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Neonatal diarrhoea and vomiting
Volume 62 Number I
SELECTED
ABSTRACTS
Kirby, A. C., Hall, E. CL, and Coackley, W.:
223
Neonatal Marrhoea and Vomiting, The
Lancet, p. 201, Aug. 5, 1950. Two outbreaks of neonatal diarrhea in a British maternity-nursery unit are described. In the first outbreak the disease was characterized by vomiting, diarrhea, anorexia, toxemia, and a tendency to relapse. Bacterhn coli D433 was found in the stools, and the mortality rate was 43 per cent. In a second outbreak the infants developed diarrhea, very little vomiting, and no relapsing tendency. Bacterkm coli D433 could not be isolated from stools, and there were no deaths. It is felt that B. coli D433 is not a normal intestinal organism in newborn babies and infants. In a series of 370 infants under 1 year of age it was found in 2 per cent, and in another series of 380 it was not found at all. During the outbreak the organism was found in occasional unaffected contact infants. This might suggest that the disease depends on a symbiosis with a second agent, but in none of the reported outbreaks where B. coEi D433 was isolated was there any other bacterium or virus. Adult volunteers developed diarrhea after swallowing cultures of this organism. It was first isolated by Bray (1945), who termed it B. coli (var. neapolitanurn), and has since been reported in several other outbreaks of neonatal diarrhea. IRVING L. FRANK Editorial:
Anoxia
in the Foetuaand Newborn,
The Lancet, p. 19, July 1, 1950.
Anoxia before and during birth is a major cause of stillbirth, neonatal death, and cerebral damage. Fetal anoxia is usually anozic anoxia due to (a) reduced oxygen tension in maternal blood (asphyxiating anesthetics, fall in maternal blood pressure), (b) systemic of placental maternal disease (anemia, heart failure, pneumonia, etc.), or (c) interruption transfer (uterine tetany, placental infarction, cord accidents). To these causes must be added neonatal apnea, which may be secondary to anoxia (as with high concentrations of nitrous oxide), or to narcosis (as with analgesic drugs or narcotizing anesthetics). Respiration normally begins in a controlled rhythm. Gasping is the most primitive respiratory form, and its presence means respiratory depression. The manner of onset of respiration is a good index to the state of the central nervous system, and a record may be of future importance. Premature infants commonly show alternate hyperpnea and apnea, even though arterial oxygen saturation is normal. This condition is correctible by giving 100 per cent oxygen, which may reflect a defective form of oxygen metabolism in the premature. Providentially, the newborn infant can survive anoxia longer than in later life, because of (a) a low cerebral metabolic rate, and (b) a faculty of anaerobic metabolism, with an end point of carbohydrate metabolism short of carbon and water. However, in the survivors, the central nervous system has been the most vulnerable point. Occult damage may be responsible for cerebral palsy, mental defects, or personality disorders. IRVINQ
L. FRANK
Steiuer, Morris, aud Pomerauce,William: Studieson Prematurity. II. Influence of Fetal Matunlty OII Fatality Rate, Pediatrics 6: 872, 1950. This is a report of 791 premature infants born at the Jewish Hospital in Brooklyn, N. Y., covering the five-year period from 1945 to 1950. Only babies weighing up to 2,250 Cm. were included in the study and no exclusions were made on the basis of “nonviability. ” In order to eliminate small errors the eases have been grouped into gestation periods differing from each other by four weeks. The data were analyzed to determine the significance of fetal maturity and the magnitude of birth weight as factors influencing survival. The fatalities among 637 babies born of single births were 140 deaths, or 21.9 per cent. For the group of 29 weeks or less the fatality rate was 82.1 per cent; for the group from 30 to 33 weeks it dropped to 23.5 per cent, while in the group from 34 to 37 it dropped to 6.4 per cent, and in the group from 38 to 40 weeks to 5.7 per cent.
SELECTED
ABSTRACTS
Kirby, A. C., Hall, E. CL, and Coackley, W.:
223
Neonatal Marrhoea and Vomiting, The
Lancet, p. 201, Aug. 5, 1950. Two outbreaks of neonatal diarrhea in a British maternity-nursery unit are described. In the first outbreak the disease was characterized by vomiting, diarrhea, anorexia, toxemia, and a tendency to relapse. Bacterhn coli D433 was found in the stools, and the mortality rate was 43 per cent. In a second outbreak the infants developed diarrhea, very little vomiting, and no relapsing tendency. Bacterkm coli D433 could not be isolated from stools, and there were no deaths. It is felt that B. coli D433 is not a normal intestinal organism in newborn babies and infants. In a series of 370 infants under 1 year of age it was found in 2 per cent, and in another series of 380 it was not found at all. During the outbreak the organism was found in occasional unaffected contact infants. This might suggest that the disease depends on a symbiosis with a second agent, but in none of the reported outbreaks where B. coEi D433 was isolated was there any other bacterium or virus. Adult volunteers developed diarrhea after swallowing cultures of this organism. It was first isolated by Bray (1945), who termed it B. coli (var. neapolitanurn), and has since been reported in several other outbreaks of neonatal diarrhea. IRVING L. FRANK Editorial:
Anoxia
in the Foetuaand Newborn,
The Lancet, p. 19, July 1, 1950.
Anoxia before and during birth is a major cause of stillbirth, neonatal death, and cerebral damage. Fetal anoxia is usually anozic anoxia due to (a) reduced oxygen tension in maternal blood (asphyxiating anesthetics, fall in maternal blood pressure), (b) systemic of placental maternal disease (anemia, heart failure, pneumonia, etc.), or (c) interruption transfer (uterine tetany, placental infarction, cord accidents). To these causes must be added neonatal apnea, which may be secondary to anoxia (as with high concentrations of nitrous oxide), or to narcosis (as with analgesic drugs or narcotizing anesthetics). Respiration normally begins in a controlled rhythm. Gasping is the most primitive respiratory form, and its presence means respiratory depression. The manner of onset of respiration is a good index to the state of the central nervous system, and a record may be of future importance. Premature infants commonly show alternate hyperpnea and apnea, even though arterial oxygen saturation is normal. This condition is correctible by giving 100 per cent oxygen, which may reflect a defective form of oxygen metabolism in the premature. Providentially, the newborn infant can survive anoxia longer than in later life, because of (a) a low cerebral metabolic rate, and (b) a faculty of anaerobic metabolism, with an end point of carbohydrate metabolism short of carbon and water. However, in the survivors, the central nervous system has been the most vulnerable point. Occult damage may be responsible for cerebral palsy, mental defects, or personality disorders. IRVINQ
L. FRANK
Steiuer, Morris, aud Pomerauce,William: Studieson Prematurity. II. Influence of Fetal Matunlty OII Fatality Rate, Pediatrics 6: 872, 1950. This is a report of 791 premature infants born at the Jewish Hospital in Brooklyn, N. Y., covering the five-year period from 1945 to 1950. Only babies weighing up to 2,250 Cm. were included in the study and no exclusions were made on the basis of “nonviability. ” In order to eliminate small errors the eases have been grouped into gestation periods differing from each other by four weeks. The data were analyzed to determine the significance of fetal maturity and the magnitude of birth weight as factors influencing survival. The fatalities among 637 babies born of single births were 140 deaths, or 21.9 per cent. For the group of 29 weeks or less the fatality rate was 82.1 per cent; for the group from 30 to 33 weeks it dropped to 23.5 per cent, while in the group from 34 to 37 it dropped to 6.4 per cent, and in the group from 38 to 40 weeks to 5.7 per cent.