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ABSTRACTThe Finnish HPV Family Study is a prospective cohort study assessing the dynamics of human papillomavirus (HPV) transmission between parents and infant. Serial genital and oral scrapings from 76 families, including mother, father, and infant, and semen samples were collected over 2 years of follow-up, analyzed by nested PCR, and confirmed by hybridization with 12 high-risk (HR) HPV types. The most common HPV profile was HR HPV in all family members (29%), followed by HPV-positive mother-infant pairs (26%). HPV-positive father-infant pairs were less frequent (11%), and in six (8%) families, only the infant was HR HPV positive. The prevalence of genital HR HPV in the parents ranged from 13 to 25%, and that of oral HPV ranged from 8 to 34%. In the infants, HPV DNA was detected in 15% of the genital and 10% of the oral samples at birth, reaching peaks of 18 and 21%, respectively, at 6 months, and declining to 10% at 24 months. Persistent HPV in the mother was a risk factor for oral HPV in the infant (odds ratio [OR], 5.69; 95% confidence interval [95% CI], 1.5 to 21.3), while oral HPV in the mother at 6 months was a risk factor for genital HR HPV (OR, 6.38; 95% CI, 1.15 to 35.32). No such independent risk could be attributed to subclinical HPV in the father. Persistent maternal cervical HPV and subclinical oral HPV affect the risk of infant HPV. The age of 6 months is a critical point for the infant to acquire or be free of HR HPV DNA.

Seventeen newborns suffering from RDS (verified by X-ray and clinical parameters) had a mean plasma progesterone of 13.9±1.2 ng/ml (mean±S.E.) at 24 h of age. This is only 62% of the normal level (22.6±1.5 ng/ml).

The intraesophageal pressure difference (ΔPes) was measured in 46 preterm infants, 36 with respiratory distress (RDS). It was 12.7±2.9 mm Hg (mean±SEM) in severe RDS, 9.6±3.2 mm Hg in moderate RDS, and 5.2±1.6 mm Hg in infants with mild disease, measured at the age of 8 h. These intergroup differences were highly significant (P<0.001). During the first 96 h of life the ΔPesdecreased to 6.1±1.1 mm Hg in severe RDS and to 4.8±1.2 mm Hg in moderate RDS. These changes were also highly significant (P<0.001) when compared with respective initial values. In infants with mild disease and in healthy preterm infants, the ΔPesdid not alter significantly during the first 96 h of life.

Clinical and radiological classifications of the severity of the respiratory distress syndrome (RDS) were made in 55 infants. According to the clinical classification 17 infants belonged to the first class (mild RDS), 22 to the second (moderate RDS), and 16 to the third class (severe RDS). In the classification based on radiological findings the numbers of infants in classes 1, 2 and 3 were 18, 19 and 18 respectively. On the basis of both the clinical and radiological findings, 11 infants belonged to the mild RDS class, 11 to the moderate, and 12 to the severe RDS class. Thus, 34 infants had the same clinical and radiological classification. In 21 infants there were discrepancies between the clinical and the radiological classifications, but only one infant with the most severe radiological findings belonged to the mild RDS class and only one infant with mild radiological findings belonged to the worst RDS class.

Purpose: To evaluate the usefulness of intravenous patient-controlled analgesia (PCA) fentanyl for labour analgesia, its effectiveness for maternal pain and safety for the fetus and newborn. Methods: Twenty primigravidas were randomised to receive intravenous PCA fentanyl or epidural analgesia for labour pain. Maternal pain, heart rate and arterial oxyhaemoglobin saturation (SpO2) were monitored. Fetal and neonatal monitoring included cardiotocogram (CTG), APGAR, neurological scoring and static-charge-sensitive bed (SCSB) recording for 12 hr postnatally with ECG and SpO2. Fentanyl concentrations and pH of umbilical artery and vein were analysed. Results: Initially, epidural analgesia was more effective (P= 0.01 ), and three patients in the fentanyl group were given epidural due to unsatisfactory pain relief. Overall satisfaction for analgesia did not differ between the groups. Maternal side-effects were more frequent in the fentanyl group (dizziness and tiredness most often,P= 0.0001). Severe side-effects were not reported. In CTG there were no differences between groups. All the newborns were healthy, APGAR and pH were normal. Naloxone was not used. Neurological scoring was similar in both groups. In 12 hr monitoring heart rate, breathing frequency and movement time were similar in both groups, but SpO2was lower in the fentanyl group (P&lt; 0.001 ). Umbilical cord fentanyl concentrations were low or beyond the detection limit. Conclusion: Intravenous fentanyl can be used for labour analgesia with the doses reported here as an alternative to epidural analgesia. However, the fetus and neonate must be appropriately monitored. Naloxone and oxygen should be available if neonatal distress occurs.

Early postnatal pulmonary hemodynamic changes were investigated with Doppler echocardiography in 17 infants with mild or moderate meconium aspiration syndrome (MAS) and 16 healthy infants in a control group. The results indicate that the physiologic adaptation of the pulmonary hemodynamics is delayed in mild and moderate forms of MAS. Thus infants with clinical evidence of MAS need careful cardiovascular monitoring during postnatal circulatory transition. (J Pediatr 1999;134:355-7)