The clinical presentation of preterm cerebellar haemorrhage

The objective of this study was to evaluate clinical symptoms and findings on cranial ultrasound (CUS) in preterm infants with cerebellar haemorrhage through retrospective analysis of all preterm infants with a postnatal CUS or MRI diagnosis of cerebellar haemorrhage admitted in a tertiary care centre between January 2002 and June 2009. Fifteen infants were identified; median gestational age was 25 2/7 weeks and median birth weight 730 g. We discerned six types of haemorrhage: subarachnoid (n = 3), folial (n = 1), lobar (n = 9, of which 4 bilateral), giant lobar (n = 1, including vermis) and contusional (n = 1). Especially in infants with lobar cerebellar haemorrhage, CUS showed preceding or concurrent lateral ventricle dilatation, mostly without intraventricular haemorrhage (IVH). Thirteen infants suffered from notable, otherwise unexplained motor agitation in the days preceding the diagnosis. In conclusion, motor agitation may be a presenting symptom of cerebellar haemorrhage in preterm infants. Unexplained ventriculomegaly can be a first sign of cerebellar haemorrhage and should instigate sonographic exploration of the cerebellum.     

Ultrasound detection of posterior fossa abnormalities in full-term neonates

Routine cranial ultrasonography, using the anterior fontanelle as acoustic window enables visualization of the supratentorial brain structures in neonates and young infants. The mastoid fontanelle enables a better view of the infratentorial structures, especially cerebellar hemorrhage in preterm infants. Reports on the usefulness and reliability of cranial ultrasonography using the mastoid fontanelle approach for the detection of posterior fossa abnormalities, focusing only on full-term neonates are limited. This article describes the technique of mastoid fontanelle ultrasonography in full-term neonates and the features of posterior fossa abnormalities that may be encountered in various neonatal disorders and conditions, combined with subsequent MRI in the same patients. Cranial ultrasound through the mastoid fontanelle plays a pivotal role in the early detection of posterior fossa pathology and selection of neonates with an indication for MRI.     

Infections in neonates delivered at term are associated with increased serum levels of ICAM-1 and E-selectin

All newborn infants consecutively admitted to the Neonatal Intensive Care Unit (NICU) at the University Hospital of Trondheim during 1993 were eligible to participate in the study. In total, 241 neonates were included, for whom anamnestic, clinical and laboratory characteristics were recorded. Peripheral blood was retrieved at admittance, and serum levels of soluble intercellular adhesion molecule-1 (ICAM-1), vascular cell adhesion molecule-1 (VCAM-1) and E-selectin were determined. Newborn infants were classified as infected or non-infected according to selected criteria, and 24 newborn infants fulfilled the criteria of having an infection, whereas 168 newborn infants were classified as non-infected. ICAM-1, VCAM-1 and E-selectin were detected in all neonatal samples. Serum concentrations of E-selectin varied by gestational age (GA), higher levels were found in non-infected term (GA ≥ 37 weeks) neonates (n= 53) than in those (n= 115) delivered prematurely (GA < 37 weeks) without infection (p < 0.0001), whereas ICAM-1 and VCAM-1 concentrations did not differ between groups of non-infected term and preterm newborn infants. Similarly, newborn infants delivered at term (n= 16) demonstrated higher levels of E-selectin than premature infants (n= 8) in association with infection (p < 0.001). Both ICAM-1 and E-selectin were increased in term newborn infants with infection (n= 16) compared to the non-infected term group (n= 53)(both p < 0.01), whereas VCAM-1 concentrations did not differ between the two groups. In the premature groups of infected (n= 8) and non-infected (n= 115) neonates, no differences in ICAM-1, VCAM-1 and E-selectin concentrations were observed. The use of ICAM-1 concentration (cut-off level: 250 μg 1^-1) as a diagnostic test for infection in term neonates yielded a sensitivity of 80% and a specificity of 61%, whereas a sensitivity of 70% and a specificity of 79% were found when E-selectin concentration (cut-off level: 150 μ 1^-1was used. Conclusively, increased shedding of soluble ICAM-1 and E-selectin is one component of infection-induced neonatal immune response after full-time pregnancies. Our data suggest that the ability of increased shedding of soluble ICAM-1 and E-selectin molecules is developed during the final weeks of pregnancy. Assessment of ICAM-1 and E-selectin concentrations may be used as diagnostic tools with a high sensitivity and a moderate specificity in term neonates suspected of infection.     

Cerebellar vermis diameter at cranial sonography for assessing gestational age in low-birth-weight infants

Background. Clinical assessment of gestational age for very-low-birth-weight infants is often inaccurate. Survival rates are more dependent on gestational age than on the birth weight. Objective. To assess whether cerebellar vermis diameter might predict gestational age in infants under 2,000 g and/or under 32 weeks' gestation. Materials and methods. We carried out a retrospective review of the hard-copy images of midline sagittal views of the cerebellum obtained at cranial sonography, performed via the anterior or posterior fontanelle, in 518 infants admitted to a regional neonatal intensive care unit between June 1991 and November 1996. The vermis diameter was measured from the base of the fourth ventricle to the junction of folium and tuber vermis. We generated regression equations for estimating gestational age from vermis diameter, and from vermis diameter and birth weight, for the 86 infants of known gestational age (less than 32 weeks), with birth weight under 2,000 g and who had scans carried out within 1 week of birth. Results. Measurement of cerebellar vermis diameter alone allowed prediction of gestational age to ± 1.53 weeks using a 68 % prediction interval, or ± 3.0 weeks using a 95 % prediction interval. Gender was not significant in the regression analysis. Conclusion. Cerebellar vermis diameter predicts gestational age with slightly more precision than the new Ballard score. Received: 10 August 1998 Accepted: 9 February 1999     

Bronchopulmonary dysplasia in infants with respiratory distress syndrome in a developing country: A prospective single centre-based study

The aim of this prospective study was to determine the incidence of bronchopulmonary dysplasia (BPD) in and the outcome of neonates ventilated for respiratory distress syndrome (RDS). The study was conducted in a developing country prior to the use of surfactant replacement therapy and the results are compared to published reports from the developed world. BPD was defined as oxygen dependency beyond day 28 of life. The incidence of BPD over a 9-month-period was 8.2% of all neonates requiring ventilation (n=169) and 41% (n=38) of neonates ventilated for RDS (n=92). Of those neonates who developed BPD, 26% were still being ventilated on day 28. Of the infants, 21 (55%) developed type 1 BPD and 17 (45%) type 2 BPD. There was no statistical difference in the severity of lung disease on any of the study days between type 1 and type 2 BPD although neonates with type 2 BPD required assisted ventilation and supplemental oxygen for a longer period: 30 versus 12 days and 95 versus 49 days, respectively. Of those neonates who developed BPD, 8 (21%) died prior to discharge from hospital and a further 5 infants (17%) died subsequent to discharge. Of the latter five, three died from treatable causes (gastroenteritisn=2, pneumonian=1). Of the 25 (83%) children seen at follow up, 68% were developing normally, 20% were classified as having suspect development and 12% had developed cerebral palsy at corrected postnatal ages of 12–24 months. None of the results differed significantly from those of neonates being ventilated in the developed world, except for the causes of post-discharge deaths.     

Outcomes of exomphalos: an institutional experience

Objective  Abdominal wall defects, particularly exomphalos, in newborn infants are associated with significant morbidity and mortality. The objective of the present study was to review the outcomes of neonates with exomphalos in our neonatal intensive care unit during the last 12 years. Study design  In this retrospective study 52 neonates with exomphalos were identified from 1996 to 2007. Exomphalos were stratified by the type of defect [exomphalos minor versus major (major defined as defect size more than 5 cm and/or liver in the sac)] [1]. Clinical data, demographic data, and outcome measures of mortality, length of stay (LOS), duration of mechanical ventilation and age at full enteral feeds were studied. Associated anomalies were compared between the two groups. Results  Of the 52 neonates, 1 was transferred back to referring hospital after surgical repair of the defect and was not analyzed. Exomphalos minor accounted for 24 cases and exomphalos major in 27 cases. Mortality was higher in infants with exomphalos major (n = 9, 33%) compared to infants with exomphalos minor (n = 2, 8%). The median LOS (10 vs. 47 days, P = 0.023), median age at full enteral feeds (5 vs. 23 days, P = 0.004) and median duration of mechanical ventilation (7 vs. 23 days, P = 0.001) were shorter for exomphalos minor compared to exomphalos major. Bacteremia was present in 4 (15%) of neonates with exomphalos major. Syndromic associations were present in 8 neonates (33%) with exomphalos minor compared to 2 neonates (7%) with exomphalos major. Beckwith Wiedemann syndrome was most frequently noted in neonates with syndromic exomphalos minor. Trisomy 13 was the only chromosomal abnormality in the entire cohort (1/51 = 2%) and was seen in a single neonate (1/27 = 3.7%) with exomphalos major. Non-syndromic anomalies were seen in 12 (50%) and 14 neonates (52%) with the minor and major defects, respectively. Only four neonates with exomphalos minor (16%) and ten neonates with exomphalos major (37%) had no associated anomalies. Pulmonary hypoplasia and pulmonary hypertension were identified on either lung biopsy or autopsy (n = 5) as causes of mortality. Conclusion  Neonates with exomphalos minor have better survival, decreased LOS, time to full enteral feeds and shorter duration of mechanical ventilation. Syndromic associations were more common in exomphalos minor. Respiratory failure was the major cause of mortality in infants with exomphalos major.     

Elevated cytokine levels in tracheobronchial aspirate fluids from ventilator treated neonates with bronchopulmonary dysplasia

Abstract Bronchopulmonary dysplasia (BPD) is a chronic lung disease often occurring in ventilator-treated very low birth weight infants. The aetiology of BPD is multifactorial and pulmonary immaturity, high oxygen concentrations, peak inspiratory pressure levels and large tidal volumes during prolonged mechanical ventilation are important factors. We measured in tracheobronchial aspirate fluid (TAF) the concentrations of the pro-inflammatory cytokines tumour necrosis factor , interleukin-1 (IL-1), IL-6, IL-8, and IL-1 receptor antagonist in infants requiring artificial ventilation for BPD (n=17) or respiratory distress syndrome (RDS) (n=15) or postoperatively after surgery (n=15). The median levels of all studied cytokines in TAF were higher in infants with BPD without local or systemic corticosteroid, treatment compared to the median TAF levels of BPD neonates treated with corticosteroids (P=0.06–P<0.01). The neonates with BPD not treated with corticosteroids also showed higher levels of the five studied cytokines in TAF compared to infants on short-time ventilator treatment (P<0.01–P<0.001) and compared to neonates with RDS (P=0.07–P<0.001). The corticosteroid treated neonates with BPD had TAF cytokine levels approaching those of the control neonates.Conclusion Tumour necrosis factors , IL-1, IL6, IL8 and IL 1 ra were markedly elevated in tracheobronchial aspirate fluids from neonates with bronchopulmonary dysplasia. Corticoid treatment seemed to reduce these levels.     

早产儿胼胝体生长率与智力运动发育的相关性研究

目的 通过超声检测VLBW早产儿胼胝体生长率,为早期评价和改善脑发育提供参考。方法 选取120例胎龄小于33周早产儿,分为26~29+6周组(64例),30~32+6周组(56例),比较两组胼胝体生长率,分析胼胝体长度与小脑蚓部长度之间的关系,胼胝体生长率与临床因素的关系及其与智能发育之间的关系。结果 早产儿胼胝体生长率于生后2周下降,26~29+6周组患儿生后3周~、5周~及7周~纠正胎龄40周时胼胝体生长低于30~32+6周组(P< 0.05)。胼胝体长度与小脑蚓部长度之间呈性线正相关。小于胎龄儿(SGA)生后2周内胼胝体生长率较差(P< 0.05)。12例智力发育严重异常早产儿胼胝体生长率于生后3~6周低于非严重异常组;5例运动发育严重异常早产儿胼胝体生长率于生后3~6周低于非严重异常组(P< 0.05)。结论 早产儿生后2~6周胼胝体生长率下降,可使其发生神经运动发育严重异常的危险性增加。     

Early magnetic resonance detection of cortical necrosis and acute network injury associated with neonatal and infantile cerebral infarction

Background

Knowledge of MRI findings in pediatric cerebral infarction is limited.

Objective

To determine whether cortical necrosis and network injury appear in the acute phase in post-stroke children and to identify anatomical location of acute network injury and the ages at which these phenomena are seen.

Materials and methods

Images from 12 children (age range: 0–9 years; neonates [<1 month], n=5; infants [1 month–12 months], n=3; others [≥1 year], n=4) with acute middle cerebral artery (MCA) cortical infarction were retrospectively analyzed. Cortical necrosis was defined as hyperintense cortical lesions on T1-weighted imaging that lacked evidence of hemorrhage. Acute network injury was defined as hyperintense lesions on diffusion-weighted imaging that were not in the MCA territory and had fiber connections with the affected cerebral cortex. MRI was performed within the first week after disease onset.

Results

Cortical necrosis was only found in three neonates. Acute network injury was seen in the corticospinal tract (CST), thalamus and corpus callosum. Acute network injury along the CST was found in five neonates and one 7-month-old infant. Acute network injury was evident in the thalamus of four neonates and two infants (ages 4 and 7 months) and in the corpus callosum of five neonates and two infants (ages 4 and 7 months). The entire thalamus was involved in three children when infarction of MCA was complete.

Conclusion

In acute MCA cortical infarction, MRI findings indicating cortical necrosis or acute network injury was frequently found in neonates and early infants. Response to injury in a developing brain may be faster than that in a mature one.     

Arrhythmia in the Neonatal Intensive Care Unit

A random sample of 457 neonates was prospectively studied in order to identify the incidence, common types, and risk factors for arrhythmias in the neonatal intensive care unit (NICU). A 12-lead EKG was studied in all neonates (n = 457). A total of 139 Holter studies was done in every fourth baby with a normal EKG (n = 100) and in all babies with an abnormal EKG (n = 39). Of the 100 infants who were thought to be arrhythmia-free by EKG, nine infants demonstrated an arrhythmia on Holter studies. When we correlated screening results with maternal, obstetrical, and neonatal risk factors; arrhythmias were significantly associated with male gender, more mature gestational age, lower glucose levels, maternal smoking, high umbilical artery lines, and the use of the nebulized β-2 adrenergic treatment, whereas umbilical venous lines and dopamine infusion did not relate to arrhythmia. We conclude that arrhythmias are more common in the NICU than in the general neonatal population. Compared to Holter monitoring, the sensitivity of the EKG was only 89%.     

Nomograms of cerebellar vermis height and transverse cerebellar diameter in appropriate-for-gestational-age neonates

Background

Evaluation of cerebellar morphology and measurement of its biometric parameters such as cerebellar vermis height and transverse cerebellar diameter may assist the neonatologist in monitoring cerebellar growth and development and detect abnormalities resulting from malformations, hemorrhage or ischemic infarction.

Aim

The aim of this study was to establish nomograms of cerebellar vermis height and transverse cerebellar diameter at birth in appropriate-for-gestational-age neonates by using cranial ultrasonography.

Study design

A cross-sectional observational study. Appropriate-for-gestational-age neonates were evaluated with cranial ultrasonography by the same neonatal sonographer.

Subjects

Healthy appropriate-for-gestational-age neonates born between 26 and 42 weeks of gestation in their first postnatal 24 h.

Outcome measures

Cranial sonographic measurements included cerebellar vermis height measured midsagitally from anterior fontanelle and transverse cerebellar diameter measured coronally from mastoid fontanelle. Measurements were taken for each gestational age between 26 and 42 weeks and nomograms were constructed.

Results

Three hundred twenty-one consecutively born appropriate-for-gestational-age neonates (163 females and 158 males) were studied. A linear growth function was observed between vermis height and gestational age and between transverse cerebellar diameter and gestational age.

Conclusion

Nomograms of cerebellar vermis height and transverse cerebellar diameter against gestational age at birth in appropriate-for-gestational-age neonates have been constructed. This can help the neonatologist to assess variations from the normal during ongoing cerebellar growth and development and to diagnose cerebellar anomalies.     

Hyperechoic foci in the thalamic region imaged via the posterior fontanelle: a potential mimic of thalamic pathology

Background. We have incidentally noted foci of increased thalamic echogenicity (FITE) on cranial sonographic images obtained via the posterior fontanelle (PF) that were not confirmed on images obtained while scanning through the anterior fontanelle (AF). Therefore, we postulated that this is a normal variant of PF imaging rather than true thalamic pathology. Objective. The purpose of this study was to determine the incidence of FITE detected on posterior and anterior fontanelle images. Materials and methods. Parasagittal images were obtained bilaterally through the trigone of the lateral ventricles (including the thalami) via both the anterior and posterior fontanelles in 15 consecutive neonates (30 thalami) and evaluated independently by two pediatric radiologists for the presence or absence of FITE. Thalami were graded as grade 0 (no FITE), grade 1 (possible FITE), or grade 2 (definite FITE). Follow-up CT (n = 3) and MR (n = 1) were reviewed. Results. FITE were absent in 87 % of thalami imaged via the AF, and possible FITE were present in 13 % of these cases. No cases of definite FITE were identified via the AF. However, possible FITE were identified in 33–40 % of thalami and definite FITE were seen in 33 % of thalami imaged via the PF. Conclusions. FITE seen only on images obtained through the PF on cranial sonography are a normal finding and should not be attributed to thalamic hemorrhage or ischemia. Received: 3 November 1998 Accepted: 11 February 1999     

Neonates Investigated for Influenza-Like Illness During the Outbreak of Pandemic H1N1 2009: Trivial Infections But Major Triage Implications

We report eight cases of neonates (from birth to 25 days) admitted to the neonatal service of a teaching hospital with influenza-like illness during the outbreak of pandemic H1N1 2009, and discuss their management and infection control issues. Empirical antibiotics were often promptly initiated and timely stopped when sepsis was ruled out. Also, there was no pandemic H1N1-09 but influenza A (H3N2, n = 1), parainfluenza (type 3, n = 3) and respiratory syncytial virus (n = 1) have been isolated. The infants recovered spontaneously without any antiviral therapy. There was no outbreak of the respiratory infections in the neonatal service during the admissions. Respiratory viral infections can occur in neonates although the clinical course may be milder and nonspecific. Emergency room and frontline staff must be vigilant of the non-specific clinical features of infections with respiratory viruses in the neonates so that prompt triage and isolation can be implemented to avoid outbreaks in the neonatal service.     

Occipital osteodiastasis: presentation of four cases and review of the literature

Background. Occipital osteodiastasis (OOD) is a form of birth injury characterized by a tear along the innominate (posterior occipital or supraoccipital-exoccipital) synchondrosis with separation of the occipital squama from the lateral or condylar parts of the occipital bone. The condition, frequently mentioned in the older literature as relatively common and invariably fatal, has been attributed to excessive pressure exerted over the subocciput during delivery, resulting in a forward and upward displacement of the anterior margin of the occipital squama into the posterior cranial fossa, with posterior fossa hemorrhage and other intracranial complications. Most likely as the result of improved obstetric techniques, this severe form of OOD has become quite rare or non-existent. A less severe form compatible with survival has been suggested, but so far only one case has been reported in some detail.¶Materials and methods. This paper reports the occurrence of this less severe form of OOD diagnosed roentgenographically in two infants who survived: a newborn and a 3-month-old child. Two additional cases of a similar lesion but of postnatal onset are also described: a 3-month-old infant with the diagnosis of child abuse who also survived and a 2-year-old girl who was involved in a fatal motor-pedestrian collision.¶Results. Based on cases in the literature and the present material, three forms of OOD can be considered: a classic, fatal form; a less severe variant compatible with survival; and OOD of postnatal onset. The diagnosis can be made on lateral skull or cervical spine roentgenograms showing specific changes in the area of the innominate synchondrosis.     

Percentiles of oxygen saturations in healthy term newborns in the first minutes of life

The aim of this study was to establish the reference values of preductal oxygen saturation (SpO₂) in healthy infants immediately after birth. SpO₂ recordings of 200 term neonates (vaginal group;n=150 and cesarean group;n=50) with regular respiratory pattern were evaluated. The median SpO₂ values in the first, fifth and tenth minutes were 71, 92, and 98% in vaginal deliveries and 70, 79, and 96% in cesarean deliveries, respectively. SpO₂ was significantly lower in the cesarean group at any time after the first minute of life (p<0.0001). The time needed to reach a SpO₂>90% was three times longer in cesarean deliveries. Healthy neonates are poorly saturated immediately after birth. The duration to reach a SpO₂>90% was longer in infants born by cesarean deliveries. This study was supported by The Marmara University Scientific Research Committee (SAG-TUS-200906-0165). Presented as a poster in Hot Topics in Neonatology 2006, Washington, DC, 2–5 December 2006.     

Sacrococcygeal teratoma: the 13-year experience of a tertiary paediatric centre

Aim: To describe the management, morbidity and mortality of infants admitted to a tertiary paediatric hospital in New South Wales, Australia with a diagnosis of sacrococcygeal teratoma (SCT). Methods: All neonates admitted to the neonatal intensive care unit with a SCT between January 1996 and December 2008 were included in this retrospective review. Data collected included maternal and neonatal demographics, time of diagnosis, tumour characteristics, surgical treatment, operative complications and outcomes. Results: Seventeen infants with a diagnosis of SCT were included in the study. Of these infants, the majority (70%) were born at term, and eight had a prenatal diagnosis made during the second trimester. Associated anomalies were detected in seven infants (41.8%), with renal anomalies being the most common. Tumour histology included mature (50%, n= 8), yolk sac tumour (18.75%, n= 3), immature (6.25%, n= 1) and mature with mixed elements (25%, n= 4). Recurrent disease occurred in two infants within 4–18 months of the primary resection, with one infant suffering a second recurrence. Only one child died prior to surgery, giving a survival rate of 94%, and mean age at follow‐up was 32 months. Long‐term sequelae found in four babies included revision of scar, vesicoureteric reflux, post‐surgical neurogenic bladder and osteotomy for hip dysplasia. Conclusions: The overall survival of neonatal SCT is high. While this is a small series, our results are consistent with the literature. Important components of management include timely diagnosis, multidisciplinary planning, long‐term follow‐up and intervention for functional sequelae.     

Effect of silicon gel sheeting in nasal injury associated with nasal CPAP in preterm infants

We conducted this study to investigate the efficacy of the silicon gel application on the nares in prevention of nasal injury in preterm infants ventilated with nasal continuous positive airway pressure (NCPAP). Patients (n=179) were randomized into two groups: Group 1 (n=87) had no silicon gel applied to nares, and in Group 2 (n=92), the silicon gel sheeting was used on the surface of nares during ventilation with NCPAP. Nasal injury developed in 13 (14.9%) neonates in Group 1 and 4 (4.3%) newborns in Group 2 (OR:3.43; 95% CI: 1.1–10.1; P<0.05). The incidence of columella necrosis was also significantly higher in the Group 1 (OR: 6.34; 95% CI: 0.78–51.6; P<0.05). We conclude that the silicon gel application may reduce the incidence and the severity of nasal injury in preterm infants on nasal CPAP.     

Rotavirus infection and bradycardia-apnoea-episodes in the neonate

Rotavirus (RV), a common cause of infectious enteritis in young children including neonates, has not been associated with central nervous symptoms in standard textbooks. However, involvement of the CNS has been reported recently in case reports and small series. From 786 neonatal admissions in 1991 we retrospectively analysed the records of 215 inpatient neonates (68 preterm and 147 term infants) who developed diarrhoea during their stay on the neonatal ward and in whom stools were investigated for RV antigen by ELISA. All 215 neonates were continuously monitored for bradycardia-apnoea-episodes (BAE) at least 2 days before and during the entire diarrhoeal period. In neonates with RV antigen in stools (n=114) we found a higher incidence of BAE compared to neonates with RV negative stools (33% vs 8%,P<0.001 for bradycardia; 7% vs 0%,P<0.05 for apnoea). Furthermore, bradycardia episodes of RV positive neonates were more often followed by cyanosis (11 vs 0%,P<0.05) and intervention was more often necessary (31 vs 14%,P<0.05) than in the RV negative neonates.     

Management of perianal abscess with hainosankyuto in neonates and young infants

Background: Perianal abscess (PA) is a common condition acquired in infancy, yet its treatment method remains controversial. We reviewed the outcome of neonates and young infants with PA who were treated with the traditional Japanese medicine, hainosankyuto (TJ‐122). Methods: Fifteen male infants with PA under the age of 3 months were reviewed. The median age of infants at disease onset was 33 days (range, 18–88 days) and the median bodyweight was 4.1 kg (range, 2.5–6.4 kg). TJ‐122 was administered at a dose of 0.20 g/kg/day (n= 13) or 0.25 g/kg/day (n= 2) orally in two or three divided doses before meals. Antibiotics were not used in any of the patients. Results: Of the 15 patients, 14 were cured and had no recurrence, with a median TJ‐122 administration of 28 days (range, 14–117 days). Eight patients were cured within 28 days (53%) and 12 were cured within 60 days (80%). One patient, who was later diagnosed with growth hormone deficiency, showed incomplete healing of PA with intermittent pus discharge and recurrence. The patient was cured by 1 year of age following repeated administration of TJ‐122 and juzentaihoto (TJ‐48). Conclusion: Medical management with TJ‐122 was effective in most neonates and young infants with PA. It appears prudent to manage these patients with hainosankyuto before resorting to surgical intervention.     

Cerebellar vermis measurement at cranial sonography for assessing gestational age in the newborn weighing less than 2000 grams

Prognosis of the very low birth weight infant depends more on gestational age than birth weight, but clinical assessment of gestational age of very low birth weight infants is inaccurate. We wished to determine how well cerebellar vermis dimensions might predict gestational age in infants of birth weight less than 2000 g. We obtained suitable midline sagittal images of the cerebellar vermis at cranial sonography, performed via the anterior or posterior fontanelle, in 41 infants, from the regional neonatal intensive care unit whose gestational age was known. We measured the cerebellar vermis area and diameter on the hard-copy image provided the margins of the vermis were clearly visible, the cerebellar tonsils were excluded from the image, and the anterior and posterior divisions of the corpus medullare were visible on the image. Vermis diameter was measured from the base of the fourth ventricle to the junction of folium and tuber vermis. Vermis area was calculated using a stereological method using a test system of regularly spaced points randomly placed over a magnified image of the cerebellar vermis. We generated regression equations for estimating gestational age using combinations of birth weight, vermis area, or vermis diameter for the 26 infants with birth weight of less than 2000 g for whom the cerebellar vermis measurements were obtained within one week of birth. Vermis area and diameter correlated very highly. They both can be used for predicting gestational age. The addition of either vermis area or diameter to birth weight improves accuracy of gestational age assessment. If birth weight was presumed to be unknown, cerebellar vermis area or diameter allow prediction of gestational age to within ± 1.3 weeks (1 standard error) or ± 2.5 weeks, using a 95% prediction interval. If the same method of reporting is applied to the New Ballard Score, the New Ballard Score predicts gestational age ± 1.7 weeks (1 standard error) or ± 3.4 weeks, using a 95% prediction interval.