Long-wave sensitivity in deep-sea stomiid dragonfish with far-red bioluminescence: evidence for a dietary origin of the chlorophyll-derived retinal photosensitizer of Malacosteus niger

Both residual downwelling sunlight and bioluminescence, which are the two main sources of illumination available in the deep sea, have limited wavebands concentrated around 450-500 nm. Consequently, the wavelengths of maximum absorption (lambdamax) of the vast majority of deep-sea fish visual pigments also cluster in this part of the spectrum. Three genera of deep-sea loose-jawed dragonfish (Aristostomias, Pachystomias and Malacosteus), however, in addition to the blue bioluminescence typical of most deep-sea animals, also produce far-red light (maximum emission >700 nm) from suborbital photophores. All three genera are sensitive in this part of the spectrum, to which all other animals of the deep sea are blind, potentially affording them a private waveband for illuminating prey and for interspecific communication that is immune from detection by predators and prey. Aristostomias and Pachystomias enhance their long-wave visual sensitivity by the possession of at least three visual pigments that are long-wave shifted (lambdamax values ca. 515, 550 and 590 nm) compared with those of other deep-sea fishes. Malacosteus, on the other hand, although it does possess two of these red-shifted pigments (lambdamax values ca. 520 and 540 nm), lacks the most long-wave-sensitive pigments found in the other two genera. However, it further enhances its long-wave sensitivity with a chlorophyll-derived photosensitizer within its outer segments. The fluorescence emission and excitation spectra of this pigment are very similar to spectra obtained from mesopelagic copepods, which are an important component of diet of Malacosteus, suggesting a dietary origin for this pigment.

Tone abnormalities are associated with maternal cigarette smoking during pregnancy in in utero cocaine-exposed infants

OBJECTIVE

Maternal cigarette smoking, alcohol use, and other factors confound studies of in utero cocaine exposure. Our goal was to determine whether in utero cocaine exposure is associated with an abnormal neurologic examination in infants, while controlling for concomitant cigarette smoke exposure and other confounding variables.

DESIGN

Healthy newborns with birth weights > or =2000 g were prospectively enrolled into a race-matched study of cocaine-exposed and cocaine-unexposed infants. Urine and meconium samples were analyzed for illicit drugs, the cocaine metabolite, benzoylecgonine, and the nicotine metabolite, cotinine. A detailed neurological examination was performed at approximately 6 weeks of age by an examiner blinded to history.

RESULTS

At 6 weeks of age, 40 cocaine-exposed infants and 56 cocaine-unexposed infants were examined. Tone abnormalities were the only neurologic abnormalities discovered, predominantly generalized hypertonia. Logistic models found that maternal urine cotinine levels were predictive of an abnormal neurologic examination, whereas cocaine exposure or benzoylecgonine levels were not. No interaction was found between maternal cigarette smoking and cocaine exposure. Race, ethanol exposure, prenatal care, homelessness, and head circumference were not predictive of an abnormal tone examination. The odds ratio for an abnormal examination was 2.9 (95% confidence interval: 1.04-8.25), if the maternal urine cotinine level was >200 ng/mL.

CONCLUSION

Our findings suggest that maternal cigarette smoking may be the major predictor of tone abnormalities reported in cocaine-exposed infants.

Visual pigments, cone oil droplets and ocular media in four species of estrildid finch

A microspectrophotometric study was conducted on the retinal photoreceptors of four species of bird: cut-throat finches (Amadina fasciata), gouldian finches (Erythrura gouldiae), white-headed munias (Lonchura maja) and plum-headed finches (Neochmia modesta). Spectral characteristics of the photoreceptors in all four species were very similar. Rods contained a medium-wavelength-sensitive visual pigment with a wavelength of maximum absorbance at 502-504 nm. Four spectrally distinct types of single cone contained a visual pigment with wavelength of maximum absorbance at either 370-373 nm (ultraviolet-sensitive), 440-447 nm (short-wavelength-sensitive); 500 nm (medium-wavelength-sensitive) or 562-565 nm (long-wavelength-sensitive). Oil droplets in the ultraviolet-sensitive single cones showed no detectable absorption between 330 nm and 800 nm. Oil droplets in the short-, medium-, and long-wavelength-sensitive single cones had cut-off wavelengths at 415-423 nm, 510-520 nm and 567-575 nm, respectively. Double cones contained the visual pigment with wavelength of maximum absorbance at 562-565 nm observed in long-wavelength-sensitive single cones. Only the principal member of the double cone pair contained an oil droplet (P-type, cut-off wavelength at 414-489 nm depending on species and retinal location). Spectral transmittance of the intact ocular media of each species was measured along the optic axis. Wavelengths of 0.5 transmittance for all species were very similar (316-318 nm).

Visual pigments, oil droplets, ocular media and cone photoreceptor distribution in two species of passerine bird: the blue tit (Parus caeruleus L.) and the blackbird (Turdus merula L.)

The spectral absorption characteristics of the retinal photoreceptors of the blue tit (Parus caeruleus) and blackbird (Turdus merula) were investigated using microspectrophotometry. The retinae of both species contained rods, double cones and four spectrally distinct types of single cone. Whilst the visual pigments and cone oil droplets in the other receptor types are very similar in both species, the wavelength of maximum sensitivity (lambda(max)) of long-wavelength-sensitive single and double cone visual pigment occurs at a shorter wavelength (557 nm) in the blackbird than in the blue tit (563 nm). Oil droplets located in the long-wavelength-sensitive-single cones of both species cut off wavelengths below 570-573 nm, theoretically shifting cone peak spectral sensitivity some 40 nm towards the long-wavelength end of the spectrum. This raises the possibility that the precise lambda(max) of the long-wavelength-sensitive visual pigment is optimised for the visual function of the double cones. The distribution of cone photoreceptors across the retina, determined using conventional light and fluorescence microscopy, also varies between the two species and may reflect differences in their visual ecology.

Retinal asymmetry in birds

Vertebrate sensory systems are generally based on bilaterally symmetrical sense organs. It is evident, nevertheless, that birds preferentially use either their left or right eye for viewing novel or familiar stimuli [1], and perform visual discrimination tasks under monocular viewing conditions better with one eye than with the other [2] [3]. Because of the nearly complete contralateral decussation of the optic nerves in birds [4], it has been assumed that this division of labour is due solely to cerebral hemispheric specialisation, generated as a result of uneven photostimulation of the eyes of the developing embryo during the last three or four days before hatching [5] [6]. Here, however, we present evidence that in the European starling, Sturnus vulgaris, even the retinae are morphologically asymmetrical in terms of photoreceptor distribution. This is the first evidence for such asymmetry in any bird and suggests that retinal photoreceptor composition should be assessed during studies involving the lateralisation of visually mediated behaviours.

Spectral sensitivity of vision and bioluminescence in the midwater shrimp Sergestes similis

In the oceanic midwater environment, many fish, squid, and shrimp use luminescent countershading to remain cryptic to silhouette-scanning predators. The mid-water penaeid shrimp, Sergestes similis Hansen, responds to downward-directed light with a dim bioluminescence that dynamically matches the spectral radiance of oceanic down-welling light at depth. Although the sensory basis of luminescent countershading behavior is visual, the relationship between visual and behavioral sensitivity is poorly understood. In this study, visual spectral sensitivity, based on microspectrophotometry and electrophysiological measurements of photoreceptor response, is directly compared to the behavioral spectral efficiency of luminescent countershading. Microspectrophotometric measurements on single photoreceptors revealed only a single visual pigment with peak absorbance at 495 nm in the blue-green region of the spectrum. The peak electrophysiological spectral sensitivity of dark-adapted eyes was centered at about 500 nm. The spectral efficiency of luminescent countershading showed a broad peak from 480 to 520 nm. Both electrophysiological and behavioral data closely matched the normalized spectral absorptance curve of a rhodopsin with lambda(max) = 495 nm, when rhabdom length and photopigment specific absorbance were considered. The close coupling between visual spectral sensitivity and the spectral efficiency of luminescent countershading attests to the importance of bioluminescence as a camouflage strategy in this species.

Visual pigments, cone oil droplets, ocular media and predicted spectral sensitivity in the domestic turkey (Meleagris gallopavo)

A microspectrophotometric survey conducted on the retinal photoreceptors of the domestic turkey (Meleagris gallopavo) revealed the presence of five different types of vitamin A1-based visual pigment (rhodopsin) in seven different types of photoreceptor. A single class of rod contained a medium wavelength-sensitive visual pigment (wavelength of maximum absorbance, lambda max, 504 nm). Four different types of single cone contained visual pigment maximally sensitive to wavelengths in either the long (LWS, lambda max 564 nm), medium (MWS, lambda max 505 nm), short (SWS, lambda max 460 nm) or violet (VS, lambda max 420 nm) spectral ranges. The LWS, MWS and SWS single cones contained pigmented oil droplets with cut-off wavelengths (lambda cut) at 514, 490 and 437 nm, respectively. The VS single cone contained a transparent oil droplet which displayed no significant absorbance above 330 nm. A single class of double cone was also identified, both the principal and accessory members of which contained the LWS cone visual pigment. The principal member contained an oil droplet with a lambda cut at 436 nm. No oil droplet was observed in the accessory member. The use of a glycerol-based cell mountant, which reduced wavelength dependent measurement artefacts in the microspectrophotometric measurements, is described. Predictions of cone effective spectral sensitivity, incorporating measurements of the spectral transmission of the ocular media, suggest that turkeys have considerable sensitivity to wavelengths in the ultraviolet-A (UV-A, 315-400 nm) spectral range. This has implications for both the visual ecology of wild birds and the welfare of intensively farmed individuals.

Proton MR spectroscopy for the evaluation of brain injury in asphyxiated, term neonates

BACKGROUND AND PURPOSE

Neurologic and developmental outcomes of asphyxiated, term neonates are difficult to predict applying clinical or laboratory criteria. In this study, we investigated the association of MR spectroscopy (MRS) results with neurodevelopmental status at age 12 months.

METHOD

Thirty-one term neonates, who were enrolled in a prospective study of the utility of MR imaging for the determination of neurologic and developmental status, underwent single-voxel proton MRS of the basal nuclei and intervascular boundary zones. Ratios of lactate, choline, creatine, and N-acetylaspartate (NAA) peaks were calculated and tested for association with neuromotor scores and Mental Development Index of the Bayley Scores of Infant Development obtained at age 12 months.

RESULTS

Elevated lactate and diminished NAA were the most common findings in infants with neurologic and developmental abnormalities at age 12 months. Although many ratios had statistically significant associations with outcome (P<.05), the highest significance was obtained with lactate/choline ratios in the basal nuclei. A false-positive finding was seen in a patient who was born after a 36-week gestation period (high lactate/choline but normal neurodevelopmental status at 12 months) and in three patients with apparent watershed injury (high watershed lactate/choline but normal neurodevelopmental status at 12 months). A false-negative MRS finding (normal lactate/choline but abnormal outcome) was seen in a patient who had an apparent prenatal injury.

CONCLUSION

Proton MRS appears to be a useful tool for assessing brain injury in neonates who have suffered hypoxia or ischemia. Correlation with gestational age and imaging findings are essential for proper interpretation of the spectra. Patients with apparent watershed injuries may have normal neurodevelopmental status at age 12 months.

Enhanced retinal longwave sensitivity using a chlorophyll-derived photosensitiser in Malacosteus niger, a deep-sea dragon fish with far red bioluminescence

Through partial bleaching of both visual pigment extracts and cell suspensions we show that the deep-sea stomiid Malacosteus niger, which produces far red bioluminescence, has two visual pigments within its retina which form a rhodopsin/porphyropsin pigment pair with lambda max values around 520 and 540 nm, but lacks the very longwave sensitive visual pigments (lambda max > 550 nm) observed in two other red light producing stomiids. The presence of only a single opsin gene in the M. niger genome was confirmed by molecular and cladistic analysis. To compensate for its apparently reduced longwave sensitivity compared to related species, the outer segments of M. niger contain additional pigments, which we identify as a mixture of defarnesylated and demetallated derivatives of bacteriochlorophylls c and d, that are used as a photosensitiser to enhance its sensitivity to longwave radiation.

Suspension Feeding Adaptations to Extreme Flow Environments in a Marine Bryozoan

We describe the effects of extreme flow on the growth and morphology of a bryozoan, Membranipora membranacea, encrusting laminarian fronds in the Rapids of Lough Hyne (=Ine), County Cork, Ireland. An ultrasonic current meter was used to characterize ambient flow regimes at the level of the algal canopy over a complete tidal cycle at three sites within the Rapids. Colonies collected from sites exposed to different flows showed a trend towards miniaturization with increased flow: the zooids were less elongate, the lophophores were smaller in diameter and had fewer tentacles, and the distances between excurrent jets were shorter. These morphological changes probably place feeding surfaces into slower flow regimes of the boundary layer. Similar growth rates of colonies at sites differing in flow provide evidence that this miniaturization is adaptive and that bryozoans are capable of adopting appropriate morphological responses to varying environmental regimes. Such plasticity should be considered when assessing feeding from different flow regimes because particular colonies may be adapted to a limited and specific range of flow conditions.

Cocaine metabolite kinetics in the newborn

The study goal was to determine the half-life elimination of cocaine and benzoylecgonine (BZE) in the newborn. Three 0.3-mL blood samples were collected during the first day of life. Urine was collected once daily. Cocaine and BZE concentrations were determined by gas chromatography-mass spectrometry. An extraction method was developed for measuring low concentrations of cocaine and BZE in small (0.1 mL) blood samples. Cocaine had a half-life of 11.6 h in one subject. The half-life of BZE during the first day of life, based on blood data in 13 subjects, was 16 h (95% confidence interval [CI], 12.8 to 21.4 h). The half-life of BZE during the first week of life, based on urine data in 16 subjects, was 11.2 h (95% CI, 10.1 to 11.8 h). The novel extraction method for small blood sample volumes should be applicable to other basic drugs.

Management of extremely low birth weight infants: perceptions of viability and parental counseling practices

OBJECTIVE

To determine physician opinions, parental counseling, and medical practices for extremely low birth weight (LBW) infants.

METHODS

A retrospective survey was sent in August 1996 to 450 California physicians practicing obstetrics.

RESULTS

There was a 41% response rate. The mean thresholds for antenatal steroid administration, cesarean delivery for fetal distress and delivery room resuscitation were gestational age between 23 and 24 weeks and weight close to 500 g. Most obstetricians counsel parents regarding survival, resuscitation, and possible death in the delivery room before delivery of an extremely LBW infant. Just over 60% of obstetricians believe that parents have a role in deciding not to resuscitate an infant born at 22 weeks' gestation, this decreases to less than 50% at 24 weeks, and decreases further to less than 30% by 26 weeks' gestation. Just over 40% of obstetricians report their counseling is affected by pediatric opinion, 33% by previous maternal perinatal losses, and less than 20% by maternal drug use or lack of prenatal care, and young maternal age. Language barriers, parental education level, and family insurance affect treatment options in less than 10% of obstetricians.

CONCLUSION

Obstetric opinions about delivery room resuscitation of extremely LBW infants are influenced by birth weight and gestational age thresholds, infant, and parental factors. There is a limited willingness by physicians to allow a parental role in decision making in the delivery room for extremely LBW infants.

The eyes of deep-sea fish. I: Lens pigmentation, tapeta and visual pigments

Deep-sea fish, defined as those living below 200 m, inhabit a most unusual photic environment, being exposed to two sources of visible radiation; very dim downwelling sunlight and bioluminescence, both of which are, in most cases, maximal at wavelengths around 450-500 nm. This paper summarises the reflective properties of the ocular tapeta often found in these animals, the pigmentation of their lenses and the absorption characteristics of their visual pigments. Deep-sea tapeta usually appear blue to the human observer, reflecting mainly shortwave radiation. However, reflection in other parts of the spectrum is not uncommon and uneven tapetal distribution across the retina is widespread. Perhaps surprisingly, given the fact that they live in a photon limited environment, the lenses of some deep-sea teleosts are bright yellow, absorbing much of the shortwave part of the spectrum. Such lenses contain a variety of biochemically distinct pigments which most likely serve to enhance the visibility of bioluminescent signals. Of the 195 different visual pigments characterised by either detergent extract or microspectrophotometry in the retinae of deep-sea fishes, ca. 87% have peak absorbances within the range 468-494 nm. Modelling shows that this is most likely an adaptation for the detection of bioluminescence. Around 13% of deep-sea fish have retinae containing more than one visual pigment. Of these, we highlight three genera of stomiid dragonfishes, which uniquely produce far red bioluminescence from suborbital photophores. Using a combination of longwave-shifted visual pigments and in one species (Malacosteus niger) a chlorophyll-related photosensitizer, these fish have evolved extreme red sensitivity enabling them to see their own bioluminescence and giving them a private spectral waveband invisible to other inhabitants of the deep-ocean.

Switch in rod opsin gene expression in the European eel, Anguilla anguilla (L.)

The rod photoreceptors of the European eel, Anguilla anguilla (L.), alter their wavelength of maximum sensitivity (lambda max) from c.a. 523 nm to c.a. 482 nm at maturation, a switch involving the synthesis of a new visual pigment protein (opsin) that is inserted into the outer segments of existing rods. We artificially induced the switch in rod opsin production by the administration of hormones, and monitored the switch at the level of mRNA accumulation using radiolabelled oligonuleotides that hybridized differently to the two forms of eel rod opsin. The production of the deep-sea form of rod opsin was detected 6 h after the first hormone injection, and the switch in rod opsin expression was complete within four weeks, at which time only the mRNA for the deep-sea opsin was detectable in the retinal cells. It is suggested that this system could be used as a tractable model for studying the regulatory control of opsin gene expression.

Cocaine, nicotine, caffeine, and metabolite plasma concentrations in neonates

The objective of this study was to measure the umbilical cord plasma levels of cocaine, nicotine, caffeine, and their metabolites. Thirty-six neonates at risk for prenatal cocaine exposure were prospectively enrolled. Umbilical cord plasma was analyzed by gas chromatography-mass spectroscopy for cocaine, cocaethylene, benzoylecgonine (BZE), nicotine, cotinine, and caffeine. Eighteen neonates were plasma positive for BZE, and 50% of these were also positive for cocaine. Cocaethylene was not found. The maximum plasma cocaine concentration was 88 ng/mL (mean, 39 ng/mL). The maximum plasma BZE concentration was 3880 ng/mL (mean, 844 ng/mL). Among BZE-positive babies, the mean plasma drug levels were as follows: nicotine, 1.8 ng/mL; cotinine, 94 ng/mL; and caffeine, 1205 ng/mL. Among the BZE-negative babies, the mean plasma drug levels were as follows: nicotine, 5.2 ng/mL; cotinine, 97 ng/mL; and caffeine, 1440 ng/mL. These cocaine levels raise the possibility of pharmacological effects of cocaine in the early neonatal period.

Prediction of neuromotor outcome in perinatal asphyxia: evaluation of MR scoring systems

PURPOSE

We developed a scoring system for the assessment of perinatal asphyxia as depicted on MR images.

METHODS

Four scoring systems were derived to evaluate MR images obtained in asphyxiated neonates: the basal ganglia (BG) score, the watershed (W) score, the combined basal ganglia/watershed (BG/W) score, and the sum of the BG and W scores, the summation (S) score. In addition, three MR sequences, T1-weighted, first-echo T2-weighted, and second-echo T2-weighted, were assessed for each patient for each scoring system. Neuromotor examinations were performed at ages 3 and 12 months, and cognitive development was tested at age 12 months. Statistical analysis was then performed to test the relationship between the MR scores and the outcome scores.

RESULTS

The BG/W score, obtained with the first-echo T2-weighted sequence, was the most useful overall score for predicting neuromotor outcome at 3 and 12 months and cognitive outcome at 12 months. T1-weighted and first-echo T2-weighted sequences showed a stronger association with outcome in patients imaged during the first postnatal week, whereas second-echo T2-weighted sequences showed a stronger association with outcome in patients imaged during the second postnatal week.

CONCLUSION

It appears that, with the use of the BG/W score, MR imaging discriminates accurately between patients with good and poor neuromotor and cognitive outcome at 3 and 12 months. In terms of our scoring systems, the first-echo T2-weighted sequence appears to discriminate best between patients with good and poor 3- and 12-month outcomes. Proper use of the imaging sequences and scoring systems described in this article can increase the knowledge base upon which treatment decisions are made in asphyxiated neonates.

Tubular eyes of deep-sea fishes: a comparative study of retinal topography

The world's deep oceans are home to a number of teleosts with asymmetrical or tubular eyes. These immobile eyes possess large spherical lenses and subtend a large binocular visual field directed either dorsally or rostrally. Derived from a lateral non-tubular eye, the tubular eye is comprised of a thick main retina, subserving the rostrally or dorsally directed binocular visual field, and a thin accessory retina subserving, the lateral, monocular visual field. The main retina is thought to receive a focussed image, while the accessory retina is too close to the lens for a focussed image to be received. Several species also possess retinal diverticula, which are small evaginations of differentiated retina located in the rostrolateral wall of the eye and thought to increase the visual field. In order to investigate the spatial resolving power of these retinae (main, accessory and diverticulum), the distribution of cells within the ganglion cell layer was analysed from retinal wholemounts and sectioned material in ten species representing four genera. In all species, the main retina possesses a marked increase in cell density towards a specialised retinal region (area centralis), with a centro-peripheral gradient range between 7:1 and 60:1 and a peak density range of between 30 and 55 x 10(3) cells per mm2. The accessory retinae and the transitional zone between the main and accessory retinae possess relatively low cell densities (between 1 and 10 x 10(3) cells per mm2) and lack an area centralis. Retinal diverticula examined in four species possess mean ganglion cell densities of between 7.2 and 109.4 x 10(3) cells per mm2. Analyses of soma areas show that the ganglion cell layer of most species possesses cells with areas in a range of 8.0 to 15.4 microns2 in the main retina and between 15.1 and 17.4 microns2 in the accessory retina. The peak spatial resolving power of the main retina of the ten species varies from 4.1 to 9.1 cycles per degree. The positions of the retinal areae centrales relative to each species' binocular visual field are discussed in relation to what is known of feeding behaviour of these fishes in the deep-sea.

MR contrast enhancement of the normal neonatal brain

PURPOSE

To determine the pattern of enhancement on contrast-enhanced MR studies of the brain in neonates.

METHODS

Contrast-enhanced brain MR studies of 16 neonates were reviewed retrospectively. All infants had normal neonatal courses, normal noncontrast MR findings, and normal neurologic examinations at age 12 months. All enhancing regions within the brain, dura, calvaria, and orbits were recorded. An enhancement factor, F = (Ic-Ip)/Ip, was calculated from region-of-interest intensity measurements in five regions of each hemisphere (basal ganglia, thalami, and three hemispheric locations), where Ic was signal intensity after contrast administration and Ip was the noncontrast signal intensity for each region.

RESULTS

Enhancement was detected in the choroid plexus, pituitary infundibula, pineal glands, dura, veins and venous sinuses, cranial sutures, and irises of the orbital globes. No enhancement of the brain parenchyma was detected by visual inspection, although some change in signal intensity of the cerebral parenchyma was detected by the region-of-interest intensity measurements, with enhancement factors ranging from 0 to 0.08 (mean, 0.04). No consistent regional variation in enhancement was detected. Because the degree of enhancement was identical to that in the normal adult brain, the slight enhancement detected was attributed to contrast material in capillaries and small venules.

CONCLUSION

In addition to the expected findings of enhancement of the pituitary stalk, the pineal gland, the choroid plexus, the dura, and the cerebral veins, we detected enhancement of the calvarial sutures and ocular irises. No evidence of enhancement of the cerebral parenchyma was detected, suggesting that the blood-brain barrier to gadolinium chelates is intact in the neonatal brain.

Ultraviolet plumage colors predict mate preferences in starlings

Avian plumage has long been used to test theories of sexual selection, with humans assessing the colors. However, many birds see in the ultraviolet (<400 nm), to which humans are blind. Consequently, it is important to know whether natural variation in UV reflectance from plumage functions in sexual signaling. We show that female starlings rank males differently when UV wavelengths are present or absent. Principal component analysis of approximately 1300 reflectance spectra (300-700 nm) taken from sexually dimorphic plumage regions of males predicted preference under the UV+ treatment. Under UV- conditions, females ranked males in a different and nonrandom order, but plumage reflectance in the human visible spectrum did not predict choice. Natural variation in UV reflectance is thus important in avian mate assessment, and the prevailing light environment can have profound effects on observed mating preferences.

Mechanisms of wavelength tuning in the rod opsins of deep-sea fishes

The main object of this study was to investigate the molecular basis for changes in the spectral sensitivity of the visual pigments of deep-sea fishes. The four teleost species studied, Hoplostethus mediterraneus, Cataetyx laticeps, Gonostoma elongatum and Histiobranchus bathybius, are phylogenetically distant from each other and live at depths ranging from 500 to almost 5000 m. A single fragment of the intronless rod opsin gene was PCR-amplified from each fish and sequenced. The wavelength of peak sensitivity for the rod visual pigments of the four deep-sea species varies from 483 nm in H. mediterraneus and G. elongatum to 468 nm in C. laticeps. Six amino acids at sites on the inner face of the chromophore-binding pocket formed by the seven transmembrane a-helices are identified as candidates for spectral tuning. Substitutions at these sites involve either a change of charge, or a gain or loss of a hydroxyl group. Two of these, at positions 83 and 292, are consistently substituted in the visual pigments of all four species and are likely to be responsible for the shortwave sensitivity of the pigments. Shifts to wavelengths shorter than 480 nm may involve substitution at one or more of the remaining four sites. None of the modifications found in the derived sequences of these opsins suggest functional adaptations, such as increased content of hydroxyl-bearing or proline residues, to resist denaturation by the elevated hydrostatic pressures of the deep sea. Phylogenetic evidence for the duplication of the rod opsin gene in the Anguilliform lineage is presented.

Death in the intensive care nursery: physician practice of withdrawing and withholding life support

OBJECTIVE

To determine the frequency of selective nontreatment of extremely premature, critically ill, or malformed infants among all infant deaths in a level III intensive care nursery (ICN) and to determine the reasons documented by neonatologists for their decisions to withdraw or withhold life support.

METHODS

This was a descriptive study based on review of the medical records of all 165 infants who died at a university-based level III ICN during 3 years. We determined whether each death had occurred despite the use of all available technologies to keep the infant alive or whether these were withheld or withdrawn, thereby leading to the infant's death. We also determined whether neonatologists documented either "futility" or "quality of life" as a reason to limit medical interventions.

RESULTS

One hundred sixty-five infants died among the 1609 infants admitted during the study period. One hundred eight infant deaths followed the withdrawal of life support, 13 deaths followed the withholding of treatment, and 44 deaths occurred while infants continued to receive maximal life-sustaining treatment. For 90 (74%) of the 121 deaths attributable to withholding of withdrawal of treatment, physicians cited that death was imminent and treatment was futile. Quality-of-life concerns were cited by the neonatologists as reasons to limit treatment in 62 (51%). Quality of life was the only reason cited for limiting treatment for 28 (23%) of the 121 deaths attributable to withholding or withdrawal of treatment.

CONCLUSIONS

The majority of deaths in the ICN occurred as a result of selective nontreatment by neonatologists, with few infants receiving maximal support until the actual time of death. Neonatologists often documented that quality-of-life concerns were considered in decisions to limit treatment; however, the majority of these decisions were based on their belief that treatment was futile. Prospective studies are needed to elucidate the determinants of neonatologists' practice decisions of selective nontreatment for marginally viable or damaged infants.

Analgesia for dying infants whose life support is withdrawn or withheld

OBJECTIVE

To determine the frequency of opiate analgesia administration to infants when life support is discontinued and to determine whether infant characteristics, such as birth weight and diagnosis, or the physician's reasons for discontinuing life support influence either the decision to provide opioid agents or the dosages administered.

METHODS

We reviewed all 165 deaths in a 3-year period at a university-based level III intensive care nursery. Of the 121 deaths attributable to withdrawal or withholding of mechanical ventilation and/or extracorporeal membrane oxygenation, we ascertained whether opioid analgesics (morphine sulfate [MS] or fentanyl) were administered either concurrent with or after life-support withdrawal and at what doses. We examined whether these end-of-life practices varied according to birth weight, diagnoses, and the reasons documented by the neonatologist for discontinuing life support.

RESULTS

Opioid analgesia was provided to 84% of infants as their life support was either withheld or withdrawn. Infants with necrotizing enterocolitis and major anomalies or chromosomal disorders were more likely to be given opiates than infants with other diagnoses. Birth weight was not different for infants who received opiates compared with those who were not given opiates. Opioid analgesia was provided to all 18 infants for whom physicians documented the patients' suffering as a reason to discontinue life support. Sixty-four percent of infants who received opiates were given doses in the usual pharmacologic range of 0.1 to 0.2 mg/kg MS. Of the 36 infants given more than 0.2 mg/kg MS, all but 2 were receiving ongoing treatment with opioid agents.

CONCLUSIONS

In most cases of withholding or withdrawal of life support in critically ill infants, neonatologists provided opioid analgesia to these infants at the end of life, despite the potential respiratory depression of opioid agents in infants whose respiratory support is discontinued.