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The transabdominal cerclage procedure was first introduced 50 years ago as an approach in those patients who had failed transvaginal cerclage. We review the history, indications, surgical technique, complications, and reported outcomes of the procedure. The procedure has evolved over time in its application and risks appear to be less than previously perceived. Physicians have found additional patient situations in which the procedure may be beneficial outside the indications defined 50 years ago. This is a valuable surgical technique which is likely underused. [ABSTRACT FROM AUTHOR]

Objective: The purpose of this study was to determine if functional lung maturity (FtLM) of triplets was affected by differentiating factors within the triplet set. Methods: This was a retrospective cohort study of triplets. Data were collected on maternal, pregnancy and neonatal characteristics and FtLM was determined, based on selected neonatal outcomes. Results: Functional lung immaturity (FtLI) was found in 35.5% of the infants and occurred in those born between 28.1 and 34.6 weeks gestation. Gestational age at delivery, pre-pregnancy BMI, and gestational diabetes were predictive of an infant having FtLM; while infertility treatment, pre-pregnancy BMI, and preeclampsia were predictors of FtLM discordance. Conclusions: Our results demonstrated FtLI was likely at early gestation (<28 weeks) and FtLM was probable beyond 35 weeks. Discordance for FtLM was likely at 32 weeks; therefore, clinicians should guard against complacency that this gestational mark assures an uncomplicated respiratory course for all infants within the set. [ABSTRACT FROM AUTHOR]

Abstract. Fourteen growing, healthy premature infants were moved from heated incubators to cribs at different points in their growth. Group A (six babies) was moved when babies reached a weight of 1,600 to 1,700 gm; group B (eight babies) when babies reached a weight of 1,800 to 1,900 gm. All other conditions of rearing were kept the same. The effect on their growth and thermal stability was measured during the week before and after the temperature change. All infants tolerated the change well. There was no drop in abdominal temperature in an environment cooler by 5 C. The rate of weight gain correlated with gross energy intake only and did not differ within or between the two groups. The rate of growth of the skinfolds increased dramatically after the infants were moved from the incubator. A cooler environment in a growing premature infant (weight > 1,600 gm) may promote faster deposition of subcutaneous fat. This might be an important factor in efficient gain in cold resistance. [ABSTRACT FROM AUTHOR]

Abstract. In the face of increasing neonatal referrals from a large geographic region, community hospital resources were recruited and coordinated with regional center resources to facilitate "community-based" neonatal transport. All transport requests were first "triaged" by an attending neonatologist. Discriminant analysis was used to assess the impact of resource allocation decisions. Decisions regarding allocation of resources to an individual transport generally reflected geographic distance to be traveled, size of delivery service at referring hospital, and apparent degree of illness. Physicians participation in transports was reduced from 95% to 15% of the trips. The incorporation of community-based transport resources and nonphysician transport teams into a coordinated triage and transport process with existing center-based resources did not adversely affect neonatal survival. Capacity of the transport system was enhanced with these reallocations. [ABSTRACT FROM AUTHOR]

Abstract. Previously published data suggested that the faster rate of weight gain observed in parenterally supplemented neonates compared to their orally fed peers might be attributable to water retention rather than to more rapid tissue accretion. The present study was designed to test that hypothesis by observing changes in extracellular water, estimated as corrected bromide space (CBS). Ten neonates with a mean birthweight of 1,250 gm (range, 800 to 1,980 gm) and a mean gestational age of 31 weeks (range, 24 to 38 weeks) were randomly assigned to a 67 cal/dl formula feeding or an oral 100 cal/dl formula feeding supplemented parenterally with dextrose and amino acids. CBS was estimated within 19 hours of birth and between the 7th and 28th postnatal days. Mean total daily water and protein intakes during the intervening period were similar for orally fed and supplemented neonates, but the latter took significantly less orally and received more parenterally. CBS increased in all but one of the supplemented neonates whereas two of four orally fed babies had decreasing values and one had stahle values. Shorter times before regaining birthweight, faster rates of weight gain, and lower arterial pH were associated with larger CBS as well as with parenteral supplementation. These data suggest that parenteral supplementation may result in water retention and/or shifts from the intracellular to the extracellular space. Previously reported earlier and greater mean daily weight gains in supplemented babies may be related to water accumulation rather than tissue accretion, but definitive conclusions must await further studies, including concomitant estimates of total and extracellular body water. [ABSTRACT FROM AUTHOR]

Fifteen normally grown premature (NG-P), seven intrauterine growth retarded premature (IGR-P) and six intrauterine growth-retarded mature (IGR-M) neonates were randomly assigned to oral (PO) or parenterally supplemented (SUP) oral feeding regimens. Supplemented babies did not have greater mean caloric intakes. Although supplementation in the NG-P group decreased postnatal weight loss, reduced the time to regain and maintain birth weight and increased the mean daily weight gain during supplementation, mean daily weight gains during the whole hospital course and the babies' weight and postconceptional age at discharge were similar for both feeding regimens. For the most part, the same trends were evident in the IGR group. These data and the fact that mean daily increases of other growth parameters (length, head circumference, skinfolds) were not influenced by mode of feeding suggest water retention rather than tissue accretion as an explanation for the early postnatal weight "advantage" in the SUP group. Severe metabolic disturbances (hyperglycemia, serum and urine hyperosmolality, metabolic acidosis) were the rule in the premature neonates with infusate glucose concentrations in excess of 12 gm/100 ml or with amino acid concentrations higher than 2 gm/100 ml. Two of seven neonates supplemented by central catheter developed sepsis and died whereas no systemic infections occurred in the PO or peripherally supplemented babies. [ABSTRACT FROM AUTHOR]