Marie A. Valdes-Dapena

The causes of neonatal mortality." An analysis of 501 autopsies on newborn infants

The major disease processes identified in a series of 501 consecutive necropsies onnewborn infants who died within the first 28 days of life are classified. The data are compared with a similar series of 102 autopsies performed elsewhere and reported in 1953, 1 national statistics on neonatal mortality as presented by the United States Public Health Service, 12 and all of the itemized entries on 501 consecutive death certificates for newborn infants who died in philadelphia in 1966. There comparisons show that vital statistics derived from death certificates of infants dying during the neonatal period must be interpreted with great caution. In certain of the major categories, data so derived do not appear to reflect the actual frequency of these processes as causes of death.

Boric acid poisoning

The autopsy findings in 3 fatal cases of boric acid poisoning are described in detail. The demonstration of intracytoplasmic inclusion bodies in the acinar cells of the pancreas is considered to have diagnostic significance. The literature on boric acid poisoning is reviewed, and the data relative to 83 fatal and 89 nonfatal cases are tabulated. In addition, various aspects of the subject, such as minimal lethal doses, blood and tissue concentrations, procedures for toxicologic analyses, and modes of absorption and elimination of the drug, are discussed.

THE NORMAL OVARY OF CHILDHOOD

The growth of the ovary from the time of birth until the menarche is largely dependent upon an increase of its stroma, the reticular fibers of which undergo drastic changes in their orientation during this period of time. Simultaneously with the growth of the ovarian stroma there is a tremendous decrease in the number of oocytes; much of this latter change probably occurs during the first year of life.

Cardiovascular causes for sudden infant death.

Although sudden infant death syndrome (SIDS) is a cause for sudden infant death, other causes should be ruled out before diagnosing SIDS. Cardiac causes for sudden infant death include viral myocarditis, congential heart disease particularly congential aortic stenosis, endocardial fibroelastosis, and anomalous origin of the left coronary artery from the pulmonary artery. Other cardiac conditions that may result in sudden death include rhabdomyomas of the heart in tuberous sclerosis and conduction system disorders. The most frequent conduction system disorders resulting in sudden death include histiocytoid cardiomyopathy, congential heart block that may be associated with maternal lupus erythematosus, arrhythmogenic right ventricular dysplasia, noncompaction of the left ventricle, and long QT syndromes.

Sudden unexpected death in infancy:A statistical analysis of certain socioeconomic factors

A statistical analysis of sudden unexpected deaths in infants in relationto race and economic status is presented. The population of Philadelphia was divided by census tracts, according to information derived from the 1960 census, into 3 categories: one of low economic status, one of moderate economic status, and one of high economic status. The incidence of sudden deaths among infants in each category was determined and expressed per 1,000 live births and per 100 deaths of infants. Sudden deaths in infancy occurred significantly more frequently among non-Caucasians than Caucasians and among the poorer segments of the population than among those with high incomes, regardless of race.

Sudden and unexpected death in infants

Protein fractionation was performed by paper electrophoresis on the sera of 114 infants who had died suddenly and unexpectedly. The sera from 33 healthy living infants of comparable age were used as controls. The values for the test group were not lower than those of the controls. Thus, abnormally low levels of gamma globulin do not appear to play a part in the mechanism responsible for these unexplained deaths.

Sudden and unexpected death in infants: II. Viral infections as causative factors**

This study was undertaken in an attempt to isolate viral agents responsible for sudden, unexpected death in apparently well infants. Eight different samples of tissue were taken from each of 109 necropsies on infants who had died suddenly and unexpectedly. Isolation techniques included the use of adult mice, suckling mice, chick embryos, and tissue cultures in HeLa cells and monkey kidney cells. A viral agent was isolated from but one autopsy, a Coxsackie B 5 from the lungs of a 3-month-old Negro female in whom histologic sections revealed no evidence of any inflammatory process. Thus, at least so far as present techniques can demonstrate them, viral infections do not play a role in the cause of these sudden deaths.

Yellow pulmonary hyaline membranes.

Yellow pulmonary hyaline membranes were observed at autopsy in 16 newborn infants between 1972 and 1974 in four hospitals of Philadelphia, Pa., and Newark, N.J. Other pediatric pathologists in this country and in Spain have seen the same lesion within the last decade. Chemical analysis of affected lung tissue, histochemistry, and electron microscopy show the yellow color to be due to the presence of bilirubin. No substantial clues concerning the basic etiology or mechanism for the formation of these unique membranes emerge from a detailed review of clinical and postmortem data nor from comparison of these data with those for 68 control infants with the usual acidophilic pulmonary hyaline membranes. We are left, however, with the impression that prolongation of life, relatively elevated levels of serum bilirubin, and protracted assisted ventilation (with either CPAP or PEEP) are intimately related to their formation.

Thrombosis of the left coronary artery in a newborn infant

A unique occurrence of antenatal thrombosis of the left main coronary artery in a term infant is presented. The clinical features are indistinguishable from those of several other forms of congenital heart disease. The etiology of the thrombosis is unknown.