Impact of hyperbilirubinaemia and transient mother-child separation in the neonatal period on mother-child attachment in the 1st year of life.

Hyperbilirubinaemia (HyB) is the most common health disturbance in the neonatal period. The aim of this prospective study is to determine whether HyB and/or phototherapy (PhT) together with transient separation during the neonatal period are associated with impaired mother-child attachment after the 1st year of life. We divided 107 healthy term infants into three groups: 29 markedly icteric infants who underwent PhT (mother-child separation), 40 mildly icteric infants without PhT and a control group of 38 nonicteric infants. At the age of 1 year a paediatric examination and a Denver test were performed, and the mother-infants pairs were observed in Ainsworth's strange situation. The results show a similar distribution of the attachment patterns in the three different groups of infants. HyB and PhT do not negatively seem to affect the quality of attachment. Analysis of additional aspects showed that maternal coping and her perception of the child appear to be more important antecedents of the quality of attachment after the 1st year of life.

[Congenital methemoglobinemia with cytochrome-b5-reductase deficiency: 4th Swiss family]. / Kongenitale Methämoglobinämie mit Mangel an Cytochrom-b5-Reduktase: vierte Schweizer Sippe.

In a female newborn presenting with pronounced cyanosis in the absence of cardiopulmonary disease, the cyanosis was due to methemoglobinemia of 33% at birth and 17% at 24 hours (upper limit 0.5%) which was found to be secondary to deficiency of red blood cell cytochrome b5 reductase (EC 1.6.2.2.). Only residual activity of this enzyme was measurable, thus indicating homozygosity. Both parents were found to be heterozygous for this inherited disease. Of the six sisters and brothers of the newborn's father, five were investigated and all found to be heterozygous for the defective allele. Measurement of cytochrome b5 reductase showed both soluble and membrane bound fractions to be affected equally in the red cells of the baby's heterozygous parents.

Jaundice and behavioral organization in the full-term neonate.

Hyperbilirubinemia is the most common problem experienced by full-term neonates during the first days of life. The short-term behavioral sequelae in infants with mild hyperbilirubinemia not requiring phototherapy were investigated by means of the Brazelton Neonatal Behavioral Assessment Scale. The behavioral integrity of 76 mildly jaundiced infants (maximum serum bilirubin 200-250 mumol/l) was compared with that of 401 control infants without clinical signs of hyperbilirubinemia (maximum serum bilirubin less than 100 mumol/l). The two groups differed on 12 of the 28 scale items reflecting five of the six dimensions of newborn behavior: habituation to disturbing stimuli when asleep, orientation to environmental events when alert, motor performance, regulation of state, and autonomic stability. The jaundiced infants showed an impaired behavioral organization compared to the control infants.

[Pregnancy in a representative Swiss population (study of pregnancy and newborn infants in Aarau). 3. Diseases and drugs in pregnancy]. / Schwangerschaftsverlauf in einem repräsentativen Schweizer Kollektiv (Aarauer Schwangerschafts- und Neugeborenenstudie). III. Krankheiten und Medikamente in der Schwangerschaft.

As part of an overall study, a cohort of 996 Swiss mothers was interviewed upon admission to the labour ward regarding illnesses, disorders and the use of drugs during pregnancy. The data are presented and compared with analogous data on the entire female population of the same age group in Switzerland, and with epidemiologic reviews of pregnancy events from other countries. Somatic illness, particularly the common cold, were reported by 55%, and complaints of a more psychosomatic character by 47%. Illness related to pregnancy was found in more than 40% of the women. Only 16% reported no illnesses or complaints during the course of pregnancy. On the other hand, 33% of the mothers had taken no medication during pregnancy. Compared with studies from other countries the use of medication in this group of women was lower, particularly self-medication for minor complaints. The women reported an average intake of 1.6 drugs. In the offspring of these mothers only a few minor somatic effects were demonstrable. The Brazelton behavioral assessment did, however, reveal some significant correlations.

[The course of pregnancy in a representative Swiss sample (Aarau Pregnancy and Newborn Infant Study). II. Stimulants in pregnancy]. / Schwangerschaftsverlauf in einem repräsentativen Schweizer Kollektiv (Aarauer Schwangerschafts- und Neugeborenenstudie). II. Genussmittel in der Schwangerschaft.

Within the framework of a study on the course of pregnancy, a cohort of 996 Swiss mothers was interviewed upon admission for delivery at Aarau Maternity Hospital regarding nicotine, alcohol, caffeine and narcotics consumption. The data are presented and compared with analogous data on the entire female population of the same age group in Switzerland and with epidemiologic reviews of pregnancy events from other countries. The relationship between these data and effects on the newborn is also discussed. This group of mothers aged 20-40 years had, even prior to pregnancy, below-average alcohol and nicotine consumption. During pregnancy nicotine use in the last trimester, though reduced, was still admitted by 18% of the gravidae despite the fact that about 3/4 of the mothers were well informed about detrimental effects on the offspring. Nicotine use by the mother had several somatic effects on the newborn, in contrast to consumption of caffeine and small amounts of alcohol. The behavioral assessment was altered by previous use of nicotine and caffeine.

[The course of pregnancy in a representative Swiss population (the Aarau Pregnancy and Newborn Infant Study). I. Social medicine aspects]. / Schwangerschaftsverlauf in einem repräsentativen Schweizer Kollektiv (Aarauer Schwangerschafts- und Neugeborenenstudie). I. Sozialmedizinische Aspekte.

Excluding multiple births, a cohort of 996 Swiss mothers was interviewed upon admission to the labour ward regarding the overall course of pregnancy, illnesses, disorders, use of drugs, and nicotine and alcohol consumption. During the postnatal stay at the hospital additional information on socioeconomic background, mental and physical stress and the pattern of medical care during pregnancy was obtained. The data are presented and compared with analogous data on the entire female population of the same age group in Switzerland and with epidemiologic reviews of pregnancy events from other countries. This group of pregnant women represents a cross-section of the average mixed small town and rural population of German-speaking Switzerland. The socioeconomic conditions for motherhood appear favorable, though the percentage of women from lower socioeconomic classes was lower than in the general population. Employment during pregnancy had no influence on birthweight and neonatal morbidity, in contrast to chronic physical and emotional stress. On average the women had eight medical checkups during pregnancy.

[Employment during pregnancy and neonatal morbidity]. / Erwerbstätigkeit während der Schwangerschaft und neonatale Morbidität.

Neonatal morbidity was higher among the babies of 521 women who were gainfully employed during pregnancy compared to those of 475 non working women of the same area (Aarau, Switzerland). The difference was lower (6%) in the part time employed than in those working full time (11%.) It was almost entirely due to the higher number of primiparae and of smokers among those women who were working during pregnancy.

[Employment during pregnancy and birth weight]. / Erwerbstätigkeit während der Schwangerschaft und Geburtsgewicht.

The average weight of the newborn was found significantly lower (almost 170 g) among 521 women with gainful employment during pregnancy compared to 475 other singleborn babies of residents of the Aarau region (Switzerland), who did not indicate such an occupation. Multivariate analysis, however, revealed that the observed difference was accounted for by the higher proportion of primiparae and of smokers among the working women, a direct influence of the occupation on birth weight could not be confirmed.

[Severe neonatal anemia associated with fetomaternal transfusion and persistent fetal circulation]. / Schwere neonatale Anämie bei fetomaterneller Transfusion mit persistierendem fetalem Kreislauf.

A newborn infant with massive fetomaternal hemorrhage is reported. The fetal blood loss led to severe late decelerations in the antepartal CTG. The newborn showed a marked anemia (Hb 4.9 g%!) and a rapidly progressive heart failure. Despite blood transfusions and digoxin therapy the infant developed the symptoms of a "persistent fetal circulation". This mechanism may have been responsible for the lethal outcome in other reported cases. A successful therapeutic approach adaptable to the different stages of severity of this dangerous perinatal condition is outlined.

[Prenatal hypoxic brain damage (prenatal CTG and postpartum CT changes]. / Antepartale hypoxische Hirnschädigung (antepartale CTG- und postpartale CT-Veränderungen).

A para III was found to have a constantly silent CTG. In two fetal blood analyses the pH was normal. During the first few hours post partum the infant had rapidly increasing neurologic disturbances with violent convulsions and coma. As early as on the first day of life the computer tomogram showed extensive, later persistent hypodense zones corresponding to severe asphyxial cerebral necrosis. Based an the course of CT changes it has to be assumed that the hypoxic crisis occurred some days prior to the onset of labor. Pathologic changes in the umbilical cord indicated that the cause could have been a transitory occlusion in utero. The computer tomogram enables cerebral insults to be dated more accurately. If prenatal hypoxia occurs repeatedly new methods of prevention must be sought.

[Survival capacity of children with severe perinatal risk]. / Uberlebensqualität von Kindern mit erhöhtem perinatalen Risiko.

From July 1971 to June 1972 485 infants were admitted to the neonatal ward of the Children's Hospital, Aarau, Switzerland. Out of these, 138 newborns with the most severe complications and risk factors were selected. Group I consisted of 37 infants with a birthweight below 1500 g; 20 of these survived (54%). Group II consisted of 101 infants above 1500 g, 90 of whom survived (89%). The main causes of death were extreme prematurity (less than or equal to 27 weeks' gestation), hyaline membrane disease and cerebral hemorrhage. Somatic and mental development were investigated in 80 of the surviving infants at an average age of 5 years: 61 children (76%) were entirely normal, 94% had an IQ above 80, and 82.5% had no neurological deficits. Of the 19 handicapped children, 3 in group II were severely affected, 6 others were affected to a lesser degree. These 9 children (11% of all those examined) will need medical care and special education for many years to come. More than half, i.e. 10 children, were only mildly handicapped, exhibiting either minimal brain dysfunction or minimal cerebral palsy.

[Intermittent mandatory ventilation in the treatment of the idiopathic respiratory distress syndrome of newborns]. / Intermittierend obligate Beatmung in der Behandlung des idiopathischen Atemnotsyndroms bei Neugeborenen.

Intermittent mandatory ventilation (IMV) is a combination of CPAP and IPPV. In the newborn period it offers the following advantages compared to IPPV alone: weaning is faster, independent control of respiration is maintained and the effect on cardiac venous return is minimized. 36 patients with idiopathic respiratory distress syndrome treated by IMV were compared with 18 patients ventilated with IPPV: IMV reduced the total time on the respirator by more than 50%. Exposure to increased FIO2 and hospital stay were markedly shortened, and the incidence of complications was decreased. Intermittent mandatory ventilation represents an optimal method for stress-free and safe ventilation of newborn infants.

[Congenital, self-healing reticulohistiocytosis]. / Kongenitale, selbstheilende Retikulohistiozytose.

The described skin condition is characterized by multiple congenital skin tumours and disseminated papules on the trunk, which regressed without therapy during the first two months of life. Apart from the skin, no other organs were involved. The histological examination showed a histiocytic infiltrate composed of cells with large, irregularly formed nuclei and partly opaque, foamy cytoplasm. Extravasation of erythrocytes was frequent. The skin disorder is similar to the congenital self-healing reticulohistocytosis of Hashimoto and Pritzker.

Narcotic addiction, pregnancy, and the newborn.

Between 1954 and 1973, 101 heroin-addicted mothers gave birth to 149 babies at Vancouver General Hospital. Thirty-seven percent of the infants had low birth weights and two thirds were born preterm. Average birth weight was 2,710 gm as compared with an overall average of 3,420 gm for this hospital. Tobacco and alcohol abuse, and poor maternal nutrition probably contributed to the growth retardation. Withdrawal symptoms were observed in 68% of the babies, and this may have been aggravated by multiple drug use, which was prevalent, including alcohol, barbiturates, and "soft drugs." Neonatal mortality rate of 6.7% and a stillbirth rate of 4% resulted in a perinatal mortality rate of 10.7%. Prematurity, respiratory distress syndrome, and other perinatal complications related to an unfavorable social background accounted for most neonatal deaths, but none was attributable directly to narcotic withdrawal.