The Journal o[ Pediatrics August 1972
The average pH of the infants with pneumonia was 7.35, significantly higher than the average of 7.25 in the group with septicemia (P < 0.01). The difference in base excess between the groups with pneumonia (-5.4) and septicemia (-11.4) was also significant (P < 0.01). In the study group, the number of infants born at 37 weeks' gestation or less was high: 20 per cent, significantly greater than the over-all incidence of 6.8 per cent in our hospital during the same period. The incidence of infections was also greater in the preterm newborn infants (50 per cent as opposed to 20 per cent in the fullterm infants). The most important predisposing factors related to neonatat infection were sex (infection being twice as frequent in males), acute fetal distress (present in 47 per cent of the infected newborn infants as opposed to 19 per cent of those free of infection [P < 0.005]), and chorioamnionitis and foul amniotic fluid (77 and' 70 per cent, respectively, of the cases being associated with infection of the newborn infants). Although the incidence of one-minute Apgar scores of 6 or less was higher in the infected group (50.6 per cent), the difference from noninfected infants was significant only in the preterm subgroup. The interval to birth following rupture of the membranes was greater in the infected newborn infants (86 hours) than in the noninfected (62 hours). Culture of the placenta was the only one correlated with infection (P < 0.005). Three of the 111 newborn infants died (mortality rate 2.7 per cent).
The effect o/certain maternal/actors on birth weight, gestational age and intrauterine growth V. B. Penehaszadeh, J. B. Hardy, E. D. Mellits, B. H. Cohen, and V. A. MeKusiek, Johns Hopkins University, Baltimore, Md., and Centro de Gen6tica M6diea, Buenos Aires, A r g e n t i n a . This report examines the relation of length of gestation and birth weight of 4,132 live-born infants (3,165 Negro, 967 Caucasian) of mothers registered in the Johns Hopkins Perinatal Collaborative Project to certain maternal factors. The average length of gestation was shorter and the mean birth weight lower in Negro than in
Caucasian infants (3'8.2 versus 39.2 weeks, 2,997 versus 3,178 Gm.; P < 0.01). These variables were analyzed as functions of four maternal factors recorded during the prenatal visits: age, parity, smoking habits, and socioeconomic level. Multiparity, independent of maternal age, had a positive association with birth weight (Table I) but did not influence the length of gestation. The relationship between maternal age and birth weight, as observed in primiparae, was, on the other hand, inverse (Table I). Lower socioeconomic levels were in general associated with lower birth weights and shorter periods of gestation. The differences in birth weight within each subgroup were statistically significant. While within each racial group the pattern of the variations was similar, the Negro infants had, on the average, lower birth weights and shorter gestational periods than the Caucasians with respect to each maternal factor. Mean birth weights at each week of gestation between 37 and 41 were analyzed to assess the effects of the variables under study on fetal growth. The rate of intrauterine growth was determined to have been more rapid in newborn infants of multiparae than in first born infants~ in infants of nonsmokers than in those of smokers, and in babies of mothers of high socioeconomic status than in those from lower levels. In each category the fetal growth rate of Negro infants was lower than that of Caucasians. This report shows that birth weight was positively influenced by multiparity and high socioeconomic level, and negatively by increasing maternal age and smoking. While length of gestation was also affected, the variations were less clearcut, therefore leading to the suggestion that the influence of the factors under study was exerted principally on the rate of fetal growth.
Insulin secretion in response to glucose or tolbutamide in children with chemical diabetes Isidoro Luis Dujovne, Juan Carlos Cresto, Jorge M~ximo Sires, Horaeio Gimenez, and Salvador Felix de Majo, Serviclo de Endocrinologla, Hospital Aires, A r g e n t i n a .
Table I. Average birth weight (Gin.)
Subjects Negro Caucasian
Parity of mother Primipara I Multipara 2,885 3,090
Age of primiparous mothers 16-19 yr. I > 35 yr. 2,940 3,110
Maternal smoking Yes ] No 2,955 3,105
Volume 81 Number 2
Eight normal children (N) and 8 with chemical diabetes (CD) were given intravenous glucose or tolbutamide; the resulting changes in blood glucose and insulin were studied. T h e CD children all h a d family histories of diabetes and abnormal oral glucose tolerance tests ( O G T T ) . The control group consisted of children without family history of diabetes and with normal O G T T . Neither the CD nor the N group included children with clinical manifestations of illness at the time they were studied. The mean age was 10.6 • 1.8 years in the CD group and 10.6 + 1.1 years in the control group. Weight was normal for height in all the children. Venous blood samples were taken with a Perfus 11/10 catheter after a 12 hour overnight fast a n d at 1, 3, 5, 10, 15, 30, 45, 60, 75, and 90 minutes after the intravenous infusion of glucose (0.4 Gm. per kilogram of body weight) or tolbutamlde (Rastinon 20 rag. per kilogram). Blood glucose was determined by the Somogyi-Nelson method a n d insulin by an immunoreactive technique. T h e glucose infusion produced a maximum rise in blood glucose up to 248 • 14.8 mg. per 100 ml. at one minute in the CD children a n d 215 +- 14.7 mg. per 100 ml. in the N group. T h e blood glucose fell similarly in both groups, although it remained at statistically higher levels in the CD patients at 45, 60, a n d 75 minutes. Insulin secretion was greater in the N group at 1, 3, and 5 minutes (47 + 7.64, 50 • 7.78, and 45 + 7.31 # U per milliliter) than in the CD group (28 • 5.40, 27 + 6.48, and 25 + 4.67 # U p e r milliliter) (P < 0.05). Intravenous tolbutamide produced a fail in blood glucose, which reached its lowest point at 30 minutes in both groups, then gradually rose throughout the test; it was statistically higher in the CD group (P < 0.05) at 5 and 10 minutes. Insulin response was maximum one minute after the injection of tolbutamide (CD, 46 • 6.86; N, 58 • 5.73 # U per milliliter). By 30 minutes blood insulin had returned to its basal level in both groups, having been statistically higher in the N group at 5 and 10 minutes.
Alterations in blood.coagulatlon of newborn in[ants with severe depression (one-minute Apgar score three or less) consequent to intrauterine asphyxia A. Miguel Largula, Osvaldo Stollar, Francisco Capizzano, Jorge C~sar Martlnez, Ana Maria Ibafiez, and Beatriz Portas, Hospital Municipal Materno Infantil "Ramon Sarda," Buenos Aires, Argentina. Coagulation factors and clotting times were studied in 80 seriously depressed newborn infants (Apgar score 3 or less) during the first 72 hours of life. Concomitantly, 43 studies of umbilical
cord blood were carried out in vigorous fullterm newborn infants (Apgar score 7 or above) without associated pathology. In 15 of these newborn infants a n additional bIood sample for study was obtained between 24 and 36 hours of age. The infants of both groups received 1 mg. of vitamin K1 intramuscularly at birth. Our results in the control group were similar to those reported in various published studies. In the seriously depressed newborn infants, the vitamin K - d e p e n d e n t factors and Quick clotting time were within normal limits and concentrations became higher after 24 hours. In spite of this apparently adequate response to vitamin K1, the frequency with which individual children had a fall in these factors was high (8 cases). Partial thromboplastin time ( P T T ) was significantly prolonged, to 79.6 seconds in depressed full-term newborn infants and 95 second's in premature infants. Factor V concentration was sigificandy decreased (average 51.6 per cent). In 33.3 per cent of depressed newborn infants factor V was less t h a n 50 per cent or P T T was greater than 150 seconds. These newborn infants had a mean pH of 7.28 in the first 24 hours, significantly lower t h a n that of patients without these alterations. All of the seriously depressed newborn infants who later died had a factor V concentration below 50 per cent and a P T T greater than 150 seconds. Factor I and platelets were also within the normal limits of our laboratory; concentrations of these factors rose after the first 24 hours of life. The alterations summarized above suggest consumption of clotting factors by intravascuIar coagulation. T h e common denominator of intrauterine asphyxia would initiate the process via fetal mechanisms of circulatory "sparing" which reduce perfusion through selected areas. In those infants who later died, postnatal pathologic factors would be added to the initiating events in consequence of inadequate cardiocirculatory and pulmonary adjustment mechanisms leading to asphyxia and shock. This concept is further confirmed by correlations, in the study group, between decrease in clotting factors and acidosis, idiopathic respiratory distress syndrome, and massive aspiration of meconium-containing amniotic fluid.
Laparotomy and splenectomy in Hodgkin's disease in childhood Federico Sackmann Muriel, Angela Cebrian Bonesana, and Bristobal M. Papendieck, Centro de Estudio y Tratamiento de las Neoplasias de la Infancia y Servicio de Hematologla, Hospital de Nifios, Buenos Aires, Argentina. The major obstacle in the precise recognition of the extent of Hodgkln's disease (HD) is un-