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Experimentally modified breathing pattern in human subjects, by varying the inspired gas mixture or administering different neuromodulators, has been studied extensively in the past, yet unmodified breathing has not. Moreover, most data refer to infants during sleep and adults during wakefulness. We studied the baseline breathing pattern of preterm infants [n = 10; GA 30 (27-34) wk (median, range)]; term infants [n = 10; GA 40 (39-41) wk)], and adult subjects [n = 10; age 31 (17-48) y)] during quiet sleep. A flow-through system was used to measure ventilation. We found: (i) instantaneous ventilation was 0.273 ± 0.006, 0.200 ± 0.003, and 0.135 ± 0.002 L · min[sup -1] · kg[sup -1] in preterm, term infants, and adult subjects; the coefficients of variation were 39%, 25%, and 14% (p < 0.01). The greater coefficient of variation in neonates compared to adults related to increased variability in Vt (39% and 25% in preterm and term infants vs 14% in adults; p < 0.01) and f (39% and 22% vs 9%; p < 0.01). The major determinant of frequency in preterm infants was Te (81% variability), Ti varying less (25% variability); (ii) V[sub T]/Ti decreased and Ti/Ttot increased with age; (iii) the higher breath-to-breath variability in preterm infants was associated with larger changes in alveolar PCO[sub 2] and a larger variability in O[sub 2] saturation than later in life. We conclude: (i) the high breath-to-breath variability in frequency in preterm infants closely relates to variation in Te; (ii) decreased effective inspiratory timing (Ti/Ttot) in preterm infants compared with adults likely reflects their high pulmonary impedance; and (iii) greater breath-to-breath variability in ventilation in neonates with large variations in alveolar PCO[sub 2] and O[sub 2] saturation remains when compared with values in the sleeping adult. We speculate that high variability in Te early in life represents an effort to maintain lung volume through increased post-inspiratory diaphragmatic activity and increased upper airway resistance in an attempt to avoid collapse due to poor chest wall recoil. [ABSTRACT FROM AUTHOR]

Sixty-five infertile women, 37 with anovulation, eight with ovulatory disturbances and 20 with unexplained infertility were treated by a combination of clomiphene citrate (CC) from cycle day S (or 3) and human menopausal gonado trophin (HMG) begun 3 days later for induction or enhancemeat of ovulation. Monitoring was carried out by measuring preovulatory 17-β-oestradiol (E) and progesterone (P) concentrations in blood samples and by follicle measurements using ultrasound. Forty-seven pregnancies resulted with a multiple pregnancy rate of 7.7% for those completed. This incidence is very low and within the range found for CC induction and might result from the later commencement of stimulation compared with many other protocols. These results were achieved with a low incidence of ovarian hyperstimulation syndrome (2.6% per cycle). The HMG doses given were low in comparison with those found in other forms of induction. The deleterious effects of this combined mode of induction on cervical mucus and the occurrence of premature spontaneous ovulation were much less than in the sequential mode of treatment. These results suggest that combined induction treatment by CC and HMG as described offers a means of achieving low rates of multiple pregnancies a known complication in the induction of ovulation. [ABSTRACT FROM PUBLISHER]

The movement of the chest during breathing has been recorded in normal and asthmatic subjects by means of electronic transducers which measured changes in anteroposterior and lateral diameters. Preliminary studies showed that exercise-induced bronchoconstriction caused distortion of the movement of the diameters in relation to each other and to volume change recorded at the mouth. Because of the thoracic gas compression which occurs during breathing, volume change at the mouth does not represent the change in chest volume and further studies were therefore undertaken in a whole-body plethysmograph. These studies showed that the addition of a resistance to the airway of a normal subject distorted the movement of one diameter (usually the anteroposterior) in relation to the other and to volume. With exercise-induced asthma, the movement of both diameters was affected with the anteroposterior lagging behind the volume change. There was an approximate linear relationship between the degree of distortion and airways resistance in the asthmatic subjects and in one normal subject. The physical sign of costal margin paradox could be related to the severity of the obstruction. [ABSTRACT FROM PUBLISHER]

Evidence is accumulating for the transgenerational effects of maternal stress on offspring. A particular increasing concern is the possible transgenerational effects of community exposure to war and terror. Here, 107 mothers that had been exposed to war, were assessed with their 3 year old children (52 % girls) who had been conceived after the end of the war, and thus never directly exposed to war. The circumscribed nature (missile bombardment) and temporal limits (34 days) of the tragic 2006 Lebanon war in the north of Israel, affords a unique methodological opportunity to isolate an epoch of stress from preceding and subsequent normal life. We find that war experience engenders higher levels of mothers' separation anxiety, lower emotional availability in mother-child interaction, and lower levels of children's adaptive behavior. The novelty of these findings lies in documenting the nature and strength of transgenerational effects of war-related stress on offspring that were never exposed. In addition, because these effects were obtained after 4 years of a continuing period of normality, in which the children were born and raised, it suggests that an extended period of normality does not obliterate the effects of the war on mother and child behavior as assessed herein. Despite the study limitations, the results are indicative of persisting transgenerational effects of stress.

Objective: To evaluate the association between stage III or higher retinopathy of prematurity (ROP) and other prematurity disorders and parameters., Design: Retrospective, case-control study., Participants: The subjects of the study were 55 consecutive premature neonates with stage III or higher ROP and 110 consecutive premature neonates without ROP., Methods: We compared consecutive premature neonates regarding the presence of ROP and other disorders as well as demographic and laboratory parameters., Results: Gestational age (p < 0.001); birth weight (p < 0.001); male sex (p = 0.031); bilirubin levels (p < 0.001); breast feeding (p < 0.001); clinical and laboratory sepsis (p < 0.001); number of sepsis events (p < 0.001); ventilation need (p < 0.001); number of ventilation days (p < 0.001); theophylline and surfactant use (p < 0.001); blood transfusions (p < 0.001); number of blood transfusions (p < 0.001); intraventricular hemorrhage and bronchopulmonary dysplasia (p = 0.001); and other factors differed in the two groups. The logistic regression model showed a correlation between low gestational age (OD 0.474, CI 0.359-0.626); male sex (OD 2.991, CI 1.077-8.305); blood transfusion (OD 14.159, CI 1.570-127.7); and sepsis (OD 12.376, CI 2.532-60.503)., Conclusions: Certain disorders and parameters, such as sepsis and blood transfusions, may be predict the appearance of stage III or higher ROP. Close monitoring of neonates with these findings is imperative. Early detection and treatment of sepsis and reduction of blood transfusions may decrease the incidence of ROP that requires treatment., (Crown Copyright © 2011. Published by Elsevier Inc. All rights reserved.)

Purpose: To evaluate the efficacy of povidone iodine solution 2.5% and tetracycline ointment 1% in prevention of ophthalmia neonatorum (ON)., Design: Prospective, randomized, controlled observational study., Participants: Three-hundred ninety-four full-term neonates., Methods: A randomized comparison between 201 neonates randomly treated with povidone iodine 2.5% solution and 193 treated with tetracycline 1% ointment., Main Outcomes Measures: Incidence of ON., Results: The incidence of ON was significantly higher after povidone iodine than tetracycline prophylaxis (15.4% and 5.2% respectively; P = 0.001). Noninfective ON developed in 10 (5%) of the 201 neonates treated with povidone iodine and in none (0%) of the neonates treated with tetracycline (P = .002). Infective ON was detected in 21 (10.4%) of the neonates treated with povidone iodine and in 10 (5.2%) after treatment with tetracycline (P = .052). Ophthalmia neonatorum appeared more commonly in the first 3 days after treatment with povidone iodine (P = .043). The spectrum of the infective isolates was similar in the 2 groups., Conclusions: Povidone iodine was associated with noninfective (sterile) conjunctivitis, probably because of its toxicity to the ocular surface in neonates. Tetracycline was marginally more effective against infective ON. For these reasons, tetracycline, rather than povidone iodine, is recommended for prevention of ON., (Copyright © 2011 American Academy of Ophthalmology. Published by Elsevier Inc. All rights reserved.)

Background: The perinatal-neonatal course of very-low-birth-weight (VLBW) infants might affect their childhood growth. We evaluated the effect of parental anthropometry and perinatal and neonatal morbidity of VLBW neonates on their childhood growth., Methods: We obtained parental anthropometry, height and weight at age 6-10.5 years of 334 children born as VLBW infants. Parental, perinatal and neonatal data of these children were tested for association with childhood anthropometry., Results: (1) Maternal and paternal weight standard deviation score (SDS) and discharge weight (DW) SDS were associated with childhood weight SDS (R(2)= 0.111, p < 0.00001); (2) Maternal and paternal height SDS, corrected gestational age (GA) at discharge, maternal assisted reproduction and SGA status were associated with childhood height SDS (R(2)= 0.208, p < 0.00001); (3) paternal weight SDS, DW SDS and surfactant therapy were associated with childhood body mass index (BMI) SDS (R(2)= 0.096, p < 0.00001). 31.1% of VLBW infants had DW SDS < -1.88, and are to be considered small for gestational age ('SGA'). One quarter of these infants did not catch up by age 6-10.5 years., Conclusion: Childhood anthropometry of VLBW infants depends on parental anthropometry, postnatal respiratory morbidity and growth parameters at birth and at discharge. Almost one-third of VLBW premature infants had growth restriction at discharge from neonatal intensive care unit (NICU), a quarter of whom did not catch up by age 6-10.5 years.

Unlabelled: Screening for Group B streptococcus (GBS) in pregnant women is controversial in Israel., Objective: To investigate cases of neonatal sepsis due to GBS in Western Galilee Hospital Nahariya., Method: We retrospectively evaluated 70,589 live births from 1996 to 2007., Results: The number of cases of neonatal sepsis preceded by GBS bacteremia was 26, an incidence rate of 0.37/1000 live births. Of the newborns, 16 were male and 10 female. The median gestational age was 38 weeks (range: 25-42 weeks, STD: 3.27 weeks). The median birth weight was 2945 grams (range: 750-4000 grams, STD: 683 grams). Three of the newborns also had GBS in a CSF culture. Early onset GBS sepsis presented in 23 of the newborns (88%), compared to late onset in 3 (12%). Seventeen were Arabs (65%) and 9 Jews (35%). Three of the newborns, all females, died. One was with gestational age of 25 weeks and birth weight 750 grams. A second, with gestational age of 37 weeks, and birth weight 2945 grams, died from pneumonia and septic shock. The third, with gestational age 38 weeks and birth weight 2460 grams, died of meningitis and septic shock. Vaginal and rectal smears of mothers of the latter two newborns were negative for GBS at 30 weeks gestation., Conclusion: Although the morbidity rate due to neonatal GBS sepsis is lower in the Western Galilee, Israel than in the U.S.A., the current policy in Israel of treating pregnant women at risk for GBS does not seem sufficient. General screening of pregnant women at 35-37 weeks of gestation should be considered.

The rare autosomal recessive disorder pyridoxine 5'-phosphate oxidase (PNPO) deficiency is a recently described cause of neonatal and infantile seizures. Clinical evaluation, and biochemical and genetic testing, were performed on a neonate with intractable seizures who did not respond to anticonvulsant drugs and pyridoxine. Sequencing of the PNPO gene revealed a novel homozygous c.284G>A transition in exon 3, resulting in arginine to histidine substitution and reduced activity of the PNPO mutant to 18% relative to the wild type. This finding enabled molecular prenatal diagnosis in a subsequent pregnancy, accurate genetic counseling in the large inbred family, and population screening.

Cryogenic temperature transmission electron microscopy (cryo-TEM) makes it possible to study the nanostructure of a wide range of fluid phases with a high degree of preservation. Most studies based on scanning electron microscopy or TEM employ specimen preparation techniques that give extraordinary results for tissues, but alter the native structure of complex fluid substances such as lung surfactant. In this paper, we evaluated direct-imaging cryo-TEM as a method to study the morphology of the aqueous form of lung surfactant. We compared the morphology of samples obtained from different species, and cryo-TEM data to data obtained by staining-and-drying. We demonstrate that cryo-TEM preserves and images much better sample morphology and fine details of the surfactant structures. We show that cryo-TEM, a method based on physical fixation, which avoids chemical changes and aggregate rearrangement, is a most useful tool to further our understanding of lung surfactant and its function.

Forty-one children aged 10.5 +/- 0.2 years (range, 8.0-15.0 yr), born with low birth weight of 1,218.2 +/- 36.6 g (range, 765-1,580 g) were selected from hospital archives on the basis of whether they had received neonatal diuretic treatment or as healthy matched controls. The children were tested for salt appetite and sweet preference, including rating of preferred concentration of salt in tomato soup (and sugar in tea), ratings of oral spray (NaCl and sucrose solutions), intake of salt or sweet snack items, and a food-seasoning, liking, and dietary questionnaire. Results showed that sodium appetite was not related to neonatal diuretic treatment, birth weight, or gestational age. However, there was a robust inverse correlation (r = -0.445, P < 0.005) between reported dietary sodium intake and the neonatal lowest serum sodium level (NLS) recorded for each child as an index of sodium loss. The relationship of NLS and dietary sodium intake was found in both boys and girls and in both Arab and Jewish children, despite marked ethnic differences in dietary sources of sodium. Hence, low NLS predicts increased intake of dietary sodium in low birth weight children some 8-15 yr later. Taken together with other recent evidence, it is now clear that perinatal sodium loss, from a variety of causes, is a consistent and significant contributor to long-term sodium intake.

Background: Group B Streptococci (GBS) asymptomatically colonize the vaginal or rectal areas of about 20% of pregnant women (4-40%). About 50% of infants to mothers with GBS colonization also become colonized at rectal, umbilical or oral sites. GBS is a leading bacterial cause of neonatal illness and death. The present prevalence rate of GBS carriers among parturients in the western Galilee in Israel is unknown., Aim: A prospective study of the GBS carrier rate according to origin and gestational age in the western Galilee in Israel., Methods: A prospective study including 700 pregnant women. All women were screened for carriage of GBS by vaginal and rectal cultures., Results: Sixteen percent of the parturients were found to be GBS colonized. The prevalence of GBS was 13.7% in Jewish women and 19% in Arab women, P=0.038. The women were also divided into two groups according to the gestational age one group included 414 women in 24-37 weeks gestation, and the other group included 286 women in term pregnancy. No difference was found in the rate of GBS carriers between the two gestational age groups., Conclusions: In the present study we found a significant increase in the incidence of GBS colonization in pregnant women in northern Israel. We also found an increased rate of GBS carriers in Arab women relative to Jewish women.

Diagnosis and treatment of an anuric premature infant with severe respiratory compromise and a normal renal ultrasound (US), is a difficult task that requires a multidisciplinary approach. A 29-week gestation premature male infant, born after 5 weeks of worsening oligohydramnios, was ventilated for respiratory distress and remained anuric. Intensive clinical investigations and pediatric nephrology consultation that predicted very poor prognosis were followed by progressive renal failure, electrolyte imbalance, respiratory failure, ventricular arrhythmia, and finally cardiac arrest and death on day 5. In view of the predicted poor outcome, and after discussion with the parents, a decision was made not to start peritoneal dialysis (PD), and to offer only palliative therapy, with comfort care alone. Pre and postnatal diagnosis lead, in this case, to an ethical challenge that focuses on the question of futility., (Copyright 2006 John Wiley & Sons, Ltd.)

Nine premature infants developed early onset sepsis and/or pneumonia with Haemophilus influenzae during a period of 53 months (January 2000 -May 2004). Their respiratory problems were pneumonia-like rather than classic respiratory distress syndrome. In 8 of the cases, the pathogen was a beta-lactamase-negative, nontypable H. influenzae. In the remaining case, the Haemophilus identified was type d. Before January 2000, no case of beta-lactamase-negative, nontypable H. influenzae sepsis or pneumonia had been recorded.

Splanchnic ischemia-reperfusion (I/R) causes tissue hypoxia that triggers local and systemic microcirculatory inflammatory responses. We evaluated the effects of hyperoxia in I/R induced by 40-min superior mesenteric artery (SMA) occlusion and 120-min reperfusion in four groups of rats: 1) control (anesthesia only), 2) sham operated (all surgical procedures without vascular occlusion; air ventilation), 3) SMA I/R and air, 4) SMA I/R and 100% oxygen ventilation started 10 min before reperfusion. Leukocyte rolling and adhesion in mesenteric microvessels, pulmonary microvascular blood flow velocity (BFV), and macromolecular (FITC-albumin) flux into lungs were monitored by intravital videomicroscopy. We also determined pulmonary leukocyte infiltration. SMA I/R caused marked decreases in mean arterial blood pressure (MABP) and blood flow to the splanchnic and hindquarters vascular beds and pulmonary BFV and shear rates, followed by extensive increase in leukocyte rolling and adhesion and plugging of >50% of the mesenteric microvasculature. SMA I/R also caused marked increase in pulmonary sequestration of leukocytes and macromolecular leak with concomitant decrease in circulating leukocytes. Inhalation of 100% oxygen maintained MABP at significantly higher values (P < 0.001) but did not change regional blood flows. Oxygen therapy attenuated the increase in mesenteric leukocyte rolling and adherence (P < 0.0001) and maintained microvascular patency at values not significantly different from sham-operated animals. Hyperoxia also attenuated the decrease in pulmonary capillary BFV and shear rates, reduced leukocyte infiltration in the lungs (P < 0.001), and prevented the increase in pulmonary macromolecular leak (P < 0.001), maintaining it at values not different from sham-operated animals. The data suggest that beneficial effects of normobaric hyperoxia in splanchnic I/R are mediated by attenuation of both local and remote inflammatory microvascular responses.

Over the last two decades, drug and alcohol abuse by pregnant women has spread to epidemic proportions. Maternal drug abuse has neurobehavioral and somatic effects which may be long-lasting and devastating to the offspring. Opiates, such as heroin and pain killers that contain a narcotic component, are widely abused today. A prominent manifestation of fetal exposure to these drugs is the neonatal withdrawal syndrome, which typically includes wakefulness, jitteriness and other symptoms of cerebral irritability. These, in turn, may interrupt early mother-infant interaction, affecting the infant's long-term emotional and cognitive development. Fetal cocaine exposure may cause neonatal cerebral irritability, changes in habituation responses, reduced head circumference, poor mental development and long-lasting impairment of the brain. Benzodiazepines can cause fetal dysmorphism (including microcephaly), neurological and behavioral impairments and neonatal withdrawal symptoms. Maternal use of amphetamines may cause neonatal dysphoria and agitation, as well as long-term lassitude and drowsiness that may result in poor feeding. Fetal exposure to alcohol may cause neonatal withdrawal symptoms, maladaptive behavior in childhood and the fetal alcohol syndrome (including microcephaly). Maternal alcohol consumption is also a common cause of mental retardation. Fetal exposure to marijuana may delay maturation of the visual system and impair memory and verbal performance at 2 years of age. The inevitable conclusion is that society must seek ways not only to treat, but also to prevent this epidemic. To this end, a key factor would be to identify potential drug abusing mothers before they reach the stage of prenatal care and educate them regarding the fatal consequences of drug abuse.