Roles of nitric oxide in brain hypoxia-ischemia.
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A large body of evidence has appeared over the last 6 years suggesting that nitric oxide biosynthesis is a key factor in the pathophysiological response of the brain to hypoxia-ischemia. Whilst studies on the influence of nitric oxide in this phenomenon initially offered conflicting conclusions, the use of better biochemical tools, such as selective inhibition of nitric oxide synthase (NOS) isoforms or transgenic animals, is progressively clarifying the precise role of nitric oxide in brain ischemia. Brain ischemia triggers a cascade of events, possibly mediated by excitatory amino acids, yielding the activation of the Ca2+-dependent NOS isoforms, i.e. neuronal NOS (nNOS) and endothelial NOS (eNOS). However, whereas the selective inhibition of nNOS is neuroprotective, selective inhibition of eNOS is neurotoxic. Furthermore, mainly in glial cells, delayed ischemia or reperfusion after an ischemic episode induces the expression of Ca2+-independent inducible NOS (iNOS), and its selective inhibition is neuroprotective. In conclusion, it appears that activation of nNOS or induction of iNOS mediates ischemic brain damage, possibly by mitochondrial dysfunction and energy depletion. However, there is a simultaneous compensatory response through eNOS activation within the endothelium of blood vessels, which mediates vasodilation and hence increases blood flow to the damaged brain area. (+info)
Stephane Tarnier (1828-1897), the architect of perinatology in France.
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Stephane Tarnier studied medicine in Paris and became the doyen of obstetrics in France during the second half of the 19th century. He pioneered many advances and encouraged a perinatal approach to childbirth that was further developed by his disciples, Budin and Pinard. (+info)
Comparison of perinatal health of children born from IVF in Finland in the early and late 1990s.
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BACKGROUND: The purpose of this study was to investigate whether perinatal health outcomes changed during the 1990s with the increasing use of IVF. METHODS: Data were from the Finnish Medical Birth Register for periods 1991-1993 and 1998-1999. Outcomes of IVF infants and other infants were compared, both overall and separately for singleton and multiple births, by adjusting for mothers' background variables by logistic regression. RESULTS: The IVF multiple birth rate, especially the number of triplets, declined from the first (1991-1993) to the second (1998-1999) time-period. The outcomes for IVF newborns improved, especially for multiple births. After adjusting for mothers' background variables, the odds ratios for preterm birth and low birthweight decreased among singletons from 2.2 [95% confidence interval (CI) 1.8-2.8] to 1.8 (CI 1.5-2.1) and from 2.4 (CI 1.9-3.1) to 1.7 (CI 1.4-2.1) respectively and more among multiples from 2.4 (CI 2.0-2.9) to 1.5 (CI 1.2-1.7) and from 1.9 (CI 1.6-2.3) to 1.1 (CI 1.0-1.3) respectively. Still, overall the outcomes for IVF infants remained poorer than those for other infants. A correlation was found between increased use of antenatal services and improved outcomes, but causality cannot be assumed. CONCLUSION: A trend of improved perinatal health of multiple IVF children was found, mainly due to a decrease in higher order multiple births. (+info)
Treatment of transient hypothyroxinemia of prematurity: a survey of neonatal practice.
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We mailed a survey on treatment practices for transient hypothyroxinemia of prematurity (THOP) to 100 randomly selected neonatologists. In the year before the survey, 13 of 62 respondents (21.0%) had treated an average of 4.5 THOP patients with thyroid hormone, and 3 had treated 10 or more patients. Randomized trials assessing the value of thyroid supplementation in THOP are urgently needed. (+info)
Neonatal outcomes and quality of care in level II perinatal centers supported by a children's hospital-medical school level III program.
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OBJECTIVE: Eight Level II perinatal centers developed contracts with the children's hospital to provide consultative neonatal patient care, education, and administrative support. The purpose of the present study was to evaluate infant outcomes and quality of care during a 3-year period of the program, 1994 to 1996. STUDY DESIGN: Neonatal mortality rates were determined for the 18,703 live births. Quality of care was assessed for 30 infants who died at the Level II centers and 315 infants transferred to the children's hospital. RESULTS: The neonatal mortality rate was 2.2/1000 live births. Quality-of-care issues primarily involved 80 "drop-in" deliveries +info)
Effect of ethnicity on mortality of very low birthweight infants in Israel.
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BACKGROUND: Multiple demographic, genetic, and environmental factors differ between Muslim and Jewish infants in Israel. OBJECTIVE: To evaluate whether, after adjustment for perinatal factors associated with mortality, excess mortality occurs in very low birthweight (VLBW) Muslim compared with Jewish infants. DESIGN: The Israel National VLBW infant database includes data on 99% of all VLBW births in Israel. The study population comprised 5015 Jewish and 1549 Muslim VLBW infants of more than 23 weeks gestation, born between 1995 and 1999. The Mantel-Haenszel test was used for stratified analysis and logistic regression analysis to assess the effect of ethnic origin on mortality. RESULTS: The death rate was significantly higher among Muslim infants (22.7% v 17.2%; crude odds ratio 1.42; 95% confidence interval 1.24 to 1.63). Excess mortality in Muslims occurred mainly in the 32-33 week (8.0% v 2.8%) and >33 week (14.7% v 4.7%) gestational age groups, and in birthweight groups of 1000-1249 g (17.6% v 9.3%) and 1250-1500 g (9.1% v 3.6%). In VLBW infants without congenital malformations, there was a significantly higher risk of mortality among Muslim infants (odds ratio 1.28; 95% confidence interval 1.04 to 1.57) compared with Jewish infants, after adjustment for gestational age, birth weight, small for gestational age, prenatal care, prenatal steroid treatment, plurality, mode of delivery, and Apgar score. CONCLUSIONS: Excess mortality was present among Muslim VLBW infants without congenital malformations. Perinatal factors associated with increased risk of mortality were more prevalent in the Muslim VLBW population. The pattern of disparities suggests inadequate access to, or utilisation of, effective perinatal technology in the Muslim population in Israel. (+info)
Dr Erasmus Darwin (1731-1802) of Lichfield and placental respiration.
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Erasmus Darwin was a great philosopher, scientist, inventor, poet, and physician. His creative intellect has been compared with that of Leonardo da Vinci. This brief article draws attention to two perinatal contributions made on placental respiration and management of the umbilical cord. (+info)
The potential impact on costs and staffing of introducing clinical networks and British Association of Perinatal Medicine standards to the delivery of neonatal care.
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OBJECTIVE: To produce models to estimate the impact of introducing clinical networks and the 2001 BAPM standards to the delivery of neonatal care. DESIGN: Prospective observational study using a geographically defined population and data collected by questionnaire on staffing levels and cot availability. SETTING: Trent Health Region UK. SUBJECTS: All infants born to Trent resident mothers at or before 32 weeks gestation between 1 January 1998 and 31 December 1999. Staffing numbers and cot availability for neonatal care in 2001. METHODS: A modelling exercise was carried out using information for all neonatal admissions for Trent resident infants. Three models were investigated: (a). the current care provision; (b). a network where three lead centres provided the intensive care for the region and the remaining units provided either high dependency or special care alone; (c). a network where six lead centres provided the intensive care for the region and the remaining units provided either high dependency or special care alone. Overall costings, staffing levels, and cot requirements were calculated for each model. Data on staffing levels and cot availability were used to calculate current care provision costings. RESULTS: The current cost of running the service is approximately pound 33.35 million, although a proportion of nursing posts are currently unfilled. Estimates for the introduction of a three centre model meeting BAPM 2001 standards range from pound 37.31 to pound 43.40 million. Equivalent figures for the six centre model were: pound 36.32 to pound 42.62 million. Approximately 370 and 230 babies a year would be involved in transfer in the three and six centre models respectively. This is in contrast with 374 and 368 urgent transfers that actually took place in 1998 and 1999 respectively. CONCLUSION: The costs associated with the introduction of managed clinical networks and meeting BAPM standards of care are not excessive, especially when considered against the likely implementation timetable of perhaps 7-10 years. Attracting and retaining sufficient staff will pose the major challenge. (+info)