Short-term outcome of perinatal care in a Swedish county. Mortality, neonatal intensive care and overall evaluation of neuromotor function at 0-10 months of corrected age in preterm and term infants.

Improvements in obstetrical and neonatal care during the last decades have led to a marked increase in survival rate of preterm and term infants. In order to study the short- and long-term outcome in infants who survived neonatal intensive care (NIC) and were born in the county of Uppsala between January 1st 1986 and April 30th 1989, a prospective long-term follow-up study was conducted. Epidemiological data on all infants born in the county during the study period and the short-term outcome, measured as overall neuromotor function at term and at 2, 4, 6 and 10 months of corrected age in 245 infants surviving NIC and 72 healthy control infants are presented. The infants' neuromotor function was evaluated with different clinical neurological methods. In the study population of NIC infants 85.9% survived the neonatal period. The early infant mortality was high in this group 11.6% compared to that of all infants born in the county of Uppsala (0.30%). Only a minority of the infants showed abnormal neuromotor function. A comparison of the results of the overall evaluation of neuromotor function at 10 months of age with those of the examinations made at an earlier age showed poor correspondence in individual infants, especially in preterm and very preterm infants.

Isotypes and opsonophagocytosis of pneumococcus type 6B antibodies elicited in infants and adults by an experimental pneumococcus type 6B-tetanus toxoid vaccine.

Streptococcus pneumoniae is a major respiratory pathogen of infants, children, and the elderly. Polysaccharide vaccines have been useful in adult populations but do not elicit protective immunity in infants and young children. To enhance their immunogenicity, vaccines of pneumococcal polysaccharides conjugated to proteins are being developed. In this study antibody levels and opsonic activities were compared in sera of infants and adults injected with pneumococcal polysaccharide type 6B (Pn6B) conjugated to tetanus toxoid (TT) (Pn6B-TT). Healthy infants were injected with Pn6B-TT; group A was injected at 3, 4, and 6 months of age, and group B was injected at 7 and 9 months of age. A booster injection was given at 18 months. Adults were injected once. Antibodies were measured by enzyme-linked immunosorbent assay and radioimmunoassay, and their functional activities were measured by opsonophagocytosis of radiolabelled pneumococci. In adults, increases in immunoglobulin M (IgM), IgG, IgA, IgG1, and IgG2 to Pn6B were observed. Infants reached adult levels of IgG1 anti-Pn6B after the primary injections. After the booster injection the infant groups had total IgG- and IgM-Pn6B antibody levels similar to those of adults. After the booster injection, IgG1 was the dominant infant anti-Pn6B isotype and at a level higher than in vaccinated adults, but IgA and IgG2 antibodies remained at very low levels. Opsonic activity increased significantly after Pn6B-TT injections; the highest infant sera showed opsonic activity comparable to that of vaccinated adults. Overall, opsonic activity correlated best with total and IgG anti-Pn6B antibodies (r = 0.741, r = 0.653, respectively; n = 35) and was highest in sera with high levels of all Pn6B antibody isotypes. The results indicate the protective potential of a pneumococcal 6B polysaccharide protein conjugate vaccine for young infants.

Immune responses of infants vaccinated with serotype 6B pneumococcal polysaccharide conjugated with tetanus toxoid.

BACKGROUND: Streptococcus pneumoniae is a major cause of meningitis, bacteremia, pneumonia and otitis media. Pneumococcal polysaccharides are not immunogenic in infants, but improved immunogenicity of polysaccharide-protein conjugates has been demonstrated. Antibiotic-resistant pneumococci have increased the need for an effective vaccine. OBJECTIVE: To study the safety and immunogenicity of a pneumococcal type 6B polysaccharidetetanus toxoid conjugate (Pn6B-TT) in infants and to assess the function of antibodies. METHODS: Healthy infants were injected, Group A at 3, 4 and 6 months (n = 21) and Group B at 7 and 9 months (n = 19). Booster injection was given at 18 months. Antibodies were measured by enzyme-linked immunosorbent assay and radioimmunoassay, and functional activity was measured by opsonization of radiolabeled pneumococci. Nasopharyngeal cultures were obtained. RESULTS: No significant adverse reactions were observed. Pn6B-IgG (enzyme-linked immunosorbent assay) increased to a geometric mean of 0.62 microgram/ml (P = 0.367, compared with prevaccination titers) in Group A at 7 months and 1.22 micrograms/ml (P < 0.001) in Group B at 10 months. Total Pn6B antibodies (radioimmunoassay) were 44 ng of antibody N/ml (P < 0.053) in Group A and 211 ng of antibody N/ml (P < 0.001) in Group B. A smaller increase in IgM and IgA anti-Pn6B was observed. Reinjection at 18 months elicited booster responses in total and IgG anti-Pn6B; 62% of those in Group A and 79% of those in Group B had > 300 ng of antibody N/ml. Opsonic activity, after initial and booster vaccinations, correlated with Pn6B-antibody titers. Three infants with nasopharyngeal cultures repeatedly positive for serogroup 6 had poor serum IgG responses. CONCLUSION: Our results demonstrate that Pn6B-TT is safe, elicits functional antibodies and memory responses in infants.

[Parathyroid surgery in Landakotsspítali 1973-1994.].

The results of 44 operations on 42 patients (nine men and 33 women) for primary hyperparathyroidism in Landakotsspitali, Reykjavik during the period 1973-1994 were studied. Only one patient needed reoperation because of persistent hypercalcemia. The operative success rate is 97.7%. One patient had two recurrent single adenomas with an interval of three years during which the patient was normocalcemic. Two patients were diagnosed having multiple endocrine neoplasia type I (MEN) before the operation. One of those had a brother with parathyroid carcinoma. Hyperparathyroidism was histologically verified in all 42 patients. Thirtyseven (88%) had adenoma, and four (9.5%) had chief cell hyperplasia. Double adenomas were diagnosed in four patients (9.5%). In two patients functioning oxyphil cell adenomas were encountered. One case (2.4%) could not be histologically sub typed. This patient had a brother who died of parathyroid carcinoma. One patient with type I MEN syndrome had adenoma, the other had chief cell hyperplasia. No parathyroid carcinoma was diagnosed. Thirtyone patients needed medical treatment for transient postoperative hypocalcemia. Permanent hypocalcemia was found in three patients. Vocal cord paralysis was recorded in one case. No other complication was found. Two patients had elevated parathyroid hormone (PTH), both nine years after the operation. One of those is normocalcemic and without symptoms, the other hypocalcemic for unexplainable reasons.

Water loss from the skin of term and preterm infants nursed under a radiant heater.

The rate of evaporation from the skin (g/m2/h) was measured in 12 full-term and 16 preterm infants (gestational age 25-34 wk) both during incubator care and when nursed under a radiant heater. The method for evaporation rate measurement is noninvasive and based on determination of the water vapor pressure gradient close to the skin surface. Measurements were first made with the infant nursed in an incubator with a controlled environment with respect to humidity, temperature, and air velocity. The measurements in the term infants were performed at an ambient relative humidity (RH) of 50%, and in the preterm infants first at 50% and subsequently at 30-40%. Evaporation rate was then measured with the infant nursed under a radiant heater. In term infants, mean evaporation rate was 3.3 g/m2/h during incubator care (RH 50%) and 4.4 g/m2/h during care under the radiant heater. In preterm infants, the corresponding values were 15.5 g/m2/h in the incubator at RH 50%, 16.7 g/m2/h at RH 30-40%, and 17.9 g/m2/h under the radiant heater. It is concluded that the evaporative water loss from the skin depends on the ambient water vapor pressure, irrespective of whether the infant is nursed in an incubator or under a radiant heater. The higher rate of evaporation during care under a radiant heater is due to the lower ambient water vapor pressure and not to any direct effect of the nonionizing radiation on the skin.

Respiratory water loss and oxygen consumption in full-term infants exposed to cold air on the first day after birth.

Respiratory water loss, oxygen consumption, carbon dioxide production and skin blood flow were measured continuously in nine full-term infants on the first day after birth. After at least 18 min of measurements with the infant asleep in an incubator, with an air temperature of 33 degrees C and a relative humidity of 50%, the temperature of the incubator air was lowered to less than 27.5 degrees C. This resulted in a significant decrease in skin temperature and peripheral skin blood flow, while the infant's core temperature remained unchanged. At the same time, mean respiratory water loss increased from 3.7 to 6.1 mg/kg.min, which can be explained partially by the decrease in ambient humidity that accompanied the decrease in air temperature. In addition, mean oxygen consumption increased from 5.3 to 7.9 ml/kg.min and mean carbon dioxide production increased from 3.8 to 5.9 ml/kg.min. There was no concomitant increase in motor activity. Thus, when the newborn infants were exposed to cool air, they reacted with an increase in respiratory water loss, oxygen consumption and carbon dioxide production before their core temperature was affected and without increasing their motor activity.

Insensible water loss from the skin during phototherapy in term and preterm infants.

The rate of evaporation from the skin was measured before and during phototherapy in 10 full-term and seven preterm infants (gestational age 29-33 weeks). The method for measurement of rate of evaporation was non-invasive and was based on determination of the water vapour pressure gradient close to the skin surface. All infants were studied naked in an incubator with an ambient relative humidity of 50% and with a controlled environment with respect to temperature and air velocity. In the term infants the mean rate of evaporation, measured from an interscapular skin area, was 3.1 g/m2h both before and after 30 min of phototherapy. In the preterm infants the corresponding value was 9.8 g/m2h before and 9.7 g/m2h after 120 min of phototherapy. Thus, in thermally stable infants, non-ionizing radiation from phototherapy equipment does not increase water loss from the skin.

Respiratory water loss and oxygen consumption in newborn infants during phototherapy.

Respiratory water loss was measured together with oxygen consumption (VO2) and carbon dioxide production (VCO2) in 11 full-term and eight preterm infants (mean gestational age 34 weeks, range 31-36 weeks) before and during 1 h of phototherapy. The method for determination of respiratory water loss, VO2 and VCO2 was based on an open flow-through system with a mass spectrometer for measurement of gas concentrations. All infants were studied naked in an incubator with an ambient relative humidity of 50% and with a controlled environment with respect to temperature and air velocity. The infants were calm during the measurements. Before phototherapy, in term infants respiratory water loss was 4.4 (SD 0.7) mg/kg min and VO2 5.9 (0.9) ml/kg min and in preterm infants respiratory water loss was 4.7 (0.8) mg/kg min and VO2 6.1 (0.8) ml/kg min. No significant difference was found between values obtained during or after 1 h of phototherapy and those obtained before.

Ectrodactyly-ectodermal dysplasia-clefting syndrome (EEC): the clinical variation and prenatal diagnosis.

Six patients with the ectrodactyly-ectodermal dysplasia-clefting (EEC) syndrome, namely five members of the same family and one sporadic case, are presented. One of the main features of the EEC syndrome, ectrodactyly, was missing in five of the patients. The diagnosis did not become clear until the youngest son of the family was born. All of our six patients had a low birth weight and some were born preterm, and four had poly- and/or syndactyly without ectrodactyly. A low birth weight and polysyndactyly have been reported previously in patients with the EEC syndrome and might be features of the syndrome. The present patients illustrate the great phenotypic variability in the EEC syndrome and the need for a careful search for microsymptoms in potential gene-carriers. In two members of the affected family, EEC syndrome was diagnosed prenatally after 16 weeks of gestation by detection of the cleft lip and palate on ultrasound examination. The mother chose to continue the pregnancies. However, prenatal diagnosis of cleft lip and palate might be of value in genetic counselling for other inherited syndromes leading to severe disability.

Cancer of the pancreas in Iceland. An epidemiologic and clinical study, 1974-85.

A retrospective study was performed of all patients diagnosed as having pancreatic cancer in Iceland during the period 1974-85 (12 years). The incidence of the disease during the period according to this study was 10.7 per 100,000 males and 9.8 per 100,000 females, with age-adjusted world standard incidences of 9.0 per 100,000 males and 6.7 per 100,000 females. A total of 301 patients were identified; adequate information could be obtained for 281 patients, and 225 (74.8%) had the diagnosis histologically confirmed. Two hundred and five patients with adenocarcinoma were accepted for detailed analysis. Of the patients with adenocarcinoma 139 (67.8%) were diagnosed at laparotomy, and 33 of them had the tumour resected, with an operative mortality of 12.1%. The cancer was located in the head of the pancreas in 102 patients (49.8%), and in 159 (77.6%) metastases were found at the time of diagnosis. The median survival time for the patients with adenocarcinoma was 95.4 days (SD +/- 11.1 days), although there were two patients in this group who were alive 5 years after diagnosis. The median survival for the total group of 281 patients was 98.3 days (SD +/- 11.0 days), although 6 of these patients lived for more than 5 years. The percentage of histologically confirmed tumours in Iceland is high compared with many previously reported studies.

Does non-ionizing radiant energy affect determination of the evaporation rate by the gradient method?

A study was performed to investigate whether measurements of the evaporation rate from the skin of newborn infants by the gradient method are affected by the presence of non-ionizing radiation from phototherapy equipment or a radiant heater. The evaporation rate was measured experimentally with the measuring sensors either exposed to or protected from non-ionizing radiation. Either blue light (phototherapy) or infrared light (radiant heater) was used; in the former case the evaporation rate was measured from a beaker of water covered with a semipermeable membrane, and in the latter case from the hand of an adult subject, aluminium foil or with the measuring probe in the air. No adverse effect on the determinations of the evaporation rate was found in the presence of blue light. Infrared radiation caused an error of 0.8 g/m2h when the radiant heater was set at its highest effect level or when the ambient humidity was high. At low and moderate levels the observed evaporation rate was not affected. It is concluded that when clinical measurements are made from the skin of newborn infants nursed under a radiant heater, the evaporation rate can appropriately be determined by the gradient method.

Abnormalities of the cerebellum in oro-facio-digital syndrome II (Mohr syndrome).

Two patients with oro-facio-digital syndrome type II (OFD-II, Mohr syndrome) with associated cerebellar atrophy are described. Three other cases of the Mohr syndrome with cerebellar abnormalities are cited from the literature. Cerebellar involvement seems to be a clinical feature of this syndrome. Unfortunately, there is a lack of CNS reports for many of the previously described patients. In all cases with this entity, careful neurological and radiological examinations of the cerebellum are recommended.

Dermatitis herpetiformis and herpes gestationis. Analysis of γA and γM serum proteins by immunoelectrophoresis.

Serums from patients with dermatitis herpetiformis, herpes gestationis and pemphigus vulgaris were examined and compared with serums from normal individuals. Consistent deviations from normal were found, in that the γA globulin fraction was increased. The γM globulins appeared normal in dermatitis herpetiformis and herpes gestationis but decreased in pemphigus vulgaris. The γA and γM globulin changes in dermatitis herpetiformis and in herpes gestationis were similar.