 790 ml/kg and ICW, 379 ml/kg in IGR; mean APS, 809 ml/kg and ICW, 375 ml/kg in NG prematures) but considerably in excess of values seen in gestational peers (mean APS, 688 ml/kg and ICW, 324 ml/kg in NG mature infants). The high total body water and cell water values were particularly prominent in the earlier-studied IGR infants (mean APS, 841 ml/kg and ICW, 494 ml/kg); a notable finding was the rapid downward adjustment of cell water to values similar to those in NG mature infants (ICW, 335 ml/kg in later-studied IGR infants and 314 ml/kg in later-studied NG mature neonates). This expansion of cell water in earlier-studied IGR infants persisted despite correction for a presumed total depletion of body fat (ICW/lean mass, 494 ml/kg in IGR infants, and 389 ml/kg in NG mature babies; ICW/APS was 0.56 in IGR neonates and 0.50 in NG mature infants, P < 0.001 for both). These findings indicate a real increase in cell water at birth in the IGR infant.Speculation: Changes in body composition in infants with intrauterine growth retardation (IGR) include sizable expansions, on a per kilogram basis, of all body water compartments. Although these findings resemble those observed in chronic protein-calorie malnutrition, rapid adjustments toward normal in the early hours after birth suggest a more transient, acute expansion, primarily of cell water, in the IGR neonate. These changes may reflect impaired cellular metabolism and increased cell acidity consequent to an increased asphyxial stress of labor and delivery in these infants

Anencephaly: A 6 year study of 367 cases

Abstract A retrospective study of birth and death certificates for 6 consecutive years 1961–1966 in a single state revealed 367 anencephalic births, an incidence of 0.826 per 1,000. A steadily rising incidence from 0.58 per thousand 1961 to 1.01 per thousand 1966 was observed. Incidence of this malformation in the Caucasian was found to exceed by almost sevenfold that in the Negro population. Seasonal and geographic factors were shown to have no direct effect on incidence of the defect. Previous reports suggesting an excess of females (64 per cent of the present series), premature delivery (58 per cent of this series), and fetal growth retardation (57 per cent of this series) were confirmed. An excessive perinatal mortality of 112.9 per thousand was recorded in the 204 multiparous mothers in this series, confirming the concept that birth of an anencephalic fetus may predict or accompany a disastrous obstetric career.

The placental transfer of cephalothin

Various neonatal effects of a single maternal injection of 1 Gm. of cephalothinwithin the hour prior to delivery were studied in 43 patients. Peak drug levels in the infants lagged 15 to 30 minutes behind peak maternal levels, and the neonate achieved absolute plasma-drug levels far below the mothers. No acute evidences of drug toxicity were noted. Evidence of effective neonatal renal excretion of cephalothin was observed and the rate of plasma decay of drug was relatively rapid.

The amniotic fluid in anencephaly. Preliminary report.

Abstract With increasing frequency, characteristics of the amniotic fluid are being used to predict fetal condition in utero. In the present report, spectrophotometric changes previously considered specific for Rh immunization are described in maternal hydramnios with fetal anencephaly.

The hazard of fetal-maternal transfusion after transabdominal amniocentesis.

Abstract Fifty-four amniocenteses in 34 women were preceded and followed by direct staining of maternal blood for fetal cells. Transplacental fetal to maternal bleeding consequent to the procedure was uncommon, exceeding 0.1 ml. in only 2 instances (4 per cent). The immunologic hazard of amniocentesis appears to be no greater than that of pregnancy.

Radionuclide angiography in the evaluation of ductal shunts in preterm infants

Radionuclide angiograms were compared with radiographic and physical findings and with echocardiographic left atrial to aortic ratios in 30 neonates clinically suspected of having a persistent ductus arteriosus. In three infants without clinical signs and with normal LA/Ao ratios (10%), radionuclide angiograms provided evidence of a large left-to-right shunt, which was confirmed by the finding of a large ducts arteriosus at surgery. Whereas routine physical, radiographic, and echocardiographic criteria fail to identify some neonates with large PDAs, the present study suggests that radionuclide angiography can be performed in a neonatal intensive care unit setting and may be a valuable addition to currently employed diagnostic techniques.