The Immunity of the Human Foetus and Newborn Infant

The motive to prepare this volume on antibiotics for the physician caring for women was based upon the editor's perception that the subject matter had never been fully developed for the obstetrician-gynecologist. Most textbooks of infectious disease have a small section devoted to antibiotics, which has little relevance for the physician caring for post-operative or post-partum infections. Basic antibiotic pharmacology is described and there is a reflex prohibition of antibiotics for the pregnant woman. Correctly, the reader assumes that the authors themselves do not care for women with bacterial infections of the pelvis. Recent texts in infectious disease in obstetrics­ gynecology have been little better. Although the focus has been more clini­ cally oriented, space requirements have too often kept the discussions at a superficial level. A total focus upon antibiotics in this volume eliminates the restraints of space in prior publications. The greatest reward in my task as editor of this volume is related to the quality of the individual authors. They range from former students, to con­ temporary colleagues, to respected peers in infectious disease. Since the quality of this volume is related to the sum total of the individual chapters, I wish to comment about each of the contributors. Philip Mead from the University of Vermont is an old friend, who brings to the question of prophylactic antibiotics, his wide clinical experience and encyclopedic knowledge. Introduction - what is ontogenesis? 9 Ontogenesis of immunity of the human foetus 12 Development of the cellular substrate of the immune system ... 13 . Development of the lymphatic system ... 14 . . Synthesis of immunologically active proteins - the complement components and immunoglobulins - in the foetal period 18 Complement components ... 18 . Immunoglobulin synthesis ... 23 . B lymphocytes with surface membrane immunoglobulins ... 26 Transmission of antibodies anrl immunoglobulins from mother to foetus 29 Transplacental transmission of specific antibodies ... - 29 Transplacental transmission of immunoglobulins ... 33 Physiological conditions for the transmission of immunoglobulins from mother to foetus ... 36 ... Mechanism of transplacental transmission of IgG ... 39 . Role of the Fe fragment of the IgG molecule and of cell receptors in the transplacental transmission of IgG ... 42 Antibacterial mechanisms of the amniotic fluid ... 45 . . Ontogenesis of the foetus's cellular immunity ... 4 7 Incidence in the foetus of T lymphocytes forming spontaneous E rosettes 48 Functional activity of the T cell system ... 49 . . Response offoetallymphocytes to phytohaemagglutinin (PHA) stimulation in vitro ... 49' ... Proliferative response of foetal lymphocytes to stimulation by allogenic cells in mixed lymphocyte cultures ... 51 . . Effector activity of foetal lymphocytes - cytotoxicity ... 52 Chronological survey of the commencement of foetal immunocompetence 53 Immunity of the physiological neonate Natural (nonspecific) neonatal immunity ... 61 th th st. On December 19,20 and 21 1979, we had the opportunlty to organize a Workshop on'Antenatal factors affecting meta­ bolic adaptation to extrauterine life - Role of carbohydra­ tes and energy metabolism'. This meeting was made possible thanks to grants from the Committee of Medical Research and Public Health (CRM) of the Commission of European Communi­ ties. We want to express our warmst gratitude for the effort that has been made and we hope that the exchange of information between the participants will allow better understanding of the mechanism of adaptation to extrauterine life and that the conclusions drawn will contribute to a better care of the newborn. Adaptation to extrauterine life is one of the most impor­ tant steps in life. At the moment of birth, numerous conditions are drastically changed and in order to survive the newborn has to rely upon new sources of energy and of substrates. This switch over has to occur smoothly and any adaptation failure will result in the disturbance of impor­ tant metabolic functions. Mortality and morbidity in neo­ natal period remain still very high in comparison with the figures observed later in life; the reduction of mortality has been much more important in child and adult than in neonates. Front Matter....Pages 1-8 Introduction — What is Ontogenesis?....Pages 9-11 Ontogenesis of Immunity of the Human Foetus....Pages 12-59 Immunity of the Physiological Neonate....Pages 60-162 Immunity of the High Risk, Pathological Neonate....Pages 163-213 Back Matter....Pages 214-257 Sponsored By The Commission Of The European Communities, As Advised By The Committee On Medical And Public Health Research ; R. De Meyer, Editor. Includes Bibliographies.