RESUMO
To study some of the factors relating to the care of mothers and newborns in an inner-city hospital, three sources of information were reviewed: an obstetric database including information on prenatal care and perinatal mortality, a database of all admissions to the hospital neonatal intensive care unit over the past 5 years, and a detailed questionnaire concerning attitudes and behaviors of recently delivered women. While analyses from these hospital-based data are not conclusive, the results add evidence for the following propositions: 1) Optimal prenatal care is infrequently obtained by mothers delivering at inner-city hospitals. Lack of prenatal care is clearly associated with increased perinatal mortality. While the need for prenatal care is appreciated by 98% of the mothers in this sample, the most frequent reasons why prenatal care is not obtained earlier or more frequently involve knowledge about and access to prenatal care. 2) Inner-city mothers, in general, manifest attitudes and behaviors that promote the welfare of their pregnancies and newborns. These attitudes and behaviors are in stark contrast to those that are frequently attributed to inner-city women by the media. 3) Acute perinatal medical and nursing care are perceived by many postpartum women as suboptimal, particularly in terms of the lack of respect shown to patients by nurses and doctors. 4) Improved acute obstetric and neonatal care improves perinatal morbidity and mortality of infants delivered at inner-city hospitals.
Assuntos
Negro ou Afro-Americano/psicologia , Parto Obstétrico , Conhecimentos, Atitudes e Prática em Saúde , Americanos Mexicanos/psicologia , Cuidado Pré-Natal , Adulto , Feminino , Humanos , Los Angeles , Comportamento Materno , Áreas de Pobreza , GravidezRESUMO
Thymic size can be affected by both exogenous and endogenous glucocorticoids. The risk of respiratory distress syndrome is reduced after maternal steroid administration. To find whether fetal lung maturity correlates with size of the thymus, the cardiothymic:thoracic ratio was measured in 167 newborn infants with and without RDS. Mean CT/T was significantly greater (0.40 vs 0.35; P less than 0.001) in those babies with RDS. This relation was independent of gestational age, although an increase in CT/T with advancing gestational age was shown. Prepartum maternal steroid administration did not result in significant involution of the cardiothymic shadow when compared with control infants with and without RDS. The CT/T may be of use in predicting which premature babies are more likely to develop RDS.
Assuntos
Doenças do Prematuro/etiologia , Síndrome do Desconforto Respiratório do Recém-Nascido/etiologia , Timo/anatomia & histologia , Feminino , Feto/anatomia & histologia , Idade Gestacional , Coração/anatomia & histologia , Humanos , Recém-Nascido , Doenças do Prematuro/diagnóstico por imagem , Gravidez , RadiografiaRESUMO
Dexamethasone concentration was measured in plasma and amniotic fluid by radioimmunoassay using a rabbit antiserum raised against DX-hemisuccinate-albumin. Recoveries of added tracers averaged 70% after paper chromatography. The within- and between-assay coefficients of variation averaged 10%. The lower limit of detection was 0.2 mug/dl when 0.4 ml of plasma was assayed. Ten healthy pregnant women at term had cesarean sections 8 to 11 hours following administration of 8 mg of DX orally. DX levels in maternal vein, in umbilical vein and artery, and in amniotic fluid averaged 2.2, 2.9, 2.6, and 2.5 mug/dl, respectively. Although cortisol levels were markedly suppressed, the total relative glucocorticoid activity in blood of fetuses treated with DX far exceeded that of the untreated group.
Assuntos
Dexametasona/metabolismo , Líquido Amniótico/metabolismo , Dexametasona/sangue , Dexametasona/uso terapêutico , Feminino , Humanos , Hidrocortisona/sangue , Hidrocortisona/metabolismo , Recém-Nascido , Masculino , Troca Materno-Fetal , Gravidez , Radioimunoensaio , Síndrome do Desconforto Respiratório do Recém-Nascido/prevenção & controle , Artérias Umbilicais , Veias UmbilicaisRESUMO
Recent studies have shown that ventilation in the newborn period is affected by sleep state. We investigated various measures affecting ventilation using the single breath airway occlusion technique in ten healthy, full-term newborn infants. There was a significant increase in respiratory rate and in minute ventilation in rapid eye movement sleep compared to non-REM sleep, and there was no significant change in tidal volume between the two sleep states. The variability of ventilation was increased in REM sleep, and inspiratory pressure at one-tenth of a second following airway occlusion was significantly increased in REM sleep. Effective elastance was similar in both sleep states. Measures that reflect activity of the Hering-Breuer reflex were significantly increased in non-REM sleep as compared with REM sleep. These results document the interdependence of sleep state and respiratory control mechanisms in full-term infants.
Assuntos
Recém-Nascido , Respiração , Fases do Sono , Resistência das Vias Respiratórias , Feminino , Humanos , Masculino , Consumo de Oxigênio , Testes de Função Respiratória , Sono REM , Volume de Ventilação PulmonarRESUMO
Studies of airway pressure, tidal volume, respiratory duration, and total breath duration before and after elastic loading airway occlusions were carried out on ten full-term, normal infants on two occassions in the first week of life. Using these noninvasive techniques we infer that static compliance and the Hering-Breuer reflex are unchanged during the first week; that infants may increase sensitivity to chemical drive toward the end of the first week; and that there may be a volume related threshold for vagal inhibition of inspiration in some infants.
Assuntos
Dióxido de Carbono/farmacologia , Recém-Nascido , Respiração , Testes de Função Respiratória , Feminino , Humanos , Complacência Pulmonar , Masculino , Ventilação Pulmonar , Volume Residual , Respiração/efeitos dos fármacos , Volume de Ventilação PulmonarRESUMO
Much evidence suggests that glucocorticoids may increase the rate of lung development during late fetal life, and thereby decrease the risk of respiratory distress syndrome if the fetus is born prematurely. Results of human and animal studies are basically in agreement. The risks of this form of therapy are less well examined, especially in human studies. This review briefly outlines studies that relate to toxicity so that the "risk/benefit ratio" of this form of therapy may be assessed.