Abandonment of newborn infants: a Danish forensic medical survey 1997–2008

Concealment of pregnancy and newborn infant abandonment are closely associated with neonaticide, the killing of an infant within the first 24 h of life or less than 28–30 days depending on the jurisdiction. Abandonment of newborn infants occurs throughout the world and often the outcome for the infant is death. Together with neonaticide it is felt to be one of the least preventable crimes. In this retrospective study we present all forensically known Danish cases of abandoned newborn infant corpses, covering the period from 1997 to 2008. Eleven newborn infant corpses were found; we registered characteristics of the newborn infants and the circumstances of the cases based on autopsy reports. One further newborn infant was included, dating back to 1992, as it was found to be connected with one of the later cases. The mean age of the women who abandoned their newborn infants was 22 years, and five of the autopsied newborn infants were probably alive when abandoned. In two cases the newborn infants were half siblings and abandoned by the same mother. The time span from abandonment to when the newborn infant was found ranged from hours to 7 years. Two-thirds of the newborn infants were girls (66.6%). The most common means of disposal was in a plastic bag (~60%); only one newborn infant was wearing clothes when found. Causes of death were usually given as asphyxia, brain injury or simply undetermined. Two-thirds of the newborn infants showed signs of violence. None of the newborn infants had congenital malformations.     

64层螺旋CT自动管电流调节技术对婴幼儿头颅扫描的应用

目的 评估64层螺旋CT自动管电流调节技术对婴幼儿头颅的图像质量和辐射剂量的影响。 方法 按2.5、2.75、3.0和4.0的SD(标准差)值将200例婴幼儿随机分成4组,用自动管电流调节技术行头颅CT扫描,每组各50例,回顾性统计分析各组的图像质量和辐射剂量。结果 当SD为2.5、2.75、3.0和4.0时,CTDI_vol最高值分别为60、49.8、42.9和25.8 mGy,有效剂量分别为(3.27±1.01)、(2.78±0.85)、(2.40±0.74)和(1.49±0.45)mSv·mGy^-1·cm^-1,各组比较差异均有统计学意义(F=48.99, P＜0.05);图像质量优秀率分别为100%、96%、70%和20%,其中SD 2.5组新生儿12例,SD 2.75组新生儿(2例)的图像质量均为良,SD 3.0组图像质量良以下均为＜1周岁的病例,SD 4.0组图像质量优均为＞2岁6个月和头围较大的病例。结论 ATCM的个性化应用可实现婴幼儿头颅CT的图像质量、辐射剂量和诊断图像的最佳平衡,建议对新生儿、1个月～1周岁、1～3周岁和头围较大或复查病例分别采用2.5、2.75、3.0和4.0 的SD值。     

ACR Appropriateness Criteria Vomiting in Infants up to 3 Months of Age

Vomiting is a commonly reported symptom in infants less than three months of age. There are a multitude of pathologies to consider, both within and outside the gastrointestinal tract. In addition to conducting a thorough history and physical examination, a clinician formulates a reasonable differential diagnosis by consideration of two main factors: the infant’s age and the characterization of the vomit as bilious or nonbilious. In this endeavor, the clinician is able to determine if an imaging study is needed and, if so, the urgency of the request. A review of the appropriate imaging evaluation of vomiting infants in the newborn to three-month-old age group is provided by organizing the discussion around the following three clinical scenarios: bilious vomiting, intermittent nonbilious vomiting since birth, and new-onset bilious vomiting.The ACR Appropriateness Criteria are evidence-based guidelines for specific clinical conditions that are reviewed every three years by a multidisciplinary expert panel. The guideline development and review include an extensive analysis of current medical literature from peer-reviewed journals and the application of a well-established consensus methodology (modified Delphi) to rate the appropriateness of imaging and treatment procedures by the panel. In those instances in which evidence is lacking or not definitive, expert opinion may be used to recommend imaging or treatment.     

Radiologic and real time echocardiographic evaluation of the cyanotic newborn

Prior to echocardiography, the recognition of serious heart disease in the cyanotic newborn or young infant could be extremely difficult. The profound hemodynamic changes taking place in the heart and lungs after birth influence the clinical manifestations of many cardiac disorders, and sometimes suggest the existence of a cardiac disorder when none is present. Real time echocardiography has revolutionalized the diagnosis of the cyanotic infant. If the reason for the infant's cyanosis or respiratory distress is not apparent from the history, physical examination, laboratory values, and chest radiograph; real time echocardiography should be performed to exclude or diagnose cyanotic congenital heart disease and persistent fetal circulation. This will prevent misdiagnosis in cyanotic infants and assure rapid and appropriate treatment.     

Altered white matter diffusion anisotropy in normal and preterm infants at term‐equivalent age

To investigate white matter (WM) development, voxelwise analyses of diffusion tensor MRI (DTMRI) data, acquired from 12 very preterm and 11 preterm infants with gestational ages (GA) ranging from 25 to 29 and 29 to 32 weeks, respectively, and 10 newborn normal term infants were performed. T₂ relaxation measures were also generated to assess brain water content. Compared with newborn term infants, very preterm infants were found to possess reduced fractional anisotropy (FA) within the frontal lobe, and a number of anterior and posterior commissural pathways. Preterm infants possessed reduced FA mainly within the posterior regions of the corpus callosum. Unexpectedly, we observed significantly reduced FA and increased T₂ within a number of corticospinal projections in the newborn term infants compared to the preterm groups. This finding may reflect increased water concentration and/or a lowering of FA due to the presence of crossing interhemispheric WM projections. These findings indicate that care should be taken when interpreting FA indices without knowledge of the possible effects of water concentration in the newborn infant brain. Magn Reson Med 60:761–767, 2008. © 2008 Wiley‐Liss, Inc.     

螺旋CT低剂量扫描在新生儿腹部检查中的应用研究

目的:评价新生儿腹部单排螺旋CT低剂量与常规剂量扫描图像质量,探讨低剂量扫描在新生儿应用的可行性。方法:对高度怀疑腹部病变的足月新生儿150例和早产儿90例,随机各分3组行常规(150mAs)及低剂量(40mAs、30mAs)腹部CT扫描,观察比较其对腹部正常结构的显示差异。结果:图像质量评价结果:足月新生儿150mAs,40mAs扫描获得的可诊断图像,χ2检验,P>0.05,提示图像无显著性差异;30mAs的可诊断图像,χ2检验,P<0.05,提示图像质量有显著性差异。早产儿150mAs,40mAs,30mAs可诊断图像,χ2检验,P>0.05,提示上述剂量图像质量差异无显著性意义。结论:单排螺旋CT低剂量扫描适用于新生儿腹部检查,在保证图像质量的前提下,足月新生儿采用40mAs、早产儿采用30mAs左右的扫描条件较为适宜且有利于患儿的辐射防护。     

Unusual renal mass in a newborn infant

A newborn male infant had a right flank mass and hematuria. A solid renal mass was demonstrated on ultrasound and computed tomography studies, while Doppler studies suggested the diagnosis of renal vascular injury. Laparotomy disclosed avulsion of the right renal pedicle, and a right nephrectomy was performed. Traumatic renal hemorrhage should be considered in the differential diagnosis of a solid renal mass in the neonate, especially if the history or physical findings suggest trauma or if there is evidence of abdominal hemorrhage.     

足月新生儿急性呼吸窘迫综合征的X线表现

目的：探讨足月新生儿急性呼吸窘迫综合征(ARDS)胸部诊断标准。方法：参照1994年美国和欧洲ARDS评审会议制订的ARDS诊断标准,对1999年1月一2002年3月我院符合诊断标准的足月新生儿87例进行回顾性分折,对符合足月新生儿ARDS诊断标准的10例病例资料进行分折。结果：X线表现为“白肺”4例;肺野呈“毛玻璃”样1例;双肺大片状浸润3例;双肺纹理增多模糊,弥漫性小片状浸润伴代偿性肺气肿2例。结论：ARDS的x线表现有一定特点,可为临床诊断提供重要影像学依据,同时可评估治疗效果。     

EM reconstruction algorithms for emission and transmission tomography

Two proposed likelihood models for emission and transmission image reconstruction accurately incorporate the Poisson nature of photon counting noise and a number of other relevant physical features. As in most algebraic schemes, the region to be reconstructed is divided into small pixels. For each pixel a concentration or attenuation coefficient must be estimated. In the maximum likelihood approach these parameters are estimated by maximizing the likelihood (probability of the observations). EM algorithms are iterative techniques for finding maximum likelihood estimates. In this paper we discuss the general principles behind all EM algorithms and derive in detail the specific algorithms for emission and transmission tomography. The virtues of the EM algorithms include (a) accurate incorporation of a good physical model, (b) automatic inclusion of non-negativity constraints on all parameters, (c) an excellent measure of the quality of a reconstruction, and (d) global convergence to a single vector of parameter estimates. We discuss the specification of necessary physical features such as source and detector geometries. Actual reconstructions are deferred to a later time.     

Hepatoblastoma: radiologic-pathologic correlation in 50 cases

Fifty cases of hepatoblastoma were reviewed. Virtually all patients were infants or young children with hepatomegaly or a mass. Calcification seen on 11 of 20 radiographs was often in a pattern of small chunks, and eight of these correlated with osteoid formation in histologically mixed hepatoblastomas. Angiography generally showed tumor vascularity, sometimes with a spoke-wheel pattern. Suggestion of tumor nodularity or lobulation on sonography or computed tomography (CT) correlated with the gross appearance. The tumor was usually echogenic and occasionally had small hypoechoic or anechoic areas representing necrosis or hemorrhage. On CT it was usually hypodense, with minimal if any enhancement. The calcification pattern and demonstration of tumor lobulation with septation may help differentiate hepatoblastoma from other liver neoplasms in infants and children under 5 years of age.     

Congenital nasal pyriform aperture stenosis: clinical and radiologic findings and treatment

Congenital nasal pyriform aperture stenosis (CNPAS) is an unusual cause of airway obstruction in the newborn and infants. Immediate recognition and therapy are essential for this potentially life-threatening circumstance. CNPAS should be considered in the differential diagnosis of any infant with episodic apnea, cyclical cyanosis, and feeding difficulty. Computerized tomographic (CT) measurements and imaging features enable accurate diagnosis of this abnormality. In this report we demonstrated CT examination findings of CNPAS in a neonate.     

早产儿贫血40例临床观察

目的观察早产儿出生后贫血的发生及红细胞、血红蛋白动态变化情况。方法观察对比我院产科出生的40例早产儿及50例足月儿在不同年龄段红细胞及血红蛋白变化情况。结果早产儿在出生后24h内血红蛋白及红细胞总数与正常足月儿相同,但1周后其血红蛋白及红细胞数即开始出现下降,且随着年龄的增长,早产儿组1个月、3个月末血红蛋白及红细胞总数均较正常足月儿下降明显,贫血情况进行性加重。结论早产儿出生后贫血较足月儿显著且进行性加重。     

新生儿头部床旁实时监测用多通道近红外光谱系统的研制

目的研制一款适用于新生儿头部血流血氧状态床旁实时监测的多通道近红外光谱系统。方法基于修正的朗伯比尔定律,确定所选三波长检测光对应的系统算法。大量使用集成元件以简化系统设计,提高便携性和稳定性。针对新生儿特点,优化源探距离、探头的外形及封装。在确保系统安全后,通过前臂阻断实验和ValSalva实验对系统的有效性进行验证。结果系统整机质量小于0.5 kg,且满足与皮肤接触的安全要求。探头灵活,能与新生儿头皮良好贴合。实验的结果符合生理规律,并与已有文献的报道一致。结论该系统成本低廉,轻便、安全、有效,适用于新生儿头部血流血氧状态的床旁监测。     

早期新生儿黄疸的动态监测及早期干预治疗效果评价

目的观察出生1周内新生儿黄疸的动态变化、高胆红素血症患儿病因分析及早期干预治疗的效果。方法利用经皮胆红素测定仪对我院产科出生的928例新生儿每日进行同一部位的皮肤测定,根据新生儿不同出生情况对超过胆红素值安全范围的及时给予口服药物或转儿科蓝光治疗。结果928例新生儿因高胆红素血症住院156例,高胆红素血症发生率为15.74%,无1例发生胆红素脑病。结论对新生儿黄疸进行监测和早期干预治疗,可大幅度降低高胆红素血症的发病率,从而防止胆红素脑病的发生。     

Quality control of a laser camera with the SMPTE test pattern: optical density variations with printing format and frame position

The purpose of this study was to investigate the use of the Society of Motion Picture and Television Engineers (SMPTE) test pattern in the quality control of a modern laser camera and the variations in the optical density (OD) of the film when different formats are used. The SMPTE pattern was printed on all the available frames in eight different formats. Furthermore, six films were produced using the same format to check for any reproducibility problems. The OD values of the 11 step greyscale of the SMPTE patterns were measured with a densitometer, as well as the OD of steps 10 and 11 of the 16 step monitor greyscale printed to the left of each frame along with the SMPTE pattern. Variations up to 0.2 were observed in the OD of the same step when different formats and different frames within the same film were compared. Furthermore, the OD variations with frame position were found to follow a specific pattern. The OD variations observed with printing format and frame position can not be explained with certainty. They may indicate a laser camera malfunction and, if this is the case, limits to the maximum variation allowed should be set.     

3D intraoral scan and diagnostic plaster model under General Data Protection Regulation – Legal protection

No legal subsumption of dental impressions, plaster models and intraoral scanning has been attempted yet. It should be examined to what extent the General Data Protection Regulation (GDPR) applies to them. The aim of this study is to legally classify 3D intraoral scans and plaster models prepared on the basis of alginate impressions within the context of personal data safety and determination of legal protection applicable to their use. The authors set the deliberations concerning legal protection of plaster models and 3D intraoral scans in the light of recently published articles regarding palatal rugae pattern stability, thus enabling accurate personal identification regardless of age or dental treatment. The deliberations concerning legal protection will be based on the analysis of the international legal acts, in particular GDPR. The intraoral scan constitutes biometric data, because it is information about a natural person – a patient is identifiable on the basis of elements defining physical identity. The plaster model itself does not constitute personal data. However, both of them constitutes medical documentation. The biometric data must be processed in a manner compliant with the GDPR provisions. The GDPR shapes only aims which should be attained. When creating a data safety system, ISO or NIST standards may help to ensure the proper level of protection against possible liability resulting from breaches in the scope of personal data processing.     

Calcification of the ductus venosus: a cause of right upper quadrant calcification in the newborn

The authors report three cases of ductus venosus calcification as an additional cause of vascular liver calcification in the newborn. All three infants had umbilical venous catheters. The calcification may be caused by extravasated fluids given through the catheter or by local trauma due to catheter insertion. An obliquely oriented, paravertebral "tram-track" calcification in the right upper quadrant, particularly in a premature infant with a history of umbilical venous catheterization, should suggest the diagnosis of calcified ductus venosus.     

Rectal temperature-based death time estimation in infants

In determining the time of death in infants based on rectal temperature, the same methods used in adults are generally used. However, whether the methods for adults are suitable for infants is unclear. In this study, we examined the following 3 methods in 20 infant death cases: computer simulation of rectal temperature based on the infinite cylinder model (Ohno’s method), computer-based double exponential approximation based on Marshall and Hoare’s double exponential model with Henssge’s parameter determination (Henssge’s method), and computer-based collinear approximation based on extrapolation of the rectal temperature curve (collinear approximation). The interval between the last time the infant was seen alive and the time that he/she was found dead was defined as the death time interval and compared with the estimated time of death. In Ohno’s method, 7 cases were within the death time interval, and the average deviation in the other 12 cases was approximately 80 min. The results of both Henssge’s method and collinear approximation were apparently inferior to the results of Ohno’s method. The corrective factor was set within the range of 0.7–1.3 in Henssge’s method, and a modified program was newly developed to make it possible to change the corrective factors. Modification A, in which the upper limit of the corrective factor range was set as the maximum value in each body weight, produced the best results: 8 cases were within the death time interval, and the average deviation in the other 12 cases was approximately 80 min. There was a possibility that the influence of thermal isolation on the actual infants was stronger than that previously shown by Henssge. We conclude that Ohno’s method and Modification A are useful for death time estimation in infants. However, it is important to accept the estimated time of death with certain latitude considering other circumstances.     

新生儿高胆红素血症484例临床分析

目的了解住院新生儿高胆红素血症的发病情况及探讨采用间歇性蓝光照射治疗新生儿高胆红素血症的疗效。方法总结分析我院2002年1月至2007年8月收治的484例高胆红素血症患儿临床资料。结果高胆红素血症发病率占同期新生儿的40．5％，引起本组高胆红素血症的病因中，围产期因素占37．4％，感染占21．6％，母乳性黄疸占18．5％，新生儿溶血占6．2％。其中发病日龄在7天以内占69％。435例治愈，49例好转。结论加强围产期保健，对所有新生儿特别是7天内新生儿应进行每天至少1次的临床评估。对所有24小时内出现黄疸的新生儿应进行经皮测胆红素及血清总胆红素的监测。对耶些在血总胆红素达到高峰水平前离院的新生儿应随访。对于出生24小时内出现黄疸，早产儿低于正常值但有高危因素，健康足月儿总胆红素〉256μmol／L，无高危因素，都应积极治疗以降低高胆红素的发病率、死亡率和伤残率。