After Birth Ebook

Getting Back Into Shape After The Pregnancy

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.

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Pregnancy Without Pounds

This proven program will get you through your pregnancy in better shape than most other women in as little as 27 minutes a day and with minimal effort. It contains all the information that I believe will Help you to look and feel like I did barefoot and beautiful! Inside you will learn Exactly how to avoid unwanted pounds, overcome your food cravings, care for your skin, dress to kill and look like one Hot Mama. Ive also put together Fifty simple, yet extremely effective pregnancy-friendly exercises and stretches to keep you and your body looking and feeling Great (includes 3 different fitness programs depending on Your fitness level)!

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Author: Michelle Moss
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Ontogenic development

In general, P450 expression is low, but detectable, in the developing human fetal liver, increases after birth, and reaches adult levels during the first 10 years of life.27 CYP1A2 is typical in this regard, with fetal hepatic expression of CYP1A2 protein or mRNA essentially absent in samples from individuals in early gestational stages,28'29 but steadily increasing in infants to reach 50 of levels seen in adults at 1 year of age.30 However, temporal expression patterns of individual human liver P450s can vary widely, often among closely related isoforms with the same subfamily. Here the CYP3A family in humans is instructive. Whereas CYP3A4 is the predominant liver isoform in adults, CYP3A7 is the major P450 detected in human embryonic, fetal, and newborn liver. CYP3A7 activity is abundant during embryonic and fetal life and rapidly decreases during the first week of life. In contrast, CYP3A4 levels are very low before birth, but increase steadily thereafter and reach 50 of adulthood...

Tissue expression and ontogenic development

Hepatic FMO1 is restricted to the fetus, peaking in the early embryo, and decreasing steadily within 3 days postpartum (Table 4).49 Conversely, hepatic FMO3 protein is not detectable in the fetal state, and its onset of expression after birth can be slow. As noted above, FMO3 is necessary for the conversion of trimethylamine to its nonodoriferous N-oxide metabolite, so delayed onset of expression of this enzyme may contribute to cases of transient childhood trimethylaminuria.50 The temporal switch for these FMO isoforms contrasts with that observed for CYP3A7 and CYP3A4 5, in which the suppression of CYP3A7 expression is accompanied by a simultaneous increase in CYP3A4 5, and the net hepatic CYP3A content remains constant.51 The relatively high expression levels of FMO1 during prenatal development and the embryonic periods, in particular, might argue for a role for FMO1 in the metabolism of endogenous substrates that are important for development, but this remains to be determined.

Tissue distribution and ontogenic development

Tissue-specific ontogenic expression of GST has been demonstrated for hepatic GSTA1 and GSTA2, both of which were detected as early as 10 weeks' gestation age, increasing to adult levels within the first 2 years of life.25 GSTM(1-5) was also detected in fetal liver samples, albeit at lower levels, and increased to adult levels following birth. In contrast, GSTP1 expression has been detected in fetal liver samples (10-22 weeks' gestation age), but declined in the second and third trimester and was virtually undetectable in adult samples. In the fetal lung, GSTP1 is the major GST isozyme, detectable in lung tissue at less than 20 weeks' gestation, and decreased continuously in the developing fetus and infant after birth. In fetal kidney at less than 20 weeks' gestation, both GSTA1 and GSTA2 were detected and increased to adult levels within the first 2 years of life. GSTM levels, however, decreased between the fetal and postnatal samples, while GSTP1 levels remained constant during...

Behavior Circuits And Biochemical Machinery

In the honeybee, two brain structures are potentially involved in NO-mediated memory formation, the antennal lobes, and the mushroom bodies. Both neuropils exhibit high NOS activity (148) and have been shown to be implicated in distinct aspects of olfactory learning in the honeybee (6,97,98). Based on findings from the olfactory system in mammals however, the NO system in the antennal lobes are likely candidates. In mice and sheep, the NO system in the accessory olfactory system has been implicated in the formation of distinct olfactory memory. Whereas female mice form a memory of the pheromones of the mating male, sheep learn to recognize the odors of their lambs in the first hours after birth (9,190,200). The formation of this memory is mediated by a reduced inhibitory transmission of gamma-amino-butyric acid (GABA) from the granule cells to the mitral cells. In both cases, NO has been demonstrated to mediate the formation of this memory. Whereas, in mice, the coincident activation...

Risk Of Fetalneonatal Infection

Since the institution, about 30 years ago, of the recommendation for passive immunization of exposed newborns with VZIG as soon as possible after birth, it is rare for a newborn infant to die of disseminated varicella. Before VZIG became available, one study suggested a 20 fatality rate when the mother had onset of rash less than 4 days and up to 2 days after onset of rash at delivery (13). Infants in whom varicella is fatal often have a disseminated infection with pneumonia, extensive hemorrhagic skin vesicles, hepatitis, and thrombocytopenia. Mothers whose onset of rash is more than 48 hours after delivery may transmit varicella to their babies, but the disease is usually not severe because they transfer antibodies as well (7).

CD4CD25 Regulatory T Cells

Immune tolerance has been a topic of intensive research since the early 1950s. The Nobel Prize winning work of Peter Medawar and colleagues showed that intraembryonic injection of foreign tissue cells into CBA mice resulted in tolerance when skin grafts from the same donor were transplanted into the mice after birth 1 . This immune tolerance was not due to antigenic alteration of the grafts, since injection of lymph node suspensions derived from CBA mice pre-immunized with donor cells led to breakdown of tolerance. Rather it was suggested that active immune tolerance was present. The concept that active tolerance could be mediated by suppressor T cells was introduced in the early 1970s by Gershon and co-workers 2-4 . They showed that the presence of thymocytes during antigen exposure of thymectomized, lethally irradiated and bone marrow-grafted mice resulted in tolerance upon subsequent exposure to the same antigen, even after the addition of fresh thymocytes during the rechallenge....

Ethics Of Dna Testing For Inherited Disease

In the future it may be possible to correct genetic defects before or after birth by replacing mutated genes by a normal copy. The technology to carry out such experiments is very demanding and important ethical questions are raised. In Chapter 20 we will discuss the potential use of gene therapy for the correction of the genetic disorder cystic fibrosis.

Lymphocyte Development

B cells at the pre-antigen receptor checkpoint, and selection of the mature B cell repertoire. Before birth, B lymphocytes develop from committed precursors in the fetal liver, and after birth, B cells are generated in the bone marrow. The majority of B lymphocytes arise from adult bone marrow progenitors that are initially Ig negative, develop into immature B cells that express membrane-bound IgM molecules, and then leave the bone marrow to mature further primarily in the spleen. In the spleen, cells that develop into follicular B cells express IgM and IgD on the cell surface and acquire the ability to recirculate and populate all peripheral lymphoid organs. These follicular B cells home to lymphoid follicles and are able to recognize foreign antigens and to respond to them. The development of a mature B cell from a lymphoid progenitor is estimated to take 2 to 3 days in humans.

Physiological Control of Ghrelin Secretion

In humans, ghrelin secretion has been reported to occur throughout the lifespan, with some age-related variations. In particular, ghrelin secretion significantly increases after birth, peaking during the first two years of life, then decreases until the end of puberty 37 . Moreover, a further decrease of ghrelin levels in elderly subjects has also been reported recently 38 .

Production by Lung Hyaluronidases

The content of both HA and hyaluronidase in the chick embryo lung change with development (60), and in humans HA is higher in fetal lung than it is after birth or in adult lung (61). Hyaluronidase activity also changes, showing a rapid increase in rat lung immediately after birth (62). Presumably, the removal of HA is necessary to lower the water content of the lung, with which HA has a direct correlation (8,9), in order to facilitate breathing in air.

Definition frequency and pathogenesis

During the perinatal period, maternal varicella can infect the baby by (i) trans-placental viremia, (ii) ascending infection during birth, or (iii) respiratory droplet direct contact with infectious lesions after birth. Chickenpox occurring in the first 12 days of life is described as intrauterine-acquired neonatal varicella. The disease can be expected if a mother contracts chickenpox during the last 3 weeks of pregnancy. Intrauterine-transmitted neonatal chickenpox has been occasionally referred to as ''congenital varicella'' or ''neonatal varicella syndrome'' (Sauerbrei and Wutzler, 2001). These terms should be avoided, since they do not allow a clear differentiation from the CVS caused by maternal chickenpox in the first two trimesters.

Timing And Routes Of Transmission

Further evidence of in utero infection is provided by the small number of reported cases of neonatal EV disease with onset in the first few hours after birth. In utero infection has been substantiated in these cases by viral culture of amniotic fluid and umbilical cord blood, antigen detection in myocardia hours after birth, culture of neonatal organs a few hours after delivery, and detection of serum-neutralizing immunoglobulin (Ig) M antibody on the first day of life (17,46,61-64). Identification of EVs in placentas, often in association with placentitis, villitis, villous necrosis, vasculitis, thrombosis, or other placental pathology, suggests that some fetal infections occur via a transplacental route (10,12,14,65). Shedding of EVs from the stool and cervixes of pregnant women, demonstration of susceptibility of amnion cells to EV infection in vitro, and growth of EVs from amniotic fluid in vivo point to the potential for ascending infection also (11,12,36,61,66-69). Based on the...

Congenital Adrenal Hyperplasia

In addition to being precursors of cortisone, many of the early intermediates are also estrogenic compounds. In the presence of abnormally high production of androgens, secondary sexual characteristics are affected. If this condition is manifested in utero, pseudohermaphroditism (masculinzation) of external genitalia occur in girls and macrogentisomia praecox (accentuation of male genitalia) occurs in boys. If the condition is not manifested until after birth, virilism (masculinization) develops in girls and precocious puberty in boys. In CAH variants IV, V, and VI, there is also some degree of interruption of the adrenal pathway, so that the external appearance of the female genitalia is not significantly affected and subsequent virilization is minimal or absent.

Total Anomalous Pulmonary Venous Connection

Total repair is carried out soon after establishing the diagnosis and medical stabilization of the patient. The procedure can be emergent shortly after birth when there is obstruction of the common pulmonary venous channel (as with a subdiaphragmatic connection), or in the early days of life when there is obstruction at the atrial septal level (supracardiac or intracardiac connection). When there is no obstruction to pulmonary venous return, surgery is required in the early weeks of life because the large left-to-right shunt causes congestive heart failure or failure to thrive with or without pulmonary artery hypertension.

Naturally Occurring Regulatory T Cells

Recently the focus has been largely on naturally occurring CD4+ T cells constitutionally expressing the a chain of the IL-2 receptor (CD25) for a review see (Shevach 2002). Even though CD25- regulatory T cells exist (Apostolou et al. 2002 Lehmann et al. 2002), the CD25 marker has been used to define the properties of regulatory cells. The regulatory population was first identified as a subset of CD4+ T cells able to prevent the development of organ-specific autoimmune disease in mice thymectomized on day 3 after birth (Asano et al. 1996 Sakaguchi et al. 1995). Subsequently, the regulatory T cells have been shown to inhibit many autoimmune diseases (Shevach 2000 von Herrath et al. 2003), transfer tolerance to alloantigens (Taylor et al. 2001), hinder antitumor immunity (Shimizu et al. 1999) and regulate the expansion of other

Maternal Hiv1 Testing And Counseling

There are four rapid HIV-1 tests approved by the Food and Drug Administration for use in the United States the OraQuick Rapid HIV-1 Antibody test, the Reveal Rapid HIV-1 Antibody Test, the Uni-Gold Recombigen HIV-1 Test, and the Murex-SUDS-Single Use Diagnostic System HIV-1 Antibody Test (manufacture of this test was discontinued in 2003). All have good sensitivity and specificity. As with other HIV-1 testing, consent is required for the rapid test, and if positive, a follow-up HIV-1 ELISA and Western blot or IFA test needs to be done to confirm the HIV-1 infection. The advantages of this test are that results are available within 30-60 minutes, and the results can be immediately given to the individual tested. A reactive result from a rapid test is considered to be a preliminary positive test result. Thus, if a pregnant woman does not know her HIV-1 status and is late in gestation, a positive rapid HIV-1 test can be used to institute antiretroviral therapy, or if she is in labor, she...

Cytokine Requirements for the Control of Colitis by CD4CD25 Treg

Ex vivo (Asano et al. 1996) as well as direct secretion of these cytokines by the CD4+CD25+ T cells when stimulated in an appropriate fashion (Nakamura et al. 2001). We know that IL-10 plays an important function in the intestinal homeostasis, revealed by the fact that IL-10-deficient mice (Rennick et al. 2000) orwildtype mice treated with anti-IL-10R (Asseman et al. 2003) develop chronic inflammation in the intestine and IL-10 in general plays a role as a negative regulator of the immune response. In addition, administration of exogenous IL-10 inhibits the development of colitis in SCID mice reconstituted with CD4+CD45RBhigh T cells (Powrie et al. 1994) as well as in other models of IBD (Leach et al. 1999). Consistent with these studies, CD4+CD45RBhigh T cells isolated from transgenic mice, which expressed IL-10 under control of the IL-2 promoter, failed to induce colitis in SCID mice and were able to inhibit the disease when transferred with CD45RBhigh CD4+ T cells from normal mice....

Energy Protein and

In the second half of pregnancy, protein needs almost double - the average woman requiring 40-50 g day before pregnancy now requires 70-90 g day.4 The choice of dietary fat is important. A pregnant woman's diet should be rich in the omega-3 fatty acids, eicosapenta-noic acid (EPA), and docosahexanoic acid (DHA). These fatty acids are important components of the developing baby's central nervous system and eyes. Because most of the cells in the central nervous system are formed during pregnancy and the first year after birth, ample intakes of EPA and DHA are vital during this period.5 Although adults are able to synthesize some EPA and DHA from li-nolenic acid (see pp.89), the fetus cannot because the necessary metabolic pathways have not fully developed. These fatty acids need to be supplied to the fetus by the mother.

Clinical Features

The disease presents a few weeks after birth with feeding difficulties, lethargy, hypotonia, hypothermia, and seizures. Psychomotor development is markedly delayed, and death usually occurs within 1 to 2 years of onset. Somatic, vascular, and bony changes are characteristic. The infant's hair is short, stringy, wiry, often white, and, under the microscope, appears twisted. The skin is pale and thick or pasty. The blood vessels, as revealed by angiogram or at autopsy, are elongated, tortuous, and display focal luminal narrowing and dilations resulting from disruption and fragmentation of the elastic layer. The bone shows osteoporosis and an irregular lucent trabecular pattern on radiographs.

Clinical Manifestations In The Fetus And Neonate

Fetal infection with syphilis can be recognized by antenatal ultrasonography. Hydrops fetalis and hepatomegaly are seen in infected fetuses. Bowel dilation also has been described. After birth, the clinical signs of congenital syphilis have been divided arbitrarily into those manifestations that appear in the first 2 years of age, termed early congenital syphilis those that are a result of active infection and inflammation and those that occur beyond 2 years, designated as late congenital syphilis (24-26). The last represent sequelae of the early manifestations or reaction to ongoing inflammation. The clinical findings of early and late congenital syphilis are provided in Table 1. Many infants with congenital syphilis have no clinical signs of infection, and the diagnosis is often impossible to ascertain.

Results And Discussion

Light microscopic visualization of proliferating cells in the postnatal rabbit cerebellum by the in vivo BrdU labeling procedure described in the Protocols section. After 1 hour survival, labeled nuclei are detected mainly in the EGL both in P0 (A) and P5 (B) animals. Scattered positive nuclei are also apparent in the ML and IGL. Panel C shows the pattern of labeling in a P5 animal which received an injection of the marker immediately after birth. Note labeled nuclei in the inner (premigratory) part of the EGL and positive nuclei in the ML, which likely correspond to newly generated granule cells during the route of their migration to the IGL. Scattered positive cells are also detected in the WM. Abbreviations BrdU, 5-bromodeoxyuridine EGL, external granular layer IGL, internal granular layer ML, molecular layer P0, postnatal day 0 P5, postnatal day 5 WM, white matter. Scale bars 100 pm.

It is apparent that spoken language development occurs spontaneously in the presence of normal hearing from birth given

While onset of deafness after birth is generally considered an advantage over congenital deafness for auditory development 46 , when only those children with age at onset under 3 years of age are considered (i.e. prelingually deaf), the advantage of later onset was no longer apparent in speech perception outcomes 47, 48 . It was reported 49 that 80 of children who became deaf between birth and 36 months of age and received a cochlear implant within a year of onset of deafness achieved both speech and language skills within expected levels for hearing age-mates when they were 8 or 9 years old. Only 36 of children with similar age at onset of deafness but implanted after being

Risk Of Fetal Or Neonatal Infection When Infection In The Mother Is Diagnosed Or Suspected

An infant born to a woman with active cervical infection with C. trachomatis is at risk of acquiring the infection during passage through the infected birth canal. Approximately 50-75 of infants born to infected women become infected at one or more anatomic sites, including the conjunctiva, nasopharynx, rectum, and vagina (Table 1). Overall, the nasopharynx is the most frequently infected site in the infant. Approximately 30-50 of infants born to Chlamydia-positive mothers will develop conjunctivitis (11-14). Studies in the 1980s identified C. trachomatis in 14-46 of infants younger than 1 month of age presenting with conjunctivitis. Chlamydia ophthalmia appears to occur much less frequently now secondary to systematic screening and treatment of pregnant women. The incubation period is 5-14 days after delivery. C. trachomatis is usually not detectable in the eye or nasopharynx immediately after birth unless there has been prolonged rupture of membranes. At least 50 of infants with...

Brain Plasticity under Cochlear Implant Stimulation

The benefit of cochlear implantation crucially depends on the ability of the brain to learn to classify neural activity evoked by the cochlear implant. Brain plasticity is a complex property with massive developmental changes after birth. The present paper reviews the experimental work on auditory plasticity and focuses on the plasticity required for adaptation to cochlear implant stimulation. It reviews the data on developmental sensitive periods in auditory plasticity of hearing, hearing-impaired and deaf, cochlear-implanted, animals. Based on the analysis of the above findings in animals and comparable data from humans, a cochlear implantation within the first 2 years of age is recommended.

Gonadal Toxicity Following Malignancy Treatment

Unlike male germ cells, female germ cells proliferate only during prenatal life after birth, these progressively decrease in number due to apoptosis, and ovulation. Germ cells inside the female gonad do not proliferate, whereas the somatic cells do. Radiation and chemotherapy induce oocytes to undergo apoptosis, which reduces the number of germ cells,18 resulting in estrogen insufficiency. Therefore, when follicles are destroyed by cytotoxic therapy, the frequency of menses decreases and amenorrhea commonly occurs. Irreversible ovarian failure and menopause occur if the number of follicles falls below that is required for menstrual cyclicity.

The Osteopathic Approach to Children with Seizure Disorders

The osteopathic approach has distinguishing features. First, the osteopathic physician examines the presenting problem of seizure disorder and the patient suffering from it as a dynamic unit of function, not as a case of epilepsy. The whole history, from the moment of conception to the present, is explored. The history covers events in the lives of the parents before birth, including during pregnancy as well as the duration, conduct, difficulty or ease of labor, and delivery. Trauma after birth, such as falls down stairs, off counters, scooters, or bicycles, out of trees, in sports, and any other untoward events are recorded. We are not only concerned with the major trauma, loss of consciousness, or fractures that parents rarely forget, but also with minor head injuries, a field that has received more and more attention in the last decade. A history of immunizations, the dates, and any reactions that followed are important and may contribute to the analysis of this problem. A high...

Historical Context

The main topic Walker addresses in Possessing the Secret of Joy is how the female genital mutilation ritual in a specific African tribe affects the mind, body, and spirit of its bicultural protagonist, her family, and her countries. However, it is necessary to note that Walker's literary representation of FGM applies to only a small percentage of African tribes and that the surgical ritual is conducted in many different ways, in hospitals as well as in huts, for many different reasons. For these general purposes, the procedure is more descriptively called female genital cutting (FGC) because, by degree, it ranges from a slight ceremonial nicking of the clitoris to draw blood to the more radical excision (removing some or all of the outer genitals) and infibulation (sewing up the vagina and leaving a small opening for urination and menstrual flow). The ritual's end result spans the gamut from a proud youth who has experienced a spiritual initiation into adulthood and elevated tribal...

Male Involvement with Infants

Male-infant interactions are weakly developed among prosimians, and in these primitive primates, male care more or less ( but not completely) coincides with monogamy (Vogt, 1984). Direct male care occurs in 7 out of 17 genera, including one of the most primitive of all lemurs, the nest-building ruffed lemur (Lemur variegatus), where the male diligently tends the nest while the mother forages (personal communication from Patricia Wright). Among New World monkeys, 12 of 16 genera (Vogt, 1984) or, calculated differently, 50 of all species (Wright, 1984) exhibit direct male care, often with the male as the primary caretaker. That is, shortly after birth, an adult male often with the help of various immatures in the group or other males will take the infant, carry it (or them, in the frequent case of twins) on his back, share food with infants, either adult males or juveniles may catch beetles to feed them, or assist them by cracking the casing of tough fruit.

Age and Gender Related Differences

Many studies report higher BNP and NT-proBNP concentrations in women, and a concurrent increase with age in both genders (see Fig. 4 8,12,19-22). This variation by age and gender is mediated in part by mild renal impairment, left ventricular hypertrophy, and abnormal systolic and diastolic cardiac function (22). Nevertheless, studies that excluded subjects with any measurable renal dysfunction and even subtle evidence of diastolic dysfunction have shown age and gender differences in BNP and NT-proBNP to remain. The physiological basis for these differences is not yet clearly defined. However, observations from several settings provide some clues as to potential contributors. For example, there are no significant variations in BNP plasma concentrations throughout the menstrual cycle (23). However, increased plasma BNP levels have been reported in the last trimester of pregnancy and in the immediate puerperium (24). In healthy neonates, BNP and NT-proBNP concentrations are much higher...

Embryonic Development

Embryonic and Postnatal-Lethality in MX MII Double Deficient Mutant Although it is widely assumed that cell surface carbohydrates play a significant role in mammalian embryonic development, the first evidence for this hypothesis came from the GnT-I gene knockout mouse, which dies at early embryonic stages (65,66). We generated MII MX double-null mutant mice by crossing MII- and MX-null mice. All double-null embryos survived until E15, but some double nulls died between E15 and the day of birth (E18). The majority of double nulls died soon after birth, with many double-null neonates dying after gasping for air at birth, suggesting that neonatal lethality is due to respiratory failure (69). 2. Glycosylation Enzymes Essential for Embryonic Development GnT-I nulls die in utero around embryonic day 10 (65,66). GnT-II nulls show genetic background-dependent postnatal lethality 1-4 weeks after birth (67,68). For example, GnT-II nulls back-crossed to C57 BL6 strain died in 4 weeks, while One...

Type Natriuretic Peptide

Ventricular synthesis of ANP is high in late fetal and early neonatal life but is rapidly reduced within the first few weeks after birth (30,31). Volume or pressure overload of the cardiac ventricles, leading to ventricular hypertrophy, is associated with ventricular reexpression ofthe gene for ANP (32). In fact, expression ofthe genes encoding ANP and BNP is considered a reliable marker ofthe hypertrophic program in experimental models associated with ventricular hypertrophy. The predominant stimulus for ANP release appears to be myocyte stretch, rather than transmural pressure load (33) (Table 2). In vivo, plasma ANP levels increase rapidly in response to pressure as well as volume loading (34-36),

Obstetric And Developmental Effects

Indirect effects of maternal cocaine use include negative health consequences for mothers, which then impact their pregnancies. Women using cocaine are more likely to suffer arrhythmias, cardiac ischemias, and hemor-rhagic strokes. In addition, they may develop pregnancy complications similar to preeclampsia, including hypertension, headaches, blurred vision, and placen-tal abruption, as well as vascular damage and uterine vasoconstriction, leading to problems such as spontaneous abortion and premature delivery (Church & Subramanian, 1997). Poor maternal weight gain and increased energy demands are another common effect of cocaine use in pregnant women, often leading to decreased birthweights and poorer prenatal nutrition (Church et al., 1991).

Laboratory Diagnosis Of Congenital Toxoplasmosis

With HIV or whose anti-Toxoplasma therapy is begun perinatally or soon after birth. Such treatment, if it is begun early in infection, reduces antigenic challenge by killing tachyzoites, thus blunting antibody synthesis. Serological rebound occurs in a majority of such infants 2-6 months following cessation of therapy (49-53). Typically, once established the Toxoplasma IgG titer will remain positive for life. Congenitally infected infants who have rapidly progressive HIV-1 disease may not be able to synthesize Toxoplasma-specific antibodies (38).

Annexins And Diabetes

Further evidence for a role of annexins in diabetes comes from one study of a heterozygous annexin 7 knock-out mouse. In this study the annexin 7 null mouse was found to be embryonic lethal at day 10 but the heterozygote was viable and fertile. The heterozygous mice have enlarged islets of Langerhans with an 8-10 fold increase in vesicle insulin content at 6 weeks after birth. Abnormal calcium-mediated insulin secretion was observed in heterozygotes with a reduction in insulin secretion of 67 at 1mM Ca2+, and a higher level of secretion at high calcium concentration 5mM Ca2+. This was attributed to a decrease in the amount of IP3 receptors in the heterozygotes that was confirmed by electron microscopy (Srivastava, 1999). These results however have not been reproduced in another annexin 7 knockout mouse which appears to have no defects in insulin metabolism

Ophthalmia Neonatorum

It is important to realise that in the early part of this century, a large proportion of the inmates of blind institutions had suffered from ophthalmia neonatorum. The disease affects primarily the conjunctiva and cornea and is the result of infection by organisms resident in the maternal birth passage. The gonococcus was the most serious cause of blindness but a number of other bacteria have been incriminated, including staphylococci, streptococci and pneumococci. It has also been shown that chlamydial infection of the genital tract can lead to the same problem, as can infection by the herpes simplex virus. The blindness that resulted from this condition was so serious that any excessive discharge from the eyes has been a notifiable disease in this country since 1914. Ophthalmia neonatorum is caused by unhygienic conditions at birth and its relative rarity nowadays is because of the fact that midwives are trained to screen for the condition. Bacterial conjunctivitis usually occurs...

Clinical Evaluation Of Infant

Babies whose mothers have the onset of rash in the high-risk period (4 days before to 2 days after delivery) do not need any particular diagnostic workup, but they should be given VZIG as soon as possible after birth. About 50 will nevertheless develop varicella, which is usually mild. A small percentage, however, may develop more severe varicella and require antiviral therapy. Treatment for these infants must be individualized carefully with close follow-up. It is preferable to overtreat in the sense of administering intravenous acyclovir to babies who may not turn out to need it rather than to withhold medication until an infant has developed full-blown disseminated varicella, which may be rapidly fatal. Infants with possible severe varicella should have a complete blood cell count, liver chemistries, and a chest x-ray at the bare minimum. A lumbar puncture is usually not indicated. Skin lesions that appear to be caused by varicella may be cultured for virus, tested for VZV antigens...

Asad Ansaria Adriana Weinbergb

A minority of HHV-6 infections, 1-2 , are deemed to be acquired in utero based on the encounter of viral DNA in the cord blood and other studies (Adams et al., 1998 Hall et al., 2004 Weinberg et al., 2005). However, transmission occurs primarily after birth via infected oral secretions with variant B causes the majority of early childhood infections, which are symptomatic. During the first few months of life, actively transported maternal antibodies may play a role in protecting most newborns against HHV-6 and -7 infections, along with other currently unknown factors (Ohashi et al., 2001 Sugimoto et al., 2002). Maternal antibodies against HHV-6 decline by 5-7 months of life, after which the infants start acquiring HHV-6B infection rapidly. Half of them acquire the infection in the second 6 months of life with the peak occurring between 9 and 21 months of life. It is unclear when infection with HHV-6A occurs, as it is typically asymptomatic. Maternal antibodies...

Differentiation and Morphogenesis

Maturation of adult spinal cord motor neurons may involve NO (75). NO may also play a role in the development of proper patterns of connections in the retinotectal system, as NOS expression peaks at the time when refinement of the initial pattern of connections is occurring (76). Neurons of the developing olfactory epithelium during migration and the establishment of primary synapses in the olfactory bulb of rats express nNOS during embryonic development (77). Olfactory nNOS expression rapidly declines after birth and is undetectable by postnatal day 7. These obsevations reinforce the notion that nNOS induction is a manifestation of cellular processes essential for neuronal cell differentiation. In addition, nNOS expression is rapidly induced in regenerating olfactory receptor neurons after bulbectomy and is particularly enriched in their outgrowing axons. Thus, NO may play a role in activity-dependent establishment of connections in both developing and regenerating olfactory neurons.

Astrocytes

The role of astrocytes begins during brain development, when the radial astrocytes guide the migrating neurons. After birth, the astrocytes are important in a number of physiologic processes They provide support and nutrients to the neurons, protect them from excitotoxic neurotransmitters, contribute to the blood-brain barrier, and maintain homeostasis in the extracellular compartment.

Benign Tumours

Seen as a red strawberry mark at or shortly after birth, this lesion can regress completely during the first few years of life. Figure 5.13 shows a gross example of the rare cavernous haemangioma, which might be disfiguring. This also can regress in a remarkable way. Port wine stain is the name applied to the capillary haemangioma. This is usually unilateral and when the eyelids are involved, there is a risk of association with congenital glaucoma, haeman-gioma of the choroid and haemangioma of the meninges on the ipsilateral side (Sturge-Weber syndrome). Children with port wine stains involving the eyelids need full ophthalmological and neurological examinations.

Anatomy

The hymen is the tissue that partially or completely surrounds the opening of the vagina. It appears that all females have hymenal tissue present at birth (91). The hymen may be annular (encircling the vaginal opening), cres-centic (present at the lateral and posterior margins), fimbriated (frilly edged), or, usually after childbirth, present only as interrupted tags or remnants. It is important that the reader refer to atlases that illustrate these variations (2,92). There is usually a single opening in the hymen. Uncommon congenital variants include two or more hymenal openings, referred to as septate or cribriform, respectively, and, rarely, complete absence of an opening (imperforate hymen).

Maternal varicella

At any stage during pregnancy, chickenpox may cause intrauterine infection. Maternal varicella resulting in viremia may transmit the virus into the fetus by either transplacental spread, or by ascending infection from lesions in the birth canal (Birch et al., 2003). Furthermore, direct contact or respiratory droplet can lead to infection after birth. The consequences for the infant depend on the time of maternal disease. They range from asymptomatic infection to fetal loss especially in case of severe maternal disease. Pregnant women who contract varicella are at risk Congenital varicella syndrome (risk 2 , mortality 30 ) Maternal pneumonia (risk 10-20 , mortality 10-45 ) Neonatal varicella at ages 10 (-12) days (risk 20-50 , mortality 0 ) Neonatal varicella 0-4 days after birth (risk 20-50 , mortality 0-3 ) neonatal varicella 5-10 (-12) days delivery after birth (risk 20-50 , mortality 20-25 ) No risk for severe maternal, fetal or neonatal infections

Germ Cell Tumors

After the development of puberty, while ovarian GCTs in females can occur anytime after birth and are much more common in preadolescents. Genetic analysis of ovarian GCTs that present in the second decade of life reveal isochromosome 12p, the characteristic cytogenetic abnormality found in testicular GCT 1315 . Biologic studies from early co-operative pediatric GCT trials showed that such cytogenetic aberrations were age-dependent. Chromosome I(12p) abnormality has been reported 16 in tumors from pubertal and postpubertal males, but the most common abnormalities in prepubertal females in order of prevalence were gains of 1q, +14, +8, +12, +2, +3, and +7.

Case Description

This 7-yr-old boy was evaluated in the Endocrinology Clinic because of precocious sexual development and, as his legal guardian described, behavioral problems at school. The patient, an orphan living in a foster home, was brought to the clinic by his foster mother who was concerned about his precocious sexual development and behavior. The patient had been born of a full-term delivery in a Los Angeles hospital, and was healthy at birth. Shortly after birth, he was placed in a foster home because of the incarceration of his mother. The whereabouts of his father are not known. Until 1 yr prior to his clinic visit, his growth had been normal in comparison to other children at the foster home. In the year preceding the visit, he started to develop facial hair, phallic growth, and acne on his face. Also, he started to masturbate and his foster parent was concerned about his excessive attention to girls in his classroom. His grades at school deteriorated over the previous year. He did not...

Fetal Growth

Many LBW infants do not catch up after birth even with adequate nutrition after birth, most will be shorter than average for the rest of their lives, and many show long-term impairments in intellect and mental development. In addition, LBW infants tend to have more chronic health problems in later life. Thus, poor nutrition in utero may have profound effects that cannot be reversed after birth. A multivitamin mineral supplement taken during pregnancy may decrease risk of delivering a LBW infant.3

Neonatal Immunity

Neonatal mammals are protected from infection by maternally produced antibodies transported across the placenta into the fetal circulation and by antibodies in ingested milk transported across the gut epithelium of newborns by a specialized process known as transcytosis. Neonates lack the ability to mount effective immune responses against microbes, and for several months after birth, their major defense against infection is passive immunity provided by maternal antibodies. Maternal IgG is transported across the placenta, and maternal IgA and IgG in breast milk are ingested by the nursing infant. The transepithe-lial transport of maternal IgA into breast milk depends on the poly Ig receptor described in Chapter 13. Ingested IgA and IgG can neutralize pathogenic organisms that attempt to colonize the infant's gut, and ingested IgG antibodies are also transported across the gut epithelium into the circulation of the newborn. Thus, a newborn contains essentially the same IgG antibodies...

Glycogenoses

In infants, the disease manifests soon after birth with progressive muscle weakness and firmness, cardio-myopathy, and macroglossia. Death, usually from cardiac failure, occurs within 1 to 2 years. A myopathic EMG pattern and the presence of discrete cytoplasmic vacuoles in the circulating lymphocytes are helpful diagnostic clues. The neuronal glycogen storage is ubiquitous and particularly prominent in the spinal cord and brain stem. Astrocytes store glycogen in the cerebral hemispheric white matter (Fig. 9.9).

Vitamins

Vitamin K is important during the newborn period for normal blood clotting. However, the infant requirement for vitamin K cannot be met by usual levels in breast milk. Poor vitamin K status can lead to hemorrhagic disease of the newborn. Therefore, to prevent bleeding problems and provide adequate body stores, newborns often receive a single dose of 0.5-1 mg of vitamin K soon after birth.

AtRisk Groups

Pneumonia can occur in up to 10 of pregnant women with chicken pox, and the severity is increased in later gestation (34). They can also transmit infection to the unborn baby (35). If infection is acquired in the first 20 weeks, there is a less than 3 chance of it leading to congenital Varicella syndrome. Infection in the last trimester can lead to neonatal Varicella, unless more than 7 days elapse between onset of maternal rash and delivery when antibodies have time to cross the placenta leading to either mild or inapparent infection in the newborn. In this situation, Varicella immunoglobulin (VZIG) should be administered to the baby as soon as possible after birth (36).

Cell Division

Cell proliferation and differentiation may coexist at a given time. The relative activity of cell proliferation and differentiation is dependent on the stage of development. During the embryonic and fetal stages, the two processes occur simultaneously. The differentiation of embryonic stem cells gives rise to various types of specialized cells for various tissue and organ systems, whereas the proliferation of a specialized cell type contributes to cell multiplication and the construction of a specialized tissue and organ. After birth, the activity of cell differentiation is relatively reduced, while cell proliferation remains prominent for tissue and organ growth. After reaching maturation, both cell differentiation and proliferation are reduced significantly. However, a basal level of cell proliferation and differentiation remains for the replacement of malfunctioned, lost, or aging cells. Although cell proliferation and differentiation result in different cell fates, both undergo a...

Followup

The prognosis of infants with congenital syphilis has not been well studied, but it should be excellent if neonates are identified soon after birth and are provided with effective penicillin therapy early in infancy. Infants treated for early congenital syphilis are at risk of developing such late complications or sequelae as hypopituitarism (62), interstitial keratitis, and teeth as well as bone and joint abnormalities (25).

Lacrimal Obstruction

The watering of one or both eyes soon after birth is a common problem. The obstruction is normally at the lower end of the nasolacrimal duct, where a congenital plug of tissue remains. Infection causing purulent discharge can be treated effectively by the use of antibiotic drops. Although these should clear the unpleasant discharge, the eye continues to water as long as the tear duct is blocked. The mother can be shown how to massage the tear sac. This manoeuvre causes mucopurulent material to be expressed from the lower punctum when there is a blockage and can be used as a diagnostic test. If carried out regularly, this helps to relieve the obstruction. In most cases, spontaneous relief of the obstruction occurs, but if this does not occur after about six to nine months, probing and syringing of the lacrimal passageway under general anaesthesia is an effective procedure, which can be done as a day case. It is important to remember that a watering eye can be caused by excessive...

Conclusion

In the United States, TB continues to be a problem, especially among recent immigrants from high-risk countries and persons who have been in contact with adults with contagious disease. Congenital TB, tuberculosis acquired prior to birth, is quite rare. Transmission to infants after birth, either from the mother or other contagious household contacts, is more common. The diagnosis may be difficult, and a high index of suspicion as well as awareness of the risk factors and presenting symptoms are important. The presentation of TB in infants may be similar to other more common infections, and currently available diagnostic tests have low sensitivity in children. Diagnosis is often based on the clinical presentation of the infant coupled with finding TB disease in the mother or other close contacts. Tuberculosis may be rapidly progressive and life threatening to infants and young children. Therefore, when contagious pulmonary disease is diagnosed in an adult who has contact with...

Diagnostic Approach

Routine screening of neonates is not clinically justified based on the available evidence that many healthy neonates may be colonized without consequence. However, if there is clinical, radiologic, or laboratory evidence of pneumonia, meningitis, or overall instability suggestive of sepsis, particularly in preterm neonates in whom there are no obvious alternative etiologies, infection with M. hominis or Ureaplasma spp should be considered, and appropriate diagnostic studies should be obtained. It may also be useful to assess preterm neonates whose birth weight is less than 1250 g for the presence of ureaplasmas if they have respiratory distress that lasts more than a few hours after birth. Obtaining mycoplasmal cultures is particularly important if routine bacteriological studies fail to yield an etiologic agent within 2-3 days.

Galactosemia

The disease presents soon after birth with prolonged jaundice, vomiting, diarrhea, hepatomegaly, and anemia. Untreated patients develop ocular, neurologic, visceral, and metabolic disorders hepatomegaly progressing to nodular cirrhosis kidney dysfunction hypoglycemic episodes and lenticular cataract. Mental retardation, seizures, extrapyramidal and cerebellar symptoms, and microcephaly are chief neurologic features. The dietary elimination of galactose (lactose-containing products) prevents the development of complications, provided it is initiated a few days after birth and continued throughout life.

Hyperammonemia

Hyperammonemia presents shortly after birth with lethargy, vomiting, alkalosis, temperature abnormalities and, if not treated, death ensues from cerebral edema. Partial enzyme deficiencies are prone to cause episodic encephalopathies that can be precipitated by high protein intake, infection, and treatment with valproate.

The Future

Medical Success and a Setback with SCID Relevance Children with severe combined immunodeficiency disease (SCID) show an almost 20.1 complete failure to fight infection and die soon after birth if not kept in sterile conditions. SCID is more widely known as bubble boy disease because confinement to a germfree plastic bubble was the way in which patients were kept alive for a number of years. One rare form of SCID, caused by a failure to make an enzyme called adenosine deaminase, can be treated by regular injections of recombinant protein (page 149). In 1990 the first trial of a genetic therapy began at the National Institutes of Health in Washington. White blood cells from patients were transfected with a plasmid encoding adenosine deaminase, which inserted into random positions in the genome and began to be transcribed. Although the therapy does seem to have helped the patients, they still need to be periodically injected with recombinant adenosine deaminase.