ALTHOUGH carefully controlled studies have shown that a clean voided sample of urine may be reliably obtained in more than three fourths of newborn and older infants of both sexes,1,2 our experience has been that when used routinely in the newborn nursery, clean voided urine specimens may give erroneous bacteriological results. Because we have been reluctant to catheterize newborn infants, we fortunately confirmed that under certain specific conditions infants urinate upon eliciting the Perez reflex.3 This led us to the use of this reflex in obtaining midstream urine specimens for bacteriologic investigation. Methods and MaterialsWe studied 153 infants, 87 boys and 66 girls, between the first and fourth days of life. All infants were born at the University of Kentucky Hospital. Clean voided specimens were collected as follows :The nursery nurses were instructed to cleanse the genitalia by scrubbing the prepuce and glans penis in the boy and the perineum and vulva in the girl with undiluted hexachlorophene detergent (pHiso-Hex) for approximately one minute. Sterile water was then applied with a cotton swab in single strokes; sterile water washings were repeated six times and then the area was dried with a sterile cotton swab. A sterile, commercially available plastic pediatrie urine collector was then applied. If infants had not voided within four hours, the nurses were instructed to remove the urine collector and apply a new one after renewed scrubbing.Fifty-five infants who demonstrated over 1,000 colonies of bacteria per milliliter in the clean-voided urine culture were restudied the following day. How¬ ever, in these infants repeat urines were collected using the "midstream catch" technique. Just after a feeding and before voiding had occurred, each infant was cleansed as before and held face down in the investigator's hand (Fig 1). We then elicited the spinal reflex by stroking the back along the paravertebral group of muscles (Fig 2), causing extension of the back and flexion of the legs (Fig 3). Upon repetitive elicitation of this reflex, urina¬ tion occurred within five minutes in the majority of cases. The midportion of the stream was aimed into a sterile cup (Fig 4). After voiding, the urine specimens were placed in the refrigerator and within four hours treated in the following manner: Each specimen was cul¬ tured on a blood agar plate, and two trypticase soy agar pour plates, one containing a 1:100 dilution of urine and the other, a 1:1,000 dilution of urine, using the technique of Pryles et al.* These plates then incubated at 37 C overnight (or from 15 to 20 hours). Identification of all bacteria was made by examination of the blood agar plate. If specific identification could not be made, colonies were transferred to eosin-methylene blue media from which identification was made. Bacterial colony counts were reported as the number of colonies per milliliter of urine.
We have attempted to use perinatal islet performance as an index of the impact of maternal fuels during fetal development. Accordingly, we analyzed cord plasma for C-peptide and amniotic fluid (secured several weeks before delivery) for immunoreactive insulin in infants of mothers with normal metabolism (NM), gestational diabetes (GDM), and tightly regulated White Class B or Class C insulin-dependent diabetes mellitus (IDDM). We tried to subdivide mothers with GDM on the basis of severity by distinguishing between those with fasting plasma glucose within the normal range for pregnancy (i.e., less than 105 mg/dl and those with fasting plasma glucose of 105 mg/dl or greater). Most of the latter were treated with insulin whereas the former received diet alone. We found that cord plasma levels of C-peptide in infants of mothers with GDM < 105, GDM ≥ 105, and IDDM did not differ significantly from one another; all were approximately twofold greater than in infants from mothers with NM. Values for insulin and ratios of insulin/glucose in amniotic fluid were also increased and to a similar degree in all three diabetic groups; all exceeded the findings in the NM group. Our results indicate that islet function is enhanced at birth in the offspring of mothers with even the mildest forms of untreated gestational diabetes (i.e., GDM < 105) to a degree that is not appreciably different than in more severe forms of diabetes receiving tightly regulated insulin therapy. The augmented B-cell secretion cannot be ascribed to intrapartum events, since similar changes were also found in amniotic fluid secured several weeks before delivery. We conclude that neonatal insulin secretion may constitute an exquisitely sensitive index of the effects of ambient fuels during intrauterine life. Neonatal B-cell function thereby may provide a useful yardstick for the retrospective evaluation of maternal glucoregulation during late gestation.
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