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Antenatal ultrasound screening to detect renal abnormalities: a prospective screening programme in a district population
12 Are the beh~vioaral states of the term buman fetus enrlgous to those of the newborn? M. Pillai and D.K. James, University Department of Obstetrics, Bristol Maternity Hospital, Bristol BS2 8EG, U.K. Behavioural studies have established that in the last few weeks of gestation the human fetus develops behavioural states which appear similar to those of the newborn. These have been designated states lF, 2F, 3F, and 4F to distinguish them from states Sl to S5 of the newborn [l]. Using real time ultrasound and fetal heart rate recording we have studied 40 low risk singleton fetuses at term and determined the proportion of time spent in each behavioural state. Twelve of the subjects underwent further evaluation of the same behavioural parameters between 3 and 5 days of age. We found that 2F was the predominant fetal behavioural state and during most of the studies this cycled with 1F. State 4F occurred infrequently, but in one case this persisted for the entire duration of study (117 min). The maximum durations of 1F and 2F were 37 and 94 min, respectively. We did not find a state 3F in any of the recordings. In the newborn studies we found that the eye movements, level of activity and heart rate pattern in Sl (quiet sleep) were entirely analagous to lF, in S2 (REM sleep) were analagous to 2F, in S4 (active awake) were analagous to 4F and this was particularly evident on an individual level. The only apparent difference was a fall in heart rate of about 20 beats/min in most of the newborns in each of the three states, when compared with their analagous fetal state. We found no equivalent of SS (crying) or S3 (quiet awake) in the fetus. S3 was also the least common state in the newborn, and was only seen in association with feeding. We conclude that there is continuity of behaviour only with regard to the sleep states going from prenatal to post natal life. Episodes analagous to wakefulness occur infrequently before birth, and we could not find any prenatal behaviour analagous to quiet awake or crying. Funded by grant No S/P/1645 from Action Research for the crippled child. 1 Nijhuis, J.G. Prechtl, H.F.R., 6, 177-195.
Martin, C.B. Jr. and Bots, R.S.G.M.
(1982): Early Hum. Dev.,
Antenatal ultrasound screening to detect renal abnormalities: a prospective screening programme in a district population. L.N. Livera, J.A. Egginton, D.S.K. Brookfield, (introduced by S.A. Spencer), Departments of Paediatrics and Radiology, North Staffordshire Maternity Hospital, Stroke-onTrent, U.K. A prospective study was undertaken over a 1Zmonth period to evaluate the effectivenes’s of an ultrasound screening programme in detecting fetal renal tract abnormality at or around 28 weeks gestation. Ninety-eight percent of pregnant women (a total of 6292), in North Staffordshire were scanned at this stage over a 1Zmonth study period. Ninety-two scans were abnormal giving an incidence of 1.4%. Forty-seven (51%) of these patients had normal renal tracts on postnatal scan, or minor variants of normal. Forty-two (46%) had significant abnormality confirmed, and just under half of these have had surgery or will require this in the near future. Three patients (3%) were lost to follow-up, having repeatedly failed to attend for postnatal scan. Seven babies born to the study group had renal abnormality which was missed antenatally but was detected after presentation with urinary tract infection. The overall incidence of renal tract abnormality detected by 18 months of age in this population was 0.77%. The incidence of abnormality detected by antenatal scanning was 0.66%. This is much higher than recent reports which give an incidence of fetal uropathy varying from 0.14% to 0.39% [l]. This may reflect the fact that in our study a high proportion of the population was scanned and that all the scans were carried out at the same stage of pregnancy. The proportion of patients requiring surgery was compatible with previous reports [1,2]. We conclude that screening with ultrasound antenatally at 26-30 weeks gestation is an effective method of detecting structural renal abnormality.
13 1 Madarikan, B.A., Hayward, C., Roberts, GM. and Lari, J. (1988): Arch Dis. Child., 63, %l963. 2 Smith, D., Egginton, J.A. and Brookfield, D.S.K. (1987): Br. Med. J. 294, 27-28. Comparison
of egg-based with breastmilk-based nitrogen source of parenteral nutrition. J.W.L. Puntis, P.A. Ball, M.A. Preece, A. Green, I.W. Booth, Institute of Child Health, University of Birmingham, and Departments of Pharmacy and Clinical Chemistry, The Children’s Hopsital, Birmingham, U.K.
Plasma phenylalanine concentrations may reach potentially neurotoxic levels in neonates parenterally fed with Vamin 9 [l-3], a widely used amino acid preparation based on egg-protein. Fourteen subjects in a neonatal surgical ward were randomly allocated to either Vamin 9 (V9) or Vaminolac Novum (VN), a nitrogen source with an amino acid profile similar to breast milk, but were otherwise fed to identical feeding regimens. Indications for TPN were: V9 - 2 gastroschisis, 2 NBC, 2 small bowel atresia, 1 malrotation (median weight 2.470 kg, range 1.470-2.910); VN - 3 gastroschisis, 4 NEC (2.330 kg, 1.070-3.200). At the start of the study, the two groups did not differ significantly with respect to weight, post-conceptual age or post-natal age. Over a 6-day period on full nutritional intake there was no significant difference in weight gain between the two groups. 72 hour nitrogen balance studies were not significantly different. V9: median nitrogen retention 75% (range 52-85%); VN: 74% (44-85%). However, plasma amino acid profiles in the V9 fed infants were often abnormal whilst in the group receiving VN, were more similar to those reported in breast fed infants [4]. Notably, concentrations of potentially neurotoxic phenylalanine An amino acid and tyrosine were much lower in patients on V9 (P = 0.0028; P = 0.0004). solution based on the composition of breast milk protein corrects plasma amino acid profiles during parenteral nutrition, reducing in particular the risk of hyperphenylalaninaemia and hypertyrosinaemia. Puntis; J.W.L., Edwards, M.A., Green, A., Morgan, I., Booth, I.N. and Ball, P.A. (1986): Lancet, ii, 1105-1106. Walker, V., Hall, M.A., Bulusu, S. and Allan, A. (1986): Lancet, ii, 1284. Evans, S.J., Wynne Williams, T.C.J.E., Russell, C.A. and Fairbrother, A. (1986): Lancet, ii, 1404--1405. Wu, P.Y.K., Edwards, M.A. and Storm, M.C. (1986): J. Pediatr., 109, 247-349.
Martin, C.B. Jr. and Bots, R.S.G.M.
(1982): Early Hum. Dev.,
Antenatal ultrasound screening to detect renal abnormalities: a prospective screening programme in a district population. L.N. Livera, J.A. Egginton, D.S.K. Brookfield, (introduced by S.A. Spencer), Departments of Paediatrics and Radiology, North Staffordshire Maternity Hospital, Stroke-onTrent, U.K. A prospective study was undertaken over a 1Zmonth period to evaluate the effectivenes’s of an ultrasound screening programme in detecting fetal renal tract abnormality at or around 28 weeks gestation. Ninety-eight percent of pregnant women (a total of 6292), in North Staffordshire were scanned at this stage over a 1Zmonth study period. Ninety-two scans were abnormal giving an incidence of 1.4%. Forty-seven (51%) of these patients had normal renal tracts on postnatal scan, or minor variants of normal. Forty-two (46%) had significant abnormality confirmed, and just under half of these have had surgery or will require this in the near future. Three patients (3%) were lost to follow-up, having repeatedly failed to attend for postnatal scan. Seven babies born to the study group had renal abnormality which was missed antenatally but was detected after presentation with urinary tract infection. The overall incidence of renal tract abnormality detected by 18 months of age in this population was 0.77%. The incidence of abnormality detected by antenatal scanning was 0.66%. This is much higher than recent reports which give an incidence of fetal uropathy varying from 0.14% to 0.39% [l]. This may reflect the fact that in our study a high proportion of the population was scanned and that all the scans were carried out at the same stage of pregnancy. The proportion of patients requiring surgery was compatible with previous reports [1,2]. We conclude that screening with ultrasound antenatally at 26-30 weeks gestation is an effective method of detecting structural renal abnormality.
13 1 Madarikan, B.A., Hayward, C., Roberts, GM. and Lari, J. (1988): Arch Dis. Child., 63, %l963. 2 Smith, D., Egginton, J.A. and Brookfield, D.S.K. (1987): Br. Med. J. 294, 27-28. Comparison
of egg-based with breastmilk-based nitrogen source of parenteral nutrition. J.W.L. Puntis, P.A. Ball, M.A. Preece, A. Green, I.W. Booth, Institute of Child Health, University of Birmingham, and Departments of Pharmacy and Clinical Chemistry, The Children’s Hopsital, Birmingham, U.K.
Plasma phenylalanine concentrations may reach potentially neurotoxic levels in neonates parenterally fed with Vamin 9 [l-3], a widely used amino acid preparation based on egg-protein. Fourteen subjects in a neonatal surgical ward were randomly allocated to either Vamin 9 (V9) or Vaminolac Novum (VN), a nitrogen source with an amino acid profile similar to breast milk, but were otherwise fed to identical feeding regimens. Indications for TPN were: V9 - 2 gastroschisis, 2 NBC, 2 small bowel atresia, 1 malrotation (median weight 2.470 kg, range 1.470-2.910); VN - 3 gastroschisis, 4 NEC (2.330 kg, 1.070-3.200). At the start of the study, the two groups did not differ significantly with respect to weight, post-conceptual age or post-natal age. Over a 6-day period on full nutritional intake there was no significant difference in weight gain between the two groups. 72 hour nitrogen balance studies were not significantly different. V9: median nitrogen retention 75% (range 52-85%); VN: 74% (44-85%). However, plasma amino acid profiles in the V9 fed infants were often abnormal whilst in the group receiving VN, were more similar to those reported in breast fed infants [4]. Notably, concentrations of potentially neurotoxic phenylalanine An amino acid and tyrosine were much lower in patients on V9 (P = 0.0028; P = 0.0004). solution based on the composition of breast milk protein corrects plasma amino acid profiles during parenteral nutrition, reducing in particular the risk of hyperphenylalaninaemia and hypertyrosinaemia. Puntis; J.W.L., Edwards, M.A., Green, A., Morgan, I., Booth, I.N. and Ball, P.A. (1986): Lancet, ii, 1105-1106. Walker, V., Hall, M.A., Bulusu, S. and Allan, A. (1986): Lancet, ii, 1284. Evans, S.J., Wynne Williams, T.C.J.E., Russell, C.A. and Fairbrother, A. (1986): Lancet, ii, 1404--1405. Wu, P.Y.K., Edwards, M.A. and Storm, M.C. (1986): J. Pediatr., 109, 247-349.