Marguerite Herschel

Use of cytomegalovirus immunoglobulin in multiply transfused premature neonates.

We undertook a randomized, placebo‐controlled, double blind trial of cytomegalovirus (CMV) immunoglobulin (CMVIG) for prevention of CMV‐associated disease in 183 multiply transfused, premature neonates. CMVIG (150 mg/kg) or placebo was given within 24 hours of the first transfusion and at Day 10. If an intravenous catheter was still in place an additional dose was given between Days 20 and 30. The globulin and placebo groups were well‐matched with respect to birth weight, gestational age, Apgar score, birth to a CMV‐seropositive mother, requirement for assisted ventilation and exposure to CMV‐positive, unscreened blood products. Among infants followed for more than 10 days, 18 (10.5%) developed CMV infection; 9 had symptomatic CMV disease (5 placebo; 4 CMVIG). Among infants born to a CMV‐seropositive mother, CMVIG use was associated with a CMV syndrome rate of 3.2% (95% confidence interval, 0.2 to 18.5%) compared to 12.5% (95% confidence interval, 4.5 to 27.6%) among placebo recipients (P = 0.163). Among placebo recipients infants born to CMV‐seropositive mothers were more likely to have a virologically confirmed CMV syndrome than those born to a CMV‐seronegative mother, despite receipt of blood not screened for CMV antibody (P = 0.012). Multivariate analysis demonstrated that two factors were independently associated with CMV acquisition: the volume of CMV‐seropositive blood products transfused (P = 0.005); and birth to a CMV‐seropositive mother (P = 0.006). Infusions of CMVIG were well‐tolerated. This study reaffirms that perinatally acquired CMV disease is more common among infants born to CMV‐seropositive mothers than CMV‐seronegative mothers, even without use of CMV‐screened blood products.

Positive correlation of optical density at 650 nm. with lecithin/ sphingomyelin ratios in amniotic fluid

In this study, we have attempted to correlate optical density measurements of amniotic fluids with L/S ratios. We may conclude, with over a 98 per cent accuracy, that fluids having optical density readings of 0.15 and above, at 650 nm. will have an L/S ratio over 2.0. Fluids having optical density readings up to 0.05 will have L/S ratios of about 1.3. Finally, amniotic fluids having optical densities greater than 0.05 and less than 0.15 will have L/S ratios of approximately 1.5.

The effect of cervical/vaginal secretions on measurements of lecithin/sphingomyelin ratio and optical density at 650 nm

Free-flowing amniotic fluid collected vaginally can be used in a reliable way for determination of fetal pulmonary maturity. Lavaging the vaginal/cervical area with sterile saline and examining the lavage fluid for lecithin/sphingomyelin (L/S) spots showed no detectable spots in the supernatants (one exception) and barely detectable L/S spots in the sediment. Vaginal-cervical saline-wash fluids did not affect fluid L/S ratios. Lavaging the vaginal-cervical area with abdominal amniotic fluid did not affect the L/S ratio of the original amniotic fluid.

Measurements of amniotic fluid optical density

Collea, J. V., Rabin, S. C., Weghorst, G. R.. and Quilligan. E. I.: The randomized manacrement of term frank breech presentation: Vaginal delivery versus cesarean section, AM. J. OBSTET. GYNECOL. 131:186, 1978. Karp, L. E., Doney, J. R., McCarthy. T., et al.: The premature breech: Trial of labor or cesarean section? Obstet. Gynecol. 53:88, 1979. Bowes. W. A., Jr., Taylor, E. S., O’Brien. M., and Bowes. C.: Breech delivery: Evaluation of the method of delivery on pcrinatal results and maternal morbidity. AM, J. OBSTET. GYNECOL. 135:965. 1979. Kurjak. .4.. and Breyer. B.: Estimation of fetal weight by ultrasonic abdominometry. AM. .J. OBSTET. GYNECOL. 125:962, 1976.

1189 MECHANICAL OVER VENTILATION (MOV) AS A FACTOR IN PULMONARY AIR LEAK (PAL)

36 infants treated from Oct. 76 to Dec. 77 with pressure limited ventilation for respiratory failure in HMD had a 25% incidence of pulmonary air leak (PAL). Mortality was 80% with PAL, 20% without. PAL occurred at <48 hrs. in 8/9.PAL was common in patients who had sustained PaCO2 < 40 mm Hg (mechanical over ventilation - MOV) and whose FiO2 and breaths per minute were lowered rather than peak airway pressure, as PaO2 improved. 5/6 of the infants with early ventilation who died without MOV were severely asphyxiated at 1 min (Apgar ≤ 3) compared with 1/5 of the infants who died with MOV. Deaths in Non-MOV infants may be associated with adverse perinatal factors predisposing the lung to injury.