Use of human stem cell derived cardiomyocytes to examine sunitinib mediated cardiotoxicity and electrophysiological alterations

Sunitinib, an oral tyrosine kinase inhibitor approved to treat advanced renal cell carcinoma and gastrointestinal stroma tumor, is associated with clinical cardiac toxicity. Although the precise mechanism of sunitinib cardiotoxicity is not known, both the key metabolic energy regulator, AMP-activated protein kinase (AMPK), and ribosomal S 6 kinase (RSK) have been hypothesized as causative, albeit based on rodent models. To study the mechanism of sunitinib-mediated cardiotoxicity in a human model, induced pluripotent stem cell-derived cardiomyocytes (iPSC-CMs) having electrophysiological and contractile properties of native cardiac tissue were investigated. Sunitinib was cardiotoxic in a dose-dependent manner with an IC₅₀ in the low micromolar range, observed by a loss of cellular ATP, an increase in oxidized glutathione, and induction of apoptosis in iPSC-CMs. Pretreatment of iPSC-CMs with AMPK activators AICAR or metformin, increased the phosphorylation of pAMPK-T172 and pACC-S79, but only marginally attenuated sunitinib mediated cell death. Furthermore, additional inhibitors of AMPK were not directly cytotoxic to iPSC-CMs up to 250 μM concentrations. Inhibition of RSK with a highly specific, irreversible, small molecule inhibitor (RSK-FMK-MEA) did not induce cytotoxicity in iPSC-CMs below 250 μM. Extensive electrophysiological analysis of sunitinib and RSK-FMK-MEA mediated conduction effects were performed. Taken together, these findings suggest that inhibition of AMPK and RSK are not a major component of sunitinib-induced cardiotoxicity. Although the exact mechanism of cardiotoxicity of sunitinib is not known, it is likely due to inhibition of multiple kinases simultaneously. These data highlight the utility of human iPSC-CMs in investigating the potential molecular mechanisms underlying drug-induced cardiotoxicity.

Effects of impulse noise stimulation on electrocorticogram and heart rate

It is now recognized that high-level impulse noises penetrate the uterus of pregnant sheep, elevate thresholds of fetal auditory-evoked potential and produce damage to fetal inner ear hair cells. However, little is known about functional effects of airborne impulse noise on the late-term fetus. In the present study, the effects of a series of 20 impulses on the behavioral state of 6 fetal sheep were tested. Noise impulses produced 169.3 peak sound pressure level (pSPL) in air. Peak levels recorded near the fetal head averaged 161.1 dB. Impulses delivered to the fetus during periods of NREM sleep resulted in a decrease in average fetal heart rate (FHR) from 185 +/- 22 beats/min (bpm) before stimulation to 174 +/- 23 bpm 2-5 s after stimulation (p < 0.05). During REM sleep, an FHR acceleration occurred (before stimulation: 177 +/- 24 bpm, after stimulation: 189 +/- 31 bpm; p < 0.05). Impulse exposure during NREM sleep resulted in reductions in delta-, theta- and alpha-band powers. As a consequence, total power decreased from 100 to 72 +/- 16% (p < 0.05). During REM sleep, stimulation provoked a short decrease in total band power from 100 to 73 +/- 20% and a similar decrease in the theta- and beta-band powers. The results indicated that impulse noise evoked short-term alterations in FHR and cortical activity. These changes were mediated by auditory brain stem activation that led to cortical desynchronization during both NREM and REM sleep in late-term fetal sheep.

The acoustic environment and physiological responses of the fetus

The acoustic environment of the fetus is composed of continuous cardiovascular, respiratory, and intestinal sounds that are punctuated by isolated, shorter bursts during maternal body movements and vocalizations. The distribution of sounds is confined to frequencies below 300 Hz. Additionally, vibrations on the external surface of the maternal abdomen can induce sounds inside the uterus. The half-round sound pressure contours in the abdomen during vibroacoustic stimulation differ from the circular distribution of contours resulting from airborne sound pressure exposure. The static and dynamic forces of the vibrator and the vibrator distance from the target are also factors in sound transmission. Responses to sound are best described in animals and include changes in behavioral state, brain bloodflow, auditory brainstem response, and local cerebral glucose utilization along the central auditory pathway.

Fetal exposures to sound and vibroacoustic stimulation

Sounds in the environment of a pregnant woman penetrate the tissues and fluids surrounding the fetal head and stimulate the inner ear through a bone conduction route. The sounds available to the fetus are dominated by low-frequency energy, whereas energy above 0.5 kHz is attenuated by 40 to 50 dB. The fetus easily detects vowels, whereas consonants, which are higher in frequency and less intense than vowels, are largely unavailable. Rhythmic patterns of music are probably detected, but overtones are missing. A newborn human shows preference for his/her mother's voice and to musical pieces to which he/she was previously exposed, indicating a capacity to learn while in utero. Intense, sustained noises or impulses produce changes in the hearing of the fetus and damage inner and outer hair cells within the cochlea. The damage occurs in the region of the inner ear that is stimulated by low-frequency sound energy.

Intra-abdominal sound pressure levels during impulse noise exposure in sheep

Ambient sound pressure levels (SPLs) created with intense blasts were compared with SPLs recorded in the abdomen of euthanized sheep. Hydrophones were placed in the abdominal cavity at locations referred to as proximal, medial, and distal with respect to a shock tube that created 169-dB peak SPL (pSPL). No differences in pSPL, duration, or rise time were found between recordings in air and at the intra-abdominal proximal position. Significant differences were noted in these variables when recordings in air were compared with recordings made at the medial and distal locations. Intra-abdominal pSPL varied by 20 dB depending on recording location.

Effects of intense noise exposure on fetal sheep auditory brain stem response and inner ear histology

OBJECTIVE

To evaluate, in two separate experiments, the effects of intense noise exposures delivered to fetal sheep in utero during a time of rapid auditory development.

DESIGN

In the first experiment, auditory brain stem response (ABR) thresholds to clicks and tone bursts were recorded from chronically instrumented fetal sheep in utero before and after exposure of pregnant ewes to intense broadband noise. A single 16 hr exposure was delivered at 113 days gestational age, a time when the ABR is just emerging. Thresholds were compared with an age-matched, nonexposed control group. In the second experiment, fetal sheep at the same gestational age were exposed four times to broadband noise and their cochleae were harvested 20 days later for histological analysis by the use of scanning electron microscopy. Comparisons were made with an age-matched, nonexposed control group.

RESULTS

Experiment One: ABR thresholds recorded between 10 to 20 days after the exposure were not as sensitive as thresholds obtained from control fetuses. There was a tendency for thresholds to 0.5 kHz tone bursts to be more affected than thresholds to clicks. Experiment Two: Scanning electron microscopy of the organ of Corti from fetuses exposed to noise from 111 to 114 days gestational age revealed significant damage to inner and outer hair cells in the middle and apical turns of cochleae. Similar hair cell damage was not present in control fetuses.

CONCLUSIONS

Intense exogenous noise penetrated the uterus of pregnant sheep and resulted in elevations in ABR thresholds 2 to 3 wk after exposure. In fetuses repeatedly exposed to noise, the middle and apical turns of the cochlea showed greater hair cell damage than found at the same locations in control cochlea. The basal turn of the cochlea was not damaged.

Vestibular caloric responses and behavioral state in the fetal sheep

Functional activity of the vestibular system in relation to behavioral state of fetal sheep in utero was studied by cooling and heating of the fetal middle ear and skin (control) with implanted copper-tube heat exchangers. Eye movements and fetal cortical activity were assessed before, during, and after 2 min irrigations with water at 6, 46, or 39.5 degrees C (isothermic). Cold water induced slow-phase eye movements toward the irrigated ear followed by saccades toward the opposite ear after a delay of several seconds. The direction of the response reversed with warm water, and saccades were absent during irrigation with body-temperature water. Cold-water irrigations of the skin over the jaw did not result in nystagmus. Arousal-like responses were elicited with thermal stimulation of the ear or facial skin while the fetus was in either rapid eye movement (REM) or non-REM states. Circulation of 39.5 degrees C water through the ear also produced arousal-like responses, possibly due to turbulence-induced noises in the heat exchanger or slight deviations between the irrigation temperature and the actual fetal inner ear temperature. These results suggest that mechanisms responsible for saccade suppression during depressed levels of consciousness (i.e. sleep) are inactive in utero. Fetal behavioral state responsiveness to vestibular and somatosensory thermal stimulation may be of great significance, especially in the premature neonate.

Vestibular function in the fetal sheep

Little is known about the functional development of the vestibular system before birth. The purpose of this study was to determine whether vestibular response to caloric stimulation could be elicited in the fetal sheep in utero. Late gestational fetal sheep (n = 6) were instrumented through a midline hysterotomy. Copper caloric probes were inserted into the right bulla and beneath the left facial skin. Electrodes were placed in the skull for monitoring of electro-ocular activity. At least 3 days after surgery the probes were irrigated with water (100 ml/minute) at body temperature, 46 degrees C, and 6 degrees C. Cold water infusion of the bulla consistently produced well-recognized, slow-phase deviations followed by saccades directed contralaterally, findings consistent with vestibular nystagmus. The direction of the response reversed with warm water irrigation. The response was absent with irrigation at fetal body temperature. Only random eye movements were observed in response to caloric stimulation of the facial skin, regardless of water temperature. These results demonstrate that the sheep vestibular system is functioning prenatally. The importance of vestibular function for normal fetal brain maturation may be revealed in future studies using this animal model.

Temporary threshold shifts induced by low-pass and high-pass filtered noises in fetal sheep in utero

Auditory brainstem responses (ABRs) were obtained from nine late gestational age fetal sheep in utero before and after a 16-h exposure to low-pass (cut-off frequency 1.0 kHz) and high-pass (cut-off frequency 1.0 kHz) noises (approximately 120 dB sound pressure level, recorded in air). Bone-conduction ABRs were elicited by broadband clicks and 0.5, 1.0 and 2.0 kHz tone bursts. Following low-pass noise exposure, ABR thresholds and wave IV latencies increased significantly for 0.5 and 1.0 kHz tone bursts. The high-pass noise exposure produced significant shifts in ABR thresholds and wave IV latencies only for the 1.0 kHz tone bursts. These findings confirm previous reports of low-frequency sound transmission into the fetal inner ear.

Effect of abdominal vibroacoustic stimulation on sound and acceleration levels at the head of the fetal sheep

OBJECTIVE

To measure the vibratory response of the fetal head and abdominal wall in sheep during vibroacoustic stimulation.

METHODS

A piezoresistive accelerometer was attached to the skulls of seven sheep fetuses (128-134 days' gestational age), and a miniature hydrophone was attached to the skin overlying the fetal temporal bone. During fetal preparation and vibroacoustic stimulation procedures, ewes were anesthetized and supine. Vibroacoustic stimulation of the maternal abdomen was produced by each of two clinical devices that differed in spectral content, and an electric toothbrush.

RESULTS

The approximate fundamental frequencies (f0) and first overtones (f1), as determined by both recordings of intrauterine sound pressure level and fetal head acceleration, were as follows: fetal acoustic stimulator, 75 and 150 Hz; electronic larynx, 150 and 300 Hz; and electric toothbrush, 25 and 50 Hz, respectively. At fundamental frequencies and first overtones, the ranges of fetal head accelerations (expressed in 1/12-octave bands) were as follows: fetal acoustic stimulator, 10-53 and 25-224 mm/sec2; electronic larynx, 10-53 and 18-114 mm/sec2; and electric toothbrush, 33-792 and 8-116 mm/sec2, respectively. Sound pressure levels exceeded 110 dB in all cases. High sound pressure levels in the uterus were proportional to fetal head vibration levels.

CONCLUSION

Vibroacoustic stimulation of the surface of the abdomen of pregnant sheep is accompanied by both acoustic and vibratory exposure of the fetus.

Electrocortical and heart rate response during vibroacoustic stimulation in fetal sheep

OBJECTIVE

Our purpose was to study effects of vibroacoustic stimuli on electrocortical activity and heart rate changes in fetal sheep in utero.

STUDY DESIGN

Seven chronically instrumented near-term fetal sheep were repeatedly stimulated by an electronic artificial larynx for 32 seconds during periods of rapid-eye-movement and non-rapid-eye-movement sleep. Responses to vibroacoustic stimulation were obtained by spectral analysis of the electrocorticogram (fast Fourier transform) and by assessment of changes in fetal heart rate and fetal heart rate variability.

RESULTS

During non-rapid-eye-movement sleep vibroacoustic stimulation led to electrocorticogram desynchronization that consisted of a marked reduction of delta and theta band power (p < 0.05). A concomitant fetal heart rate decrease and fetal heart rate variability increase were also noted (p < 0.05). During rapid-eye-movement sleep vibroacoustic stimulation induced a significant increase in alpha and beta band power (p < 0.05) and a slight deviation in basal fetal heart rate and fetal heart rate variability (p < 0.05).

CONCLUSION

Vibroacoustic stimulation of fetal sheep provokes reproducible changes in fetal electrocortical activity and heart rate patterns. These changes, which are not easily identifiable in gross polygraphic assessments of the fetal behavioral state, are indicative of fetal arousal.

Rates of local cerebral protein synthesis in fetal and neonatal sheep

During gestation there is likely to be a constantly changing rate of protein synthesis in the brain that may exhibit regional specificity. With the use of the quantitative autoradiographic L-[1-(14)C]leucine method for the determination of local rates of leucine incorporation into cerebral protein (lCPS(Leu)), we have sought to characterize this important process. lCPS(Leu) was measured in nine fetal sheep (118-139 days gestational age) and five newborn lambs (1-5 days of age). In other experiments, the fraction of leucine in the precursor pool for protein synthesis in the brain derived from the arterial plasma was determined to be 0.57 +/- 0.04 (mean +/- SE) in one fetus and two lambs. This value was used in the calculation of lCPS(Leu) in 35 regions of the central nervous system, pineal body, and whole brain. Regardless of age, lCPS(Leu) was highest in the pineal body, brain stem, and hypothalamic nuclei and lowest in white matter. In sensorimotor cortex, corona radiata, pyramidal tracts, and whole brain, lCPS(Leu) was positively correlated with prenatal age (P < or = 0.05). These increases in lCPS(Leu) probably reflect myelination in the cerebrum, which is known to occur in late gestation.

Fetal sheep in utero hear through bone conduction

PURPOSE

Although the air-conduction pathway is the principal mode of sound transmission to the inner ear, this may not be true for the fetus in utero. The fetus detects and responds to sounds in the maternal environment. Exogenous sounds can reach the fetal inner ear through the ear canal and middle ear system, bone conduction, or both. This study was designed to compare the effectiveness of these two routes of sound transmission by recording cochlear microphonic potentials from the fetus in utero in response to airborne sounds.

MATERIALS AND METHODS

Cochlear microphonics (CMs) recorded from one round window (RW) of fetal sheep in utero were obtained in three conditions: (1) head uncovered; (2) head covered with a neoprene hood; and (3) head covered with a neoprene hood fashioned with a hole that permitted the pinna and ear canal to be exposed. Tone bursts (0.5, 1.0, and 2.0 kHz) were delivered through a loudspeaker at high intensities (100 to 135 dB sound pressure level) to the flank of the ewe. CMs were detected with indwelling electrodes, amplified, and averaged. CM input-output functions were obtained from the fetus in each of the three conditions described above.

RESULTS

CMs recorded with the head uncovered were more sensitive than were the CMs recorded with the hood in place. There was no difference in sensitivity between the condition during which the head was completely covered and the condition in which the pinna and ear canal are exposed.

CONCLUSION

The principal mode of sound transmission into the fetal inner ear is through bone conduction.

Myocardial and cerebral oxygen delivery are not adversely affected by cocaine administration to early-gestation fetal sheep

OBJECTIVES

Cocaine administration to near-term pregnant sheep causes fetal hypoxemia, but oxygen delivery to the heart and brain are preserved because of increased blood flow. We hypothesized that cocaine administration during earlier fetal gestation impairs oxygen delivery to the heart and brain.

STUDY DESIGN

Ten pregnant ewes and fetuses at 0.7 term gestation underwent surgical instrumentation. After 48 hours of recovery fetal blood pressure, heart rate, cerebral and myocardial blood flow, and arterial oxygen content were determined before and during cocaine administration to the ewe.

RESULTS

Fetal hypoxemia was not noted in these animals. Fetal myocardial blood flow increased from 220 +/- 100 ml per 100 gm per minute to 349 +/- 183 ml per 100 gm per minute (p=0.03), and oxygen delivery increased from 16 +/- 5 ml of oxygen per 100 gm per minute to 22 +/- ml of oxygen per 100 gm per minute (p=0.02). Fetal cerebral blood flow and oxygen delivery remained unchanged.

CONCLUSION

Cerebral and myocardial oxygen delivery are unimpeded by maternal cocaine administration in 0.7 term gestation ovine fetuses.

Vibration of the abdominal segment in pregnant sheep

Mechanical vibration of the abdominal wall results in a frequency-related distribution of intra-abdominal sound pressure levels. A greater attenuation of applied signals of equal dynamic force occurs as frequency increases. A broad resonance peak exists between 6 and 18 Hz. Transducers fixed to the fetal head show clear increases in acceleration levels during stimulation of the abdominal surface with the artificial electronic larynx. Sine-wave stimulation results in a frequency-dependent increase in vibration levels of the abdominal wall of 4% to 140% of the input levels. At the fetal head, a broad peak in response was noted between 6 and 12 Hz, but the overall levels never exceeded 4% of the input level.

Fetal hearing: characterization of the stimulus and response

Before sounds originating outside the abdomen of pregnant women can reach the inner ear of the fetus, they must first pass through the tissues and fluids surrounding the fetal head. Low-frequency sound energy easily penetrates to the fetal head, less than 5 dB attenuation for frequencies below 500 Hz, whereas higher frequencies are attenuated by up to 20 to 30 dB. The sound energy in amniotic fluid stimulates fetal hearing through a bone conduction route rather than through the external and middle ear systems. During passage through the bones of the skull, sound energy is slightly diminished for frequencies less than 250 Hz (10 to 20 dB), yet significantly reduced for frequencies from 500 to 2,000 Hz (40 to 50 dB). Thus, the fetus in utero can easily detect low-frequency sound energy (< 500 Hz) produced at levels that are comfortably loud for its mother, but probably cannot detect acoustic energy at frequencies higher than 500 Hz.

Acceleration of fetal head induced by vibration of maternal abdominal wall in sheep

OBJECTIVE

The human body is often exposed to significant vibration stress in the workplace, at home, and during recreational activities. The current study was designed to evaluate whether low- to midfrequency vibrations present at the extraabdominal wall would be attenuated across this wall and what the levels of exposure would be once these vibrations reached the fetal head.

STUDY DESIGN

Four pregnant sheep were instrumented with acceleration transducers to obtain acceleration levels at the extraabdominal and intraabdominal walls and at the fetal head. Sine-wave vibration stimulation was applied over a frequency range of 3 to 150 Hz at a constant acceleration level of 2.5 m/sec2 (root-mean-square).

RESULTS

Vibration of the extraabdominal wall resulted in a frequency-dependent rise in vibration levels at the intraabdominal wall, from 4% to 140% of the input level. At the fetal head a broad peak in response was noted between 6 and 12 Hz, but the overall levels never exceeded 4% of the input level.

CONCLUSION

Fetal exposure to localized vibratory stimulation of the maternal abdomen is maximal in the range of 6 to 12 Hz.

Vibroacoustic stimulation with a complex signal: effect on behavioral state in fetal sheep

An ideal vibroacoustic stimulus for testing fetal reactivity has yet to be developed. In the present study in fetal sheep we tested the effect on behavioral state of an amplitude and frequency-modulated signal produced at the abdominal surface of the ewe. The stimulus was presented during periods of fetal non-rapid eye movement (NREM) sleep and rapid eye movement (REM) sleep. Evaluation of behavioral state was accomplished by visual observation of strip-chart recordings. Assessed in this manner, vibroacoustic stimulation during NREM sleep consistently resulted in a change to an indeterminate state. However, stimulation during REM sleep failed to have an effect. Additional evaluation applying spectral analysis to the fetal electrocorticogram during stimulation in NREM sleep revealed a marked decrease in delta band power from 100 to 27 +/- 5% and in theta band power from 100 to 40 +/- 4% resulting in a decrease in total power from 100 to 35 +/- 4% (p < 0.05). Stimulation during REM sleep revealed a significant increase in beta band power from 100 to 123 +/- 14%. Vibroacoustic stimulation in both NREM and REM sleep led to an increase in spectral edge frequency, implying central arousal.

Auditory brainstem response in sheep. Part II: Postnatal development

The auditory brainstem response (ABR) was recorded from 15 chronically instrumented lambs between birth and 7 weeks of age as well as from four adult ewes. Latency changes observed within two days of birth may be related to the dissipation of fluid from the lamb external auditory canal and middle ear cavity. Developmental changes observed in the lambs included an early period of wave latency decrements from 1 to 4 weeks followed by a subsequent increase in wave latencies from 4 to 7 weeks. These changes were significant for the I-IV interwave interval, possibly reflecting the combined effects of increased myelinization and increased neural track length. Responses from 7 week-old lambs were not significantly different from those obtained from the ewes.

Cocaine does not compromise cerebral or myocardial oxygen delivery in fetal sheep

Eight time-dated pregnant ewes at 125 days' gestation (145 days = term) underwent surgery for placement of fetal vascular catheters, electrodes for recording fetal behavioural state, and maternal venous catheters. Three days later, fetal cerebral and myocardial blood flow were determined by the coloured microsphere technique under four conditions: (1) during rapid-eye movement (REM) sleep, before fetal cocaine infusion, (2) 30 min after initiation of a cocaine infusion to the fetus at 0.2 mg/kg per min, (3) during REM sleep, before maternal cocaine infusion, and (4) 30 min after initiation of a cocaine infusion to the ewe at 0.3 mg/kg per min. Cocaine infusion directly to the fetal lamb did not cause hypoxaemia or significantly change cerebral or myocardial blood flow or oxygen delivery. Cocaine administered to the ewe led to a drop in fetal oxygen tension from 3.0 +/- 0.5 to 2.5 +/- 0.3 kPa (P < 0.0001) and in fetal oxygen content from 3.8 +/- 0.7 to 2.8 +/- 0.4 mmol O2/L (P < 0.0001). Prior to maternal cocaine administration, fetal cerebral blood flow was 146 +/- 103 mL/100 g per min and during maternal cocaine infusion it went to 184 +/- 147 mL/100 g per min (P = NS) while myocardial blood flow increased from 156 +/- 92 to 333 +/- 178 mL/100 g per min (P < 0.002). This increase in blood flow negated the effects of hypoxaemia so that cerebral oxygen delivery was unaffected while myocardial oxygen delivery increased an average of 67%. It is concluded that cocaine administration to pregnant sheep does not impede fetal cerebral or myocardial oxygen delivery.

Fetal acoustic stimulation test: stimulus features of three artificial larynges recorded in sheep

OBJECTIVE

The purpose of the current study was to evaluate the characteristics of vibroacoustic devices used for fetal stimulation.

STUDY DESIGN

Intrauterine sound pressure levels over a frequency range of 40 to 5000 Hz were measured with hydrophones in anesthetized sheep. Stimulators included the AT&T (Martinsburg, W.V.) and Servox (Hearing Instruments, Piscataway, N.J.) artificial larynges, the Corometrics fetal acoustic stimulator (Wallingford, Conn.) and electric toothbrush.

RESULTS

Intrauterine spectral patterns resulting from stimulation with the AT&T, Servox, and Corometrics devices were characterized by numerous high-level overtones above a fundamental frequency between 97 and 163 Hz. Fundamental frequencies recorded during toothbrush stimulation were 22 to 24 Hz with reduced but identifiable overtones up to 250 Hz.

CONCLUSIONS

Fetal vibroacoustic stimulators that operate on the principle of the electronic artificial larynx produce very similar intrauterine sound pressure levels.

Auditory brainstem response in sheep. Part I: Fetal development

The Auditory Brainstem Response (ABR) was recorded from fetal sheep in utero between gestational ages of 111 days and 136 days (Normal gestation is 145 days). The ABR was detected at 111 days gestation (dGA) and morphology of the waveform improved rapidly from 116 to 123 dGA. At 123 dGA, the four vertex-positive peaks were similar to those observed in adult ewes. Thresholds of the ABR to clicks and tone bursts improved rapidly between 111 and 123 dGA. From 123 to 136 dGA, ABR thresholds continued to improve, but at a much slower rate. Latencies for the peaks also decreased during development from 111 to 136 days, with latencies for Waves III and IV showing a greater decrease than latencies for Waves I and II.

Fetal behavioral state patterns during and after prolonged exposure to cocaine in sheep

OBJECTIVE

Studies on the effects of cocaine in fetal animals have been limited to acute exposures to the drug. We hypothesized that a prolonged infusion of cocaine to the fetal sheep would initially interrupt normal behavioral state cycling but the effects would be short lived as the fetus gained tolerance to the drug.

STUDY DESIGN

The study was performed in a university laboratory on six time-dated pregnant ewes at 125 days' gestation. Fetal sheep, surgically instrumented 3 days before study, were given cocaine hydrochloride 0.6 mg/min for 6 hours. Fetal behavioral state before, during, and after the infusion was compared by repeated-measures analysis of variance.

RESULTS

Infusion of cocaine caused a drop in the percentage time that the fetuses spent in both rapid-eye-movement (p < 0.03) and non-rapid-eye movement (p < 0.001) sleep, which was sustained throughout the 6-hour infusion. This was related to a decrease in the number of rapid-eye-movement and non-rapid-eye-movement episodes as opposed to a decrease in the lengths of these behavioral states. With cessation of cocaine infusion, the fetal sheep showed an increase in rapid-eye-movement sleep, with a higher percentage than during control periods (p < 0.02).

CONCLUSIONS

Cocaine disrupts fetal rapid-eye-movement sleep without evidence for tolerance to the drug over a 6-hour period. "Catch-up" rapid-eye-movement sleep occurs with cessation of cocaine infusion. Neurobehavioral abnormalities associated with in utero cocaine exposure may be caused by chronic disruption of rapid-eye-movement sleep.

Effect of impulse noise on the auditory brainstem response of the fetal sheep and the adult ewe: case study

Auditory brainstem responses (ABR) were obtained from a sheep fetus in utero and from a nonpregnant ewe before and after a noise exposure generated by 10 105-mm howitzer impulses (160-166 dB peak pressure). Fetal ABR thresholds shifted by less than 15 dB, whereas the adult thresholds shifted more than 50 dB. Comparison of exposed and nonexposed fetal cytocochleograms revealed minimal sensory cell loss in two age-matched animals. Although fetal ABR threshold shifts were noted in this study, the magnitude of shift was modest when compared to the significant elevation of the adult ABR thresholds.

The perception of speech sounds recorded within the uterus of a pregnant sheep

The intelligibility of speech stimuli recorded within the uterus of a pregnant sheep was determined perceptually using a group of untrained judges. The intrauterine sound environment of the ewe was intended to simulate that of a pregnant woman. Two separate lists, one of meaningful and one of nonmeaningful speech stimuli, were delivered through a loudspeaker to the side of the ewe and were simultaneously recorded with an air microphone located 15 cm from the flank and with a hydrophone previously sutured to the neck of the fetus. Perceptual test tapes generated from these recordings were played to 102 judges. The intelligibility of the phonemes recorded in the air was significantly greater than the intelligibility of phonemes recorded from the uterus. A male talker's voice was more intelligible than a female talker's voice when recorded from within the uterus, but not so when recorded in the air. An analysis of the feature information transmission from recordings inside and outside the uterus revealed that voicing information is better transmitted in utero than place or manner information.

Noise induced hearing loss in fetal sheep

The auditory brainstem response (ABR) was recorded in utero from chronically instrumented fetal sheep prior to and following exposure of pregnant ewes to intense broadband noise (120 dB SPL for 16 h). ABRs were elicited by clicks and tone bursts (0.5, 1, 2, and 4 kHz) delivered through a bone oscillator secured to the fetal skull. Latency-intensity functions for most of the four vertex-positive waves (labelled I-IV) were prolonged and ABR thresholds were temporarily elevated by an average of 8 dB following the noise exposure. Results show that exogenous sounds can penetrate the uterus and result in alterations of the fetal ABR.

Respiratory muscle activities after birth in asphyxiated preterm lambs

Laryngeal and pump muscle activities are important in the establishment and maintenance of functional residual capacity (FRC) after birth. The aim of this study was to determine the expiratory mechanisms by which laryngeal and diaphragmatic activities achieve the increments in FRC postnatally. Wire electrodes were placed in: the laryngeal abductor, a major laryngeal adductor, the inferior pharyngeal constrictor and the diaphragm of six fetal sheep. The lambs were delivered prematurely by cesarean section and a face mask with a pneumotachograph applied. A grunting respiratory pattern was characterized by severe expiratory airflow retardation, associated with laryngeal adductor activity. In grunting breaths, minimal volume loss at end-expiration and incremental increases in FRC occurred when the onset of diaphragmatic activity preceded the onset of laryngeal muscle activities associated with laryngeal opening. Thus the timing order of laryngeal and diaphragmatic muscle activities near end-expiration is a determinant of increments in FRC.

Three-dimensional intraabdominal sound pressures in sheep produced by airborne stimuli

OBJECTIVE

Our aims were to investigate how airborne sound was distributed within the abdominal cavity of sheep as function of frequency.

STUDY DESIGN

Airborne broad-band noise was measured with a hydrophone at 45 locations within the abdomen of five nonpregnant sheep post mortem and with a microphone extraabdominally. Sound pressure attenuation provided by the abdomen and its contents was determined for frequencies between 50 and 5000 Hz. An analysis of variance was applied to assess the effects of frequency, hydrophone location, and animal on intraabdominal distribution of sound pressures.

RESULTS

Below 250 Hz sound pressure was higher inside the animal than outside. Little attenuation (< 10 dB) was found for sounds > 3000 Hz. Attenuation was greatest in the center of the abdomen and least along the inner margin of the abdomen. Intraabdominal sound pressure level varied with frequency (p < 0.0001) and with position of the hydrophone in the cross-sectional plane (p < 0.005) but not in the sagittal plane (p = 0.51). There was no animal effect (p = 0.18).

CONCLUSION

During maternal exposure to airborne, broadband noise the fetus could be subjected to intense sound pressures at low frequencies regardless of position within the uterus and at high frequencies when positioned near the abdominal surface.

Laryngeal and diaphragmatic muscle activities and airflow patterns after birth in premature lambs

The nature and control of early neonatal respiratory patterns were determined in 10 premature, asphyxiated lambs. Severe retardation of early expiratory airflow (braking) characterized an initial pattern (A), but was absent in a final one (B). During a transition pattern (pattern T), pattern A and B airflow types occurred. Close temporal relationships between the airflow patterns and posterior cricoarytenoid (PCA), thyroarytenoid (TA), and diaphragm (D) integrated muscle activities were demonstrated quantitatively. Specifically, in pattern A, the duration of braked expiratory airflow was related to the durations of TA burst activity and the absence of PCA burst activity (r2 = 0.99). In pattern A, pH, but not arterial PCO2 or arterial PO2, differed from that in patterns T and B [7.01 +/- 0.14 (A), 7.11 +/- 0.12 (T), 7.19 +/- 0.08 (B) (P < 0.03)]. Within-breath airflow and respiratory muscle activity relationships and differences in neural and mechanical respiratory timing intervals between patterns suggested that neural feedback was important in the control of central pattern generation. Thus activities of PCA, TA, and D shape the early neonatal airflow patterns and are influenced mainly by neuromechanical, and not chemical, feedback.

Cocaine depresses cerebral glucose utilization in fetal sheep

To assess if cocaine alters cerebral glucose metabolism in the fetus, we infused cocaine 0.6 mg/min intravenously to 6 of 13 fetal sheep for the 55 min prior to measurement of glucose utilization by an autoradiographic method. Overall, local cerebral glucose utilization (LCGU) was lower in cocaine-exposed fetuses than in 7 controls (P = 0.058). In the cocaine-exposed fetuses, 33 of 34 structures had lower mean LCGU than in the comparable structures of control fetuses. In addition, the autoradiographs in 4 of 6 cocaine-exposed fetuses revealed thin, dark lines of increased glucose utilization within the central white matter of some frontal gyri which were not seen in any of the 7 control fetuses. These lines were distributed similarly to ones seen earlier in severely hypoxic newborn lambs. In fetal lambs, cocaine resulted in a generalized decrease in LCGU and a specific increase in glucose utilization in parts of cortical white matter of the frontal gyri, possibly secondary to local ischemia.

Abdominal vibration alters sleep state in fetal sheep

Many pregnant women are exposed to low frequency sounds and vibrations while at work or play. How the fetus is affected by these physical stimuli is not clearly documented. We recorded behavioral state and intrauterine sound pressure levels in eight fetal sheep previously instrumented with electrocortical, electroocular and neck electromyographic leads, and with a miniature hydrophone. Data were collected before, during and after 30 min of abdominal vibration using a belt vibrator commonly used by humans in weight reduction programs. A sudden shift in behavioral state occurred at the onset of vibration. There was a decrease in non-rapid eye movement sleep (P < 0.02) and an increase in time during which the sleep state could not be determined (P < 0.03). A 63% increase in number of epochs spent in this indeterminate period was evident during vibration. During the post-stimulus period, percentage of time spent in rapid eye movement sleep decreased as compared to the pre-stimulus period (P < 0.04), and non-rapid eye movement sleep increased as compared to the stimulus period (P < 0.01). Vibration-induced intrauterine sound pressures ranged from 131-142 dB at the fundamental frequency of 19 Hz and were 20-40 dB lower at the overtones which appeared in the spectrum between 35-200 Hz. Results indicated that environmental vibration can disrupt fetal behavioral state, induce abnormal state changes, and alter distribution of sleep states.

Vibroacoustic stimulation in fetal sheep: effect on cerebral glucose utilization and behavioral state

Behavioral state and cerebral glucose utilization were measured in six fetal sheep subjected to high intrauterine sound pressures created with a vibroacoustic stimulator pressed against the maternal abdomen. The signal consisted of a complex waveform that varied over time with a 50% duty cycle. An implanted hydrophone showed highest spectral levels between 3,000-16,000 Hz. The pulsed sound resulted in a significant loss of fetal rapid eye movement and non-rapid eye movement sleep. The stimulus also resulted in a disruption in the normally close relationship between these sleep states and cerebral glucose utilization rates in the brain as a whole and in its component parts.

Fetal vibroacoustic stimulation test: vibrator response characteristics in pregnant sheep postmortem

OBJECTIVE

To determine the effect of small decreases in battery voltage on the sound pressure level and spectral features of sound within the uterus during vibroacoustic stimulation with a battery-powered electronic artificial larynx.

METHODS

In eight pregnant, recently sacrificed sheep, the fluid-borne, intra-amniotic sound pressures resulting from vibration of the abdominal wall with an electronic artificial larynx were compared with airborne sound pressures produced by an artificial larynx and measured at 50 cm.

RESULTS

At all frequencies, the intrauterine sound pressure was higher than the sound pressure in air. Decreasing battery voltage from 9 to 7 V resulted in a 5-18-dB decrease in intrauterine sound pressure at the electronic artificial larynx fundamental frequency and most overtones, but only a 4-8-dB decrease in the airborne signal. The results indicate that for frequencies relevant to fetal hearing, the reduction of sound pressure level caused by inadequate battery voltage may result in a difference in fetal response.

CONCLUSION

Routine verification of the function of a vibroacoustic device by means of a battery voltage check is recommended.

Effect of cocaine on electrocortical activity in fetal sheep

The effect of cocaine on the behavioral state of six fetal sheep was studied during gestational ages between 128-135 days. Two to eight days after surgery, fetuses received either a continuous 60 min intravenous infusion of cocaine HCl (33.4 mg) or saline. The infusions were preceded and followed by control periods of 102 min. Cocaine induced a disruption in fetal behavioral state cyclicity and a decrease in the amount of time spent in rapid eye movement sleep (P < 0.01) and non-rapid eye movement sleep (P < 0.05) during the infusion, but not during the recovery period. Spectral amplitude of the electrocortical activity at all three cortical locations increased within most one-third octave bands between 0.8-4 Hz and decreased within most bands between 16-25 Hz (P < 0.05) compared to controls. There were no differences in spectral amplitude between pre- and post-cocaine periods at any location over the 25 frequency bands studied (P > 0.6) except for one frequency band centered at 12.5 Hz. The effects of a one hour cocaine infusion on fetal cortical electrical activity are diffuse, but short-lived, and occur independently of changes in fetal oxygenation.

Seizures in a fetal lamb after cocaine exposure: a case report

We report the chance observation of two generalized seizures in a fetal lamb that received cocaine. Cocaine was infused intravenously into a 138-day-old fetus while electrocortical (ECoG), electroocular (EOG), and neck electromyographic (EMG) activity were recorded. Fetal rapid eye movement (REM) and nonrapid eye movement (NREM) sleep were disrupted during the cocaine exposure and returned to a normal pattern after infusions were stopped. Seventy-two hours later, however, we recorded generalized seizures with ECoG spike and spike wave activity.

Sound levels in the human uterus

OBJECTIVE

We sought to determine the degree to which noises and voices are attenuated or enhanced as they pass into the uterus.

METHODS

In eight parturients, a hydrophone in the uterus was used to measure sound pressure levels for externally generated one-third-octave band noises, male and female voices, and the subject's voice.

RESULTS

Low-frequency sounds (0.125 kHz) generated outside the mother were enhanced by an average of 3.7 dB. There was a gradual increase in attenuation for increasing frequencies, with a maximum attenuation of 10.0 dB at 4.0 kHz. Sound attenuation was slightly less if the insonation was from in front of the woman rather than behind. Intrauterine sound levels of the mother's voice were enhanced by an average of 5.2 dB, whereas external male and female voices were attenuated by 2.1 and 3.2 dB, respectively. The effect of frequency on attenuation, the differences between front and back insonation, and the differences between speakers in attenuation were all statistically significant.

CONCLUSIONS

The intrauterine environment is rich with externally generated sounds. This may imply fetal risk from maternal noise exposure and may aid in understanding fetal imprinting from prenatal exposure to voices.

Cochlear microphonics recorded from fetal and newborn sheep

PURPOSE

Sounds present within the uterus stimulate the fetal inner ear and central auditory pathway. This study was undertaken to determine the efficiency of transmission of exogenous airborne stimuli to the fetal inner ear. In this way, we may quantify the extent to which the fetal auditory system is isolated from sounds produced outside the mother.

MATERIALS AND METHODS

Cochlear microphonics were recorded from fetal and newborn sheep to evaluate the extent to which the fetus is isolated from sounds exogenous to the ewe. Electrodes were surgically placed in contact with the round window membrane in nine near-term fetal sheep. Cochlear microphonics were recorded in response to 1/3 octave-band noises (0.125 to 2.0 kHz) delivered through a loudspeaker 1.8 m from one side of the pregnant ewe. Sound pressure levels generated by the noises were simultaneously recorded ex utero with a microphone and in utero with a hydrophone previously sutured to the fetal neck. After cochlear microphonic amplitudes were recorded, the fetus was delivered through an abdominal incision. Recordings were repeated from the newborn lamb. Fetal sound isolation was calculated as the difference between the sound pressure levels that were necessary to evoke equal cochlear microphonic amplitudes from the fetus and from the newborn lamb.

RESULTS

The sound attenuation observed was variable for all frequencies. The fetus was isolated from external sounds by 11.1 dB for 0.125 kHz, 19.8 dB for 0.25 kHz, 35.3 dB for 0.5 kHz, 38.2 dB for 1.0 kHz, and 45.0 dB for 2.0 kHz.

CONCLUSIONS

Other investigators have demonstrated that the immature auditory system is more susceptible to damage produced by noise exposure than is the mature auditory system. Low-frequency noise produces damaged cells that later in life code higher frequencies. A possibility of fetal hearing loss produced by intense noise exposure needs more careful evaluation.

Effects of vibration frequency and tissue thickness on intrauterine sound levels in sheep

Pure-tone sinusoidal mechanical vibratory stimuli ranging in frequency from 4 to 4000 Hz were applied to the ventral abdominal wall of pregnant ewes, and intrauterine sound pressure levels were recorded with a hydrophone 5, 10, 15, and 20 cm from the surface. There were significant decreases in sound pressure levels with increasing frequencies (p less than 0.0001) and increasing depth (p = 0.01). There was no significant interaction between these two variables. An electronic artificial larynx was also activated on the abdominal wall, resulting in quite high sound pressure levels (mean, 119 dB) measured 5 cm from the surface, with a significant decrease in sound pressure levels as the thickness of the intervening maternal tissues increased (p = 0.005). These results suggest that the frequency of vibratory stimulus used and the thickness of the maternal abdominal wall could influence fetal response to the vibroacoustic stimulation test by affecting intrauterine sound pressure levels.

Behavioral state transition and local cerebral blood flow in fetal sheep

Local cerebral blood flow in four near term fetal sheep was evaluated continuously before and after natural alternations in fetal behavioral state. Measurements were made in fetuses several days following an aseptic surgery to place electrodes for behavioral state recordings as well as heated and reference thermojunctions in cortical and subcortical tissue. These thermojunctions were used to qualitatively assess local cerebral blood flow. The time of transition between rapid eye movement sleep (REMS) and non-rapid eye movement sleep (NREMS) was based on visual inspection of strip chart recordings of electrocortical, electroocular, and neck electromyographic activity and application of published criteria for their assessment. To confirm that transition had occurred, the amplitude of the spectrum of the electrocorticogram in one-third octave bands centered around 1 Hz and 20 Hz was measured before and after the transition point. Mean cerebral blood flow rose significantly by 24 s (P less than 0.05) after the transition from NREMS to REMS and fell by 12 s after the transition from REMS to NREMS (P less than 0.05).

Disposition and pharmacodynamics of methamphetamine in pregnant sheep

To determine the placental transfer of methamphetamine, its subsequent fetal disposition, and its hemodynamic effects, we administered methamphetamine intravenously to 15 pregnant ewes 3 days after placement of maternal and fetal vascular catheters. Methamphetamine crossed the placenta within 30 seconds of its administration. Although the ewes had higher peak concentrations, the fetuses' longer elimination half-life ultimately led to higher fetal than maternal methamphetamine concentrations. The ratio of fetal tissue to plasma drug concentration 2 hours after administration was highest in the lung, followed by the placenta, kidney, intestine, liver, brain, and heart. Methamphetamine caused a 54% to 63% rise in maternal blood pressure, a 20% to 37% increase in fetal blood pressure, and a drop in fetal oxyhemoglobin saturation and arterial pH. We conclude that methamphetamine, in doses at or below what is commonly abused, has effects that could be detrimental to the health of the mother and her fetus.

Intraabdominal sound levels during vibroacoustic stimulation

Vibroacoustic stimulation is widely used in the United States as a test for fetal well-being, yet little information is available on the adequacy of the electronic artificial larynx that is commonly used as the stimulator. To determine whether the intraabdominal sound pressure level was dependent on the static force applied to the electronic artificial larynx, we measured the sound pressure level at a position 20 cm from the surface of the anterior abdominal wall in nonpregnant ewes. The electronic artificial larynx was pressed against the surface with three levels of static force: mild, moderate, and strong. Between mild and strong static forces there was a trend toward a reduction in sound pressure level at the fundamental frequency (85 Hz) and the overtones (170 to 1600 Hz) (p less than 0.08). To further examine the relationship between the static force of sound source against the abdomen and the intraabdominal sound pressure level, sine wave oscillations between 20 Hz and 4.0 kHz were produced with an industrial shaker. With a constant dynamic force (0.16 N) applied to the shaker across frequencies, the sound pressure level was greatest at lower frequencies (100 to 110 dB) and less at higher frequencies, above 1.0 kHz (60 to 80 dB). Consistent with the electronic artificial larynx experiments, strong application of the shaker resulted in greater transmission of sound than did mild application (p less than 0.02).

Inhalational administration of cocaine in sheep

A pipe for administration of inhaled cocaine and its pyrolytic products in laboratory animals was developed and tested. In-vitro trials showed 30.0 +/- 5.2% (mean +/- SE) recovery of cocaine in solvent. Five non-pregnant ewes were instrumented with tracheal T-tubes and vascular catheters. After surgical recovery, ewes received three doses of cocaine (free base) in a randomized fashion; 2 mg/kg and 4 mg/kg both by inhalation, and 2 mg/kg intravenously. Arterial blood samples were collected and assayed for cocaine and its major metabolites by high performance liquid chromatography. Blood pressure and heart rate were continuously recorded. Cocaine administered by inhalation was eliminated with a half-life of 1.6 +/- 0.5 min (mean +/- SE) compared to 3.4 +/- 0.9 following intravenous administration (p less than 0.03). Likewise, clearance values were greater following inhalation, 5532 +/- 1756 ml/min/kg, than following intravenous administration, 163 +/- 20.6 ml/min/kg (p less than 0.04). Both routes of administration led to significant elevations in blood pressure, 7.5% increase after smoking vs 20% increase after intravenous administration. No correlation was found between inhalational dose of cocaine and peak plasma cocaine concentration.

Cocaine alters behavioral states in fetal sheep

Intrauterine cocaine exposure causes subtle neurologic abnormalities in human newborn infants; however, the mechanism for these abnormalities is not known. To investigate whether cocaine alters fetal behavioral state, the electrocortical, electro-ocular and neck muscle electrical activity was monitored in 7 chronically instrumented fetal sheep before and during both saline and cocaine HCl infusions directly to the fetus. Saline infusion to the fetus had no effect on the percentage of time spent in rapid eye movement sleep compared to no infusion (37.5 +/- 11.6% vs 46.3 +/- 4.6%, mean +/- SD, P greater than 0.1). Cocaine infusion directly to the fetus had no effect on fetal arterial pO2, but did increase mean arterial pressure from 53.6 +/- 15 mmHg to 61.0 +/- 21 mmHg (P less than 0.01). In addition, during cocaine infusion, the percentage of time spent in rapid eye movement sleep dropped to 3.9 +/- 5.1% (P less than 0.0001) and the average duration of rapid eye movement epochs decreased from 10.1 +/- 3.0 min precocaine infusion to 1.9 +/- 2.6 min during cocaine infusion (P less than 0.02). The influence of cocaine was noted in a frequency analysis of the electrocorticogram. The amplitude of the energy centered at 1 Hz during cocaine infusion (73.8 +/- 4.0 dB) was greater than the amplitude during rapid eye movement sleep (65.5 +/- 4.7 dB) and less than the amplitude during non-rapid eye movement periods (79.9 +/- 4.5 dB) (P = 0.01). Cocaine appears to alter fetal behavioral state directly and this may play a role in the abnormal behavior in newborn infants exposed to cocaine in utero.

Local cerebral glucose utilization in normoxemic and hypoxemic newborn lambs

To determine if hypoxemia altered local cerebral glucose utilization (LCGU) in newborn lambs, and where these alterations occurred, we measured LCGU using the 2-[14C]deoxyglucose [( 14C]DG) autoradiographic technique in lambs made hypoxemic by gradual reduction in inspired oxygen concentration. In 5 normoxemic control lambs, aged 3 days. LCGU of the cerebral cortex and white matter was higher than published values of LCGU in similar structures in near term normal fetuses and 2-4 times higher than reported values in normoxemic puppies. LCGU was highest in vestibular nuclei and auditory structures, followed by cerebellar nuclei, cerebral subcortical structures, and white matter. In 6 hypoxemic newborn lambs (paO2 14-18 torr) consistent increases in LCGU were noted only in the corona radiata compared to the values obtained in the normoxemic control lambs (36.5 +/- 8.1 vs. 23.9 +/- 1.7 mumol/100 per min, mean +/- S.D., P less than 0.02). This increase in LCGU in white matter was clearly noted in autoradiographs in which thin dark central regions within white matter often reached high into the gyri. In the hypoxic group. LCGU of the corona radiata superseded the value in many gray matter structures. In addition, patchy increases of [14C]DG utilization were present in the cerebral cortex of two hypoxemic lambs. Acute hypoxemia increases glucose utilization of the corona radiata to values equivalent to many gray matter structures, and leads to heterogeneous glucose metabolism in the cerebral cortex, but does not alter LCGU in other gray matter structures of newborn sheep.

Local cerebral blood flow is increased in rapid-eye-movement sleep in fetal sheep

Behavioral state-induced changes in fetal cerebral blood flow were continuously monitored with a simple thermal dilution method. Thermojunctions were heated 1.5 degrees C above reference thermojunctions implanted contralaterally in various cerebral cortical and subcortical structures of four near-term fetal sheep. Temperature difference in rapid-eye-movement sleep was lower than in non-rapid-eye-movement sleep (p = 0.014), reflecting convective heat loss from increased blood flow. Temperature difference also varied significantly with the locus of placement in the brain (p = 0.003), reflecting, in part, regional differences in cerebral blood flow. The thermocouple method gives qualitative, continuous information on local cerebral blood flow that could be useful in monitoring the vascular response to changing functional activity during prenatal brain development.

Sound environment of the fetal sheep

The internal sound pressure levels within the intact amnion of pregnant ewes surgically implanted with a hydrophone was determined during conditions of quiet and during sound field exposures to broadband and octave-band noise. Measurements were made of sound pressures outside and inside the ewe, and sound attenuation through maternal tissues and fluids was calculated. Sound pressures generated by low frequencies (less than 0.25 kHz) were 2 to 5 dB greater inside than outside the ewe. Above 0.25 kHz, sound attenuation increased at a rate of 6 dB per octave. For 4.0 kHz, sound attenuation averaged 20 dB. The sound pressure recorded at different locations within the amnion with respect to the sound source varied by up to 6 dB. The internal noise floor in the absence of externally generated sounds was as low as 50 dB (spectrum level) above 0.2 kHz. Thus the fetus is developing in an environment that is rich with internal and external sounds.