Toshio Fujikura

Significance of a single umbilical artery. Report from the collaborative study of cerebral palsy.

Abstract 1. 1. A total of 26,539 placentas of single births obtained from 12 different institutions enrolled in the collaborative study were evaluated, in which 203 (0.76 per cent) showed a single umbilical artery on gross and microscopic examination. 2. 2. The incidence of single umbilical artery in the white was 1.22 per cent, a higher incidence than in the Negro, which was 0.44 per cent. This racial difference was consistently present in the various institutes and in all maternal age and birth weight groups. Conversely, the incidence of associated congenital malformations was higher in the Negro (42.1 per cent) than in the white (23.0 per cent). 3. 3. Associated congenital malformations were classified into three Types of malformations: A (lethal or major), B (nonlethal), and C (borderline). The over-all incidence of associated malformations (Types A, B, plus C) was 28.6 per cent. When the Type C malformations were excluded, the incidence was 16.7 per cent. Type A malformations were found in 9 of the 20 stillbirths and in 4 of the 6 neonatal deaths, but only in 7 (4.0 per cent) of the 174 survivors. Skeletal system anomalies showed the highest incidence in the associated malformations. 4. 4. The incidence of SUA was 1.98 per cent in infants of low birth weight (2,500 grams and under). In infants weighing over 2,500 grams the incidence was 0.63 per cent. 5. 5. Maternal diabetes was 6.4 per cent, an incidence 5 times higher than in the control group.

The influence of race and other factors on pulmonary hyaline membranes: A report from the Collaborative Study of Cerebral Palsy

Abstract 1. The pulmonary sections of 434 neonatal deaths out of 27,407 single live births in consecutive deliveries were reviewed, of which 131, or 4.8 per 1,000 live births showed HM. 2. The frequency of live births below 2,501 grams was nearly twice as high in the Negro as in the white. However the neonatal death rate was lower in the Negro than in the white for this birth weight group, but slightly higher in the Negro than in the white for birth weights over 2,500 grams. The HM rate was consistently lower in the Negro for all birth weight groups. 3. Hyaline membranes do occur in infants weighing over 2,500 grams and constitute 17.6 per cent of the total HM cases. In this birth weight group moderate and marked membranes were encountered with nearly the same frequency as slight membranes. 4. In the 500 to 1,500 gram birth weight group of infants with HM, more than 80 per cent died within 24 hours. The heavier infants with HM survived longer. In the non-HM group of all races, more than 50 per cent of the cases died within 24 hours regardless of birth weight. HM infants dying within 24 hours showed slight membranes more frequently than moderate or marked membranes in each birth weight group. The reverse was true with survival times of between 24 to 72 hours. 5. In whites, the survival time pattern of the HM group was similar to that of the non-HM group. In the Negro, 71.2 per cent of the HM group were dead within 24 hours, as against 49.4 per cent of the non-HM group. Only 1.5 per cent of the Negroes in the HM group were still alive at 72 hours in contrast to 23.1 per cent of Negroes in the non-HM group. 6. Pneumonia was seen in 33 of HM cases, and the associated membranes were frequently of moderate or marked degree. HM cases with pulmonary edema were fairly evenly distributed between those with slight (19.2 per cent) as with moderate and marked (20.8 per cent) membranes.

Birth weight, gestational age, and type of delivery in rhesus monkeys.

Abstract The frequency distribution of birth weights at any given gestational age spans a wide range in human newborn infants. To describe the infants in whom a discrepancy between birth weight and gestational age has been remarkable, a variety of terms have been used: intrauterine growth retardation, dysmaturity, placental insufficiency syndrome, low birth weight infants, etc. The variability in birth weights of 471 rhesus monkeys at a specific gestational age was wide, just as in human newborn infants. The variability in birth weights, as indicated by the coefficient of variation, was roughly constant regardless of gestational age, sex, and type of delivery. Since gestational ages of these animals were presumed to be accurate because of timed matings, such a variability in birth weights could be a biological phenomenon; fetal development is highly independent even in similar environmental situations.

Organ-weight/brain-weight ratios as a parameter of prenatal growth: A balanced growth theory of visceras

Abstract Except for the spleen, organ-weight/brain-weight ratios (O/B ratios) remained practically constant for each group in infants weighing 1,000 to 3,500 grams. This suggests that organ weights seem to increase proportionately at constant rates during the prenatal period (a balanced growth theory of viscera). Subtle weight changes in internal organs were detected by using O/B ratios. The thymus was small in infants with erythroblastosis; the lungs were large in infants of diabetic mothers; and the lungs and kidneys were small in infants of toxemic mothers. The liver was small in Negro male infants and twins, two groups known to have high perinatal mortality rates. Brain weights in infants with diabetes, toxemia, and erythroblastosis were within the normal expected range.

Intrauterine pneumonia in relation to birth weight and race.

Abstract Intrauterine pneumonia remains a common and often fatal infectious process despite the advent of antibiotics. Acute chorioamnionitis is generally accepted as its frequent precursor. In a histologic evaluation of the pulmonary sections of 512 neonatal deaths within the first 48 hours of life out of 36,212 single live births, 100 or 19.5 per cent were found to have pneumonia. The proportion of neonatal deaths showing pneumonia was higher in the Negro (27.7 per cent) than in the white (11.3 per cent) and consistently higher in the Negro at each birth weight interval. The association of pneumonia and chorioamnionitis was more pronounced in the Negro (50.7 per cent) than the white (28.0 per cent). In the white the incidence of pneumonia was higher in mature (birth weight over 2,500 grams) than in premature infants; in the Negro it was not higher in prematures compared to mature infants. This is in contrast to chorioamnionitis, which is more common in premature births.

TRANSPLACENTAL PASSAGE OF MATERNAL ERYTHROCYTES WITH SICKLING

Sickled erythrocytes served as a marker for maternal blood in a cell transfer study of placentas from uncomplicated term pregnancies of women with sicklemia. The incidence of concurrent sickling in maternal and fetal blood was 100% in the 44 cases examined. Maternofetal passage of the erythrocytes was found four times more frequently in umbilical or chorionic veins (8.4%) than in arteries (1.9%). Deported chorionic villi were found in the veins in three of 44 cases but not in the arteries. These findings indicate fresh maternofetal leakage of blood during the third stage of labor.

FOLLOW-UP OF INFANTS WITH SINGLE UMBILICAL ARTERY

Of 39,773 white and black consecutive single births, 344 (0.9%) had single umbilical artery (SUA). The incidence was higher in whites (1.2%) than in blacks (0.5%). Despite high mortality in infants with SUA (14.0%) the incidence was still 0.7% among surviving infants. Associated malformations were present in 19 of 36 dead infants with SUA, or 52.8%, and in 11 of 266 SUA survivors, or 4.1%. Cardiovascular and genitourinary anomalies were not higher in dead infants with SUA compared to all dead malformed infants. A follow-up study of infants up to 4 years of age was undertaken, comparing 266 SUA survivors with 798 matched controls. Among malformations found in survivors, only inguinal hernia was significantly higher in SUA children compared to controls. The incidences of other specific abnormal conditions were not significantly different in the two groups. The mean values of body weight, body length, and head circumference at 4 months, 1 year, and 4 years of age, were almost equal in the two groups, as were the mental and motor scores at 8 months and the I.Q. at 4 years of age.