Thomas R. Boggs

Toxicity to bilirubin in neonates: Infant development during first year in relation to maximum neonatal serum bilirubin concentration****

Neurologic and developmental performance during the first year of life was correlated with maximum neonatal serum bilirubin levels for 27,000 infants in the Collaborative Perinatal Project. The infants were grouped by race and by five birth weight/gestational age categories to control for the effect of these factors on hyperbilirubinemia and developmental outcome. Low mean eight-month motor scores and delayed one-year motor development were associated with serum bilirubin levels in the range of 10 to 14 mg/dl and above. This relationship was strongest for low-birth-weight/short-gestational-period infants. A persistent association of developmental outcome with hyperbilirubinemia was found over and above the variation of maturity within the birth weight/gestational age categories.

Correlation of neonatal serum total bilirubinconcentrations and developmental status at age eight months

Through the Collaborative Study on Cerebral Palsy of the National Institute of Neurological Diseases and Blindness, 23,000 infants 8 months of age have been observed from birth through June 30, 1964. The findings appear to indicate a positive relationship between increasing neonatal hyperbilirubinemia and the incidence of low motor and/or mental scores attained at 8 months. These relationships do not begin abruptly at the 20 mg. per cent level but may be seen to rise progressively and to become substantial at the 16 to 19 mg. per cent concentration. Since this study will ultimately include 60,000 infants who are to be followed through the age of 7 years, this is a preliminary report both as to the number of cases studied and as to the final outcome for the child.

Respiratory Distress Syndrome of Newborn Infants I. New Clinical Scoring System (RDS Score) with Acid-Base and Blood- Gas Correlations

From the Section on 1~’ecvborn Pediatrics, Pennsylvania Hospital, and the Departments of Anesthesia and Pediatrics, University of Pennsylvania School of Medicine, Philadelphia, Pa. 19104. Supported in part by grants NB 04828, NB 02367, and PA 43684 from the U. S. Public Health Service, National Institutes of Health. P-r-AJL 0 assess objectively the severity of idiopathic respiratory distress syndrome of the newborn (RDS) and the effects of therapy requires serial measurements of arterial pH and blood-gas tensions., The pediatrician for whom these measurements are not available

An outbreak of coxsackie B-5 virus infection in a newborn nursery

An outbreak of Coxsackie B-5 virus infection among newborn infants in a maternity hospital is described. The infection was sporadic and mild among full-term infants, whereas the majority of premature infants exposed became infected and ill. The infected infants showed a spectrum of illness from apparent health to manifest aseptic meningitis, but the severe reactions usually associated with Coxsackie infections in the newborn were absent; there was no clinical evidence of myocarditis. The first cases detected were the result of in utero infections. The majority of infants developed a neutralizing titer to the virus, but some premature infants failed to develop complement-fixing antibodies.

Neonatal hyperbilirubinemia associated with high obstruction of the small bowel

A review of the last 48 patients admitted to the Surgical Service of The ChildrensHospital of Philadelphia for duodenal atresia, annular pancreas, and jejunal atresia reveals that approximately one half of the infants developed hyperbilirubinemia. Forty-four per cent of the infants with duodenal atresia and annular pancreas also had mongolism. None of the infants with jejunal atresia had mongolism. No excessive bleeding was encountered at or following surgery in those infants who had exchange transfusions prior to operation.

A classification of retrolental fibroplasia to evaluate vitamin E therapy.

A refined classification of the stages of the retinopathy of prematurity (RLF) based on the experience of over 7500 examinations during the past decade is presented. We have been using the basic elements of this classification since 1972 in order to evaluate the influence of vitamin E on retrolental fibroplasia (RLF). It is our impression that it provides a more accurate clinical method of following the course of the retinopathy and a tool for assessing the factors other than prematurity and hyperoxia that may play a subtle role in the development of RLF.

Pneumomediastinum, a silent lesion in the newborn

During a six year period, the diagnosis of pneumomediastinum was maderadiologically in 21 newborn infants. Fifteen of these patients had an isolated pneumomediastinum and all survived with conservative management. Most of the infants were not resuscitated. Male infants were affected more frequently, as were dysmature infants. The incidence of 25 per 10,000 live births is greater than that previously reported, but is probably below the actual incidence since many of the infants with pneumomediastinum had minimal symptoms.

Possible role of the fetal adrenal glands in the etiology of postmaturity

Plasma cortisol levels were studied in the cord blood and neonatal blood of the following vaginally delivered groups: (A) postmature; (B) postterm (but not postmature); and (C) term neonates. Significantly lower levels of 8 A.M. neonatal plama cortisol were found in postmature neonates when compared with term neonates (P LESS THAN 0.02) or merely postterm neonates (P LESS THAN 0.02). No difference was found in the cord blood cortisol levels in all three groups. Contrary to the traditional belief that postmaturity results from placental aging, our findings appear to indicate that postmaturity represents a specific fetal disorder. Fetal adrenal insufficiency may be a characteristic of this disorder. Prolonged pregnancy in these cases may be reflected inability of the affected fetus to initiate labor.

Respiratory Distress Syndrome of Newborn Infants: II. Technic of Catheterization of Umbilical Artery and Clinical Results of Treatment of 124 Patients

Supported in part by grants NB 04828, NB 02367, and PA 43684 from the U. S. Public Health Service, National Institutes of Health. OPTIMAL management of the respiratory distress syndrome of the newborn (RDS) now includes sequential sampling of arterial blood for measurement of pH and gas-tension readings. Repeated punctures of the radial and temporal 2 arteries can serve this purpose, but these procedures are difhcuit with newborns of low birth weight. And, unfortunately, readings based on capillary blood cannot be considered reliable, particularly for oxygen tension (Pao,), in infants with the respiratory distress syndrome (RDS).3 We have been employing catheterization of the umbilical artery in management of newborn infants with RDS for the past five years. Such catheterization, employing a plastic feeding tube for one to five days, is technically simple and ef~cient and reasonably safe .4-T This report deals with our experience in the first 124 infants with whom the procedure was used.

Possible adrenocortical insufficiency in postmature neonates

Total plasma cortisol in cord and neonatal blood was measured by a radioassay method in neonates resulting from (1) term vaginal delivery following uncomplicated labor (control group), (2) term vaginal delivery following fetal distress during labor, (3) postterm, postmature vaginal delivery following fetal distress during labor, and (4) postterm, postmature emergency cesarean section performed because of signs of severe fetal distress during labor. Comparison of the mean peripheral plasma cortisol values showed that whereas the mean level (plus or minus S.E.) of the distressed term neonates (22.2 plus or minus 5.3 mug per 100 ml.) use 180 per cent of that of the control group (12.3 plus or minus 1.1 mug per 100 ml.; P smaller than 0.01) the mean level for the vaginally delivered postmature group (7.5 plus or minus 1.8 mug per 100 ml.) was only 61 per cent of that of the control group (P smaller than 0.05). Furthermore, in the postmature group with sufficient intrapartum distress to warrant emergency cesarean section the mean level (4.6 plus or minus 1.5 mug per 100 ml.) was found to be only 37 per cent of that of the control group. No differences were observed among the cord plasma cortisol values. These results are strongly suggestive of a relative adrenocortical insufficiency in postmature neonates. Such insufficiency could result from a defect in any portion of the adrenal-pituitary-hypothalamic axis. Effort is under way to further define such a defect.