Leo Stern

Anxiety, pregnancy, labor, and the neonate

Abstract In order to study the relationship between maternal anxiety during pregnancy and birth weight, a prospective study involving 61 pregnant women was undertaken. At the same time, provision was made for the testing of several other hypotheses, among them that anxiety during pregnancy would be negatively correlated with age, gravidity, and parity and that those mothers who had an abnormal labor had been more anxious during their pregnancy than those whose labors were normal. In all cases anxiety was measured objectively by means of two anxiety scales of the “true or false” type. Although the results did not support the postulated relationship between anxiety and birth weight, several of the other hypotheses postulated proved to be statistically significant.

Systemic cyclopentolate (Cyclogyl) toxicity in the newborn infant.

Two cases of atropine-like toxicity following the ocular administration of cyclopentolate hydrochloride (Cyclogyl) in a pair of premature Negro twins are reported. The symptoms were confined to the gastrointestinal tract with vomiting, distension, and ileus. Both infants apparently recovered from the initial episode, but one of the twins subsequently died from necrotizing enterocolitis complicated by an intestinal perforation. In both children systemic concentrations of the drug supported the clinical impression of Cyclogyl intoxication.

Relationship of premature rupture of the membranes to gastric fluid aspirate in the newborn

Abstract Gastric aspirate was examined for leukocytes and bacterial growth in 68 infants divided into four groups based on the length of time of ruptured membranes antenatally. Positive cell smears were seen in 35 of the infants, the incidence rising steeply in those with membranes ruptured more than 12 hours. Positive cultures of the aspirate were found in 11 of the 35 infants, 3 of whom subsequently developed clinical infections. Three other infants with positive cell smears but negative gastric cultures showed clinical signs suggestive of systemic sepsis, which could not be confirmed bacteriologically. No instances of either gastric aspirate bacterial growth or clinical infection were found in the 33 infants with negative cell smears. Examination of the gastric aspirate for cells, while indicating numerically greater numbers of suspected than subsequently proved infections, can nevertheless be used as a rapid, simple, and effective means of identifying the infant at risk.

Serum ionic magnesium in exchange transfusion

Serum ionic magnesium was determined with citrated blood during 33 exchange transfusions given to 16 newborn infants. In each instance there was a reduction of Mg ++ at the end of the transfusion with an average fall to less than 60 per cent of the pre-exchange value. With repeated transfusions the pre-exchange level became lower, so that the lowest values occurred at the conclusion of multiple exchanges performed at close intervals. The effect is the results of citrate binding of magnesium, in vitro evidence for which is presented here. No clinical effects are described, but electrocardiographic changes were seen at the lowest levels.

The lesson of thalidomide

The association between thalidomide and phocomelia was discovered because of the rarity of phocomelia. When we give a drug to a pregnant woman we are also giving it to the fetus whether we want to or not. We must therefore insist that every precaution be taken to identify possible harm to the fetus before any new drug is released.

Prolonged rupture of membranes associated with a decreased incidence of respiratory distress syndrome

The finding of an increased occurrence of prolonged ruptured membranes (ROM) in a group of prematures without RDS led to a prospective study of the effect of prolonged rupture (defined as greater than 16-hour duration) on the subsequent course of premature infants. Seventeen mother-infant pairs were included in the study and steroid determinations (total blood corticosteroids, cortisol, and corticosterone) were performed on paired maternal plasma obtained prior to delivery and infant plasma obtained within the first hour of life. There was a lower incidence of RDS in infants born after greater than 16 hours ROM (0/10), when compared to those who were born after membranes had been ruptured less than 16 hours (4/7). A correlation between steroid levels (both total blood corticosteroids and cortisol) in the infants and duration of ruptured membranes was seen. However, no correlations existed with the duration of labor. It is postulated that the protective influence which prolonged rupture of membranes imparts on the premature fetus is mediated by elevated blood corticosteroids, which result in accelerated lung maturation and a subsequent decreased incidence of respiratory distress syndrome.

PLASMA CORTICOSTEROIDS IN INFANTS WITH THE RESPIRATORY DISTRESS SYNDROME

Plasma total corticosteroid concentrations were measured in 44 premature infants with the respiratory distress syndrome (RDS). Further assay of serum concentrations of cortisol, cortisone, corticosterone, corticosterone sulfate, and 11-deoxycorticosterone sufate was carried out in 24 of these infants and in 10 healthy, nonstressed premature controls. Infants with RDS had higher concentrations of cortisol (22.1±4.3µg/100 ml) and corticosterone sulfate (7.7 ± 0.8 µg/100 ml) than control infants (6.6 ± 0.8 µg/100 ml, 1.2 ± 0.3 µg/100 ml, and 4.2 ± 0.4 µg/100 ml, respectively). A significant correlation was found with the five-minute Apgar score (negative correlation, p = 0.005) and a possible correlation with the A-aDO2 gradient. Among premature infants with RDS, those of 32 weeks9 gestation or less had higher concentrations of cortisol (28.3 ± 23.6 µg/100 ml) and corticosterone (3.9 ± 2.7 µg/100 ml) than those of more than 32 weeks (11.5 ± 5.4 µg/100 ml and 1.7 ± 0.7 µg/100 ml, respectively), suggesting either elevated response to stress or a diminished ability to metabolize these compounds.