CLINICAL AND EXPERIMENTAL PHARMACOLOGY AND PHYSIOLOGY, Issue 2007
Lawrence Beilin
SUMMARY 1Longitudinal studies from the US, Australia and Europe have demonstrated tracking of childhood risk factors for cardiovascular disease from adolescence into adult life. These factors include obesity, blood cholesterol levels, blood pressure and measures of insulin resistance. Worldwide increases in childhood obesity and overweight are already resulting in increases in adolescent diabetes and are likely to translate into earlier onset hypertension and cardiovascular disease in adults. 2Low birth weight has also been associated with increased risk of adult cardiovascular disease, diabetes and high blood pressure, but there is considerable debate as to the relative importance of pre- and postnatal influences. 3These issues are discussed in the context of results of a longitudinal cohort study of cardiovascular and metabolic risk factors in Western Australia, the ,Raine' childhood cohort, which showed that in a well-nourished Australian population at age 8 there was a U-shaped relationship between birth weight and a cluster of factors predisposing to adult cardiovascular disease, with postnatal weight gain being the dominant factor. 4Future public health programmes should focus on both pre- and early postnatal factors predisposing to obesity, hypertension and diabetes. [source]

The burden of paediatric stroke and cerebrovascular disorders in Croatia

INTERNATIONAL JOURNAL OF STROKE, Issue 5 2009
J. Lenicek Krleza
Pediatric stroke is significantly less common than stroke in adults, but represents a major challenge to public health authorities. The aim of this retrospective study was to identify the total and annual number of children younger than 18 years with arterial ischaemic stroke and transient ischaemic attack referred to the Children's Hospital Zagreb, which is a major national centre specialised for the treatment and prevention of stroke in children. We reviewed the medical records of the Department of Neuropediatrics database at the Children's Hospital Zagreb between 1998,2005 in order to provide demographic and clinical characteristics and neuroimaging findings in children with arterial ischaemic stroke. In the 7-year period, we identified a total of 124 children from different geographic areas of Croatia with a confirmed diagnosis of transient ischaemic attack (N=77), and arterial ischaemic stroke (N=47). Perinatal and childhood arterial ischaemic stroke were equally represented (23 and 24 children, respectively). The average number of new cases identified each year was 18 cases (range: 12,21), seven arterial ischaemic stroke and 11 transient ischaemic attack cases. Male predominance was found in children with arterial ischaemic stroke with a male : female ratio of 1·76 : 1, and was slightly higher in childhood arterial ischaemic stroke compared with perinatal arterial ischaemic stroke (2 : 1 and 1·56 : 1, respectively). In contrast, transient ischaemic attack was more frequently found in girls, and more likely identified in older children compared with younger children with arterial ischaemic stroke. Obtained data will contribute to better understanding of paediatric stroke in Croatia and will provide a base for the establishment of the national referral center and national pediatric stroke registry. [source]

Perinatal and intrafamily transmission of hepatitis B virus in three generations of a low-prevalence population

JOURNAL OF MEDICAL VIROLOGY, Issue 2 2003
Katalin Ördög
Abstract Family members of 47 hepatitis B virus (HBV)-carrier pregnant women were tested for the presence of hepatitis B surface antigen (HBsAg), other markers of HBV infection, and hepatitis A virus (HAV) antibodies. Eleven members of six families were found to be HBV DNA positive. Five of the anti-HBe-positive persons were found to be HBV DNA carriers, too. The mean age of the HBV DNA carriers was found to be lower than that of Hbe carriers; therefore, it is suggested that seroconversion to HBe occurs before the resolution of HBV DNA carrier state. Superinfection with hepatitis A virus was not found to influence the elimination of HBV-carrier state, as there was no correlation found between the hepatitis A exposure and the hepatitis B virus markers in the families. The low HBV prevalence in the population (0.3%) was in contrast to the high prevalence of the families of the HBV-carrier mothers (27.1%) and family members with HBV markers (50.4%). Significant positive correlation was found in the proportion of HBV-positive children, and the HBV history of their parents. When fathers were shown to be seronegative, the probability of HBV transmission was reduced by a factor of 6 (12.5% instead of 75%) probably due to reduced viral load and possibly by other factors. Several results indicate, that the noncytocidal hepatitis B virus clearing mechanism suggested by Guidotti et al. [1996, 1999] was effective also in the HBV-carrier human population. J. Med. Virol. 70: 194,204, 2003. © 2003 Wiley-Liss, Inc. [source]

Emergency Preparedness and Disaster Response Core Competency Set for Perinatal and Neonatal Nurses

JOURNAL OF OBSTETRIC, GYNECOLOGIC & NEONATAL NURSING, Issue 4 2010
Anne M. Jorgensen
ABSTRACT A nationally derived consensus-based core competency set provides perinatal and neonatal nurses a template to guide emergency preparedness and disaster response educational and training activities. Moreover, this consensus-based core competency set allows for the identification and incorporation of measurable objectives that address the learning needs of nurses as well as the unique needs of pregnant women, new mothers, and infants during public health emergencies and disaster events. [source]

Leadership in Nursing Informatics

JOURNAL OF OBSTETRIC, GYNECOLOGIC & NEONATAL NURSING, Issue 3 2004
Patricia Robin McCartney RNC
Nursing informatics is a 21st century science with great potential for improving the quality, safety, and efficiency of health care. Perinatal, neonatal, and women's health nurses have an opportunity to contribute and lead in informatics. Leaders must learn about current informatics issues from essential resources, including the literature, professional organizations, and education programs, to develop successful strategies for innovation, collaboration, and implementation. Most important, nurses must be accountable for humanizing the use of technology using a nursing model. [source]

Vacuum-assisted delivery is associated with late-onset asthma

ALLERGY, Issue 10 2009
L. Keski-Nisula
Background:, Perinatal factors during delivery might modulate fetal immunological development and thereby be associated with the development of allergic diseases and asthma later. Methods:, Perinatal data was recorded during pregnancy and at the time of delivery in regard to 5823 children who were born in Northern Finland in 1985,1986. Data from self-administered questionnaires were available at the ages of 7 and 15,16 years and skin prick tests for four main allergens were carried out at the age of 15,16 years. Only singletons delivered by the vaginal route were analyzed. Results:, There was a higher prevalence of doctor-diagnosed asthma at any time of life among children who were delivered by vacuum extraction (RR 1.80, 95% CI 1.27,2.56; P < 0.001) in comparison with spontaneously delivered children. In particular, this risk was increased as regards late-onset asthma (RR 2.41, 95% CI 1.52,3.81; P < 0.001). Perinatal effects had less impact on the development of other asthma, atopy or hay fever. Conclusions:, The delivery by vacuum extraction had significant impact on the development of late-onset asthma compared with spontaneously delivered children. [source]

AWHONN 2003 Convention Sessions Highlight Perinatal and Neonatal Prematurity Topics

NURSING FOR WOMENS HEALTH, Issue 2 2003
Article first published online: 9 MAR 200
No abstract is available for this article. [source]

Early onset, severe fetal growth restriction with absent or reversed end-diastolic flow velocity waveform in the umbilical artery: Perinatal and long-term outcomes

AUSTRALIAN AND NEW ZEALAND JOURNAL OF OBSTETRICS AND GYNAECOLOGY, Issue 1 2009
Scott G. PETERSEN
Objective: To assess perinatal and long-term outcomes for pregnancies complicated by early onset, severe fetal growth restriction with absent or reverse end-diastolic flow velocity waveform (AREDF) in the umbilical artery. Methods: A retrospective cohort study of 36 singleton pregnancies with AREDF when the estimated fetal weight (EFW) is less than 501 g at presentation. Results: At presentation, the median gestational age and EFW were 24 (18,29) weeks and 364 (167,496) g, respectively. The median interval between presentation and live birth or diagnosis of intrauterine fetal death (IUFD) was 13 (0,60) days. Delivery was for IUFD in 19 cases (53%), fetal indications in 13 cases (36%) and maternal indications in four cases (11%). Caesarean section (CS) was performed for the 17 live births of which 10 (59%) were by classical CS. Of the total cohort, five infants survived to hospital discharge giving an overall perinatal survival rate of 14%. All survivors had short-term morbidity. The cognitive function in four children was assessed as normal at two years of age. One survivor had developmental delay. None of the surviving children had any evidence of cerebral palsy. Conclusion: The overall perinatal survival rate for pregnancies complicated by early onset, severe growth restriction with an EFW of < 501 g and AREDF is low. When delivery occurs for fetal indications, the majority of these women require classical CS. Short-term neonatal morbidity is high though none of the survivors had cerebral palsy. [source]

The expression of Scratch genes in the developing and adult brain

DEVELOPMENTAL DYNAMICS, Issue 9 2006
Faustino Marín
Abstract The Scratch genes belong to the Snail superfamily of zinc-finger transcription factors present in the metazoa, represented in mammals by the Scratch1 and Scratch2 genes. We have analyzed the expression of these genes in the brain of mice at developmental stages between 9.5 days-post-coitum to adulthood. Both genes are expressed in the mantle layer of the neuroepithelium at mid-gestational stages in all regions except for the region corresponding to the V2 interneuron column, which lacked Scratch2 transcripts. From perinatal to adult stages, the expression patterns of the two genes differ. Scratch1 remains strongly expressed in almost all brain regions, although it is not found in some ventral structures such as motor nuclei and hypothalamic regions. In contrast, Scratch2 expression progressively diminishes and virtually no expression can be detected in the adult brain. Nevertheless, strong expression of Scratch2 is retained in the postnatal cortical subventricular zone, in the inner part of the cerebellar external granular layer, and in the glial cells of the adult vomeronasal nerve. Developmental Dynamoics 235:2586,2591, 2006. © 2006 Wiley-Liss, Inc. [source]

Aetiology in severe and mild mental retardation: a population-based study of Norwegian children

DEVELOPMENTAL MEDICINE & CHILD NEUROLOGY, Issue 2 2000
Petter Strømme MD PhD
The aetiology of mental retardation (MR) was studied in a population-based series of Norwegian children derived from 30 037 children born between 1980 and 1985. The study included 178 children, 79 with severe MR (SMR) (IQ<50) and 99 with mild MR (MMR) (IQ 50 to 70). Aetiology was divided into two main groups: biopathological and unspecified. The biopathological group comprised 96% of SMR and 68% of MMR, and was subdivided into prenatal (70% and 51%), perinatal (4% and 5%), and postnatal damage (5% and 1%), and a group of undetermined timing of the damaging event (18% and 11%). Single-gene disorders accounted for 15 of the 63 children with genetic disorders, including X-linked recessive in six. During the course of the study, at least 27 (15%) children had their aetiological diagnosis revised. Gestational age <32 weeks, birthweight <1500g, and Apgar scores 0 to 2 at 1 and 5 minutes implied a significantly increased risk of MR, but contributed to only 4% of the children in the study. Decreased birthweight (1500 to 2499 g) and Apgar scores 3 to 6 at 1 and 5 minutes showed increased probability of MR. Despite extensive investigations, 4% of SMR and 32% of MMR were not identified with any biological markers and were considered as unspecified MR, several most probably representing the lower end of the normal IQ distribution in the population. [source]

Human immunodeficiency virus,hepatitis C coinfection: swapping new problems for newer ones

INTERNAL MEDICINE JOURNAL, Issue 7 2001
J. Sasadeusz
Abstract Recent successes in HIV therapy have uncovered other health problems for HIV-infected individuals. Hepatitis C has become an especially significant problem, partly due to its faster progression in an immunocompromised setting. In addition, the higher viral loads in coinfected patients likely result in more efficient perinatal and perhaps even sexual transmission. Therapy has largely been neglected, despite data suggesting its efficacy in HIV,HCV coinfected patients. Studies of combination interferon and ribavirin studies are lacking, although underway. A major concern is the potential inactivation of certain thymidine analogues by ribavirin. Some antiretroviral therapies, such as ritonavir, indinavir and nevirapine, may enhance liver toxicity in coinfected patients and should be avoided if possible. The role of chronic low-grade liver function abnormalities remains uncertain and requires further investigation. (Intern Med J 2001; 31: 418,421) [source]

Prenatal and perinatal risk factors for neuroblastoma,

INTERNATIONAL JOURNAL OF CANCER, Issue 12 2008
Elizabeth Bluhm
Abstract Neuroblastoma is a rare embryonal tumor of childhood for which risk factors are not well known. Using a nested case,control design, we investigated prenatal, perinatal and neonatal risk factors in detail by linking 245 pediatric neuroblastoma cases identified in the Swedish Cancer Register diagnosed in the year 1973,1995 with the Swedish Medical Birth Register. Five living controls per case were randomly selected from the birth registry, matched by gender and age. Increased risks were associated with maternal anemia during pregnancy (odds ratio (OR) = 2.95, 95% confidence interval (CI): 1.53, 5.69), neonatal respiratory distress (OR = 3.61, 95% CI: 1.41, 9.24) and low (below or equal to 7) 1-min Apgar score (OR = 2.23, 95% CI: 1.41, 3.52). Increased risks were limited to cases diagnosed before 1 year of age. Markers of prenatal, perinatal and neonatal distress may be associated with neuroblastoma in infancy, but not with diagnoses at 1 year or above. Published 2008 Wiley-Liss, Inc. [source]

Age of closure of the foramen of Huschke: an osteological study

INTERNATIONAL JOURNAL OF OSTEOARCHAEOLOGY, Issue 1 2006
L. T. Humphrey
Abstract The foramen of Huschke is a dehiscence in the antero-inferior surface of the tympanic plate, which forms during the normal post-natal development of the temporal bone. Closure of the foramen is generally reported to take place by 5 years of age, although a persistent foramen has been observed in 0,67% of adult crania depending on the population. A persistent foramen of Huschke in adult life may be involved in abnormalities of the external auditory canal and related structures, which can lead to otological complications. This paper examines age-related changes in the development of the tympanic plate from the perinatal to the adult condition using two osteological samples from Britain, and is the first systematic evaluation beyond the age of six years. The results suggest that the widely cited chronology for the closure of the foramen of Huschke is erroneous. Earlier stages of formation may be used for narrowing age estimation in fragmentary remains of juveniles in a skeletal collection of unknown age or in a forensic or clinical context. Copyright © 2005 John Wiley & Sons, Ltd. [source]

Perinatal nursing education for single-room maternity care: an evaluation of a competency-based model

JOURNAL OF CLINICAL NURSING, Issue 1 2005
Patricia A Janssen PhD
Aims and objectives., To evaluate the success of a competency-based nursing orientation programme for a single-room maternity care unit by measuring improvement in self-reported competency after six months. Background., Single-room maternity care has challenged obstetrical nurses to provide comprehensive nursing care during all phases of the in-hospital birth experience. In this model, nurses provide intrapartum, postpartum and newborn care in one room. To date, an evaluation of nursing education for single-room maternity care has not been published. Design., A prospective cohort design comparing self-reported competencies prior to starting work in the single-room maternity care and six months after. Methods., Nurses completed a competency-based education programme in which they could select from a menu of learning methods and content areas according to their individual needs. Learning methods included classroom lectures, self-paced learning packages, and preceptorships in the clinical area. Competencies were measured by a standardized perinatal self-efficacy tool and a tool developed by the authors for this study, the Single-Room Maternity Care Competency Tool. A paired analysis was undertaken to take into account the paired (before and after) nature of the design. Results., Scores on the perinatal self-efficacy scale and the single-room maternity care competency tool were improved. These differences were statistically significant. Conclusions., Improvements in perinatal and single-room maternity care-specific competencies suggest that our education programme was successful in preparing nurses for their new role in the single-room maternity care setting. This conclusion is supported by reported increases in nursing and patient satisfaction in the single-room maternity care compared with the traditional labour/delivery and postpartum settings. Relevance to clinical practice., An education programme tailored to the learning needs of experienced clinical nurses contributes to improvements in nursing competencies and patient care. [source]

Emergency Preparedness and Disaster Response Core Competency Set for Perinatal and Neonatal Nurses

Nursing Leadership in the Boardroom

JOURNAL OF OBSTETRIC, GYNECOLOGIC & NEONATAL NURSING, Issue 3 2004
Kathleen E. Thorman BSN
It is critical that nurse leaders, including chief nurse executives and service line directors, be part of the institutional decision-making process about resource allocation, strategic direction, and planning for the future. Nurse leaders can use numerous strategies to influence decisions made in the boardroom that affect the women's service line, including perinatal and women's health. These strategies include building on the importance of women's services to the organization, working in collaboration with senior leaders and key physician leaders, marketing, and reaching out to governing boards with information. Nurse leaders must continue to prepare for the future to thrive in the increasingly complex health care environment. [source]

Prenatal diagnosis of congenital heart disease: Trends in pregnancy termination rate, and perinatal and 1-year infant mortalities in Korea between 1994 and 2005

JOURNAL OF OBSTETRICS AND GYNAECOLOGY RESEARCH (ELECTRONIC), Issue 3 2010
Ji Eun Lee
Abstract Aim:, To determine the pregnancy termination rate, and perinatal and 1-year infant mortality rates following prenatally-detected congenital heart disease (CHD) and trends over an 11-year period. Methods:, Between 1994 and 2005, 1603 gravidas underwent fetal echocardiography in our institution, in which 378 fetuses were diagnosed with CHD. The study period was divided into the following three groups for time-trend analysis: 1994,1997, 1998,2001, and 2002,2005. Data regarding gestational age at diagnosis and delivery, the presence of extracardiac or chromosomal abnormalities, pregnancy termination rate, and perinatal and 1-year mortalities were collected by review of medical records and telephone interviews. Results:, Among 378 fetuses with a prenatally-detected CHD, complete perinatal and infant outcomes were available for 336 fetuses (88.9%). There was a gradual increase in prenatally-detected CHD by fetal echocardiography during the study period (1994,1997, 10.3%; 1998,2001, 17.3%; and 2002,2005, 24.3%). The mean gestational ages at diagnosis and delivery were 27.2 ± 5.6 and 37.8 ± 2.9 weeks, respectively. Overall, the pregnancy termination rate in this study population was 20.2% and the perinatal and 1-year infant mortality rates were 6.3% and 9.7%, respectively. Among the fetuses who underwent cardiac surgery, surgical mortality occurred in two (3.8%); both died more than 1 month after surgery. Although the pregnancy termination rates remained unchanged, there was a significant decrease in perinatal and 1-year infant mortality rates over the study period. Conclusion:, Although the perinatal and 1-year infant mortalities following prenatally-detected CHD have continued to decrease significantly during the past 11 years, pregnancy termination rates have remained unchanged. [source]

De novo mutation in the mitochondrial tRNALeu(UUR) gene (A3243G) with rapid segregation resulting in MELAS in the offspring

JOURNAL OF PAEDIATRICS AND CHILD HEALTH, Issue 1 2001
CH Ko
Abstract: A 14-year-old Chinese boy with a normal perinatal and early developmental history presented at 5 years of age with migraine, intractable epilepsy, ataxia, supraventricular tachycardia, paralytic ileus and progressive mental deterioration. Computerized tomography revealed multiple cerebral infarcts in the parieto-occipital region without basal ganglial calcification. Magnetic resonance imaging showed increased signal intensity in T2 weighted images in the same regions. A cerebral digital subtraction angiogram was normal. Venous lactate, pyruvate, lactate to pyruvate ratio and cerebrospinal fluid lactate were elevated. Muscle biopsy did not reveal any ragged red fibres; dinucleotide,tetrazolium reductase activity was normal. Mitochondrial DNA analysis detected an adenine to guanine mutation at nucleotide position 3243 of tRNALeu(UUR). All four tissues analysed demonstrated heteroplasmy: leucocyte 56%, hair follicle 70%; buccal cell 64%; muscle 54%. The mother and brother of the proband, both asymptomatic, were also found to have a heteroplasmic A3243G mutation in the leucocytes, hair follicle and buccal cells. Other members of the maternal lineage, including the maternal grandmother, did not have the mutation. This report describes a patient with mitochondrial encephalopathy, lactic acidosis, stroke-like episodes, who presented with multisystem involvement. The absence of ragged red fibres in muscle biopsy did not preclude the diagnosis. Mutational analysis of mitochodrial DNA conveniently confirmed the diagnosis of the disorder. A de novo mutaton is demonstrated in this family. [source]

Perinatal risk factors and coeliac disease in children and young adults: a record linkage study

ALIMENTARY PHARMACOLOGY & THERAPEUTICS, Issue 2 2009
S. E. ROBERTS
Summary Background, Little is known about perinatal risk factors and coeliac disease. Aim, To investigate the relationship between perinatal risk factors and subsequent coeliac disease among offspring. Methods, Record linked abstracts of birth registrations, maternity, in-patient and day case records in a defined population of southern England. Results, Using univariate analysis, coeliac disease in the child was associated with maternal coeliac disease (odds ratio = 20.6; 95% CI = 5.04,84.0; based on two cases in both mother and child) and with social class, year of birth, maternal smoking and parity. Multivariate analysis confirmed an increased risk of coeliac disease of 3.79 (95% CI = 1.85,7.79) for classes IV and V compared with I and II, an increased risk of 1.92 (1.06,3.49) for births during 1975,1979 compared with 1970,1974 and an increased risk of 1.80 (1.05,3.09) for ,subsequent' compared with ,first' births. Smoking during pregnancy was no longer associated with coeliac disease. Because numbers were small, maternal coeliac disease was excluded from the multivariate anaylsis. Conclusions, This study shows increased risks of coeliac disease for manual social classes, births during the late 1970s and ,subsequent' births. Overall, perinatal risk factors seem to have a limited role in the aetiology of coeliac disease in children and young adults. [source]

The impact of caesarean delivery and type of feeding on cow's milk allergy in infants and subsequent development of allergic march in childhood

ALLERGY, Issue 6 2009
F. Sánchez-Valverde
Background:, The incidence of IgE-mediated cow's milk allergy (CMA) has increased over the last few years. There are several genetic and environmental risk factors that may be related to this allergy and the subsequent allergic march (AM). Methods:, A prospective, cohort study was conducted in patients recruited into the study between 1998 and 2002. Information on clinical variables and complementary tests, perinatal and obstetric factors and the type of hydrolysed formula used was recorded. A cross sectional study on the prevalence of allergic diseases in this cohort was performed in 2004. Results:, We compared IgE-mediated CMA patients with non-IgE-mediated CMA patients and found that IgE-mediated CMA is associated with caesarean delivery (OR = 2.14 95% CI: 1.02,4.49), duration of breast feeding (>2 months, OR = 4.14; 95% CI: 2.17,7.89) and the use of supplementary artificial formula whilst breast feeding (OR = 2.86; 95% CI: 1.33,6.13). The factors associated with AM in IgE-mediated CMA patients were caesarean delivery (OR = 0.42; 95% CI: 0.19,0.92) and the use of more extensively hydrolysed high grade hydrolysates (+EH/HGH) (OR = 0.44; 95% CI: 0.20,0.98), both as protective factors. Conclusions:, Caesarean delivery is demonstrated as being a risk factor for IgE-mediated CMA, but it does not increase the risk of AM in these infants. The use of +EH/HGH appears to protect IgE-mediated CMA patients from eventually developing AM. [source]

Functional neuroanatomy of the human pre-Bötzinger complex with particular reference to sudden unexplained perinatal and infant death

NEUROPATHOLOGY, Issue 1 2008
Anna M. Lavezzi
The authors are the first to identify in man the pre-Bötzinger complex, a structure of the brainstem critical for respiratory rhythmogenesis, previously investigated only in rats. The evaluation of the neurokinin 1 receptors and somatostatin immunoreactivity in a total of 63 brains from 25 fetuses, nine newborns and 29 infants, allowed to delineate the anatomic structure and the boundaries of this human neural center in a restricted area of the ventrolateral medulla at the obex level, ventral to the semicompact ambiguus nucleus. The neurons of the pre-Bötzinger complex were roundish in fetuses before 30 gestational weeks and lengthened after birth, embedded in a dendritic system belonging to the reticular formation. Besides, structural and/or functional alterations of the pre-Bötzinger complex were present in a high percentage of sudden deaths (47%), prevalent in late fetal deaths. In particular, different developmental defects (hypoplasia with a decreased neuronal number and/or dendritic hypodevelopment of the reticular formation, abnormal neuronal morphology, immunonegativity of neurotransmitters, and agenesis) were found. The authors suggest that the pre-Bötzinger complex contains a variety of neurons not only involved in respiratory rhythm generation, but more extensively, essential to the control of all vital functions. Sudden death and in particular sudden unexpected fetal death could therefore be ascribed to a selective process when developmental alterations of the pre-Bötzinger complex arise. [source]

Hypoplasia of the arcuate nucleus and maternal smoking during pregnancy in sudden unexplained perinatal and infant death

NEUROPATHOLOGY, Issue 4 2004
Anna Maria Lavezzi
Maternal smoking during pregnancy is the most important risk factor for sudden perinatal and infant death in more industrialized countries. The frequent observation of hypoplasia of the arcuate nucleus in the brainstem of these victims prompted the verification of whether maternal cigarette smoking could be related to defective development of this nucleus during intrauterine life, by affecting the expression of specific genes involved in its developmental process. In serial sections of the brainstem of 54 cases of sudden and unexplained fetal and infant deaths (13 stillbirths, 7 neonatal deaths and 34 sudden infant death syndrome (SIDS) victims), morphological and morphometrical analysis was used to observe the different structural alterations of the arcuate nucleus (bilateral hypoplasia, monolateral hypoplasia, partial hypoplasia, delayed neuronal maturation and decreased neuronal density) detected in 24 cases (44%). Correlating this finding with smoking in pregnancy, a significantly increased incidence of cytoarchitectural alterations of the arcuate nucleus was found in stillborns and SIDS victims with smoker mothers compared to victims with non-smoker mothers. Moreover, the observation of a wide range of developing morphological defects of the arcuate nucleus related to maternal smoking led to the hypothesis that the constituents of the gas phase in cigarette smoke could directly affect the expression of genes involved in the development of this nucleus, such as the homeobox En-2 gene. [source]

Do stress reactions cause abdominal obesity and comorbidities?

OBESITY REVIEWS, Issue 2 2001
P. Björntorp
Summary ,Stress' embraces the reaction to a multitude of poorly defined factors that disturb homeostasis or allostasis. In this overview, the activation of the hypothalamic-pituitary-adrenal (HPA) axis and the sympathetic nervous system have been utilized as objective measurements of stress reactions. Although long-term activation of the sympathetic nervous system is followed by primary hypertension, consequences of similar activation of the HPA axis have not been clearly defined. The focus of this overview is to examine whether or not repeated activation of these two stress centres may be involved in the pathogenesis of abdominal obesity and its comorbidities. In population studies adrenal hormones show strong statistical associations to centralization of body fat as well as to obesity. There is considerable evidence from clinical to cellular and molecular studies that elevated cortisol, particularly when combined with secondary inhibition of sex steroids and growth hormone secretions, is causing accumulation of fat in visceral adipose tissues as well as metabolic abnormalities (The Metabolic Syndrome). Hypertension is probably due to a parallel activation of the central sympathetic nervous system. Depression and ,the small baby syndrome' as well as stress exposure in men and non-human primates are followed with time by similar central and peripheral abnormalities. Glucocorticoid exposure is also followed by increased food intake and ,leptin resistant' obesity, perhaps disrupting the balance between leptin and neuropeptide Y to the advantage of the latter. The consequence might be ,stress-eating', which, however, is a poorly defined entity. Factors activating the stress centres in humans include psychosocial and socioeconomic handicaps, depressive and anxiety traits, alcohol and smoking, with some differences in profile between personalities and genders. Polymorphisms have been defined in several genes associated with the cascade of events along the stress axes. Based on this evidence it is suggested that environmental, perinatal and genetic factors induce neuroendocrine perturbations followed by abdominal obesity with its associated comorbidities. [source]

Prospective community-based cluster census and case-control study of stillbirths and neonatal deaths in the West Bank and Gaza Strip

PAEDIATRIC & PERINATAL EPIDEMIOLOGY, Issue 4 2008
Henry D. Kalter
Summary Obstetric complications and newborn illnesses amenable to basic medical interventions underlie most perinatal deaths. Yet, despite good access to maternal and newborn care in many transitional countries, perinatal mortality is often not monitored in these settings. The present study identified risk factors for perinatal death and the level and causes of stillbirths and neonatal deaths in the West Bank and Gaza Strip. Baseline and follow-up censuses with prospective monitoring of pregnant women and newborns from September 2001 to August 2002 were conducted in 83 randomly selected clusters of 300 households each. A total of 113 of 116 married women 15,49 years old with a stillbirth or neonatal death and 813 randomly selected women with a surviving neonate were interviewed, and obstetric and newborn care records of women with a stillbirth or neonatal death were abstracted. The perinatal and neonatal mortality rates, respectively, were 21.2 [95% confidence interval (CI) 16.5, 25.9] and 14.7 [95% CI 10.2, 19.2] per 1000 livebirths. The most common cause (27%) of 96 perinatal deaths was asphyxia alone (21) or with neonatal sepsis (5), while 18/49 (37%) early and 9/19 (47%) late neonatal deaths were from respiratory distress syndrome (12) or sepsis (9) alone or together (6). Constraint in care seeking, mainly by an Israeli checkpoint, occurred in 8% and 10%, respectively, of 112 pregnancies and labours and 31% of 16 neonates prior to perinatal or late neonatal death. Poor quality care for a complication associated with the death was identified among 40% and 20%, respectively, of 112 pregnancies and labour/deliveries and 43% of 68 neonates. (Correction added after online publication 5 June 2008: The denominators 112 pregnancies, labours, and labour/deliveries, and 16 and 68 neonates were included; and 9% of labours was corrected to 10%.) Risk factors for perinatal death as assessed by multivariable logistic regression included preterm delivery (odds ratio [OR] = 11.9, [95% CI 6.7, 21.2]), antepartum haemorrhage (OR = 5.6, [95% CI 1.5, 20.9]), any severe pregnancy complication (OR = 3.4, [95% CI 1.8, 6.6]), term delivery in a government hospital and having a labour and delivery complication (OR = 3.8, [95% CI 1.2, 12.0]), more than one delivery complication (OR = 4.4, [95% CI 1.8, 10.5]), mother's age >35 years (OR = 2.9, [95% CI 1.3, 6.8]) and primiparity in a full-term pregnancy (OR = 2.6, [1.1, 6.3]). Stillbirths are not officially reportable in the West Bank and Gaza Strip and this is the first time that perinatal mortality has been examined. Interventions to lower stillbirths and neonatal deaths should focus on improving the quality of medical care for important obstetric complications and newborn illnesses. Other transitional countries can draw lessons for their health care systems from these findings. [source]

Training the next generation of reproductive, perinatal and paediatric epidemiologists

PAEDIATRIC & PERINATAL EPIDEMIOLOGY, Issue 3 2004
David A. Savitz
No abstract is available for this article. [source]

Aetiology of childhood vision impairment, metropolitan Atlanta, 1991,93

PAEDIATRIC & PERINATAL EPIDEMIOLOGY, Issue 1 2000
Cynthia A. Mervis
Data from the population-based Metropolitan Atlanta Developmental Disabilities Surveillance Program (MADDSP) were used to describe the underlying causes of vision impairment (VI; corrected visual acuity in the better eye of 20/70 or worse) in young children (n = 228) in metropolitan Atlanta in 1991,93. Children with VI were identified through record review at multiple educational and medical sources. Children were categorised as having isolated VI or multiple disabilities (i.e. VI plus one or more of four additional developmental disabilities) and as having low vision (visual acuity 20/70,20/400) or blindness (visual acuity worse than 20/400). Medical conditions abstracted from MADDSP sources were reviewed to determine the probable aetiology of a child's VI. Aetiologies were assigned to one of three developmental time periods: prenatal, perinatal, or postnatal. Prenatal aetiologies were identified in 43% of the children; 38% of the prenatal aetiologies were genetic. Perinatal aetiologies were found in 27% of the children. Postnatal aetiologies were rare. Prenatal aetiologies were more common in children with isolated VI; perinatal and postnatal aetiologies were more common in children with multiple disabilities. Children with prenatal aetiologies tended to have less severe vision loss than did children with perinatal or postnatal aetiologies. The distribution varied by birthweight, but did not differ significantly by sex or race. [source]

Altered levels of insulin-like growth factor binding protein proteases in preeclampsia and intrauterine growth restriction

PRENATAL DIAGNOSIS, Issue 9 2010
Julian K. Christians
Abstract Intrauterine growth restriction (IUGR) and preeclampsia (PE) are leading causes of perinatal and maternal morbidity and mortality. Many studies have found association between low levels of insulin-like growth factor binding protein (IGFBP) proteases in the first trimester maternal circulation and the risk of subsequent development of PE and/or IUGR. These results are generally interpreted to reflect decreased production of the proteases by the placenta, leading to reduced proteolysis of IGFBPs and lower free levels of insulin-like growth factor (IGF), resulting in diminished feto-placental development. However, the association between low circulating levels of placental proteins early in pregnancy and the subsequent development of IUGR and/or PE could be due to low exchange in the placenta and not due to reduced production. In contrast, late in pregnancy, the circulating levels of these proteins and their expression in the placenta are often elevated in PE, which may reflect upregulation to compensate for abnormal placental development, that is an adaptive mechanism to increase IGFBP proteolysis, increase local IGF levels and promote feto-placental growth. Further research into the biological mechanisms underlying these associations will aid the identification of high-risk pregnancies and the development of therapeutic targets for diseases for which there are presently no preventative measures. Copyright © 2010 John Wiley & Sons, Ltd. [source]

Severe perinatal hypophosphatasia due to homozygous deletion of T at nucleotide 1559 in the tissue nonspecific alkaline phosphatase gene

PRENATAL DIAGNOSIS, Issue 9 2003
Hideaki Sawai
Abstract Objectives Hypophosphatasia is an inherited disorder characterized by defective bone mineralization and deficiency of tissue nonspecific alkaline phosphatase (TNSALP) activity. This disorder is caused by various mutations in the TNSALP gene. We report here hypophosphatasia in two siblings, both of them severely affected by the perinatal (lethal) type. Methods We diagnosed the first infant by clinical and radiologic manifestations, and laboratory findings. Laboratory findings were characterized by deficiency of serum alkaline phosphatase. Both parents and the second infant were then analyzed by molecular techniques. Results The radiograph of the first infant showed severe hypomineralization of the skeleton. Molecular analysis of the second infant showed that this condition was caused by a homozygous single T nucleotide deletion at cDNA number 1559 (1559delT). Both parents were heterozygous carriers for this mutation, although they were not consanguineous. Conclusion This mutation has been frequently found in Japanese hypophosphatasia patients, but this is the first observation of a homozygous deletion. This report shows that homozygosity for the 1559delT mutation of the TNSALP gene results in a severe lethal phenotype. Copyright © 2003 John Wiley & Sons, Ltd. [source]

Morphology of Reproductive Organs, Semen Quality and Sexual Behaviour of the Male Rabbit Exposed to a Soy-containing Diet and Soy-derived Isoflavones during Gestation and Lactation

REPRODUCTION IN DOMESTIC ANIMALS, Issue 6 2009
JR Cardoso
Contents Placental and breastfeeding transfer of soy isoflavones are potential routes for animal and human exposure to phytoestrogens, and reproductive dysfunctions have been linked to early exposure to these compounds. So, the aim of this study was to investigate the effects of perinatal (intrauterine and lactational) exposure to soy-containing diet and soy-derived isoflavones on the reproductive parameters of male rabbits. For this purpose, 12 female rabbits were randomly assigned to receive: (1) a soy- and alfalfa-free diet (control diet); (2) a soy- and alfalfa-free diet supplemented with 10 mg/kg body wt/day of soy isoflavones; (3) a soy- and alfalfa-free diet supplemented with 20 mg/kg body wt/day of soy isoflavones; and (4) a diet containing 18% of soy meal, throughout gestation and lactation. Weight and morphology of the reproductive organs of some of the male offspring were evaluated at weaning (between days 29 and 31). The remaining males were placed on the control diet from weaning to adulthood (gestational and lactational exposure only). Sexual behaviour, semen quality and reproductive organs' morphology were evaluated after puberty. There were no significant differences in litter size and gestation duration between control and treatment groups. Perinatal exposure to soy-containing diet and soy isoflavones did not alter testis, epididymides, proprostate and prostate weight and gross morphology. After puberty, sexual behaviour and semen parameters did not differ significantly from the control group. These results indicate that intrauterine and lactational exposure to soy-containing diet and soy-derived isoflavones may not adversely affect reproductive development and function of male rabbits. [source]

Predictors for wheezing phenotypes in the first decade of life

RESPIROLOGY, Issue 4 2008
William K. MIDODZI
Background and objective: This study examined prenatal, perinatal and early childhood predictors of wheezing phenotypes in the first decade of life. Methods: Information on current wheezing, was collected prospectively from five surveys conducted every 2 years over the first decade of life. Five wheezing phenotypes were defined: non-wheezers, preschool, primary-school, intermittent and persistent wheezers. Logistic regression with adjustment for survey design was used to determine the predictors of wheezing phenotypes. Results: Data on 2711 children were used in the analysis. Early respiratory infection, the child's allergy and parental asthma were significant risk factors for preschool, intermittent and persistent wheeze. The child's allergy and parental asthma had stronger associations with persistent wheeze than with preschool wheeze. Breastfeeding was a significant predictor of both preschool and intermittent wheezing. Daycare attendance was a risk factor for preschool wheeze but a protective factor for primary-school wheezing. Crowding at home was a protective factor for both preschool and primary-school wheeze. Parental smoking was a significant factor for preschool wheeze. Conclusion: This study identified different predictors for each wheezing phenotype with some degree of overlap. The observed differential effects for these conditions raises the possibility that there are different aetiologies for asthma among children. [source]