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.
The existence of immunological tolerance was the logical consequence of Paul Ehrlich's postulate that there was a horror autotoxicus a mechanism that inhibited formation of potentially harmful autoantibodies to self in vivo. It was Owen to show that dizygotic calves whose circulation was connected in utero were unable to respond to each other's antigens after birth. Out of this and similar observations, the clonal deletion theory was invented by Burnet meaning that antigen present during embryonic life would somehow cause destruction of self-reactive clones. The observation that adult animals could be rendered unresponsive to foreign antigens by the administration of large doses of the antigen led to the notion that immunological tolerance could be also acquired.
Within the past 70 years, changes have occurred in the bacterial etiology of neonatal bacterial septicemia. In the preantibiotic era before 1940, the predominant organism was Group A beta-hemolytic streptococci. In the 1950s, Staphylococcus aureus became the major pathogen, to be replaced by Escherichia coli and Group B streptococci. Since the beginning of the 1960s, the latter two pathogens have accounted for up to 70 of bacteremia in the newborn (1). Early-onset sepsis (that occurring within 72 hours after birth) is currently caused by predominantly aerobic gram-positive organisms and late onset is due to predominantly aerobic gram-negative bacteria (1). The role of anaerobic bacteria in neonatal bacteremia has not been studied adequately. Most of the reports of bacteremia due to anaerobes were through case report (2,3,6-38). The true incidence of neonatal anaerobic bacteremia is difficult to ascertain since anaerobic blood cultures were not employed in the reported major series of...
The classical ophthalmia neonatorum caused by N. gonorrhoeae is an acute purulent conjunctivitis that appears from two to five days after birth. If untreated, the infection progresses rapidly until the eye becomes puffy and the conjunctiva is intensely red and swollen. The subsequent outcome would be corneal ulceration. Ophthalmia caused by organisms other than gonococcus, including Clostridium spp., occurs usually from 5 to 14 days following delivery, is indistinguishable clinically, and the conjunctival inflammatory reaction usually is milder than in ophthalmia caused by gonococci.
The relative frequency of various clinical manifestations of neonatal anaerobic bacteremia in newborns is not different from those seen in aerobic bacteremia (3). Over half of the infants had evidence of fetal distress, and three-fourths had a low Apgar score. A positive correlation between the presence of foul-smelling discharge at birth and bacteremia caused by Bacteroides organisms was also noted (3). About two-thirds of the infants may manifest respiratory distress, with tachypnea and or cyanosis shortly after birth. Chest films may reveal pneumonitis, confirming a correlation between prenatal aspiration of infected amniotic fluid and subsequent development of pneumonia or sepsis in the newborn infant.
The classic triad of symptoms includes abdominal distention, bilious vomiting, and bloody stools. Most patients, however, present with less specific symptoms. The onset of acute NEC has a bimodal pattern. It generally occurs in the first week of life (in newborns more than 34 weeks of gestational age), but in some it may be delayed to the second to the fourth week (mostly in those less than 30 weeks of gestational age). The affected term neonate is usually systemically ill with other predisposing maternal and individual conditions (see above). Premature babies are at risk for several weeks after birth, with the age of onset inversely related to their gestational age. The typical infant with NEC is premature and recovering from some form of stress, but is well enough to begin gavage feedings. Initial symptoms may include progressive subtle signs of feeding intolerance, and subtle systemic signs. In advanced disease, a fulminant systemic collapse and consumption coagulopathy occurs....
Drugs may affect the fetus at any stage of pregnancy. During the first trimester the developing organ systems and overall body structure are especially at risk, particularly between the third and tenth weeks administration of certain drugs during this period may result in congenital malformations. During the second and third trimesters, the growth and development of fetal tissues may be affected. Finally, drugs given before delivery may affect fetal oxygenation indirectly (e.g. by causing maternal hypotension or respiratory depression), may affect labour (e.g. b-agonists), or may have neonatal effects after birth (e.g. opioids). Many drugs are known to be harmful when given during pregnancy, but for many others, precise information is not always available. Thus, in general, drugs are not prescribed unless the benefits are felt to outweigh any possible risk, especially during the first trimester. Where possible, older drugs of which clinicians have greater experience are preferred over...
The nail grows slowly for the first day after birth then more rapidly until it slows in old age. The rate of nail growth is greater in the fingers than the toes, particularly on the dominant hand. It is slower in women but increases during pregnancy. Finger nails grow at approximately 0-8 mm per week and toe nails 0-25 mm per week.
In infancy heart failure is usually secondary to structural heart disease and medical treatment is directed to improving the clinical condition prior to definitive surgery.With modern obstetric management many babies are now discharged from the maternity unit only hours after birth. Therefore babies with serious congenital neonatal heart disease may present to paediatric or Accident and Emergency departments.
Cellular immunity begins to appear early in fetal development, but the immune responses of the neonate are still weak. Fortunately, an infant is born with a near-adult level of IgG acquired from the mother through the placenta. This maternal IgG breaks down rapidly after birth, declining to about half the initial level in the first month and to essentially none by 10 months. Nevertheless, maternal IgG levels remain high enough for 6 months to protect the infant from measles, diphtheria, polio, and most other infectious diseases (but not whooping cough). By 6 months, the infant's own IgG reaches about half the typical adult level. The lowest total (maternal + infant) level of IgG exists around 5 to 6 months of age, and respiratory infections are especially common at that age. A breast-fed neonate also acquires protection from gastroenteritis from the IgA present in colostrum.
The needs of children and young people with a life threatening illness and their families are summarised in the report by ACT and the Royal College of Paediatrics and Child Health. Families need support from the time of diagnosis and throughout treatment, as well as when the disease is far advanced. Professionals must be flexible in their efforts to help. Each family and individual within a family is unique, with different strengths and coping skills. The needs of siblings and grandparents should be included. The family of a child with an inherited condition have additional difficulties. They may have feelings of guilt and blame, and they will need genetic counselling and information about prenatal diagnosis in the future. When an illness does not present until some years after birth, several children in the same family may be affected.
In creating a strategy for suppressing the expression of a target protein in vivo, we were confronted by several formidable obstacles. Although adapted first to the elimination of a G-protein a-subunit, the approach was designed for the broader use in targeting G-protein-linked receptors and other accessory proteins. The approach of employing Gia2-specific antisense RNA is far simpler than gene disruption by homologous recombination. To ensure accumulation of the antisense RNA in vivo, the target sequence was inserted in the first exon of the rat PEPCK mRNA. The PEPCK gene was selected for this work based on three considerations (5). First, this 2.8-kb hybrid mRNA would be far more stable than a comparatively short-lived antisense RNA oligonucleotide. Second, expression of PEPCK is controlled by several hormones, including glucagon (acting via cAMP), glucocorticoids, thyroid hormone, and insulin. Insertion of the antisense sequence within the PEPCK gene confers regulated expression of...
Probiotics offer another means to prevent the development of food allergy. The rationale for using probiotics in allergic diseases is that normal enteric flora established shortly after birth provides counter regulatory signals against a sustained T-helper type 2 cell (Th2)-skewed immune response (Isolauri, 2002). A number of randomized placebo controlled studies show that Lactobacillus GG (also called Lactobacillus rhamnosus ATCC 53103 ) given to women before and during subsequent breastfeeding reduced the occurrence of allergic eczema in their offspring. Other studies suggest that probiotics such as Lactobacillus GG may also be beneficial in ameliorating the severity of allergic responses in established food allergy particularly in younger subjects.
Because of its universal occurrence and importance for neurite outgrowth, we decided to investigate the regulation of tubulin synthesis at both the transcriptional and translational levels. As a first step, Henri Schmitt and Illana Gozes (then a graduate student, currently a Professor and Head of the Department of Clinical Biochemistry at Tel Aviv University) studied the synthesis of tubulin in rat brain. They showed that during the first ten days after birth, the percentage of cytoplasmic rat brain tubulin increases moderately or remains almost constant. Thereafter, a progressive decrease in the percentage of cytoplasmic brain tubulin occurs until the rat reaches adulthood 86 . The postnatal decline in tubulin level occurs in the soluble fraction and is accompanied by a decrease in the relative amounts of its mRNA chains 87 . This decrease may be characteristic of all cell types of the brain and results from an age-dependent
Are morphologically different from the PGCs (60-62). Gonocytes proliferate for a while and then become quiescent. In mice and rats, gonocytes start spermatogenesis shortly after birth and give rise to spermatogonial stem cells as well as the first A1 spermatogonia (see review in ref. 63).
Intestinal transplantation is indicated in cases of intestinal failure, defined as the irreversible inability of the intestine to adequately sustain the body's nutritional, fluid, and electrolytic balance in the absence of parenteral support. Irreversible intestinal failure can be the result of loss of surface area, functional disturbances, or the presence of unresectable tumors involving the intestine. The etiology of these in turn can be either congenital or acquired. Clinical manifestations include but are not limited to dehydration, deficiencies of nutrients and vitamins, gallstones, stomach hyperacidity, renal stones, hyperoxaluria, skin irritation, and malabsorptive diarrhea. It has been observed that 20 of adults with 100 cm of intestine or end jejunostomy will be able to maintain nutritional requirements in the absence of total parenteral nutrition (TPN) (Messing et al, 1999). In the pediatric population, failure to wean from TPN has been found to be associated with absence of...
The investigations of Freeman et al. 34 showed that anal sensation as detected by evoked cortical responses was not present at birth, but showed maturation in the first 3-4 months of life. If the eye of a newborn kitten is kept closed for 4-5 weeks after birth and then opened, the eye is permanently blind appropriate repetitive somatosensory stimuli during the critical interval of brain development have not occurred. On this basis, they argued that the definitive pullthrough operation should be completed by 34 months of age to achieve the best functional results 34 . The results in neonatal pullthrough operations lend support to the above hypothesis 35 .
During embryonic development in mice, five pairs of lenticular structures called mammary buds form from localized thickenings or milk streaks that form on both sides of the midventral line in the epidermis. These mammary buds start to develop between embryonic d 10 and 11 (E10 and E11, respectively), and their early enlargement appears to occur by addition of cells migrating from the adjoining epidermis. At later embryonic stages, enlargement results from proliferation of the cells in the mammary bud and invasion into the underlying mammary fat pad precursor until, at birth, there is a rudimentary ductal tree comprising up to 15 canalized branches arising from a single duct attached to each nipple and that terminate in small clublike ends that regress shortly after birth (12,13).
The woman who presents with severe backache or a long history of back trouble in the antenatal clinic should be warned that it is very likely that this will continue after childbirth. Epidural analgesia should not be contraindicated in these cases but it may sometimes be more painful having an epidural sited in a sensitive back. A 'mobile' technique should be preferred, to allow the patient to move freely in labour, and care should be taken to avoid unnatural postures that will unduly stress the ligaments. Support of lumbar lordosis and prevention of hyperextension at the hips is helpful.
Infection that occurs within 11 days of childbirth. In addition to the raging fever and pus emanating from the birth canal, victims often developed painful abscesses in the abdominal cavity and chest, and fatal septicemia. The reason for the vulnerability of puerperal women to life-threatening infections had been recognized by the great seventeenth-century physician and physiologist William Harvey (1578-1657) after childbirth the site of placental detachment constituted a large internal wound. Except for burns, which often become infected, wounds are rarely very large. Although the term puerperal fever implies a causal link to childbirth, the definition provides no specific information about the etiology of the disease. Not all postpartum fevers and infections should be called puerperal fever, a condition now typically attributed to Group A hemolytic streptococcus. Streptococcal disease can also appear as scarlet fever, septic sore throat, erysipelas, and rheumatic fever. This makes...
Type II osteogenesis imperfecta which is perinatally lethal. Death occurs before or shortly after birth. The lethal form is autosomally dominant but they are mostly new mutations. Rarely it is autosomally recessive. Note the markedly abnormal skull (which is soft and impressionable) and short limbs due to osteogenesis imperfecta. The damage to the neck and abdomen was present at birth. Figure 2.64. Type II osteogenesis imperfecta which is perinatally lethal. Death occurs before or shortly after birth. The lethal form is autosomally dominant but they are mostly new mutations. Rarely it is autosomally recessive. Note the markedly abnormal skull (which is soft and impressionable) and short limbs due to osteogenesis imperfecta. The damage to the neck and abdomen was present at birth.
At the coccygeal end, the C point is just caudal to the last or fifth ossific center of the sacrum. The ossification center of this fifth piece normally appears at the 4th month of fetal development. The coccyx, by contrast, does not ossify until 2-5 years after birth. If the caudal segments of the sacrum are deficient, the PC line can be developed by projection from the pubis through the same site on the ischium, which is approximately the junction between the upper quarter and the lower three-quarters. The soft tissues lying at the level of the PC line are the bladder neck, the veru-montanum, the pelvic reflection from the rectum to the prostate, and the external os of the cervix. The prone, cross-table lateral x-ray should be delayed for 12-24 h after birth to allow gas to reach the distal rectum. The baby should be placed in the prone
Screening ultrasound of the genitourinary tract should be performed before any initial surgery 7, 31 . This is a quick, noninvasive test with high sensitivity and specificity that can be performed at the patient's bedside if required (Fig. 9.15). Depending on the clinical situation, this should be delayed for between 24 and 72 h after birth, as during this time the urinary output may be low, resulting in a false negative scan for hydronephrosis. The examination should include ultrasound of the pelvis in females to look for hydrocolpos, which may compress the bladder base producing ureteric obstruction and hydronephrosis. Pelvic ultrasound in female will also provide information about the presence of uterine or vaginal anomalies such as uterus didelphys. MCUG should also be performed to assess for vesicoureteric reflux, as well as to help in assessing the bladder in those with spinal anomalies.
In transient bullous der-molysis of the newborn, the lesions are present at birth or shortly thereafter. With the bullous appearance of the lesions, epidermolysis bullosa should be considered in the differential diagnosis, but the family history and rapid regression of the lesions can confirm die diagnosis of transient bullous dermolysis of the newborn. The sibling of this infant had similar lesions at birth. In the figure on the left note the large bullous lesions on the 5 th finger of the right hand. There were similar lesions on the left hand at birth. In the figure on the right note the healing of the lesions 5 days after birth.
Congenital varicella in an infant which presented at the age of 7 days. Mother developed varicella 10 days prior to delivery. This infant had very few lesions and was not ill. If the onset in the mother is within 4 days prior to or within 48 hours after delivery, or if the onset in the newborn is between 5 to 10 days after birth, the infant's condition is usually more severe. In these cases, varicella-zoster immune globulin (VZIG) should be given as soon as possible after birth.
Endothelins are also involved in angiogenesis 170 , and it is clear from recent animal studies that the exceptional circulatory physiology of the newborn is dependent upon the endothelin-controlled behaviour, which is not the case 1 month after birth 171 . In the study by Nankervis, the mesenteric arteries of newborn pigs demonstrated significant diameter changes in response to the blockade of endogenous nitric oxide production or blockage of endothelin receptors (EDNRB) compared to 1 month later. In addition, hypoxia-ischaemia experiments on 14-day-old sl sl rats have shown that ETB-deficient animals have an increased susceptibility to in vitro hypoxia, with a significant decrease in surviving neuronal cells
Extrahepatic biliary atresia is an obliterative cholangiopathy that involves all or part of the extrahepatic biliary tree and, in many instances, the intrahepatic bile ducts. In the U.S.A., from 400 to 600 new cases of biliary atresia are encountered annually (46). The diagnosis is usually suggested by the persistence of jaundice for six weeks or more after birth. Several factors have been considered for the pathogenesis of extrahepatic biliary atresia, including viral infection (e.g., cytomegalovirus) (47), metabolic insults, and abnormalities in bile duct morphogenesis. Although selected patients benefit from prompt diagnosis and Kasai portoenterostomy surgical intervention (48,49) within the first 60 days of life, many ultimately require liver transplantation because of portal hypertension, recurrent cholangitis, and cirrhosis (50).
Acquired immunodeficiency diseases are nonhereditary diseases contracted after birth. The best-known example is acquired immunodeficiency syndrome (AIDS), a group of conditions that involve a severely depressed immune response resulting from infection with the human immunodeficiency virus (HIV).
Epidermolysis bullosa is an autosomally inherited blistering and bullous disorder which is present at birth or becomes manifest soon after birth. It commonly affects die face, hands, feet, and variably the limbs and trunk and is characterized by trauma-inflicted erosions (Nikolsky's sign) and loss of the epidermis. As in this infant, the lesions are most commonly seen over the extensor surfaces and there are broken bullae with underlying erythroderma. Epidermolysis bullosa occurs in three major inherited forms e. bullosa simplex (epidermolytic), junctional e. bullosa (letalis gravis), and e. bullosa dystrophica (dominant and recessive forms) based on die presence or absence of scarring, the mode of inheritance, and the level of skin cleavage following minor trauma.
About 10 to 15 of infants of myasthenic mothers are affected and signs present in the baby at or shortly after birth. The clinical picture of neonatal myasthenia gravis is dominated by general hypo-tonia, there being symmetrical involvement of the face, trunk and limbs. In severe cases there is lack of facial expression and difficulty in sucking and swallowing. Prognosis is good, with improvement within a week the infant may be symptomatic as long as 6 weeks.
Microcephaly in a term infant with congenital rubella. Microcephaly may be idiopathic or acquired as a result of intracranial pathology. It may also result from serious perinatal brain injury in which case the FOC (fronto-occipital circumference) may be normal at birth, but then fail to increase as the brain fails to grow after birth. Severe physical and mental retardation may follow. This infant had an FOC of 30 cm and closed fontanelles.
Just like the long bones, the short tubular bones in the hands develop by way of transformation of the primitive mesenchyme into an intermediate cartilaginous model, which subsequently undergoes ossification. Proliferation and ossification of the physeal cartilage and development of the secondary ossification centers are further steps in bone development. These processes of chondrification and ossification both proceed during embryonic and fetal life, in a fixed and predictable order. Most of the cartilaginous buds for the small bones in the hands and feet are present by the 7th week of gestation. The primary ossification centers for the metacarpals appear at the 9th week of gestation, while those for the phalanges are evident between the 8th and 11th weeks of gestation. Considerable regularity also exists in the order in which the carpals and epiphyses (secondary ossification centers) begin to ossify after birth, and in the sequence in which the epiphyses eventually fuse with their...
Another infant with cytomegalovirus infection showing the typical blueberry muffin appearance and jaundice soon after birth. Note that the head size is normal. Since most infections are asymptomatic, early diagnosis is only made in the full-blown syndrome manifested by the appearance of jaundice within the first 24 hours of life, hepatosplenomegaly, abdominal distention, anemia, thrombo-cytopenia, respiratory distress and neurologic changes. Figure 2.93. Another infant with cytomegalovirus infection showing the typical blueberry muffin appearance and jaundice soon after birth. Note that the head size is normal. Since most infections are asymptomatic, early diagnosis is only made in the full-blown syndrome manifested by the appearance of jaundice within the first 24 hours of life, hepatosplenomegaly, abdominal distention, anemia, thrombo-cytopenia, respiratory distress and neurologic changes.
Vernix caseosa in a female infant. After birth the infant is bathed and the vernix removed by the nurse. If there is any question as to whether or not Figure 1.8. Vernix caseosa in a female infant. After birth the infant is bathed and the vernix removed by the nurse. If there is any question as to whether or not
Interactions in secretory granule storage or exocytosis 87-90 . There are differences, however, in the timing of expression of IA-2 and phogrin, since the latter is expressed in the developing pancreas very early in fetal development, while IA-2 is not detectable until shortly after birth 91, 92 . The timing of IA-2 expression, concomitant with maturation in insulin secretory responses of pancreatic islets to glucose in early life, provides additional evidence for a role of the protein in hormone secretion 93 . The late expression of IA-2 in development may also have implications for the autoimmune response 92 , since late fetal and early neonatal life is a critical period in induction of immunological self-tolerance.
The immediate and long-term effects of perinatal infection are a major problem throughout the world. Perinatal infection is relatively common among the over 4 million births per year in the United States but the incidence is dependent upon the organism. One percent of newborn infants excrete cytomegalovirus. Fifteen percent are infected with Chlamydia trachomatis one-third develop conjunctivitis and one-sixth, pneumonia. One to eight per 1,000 live births develop bacterial sepsis. In utero or perinatal infection with herpes simplex virus, Toxoplasma gondii and varicella-zoster virus occurs in about 1 per 1,000 live births and the sequelae may be severe. In-utero acquired infection may result in resorption of the embryo, abortion, stillbirth, malformation, intrauterine growth retardation, prematurity, and the numerous untoward sequelae associated with chronic infection. Infection acquired at or soon after birth may lead to death or persistent postnatal infection. Some infections may be...
During early development, the spinal cord is the same length as the vertebral canal and the entering exiting nerve roots correspond to the spinal cord vertebral levels. During the second part of fetal development, the body and the bony spine continue to grow, but the spinal cord does not. After birth, the spinal cord only fills the vertebral canal to the level of L2, the second lumbar vertebra (see also Figure 3). The space below the termination of the spinal cord is the lumbar cistern, filled with cere-brospinal fluid.
Since IgG4 has the potential to pass the placenta, neonatal pemphigus may occur by the diaplacentar transfer of anti-Dsg3 IgG4 from mothers with PV to their unborn children. After birth, the newborn exhibit crusty erosions of the skin with the histopathological findings of PV. These skin lesions disappear after a few months once circulating auto-Ab are degraded.
Before developing this theme further, it is very important to make the distinction between an animal's life in a natural environment, and a life in a protected environment, such as a zoo, or under domestication. As I have repeatedly stressed, animals live in hazardous natural environments. Some offspring do not survive long after birth others never reach adulthood some that do so may not breed, and those that do breed are unlikely to have nearly as many offspring as they are potentially capable of producing. In contrast, animals living in a protected environment, which provides food ad libitum and the absence of predators, have very different reproductive success, provided of course, that they have the freedom to breed. Infant mortality is usually quite low, most offspring develop to full adulthood and will continue to breed, unless human and other intervention prevents them from doing so. Under these conditions the important reproductive parameters are 1) the time it takes to reach...
The CYP3A family is the most abundant CYP in the human liver, representing about 40 of the total specific content of CYP. The entire CYP3A family is located at chromosome 7q21.1. The human CYP3A family includes CYP3A4 and its allelic variant CYP3A3, as well as CYP3A5 and CYP3A7 (33). CYP3A7 is considered a fetal enzyme, and its expression is not observed in the liver after birth, but expression has been observed in the endometrium and placenta (34). CYP3A5 is expressed in only 10-30 of livers but is expressed in 80 of all human kidneys.
Causes an economically important, lethal disease in ranch-raised mink. All types of mink are susceptible, but the Aleutian genotype, so named because the blue-gray coat color is similar to that of the Aleutian blue fox, develop more severe lesions and die sooner. Ferrets are also susceptible. The virus can cross the placenta to infect the fetus, but chronically infected females produce few live kits. Animals infected in utero have a less severe disease than those infected after birth. Virus is excreted in the urine, feces and saliva, and infection is readily transmitted by contact and handling. After infection there is rapid replication and high virus titers are present in spleen, liver and lymph nodes within 10 days. A
Milk synthesis is promoted by prolactin, a hormone of the anterior pituitary gland. In the nonpregnant state, dopamine ( prolactin-inhibiting hormone) from the hypothalamus inhibits prolactin secretion. Prolactin secretion begins 5 weeks into the pregnancy, and by full term it is 10 to 20 times its normal level. Even so, prolactin has little effect on the mammary glands until after birth. While the steroids of pregnancy prepare the mammary glands for lactation, they antagonize prolactin and suppress milk synthesis. When the placenta is discharged at birth, the steroid levels abruptly drop and allow prolactin to have a stronger effect. Milk is synthesized in increasing quantity over the following week. Milk synthesis also requires the action of growth hormone, cortisol, insulin, and parathyroid hormone to mobilize the necessary amino acids, fatty acids, glucose, and calcium.
Another mechanism is suppression of TCR expression. This has been shown with pregnant mice expressing a transgenic TCR that recognizes the foreign MHC class I molecule expressed by the father and the fetus. The level of this transgenic TCR is high before and after pregnancy, but low during pregnancy. These T cells are also functionally silenced. During pregnancy, female mice become even tolerant to otherwise highly immunogenic tumor cells expressing this same antigen (Alferink et al. 1998). Thus, suppression of a TCR expression is closely associated with the occurrence of peripheral tolerance and may contribute to it. These data, even though very elegant, do not exclude that other mechanisms significantly contribute to peripheral tolerance (Alferink et al. 1998 Schonrich et al. 1991).
Thelium after pregnancy and lactation. As these changes result in a decreased risk of breast cancer if they occur early enough in a woman's reproductive lifespan, it will be important to determine whether such an adjunct population of cells exists in parous human breast and, if so, what their properties are. The conclusions from these studies is that the mammary epithelial stem cell population is not as fixed in either number or characteristics as first thought.
I have had many miscarriages and have no children. Before I was diagnosed with MS, I thought I felt good during pregnancy because of emotions ofjoy and anticipation, and badly after a miscarriage, again because of emotions, albeit ones of grief and loss. Although emotions certainly played a part, I now understand that, as is often the case with MS, I had flare-ups after pregnancy.
Over the last decade growing evidence has been documented on the relationship between intrauterine growth retardation (IUGR) and pubertal development indicating changes in timing and progression of puberty. These changes in pubertal development are part of a growing list of IUGR-related diseases, which includes type 2 diabetes mellitus, cardiovascular disease, short stature and polycystic ovary syndrome. The influence of IUGR on the mechanisms behind the onset of puberty is still elusive. In the absence of prospective studies on gonadotropin-releasing hormone pulse patterns in IUGR children, other markers of pubertal development such as age at menarche in girls and progression of puberty have been employed. We investigated pubertal development and DHEAS levels in children born small for gestational age (SGA) after third trimester growth retardation and children born appropriate for gestational age (AGA). A faster progression of puberty was found in girls but not in boys. DHEAS levels...
SMN is highly expressed during embryogenesis, but levels decline rapidly after birth. In SMA-transgenic mice, the length of the dendrites is significantly reduced, whereas the number of motor neurons is not significantly affected as compared to controls (Monani et al. 2000). Conditional neuronal knock-out mice (SmnA7) lack axonal sprouting (Cifuentes-Diaz et al. 2002).
Pneumonia in the newborn can be classified according to the mode of acquiring the infection and the time when the infection takes place. The infection can be acquired in utero by trans-placental route or following intrauterine infection. The pneumonia could be acquired during delivery by aspiration of bacteria that colonize the birth canal. The type of infection contracted after birth is acquired by contact with environmental objects (e.g., a tracheostomy tube) or by human contact. Aspiration can occur in up to 80 of intubated premature infants (32) and is common in newborns with gastroesophageal reflux (33) or those who require general anesthesia (34), or have swallowing dysfunction (35).
Studdiford and Douglas (46) demonstrated placental bacteremia caused by gram-negative bacteria, with the fetal blood vessels distended. They considered this to be peculiar to neonatal deaths with vascular collapse. Mandsley and colleagues (47) examined at random the fetal adnexa in 494 patients and found evidence of inflammation in 34 . They found chorionitis in 21 and inflammation of the cord in 17 . They also have studied the bacteriology of the surface of the placenta and failed to correlate these findings with the histologic findings. They found deciduitis in 89.5 , suggesting that normal labor may not be that normal after all. Salem and Thadepalli (4) have examined the histology of the cord, placenta, and membranes and tried to correlate the cord blood cultures with the neonatal outcome in 50 consecutive births. Thirty percent of the cord blood cultures were positive for aerobic-anaerobic bacteria soon after birth. Anaerobes were found in cord cultures in nine samples (18 ),...
A glucose tolerance test should be repeated six weeks after delivery. More than half of the patients return to normal these women however have an approximately 50 risk of developing Type 2 diabetes later in life, sometimes within one year. An annual check of fasting blood glucose concentration is desirable, and they should be advised to avoid excessive weight gain by a regular programme of healthy eating and exercise (see chapter 3). Those patients who remain diabetic after pregnancy should be treated in the usual way.
In the fetus, the whole developing spine is curved so that it is concave forwards (primary curvature). A few months after birth the baby begins to hold its head up and the cervical spine develops a forward convexity (secondary curvature). Later in the first year the baby begins to stand up and another forward convexity develops in the lumbar region (secondary curvature). The primary curves are mainly due to the shape of the vertebral bodies but the secondary curves are due to the shape of the intervertebral discs.
Newborns present usually 3-5 days after birth with abdominal distension. Bilious vomiting may be associated in cases with delayed presentation. The condition may mimic and needs to be differentiated from long-segment Hirschsprung's disease, intestinal atresia, colonic atresia, and meco-nium ileus. A forceful anal rectal catheterization may easily perforate the bowel resulting in peritonitis and septicemia.
B-cell maturation takes place in the fetal liver and in the bone marrow after birth. At the pre-B cell stage, somatic recombination of the V, D, and J genetic elements allows expression on the cell surface of the -chain of the immunoglobulin (Ig) receptor in association with an invariant, surrogate light chain. Because of the absence of a specific light chain, this pre-B cell receptor (BCR) does not possess the antigen specificity displayed by the mature BCR, although the heavy chain may have a dominant effect in determining specificity. Surprisingly, the pre-BCR is a completely assembled signaling complex that is required for further cell maturation, but there is no counterpart in pre-B cells to positive selection, which is necessary for continual survival of pre-T cells. Therefore, B cells are intrinsically less restricted than T cells to recognize antigen. At the immature B-cell stage, a rearranged, specific light chain replaces the surrogate light chain, and allelic exclusion is...
Evidence is increasing to show that the pre-term baby is at greatest risk from overinflation of the lungs immediately after birth, and inflation volumes as little as 8 ml kg may be capable of producing lung damage. The lowest inflation pressure compatible with adequate chest wall expansion should therefore be used. Sometimes, however, pressures in excess of 30 cmH20 will be necessary to inflate the surfactant-deficient lungs.
Hepcidin was originally studied as an antimicrobial agent, HAMP (hep-cidin antimicrobial peptide). Inadvertently, investigators studying a gene important in gluconeogenesis, silenced the gene for hepcidin in a transgenic mouse experiment (14). Quite unexpectedly, the knockout mice developed hepatic and pancreatic iron overload with an absence of iron in the spleen. (Figs. 4.2 and 4.3). The pathology had all of the features of a patient with idiopathic hemochromatosis (genetically determined iron overload). In subsequent experiments, the investigators went on to overexpress the hepcidin gene in other transgenic animals (15). This resulted in mice that were severely iron deficient at birth, demonstrating the importance of hepcidin even in transplacental transport of iron to the developing fetus. The mice were born with severe microcytic hypochromic anemia and died shortly after birth, presumably because of an inability to absorb iron from the gut.
The knock-in mouse model Lmna L530P, a substitution that causes EDMD in human, seems to recapitulate more faithfully the cell and tissue alterations observed in HGPS patients (Mounkes et al. 2003). Homozygous mice show a severe growth retardation, several developmental abnormalities, and die prematurely (4-5 weeks after birth). Their phenotypic characteristics include abnormal dentition, joint stiffness, epidermal hyperkeratosis, lipodystrophy, a reduction of hair follicles and sebaceous glands, muscular atrophy, generalized osteopenia, and scapular hypoplasia. Conversely, compared to human, these mice do not develop generalized atherosclerosis nor acro-osteolyses. In these mice, a complex splicing defect (either skipping of exon 9 or retention of part of intron 9) causing a reduction of about half of the lamin A C wild-type content, has been shown to cause the phenotype, in contrast to human, in which the simple p.L530P substitution is supposed to occur. Indeed, this lamin A C...
In the inferior vena cava, placental blood mixes with venous blood from the fetus's body and flows to the right atrium of the heart. While the right heart normally pumps all of its blood into the lungs after birth, there is little need for this in the fetus because the lungs are not yet functional. Most of the fetal blood therefore bypasses the pulmonary circuit. Some passes directly from the right atrium to the left through the foramen ovale, a hole in the intera-trial septum. Some goes into the right ventricle and is Figure 29.11 Blood Circulation Before and After Birth (a) Fetal circulation. (b) Neonatal circulation. Figure 29.11 Blood Circulation Before and After Birth (a) Fetal circulation. (b) Neonatal circulation.
Natal teeth present at birth. Teeth that erupt after birth are neonatal teeth. These teeth have a familial pattern of occurrence and are more common in certain races such as American Indians and Eskimos. Neonatal teeth may occur in association with syndromes.
The globin submolecule is the protein portion of hemoglobin that associates with carbon dioxide. Each globin submolecule can transport one molecule of CO2. Normal adult hemoglobin includes three types type A hemoglobin, type A2 hemoglobin, and type F hemoglobin. Type A makes up 95 to 98 percent of hemoglobin in adults. Type A2 makes up 2 to 3 percent, and type F, fetal hemoglobin, makes up a total of 2 to 3 percent. Fetal hemoglobin is the primary hemoglobin produced by the fetus during gestation, and it falls to a much lower level after birth.
Hard nails are not uncommon on the toes, where they may present as onychogryphosis. In contrast, hard finger nails are unusual and are principally observed in an ectodermal dysplasia, pachyonychia congenita. The nails become yellowish-brown usually within months after birth and show subungual hyperkeratosis with elevation of the nail plate. The nails become progressively thicker and wedge-shaped. Jadassohn had to use a hammer and chisel on the hardened nails of his patient.
Ters for the head of the humerus, distal femur, and proximal tibia make their appearance around the 36th week of gestation, while those for the femoral head and capitulum of humerus do not appear until the 2nd to the 6th month after birth. The distal epiphysis of radius usually appears around 12 months, and the greater trochanter of femur and proximal epiphysis of fibula at about 3 years of age. Ossification of the long bones extends a long way into childhood and early adolescence, with the patella developing at about 4 years, the capitulum of the radius at
The first 6 weeks postpartum (after birth) are called the puerperium41 (PYU-er-PEER-ee-um), a period in which the mother's anatomy and physiology stabilize and the reproductive organs return nearly to the pregravid state (their condition prior to pregnancy). The shrinkage of the uterus during this period is called involution. In a lactating woman, it loses about 50 of its weight in the first week and is nearly at its pregravid weight in 4 weeks. Involution is achieved through the autolysis (self-digestion) of uterine
Anaerobes, including clostridia, are considered to be members of the normal flora of infants of this age (34). The majority of infants are colonized by 10 days of age with aerobic gram-negative rods (most frequently E. coli and Klebsiella), as well as by anaerobic flora, including B. fragilis (35,36) and clostridia species are found in a third of infants. Although clostridia are normal inhabitants of the human intestinal tract, colonization rates among neonates vary from 7 to 70 (37). The source of the neonatal intestinal flora is the environment encountered by the infant after birth. The normal flora of the cervix and vagina contains many anaerobes, including clostridia (38). Differences among neonates in gestational age, route of delivery, and type of feeding are associated with different colonization patterns of aerobic and anaerobic bacteria (36).
White blood cells use their lysosomes to digest phagocytized bacteria. Lysosomes also digest and dispose of worn-out mitochondria and other organelles this process is called autophagy37 (aw-TOFF-uh-jee). Some cells are meant to do a certain job and then die. The uterus, for example, weighs about 900 g at full-term pregnancy and shrinks to 60 g within 5 or 6 weeks after birth. This shrinkage is due to autolysis,38 the digestion of surplus cells by their own lysosomal enzymes. Such programmed cell death is further discussed in chapter 5.
Telogen effluvium occurs if all the hairs enter into the resting phase together, most commonly after childbirth or severe illness. Two or three months later the new anagen hair displaces the resting telogen hair, resulting in a disconcerting, but temporary, hair loss from the scalp. Stress of any type, such as an acute illness or an operation, causes a similar type of hair loss.
This is a temporary immunity that results from acquiring antibodies produced by another individual. The only natural way for this to happen is for a fetus to acquire antibodies from the mother through the placenta before birth or for a baby to acquire it through the colostrum or breast milk after birth.