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Birth trauma
585
REVIEWS AKD ABSTRACTS
antepartum hemorrhage, and syphilis. The second group, the one with which we are chiefly concerned, shows a gross mortality of 40 per cent. In other words, nearly half the premature babies born alive die before the end of the third week of l~ife. The percentage mortality of selected premature babies (which have no obvious disability in addition to their prematurity) may be anything from 35 to 50 times as great as that of mature babies born under the same or similar conditi.ons. Not much information is available as to the cause of this heavy mortality among the premature infants. Pet ilt is fairly safe to assumethat the predominant factor in death from prematurity is malnutrition. The fatal susceptibility of premature infants to infections of all kinds must not be overlooked. Their tissues have not yet elaborated a defense against bacterial invasion and are, therefore, incapable of resistance. The great importance of breast feeding for premature infants is emphasized. No doubt breast-fed babies do receive with the milk, immunity bodies, serviceable for defensive purposes. NORMAN
Ehrenfest: Intracranial Birth iStandpoint of the Obstetrician, tion, 1921, lxxvii,
Trauma
F. MILLER.
of the Newborn
from
the
Journal American Medical Associa-
103.
Intracranial birth injuries are produced by the mechanical exaggeration of the physiologic process of molding, resulting in excessive or sudden compression of the fetal skull ; they are prone to occur in the course even of a normal labor if prematurity predisposes the infant to traumatic Lesions; and they are necessarily aggravated by a, hemorrhagic diathesis or by inappropriate manipulations during resuscitation. Upon these premises, Ehrenfest briefly bases the more or less obvious prophylactic and therapeutic measures to be employed by the obstetrician. Forceps should be carefully applied with the minimum amount of compression. Extraction should be slow to permit gradual molding of the head. In breech cases,t,he head should remain flexed, strong pressure of the occiput against the symphysis is to be avoided as well as undue haste. Large doses of pituitary extract are dangerous. Episiotomy is preferable to extreme measures to protect the perineum. All brusque maneuvers must be avoided in resuscitation. The diagnosis of intracranial lesions must be made early. In suspect.ed easesthe clotting time should be taken. Spinal puncture is a R. E. WOBUS. measure both of diagnostic and therapeutic value.
Hereford:
Birth
Trauma.
Southern Medical Journal, 1921, xiv, 542.
For the year of 1918 the mortality statistics for the registration area of the United States showed 6,149 deaths due to birth trauma. Many infants surviving the immediate effects of birth trauma later develop into idiots, epileptics, feebleminded and insane. Some become deaf, dumb or blind. The author believes intracranial hemorrhage to be of far more frequent occurrence than is generally supposed. The so-called hemor. rhagic tendency of the newborn infants, or those dying within a short
536
THE
AMERICA?’
JOURKAL
OF
OBSTETRICS
AND
GPNECOLOGY
time after birth, show hemorrhages in the dura, over the brain surfaces or in the ventricles. Some show hemorrhages in other organs of the body. The edema produced during difficult delivery may prove the appear immediately more serious factor in some cases. Symptoms after birth, or more commonly after two or three days. The author believes lumbar puncture of the greatest diagnostic importance as well as excellent treatment. He advises daily repeated lumbar punct.ures withdrawing 10 to 12 C.C. of the bloody spinal fluid until the pressure of the fluid does not exceed 10 mm. In babies in whom t,he cerebral spinal fluid reaches a pressure of 15 mm. or higher, associated with other positive findings of increased intracranial pressure, a subtempora.1 decompression and draina.ge is advised. NORMAT\’ F. &LLER. Greenwood: Artificial Respiration in the Newborn. Journal, April 23, 1921, Ko. 3147, p. 601.
British
Medical
The infant is held with the back of the neck on the palmar nurface of t.he left hand, the occiput being supported between the thumb The ankles are held firmly and the forefinger which grasps the mastoid. from behind with the right hand. The child is held head upwards at an angle of about 15 degrees from the vertical. The child is allowed to move rapidly downward about txTo feet. It is now invert,ed, the head being downward. The infant is again moved smartly downward for a distance of about two feet. The movement of the abdominal viscera may from and toward the diaphragm stimulates cardiac and pulmonary action. F. Ii ADMR.
Formiehella: American
Amniotic Medical
Hernia Association,
Corrected
by Operation.
1921, lxxvii,
465.
Journal
The case here reported is that of a full-term female child that was well developed and normal eseept for a hernia the size of a grapefruit It conprotruding from an umbilical opening the size of a half dollar. tained intestines which were plainly visible through the enveloping shea.th of the cord. Under ether, an incision one inch in iength ITas made above and below the umbilicus~ the contents reduced, and the abdomen sewed up with catgut. The child made a good recovery. R. E. \yOBVS.
ERRATA OH page 408 of the Oct,ober, 1921, issue of the journal, the “note” imnzccliatel~ under Fig. 1 in the article by Dr. C’ary on “Sterility Studies-SlmI)lified $I:ethods in Diagnosis” should be deleted.
Issi;e of October, 1921, page -133: The name of Dr. W. J. Butler was inadvertently included as co-author with Dr. Reuben Petcrsou of the paper on Pneumoperitoneum~ and Roentgenography as Aids to More Accurate Obstetric and Gyneeologic Diagnosis. Dr. Reuben Pet,erson OP Ann Arbor, Nieh., was the sole author of the paper.
REVIEWS AKD ABSTRACTS
antepartum hemorrhage, and syphilis. The second group, the one with which we are chiefly concerned, shows a gross mortality of 40 per cent. In other words, nearly half the premature babies born alive die before the end of the third week of l~ife. The percentage mortality of selected premature babies (which have no obvious disability in addition to their prematurity) may be anything from 35 to 50 times as great as that of mature babies born under the same or similar conditi.ons. Not much information is available as to the cause of this heavy mortality among the premature infants. Pet ilt is fairly safe to assumethat the predominant factor in death from prematurity is malnutrition. The fatal susceptibility of premature infants to infections of all kinds must not be overlooked. Their tissues have not yet elaborated a defense against bacterial invasion and are, therefore, incapable of resistance. The great importance of breast feeding for premature infants is emphasized. No doubt breast-fed babies do receive with the milk, immunity bodies, serviceable for defensive purposes. NORMAN
Ehrenfest: Intracranial Birth iStandpoint of the Obstetrician, tion, 1921, lxxvii,
Trauma
F. MILLER.
of the Newborn
from
the
Journal American Medical Associa-
103.
Intracranial birth injuries are produced by the mechanical exaggeration of the physiologic process of molding, resulting in excessive or sudden compression of the fetal skull ; they are prone to occur in the course even of a normal labor if prematurity predisposes the infant to traumatic Lesions; and they are necessarily aggravated by a, hemorrhagic diathesis or by inappropriate manipulations during resuscitation. Upon these premises, Ehrenfest briefly bases the more or less obvious prophylactic and therapeutic measures to be employed by the obstetrician. Forceps should be carefully applied with the minimum amount of compression. Extraction should be slow to permit gradual molding of the head. In breech cases,t,he head should remain flexed, strong pressure of the occiput against the symphysis is to be avoided as well as undue haste. Large doses of pituitary extract are dangerous. Episiotomy is preferable to extreme measures to protect the perineum. All brusque maneuvers must be avoided in resuscitation. The diagnosis of intracranial lesions must be made early. In suspect.ed easesthe clotting time should be taken. Spinal puncture is a R. E. WOBUS. measure both of diagnostic and therapeutic value.
Hereford:
Birth
Trauma.
Southern Medical Journal, 1921, xiv, 542.
For the year of 1918 the mortality statistics for the registration area of the United States showed 6,149 deaths due to birth trauma. Many infants surviving the immediate effects of birth trauma later develop into idiots, epileptics, feebleminded and insane. Some become deaf, dumb or blind. The author believes intracranial hemorrhage to be of far more frequent occurrence than is generally supposed. The so-called hemor. rhagic tendency of the newborn infants, or those dying within a short
536
THE
AMERICA?’
JOURKAL
OF
OBSTETRICS
AND
GPNECOLOGY
time after birth, show hemorrhages in the dura, over the brain surfaces or in the ventricles. Some show hemorrhages in other organs of the body. The edema produced during difficult delivery may prove the appear immediately more serious factor in some cases. Symptoms after birth, or more commonly after two or three days. The author believes lumbar puncture of the greatest diagnostic importance as well as excellent treatment. He advises daily repeated lumbar punct.ures withdrawing 10 to 12 C.C. of the bloody spinal fluid until the pressure of the fluid does not exceed 10 mm. In babies in whom t,he cerebral spinal fluid reaches a pressure of 15 mm. or higher, associated with other positive findings of increased intracranial pressure, a subtempora.1 decompression and draina.ge is advised. NORMAT\’ F. &LLER. Greenwood: Artificial Respiration in the Newborn. Journal, April 23, 1921, Ko. 3147, p. 601.
British
Medical
The infant is held with the back of the neck on the palmar nurface of t.he left hand, the occiput being supported between the thumb The ankles are held firmly and the forefinger which grasps the mastoid. from behind with the right hand. The child is held head upwards at an angle of about 15 degrees from the vertical. The child is allowed to move rapidly downward about txTo feet. It is now invert,ed, the head being downward. The infant is again moved smartly downward for a distance of about two feet. The movement of the abdominal viscera may from and toward the diaphragm stimulates cardiac and pulmonary action. F. Ii ADMR.
Formiehella: American
Amniotic Medical
Hernia Association,
Corrected
by Operation.
1921, lxxvii,
465.
Journal
The case here reported is that of a full-term female child that was well developed and normal eseept for a hernia the size of a grapefruit It conprotruding from an umbilical opening the size of a half dollar. tained intestines which were plainly visible through the enveloping shea.th of the cord. Under ether, an incision one inch in iength ITas made above and below the umbilicus~ the contents reduced, and the abdomen sewed up with catgut. The child made a good recovery. R. E. \yOBVS.
ERRATA OH page 408 of the Oct,ober, 1921, issue of the journal, the “note” imnzccliatel~ under Fig. 1 in the article by Dr. C’ary on “Sterility Studies-SlmI)lified $I:ethods in Diagnosis” should be deleted.
Issi;e of October, 1921, page -133: The name of Dr. W. J. Butler was inadvertently included as co-author with Dr. Reuben Petcrsou of the paper on Pneumoperitoneum~ and Roentgenography as Aids to More Accurate Obstetric and Gyneeologic Diagnosis. Dr. Reuben Pet,erson OP Ann Arbor, Nieh., was the sole author of the paper.