Leonard Glass

Death-Scene Investigation in Sudden Infant Death

We conducted death-scene investigations in 26 consecutive cases in which a presumptive diagnosis of sudden infant death syndrome (SIDS) was made and the infants were brought to the emergency room of the Kings County Hospital Center between October 1983 and January 1985. In six cases, we observed strong circumstantial evidence of accidental death. In 18 other cases, we discovered various possible causes of death other than SIDS, including accidental asphyxiation by an object in the crib or bassinet, smothering by overlying while sharing a bed, hyperthermia, and shaken baby syndrome. This study suggests that many sudden deaths of infants have a definable cause that can be revealed by careful investigation of the death scene and that the extremely high rate of SIDS (4.2 per 1000 live births) reported in the population of low socioeconomic status served by Kings County Hospital Center should be questioned.

The biologic and social consequences of perinatal cocaine use in an inner-city population: Results of an anonymous cross-sectional study

Cocaine use among pregnant women and reports of its adverse perinatal consequences have increased substantially over the past 10 years. However, most researchers have studied patients registered at drug treatment centers or have relied on voluntary participation by patients, either of which introduces the possibility of selection bias. To determine the frequency and consequences of prenatal cocaine use among an unselected inner-city obstetric population, we collected urine samples from parturient women at a municipal hospital and anonymously tested these specimens for metabolites of cocaine, marijuana, opiates, and methadone. Urine specimens, with linked obstetric data sheets, were available from a study population of 1111 patients, and pediatric data sheets were available for 846 mother-infant pairs. Cocaine metabolites were found in 11.5% of the urine samples collected, whereas metabolites of marijuana, opiates, and methadone, respectively, were present in 1.1%, 1.2%, and 0.3% of the specimens. Cocaine users were more likely than nonusers to have had no prenatal care (51% vs 8.8%; p less than 0.0001), to be American-born rather than Caribbean-born (71% vs 33%; p less than 0.001), and to have a higher parity (1.83 vs 1.14; p less than 0.0001). Infants of cocaine users had a lower mean gestational age (-0.93 weeks; p less than 0.01), a lower mean birth weight (2560 +/- 788 vs 3151 +/- 699 gm; p less than 0.001), and an increased probability of having an Apgar score of less than 7 at 5 minutes (12.5% vs 3.2%; p less than 0.0001). Multiple linear regression analysis that isolated confounding variables such as the presence or absence of prenatal care, maternal age and parity, and the use of cigarettes and alcohol did not substantially affect the differences described above. The effect of cigarette smoking on reducing fetal size was cumulative. In conclusion, cocaine is the most commonly used illicit drug among parturients in this community and is strongly associated with underutilization of prenatal care services. Infants of cocaine users are more likely to be preterm and depressed at birth and to have a low birth weight. Cocaine use, through the above-noted effects, increases the need for prenatal care while simultaneously decreasing the likelihood that it will be obtained.

Mycoplasma hominis and Ureaplasma urealyticum in neonates with suspected infection

The role of genital mycoplasmas in the pathogenesis of neonatal infection is incompletely understood. We performed nasopharyngeal, blood and cerebrospinal fluid (CSF) cultures for Mycoplasma hominis and Ureaplasma urealyticum in 69 neonates who underwent a diagnostic workup for suspected sepsis. The mean gestational age was 35.9 weeks (range, 25 to 42 weeks) with a mean birth weight of 2386 g (range, 652 to 4420 g). Twenty-seven infants (39.1%) had positive nasopharyngeal cultures; 6 were positive for M. hominis, 10 for U. urealyticum and 11 for both organisms. Seven (26%) of these 27 patients developed chronic lung disease compared with 2 (4.7%) infants in the non-colonized group. Nine infants had positive CSF cultures for M. hominis and one infant had a positive CSF culture for U. urealyticum. All blood cultures were sterile. One of the infants with a positive CSF culture for M. hominis had clinical evidence of systemic infection. All of the infants were treated with antibiotic agents that were not active against mycoplasmas. These data indicate that genital mycoplasmas can be found commonly in the CSF and nasopharynx of infants with suspected sepsis. Their etiologic role in the causation of infection and chronic lung disease, however, remains unclear.

Amniotic fluid shake test versus lecithin/sphingomyelin ratio in the antenatal prediction of respiratory distress syndrome

Abstract Evaluation of amniotic fluid shake test and L/S ratio was done on 98 patients in the third trimester of pregnancy to predict fetal pulmonary maturity. The shake test proved to be a useful tool in assessment of fetal pulmonary maturity. The L/S ratio, although mostly corroborative with the clinical picture of the babies, sometimes shows higher or lower levels than expected, depending on the clinical condition of the mother.

α1-Antitrypsin Concentration in Amniotic Fluid

Concentrations of α1-antitrypsin were measured in 80 specimens of amniotic fluid collected at various stages of pregnancy. Levels remained relatively unchanged throughout gestation, with a median concentration of 10.0 mg/100 ml at 12–24 weeks, 18.7 mg/100 ml at 34–37 weeks, and 16.2 mg/100 ml, after the 37th week. In three instances where the infant developed RDS, the median concentration was 12.4 mg/100 ml.

Flora in Newborn Infants

Marked annual variations in prevalence of several bacteria in the nares and umbilicus of newborns were observed in a four-year survey that included 1,804 infants. Significant differences between highest and lowest seasonal prevalence of Staphylococcus aureus occurred nearly every year among both premature and full-term infants, with a decline in autumn as the most consistent trend. Similar fluctuations occurred, mainly among premature newborns, in prevalence of Escherichia coli and streptococci. In contrast, S epidermidis and Enterobacter organisms showed no cyclical variation. Hexachlorophene was used only minimally in cleaning the newborns. Skin infections were infrequent, mild, and not seasonal in distribution. The basis for prevalence variations is uncertain, but ambient temperature, humidity, and gestational age can be excluded. These data suggest that cyclical fluctuation in S aureus and other bacteria be considered in evaluating efficacy of routine hexachlorophene bathing or other antibacterial mea...

ALKALOIDAL COCAINE (“CRACK”) IN PREGNANCY: A PROSPECTIVE COHORT STUDY

Twenty-five women who used crack during pregnancy were compared to a cohort group of non crack using women matched for age, socioeconomic status, parity, presence or absence of prenatal care and use of tobacco and alcohol. Crack exposed infants were eight times more likely to weigh less than 2.5 kg than infants of cohort mothers. There was a higher frequency of head circumference less than the tenth percentile for gestational age (p<0.025) in the study group infants, and mean gestational age in this group (37.5±3.8 weeks) was significantly lower than in the cohort infants (39.3±2.1 weeks; p=0.027). There was a higher frequency of premature rupture of membranes (p=0.046) in the crack than in the cohort group. Fifty-five percent of infants exposed to crack in-utero had abnormal neuromuscular symptoms, usually of short duration.These studies suggest that use of crack has a deleterious effect on the outcome of pregnancy, and that careful medical follow-up of these infants is necessary.

EFFECT OF THERMAL ENVIRONMENT AND CALORIC INTAKE ON HEAD GROWTH OF LOW BIRTH INFANTS DURING THE LATE NEONATAL PERIOD

Prolonged exposure of low birth weight infants to subther-moneutral environmental temperatures in the late neonatal period is associated with decreased rates of weight gain and linear growth. In order to assess the effects of ambient thermal conditions on postnatal head growth, we have reared 40 asymptomatic infants (birth weights 900 to 1800 gm) under 4 study conditions (WH-abd. skin temp. 36.5°C, caloric intake 144 Cal/kg/day; WL-abd. skin temp. 36.5°C, caloric intake 120 Cal/kg/day; SH-abd. skin temp. 35.0°C, caloric intake 144 Cal/kg/day; SL-abd. skin temp. 35.0°C, caloric intake 120 Cal/kg/day) after the first week of life.The rate of head growth (average daily increase in head circumference) was significantly greater (P<0.01) in the WH and WL groups than in the SL group. These differences in head growth may be of importance in the psychomotor development of low birth weight infants.

307 ERYTHROCYTE (RBC) GLUTATHIONE S-TRANSFERASE: DEVELOP MENTAL PATTERNS IN PRETERM INFANTS

The glutathione S-transferases (GST) are a group of enzymes present in a number of tissues, including liver and RBCs. They initiate detoxification of endogenous and exogenous substances by conjugation with glutathione, and might act as storage proteins by binding nonsubstrate compounds such as heme and bilirubin. They also exhibit non-selenium-dependent glutathione peroxidase (GSH-Px) activity. The low activity of Se-dependent GSH-Px in neonatal RBCs compared with those from adults, and comparatively high activity of RBC GST in fullterm (FT) neonates, prompted a study of developmental patterns of RBC GST in preterm (P) infants.RBC GST was assayed in 23 P infants (birth wt 700–2100gm) and 12 FT infants soon after birth.Results:P had significantly higher activity than FT (*p<.01). Within the P group, a highly significant negative correlation was found between birth wt and enzyme activity (r=−0.61; p<.01). We speculate that these developmental patterns might reflect changes in heme &/or bilirubin ligand functions associated with heme turnover rates. They might also indicate a physiological inverse relationship between Se-dependent and Se-independent GSH-Px activity during development, and might require a re-evaluation of the interaction of fetal anti-oxidant protective mechanisms.

354 EFFECT OF INTRAUTERINE EXPOSURE TO NARCOTICS ON CORD BLOOD CONCENTRATIONS OF PROLACTIN (PRL), CORTISOL(C), AND THYROXINE (T 4 ) IN PRETERM INFANTS

PRL, C and T4 enhance fetal lung maturation, and decreased cord blood levels of these hormones have been found in infants with RDS. Use of narcotics during pregnancy may both decrease the incidence of RDS and affect the metabolism of these hormones.Cord blood concentrations were measured in 33 infants with a G.A. of 30 to 36 weeks. Ten were exposed to either heroin, methadone, or both and two of these developed RDS. Of the 23 non-narcotic exposed infants, 8 developed RDS and 15 did not.The following results (median and range) were obtained:The differences in PRL concentrations between the narcotic exposed and RDS groups were of borderline statistical significance (p=0.08), while levels of C were significantly higher in the no RDS than in the RDS or narcotic exposed groups (p<0.01). None of the other inter-group differences was statistically significant.Intrauterine exposure to narcotics may play a modifying role in the synthesis of pulmonary surfactants.