After Birth Ebook
Getting Back Into Shape After The Pregnancy
Once your pregnancy is over and done with, your baby is happily in your arms, and youre headed back home from the hospital, youll begin to realize that things have only just begun. Over the next few days, weeks, and months, youre going to increasingly notice that your entire life has changed in more ways than you could ever imagine.
In the first three months of pregnancy, a woman's blood volume rises rapidly. This increase continues into mid-pregnancy, then slows down. The average overall increase in blood volume is 50 percent but varies among individuals and is connected to fetal weight, placental size, and maternal weight gain. As a result, larger increases are seen
Environmental exposure also appears to be an important factor in the etiology of asthma. Patients with occupational asthma develop the disease late in life upon exposure to specific allergens in the workplace. Exposure to second-hand smoke after birth increases the risk of childhood asthma.1 Adult-onset asthma may be related to atopy, nasal polyps, aspirin sensitivity, occupational exposure, or a recurrence of childhood asthma.
In humans, the notochordal cells in the nucleus pulposus (NP) dramatically decrease after birth, and they eventually disappear, probably through apoptosis, and are replaced by chondrocyte-like cells by the first decade. The reduction in notochordal cell population with maturity could decrease proteoglycan production and contribute to the degenerative process. Furthermore, the naturally occurring cellular senescence, via telomere shortening, plays a role in disc aging as well as degeneration. However, degenerated discs are prone to increased cell senescence as the
Fears about the physical harms of nuclear transfer cloning are prompted by the research on animal cloning. A high percentage of the animal embryos created through cloning have not been brought successfully to term, and a high percentage of those that were died shortly after birth. Dolly was the only sheep produced out of 277 attempted fusions and 29 implantations. Attempts to clone cows were more successful but still led to many failures. The 8 calves produced by cloning in Japan were the result of 249 attempts, which led to 38 embryos. Ten of the 38 embryos were transferred to cows, and of these, 8 were brought to term. Four died shortly after birth. ducing a single child would typically require many attempts, with many children dying during gestation or shortly after birth. Further, if there were only one candidate for egg donor and one candidate for birth mother, then the egg donor would be subject to considerable hormonal manipulation and the birth mother might undergo multiple...
The concept of TSC has evolved over the past 2 centuries. In 1835 Pierre Francois Olive Rayer45 published an atlas of skin disease, and in one of the pictures in that book he produced a color drawing of a man's face dotted with erythematous papules that resembled facial angiofibroma. In 1862 Friedrich Daniel Recklinghausen59 presented the autopsy finding of cardiac myomata and cerebral sclerosis of a newborn who died almost immediately after birth. In 1880 Deisire-Magloire Bourneville10 described a girl with mental retardation, seizures, and facial angiofibroma. The girl died at the age of 15. At autopsy he discovered opaque whitish sclerotic areas on the cerebral convolutions and a nodular tumor of the corpus stria-tum projecting into the lateral ventricle. To denote these lesions of potato-like consistency in cortical gyri he coined the term tuberous sclerosis. He concluded that the tuber was the cause of the seizures. In fact, it is Bourneville who established tuberous sclerosis as...
The timing of umbilical cord clamping is vari-able76. In the active management of the third stage of labor, early cord clamping is generally carried out in the first 30 s after birth, regardless of the presence or absence of cord pulsations77. Late cord clamping constitutes expectant management, whereby clamping is deferred until cord pulsations have ceased. A precise definition of early or late cord clamping is not currently available78.
Infants who develop strong attachments with adults are not only more psychologically adjusted but are also protected against developing mental disorders as adults. Conversely, the failure to develop attachments or losing attachments in early life is associated with both psychological disturbance among children and with vulnerability to mental disorders in adulthood (Brown, Harris, & Bifulco, 1986). Brief separations from caregivers after birth are not harmful nor are those where substitute caregivers replace absent parents (Rutter, 1981). Prolonged separations, however, result in a state of profound detachment where young children cease to respond to parental figures when they are restored to their lives.
The majority of HOP mutants survive to adulthood. Hearts from these animals show an 30 excess of cardiomyocytes, which can be attributed to delayed exit from the cell cycle during the first few days after birth. These mutant hearts show increased ventricular wall thickness without evidence of myocyte hypertrophy at young age. However, at advanced ages ( 6 months) a subset of these mice develops severe cardiomyopathy with myocyte hypertrophy and ventricular fibrosis.
A 23-year-old woman developed diarrhea and vomiting 4 weeks after childbirth. On the second day of illness she had a diffuse headache and felt discomfort in her right jaw and lower part of the face. She noted that her right eyelid was drooped, and she became aware of a whooshing sound in her right ear. It was difficult for her to pronounce some words. Examination showed normal vital signs the right eyelid drooped, and the right pupil was smaller than the left but reacted to light. Her right palate and right tongue were weak.
And that an entity has interests only if it is possible for the entity to know that these interests have been harmed. An entity therefore has an interest in not experiencing pain if and only if it can experience pain, and it has an interest in not being killed if and only if it is conscious of its life as a life, and not just as a series of unconnected experiences. In the context of the embryo this leads to the conclusion that it does not have any rights until it develops sentience in the fetal stage, and that it never develops a right not to be killed, because it does presumably not develop a conception of its own life as a life before well after birth. One problem for views of this sort is that they necessarily lead to the conclusion that full moral status is not attained until well after birth, since it is highly unlikely that infants have any idea of themselves as existing over time (i.e., of having a life). Infanticide is therefore not intrinsically wrong.
From watching babies' eye movements and behaviors, researchers have also determined that they can detect and mimic other people's moods and expressions starting a few days after birth. If a baby sees a playmate or caregiver crying, he frowns. If another child is joyful, he responds in kind. This sort of mimicking is called an empathetic response. When Charles Darwin noticed that certain animal species acted empathetically and so did his own 6-month-old son, he concluded that empathy must be innate. Demonstrations of empathy in toddlers are the basis for the belief that altruism came about as a human adaptation to assure the survival of the species.
Patients with C. sordellii infection present with unique clinical features including edema, absence of fever, leukemoid reaction, hemoconcentration, and, later, shock and multiorgan failure.20 Often, C. sordellii infections develop after childbirth or after gynecologic procedures,40 although some cases involve sites of minor trauma such as lacerations. Unlike C. perfringens and C. septicum infections, pain may not be a prominent feature. The absence of fever and a paucity of signs and symptoms of local infection make early diagnosis difficult.20 The mechanisms of diffuse capillary leakage, massive edema, and hemoconcentration are not well established but clearly are related to elaboration of a potent toxin. Hematocrits of 75-80 have been described, and leukocytosis of 50100 000 cells mm3 with a left shift is common.12,40
Preferentially turn to look at a pattern arranged like a face rather than a random pattern. At a few months old, infants expect objects to be solid and think of any whole object that moves as a single entity, regardless of its size, shape or colour (contrast this with a cat, which is programmed to detect and respond to movement, regardless of what the whole object is, and might well attack its own tail or the owner's hand), and are surprised by apparently solid objects passing through each other. Babies less than a year old can distinguish animate from inanimate objects, even when the inanimate objects are moved, and attribute the movement of animate objects to that object's unknown goals and desires. Toddlers assume that an adult making a word-like sound and pointing to an object is referring to the whole object rather than a part of it. These observations suggest that, even early in development, we have certain assumptions. Although it could be argued that reactions occurring months...
To understand the mechanism of ectopic ossification in ttw, early radiographic and histological changes of ttw were examined. As early as 3 weeks after birth, calcification was observed in tendons, ear cartilage, and periar-ticular tissues. Ectopic calcification has been observed in annulus fibrosus at 4 weeks. In the Achilles tendon, it initially presents as focal calcification in the middle of the tendon (Fig. 6a), which then extends longitudinally along the collagen fibers. There is no infiltration of inflammatory cells. The lesion progresses along the substance of the tendon and finally merges with bone (Fig. 7). Therefore, the initial event of ectopic ossification in ttw is not enthesopathy (Fig. 6b). The ectopic ossification occurs via a mechanism different from that of enchondral ossification, which is a more reasonable explanation, taking into consideration the function of NPPs.
There are numerous studies suggesting that complications during pregnancy, birth, or within the first month after birth are important risk factors for at least some types of schizophrenia. Those that have been significantly associated with schizophrenia include preeclampsia, bleeding during pregnancy, umbilical cord complications, premature rupture of amniotic membranes, prematurity, prolonged labor, use of resuscitation, incubator, forcep or suction delivery, abnormal fetal presentation at delivery, low birth weight, small head circumference, and low Apgar scores (McNeil et al., 2000 Lobato et al., 2001). Perinatal abnormalities in particular, collectively called obstetric complications, have been reported in 21 to 40 percent of patients with schizophrenia. In sum, there are several obstetric complications that appear to be risk factors for schizophrenia.
While the fetal heart is developing, a tube develops between the aorta and the pulmonary artery. This tube, called the ductus arteriosus, is responsible for bypassing the lungs, moving blood from the pulmonary artery to the aorta. Because the fetus receives oxygenated blood from its mother through the placenta, it has no need for functioning lungs. After the child is born, however, the lungs begin to function, and the ductus arteriosus is no longer needed. It normally closes from a couple of hours to a couple of days after birth. However, if it remains open, or patent, it is considered a congenital defect and usually needs treatment (Fig. 7.3).
The electrocardiogram is a reflection of right ventricular hypertrophy that is acquired after birth (Fig. 14-13).97 Abnormal P waves show pure right atrial configurations (see Fig. 14-13).121 Atrial fibrillation is exceptional.97 The PR interval is normal or slightly prolonged. The QRS axis varies from normal to right axis deviation, and the QRS duration is normal or slightly increased (see Fig. 14-13).
Infants suffering from transposition are usually quite cyanotic, and if it is not corrected, they will probably not survive their first year of life. Before the advent of the heart-lung machine, there were some palliative operations developed, but these procedures were not cures. In fact, even today many infants with transposition undergo a procedure to make or enlarge a hole in the atrial septum shortly after birth. This procedure is done in the cardiac catheterization laboratory with a special catheter threaded up through a blood vessel in the groin. The hole in the atrial septum allows mixing of blood and temporarily improves the infant's condition until a surgical repair can be made.
Without surgery, 99 percent of patients with HLHS will die shortly after birth. In 1983, Dr. William Norwood at Boston Children's Hospital reported that he had successfully operated on an infant in two separate stages about a year and a half apart. That two-stage operation has greatly improved the chance of survival for infants born with HLHS. Today, Norwood's two-stage repair has evolved into a three-stage repair performed over the first few years of the patient's life.
Differentiation theory says that babies don't put their sense experiences together one-by-one in a linear fashion. The differentiation theorists insist that babies perceive whole ideas directly from the flow of sensory input that they experience. In the view of the first proponent of this view, Eleanor Gibson, babies constantly look and listen, trying to make sense of what they experience. This means that humans, including babies, have a built-in cognitive ability to organize knowledge through what Piaget called schemas to interpret sensory information. The important point offered by differentiation theory is that this ability to interpret sights, sounds, and more begins soon after birth. It is not something that babies must learn to do later.
Smell and taste are known as the chemical senses because both are activated by nerves in response to certain molecules in the environment. But smell has a unique neural pathway among all mammalian senses. It is the only one where the information (molecules carrying an odor) is relayed directly to the cerebral cortex without going through the lower brain. Because their sense of smell has this direct route to the thinking brain immediately after birth, newborn babies rely more on this sense than any other, and more so in infancy than later in life.
After birth, serum testosterone levels decrease to a low baseline value until puberty, when they rise to the adult range (Frasier et al. 1969) (Fig. 12.2). Until puberty, the prostate remains small (approximately 1-2 g) (Isaacs 1984a). During puberty, the prostate grows to its adult size of approximately 20 g (Isaacs 1984a). Between the age of 10 and 20 years, the rate of prostatic growth is exponential with a prostatic weight-doubling time of 2.78 years (Isaacs 1984a) (Fig. 12.3). This period of exponential growth corresponds to the time period when the serum testosterone levels are rising from initially low levels seen before the age of 10 to the high levels seen in an adult male (Frasier etal. 1969) (Fig.12.2). If a boy is castrated
Emotional learning begins immediately after birth in the form of imitation. Investigators found that babies who are only hours old are capable of mimicking an adult's facial and hand gestures, suggesting a primitive form of empathy. A baby's ability to imitate also equips him to meet the challenge of regulating his emotions.
Cardiac hypertrophy is an increase in the size of the heart. Heart enlargement is typically caused by enlargement of the individual muscle cells because heart muscle cells do not divide to any extent after birth. The most common form of cardiac hypertrophy occurs during normal development as the heart enlarges to maintain CO to the growing organism. This is considered an adaptive or physiological hypertrophy because cardiac function improves. In heart disease, hypertrophy is ubiquitous and is thought to be adaptive initially. However, function deteriorates eventually in the hypertrophy seen in heart disease, resulting in the important clinical syndrome of heart failure therefore, hypertrophy in disease is called maladaptive or pathological hypertrophy.
Headache during and after pregnancy is common and most often has a benign explanation. Nevertheless the diagnosis of primary headache disorders should be made only after thorough consideration of other diagnoses. The onset of new headache during or after pregnancy should be considered an ominous sign until the secondary causes have been excluded.
After birth, the gastrointestinal system of the newborn is exposed to food proteins in breast milk as well as environmental bacteria. This represents a dramatic change compared with conditions in utero where the gut was perfused with swallowed amniotic fluid that is sterile and free of antigens.86 There is even some evidence suggesting that IgE sensitization may occur as early as during the foetal period.86,87 The gastrointestinal system has several barrier mechanisms to protect the newborn infant from microbial invasion, including gastric acid, proteolytic digestive enzymes, epithelial tight junctions, a protective mucus layer and, most importantly, the mucosal local immune system.88 In order to avoid immune reactions against food antigens, the gastrointestinal immune system has the ability to down-regulate its responsiveness towards ingested soluble food antigens. This phenomenon is called 'oral tolerance'.
The degree of left-to-right shunt through a congenital VSD is dependent on the size of the defect and on the pulmonary vascular resistance (101,103,104). The larger the size, the larger the flow, as long as the pulmonary vascular resistance is not high. The pulmonary vascular resistance is initially high in the newborn because of the muscular nature of the pulmonary vasculature. This usually takes a few weeks to regress. Thus, the murmur of the VSD may not be apparent at birth and may become audible only a few weeks after birth.
With a large VSD in the presence of severe pulmonary stenosis, the right ventricular pressures will rise secondary to the obstruction to systemic levels but no higher because of the large size ofthe VSD. Less blood will be ejected into the pulmonary artery because of the obstruction, and the venous blood from the right ventricle may be directly ejected into the aorta. This is the case with classic cyanotic forms of tetralogy. The pulmonary stenosis can be either at the valve or, as is more often the case, at the infundibular level. The aorta would receive a large volume ofblood from the right ventricle and may become dilated. The VSD will not have significant left-to-right shunt because of the raised right ventricular pressures, and the VSD murmur will be replaced by a pulmonary ejection murmur. The murmur, however, may be shorter and softer when the obstruction is severe because pulmonary blood flow will be significantly diminished. The dilated aorta may be associated with an aortic...
During prenatal development, shunts between the left and right atria and ventricles allow for efficient gas exchange between the placenta and fetus. These shunts, the foramen ovale and ductus arteriosus, normally close at birth, allowing the lungs to become the primary center for gas exchange. Atrial septal defects occur when the shunt between the atria does not close and blood is allowed to flow from the left to right atrium, whereas ventricular septal defects occur when the interventricular septum does not close and blood is allowed to flow from the left to right ventricle. A patent ductus ar-teriosus occurs when the embryological connection between the aorta and the pulmonary trunk persists after birth. Treatment is varied due to the wide
Neonates suffering from respiratory distress syndrome are examined soon after birth to demonstrate the lungs, which are immature and unable to perform normal respiration. The baby will be nursed in an incubator and may be attached to a ventilator. The primary beam is directed through the incubator top, with care being taken to avoid any opacity or cut-outs in the incubator top falling within the radiation beam.
As in outpatients, other specific preparation for simple radiographs is rarely required. However, a prone invertogram (see page 401) for assessment of imperforate anus should not be performed in neonates less than 24 hours after birth, so as to allow more distal bowel to be delineated, and should be taken after the patient has been kept in the prone position for 15 minutes. In our experience, sedation has not been required for plain radiography. However, more lengthy procedures, which are beyond the scope of this book, may need sedation. Our preference is to use chloral hydrate (50mg kg for scanning procedures). Complex procedures may require a short general anaesthetic. It is essential that all those involved in the sedation of children are well trained and updated in resuscitative techniques.
Yet when the mother had suffered paralysis between 7 days before and 10 days after birth, 40 percent of the babies suffered concurrent paralysis, with a 56 percent case-fatality rate. By contrast, babies born of mothers who had experienced paralysis earlier in the pregnancy (nonconcurrent) had a less than 0.01 percent chance of polio in the month after birth and only a 10 percent case-fatality rate. The few babies born by Caesarian section of mothers who contracted polio just before birth were not affected. Babies with paralysis 0 to 10 days after birth had a very short incubation time - 6 days - as compared with 12 days for concurrent cases in babies with paralysis 11 to 28 days after birth.
There are only two definitions for post-partum hemorrhage, primary (occurring within the first 24 h after birth) or secondary (occurring after 24 h and before 6 weeks postpartum). In contrast, experienced health-care practitioners will recognize that, in practice, there are three different presentations of postpartum hemorrhage
A carotid-cavernous sinus fistula (CCF) is an abnormal communication between the cavernous sinus and the carotid arterial system. CCFs usually develop after head trauma but can occur spontaneously. CCFs are classified into direct and dural types. y The most common type is the direct type (70 to 90 percent) in which there is a direct connection between the intracavernous portion of the ICA and the cavernous sinus. This is a high-flow type often caused by a traumatic tear of the arterial wall. The other dural types are communications between the cavernous sinus and meningeal arterial branches of the ICA, of the external carotid artery, or of both. They develop spontaneously or in the setting of atherosclerosis, systemic hypertension, collagen vascular disease, and during and after childbirth. These fistulas usually are of the low-flow type and almost always produce symptoms and signs spontaneously without antecedent trauma. '77
Entiation advance from the center to the periphery of the lung for the bronchus tree, whereas the alveolar differentiation follows a distal-proximal sequence and is asynchronous between the lobes (Kotas et al. 1977 Zeltner et al. 1990). Burri's classification of the stages of prenatal lung development (1984) could be a model for staging fetal differentiation of the pleura early stage (until 17GW), and late stage up to birth. According to Otto-Verberne et al. (1988) this time interval (16GW) is labeled with the transformation of the type II and type I pneumocytes in the pseudoglandular period and its beginning is between 4GW and 7GW (Lee and Olak 1994). We divided the pleural components of the human and the rat into two basic groups first, mesothelial layer and underlying BL, which undergoes epithelial development and second, submesothelial mesenchyme, which differentiates as a connective tissue layer. The mesothelial and BL changes start early in gestation and continue throughout the...
Umbilical Cord Blood Transplant with umbilical cord blood offers an alternative stem cell source to patients who do not have an acceptable matched related or unrelated donor. When allogeneic hematopoietic cells are obtained from umbilical cord blood, the cord blood is obtained from a consenting donor in the delivery room after birth and delivery of the placenta. The cord blood is processed, a sample is sent for HLA typing, and the cord blood is frozen and stored for future use. Numerous umbilical cord blood registries exist, with the goal of providing alternative sources of allogeneic stem cells. One potential limitation to the use of umbilical cord blood transplants is the inability to employ donor-lymphocyte infusions in the event of relapse.
Breast problems are common during and immediately after pregnancy but are usually easy to treat. During pregnancy, hormones cause changes in the breasts the milk-producing glands become larger and increase in number, and the breasts may become tender. After the baby is born, the breasts can produce about 1 litre (2 pints) of milk per day. Problems soon after childbirth are often associated with establishing breast-feeding. However, these problems are usually shortlived. In most cases, breast-feeding is still possible and is the best option for the baby (see Feeding your baby, below).
Ductus arteriosus A tube connecting the pulmonary artery to the aorta. After birth, when the lungs begin to function, this tube normally closes. If it stays open, it's known as patent ductus arteriosus. Over time, this can cause problems such as heart failure and may need to be surgically closed. present in the fetus. If it remains open after birth, it is called a patent foramen ovale.
Here also, these concepts are dealt with in detail in chapters that follow. Ideally, every woman in labor must be closely monitored after childbirth for symptoms and or signs of postpartum hemorrhage, although this is not yet possible in Nigeria. In addition, steps should be taken to eliminate the unnecessary procedures that contribute to the high incidence of postpartum hemorrhage such as episiotomy or operative vaginal delivery without clear indications. Apart from medical management of postpartum hemorrhage, the surgical approach is well documented and discussed in detail elsewhere.
Passive smoking also increases the risk of sudden infant death syndrome. Infants exposed to secondhand smoke have twice the risk of SIDS, and infants whose mothers smoke before and after birth are three to four times more likely to die from SIDS (US Surgeon General, 2004, 2006).
In contrast to gonococcal conjunctivitis, which has declined in the developed world, chronic follicular conjunctivitis and acute conjunctivitis in newborns have been on the increase along with other sexually transmitted diseases. Chlamydia trachomatis serotypes D through K is now the most common sexually transmitted infection in the developed world (Insler 1987). It causes not only conjunctivitis in newborns and adults but also genital tract infections. In adults symptoms of chronic follicular conjunctivitis include foreign body sensation, tearing, redness, photophobia, and lid swelling. In newborns inclusion conjunctivitis or blennorrhea of the newborn usually appears 5 to 14 days after birth, since the baby acquires the chlamydial infection during its passage through the birth canal. Descriptions of infants with purulent ophthalmia - abnormal discharges of mucus some days after birth - may suggest this disease. Because purulent ophthalmia usually does not lead to severe visual loss,...
Early myoclonic encephalopathy is a disorder affecting severely neurologically impaired infants shortly after birth. Erratic fragmentary myoclonus and generalized myoclonic, tonic, and focal motor seizures are observed. The EEG shows a suppression-burst pattern that evolves to hypsar-rhythmia or multifocal spike discharges within months. Antiepileptic medications are ineffective, and 50 percent of patients do not survive beyond the first year of life. Inborn errors of metabolism and congenital malformations are present in some cases.
Measles during pregnancy has a more severe clinical course and is associated with an increased risk of premature labor or spontaneous abortion. y , y Pregnancy is a significant risk factor for mortality during measles. y Measles infection in pregnancy does not, however, appear to be associated with an increased risk of congenital anomalies, leading to the suggestion that although infection with measles increases the risk of premature termination of pregnancy within the first 2 weeks of onset of the rash, if pregnancy continues, the likelihood of a favorable outcome is high. y It is recommended that susceptible pregnant women exposed to a person with active measles receive serum immune globulin (gamma globulin 16.5 percent) within 6 days of exposure to prevent or modify subsequent disease. All infants born to mothers with active measles in the 6 days before delivery should also receive intravenous immunoglobulin prophylaxis (500 mg kg) immediately after birth and again 1 week later.y ,...
Most urologists encourage patients undergoing prostate cancer treatment to do Kegel exercises to increase continence. These exercises were developed by Arnold Kegel in the 1940s for use by women who wanted to strengthen the muscles in the pelvis after childbirth. The difficulty is locating the correct muscles to be exercised. One set is used to stop urine flow halting the flow in midstream and holding it for several seconds is the recommended way to identify these muscles. The other set is used to tighten the buttocks. One author suggests imagining that ''you're trying to hold a quarter between your cheeks,'' while another, perhaps to greater effect, suggests the following
Succedaneous teeth - All the permanent successors to the deciduous teeth begin to form in a time range between five fetal months for the central incisors, to about 10 months after birth for the second premolars. 3. Deciduous eruption pattern - The first deciduous teeth to emerge are the mandibular central incisors at about six months after birth. They are followed shortly thereafter by the mandibular lateral and maxillary central incisors. It is interesting to note that one in every several thousand infants enters the world b. Accessory roots - Most often, extra roots are found on teeth which un-ACCESSORY dergo root development after birth, and so the etiology is considered to be
This term covers a range of abnormalities from asymptomatic spina bifida occulta to large, open, posterior spinal defects with total loss of cord function. Open defects need to be closed soon after birth. Less major (closed) spina bifida defects may only become apparent as the child grows and develops problems with walking. An MRI scan is the investigation of choice.
Hemangiomas are the most common congenital malformations. Most are cutaneous, but they can also be found in deep tissues. The most common deep location in the head and neck is the masseter muscle. Hemangiomas are characterized by appearance at or after birth, followed by a rapid prolifera-tive phase at 6 to 18 months of age. The lesion then reaches a plateau phase, followed by a slow, involutional phase over 6 to 8 years. Even large, uncomplicated lesions left untreated usually undergo almost complete resolution. Conservative management is almost always recommended.
At the time of a circumcision, the sleeve of the skin which normally covers the head of the penis, called the foreskin, is cut off for religious reasons or for cleanliness.'' It has been a religious tradition carried out a few days after birth for thousands of years for both Jews and Muslims, on the basis originally that God had made a covenant to this effect with Abraham. In infancy, it has usually been performed without anesthesia on the unproved assumption that babies will not remember the pain later, though they certainly cry out with pain at the time. When I wrote the first edition of Baby and Child Care, ten years after starting practice, I explained that there are three possible ways of dealing with the foreskin. I favored circumcision within a few days of birth because there would be no chance of a physician recommending the operation later in childhood and scaring the bejeebers out of a little boy. I also leaned toward circumcision right after birth because of the universal...
Different research studies show that, after childbirth, between 50 percent and 80 percent of Western women experience the so-called maternity blues, and approximately 20 percent go on to develop postnatal depression. The severity varies considerably but usually ranges from mild to moderate clinical depression. Aside from the hormonal explanation, there are a number of psychological theories of postpartum depression. All of these focus on certain defects in the individual woman. The woman who develops
Although numbers may be declining in some U.S. areas, circumcision remains one of the most common procedures performed. A neonatal circumcision is normally performed at 12 to 48 hours old once the infant has stabilized after birth, but may be performed up to 4 to 6 weeks of age. Before the procedure, each patient should be examined thoroughly for signs of congenital anomalies of the penis, urethra, or urinary tract. If hypospadias is present, circumcision is stopped or not performed, to allow the tissue to be used in a corrective surgical procedure to repair the urethra and glans.
Papillary muscle dysfunction may occur in anomalous origin of the left coronary artery from the pulmonary artery. This congenital lesion can result in ischemia and infarction of the anterolateral wall and the anterolateral papillary muscle (40). When the high pulmonary artery pressures of the newborn fall after a few weeks after birth, the low-pressure left coronary artery offers a path of least resistance through intercoronary anastomotic connections for the blood from the aorta to reach the pulmonary artery. Once this retrograde flow is established, the capillary bed of the left coronary artery is bypassed and the myocardium supplied by it becomes ischemic. The symptoms characteristically start a few months after birth, reflecting the lag period before retrograde flow will become established.
All newborn babies have floppy heads. This is because the muscles around the neck that eventually support the head take time to strengthen after birth. Also, the baby's head is large in proportion to the rest of the body. This adds to the floppy appearance. The The journey through the birth canal is a slow process. To your baby (and you) it may seem endless. Since the head of a newborn baby is very large compared to its body size, the head is molded during the delivery. Newborns often appear with heads in the shape of a football. It's remarkable to see how quickly head shape returns to normal within one or two weeks. This molding of the head does not have any adverse effect on the brain or other aspects of your baby's health. Less commonly, a swelling on the back of the head, usually on only one side, may persist for a few weeks after birth. This happens when a small blood clot fonns beneath the scalp skin during delivery. Similar to Many newborn babies develop a yellow tinge to their...
Caput succedaneum should be differentiated from a cephalohematoma, which is a subperi-osteal hemorrhage limited to one cranial bone, often the parietal. There is no discoloration of the overlying scalp, and the swelling does not cross the suture line. The swelling is usually not visible until several hours or days after birth, inasmuch as subperiosteal bleeding is generally a slow process. About 15 of cephalohematomas are bilateral, and each is palpably distinct from the other side. No treatment is required for cephalohematomas, which are generally resorbed by 2 to 12 weeks, depending on the size. Figure 24-19 shows a newborn with a caput
Prader-Willi syndrome (PWS), with a prevalence of 1 in 10,000, is a rare condition. Children become symptomatic soon after birth. Infants are initially hypotonic and sometimes then fail to thrive. Subsequently, within the first 2 years of life, they become Angelman syndrome (AS), also rare, has a prevalence similar to that of PWS. Infants with AS are often hypotonic. They then develop motor delays, ataxia, and moderate to severe mental retardation. Only rarely do they develop speech. They often have characteristic facial features, including a wide mouth, large mandible, pointed chin, prominent tongue, wide spaced teeth, and blue eyes. Some develop the remarkable symptoms of excessive laughter or of puppetlike limb movements. Seizures usually develop soon after birth, and all with AS have abnormal EEGs.
Qualitative experiences acquire their meaning by association to other experiences that provide their aboutness or reference this allows organisms without language to navigate the environment and to satisfy their biological needs. Infants quickly learn what to do when they feel thirsty, hungry, or in pain. Actually, there is evidence that the aboutness of most experiences may be innate, especially in some animal species that are born more mature than humans are and seem to know what to do immediately after birth. Even so, all animals including humans learn progressively more about how to interpret experiences and what to do about them. This knowledge is language independent, so their understanding is what gives origin to phenomenal concepts (see Chap. 6). Thus, most endoqualia are spontaneously associated to other experiences. For example, thirst produces the desire to drink water, even if the subject does not understand the nature of dehydration. Animals learn empirically that an...
Intraspinal dermoids and epidermoids tend to remain extramedullary and gradually displace the neural elements as they enlarge. Rare lesions may directly invade the spinal cord. These lesions tend to occur in the lumbosacral area3,24,29 and are also associated with dermal sinus tracts that are noticed either on physical inspection after birth or with recurring bouts of meningitis.32,41 These lesions have also occurred many years after a lumbar puncture with a hollow needle and no stylet during which a small plug of epidermis is deposited within the spinal canal.4,9 Dermoids and epidermoids are also well-known lesions in the spina bifida population and occur years after closure of the myelomeningocele if small dermal elements are
Even within the womb it is predicted that the child can hear and recognise sound, especially its mother's voice. De Casper and Spence (1986) asked mothers to read a passage of text from a children's book in late pregnancy and found that after birth such babies would alter their sucking rate in order to hear this, compared to a control group. After birth preference is shown for familiar speech sounds the human voice rather than other sounds.
The mechanisms responsible for the location of coarctation take into account a number of variables (1) the quantitative morphology and growth of the aortic arch in the normal fetus96,123,153 (2) the site of the aortic orifice of the ductus arteriosus (3) the presence of ductal tissue in the coarctation66,188 (4) constriction of ductal tissue immediately after birth (5) the occurrence of coarctation in the presence of a widely patent ductus in the fetus3,4 and (6) the occurrence of coarctation in the presence of a widely patent ductus after birth.66 Current consensus favors an interplay between aortic growth and blood flow.96,123,153 High-resolution echocardiographic imaging in the normal fetus has disclosed progressive tapering of the diameter of the aortic arch at all gestational ages, with the smallest diameter consistently at the isthmus.96 Tapering is believed to reflect the relative proportion of fetal cardiac output traversing each aortic segment. The smallest proportion...
Galen knew of the foramen ovale and its normal postnatal closure.123 Leonardo da Vinci wrote, I have found from left auricle to right auricle the perforating channel, and his subsequent account a true atrial septal defect is believed to be the first record of a congenital malformation of the human heart.145 Botallo described a persistent foramen ovale after birth but without understanding its function in the fetus.123 Gassendi composed an entire treatise based on observations of a patent foramen ovale in an adult cadaver.123 In 1875, Karl von Rokitansky published superb observations on the pathological anatomy of atrial septal defects together with their presumed embryologic basis, and distinguished septum primum from septum secundum defects.359 In 1921, Assmann described the radiologic features of atrial septal defects that paved the way for clinical recognition.22 In 1934, Roesler analyzed 62 necropsy cases, only one of which had been correctly diagnosed during life.357 Bedford,...
This characteristic appearance, occasionally coupled with the reported history of rapid proliferation during early childhood (with or without subsequent involution), is usually adequate for diagnosis. Accordingly, biopsy of these lesions is rarely if ever performed or indicated unless a malignant neoplasm is suggested by aggressive invasion of local structures.
Abnormalities of uterine vasculature such as arteriovenous malformations and false aneurysms may also lead to secondary postpartum hemorrhage. Arteriovenous malformations are due to an abnormal communication between an artery and vein with proliferation of each vessel with interconnecting fistula. It is believed these malformations may result from venous sinuses becoming incorporated in scars within the myo-metrium after necrosis of the chorionic villi. The majority are acquired after pregnancy and may result from trophoblastic disease, previous uterine curettage, uterine or cervical malignancy8,9 or Cesarean section10,11. Diagnosis is made using ultrasound with color Doppler analysis.
In the uterus, babies may be tested for genetic disorders such as Down's syndrome. Immediately after birth, a baby's appearance and responses are checked for abnormalities, and a few days later, a blood sample is taken from the heel to look for hypothyroidism (underactivity of the thyroid gland) and phenylketonuria (a metabolic defect that can cause brain damage). In early childhood, the acquisition of certain skills, known as Shortly after birth Most routine immunizations are given during infancy and childhood according to an immunization schedule (below). The immunization schedule begins shortly after birth because it is important to protect babies against infectious diseases that may be life-threatening in infancy. You should keep records of all your immunizations and those of your children in case a doctor other than your GP needs to know about your immune status.
She became depressed with the birth of her daughter and presented within weeks after childbirth to her general practitioner, and thence for psychiatric assessment. The birth had been difficult but the pregnancy had been wanted. However, since the birth, she had developed suicidal feelings and ideas of worthlessness and had contemplated taking an overdose of an-tidepressants. Unfortunately her mother had also been seriously ill four months previously, removing one potential source of support. Nicky had become preoccupied with germs and cleaning. She was admitted to a mother and baby unit and treated with ten electroconvulsive treatments.
Indices of cerebral oxygenation and haemodynamics may be quantified by this technique. Concentrations of oxygenated and reduced haemoglobin, oxidized cytochromes and total haemoglobin, together with cerebral blood volume and changes in cerebral blood flow, may be measured and displayed instantaneously. Striking changes have been observed in babies with cerebral oedema after birth trauma.
Embryologically these are two separate conditions. However, both present similar challenges to the anaesthetist. The abdominal contents, which have herniated through the abdominal wall, offer a large surface area by which heat and fluid can be lost. It is imperative that the abdominal contents are placed into a clear sterile polythene bag as soon as possible after birth. The defects should be corrected as a matter of urgency. Nitrous oxide should be avoided to facilitate surgery and a nasogastric tube must be in place to decompress the stomach. If it is not possible to return all the viscera into the peritoneal cavity, a silastic silo may be used. It is usual to ventilate the child's lungs postoperatively because of the reduction in compliance caused by return of the viscera to the peritoneum. As with all congenital anomalies, associated abnormalities are described with these conditions, particularly with exomphalos.
The action of most drugs is terminated by metabolism or excretion through the liver and kidney. In the liver, phase I reactions convert the original drug to a more polar metabolite by the addition or unmasking of a functional group such as -OH, NH2 or -SH. These reduction oxidation reactions are a function of liver size and the metabolizing ability of the appropriate microsomal enzyme system. The volume of the liver relative to body weight is largest in the first year of life. The enzyme systems in the liver responsible for the metabolism of drugs are incompletely developed in the neonate. Their activity appears to be a function of postnatal rather than post-conceptual age, because premature and full-term infants develop the ability to metabolize drugs to the same degree in the same period after birth. Adult levels of activity are achieved within a few days of birth. Phase II reactions that involve conjugation with moieties such as sulphate, acetate, glucuronic acid etc. are severely...
After birth, only a small proportion of red cell clones remain to produce HbF. The elasticity of young erythroid cells enables them to deform and squeeze through capillaries (Fig. 68-2). As RBCs age, mean corpuscular hemoglobin concentration (MCHC) increases, deformability decreases, and the cells are removed by the reticuloendothelial system. Impaired circulation, destruction of RBCs, and vascular stasis are three known problems that are primarily responsible for the clinical manifestations of SCD (Fig. 68-3).
Cussing heredity were usually abstract qualities such as good and evil or desirable normal characteristics such as eye color, strength, speed, and beauty. Of course, they also took notice of the shocking and fantastic, gross malformations, or severe illness. Em-pedocles suggested in the fifth century B.C. that the cause of monsters, as grossly malformed infants came to be called, was an excess or deficit of semen. Many other writers held similar views, which presumably became part of the hereditary theory of Hippocrates. The treatment of infants with abnormalities was roughly the same everywhere in the ancient world. They either were left to die or were killed outright. Often, the mother suffered the same fate as her offspring. The practice of destroying abnormal infants was advocated by Hippocrates, Plato, Aristotle, and virtually all others whose works on the subject have survived. Yet the practice was not universal, as evidenced by the mummy of an anencephalic (20650) infant at...
Rubella is a highly contagious disease transmitted by contact of susceptible individuals with the nose and throat secretions of infected persons, primarily by droplet spread. Infection also occurs by direct contact, by indirect contact through freshly soiled articles, and by airborne transmission. There is no reservoir for rubella other than human beings, which means that a continuous chain of susceptible contacts is necessary to sustain transmission. The period of communicability is from about 1 week before rash onset to at least 4 days after. There is no carrier state except for infants with congenital rubella, who may shed virus for many months after birth. Rubella's incubation period from time of exposure to onset of rash is 16 to 18 days, with a range of 14 to 23 days.
Sickle-cell disease can be diagnosed prenatally by a procedure known as amniocentesis. After birth the diagnosis is generally made by hemoglobin electrophoresis using cord or peripheral blood. Early diagnosis is now encouraged because of the benefits of new preventive therapies for infection.
Among puerperae the clinical manifestations of puerperal sepsis include acute fever, profuse lochial flow, and an enlarged and tender uterus. Onset is generally between 2 and 5 days after delivery. Normally there is inflammation of the endometrium and surrounding structures as well as of the lymphatic and vascular systems. One also finds pelvic cellulitis, septic pelvic thrombophlebitis, peritonitis, and pelvic abscesses. Among neonates, infection usually becomes apparent in the first 5 days after birth, but onset is sometimes delayed by several weeks. Symptoms include lethargy, poor feeding, and abnormal temperature. Infection by group B streptococci is often clinically indistinguishable from other bacterial infections.
Since the late 1920s, awareness of the importance of child health care has increased. Along with better control of infectious disease and great strides in nutrition and technology has come the recognition of the importance of the behavioral and social aspects of a child's health. Despite the many advances and the marked reduction in infant mortality rates, the neonatal period remains a time of very high risk.* In 2004, a total of 27,936 deaths occurred in children younger than 1 year, an infant mortality rate of 6.8 per 1000 live births 70 of these deaths occurred in the first month after birth, almost all of those in the first week. The three leading causes of neonatal death were congenital malformations, deformations, and chromosomal abnormalities (20 ) disorders related to short gestation and low birth weight (16 ) and maternal complications of pregnancy that affected newborns (5.4 ).
The newborn is assessed in the delivery room immediately after birth to determine the integrity of the cardiopulmonary system. The infant is dried with a towel and placed on a warming table, where the initial examination is conducted. Gloves are worn for this initial examination, because the newborn is coated with the mother's vaginal secretions and blood. Dr. Virginia Apgar developed a scale for rating these signs 1 and 5 minutes after birth. The Apgar scale is shown in Table 24-2. Each of the signs is scored from 0 to 2. At 1 minute, a total score of 3 to 4 indicates severe cardiopulmonary depression, and the infant requires immediate resuscitative measures a score from 5 to 6 indicates mild depression. The tests are repeated at 5 minutes a score of 8 or more indicates grossly normal findings of the cardiopulmonary examination.
The infant's temperature is usually measured by the nursing staff. It should be done rectally, as described for the newborn, until the child is at least 6 months of age.* After that, there are a number of devices for estimating the child's temperature in a less invasive way. For the first 3 months after birth, a temperature of 100.4 F, or 38 C, is considered elevated and may indicate that the child has a serious bacterial infection. The average heart rate of a child during the first 6 months of life is 130 beats per minute, with a range of 80 to 160 at rest. The average resting heart rate during the second 6 months of life is 110 beats per minute, with a range of 70 to 150. The normal respiratory rate varies from 20 to 40 breaths per minute. Blood pressure is difficult to assess in this age group but may be determined by the flush method. In this technique, the arm is elevated while the uninflated infant cuff is applied to the arm. The examiner then presses on the arm from the fingers...
In about 50 of women, GDM is reversible after pregnancy and does not inevitably evolve to type 2 diabetes. Asymptomatic type 1 or 2 diabetes or LADA existing before pregnancy may become clinical and irreversible. Women with no prior evidence of diabetes may demonstrate their type 2 diabetic gene during pregnancy and either remain diabetic postpartum or experience a long, normal latent period before the gene is expressed again. The expected conversion rate of women with GDM to type 2 diabetes after pregnancy can be reduced with therapeutic lifestyle changes.
The maternal hypercalcemia accompanying maternal HPT depresses fetal parathyroid function.37 After birth, the neonate no longer has access to maternal serum calcium and is unable to mobilize calcium adequately from bone because of depressed parathyroid function, resulting in a risk of neonatal tetany. The pregnant woman, in turn, is at risk for hypercalcemic crisis. Placental delivery of calcium to the fetus is greatest during the third trimester and is protective for the mother.33,38 Because this protection is lost with the delivery of the child, the neonate is at greatest risk for tetany several hours after delivery, and the mother is at greatest risk for hypercalcemic crisis during the same period.37,39
GI involvement may present initially as small bowel obstruction shortly after birth due to abnormally thick meconium that cannot be passed (meconium ileus). Older CF patients may develop distal intestinal obstruction syndrome (DIOS), formerly called meconium ileus equivalent, which occurs due to fecal impaction in the terminal ileum and cecum.
The clinical presentation of holoprosencephaly is dependent on the degree of CNS involvement. Infants with severe alobar forms often die shortly after birth. Survivors frequently present with severe mental retardation, seizures (infantile spasms occur early), severe motor impairments, poikolothermia, and endocrine insufficiencies. In the milder forms of holoprosencephaly, longer survival with various degrees of psychomotor retardation is possible. Endocrine dysfunction may become apparent, with diabetes insipidus and growth hormone deficiency having been reported in a number of cases. It should be re-emphasized that only the classic facial phenotypes are predictive of the severe alobar holoprosencephaly with its associated very poor prognosis but that a number of partial facial phenotypes, such as midline cleft lip or midface hypoplasia, are not necessarily associated with the most severe malformations in the spectrum.
These rare embryonic remnant tumors may present anywhere in the CNS but most commonly occur in the posterior fossa and the cauda equina. They are congenital tumors and may be seen at any age however, they are more likely to occur in children or young adults of either sex. They are slow growing and present with symptomatology specific for compressive syndromes at their location within the central nervous system. These symptoms can be insidious, and blockage of cerebrospinal flow occurs rarely. Seizures or headaches are not common. Skin lesions are commonly associated with these tumors, and any infant with a dermal sinus tract should undergo neuroradiological evaluation to exclude these growths. Communication with a dermal tract may lead to recurrent meningitis, and any patient with repeated meningitis, whether associated with a bacterial cause or not, should undergo evaluation for an unnoticed dermal sinus. Prenatal diagnosis with ultrasound and resection shortly after birth are now...
*Apgar scoring should be completed at 1 and 5 minutes. The normal Apgar score at 5 minutes is 7 or higher. If the 5-minute Apgar is less than 7, continue resuscitative efforts and assign additional scores every 5 minutes for up to 20 minutes after birth. Modified from Kattwinkel J (ed). Textbook of Neonatal Resuscitation. 5th ed. Elk Grove Village, Ill, American Academy of Pediatrics and American Heart Association, 2006.
Before delivery, gestational age is estimated using the date of the last menstrual period or obstetric ultrasound measurements. After birth, however, physical and neurologic criteria should be used to estimate the gestational age of the infant. The new Ballard score accurately estimates gestational age within 2 weeks for infants older than 20 weeks' gestation (Ballard et al., 1991). Identifying the preterm (less than 37 weeks) and post-term (more than 42 weeks) infant is important for appropriate risk management and observation after delivery.
Ductus arteriosus is a vascular channel that is normally present in the fetus connecting the aorta just distal to the left subclavian artery to the pulmonary trunk near the origin of the left pulmonary artery. In the unaerated lungs of the fetus, the pulmonary capillaries are shut down. The pulmonary vascular resistance is equal to the systemic resistance. The mixed venous and placental blood from the right ventricle passes through the ductus into the descending aorta. At the same time, part of the mixed venous and the placental blood goes through the foramen ovale to the left side and is pumped by the left ventricle into the ascending aorta supplying the head and the upper extremities. At birth, the expansion of the lungs and alveolar oxygenation lead to rapid lowering of the pulmonary vascular resistance. The ductus normally closes functionally during the first 24 h after birth. It becomes anatomically closed within a few weeks after birth. Closure may be delayed in premature as...
Is usually the first branch off the anterior trunk and ascends out of the pelvis along the internal surface of the anterior abdominal wall to terminate at the umbilicus. In the fetus, the umbilical artery transports blood from the fetus through the umbilical cord to the placenta. After birth, the vessel collapses after the umbilical cord is cut. The superior vesical artery is a branch of the umbilical artery, which supplies the bladder and the ductus deferens.
At birth, the breasts contain a branching system of ducts emptying into a developed nipple. There is elevation of only the nipple at this stage. Shortly after birth, there is a slight secretion of milky material. After 5 to 7 days, this secretory activity stops. Before puberty, there is elevation of the breast and nipple, called the breast bud stage. The areola has increased in size. At the onset of puberty, the areola enlarges further and darkens. A distinct mass of
Goslings, this is the first twenty-four hours, after which the imprinting circuits are permanently fixed. Goslings usually imprint on their mother because she is the first large, moving object they come across, but will imprint on any large object, so long as it moves. Lorenz showed that they imprinted on cars, on same sex geese, on himself and even on light aircraft. The imprinted object forms the basis for choice of mate in adult life, so this is an example of a programmed response leading to a specific behaviour years later. Imprinting can work both ways, so that parents also imprint on their offspring. For example, mother sheep imprint on the smell of their offspring in the first few hours after birth.
HIF-2a are similarly regulated by hypoxia and are positive effectors of target gene expression, whereas HIF-3a lacks a trans-activation domain and appears to function as a dominant-negative transcriptional repressor (Hara et al. 2001). While under similar oxygen regulation, the tissue distribution and functions of HIF-1 a and HIF-2a are distinct (Talks et al. 2000). This dichotomy was underscored by mouse knockouts. HIF-1a knockout mice die at embryonic day 9.5-10.5 of a failure of the neural plate microvasculature to grow and arborize into the developing brain (Iyer et al. 1998 Ryan et al. 1998). In addition, HIF-1a mice display cardiac defects (see Simon et al., this volume). In contrast, HIF-2a knockout mice die either at day 16-18 antepartum due to a failure of development of the neuroendocrine organ of Zuckerandl, the critical source of fetal catecholamines, or soon after birth, because of failure to mature the lungs (Tian et al. 1998). These data demonstrate that HIF-a molecules...
The most important risk factor for penile cancer is non-circumcision of the penis. Penile cancer is rarely seen in populations who routinely practice circumcision during the neonatal or childhood period.7-10 The protective effect of circumcision has also been found in developing countries with a high incidence of penile cancer, such as Nigeria and India. In these countries the disease is rare in subpopulations that ritually practice circumcision after birth.10
Sex is also an ascribed characteristic, yet for the most part unchangeable. With but a few exceptions, it is fixed at birth. When a baby is born, its sex is determined on the basis of the newborn's genital tubercle. On average, boys are born with penises ranging in length from 2.9 to 4.5 cm (Flatau et al. 1975). For girls, clitoral length at birth ranges from 0.2 to 0.85 cm (Fausto-Sterling 2000 60 Sane and Pescovitz 1992). When the length of the tubercle is between these two average ranges, sex determination is open for discussion and decision making by the parents and medical workers. But even in such extreme situations (one or two cases per 1,000 live births), sex assignment is usually made soon after birth, and most often is permanent (Money 1988). The census definition of sex therefore is usually not problematic because everyone knows his or her sex, and it is easily ascertainable.
Others (Poggi etal. 1991 Nakatani etal. 1997 Shao etal. 1998 Ohtani etal. 2001) examined the process of sequential formation of stomata and the morphogenesis of the lymphatic vessels during the prenatal and postnatal periods. All authors pointed out that stomata appear late in ontogeny. Nakatani et al. (1996 1997) found for the first time stomata in newborn rats, and their number increased exponentially until postnatal day (PD) 10. Also in rats, distinct lymphatics are noted in the subpleural space of the diaphragm periphery by ED16, and by ED19 lymphatics appear in the subperitoneal space of the diaphragm. However, it is only during the early postnatal days that endothelium projects 'many bulges that subsequently become elongated and contacted with pores among mesothelial cells', and direct connections of the LL to the peritoneal cavity are formed after birth (Nakatani et al. 1996 Shao et al. 1998 Ohtani et al. 2001).
Early in development the motor nerves migrate from the anterior horn cells in the spinal cord to regions where muscle tissue is under formation this migration is dominated by a high degree of specificity although the details are not fully known. When the developed myofiber and axon terminals meet, acetyl-choline receptors spread along the sarcolemma are aggregated into the region of the nerve contact and develop further into the motor endplate or neuromus-cular junction (NMJ). In fetal life, axons from several motoneurons can form NMJs on a single myofiber, but later on only one single NMJ remains on each muscle fiber, while the other NMJs undergo degeneration after birth 4 .
Neonatal screening must be done for all infants because mental retardation and growth abnormality caused by hypothyroidism can be prevented by thyroid hormone treatment. Because serum TSH levels in normal newborns are elevated immediately after birth, blood samples should be obtained 4 to 6 days after birth. Neonatal screening is generally performed by spotting blood from the heel onto filter paper. Measurement of T4 and TSH is done in the eluate from the filter paper. T4 therapy should be started immediately after the diagnosis of hypothyroidism is established. For newborn infants, the dosage is 25 to 50 Xg day for infants 6 to 12 months old, 50 to 75 Xg day is commonly used. T4 should be crushed and mixed with milk for administration. Early treatment of infants in whom hypothyroidism was discovered 3 to 6 days after birth was associated with a normal IQ and normal growth.104
High-degree heart block is rarely present in utero but is occasionally present shortly after birth (see Fig. 6-8),40,74 or may subsequently announce itself as a Stokes-Adams attack or sudden death.35,40,73 The age-related risk of developing complete heart block is about 2 per year.40
About six weeks after birth, a man's hormone levels begin to return to normal. Higher estrogen, along with lots of skin contact with his baby, triggers the release of oxytocin in a man. All this chemistry helps reinforce a father's newfound cuddling and cooing behaviors.
They suck not only for feeding, but for the pure joy of sucking. You may observe this vigorous response immediately after birth when a baby is breast-fed while its mother is still on the delivery table. If you are nursing and choose to offer your baby a pacifier, wait a week or two until the baby has learned to nurse effectively. When some nursing babies are given a pacifier in the first few days after birth, they may find it difficult to learn to suck at the breast.
In the RPE, the expression of claudins-1, -2, and -5 have been detected in the developing chick embryo by embryonic day 14 (43). Claudin-1, claudin-5, and claudin-15 have been localized in endothelial cells and contribute to the BRB (40, 44). Specifically, gene deletion of claudin-5 in mice leads to normal development in utero and the tight junctions appear normal by electron microscopy. However, the mice die within 10 h after birth due to brain hemorrhage (45). Under conditions of hypoxia, retinal claudin-5 is reduced by 59 and permeability to 10 kDa dextran is increased (46).
Growing puppies need twice as much dietary energy on a per-kilogram basis as adults. This need is greatest just after birth and then decreases as the dog grows and matures. Excessive dietary energy may support a growth rate that is too fast for proper skeletal development, which results in increased frequency of skeletal disorders in large and giant breeds. Because fat has twice the calorific density of protein or carbohydrate, dietary fat is the primary contributor to excess energy intake. Not only does excess energy result in rapid growth but dietary energy in excess of the puppy's needs will be stored as fat and hence predispose to juvenile obesity. Puppies that are allowed to get fat will increase the number of fat cells they have (called fat cell hyperplasia) and are then predisposed to obesity for the rest of their lives.
Choanal atresia is a common cause of nasal obstruction in children but can also be seen in adults. If bilateral, it manifests shortly after birth as an airway emergency, because neonates are obligate nasal breathers and cannot tolerate nasal obstruction. Typically they will oxygenate well while crying but will become cyanotic when crying stops and they cannot feed. This condition requires urgent ENT consultation. The airway is stabilized and the atresia repaired shortly thereafter. If unilateral, the atresia can go undiagnosed until later in childhood or even adulthood. The patient will report a lifelong history of nasal obstruction and rhinorrhea. Diagnosis is made with endoscopy and CT. Treatment is surgical.
Censoring is the bias that results from the fact that the period of observation is limited in time. The extreme version of censoring is the cross-sectional study. It is possible to approximate measures of incidence, remission, and recurrence using data gathered at one point in time, but this requires assumptions that are not generally tenable. Age of onset can be determined in a cross-sectional sample, for example, by asking each respondent who meets lifetime criteria for disorder when the symptoms began. Even if the recall is accurate (discussed below), episodes of individuals who have onsets after the data collection is complete will be omitted, and this will lead to a downward bias in the estimate of age of onset. The problems of censoring are less severe with a cohort study, but exist nevertheless in any study which begins after birth and ends before all members of the cohort have died. In estimating the duration of an episode of psychopathology, for example, there will always be...
For women who do bear children, one question has been whether the institutional arrangements friendly to working mothers have made a difference. Klerman and Lei-bowitz (1999) show that maternity leave provisions have relatively little impact on return to the labor force after delivery, but Glass and Riley (1998) find that employer policies such as leave reduced attrition. Gustafsson et al. (1996) find that social policy contributes to the return of women to work after childbirth.
Glucose remains below this level or does not rise after a feeding, intervention is recommended. Liver glycogen stores are rapidly depleted within a few hours after birth. In the newborn, serum glucose levels decline after birth until 1 to 3 hours of age, when levels tend to begin spontaneously rising. Infants who are known to be at higher risk for hypogly-cemia should have blood glucose concentrations routinely measured. Infants at high risk for hypoglycemia include infants of diabetic mothers (IDMs), small-for-gestational-age (SGA) newborns, infants with a history of perinatal hypoxia or ischemia, and infants who become hypothermic from cold stress. Infants who become septic are also at higher risk for hypoglycemia. For infants at risk, glucose monitoring should be initiated as soon as possible after birth, and within the first hour of life in IDMs. Healthy term newborns delivered after a normal pregnancy, with no known risk factors for hypogly-cemia and with no clinical signs of low...