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The state of health care is reflected by perinatal and neonatal morbidity and mortality as well as by the frequencies of long-term neurologic and developmental disorders. Many factors, some"without immediately recognizable significance to childbearing and many still unknown, undoubtedly contribute beneficially or adversely to the outcome of pregnancy. Knowledge concerning the impact of such factors on the fetus and surviving infant is critical. Confounding analyses of pregnancy outcome, especially these past two or three decades, are the effects of newly undertaken invasive or inactive therapeutic approaches coupled with the advent of high technology. Many innovations have been intro duced without serious efforts to evaluate their impact prospectively and objectively. The consequences of therapeutic misadventures character ized the past; it seems they have been replaced to a degree by some of the complications of applied technology. Examples abound: after ov eruse of oxygen was recognized to cause retrolental fibroplasia, its restriction led to an increase in both neonatal death rates and neurologic damage in surviving infants. Administration of vitamin K to prevent neonatal hemorrhagic disease, particularly when given in what we now know as excessive dosage, occasionally resulted in kernicterus. Prophy lactic sulfonamide use had a similar end result. More recent is the observation of bronchopulmonary dysplasia as a complication of re spirator therapy for hyaline membrane disease. The decade of the eighties opened with the all-time highest rate of cesarean section in the United States.

Advances in Perinatal Medicine: Volume 4

1 Nutrition and Fetal Growth.- 1. Introduction.- 2. The Nutritional Needs of the Human Fetus.- 2.1. Energy Requirements.- 2.2. Amino Acids and Protein.- 2.3. Carbohydrates.- 2.4. Lipids.- 2.5. Vitamins.- 2.6. Minerals.- 3. Maternal Protein-Calorie Intake and Fetal Growth.- 3.1. Gestational Changes in Weight and Body Composition.- 3.2. Maternal Weight Gain and Birth Weight.- 3.3. Gestational Undernutrition.- 3.4. Food Restriction and Birth Weight in Humans.- 3.5. Supplementation during Gestation in Animals: The Roles of Protein and Calories.- 3.6. Supplementation in Humans.- 4. Fetal Consequences of Vitamin and Mineral Deficiencies.- 4.1. Vitamin Deficiencies.- 4.2. Mineral Deficiencies.- 5. Conclusions.- References.- 2 Fetal Cardiac Dysrhythmias: Detection and Management.- 1. Introduction.- 1.1. Historical Notes.- 1.2. Incidence.- 2. Pathophysiology.- 2.1. Embryology.- 2.2. Extrinsic Factors.- 2.3. Hydrops Fetalis.- 3. Detection.- 3.1. Tools.- 3.2. Normal Fetal Heart Rate Patterns.- 3.3. Detecting the Fetus At Risk.- 4. Specific Dysrhythmias.- 4.1. Sinoatrial Node Disorders.- 4.2. Supraventricular Dysrhythmias.- 4.3. Ventricular Dysrhythmia.- 4.4. Atrioventricular Node Disorders.- 5. Fetal Antiarrhythmic Pharmacology.- 5.1. Digoxin.- 5.2. Propranolol.- 5.3. Procainamide.- 5.4. Quinidine.- 5.5. Verapamil.- References.- 3 Factors Predisposing to Birth-Associated Injury.- 1. Introduction.- 2. Pathogenetic Factors.- 3. Antenatal Injuries.- 4. Birth-Associated Injuries: Fetal Surveillance in Labor.- 4.1. Fetal Scalp Sampling.- 4.2. Fetal Scalp Electrodes.- 5. Breech Presentation-Associated Injuries.- 6. Birth Injuries Associated with Methods Used in Delivery of Cephalic Presentation.- 7. Vacuum Extraction.- 8. Birth-Associated Injuries with Multiple Factors of Causation: Soft Tissue Injuries.- 8.1. Cephalhematoma.- 8.2. Edema of the Scalp and Face.- 8.3. Soft Tissue Lacerations.- 8.4. Subcutaneous Fat Necrosis.- 8.5. Torticollis.- 8.6. Other Lesions.- 9. Injuries to the Eye.- 9.1. External Eye Injuries.- 9.2. Injuries of the Anterior Chamber.- 9.3. Ruptures of Descemet's Membrane and Corneal Trauma.- 9.4. Retinal Hemorrhages.- 10. Bony Injuries.- 10.1. Fractures of the Skull.- 10.2. Fractures of Vertebrae.- 10.3. Fractures of the Clavicle.- 10.4. Fractures and Epiphyseal Injuries of Long Bones.- 10.5. Fractures of Ribs.- 10.6. Fractures of Facial Bones.- 10.7. Injuries of the Temporomandibular Joint.- 10.8. Dislocations.- 11. Visceral Injuries of the Abdomen.- 12. Other Visceral Injuries: Pseudodiverticulum of the Pharynx.- 13. Neurologic Injuries.- 13.1. Facial Nerve Injuries.- 13.2. Brachial Plexus Injuries.- 13.3. Phrenic Nerve Injuries.- 13.4. Vocal Cord Paralysis.- 13.5. Peripheral Nerve Injuries.- 14. Summary.- References.- 4 Medical Applications of Infant Cry Analysis.- 1. Introduction.- 2. Definitions.- 3. Strategies for Cry Analysis.- 3.1. Pattern Recognition.- 3.2. Physioacoustic Model of Cry Production.- 3.3. Biosocial Cry Model.- 4. Cry Analysis Techniques.- 4.1. Auditory Analysis.- 4.2. Time Domain Analysis.- 4.3. Frequency Domain Analysis.- 4.4. Spectrographic Analysis.- 4.5. Computer-Based Signal Processing.- 5. Conclusion.- References.- 5 Retrolental Fibroplasia: Old Problems, New Challenges.- 1. Definition.- 2. Introduction.- 3. A Model of Normal Vasculogenesis.- 4. A Model of Abnormal Vasculogenesis: Vascular Injury and Response.- 5. The Need for a New Classification of the Disease.- 6. Current Problems.- 6.1. Current Incidence of Disease.- 6.2. Specification of the Vulnerable Infant.- 6.3. Specification of the Injurious Agent.- 6.4. Timing, Technique, and Precautions for the Ophthalmological Examination.- 6.5. Treatment.- 6.6. Medicolegal Aspects.- 7. Summary.- References.- 6 Assessing Risk Assessment.- 1. Introduction.- 2. Methods of Risk Assessment.- 2.1. An Overview.- 2.2. Techniques to Derive Scoring Systems.- 2.3. Techniques to Assess Scoring Systems.- 2.4. Single Evaluative Measures.- 2.5. Validation of Scoring Systems.- 3. Performance of Various Systems.- 3.1. Introduction.- 3.2. Risk of Perinatal/Neonatal Mortality.- 3.3. Low Birth Weight or Growth Retardation.- 3.4. Short Gestation.- 3.5. Morbidity.- 3.6. General Issues.- 4. Discussion.- 4.1. General.- 4.2. Statistical Methods.- 4.3. Application.- 4.4. The Risk Approach Paradox.- 4.5. Simplicity.- 4.6. Timing.- 4.7. Gestation-Dependent Scores.- 4.8. Generalized Risk Predictors.- 4.9. Specific Risk Predictors.- 4.10. Population Definition.- 4.11. Primiparas and Multiparas.- 4.12. Outcome Definition.- 5. Conclusions.- References.- 7 Neonatal Electroencephalography.- 1. Introduction.- 2. Background.- 3. Technical Considerations.- 4. Patterns Observed in Normal Term and Preterm Infants.- 4.1. The Term Infant.- 4.2. The Preterm Infant.- 5. Abnormal Electroencephalograms.- 5.1. Isoelectric Pattern.- 5.2. Paroxysmal or Burst-Suppression Patterns.- 5.3. Diffusely Slow Patterns.- 5.4. Low-Voltage Patterns.- 6. Abnormal Patterns in Preterm Infants.- 7. Seizures.- 8. Hemorrhages.- 9. Focal EEG Abnormalities.- 10. Herpes Encephalitis.- 11. Metabolic Derangements.- 11.1. Hypoxemia.- 11.2. Miscellaneous.- 12. Congenital Malformations.- 13. The Prognostic Value of the EEG.- 14. Conclusion.- 15. Glossary.- References.- 8 Atopic Sensitization of the Fetus and Newborn in Relation to the Development of the Human Immune System.- 1. Introduction.- 2. Maturation of Antigen Responsiveness.- 2.1. Synthesis of IgE in Utero.- 2.2. Allergic Sensitization of the Newborn and Infant.- 3. Genetics of Atopic Allergy.- 4. Prediction of Atopic Disease from Early IgE Measurements.- 5. Other Risk Factors for Atopic Allergy.- 6. Prophylaxis of Atopic Allergy.- 7. Conclusions and Prospects for the Future.- References.